Transcatheter Embolization of High-flow Renal Arteriovenous Fistula Using N-butyl Cyanoacrylate Accompanied by Delayed Hydronephrosis.

Renal arteriovenous fistula (AVF) is an uncommon anomaly characterized by the communication between renal arteries and veins. Renal AVFs are often asymptomatic but are occasionally accompanied by hematuria or heart failure. Transcatheter closure with embolization is a safe and effective treatment for renal AVF. We herein report an 87-year-old patient with heart failure due to renal AVF who was treated by transcatheter embolization. She developed bacteremia with hydronephrosis, which is a rare complication following the embolization of renal AVF.

Provocative Endoscopy to Identify Bleeding Site in Upper Gastrointestinal Bleeding: A Novel Approach in Transarterial Embolization.

This report describes a novel approach to endoscopically induce bleeding by removing a clot from the bleeding site during angiography for upper gastrointestinal (UGI) hemorrhage. This procedure enabled accurate identification of the bleeding site, allowing for successful targeted embolization despite a negative initial angiogram. Provocative endoscopy may be a feasible and useful option for angiography of obscure bleeding sites in patients with UGI arterial hemorrhage.

Contrast-enhanced MRI for detecting intravertebral cleft formation: relation to the time since onset of vertebral fracture.

OBJECTIVE: The purpose of this study was to investigate the advantages of contrast-enhanced MRI (CE-MRI) for detecting intravertebral clefts over unenhanced MRI in relation to the time since onset of vertebral fracture. MATERIALS AND METHODS: In this retrospective study, a total of 115 patients (88 women, 27 men; mean age, 77.1 years) who underwent percutaneous vertebroplasty for a single-level compression fracture within 7 days of preprocedural MRI were enrolled. Two radiologists evaluated preprocedural unenhanced MRI (T1-weighted and STIR) and CE-MRI examinations for intravertebral clefts on separate days by consensus. The time from the onset of fracture to MRI was classified into three groups: early phase fractures (< 1 month), late phase fractures (1-3 months), and chronic phase fractures (≥ 3 months). The cement distribution during percutaneous vertebroplasty was used as a reference standard, and detectability of clefts was compared between unenhanced MRI and CE-MRI in relation to the time frame. An analog of the McNemar test was used for analyses. RESULTS: There were 104 patients (90.4%) with and 11 patients (9.6%) without a cleft. The sensitivities of unenhanced MRI and CE-MRI, respectively, for detecting clefts were 60.9% and 91.3% for early phase fractures (p = 0.02); 78.6% and 100% for late phase fractures (p = 0.014); and 92.5% and 94.3% for chronic phase fractures (p = 0.3). The specificities were the same for both groups (100% for each time frame). CONCLUSION: CE-MRI is more sensitive than unenhanced MRI for detecting intravertebral clefts in patents with benign compression fractures less than 3 months old.

Prognosis of patients with hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization: risk factors for one-year recurrence and two-year mortality (preliminary data).

OBJECTIVE: Transcatheter arterial chemoembolization (TACE) is an essential therapy for patients with hepatocellular carcinoma (HCC) in whom administering other treatments such as liver transplantation, resection or local therapy is not feasible. The purpose of our study was to determine the independent risk factors for one-year recurrence and two-year mortality in patients treated solely with TACE. METHODS: We conducted a retrospective cohort study of 34 consecutive patients (Group 1) with incident HCC who were treated solely with epirubicin-based TACE between April 2004 and March 2009. A subgroup analysis was performed among 24 patients (Group 2) who underwent complete TACE confirmed with abdominal computed tomography (CT) one month later. Tumor recurrence was evaluated using contrast CT every three months after the initial TACE. We calculated Kaplan-Meier estimates and performed a multiple regression analysis using a Cox-proportional hazard model. RESULTS: The patients in Group 1 (men, 59%), all of whom had liver cirrhosis, underwent TACE as the sole therapy for HCC. Kaplan-Meier estimates revealed a two-year survival rate [95% CI] of 70% [48-84%]. For the non-Child A patients, the adjusted hazard ratio (HR) [95% CI] for two-year survival was 7.1 [1.06-51.7]. In Group 2, the Kaplan-Meier estimate of the one-year recurrence rate [95% CI] was 61% [42-81%]. The adjusted HRs [95% CIs] for one-year recurrence for age and indocyanine green (ICG) 15-min >30% were 1.1 [1.0-1.26] and 7.87 [1.94-45.1], respectively. CONCLUSION: Non-Child A cirrhosis is an independent risk factor for two-year mortality in patients treated solely with TACE. For ICG 15-min >30%, careful monitoring for HCC recurrence at one year, even after complete TACE, is warranted.

