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1.
Acta Biomed ; 92(3): e2021201, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212920

RESUMO

BACKGROUND: We aimed to demonstrate the safety and efficacy of bronchial artery embolization (BAE) in patients with pulmonary tuberculosis in the planned management of "mild" hemoptysis. This treatment, already widely documented and used as a life-saving therapy in an emergency regimen, if properly planned in poorly controlled patients through medical therapy alone, can provide a valid opportunity by reducing the frequency and extent of non-fatal bleeding, but which still worsen the quality of life of these already significantly traumatized patients. METHODS: All procedures were conducted through a right common femoral access with a 5 Fr catheter and a 2.7 Fr super-selective catheter coaxial technique of the branches of the bronchial arteries with suspected bleeding sources. Embolizations were performed with 500-700 micron Terumo PVA plastic microparticles. We decided to adopt the following inclusion criteria for the selection of patients to be enrolled: documented diagnosis of pulmonary TB, the presence of at least one bleeding episode that required at least two blood transfusions, evaluation with bronchoscopic examination to ascertain the bronchial origin of bleeding and the affected lobar site, execution of an angio-ct radiological study for the evaluation of the bronchial systemic anatomy as well as the patency of the pulmonary arterial circulation, general hemodynamic compensation and an age of enrollment between 25 and 65 years. RESULTS: All selective embolization interventions demonstrated a technical success of 100% of the total number of patients. 11 out of 12 patients did not show any signs of relapse or complications related to the interventional procedure at a first check-up carried out at 48 hours, instead a fatal massive hemoptysis occurred in only one patient. At the next three-month follow-up, no relapses were documented in all selected patients. Only one patient required a second embolization four months after the first procedure. CONCLUSIONS: Radiological-interventional approach in the elective regimen of super-selective embolization of the bronchial arteries (BAE) in the management and control of "mild" hemoptysis in patients with pulmonary tuberculosis not controlled exclusively by medical therapy, according to a strategy systematic of planned intervention and respecting clear and standardized inclusion criteria, represented in our experience a safe and effective procedure, free from significant short and long term complications, especially in well selected patients, which, although not always allows a definitive and stable control of hemoptysis, can in any case significantly limit the risks, also allowing a better planning of the most appropriate therapeutic intervention strategy.


Assuntos
Embolização Terapêutica , Tuberculose Pulmonar , Adulto , Idoso , Artérias Brônquicas/diagnóstico por imagem , Hemoptise/etiologia , Hemoptise/terapia , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose Pulmonar/complicações
2.
J Med Case Rep ; 15(1): 356, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34238340

RESUMO

BACKGROUND: Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization. CASE PRESENTATION: We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative. CONCLUSIONS: Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.


Assuntos
Embolização Terapêutica , Obstrução Intestinal , Leiomioma , Embolização da Artéria Uterina , Doenças Uterinas , Neoplasias Uterinas , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Leiomioma/complicações , Leiomioma/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia
3.
J Med Case Rep ; 15(1): 343, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247654

RESUMO

BACKGROUND: Aneurysm formation is a possible, but rare, complication of granulomatosis with polyangiitis, known as Wegener's granulomatosis. Urgent diagnosis and therapy is very important because a ruptured aneurysm could be life threatening. CASE PRESENTATION: We, therefore, present the case of a 63-year-old Greek man who was diagnosed with granulomatosis with polyangiitis and retroperitoneal hematoma due to ruptured aneurysm in renal artery and upper pancreaticoduodenal artery. His clinical course was complicated by acute renal failure and acute respiratory failure due to alveolar hemorrhage. Emergency coil embolization was performed. Postembolization recovery was uneventful; no bleeding occurred. The patient underwent mechanical ventilation and continuous veno-venous hemofiltration and received combined immunosuppression and supportive therapy, but eventually died 30 days after admission to hospital from severe septic shock and multiple organ failure. CONCLUSION: Endovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable. Early diagnosis is very important, as urgent embolization and early initiation of immunosuppression therapy are the treatment of choice.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Granulomatose com Poliangiite , Síndrome do Desconforto Respiratório , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade
4.
Rev Med Suisse ; 17(743): 1150-1154, 2021 Jun 16.
Artigo em Francês | MEDLINE | ID: mdl-34133091

RESUMO

Some hepato-biliary cancers require major liver resections. Post hepatectomy liver failure is a complication that occurs when the remnant liver cannot maintain its synthetic and excretory functions. To overcome this issue, portal vein embolization has been developed to induce future remnant liver hypertrophy preoperatively. However, up to 20% of patients cannot proceed to the hepatectomy due to insufficient hypertrophy or tumor progression in the interval between the embolization and the planned surgery. Liver venous deprivation (LVD) is a technique that combine ipsilateral portal and hepatic vein embolization. With this technique, the hypertrophy seems to be faster and more important, with low complications rate and no mortality associated with the procedure.


