Clinical results of polidocanol sclerotherapy in venous malformation treatment: Patient-perceived improvement and satisfaction.

PURPOSE: This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction. MATERIAL AND METHOD: Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire. RESULTS: This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45 years (range 3-72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction (p < 0.01, p = 0.012, respectively). Clinical response to pretreatment swelling was related to significant satisfaction (p = 0.02). CONCLUSION: Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates.

Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement.

Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acibadem Mehmet Ali Aydinlar and Koç Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.

Endovascular management of life-threatening retroperitoneal bleeding.

BACKGROUND: The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitoneal bleedings. METHODS: A total of 16 patients with retroperitoneal bleeding who underwent angiography followed by transcatheter embolization within a 4-year period in a single centre were reviewed retrospectively. Electronic charts as well as procedural reports were reviewed to assess immediate angiographic findings and results of embolization. RESULTS: Computed tomography was carried out in eight patients. All computed tomography scans showed retroperitoneal haematoma. In addition, contrast material extravasation consistent with active bleeding was seen in two patients and pseudoaneurysm in one. In the remaining eight patients, diagnosis of retroperitoneal bleeding was established based on combined ultrasound and clinical findings. The technical success rate for selective embolotherapy was 100%. Five of these 16 patients (three women and 13 men) had lumbar artery injury; 10 patients were associated with renal artery injury and one had bilateral internal iliac artery injury. Angiography showed active extravasation, pseudoaneurysm and arteriovenous fistula. For embolization, coils were used in six patients and N-butyl-2-cyanoacrylate in the remaining 10 patients. Four patients died within 1 month of embolotherapy. CONCLUSION: Transcatheter embolotherapy appears to be a life-saving, safe and effective treatment for retroperitoneal bleedings that may be carried out in emergency situations in haemodynamically unstable patients.

Undifferentiated embryonal sarcoma of the liver in a child complicated by haemorrhage.

Undifferentiated embryonal sarcoma (UES) of the liver is a rare malignant neoplasm that mostly affects children younger than 15 years of age. We report a patient with UES in the right lobe that was complicated by haemorrhage after needle biopsy. The tumour was managed by embolization of the right hepatic artery and treated successfully with chemotherapy and surgical resection. Prophylactic embolization of the feeding artery should be undertaken before a biopsy procedure if there is the possibility of tumour rupture, in the presence of signs of intratumoral or peritumoral bleeding, or in the presence of a vascular liver mass.

Use of glue and microcoils for transarterial catheter embolization of a type 1 endoleak.

We present a unique case of abdominal aortic aneurysm initially presenting with inferior vena cava compression leading to deep venous thrombosis, for which the patient subsequently underwent an endovascular aortic repair. Aorto-uni-iliac endografting was performed for subacute occlusion of left common iliac artery complicated by proximal type 1 endoleak. Subsequent management of the endoleak was successful, using a liquid embolic agent (cyanoacrylate) by transarterial approach. Transarterial catheter embolization with glue and coils is a feasible technique for high flow type 1 endoleaks. Glue injection carries the risk of non-target embolization, and thus this option should be reserved for experienced hands.

[Endovascular treatment of aortic lesions using the Medtronic Talent system: single center experience with mid-term follow-up]. / Aortik lezyonlarin Medtronic Talent stent-greft ile endovasküler tedavisi: Tek merkez deneyimi ve orta dönem takip sonuçlari.

OBJECTIVE: The aim of this retrospective study is to investigate the safety and efficacy of endovascular repair of aortic lesions with the Medtronic Talent stent-graft system and to present mid-term results of endovascular aortic repair performed in our center. METHODS: Between December 2002 and March 2007, 54 patients (6 women) with aortic (14 thoracic and 40 abdominal) lesions underwent treatment with Talent stent-graft. The average age of the patients was 64.8 (20-88) years. Duration of follow-up period ranged from 1 to 49 months (average 21 months). Indications for endovascular repair were degenerative aneurysm in 45, degenerative aneurysm and penetrating ulcer in 2, only penetrating ulcer in 1, traumatic thoracic isthmic transsection in 4 and vasculitic aneurysm secondary to Behcet's disease in 2 patients. RESULTS: Repair was performed with the tubular (16), aortouniiliac (1) or bifurcated (37) stent-grafts. Technical success rate was 100%. No death, major complication or need of immediate conversion to open repair was seen. Endoleak rate was 18.5% at 1 month follow-up period. Thirty-day mortality was 1.8% and morbidity (other than endoleaks) rate was 12.9%. During the follow-up period, secondary intervention was required in 12.9% of patients. Iliac limb occlusion was detected in 1 patient (1.8%). Graft migration causing type 1 endoleak and requiring open surgical treatment was seen in 1 patient (1.8%). Four patients (7.4%) are still under follow-up for type-2 endoleaks that do not require intervention. No graft infection or death due to aneurysm rupture was detected. CONCLUSION: Endovascular treatment of aortic lesions in selected patients with comorbid conditions using the Talent stent-graft exhibits a high degree of technical success with a low perioperative morbidity and mortality rate. The major disadvantage of endovascular aortic repair is necessity of life-long imaging follow-up and secondary interventions.

Transvenous embolization of a spontaneous femoral AVF 5 years after an incomplete treatment with arterial stent-grafts.

A 66-year-old man with complex left femoral arterio-venous fistula (AVF) was first diagnosed after a deep venous thrombosis incident approximately 5 years ago. Partial treatment was performed by means of endografts along the superficial femoral artery, which remained patent for 5 years. The patient had been doing well until a couple of months ago when he developed severe venous stasis and ulcers of the left cruris, due to a high-flow nonhealing complex AVF with additional iliac vein occlusion. Therefore; the definitive treatment was performed by a unique endovascular technique combined with surgical venous bypass (femoro-femoral crossover saphenous bypass, the Palma operation). A novel percutaneous transvenous technique for occlusion of a complex high-flow AVF is reported with a review of the literature. The case is unique with spontaneous AVF, transvenous embolization with detachable coils and ONYX, and the hybrid treatment technique as well as the long-term patency of superficial femoral artery stent-grafts.