Intra-arterial chemotherapy in retinoblastoma – A paradigm change

Intra-arterial chemotherapy (IAC), also known as superselective ophthalmic artery chemotherapy or chemosurgery, is currently widely accepted as one of the primary treatment modalities for intraocular retinoblastoma worldwide. Following the introduction of the technique in 1998, IAC has evolved over the past decades to be safer and more effective. Accumulated evidence shows that IAC is more effective in providing eye salvage in group D and E retinoblastoma as compared to conventional systemic intravenous chemotherapy (IVC). In contrast to IVC, IAC has the added benefits of reduced overall treatment duration and minimal systemic toxicity. This review provides a comprehensive update on the history, technique, indications, contraindications, and outcome of IAC. We have also identified the strengths, weaknesses, opportunities and threats (SWOT analysis) of the technique in this review.

Application of superselective lingual artery embolization in treatment of severe hemorrhange in patients with carcinoma of tongue / 中华口腔医学杂志

To explore the clinical value of superselective lingual artery embolization in treating the severe hemorrhage in patients with advanced carcinoma of tongue. Four patients with advanced tongue cancer hemorrhage from March 2014 to February 2016 were enrolled in this study. T3N2M0 (2 cases) and T4N1M0 (2 cases) were diagnosed preoperatively. Two cases of advanced tongue carcinoma tumors had severe bleeding and the other 2 cases of hemorrhage were after radiotherapy. All cases including 3 squamous cell carcinoma and 1 adenocarcinoma were firstly demonstrated by arterigraphy under seldinger technique with digtial subtraction angiogarphy to ensure the rupture site and then all cases were followed by superselective artery embolization. The efficacy and complications of interventional embolizationg were observed. There was no serious complication of central nervous system injury such as hemorrhage and hemiplegia during follow-up. Superselective lingual artery embolization can accurately locate the responsibility of blood vessels, and the injury is small, significant effect, fewer complications.

Causes of bleeding due to arterial injury after minimally invasive percutaneous nephroclithotomy / 中华泌尿外科杂志

Objective To investigate the causes of bleeding due to arterial injury after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods We retrospectively analyzed the clinical data of 2 980 patients who underwent ultrasound-guided mPCNL between January 2012,and January 2017,in our hospital.Among them,1 853 were male and 1 127 were female.Age from17 to 76 years old,average age was (45.7 ± 24.1) years.The calculi size was from 1.5 to 4.2 cm,average of (2.62 ± 1.08) cm.There were 2 478 kidney stones and 502 cases of ureteral calculi.Besides,727 cases with mild hydronephrosis,1 971 cases with moderate hydronephrosis,282 cases with severe hydronephrosis;480 patients with urinary tract infection;103 patients with renal empyema or acute renal failure;63 patients with cardiovascular and cerebrovascular stent implantation;214 patients with diabetes mellitus.Results In this study,all of the patients were established percutaneous renal tract successfully,indwelling drainage tube (6 ± 2)d,and postoperative hemorrhage in 117 cases,of which 29 patients suffered from bleeding due to arterial injury and DSA showed 20 cases with acute arterial injury,5 cases with pseudo-aneurysm,and 4 cases with arteriovenous fistula.However,all these cases were rehabilitated after the treatment of super-selective renal artery embolization.The rates of arterial injury of renal calyx access and pelvic access were 0.39％ (10/2 535) and 4.27％ (19/445),respectively.The rate of arterial injury in renal pelvic access was significantly higher than renal calyx access of PCNL (P ＜ 0.05).The rates of arterial injury in lower,middle,upper calyx access were 0.38％ (1/267),0.40％ (6/1 516),0.40％ (3/752),respectively.There was no significant effect of different renal calyx on postoperative arterial injury rate of mPCNL(P ＞0.05).All the percutaneous renal accesses were dilated with Amplatz sheaths,and the arterial injury rate of F16-18 and F20-22 tracts in the calyx access were 0.35％ (5/1 446),0.46％ (5/1 089),respectively,with no significant difference in size of calyx access associated with rate of arterial injury after mPCNL(P ＞0.05).The arterial injury rates of F16-18 and F20-22 tracts in the pelvic access were 1.98％ (5/253) and 7.29％ (14/192),respectively.There was significant difference in the size of the pelvic access in the rate of arterial injury after mPCNL(P ＜ 0.05).In addition,the arterial injury rate of single tract PCNL was 0.94％ (25/2 653) as compared to 1.22％ (4/327) in multi-tracts PCNL.There was no significant difference in the rate of arterial injury between single and multi-tracts PCNL(P ＞ 0.05).Conclusions The puncture of the renal pelvis and size of renal pelvis tract significantly increased the probability of postoperative bleeding due to arterial injury.

