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1.
Medicine (Baltimore) ; 99(40): e22531, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019457

RESUMO

RATIONALE: Although surgery has been the standard treatment for pancreaticoduodenal trauma because of the complex anatomical relation of the affect organs, transcatheter arterial embolization (TAE) has recently been introduced as a safe and effective treatment. However, TAE for pancreaticoduodenal arterial hemorrhage (PDAH) can be challenging because it is difficult to localize the involved artery and to embolize the bleeding completely due to the abundant collateral channels of the pancreaticoduodenal artery (PDA). PATIENT CONCERNS: Herein, we report 2 cases of PDAH that occurred after falling down in case 1 and a pedestrian traffic accident in case 2. DIAGNOSES: Multidetector computed tomography scan revealed massive retroperitoneal hematoma with active extravasation of contrast media from the PDA without any duodenal perforation or advanced pancreatic injury in both patients. INTERVENTIONS: All patients were successfully treated using only TAE with a combination of microcoils and n-butyl cyanoacrylate (NBCA) in case 1, and only NBCA in case 2. OUTCOMES: There was no complication such as duodenal ischemia or pancreatitis. Laparotomy was not needed after TAE. LESSONS: In selective PDAH cases, TAE may be a reasonable alternative to emergency laparotomy. It is expected that a careful and repetitive approach, based on complete angiography and embolization with a permanent liquid embolic agent such as NBCA could increase the success rate of TAE.


Assuntos
Traumatismos Abdominais/complicações , Embolização Terapêutica/métodos , Hemorragia/etiologia , Hemorragia/terapia , Ferimentos não Penetrantes/complicações , Duodeno/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/lesões
2.
Einstein (Sao Paulo) ; 18: eAO5458, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32965299

RESUMO

OBJECTIVE: To evaluate improvement in quality of life, reduction of uterine volume, and the correlation between these two variables after uterine fibroid embolization. METHODS: Data on quality of life before and after uterine fibroid embolization were collected from 60 patients using the Uterine Fibroid Symptom - Quality of Life questionnaire. In 40 of these patients, uterine volume information on magnetic resonance imaging examinations performed before and after uterine fibroid embolization was collected, and compared using the nonparametric Wilcoxon test for paired data. Correlation between quality of life and uterine volume before and after procedure was measured using Spearman's correlation coefficient. RESULTS: There was significant improvement in quality of life after uterine fibroid embolization on Uterine Fibroid Symptom - Quality of Life questionnaire, in both subscales scores and the total score. There was a significant median reduction of -37.4% after uterine fibroid embolization, but no correlations between uterine volume and quality of life scores were found before or after embolization. CONCLUSION: Uterine embolization is an alternative to treat uterine fibroids, resulting in relief of symptoms and better quality of life. Although reduction in uterine volume plays an important role in the evaluation of therapeutic success, it does not necessarily have a definitive correlation with relief of symptoms.


Assuntos
Embolização Terapêutica/métodos , Leiomioma/terapia , Qualidade de Vida/psicologia , Neoplasias Uterinas/terapia , Feminino , Humanos , Leiomioma/psicologia , Resultado do Tratamento , Neoplasias Uterinas/psicologia
3.
Radiología (Madr., Ed. impr.) ; 62(4): 313-319, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-ET6-361

RESUMO

OBJETIVO: El objetivo de este trabajo es presentar nuestros resultados, describiendo la técnica utilizada en el tratamiento endovascular de las hemorroides. MATERIAL Y MÉTODO: La embolización se realizó mediante punción de la arteria femoral derecha o vía arteria radial, y se cateterizó la arteria mesentérica inferior (AMI) accediéndose a la arteria rectal superior con un microcatéter (2,7 F) con el que cateterizábamos cada rama distal, ocluyéndolas distalmente con partículas de PVA (300-500 micras), y proximalmente con coils de 2-3mm. Los pacientes recibieron el alta a las 24 horas, al mes se les evaluó clínicamente y se les realizó una anoscopia. RESULTADOS: El estudio incluye 20 pacientes. (4 mujeres y 16 hombres), edad media de 61,85 años (27-81), con seguimiento medio de 10,6 meses (rango de 28-2 meses). El éxito técnico fue del 90% (18/20) y el éxito clínico de 83,4% (15/18); un paciente requirió nueva embolización de la arteria rectal media y dos pacientes requirieron cirugía. La recuperación fue prácticamente indolora. Al mes todos referían gran satisfacción y la anoscopia demostraba importante mejoría de las hemorroides. No hubo complicaciones secundarias a la embolización. CONCLUSIONES: Los resultados iniciales sugieren que la ESARS es un procedimiento seguro e indoloro, bien tolerado que evita el trauma anorrectal, y recuperación inmediata del paciente


