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2.
Tech Vasc Interv Radiol ; 22(4): 100630, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864535

RESUMO

Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.


Assuntos
Procedimentos Endovasculares , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Malformações Vasculares/terapia , Veias/anormalidades , Tomada de Decisão Clínica , Terapia Combinada , Procedimentos Endovasculares/efeitos adversos , Humanos , Seleção de Pacientes , Fatores de Risco , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Veias/diagnóstico por imagem , Veias/fisiopatologia
3.
Can Assoc Radiol J ; 68(3): 318-327, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28396005

RESUMO

PURPOSE: The study sought to describe a single centre's technical approach to transradial intervention and report on clinical outcomes and safety. METHODS: A total of 749 transradial access (TRA) procedures were performed at a single hospital in 562 patients (174 women and 388 men). Procedures included 445 bland embolizations or chemoembolizations of the liver, 88 uterine artery embolizations, and 148 procedures for Selective Internal Radiation Therapy (Y90), which included mapping and administration. The mean age of the patients was 62 years (range 27-96 years). RESULTS: Four cases (0.5%) required crossover to transfemoral (tortuous anatomy, inability to secure a stable position for embolization, vessel spasm and base catheter not being of a sufficient length). A single asymptomatic, short-segment radial artery occlusion occurred (0.3%), 3 patients (0.4%) developed small hematomas postprocedurally, and 2 patients (0.7%) had transient neurological pain, which was resolved within a week without treatment. It was found that 98% of patients who had a previous femoral access procedure would choose radial access for subsequent procedures. CONCLUSIONS: Transradial access is a safe, effective technique, with a learning curve; however, this procedure has the potential to significantly improve departmental workflow and cost savings for the department and patient experience.


Assuntos
Artéria Radial , Radiografia Intervencionista/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Cateterismo Periférico , Embolização Terapêutica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Resultado do Tratamento
4.
Semin Intervent Radiol ; 27(2): 209-31, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21629410

RESUMO

Within vascular anomalies, vascular malformations are those present at birth that grow with the patient and exhibit abnormal dilated vascular channels lined by mature endothelium. Vascular tumors, the other group of vascular anomalies, demonstrate endothelial hypercellularity. Vascular malformations are further divided into low-flow varieties (capillary, venous, and lymphatic malformations) and high-flow varieties (arteriovenous malformation and fistula). All malformations exhibit a predictable group of clinical patterns that vary in severity and rate of progression. The interventional radiologist must incorporate this clinical data with characteristic ultrasound and magnetic resonance findings to arrive at a diagnosis. One must then decide in a multidisciplinary fashion, based on objective clinical criteria and image-based morphology, if the patent is a candidate for intervention. Sclerotherapy is a technique used to treat vascular malformations whereby an endothelial-cidal agent is introduced into the endoluminal compartment to initiate vascular closure. The high flow rate of an arteriovenous malformation requires the incorporation of superselective transarterial, direct, and transvenous access with flow reduction techniques to deliver adequate dose of sclerosant and embolic to the nidus. Satisfactory outcomes are seen in over half of all malformations patients. Similar treatment-related complications are seen between malformations but are lowest in lymphatic and highest in arteriovenous malformations.

5.
Radiol Clin North Am ; 46(3): 487-514, v-vi, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18707959

RESUMO

The field of spinal injection procedures is growing at a tremendous rate. Many disciplines are involved, including radiology, anesthesiology, orthopedics, physiatry and rehabilitation medicine, as well as other specialties. However, there remains tremendous variability in the assessment of patients receiving these therapies, methods for evaluation of outcome, and in the understanding of where these procedures belong in the triaging of those who require surgery. In this article, we attempt to highlight the biologic concepts on which these therapies are based, controversies that have arisen with their increasing use, and a description of complications that have been reported.