Application of High Quality Nursing for Super-selective Renal Artery Embolization In Treating Bleeding after Percutaneous Nephrolithotomy / 昆明医科大学学报

Objective To evaluate the clinical application of high quality for super-selective renal artery embolization (SRAE) in treating bleeding after percutaneous nephrolithotomy (PCNL).Methods 134 patients received percutaneous nephrolithotomy were divided into control group (67 patients) and observation group (67 patients).All of patients with serious bleeding after PCNL were given SRAE in the Second Affiliated Hospital of Kunming Medical College from June 2010 to June 2015.At the same time,we gave high quality nursing to observation group.The patients in control group received routine nursing.The effect of nursing was observed.Results The degree of hematuria disappear of the patients in observation group was higher than that in control group (P＜ 0.05).There were fewer complications in observation group.In the sixth month after discharge,none of them had obvious renal impairment.No recurrence of hematuria,pus kidney and urinary cyst was tested.All cases were satisfied with the treatment.Conclusion It's the key to prevent serious complications and cure successfully with effective and timely supervision and high quality nursing care during the perioperation of SRAE in treating bleeding after PCNL.

Application of an “Island hopping” approach in laparoscopic partial nephrectomy for clamping tumor-specific renal arterial branches / 第二军医大学学报

Objective To study the feasibiiity and safety of an “island hopping” approach in segmental renal artery dissectlon and clamping m laparoscopic partial nephrectomy. Methods Between August 2014 and August 2015, 10 cadaveric kidneys and 20 kidneys from radicai nephrectomy were used to dissect the renal arteries. The route of renal artery branches and its relationship with location of the renal hilum were observed and recorded A retrospective analysis was made for 10 patients undergoing laparoscopic partial nephrectomy using traditional supersellective artery clamping method (n=5) or “isiand hopping” superselective artery camping method (n=5) The time of dissecting the segmental arteries and the warm ischemia time were recorded and the clinical efficacy of “island hopping” superselective artery clamping method was evaluated. Results For cadaveric kidneys, 72. 2% (39/54) of the renal artery branches entered the kidney along the edge of renal hilum, and the number” was 70. 8% (68/96) in the 20 kidneys from radical nephrectomy clinically the laparoscopic partial nephrectomy procedures were successful in all the 10 patients. One of the 5 cases receiving “island hopping” approach were converted to hilus clamping due to poor operation field for tumor resection. Compared with patients undergoing traditional superseiective artery cliamping, those undergoing “island hopping” approach had a shorter time of dissecting segmental arteries (6-11 min VS 10-18 min) and a similar warm ischemia time (14-26 min vs 15-25 min) Conclusion The “island hopping” approach for tumor-specific renal arterial branches clamping is safe and feasible, and also makes it easier for manipulation, leading to convenient popularization.

The value of combining mesenteric angiography with methylene blue injection for localization of the obscure gastrointestinal bleeding / 实用放射学杂志

Objective To discuss the value of combining superselective mesenteric angiography (SSMA)with methylene blue in-jection for localization of the Obscure Gastrointestinal Bleeding (OGIB).Methods 12 patients presenting with OGIB had preopera-tive localization of the bleeding site by SSMA.The microcatheter was remained inside the bleeding artery branch after angiography. Then the methylene blue was injected via the microcatheter for localization during exploratory laparotomy and the dyed intestine was then removed.Results The detected rate of bleeding sites by using preoperative SSMA was 100%.The lesions in total 12 patients were found quickly during the exploratory laparotomy.The length of the removed intestine was 9 -12 cm (median,10 cm).After followed up for 10-24 months (median,18 months),all patients with OGIB had no recurrence.Conclusion The method of SSMA combined with the use of methylene blue injection is a safe and effective procedure for the localization of OGIB and could be beneficial for increasing the surgical success rate of hemostasis.