Radiological findings as favorable predictors of pain relief in patients with osteoporotic compression fractures after percutaneous vertebroplasty: a retrospective study of 156 cases.

PURPOSE: We evaluated the relationships between pre-procedural radiological findings and short-term pain relief in patients with osteoporotic compression fractures after percutaneous vertebroplasty (PVP). MATERIALS AND METHODS: A retrospective review of pre-procedural radiological images of 156 patients with painful osteoporotic compression fracture was performed. Pain was measured with a visual analogue scale (VAS). Complete pain relief was defined as a VAS pain score of 0 or 1 at 3 months after PVP. Statistical analyses were conducted to evaluate the relationship between the pre-procedural imaging factors and pain relief using Pearson's chi-squared test. Multivariate logistic regression analysis was also performed. RESULTS: Complete pain relief was obtained in 45.5% of patients. An intravertebral cleft larger than half the height of the fractured vertebral body (FVB) was a significant key factor in the complete pain relief group after 3 months. Further, ≥40% of the spinal canal occupied by bony fragments of the FVB was related to incomplete pain relief. CONCLUSION: A large intravertebral cleft was a favorable short-term outcome predictor in patients with osteoporotic compression fractures after PVP, while severe protrusion of the FVB causing lumbar spinal canal stenosis was not a favorable short-term outcome predictor of complete pain relief.

New vertebral compression fractures after prophylactic vertebroplasty in osteoporotic patients.

OBJECTIVE: Previous studies have shown the possible efficacy of prophylactic cement injection for nonfractured vertebrae during percutaneous vertebroplasty for compression fractures. The purpose of this study was to investigate risk factors for subsequent fractures after prophylactic percutaneous vertebroplasty. MATERIALS AND METHODS: This retrospective study included 116 patients with osteoporotic compression fractures who underwent prophylactic percutaneous vertebroplasty. The patients were monitored with physical examinations and radiographs at 1 day and at 3 and 12 months after percutaneous vertebroplasty, and if back pain recurred. We analyzed the following multiple covariates to determine whether they were associated with recurrence: age, sex, steroid use, and the preoperative number of unhealed or chronic compression fractures. RESULTS: Subsequent fractures in any vertebra occurred within 3 months after the procedure at 26 vertebrae in 21 patients (18.1%), and 36 occurred in 28 patients (24.1%) within 12 months. The occurrence of subsequent fractures within 12 months depended on the preoperative number of unhealed vertebrae: the occurrence rate was 16.9% (11/65) for one vertebra, 27.0% (10/37) for two vertebrae, and 50.0% (7/14) for three or more vertebrae. The incidence of subsequent fractures was significantly higher in patients with three or more fractures than in those with one fracture (p < 0.05). There were no statistically significant differences for the other factors. CONCLUSION: Patients with three or more fractures tended to have subsequent fractures, despite undergoing prophylactic percutaneous vertebroplasty. However, there was no increased risk of subsequent fractures related to prophylactic percutaneous vertebroplasty.

Therapeutic effects of percutaneous vertebroplasty for vertebral metastases.

