Paediatric interventional radiology: it's not child's play.

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials pose significant challenges and opportunities.

Radiología intervencionista en pediatría: no es un juego de niños / Pediatric interventional radiology: It's not a child's play

La radiología intervencionista pediátrica es una subespecialidad dinámica y en crecimiento. Las nuevas vías de formación en radiología intervencionista, el mantenimiento de las competencias con un pequeño volumen de casos o procedimientos complejos, la disponibilidad limitada de equipos y material pediátrico específico, los efectos de la sedación o de la anestesia sobre el neurodesarrollo y la protección radiológica suponen importantes retos y oportunidades.(AU)

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials, the effects of sedation or anesthesia on neurodevelopment or radiological on neurodevelopment or radiation protection pose significant challenges and opportunities.(AU)

Irreversible electroporation: Beyond the limits of tumor ablation.

Irreversible Electroporation (IRE) is a non-thermal tumor ablation technique. High-voltage electrical pulses are applied between pairs of electrodes inserted around and/or inside a tumor. The generated electric current induces the creation of nanopores in the cell membrane, triggering apoptosis. As a result, IRE can be safely used in areas near delicate vascular structures where other thermal ablation methods are contraindicated. Currently, IRE has demonstrated to be a successful ablation technique for pancreatic, renal, and liver tumors and is widely used as a focal therapeutic option for prostate cancer. The need for specific anesthetic management and accurate parallel placement of multiple electrodes entails a high level of complexity and great expertise from the interventional team is required. Nevertheless, IRE is a very promising technique with a remarkable systemic immunological capability and may impact on distant metastases (abscopal effect).

Electroporación irreversible: ampliando las fronteras de la ablación / Irreversible electroporation: Beyond the limits of tumor ablation

La electroporación irreversible o IRE (irreversible electroporation) es una técnica de ablación tumoral no térmica basada en la aplicación de pulsos eléctricos de alto voltaje entre pares de agujas insertadas alrededor de un tumor. La corriente generada favorece la creación de nanoporos en la membrana plasmática, desencadenando la apoptosis. Por ello, la IRE puede utilizarse de manera segura en localizaciones cercanas a estructuras vasculares delicadas, contraindicadas para el resto de técnicas termoablativas. Actualmente la IRE se emplea con éxito para la ablación de tumores en páncreas, riñón e hígado y, de manera muy extendida, como opción terapéutica focal para el cáncer de próstata. La necesidad de un manejo anestésico específico y la colocación precisa y en paralelo de múltiples agujas implican un alto nivel de complejidad, siendo necesaria una gran experiencia del equipo intervencionista. No obstante, se trata de una técnica muy prometedora con una gran capacidad inmunológica sistémica que puede provocar un efecto a distancia del tumor tratado (efecto abscopal).(AU)

Irreversible electroporation (IRE) is a non-thermal tumor ablation technique. High-voltage electrical pulses are applied between pairs of electrodes inserted around and/or inside a tumor. The generated electric current induces the creation of nanopores in the cell membrane, triggering apoptosis. As a result, IRE can be safely used in areas near delicate vascular structures where other thermal ablation methods are contraindicated. Currently, IRE has demonstrated to be a successful ablation technique for pancreatic, renal, and liver tumors and is widely used as a focal therapeutic option for prostate cancer. The need for specific anesthetic management and accurate parallel placement of multiple electrodes entails a high level of complexity and great expertise from the interventional team is required. Nevertheless, IRE is a very promising technique with a remarkable systemic immunological capability and may impact on distant metastases (abscopal effect).(AU)

Primeros pasos en el intervencionismo. Lecciones de la práctica diaria / First steps in interventionism. Lessons from daily practice

Resumen Las características del paciente y la localización de la lesión diana pueden hacer más complejo un procedimiento intervencionista. Una adecuada formación basada en el conocimiento de los instrumentos, manejo de técnicas alternativas y complementos hacen que estos procedimientos sean efectivos y seguros. Destacaremos la planificación anticipada, los enfoques seguros, el papel de la integración y la discusión interdisciplinaria. Los elementos descritos aquí y la bibliografía adjunta pueden tomarse como una guía para comenzar una carrera en radiología intervencionista.