Hematuria incoercible en poliquistosis renal: tratamiento exitoso mediante embolización arterial superselectiva incoercible / Hematuria in polycystic kidney disease: successful treatment using superselective artery embolization

Se presenta el caso de un paciente de 81 años de edad, con riñones poliquísticos de gran tamaño, enfermedad renal crónica en estadío 3, y un quiste polar derecho sangrante que provocaba severa anemización. Previa aplicación de un protocolo de nefroprotección, se cateterizó la arteria renal derecha, accediéndose al ramo polar inferior de la arteria retropiélica e identificando angiográficamente el sitio de sangrado; desde este punto se realizó la embolización arterial superselectiva con fragmentos de Spongostan. Finalizado el procedimiento, se comprobó la interrupción del sangrado luego de dos horas y el examen del sedimento urinario a los noventa días de seguimiento, mostraba entre 6 a 10 hematíes por campo. Se discute el rol de la red vascular en poliquistosis, la expansión celular en la pared quística, y la provocación de isquemia mediante tratamiento intervencionista ultraselectivo, a fin de preservar la función renal y prevenir complicaciones.

A patient of 81 years old, with oversized polycystic kidneys, chronic kidney disease in stage 3, and a bleeding right polar cyst, that caused severe anemia, is presented. First, a nephroprotective protocol was applied. Then, the right renal artery was catheterized, accessing the polar lower branch of the retro-pyelic artery and angiographically identified the bleeding area, and the superselective arterial embolization was performed with fragments of Spongostan. When the procedure concluded, the stopping of the bleeding was proved after two hours. The urinary sediment examination after ninety days of monitoring showed between 6 and 10 red cells per field. The function of the vascular network in polycystic disease, the cell expansion in the cyst wall, and the induced ischemia through the ultraselective interventionist treatment, is discussed in order to preserve kidney function and prevent any complications.

Resección quirúrgica de malformación arteriovenosa de alto flujo en ángulo nasogeniano con embolización preoperatoria: reporte de un caso / Surgical resection of high-flow arteriovenous malformation of the nasogenian sulcus with preoperatory embolization: a case report

El 50% de las malformaciones arteriovenosas (MAVs) de alto flujo se ubican en la región craneofacial y pueden producir sangrado con riesgo vital sin diagnóstico y tratamiento adecuado. La resonancia magnética (RM) es útil en el diagnóstico diferencial de las lesiones vasculares, siendo el gold standard la angiografía selectiva. Dado que las MAVs de alto flujo no involucionan espontáneamente, el tratamiento usualmente consiste en embolización con posterior resección quirúrgica. Se presenta un paciente de sexo masculino de 20 años que consulta por aumento de volumen nasogeniano derecho, progresivo, violáceo, blando y pulsátil. Se objetiva mediante RM una zona de vasos serpentiginosos, que se extiende desde el subcutáneo hasta la pared anterior del maxilar. La angiografía cerebral confirma MAV de alto flujo e informa mapeo vascular. Se decide embolización prequirúrgica superselectiva con posterior resección tumoral mediante acceso transvestibular.

The 50 % of arteriovenous malformations (AVMs) of high flow are located in the craniofacial region and can cause life-threatening bleeding without a diagnosis and appropriate treatment. Magnetic resonance imaging is useful in the differential diagnosis of vascular lesions, being the gold standard selective angiography. Since high-flowA VMs do not regress spontaneously, treatment usually involves surgical resection with subsequent embolization. We present a 20 years male patient consulting with a purple, progressive, soft, pulsating enlargement of right-side nasogenian region. Magnetic resonance imaging shows serpiginous vessels, extending from the subcutaneous to the anterior wall of the maxillary. Cerebral angiography confirms high flowAVM and shows vascular mapping. It was decided superselective preoperative embolization with subsequent tumor by transvestibular access.

