Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis.

PURPOSE: To present our experience with helical computed tomographic (CT) arteriography as the initial diagnostic examination in patients suspected to have focal arterial injuries of the proximal extremities. MATERIALS AND METHODS: During 19 months, 142 arterial segments in the proximal portions of the extremities of 139 patients with trauma were evaluated with helical CT arteriography. CT arteriograms were interpreted on site by the radiologist in charge of emergency procedures and retrospectively with consensus interpretation between two radiologists. CT study quality and the presence of arterial injuries were noted. CT arteriographic findings were compared with those of surgery, conventional arteriography, and/or clinical follow-up. RESULTS: Five (3.6%) patients had nondiagnostic studies and underwent conventional arteriography. In the remaining 137 arterial segments in 134 patients, helical CT arteriography demonstrated arterial injuries in 61 segments and normal arteries in 76 segments. These segments were treated initially with surgery (55 segments) or endovascular intervention (four segments) or were observed (78 segments); 77 of the 78 observed segments remained stable at 3-18 months (mean follow-up, 5.2 months). There were no differences between the on-site and consensus interpretations (kappa = 1.0). The sensitivity of CT arteriography was 95.1%, and the specificity was 98.7%. CONCLUSION: Helical CT arteriography can be performed as the initial diagnostic method in most patients suspected to have focal arterial injuries of the proximal portions of the extremities.

Embolizacion arterial transcateter para el control de la hemorragia severa en pacientes con carcinoma cervical avanzado / Transcatheter arterial embolization in treatment of severe hemorrhage in patients with advanced carcinoma of the cervix

Entre 1984 y 1999 se realizaron veintiocho embolizaciones arteriales transcateter en 26 pacientes con hemorragia vaginal severa secundaria a cáncer de cérvix avanzado. El estadio del cáncer cervical fue IIIB en 24 pacientes, IIB en una paciente y IV en una paciente. Se realizó angiografía de las arterias pélvicas con embolización de las arterias hipogástricas usando Gelfoam (n= 19, espirales de alambre metálicos y Gelfoam (n= 1), partículas de alcohol polivinilo (PVA) y espirales de alambre (n=4) y partículas de PVA únicamente (n=4). El sangrado agudo fue controlado en 23 pacientes con estabilización de la condición clínica. Embolizaciones repetidas fueron necesarias en tres pacientes. Complicaciones mayores incluyeron trombosis arterial (n= 1), complicaciones neurológicas mayores secundarias a la embolización accidental de nervios de las extremidades inferiores (n=2) y necrosis de grandes miomas requiriendo histerectomía (n=1). El seguimiento fue posible en 16 pacientes. Ocho pacientes murieron entre 1-14 meses después del procedimiento. No hubo episodios significativos de resangrado tardío en ninguna de las pacientes. La embolización arterial transcateter es un método efectivo para controlar la hemorragia severa refractaria al manejo conservador en pacientes con carcinoma cervical avanzado