ABSTRACT
Objective To treat hydrosalpinx by using interventional embolization of fallopian tube or laparoscopic salpingectomy before the performance of auxiliary reproductive technology,i.e.in vitro fertilization and embryo transplant (IVF-ET),and to compare the clinical effect,technical advantages and disadvamages between the two methods.Methods A total of 170 patients with tubal infertility who had received IVF-ET were selected,the clinical data were retrospectively analyzed.The patients were divided into three groups:(1) interventional embolization group (n=65),using interventional embolization for hydrosalpinx;(2) laparoscopic salpingectomy group (n=55),adopting laparoscopic salpingectomy for hydrosalpinx;and (3) control group (n=50):for these patients bilateral proximal fallopian tube obstruction was performed,and IVF-ET was directly carried out if the patient had no hydrosalpinx.Results No statistically significant differences in the used dosage of gonadotropin (Gn),E2 level on HCG-injection day,the number of follicles on HCG-injection day,the number of retrieved oocytes,the fertilization rate,cleavage rate,clinical pregnancy rate,abortion rate,and ectopic pregnancy rate existed between each other among the three groups (P＞0.05).The technical success rate in both interventional embolization group and laparoscopic salpingectomy group was 100％.No severe complications occurred.The interventional embolization procedure had some advantages,it could be completed at clinic room,the operation time was short,no anesthesia was needed,the medical cost was low,etc.Conclusion Interventional embolization of fallopian tube and laparoscopic resection are equally effective in treating hydrosalpinx before IVF-ET is conducted.Both methods can improve pregnancy outcome,but interventional embolization method is more simple,safe,economical and effective,which deserves to be the preferred method of treatment.
ABSTRACT
Objective To assess the feasibility and effectiveness of percutaneous transluminal angioplasty (PTA)for the salvage of immature arteriovenous fistula (AVF) and to identify the incidence of arterial and venous puncture site spasm.Methods The medical records and radiological data of 88 patients with 112 interventional procedures for immature AVFs were retrospectively reviewed.Results The stenosis lesions were (2.0 ± 1.4) cm long.Technical success rate and clinical success rate were 80.4％ (78/97) and 92.8％ (90/97) for PTA via brachial artery,85.7％ (6/7) and 100％ (7/7) for PTA via vein,25％ (2/8) and 50％ (4/8) for PTA via both brachial artery and vein,respectively.Spasm of pure arterial PTA occurred in 2 patients (2.1％) and was mild and moderate.Spasm of pure venous PTA occurred in 2 patients (28.6％) and was both moderate.Spasm of combined arterial and venous PTA occurred in 3 patients (37.5％) and from being severe to completely occluded.By comparison,there were statistical differences of technical and clinical success rate (P =0.000,0.019 ; P =0.000,0.029),fistulas spasm rate was statistically significant different (P =0.000).Conclusions Endovascular therapy was effective in restoring the dysfunctional native AVFs,it was safer and more effective and with less sideeffects especially in selecting coronary balloon to treat patients without large phlebangioma and round fistulas.
ABSTRACT
Objective To study the locations, types and causes of different pseudoaneurysms in order to find out the optimal individualized treatment for different pseudoaneurysms. Methods Different methods were applied in treating 21 patients with pseudoaneurysm, which were located at limb (n = 11 ), spleen (n =3), kidney (n = 2) , common lilac artery (n = 1), internal iliac artery (n = 1), gallbladder (n = 1) and penis (n = 1 ). Different managements were employed in treating these pseudoaneurysms. Temporary obstruction of blood circulation with balloon together with arterial anastomosis or direct incision neoplasty was performed in 9 cases with pseudoaneurysms at limb arteries close to the larger joints. Endovascular stent graft was used to isolate the trunk type of pseudoaneurysm in 4 cases, in 2 of them branch arterial embolism and stent graft endovascular exclusion were applied as they had common iliae artery trunk type of pseudoaneurysm at the opening of internal iliac artery. Gelfoam together with metallic coils embolization was employed in 6 cases with terminal type of pseudoaneurysms. Results After different treatments, tumor cavities disappeared in the 21 cases with pseudoaneurysms. Distal arterial pulse returned to normal and no nerve damage occurred in 11 cases with limb pseudoaneurysms. No internal hemorrhage was observed and distal blood circulation returned to normal after graft endovascular exclusion in 2 eases with pseudoaneurysms at spleen artery trunk and in 2 cases with pseudoaneurysms at iliac artery trunk. In 6 cases with terminal type of pseudoaneurysms,the tumor cavity disappeared, hemorrhage stopped and no ischemic necrosis of organ occurred. But one of them with multiple traumatic pseudoaneurysms located at the second grade branch died one week after embolism due to a serious pelvic trauma accompanied with serious infection. Conclusion Based on the locations, types and causes of pseudoaneurysms, different individualized treatment should be adopted in order to obtain optimal results with least damages.