Emergent endovascular embolization of iatrogenic renal vascular injuries / 介入放射学杂志

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)

Investigation of bile duct injury after transcatheter arterial chemoembolization / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the image findings of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy.</p><p><b>METHODS</b>During the past 3 years, 1240 patients with different hepatic malignancies had undergone a total of 2680 TACE procedures. Eighteen patients (1.4%) developed bile duct injuries from 3 weeks to 3 months after TACE. All of the 18 patients received follow-up CT and ultra-sonography, 14 MRI and 15 digital subtract angiography (DSA). The image data was retrospectively reviewed, with the potential predisposing factors correlated to TACE-induced bile duct injury.</p><p><b>RESULTS</b>TACE-induced bile duct injuries developed in 13 of 148 patients with liver metastasis (8.8%), 5 of 1092 patients with hepatocellular carcinoma (HCC) (0.5%). On image examination, focal peripheral intrahepatic bile duct dilatation was detected in 4 cases, multiple bile duct dilatations with segmental or sub-segmental distribution in 8, and a large lobular cystic lesion or biloma in 6 cases, and progressive atrophy of the corresponding hepatic parenchyma in 6 patients in whom the TACE induced-bile injury developed at different intervals after TACE. The incidence of bile duct injury was higher in non-cirrhotic patients with metastatic liver lesions than in patients with hepatocellular carcinoma associated with cirrhosis (P < 0.01), and it was also higher in patients using an emulsion of lipiodol-cisplatin or carboplatin than in patients using other emboliging agents (P < 0.01). The incidence was higher either in patients with hypovascular lesions than in patients with hypervascular lesions (P < 0.05).</p><p><b>CONCLUSION</b>Biliary abnormalities, including focal and multiple intrahepatic bile duct dilatation, and cystic lesion or biloma, may develop and can be detected during the follow-up examination imaging in patients with hepatic malignancy after TACE. Noncirrhotic liver and intact function, due to the lack of peri-biliany collateral circulation, are the significant predisposing factors to the development of TACE-induced bile duct injury.</p>

Treatment of celiac and mesenteric arteries stenoses with interventional radiologic techniques / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of the interventional techniques for management of celiac and mesenteric arteries stenoses.</p><p><b>METHODS</b>Eight patients with celiac artery (CA) or superior mesenteric artery (SMA) focal stenotic lesions were treated with percutaneous transluminal balloon angioplasty (PTA) and stent placement. CA stenosis was present in 2 patients, SMA stenosis was present in 4, and both CA and SMA were involved in 2 patients. Postprandial pain was present in 4 patients, an epigastric bruit was present in 5. All patients presented with weight loss averaging 8 kg. The causes of the stenoses were atheroscleroses in 7 patients, median arcuate ligament syndrome (MALS) involvement of the CA in 1 patient.</p><p><b>RESULTS</b>PTA and stent placement was technically successful in the 8 patients. Three patients underwent stent placement in CA, 5 patients in SMA. Seven patients were treated with 1 stent, one was treated with 2 stents. The post-procedural arteriograms showed good dilation of the stenotic lesions in all patients. The puncture site hematoma occurred in 2 patients without severe consequences. Complete alleviation of abdominal pain occurred in 5 patients, significant improvement in 2, and no improvement in 1 patient. At three months after the procedures, weights were regained in 6 patients. Clinical follow-up was available in all 8 patients, with a mean follow-up of 42 months (median 28 months, range 6 to 72 months). Follow-up Doppler ultrasound examinations showed normal flow patterns, without evidences of re-stenosis in the stenting arteries. Five patients remained asymptomatic, one patient had intermittent abdominal pain even the stenting SMA to be patent. Two patients respectively died of unrelated CA/SMA stenosis in 14 and 24 months after the treatment.</p><p><b>CONCLUSION</b>PTA and stent placement are safe and effective methods for treatment of chronic CA and SMA focal stenoses, especially useful for these patients with a high surgical risk.</p>