Abstract The characteristics of the patient and the location of the target lesion can make an interventional procedure more complex. An adequate training based on the knowledge of instruments, handling of alternative techniques and supplementary tools make these procedures effective and safe. We will emphasize advanced planning, safe approaches, the role of integration, and interdisciplinary discussion. The items described here and the accompanying bibliography can be taken as a guide to starting a career in interventional radiology.

Disección carotídea espontánea: Presentación de un caso clínico con revisión de la literatura / Carotid Artery Dissection. Case Report and Literature Review

Resumen Introducción: La disección carotídea consiste en el desgarro de la pared del vaso. Es una patología infrecuente, pero es la causa más común de enfermedad vascular cerebral (EVC) isquémica en personas menores de 45 años. Las manifestaciones clínicas son muy variables. Método: Utilizamos las recomendaciones CARE para el reporte de casos clínicos. Caso clínico: Hombre de 45 años previamente sano, con debilidad aguda de la extremidad torácica derecha sin causa aparente. La tomografía simple de cráneo no evidenció alteraciones. La resonancia magnética mostró una oclusión completa de la arteria carótida interna en todos sus segmentos y disminución del flujo de la arteria cerebral media izquierda. La evolución clínica fue desfavorable. Conclusión: La disección carotídea debe sospecharse en personas con EVC sin factores de riesgo cardiovascular.

Abstract Introduction: Carotid dissection consists of a tear in the vessel wall. It is a rare pathology, but it is the most common cause of ischemic cerebral vascular disease (CVD) in people under 45 years of age. The clinical manifestations are very variable. Method: We used CARE recommendations for reporting clinical cases. Clinical case: Previously, a healthy 45-year-old man with acute weakness of the right thoracic extremity without apparent cause. The simple skull tomography did not show any alterations. MRI showed complete occlusion of the internal carotid artery in all its segments and decreased flow of the left middle cerebral artery. The clinical evolution was unfavorable. Conclusion: Carotid dissection should be suspected in people with CVD without cardiovascular risk factors.

The essential role of thoracic duct embolization in management of traumatic iatrogenic chylothorax / O papel fundamental da embolização do ducto torácico no manejo de quilotórax traumático iatrogênico

Abstract This study aims to describe a case series of patients who underwent thoracic duct embolization (TDE) to treat traumatic iatrogenic chylothorax (TIC). Three patients were included: Case #1, a 49-year-old woman with follicular lymphoma developed a TIC following video-assisted thoracoscopic surgery to resect a solid right paravertebral mass and was treated with TDE using microcoils and N-butyl cyanoacrylate (NBCA) glue. Case #2, a 68-year-old man with cardiac amyloidosis developed a TIC following heart transplantation and was treated with TDE using microcoils and ethylene vinyl alcohol copolymer. Case#3: A 6-year-old patient with congenital heart disease developed a TIC following a Fontan procedure and was treated with TDE using NBCA glue. All lesions were identified during lymphangiography and TDE was successfully performed in all cases. TDE is a safe and valuable technique that provides minimally invasive treatment for TCI.

Resumo Este estudo objetiva descrever uma série de casos de pacientes submetidos a embolização do ducto torácico (EDT) para tratamento de quilotórax iatrogênico (QI). Três pacientes foram incluídos. Caso 1: um homem de 49 anos com linfoma folicular apresentou QI após ressecção de uma massa paravertebral por toracoscopia vídeo-assistida e foi submetido a EDT com micromolas e n-butil-cianoacrilato (NBCA). Caso 2: um homem de 68 anos com amiloidose cardíaca apresentou QI após ser submetido a transplante cardíaco e foi submetido a EDT com micromolas e copolímero de etileno e álcool vinílico. Caso 3: um paciente de 6 anos com malformação cardíaca congênita apresentou QI após cirurgia de Fontan e foi submetido a EDT com NBCA. Todas as lesões foram identificadas durante a linfangiografia, e a EDT foi realizada com sucesso. A EDT é uma técnica segura e valiosa, que pode oferecer um tratamento minimamente invasivo em casos de QI.

