Short- and long-term outcomes of emergency resection versus transarterial embolization followed by resection for spontaneous rupture hepatocellular carcinoma: a meta-analysis / 中华肝胆外科杂志

Objective:To study the optimal surgical strategy for patients with hepatocellular carcinoma (HCC) presenting with spontaneous rupture and hemorrhage.Methods:The electronic databases of PubMed, Web of Science, Embase, and Cochrane Library were searched, and studies reporting on survival outcomes comparing emergency resection (ER) and transarterial embolization followed by hepatectomy (SH) were included by using predetermined inclusion and exclusion criteria. The perioperative and survival data were compared using the Review Manager 5.3 software.Results:Eight retrospective studies were included. The total sample size was 556, with 285 (51.3%) in the ER group and 271 (48.7%) in the SH group. Perioperative blood loss ( WMD=683.61, 95% CI: 283.36-1 083.86, P=0.0 008) and blood transfusion volume ( WMD=453.43, 95% CI: 250.27-656.58, P<0.0 001) in the SH group were significantly less than those in the ER group. There were no significant differences in operative time, incidences of complications, mortality and recurrence rates of tumors between the two groups (all P>0.05). The 1-, 2-, 3-year overall survival and 1-, 2-, 3-, 5-year disease-free survival of the ER group were not significantly different from those of the SH group (all P>0.05). The 5-year overall survival rate of the ER group was significantly lower than that of the SH group ( HR=1.52; 95% CI: 1.14-2.03, P=0.005). Conclusions:There was no significant difference in short-term outcomes in treatment of ruptured HCC, SH was superior to ER in long-term survival outcomes.

Obstructive Hydrocephalus Produced by Venous Ectasia of Dural AV Fistula

Dural arteriovenous fistula (Dural AVF) is an anomalous shunt between dural arterial and venous channels. About 10–15% ofall intracranial vascular malformation are dural fistulas which represent anomalous shunts among arterial branches and duralvenous sinuses, meningeal, or cortical veins.We are presenting a rare case of dural AVF treated by transarterial embolizationand complicated by hydrocephalus.

Bilateral Gluteal Necrosis and Deep Infection after Transarterial Embolization for Pelvic Ring Injury in Patient with Hemodynamic Instability: A Case Report

Transarterial embolization is accepted as effective and safe for the acute management in hemodynamically unstable patients with pelvic ring injury. However, transarterial embolization has potential complications, such as gluteal muscle/skin necrosis, deep infection, surgical wound breakdown, and internal organ infarction, which are caused by blocked blood flow to surrounding tissues and organs, and many studies on the complications have been reported. Here, we report an experience of the management of gluteal necrosis and infection that occurred after transarterial embolization, with a review of the relevant literature.

Endovascular intervention for late postpancreaticoduodenectomy hemorrhage / 中华普通外科杂志

Objective To evaluate the safety,efficacy of interventional treatment for late postpancreaticoduodenectomy hemorrhage (LPPH).Methods From Jan 2008 to Dec 2017,678 patients underwent pancreaticoduodenectomy (PD).33 patients (4.9％) suffered from LPPH.30 of these 33 patients underwent diagnostic angiography and endovascular treatment,either transcatheter arterial embolization (TAE,n =21) or covered stent placement (CSP,n =9),and the other 3 underwent laparotomy.Results The incidence of LPPH is 4.9％ with a 12％ motality.The most common presentation is bleeding from abdominal drainage (24.2％) and melena (24.2％).The incidence of sentinel bleeding (SB) is 45.5％ and postoperative pancreatic fistula (POPF) is 69.7％.Intra-abdominal infection were identified in 24 patients (72.7％) and the most common pathogenic bacteria is pseudomonas aeruginosa (11/24,45.8％).The mean time between PD operation and LPPH was 17.4 days.In 21 patients receiving TAE,4 got liver damage and 2 with liver abscesses,1 died.The most common site of LPPH is GDA stump and re-bleeding occurred in 5 patients.9 patients by CSP got bleeding under control.In all 7 re-bleeding patients,2 were saved by CSP,1 was saved by TAE,while the other 4 died.Conclusion Early intervention plays an important role for LPPH.CSP is better than TAE.