OBJECTIVE: To present our results and describe the technique used for the endovascular treatment of hemorrhoids. MATERIAL AND METHODS: We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500μm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy. RESULTS: We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization. CONCLUSIONS: Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/métodos , Hemorroidas/diagnóstico por imagem , Hemorroidas/terapia , Procedimentos Endovasculares , Artéria Femoral/diagnóstico por imagem , Artéria Radial/diagnóstico por imagem , Estudos Retrospectivos , Anemia/etiologia
4.
Medicine (Baltimore) ; 99(34): e21725, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846791

RESUMO

Reports on lymphatic intervention for chylothorax complicating thoracic aortic surgery are limited. We aimed to evaluate technical and clinical outcomes of lymphangiography and thoracic duct embolization (TDE) for chylothorax complicating thoracic aortic surgery.Nine patients (mean age, 38.9 years) who underwent chylothorax interventions after thoracic aortic surgery (aorta replacement [n = 7] with [n = 2] or without [n = 5] lung resection, and vascular ring repair [n = 2]) were reviewed retrospectively. Magnetic resonance (MR) lymphangiograms were obtained in 5 patients. The median interval between surgery and conventional lymphangiography was 9 days (range, 4-28 days). TDE clinical success was defined as lymphatic leakage resolution with chest tube removal within 2 weeks.MR lymphangiograms revealed contrast leakage from the thoracic duct (n = 4) or no definite leakage (n = 1), which correlated well with conventional lymphangiogram findings. The technical success rate of conventional lymphangiography was 88.9% (8/9); 8 patients showed contrast leakage, while the patient without definite leakage on MR lymphangiography had small inguinal lymph nodes, and thoracic duct visualization by conventional lymphangiography failed. The technical success rates of antegrade and retrograde TDE via pleural access were 75% (6/8) and 100% (3/3), respectively. Clinical outcomes after embolization, as judged by the tube-removal day, were similar between low- (<500 mL/day) and high-output (≥500 mL/day) chylothorax patients. The drainage amount decreased significantly after lymphangiography/TDE, from 710.0 mL/day to 109.7 mL/day (p < .05). The clinical success rate of TDE was 87.8% (7/8).Conventional lymphangiography and TDE yielded high technical success rates and demonstrated encouraging clinical outcomes for chylothorax complicating thoracic aortic surgery.


Assuntos
Aorta Torácica/cirurgia , Quilotórax/terapia , Embolização Terapêutica/métodos , Linfografia/métodos , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Adulto Jovem
5.
Medicine (Baltimore) ; 99(32): e21489, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769883

RESUMO

For the treatment of huge unresectable hepatocellular carcinoma (HCC), transcatheter arterial chemoembolization (TACE) or transcatheter arterial embolization (TAE) generally had poor effects and high complication rates. Our previous study found that Hepatic arterial infusion chemotherapy (HAIC) is a safe procedure and provides better survival than symptomatic treatment for the patients with huge unresectable HCC. The aim of the study is to compare the effect of HAIC vs TAE in patients with huge unresectable HCC.Since 2000 to 2005, patients with huge (size > 8 cm) unresectable HCC were enrolled. Twenty-six patients received HAIC and 25 patients received TAE. Each patient in the HAIC group received 2.5 + 1.4 (range: 1-6) courses of HAIC and in the TAE group received 1.8 + 1.2 (range: 1-5) courses of TAE. Baseline characteristics and survival were compared between the HAIC and TAE group.The HAIC group and the TAE group were similar in baseline characteristics and tumor stages. The overall survival rates at 1 and 2 years were 42% and 31% in the HAIC group and 28% and 24% in the TAE group. The patients in the HAIC group had higher overall survival than the TAE group (P = .077). Cox-regression multivariate analysis revealed that HAIC is the significant factor associated with overall survival (relative risk: 0.461, 95% confidence interval: 0.218-0.852, P = .027). No patients died of the complications of HAIC but three patients (12%) died of the complications of TAE.In conclusion, HAIC is a safe procedure and provides better survival than TAE for patients with huge unresectable HCCs.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma Hepatocelular/terapia , Embolização Terapêutica/mortalidade , Infusões Intra-Arteriais/mortalidade , Neoplasias Hepáticas/terapia , Idoso , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Embolização Terapêutica/métodos , Feminino , Artéria Hepática , Humanos , Infusões Intra-Arteriais/métodos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Análise de Regressão , Resultado do Tratamento
6.
PLoS One ; 15(8): e0237798, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822396

