Transanal eco-Doppler evaluation after hemorrhoidal artery embolization

BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes.

Comparative study between Embosphere®and Marine gel®as embolic agents for chemoembolization of hepatocellular carcinoma

BACKGROUND While gelatin sponge particles and calibrated microspheres are commonly used as embolic materials in conventional transarterial chemoembolization(cTACE),direct comparisons between these embolic agents are rare.AIM To compare the efficacy and safety of superselective cTACE using Embosphere®or Marine gel®in patients with early-stage hepatocellular carcinoma(HCC).METHODS This retrospective study included 70 patients with small(<4 cm)HCC who underwent cTACE with Embosphere®(n=33)or Marine gel®(n=37)as the embolic agent at a single center between March 2021 and July 2022.The radiologic images and clinical data were retrospectively reviewed,with an emphasis on tumor response,procedure-related complications,and local tumor recurrence.The primary index tumor was assessed on a 1-mo follow-up image,and local progression-free survival was obtained using the Kaplan-Meier method and was compared by the log-rank test.RESULTS The median tumor size of both groups was 1.5 cm,and 69 patients achieved a complete response one month after cTACE.The cumulative local recurrence rate at 12 mo was 15.5%in the Embosphere®group and 14.4%in the Marine gel®group.The local progression-free survival was not significantly different between the two groups(P=0.83).In the multivariate analysis,high serum alphafetoprotein was the only significant poor prognostic factor for local tumor progression(P=0.01).Postembolization syndrome occurred in 36.4%of the Embosphere®group and 35.1%of the Marine gel®group,and there were no cases of biloma,biliary duct dilation,or liver abscess in either group.CONCLUSION Calibrated gelatin sponge particles(Marine gel®)and calibrated microspheres(Embosphere®)have similar outcomes in terms of tumor response for superselective cTACE of small HCC.

Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment:A prospective study

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation between ovarian function,fertility indicators,and the type or amount of embolic agent used or the change in fibroids posttreatment.CONCLUSION UAE resulted in significantly positive pregnancy outcomes,no adverse events post-treatment,and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

Does hemorrhoidal artery embolization really benefit patients with hemorrhoids?

This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology.Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment,but inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications.In this article,the most appropriate candidate patients,embolization materials,embolization methods,and clinical evaluation methods are discussed to improve the safety and effectiveness of the procedure.

Pyomyoma as a Complication of Uterine Artery Embolization (A Case Report)

Pyomoyoma is a rare complication of Uterine Artery Embolization (UAE). This case report reflects on this condition. A 45-year-old female, a known case of adenomyosis, presented with intermittent fever and foul vaginal discharge. These symptoms occurred shortly after the patient underwent UAE for menorrhagia secondary to adenomyosis. Computed tomography scan of the abdomen and pelvis aided in the diagnosis of Pyomyoma secondary to UAE. After a trial of broad spectrum antibiotics and Suction and Evacuation of the uterus had little to no help in the patient’s condition, she underwent Total Abdominal Hysterectomy in which a big, organized pus collection was removed from the uterus. Conclusion: Pyomyoma should be considered in the differentials for patients presenting with fever and vaginal discharge post UAE.

Spontaneous Paravesical and Broad Ligament Hematoma after Vaginal Delivery Had Uterine Artery Embolization after Evacuating the Hematoma

Broad ligament hematoma is typically seen during cesarean section due to rupture of branches of uterine and vaginal vessels and it’s rare to be seen post-normal vaginal delivery. Addressing puerperal hematomas postpartum presents considerable challenges for obstetric care providers. While hematomas such as those affecting the vulva, vulvovaginal region, or paravaginal area are frequently encountered, retroperitoneal hematomas are rare and notably pose a greater risk to the life of the patient. The medical literature contains scant case reports on retroperitoneal hematomas, with no consensus on a definitive treatment approach. Pelvic arterial embolization has emerged as both a sensible and increasingly preferred method for treating these hematomas recently, but its application is contingent upon the patient maintaining hemodynamic stability and the availability of a specialized interventional embolization unit. In our case, we are presenting a very rare case of a 31-year-old primigravida female with a history of in vitro fertilization pregnancy. She delivered a normal vaginal delivery at 31 weeks gestation. Unfortunately, she experienced multiple complications intrapartum, including preeclampsia and placental abruption. These complications increased her risk of developing a broad ligament hematoma.

