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1.
Medicine (Baltimore) ; 100(11): e25149, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725998

RESUMO

ABSTRACT: Pipeline embolization devices (PLEDs) are flow diverting stents that have exhibited be safe and efficient in the treatment of complex aneurysms. Nevertheless, in-stent stenosis (ISS) has been reported as one of the cardinal complications associated with PLED. The association of wall malapposition and ISS in patient treated with PLED has not been reported.A retrospective study was conducted to identify patients with ISS after implantation of PLED as treatment for intracranial aneurysms from April 25, 2018 to April 24, 2019. Incidence of ISS and its associated causes such as sharp change of the PLED, distal wall malapposition, inconsistent compliance between parent artery as well as the PLED occlusion due to intimal hyperplasia and vessel tortuosity. Assessment of conservative treatment and retreatment outcomes of ISS were documented.In all, 6 ISS cases were identified by 2 independent neurointerventionalists out of 118 aneurysm patients treated with PLED. Thus, the incidence rate of ISS in patients treated with PLED was as low as 5% at our institution compared to other studies. The follow-up time for detection of ISS ranged from 6 to 12 months after implantation. Several combinations of reasons such as sharp change of the PLED, distal wall malapposition, inconsistent compliance between parent arteries as well as PLED occlusion due to intimal hyperplasia and vessel tortuosity accounted for the causes of ISS during our analysis. Conservative treatment with a combination of antiplatelet during follow-ups did not resolve the ISS in our study probably due to associated underlying factors above.


Assuntos
Prótese Vascular/efeitos adversos , Estenose Coronária/epidemiologia , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias , Stents/efeitos adversos , Adulto , Estenose Coronária/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhonghua Wai Ke Za Zhi ; 59(3): 196-202, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33685053

RESUMO

Objective: To evaluate the safety and efficacy of stent-assisted coil embolization in patients with recurrent intracranial bifurcation aneurysms,after initial simple coiling or microsurgical clipping. Methods: Clinical data of 20 patients with recurrent intracranial bifurcation aneurysms who initially underwent simple coiling or surgical clipping and subsequently re-treated by stent-assisted coiling embolization at the Radiology Intervention Department of Huashan Hospital between March 2009 and November 2019 were collected and analyzed retrospectively.There were 9 males and 11 females,with a median age of 55.5 years (range:33 to 71 years),including 17 aneurysms initially treated with simple coiling and 3 treated with surgical clipping.All cases were re-treated with stent-assisted coiling,15 using a single stent and 5 employing two stents in a Y-configuration.Peri-and post-operative complications and outcomes were evaluated.Mann-Whitney U tests were performed to compare the follow-up duration between initial treatment and re-treatment.Student's t tests were used to compare the parent artery angles before re-treatment, after re-treatment and at the last follow-up. The parent artery angle was defined using the proximal main trunk and the stented branch. Results: Immediate complete occlusion (Raymond Ⅰ) was achieved in 18 aneurysms (90.0%) while 2 aneurysms (10.0%) had a residual neck (Raymond Ⅱ).The median follow-up time(M(QR)) was 8.5(16.3)months,which had no significantly different from the initial treatment follow-up duration (15.5(27.0)months)(U=157.7,P=0.25). During the follow-up period,2 aneurysms (10.0%) with immediate post-operative residual necks recanalized again,including 1 aneurysm re-treated with the Y-configuration stent.Symptomatic thromboembolic complications occurred in 6 patients,including 4 re-treated with the Y-configuration stent.No peri-operative hemorrhagic complications occurred,along with no operation-related permanent disability or death. The parent artery angle increased significantly from pre-operative(90.1±21.1)°to post-operative and the last follow-up ((115.4±28.9)° and (132.6±26.8)°);t=5.14,P<0.01;t=7.78,P<0.01). Conclusion: For recurrent intracranial bifurcation aneurysms after initial surgical clipping or simple coiling,stent assisted coil embolization is proved to be safe and can decrease recurrence rate.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Stents , Adulto , Idoso , Angiografia Cerebral , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Estudos Retrospectivos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/instrumentação , Falha de Tratamento , Resultado do Tratamento
3.
BMC Neurol ; 21(1): 31, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472604

