Embolización intraarterial selectiva como tratamiento de la patología hemorroidal / Selective intra-arterial embolization to treat hemorrhoids

OBJETIVO: El objetivo de este trabajo es presentar nuestros resultados, describiendo la técnica utilizada en el tratamiento endovascular de las hemorroides. MATERIAL Y MÉTODO: La embolización se realizó mediante punción de la arteria femoral derecha o vía arteria radial, y se cateterizó la arteria mesentérica inferior (AMI) accediéndose a la arteria rectal superior con un microcatéter (2,7 F) con el que cateterizábamos cada rama distal, ocluyéndolas distalmente con partículas de PVA (300-500 micras), y proximalmente con coils de 2-3mm. Los pacientes recibieron el alta a las 24 horas, al mes se les evaluó clínicamente y se les realizó una anoscopia. RESULTADOS: El estudio incluye 20 pacientes. (4 mujeres y 16 hombres), edad media de 61,85 años (27-81), con seguimiento medio de 10,6 meses (rango de 28-2 meses). El éxito técnico fue del 90% (18/20) y el éxito clínico de 83,4% (15/18); un paciente requirió nueva embolización de la arteria rectal media y dos pacientes requirieron cirugía. La recuperación fue prácticamente indolora. Al mes todos referían gran satisfacción y la anoscopia demostraba importante mejoría de las hemorroides. No hubo complicaciones secundarias a la embolización. CONCLUSIONES: Los resultados iniciales sugieren que la ESARS es un procedimiento seguro e indoloro, bien tolerado que evita el trauma anorrectal, y recuperación inmediata del paciente

OBJECTIVE: To present our results and describe the technique used for the endovascular treatment of hemorrhoids. MATERIAL AND METHODS: We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500μm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy. RESULTS: We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization. CONCLUSIONS: Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately

Selective intra-arterial embolization to treat hemorrhoids. / Embolización intraarterial selectiva como tratamiento de la patología hemorroidal.

OBJECTIVE: To present our results and describe the technique used for the endovascular treatment of hemorrhoids. MATERIAL AND METHODS: We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500µm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy. RESULTS: We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization. CONCLUSIONS: Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately.

Papel de la embolización selectiva intraarterial en los tumores hepáticos benignos / Role of selective intra-arterial embolization in benign liver tumors

Objetivo. Presentar los casos de tumores hepáticos benignos sintomáticos diagnosticados y tratados con embolización intraarterial previa a la cirugía. Describimos la técnica y analizamos los resultados obtenidos. Material y métodos. Presentamos 7 pacientes diagnosticadas de tumores benignos sintomáticos que requirieron tratamiento: 1 hiperplasia nodular focal, 2 hemangiomas cavernosos gigantes, 1 adenomatosis hepática y 3 adenomas hepáticos. Una vez identificadas las arterias nutricias de cada tumor se embolizaron con partículas de PVA de 500 a 700 micras y posteriormente se cerró la arteria nutricia con coils si presentaban pedículo arterial para asegurar la exclusión vascular total del tumor. La intervención quirúrgica se realizó de 4 a 7 días después de la embolización. Resultados. Los 7 casos eran mujeres con un rango de edad de 23 a 74 años. En 6 pacientes se realizó la embolización intraarterial prequirúrgica. En 1 caso, de adenomatosis, la embolización fue para control de una hemorragia intraparenquimatosa hepática. En las 6 pacientes intervenidas se realizó una exéresis tumoral completa y no tuvieron eventos hemorrágicos intraoperatorios ni ulteriores complicaciones. Conclusiones. La embolización de los tumores hepáticos benignos gigantes y/o sintomáticos es una opción terapéutica útil para el manejo perioperatorio, siempre consensuado en un comité multidisciplinar (AU)

Objective. To present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery. Material and methods. We present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas. Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500μm–700μm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4 to 7 days after embolization. Results. All 7 patients were women (age range, 23-74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred. Conclusions. Provided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors (AU)

Role of selective intra-arterial embolization in benign liver tumors. / Papel de la embolización selectiva intraarterial en los tumores hepáticos benignos.

OBJECTIVE: To present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery. MATERIAL AND METHODS: We present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas. Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500µm-700µm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4 to 7 days after embolization. RESULTS: All 7 patients were women (age range, 23-74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred. CONCLUSIONS: Provided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors.

