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1.
Medicine (Baltimore) ; 98(39): e17151, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574820

RESUMO

RATIONALE: Persistent primitive hypoglossal artery (PPHA) is often associated with intracranial anomalies such as aneurysms. Surgical treatment of aneurysms on the PPHA is challenging due to that the posterior circulation depends solely on PPHA. PATIENT CONCERNS: A case of an 83-year-old woman with a large aneurysm on PPHA presented with vertigo was reported. DIAGNOSIS: Three-dimensional angiogram revealed a wide-neck aneurysm on the PPHA. INTERVENTIONS: The aneurysm was successfully treated using a novel low-profile visualized intraluminal support stent-assisted coiling technique. OUTCOMES: No complications occurred during the procedure. The final angiogram confirmed the patency of the posterior inferior cerebellar artery and the parent artery and its distal branches. LESSONS: Our case suggests that stent-assisted coil embolization is safe and effective for the treatment of aneurysms on the PPHA.


Assuntos
Embolização Terapêutica/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Posterior/cirurgia , Stents , Idoso de 80 Anos ou mais , Embolização Terapêutica/instrumentação , Feminino , Humanos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(37): e17107, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517843

RESUMO

BACKGROUND: Percutaneous mechanical circulatory support devices (pMCSDs) are increasingly used on the assumption (but without solid proof) that their use will improve prognosis. A meta-analysis was undertaken according to the PRISMA guidelines to evaluate the benefits of pMCSDs in patients undergoing high-risk percutaneous coronary intervention (hr-PCI). METHODS: We searched PubMed, EMbase, Cochrane Library, Clinical Trial.gov, and other databases to identify eligible studies. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for 30-day and 6-month all-cause mortality rates, reinfarction, and other adverse events using a random effect model. RESULTS: Sixteen randomized controlled trials (RCTs) were included in this study. In the pooled analysis, intra-aortic balloon pump (IABP) was not associated with a decrease in 30-day and 6-month all-cause mortality (RR 1.01 95% CI 0.61-1.66; RR 0.88 95% CI 0.66-1.17), reinfarction (RR 0.89 95% CI 0.69-1.14), stroke/transient ischemic attack (TIA) (RR 1.75 95% CI 0.47-6.42), heart failure (HF) (RR 0.54 95% CI 0.11-2.66), repeat revascularization (RR 0.73 95% CI 0.25-2.10), embolization (RR 3.00 95% CI 0.13-71.61), or arrhythmia (RR 2.81 95% CI 0.30-26.11). Compared with IABP, left ventricular assist devices (LVADs) were not associated with a decrease in 30-day and 6-month all-cause mortality (RR 0.96 95% CI 0.71-1.29; RR 1.23 95% CI 0.88-1.72), reinfarction (RR 0.98 95% CI 0.68-1.42), stroke/TIA (RR 0.45 95% CI 0.1-1.95), acute kidney injury (AKI) (RR 0.83 95% CI 0.38-1.80), or arrhythmia (RR 1.52 95% CI 0.71-3.27), but LVADs were associated with a decrease in repeat revascularization (RR 0.26 95% CI 0.08-0.83). However, LVADs significantly increased the risk of bleeding compared with IABP (RR 2.85 95% CI 1.72-4.73). CONCLUSIONS: Neither LVADs nor IABP improves short or long-term survival in hr-PCI patients. LVADs are more likely to reduce repeat revascularization after PCI, but to increase the risk of bleeding events than IABP.


Assuntos
Coração Auxiliar/normas , Balão Intra-Aórtico/normas , Intervenção Coronária Percutânea/métodos , Arritmias Cardíacas/terapia , Embolização Terapêutica/métodos , Insuficiência Cardíaca/terapia , Coração Auxiliar/estatística & dados numéricos , Humanos , Balão Intra-Aórtico/métodos , Balão Intra-Aórtico/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
3.
Surg Clin North Am ; 99(5): 921-939, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446918

RESUMO

This article reviews a few surgical palliative care procedures that can be performed by surgeons and interventional radiologists using image-guided techniques. Treatment of recurrent pleural effusions, gastrostomy feeding tube maintenance, percutaneous cholecystostomy, and transjugular intrahepatic portosystemic shunts (TIPS) with embolotherapy of bleeding stomal varices is discussed.