RESUMO

BACKGROUND: Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the "snuffbox", which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study. MATERIAL & METHODS: Distal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period. RESULTS: The technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120-360 minutes). CONCLUSION: Distal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.


Assuntos
Procedimentos Endovasculares/métodos , Mãos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/cirurgia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
7.
Am Surg ; 86(6): 690-694, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683975

RESUMO

OBJECTIVES: The purpose of this study is to examine the outcomes of splenic angioembolization (SAE) as the first modality for nonoperative management (NOM) in hypotensive patients with high-grade splenic injuries. METHODS: Data were collected from the 2007-2010 National Trauma Data Bank data sets of the United States. The data included patients with massive blunt splenic injuries with an Abbreviated Injury Scale (AIS) of 4 or 5, initial systolic blood pressure ≤90, and who underwent either a total splenectomy or SAE (Group 1 and Group 2, respectively) within 4 hours of hospital arrival. The outcomes of interest are in-hospital mortality and complications. RESULTS: Of the 1052 patients analyzed, 996 (94.7%) underwent total splenectomy while 56 (5.3%) underwent SAE. There were significant differences regarding injury mechanism (P = .01) and the proportion of patients with an AIS of 5 (57.6% vs 39.3% respectively, P = .01). A significantly higher number of patients, however, developed organ space infections (3.9% vs 11.6%, P = .02) in Group 2. The multivariate logistic regression model for mortality, which accounted for demography, Glasgow Coma Scale Motor (GCSM) score, Injury Severity Score (ISS), AIS, time to procedure, and procedure type showed the procedure type was not a contributing factor to patient mortality, but higher age, ISS, and lower GCSM score were strong predictors of mortality. CONCLUSION: The treatment of approximately 95% of hypotensive patients with massive splenic injury was total splenectomy. However, if the interventional radiology resources are immediately available, SAE can be used as a first intervention without an increased risk of mortality.


Assuntos
Traumatismos Abdominais/cirurgia , Embolização Terapêutica , Hipotensão/terapia , Baço/lesões , Esplenectomia , Ferimentos não Penetrantes/cirurgia , Escala Resumida de Ferimentos , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Adulto , Embolização Terapêutica/métodos , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Esplenectomia/métodos , Estados Unidos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/mortalidade
8.
Ann Surg ; 272(2): 199-205, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675481

RESUMO

OBJECTIVE: The aim of this retrospective study was to compare portal vein embolization (PVE) and radiologica simultaneous portohepatic vein embolization (RASPE) for future liver remnant (FLR) growth in terms of feasibility, safety, and efficacy. SUMMARY OF BACKGROUND DATA: After portal vein embolization (PVE), 15% of patients remain ineligible for hepatic resection due to insufficient hypertrophy of the FLR. RASPE has been proposed to induce FLR growth. MATERIALS AND METHODS: Between 2016 and 2018, 73 patients were included in the study. RASPE was proposed for patients with a ratio of FLR to total liver volume (FLR/TLV) of <25% (RASPE group). This group was compared to patients who underwent PVE for a FLR/TLV <30% (PVE group). Patients in the 2 groups were matched for age, sex, type of tumor, and number of chemotherapy treatments. FLR was assessed by computed tomography before and 4 weeks after the procedure. RESULTS: The technical success rate in both groups was 100%. Morbidity post-embolization, and the time between embolization and surgery were similar between the groups. In the PVE group, the FLR/TLV ratio before embolization was 31.03% (range: 18.33%-38.95%) versus 22.91% (range: 16.55-32.15) in the RASPE group (P < 0.0001). Four weeks after the procedure, the liver volume increased by 28.98% (range: 9.31%-61.23%) in the PVE group and by 61.18% (range: 23.18%-201.56%) in the RASPE group (P < 0.0001). Seven patients in the PVE group, but none in the RASPE group, had postoperative liver failure (P = 0.012). CONCLUSIONS: RASPE can be considered as "radiological associating liver partition and portal vein ligation for staged hepatectomy." RASPE induced safe and profound growth of the FLR and was more efficient than PVE. RASPE also allowed for extended hepatectomy with less risk of post-operative liver failure.