Evaluación de la anatomía angiográfica de las arterias hepáticas y sus variantes / Evaluation of the angiographic anatomy of the hepatic arteries and its variants

Resumen Objetivo: Evaluar y describir la prevalencia de variantes anatómicas arteriales hepáticas observadas en una serie multicéntrica de pacientes con patologías hepatobiliares. Método: Estudio retrospectivo de anatomía arterial según la clasificación de Michels de angiografías digitales y tomografías computadas helicoidales abdominales realizadas entre febrero de 2009 y diciembre de 2020 en tres hospitales del Área Metropolitana de Buenos Aires. Resultados: Se incluyeron 275 pacientes en el estudio. Edad mediana 58,5 años. Sexo masculino 73,1%. Variante anatómica tipo 1 (normal) de la arteria hepática en 192 casos (69.8%); tipo 2 en 18 casos (6.5%); tipo 3 en 19 casos (6.9%); tipo 4 en 7 casos (2.5%); tipo 5 en 4 casos (1.5%); tipo 6 en 3 casos (1.1%); tipo 7 en 2 casos (0.7%); tipo 8 en 7 casos (2.5%); tipo 9 en 17 casos (6.2%) y otros tipos fuera de la clasificación de Michels en 6 casos (2.2%). También hallamos la presentación de 3 casos (1.1%) con arco de Bühler. Conclusiones: En nuestra serie se observaron variantes anatómicas no clásicas de la arteria hepática aproximadamente en un tercio de los casos. El conocimiento de las variantes anatómicas fue esencial para los procedimientos radiológicos y quirúrgicos en el tratamiento de tumores hepáticos, determinando la técnica de abordaje de las arterias involucradas.

Abstract Objective: To evaluate and describe the prevalence of hepatic artery anatomical variants observed in a multicenter series of patients with hepatobiliary pathologies. Method: Retrospective study of arterial anatomy according to Michels classification of digital angiographies and abdominal helical computed tomography performed between February 2009 and December 2020 in three hospitals of the Buenos Aires Metropolitan Area. Results: 275 patients were included in the study. Median age 58.5 years. Male sex 73.1%. Type 1 (normal) variant of hepatic artery anatomy in 192 cases (69.8%); type 2 in 18 cases (6.5%); type 3 in 19 cases (6.9%); type 4 in 7 cases (2.5%); type 5 in 4 cases (1.5%); type 6 in 3 cases (1.1%); type 7 in 2 cases (0.7%); type 8 in 7 cases (2.5%); type 9 in 17 cases (6.2%), and other types out Michels classification in 6 cases (2.2%). We also found 3 cases (1.1%) with Bühler's arch. Conclusions: In our series, non-classical anatomical variants of the hepatic artery were observed in approximately one third of cases. Knowledge of anatomical variants was essential for radiological and surgical procedures in the treatment of liver tumors, determining the approach technique of the arteries involved.

Biopsia percutánea de nódulos y masas pulmonares bajo ecografía: una alternativa a la tomografía computada / Ultrasound guided percutaneous biopsy of pulmonary nodules and masses: an alternative to CT

Resumen Los nódulos y masas pulmonares tradicionalmente son biopsiados mediante tomografía computada (TC). La ecografía está subestimada como guía para biopsias pulmonares. Las imágenes pulmonares factibles de biopsia con ecografía son aquellas en contacto pleural. Las contraindicaciones específicas incluyen ventilación mecánica asistida, neumonectomía contralateral, paciente no colaborador, tos incontrolable. En el monitoreo posbiopsia deberán controlarse los signos vitales, el dolor y la presencia de complicaciones. Por la localización de las lesiones abordables por este método, el neumotórax y el sangrado parenquimatoso como complicación son menos frecuentes que en las biopsias dirigidas por TC. En este artículo describimos los conceptos básicos para la correcta selección de paciente, planificación y ejecución segura de una biopsia de nódulo pulmonar bajo ecografía.

