Prostate artery embolisation: an initial experience from an Indian perspective.

PURPOSE: The study aims to report our very early experience with prostate artery embolisation in patients with benign prostatic hypertrophy (BPH) in an Indian setting. MATERIAL AND METHODS: This prospective study was approved by the Institutional Ethical Review Board, and informed consent was obtained from all the patients. Four patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent prostate embolisation. Embolisation was performed using polyvinyl alcohol (PVA) particles. International Prostate Symptom Score (IPSS), quality of life (QOL) score, postvoid residual volume, and prostate volume was recorded in each patient for 12 months. No major complications were seen in any patient. RESULTS: Four patients with a mean age of 74.2 years underwent prostate artery embolisation. It was successful in all the cases. Bilateral embolisation was performed in three patients and unilateral approach in one patient. Clinical improvement was characterised by a mean prostate volume reduction of 22% and mean IPSS reduction of 30% at 12-month follow-up. CONCLUSIONS: The initial experience with prostate embolisation has been very rewarding and is a great alternative treatment for BPH. It is a very safe and effective procedure and can be an ideal procedure from an Indian perspective.

Selective internal radiation therapy: 90Y (yttrium) labeled microspheres for liver malignancies (primary and metastatic).

Selective Internal Radiation Therapy is a relatively new technique that irradiates malignant liver lesions using microscopic beads. It provides micro-embolization coupled with high-dose interstitial radiotherapy. Besides colorectal cancers, this therapy has shown benefit in patients with a variety of other tumors including carcinoid tumors, lung, breast, sarcoma, colon, hepatocellular and ocular melanoma. Its clinical benefit can be as much as 85%, survival can be doubled and patients with extensive colorectal metastases not amenable to resection or ablation can be offered a 32% chance of surviving for 18 months. Ongoing and future studies will refine our understanding of optimizing patient eligibility, dosage, frequency as well as novel applications.

Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology.

Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition.

Endovascular therapy for a profunda femoris artery aneurysm which ruptured following intravenous thrombolysis.

Arterial aneurysms are a relative contraindication for systemic thrombolytic therapy due to the risk of rupture. This case report describes rupture of a rare profunda artery aneurysm (PFAA) following systemic thrombolysis for myocardial infarction. Subsequent imaging and endovascular management of this rare complication is presented with a brief discussion.

Multidetector CT appearances of splanchnic arterial pathology.

Recent advances in multidetector computed tomography (MDCT) technology have enabled the production of high-resolution diagnostic images of the visceral vessels. The potential of MDCT in relation to splanchnic artery pathology is still being realized, but it already provides a credible quick, non-invasive, low-dose alternative to digital subtraction angiography. A variety of categories of splanchnic artery pathology are demonstrated, including stenosis and occlusion (due to extrinsic compression, mural thrombus, and atherosclerosis), aneurysms, dissection, and haemorrhage.

Retrograde or antegrade double-pigtail stent placement for malignant ureteric obstruction?

AIM: To determine the optimum approach for double-pigtail stent placement in malignant ureteric obstruction. PATIENTS AND METHODS: Retrograde stent placement was attempted in a consecutive series of patients presenting with malignant ureteric obstruction. If retrograde stent placement was unsuccessful, percutaneous nephrostomy was performed immediately followed by elective antegrade stent placement. Identical digital C-arm fluoroscopy for image-guidance and conditions for anaesthesia and analgesia were employed for both retrograde and antegrade procedures. Identical 8 Fr (20-26 cm) double-pigtail hydrophilic coated stents were used for each approach. RESULTS: Retrograde placement was attempted in 50 ureters in 30 patients {19 male, 11 female, average age 61.4 yr (range 29-90 yr)} over a 24-month period. The success rate for retrograde ureteric stent placement was 50% (n = 25/50). Technical failures were due to failure to identify the ureteric orifice (n = 22), failure to cross the stricture (n = 1), failure to pass the stent (n = 1) and failure to pass a 4 Fr catheter (n = 1). Antegrade placement was attempted in 25 ureters with a success rate of 96% (n = 24/25). Failure in the one case was due to inability to cross an upper third stricture secondary to pyeloureteritis cystica. CONCLUSION: It is suggested that retrograde route should be the initial approach if imaging shows no involvement of ureteric orifice (UO), when nephrostomy is technically very difficult or in cases of solitary kidney. The antegrade route is preferred if imaging shows tumour occlusion of the UO or if there is a tight stricture very close to the uretero-vesical junction (UVJ) making purchase within the ureter difficult for crossing the stricture.