Assuntos
Embolização Terapêutica/métodos , Hepatectomia/métodos , Hepatomegalia/prevenção & controle , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Intervalo Livre de Doença , Feminino , França , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(27): e20467, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629630

RESUMO

INTRODUCTION: In blunt traumatic superficial femoral arterial (SFA) injuries, hemorrhage from the branches without injury to the main artery is rare, but can lead to serious complications, such as compartment syndrome affecting the clinical outcomes. Although open surgical repair has been the standard approach to peripheral vascular injuries, endovascular treatment has become more refined and is now an alternative to open surgery, which potentially involves lower morbidity and mortality rates. However, management of arterial injuries, especially when they involve simple bleeding from small branches of the main artery, can be challenging, and the best treatment options for such injuries remains controversial. PATIENT CONCERNS: Three cases suffered blunt trauma that resulted in hemorrhage from branches of the SFA. DIAGNOSIS: All patients underwent selective angiography, which demonstrated active extravasation from branches of the SFA. INTERVENTIONS: All patients were treated using embolization with n-butyl cyanoacrylate (NBCA). OUTCOMES: A post-embolization angiography demonstrated successful hemostasis, with no complications. CONCLUSION: Superselective catheterization using a coaxial technique with a 5-F curved catheter and the smallest caliber microcatheter, and using a permanent liquid embolic agent, such as NBCA, increases the success rate of embolization for cases of hemorrhage from SFA branches.


Assuntos
Embolização Terapêutica/métodos , Embucrilato/uso terapêutico , Procedimentos Endovasculares , Artéria Femoral/lesões , Hemorragia/cirurgia , Idoso , Feminino , Humanos , Masculino
11.
Cochrane Database Syst Rev ; 7: CD013168, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32691854

RESUMO

BACKGROUND: Endovascular aortic aneurysm repair (EVAR) is used to treat aorto-iliac and isolated iliac aneurysms in selected patients, and prospective studies have shown advantages compared with open surgical repair, mainly in the first years of follow-up. Although this technique produces good results, anatomic issues (such as common iliac artery ectasia or an aneurysm that involves the iliac bifurcation) can make EVAR more complex and challenging and can lead to an inadequate distal seal zone for the stent-graft. Inadequate distal fixation in the common iliac arteries can lead to a type Ib endoleak. To avoid this complication, one of the most commonly used techniques is unilateral or bilateral internal iliac artery occlusion and extension of the iliac limb stent-graft to the external iliac arteries with or without embolisation of the internal iliac artery. However, this occlusion is not without harm and is associated with ischaemic complications in the pelvic territory such as buttock claudication, sexual dysfunction, ischaemic colitis, gluteal necrosis, and spinal cord injury. New endovascular devices and alternative techniques such as iliac branch devices and the sandwich technique have been described to maintain pelvic perfusion and decrease complications, achieving revascularisation of the internal iliac arteries in patients not suitable for an adequate seal zone in the common iliac arteries. These approaches may also preserve the quality of life of treated individuals and may decrease other serious complications including spinal cord ischaemia, ischaemic colitis, and gluteal necrosis, thereby decreasing the morbidity and mortality of EVAR. OBJECTIVES: To assess the effects of internal iliac artery revascularisation versus internal iliac artery occlusion during endovascular repair of aorto-iliac aneurysms and isolated iliac aneurysms involving the iliac bifurcation. SEARCH METHODS: The Cochrane Vascular Information Specialists searched the Cochrane Vascular Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 28 August 2019. The review authors searched Latin American Caribbean Health Sciences Literature (LILACS) and the Indice Bibliográfico Español de Ciencias de la Salud (IBECS) on 28 August 2019 and contacted specialists in the field and manufacturers to identify relevant studies. SELECTION CRITERIA: We planned to include all randomised controlled trials (RCTs) that compared internal iliac artery revascularisation with internal iliac artery occlusion for patients undergoing endovascular treatment of aorto-iliac aneurysms and isolated iliac aneurysms involving the iliac bifurcation. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions. MAIN RESULTS: We identified no RCTs that met the inclusion criteria. AUTHORS' CONCLUSIONS: We found no RCTs that compared internal iliac artery revascularisation versus internal iliac artery occlusion for endovascular treatment of aorto-iliac aneurysms and isolated iliac aneurysms involving the iliac bifurcation. High-quality studies that evaluate the best strategy for managing endovascular repair of aorto-iliac aneurysms with inadequate distal seal zones in the common iliac artery are needed.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Humanos
12.
Radiologe ; 60(8): 693-703, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32666151

