Research on injection flow velocity planning method for embolic agent injection system / 生物医学工程学杂志

Interventional embolization therapy is widely used for procedures such as targeted tumour therapy, anti-organ hyperactivity and haemostasis. During embolic agent injection, doctors need to work under X-ray irradiation environment. Moreover, embolic agent injection is largely dependent on doctors' experience and feelings, and over-injection of embolic agent can lead to reflux, causing ectopic embolism and serious complications. As an effective way to reduce radiation exposure and improve the success rate of interventional embolization therapy, embolic agent injection robot is highly anticipated, but how to decide the injection flow velocity of embolic agent is a problem that remains to be solved. On the basis of fluid dynamics simulation and experiment, we established an arterial pressure-injection flow velocity boundary curve model that can avoid reflux, which provides a design basis for the control of embolic agent injection system. An in vitro experimental platform for injection system was built and validation experiments were conducted. The results showed that the embolic agent injection flow speed curve designed under the guidance of the critical flow speed curve model of reflux could effectively avoid the embolic agent reflux and shorten the embolic agent injection time. Exceeding the flow speed limit of the model would lead to the risk of embolization of normal blood vessels. This paper confirms the validity of designing the embolic agent injection flow speed based on the critical flow speed curve model of reflux, which can achieve rapid injection of embolic agent while avoiding reflux, and provide a basis for the design of the embolic agent injection robot.

Tratamento de aneurismas de artéria esplênica e renal no mesmo tempo operatório: relato de caso e revisão / Treatment of aneurysms in the splenic and renal arteries in a single operation: case report and review

Resumo Aneurismas de artérias viscerais e renais são raros (0,01 a 2%) e seu risco de ruptura varia entre os diferentes tipos e de acordo com sua anatomia e contexto do paciente (comorbidades, gravidez e histórico de transplante hepático). A mortalidade decorrente da ruptura desses aneurismas é em torno de 25%. Novas técnicas e materiais derivados da neurointervenção parecem alternativas promissoras para o tratamento desses aneurismas. Neste contexto, relatamos um caso de paciente submetida a tratamento endovascular no mesmo procedimento de aneurisma de artéria esplênica e de artéria renal com a utilização de stent Solitaire® (Medtronic, Minneapolis, EUA) e molas de liberação controlada Ruby® (Penumbra, Alameda, EUA). A paciente apresentou boa evolução com ambos aneurismas tratados de forma adequada. Em conclusão, o tratamento endovascular de aneurismas de artéria esplênica e renal no mesmo tempo operatório é exequível e demonstrou segurança e efetividade no caso relatado.

Abstract Visceral and renal artery aneurysms are rare (0.01 to 2%) and their risk of rupture varies between different types and depending on their anatomy and patient context (comorbidities, pregnancy, and liver transplant history). Mortality due to rupture of these aneurysms is around 25%. New techniques and materials derived from neurointervention seem to be promising options for treatment of these aneurysms. In this context, we report the case of a patient undergoing endovascular treatment of both splenic artery and renal artery aneurysms during the same procedure, using Solitaire stents and controlled release coils in both repairs. The patient recovered well with both aneurysms adequately treated. In conclusion, endovascular treatment of splenic and renal artery aneurysms during the same operation is feasible and has proved safe and effective in the case reported.

Embolization of unruptured intracranial aneurysms combined with brain arteriovenous malformations / 中国介入影像与治疗学

