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In recent years, endovascular treatment has emerged as the preferred approach for aortic aneurysms. From an anatomical perspective, the current focus of research remains on the reconstruction of iliac artery branches, multiple branches of visceral arteries, and branches of the aortic arch. Substantial clinical evidence has been accumulated in these areas. Simultaneously, future research is expected to explore the reconstruction of the aortic root involving coronary arteries openings and the inhibition of small arterial aneurysm progression through pharmacological means. This article aims to provide a review of significant research data in recent years related to the treatment of aortic aneurysms, offering insights and prospects for future research directions.
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Objective:To investigate the feasibility and clinical value of endovascular treatment of iliac vein disease via the great saphenous vein approach.Methods:Eighty-six patients with nonthrombotic left iliac vein compression lesions identified by anterograde lower limb vein angiography were divided into 2 groups: group A ( n=46) was treated via great saphenous vein and group B ( n=40) was treated via femoral vein. The success rate of puncture, time consuming of puncture catheterization, postoperative bed immobilization and complication rate of puncture were observed and compared between the two groups. Results:The puncture success rate was 97.8% (45/46) in group A and 100% (40/40) in group B, there was no significant difference between the two groups（ P>0.05）. The average puncture time was (9.4±2.7) min in group A and (5.5±1.3) min in group B ( P<0.05). The complication rate of group A was lower than that in group B ( P<0.05). The patency rate of iliac vein stent was 100%, as indicated by venous color ultrasound or angiography. Conclusion:Endovascular treatment of iliac vein disease via great saphenous vein approach is a safe and feasible method with less trauma and easier postoperative care.
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ABSTRACT Purpose To analyze the learning curve regarding complication rates of transrectal prostate biopsy (TRPB) versus transperineal prostate biopsy (TPPB), using real time software-based magnetic resonance imaging ultrasound (MRI-US) fusion techniques, along with first year experience of transperineal approach. Materials and Methods retrospective unicentric cohort study at a quaternary care hospital. Medical records of all consecutive patients that underwent TPPB between March 2021 and February 2022, after the introduction of MRI-US fusion device, and those who underwent TRPB throughout the entire years of 2019 and 2020 were analyzed. All complications that occurred as consequences of the procedure were considered. Descriptive statistics, Chi-squared and Fisher tests were used to describe complications and compare the two groups. Results A total of 283 patients were included in the transperineal group and 513 in the transrectal group. The analysis of a learning curve for the transperineal method showed lower complications rates comparing the first six months of TPPB procedures (group 1); The complication rate for TPPB was lower than that of TRPB (55.1% versus 81.9%, respectively; p<0.01). TPPB showed specifically lower rates of hematuria (48.8% versus 66.3%;p<0.001) and rectal bleeding(3.5% versus 18.1%; p<0.001). There were no cases of prostatitis after transperineal biopsies and three cases (0.6%) after transrectal procedures. Conclusions We evidenced the learning curve for performing the transperineal biopsy, with a lower rate of complications for the experienced team, after 142 cases after 6 months of practice. The lower complication rate of TPPB and the absence of infectious prostatitis imply a safer procedure when compared to TRPB.
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Interventional diagnosis and treatment of heart disease is the gold standard to evaluate the anatomy and physiology of children with congenital heart disease. It plays an important role in the treatment of congenital heart disease. However, ionizing radiation is inevitably harmful to the health of children and surgery operators to varying degrees. More and more attention has been paid by surgery operators to children's unique characteristics, protective awareness and skills. This paper reviews recent literature regarding the application, radiation hazards, and research status of interventional surgery in children with congenital heart disease, which hope to help people to better understand the importance of ionizing radiation protection.