RESUMO

BACKGROUND: Transarterial radioembolization (TARE) is a locoregional minimally invasive therapeutic strategy to treat primary and secondary hepatic neoplasia. AIM: The objective was to assess TARE-induced immuno-oncological effects and its perspective for potential therapy improvement by using a combinatory strategy with immune checkpoint inhibitors (ICI). RESULTS: Yttrium-90 (90Y) TARE is used in patients with persisting liver function as the first- and second-line treatment for cholangiocarcinoma and hepatocellular carcinoma and chemotherapy refractory liver metastasis of different primaries. Combination therapy with 90Y TARE and ICI may synergistically improve antitumoral immunity and patient outcome. Currently, there are no clinical studies with published data regarding this combination therapy and the subsequently induced immunological effects. Clinical data on other isotopes, e.g., holmium-166 (166Ho), are also lacking. CONCLUSION: The clinical evidence of combined treatment with TARE and ICI must be considerably improved. This innovative therapy concept must be studied in new trials assessing the immunological data, including cellular phenotypes, activation, functions, and biomarkers. This may provide valid, sensitive, and specific models in order to evaluate the optimal therapy concept and/or the therapy combination for the best patient outcome.


Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Imunoterapia/métodos , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/imunologia , Humanos , Neoplasias Hepáticas/imunologia , Resultado do Tratamento
13.
Niger J Clin Pract ; 23(6): 879-882, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525126

RESUMO

Dural arteriovenous fistulas (DAVFs) of the sphenoparietal sinus are extremely rare. In the present report, we describe a 46-year-old male patient who presented with headache, pulsatile tinnitus on the right side, and a single course of focal seizure starting 2 months after a closed head injury causing right temporal and occipital bone fractures. Cranial magnetic resonance imaging which was obtained 11 months after the injury showed white matter necrosis in the right frontal lobe while digital subtraction angiography (DSA) revealed a right-sided DAVF in the region of sphenoparietal sinus. The patient underwent successful intra-arterial Onyx-18 embolization using Scepter C balloon microcatheter. Complete occlusion of the fistula was confirmed by control cerebral DSA at 6-month follow-up. Thus, we conclude that double lumen Scepter C balloon microcatheter is a feasible, safe and effective treatment for intra-arterial Onyx-18 embolization of the DAVFs of the sphenoparietal sinus, particularly in cases with high tortuosity.


Assuntos
Cateterismo Venoso Central , Malformações Vasculares do Sistema Nervoso Central/terapia , Veias Cerebrais/diagnóstico por imagem , Embolização Terapêutica/métodos , Polivinil , Tantálio , Oclusão com Balão , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral/métodos , Meios de Contraste , Combinação de Medicamentos , Embolização Terapêutica/instrumentação , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
PLoS One ; 15(6): e0234478, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555657

