Clinical application of preset balloon in abdominal aorta in assisting cesarean section for patients with placenta previa complicated by placenta accreta / 介入放射学杂志

Objective To investigate the clinical value of preset balloon in abdominal aorta in assisting cesarean section for patients with placenta previa complicated by placenta accreta.Methods Preset balloon in abdominal aorta was performed in 72 patients with placenta previa complicated by placenta accreta before cesarean section was carried out.Of the 72 patients,pernicious placenta previa (type A) was seen in 33,scar uterus,placenta previa with placenta accreta (type B) in 36 patients,and placenta previa complicated by placenta accreta with no cesarean section history (type C) in 3.The amount of blood loss during cesarean section,the course of uterine resection,the X-ray radiation dose in performing placement of balloon,and the procedure-related complications were recorded.Results The average amount of intraoperative blood loss in type A,B and C group was 1461 ml,947 ml and 533 ml,respectively.Subtotal hysterectomy was adopted in 9 patients and uterine repair in 32 patients.The average radiation doses in 17 patients who received preset balloon procedure in 2015 and in 55 patients who received preset balloon procedure in 2016 were (28.5±14.1) mGy and (3.7±2.5) mGy,respectively.During hospitalization period,one patient developed right superficial femoral artery thrombosis,one patient developed venous thrombosis of right lower extremity,and subcutaneous hematoma occurred in two patients.Conclusion Temporary occlusion of the abdominal aorta with preset balloon to assist the cesarean section for patients with placenta previa complicated by placenta accreta can effectively reduce the amount of intraoperative blood loss and markedly reduce hysterectomy rate.The procedure of preset balloon is simple,and the X-ray exposure time is short.Skilled and experienced manipulation can further reduce the incidence of complications.

Embolotherapy with Onyx for ma xillofacia l arteriovenous malformations / 中国耳鼻咽喉头颈外科

OBJECTIVE To discuss the efficacy and safety of Onyx embolization for the treatment of maxillofacial arteriovenous malformation(mAVMs). METHODS Between February 2013 to May 2014, 16 patients with mAVMs received embolotherapy in our department. Eight cases' mAVMs located in mandibular region, 5 cases located in the maxillary region and the other 3 cases located near the orbital region. Embolotherapy with Onyx was carried out in all patients and all the patients were followed-up. The effect of embolization was evaluated according to the deformity arteriolar blood flow. RESULTS After the embolization, angiograpy showed that complete occlusion of mAVMs was achieved in 3 cases, 50%-90%occlusion in 10 cases, <50% occlusion in 3 cases, and the overall response rate was 81.25% (13/16). After operation, temporary decreased vision was obtained in one patient and recovered after 20 days, no permanent visual abnormality was found in all of the cases. Complications as distending pain, fever disappeared in 13 patients, improved in 2 patients and became worse in one patient. There was no case of skin necrosis occurred. Follow-up for 6 months after treatment, the deformity arteriolar blood flow larger than before was found in 2 cases and the others were stable. CONCLUSION Onyx embolization for the treatment of maxillofacial arteriovenous malformation is a safe and effective method, the short term curative effect has been confirmed while the long term curative effect should be further evaluated.

Efficacy of splenic artery trunk embolization with detachable balloon for portal hypertension and hypersplenism / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of detachable balloon for splenic artery trunk embolization in patients with cirrhotic portal hypertension and hypersplenism.</p><p><b>METHODS</b>Eight patients with cirrhotic portal hypertension received splenic artery trunk disconnection using detachable balloons under the guidance of digital subtraction angiography. The diameter and blood flow of the portal vein, the superior mesenteric vein, the splenic vein and the hepatic artery were measured by color Doppler ultrasound. Markers of liver function and blood coagulation, and routine blood parameters were assessed. Gastroscopy was used to evaluate to the degree of gastroesophageal varices. All complications experienced during the perioperative period were recorded.</p><p><b>RESULTS</b>The portal vein diameter decreased from 1.55±0.38 cm to 1.55±0.38 cm, and the splenic artery diameter decreased from 1.45±0.10 cm to 1.41±0.09 cm (P < 0.05). The portal vein blood flow was reduced from 971.52±174.77 ml/min to 785.86±100.17 ml/min, and the splenic vein blood flow decreased from 938.01±208.86 ml/min to 644.02±188.15 ml/min, while the hepatic artery blood flow increased from 261.25±65.47 ml/min to 449.32±84.05 ml/min (P < 0.05). The symptoms of splenism were improved effectively, with platelet counts rising from 37.75±10.61*109/L to 138.63±28.22*109/L after the procedure (P < 0.05). There were no episodes of severe complications or death in the perioperative period, and all patients showed remarkable improvement in markers of liver function and coagulation function, and improvement of esophagogastric varices.</p><p><b>CONCLUSIONS</b>The interventional disconnection technique of the splenic artery trunk using detachable balloon for the treatment of portal hypertension and hypersplenism is safe and effective.</p>

Endovascular embolization treatment for the spinal dural arteriovenous fistulae / 介入放射学杂志

Objective To investigate the clinical effect of endovascular embolization in treating spinal dural arteriovenous fistulae, and to discuss its imaging manifestations. Methods A total of 7 patients with spinal dural arteriovenous fistulae were included in this study. Endovascular embolization was carried out in all the 7 patients. The clinical data, including epidemiology, spinal MRI and DSA manifestations, therapeutic method and follow-up findings, were retrospectively analyzed. Results Abnormal MRI manifestations of spinal cord were demonstrated in all 7 patients. After the diagnosis was confirmed by DSA, endovascular embolization was carried out. All patients were followed up for 6 months, and their clinical symptoms were improved in different degrees. N-butyl cyanoacrylate (NBCA) glue was used as embolization agent in 4 cases, and no recurrence was observed in them. Onyx liquid glue was used in 3 patients, and in one of them the arteriovenous fistula recurred. Conclusion For the treatment of spinal dural arteriovenous fistulae, endovascular embolization is effective and safe although further investigation is still needed.

Endovascular interventional treatment of carotid artery injury / 中华创伤杂志

Objective To evaluate the efficacy and safety of the endovascular interventional minimally invasive techniques(IMIT)for treatment of carotid artery iniury. Methods A total of 111 cases of carotid artery injury diagnosed by digital subtraction angiography(DSA)were treated with IMIT.Except for 1 case of extracranial segment injury of internal carotid artery treated with transcatheter stentgraft placement to obturate the rupture of carotid artery,the other 110 cases of intracranial segment injury of internal carotid artery(ICA)were treated with embolization with balloons in 73,embolization with coils in 12,injection of NBCA and PVA in 6,stent-graft placement in 11 and embolization with multiple materials in 8. Results Angiography demonstrated rupture of extracranial segment of internal carotid artery and arteriovenous fistula(AVF)at the neck in 1 case,traumatic carotid cavernous fistula(TCCF)in 83.traumatic pseudoaneurysm at intracranial segment of carotid artery in 14 and both TCCF and pseudoaneurysm in 13.The interventional treatment succeeded in all cases and interual carotid arteries were well protected in 62 cases.Completion angiography documented complete obliteration of the fistulas,with complete disappearance of the clinical symptoms in 110 cases and improvement in 1.Minor complications occurred in 2 cases,without death occurred.During the follow-up for 1-14 months,16 cases reexamined with DSA,which showed that the symptoms of 3 cases reoccurred,2 of whom were cured by re-embolization and 1 was under clinical observation. Conclusions IMIT including transcatheter selective embolization and stent-graft implantation is minimally invasive,safe and effective for treatment of carotid artery injury.