Assuntos
Fluoroscopia/métodos , Injeções Espinhais , Radiografia Intervencionista , Tomografia Computadorizada por Raios X/métodos , Corticosteroides/administração & dosagem , Adulto , Anestésicos Locais/administração & dosagem , Fluordesoxiglucose F18 , Humanos , Injeções Epidurais/métodos , Injeções Espinhais/efeitos adversos , Injeções Espinhais/métodos , Dor Lombar/tratamento farmacológico , Imagem por Ressonância Magnética/métodos , Masculino , Cervicalgia/tratamento farmacológico , Bloqueio Nervoso/métodos , Compostos Radiofarmacêuticos , Ensaios Clínicos Controlados Aleatórios como Assunto , Cisto Sinovial/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único/métodos
6.
Radiol Clin North Am ; 46(3): 545-97, vi, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18707962

RESUMO

Venous malformations are categorized as low-flow vascular malformations within the domain of vascular anomalies and are the most common vascular malformation encountered clinically. Venous malformations are by definition present at birth, undergo pari passu growth, and present clinically because of symptoms related to mass effect or stasis. Although diagnosis can usually be made by clinical history and examination, differentiation from other vascular and nonvascular entities often requires an imaging work-up that includes ultrasound, CT, MR imaging, and diagnostic phlebography. All decisions regarding imaging work-up and decision to treat must be coordinated though referral and discussions with a multidisciplinary team and be based on clearly defined clinical indications. Percutaneous image-guided sclerotherapy has become the mainstay of treatment for venous malformations and involves the introduction of any one of a number of endothelial-cidal sclerosants into the vascular spaces of the lesion, with each sclerosant possessing its own unique spectrum of advantages and disadvantages.


Assuntos
Embolização Terapêutica/métodos , Flebografia/métodos , Radiografia Intervencionista , Escleroterapia/métodos , Malformações Vasculares , Veias/anormalidades , Adulto , Algoritmos , Angiografia/métodos , Criança , Humanos , Lactente , Recém-Nascido , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética/métodos , Malformações Vasculares/classificação , Malformações Vasculares/diagnóstico , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/embriologia , Malformações Vasculares/terapia
7.
Can Assoc Radiol J ; 59(2): 77-82, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18533396

RESUMO

OBJECTIVE: To provide an overview of the current status of percutaneous vertebroplasty (PVP) practice in Canada, including the preprocedure work up, operative technique and follow-up practice of physicians performing the procedure in this country. METHODS: Questionnaires were emailed to 31 institutions performing percutaneous vertebroplasty across Canada. RESULTS: Twenty-three (74.2%) completed surveys were returned, representing data from 1516 vertebroplasties performed by 66 radiologists and surgeons. Preoperative routine imaging and screening practice varies widely. The majority of respondents perform PVP under conscious sedation; however, an anaesthetist is present in only 22% of institutions. Biplane fluoroscopy is used in 43.5% of practices. The preference for unipedicular or bipedicular injection varies: in 7 institutions, a unipedicular approach is used in at least 80% of cases. Patients receive a follow-up by the screening physician in 65.2% of institutions. There were 4 complications requiring treatment. Venous and intradiscal extravasation rates were 20.8% and 25.3%, respectively; however, the vast majority of these were clinically insignificant. CONCLUSION: PVP complication rates reported in our Canadian survey compare favourably with those in the published literature. The number of PVPs performed annually in the institutions surveyed appears small, relative to the figures from the United States. The prevalence of osteoporosis and incidence of vertebral compression fractures in Canada is increasing as the population ages, and demand for PVP is likely to rise significantly in the coming years.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Padrões de Prática Médica/estatística & dados numéricos , Vertebroplastia/métodos , Canadá , Fraturas por Compressão/cirurgia , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Inquéritos e Questionários , Vertebroplastia/efeitos adversos , Vertebroplastia/estatística & dados numéricos
9.
Skeletal Radiol ; 36(9): 875-8, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17410354

RESUMO

Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis.


Assuntos
Falso Aneurisma/patologia , Nádegas/irrigação sanguínea , Nádegas/lesões , Traumatismo Múltiplo , Dor , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Humanos , Masculino , Dor/etiologia , Radiografia , Tomógrafos Computadorizados
10.
J Ultrasound Med ; 25(11): 1387-92; quiz 1394-5, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17060424