RESUMO

BACKGROUND: This study aimed to evaluate the efficacy and safety of Scepter dual-lumen balloon catheter for transarterial Onyx embolization of dural arteriovenous fistula (DAVF). METHODS: Transarterial Onyx embolization using a Scepter dual-lumen balloon catheter (Scepter-assisted Onyx embolization) for DAVF was attempted in a total of 35 patients (mean age, 52.5 years; M:F = 24:11) between October 2012 and December 2018. The results of Scepter-assisted Onyx embolization were evaluated with respect to total procedural and Onyx injection times, the types and number of feeders requiring embolization, angiographic and clinical outcomes, and treatment-related complications. RESULTS: Initial presentations were non-hemorrhagic neurological deficits in 10, intracranial hemorrhage in 8, seizure in 7, headache in 7, and intractable tinnitus in 3. All DAVF were aggressive type (Borden type 2, 14.3 %; type 3, 85.7 %). Scepter-assisted Onyx embolization resulted in immediately complete occlusion in 33 patients (94.3 %) and near complete occlusion in 2 patients. Middle meningeal artery (51.4 %) was the most commonly used for Scepter-assisted technique, followed by occipital artery (42.9 %), ascending pharyngeal artery (2.9 %) and superficial temporal artery (2.9 %). There was no difference in complete occlusion rate between middle meningeal artery and the other arteries (94.4 % versus 94.1 %). The median number of total feeders embolized was 1 (range, 1-3). The median total procedural time was 45 minutes (range, 21 minutes - 127 minutes) and the median Onyx injection time was 11 minutes (range, 3 minutes - 25 minutes). All patients recovered completely (n = 31) or partially (n = 4) from presenting symptoms. Treatment-related complications occurred in 2 patients, of whom one had a permanent morbidity (2.8 %, ipsilateral facial nerve palsy). No patient showed a recurrence on follow-up imaging (median, 15 months; range, 3-56 months). CONCLUSIONS: Scepter-assisted transarterial Onyx embolization showed a very high complete occlusion rate with a low morbidity and no recurrence in aggressive type DAVF. Scepter dual-lumen balloon catheter seems to be a useful tool for transarterial Onyx embolization of DAVF.


Assuntos
Cateteres , Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica/instrumentação , Adulto , Dimetil Sulfóxido , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polivinil , Estudos Retrospectivos , Resultado do Tratamento
4.
AJNR Am J Neuroradiol ; 42(2): 327-333, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384292

RESUMO

BACKGROUND: Newer flow diverters are enhanced with antithrombogenic surface modifications like the Pipeline Embolization Device with Shield Technology and the Derivo Embolization Device and are purported to facilitate deployment and reduce ischemic events. PURPOSE: Our aim was to review the safety and efficacy of surface-modified flow diverters in treating patients with cerebral aneurysms. DATA SOURCES: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis covering 3 major data bases and gray literature between 2014 and 2019. STUDY SELECTION: Two reviewers independently reviewed human studies of surface-modified flow diverters for eligibility based on predetermined criteria. DATA ANALYSIS: The random effects model and Freeman-Tukey arcsine transformation were used to pool efficacy outcomes (technical success, aneurysm occlusion at 6 and 12 months) and safety outcomes (mortality, morbidity, all ischemia, and serious ischemia). Subgroup analysis was performed to compare outcomes between 2 different flow diverters. DATA SYNTHESIS: Eight single-arm case series involving 911 patients and 1060 aneurysms were included. The median follow-up was 8.24 months. Pooled estimate for technical success was 99.6%, while the aneurysm occlusion at 6 and 12 months were 80.5%, and 85.6%, respectively. Pooled estimates for mortality, morbidity, total ischemia, and serious ischemia rates were 0.7%, 6.0%, 6.7%, and 1.8%, respectively. Most studies were of good quality, and no significant heterogeneity was observed. LIMITATIONS: Limitations include a retrospective, observational design in some studies; heterogeneous and underreported antiplatelet therapy; and potential performance and ecologic bias. CONCLUSIONS: Early-to-midterm safety and efficacy for surface-modified flow diverters appear comparable with older devices, especially for small, unruptured anterior circulation aneurysms. Long-term clinical data are required to further corroborate these results.