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Objective:To evaluate the safety and efficacy of drug-coated balloon (DCB) in the treatment of symptomatic intracranial atherosclerotic stenosis.Methods:Forty-nine patients with symptomatic intracranial atherosclerotic stenosis treated with DCB in the People′s Hospital of Zhengzhou University from January 2018 to August 2021 were retrospectively included. The location and number of lesions were as follows: 21 cases of the middle cerebral artery, 11 cases of the intracranial segment of vertebral artery, 12 cases of the basilar artery, and 5 cases of the intracranial segment of internal carotid artery. Pre-dilatation of the lesion with a normal balloon followed by DCB angioplasty. Clinical follow-up (outpatient or telephone) was carried out at 30 days, 3 months, 6 months, and 1 year after the operation. Imaging follow-up was carried out at 6 months postoperatively. The surgical success rate (defined as the proportion of patients with residual stenosis<50% after balloon dilatation), perioperative safety (any strokes, TIA, and deaths within 1 month), stroke recurrence, and restenosis were analyzed.Results:The operation was performed in all patients successfully. The median stenosis level was 80% (75%, 85%) preoperatively and 20% (15%, 30%) at the time after the operation. The success rate of the operation was 91.8% (45/49). Stenting was given in 11 cases (22.4%, 11/49) for severe flow-limiting vascular entrapment, or non-flow-limiting entrapment, owing to the concern of subsequent progression of the entrapment. Three cases (6.1%, 3/49) had significant vascular elastic retraction and implement stent implantation. One patient (2.0%, 1/49) developed symptomatic cerebral infarction during perioperative period, and the symptoms improved after treatment. No fatal or disabling stroke occurred. All patients were followed-up successfully. The median follow-up time was 12 months. Two patients (4.1%, 2/49) had a stroke in the responsible vascular area, and 1 (2.0%, 1/49) patient had a stroke in the non-responsible vascular area. Thirty-eight patients (77.6%, 38/49) had followed-up images. The median follow-up time of postoperative imaging was 6 months. Restenosis occurred in two cases (1 case had symptomatic restenosis), and the incidence of restenosis was 5.3% (2/38).Conclusions:DCB in the treatment of symptomatic intracranial atherosclerotic stenosis has a high technical success rate, good perioperative safety, and low stroke recurrence rate in short-term follow-up, demonstrating the good feasibility, safety, and efficacy of DCB.
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Objective:To evaluate the feasibility, safety, treatment outcome, and the individualized surgical procedure selection of the interventional treatments of chylous leakage.Methods:From July 2019 to January 2022, the clinical data of 60 consecutive patients with chylous leakage underwent interventional treatment were respectively analyzed. The cases included chylothorax ( n=37), chylous ascites ( n=10), chyluria ( n=4), chylothorax combined with chylous ascites ( n=5), chylothorax combined with chylopericardium ( n=2), and pelvic chylous effusion ( n=2). Conservative treatment was considered to have failed for all patients. The lymphangiography was firstly performed to detect chylous leakage, then an individualized procedure was selected according to the lymphangiography results. The treatment outcomes and complications were recorded, and follow-up was performed. Results:Lymphangiography was technically successful in 55 of 60 patients (91.7%), and no cisterna chyli and thoracic duct opacification was observed in 5 patients. The procedures for the patients included lymphangiography alone ( n=23), thoracic duct embolization ( n=23), thoracic duct disruption ( n=5), lymphatic embolization for pelvic chylous effusion ( n=4), and balloon plasty for thoracic duct ( n=5). Clinical success was achieved in 53 of 60 cases (88.3%). The complication rate was 8.3% (5/60), and all complications were minor. The median follow-up time was 11 months (range 0.5-30 months) for 56 patients, and 4 patients were lost to follow-up. There was one patient presenting the reoccurrence of symptom, and 8 patients died. Conclusions:The interventional treatment of chylous leakage is safe with good outcomes and low complication rate. Individualized treatment procedures based on the lymphangiography findings is feasible and with good curative effect.
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Objective:To investigate the histopathological and immunohistochemical changes of gastric fundus and duodenum after bariatric embolization of left gastric artery and gastroduodenal artery in obesity New Zealand rabbit models.Methods:Twenty obesity New Zealand rabbit models were successfully established and divided into two groups using stratified randomization. Left gastric artery and gastroduodenal artery were embolized with gelatin sponge (350-560 μm) in experimental group, left gastric artery and gastroduodenal artery were perfused with normal saline in control group. All animals were sacrificed for pathological, immunohistochemical examination and Western Blot analysis 4 weeks post embolization, the density of ghrelin producing cells and the gray ratio of ghrelin protein band were measured and compared by the independent sample t test. Results:Macropathological examination showed ulceration in the anterior wall of the gastric body in one rabbit, histopathological examination showed mucosa ulceration in the gastric body in 3 rabbits in experimental group. Immunohistochemical examination showed that the ghrelin producing cells of gastric fundus and duodenum in the experimental group were significantly less than those in the control group (10.0±5.1 vs.27.7±3.4, t=12.35, P<0.05;5.6±2.6 vs. 12.3±2.1, t=4.73, P<0.05). Western Blot analysis showed that the gray ratio of ghrelin bands of gastric fundus and duodenum in the experimental group were significantly lower than that in the control group (0.65±0.05 vs.1.12±0.09, t=9.62, P<0.05;0.55±0.03 vs. 0.94±0.08, t=7.98, P<0.05). Conclusions:Immunohistochemical and Western Blot analysis showed that the ghrelin-producing cells of gastric fundus and duodenum in the experimental group were significantly less than those in the control group after bariatric embolization, histopathologic analysis indicated that bariatric embolization was a safe technique.
