Asunto(s)
Aneurisma/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagen , Adulto , Angiografía , Broncoscopía , Diagnóstico Diferencial , Embolización Terapéutica , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar/terapiaAsunto(s)
Aneurisma/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador , Arteria Pulmonar/diagnóstico por imagen , Intensificación de Imagen Radiográfica , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagen , Adulto , Angiografía , Diagnóstico Diferencial , Embolización Terapéutica , Femenino , Hemoptisis/etiología , Humanos , Tuberculosis Pulmonar/terapiaRESUMEN
PURPOSE: Protective occlusion of the gastroduodenal artery (GDA) is required to avoid severe adverse effects and complications in radioembolization procedures. Because of the expandable features of HydroCoils, our goal was to occlude the GDA with only one HydroCoil to provide particle reflux protection. METHODS: Twenty-three subjects with unresectable liver tumors, who were scheduled for protective occlusion of the GDA before radioembolization therapy, were included. The primary end point was to achieve a proximal occlusion of the GDA with only one detachable HydroCoil. Evaluated parameters were duration of deployment, and early (during the intervention) and late (7-21 days) occlusion rates of GDA. Secondary end points included complete duration of the intervention, amount of contrast medium used, fluoroscopy rates, and adverse effects. RESULTS: In all cases, the GDA was successfully occluded with only one HydroCoil. The selected diameter/length range was 4/10 mm in 2 patients, 4/15 mm in 6 patients, and 4/20 mm in 15 patients. HydroCoils were implanted, on average, 3.75 mm from the origin of the GDA (range 1.5-6.8 mm), with an average deployment time of 2:47 (median 2:42, range 2:30-3:07) min. In 21 (91%) of 23 patients, a complete occlusion of the GDA was achieved during the first 30 min after the coil implantation; however, in all patients, a late occlusion of the GDA was present after 6 to 29 days. No clinical or technical complications were reported. CONCLUSION: We demonstrated that occlusion of the GDA with a single HydroCoil is a safe procedure and successfully prevents extrahepatic embolization before radioembolization.
Asunto(s)
Arteriopatías Oclusivas/prevención & control , Embolización Terapéutica/instrumentación , Arteria Ilíaca/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Radiografía Intervencional/métodos , Terapia Recuperativa/métodos , Adulto , Angiografía/métodos , Estudios de Cohortes , Duodeno/irrigación sanguínea , Embolización Terapéutica/métodos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/radioterapia , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prevención Primaria/métodos , Implantación de Prótesis/métodos , Radiografía Intervencional/instrumentación , Medición de Riesgo , Stents , Estómago/irrigación sanguínea , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: Biliary cast syndrome (BCS) is the presence of casts within the intrahepatic or extrahepatic biliary system after orthotopic liver transplantation. Our work compares two percutaneous methods for BCS treatment: the mechanical cast-extraction technique (MCE) versus the hydraulic cast-extraction (HCE) technique using a rheolytic system. MATERIALS AND METHODS: A total of 24 patients were included in the study. Six patients were referred for HCE, and 18 patients were treated with MCE. A statistically significant larger number of sessions was required in the MCE group (21.0, range 11 to 72 sessions) (p = 0.033). RESULTS: Median therapy duration was shorter in the HCE group at 2.4 months (range 2 to 5) compared with 6.7 months (range 3 to 39) in the MCE group (p < 0.001). Both patient acceptance was better and costs for total therapy were 40% less in the HCE group. No significant differences where found concerning clinical and biochemical improvement or graft and patient survival. CONCLUSION: The use of the hydraulic rheolytic system decreased total therapy time, thereby decreasing the induced inflammation time of the biliary tree. A significant benefit of HCE has been observed in our patients when we compare our results with those of MCE.