Objective To explore the value of interventional therapy in unruptured intracranial aneurysms combined with brain arteriovenous malformations (BAVM).Methods Data of 23 patients with unruptured aneurysms combined with BAVM were retrospectively analyzed.All patients were treated with interventional embolization,and the embolization methods were choosen according to the Redekop classification.The proximal or distal hemodynamic aneurysms were embolized with coils,and the intranidal aneurysms were embolized with Onyx.The outcome was assessed by the Glasgow outcome score (GOS) one week after treatment.DSA scan was used to observe whether there was recurrence during 3-6 months after embolization.Results Totally there were 36 aneurysms in 23 patients,including 8 intranidal aneurysms,16 proximal flow-related aneurysms,11 distal flow-related aneurysms and 1 unrelated aneurysm.Embolizations of 16 proximal hemodynamic aneurysms and l0 distal hemodynamic aneurysms were done with coils.And embolization of 8 intranidal aneurysms were done with Onyx.One distal hemodynamic aneurysm was not embolized due to the difficulty of embolization and the regular shap of aneurysm;and the patient died of cerebral hernia caused by intracranial hemorrhage on the sixth day after embolization.Because it was more suitable for surgical clipping,1 unrelated hemodynamic aneurysm was not embolized.In 23 cases,BAVM were completely embolized in 7 cases and incompletely embolized in 16 cases.A week after operation,the GOS score were 5 in 19 cases and 4 in 3 cases.The GOS score was not evaluated in the dead case.Except for 1 cases of death,the other 22 cases were followed up after embolization.No recurrence and intracranial hemorrhage occurred.Conclusion Interventional treatment of unruptured intracranial aneurysms combined with BAVM is safe and effective.Making treatment plan according to the hemodynamic characteristics of lesions and completely embolizing all lesions to prevent postoperative bleeding is helpful to improve the prognosis of patients.

Preoperative Embolization of Cerebellar Hemangioblastoma with Onyx: Report of Three Cases / 신경중재치료의학

Hemangioblastoma is a benign and highly vascular tumor. Complete surgical resection of highly vascular tumor such as hemangioblastoma may be challenging due to excessive bleeding. Preoperative embolization of these lesions may decrease the intraoperative blood loss and facilitate excision. We report three cases of cerebellar hemangioblastomas that were embolized using Onyx.

Incidência de sangramento renal nos pacientes em tratamento não operatório no Hospital João XXIII no período de 2004 a 2008 - Relato de caso / Incidence of renal bleeding in patients under non-operative treatment in Hospital João XXIII between 2004 and 2008 - A case report

Cada vez mais se tem utilizado o tratamento não operatório em vísceras maciças. Em decorrência desse fato, os pacientes apresentam melhores condições de morbidade e mortalidade, entretanto, novos desafios surgem, especialmente quanto às complicações associadas. Este relato mostra a abordagem de tratamento não operatório de trauma renal com embolização, além de comunicar a experiência do Serviço de Cirurgia Geral e do Trauma do Hospital João XXIII de Belo Horizonte, Minas Gerais, em relação ao tratamento da complicação sangramento associado ao trauma após tratamento não operatório do rim.

Non-operative treatment has been increasingly used for solid organs, improving patients' morbidity and mortality. However, it also raises new challenges, especially with regards to associated complications. This report shows the non-operative treatment approach to renal trauma using embolization, sharing the experiences of the Department of General Surgery and Trauma at the Hospital João XXIII in the city of Belo Horizonte, Minas Gerais, in treating complications associated with bleeding after trauma in non-operative kidney treatment.

Selective portal vein embolization with ethanol in treatment of implanted liver tumor in rats / 中华放射学杂志

Objective To evaluate the feasibility, safety and efficacy of selective portal vein embolization (SPVE) in treatment of liver tumor in rats and to provide the groundwork for its future clinical applications. Methods 24 healthy rats underwent the embolization. Pre and post SPVE portogram and liver chemical profile were obtained. Four rats were sacrificed at 10 min, 7,14, 21 and 28 days respectively following follow up portography. The liver, heart, lungs and kidneys were examined macroscopically and microscopically. Fifteen rats implanted with Walker 256 tumor sized from 3 to 10 mm in liver were scanned with MRI and portography pre SPVE taken. Post SPVE 3 rats were examined with MRI for each group at the same interval as above and the lives were examined microscopically. Results (1) The blood flow to the target portal branches were immediately halted after SPVE. These vessels remained occluded without collateral formation up to 28 days. (2) The liver indexes and BUN level increased after embolization, but returned to normal within 21 d. Macroscopic and microscopic changes were not found in the heart, lungs or kidneys. (3) In the healthy rats, the affected segment was atrophic and the remaining liver underwent compensatory hypertrophy. Histologic examination revealed that the targeted portal veins were coagulated, the endothelium were degenerated and the local hepatocytes were necrotic after embolization. (4) In the rats with implanted liver tumor, the affected segment including the tumor was necrotic and atrophic. The tumors were completely necrotic, and no viable tumor cell was seen under microscope in 12 among the 15 rats. Three tumors 10 mm in diameter were not completely necrotic. Part of tumor cells were still alive and infiltrated into the surrounding liver. Conclusion SPVE with ethanol is effective in the treatment of small liver tumor in rats. However,in case of bigger tumors involving several segments, SPVE should be combined with other treatment.

