Role of interventional radiology in the management of acute gastrointestinal bleeding

Acute gastrointestinal bleeding(GIB) can lead to significant morbidity and mortality without appropriate treatment. There are numerous causes of acute GIB including but not limited to infection, vascular anomalies, inflammatory diseases, trauma, and malignancy. The diagnostic and therapeutic approach of GIB depends on its location, severity, and etiology. The role of interventional radiology becomes vital in patients whose GIB remains resistant to medical and endoscopic treatment. Radiology offers diagnostic imaging studies and endovascular therapeutic interventions that can be performed promptly and effectively with successful outcomes. Computed tomography angiography and nuclear scintigraphy can localize the source of bleeding and provide essential information for the interventional radiologist to guide therapeutic management with endovascular angiography and transcatheter embolization. This review article provides insight into the essential role of Interventional Radiology in the management of acute GIB.

Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology

Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient's work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.

Interventional treatment of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations(PAVM) are congenital vascular communications in the lungs.They act as right to left shunts so that the blood running through these malformations is not oxygenated or filtered.These patients are typically hypoxaemic with exercise intolerance and are at high risk of paradoxical emboli to the brain and other organs.These malformations are most commonly seen in hereditary haemorrhagic telangiectasia(HHT)(Mb.Osler-Weber-Rendu syndrome).Nowadays,the generally accepted treatment strategy of first choice is embolization of the afferent arteries to the arteriovenous malformations.It is a minimally invasive procedure and at the same time a lung preserving treatment with a very high technical success,high effectiveness and low morbidity and mortality.Embolization prevents cerebral stroke and abscess as well as pulmonary haemorrhage and further raises the functional level.Embolization is a well-established method of treating PAVM,with a significant effect on oxygenation of the blood.Screening for PAVM in patients at risk is recommended,especially in patients with HHT.

Uterine artery embolization in association with methotrexate infusion for the treatment of tubal ectopic pregnancy

Objective To investigate the safety, feasibility, and effectiveness of uterine artery embolization in association with methotrexate(MTX) infusion for the treatment of tubal ectopic pregnancy. Methods Fifty-one patients with tubal ectopic pregnancy were referred for interventional management. All patients received super-selective arteriography of the uterine artery, were infused with 50–100 mg methotrexate(MTX) through a catheter, and underwent embolization of the uterine artery with a gel-foam pledge. Clinical presentation, findings of physical examination, β-HCG values, and the size of the ectopic mass were documented for comparison. The concentration of MTX in blood was evaluated at 0.5, 6, 12, 24, 36, and 48 hours after the procedure. Results Forty-seven out of the 51 patients had clinical resolution of their tubal pregnancy(92.2%). The average time for the β-HCG value to decrease and come back to normal was 9.16 ± 2.54 days(mean +/-SD). MTX levels in peripheral blood could not be detected for patients who received 50 or 75 mg MTX at 36 hours after the procedure, while the MTX level was 0.01 μmol/L at 48 hours after the procedure for patients who received 100 mg. Out of the 4 cases whose ectopic mass size was ≥5 cm, 3 failed to respond to the treatment; however, those whose ectopic mass size was ≤5 cm responded positively to the treatment, regardless of the β-HCG concentration and abdominal bleeding, except for 1 patient who had to undergo laparoscopy for severe abdominal pain and who showed a reduction in her β-HCG level. Conclusion Uterine artery embolization in association with methotrexate infusion is safe and effective in the treatment of tubal ectopic pregnancy, especially for those women with mild to moderate bleeding, or for those at risk of a major hemorrhage. The selection criterion of mass size >5 cm should, therefore, be carefully considered.

Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage: A case report

We present a 69-year-old woman with a duodenal obstruction after successful selective transcatheter arterial embolization (TAE) for a duodenal diverticular hemorrhage. Two weeks after TAE, the patient showed abrupt symptoms of duodenal obstruction. Resolving hematomas after successful selective transcatheter arterial embolization should be thoroughly observed because they might result in duodenal fibrotic encasement featuring inflammatory duodenal wall thickening, duodenal deformity, dysmotility, and fi nally obstruction.

