Clinical Analysis of Transcatheter Embolotherapy for Congenital Pulmonary Arteriovenous Fistulas in Children

Objective:To summarize the clinical features and therapeutic effects of transcatheter embolotherapy for congenital pulmonary arteriovenous fi stulas(PAVFs)in children,and to explore the method and therapeutic principle of transcatheter embolotherapy for congenital PAVFs in children.Method:We retrospectively reviewed nine patients with PAVF who underwent transcatheter embolotherapy in the Children’s Hospital of Chongqing Medical University from July 2004 to July 2019,including the demographic characteristics,clinical manifestations,effi ciency of closure,and follow-up.Results:Transcatheter embolotherapy was successful in all cases,and the symptom remission rate was 100%during the follow-up.No residual shunts or other complications occurred during the follow-up period.Compared with before embolotherapy,there were signifi cant changes in the percentage of saturated oxyhemoglobin and total hemoglobin level at the last follow-up(t=10.06,P=0.000;t=3.055,P=0.0076).No signifi cant difference was observed in pulmonary artery pressure before and after embolotherapy(t=0.13,P=0.90).Conclusions:Transcatheter embolotherapy offers the advantages of safety,with a decreased risk of trauma and a specifi c effect of treatment,and therefore is recommended as the fi rst-line treatment for congenital PAVFs in children.However,continued research is necessary to understand the full potential of transcatheter embolotherapy.

Systemic Hemodynamic Changes in Low-Dose Ethanol Embolotherapy for Soft-Tissue Arteriovenous Malformations

Background Ethanol embolotherapy is considered an optimal choice for the treatment of arteriovenous malformations(AVMs);however,there are some complications associated with this treatment.This study aimed to prospectively investigate systemic hemodynamic changes in high-flow AVMs using ethanol embolotherapy.Methods From September 2012 to September 2014,34 male patients and 26 female patients with AVMs who underwent embolotherapy(100 sessions in total)with absolute ethanol were included in this study.Invasive systolic blood pressure(SBP)and heart rate(HR)were recorded before and after each injection and throughout the procedure.Differences between the initial and highest SBP(ΔmaxSP)and HR values(ΔmaxHR),as well as the initial and final SBP(ΔSP)and HR(ΔHR)values,were analyzed.We aimed to explore the potential association between these values and the amount of ethanol that was used.Results The total ethanol used was variable(0.01–0.40 mL/kg;mean,0.20 mL/kg).SBP and HR increased after ethanol injection in most sessions(91 in 100 sessions).SBP decreased in 9 sessions(9 in 100 sessions),while HR,oxygen saturation,and end-tidal CO2 decreased in one of the 9 sessions.ΔmaxSP andΔmaxHR averaged 38.4 mmHg and 27.8 bpm,respectively(both P<0.05),whileΔSP andΔHR averaged 3.4 mmHg and 4.0 bpm,respectively(both P<0.05).ΔmaxSP andΔmaxHR were positively correlated with the total dose of ethanol injected.Conclusions Elevations in SBP and HR during ethanol embolotherapy are common,temporary,and most likely pain-mediated;these increases tend to be positively correlated with ethanol dose.Hypotension may be regarded as an acute complication of ethanol embolotherapy.Hypotension combined with bradycardia,oxygen desaturation,and decreased end-tidal CO2 may be a potential predictor of cardiovascular collapse.

Comparison of embolic agents for varices during transjugular intrahepatic portosystemic shunt for variceal bleeding: Tissue gel or coil?

Purpose:We aimed to compare treatment efficacy,safety and material cost between tissue gel and coil regarding variceal embolization during transjugular intrahepatic portosystemic shunt(TIPS).Materials&Methods:This retrospective study including cirrhotic patients with variceal bleeding treated with TIPS combined with variceal embolization between January 2016 and August 2017.Patients were divided into three groups according to embolic agents used in variceal embolization:tissue gel group(Group A),combination group(Group B),and coil group(Group C).The primary endpoint was 1-year rebleeding rate after TIPS creation.The secondary endpoints included shunt dysfunction,overt hepatic encephalopathy,liver function,and embolic agents-related expense.Results:A total of 60 patients(30,10,and 20 in Group A,B,and C)were included.Variceal rebleeding occurred in3(10%),0(0%),and 4(20%)patients within one year after TIPS creation in Group A,B,and C,respectively.Stent dysfunction occurred in 2(3.3%)patients and 9(15.0%)patients experienced overt hepatic encephalopathy.No significant differences were observed between three groups regarding primary and secondary endpoints except embolic agents-related expense,with a significantly lower cost in Group A when compared to the other two groups.Stent dysfunction occurred in two patients,with one patient in Group A developed acute occlusion caused by thrombus and another patient in Group C underwent stent stenosis during follow-up.Conclusions:Compares to coil alone or combines with coil,tissue gel has similar treatment efficacy and safety,but with significantly lower cost for variceal bleeding during TIPS.

Spontaneous rupture of liver metastasis tumors with disturbance of consciousness and progression of hemiplegia as the first manifestation:a case report

Objective:rupture of liver metasta-ses with disturbance of consciousness accompanied by aggravation of hemiplegia is very rare.We describe the clinical features of a case of spontaneous rupture of liver metastasis tumors with disturbance of consciousness and progression of right limb hemiplegia.Methods:collect the patient's medical history,conduct a detailed physi-cal examination,timely improve the relevant laboratory and imaging examination,formulate a comprehensive treatment plan,and track the changes of the disease and the treatment effect.Results:the patient presented with blurred consciousness,hemiplegia of the right limb,and epigastric tenderness when admitted to the hospital.No evident new lesions were found on cranial computed to-mography(CT).Blood routine examination showed that hemoglobin decreased significantly compared with be-fore.Abdominal CT showed tumor rupture and bleeding.The patient in critical condition did not have operation conditions,but improved after conservative treatment.Conclusion:when patients with liver metastasis tumors suddenly have a disturbance of consciousness and prog-ress of hemiplegia,they should not only be considered to have acute cerebrovascular diseases,but also the possi-bility of rupture of liver metastasis tumors.If only treated according to acute stroke,it will endanger their lives.For the liver metastasis tumor rupture,if there is no oppor-tunity for embolotherapy,timely conservative treatment with drugs can also achieve good results.

Diagnosis and treatment of epistaxis caused by non-traumatic pseudoaneurysms of carotid artery

Epistaxis remains one of the most common otolaryngology emergencies. Severe epistaxis may be caused by internal carotid artery （ICA） pseudoaneurysm or cavernous fistula, which is clinically rare but life threatening if it is not diagnosed and treated timely. Most ICA pseudoaneurysms are mainly caused by trauma with few other causes. From January 1998 to December 2005, a total of 8 cases with non-traumatic carotid artery pseudoaneurysm were correctly diagnosed through digital subtraction angiography （DSA） in Ganzhou People＇s Hospital. The patients had suffered from serious nose bleeding repeatedly and had been resistant to routine treatments.