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.

The administration of contrast media: is there a risk of acute kidney injury? / Administración de medios de contraste. ¿Existe riesgo de daño renal agudo?

OBJECTIVE: To determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury. MATERIAL AND METHODS: This retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72hours later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤ 0.4mg/dl or ≥4.0mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (n=6,642), those who underwent noncontrast CT (n=6,193), and those who did not undergo CT (n=33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses. RESULTS: We analyzed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16mg/dl (SD: 0.61); C2: 1.14mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (odds ratio [OR: 0.90; 95% CI: 0.83-0.99] and [OR 0.89, 95% CI: 0.81-0.98], respectively). The propensity score matching study using both sets of criteria (AKIN+CIN) yielded OR 0.80 [95% CI: 0.77-0.84]. Glomerular filtration rates less than 30ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47-0.91]. CONCLUSION: The administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury.

Suspicion of acute appendicitis in adults. The value of ultrasound in our hospital. / Sospecha de apendicitis aguda en adultos. El valor de la ecografía en nuestro hospital.

OBJECTIVE: To evaluate the accuracy of ultrasonography for the diagnosis of acute appendicitis in adults, to calculate the negative appendicectomy rate in operated patients and the accuracy of pre-defined diagnostic categories and to identify statistically significant signs and symptoms of acute appendicitis in ultrasonography. MATERIAL AND METHODS: Descriptive prospective study in which we collected the findings of the urgent ultrasonographies ordered in a one-year period for adult patients with pain in the right iliac fossa (RIF), along with their symptoms. We classified them in 5 different diagnostic categories presented in the radiological report: normal appendix, non-visible appendix and no secondary signs, non-conclusive, probable appendicitis, certain appendicitis. By mean of the Stata14 software descriptive analysis, T-test and Chi-square were performed and the data were compared with the final pathological report. RESULTS: Population: 139 patients (45% men, 55% women), mean age: 32,68 (15-84). Prevalence of acute appendicitis: 50,35% (70/139). Negative appendicectomy rate: 0%. Negative predictive value for the categories 1,2 and 3 taken together: 90,78%. Positive predictive value for the categories 4 and 5 taken together: 100%. Ultrasound sensibility and specificity 90% and 100%, respectively. Statistically significant signs and symptoms (p<0.05): RIF pain, fever, leukocytosis, left shift, visible appendix, non-compressibility, hyperechogenic fat, appendicolith and free fluid. CONCLUSION: Ultrasound is very accurate for the diagnosis of acute appendicitis in adults.

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)

Embolización selectiva como tratamiento de la hemorragia obstétrica / Selective embolization to treat obstetric hemorrhage

Objetivo: Describir los casos de hemorragias obstétricas que han precisado embolización selectiva intraarterial, referir las diferentes técnicas de embolización empleadas, valorar los resultados clínicos y la fertilidad posterior. Material y métodos: Se estudiaron 27 mujeres con hemorragia obstétrica. La embolización se realizó cateterizando ambas arterias uterinas en 24 pacientes y solo una arteria uterina en 2 (pseudoaneurisma), en 17/27 se embolizó con Espongostán®, en 9/27 con partículas y un paciente con coils. Se realizó un seguimiento clínico de las pacientes analizando la aparición de complicaciones inmediatas y tardías, y la posterior fertilidad. Resultados: Las hemorragias fueron primarias (25/27) y secundarias (2/27).Las causas fueron: partos vaginales (20), cesáreas (5), aborto (1) y embarazo ectópico cervical (1).El éxito técnico inicial fue del 100% y el éxito clínico del 92,6% (25/27) de las pacientes, El resultado fue satisfactorio en 25 pacientes cesando la hemorragia. Se realizó seguimiento clínico entre 1 y 7 años tras la embolización, en 23 pacientes se constataron menstruaciones normales y se produjeron 7 embarazos a término en 6 pacientes. Conclusión: La embolización intraarterial en la hemorragia obstétrica ofrece buenos resultados, pocas complicaciones y preserva la fertilidad (AU)

Objective: To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. Material and methods: We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. Results: Hemorrhage was classified as primary (25/27) or secondary (2/27).The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1).The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients).Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. Conclusion: Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility (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.

[Selective embolization to treat obstetric hemorrhage]. / Embolización selectiva como tratamiento de la hemorragia obstétrica.

OBJECTIVE: To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. MATERIAL AND METHODS: We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. RESULTS: Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. CONCLUSION: Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility.

[Comparison of doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) with conventional transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma]. / Quimioembolización del hepatocarcinoma: partículas cargadas frente a quimioembolización convencional.