Assuntos
Prótese Vascular , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Adulto , Idoso , Prótese Vascular/efeitos adversos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Vasc Endovascular Surg ; 55(3): 221-227, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33308092

RESUMO

PURPOSE: Symptomatic rectus muscle sheath hematoma may be the result of bleeding originating from the inferior epigastric artery. We report the technique and the results from a series of consecutive patients treated by transcatheter embolization, evaluating both ipsilateral and contralateral retrograde approaches. METHODS: This was a retrospective study including patients with verified rectus muscle sheath hematoma as a result of active extravasation from the inferior epigastric artery referred for transcatheter embolization. Technical success, clinical success and major complications were calculated. In addition, minor complications, blood transfusions required after a technically successful embolization, length of stay, peri-procedural and 30-day mortality and overall survival at 6 months were obtained. All statistical analysis was performed using SPSS. RESULTS: Twenty-one patients (mean age = 59.67 ± 19.51 years old) were included. The cause of the bleeding in the vast majority was iatrogenic trauma (n = 12/21, 57.14%). Both contralateral (n = 12/21, 57.14%%) and ipsilateral (n = 9/21, 42.86%) retrograde approaches were used. Embolic materials included micro-coils (n = 13/20, 65%), microspheres (PVA) (n = 1/20, 5%), a combination of PVA and micro-coils (n = 5/20, 25%) and gel-foam (n = 1/20, 5%). Overall technical success was 95.2% (n = 20/21) while clinical success was achieved in all but one of the technically successful cases 95% (n = 19/20). One patient died peri-procedurally due to profound hemodynamic shock. There were no other major complications. Additional transfusion was necessary in 7 patients (n = 7/21, 33.33%). There was a significant increase in the hemoglobin levels after the embolization (7.03 ± 1.78 g/dL pre-procedure Vs 10.91 ± 1.7 g/dL post-procedure, p = 0.048). The median hospital stay was 8 days. The peri-procedure and 30-day mortality was 4.8% (n = 1/21) and 28.6% (n = 6/21) respectively. The 6-month survival was 61.9% (13/21). CONCLUSION: Percutaneous embolization of the inferior epigastric artery is a minimally invasive method with satisfactory results. Both ipsilateral and contralateral retrograde approaches are feasible.


Assuntos
Cateterismo Periférico , Embolização Terapêutica , Artérias Epigástricas , Hematoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Artérias Epigástricas/diagnóstico por imagem , Feminino , Hematoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/terapia , Reto do Abdome , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Vasc Endovascular Surg ; 55(4): 419-421, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33375907

RESUMO

The carotid-esophageal fistula is a rare and serious complication of the metallic esophageal prosthesis. A high index of suspicion is required for early diagnosis and treatment, decreasing the morbidity and mortality rate of this severe complication. We report a case of a 4-year-old boy presenting severe upper gastrointestinal bleeding due to a carotid-esophageal fistula, secondary to deployment of an esophageal metallic prosthesis for treatment of a recurrent stenosis. The carotid pseudo-aneurism was successfully treated with stents and coils. Although endovascular treatment is a safe and effective option, arterial stenting in children needs further studies with long-term follow-up.