El síndrome congestivo pélvico. Resultados tras la embolización con espirales / Pelvic congestion syndrome: outcome after embolization with coils

Objetivo: Estudiar las manifestaciones clínicas y los hallazgos venográficos en las pacientes con síndrome congestivo pélvico (SCP), y evaluar los resultados después de la embolización percutánea con espirales. Materiales y métodos: Se estudiaron 34 mujeres en la sección de Radiología Vascular del hospital, todas remitidas con sospecha clínica de SCP desde el servicio de Cirugía Vascular. Las pacientes se estudiaron mediante venografía, valorando la competencia de las venas ováricas y la existencia de otras venas varicosas pélvicas. En las pacientes en las que se detectaron varices pélvicas se procedió a la embolización percutánea con espirales. Posteriormente se registró el resultado clínico revisando el historial clínico de las pacientes y por medio de un cuestionario telefónico. Resultados: En 22 de las 34 pacientes se encontraron signos de insuficiencia venosa pélvica. Los síntomas que referían las pacientes eran principalmente la sensación de peso pélvico y perineal (20/22) y el dolor pélvico (18/22). El éxito técnico alcanzado en las distintas venografías y embolizaciones fue del 100%. En 3 ocasiones se presentaron complicaciones menores que no requirieron de ingreso hospitalario. La mejoría de la sensación de peso pélvico se constató en 14 pacientes (en 13 fue completa). El dolor desapareció en 11 pacientes y disminuyó de forma parcial en otras 2. Conclusión: La embolización de las venas insuficientes pélvicas consigue una mejoría clínica en las pacientes con SCP, con cortos periodos de hospitalización y escasas complicaciones (AU)

Objective: To study the clinical manifestations and findings at venography in patients with pelvic congestion syndrome and to evaluate the outcome after percutaneous embolization using coils. Materials and methods: We studied 34 women referred to the vascular radiology unit from the vascular surgery department for clinical suspicion of pelvic congestion syndrome. All patients underwent venography to assess the competence of the ovarian veins and to detect other varicose pelvic veins. When pelvic varicose veins were detected, they were embolized with coils. Clinical outcomes were recorded after reviewing the clinical history and administering a questionnaire over the phone. Results: In 22 of the 34 patients, signs of pelvic venous insufficiency were found. The symptoms were mainly pelvic and perineal heaviness (20/22) and pelvic pain (18/22). The technical success of venography and embolization was 100%, with three minor complications that did not require hospitalization. Pelvic heaviness improved in 14 patients (in 13 it was completely eliminated). Pain disappeared in 11 patients and was partially alleviated in another 2. Conclusion: In patients with pelvic congestion syndrome, the embolization of insufficient pelvic veins achieves clinical improvement with short hospital stays and few complications (AU)

[Pelvic congestion syndrome: outcome after embolization with coils]. / El síndrome congestivo pélvico. Resultados tras la embolización con espirales.

OBJECTIVE: To study the clinical manifestations and findings at venography in patients with pelvic congestion syndrome and to evaluate the outcome after percutaneous embolization using coils. MATERIALS AND METHODS: We studied 34 women referred to the vascular radiology unit from the vascular surgery department for clinical suspicion of pelvic congestion syndrome. All patients underwent venography to assess the competence of the ovarian veins and to detect other varicose pelvic veins. When pelvic varicose veins were detected, they were embolized with coils. Clinical outcomes were recorded after reviewing the clinical history and administering a questionnaire over the phone. RESULTS: In 22 of the 34 patients, signs of pelvic venous insufficiency were found. The symptoms were mainly pelvic and perineal heaviness (20/22) and pelvic pain (18/22). The technical success of venography and embolization was 100%, with three minor complications that did not require hospitalization. Pelvic heaviness improved in 14 patients (in 13 it was completely eliminated). Pain disappeared in 11 patients and was partially alleviated in another 2. CONCLUSION: In patients with pelvic congestion syndrome, the embolization of insufficient pelvic veins achieves clinical improvement with short hospital stays and few complications.

Formación en radiología vascular intervencionista. ¿Una carrera de obstáculos? / No disponible

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