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PURPOSE: To evaluate the clinical outcome of ultraselective transcatheter arterial embolization (TAE) with small-sized microcoils for acute lower gastrointestinal bleeding (LGIB). MATERIALS AND METHODS: The subjects were 17 consecutive patients (mean age, 69 years) with LGIB who were treated with ultraselective TAE using small-sized microcoils between December 2013 and December 2019. Ultraselective TAE was defined as embolization of one or both of the long or short branches of the vasa recta. The etiologies of bleeding were colonic diverticulosis in 16 patients (94%) and malignancy in one patient (6%). The bleeding foci were in the ascending colon in 11 patients (65%), transverse colon in 2 patients (12%), and sigmoid colon in 4 patients (23%). A total of 18 branches (diameter: range 0.5-1.5 mm, mean 1.1 mm) of the vasa recta in 17 patients were embolized with small-sized microcoils (size range 1-3 mm, mean combined lengths of all microcoils 7.6 cm). The mean follow-up period was 19 months (range 1-80 months). The technical and clinical success rate, recurrent bleeding rate, major complications and long-term clinical outcomes were retrospectively evaluated. RESULTS: Technical and clinical success was achieved in all patients (17/17). The rates of early recurrent bleeding (within 30 days of TAE) and major complications were 0% (0/17). Recurrent bleeding occurred in one patient at 2 months after TAE, but was stopped with conservative treatment. There were no other bleeding episodes or complications in the follow-up period. CONCLUSION: Ultraselective TAE with small-sized microcoils is a highly effective and safe treatment modality for LGIB.
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Purpose: Intranodal embolization using n-butyl cyanoacrylate glue is an emerging treatment option for persistent lymphatic leakage. This report describes the procedure details of intranodal embolization for groin lymphocele and evaluates the efficacy of intranodal embolization at our institution via retrospective chart review. Material and Methods: Nine consecutive patients (six men and three women; median age, 77.4 years; range, 43-95 years) who underwent intranodal embolization for groin lymphocele between January 2017 and December 2019 were included as study subjects. Intranodal lymphangiography with iodinated contrast was performed to confirm lymphatic leakage, followed by intranodal embolization using n-butyl cyanoacrylate glue mixed with iodized oil for all nine patients. The etiologies of lymphocele, technical and clinical success rates of intranodal embolization, duration of treatment, follow-up period, and acute and chronic complications were retrospectively investigated. Results: The etiologies of groin lymphoceles were the cutdown access of inguinal vessels (n = 7), lymph node biopsy (n = 1), and trauma (n = 1). The technical and clinical success rates of both lymphangiography and subsequent intranodal embolization were 100%. For intranodal embolization, 16.7%-33.3% n-butyl cyanoacrylate glue was used. The median duration of treatment was 2 days (range, 1-13 days). The follow-up period lasted 0-895 days (median, 9 days). No acute or chronic complications were observed. Conclusions: In this study, intranodal embolization showed promising results for groin lymphocele with a short duration of treatment with a median of 2 days. Intranodal embolization using n-butyl cyanoacrylate glue could be a treatment option for persistent groin lymphocele. However, further research is warranted to further evaluate the efficacy of intranodal embolization.
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Anomalous retro-psoas artery is an extremely rare congenital anomaly of the iliac arteries reported in the English-language literature. Using contrast-enhanced computed tomography, we incidentally diagnosed an anomalous retro-psoas artery in a 60-year-old male patient with right renal cancer. Although anomalous retro-psoas artery is extremely rare and mostly asymptomatic, knowledge of it is needed to avoid severe vascular complications in the event of vascular intervention and surgery.
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BACKGROUND: Timely angioembolization (AE) is known to improve outcomes of patients with hemorrhage resulting from pelvic fracture. The hybrid emergency room system (HERS) is a novel trauma resuscitation room equipped with a computed tomography scanner, fluoroscopy equipment, and an operating room setup. We hypothesized that the HERS would improve the timeliness of AE for pelvic fracture. METHODS: A retrospective medical record review of patients who underwent AE for pelvic fracture at our institution from April 2015 to December 2018 was conducted. Patients' demographics, location of AE, Injury Severity Score, Revised Trauma Score, probability of survival by the trauma and injury severity score (TRISS Ps) method, presence of interventional radiologists (IRs) upon patient arrival, time from arrival to AE, and in-hospital mortality were analyzed. These data were compared between patients who underwent AE in the HERS (HERS group) and in the regular angio suite (non-HERS group). RESULTS: Ninety-six patients met the inclusion criteria. The HERS group comprised 24 patients, and the non-HERS group, 72 patients. Interventional radiologists were more frequently present upon patient arrival in the HERS than non-HERS group (IRs, 79% vs. 22%, p < 0.01). The time from arrival to AE was shorter in the HERS than non-HERS group (median [range], 46 [5-75] minutes vs. 103 [2-690] minutes, p < 0.01). There were no differences in the rate of in-hospital mortality (13% vs. 15%, p = 0.52) between the two groups. Survivors in the HERS group had a lower probability of survival by the trauma and injury severity score (median [range], 61% [1%-98%] vs. 93% [1%-99%], p < 0.01) than survivors in the non-HERS group. CONCLUSION: The HERS improved the timeliness of AE for pelvic fracture. More severely injured patients were able to survive in the HERS. The new team building involving the addition of IRs to the traditional trauma resuscitation team will enhance the benefit of the HERS. LEVEL OF EVIDENCE: Therapeutic, level IV.