RESUMO

OBJECTIVE: The purpose of this study was to describe the sonographic features of uterine arteriovenous malformations (AVMs) and to describe the role and clinical outcome after transcatheter arterial embolization of symptomatic uterine AVMs. METHODS: In our institution, over a 4-year period, symptomatic uterine AVMs were diagnosed in 21 women. Endovaginal sonography with gray scale, color, and spectral Doppler imaging was performed on all patients. Fourteen patients required therapeutic angiography/embolization to control bleeding. These 14 patients had follow-up endovaginal sonography 24 hours after the procedure. RESULTS: The sonographic gray scale findings of uterine AVMs were nonspecific. The most common finding was subtle myometrial heterogeneity (n = 14), whereas other patients had small anechoic spaces in the myometrium (n = 7). Color Doppler sonography showed a tangle of vessels with multidirectional high-velocity flow that produced a "color mosaic" pattern. Spectral Doppler analysis showed arteriovenous shunting with high-velocity, low-resistance flow. Fourteen patients required transcatheter arterial embolization to control bleeding. Thirteen of 14 patients had no sonographic evidence of a residual AVM 24 hours after the procedure. One of 14 patients had a residual AVM requiring additional embolization. One patient had recurrent bleeding at 4 months and required further embolization. The remaining 7 patients were treated conservatively. CONCLUSIONS: Endovaginal sonography is the imaging modality of choice in patients with abnormal uterine bleeding. Routine use of color and spectral Doppler sonography allows one to confidently make the correct diagnosis. Transcatheter arterial embolization is an excellent treatment option. Endovaginal sonography should be used to monitor postembolization outcomes.


Assuntos
Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/radioterapia , Útero/efeitos da radiação , Adolescente , Adulto , Feminino , Humanos , Resultado do Tratamento , Útero/anormalidades , Útero/irrigação sanguínea
11.
Orthop Clin North Am ; 37(3): 409-34, vii, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16846770

RESUMO

Percutaneous vertebroplasty is a safe and effective alternative for the treatment of many different types of painful vertebral lesions, including osteoporotic compression fractures,hemangiomas, or malignancy-induced pathologic vertebral fractures. Medical therapy often is limited to pain control and immobilization. Because surgery is contraindicated frequently in patients who have osteoporotic compression fractures, and because patients who have widespread metastatic disease often are not surgical candidates, vertebroplasty may be the only practical option. In experienced hands and with appropriately selected patients, percutaneous vertebroplasty is a safe, inexpensive, and highly efficacious procedure; however, because of the potential for devastating complications, all efforts must be made to optimize patient safety.


Assuntos
Cimentos para Ossos/uso terapêutico , Procedimentos Ortopédicos , Polimetil Metacrilato/administração & dosagem , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Antibioticoprofilaxia , Fluoroscopia , Hemangioma/cirurgia , Humanos , Procedimentos Ortopédicos/instrumentação , Osteoporose/complicações , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X
12.
Orthop Clin North Am ; 37(3): 435-74, vii-viii, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16846771

RESUMO

Vascular anomalies are comprised of either hemangiomas or vascular malformations.Low-flow vascular malformations can be divided into capillary, venous, and lymphatic types and are usually present at birth, undergo pari passu growth, and produce symptoms related to mass effect or stasis. High-flow malformations are comprised pre-dominantly of arteriovenous malformations that follow a more aggressive clinical course of hyperemia, adjacent mass effect, steal phenomenon, tissue destruction, and ultimately high output failure. Ultrasound, CT, nuclear medicine, angiography, and particularly MRI have greatly enhanced diagnostic accuracy and provide detailed information for percutaneous and surgical treatment planning and an objective means of following therapeutic efficacy. Interventional radiologic percutaneous sclerotherapy for low-flow lesions and embolosclerotherapy for high-flow lesions with or without adjunctive surgical intervention have become the mainstay of therapy.


Assuntos
Malformações Arteriovenosas/diagnóstico , Anormalidades Linfáticas/diagnóstico , Radiografia Intervencionista , Antimetabólitos Antineoplásicos/uso terapêutico , Malformações Arteriovenosas/classificação , Malformações Arteriovenosas/diagnóstico por imagem , Bleomicina/uso terapêutico , Humanos , Imuno-Histoquímica , Anormalidades Linfáticas/classificação , Anormalidades Linfáticas/diagnóstico por imagem , Imagem por Ressonância Magnética , Ácidos Oleicos/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Tetradecilsulfato de Sódio/uso terapêutico
13.
J Vasc Interv Radiol ; 16(8): 1125-8, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16105925

RESUMO

Stent embolization is a rare complication in the treatment of central venous stenoses in patients receiving long-term hemodialysis. The authors report a case of nitinol stent embolization into the right atrium in which the stent could not be repositioned across an indwelling permanent inferior vena cava (IVC) filter. The migrated stent was managed by advancing the stent to the superior margin of the IVC filter and then deploying a second suprarenal IVC filter to prevent repeat embolization.


Assuntos
Migração de Corpo Estranho/terapia , Átrios do Coração , Stents , Filtros de Veia Cava , Ligas , Migração de Corpo Estranho/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Veia Cava Superior
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