Assuntos
Embolização Terapêutica , Neoplasias Hepáticas , Hepatectomia , Veias Hepáticas , Humanos , Fígado , Neoplasias Hepáticas/cirurgia , Veia Porta , Cuidados Pré-Operatórios , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(24): e26351, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128887

RESUMO

BACKGROUND: Both coil embolization (CE) and flow-diverting device (FDD) placement are widely used for treatment of intracranial aneurysms (IAs). The aim of this meta-analysis is to compare the relative clinical safety and efficacy of FDD and CE for the treatment of unruptured IAs. METHODS: The PubMed, Embase, and Cochrane Library databases were searched for relevant studies from the date of inception through April 2020. The primary endpoint for this meta-analysis was the 6-month rate of complete occlusion, while secondary endpoints included rates of retreatment, complications, and parental arterial patency. RESULTS: This meta-analysis includes 8 studies, which included 839 total patients that underwent FDD and 2734 that underwent CE. FDD group exhibited a significantly higher pooled 6-month complete occlusion rate (P = .02). The subgroup analysis demonstrated that FDD treatment was associated with significantly higher pooled 6-month complete occlusion rates in patients with large or giant IAs (P < .00001), whereas no differences in 6-month complete occlusion rates were observed between the FDD and CE groups of patients with non-large/giant IAs (P = .83). The pooled retreatment (P = .16) and complication (P = .15) rates were comparable between 2 groups. The CE group exhibited significantly higher pooled parent artery patency rate (P = .01). The funnel plots did not reveal any evidence of publication bias. CONCLUSIONS: FDDs can be used to effectively and safely treat large and giant IAs, achieving higher rates of complete occlusion than CE treatment. For non-large/giant IAs, we observed comparable efficacy between FDD and CE treatments.


Assuntos
Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Humanos , Retratamento , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
Medicine (Baltimore) ; 100(24): e26383, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128900

RESUMO

RATIONALE: Sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotid artery (ICA) caused by traumatic vessel injury is rare, and rarer is a concomitant carotid-cavernous fistula (CCF). In particular, delayed subarachnoid hemorrhage (SAH) due to pseudoaneurysm rupture has not been reported to-date in literature. Here, we report a case of sphenoid sinus pseudoaneurysm with CCF presenting with delayed SAH. PATIENT CONCERNS: A 73-year-old man presented with traumatic brain injury due to motorcycle accident. DIAGNOSES: Twenty-four days after admission, the patient's neurological status suddenly deteriorated. Brain computed tomography (CT) showed acute SAH along interhemispheric cisterns and suprasellar intracerebral hematoma. Brain CT angiography and digital subtraction angiography revealed giant sphenoid sinus pseudoaneurysm with CCF and the daughter sac of the pseudoaneurysm extended to the intracranial part via fracture in the superior wall of the sphenoid sinus. INTERVENTIONS: As the sphenoid sinus pseudoaneurysm and CCF shared one rupture point, endovascular treatment with intraarterial approach using coil and liquid embolic material by balloon assisted technique was performed simultaneously. OUTCOMES: The origin of the pseudoaneurysmal sac and CCF was sufficiently blocked after injection of liquid embolic material and the lesions completely resolved immediately after endovascular treatment. LESSONS: Sphenoid sinus pseudoaneurysm and CCF rarely occur following head trauma through a series of processes involving fracture of the lateral wall of the sphenoid sinus and ICA cavernous segment injury. Sphenoid sinus pseudoaneurysm may present as SAH through intracranial rupture with concomitant superior wall fracture of the sphenoid sinus. Therefore, early diagnosis using CT or magnetic resonance angiography and appropriate treatment through understanding the disease mechanism is necessary.