Changes in blood coagulability as it traverses the ischemic limb.

OBJECTIVE: We undertook this study to determine whether changes in blood coagulability associated with peripheral arterial occlusive disease are due to contact with the atherosclerotic arterial wall or passage through distal ischemic tissue. METHODS: Thirty patients with peripheral arterial occlusive disease undergoing angiography participated in the study. Ankle-brachial pressure index was recorded before intervention. Blood samples taken from the aorta, common femoral artery, and common femoral vein were analyzed at thromboelastography. Angiograms were scored for stenotic disease by a radiologist blinded to the other results. RESULTS: When femoral artery samples were compared with aortic samples there was a decrease in reaction time (R; P <.05), an increase in maximum amplitude (MA; P <.05), and an increase in coagulation index (CI; P <.002), indicating an increase in coagulability as blood flowed down the iliac segment. These changes also correlated (DeltaR, r = 0.442, P <.05; DeltaMA, r = 0.379, P <.05; DeltaCI, r = 0.429, P <.05) with the severity of disease in the ipsilateral iliac segment. Significant differences in R (P <.05), angle (P <.05), MA (P <.005), and CI (P <.001) between common femoral arterial and venous samples confirmed that venous samples were more coagulable in this group of patients. This difference in Thromboelastography parameters across the arteriovenous segment correlated inversely with the degree of ischemia (represented by ankle-brachial pressure index; DeltaCI, r = -0.427, P <.05; DeltaMA, r = -0.370, P <.05) in the puncture side limb. CONCLUSION: Passage of blood down an atherosclerotic artery leads to an increase in coagulability proportional to the degree of stenosis in that vessel. Passage of blood through ischemic tissue may also contribute to increased coagulability in peripheral arterial occlusive disease.

Case report: retrocaval ureter: MR appearances.

We present a case of retrocaval ureter and its MR appearances. This is the first case in reported literature. The findings on i.v. urography are correlated with the MRI findings. So far CT has been the procedure of choice to confirm the diagnosis of retrocaval ureter. However, we believe MRI is likely to replace CT in the diagnosis of retrocaval ureter.

Skin sparing in interventional radiology: the effect of copper filtration.

Complex and lengthy interventional radiological techniques have resulted in a number of patients developing skin reactions in recent years. To safeguard against these side effects, we have investigated the degree to which entrance skin dose can be reduced by inserting 0.18 mm and 0.35 mm copper filtration in the incident beam. The potential reduction was measured on a 22 cm water phantom for each of eight models of a fluoroscopy unit. Using the catheter laboratory fluoroscopy unit on which radiofrequency ablations are routinely performed, we assessed the relative effectiveness of adding filtration and increasing the kV:mA ratio. Image quality was subjectively assessed for diagnostic and therapeutic acceptability in two groups of 10 patients undergoing radiofrequency ablations, pacemaker insertions or electrophysiology studies. One of the groups was screened with 0.35 mm copper filtration in place and the other group acted as the control. Maximum patient skin dose proved difficult to measure directly because of the unpredictable dose pattern. This pattern was studied in four patients using a film method in conjunction with thermoluminescent dosemeters. Copper filtration 0.35 mm thick inserted in the beams of the eight fluoroscopy units produced a mean reduction in entrance dose to the phantom of 58% with a mean increase in tube loading of 29%. At 100 kV the increased loading on the X-ray tube was equivalent to increasing the anteroposterior separation of the patient by 2 cm. Measurements on the catheter laboratory unit showed that the tube voltage would need to be raised above the normal diagnostic range to obtain an equivalent entrance dose reduction without the filter. The blackening of films under the patients showed complex patterns, but the estimated skin doses were consistent with those predicted by the phantom experiments. All six cardiologists considered there to be insignificant detriment to image quality in the procedures investigated.