Ethanol embolization therapy for arteriovenous malformations / 介入放射学杂志

For recent years, ethanol embolization therapy has achieved satisfactory results in treating arteriovenous malformations (AVMs), which indicate that this technique will hopefully become an acceptable therapeutic form in clinical practice. It is now the preferred technique for the management of some extremely complex lesions. However, the endovascular injection of alcohol is such a work that is full of risks as weel as challenges. The ethanol embolization of AVMs may cause a series of significant complications, some of which may lead to serious outcomes. This article aims to discuss the mechanism of the ethanol embolization for AVMs, the technical principles and points, the postoperative histologic changes and the possible complications as well as their preventions.

Emergency Call Embolization Treatment of Hemorrhage of Digestive Tract / 实用放射学杂志

Objective To discuss the value of emergency angiography and embolization treatment of hemorrhage of digestive tract.Methods Give emergency angiography and embolization treatment for 15 patients with hemorrhage of digestive tract.Male is 12.Famale is 3.Adopt to Seldinger technic and method of coaxial duct,the head of ducts accesses to the region of bleeding,with gelatin foam or suture to embolism.Results All 15 patients were sucessful embolismed and get objective of hemostasis.Angiography appeared contrast medium overflowing and the humens,mucosa development.All patients were not bleeding again.Conclusion Clinic efficiency of emergeney ;embolization treatment for hemorrhage of digestive tract is assurance and explanation the principle and events of attention.

2 Cases of Transcatheter Embolization Therapy of Massive Lower Gastrointestinal Bleeding due to Typhoid Fever / 대한내과학회지

Typhoid fever is still endemic in developing countries and the cause of much morbidity and mortality. Complications such as intestinal hemorrhage, intestinal perforation, hepatitis, pyelonephritis, cholecystitis, osteomyelitis are known to occur. The classical approach to management of intestinal hemorrhage due to typhoid ulceration has been conservative. In, however, the event of massive, persistent and life-threatening hemorrhage not responding to conservative measures, early surgical intervention is life-saving. But surgical intervention is difficult due to multiple bleeding sites and friable distal ileum and colon. These two cases are reported in order to draw attention to the usefulness of mesenteric arteriography and the effectiveness of transcatheter embolization therapy in massive intestinal hemorrhage due to typhoid fever.

A Case of Hughes - Stovin Syndrome / 결핵

Hughes-Stovin Syndrome is an exceedingly rare combination of distal pulmonary arterial aneurysm and deep vein thrombosis, mostly found in young patients. There are striking similarities between the vascular manifestation of Behcet's disease and Hughes-Stovin Syndrome. It has been suggested that they may have a similar pathogenesis. Most patients died of massive hemoptysis due to rupture of aneurysm. Recently we have experienced the first case of Hughes-Stovin Syndrome in Korea. A 37 year old male patient was admitted because of recurrent hemoptysis and intermittent fever. He had a history of recurrent aphthous ulcers and erythema nodosum-like skin rash, But no other findings of Behcet's disease was found. Angiography showed multiple pulmonary arterial aneurysm and deep vein thrombosis in Right lower extremity. Histologic examination of specimens of open lung biopsy revealed leukocyto- clastic angiitis. Pulmonary arterial aneurysms were successfully treated by coil embolization and he is in good condition with corticosteroid and cyclophosphamide therapy.