Assuntos
Falso Aneurisma/etiologia , Lesões Encefálicas Traumáticas/complicações , Fístula Carotidocavernosa/complicações , Seio Esfenoidal , Hemorragia Subaracnóidea/etiologia , Acidentes de Trânsito , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Angiografia Digital , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Humanos , Masculino , Motocicletas , Seio Esfenoidal/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Fatores de Tempo
7.
Pan Afr Med J ; 38: 307, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34178225

RESUMO

Uterine arteriovenous malformations are possible causes of persistent metrorrhagia, in particular in patients with a history of abortion and trophoblast diseases. We here report the diagnostic and therapeutic features of two patients with uterine arteriovenous malformations complicating post-abortion in the Maternity Ward of the University Hospital of Pointe-a-Pitre in Guadeloupe. Patients had metrorrhagias after abortion with curettage. Arteriovenous malformation was suspected based on ultrasound combined with Doppler. Arteriography confirmed the diagnosis and allowed, in the same time, for conservative treatment by arterial embolization. No complication was reported. The lack of knowledge about uterine arteriovenous malformations can lead to deleterious consequences ranging from haemostatic hysterectomy due to cataclysmic hemorrhage to death.


Assuntos
Malformações Arteriovenosas/diagnóstico , Embolização Terapêutica/métodos , Metrorragia/etiologia , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Aborto Induzido/efeitos adversos , Adulto , Angiografia , Malformações Arteriovenosas/terapia , Feminino , Humanos , Gravidez , Ultrassonografia Doppler , Anormalidades Urogenitais/terapia , Útero/diagnóstico por imagem , Adulto Jovem
8.
Tech Vasc Interv Radiol ; 24(1): 100732, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34147199

RESUMO

Pelvic Venous Disease (PeVD) is characterized by pelvic varicosities and chronic pelvic pain, defined as noncyclic pelvic pain that persists for more than 6 months. Pain and discomfort related to PeVD typically worsen with upright positioning and occur more frequently in multiparous and premenopausal women. The most common cause of PeVD is pelvic venous insufficiency (PVI) due to incompetent valves. Noninvasive imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging, and invasive catheter-based venography can help characterize varicosities and venous insufficiency, supporting the diagnosis of PeVD. In patients with PeVD, ovarian and/or internal iliac vein embolization demonstrate excellent technical and clinical success rates with relatively low complication rates and should be considered as standard management, in conjunction with medical therapy. Appropriate diagnostic work-up and patient selection are important prior to any intervention for achieving therapeutic success, as multiparous women have a higher success rate compared to patients with dyspareunia after embolization therapy. Post-procedure follow-up is critical for assessing symptom improvement and need for repeat intervention. However, further research is needed to identify additional predictors of successful outcomes after embolization therapy. This article aims to provide an overview of patient selection, interventional technique, challenges, and outcomes of ovarian vein embolization.


Assuntos
Dor Crônica/terapia , Embolização Terapêutica , Ovário/irrigação sanguínea , Dor Pélvica/terapia , Pelve/irrigação sanguínea , Radiografia Intervencionista , Varizes/terapia , Veias/diagnóstico por imagem , Insuficiência Venosa/terapia , Dor Crônica/diagnóstico por imagem , Dor Crônica/fisiopatologia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Dor Pélvica/diagnóstico por imagem , Dor Pélvica/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
9.
Tech Vasc Interv Radiol ; 24(1): 100733, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34147201

RESUMO

Iliac vein stenosis is a clinical condition resulting from external compression of the iliocaval venous unit with the consequent remodeling of the vascular wall, hemodynamic alterations, and predisposition to venous thrombosis. As such, the most common indications for percutaneous endovascular iliac vein stenting supported by the literature, include the management of thrombotic and non-thrombotic iliac venous lesions associated with advanced chronic venous disease (CVD). However, its clinical presentation is variable, and it may also include features associated with PeVD such as chronic pelvic pain, perineal heaviness, urinary urgency, postcoital pain, and vulvar or superficial non-saphenous veins varicosities. In this setting, the management revolves around the relieving venous obstruction and restoring normal blood flow through the compressed vein with percutaneous endovascular iliac vein stenting, that can be augmented with ovarian vein embolization (OVE) or direct embolization of the superficial varices. Given the heterogeneity of PeVD presentation and the lack of high-level quality data in outcomes for iliac vein stenosis stenting, this review will discuss the current evidence available for this intervention and clinical issues to consider when evaluating these patients.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca , Síndrome de May-Thurner/terapia , Stents , Fatores Etários , Constrição Patológica , Embolização Terapêutica , Procedimentos Endovasculares/efeitos adversos , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Radiografia Intervencionista , Fatores de Risco , Resultado do Tratamento
10.
J Clin Neurosci ; 89: 283-291, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119282

