Prophylactic uterine artery embolization in first-trimester cervical pregnancy termination with placenta accreta: A case report.

The current standard treatment for placenta accreta is a hysterectomy, which carries a significant risk of hemorrhage. Although prophylactic uterine artery embolization (UAE) is established as an effective means of minimizing perioperative bleeding, there are few reports of its use early in pregnancy with invasive placenta. A 45-year-old woman, gravida 6, para 1, at 11 weeks of gestation presented with heavy, painless uterine bleeding and was diagnosed with a spontaneous abortion complicated by cervical pregnancy and placenta accreta. The patient underwent bilateral UAE followed by gravid hysterectomy. This case report encourages prophylactic UAE prior to abdominal hysterectomy in patients with early gestational cervical pregnancy and placenta accreta to minimize blood loss during surgery.

Angiographic Analysis of Anatomical Variants in Adhesive Capsulitis Embolization.

PURPOSE: To analyze the complex shoulder vasculature and identify potential challenges during adhesive capsulitis embolization (ACE). MATERIALS AND METHODS: Two interventional radiologists evaluated angiographic findings from 21 ACE procedures. The suprascapular artery (SSA), thoracoacromial artery (TAA), coracoid branch (CB), circumflex scapular artery (CSA), and anterior/posterior circumflex humeral artery (ACHA/PCHA) were assessed for their presence, course, diameter within 1 cm of origin, angle to the proximal parent vessel, and distance from the clavicle. RESULTS: 83 arteries were embolized: CB (20.5%), TAA (19.3%), PCHA (19.3%), ACHA (16.9%), CSA (14.5%), and SSA (9.6%). The CSA had the largest diameter (4.3 mm), while CB had the smallest diameter (1.0 mm). An acute angle to the parent vessel was noted with the SSA, TAA, ACHA, and PCHA. A common origin for CSA and PCHA was noted in 2 patients. A common origin for TAA and SSA was also noted in one patient. The CB appears perpendicular to the axillary artery and courses vertically toward the coracoid process. The TAA branches off the axillary artery and courses along the medial border of the pectoralis minor. The PCHA and ACHA originate from the axillary artery. The CSA is located on the medial side of axillary artery. The SSA originates from the thyrocervical trunk and courses laterally toward the superior border of the scapula. CONCLUSION: An anatomical-technical guide is provided to help interventional radiologists during ACE to treat adhesive capsulitis.

Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center.

PURPOSE: To evaluate the safety and efficacy of outpatient transarterial embolization for symptomatic refractory internal hemorrhoids. MATERIALS AND METHODS: Retrospective analysis of 134 patients who underwent hemorrhoidal artery embolization (HAE) for symptomatic internal hemorrhoids between August 2021 and June 2022 (76 men and 58 women) was performed. The mean age was 54.9 years, with a mean Goligher hemorrhoid grade (HG) of 2.1. Branches of the superior rectal artery (SRA) or middle rectal artery supplying the corpus cavernosum recti were embolized with both spherical particles and microcoils. Standard-of-care evaluations were performed at baseline and the 1 month follow-up, which included hemorrhoid-related pain (HRP) (0-10), hemorrhoid symptoms score (HSS) (5-20), quality of life (QoL) (0-4), French bleeding score (FBS) (0-9), and HG (0-4). Clinical success was defined as improvement of symptoms without additional treatment. RESULTS: Embolization of at least 1 hemorrhoidal artery was achieved in 133 (99%) of the 134 patients. The mean number of SRA branches embolized per patient was 2.9 ± 1.0. Clinical success was seen in 93% (124 of 134) of patients at the 1-month follow-up, with 10 patients requiring repeat embolization. There were significant improvements in all mean outcomes at 1 month: HSS (11-7.8; P < .01), HRP (4.1-1.3; P < .01), QoL (2.2-0.8; P < .01), FBS (4.4-2.2; P < .01), and HG (2.3-1.2; P < .05). There were no severe adverse events. CONCLUSIONS: HAE is a safe and effective outpatient treatment for refractory symptomatic internal hemorrhoids in the short term.

Dendrimer directed assembly of dicarboxylated hairy nanocellulose.

HYPOTHESIS: Dendrimer-directed assembly of electrosterically stabilized nanocrystalline cellulose (ENCC) to form network structures was studied. ENCC is a member of the family of hairy nanocelluloses and consists of a crystalline rod and dicarboxylated cellulose chains ("hairs") protruding from both ends, which are very reactive. We hypothesized that covalent linking of ENCC and dendrimers should lead to self-assembled hybrid network structures in which dendrimeric nodes connect cellulose nanorods. EXPERIMENTS: Polyamidoamine (PAMAM) dendrimers were covalently linked to ENCC by a bioconjugation reaction with different ratios of ENCC to PAMAM. To control the self-assembly process and prevent aggregation, acid hydrolysis of ENCC was performed to obtain crew-cut ENCC with shorter hairs and less negative charge. The formation of self-assembled structures from different PAMAM concentrations were analyzed using atomic force microscopy. FINDINGS: It was observed that depending on the concentration of PAMAM, various linear, star-shaped, and closed-loop structures were formed. Also, networks were formed with dendrimers acting as the nodes, connecting long cellulose rods, thus producing a network with a characteristic length of around 100-200 nm, which is difficult to obtain otherwise. We have demonstrated that the reactions of dendrimers with ENCC are solely occurring at the hairs and not at the crystalline regions.