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Objective:To investigate the characteristics of primary catheter malposition (PCM) following totally implantable venous access port (TIVAP) implantation via the internal jugular vein (IJV) and management strategies.Methods:Clinical data of 587 consecutive breast cancer patients undergoing TIVAP implantation via the IJV performed by single team at the Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University from Aug 2017 to Aug 2022 was retrospectively analyzed.Results:A total of 593 TIVAP were implanted and PCM was found in 18 cases (3.0%). Four hundred and twenty five TIVAP were implanted via the right IJV with one PCM case (0.2%). One hundred and sixty eight TIVAP implantations were performed via the left IJV and PCM occurred in 17 cases (10.1%). The interventional management with a pigtail catheter was performed as a first-line strategy in 11 of the 18 PCM cases, with a success in 10 cases and failure in one. Three cases were successfully managed with the digital subtraction angiography (DSA)-guided open approach. Four cases underwent blind open procedure firstly and 2 suffered a failure.Conclusions:A higher incidence of PCM is found in TIVAP implantations via the left IJV than the right one. The interventional management with a pigtail catheter or the DSA-guided open procedure proves to be feasible for the correction of PCM.
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ObjectiveTo investigate the efficacy and safety of 125I intraluminal irradiation combined with lenvatinib in the treatment of progressive extrahepatic cholangiocarcinoma. MethodsA retrospective analysis was performed for 25 patients with progressive extrahepatic cholangiocarcinoma who attended Department of Interventional Radiology， The First Affiliated Hospital of Zhengzhou University， from January 2018 to November 2021， and according to the treatment modality， they were divided into combination group with 13 patients （125I intraluminal irradiation combined with lenvatinib） and control group （125I intraluminal irradiation alone）. The two groups were compared in terms of technical success rates， changes in liver function， stent patency， survival time， and incidence rates of adverse events. The independent－samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank－sum test was used for comparison of continuous data with skewed distribution between two groups； the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan－Meier method and the log－rank test were used to evaluate survival time and stent patency. ResultsAll patients had successful implantation of biliary stents and 125I particles， with a technical success rate of 100%. After 1 month of treatment， both groups had significant improvements in the serum levels of total bilirubin， direct bilirubin， alanine aminotransferase， and aspartate aminotransferase （all P<0.05）. There were significant differences between the control group and the combination group in the duration of stent patency （7.0 months vs 9.5 months， P=0.022） and median survival time （11.5 months vs 15.6 months， P=0.008）. There were no intolerable adverse events in the combination group during treatment. ConclusionCompared with 125I intraluminal irradiation alone， 125I intraluminal irradiation combined with lenvatinib has better efficacy and is a safe and effective treatment regimen for progressive extrahepatic cholangiocarcinoma.
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ABSTRACT Objective To describe the radiological characteristics of hepatocellular carcinoma (HCC) lesions that achieved a complete response following drug-eluting bead transarterial chemoembolization (DEB-TACE) preceding liver transplantation. Methods This single-center case-control study enrolled patients with hepatocellular carcinoma who underwent neoadjuvant DEB-TACE therapy, were followed up with contrast-enhanced magnetic resonance imaging or computed tomography, and were successively evaluated according to the modified Response Evaluation Criteria in Solid Tumors. The HCCs were divided into two groups based on their diameter (Group A: ≤3cm; Group B: 3cm). Viability was assessed using the Kaplan-Meier method according to tumor size categories. The relationship between tumor variables was analyzed using bivariate Cox regression. Results Three-hundred and twenty-eight patients with 667 hepatocellular carcinomas who underwent their first DEB-TACE session were enrolled. A total of 105 hepatocellular carcinomas in 59 patients exhibited complete response after the initial DEB-TACE session and were divided into Group A (92 HCCs) and Group B (13 HCCs). The diameter in Group A decreased significantly compared to the pre-procedure size until the second assessment (p<0.001), with no subsequent reduction in diameter, despite maintaining a complete response. In Group B, the reduction in diameter remained significant compared with the initial value until the sixth imaging evaluation (p=0.014). The average reduction was 45.1% for Group B and a maximum of 14.9% in Group A. Conclusion HCCs >3cm exhibited a greater reduction in size and a longer time to recurrence. HCCs ≤3cm had a shorter relapse time. The recurrence rates were similar. These findings may aid in planning for liver transplantation.