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of embolization via transvenous approaches in patients diagnosed with Cavernous Sinus Dural Arteriovenous Fistula (CSDAVF). We also hope to further summarize our preliminary experiences with transvenous approaches. MATERIAL AND METHODS: We retrospectively collected data from patients who were diagnosed with CSDAVF and were treated with embolization via transvenous approaches from June 2014 to November 2020 at Beijing Tiantan Hospital. We evaluated the safety and efficacy of this treatment using radiological results and clinical follow-up. RESULTS: A total of 83 patients were included in this study. Complete occlusion was obtained in 76 (89.4%) patients. Sub-total occlusion was obtained in eight (9.4%) patients. Partial occlusion was obtained in one (1.2%) patient. There was no recurrence. Seventy-six patients (91.5%) were cured, and seven patients showed symptom improvement (8.5%). There were no cases of worsening symptoms following embolization, and only ten (12.0%) cases had mild complications. CONCLUSION: There was a high occlusion rate and a low complication rate in our study. Thus, completing embolization of CSDAVF via transvenous approaches may be safe and effective. However, this operation is more difficult than those via transarterial approaches. Transvenous embolization should therefore be performed in an experienced medical center.


Assuntos
Seio Cavernoso/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica/métodos , Adulto , Idoso , Seio Cavernoso/patologia , Angiografia Cerebral , Embolização Terapêutica/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade
11.
J Int Med Res ; 49(6): 3000605211019926, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34162257

RESUMO

Transcatheter arterial embolization (TAE) is the standard of care for haemodynamically-stable patients with blunt hepatic injury but it is sometimes impossible due to unfavourable vascular anatomies. This case report describes a 43-year-old male patient with abdominal pain following a motorcycle accident. Based on computed tomography (CT) findings, he was diagnosed with high-grade hepatic injury with coeliac axis stenosis (CAS) due to compression by the median arcuate ligament, and an aberrant right hepatic artery. Contrast-enhanced ultrasonography (CEUS) demonstrated multiple high echogenic tubular and ovoid structures suggestive of active bleeding within the injured liver area. Angiography revealed unique interlobar and intrahepatic collateral vessels between the right and left hepatic arteries. Liver haemorrhages were also identified. Catheterization of the feeding arteries through the collateral pathway was unsuccessful, so a decision was made to cannulate the stenotic portion of the coeliac trunk with a 5-Fr Yashiro catheter. After several attempts, the microcatheter was successfully advanced coaxially into the common hepatic artery. Embolization was performed with a 1:2 mixture of N-butyl cyanoacrylate and iodized oil. Successful haemostasis was confirmed following TAE. CEUS helped clinicians identify active bleeding following traumatic solid organ injury. TAE was a safe and effective treatment strategy. Before performing TAE, attention should be given to the presence of CAS associated with compression by the median arcuate ligament.


Assuntos
Embolização Terapêutica , Artéria Hepática , Adulto , Angiografia , Artéria Hepática/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Masculino , Ultrassonografia
12.
Medicine (Baltimore) ; 100(26): e26581, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190202