Minimally invasive image-guided therapy of primary and metastatic pancreatic cancer

Pancreatic cancer is a challenging malignancy with limited treatment options and poor life expectancy.The only curative option is surgical resection,but only 15%-20%of patients are resectable at presentation because more than 50%of patients has distant metastasis at diagnosis and the rest of them has locally advanced pancreatic cancer(LAPC).The standard of care first line treatment for LAPC patients is chemotherapy with or without radiation therapy.Recent developments in minimally invasive ablative techniques may add to the treatment armamentarium of LAPC.There are increasing number of studies evaluating these novel ablative techniques,including radiofrequency ablation,microwave ablation,cryoablation and irreversible electroporation.Most studies which included pancreatic tumor ablation,demonstrated improved overall survival in LAPC patients.However,the exact protocols are yet to set up to which stage of the treatment algorithm ablative techniques can be added and in what kind of treatment combinations.Patients with metastatic pancreatic cancer has dismal prognosis with 5-year survival is only 3%.The most common metastatic site is the liver as 90%of pancreatic cancer patients develop liver metastasis.Chemotherapy is the primary treatment option for patients with metastatic pancreatic cancer.However,when the tumor is not responding to chemotherapy or severe drug toxicity develops,locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease progression and improve survival in selected patients.During the last decade new therapeutic options arose with the advancement of minimally invasive technologies to treat pancreatic cancer patients.These new therapies have been a topic of increasing interest due to the severe prognostic implications of locally advanced and metastatic pancreatic cancer and the low comorbid risk of these procedures.This review summarizes new ablative options for patients with LAPC and percutaneous liver-directed therapies for patients with liver-dominant metastatic disease.

Early- and intermediate-term outcome of transarterial embolization for symptomatic hepatic focal nodular hyperplasia

Purpose: To evaluate the early-and intermediate-term outcome in patients with symptomatic hepatic focal nodular hyperplasia(FNH) treated with transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol(PVA) particles. Materials and methods: In this two-center retrospective study between January 2005 and December 2013, 27 consecutive patients with symptomatic hepatic FNH underwent superselective catheterization by microcatheter techniques and embolization using bleomycin-iodinated oil combined with PVA. Early-term(3–41 months) follow-up of TAE was performed in terms of symptom control, changes in lesion size, and complications. Intermediate-term(45–112 months) follow-up was carried out to assess symptom control and reinterventions for recurrence. Results: Embolization was performed in 27 patients with 31 lesions. Technical success was achieved in all cases. The follow-up period ranged from three to 112 months. At early-term follow-up, mean lesion diameters were decreased significantly from 6.4±2.7 cm pre-intervention to 3.6±1.8 cm at 3-9 months after embolization(P<0.001). A total of 7 lesions had complete resolution during the whole follow-up period. At intermediate-term follow-up, local recurrence was found in 1 treated lesion at 54-months. Contrast-enhanced scans showed complete lack of residual arterial blood supply in the majority of lesions during the follow-up period. There was no major complication associated with the procedure. Conclusion: Transarterial embolization using bleomycin-iodinated oil and PVA is a feasible, safe and effective alternative in both early-and intermediate-terms for the treatment of symptomatic hepatic FNH.

双腔微球囊导管在血管介入治疗中的应用

管径在3F以下的双腔微球囊导管可经迂曲、细小或解剖结构复杂的血管引入至靶病变,临时阻断血流以改变局部血流力学,或辅助实施液体栓塞剂或弹簧圈栓塞术,以提高介入治疗的临床效果和安全性。本文描述了最新双腔微球囊导管的产品结构,着重讨论微球囊阻断下经动脉栓塞术在肝癌介入治疗中的临床应用,评价微球囊辅助下液体栓塞术治疗富血供病变和血管性疾病,以及微球囊辅助下弹簧圈栓塞术治疗内脏动脉瘤的临床价值,介绍双腔微球囊导管在球囊阻断逆行经静脉闭塞术治疗胃静脉曲张中的特殊应用,评估微球囊阻断技术提高前列腺动脉栓塞术安全性的应用前景。

Percutaneous transsplenic embolization of esophageal and gastrio-fundal varices in 18 patients