Clinical study of superselective renal arterial embolization in the treatment of iatrogenic renal hemorrhage / 中华急诊医学杂志

Objective To prospectively investigate superselective renal arterial embolization (SRAE) in the treatment of iatrogenic renal hemorrhage MethodsFrom November 2005 to November 2010,19 patients with iatrogenic renal hemorrhage in the Affiliated Hospital of Hangzhou Normal University underwent diagnostic renoarteriography to reveal the site and degree of renal artery rupture,then superselective embolization by coins,or coins combined with spongia gelatinosa were performed for these patients.Results Renal arteriography showed hemorrhage was located at the renal segmental arteries and/ or their branches ( 9 cases at segmental renal artery,6 cases at interlobar artery and 4 cases at arciform artery),two cases were found with simple hemorrhage of segmental renal artery ( SRA ),9 cases with pseudoaneurysm,5 cases with arterio- venous fistula (AVF),3 cases with pseudoaneurysm combined with AVF.Seventeen cases received embolization with coins,while 2 cases with pseudoaneurysmes received embolization with coins and spongia gelatinosa at the same time.Bleeding was successfully ceased immediately and did not recur in all cases.Conclusions Superselective renal arterial embolization could be considered as a safe and effective method to treat hemorrhage of iatrogenic renal vascular injuries..

The clinical value of super-selective renal arterial embolization for severe renal hemorrhage / 介入放射学杂志

Objective To evaluate super-selective renal arterial embolization(SRAE)in treating severe renal hemorrhage when conservative treatment had failed. Methods SRAE was performed in 111 patients with severe renal hemorrhage who had failed to respond the conservative management.The clinical data,the way of embolization,the medication and the follow-up findings were retrospectively analyzed.Results Excellent results were obtained in all patients after SRAE and no serious complications occurred.The technical successful rate with single session was 95.5%(106/111).Gross hematuria disappeared within 1-4 days after the treatment.Two patients developed shock after renal embolization and had to receive surgery after the shock was controlled.Three patients had a recurrence of hematuria,the blood urine subsided after SRAE was employed again.A follow-up with a mean period of 37.4 months was carried out in 92 patients,and the follow-up checkups showed that the renal function was well preserved in all patients.Conclusion Super-selective renal artery catheterization and embolization is a safe and effective treatment for severe renal hemorrhage,it can maximally preserve the healthy renal parenchyma as well as the renal function.Therefore,this technique should be regarded as the treatment of first choice for patients with severe renal hemorrhage.

Superselective renal artery embolization with lipiodol and absolute alcohol emulsion for renal tumor / 介入放射学杂志

Objective To evaluate the efficacy of the renal arterial embolization with lipidol and absolute alcohol emulsion in the treatment of renal tumors. Methods The superselective renal arterial embolization by using coaxial-cathaterization with infusion of lipiodol and absolute alcohol (in proportion of 2 ∶ 1) emulsion was performed in twenty patients with malignant and benign kidney tumors. 4 weeks later, the renal arteriography was taken routinely and repeated embolization was performed in case of necessary; and follow up was carried out periodically. Results The imaging findings showed thorough tumor necrosis and feeding vessel abruption in 18 cases after one session of treatment. The volume of tumors decreased more than a half in 13 patients (82.25%, 13 / 18) associated with a well-distributed lipidol inside the tumors. The second session of treatment was performed in other 2 patients and the clinical symptoms relieved obviously. Conclusions The superselective renal artery embolization with lipidol and absolute alcohol emulsion can permanently embolize all tumor feeding arteries in capillary vessel level with maximum reservation of renal function, providing definitively efficacy and worthwhile to be recommended widely.

Problems in superselective angiography and embolization for acute hemorrhagic lesions / 介入放射学杂志

Superselective angiography and embolization is one of the important methods in the management of acute hemorrhage, providing mini-invasion and high efficacy, etc. The implication of angiography and embolization on bleeding were reviewed and the embolic agents as well as the interventional procedures were commented in this article.