Abstract Pulmonary nodules and masses are traditionally biopsied under computed tomography (CT) guidance. Ultrasound remains underrated as lung nodule biopsy guide. Ultrasound can be employed to target pleural based lung nodules. Specific contraindications include: mechanical ventilation, contralateral pneumonectomy, non-cooperative patient and uncontrollable coughing. Post procedural care should cover vital signs check, pain assessment and complication evaluation. Due to lesion localization, complications such as pneumothorax and parenchymal bleeding are less frequent than in CT guided biopsies. In this article we provide basic concepts for patient selection, plan and safe execution of ultrasound guided pulmonary nodule biopsy.

Radiología intervencionista paliativa: una mirada sobre nuestra experiencia / Palliative interventional radiology: a review of our experience

Introducción: El Intervencionismo paliativo se ha convertido en una alternativa válida a tener en cuenta en los pacientes con enfermedades oncológicas avanzadas, cercanas al final de la vida, sin otras opciones de tratamiento, para conseguir mejorar el control sintomático de las complicaciones que se derivan de su enfermedad, cuando los tratamientos convencionales no son posibles. El objetivo de este estudio es analizar la supervivencia de los pacientes después de la realización de cualquier técnica intervencionista paliativa y evaluar las posibles complicaciones derivadas de la técnica. Material y métodos: Estudio observacional, descriptivo y prospectivo. Se incluyeron todos los pacientes atendidos por nuestra unidad a quienes se les indicó una técnica intervencionista. Se analizaron variables demográfi cas y clínicas, así como las técnicas más frecuentemente utilizadas, la supervivencia postintervención y las complicaciones que presentaron los pacientes después del procedimiento. Resultados: Se incluyeron 26 pacientes, todos con enfermedades oncológicas avanzadas, sin opciones de tratamiento oncoespecífi co, a los cuales se les realizó alguna técnica intervencionista indicada para control sintomático. La supervivencia postintervención fue de 43 días de mediana. Nueve pacientes presentaron complicaciones postintervención, pero estas fueron de carácter leve en la mayoría de los casos, y se resolvieron con tratamiento conservador, sin precisar recambio del dispositivo en la mayoría de los casos. Conclusión: Las técnicas de radiología intervencionista disponibles son una alternativa válida y segura para utilizar en el caso de pacientes oncológicos sin opciones de tratamiento curativo, con pronóstico limitado a las etapas fi nales de la vida, con el objetivo de mejorar el control sintomático. (AU)

Introduction: Palliative interventionism has become a valid alternative to consider in patients with advanced oncological disease, close to the end of life, without further treatment possibilities, to provide improved symptomatic control of the complications derived from their disease, when conventional treatments are not possible. The aim of this study was to analyze patient survival after any palliative interventional technique, and to assess potential technique-derived complications. Patients and methods: An observational, descriptive, prospective study was carried out. All patients in our unit who were candidates to undergo an interventional technique were included. Demographic and clinical variables were analyzed, as were the most commonly used techniques, postprocedural survival, and the complications presented by patients after the intervention. Results: Twenty-six patients were included in the study, all of them with oncological advanced disease, without options for an oncospecific treatment. A suitable interventional technique was performed for all these patients to achieve symptomatic control. Postprocedural survival was 43 days on median. Nine patients had postprocedural complications, but these were mild in a majority of cases and were solved with conservative treatment, requiring no device replacement in most cases. Conclusions: Available interventional radiology techniques are a valid and safe alternative to use in the case of advanced cancer patients when a medical and/or surgical traditional treatment is not recommended, with the aim of improving symptom control. (AU)

Biopsias pelvianas percutáneas: guía iconográfica de abordajes seguros / Percutaneous pelvic biopsies: An illustrative guideline for safe approaches

Resumen Las biopsias percutáneas a nivel de la pelvis plantean un desafío dada la compleja anatomía regional. El conocimiento de las estructuras afectadas y el tipo de lesión a intervenir son algunos de los aspectos que van a influenciar la técnica que se utilice. Se han propuesto distintas vías de abordaje, pero aún carecen de sistematización. El objetivo de este artículo es destacar accesos seguros ejemplificando con casos ilustrativos de nuestra institución. Además, agregamos comentarios basados en nuestra experiencia.