AIM: Clinical application and potential complication of percutaneous transsplenic varices embolization (PTSVE) of esophageal or gastrio-fundal varices in patients with hepatocellular carcinoma (HCC) complicated with portal vein cancerous thrombosis (PVCT).METHODS: 18 patients with HCC complicated with PVCT and esophageal or gastrio-fundal varices who underwent PTSVE were collected. The rate of success, complication, mortality of the procedure and postoperative complication were recorded and analyzed.RESULTS: PTSVE were successfully performed in 16 of 18cases, and the rate of success was 89%. After therapy erythrocyte counts decreased in all of the natunts. 5 of patients needed blood transfusion, 2 patients requiredsurgical intervention because of and 11 patients with ascites were alleviated by diuresis. Among these 18patients, the procedure-related mortality was 11% (2/18),one died of acute hepatic failure on the forth day after procedure, another died of acute renal failure on the fifth day. The patients were follow up for 112 mon exceptone. 13of them died of their tumors but none of them experienced variceal bleeding.CONCLUSION: PTSVE is a relatively safe and effective method to treat esophageal or gastrio-fundal varices in HCCpatients with PVCT when percutaneous transhepatic varices embolization (PTHVE) of varices is impossible.

临床模型预测经导管动脉栓塞治疗急性非静脉曲张性上消化道出血术后30天内再出血

目的 根据急性非静脉曲张性上消化道出血(ANVUGIB)患者临床资料建立logistic模型,观察其预测经导管动脉栓塞(TAE)治疗后30天内再出血的价值。方法 纳入139例接受TAE的ANVUGIB患者,记录TAE成功率及术后30天内再出血率;基于临床资料行单因素及多因素分析,筛选再出血的影响因素,建立临床logistic模型,分析其预测TAE后再出血的价值。结果 TAE技术成功率为95.68%(133/139)。对133例TAE技术成功患者随访30天,其中29例再出血,再出血率21.80%(29/133)。术前凝血功能障碍(OR=3.74,P=0.045)及术前高Rockall评分(OR=1.97,P=0.005)为TAE治疗ANVUGIB后30天内再出血的危险因素,男性(OR=0.19,P=0.007)及术前CT阳性(OR=0.06,P=0.047)为其保护因素。基于上述4个因素建立的logistic模型预测ANVUGIB患者TAE后30天内再出血的敏感度和特异度分别为82.80%和75.00%,曲线下面积为0.817,高于Rockall评分、Blatchford评分及澳洲医药科学家协会65评分(P均<0.05)。结论 基于性别、术前凝血功能障碍情况、Rockall评分及CT表现建立的临床模型有助于预测TAE治疗ANVUGIB后30天内再出血。

125I粒子条-门静脉支架联合经皮经肝曲张静脉栓塞预防肝细胞癌合并门静脉主干癌栓患者上消化道再出血

目的 观察125I粒子条-门静脉支架联合经皮经肝曲张静脉栓塞(PTVE)预防肝细胞癌(HCC)合并门静脉主干癌栓(MPVTT)患者上消化道再出血的效果。方法 回顾性分析16例接受125I粒子条-门静脉支架植入联合PTVE治疗的原发性HCC伴MPVTT患者,统计治疗后随访期间上消化道再出血、支架通畅性和生存时间。结果 16例均成功接受125I粒子条-门静脉支架植入联合PTVE,未见严重治疗相关不良事件。随访15~1 620天,中位随访时间207天;期间10例发生上消化道再出血(其中4例死亡),中位再出血时间为185天,治疗后1、3、6及12个月累积无上消化道再出血率分别为87.50%、68.18%、53.03%及26.51%;5例门静脉支架闭塞,11例支架均通畅,中位支架通畅时间为252天,治疗后1、3、6及12个月累积支架通畅率分别为100%、93.33%、84.00%及31.50%。共14例死亡,中位生存时间为210天,治疗后1、3、6及12个月累积总体生存率分别为93.75%、74.04%、60.58%及13.46%。结论125I粒子条-门静脉支架联合PTVE对预防HCC伴MPVTT患者上消化道再出血有一定效果。