Assuntos
Artérias Carótidas , Embolização Terapêutica , Procedimentos Endovasculares , Fístula Esofágica/terapia , Estenose Esofágica/terapia , Implantação de Prótese/instrumentação , Stents , Fístula Vascular/terapia , Artérias Carótidas/diagnóstico por imagem , Pré-Escolar , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Estenose Esofágica/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Implantação de Prótese/efeitos adversos , Recidiva , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia
9.
AJNR Am J Neuroradiol ; 42(2): 347-353, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33361372

RESUMO

BACKGROUND AND PURPOSE: Visualization in neuroendovascular intervention currently relies on biplanar fluoroscopy and contrast administration. With the advent of endoscopy, direct visualization of the intracranial intravascular space has become possible with microangioscopes. We analyzed the efficacy of our novel microangioscope to enable direct observation and inspection of the cerebrovasculature, complementary to a standard fluoroscopic technique. MATERIALS AND METHODS: Iterations of microangioscopes were systematically evaluated for use in neurodiagnostics and neurointerventions in both live animal and human cadaveric models. Imaging quality, trackability, and navigability were assessed. Diagnostic procedures assessed included clot identification and differentiation, plaque identification, inspection for vessel wall injury, and assessment of stent apposition. Interventions performed included angioscope-assisted stent-retriever thrombectomy, clot aspiration, and coil embolization. RESULTS: The microangioscope was found helpful in both diagnosis and interventions by independent evaluators. Mean ratings of the imaging quality on a 5-point scale ranged from 3.0 (clot identification) to 4.7 (Pipeline follow-up). Mean ratings for clinical utility ranged from 3.0 (aspiration thrombectomy) to 4.7 (aneurysm treatment by coil embolization and WEB device). CONCLUSIONS: This fiber optic microangioscope can safely navigate and visualize the intravascular space in human cadaveric and in vivo animal models with satisfactory resolution. It has potential value in diagnostic and neurointerventional applications.


Assuntos
Angioscópios , Angioscopia/instrumentação , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Neuroendoscopia/instrumentação , Animais , Embolização Terapêutica/instrumentação , Fluoroscopia/métodos , Humanos , Coelhos , Suínos
10.
Vasc Endovascular Surg ; 55(1): 81-85, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32873222

RESUMO

Treating carotid blowout syndrome following rupture of giant pseudoaneurysms is difficult because the destroyed parent artery precludes conventional treatment. We present a patient with a ruptured giant pseudoaneurysm that we occluded using a modified internal trapping technique with low-concentration N-butyl-2-cyanoacrylate (NBCA) and a minimum number of coils. An 80-year-old man with a history of chemoradiation therapy for oropharyngeal cancer presented with several episodes of active bleeding from the subsequent tracheostomy site. Radiological examination revealed a giant right common carotid artery (CCA) pseudoaneurysm. Endovascular internal trapping was performed using both NBCA and coils under proximal flow control. We slowly injected 9 ml of low-concentration NBCA, which subsequently filled the entire pseudoaneurysm. We then injected an additional 2 ml of NBCA into the proximal CCA to achieve complete obliteration. No re-bleeding was observed during the 6-month follow-up. Endovascular internal trapping using low-concentration NBCA was feasible to treat a giant CCA pseudoaneurysm. The injected low-concentration NBCA filled the entire pseudoaneurysm without the risk of catheter entrapment.


Assuntos
Falso Aneurisma/terapia , Aneurisma Roto/terapia , Doenças das Artérias Carótidas/terapia , Artéria Carótida Primitiva , Embolização Terapêutica , Embucrilato/administração & dosagem , Procedimentos Endovasculares , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Aneurisma Roto/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Resultado do Tratamento
11.
Vasc Endovascular Surg ; 55(1): 50-57, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33043841