Assuntos
Cuidados Paliativos/métodos , Sistema Biliar/diagnóstico por imagem , Colecistostomia/métodos , Drenagem/métodos , Embolização Terapêutica/métodos , Nutrição Enteral/métodos , Varizes Esofágicas e Gástricas/terapia , Vesícula Biliar/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/terapia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Radiografia , Toracentese/métodos , Ultrassonografia
4.
Orv Hetil ; 160(32): 1260-1269, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31387372

RESUMO

Introduction: Resecability of liver tumors is exclusively depending on the future liver remnant (FLR). The remnant can be hypertrophised using portal vein occlusion techniques. The latest hypertrophising method is Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS), which provides the most significant induced hypertrophy in the shortest time. Morbidity and mortality of this procedure were initially unacceptably high. Aim: Reducing complications by better patient selection and modified surgical technique. Method: The First Department of Surgery, Semmelweis University, Budapest, prefers the 'no touch' technique, instead of 'complete mobilization'. For optimizing patient selection, an international registry (including our patients' data) was established. In addition to the surgical, we collected demographic, disease, liver function, histology, morbidity (Clavien-Dindo) and mortality parameters. Volume and function measurements were performed by using CT-volumetry and 99mtechnecium-mebrofenin SPECT/CT. Data were analyzed by multivariate analysis (significance: p<0.05). Results: We performed 20 ALPPS procedures from 2012 to 2018. The relative volume increment and resectability in our department and among the 320 registry patients were 96% vs. 86% and 95% vs. 98%. Using 'no touch' technique, the Clavien-Dindo III-IV morbidity and mortality rates were significantly lower (22%-0%) than with 'complete mobilization' (63%-36%) (p<0.05). Based on the multivariate analysis of the registry patients, age over 60 years, liver macrosteatosis, non-colorectal liver tumor, >300 minutes operation time, >2 units of red blood cell transfusion, or insufficient FLR function before stage 2 were identified as independent factors influencing mortality (p<0.05). Conclusion: Mortality and morbidity of ALPPS can be reduced by proper patient selection and 'no touch' surgical technique. Orv Hetil. 2019; 160(32): 1260-1269.


Assuntos
Embolização Terapêutica/métodos , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Seleção de Pacientes , Veia Porta/cirurgia , Humanos , Ligadura , Fígado/irrigação sanguínea , Neoplasias Hepáticas/epidemiologia , Morbidade , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(33): e16821, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415399

RESUMO

Aneurysmal subarachnoid hemorrhage (SAH) is a complex neurovascular syndrome with high disability and mortality. SAH patients may be managed with surgical clipping or coil embolization. In this study, we provided a real-world analysis of the outcome and prognostic factors of aneurysmal SAH in patients treated with coil embolization or microsurgical clipping.We retrospectively analyzed the medical records of aneurysmal SAH patients (n = 583) who underwent treatment at the First Hospital and the Second Hospital of Hebei Medical University, and Tangshan Worker's Hospital in China. All patients were evaluated by a combined neurosurgery and interventional neuroradiology team. Microsurgical aneurysmal clipping was performed using the skull base approach, while coil embolization was performed with bare platinum coils (with or without balloon assistance). The primary outcome was the Glasgow Outcome Scale (GOS) score at discharge.A total of 583 patients were included in this study, of which 397 (68.1%) of them underwent clipping and 186 (31.9%) received coil embolization. The patient cohort consisted of both poor grade and good grade aneurysmal SAH: 441 (75.6%) patients had good-grade (Hunt and Hess grade II or III) and 142 (24.4%) had poor grade (Hunt and Hess grade IV or V). Overall, 123 (21%) patients had unfavorable neurologic outcome (GOS score 1-3) and 460 (78.9%) patients had favorable neurologic outcome (GOS score 4 or 5). The mean GOS score at discharge was comparable for patients who underwent clipping and those received coil embolization (P > .05). Multivariate analysis showed that clipping only [OR (95%CI): 0.03 (0.01, 0.36); P = .000] and clipping with CSF drainage [OR (95%CI): 0.41 (0.18, 0.89); P = .001] were independent factors of a favorable outcome in patients with aneurysmal SAH. Coil embolization with hematoma removal [OR (95%CI): 0.03 (0.01, 0.36); P = .000] was also an independent determinant of a favorable outcome. High baseline Fisher grades were associated with significantly increased risk of an unfavorable outcome [OR (95%CI): 2.08 (1.30, 3.33); P = .002].Our findings suggested that both coil embolization and microsurgical clipping are viable treatment options for aneurysmal SAH patients. Procedures, such as CSF drainage and hematoma removal, performed in parallel with coil embolization and chipping should be considered when treating individual patients.