Influence of transcatheter arterial embolization on symptom distress and fatigue in liver cancer patients

BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy,and transcatheter arterial embolization(TAE)has emerged as a pivotal therapeutic modality.How-ever,TAE may induce symptom distress and fatigue,adversely affecting the quality of life of patients.AIM To investigate symptom distress,fatigue,and associated factors in HCC patients undergoing TAE.METHODS We used a cross-sectional design and purposive sampling to enroll HCC patients who underwent TAE at our institution from January to December 2022.Question-naires were utilized to collect data on symptom distress and fatigue scores from the first to the third day after TAE.RESULTS Our study revealed a significant reduction in fatigue and symptom distress among patients after TAE.Pain,fatigue,insomnia,fever and abdominal dis-tension were the most common symptoms troubling patients during the first 3 d post-TAE.Marital status,presence of family support,physical functional status,age,and symptom distress were identified as predictors of fatigue in patients.CONCLUSION Healthcare professionals should educate HCC patients on symptom distress and INTRODUCTION Hepatocellular carcinoma(HCC)ranks as the fifth most prevalent cancer and the third leading cause of cancer-related mortality globally.Surgical intervention remains the cornerstone of HCC treatment;however,due to the challenges associated with early diagnosis and the lack of specific diagnostic markers,a considerable proportion of patients are diagnosed at advanced stages,rendering them ineligible for surgical interventions.Transcatheter arterial embolization(TAE)is an interventional therapeutic approach involving the insertion of a fine catheter via the femoral artery to reach the vasculature near the tumor site.TAE aims to obstruct the arterial supply to the tumor by deploying embolic agents,thereby inducing necrosis in cancer cells.This procedure is suitable for patients with good liver function and overall health,particularly those with large HCCs that have not invaded the portal vein[1,2].Nonetheless,following TAE,hepatocytes incur variable degrees of damage,leading to the development of a constel-lation of symptoms reminiscent of acute hepatitis.These symptoms include fatigue and systemic discomfort,such as nausea,vomiting,fever,abdominal pain,as well as transient elevations in aspartate aminotransferase(AST)and alanine aminotransferase(ALT),collectively referred to as postembolization syndrome[3,4].These symptoms may arise due to ischemia of the liver and gallbladder,temporary liver enlargement,and peritoneal irritation.While many studies have explored fatigue and symptom distress in cancer patients both nationally and internationally,with some focusing on symptom distress following transcatheter arterial chemoembolization,there has been limited in-depth investigation into the fatigue and symptom distress resulting from TAE treatment[5-8].Fatigue and pain are both subjective experiences,typically arising from the gradual depletion of energy reserves during the course of illness[9].Fatigue is particularly prevalent among cancer patients,with rates soaring as high as 90%.Despite extensive research exploring cancer-related fatigue and its influencing factors,a unanimous consensus remains elusive.Hence,the primary objective of this study was to investigate the symptom distress and fatigue experienced by liver cancer patients following TAE treatment and to analyze potential contributing factors.

Will partial splenic embolization followed by splenectomy increase intraoperative bleeding?

BACKGROUND Partial splenic embolization(PSE)has been suggested as an alternative to splenectomy in the treatment of hypersplenism.However,some patients may experience recurrence of hypersplenism after PSE and require splenectomy.Currently,there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications.AIM To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.METHODS Between January 2010 and December 2021,321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department.Based on whether PSE was performed prior to splenectomy,the patients were divided into two groups:PSE group(n=40)and non-PSE group(n=281).Patient characteristics,postoperative complications,and follow-up data were compared between groups.Propensity score matching(PSM)was conducted,and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding(IB).The receiver operating characteristic curve,Hosmer-Lemeshow goodness-of-fit test,and decision curve analysis(DCA)were employed to evaluate the differentiation,calibration,and clinical performance of the model.RESULTS After PSM,the non-PSE group showed significant reductions in hospital stay,intraoperative blood loss,and operation time(all P=0.00).Multivariate analysis revealed that spleen length,portal vein diameter,splenic vein diameter,and history of PSE were independent predictive factors for IB.A nomogram predictive model of IB was constructed,and DCA demonstrated the clinical utility of this model.Both groups exhibited similar results in terms of overall survival during the follow-up period.CONCLUSION Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.

