RESUMO
Two patients were treated for bleeding gastric varices, developed due to splenic vein occlusion. In one patient with occlusion of the main splenic artery, splenic embolization performed via collaterals facilitated open splenectomy with minimal blood loss. In another patient, bleeding from the gastric varices stopped after partial arterial splenic embolization performed via the accessory left gastric and inferior phrenic arteries. No complications were encountered.
Assuntos
Arteriopatias Oclusivas/terapia , Circulação Colateral , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/etiologia , Veia Esplênica/fisiopatologia , Insuficiência Venosa/fisiopatologia , Resinas Acrílicas/uso terapêutico , Adulto , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico , Meios de Contraste , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/terapia , Feminino , Seguimentos , Gelatina/uso terapêutico , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica/métodos , Esplenectomia , Veia Esplênica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Insuficiência Venosa/complicaçõesRESUMO
The management of acute massive pulmonary embolism (PE) constitutes a major clinical problem because of the associated derangement of hemodynamic and respiratory functions from obstruction to pulmonary blood flow. Despite advances in management with thrombolytic therapy or open embolectomy, the mortality rate remains high. To improve the chance of survival, catheter techniques that are capable of removing or fragmenting the clot have been developed. These include catheter pulmonary embolectomy and thrombofragmentation. The former involves the introduction of a suction catheter from a femoral or jugular venotomy through the right heart into the appropriate pulmonary artery under fluoroscopic guidance. The technique for the latter involves the percutaneous introduction of a fragmentation catheter from a femoral vein through a guiding catheter into the appropriate pulmonary artery. The success of the catheter technique in removing pulmonary emboli varies with different devices. The overall success rate is approximately 76%, with a mortality rate of 25%. Transvenous pulmonary embolectomy and thrombofragmentation are safe and effective techniques for treating patients with massive PE. The success of each of the techniques depends on a thorough understanding of the mechanism of action of each of the devices used and a facile catheterization technique.
Assuntos
Cateterismo Periférico/métodos , Embolectomia , Embolia Pulmonar/cirurgia , Trombectomia , Cateterismo Periférico/instrumentação , Desenho de Equipamento , Veia Femoral , Fluoroscopia , Humanos , Veias Jugulares , Embolia Pulmonar/fisiopatologia , Radiografia Intervencionista , Segurança , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: To investigate the significance of increased perfusion associated with some hepatic hemangiomata during radionuclide blood volume imaging. METHODS: Immediate dynamic planar projections and delayed SPECT imaging of a hepatic lesion were obtained after the administration of Tc-99m-labeled RBC. Scintigraphic data were compared with X-ray CT, contrast angiography and postresection histopathology. RESULTS: A surgically proven, cavernous hemangioma with typical findings on delayed radionuclide blood-pool imaging showed markedly increased perfusion by scintigraphy. This correlated with arterioportal venous shunting (AVPS) on contrast angiography. CONCLUSION: Increased perfusion on radionuclide blood-volume imaging of hepatic hemangiomata may be a scintigraphic marker of AVPS. This may serve to identify patients with increased risk for spontaneous rupture or may identify them for the development of portal hypertension.