RESUMO

INTRODUCTION: This study reports our experience with the use of an ethylene vinyl alcohol copolymer (Onyx™) for the treatment of type II endoleak after endovascular repair of abdominal aortic aneurysms (EVAR) in comparison to coils and cyanoacrylate glue. METHODS: Clinical data of all patients treated for type II endoleak following EVAR between 2009 and 2017 were retrospectively analyzed. Abdominal aortic aneurysm (AAA) diameter and AAA sac volume during follow-up were measured using computed tomography angiography (CTA). Treatment failure variables were created for the change in sac diameter and volume. An increase in sac diameter ≥ 5 mm was considered a failure, as was an increase ≥ 10% in AAA sac volume. RESULTS: 35 patients underwent treatment for a persistent type II endoleak following EVAR. Of these patients, 18 (51.4%) were treated with Onyx and 17 (48.6%) were treated with coils ± cyanoacrylate glue embolization. There were no significant differences between the 2 groups with regard to demographics. The average volume of Onyx used per treatment was 13.4 ml (range 4.5 ml- 39 ml). There was no difference in efficacy between the Onyx and non-Onyx group. Complications were limited to 1 non-target embolization without significant clinical sequelae. CONCLUSIONS: Ethylene vinyl alcohol copolymer (Onyx™) embolization is similarly effective compared to traditional cyanoacrylate glue or coil embolization in the treatment of type II endoleak after EVAR.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Cianoacrilatos/administração & dosagem , Embolização Terapêutica , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Polivinil/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Cianoacrilatos/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Feminino , Humanos , Masculino , Polivinil/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
12.
Tech Vasc Interv Radiol ; 23(3): 100691, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308534

RESUMO

In the last decade, prostatic artery embolization (PAE) established itself as a safe and effective treatment option for lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH), with reproducible results across multiple centers and endorsement by important international societies. However, PAE is also known to be a technically demanding procedure. Accompanying the prevalence of benign prostate hyperplasia, the procedure is usually performed in older patients, in whom atherosclerosis and comorbidities are common features. Also, prostatic vascular anatomy is described to be complex and variable, and pelvic structures are deeply interconnected by anastomosis. Thus, PAE demands a deep familiarization with materials and devices, intraprocedure imaging techniques, microcatetherization skills and with the pelvic vascular anatomy. Especially in the beginning of the learning curve, the procedure can be time-consuming and related to high radiation exposure for both medical team and the patient. In this article, the main points of technical concern during PAE are described and discussed, such as the equipment needed, the effect of different embolic materials, patient's preparation for the procedure, arterial access sites, identifying and catheterizing the prostatic arteries, the embolization techniques, among others. Finally, the most frequent technical challenges are presented, and the possible strategies to overcome them are exemplified and discussed.


Assuntos
Cateteres , Embolização Terapêutica/instrumentação , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/instrumentação , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
13.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370948

RESUMO

Visceral artery aneurysms (VAAs) are uncommon with an approximate incidence of 0.01%-0.2%. Gastroduodenal artery (GDA) aneurysm is a rare subtype of these uncommon visceral aneurysms that can be fatal if ruptured. We present a case of a 58-year-old Caucasian woman with a VAA and a large haematoma arising from an actively bleeding GDA. While patients with VAA may remain asymptomatic, with some of the aneurysms found incidentally during imaging, they may also present with abdominal pain, anaemia and possible multiorgan failure which may be fatal.


Assuntos
Dor Abdominal/etiologia , Falso Aneurisma/diagnóstico , Embolização Terapêutica/instrumentação , Hematoma/etiologia , Artéria Hepática/diagnóstico por imagem , Dor Abdominal/terapia , Falso Aneurisma/complicações , Falso Aneurisma/terapia , Angiografia Digital , Feminino , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
15.
BMC Neurol ; 20(1): 384, 2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33092561