The clinical value of combination of transcatheter superselective intra-arterial chemotherapy in the combined treatment of advanced nasopharyngeal carcinoma / 肿瘤研究与临床

Objective To evaluate the clinical value of selective arterial chemotherapy after radiotherapy for advanced nasopharyngeal carcinoma (stageⅢ,Ⅳa). Methods Sixty patients with advanced nasopharyngeal carcinoma were randomized to receive either combined elective arterial chemotherapy and radiotherapy (IACT group, 30 patients) or combined general intravenous chemotherapy and radiotherapy(IVCTgroup, 30 patients). Four weeks after radiotherapy, the effect of two methods was compared. Results The efficiency rate and the 1-year local disease control rate were 93.33 %, 92.86 % in IACT and 70.00 %, 71.43 % in IVCT, respectively. There were outstanding differences between the two groups(P

Analysis of complications for the treatment of uterine fibroids with bilateral uterine artery superselective embolization / 介入放射学杂志

Objective To discuss the complications of the bilateral uterine artery superselective embolization for uterine fibroids. Methods Fourty one cases(mean 42 years old) with uterine fibroids were approached by right femoral artery puncture; including thirty six cases of single hysteromyoma(33 cases with diameter 10 cm), and 5 cases of multi hysteromyoma. Bilateral uterine artery super selective 5F catheterization embolization were done along uterine descending artery(neck of uterus to vagina)with PVA particles. Rdsults Embolization succeeded with 100% and effective ratio was 92.3%. Sixteen of these cases showed post embolization syndrome, with something outflowed from vagina and 10 cases showed changes of emmenia but with no serious complications in all 41 cases. Conclusion Using bilateral uterine artery superselective embolization for uterine fibroids with PVP grains can decrease the incidence of complications. (J Intervent Radiol, 2006, 15: 280-282)

Clinical significance of preoperative endovascular embolization in treatment of patients with vascularized me-ningioma / 介入放射学杂志

Objective To investigate the clinical efficacy and significance of preoperative superselective endovascular embolization in treatment of patients with vascularized meningioma.Methods 3-9 days before operation, 98 patients with vascularized meningioma underwent DSA and preoperative superselective embilization with PVA particles, gelatin sponge, and silk. The surgical intervention was performed after embolization. Results The vascularized meningioma was mainly supplied by the middle meningeal artery, ascending pharyngeal artery, occipital artery, internal maxillary artery as well as submeningeal artery. After the supplying artery was embolized, tumors' staining in 42 cases disappeared completely and that of 56 cases disappeared totally or partly. Most patients were operated on 3-9 days after embolization. 64 tumors were removed completely, while other 34 cases were removed totally or partly. The average volume of bleeding during the operation was 950 ml in the former and 1 500 ml in the latter.Conclusions The best time for operation is 7～9 days after embolization. Preoperative embolization of the vascularized meningioma contributes to reduce the bleeding significantly during the operation, increase the safety of the operation and improve the total removal of the tumor. It is a safe and effective microinvasive method.

A Case of High-flow Priapism Treated by Superselective Embolizations of Bilateral Cavernosal Arteries / 대한비뇨기과학회지

We report a case of priapism secondary to bilateral rupture of the cavernosal arteries following perineal blunt trauma in a 34 year old man. He complained of painless but persistent erection for the period of 1 week. We confirmed non-ischemic high-flow priapism by arterial blood gas analysis, Doppler ultrasonography and arteriography. Arteriography showed a leakage on both sides of the end of the cavernosal arteries and the leakage was blocked by superselective cavernosal artery embolization. After the embolization, tumescence began to disappear and the detumescence process was completed on the third day. The examination of the patient after 4 months following embolization revealed that the patient was fully free of priapism and returned to the normal erectile status like before his priapism. During 2 years of follow up, the patient had no complications such as priapism or impotence.

The clinical usefulness of interventional thrombolytic therapy in acute middle cerebral artery infarction with early CT signs

BACKGROUND AND PURPOSE: If early middle cerebral artery signs (EMCAS) are present, prognoses are known to be poor, even if interventional therapy is performed. The aim of this study is to evaluate the clinical effect of a superselective intra-arterial urokinase infusion in cerebral infarction patients presenting EMCAS. METHODS: We conducted prospective longitudinal clinical trial and observed patients (n-22) with middle cerebral artery infarctions who manifested EMCAS in precontrast brain CT scans between January 1996 and April 1997. The patients were divided into two groups, one group (n-11) underwent superselective intra-arterial urokinase infusion; and the other (n-11) was treated with classic osmotherapy and heparinization. We evaluated the clinical outcome for each patient using the Canadian Neurological Scale (CNS) and the National Institutes of Health Stroke Scale (NIHSS) on admission (pre-treatment state) and on, the 3rd, 7th, and 30th days. RESULTS: The two patients groups had an even distribution of risk factors, EMCAS, age and the interval from the ictus to the initiation of treatment. The outcome at the 30th day after stroke therapy improved for all patients compared to their status on admission (p<0.01), and there was a significant interaction between the group and the time (p<0.01). This means that the group which underwent superselective intra-arterial urokinase infusion had better clinical outcomes. Hemorrhagic transformation occurred in 5 cases (22.7%), 2 from the superselective intra-arterial urokinase infusion group and 3 from the heparinization group. However, this did not influence the clinical outcome. CONCLUSIONS: Compared to previous reports suggesting the poor prognostic value of EMCAS, even when all patients having these signs, this study showed that the clinical outcomes in the thrombolyic therapy group were better than in the conservatively treated one. Therefore, more aggressive interventional therapies such as superselective intra-arterial urokinase infusion may be considered option.