Safety and efficacy of transcatheter arterial embolization in autosomal dominant polycystic kidney patients with gross hematuria: Six case reports

BACKGROUND To retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating autosomal dominant polycystic kidney disease(ADPKD)patients with gross hematuria.CASE SUMMARY The purpose of this study is to retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating ADPKD patients with gross hematuria.Materials and methods:During the period from January 2018 to December 2019,renal transcatheter arterial embolization was carried out on 6 patients with polycystic kidneys and gross hematuria.Renal arteriography was performed first,and then we determined the location of the hemorrhage and performed embolization under digital subtraction angiography monitoring.Improvements in routine blood test results,routine urine test results,urine color and postoperative reactions were observed and analyzed.Results:Renal transcatheter arterial embolization was successfully conducted in 6 patients.The indices of 5 patients and the color of gross hematuria improved after surgery compared with before surgery.No severe complication reactions occurred.CONCLUSION For autosomal dominant polycystic kidney syndrome patients with gross hematuria,transcatheter arterial embolization was safe and effective.

Anorectal hemangioma, a rare cause of lower gastrointestinal bleeding, treated with selective embolization: A case report

BACKGROUND Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal(GI)bleeding.Here,we present a minimally invasive therapy with selective embolization.CASE SUMMARY A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis.Diagnostic studies later revealed specific characteristics for vascular lesions-anorectal hemangiomas.The severity of rectal bleeding caused symptomatic anemia and possible surgical treatment was asso-ciated with a high risk of fecal incontinence.Here,we present selective emboli-zation,a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice.The patient significantly improved temporarily and had a small ischemic ulcer,which healed with a control colonoscopy and deve-loped no stenosis.CONCLUSION Awareness of the clinical and radiological features of GI hemangiomas may help improve diagnostics and avoid inappropriate therapeutic procedures.

Successful splenic artery embolization in a patient with Behçet’s syndrome-associated splenic rupture:A case report

BACKGROUND Splenic rupture associated with Behçet’s syndrome(BS)is extremely rare,and there is no consensus on its management.In this case report,a patient with BSassociated splenic rupture was successfully treated with splenic artery embolization(SAE)and had a good prognosis after the intervention.CASE SUMMARY The patient was admitted for pain in the left upper abdominal quadrant.He was diagnosed with splenic rupture.Multiple oral and genital aphthous ulcers were observed,and acne scars were found on his back.He had a 2-year history of BS diagnosis,with symptoms of oral and genital ulcers.At that time,he was treated with oral corticosteroids for 1 month,but the symptoms did not alleviate.He underwent SAE to treat the rupture.On the first day after SAE,the patient reported a complete resolution of abdominal pain and was discharged 5 d later.Three months after the intervention,a computed tomography examination showed that the splenic hematoma had formed a stable cystic effusion,suggesting a good prognosis.CONCLUSION SAE might be a good choice for BS-associated splenic rupture based on good surgical practice and material selection.

Intentionally unilateral prostatic artery embolization:Patient selection,technique and potential benefits

BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries(PAs)and with the systematic attempts to catheterize the PAs of both pelvic sides.Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE.The authors hypothesized that,in selected patients,these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.AIM To describe the authors’approach for intentionally unilateral PAE(IU-PAE)and its potential benefits.METHODS This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years.IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA(subgroup A),or with markedly asymmetric prostatic enlargement,with the dominant prostatic lobe occupying at least two thirds of the entire gland(subgroup B).All patients treated with IU-PAE also fulfilled at least one of the following criteria:Severe tortuosity or severe atheromatosis of the pelvic arteries,non-visualization,or visualization of a tiny(<1 mm)contralateral PA on preprocedural computed tomographic angiography.Intraprocedural contrast-enhanced ultrasonography(iCEUS)was applied to monitor prostatic infarction.IU-PAE patients were compared to a control group treated with bilateral PAE.RESULTS IU-PAE was performed in a total 13 patients(subgroup A,n=7;subgroup B,n=6).Dose-area product,fluoroscopy time and operation time in the IU-PAE group(9767.8μGy∙m^(2),30.3 minutes,64.0 minutes,respectively)were significantly shorter(45.4%,35.9%,45.8%respectively,P<0.01)compared to the control group.Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group.In the 2 clinical failures of IU-PAE(both in subgroup A),the extent of prostatic infarction(demonstrated by iCEUS)was significantly smaller compared to the rest of the IU-PAE group.CONCLUSION In selected patients,IU-PAE is associated with comparable outcomes,but with lower radiation exposure and a shorter procedure compared to bilateral PAE.iCEUS could facilitate patient selection for IU-PAE.

Transarterial embolization is an acceptable bridging therapy to hepatocellular carcinoma prior to liver transplantation

BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still have to wait for long periods.Locoregional therapies(LRTs)are employed as bridging therapies in patients with HCC awaiting LT.Although largely used in the past,transarterial embolization(TAE)has been replaced by transarterial chemoembolization(TACE).However,the superiority of TACE over TAE has not been consistently shown in the literature.AIM To compare the outcomes of TACE and TAE in patients with HCC awaiting LT.METHODS All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included.All patients underwent LRT with either TACE or TAE.Some patients also underwent percutaneous ethanol injection(PEI),concom-itantly or in different treatment sessions.The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus.The primary outcome was waitlist dropout due to tumor progression,and the secondary outcome was the occurrence of adverse events.In the subset of patients who underwent LT,complete pathological response and post-transplant recurrence-free survival were also assessed.RESULTS Twelve(18.5%)patients in the TACE group(only TACE and TACE+PEI;n=65)and 3(7.9%)patients in the TAE group(only TAE and TAE+PEI;n=38)dropped out of the waitlist due to tumor progression(P log-rank test=0.29).Adverse events occurred in 8(12.3%)and 2(5.3%)patients in the TACE and TAE groups,respectively(P=0.316).Forty-eight(73.8%)of the 65 patients in the TACE group and 29(76.3%)of the 38 patients in the TAE group underwent LT(P=0.818).Among these patients,complete pathological response was detected in 7(14.6%)and 9(31%)patients in the TACE and TAE groups,respectively(P=0.145).Post-LT,HCC recurred in 9(18.8%)and 4(13.8%)patients in the TACE and TAE groups,respectively(P=0.756).Posttransplant recurrence-free survival was similar between the groups(P log-rank test=0.71).CONCLUSION Dropout rates and posttransplant recurrence-free survival of TAE were similar to those of TACE in patients with HCC.Our study reinforces the hypothesis that TACE is not superior to TAE as a bridging therapy to LT in patients with HCC.

Safety and Effectiveness of Stent-Assisted Coil Embolization for Ruptured Intracranial Aneurysm

Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence of a sac necessitate a more stringent and rigorous management approach. Objective: The primary aim of this study is to delve into the morphological features of ruptured aneurysms situated in distinct regions of the brain. Furthermore, we endeavor to assess the degree of safety and efficacy associated with stent-assisted embolization as a treatment modality for these ruptured aneurysms. Methods: This retrospective study encompassed a cohort of 467 patients who presented with intracranial ruptured aneurysms and were diagnosed through a combination of computed tomography (CT) and digital subtraction angiography (DSA) at Nanfang Hospital of Southern Medical University, spanning from January 2009 to December 2019. The following clinical parameters were meticulously recorded: aneurysm height, width, neck measurements, immediate Raymond grade assessments, and any perioperative complications experienced. Results: Within the study population, the average dimensions of ruptured aneurysms were found to be 4.26 ± 2.10 mm (width), 4.86 ± 2.38 mm (height), and 4.04 ± 1.87 mm (neck). Categorically, the most prevalent types of aneurysms were 170 cases of anterior communicating artery aneurysms (accounting for 36.4%), followed by 161 cases of posterior communicating artery aneurysms (34.5%), 56 cases of middle cerebral artery aneurysms (12.0%), 13 cases of anterior cerebral artery aneurysms (2.8%), 45 cases of paraclinoid aneurysms (9.6%), 6 cases of superior pituitary artery aneurysms (1.3%), 7 cases of anterior choroidal artery aneurysms (1.5%), and 9 cases of vertebrobasilar artery aneurysms (2.0%). Notably, 18 patients (3.9%) presented with ruptured aneurysms coexisting with ascus. Regarding treatment approaches, 228 cases (48.8%) underwent stent-assisted embolization, 234 cases (50.1%) received coils embolization, and 5 cases (1.1%) were treated with the dual-catheter technique. Immediately post-treatment, 422 patients (90.4%) attained a Raymond Class I status, with a procedure-related complication rate of 0.9%. Importantly, no statistically significant differences were observed in the incidence of perioperative complications across the three distinct treatment groups (P = 0.505). Conclusion: The outcomes of this study affirm the safety and efficacy of stent-assisted embolization as a treatment modality for ruptured aneurysms.

Advances in Research of Post Embolism Syndrome after Transarterial Chemoembolization(TACE)for Hepatocellular Carcinoma

This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expected to reduce its incidence and degree in clinical treatment,and to improve the quality of treatment of Hepatocellular Carcinoma Carcinoma(HCC).

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon:An institutional cohort long-term study

BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons,coils,liquid embolic agents,covered stents,or flow-diverter stent through arterial or venous approaches.Despite the withdrawal of detachable balloons from the market in the United States since 2004,transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries.However,the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up.AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF.METHODS Between January 2009 and December 2019,79 patients diagnosed with TCCF were treated using detachable latex balloons(GOLDBAL)of four sizes.Pseudoaneurysm sizes were stratified into five grades for analysis.Initial and follow-up assessments involved computed tomography angiography at 1 month,6 month,1 year,and longer intervals for significant cases.Clinical follow-ups occurred semi-annually for 2 years,then annually.Factors analyzed included sex,age,fistula size and location,and balloon size.RESULTS In our cohort of 79 patients treated for TCCF,pseudoaneurysms formed in 67.1%,with classifications ranging from grade 0 to grade 3;no grade 4 or giant pseudoaneurysms were observed.The majority of pseudoaneurysms did not progress in size,and some regressed spontaneously.Calcifications developed in most large pseudoaneurysms over 5-10 years.Parent artery occlusion occurred in 7.6%and recurrent fistulas in 16.5%.The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes,with balloon SP and No.6 significantly associated with its occurrence(P=0.005 and P=0.002,respectively),whereas sex,age,fistula size,location,and the number of balloons used were not significant predictors.CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common,primarily influenced by the size of the balloon used.Despite this,all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.

Arterial Embolization: A Superior Treatment for Massive Urinary Tract Bleeding in Emergency Care

Objective:To analyze the effect of arterial embolism(AE)in patients with massive urinary system bleeding(MBUS).Methods:From September 2018 to September 2023,175 cases of MBUS patients in the emergency department of the hospital were randomly selected and divided into groups according to the length of stay.Among them,85 cases(September 2018–September 2020)underwent bladder irrigation treatment with aluminum potassium sulfate solution through a catheter(Group A),and 90 cases(October 2020–September 2023)underwent AE treatment(Group B).The treatment effects of the two groups were compared.Results:The treatment effectiveness of Group B is higher than that of Group A(P<0.05).The urinary hemoglobin level of Group B is lower than that of Group A at 1,6,12,and 24 hours after treatment(P<0.05).Among the 90 cases treated with AE,7 cases had a fever,with body temperatures ranging from 37.3°C to 38.9℃,with a mean temperature of 38.2±0.3℃.Four cases experienced local pain,nausea,and vomiting,while two cases of intra-iliac AE showed transient buttock pain.These patients with adverse reactions were treated symptomatically for 7 days.All patients recovered after treatment.Intravenous urography of 87 patients in June showed that the renal pelvis and calyces were in good condition,the renal function returned to normal,and the blood urea nitrogen and blood creatinine test results were within the normal range.After 1 year of follow-up,no hypertension occurred.Conclusion:AE treats MBUS patients in the emergency department with remarkable efficacy.It has the advantages of less damage to the body,rapid hemostasis,high safety,and maximum preservation of organ function.