OBJECTIVE: To compare conventional transarterial chemoembolization (TACE) with doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) for the treatment of hepatocellular carcinoma, evaluating the tumor response, complications after treatment, and survival. MATERIAL AND METHODS: We present 72 patients diagnosed with hepatocellular carcinoma treated consecutively between January 2000 and December 2009. We studied 25 patients treated with TACE (Group A) and 47 patients treated with DEB-TACE (Group B); adriamycin (doxorubicin) was the chemotherapy agent used in both groups. All patients had compensated cirrhosis of the liver classified on the Child-Pugh score. The results were analyzed according to the RECIST criteria. Statistical analyses consisted of ANOVA, chi-square tests, Student's t-tests, and Kaplan-Meier log-rank tests. RESULTS: Patient's age, tumor size, number of tumors, and hepatic reserve were similar in the two groups. The mean number of sessions per patient was 1.32 ± 0.67 in Group A versus 2.13 ± 0.95 in Group B. The mean dose of adriamycin per patient was 50.60 ± 29.95 mg in Group A and 231.91 ± 110.2mg in Group B. A complete response of the tumor to treatment was observed in 5.6% of the patients in Group A and in 13.9% of those in Group B. According to the RECIST criteria, no significant differences were found. DEB-TACE was better tolerated and had fewer immediate complications (p=0.001). No significant differences were found in the survival of patients in the two groups (Group A: mean 686.24 days, median 709 days; Group B: mean 765.32 days, median 672 days. CONCLUSION: In patients with unresectable hepatocellular carcinoma, DEB-TACE is safe and better tolerated than conventional TACE; moreover, it seems to lead to greater necrosis of the tumors.

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

No disponible

Embolización arterial selectiva en un caso de carcinoma de células renales como alternativa terapéutica / Selective arterial embolization in a case of renal cell carcinoma like therapeutic choice

Presentamos un caso de carcinoma de células renales muy voluminoso en una paciente de avanzada edad y con pluripatología asociada. Dada la negativa familiar a realizar cirugía radical y el elevado riesgo quirúrgico se optó por practicar embolización tumoral arterial selectiva con partículas depolivinil alcohol (PVA). Tras 28 meses de seguimiento la paciente resulta asintomática y con excelente calidad de vida. Concluimos que la embolización es una alternativa terapéutica eficaz en el control de la sintomatología para casos seleccionados (AU)

We show a big renal cell carcinoma case in an aged woman with many pathology associated. Inview of the family refuse to make the radical surgery and the high surgical risk we decided to apply transarterial embolization treatment with polivinil alcohol particles (PVA). 28 months later the patient becames with no symptoms and with high quality life. We come to the conclusion that embolization is an effective therapeutic for the symptoms control in selectionated cases (AU)

[Anterograde insertion of ureteral catheter]. / Inserción anterógrada de catéter ureteral.

We report twenty-four patients with urinary obstruction, in which twenty-seven antegrade ureteral stent (double J) insertions were attempted (in six patients the obstruction was bilateral and in three other patients we failed). In all of them access to the urinary tract was through a nephrostomy catheter, in seventeen cases we proceeded to insert the antegrade catheter immediately after percutaneous nephrostomy and in ten remaining cases we achieved in a second try after carrying nephrostomy and failing a conventional retrograde approach to ureteral stent insertion. We got a 90-per cent success rate. A case of perirrenal hematoma occurred after applying a nephrostomy. It was the only relevant complication. In conclusion we consider that the antegrade ureteral stent insertion is a good alternative when, under several circumstances, the conventional retrograde insertion fails.

Complicaciones de las prótesis esofágicas de Wallstent. resultados comparativos entre las prótesis recubiertas y las no recubiertas / Complications associated with the implantation of Wallstent endoprostheses in esophagus. Comparison between coated and uncoated prostheses

Objetivo. El objetivo de este trabajo es presentar nuestra experiencia en las prótesis esofágicas autoexpandibles en cuanto a las complicaciones a corto y a largo plazo, estudiando la permeabilidad primaria y secundaria de las prótesis no cubiertas y las recubiertas. Pacientes y método. Se han colocado 62 prótesis metálicas esofágicas de Wallstent (42 no recubiertas y 20 recubiertas) en 44 pacientes con carcinoma inoperable. La implantación de los stent ha sido peroral y con control fluoroscópico, requiriendo un ingreso hospitalario de 24 h. El estudio de la per meabilidad de las prótesis se ha estudiado con el test actuarial de Kaplan-Meier. Resultados. En 5 pacientes se requirió la colocación de 2 prótesis por estenosis muy larga. Respecto a las complicaciones inmediatas, en un paciente se produjo obstrucción inmediata de la malla al presentar un tumor muy blando; además, hubo un caso de hematemesis posprocedimiento. Un 45 por ciento de los pacientes con prótesis recubierta y un 19 por ciento con prótesis no recubierta presentaron dolor retrosternal importante. En cuanto a las complicaciones tardías, se observaron 2 casos de neumonía aspirativa, 2 pacientes con hematemesis y un caso con migración tardía de dos prótesis coaxiales 8 meses después de implantadas. El estudio de la permeabilidad primaria puso de manifiesto diferencias significativas entre los dos tipos de prótesis (92 y 90 días de mediana). En 8 pacientes existió obstrucción tumoral tardía tratada con una nueva prótesis, alcanzando este grupo una media de supervivencia de 260 días. Conclusiones. Las prótesis recubiertas producen más dolor retrosternal. No hay diferencias de permeabilidad en ambos tipos de prótesis. En caso de obstrucción tumoral del stent se debe valorar la colocación de una segunda prótesis (AU)

