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Introduction: Arteriovenous malformations (AVM) are developmental vascular malformations consisting of abnormal arteriovenous shunts surrounding a central nidus. These lesions are relatively uncommon, comprising just 7% of all benign soft-tissue masses. Most AVMs occur in the brain, neck, pelvis, and lower extremity and rarely manifest in the foot. When they do form in the foot, non-specific pain and the absence of clinical features contribute to the high rate of misdiagnosis on initial presentation. Although surgical excision combined with embolotherapy has emerged as the preferred treatment for large AVM, controversy exists over the best treatment for small lesions in the foot. Case Presentation: A 36-year-old Afro-Caribbean man was referred to the clinic with a 2-year history of increasing pain in his forefoot, affecting his ability to stand or walk comfortably. There was no history of trauma, and despite changing his footwear, the patient continued to have significant pain. Clinical examination was unremarkable except for mild tenderness over the dorsum of his forefoot, and radiographs were normal. A magnetic resonance scan reported an intermetatarsal vascular mass but could not exclude malignancy. Surgical exploration and en bloc excision confirmed the mass to be an AVM. One year post-surgery, the patient remains pain-free with no evidence of recurrence. Conclusions: The rarity of AVM in the foot, combined with normal radiographs and non-specific clinical signs, contributes to the long delay in diagnosing and treating these lesions. Surgeons should have a low threshold for obtaining magnetic resonance imaging in cases of diagnostic uncertainty. En bloc surgical excision is an option for treating small suitably located lesions in the foot.
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BACKGROUND: Osteoarthritis (OA) is the most frequent joint disease, affecting 10% of men and 18% of women older than 60 years worldwide. Traditionally, treatment is based in pain management with joint replacement of end-stage disease. In this setting, transcatheter embolization has emerged as an alternative in reduction of pain in patients with OA. CASE PRESENTATION: A 77 years-old female presenting with two previous deep vein thrombosis and 10 years of hip pain. Magnetic resonance demonstrated a focal area of enhanced pericapsular signal near the superolateral margin of the acetabulum. Embolization of branches of the ascending branch of the lateral femoral circumflex artery was performed, with decrease of the pain and improvement in the image and her walking ability in a four-month follow-up. CONCLUSION: This case report have shown that embolization of hip synovitis is feasible with early clinical success, in tune with the findings of genicular and shoulder embolization. Studies with more patients and long-term results are necessary to corroborate this finding. LEVEL OF EVIDENCE: 4.
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BACKGROUND: High-resolution chest CT (HRCT) scan is recommended after pulmonary arteriovenous malformation (PAVM) embolotherapy to assess for PAVM persistence and untreated PAVM growth. Graded transthoracic contrast echocardiography (TTCE) predicts the need for embolotherapy in PAVM screening. This study sought to determine whether postembolotherapy graded TTCE can similarly predict the need for repeat embolotherapy. METHODS: Thirty-two patients (8 men and 24 women; mean age, 51.1 ± 12.6 years) with prior PAVM embolotherapy and follow-up HRCT scan were prospectively enrolled. Patients underwent graded TTCE using a validated three-point quantitative grading scale. TTCE grade and HRCT findings were compared. RESULTS: Median time between most recent HRCT scan and TTCE was 7 days (interquartile range, 0-272 days). Thirty patients (94%) had no PAVMs requiring repeat embolotherapy on HRCT scan. Two patients (6%) had PAVMs requiring repeat embolotherapy (feeding artery [FA] ≥ 3 mm), one with untreated PAVM growth and one with treated PAVM persistence. TTCE was positive in 88% of patients (n = 28). All patients (n = 4, 12%) with negative TTCE had no visible PAVMs on HRCT scan. Nine patients (32%) had grade 1 shunt, 10 (35%) had grade 2 shunt, and nine (32%) had grade 3 shunt. No patients with grade 1 shunt had PAVMs amenable to repeat embolotherapy on HRCT scan. All patients (n = 2) with PAVMs requiring repeat embolotherapy (FA ≥ 3 mm) had grade 3 shunt. TTCE grade was significantly associated with PAVM FA diameter (P < .001). CONCLUSIONS: Postembolotherapy graded TTCE can predict the need for repeat embolotherapy on HRCT scan. Patients with negative TTCE and grade 1 shunt may not require HRCT follow-up and can potentially be followed with serial graded TTCE. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02936349; URL: www.clinicaltrials.gov.