Assuntos
Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Microcirurgia/métodos , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Prótese Vascular , China , Drenagem/métodos , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Medicine (Baltimore) ; 98(31): e16666, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31374041

RESUMO

INTRODUCTION: Pulmonary sequestration (PS) is a rare congenital lung malformation. The classical treatment of the disease has been conventional surgery with resection of abnormal parenchyma. Recently, the endovascular embolization has been proposed for the treatment of this disease. Here we present 2 cases of PS successfully treated with thoracic endograft. PATIENT CONCERNS: Two patients with abnormal consolidation in the left lower lobe were admitted in our hospital. DIAGNOSIS: Chest computed tomography angiography (CTA) showed abnormal consolidation in the left lower lobe, which received systemic blood supply from the descending aorta in both patients. So the diagnosis of PS was confirmed. INTERVENTIONS: Endovascular treatment with thoracic endograft was successfully performed. OUTCOMES: The patients recovered well and were completely free of symptoms. And the CTA follow-up showed the abnormal pulmonary parenchyma shrunk significantly. CONCLUSIONS: Endovascular treatment with thoracic endograft is a promising treatment option for PS.


Assuntos
Sequestro Broncopulmonar/terapia , Embolização Terapêutica/métodos , Adulto , Angiografia , Humanos , Masculino
7.
Presse Med ; 48(7-8 Pt 2): e245-e250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31445698

RESUMO

Embolization and percutaneous ablations became well-established therapeutic options for hepatocellular carcinomas (HCC). All are performed under minimally invasive conditions using imaging guidance. Selection of a technique over another follows guidelines but also patient's status and availability of the techniques. The aim of this review is to present these techniques performed in routine to treat HCC and to report the outcomes.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Neoplasias Hepáticas/cirurgia , Cirurgia Assistida por Computador/métodos , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/estatística & dados numéricos , Terapia Combinada , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Humanos , Fígado/irrigação sanguínea , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia Guiada por Imagem/métodos , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/estatística & dados numéricos , Resultado do Tratamento
8.
Presse Med ; 48(7-8 Pt 2): e251-e256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447338

RESUMO

Cancer patients quite commonly will report different types of pain associated with the disease substrate. Systemic analgesia and radiotherapy provide only partial pain relief in the majority of these patients. Interventional Oncology techniques for pain management and mobility improvement in cancer patients include percutaneous techniques such as neurolysis, ablation and augmentation (both in the spine and peripheral skeleton) as well as trans-arterial embolization. Percutaneous neurolysis acts indirectly providing regional anesthesia whilst the rest of the aforementioned techniques act directly upon the tumor either by inhibiting local growth or by providing stability and skeletal augmentation. Whenever possible, techniques such as ablation and trans-arterial embolization apart from pure palliation may add to the principle of local tumor control. The aim of this review is to provide details concerning the Interventional Oncology techniques used for cancer pain management and to address the necessity for a tailored-based approach applying different techniques or combinations of them in different cases and locations.


Assuntos
Dor do Câncer/terapia , Oncologia/métodos , Neoplasias/terapia , Manejo da Dor/métodos , Cuidados Paliativos/métodos , Anestesia por Condução , Osso e Ossos/cirurgia , Ablação por Cateter/métodos , Embolização Terapêutica/métodos , Humanos , Oncologia/tendências , Neoplasias/complicações , Bloqueio Nervoso/métodos , Cuidados Paliativos/tendências , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos
9.
Khirurgiia (Mosk) ; (6): 111-116, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317950

RESUMO

We present a case report of atypical hand ischemia probably caused by a combination of venous insufficiency and steal syndrome in patient with arteriovenous fistula for hemodialysis. Unclear clinical symptoms may be due to severe trophic disorders (delayed treatment) or combination of two complications (steal syndrome and venous insufficiency). At the same time, we did not get any diagnostic data confirming organic injury of the upper limb veins or central veins. AVF closure did not result positive changes. Angiography made it possible to assess veins patency, to detect additional patent AVF and to close it. It was previously assumed that this previously created AVF was completely occluded. Therefore, positive changes were observed: rapid healing of trophic ulcers, complete disappearance of pain and gradual restoration of function.