Endoscopic Management of Peptic Ulcer Bleeding: Recent Advances

Bleeding peptic ulcers remained as one of the commonest causes of hospitalization worldwide. While endoscopic hemostasis serves as primary treatment for bleeding ulcers, rebleeding after endoscopic hemostasis becomes more and more difficult to manage as patients are usually poor surgical candidates with multiple comorbidities. Recent advances in management of bleeding peptic ulcers aimed to further reduce the rate of rebleeding through—(1) identification of high risk patients for rebleeding and mortality; (2) improvement in primary endoscopic hemostasis and; (3) prophylactic angiographic embolization of major arteries. The technique and clinical evidences for these approaches will be reviewed in the current article.

Hemoperitoneo como manifestación inicial de carcinoma hepatocelular: reporte de tres casos / Hemoperitoneum as initial manifestation of hepatocellular carcinoma: report of three cases

Hepatocellular carcinoma (HCC) is the main primary liver malignancy. Its prevalence is increasing and is associated in 90% to cirrhotic patients. Hemoperitoneum secondary to spontaneous rupture of the tumor is an uncommon complication in Latin America and the Western world, being more prevalent in Asian races. However, it is associated to hemodynamic repercussion with high mortality, therefore high level of suspicion and early treatment are required. Regarding the management of the condition, in addition to hemodynamic stabilization, active hemostatic control is recommended over conservative management, transarterial chemoembolization being currently the chosen alternative. We present a series of three clinical cases of patients who debuted with clinical manifestation of hemoperitoneum during the diagnostic process of a HCC.

El carcinoma hepatocelular (CHC) corresponde a la principal neoplasia maligna primaria hepática. Su prevalencia va en aumento y se asocia en 90% a pacientes cirróticos. El hemoperitoneo secundario a rotura espontánea del tumor constituye una complicación infrecuente en Latinoamérica y Occidente, siendo más prevalente en razas asiáticas. Sin embargo, se asocia a repercusión hemodinámica con alta mortalidad, por lo que requiere un alto índice de sospecha y tratamiento oportuno precoz. En cuanto al manejo del cuadro, junto a la estabilización hemodinámica se recomienda un control hemostático activo por sobre manejo conservador, siendo la embolización transarterial la alternativa de elección actualmente. Describimos a continuación una serie de tres casos clínicos de pacientes que debutan con manifestación clínica de hemoperitoneo durante el proceso diagnóstico de un CHC.

Improving Forward Infusion Pressure during Brain Tumor Embolization with the Double Catheter and Coil Technique / 신경중재치료의학

Endovascular embolization or embosurgery of brain tumors can be used to reduce neoplasm vascularity prior to surgical resection. Two challenges with embosurgery relate to insufficient perfusion pressure into the tumor and inadvertent escape of infused agents into parenchymal branches of the adjacent brain. This report describes a multi-catheter and coil technique to improve tumor perfusion and prevent reflux into normal branches.

Selective arterial embolization for the treatment of spontaneous rupture with bleeding of hepatocellular carcinoma: analysis of curative effect and prognosis / 介入放射学杂志

Objective To investigate the curative effect of transarterial embolization (TAE) for the treatment of spontaneous rupture with bleeding of hepatocellular carcinoma (HCC),and to discuss the factors influencing prognosis.Methods A total of 57 patients with HCC complicated by spontaneous rupture and bleeding,who received initial TAE during the period from June 2012 and June 2016,were enrolled in this study.The last follow-up visit was in October 2016.Kaplan-Meier method was used to calculate the cumulative survival rate,and Cox regression model was adopted to analyze prognostic factors.Results In this series of 57 patients,the median survival time was 208 days.The 6-month,1-year and 2-year cumulative survival rates were 50.3％,35.9％ and 14.7％,respectively.Multivariate Cox regression analysis indicated that tumor size,Child-Pugh classification,history of shock,and the used embolization materials were the independent prognostic factors.Conclusion The use of selective TAE,as an initial therapy,for HCC complicated by spontaneous rupture and bleeding is safe and effective.This study reveals that larger diameter of the tumor,poor Child-Pugh classification,the presence of shock history indicate a poor prognosis.TACE using lipiodol combined with gelatin sponge particles can expect a better prognosis than TACE using PVA particles alone.