RESUMO

BACKGROUND: To investigate the clinical application and effect of laparoscopic partial nephrectomy with renal artery branch occlusion in the treatment of early renal tumors. METHODS: A retrospective analysis was conducted on the clinical data of 15 cases of renal tumor patients who underwent partial nephrectomy by laparoscopic selective renal artery branch occlusion in our department from January 2017 to January 2018. Nine male patients and 6 female patients were aged 46 to 65 years, with an average age of 54.3 ±â€Š7.2 years. The diameters of tumors were 2.2 to 4.0 cm, with an average of 3.3 ±â€Š0.7 cm. There are 10 tumors locating on the left side and 5 on the right side. Preoperative renal glomerular filtration rate (GFR) were 77.3 to 61.9 mL/min with an average of 47.6 ±â€Š7.5 mL/min. All patients' diseased kidneys underwent renal computer tomography angiography examination before surgery. And the diseased kidney underwent reexamination of renal GFR. The operation time, renal artery branch occlusion time, intraoperative blood loss, postoperative hospital stay, changes of renal function, and complications were evaluated. RESULTS: All surgery were completed successfully, the surgery time was 136.7 ±â€Š15.2 min, intraoperative renal artery branch occlusion time was 21.3 ±â€Š4.5 min, the intraoperative blood loss was 223.3 ±â€Š69.5 mL, the postoperative hospital stay was 6.5 ±â€Š1.7 days, and the postoperative 1-month GFR was 49.5 ±â€Š6.6 mL/min. There was no significant difference between the renal GFR before and after surgery (P > .05). There was no blood transfusion and transfer open surgery cases. The patients were followed up for 3 to 15 months without complications. CONCLUSIONS: Partial nephrectomy with selective renal artery branch occlusion by laparoscopy is a safe, feasible, and effective method for the treatment of early renal cancer. It makes good use of the technical advantages of clear operation field and fine operation of laparoscopic surgery, avoids the heat ischemia process of the whole kidney, and can better protect the renal function.


Assuntos
Embolização Terapêutica/métodos , Neoplasias Renais , Laparoscopia , Nefrectomia , Artéria Renal , China/epidemiologia , Angiografia por Tomografia Computadorizada/métodos , Intervenção Médica Precoce/métodos , Feminino , Humanos , Testes de Função Renal/métodos , Neoplasias Renais/irrigação sanguínea , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios/métodos , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Carga Tumoral
13.
Artigo em Japonês | MEDLINE | ID: mdl-34148899

RESUMO

Magnetic resonance angiography (MRA) using ultra-short TE (uTE) is known to be used for the evaluation of cerebral aneurysm after treatment such as clipping and coiling. However, conventional uTE sequences are not appropriate as an additional imaging sequence for 3D time-of-flight (TOF)-MRA because it is not possible to shorten scan time and acquire selective-volume imaging. To solve the problem, we focused on the combination of uTE sampling and 3D radial scan sequences. In this study, we examined the optimal imaging parameters of the proposed uTE-MRA. A simulated blood flow phantom with stents (Enterprise) and titanium clips (YASARGIL) was used for optimizing the TR, flip angle (FA), and radial percentage. The signal intensity in the simulated vessel was measured in each imaging condition, and the ratio of the presence or absence of a stent was evaluated as a relative in-stent signal (RIS). In addition, the diameter of the signal loss of the simulated artery was measured for each imaging condition, and signal loss length (SLL) of a clip was calculated from the average value. The RIS improved with increasing the FA and shortening the TR, but it did not change by changing the radial percentage. The SLL became smaller at the coil as the FA increased, but there was no significant difference between the intersection and the blade. There was also no significant difference between TR and radial percentage. The effective imaging conditions for uTE-MRA to improve the vascular description of the evaluation after treatment of cerebral aneurysms with metallic devices were those with large FA and short TR.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Angiografia Cerebral , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética , Imagens de Fantasmas , Stents
14.
Medicine (Baltimore) ; 100(22): e26203, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087891

RESUMO

ABSTRACT: The brainstem arteriovenous malformations (BS-AVMs) have a high morbidity and mortality and stereotactic radiosurgery (SRS) has been widely used to treat BS-AVMs. However, no consensus is reached in the explicit predictors of obliteration for BS-AVMs after SRS.To identify the predictors of clinical outcomes for BS-AVMs treated by SRS, we performed a retrospective observational study of BS-AVMs patients treated by SRS at our institution from 2006 to 2016. The primary outcomes were obliteration of nidus and favorable outcomes (AVM nidus obliteration with mRS score ≤2). For getting the outcomes more accurate, we also pooled the results of previous studies as well as our study by meta-analysis.A total of 26 patients diagnosed with BS-AVMs, with mean volume of 2.6 ml, were treated with SRS. Hemorrhage presentation accounted for 69% of these patients. Overall obliteration rate was 42% with mean follow-up of more than five years and two patients (8%) had a post-SRS hemorrhage. Favorable outcomes were observed in 8 patients (31%). Higher margin dose (>15Gy) was associated with higher obliteration (P = .042) and small volume of nidus was associated with favorable outcomes (P = .036). After pooling the results of 7 studies and present study, non-prior embolization (P = .049) and higher margin dose (P = .04) were associated with higher obliteration rate, in addition, the lower Virginia Radiosurgery AVM Scale (VRAS) was associated with favorable outcomes (P = .02) of BS-AVMs after SRS.In the BS-AVMs patients treated by SRS, higher margin dose (19-24Gy) and non-prior embolization were the independent predictors of higher obliteration rate. In addition, smaller volume of nidus and lower VRAS were the potential predictors of long-term favorable outcomes for these patients.