Assuntos
Fístula Arteriovenosa/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Embolização Terapêutica/métodos , Mãos/irrigação sanguínea , Isquemia/cirurgia , Insuficiência Venosa/cirurgia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Mãos/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Diálise Renal/instrumentação , Veias/diagnóstico por imagem , Insuficiência Venosa/etiologia
10.
World J Pediatr Congenit Heart Surg ; 10(4): 407-413, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307303

RESUMO

BACKGROUND: Plastic bronchitis is a dreaded complication of single ventricle physiology occurring following palliation via Fontan procedure. Medical management of plastic bronchitis often fails, requiring heart transplantation. Percutaneous lymphatic embolization is an emerging treatment for plastic bronchitis. METHODS: To determine the cost-effectiveness of competing management strategies, a modified Markov model was constructed with patients transiting through treatments-medical management, lymphatic embolization, or heart transplantation from a hospital system perspective. Health state transitions were modeled using an institutional review board-approved retrospective review of the Children's Hospital of Pennsylvania's plastic bronchitis cohort. Medication pricing data were obtained from the National Inpatient Sample. Differences in costs and quality-adjusted life years (QALYs) over a five-year horizon for each group were determined. The incremental cost-effectiveness ratio was then calculated. RESULTS: The mean cost of lymphatic embolization from procedure performance was US$340,941, US$385,841 for heart transplantation, and US$594,520 for medical management. The mean quality-adjusted survival of lymphatic embolization yielded an additional 0.66 QALYs (P < .03) relative to heart transplantation and 1.3 (P < .0001) relative to medical management. Orthotopic heart transplantation yielded an additional 0.66 QALYs (P = .06) when comparing heart transplantation to medical management. Compared to medical management, lymphatic embolization generated an incremental cost-effectiveness ratio of US$192,105. Similarly, compared to heart transplantation, lymphatic embolization yielded an incremental cost-effectiveness ratio of US$68,030. CONCLUSIONS: Of the available plastic bronchitis treatments, with a willingness to pay of US$150,000, lymphatic embolization produces an incremental cost-effectiveness ratio within the bounds considered to be cost-effective, potentially causing financial benefits to the health system.


Assuntos
Bronquite/terapia , Cateterismo Periférico/métodos , Embolização Terapêutica/economia , Técnica de Fontan/efeitos adversos , Vasos Linfáticos/diagnóstico por imagem , Complicações Pós-Operatórias , Bronquite/etiologia , Análise Custo-Benefício , Embolização Terapêutica/métodos , Feminino , Humanos , Linfografia , Estudos Retrospectivos
11.
Eur J Radiol ; 116: 8-13, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153578

RESUMO

PURPOSE: To evaluate the outcomes of combined preoperative embolization and microsurgical resection in comparison with microsurgical resection alone as the current standard of care for low-grade cerebral arteriovenous malformations (AVM) in the pediatric population. MATERIALS & METHODS: We performed a single-center retrospective study of pediatric patients presenting with Spetzler-Martin (SM) grade I and II cerebral AVMs at a high-volume tertiary pediatric hospital between January 2005 and September 2016. Low grade AVM patients were divided into two groups: pre-operative embolization with subsequent microsurgical resection or microsurgical resection alone. Patient demographics, clinical and imaging presentations, AVM morphological characteristics, post-operative complications, and mid to long-term clinical outcomes were studied. Post-embolization and post-surgical outcomes were assessed prior to and after treatment, at 3 months and at final follow-up using the modified Rankin Scale (mRS) to compare both final independent (mRS 0-2) and favorable (no change or improved mRS) clinical outcomes for comparison between study groups. Statistical associations of patient demographics, AVM characteristics/SM grading, and treatment modality group with post-operative complications were performed using univariate logistic regression analysis. RESULTS: Thirty-four patients with low grade cerebral AVMs met the study inclusion criteria (mean age 10.6 ± 3.4 years; range 3-16 years, 22M:12 F). Twenty patients (59%) presented with ruptured AVMs. Twenty-five patients (73.5%) underwent combined treatment with embolization and microsurgical resection, while 9/34 (26.5%) underwent microsurgical resection alone. A total of 35 embolization procedures performed in 25 patients (Mode, 1; Range, 1-7) were associated with two minor post-embolization and 7 subsequent post-surgical (28%) complications, resulting in clinical deterioration in a single patient. Microsurgical resection alone was associated with 3 post-surgical complications (33%), resulting in permanent neurological disability in a single patient. There was no significance association of post-operative complications with either treatment modality group, combined treatment versus surgical resection alone [OR:1.13; 95% CI:0.23-5.62; p-value 0.88]. SM Grade II and eloquent locations were found to be significantly associated with post-surgical complications of low grade pediatric cerebral AVMs [OR 13.2 and OR 8 respectively, p-value 0.004 and 0.005). On mean follow-up time of 35.7 months, final clinical outcome was favorable in the majority of both treatment arms with no dependent (mRS>2) patients in the combined endovascular and surgical cohort. Two patients in the surgical cohort failed to achieve independent functional status, primarily due to a pre-operative morbid status (p-value 0.015). However, there was no significant difference in favorable outcomes between the treatment groups [p-value 0.14]. CONCLUSION: Our study suggests equivalent safety and favorable clinical outcomes related to combined endovascular embolization and microsurgical resection of low grade pediatric cerebral AVMs in comparison to microsurgical resection alone. On long term clinical follow-up, the vast majority of patients achieved an independent and favorable functional status irrespective of pre-operative embolization.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Malformações Arteriovenosas Intracranianas/terapia , Microcirurgia/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Terapia Combinada/métodos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Modelos Logísticos , Masculino , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
12.
World J Emerg Surg ; 14: 28, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210779