RESUMO

INTRODUCTION: The use of endovascular treatments, including Pipeline embolization devices (PEDs) and coiling approaches (non-PEDs), has played an increasingly important role in the treatment of intracranial aneurysms. Despite multiple studies evaluating PEDs, a real-world evaluation of follow-up outcomes and costs remains to be completed. METHODS: The Premier Healthcare Database (PHD), 2010-2017, was queried to identify patients with unruptured intracranial aneurysms treated endovascularly. Rates of readmission, retreatment, and cost at the same hospital were compared between patients who underwent PED and non-PED endovascular treatments of their aneurysms. One-to-three (PED-to-non-PED) propensity score (PS) matching was performed to adjust for potential case selection bias into the PED cohort, with covariates including age group, sex, Charlson Comorbidity Index (CCI) group, payor, region, and randomized hospital identifier. RESULTS: A total of 679 patients underwent PED placement and 8432 had non-PED treatments. Prior to PS matching, there were significant but minor differences in age (56.7±12.8 vs. 58.2±12.6 years, p = 0.004) and sex (male 16.6% vs. 24.4%, p<0.0001) for PED and non-PED, respectively, but no differences in CCI (p = 0.08), length of stay (p = 0.88), or rate of routine discharge (p = 0.21). All-cause readmission/emergency department reevaluation rates in the two cohorts were similar at 30, 90, and 180 days and 1 and 2 years. Our results identified a significantly lower retreatment rate for PEDs at all follow-up time points over a 2-year period (range: 0.9-8.1%) compared with non-PED treatments (range: 1.7-11.6%). These findings remained consistent after PS matching: all-cause readmission/reevaluation rates were significantly lower in patients treated with PED at 90 days, 180 days, 1 year, and 2 years (p<0.001). Although the initial treatment costs were higher for PED at time of treatment (p<0.001), cumulative follow-up emergency department visit and readmission costs (inclusive of patients with no readmission and/or no retreatment) were significantly lower for patients with initial PED relative to non-PED treatment at 2 years (p = 0.021). CONCLUSIONS: These results suggest that PEDs may potentially reduce downstream retreatment rates and costs. Further work is required to improve identification of patient subgroups that could benefit from PED over non-PED treatments both initially and during follow-up.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Serviços Médicos de Emergência , Feminino , Custos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(24): e20728, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541524

RESUMO

INTRODUCTION: Infantile hepatic hemangioendothelioma is a type of benign hepatic tumor that occurs in infancy. Many hepatic tumors are diagnosed when screening is done for multiple cutaneous hemangiomas. Hepatic tumors are small multifocal lesions and are mostly asymptomatic. There have been many case reports of asymptomatic infantile hepatic hemangioendothelioma, but few of these have pointed out that hepatic hemangiomas can sometimes be life-threatening due to fatal hepatomegaly complications such as pulmonary artery hypertension or even congestive heart failure. At present, there are no standard protocols for treating infantile hepatic hemangioendothelioma, though most clinicians agree that treatment is unnecessary for multiple small hepatic hemangiomas in asymptomatic patients. Little is known about treatment for cases with life-threatening complications induced by infantile hepatic hemangioendothelioma as there are so few reported cases. Here, we report a special case with hepatomegaly, pulmonary artery hypertension, and cardiac insufficiency induced by infantile hepatic hemangioendothelioma. PATIENT CONCERNS: We present a case with hepatomegaly, pulmonary artery hypertension, and cardiac insufficiency caused by infantile hepatic hemangioendothelioma. DIAGNOSIS: Infantile hepatic hemangioendothelioma was diagnosed. INTERVENTIONS: The patient underwent transcatheter arterial embolization and was given propranolol. OUTCOMES: The patient responded well to treatment with transcatheter arterial embolization and propranolol. The patient gained weight steadily, liver volume, and mass size have decreased considerably, echocardiography showed normal pulmonary artery pressure and ejection fraction, and we discovered no serious complications after 1 year of follow-up. CONCLUSION: Transcatheter arterial embolization combined with propranolol is an effective treatment for life-threatening infantile hepatic hemangioendothelioma.


Assuntos
Anti-Hipertensivos/uso terapêutico , Embolização Terapêutica , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Hemangioendotelioma/complicações , Neoplasias Hepáticas/complicações , Propranolol/uso terapêutico , Hipertensão Arterial Pulmonar/etiologia , Hipertensão Arterial Pulmonar/terapia , Cateterismo , Terapia Combinada , Embolização Terapêutica/métodos , Humanos , Lactente , Masculino , Indução de Remissão
16.
Cancer Radiother ; 24(5): 374-378, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32527694