Assuntos
Tronco Encefálico/irrigação sanguínea , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/radioterapia , Radiocirurgia/efeitos adversos , Adolescente , Adulto , Idoso , Tronco Encefálico/patologia , Regras de Decisão Clínica , Embolização Terapêutica/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/mortalidade , Hemorragias Intracranianas/epidemiologia , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Prognóstico , Radiocirurgia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Medicine (Baltimore) ; 100(22): e26228, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087904

RESUMO

RATIONALE: Obstructive hydrocephalus (OH) frequently occurs in patients with a ruptured cerebral aneurysm (CA), and it may lead to severe neurological deficits, including life-threatening brain herniation. OH generally occurs in the early stage of CA rupture, rather than in the late stage, and rarely resolves without therapy. PATIENT CONCERNS: A 64-year-old woman with a ruptured anterior communicating artery aneurysm was treated with coil embolization. Nineteen days after her CA rupture, because of the delayed transient OH, she experienced a dramatic cycle in consciousness over 9 hours: wakefulness-drowsiness-coma-drowsiness-wakefulness. DIAGNOSIS: The patient was diagnosed with delayed transient obstructive hydrocephalus, which is a very rare condition. INTERVENTIONS: Mannitol was administered to reduce intracranial pressure. OUTCOMES: The patient was discharged from the hospital 30 days after admission, with a final GCS score of 15 and without weaknesses. At follow-up 2 months after discharge, brain CT revealed non-recurrence of hydrocephalus. LESSONS: A blood clot of any size in the ventricle is likely to lead to obstructive hydrocephalus. Prolonged bed rest for IVH patients may help to reduce the incidence of delayed OH.


Assuntos
Aneurisma Roto/terapia , Hidrocefalia/etiologia , Aneurisma Intracraniano/patologia , Assistência ao Convalescente , Aneurisma Roto/complicações , Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada/métodos , Diuréticos Osmóticos/administração & dosagem , Diuréticos Osmóticos/uso terapêutico , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/tratamento farmacológico , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Manitol/administração & dosagem , Manitol/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Br J Radiol ; 94(1123): 20210193, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34111980

RESUMO

OBJECTIVES: To compare the efficacy and safety of pre-operative localization of ground glass nodule (GGN) using embolization microcoils and the locating needles designed for pulmonary nodules. METHODS: From June 2019 to December 2020, 429 patients who received CT-guided localization of single GGN before video-assisted thoracoscopic surgery (VATS) were enrolled. The diameter and depth of GGNs were 0.84 ± 0.39 cm and 1.66 ± 1.37 cm. Among 429 cases, the first 221 GGNs were marked with microcoils (the microcoil group), and the remaining 208 GGNs were marked with the locating needles designed for pulmonary nodules (the locating needle group). SPSS 17.0 statistical software was used to compare the marking success rate, marking time, marking-related complications between two groups. p values < 0.05 were considered statistically significant. RESULTS: The marking time in the microcoil group was longer than that in the locating needle group (11.1 ± 3.9 vs 8.2 ± 2.0 min, t = -7.87, p = 0.000). The marking success rate in the microcoil group was lower than that in the locating needle group (91.4% vs 98.6%, χ2 = 11.27, p = 0.001). In the microcoil group, marking failures included 16 cases of microcoil dislocation and 3 cases of unsatisfactory microcoil position, while all 3 cases of marking failure in the locating needle group were due to unsatisfactory anchor position. No significant differences in the incidence of total complications (23.1% vs 22.1%), pneumothorax (18.1% vs 19.2%), hemorrhage (9.5% vs 9.1%), and hemoptysis (1.8% vs 1.4%) were observed between the two groups. All the complications were minor and did not need special treatment. Except for one case in the microcoil group, which was converted to thoracotomy, the remaining 428 GGNs were successfully resected by VATS. CONCLUSIONS: It is safe and effective to perform pre-operative localization of GGN using either embolization microcoil or the locating needle designed for pulmonary nodules. The locating needle is superior to microcoil for marking GGN in terms of procedure time and the success rate. The complication rate of both methods is similar. ADVANCES IN KNOWLEDGE: The locating needle designed for pulmonary nodules has recently been used to mark pulmonary nodule. Its structure can effectively avoid dislocation after localization, and the marking process is simple and quick. Compared with localization using microcoil, it takes less time and has higher success rate to mark GGNs using the locating needle. The complication rate of both methods is similar.