Superselective Local Infusion of Urokinase for Acute Ischemic Stroke in the Carotid Artery Territory

BACKGROUND: It has been known that superselective local infusion of urokinase (UK) for an acute ischemic stroke in the carotid artery territories (CAT) is associated with a high incidence of complete recanalization (RCN) of the occluded arteries and good clinical outcomes without excess risk of hemorrhagic transformation. We intended to evaluate the clinical outcomes of patients who had experienced an acute ischemic stroke in CAT who underwent superselective local infusions of UK and to find clinical variables affecting complete RCN or clinical outcomes. METHODS: Consecutively, 18 patients with acute ischemic strokes in CAT (12 in MCA occlusion and 6 in ICA) were enrolled in this study. All patients underwent superselective local infusion of UK and were assessed degree of to the RCN with angiographic findings and clinical outcomes using a modified Barthel index and a modified NIH stroke scale score prospectively. RESULTS: A complete RCN was achieved in 12 patients (67%), partial RCN in 3 patients (17%) and no RCN in 3 other patients (17%). A complete RCN seems to have been affected by the site of the occlusion (10 in MCA occlusion and 2 in ICA), and the type of ischemic stroke (10 in embolic and 2 in thrombotic). The degree of leptomeningeal collateral circulation(LCC) also affected the degree of the RCN; patients with thrombotic stroke (n=5 ; 2 in good LCC and 3 in poor), a complete RCN was achieved only in patients with good LCC. The clinical outcomes of the patients with complete RCN were significantly superior to the patients with partial or no RCN. Hemorrhagic transformation was observed in 4 patients (22%), but 2 patients did not affect clinical outcome. Three patients died(17%). CONCLUSION: Considering the natural outcome and quality of life of the patients with ischemic stroke in CAT, our results suggest that superselective local infusion of UK as a treatment modality for acute major ischemic stroke is a effective method, as long as adequate clinical variables are fulfilled.

Superselective arterial embolization with microcoils for congenital renal arteriovenous fistula / 대한비뇨기과학회지

Congenital renal arteriovenous fistula is a rare disease and manifested by gross hematuria, bladder tamponade and flank pain. We experienced one case of congenital renal arteriovenous firstula which was cirsoid type and treated with superselective transcatheter arterial embolization of four small segmental arteries. The microcoils made of platinum and synthetic fiber were used as theembolization modality.

Superselective renal artery embolization for traumatic renal hemorrhage: report of 38 cases / 介入放射学杂志

Objective To evaluate the clinical application of superselective renal artery embolization for the treatment of traumatic renal hemorrhage. Methods Thirty eight patients with traumatic renal hemorrhage were first demonstrated by renal arterigraphy under seldinger technique to ensure the rupture site and degree of renal artery and then followed by percutaneous cathetherized superselective renal arterial embolization through guidance of super slippery guide wire with gelfoam particles or steel coil. Results All 38 patients revealed occlusive abruption of bleeding arteries and disappearance of vextravasation staining after the superselective catheterized renal arterial embolization with gelfoam particles and steel spring coil under DSA. Clinically, all patients urine turned clear without macroscopic hematuria during 1 - 3 days after the procedure. Conclusions Superseclective renal arterial embolization is less aggressive and simultaneously with less complications, good hemostatic efficacy, maximal preservation of renal tissue and function for renal traumatic hemorrhage, which is worthy to be recommended.