Abstract Pelvic percutaneous biopsies are challenging due to complex regional anatomy. Knowledge of affected structures and lesion type are some of the aspects that will condition the technique applied. Different approaches to pelvic percutaneous biopsies have been proposed, but still lack systematization. The aim of this article is to highlight safe approaches supported with illustrative cases. Furthermore, we provide opinion based on our experience.

Occupational radiation and pregnancy: reality or disinformation? A review of the literature and summary of current clinical guidelines.

Exposure to ionizing radiation is a decisive factor in women's choice of entering the field of interventional radiology. This issue explains the low percentage of women in interventional radiology and the high number of women who take leave from work when they are pregnant even though they have no problems with their pregnancy. The current guidelines and legal framework regarding pregnancy and ionizing radiation from different national institutions are not in line with the scientific evidence. They establish recommendations based on disinformation and a need to protect the fetus that has not been scientifically validated. Lack of knowledge and lack of evidence-based information could contribute to gender-based inequality at work. This article reviews the evidence from the articles and clinical guidelines in PubMed, paying special attention to publications from the last five years (2015-2020). Additionally, it reports the results of an online survey of healthcare professionals exposed to radiation in their work.

O que o radiologista deve saber sobre o papel da gastrostomia percutânea: ensaio iconográfico / What the radiologist should know about the role of percutaneous gastrostomy: a pictorial essay

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.

Radiación ocupacional y embarazo: realidad o desinformación. Revisión en la literatura y actualización según guías clínicas vigentes / Occupational radiation and pregnancy: reality or disinformation? A review of the literature and summary of current clinical guidelines

La exposición a radiaciones ionizantes es un factor condicionante a la hora de elegir radiología vascular intervencionista, lo que justifica el bajo porcentaje de radiólogas dedicadas a ello y el elevado número de bajas en trabajadoras embarazadas de servicios de radiodiagnóstico sin patología gestacional. Las recomendaciones y actual legislación sobre embarazo y manejo de radiaciones ionizantes de las diferentes instituciones nacionales no se ajustan a evidencias científicas, estableciendo medidas de protección basadas en desinformación y una protección injustificada al feto cuya validez no se ha demostrado científicamente. El desconocimiento y falta de información basada en evidencias podría ser una causa de esta disparidad laboral relacionada con el género de los trabajadores.Se realiza una revisión en la base de datos PubMed de los artículos y guías de práctica clínica más relevantes, con especial atención a los publicados en los últimos 5 años (2015-2020), y se describen los resultados de una encuesta online realizada a trabajadores sanitarios expuestos.(AU)

Exposure to ionizing radiation is a decisive factor in women's choice of entering the field of interventional radiology. This issue explains the low percentage of women in interventional radiology and the high number of women who take leave from work when they are pregnant even though they have no problems with their pregnancy. The current guidelines and legal framework regarding pregnancy and ionizing radiation from different national institutions are not in line with the scientific evidence. They establish recommendations based on disinformation and a need to protect the fetus that has not been scientifically validated. Lack of knowledge and lack of evidence-based information could contribute to gender-based inequality at work.This article reviews the evidence from the articles and clinical guidelines in PubMed, paying special attention to publications from the last five years (2015-2020). Additionally, it reports the results of an online survey of healthcare professionals exposed to radiation in their work.(AU)

Impact of the first year of the COVID-19 pandemic on an interventional radiology unit.