RESUMO

Introduction: While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic fracture in the emergency department. Methods: From January 2014 to December 2016, the trauma registry and medical records of patients with pelvic fracture who underwent TAE were retrospectively reviewed. The relationship between the time to TAE and patient outcomes was evaluated. The characteristics of surviving and deceased patients were also compared to search for prognostic factors affecting survival. Results: Eighty-four patients were enrolled in the current study. Among patients with pelvic fracture who underwent TAE, the overall mortality rate was 16.7%. There were positive relationships between the time to TAE and the requirement for blood transfusion and between the time to TAE and intensive care unit (ICU) length of stay (LOS). Nonsurviving patients were significantly older (57.4 ± 23.3 vs. 42.7 ± 19.3 years old, p = 0.014) and had higher injury severity scores (ISSs) (36.4 ± 11.9 vs. 23.9 ± 10.9, p < 0.001) than were observed in surviving patients. There was no significant difference in the time to TAE between nonsurviving and surviving patients (76.9 ± 47.9 vs. 59.0 ± 29.3 min, p = 0.068). The multivariate logistic regression analysis showed that ISS and age served as independent risk factors for mortality. Every one unit increase in ISS or age resulted in a 1.154- or 1.140-fold increase in mortality, respectively (p = 0.033 and 0.005, respectively). However, the time to TAE serves as an independent factor for ICU LOS (p = 0.015). Conclusion: In pelvic fracture patients who require TAE for hemostasis, longer time to TAE may cause harm. An early hemorrhage control is suggested.


Assuntos
Embolização Terapêutica/métodos , Fraturas Ósseas/tratamento farmacológico , Hemostasia/efeitos dos fármacos , Adulto , Idoso , Angiografia/métodos , Distribuição de Qui-Quadrado , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/mortalidade , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Ossos Pélvicos/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Taiwan
13.
Adv Mater ; 31(33): e1901071, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31168915

RESUMO

Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.


Assuntos
Materiais Biocompatíveis/química , Embolização Terapêutica/métodos , Animais , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares , Humanos , Metais/química , Microesferas , Polímeros/química
14.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 297-301, May-June 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1002228

RESUMO

Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty


Assuntos
Humanos , Feminino , Adulto , Hemorragia Uterina/complicações , Mulheres , Stents , Angioplastia , Inibidores da Agregação de Plaquetas/uso terapêutico , Angioplastia Coronária com Balão/métodos , Embolização Terapêutica/métodos , Leiomioma
15.
Biomed Res Int ; 2019: 2674758, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073523