Genital tract cavernous hemangioma as a rare cause of postpartum hemorrhage

Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.

TACE with infusion of fluorouracil, oxaliplatin and pirarubicin for the treatment of primary liver ;cancer:analysis of clinical effect / 介入放射学杂志

Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) with oxaliplatin (OXA), fluorouracil (5-Fu) and pirarubicin (THP) scheme in treating primary liver cancer. Methods A total of 65 patients with primary liver cancer were treated with TACE using infusion of OXA/5-Fu/THP scheme (TACE group). Other 21 patients with primary liver cancer, who were encountered at the Department of Interventional Radiology of authors’ hospital during the same period as the patients of TACE group, received simple transarterial embolization (TAE group). The therapeutic effect, the occurrence of adverse reactions, the progression-free survival time (PFS) and overall survival time (OS) of the two groups were comprehensively evaluated. The results were compared between the two groups. Results In the TACE group, the objective response rate (ORR) and disease control rate (DCR) were 55.4%and 81.5%respectively, and the median PFS and median OS were 11.5 months and 18.5 months respectively. Single factor analysis indicated that patients, who had liver function of Child-Pugh A and received more times or treatment, and who had small-sized tumor and no portal vein tumor thrombus or metastasis, usually had a better prognosis, and the differences were statistically significant (P<0.05). The prognosis of the patients with Barcelona staging (BCLC) B was better than that of the patients with Barcelona staging C, and the difference was statistically significant (P=0.000). Cox multivariate analysis revealed that the portal vein tumor thrombus and tumor metastasis were independent risk factors for the prognosis of the patients. Compared with the TAE group, TACE with OXA/5-Fu/THP scheme could effectively improve the mean progression-free survival time. Conclusion For the treatment of primary liver cancer, TACE with infusion of OXA/5-Fu/THP is clinically effective with fewer adverse reactions.

Diagnosis and treatment of splenic arteriovenous fistula after splenectomy / 中华消化外科杂志

Splenic arteriovenous fistula is a rare disease and is also easy to be misdiagnosed.Clinical manifestations of the splenic arteriovenous fistula include portal hypertension,esophageal gastric varices,gastro-intestinal bleeding,diarrhea,abdominal pain,ascites,dyspnoea and heart failure.One patient with splenic arteriovenous fistula after splenectomy was treated at the First Affiliated Hospital of Soochow University from April to May in 2014.The patient was cured successfully by percutaneous transarterial embolization and celiac arteriography with the aid of interventional radiology.Hepatic and renal functions of the patient got a normal condition combined with a missing of the ascites and portal hypertension by abdominal enhanced computed tomography at postoperative month 2.

Clinical Experiences of Transarterial Embolization after Abdominal Surgery in Trauma Patients / 대한혈관외과학회지

PURPOSE: Transarterial embolization has been known as an effective nonsurgical treatment for selected patients with intraabdominal hemorrhage. This study was conducted to evaluate the clinical outcomes of transarterial embolization after emergency operation in the blunt abdominal trauma patients with hemoperitoneum. METHODS: Between January 2004 and December 2008, a total of 13 consecutive blunt abdominal trauma patients with intraabdominal hemorrhage who received transarterial embolization after abdominal surgery were included. The characteristics, procedures, and the clinical outcomes of patients were analyzed, retrospectively. RESULTS: There were 6 males and 7 females. Age ranged between 21 and 77 years (mean 42.3 years). The most common injured organ was the liver (10 patients, 76.9%), and the most common embolized artery was hepatic artery (8 patients, 61.5%). Transarterial embolizations were intended to control the continued bleeding (9 patients, 69.2%), delayed bleeding (3 patients), and arteriovenous fistula (1 patient). Further, technical success was achieved in all 13 patients. One of 13 patients died of multiorgan failure. No procedure-related complications were observed. CONCLUSION: Angiography has a high detection rate of bleeding sites in patients with intraabdominal hemorrhage after blunt abdominal trauma. Transarterial embolization is considered as an effective and safe method in the management of intraabdominal hemorrhage after abdominal surgery in trauma patients.