OBJECTIVES: To describe the impact of the Covid-19 pandemic on the interventional radiology unit at our hospital in the first year of the pandemic. MATERIAL AND METHODS: This prospective observational study included 83 consecutive patients with confirmed SARS-CoV-2 infections who underwent an interventional radiology procedure in the period comprising March 13, 2020 through March 13, 2021. We describe the repercussions of the situation on the unit's total activity, as well as on its activity during the different phases of the pandemic. RESULTS: Technical and clinical success were achieved in 96.43% and 82.14% of cases, respectively. During follow-up throughout the year, 68 patients remained alive and 15 died from their underlying disease. No complications related with interventional procedures occurred, and activity declined by only 12% in comparison with the same period in the previous year (2019-2020, without COVID). Similarly, the decrease in relative value units and radiology activity units was only 13% and 12%, respectively. CONCLUSION: The Covid-19 pandemic has been a challenge in our daily work, leading to an overall decrease in the number of procedures. Nevertheless, the interventional radiology unit has been actively involved in caring for Covid-19 patients, performing a wide variety of necessary procedures. Following a series of specific measures and protocols has enabled us to perform interventional radiology procedures safely during the pandemic.

Un año completo de pandemia COVID-19 y su impacto en la Unidad de Radiología Intervencionista / Impact of the first year of the COVID-19 pandemic on an interventional radiology unit

Objetivos: Describir el impacto que la pandemia de COVID-19ha supuesto en la Unidad de Radiología Intervencionista de nuestro hospital a lo largo de un año. Materiales y métodos: Se ha realizado un estudio observacional prospectivo en 83 pacientes consecutivos con infección confirmada por COVID-19 a los cuales se les realizó algún tipo de procedimiento de radiología intervencionista durante el periodo comprendido entre el 13 de marzo del 2020 y el 13 de marzo de 2021. Se describe la repercusión de la situación en la actividad total de la unidad, así como en las diferentes fases de la pandemia. Resultados: Se alcanzó el éxito técnico y clínico en el 96,43% y 82,14% de los casos, respectivamente. Durante el seguimiento a lo largo de un año, 68 pacientes seguían vivos y 15 fallecieron a causa de su enfermedad de base. No se produjeron complicaciones relacionadas con los procedimientos intervencionistas y nuestra actividad decayó solo un 12% en comparación con el mismo período del año 2019-2020 (no-COVID). Asimismo, solo se produjo una reducción en unidades relativas de valor y unidades de actividad radiológica del 13% y del 12%, respectivamente. Conclusión: La pandemia de COVID-19ha supuesto un desafío en nuestro trabajo diario condicionando una reducción general en el número de procedimientos. No obstante, la radiología intervencionista ha participado activamente en la atención de los pacientes con COVID-19 mediante la realización de una amplia variedad de intervenciones necesarias. La atención de la radiología intervencionista pudo realizarse de forma segura durante la pandemia, siguiendo una serie de medidas y protocolos específicos.(AU)

Objectives: To describe the impact of the Covid-19 pandemic on the interventional radiology unit at our hospital in the first year of the pandemic. Material and methods: This prospective observational study included 83 consecutive patients with confirmed SARS-CoV-2 infections who underwent an interventional radiology procedure in the period comprising March 13, 2020 through March 13, 2021. We describe the repercussions of the situation on the unit's total activity, as well as on its activity during the different phases of the pandemic. Results: Technical and clinical success were achieved in 96.43% and 82.14% of cases, respectively. During follow-up throughout the year, 68 patients remained alive and 15 died from their underlying disease. No complications related with interventional procedures occurred, and activity declined by only 12% in comparison with the same period in the previous year (2019-2020, without COVID). Similarly, the decrease in relative value units and radiology activity units was only 13% and 12%, respectively. Conclusion: The Covid-19 pandemic has been a challenge in our daily work, leading to an overall decrease in the number of procedures. Nevertheless, the interventional radiology unit has been actively involved in caring for Covid-19 patients, performing a wide variety of necessary procedures. Following a series of specific measures and protocols has enabled us to perform interventional radiology procedures safely during the pandemic.(AU)