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Malformations artérioveineuses/imagerie diagnostique , Malformations artérioveineuses/thérapie , Échocardiographie , Embolisation thérapeutique/méthodes , Tomodensitométrie , Produits de contraste , Femelle , Humains , Mâle , Adulte d'âge moyen , Valeur prédictive des tests , Études prospectives , Reprise du traitementRÉSUMÉ
PURPOSE: The purpose of the study was to compare safety and efficacy outcomes following prostate artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 100-300 versus 300-500 µm tris-acryl gelatin microspheres. MATERIALS AND METHODS: Patients were prospectively treated between August 2011 and June 2013 to receive PAE with 100-300 µm (group A) or 300-500 µm (group B) tris-acryl gelatin microspheres. Patients were followed for a minimum of 12 months and were assessed for changes in International Prostate Symptom Score (IPSS), quality of life (QoL) index, prostate volume determined by magnetic resonance imaging, serum prostate specific antigen (PSA), and maximum urine flow rate (Qmax), as well as any treatment-related adverse events. RESULTS: Fifteen patients were included in each group, and PAE was technically successful in all cases. Both groups experienced significant improvement in mean IPSS, QoL, prostate volume, PSA, and Qmax (p < 0.05 for all). The differences observed between the two groups included a marginally insignificant more adverse events (p = 0.066) and greater mean serum PSA reduction at 3 months of follow-up (p = 0.056) in group A. CONCLUSIONS: Both 100-300 and 300-500 µm microspheres are safe and effective embolic agents for PAE to treat LUTS-related to BPH. Although functional and imaging outcomes did not differ significantly following use of the two embolic sizes, the greater incidence of adverse events with 100-300 µm microspheres suggests that 300-500 µm embolic materials may be more appropriate.
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Résines acryliques/usage thérapeutique , Embolisation thérapeutique/méthodes , Gélatine/usage thérapeutique , Symptômes de l'appareil urinaire inférieur/thérapie , Hyperplasie de la prostate/thérapie , Sujet âgé , Humains , Symptômes de l'appareil urinaire inférieur/sang , Symptômes de l'appareil urinaire inférieur/complications , Imagerie par résonance magnétique , Mâle , Adulte d'âge moyen , Taille d'organe , Études prospectives , Prostate/anatomopathologie , Antigène spécifique de la prostate/sang , Hyperplasie de la prostate/sang , Hyperplasie de la prostate/complications , Qualité de vie , Résultat thérapeutiqueRÉSUMÉ
PURPOSE: To compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia. METHODS: We prospectively randomized 30 patients to receive TURP or original PAE (oPAE) and compared them to a cohort of patients treated by PErFecTED PAE, with a minimum of 1-year follow-up. Patients were assessed for urodynamic parameters, prostate volume, international prostate symptom score (IPSS), and quality of life (QoL). RESULTS: All groups were comparable for all pre-treatment parameters except bladder contractility and peak urine flow rate (Q max), both of which were significantly better in the TURP group, and IIEF score, which was significantly higher among PErFecTED PAE patients than TURP patients. All groups experienced significant improvement in IPSS, QoL, prostate volume, and Q max. TURP and PErFecTED PAE both resulted in significantly lower IPSS than oPAE but were not significantly different from one another. TURP resulted in significantly higher Q max and significantly smaller prostate volume than either original or PErFecTED PAE but required spinal anesthesia and hospitalization. Two patients in the oPAE group with hypocontractile bladders experienced recurrence of symptoms and were treated with TURP. In the TURP group, urinary incontinence occurred in 4/15 patients (26.7 %), rupture of the prostatic capsule in 1/15 (6.7 %), retrograde ejaculation in all patients (100 %), and one patient was readmitted for temporary bladder irrigation due to hematuria. CONCLUSIONS: TURP and PAE are both safe and effective treatments. TURP and PErFecTED PAE yield similar symptom improvement, but TURP is associated with both better urodynamic results and more adverse events.