PURPOSE: We have performed percutaneous vertebroplasty (PV) using polymethylmethacrylate (PMMA) for patients with vertebral metastases since 2002. This study investigated the therapeutic effects of PV on vertebral metastases. MATERIALS AND METHODS: A retrospective (2002-2008) review was conducted for 69 consecutive patients with 141 metastatic vertebrae treated with PV using PMMA. The clinical background of the patients, visual analog scale (VAS), improvement rate, outcomes, and complications were evaluated. RESULTS: The mean preoperative VAS score was 7.3 and significantly improved to 1.9 postoperatively (at discharge), with a mean improvement rate of 73.3%. With regard to complications, no new fractures of adjacent vertebral bodies were encountered, but cement leakage was seen in 49% of the patients. Most patients were asymptomatic during the postoperative course, although two patients (3%) experienced dyspnea that was suspected to be adult respiratory distress syndrome or a pulmonary embolism. CONCLUSION: PV can offer pain relief to patients with painful vertebral metastases and short life expectancy whose general condition makes surgery difficult.

Prophylactic vertebroplasty: cement injection into non-fractured vertebral bodies during percutaneous vertebroplasty.

RATIONALE AND OBJECTIVES: We investigated the efficacy of prophylactic cement injection into the vertebral body adjacent to fractured vertebra to prevent new fractures after percutaneous vertebroplasty (PV). MATERIALS AND METHODS: Between February 2002 to August 2004, PV was performed for osteoporotic compression fractures in 89 consecutive patients. All patients underwent PV for only fractured vertebrae. Between September 2004 and October 2006, we performed prophylactic cement injection for 155 patients, with cement injected into the non-fractured vertebra adjacent to the fractured vertebra, immediately above the fractured vertebra in the same procedure. We evaluated the frequency of new vertebral fractures and the efficacy of prophylactic therapy. RESULTS: In the non-prophylactic group, 15 of 89 patients (16.8%) developed new fractures within 3 months and 20 of 89 patients (22.4%) developed new painful compression fractures within a year after the first PV. These fractures occurred mostly in adjacent vertebra, particularly in the vertebra immediately superior to the treated one and occurred in the lower thoracic and upper lumbar spine. In the prophylactic group, 7 of 155 patients (4.5%) developed new compression fractures within 3 months and 15 of 155 patients (9.7%) developed new compression fractures within 1 year. Statistical analysis showed that fewer new fractures developed in the prophylactic group than in the non-prophylactic group at both 3 months (P = .0020, Fisher's exact test) and 1 year (P = .0079). CONCLUSIONS: Prophylactic cement injection into non-fractured vertebrae adjacent to fractured vertebrae may prevent new compression fractures after vertebroplasty for osteoporotic patients.

Percutaneous pediculoplasty for vertebral hemangioma involving the neural arch: a case report.

Vertebral hemangiomas occasionally involve the neural arch and they can be symptomatic. We report a case of symptomatic vertebral hemangioma mainly involving the unilateral neural arch which was successfully treated with percutaneous pediculoplasty using a single-needle technique.

Preprocedural MR imaging for percutaneous vertebroplasty: special interest in contrast enhancement.

PURPOSE: The success of percutaneous vertebroplasty (PVP) depends greatly on preprocedural evaluation of the patients. The purpose of this study was to evaluate the efficacy of preprocedural magnetic resonance imaging (MRI) for the indications of PVP. MATERIALS AND METHODS: A retrospective review of 122 osteoporotic compression fractures in 63 patients who underwent preprocedural gadolinium-enhanced MRI and PVP was performed. Based on the extent of contrast enhancement on preprocedural MRI, each case was classified into one of two groups: group 1, which represented more than 50% of the vertebral body enhanced; and group 2, which represented less than 50% of the vertebral body enhanced. The most enhancing level was evaluated in multilevel PVP sessions. We evaluated the difference of pre- and postprocedural pain scales between groups 1 and 2 using Mann-Whitney's U-test. RESULTS: There was a trend toward higher preoperative pain score in group 1, but it was not statistically significant (P = 0.0537). In addition, the postoperative pain score in group 2 was significantly higher than that in group 1 (P = 0.0007). The difference between the pre- and postoperative pain scores was significantly higher in group 1 than in group 2 (P = 0.0001). CONCLUSION: Contrast enhancement on MRI indicates a painful lesion and extensive contrast enhancement predicts better pain relief after PVP.