Inserción anterógrada de catéter ureteral / Antegrade ureteral stent insertion

Presentamos 24 pacientes con patología obstructiva urinaria, en los que se realizaron 27 procedimientos de colocación de un catéter doble J vía anterógrada (en 6 la obstrucción era bilateral y en 3 pacientes no se consiguió pasar el catéter).En todos los casos el acceso a la vía urinaria fue a través de un catéter de nefrostomía, en 17 casos en el mismo acto se decidió colocar el catéter doble J y en los 10 restantes se realizó en un segundo tiempo, tras llevar la nefrostomía y haber fracasado un abordaje retrógrado convencional para la colocación del catéter de doble J. El éxito de la técnica fue en el 90 por ciento de los casos. Hemos tenido una complicación reseñable por la formación de un hematoma subcapsular, tras la realización de la nefrostomía. Como conclusión, consideramos que el abordaje anterógrado para la colocación de un catéter doble J es una buena alternativa cuando, por diversos motivos, se fracasa en la colocación retrógrada convencional. (AU)

Sonographic diagnosis of a pseudoaneurysm in an intravenous drug abuser.

We report a case of a traumatic pseudoaneurysm and arteriovenous fistula in the groin of a drug abuser. Gray-scale and Doppler sonography were used to establish the diagnosis. Gray-scale sonography revealed an anechoic, ovoid, 7 x 4 cm mass posterior to the right superficial femoral artery, which was displaced anteriorly, with limited visualization of the deep femoral artery. Power Doppler sonography showed complete color filling of the mass, and turbulence was seen on conventional color Doppler sonography. The turbulence was confirmed with pulsed Doppler sonography of the mass. Pulsed Doppler imaging of the right external iliac vein also showed an arterialized spectral flow pattern.

[Axillo-subclavian effort thrombosis: main characteristics]. / Trombosis de esfuerzo axilosubclavia. Características más relevantes.

OBJECTIVE: Effort related thrombosis of the axillo-subclavian vein is a disabling disorder that occurs primarily in healthy young individuals. The aim of this study is to show our experience in diagnosis and therapy of this entity. METHODS: During a 5 years period (1994 to 1998) we studied 7 patients (6 woman and 1 man), with an average age of 26 years old. All patients underwent Doppler ultrasound examinations and, later, venography of the affected upper extremity. All of them were treated at the outset with systemic infusion of fibrinolytic agents. RESULTS: Only one patient manifested successfully clinic outcome. Five patients were treated with surgical decompression resulting in excellent function. One patient refused surgical treatment, and he was treated with warfarin sodium showing a poor clinic response. CONCLUSION: Although systemic fibrinolytic therapy can restore axillo-subclavian vein patency, surgical approach is necessary to relieve the external compression.

Trombosis de esfuerzo axilosubclavia. Características más relevantes / Effort thrombosis of the axillosubclavian vein: mains characteristics

Objetivo: La trombosis de esfuerzo axilosubclavia es una enfermedad discapacitante que aparece en individuos jóvenes y sanos. Mostramos nuestra experiencia, tanto en el diagnóstico como en el tratamiento en esta entidad. Pacientes y métodos: Durante un periodo de 5 años (1994 al 1998) hemos estudiado 7 pacientes (6 mujeres y 1 hombre) con una media de edad de 26 años. En todos los pacientes se realizó ecodoppler y flebografía posteriormente. En todos ellos se instauró tratamiento con fibrinolíticos sistémicos. Resultados: Sólo en un caso hubo evolución favorable. De los 6 restantes, 5 fueron intervenidos quirúrgicamente con buenos resultados. Un paciente se negó a este tratamiento y se utilizaron anticoagulantes orales con mala evolución clínico-radiológica. Conclusiones: Aunque los fibrinolíticos sistémicos pueden restaurar la permeabilidad de la vena axilosubclavia, la resección de la primera costilla es necesaria para evitar la compresión extrínseca (AU)

[Severe hematuria caused by radiation cystitis. Selective percutaneous embolization as an alternative therapy]. / Hematuria grave debida a cistitis rádica. Embolización percutánea selectiva como alternative terapéutica.

Post-radiotherapy cystitis is a high morbidity entity that involves difficult-to-treat haematurias and sometimes results in death. Percutaneous arterial embolization is an accepted approach for haemorrhages of pelvic origin. Selective, percutaneous embolization of both vesical arteries could be an alternative treatment to control severe haematurias caused by radiation. Presentation of our experience in two cases and proposal of this approach as a valid option in post-radiotherapy haemorrhagic cystitis.