A Case of Intraosseous Dural Arteriovenous Fistulas Involving Diploic Vein Treated with Transarterial Onyx Embolization

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous connections that lie within the dura. Intraosseous DAVFs involving diploic venous system are extremely rare. A 46-year-old woman presented with headache and right pulsatile tinnitus for three weeks. The tinnitus started after yelling. Digital subtraction angiography revealed DAVF within the basal portion of right parietal bone along the middle meningeal artery (MMA) groove. The fistula was fed by frontal branch of right MMA and drained into right transverse sigmoid sinus junction through dilated middle meningeal vein. The intraosseous DAVF involving diploic vein was successfully obliterated with Onyx embolization via transarterial route.

Vein of Galen Aneurysmal Malformation : Endovascular Management of 6 Cases in a Single Institute

OBJECTIVE: The aim of this study was to analyze the treatment outcome of patients with vein of Galen aneurysmal malformations (VGM). METHODS: Clinical and angiographic data of six consecutive patients with VGM were retrospectively reviewed. VGMs were angiographically classified by Yasargil's method. Treatment outcomes were evaluated. RESULTS: Mean age at initial treatment was 4.4+/-5.7 months. Angiographic types of VGMs were type II in two patients and type III in four. Three patients had cardiac symptoms and the others were asymptomatic. Two patients were treated with transvenous embolization, three with transarterial embolization, and one was managed conservatively. Two patients died due to venous hypertension few days after transvenous approach. Of three patients who were transarterially embolized, one was completely occluded with Onyx and two were incompletely occluded. During the follow-up period (range, one to six years) two of three patients treated with transarterial approach were asymptomatic and the other showed mild symptoms. One patient who was managed conservatively showed normal performance. CONCLUSION: Transarterial embolization of VGMs may be better than transvenous approach in terms of the treatment outcome and complication. Further studies are needed because of the rarity of the disease and rapid advancement of endovascular techniques.

Transarterial embolization of gastrointestinal hemorrhages: retrospective study in Siriraj Hospital.

Objective: To determine the technical and clinical results of transarterial embolization of nonvariceal gastrointestinal hemorrhages (GIH) which cannot be managed endoscopically. Methods: A retrospective review of 21 embolizations in 77 patients who underwent arteriography for acute nonvariceal GIH was performed. Gastrointestinal hemorrhage was classified by the site of bleeding as upper, lower, or transpapillar including hemobilia and pancreatic duct bleeding. Clinical parameters and embolized data were assessed for clinical success. In-hospital mortality was also reported. Results: Technical success (bleeding target devascularization) was achieved in all 21 patients (100%). The complete technical success rate was 71.4% (15 out of 21 patients) while the partial technical success rate was 28.6% (6 out of 21 patients). The complication rate was very low (9.5%) including only 2 cases of bowel ischemia. No other complications were found. Eight out of 21 patients (38.1%) had rebleeding within 3 days. Upper GIH seemed to recur more frequently (4 out of 7 patients representing 57.1%) within the first 3 days than did lower (4 out of 11 patients at 36.4%) and transpapillar (0 of 3) GIH. Clinical success (no rebleeding after 30 days) was achieved in 11 of 21 patients (52.4%) including 3 out of 7 patients (42.9%) with UGIH, 7 of 11 patients (63.3%) with LGIH, and all patients with transpapillar hemorrhage. The overall mortality rate was 42.9% (9 out of 21 patients), with 42.9% (3 of 7 patients) for UGIH, 27.3% (3 of 11 patients) for LGIH and none for transpapillar hemorrhage. GIH was the cause of death in 6 of 9 patients (66.7%) while 3 out of 9 patients (33.3%) died from the other causes. Conclusion: Transarterial embolization is an effective treatment modality for lower GIH and transpapillar hemorrhage but less effective in upper GIH.

Dural Arteriovenous Fistula Involving Transverse Sinus: Successful Embolization Using Onyx(R) / 신경중재치료의학

Transvenous coil embolization has been successfully applied for the treatment of cerebral dural arteriovenous fistulae. Unfortunately, the technique can not be applied in cases of poor or absent venous access route to the fistula, the situation of which is not uncommon. Transarterial embolization can be performed as an alternative method. However, the method usually ended in partial embolization of the fistulae because of the multiplicity of the dural feeders and anfractuosity of the feeders. Use of liquid embolic material, such as glue in transarterial embolization generally regarded as not conventional. Recently we experienced a successful embolization using a newly introduced liquid embolic material, Onyx in a case of transverse-sigmoid sinus dural arteriovenous fistula which was failed to be embolized with transvenous approach.