Treatment of Carotid-Cavernous Fistula with Intravascular Embolization——An Analysis of 7 Cases / 介入放射学杂志

Objective:To investigate the therapeutic effect of intravascular balloon emolization of carotid-cavernous fistula.Materials and Methods:7 cases(5 of traumatic origin, and 2 spontaneous),undewent DSA of brain vessels showing the exact sites of fistulae.The key points of angiography in this procedure were described.Results:5 of the 7 cases complete patency of ICAs.I case resulted in occlusion of ICA,and another of type D was unsatisfactory. Conclusion:DSA of brain vessele could dipiot the site,size and type fistula.Most cases of simple carotid-cavernous fistula are of traumatic arigin and intravascular balloon embolization should be the first-choice of treatment

Study of immune function in children with thalassanemia major after partial splenic embolization / 介入放射学杂志

Objective To evaluate the changes of immunologic function in children with thalassanemia major after partial splenic embolization(PSE).Methods Immunoglobulins,T cell subsets were detected by immunologic turbidimetry and APAAP with monoclonal antibody respectively in 40 children with thalassanemia major and also in 20 healthy persons before and after PSE.These immunologic indexes were compared before and after PSE.Results The levels of IgG in serum were significantly lower one week after PSE than that before PSE.It turned to normal three weeks after PSE.The IgM,IgA levels remained unchanged during PSE.The levels of CD_3、CD_4、CD_4/CD_8 ratio in children with thalassanemia major were decreased(P

Hepatic Arteriographic Findings and Interventional Treatment in the Recurrence of Primary Liver Cancer after Surgery:A Report of 40 Cases / 介入放射学杂志

The hepatic arteriographic findings and interventional treatment results in forty cases with recurrent primary liver cancer after surgery were reported.The angiograph- ic manifestations were divided into three types:type Ⅰ recurrence on edge,11 cases (27. 5%);type Ⅱ intrahepatic diffusion),23 cases (57.5%);type Ⅲ (insidious recurrence),6 cases (15%).The characters of angiographic findings were as follows:the feeding vessels relatively not rich pale staining of tumor nodules,the common multiple focuses and small tu- mor nodule (diameter of tumor

The Physicochemical Properties of Lipiodol-Anticancer Drug Emulsion and Suspension / 介入放射学杂志

Two types of emulsions and suspensions were prepared using 40% Lipiodol (LIP)and Ultra-Fluid Lipiodol(UFL)with mitomycin C(MMC)by the“pumping techni- que”.The physical stabilities of each preparation were examined microscopically and macro scopically.The drug release test was made by using dissolution tester uhder rotating oar method,the concentrations of MMC released from the preparations were determined spectro- photometrically.The results showed that the emulsion was unstable,underwent phase separation easily and drug release rapidly.The stability of the emulsion was related to the proportion Lipiodol and aqueous solution(oil/water ratio),The ratio of 4:1 was ruich made stable than that of 2:1.The stability of the UFL emulsion was better than that of the LIP. The suspension was mare stable than the emulsion.The UFL suspension was much more suitable for clinical use because of not so viscons than the LIP.

Endovascular embolization with Onyx for the treatment of brain arteriovenous malformations located in the centre-encephalic region / 介入放射学杂志

Objective To evaluate endovascular embolization with Onyx in treating brain arteriovenous malformations(AVM) located in the centre-encephalic region.Methods Eighteen patients with AVM in the brain centre-encephalic region were treated with embolization by using Onyx.According to Drake criteria of the AVM type,small type was seen in 10,medium type in 6 and large type in 2 cases.By using Onyx as embolization material,a total of 24 endovascular procedures were carried out.Results After treatment,complete obliteration was obtained in 12 cases(66.7%),disability(symptoms worsened) resulted in 2 cases(11.2%) and no death occurred.In the medium type group and the small type group complete obliteration was seen in 3(50%) and 9(90%) cases respectively,the difference between the two groups was significant(P 2 cm and the patients with the feeding artery