RESUMO

Therapeutic advances in oncology have led to longer survival in many forms of cancer, including those complicated by bone metastases. When a bone metastasis is painful or when there is a risk of fracture, interventional radiology procedures can be carried out for pain control and/or stabilisation. All of these techniques can be performed under local anaesthesia. Cementoplasty and vertebroplasty are stabilisation procedures consisting in the percutaneous injection of acrylic cement into a lytic bone lesion. The effect on pain can be explained by the consolidation of weakened, fractured or pre-fractured bone, but also to a lesser extent by the toxic, chemical and thermal effect of the cement. Tumour ablation techniques include alcoholisation or thermal ablation (by heat with radiofrequency and microwave or cold by cryoablation). Percutaneous thermal ablation of bone tumours is most often performed as a palliative measure resulting in a significant and lasting reduction in symptoms. Radiofrequency ablation consists in placing needles through which an electrical current passes. Microwave ablation acts by causing very high frequency vibrations of water molecules. Cryoablation releases argon gas at the tip of the needle, forming an "ice ball" effectively destroying tumour cells. Any of these techniques can be combined to radiation therapy, performed before or after radiation. Finally, tumour embolisation can have a goal of pain control, or preparation of surgery to reduce the risk of peroperative haemorrhage.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Dor do Câncer/terapia , Fraturas Espontâneas/terapia , Radiologia Intervencionista/métodos , Anestesia Local , Cimentos para Ossos/uso terapêutico , Ablação por Cateter/métodos , Cementoplastia/métodos , Criocirurgia/métodos , Embolização Terapêutica/métodos , Etanol/administração & dosagem , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Hemorragia/prevenção & controle , Humanos , Micro-Ondas/uso terapêutico , Bloqueio Nervoso/métodos , Cuidados Paliativos/métodos , Ablação por Radiofrequência/métodos , Solventes/administração & dosagem , Vertebroplastia/métodos
17.
Medicine (Baltimore) ; 99(21): e20229, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481296

RESUMO

RATIONALE: The incidence of pure arterial malformations is relatively low, and few cases have been reported. Only 2 cases with pure arterial malformation have been reported to receive surgery or endovascular treatment. PATIENT CONCERNS: We report 3 cases and review the relevant literatures. The head examinations of the patients suggested the presence of high-density shadows in front of the pons and midbrain, the dilation of the supraclinoid segment of the right internal carotid artery, and moyamoya in the left brain with an aneurysm-like expansion located on the left posterior communicating artery respectively. After admission, head digital subtraction angiography (DSA) was performed. DIAGNOSES: Digital subtraction angiography (DSA) for these 3 patients showed that the left posterior communicating artery, the supraclinoid segment of the right internal carotid artery, and the left posterior communicating artery appeared dilated, tortuous, and spirally elongated. In addition, the lesions in the latter 2 patients were accompanied with local aneurysmal changes. INTERVENTIONS: Two patients were given conservative treatment, and another patient was given endovascular treatment. A head DSA was reviewed 6 months after therapy. OUTCOMES: The prognosis status of the 3 patients was good. Two patients in the conservative treatment group showed no changes in the lesions on head DSA examination. The DSA examination of the third patient indicated that the vascular remodeling of the diseased vessels was good, the blood vessels were unobstructed, and the aneurysms had disappeared. LESSONS: Pure arterial malformations mostly occur in young women and may involve any blood vessels in the brain. It can be accompanied with local aneurysms and calcification. The patients are often given conservative treatment but need to be reviewed regularly. However, it is beneficial to give endovascular treatment to the patients with local aneurysms.


Assuntos
Aneurisma/diagnóstico por imagem , Angiografia Digital/métodos , Mesencéfalo/diagnóstico por imagem , Doença de Moyamoya/diagnóstico por imagem , Ponte/diagnóstico por imagem , Adolescente , Adulto , Aneurisma/patologia , Aneurisma/terapia , Vasos Sanguíneos/anormalidades , Artéria Carótida Interna/anormalidades , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral/métodos , Criança , Pré-Escolar , Tratamento Conservador/métodos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Lactente , Doenças Arteriais Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Mesencéfalo/irrigação sanguínea , Mesencéfalo/patologia , Pessoa de Meia-Idade , Doença de Moyamoya/terapia , Ponte/irrigação sanguínea , Ponte/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
18.
J Vis Exp ; (159)2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32510491

RESUMO

Carotid cavernous fistula (CCF) is a rare disease caused by abnormal communications between the internal carotid artery (direct fistula) or meningeal branches of the external carotid artery (indirect fistula) and the cavernous sinus (CS). Trauma is the most common cause of CCF. The clinical presentation of CCF is closely related to the venous drainage pattern. Orbital and neuro-ophthalmological symptoms are the most common clinical presentation of CCF with drainage through the superior ophthalmic vein (SOV). Endovascular embolization by arterial or venous approaches is the most common management of CCF. Transvenous embolization using detachable coils and ethylene-vinyl alcohol copolymer (EVOH) is an alternative method for the treatment of CCF. Endovascular embolization offers different options to treat CCF by minimally invasive approach decreasing morbidity and residual fistulas. The purpose of this article is to report our treatment experiences via the inferior petrosal sinus (IPS), and immediate-term outcomes of endovascular embolization of CCF by using detachable coils and EVOH.