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ABSTRACT BACKGROUND: Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures. OBJECTIVE: To compare AR with other learning methods in interventional radiology. DESIGN AND SETTING: Systematic review of comparative studies on teaching techniques. METHODS: We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model. RESULTS: Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR. CONCLUSION: AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model. SYSTEMATIC REVIEW REGISTRATION NUMBER: DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.
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Resumo As técnicas de gastrostomia guiadas por imagem, por via transoral e transabdominal podem ser realizadas quando há falha na técnica endoscópica ou em cenários clínicos em que a endoscopia não pode ser realizada. Este ensaio iconográfico pretende mostrar as técnicas de gastrostomia percutânea, suas indicações, aspectos técnicos, cuidados pós-procedimento e complicações.
Abstract The image-guided gastrostomy techniques, as transoral and transabdominal, can be performed when there is a failure of the endoscopic procedure or in some specific clinical scenarios. This pictorial essay intends to show the percutaneous gastrostomy techniques, indications, technical approaches, post-procedure care, and complications.
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Objective:To evaluate the safety, feasibility and efficacy of drug-coated balloon (DCB) in the treatment of in-stent restenosis (ISR) of the vertebrobasilar artery.Methods:Twenty-one patients with ISR of the vertebrobasilar artery treated with DCB at the Zhengzhou University People′s Hospital from January 2018 to December 2020 were retrospectively included. There were 22 lesions with ISR, of which 8 were located in the initial segments of vertebral artery, 12 were located in the V4 segment of the vertebral artery, and 2 were located in the basilar artery. The clinical prognosis was evaluated by modified Rankin Scale (mRS), and the target vessel restenosis was evaluated by DSA, CTA or MRA. The safety, feasibility and effectiveness of DCB in the treatment of vertebrobasilar artery ISR were analyzed by perioperative complications, technical success rate and follow-up.Results:All 21 patients with ISR underwent successful interventional surgery. No stroke, TIA and death occurred in perioperative period. During the operation, two cases (9.5%) were treated with Apollo stent due to the residual stenosis>50% after DCB dilation. The technical success rate was 90.5%. The mean stenosis of the target vessel was improved immediately from preoperative (78.1±11.3)% to postoperative (22.1±8.3)%. All the 21 patients were followed up. As of the last follow-up in September 2021, the median clinical follow-up period was 19 (12, 33.5) months, and there were no stroke, TIA and death caused by the corresponding artery. The mRS score was 0 in 18 patients 1 in 2 patients and 2 in 1 patient. Imaging follow-up was available in 13 cases (61.9%) with a median follow-up time of 7(5.5, 19) months, and the target vessel restenosis rate was 7.7% (1/13).Conclusions:This preliminary study has shown that DCB in the treatment of ISR of the vertebrobasilar artery is safe and feasible, with a high technical success rate and low restenosis rate, which provides clinical application evidence, but the long-term effect needs further follow-up observation.
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Objective:To investigate the current status of interventional radiology discipline in the provincial-level and national cancer hospitals of China, and to provide supportive data for the future systematic construction of interventional radiology.Methods:A questionnaire was used to survey 32 provincial and national cancer hospitals of China. The survey included data such as discipline settings, medical treatment, medical education, and scientific research. Then descriptive statistical analysis was performed based on the data.Results:All 32 provincial and national cancer hospitals of China had interventional radiology services and were equipped with independent wards; the deployment rates of DSA, ultrasound, CT, and radiofrequency ablation equipments were: 100%(32/32), 81.3%(26/32), 40.6%(13/32), and 75.0%(24/32), respectively. Of all 32 hospitals, 27 (84.4%) had performed more than 1 000 interventional operations per year. The proportion of hospitals that had interventional subspecialties was 21.9% (7/32). As for the interventional radiology doctors in these hospitals, the ratio of doctors with a background of medical imaging specialty was 69.6%(256/368); the proportion of doctors with ages ≤ 45 years old was 72.0%(265/368); and the ratio of doctors with a master degree was 79.9%(294/368). Among the 32 hospitals, 22 (68.8%) had more than 500 000 yuan research funds in intervention radiology discipline, and 71.9%(23/32) had intervention radiology discipline postgraduate tutors.Conclusions:The overall development of interventional radiology discipline in provincial-level and national cancer hospitals is good. The discipline development pattern might set a good example for interventional radiology discipline construction in general hospitals.