Bloqueio do Nervo Hipogástrico Superior (BNHS) para o manejo da dor após Embolização de Artérias Uterinas (EAU): revisão de literatura / Superior Hypogastric Nerve Block (SHNB) for pain management in Uterine Artery Embolization (UAE): a literature review

Introdução: a embolização de artérias uterinas (EAU) é uma opção terapêutica no tratamento de miomas uterinos sintomáticos; todavia, a dor pós-procedimento representa um grande desafio para essa técnica. Nesse contexto, o Bloqueio do Nervo Hipogástrico Superior (BNHS), já utilizado no tratamento de dor pélvica crônica associada à malignidade, apresenta-se como opção de intervenção intraprocedimento para melhorar a recuperação das pacientes e fomentar o uso da EAU na prática clínica. Objetivo: realizar uma revisão integrativa da literatura disponível sobre o BNHS no manejo de dor pós EAU. Métodos: bases de dados PubMed, The Cochrane Library, Lilacs e Medline foram avaliadas a partir da combinação dos termos "uterine artery embolization", "pain" e "superior hypogastric block". Foram incluídos estudos clínicos, disponíveis em texto completo, com pacientes adultas, submetidas à EAU, cujo objetivo era avaliar o uso do BNHS e seu impacto na dor pós-procedimento. Foram excluídos artigos de revisão, carta ao editor, e publicação em anais de congresso. Resultados: 8 artigos, em maior parte retrospectivos, indicaram consistência do BNHS em termos de sucesso terapêutico a curto prazo e redução da dor. Apenas uma complicação foi relatada, e evoluiu de forma satisfatória. Conclusões: BNHS tem potencial de aprimorar o manejo da dor após EAU, podendo impactar positivamente no tempo e na qualidade da recuperação, com redução da dor e consumo de opiodes no período pós-operatório. Esses benefícios valorizam o procedimento de embolização como uma alternativa a ser considerada no tratamento de leiomiomas sintomáticos para mulheres candidatas à preservação uterina.

Introduction: Uterine Artery Embolization (UAE) is a therapeutic option in the treatment of symptomatic uterine fibroids; however, post-procedure pain imposes as a great challenge in this technique. In this context, the Superior Hypogastric Nerve Block (SHNB), already used in the treatment of chronic pelvic pain associated with malignancy, presents itself as an option for intraprocedural intervention, to improve patients' recovery and to promote UAE in the clinical setting. Objective: to perform an integrative literature review about the effectiveness of SHNB in pain management after UAE. Methods: databases PubMed, The Cochrane Library, Lilacs and Medline were assessed using the combination of the terms "uterine artery embolization", "pain" and "superior hypogastric block". Clinical studies were included once available in full text, with adult patients submitted to UAE, whose objective was to evaluate the use of SHNB and its impact in post-procedure pain. Review articles, letters to the editor, and publication in conference proceedings were excluded. Results: 8 articles were found, most of them retrospective, indicated SHNB's consistency in terms of short-term therapeutic success and pain reduction. The single reported complication evolved satisfactorily. Conclusions: SHNB has the potential to improve pain management after UAE, which can positively impact recovery time and quality, with reduced pain and consumption of opioids in the postoperative period. Benefits like these can enhance the embolization procedure as an alternative to be considered for the treatment of symptomatic fibroids for women candidates for uterine preservation.

Psaudoaneurisma de la arteria hipogástrica izquierda, una causa extremadamente rara de sangrado puerperal tardío / Pseudoaneurysm of the left hypogastric artery, an extremely rare cause of late puerperal late puerperal bleeding

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.

Nursing care management in radiation protection in interventional radiology / Gestion del cuidado de enfermeria en la protección radiológica em radiologia intervencionista / Gestão do cuidado em enfermagem na proteção radiológica em radiologia intervencionista

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.