Assuntos
Fístula Carotidocavernosa/terapia , Seio Cavernoso/efeitos dos fármacos , Embolização Terapêutica/métodos , Polivinil/farmacologia , Fístula Carotidocavernosa/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Lancet Neurol ; 19(7): 573-581, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32562682

RESUMO

BACKGROUND: In A Randomized trial of Unruptured Brain Arteriovenous malformations (ARUBA), randomisation was halted at a mean follow-up of 33·3 months after a prespecified interim analysis showed that medical management alone was superior to the combination of medical management and interventional therapy in preventing symptomatic stroke or death. We aimed to study whether these differences persisted through 5-years' follow-up. METHODS: ARUBA was a non-blinded, randomised trial done at 39 clinical centres in nine countries. Adults (age ≥18 years) diagnosed with an unruptured brain arteriovenous malformation, who had never undergone interventional therapy, and were considered by participating clinical centres to be suitable for intervention to eradicate the lesion, were eligible for inclusion. Patients were randomly assigned (1:1) by a web-based data collection system, stratified by clinical centre in a random permuted block design with block sizes of two, four, and six, to medical management alone or with interventional therapy (neurosurgery, embolisation, or stereotactic radiotherapy, alone or in any combination, sequence, or number). Although patients and investigators at a given centre were not masked to treatment assignment, investigators at other centres and those in the clinical coordinating centre were not informed of assignment or outcomes at any of the centres. The primary outcome was time to death or symptomatic stroke confirmed by imaging, assessed by a neurologist at each centre not involved in the management of participants' care, and monitored by an independent committee using an adaptive approach with interim analyses. Enrolment began on April 4, 2007, and was halted on April 15, 2013, after which follow-up continued until July 15, 2015. All analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00389181. FINDINGS: Of 1740 patients screened, 226 were randomly assigned to medical management alone (n=110) or medical management plus interventional therapy (n=116). During a mean follow-up of 50·4 months (SD 22·9), the incidence of death or symptomatic stroke was lower with medical management alone (15 of 110, 3·39 per 100 patient-years) than with medical management with interventional therapy (41 of 116, 12·32 per 100 patient-years; hazard ratio 0·31, 95% CI 0·17 to 0·56). Two patients in the medical management group and four in the interventional therapy group (two attributed to intervention) died during follow-up. Adverse events were observed less often in patients allocated to medical management compared with interventional therapy (283 vs 369; 58·97 vs 78·73 per 100 patient-years; risk difference -19·76, 95% CI -30·33 to -9·19). INTERPRETATION: After extended follow-up, ARUBA showed that medical management alone remained superior to interventional therapy for the prevention of death or symptomatic stroke in patients with an unruptured brain arteriovenous malformation. The data concerning the disparity in outcomes should affect standard specialist practice and the information presented to patients. The even longer-term risks and differences between the two therapeutic approaches remains uncertain. FUNDING: National Institute of Neurological Disorders and Stroke for the randomisation phase and Vital Projects Fund for the follow-up phase.


Assuntos
Fístula Arteriovenosa/tratamento farmacológico , Fístula Arteriovenosa/cirurgia , Malformações Arteriovenosas Intracranianas/tratamento farmacológico , Malformações Arteriovenosas Intracranianas/cirurgia , Adulto , Fístula Arteriovenosa/mortalidade , Embolização Terapêutica/métodos , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Radiocirurgia/métodos , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
20.
Clin Imaging ; 66: 139-142, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32485399

RESUMO

Chest tube placement is a commonly performed procedure, but it is not without complication. Our case report discusses a unique complication of chest tube placement with the use of minimally invasive techniques in order to treat it.


Assuntos
Tubos Torácicos , Embolização Terapêutica/métodos , Feminino , Fluoroscopia , Humanos , Masculino
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