RESUMO

BACKGROUND: Endovascular treatment is the technique of choice for most intracranial aneurysms. However, the treatment of morphologically complex wide-necked aneurysms with an unfavorable anatomy is still a therapeutic challenge. The purpose of the study is to describe the initial experience with the Comaneci embolization assist device for the treatment of wide-necked aneurysms with an unfavorable ratio for direct embolization. METHODS: We report a retrospective single-center analysis taken from a prospective database of consecutive aneurysms of the anterior circulation treated using the Comaneci device in the period from March 2017 to March 2019. RESULTS: Eighteen aneurysms were collected from 16 patients (9 women and 7 men) treated using the Comaneci device. The mean age was 48.4 years (range 36-81). Twelve patients had SAH, three were incidental aneurysms and one had compressive symptoms. A complete asymptomatic occlusion rate of 88.8% was obtained. The major complication rate was 5.55%. CONCLUSION: The Comaneci embolization assist device is a safe, effective option for endovascular treatment of complex aneurysms with an unfavorable ratio.


Assuntos
Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
16.
J Vasc Interv Radiol ; 31(11): 1810-1816, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32958379

RESUMO

PURPOSE: To evaluate endovascular treatment of head and neck arteriovenous malformations (AVMs) based on the Yakes AVM classification and correlate treatment approach with clinical and angiographic outcomes. MATERIALS AND METHODS: A retrospective single-center study was performed in patients who underwent endovascular treatment of head and neck AVMs between January 2005 and December 2017. Clinical and operative records, imaging, and postoperative courses of patients were reviewed. Clinical stage was determined according to the Schobinger classification. AVM architecture and treatment approaches were determined according to the Yakes classification. Primary outcomes were clinical and angiographic treatment success rates and complication rates, with analysis according to the Yakes classification. RESULTS: A total of 29 patients (15 females) were identified, with a mean age of 30.6 years. Downgrading of the Schobinger clinical classification was achieved in all patients. Lesions included 8 Yakes type IIa, 5 type IIb, 1 type IIIa and IIIb, and 14 type IV. Lesions were treated using an intra-arterial, nidal, or transvenous approach, using ethanol and liquid embolic agents. Arteriovenous shunt eradication of >90% was achieved in 22 of 28 patients (79%), including 9 of 13 (69%) of Yakes type IV lesions and 13 of 15 (87%) of the other types. There were 5 significant complications in 79 procedures (6%), including 4 of 50 (8%) in Yakes type IV lesions. CONCLUSIONS: Schobinger stage was downgraded in all patients. Arteriovenous shunt eradication of >90% was achieved in most patients. Yakes type IV lesions required more sessions, and shunt eradication was higher in the Yakes II and III groups.


Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Etanol/administração & dosagem , Cabeça/irrigação sanguínea , Pescoço/irrigação sanguínea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Malformações Arteriovenosas/classificação , Malformações Arteriovenosas/diagnóstico por imagem , Criança , Pré-Escolar , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Etanol/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
17.
J Vasc Interv Radiol ; 31(9): 1483-1491, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32800664

RESUMO

PURPOSE: To examine safety and efficacy of bariatric arterial embolization (BAE) with x-ray-visible embolic microspheres (XEMs) and an antireflux catheter in swine. MATERIAL AND METHODS: BAE with selective infusion of XEMs (n = 6) or saline (n = 4, control) into gastric fundal arteries was performed under x-ray guidance. Weight and plasma hormone levels were measured at baseline and weekly for 4 weeks after embolization. Cone-beam CT images were acquired immediately after embolization and weekly for 4 weeks. Hormone-expressing cells in the stomach were assessed by immunohistochemical staining. RESULTS: BAE pigs lost weight 1 week after embolization followed by significantly impaired weight gain relative to control animals (14.3% vs 20.9% at 4 weeks, P = .03). Plasma ghrelin levels were significantly lower in BAE pigs than in control animals (1,221.6 pg/mL vs 1,706.2 pg/mL at 4 weeks, P < .01). XEMs were visible on x-ray and cone-beam CT during embolization, and radiopacity persisted over 4 weeks (165.5 HU at week 1 vs 158.5 HU at week 4, P = .9). Superficial mucosal ulcerations were noted in 1 of 6 BAE animals. Ghrelin-expressing cell counts were significantly lower in the gastric fundus (17.7 vs 36.8, P < .00001) and antrum (24.2 vs 46.3, P < .0001) of BAE pigs compared with control animals. Gastrin-expressing cell counts were markedly reduced in BAE pigs relative to control animals (98.5 vs 127.0, P < .02). Trichrome staining demonstrated significantly more fibrosis in BAE animals compared with control animals (13.8% vs 8.7%, P < .0001). CONCLUSIONS: XEMs enabled direct visualization of embolic material during and after embolization. BAE with XEMs and antireflux microcatheters was safe and effective.