Assuntos
Embolização Terapêutica/instrumentação , Agulhas , Radiografia Intervencionista , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Nódulo Pulmonar Solitário/patologia , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida
18.
Hinyokika Kiyo ; 67(4): 157-162, 2021 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-34107612

RESUMO

A 22-year-old woman was referred to our hospital for further examination of an incidentally discovered hypervascular pelvic tumor with a maximum diameter of 10 cm. Although Castleman disease was suspected based on the imaging findings and pathologic findings of the needle biopsy, a definitive diagnosis was not made. Preoperative transcatheter arterial embolization was performed to decrease intraoperative bleeding, and tumor resection was performed on the following day. As for posterior approach prior to anterior approach, the patient was placed in a prone position, and the dorsal aspect of tumor was approached through the dissection of gluteal muscles. Then, dilated branches of the internal iliac vein was found on the tumor capsule, which were safely ligated under direct vision with favorable visual field. Then, the patient was placed in a supine position, the tumor was completely resected by anterior approach without transfusion. Histopathological diagnosis was Castleman disease hyaline vascular type. The patient was discharged without complication and has been free from recurrence for 6 months after surgery.


Assuntos
Hiperplasia do Linfonodo Gigante , Embolização Terapêutica , Neoplasias , Abdome , Adulto , Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/cirurgia , Feminino , Humanos , Pelve/diagnóstico por imagem , Pelve/cirurgia , Adulto Jovem
19.
No Shinkei Geka ; 49(3): 677-682, 2021 May.
Artigo em Japonês | MEDLINE | ID: mdl-34092574

RESUMO

Here, we have reported a case pertaining to a 59-year-old man with bilateral traumatic carotid artery injury caused by vinyl umbrella penetration who was successfully treated. The patient fell from the stairs while holding an umbrella, which penetrated his neck. On admission, the patient was in a comatose state and the umbrella had been removed. Active bleeding was observed on the left side of the neck. Hence, tracheal intubation was performed to support respiration. Neck and head contrast-enhanced CT revealed bilateral extravasations from the carotid arteries and right middle cerebral artery(MCA)occlusion. Left carotid angiography showed extravasation from the external carotid artery(ECA), which was treated with coil embolization. Right carotid angiography revealed bleeding from the ECA and internal carotid artery(ICA)and occlusion of the MCA. The ECA and ICA were occluded by coil and n-butyl-2-cyanoacrylate embolization. After the procedures, the patient developed a large right cerebral infarction with massive brain swelling; therefore, external decompression was performed. Subsequently, the patient became alert and was able to walk with support within a month. Bilateral carotid injury is severe and difficult to treat. Endovascular therapy may be effective for the management of bilateral carotid injuries.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Artérias Carótidas , Artéria Carótida Externa , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
20.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059528

RESUMO

Herein, we describe the use of a novel multiplug flow control technique for the curative transarterial embolisation of cerebrovascular malformations using liquid embolic agents (LEAs). The idea behind the use of this technique is to substantially control or arrest flow during LEA injection, with multiple plugs simultaneously formed from microcatheters that are placed within all or multiple feeders, so that the penetration of LEAs is facilitated, with flow control decreasing the washout of a malformation. This technique enables the complete occlusion of a vascular malformation in a shorter injection time than that in other methods because penetration is achieved faster. Details of this technique have been described in the treatment of two cases: one case of unruptured temporal arteriovenous malformation and in the other with a falcotentorial dural arteriovenous fistula, in which the vascular malformations were successfully occluded with transarterial embolisation.


Assuntos
Malformações Arteriovenosas , Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Malformações Arteriovenosas/terapia , Malformações Vasculares do Sistema Nervoso Central/terapia , Humanos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
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