Simultaneous portal and hepatic vein embolization is better than portal embolization or ALPPS for hypertrophy of future liver remnant before major hepatectomy: A systematic review and network meta-analysis

Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful hypertrophy.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of PVE.Liver venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to ALPPS.The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative techniques.Data sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and Cochrane.Results:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,respectively.Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts.There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD cohort.Notably,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE cohorts.Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort.The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.Conclusions:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy.Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.

Efficacy of patient-controlled hydromorphone analgesia in those undergoing uterine fibroid artery embolization via the right radial artery

Objective: To evaluate the efficacy and safety of patient-controlled analgesia(PCA) with hydromorphone as perioperative analgesia during uterine artery embolization(UAE) via the right radial artery.Patients and methods: A total of 33 patients with uterine fibroids, who underwent UAE at the authors’ hospital between June 2021 and March 2022, were selected. Hydromorphone(10 mg) was dispensed into a 100 ml PCA pump with normal saline. Pump administration was initiated 15 min before the start of the procedure, and the intraoperative dose was adjusted according to patient pain level. A numerical rating scale was used to evaluate pain immediately after embolization, 5 min after embolization, at the end of the procedure, and 6, 12, 24, 48, and 72 h after the procedure. Side effects were also observed.Results: Thirty-three patients underwent uterine artery embolization via the right radial artery. Patient pain was well controlled at all time points surveyed, and patients reported satisfaction with analgesia. The median length of hospital stay was 5 days. There were 7 cases of adverse reactions, but no serious side effects were observed.Conclusion: Patients reported positive experiences with arterial embolization of uterine fibroids via the right radial artery. Hydromorphone PCA effectively controlled pain. The PCA pump is easy to operate, has a low incidence of adverse reactions, and offers economic benefits at the patient and institutional levels.

Embolization of brain arteriovenous malformations with squid co-polymer embolic material:Initial experience

Objective:To analyze the safety and effectiveness of the ethylene-vinyl alcohol copolymer(EVOH)liquid embolic agent Squid(Emboflu,Switzerland)for the treatment of brain arteriovenous malformations.Materials and procedures:Between April 2015 and July 2017,46 embolization treatments for brain arteriovenous malformations(BAVM)were performed in 25 patients using two Squid formulations(18 and 12).Six female and 19 male patients with a mean age of 34 years(range,9–62 years)were included.A total of 46 procedures were performed.The BAVMs were classified as Spetzler-Martin gradeⅡin 4 procedures,Ⅲin 27 procedures,and 1V in 15 procedures.Among the 25 patients,15 presented with hemorrhage,5 with seizures,and 5 with headache and neurology.The BAVMs were located in the temporal lobe in 5 patients,parietal lobe in 7 patients,frontal lobe in 3 patients,posterior fossa in 6 patients,basal ganglia in 3 patients,and parasagittal lobe in 1 patient.Results:The obliteration rate of the BAVMs ranged from 10%to 100%,with a mean of 33%.Most patients underwent their first or second embolization procedure.Four patients(8%)developed intracranial bleeding post procedure,with one death(2%).One patient(2%)experienced a seizure during the procedure;however,no intracranial bleeding was observed.Seven patients(15%)experienced perforations during catheter manipulation.One case(2%)of fractured catheter was recorded,but no significant complications were observed.The average volume of copolymer injected was 0.6 ml per nidus.Thirteen procedures used the Squid-12 formulation,29 procedures used the Squid-18 formulation,and 3 procedures used a combination of Squid-12 and-18 formulations.Conclusion:Squid is a safe and effective embolic agent for treating BAVMs.