个体化超选择肾动脉栓塞在肾脏损伤性出血中的临床应用

目的探讨个体化超选择肾动脉栓塞在肾脏损伤性出血治疗中的临床应用价值。方法选取肾脏损伤性出血的36例患者的资料,根据不同的出血类型、临床表现及造影表现,采用不同的栓塞时机及不同的栓塞剂组合方案,探讨个体化栓塞方法并观察疗效。结果单纯假性动脉瘤31例,共32枚,单纯聚乙烯醇(PVA)颗粒栓塞治疗2例,医用胶栓塞治疗1例,医用胶联合微弹簧圈栓塞治疗1例,微弹簧圈联合明胶海绵颗粒栓塞治疗27例;假性动脉瘤伴肾动静脉瘘2例,采用微弹簧圈联合明胶海绵颗粒栓塞;假性动脉瘤伴对比剂外溢3例,采用明胶海绵颗粒或联合弹簧圈栓塞。所有患者手术均1次成功。与介入治疗术前比较,介入治疗术后3天肌酐出现升高,差异有统计学意义(P<0.05),与介入治疗术后3天比较,介入治疗术后1个月、3个月肌酐降低,差异有统计学意义(P<0.05)。与介入治疗术前比较,术后3天、1个月、3个月血红蛋白升高,差异有统计学意义(P<0.05)。随访3个月,患者出血停止,无肾功能不全、肾脓肿等并发症发生。结论个体化栓塞方案治疗多种原因导致的损伤性出血安全有效。

介入栓塞术后应用尼莫地平治疗动脉瘤性蛛网膜下腔出血的疗效观察

目的分析动脉瘤性蛛网膜下腔出血(aSAH)患者介入栓塞术(IE)后应用尼莫地平治疗的效果。方法选取2020年1月—2022年1月我院收治的140例aSAH患者为研究对象,采用随机数字表法将其分为介入组和联合组,各70例。介入组采用IE治疗,联合组IE术后应用尼莫地平治疗。比较两组临床疗效、血管内皮因子水平、血清炎性因子水平、不良反应发生情况及短期预后。结果联合组治疗总有效率97.14%高于介入组的81.43%,差异有统计学意义(P<0.05)。治疗2周后,联合组血清内皮素-1、血管内皮生长因子、白细胞介素-8、肿瘤坏死因子-α、C反应蛋白水平均低于介入组,组间差异有统计学意义(P<0.05)。联合组并发症发生率4.51%低于介入组的15.71%,差异有统计学意义(P<0.05)。联合组短期预后格拉斯哥量表评分优于对照组,差异有统计学意义(P<0.05)。结论aSAH患者IE术后应用尼莫地平治疗能明显提高患者脑神经功能,降低应激反应,减少术后并发症,短期预后可靠。

动脉介入栓塞治疗在妇产科产后出血中的应用效果

目的探讨动脉介入栓塞治疗在妇产科产后出血中的应用效果。方法选取2020年4月至2021年4月济宁市兖州九一医院收治的50例产后出血患者,按照随机抽签法分为对照组、观察组,每组各25例。对照组采用常规治疗,观察组采用动脉介入栓塞治疗,比较两组治疗效果、不良反应发生情况。结果观察组的临床总有效率高于对照组,差异有统计学意义(P<0.05);观察组不良反应总发生率低于对照组(P<0.05)。结论动脉介入栓塞治疗在产后出血中的应用效果较好,可提升临床疗效,降低不良反应发生率,值得推广应用。

在消化道出血中DSA诊断与介入治疗的临床应用

目的：评价DSA涟诊断与介入治疗在消化道出血中的应用价值。方法：38例消化道出血病例进行了Ⅸ认检查，对动脉性出血的28例患者根据出血的原因和部位，应用不同栓塞剂或缩血管药进行介入治疗。结果：38例中发现血管源性出血23例，肿瘤性出血9例，阳性率84．2％，假阴性3例（7．89％），阴性3例。介入治疗28例患者止血成功率96．42％，术后随访3～6个月无并发症及复发。结论：DSA在消化道出血中具有较高应用价值，动脉栓塞或缩血管药灌注治疗出血性病变创伤小、安全、可靠。

消化道出血的血管造影诊断与介入治疗的相关问题探讨

目的探讨消化道出血的血管造影诊断与介入治疗的临床应用价值和影响诊疗的因素。方法对45例临床确诊为消化道大出血患者,采用选择性DSA检查,明确出血部位和出血动脉后采用栓塞治疗或注射加压素治疗。结果 45例中37例发现出血征象,阳性率为82.22%(37/45)。对其中31例进行栓塞治疗,栓塞治疗有效率为87.10%(27/31);6例注射加压素治疗,其中2例止血成功。所有患者均未发生严重并发症。结论 DSA不仅可明确诊断消化道出血,还可同时进行介入治疗,止血效果肯定。