Assuntos
Regulação do Apetite , Comportamento Animal , Cateteres , Embolização Terapêutica/instrumentação , Artéria Gástrica , Fundo Gástrico/irrigação sanguínea , Grelina/sangue , Perda de Peso , Animais , Tomografia Computadorizada de Feixe Cônico , Artéria Gástrica/diagnóstico por imagem , Fundo Gástrico/metabolismo , Fundo Gástrico/patologia , Infusões Intra-Arteriais , Microesferas , Sus scrofa , Fatores de Tempo
18.
Vasc Endovascular Surg ; 54(8): 760-764, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32787686

RESUMO

True aneurysms of the anterior tibial artery are rare with less than 20 published reports in the literature. We report an urgent endovascular repair of a true anterior tibial artery aneurysm in a patient with Ehlers-Danlos type IV, vascular type. This approach resulted in an uneventful recovery without the elevated risks associated with open vascular repair in the setting of connective tissue disorder. Continuous follow-up in the subsequent 4 years has demonstrated durability and efficacy of the original intervention.


Assuntos
Aneurisma/terapia , Síndrome de Ehlers-Danlos/complicações , Embolização Terapêutica/instrumentação , Artérias da Tíbia , Adulto , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Síndrome de Ehlers-Danlos/diagnóstico , Humanos , Masculino , Artérias da Tíbia/diagnóstico por imagem , Resultado do Tratamento
20.
J Vasc Interv Radiol ; 31(10): 1560-1569, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32855049

RESUMO

PURPOSE: The purpose of this study was to determine the efficacy and safety of embolization treatment in pelvic venous disorders in women refluxing in the ovarian and or internal iliac veins in women with chronic pelvic pain. MATERIALS AND METHODS: A retrospective study conducted from January 2000 to June 2017 in 617 patients diagnosed with pelvic venous disorders (PeVDs) with a mean age of 43.2 ± 7.2 years were treated using an embolization procedure. A total of 520 were included, and 97 patients were excluded. The main inclusion criteria were PeVD symptoms for more than 6 months and transvaginal Doppler ultrasonography (TV-DUS) diagnosis of varicose veins in the pelvis with a diameter greater than 6 mm. The main objective was to embolize the 4 main pelvic venous plexi (ovarian and internal iliac veins) whenever possible. Follow-up was performed using clinical symptoms (visual analog scale) and TV-DUS at 1, 3, 6, and 12 months and then every year up to 5 years. RESULTS: The technical success (embolization of the 4 main pelvic veins) was achieved in 84.4% of the patients. The average follow-up was 58.7 ± 5.7 months. The visual analog scale was improved from 7.63 ± 0.9 points pretreatment to 0.91 ± 1.5 at 5 years. A total of 26 patients (5%) presented with symptom recurrence and pelvic varicose veins. There were 57 minor complications (10.9%) and 11 major complications (2.1%), with 7 cases (1.34%) of device migration to the lung. CONCLUSIONS: The embolization of pelvic varicose veins is a safe and effective procedure. The selection of the embolic agents and the number of veins needed to be treated.


Assuntos
Dor Crônica/prevenção & controle , Embolização Terapêutica , Ovário/irrigação sanguínea , Dor Pélvica/prevenção & controle , Pelve/irrigação sanguínea , Varizes/terapia , Veias , Adulto , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Veias/diagnóstico por imagem
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