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Objective:To compare the efficacy of transcatheter arterial embolization (TAE) with laparotomy in the treatment of severe liver injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 48 patients with severe liver injury admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from December 2013 to June 2020, including 28 males and 20 females; aged 16-75 years [(45.7±6.2)years]. There were 25 patients with grade III, 15 grade IV and 8 grade V according to the American Association for the Surgery of Trauma (AAST) classification. After general treatments such as infusion and hemostasis, TAE was performed in 26 patients (TAE group) and laparotomy in 22 patients (laparotomy group). The operation time and length of hospital stay were compared between the two groups. Erythrocyte, hemoglobin and serum creatinine were compared before operation and at postoperative 1 day. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were analyzed before operation and at postoperative 1, 3, 7 days. Complications were observed.Results:All patients were followed up for 12-60 months [(17.1±9.1)months]. The operation time and length of hospital stay were (65.7±9.2)minutes and (21.6±6.6)days in TAE group, significantly shorter than (162.5±28.1)minutes and (31.5±7.4)days in laparotomy group ( P<0.05 or 0.01). There was no significant difference between the two groups referring to erythrocyte, hemoglobin and serum creatinine before operation and at postoperative 1 day (all P>0.05). There was no significant difference in ALT and AST between the two groups before operation (all P>0.05). TAE group showed ALT level of 1 154(884, 1 698)U/L, (975.3±400.9)U/L and (403.4±232.9)U/L at postoperative 1, 3, 7 days, significantly lower than 2 053(1 965, 2 132)U/L, (1 604.1±188.2)U/L and (915.3±160.5)U/L in laparotomy group (all P<0.05). TAE group showed AST level of (1 313.2±542.0)U/L, 525(302, 971)U/L and 174(84, 324)U/L at postoperative 1, 3, 7 days, significantly lower than (1 962.9±245.4)U/L, 1 478(1 089, 1 677)U/L and 837(674, 1 006)U/L in laparotomy group ( P<0.05 or 0.01). The complication rate was 26.9% (7/26) in TAE group, significantly lower than 59.1% (13/22) in laparotomy group ( P<0.05). Conclusion:For severe liver injury, TAE can significantly shorten operation time and length of hospital stay, accelerate the recovery of liver function and reduce the complication rate in comparison with laparotomy.
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Objective:To investigate the imaging characteristics of uncomplicated acute type B aortic dissection (uATBAD) and the short-term and mid-term outcomes treated with thoracic endovascular aortic repair (TEVAR).Methods:One hundred and forty uATBAD patients treated by TEVAR at Zhejiang Provincial People's Hospital from Jan 2015 to Aug 2021 were retrospectively analyzed. Patients were divided into non-high-risk characteristics group (uATBAD group, 22 cases) and high-risk characteristics group (high-risk uATBAD group, 118 cases) according to the presence or absence of high-risk characteristics. The clinical and follow-up data were analyzed, and the incidence of complications, re-intervention rate, and mortality in the perioperative period and 5-year follow-up were evaluated.Results:The aortic diameter, false lumen diameter and the proportion of laceration in lesser curvature in the high-risk group were higher than those in the non-high-risk group ( P<0.05). There was no significant difference in the incidence of perioperative complications and 30 day mortality between two groups ( P>0.05). The follow-up time ranged from 6 to 83 months (mean 38.3 months). The 5-year mid-term follow-up showed that there was no significant difference in the incidence of aorta-related complications, re-intervention rate, and mortality between two groups ( P>0.05). Conclusions:The imaging characteristics of different typing uATBAD were significantly different. The short- and mid-term clinical effects of TEVAR were similar between the two groups.
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ABSTRACT Objective: To reflect on the elements of nursing care management in radiological protection in interventional radiology. Methodology: A reflection paper based on national and international articles and laws addressing the nursing care management issue and radiological protection in interventional radiology. Results: From the conceptions of nursing care management and professional practice, the following elements were perceived in this management: expertise and applicability of the radiological protection principles, biological effects of ionizing radiation, occupational dose monitoring, personal and collective protective equipment, patient safety, training in radiological protection, quality assurance program. Conclusion: The management of nursing care in radiological protection in interventional radiology is implemented in an elementary way regarding care aimed at dose reduction, either for workers or patients. There is a need to recognize, understand and characterize the management of nursing care in this scenario.