Treatment of acquired arteriovenous fistulas with interventional minimally invasive techniques / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of the interventional techniques for treatment of acquired arteriovenous fistulas (AVF).</p><p><b>METHODS</b>Ten patients with acquired AVFs, including 4 with renal AVF, 3 with iliac AVF, and 3 with subclavian AVF, were treated with interventional procedures. The etiological factors of the AVFs were penetrating trauma in 5 cases, iatrogenic injury in 3, malignancy in 1, and intestine Crohn's disease in 1. The patients presented with peripheral venous hypertension (n = 6), local bruit (n = 10), cardiac overload (n = 10), the right cardiac failure (n = 2), and hematuria (n = 4). Three patients underwent transcatheter super-selective coils embolization and 7 underwent stent-graft placement in the involved arteries.</p><p><b>RESULTS</b>The technical success was achieved in all cases. Completion angiography documented complete exclusion of the fistulas. Minor complications occurred in 3 patients, but without significant consequences. The patients experienced immediate relief of the limb swelling, peripheral venous hyperemia, and tachycardia. The local bruit was disappeared. The cardiac overload conditions were improved significantly, which was confirmed by ultrasound scan. Renal function tests in patients with renal AVF were stable. Radioactive isotopic scan revealed that the function was preserved in the treated kidney in two patients using stent-graft placement in the renal arteries. Follow-up time ranged from 6 months to 6 years. Three patients respectively died of unrelated AVF diseases in 6, 9, and 14 months after the treatment. Re-intervention with an another stent-graft placement was performed on 2 patients with recurrence of the AVF respectively at 3 weeks and two months after the procedures. The minor stenosis was found in stent-graft 2 of patients on the follow-up angiography respectively at 6 and 8 months after the treatment. Seven patients are still alive and in good condition without further intervention.</p><p><b>CONCLUSIONS</b>Minimally invasive interventional procedures, including super-selective embolization and stent-graft exclusion, are safe and effective in the treatment of acquired arteriovenous fistulas.</p>

Inferior phrenic arteries supply to the pulmonary hemorrhagic lesions:angiographic identification and interventional management / 中华放射学杂志

Objective To describe the manifestations of the inferior phrenic arteries(IPA)supply to the pulmonary hemorrhagic lesions and to evaluate the safety and efficacy of transcatheter arterial embolization(TAE)of the IPA.Methods The clinical data and imaging findings of eighteen patients with the additional blood supply to the pulmonary hemorrhagic lesions from the IPA were evaluated retrospectively.The causes of the bleeding were lung malignancies in 9,bronchiectasis in 7,and chronic inflammation in 2 patients.TAE supplementally was performed in patients with IPA supply to the pulmonary lesions,using polyvinyl alcohol particles,gelatin sponge particles,and microcoils.Results Selective arteriogram demonstrates an enlarged IPA,with numerous branches and hypervascularity in all 18 cases, with tumor staining in 9,the contrast material extravasation in 6,and non-specific staining in 2 cases.In addition,IPA-to-pulmonary shunting was found in 9 cases.All the lesions supplying by IPA were adjacent to the pleurae,including adjacent to the diaphragmatic pleura in 11,the mediastinal pleura in 5,and the lateral pleura of the lower lobe in 2 cases.Technical success of IPA embolization was achieved in the 18 cases.Embolization of other nonbronchial systemic arteries(the internal thoracic artery in 7 and intercostal artery in 3)was performed at the same session.All bleeding ceased immediately after supplemental IPA embolization.Follow-up time ranged from 8 months to 4 years.Mild recurrent hemoptysis occurred in 3 patients at 1,2,6 months respectively,after the embolization.These patients were responsive to conservative management.Recurrent bleeding did not occur in 15 patients during the follow-up. Conclusion The pulmonary hemorrhagic lesions,especially adjacent to the diaphragmatic and mediastinal pleurae,can be supplied by IPA,and may result in clinical failure following BAE.Supplemental TAE of IPA is a safe and effective adjunct to BAE in the management of bronchial bleeding supplied by IPA.