介入栓塞治疗急性消化道大出血的临床应用

目的 探讨介入栓塞治疗消化道大出血的对策、方法选择和影响疗效的因素。方法 急性消化道大出血 15例 ,其中上消化道 4例 ,下消化道 11例。分别采用PVA、明胶海绵、钢丝圈 3种材料进行栓塞。下消化道采用同轴导管法。结果 15例中 14例成功止血 ,共对 16个病灶进行了 17次栓塞 ,止血成功率为 94 .1%。其中 1例术后出现小肠坏死行手术治疗切除肠管。随访 15例 ,1例术后 3个月再次出血 ,手术证实为小肠血管淋巴瘤。 2例小肠恶性肿瘤择期手术。另 1例术中出血速度太快、量太大 ,出现休克 ,以钢丝圈栓塞止血成功 ,术后外科手术证实为小肠良性肿瘤伴大面积出血。结论 使用不同方法介入栓塞治疗急性消化道大出血是有效而安全的 。

应用微导管同轴导管系统行超选择性支气管动脉栓塞治疗大咯血

目的 探讨经微导管同轴导管系统使用丝线微屑行超选择性支气管动脉栓塞 ,以达到安全有效的治疗大咯血的目的。材料与方法 3 6例大咯血患者 (女 8例 ,男 2 8例 ,年龄 2 1～ 76岁 ,平均 3 8.5岁。咯血量 3 0 0ml/2 4h)均采用经微导管同轴导管系统行超选择性支气管动脉栓塞 ,栓塞剂为丝线微屑和 /或明胶海绵微屑。全部病例随访 6～ 18个月。结果 即刻止血 3 1例 ,咯血明显减少 4例 ,有效率 97% ( 3 5 /3 6) ,1例无法止血。无严重并发症 (主要是脊髓损伤 )发生。结论 经微导管同轴导管系统使用丝线微屑进行超选择性支气管动脉栓塞治疗大咯血是安全有效的治疗方法。

肾出血的血管造影诊断及经导管栓塞治疗

目的探讨肾出血的血管造影诊断及经导管栓塞治疗的临床价值。方法62例肾出血患者中肾癌姑息治疗28例,肾血管平滑肌脂肪瘤13例,肾损伤12例,肾血管畸形7例,肾动脉瘤2例。临床表现均有肉眼血尿。先行动脉造影,了解出血原因、部位、程度及血供情况;然后超选择插管至病变处,灌注化疗药物和(或)进行栓塞治疗,栓塞方法及栓塞剂的种类、剂量根据病变性质、造影表现及插管具体位置进行选择。结果62例患者均通过动脉造影获得了明确的诊断,19例可见对比剂外溢。介入治疗后43例患者12h内肉眼血尿消失,17例24h后肉眼血尿消失;2例肾癌术后肉眼血尿术后明显减轻,持续到1周后消失。随防1～48个月,除4例肾癌患者栓塞后1个月左右又出现血尿外,其余患者均无肾出血复发,CT示栓塞满意。结论经导管血管造影诊断和栓塞治疗是肾出血的可靠诊疗方法,创伤小、止血快速、安全、有效,并发症少,并能最大程度的保护肾功能。

消化道出血的选择性动脉造影诊断与介入治疗

目的 研究消化道出血的选择性动脉造影诊断的价值及介入治疗的方法和意义。资料与方法 经选择性动脉DSA后明确消化道出血部位或原因共 57例。对非肿瘤性出血采用相应供血动脉栓塞或血管加压素局部灌注 ;肠道肿瘤及介入治疗止血不彻底者行外科切除。结果 非肿瘤性出血 41例 ,肿瘤出血 1 6例。其中 44例经动脉栓塞或灌注血管加压素治疗 ,2 5例得到完全止血 ,1 4例止血不彻底 ,5例复发。共有 32例经外科切除后得到病理诊断 ,分别为贲门溃疡 1例 ,十二指肠溃疡 7例 ,小肠憩室炎 7例 ,小肠平滑肌瘤 8例和平滑肌肉瘤 7例 ,恶性淋巴瘤 1例 ,脾动脉真性动脉瘤 1例。结论 选择性动脉造影对不明原因消化道出血的定位和定性诊断有重要的价值 ;对多数非肿瘤性出血应用选择性动脉栓塞可以得到完全止血 。