RESUMEN Objetivo: Reflexionar sobre los elementos de la gestión del cuidado de enfermeria en la protección radiológica en radiología intervencionista. Metodología: Estudio reflexivo realizado a partir de artículos y legislación nacional e internacional que abordan el tema de la gestión de cuidados de enfermería y protección radiológica en radiología intervencionista. Resultados: A partir de las concepciones de la gestión del cuidado de enfermería y la actuación profesional en la práctica, se apreciaron los siguientes elementos de esta gestión: conocimientos y aplicabilidad de los principios de protección radiológica, efectos biológicos de las radiaciones ionizantes, monitorización de dosisocupacional, equipos de protección individual y colectiva, seguridad del paciente, educación en protección radiológica, programa de garantía de calidad. Conclusión: La gestión de los cuidados de enfermería en protección radiológica en radiología intervencionista se implementa de forma incipiente en lo que respecta a los cuidados dirigidos a la reducción de dosis, ya sea para trabajadores o pacientes. Es necesario reconocer, comprender y caracterizar la gestión de los cuidados de enfermería en este escenario.
RESUMO Objetivo: Refletir sobre os elementos da gestão do cuidado em enfermagem na proteção radiológica em radiologia intervencionista. Metodologia: Estudo reflexivo realizado a partir de artigos e legislação nacional e internacional abordando a temática da gestão do cuidado em enfermagem e proteção radiológica em radiologia intervencionista. Resultados: A partir das concepções de gestão do cuidado em enfermagem e atuação profissional na prática vislumbrou-se como elementos dessa gestão: conhecimentos e aplicabilidade dos princípios de proteção radiológica, efeitos biológicos da radiação ionizante, monitoramento de dose ocupacional, equipamentos de proteção individual e coletiva, segurança do paciente, educação em proteção radiológica, programa de garantia de qualidade. Conclusão: A gestão do cuidado em enfermagem em proteção radiológica em radiologia intervencionista é implementada de forma incipiente no que tange aos cuidados voltados para redução de dose, seja para trabalhadores ou paciente. Torna-se necessário reconhecer, compreender e caracterizar a gestão do cuidado em enfermagem nesse cenário.
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ABSTRACT Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.
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Resumen ANTECEDENTES: La hemorragia puerperal tardía implica una importante morbilidad y mortalidad que requiere una actuación urgente. Su causa es muy variada y requiere una cuidadosa valoración que permita detenerla, sin complicaciones. CASO CLÍNICO: Paciente de 42 años que a las cinco semanas posteriores a una cesárea acudió a Urgencias debido a un sangrado puerperal abundante. Enseguida de un legrado y exhaustiva revisión en el quirófano en la ecografía se identificó un área parauterina anecogénica sugerente de dilatación aneurismática comunicada con la cavidad uterina. El diagnóstico se estableció con base en la angiografía y se confirmó luego de la embolización mediante radiología intervencionista, sin contratiempos, y resolución del cuadro. La paciente se dio de alta del hospital en los siguientes dos días, con posteriores revisiones que se reportaron normales. CONCLUSIONES: La patología vascular debe formar parte del diagnóstico diferencial del sangrado puerperal tardío y, si se diagnostica adecuadamente, puede facilitar el procedimiento terapéutico mediante radiología intervencionista y evitar, así, otros tratamientos más invasivos.
Abstract BACKGROUND: Late puerperal hemorrhage is a major morbidity and mortality that requires urgent action. Its cause is very varied and requires careful assessment to stop it without complications. CLINICAL CASE: A 42-year-old woman came to the emergency department five weeks after cesarean section for heavy puerperal bleeding. After curettage and thorough examination in the operating room, ultrasound identified an anechogenic parauterine area suggestive of aneurysmal dilatation in communication with the uterine cavity. The diagnosis was established based on angiography and confirmed after embolization by interventional radiology, without mishap, and resolution of the picture. The patient was discharged in two days, with subsequent revisions reported as normal. CONCLUSIONS: Vascular pathology should be part of the differential diagnosis of late puerperal hemorrhage and, if properly diagnosed, may facilitate the therapeutic procedure by interventional radiology and thus avoid other more invasive treatments.