A case of angiography and transarterial embolization in arteriovenous malformation of uterus after a cesarean section episode / 대한산부인과학회지

Uterine arteriovenous malformation are very rare but life-threatening disease with massive uterine bleeding. These lesions may be congenital or acquired, the diagnosis is made by Doppler ultrasound, CT, MRI, pelvic angiography. We have experienced a patient, 33-year-old woman with vaginal bleeding after a cesarean section episode. The diagnosis was established by angiography, and the treatment was done successfully by uterine artery embolization. We report a case of uterine arteriovenous malformation, which is presented with a brief review of the literatures.

Cases of Transarterial embolization in Arteriovenous Malformation of Uterus / 대한산부인과학회지

Uterine arteriovenous malformations are very rare but potentially life-threatening lesions. These lesions may be congenital or acquired, but especially in patients with a history of infection, curettage, abortion, pelvic surgery or cancer. Ultimate treatment depends on the patients desire for fertility. Embolization therapy is effective method in reproductive age patients of. We have experienced two clinical cases of arteriovenous malformation of uterus, which is presented with a brief review of literature.

The Clinical Study on Spontaneously Ruptured Hepatocellular Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Spontaneous rupture of hepatocellular carcinoma (HCC) is known as a rare but life- threatening condition because of massive blood loss into the peritoneal cavity. In the countries with high prevalence, the reported incidence of spontaneous rupture and hemorrhage ranged from 10.2% to 14.5% of patients with HCC. This study was aimed to analyze the risk factors for spontaneous rupture and prognosis in the patients with ruptured HCC. METHODS: Among 642 consecutive patients with HCC who had admitted to Gyeongsang National University Hospital from January 1998 to September 2003, spontaneous rupture of HCC occurred in 83 patients (12.9%). The medical records of the 83 patients were reviewed retrospectively, and the clinico-laboratory parameters and radiologic findings were analyzed. RESULTS: Sixty-nine out of the 83 patients were male, the mean age was 57.7 +/- 13.2 years (male, 56.8 +/- 12.9 years; female, 62.3 +/- 13.5 years). Location of tumor, Child-Pugh class and Okuda stage were the risk factors influencing spontaneous rupture of HCC, whereas the TNM stage, presence of portal vein thrombosis, and size of the tumor were not. Among the 83 patients with ruptured HCC, 51 were treated by transarterial embolization (TAE), 31 by supportive measures, and 1 by operation. The median survival time was 3.4 +/- 4.5 months in all patients with ruptured HCC, 4.9 +/- 5.1 in successful TAE, and 2.1 +/- 3.4 in supportive measure groups. CONCLUSIONS: Advanced Child-Pugh class, advanced Okuda stage, and peripheral location were the risk factors for spontaneous rupture of HCC. The prolonged survival could be achieved in patients eligible for successful transarterial embolization rather than supportive measures.

Failed two cases' analysis of eight Transarterial embolization therapy for Pseudoaneurysm followed by D&C / 대한산부인과학회잡지

OBJECTIVE: It was to analyze two failed arterial embolization cases in the treatment for pseudoaneurysm followed by D&C. METHODS: Two failure cases out of eight cases were gained in the transarterial embolization treatment for eight years.(1. 1. 1992 - 12. 31. 1999) To search for the factors of failure, we went through obstetrical history and biopsy. RESULTS: Eight cases of transarterial embolization were performed to the treatment for pseudoaneurysm appeared after undergoing D&C. Six cases were successfully treated without complications. However, laparotomy was done due to the continuous bleeding in the other two cases. According to tissue biopsy, they showed the cervical pregnancy in one case and placenta accreta in the other. CONCLUSION: Transarterial embolization is proved to be more preferable to operate in the treatment of pseudoaneurysm than laparotomy, and transarterial embolization therapy failure rate is higher in case of existing remnant villi than not.