RESUMO

Aims: To evaluate the safety and effectiveness of percutaneous transhepatic antegrade embolization (PTAE) with 2-octyl cyanoacrylate assisted with balloon occlusion of the left renal vein or gastrorenal shunts (GRSs) for the treatment of isolated gastric varices (IGVs) with large GRSs. Methods: Thirty patients with IGVs associated with large GRSs who had underwent PTAE assisted with a balloon to block the opening of the GRS in the left renal vein were retrospectively evaluated and followed up. Clinical and laboratory data were collected to evaluate the technical success of the procedure, complications, changes in the liver function using Child-Pugh scores, worsening of the esophageal varices, the rebleeding rate, and survival. Laboratory data obtained before and after PTAE were compared (paired-sample t-test). Results: PTAE was technically successful in all 30 patients. No serious complications were observed except for one nonsymptomatic pulmonary embolism. During a mean follow-up of 30 months, rebleeding was observed in 4/30 (13.3%) patients, worsening of esophageal varices was observed in 4/30 (13.3%) patients, and newly developed or aggravated ascites were observed on CT in 3/30 (10%) patients. Significant improvement was observed in Child-Pugh scores (p=0.009) and the international normalized ratio (INR) (p=0.004) at 3 months after PTAE. The cumulative survival rates at 1, 2, 3, and 5 years were 96.3%, 96.3%, 79.9%, and 79.9%, respectively. Conclusion: Balloon-assisted PTAE with 2-octyl cyanoacrylate is technically feasible, safe, and effective for the treatment of IGV associated with a large GRS.


Assuntos
Oclusão com Balão/métodos , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/terapia , Cirrose Hepática/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Oclusão com Balão/efeitos adversos , Cianoacrilatos/administração & dosagem , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Fístula/fisiopatologia , Fístula/terapia , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/patologia , Hemorragia/complicações , Hemorragia/patologia , Humanos , Estimativa de Kaplan-Meier , Fígado/fisiopatologia , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Veias Renais/efeitos dos fármacos , Veias Renais/cirurgia , Adesivos Teciduais/administração & dosagem , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(18): e15464, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045824

RESUMO

There have been few studies comparing percutaneous transhepatic variceal embolization (PTVE) and transjugular intrahepatic portosystemic shunt (TIPS) for the prevention of recurrent gastric variceal bleeding (GVB).Compare the outcomes of these 2 procedures in patients with GVB.A total of 74 cirrhosis patients with GVB who underwent TIPS and modified PTVE were enrolled. The rebleeding and mortality rates, portal vein pressure (PVP) variation, and rates of hepatic encephalopathy (HE) were compared between the 2 groups.A total of 43 PTVE and 31 TIPS patients were enrolled in this study. The difference of rebleeding rate in the 2 groups was not statistically significant (P = .190). The difference of early rebleeding rates and cumulative rebleeding-free rates were all not statistically significant (P = .256, P = .200). The difference of mortality rates in the 2 groups was not statistically significant (χ = 1.206, P = .272). The rate of HE in TIPS group was statistically higher than that in PTVE group (P < .0001).Both PTVE and TIPS were effective for preventing rebleeding of GVs. There were no significant differences in rebleeding and mortality rates. The incidence of HE after TIPS was higher than PTVE.


Assuntos
Embolização Terapêutica/efeitos adversos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Fígado/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Adulto , Idoso , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Humanos , Incidência , Fígado/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
17.
Rev Assoc Med Bras (1992) ; 65(4): 518-523, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31066803

RESUMO

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Assuntos
Embolização Terapêutica/métodos , Dor Pélvica/terapia , Pelve/irrigação sanguínea , Varizes/terapia , Brasil , Dor Crônica , Tomada de Decisão Clínica , Feminino , Humanos , Reprodutibilidade dos Testes , Síndrome , Resultado do Tratamento
18.
J Neurointerv Surg ; 11(8): e4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31118268

RESUMO

Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica/métodos , Artéria Radial/diagnóstico por imagem , Sacro/diagnóstico por imagem , Idoso , Embucrilato/administração & dosagem , Humanos , Masculino , Artéria Radial/efeitos dos fármacos , Sacro/irrigação sanguínea , Resultado do Tratamento
20.
Chin J Traumatol ; 22(3): 129-133, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31076162

RESUMO

PURPOSE: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. METHODS: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200-10,000 mL, with an average volume of 2850 mL. Postoperative follow-up ranged from 6 months to 1.5 years. RESULTS: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy. CONCLUSION: The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory.


Assuntos
Fraturas Ósseas/terapia , Traumatismo Múltiplo/terapia , Ossos Pélvicos/lesões , Adulto , Embolização Terapêutica/métodos , Fator VII/administração & dosagem , Feminino , Fraturas Ósseas/complicações , Hemostasia Cirúrgica , Humanos , Artéria Ilíaca/cirurgia , Escala de Gravidade do Ferimento , Ligadura , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Prognóstico , Proteínas Recombinantes/administração & dosagem , Estudos Retrospectivos , Choque Hemorrágico/etiologia , Choque Hemorrágico/prevenção & controle , Adulto Jovem
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