Asunto(s)
Enfermedades de los Conductos Biliares/terapia , Trasplante de Hígado/efectos adversos , Anciano , Enfermedades de los Conductos Biliares/diagnóstico por imagen , Enfermedades de los Conductos Biliares/etiología , Cateterismo , Colangiografía , Femenino , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Radiografía IntervencionalRESUMEN
The aim of this study is to report our interventional radiologic procedures (IRP) in liver transplant (LTX) patients. These include procedures for biliary, arterial, venous, and portal complications, as well as the treatment of infected and non-infected fluid collections. This retrospective study covered 583 patients (mean age: 44 +/- 14 yr) in whom a total of 685 LTX were performed from August 1987 to April 2005. Overall, 182 LTX patients underwent a total of 428 IRP, including digital subtraction angiography (n = 152/35.51%), percutaneous transluminal angioplasty (PTA) (n = 4/0.93%) and PTA + stent (n = 7/1.63%) of arterial anastomosis, PTA + stent of the celiac trunk (n = 2/0.46%), transjugular intrahepatic portosystemic shunt (TIPS) (n = 2/0.46%), arterial lysis (n = 4/0.93%), venous lysis (n = 2/0.46%), inferior vena cava stenting (n = 2/0.46%), percutaneous biliary drainage (n = 34/7.94%), percutaneous transluminal dilatation (PTD) of the choledocho-enteric anastomosis (n = 16/3.73%), biliary stent (n = 5/1.16%), intrahepatic biliary flushing treatment, stone and cast biliary extraction (n = 27/6.30%), other interventions (e.g., embolization in other regions, transjugular liver biopsies, lymphangiographies) (n = 9/2.10%), and ultrasound- and computer tomography-guided biopsies and percutaneous drainage (n = 153/35.74%). The overall success rate was 85.7%. Technical improvements in LTX and interventional radiology permit vascular and biliary complications to be treated successfully by interventional radiology.
Asunto(s)
Trasplante de Hígado/efectos adversos , Trasplante de Hígado/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía Intervencional , Adulto , Angioplastia de Balón , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación Portosistémica Intrahepática Transyugular , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Stents , Análisis de SupervivenciaRESUMEN
Early HAT is the most frequent and severe vascular complication following liver transplantation. It is one of the major causes of graft failure and mortality. Endovascular thrombolytic treatment in patients with thrombotic complications after liver transplantation is an attractive alternative to open surgery as lower morbidity and mortality rates are reported for it. PTA following transcatheter thrombolysis has been successfully used to treat HAT in adults. To the best of our knowledge, there have not been any reports of a successful transcatheter thrombolysis using interventional radiological techniques in a patient only four months old. The present report describes the successful endovascular emergency treatment of a HAT three days after DD split liver transplantation.
Asunto(s)
Angioplastia de Balón/métodos , Arterias/patología , Arteria Hepática/patología , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Terapia Trombolítica/métodos , Trombosis/terapia , Síndrome de Alagille/terapia , Femenino , Rechazo de Injerto , Arteria Hepática/cirugía , Humanos , Lactante , Hígado/diagnóstico por imagen , Hígado/enzimología , Cirrosis Hepática/terapia , Resultado del Tratamiento , Ultrasonografía Doppler en Color/métodosRESUMEN
Through the large numbers of ultrasound studies and computed tomography (CT) and magnetic resonance imaging (MRI) scans being done, many symptomless renal tumors are detected. The radiologist has a duty to differentiate renal lesions and diagnose malignant tumours in adults. Modern imaging modalities such as CT and MRI have the capability to further differentiate renal tumours by specific attributes. In this article, the most common renal tumours are presented, and typical findings are discussed.
Asunto(s)
Aumento de la Imagen/métodos , Neoplasias Renales/diagnóstico , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , HumanosRESUMEN
Modern imaging modalities, especially noninvasive cross-sectional imaging techniques, have advanced dramatically in recent years and are now the backbone of pre- and postoperative evaluation of aortic pathologies. The planning in particular, but also the aftercare following endovascular aortic reconstructions, make heavy demands on physicians. It is necessary to select the method of examination that is best suited to the pathology concerned and to apply it to the patient in an individual manner. Ultrasound is the examination of choice for screening and follow-up of infrarenal aneurysms. Transesophageal echocardiography and magnetic resonance angiography are used in diagnosis, in intraoperative navigation during the implantation of endografts and in follow-up of patients with thoracic aortic aneurysms and aortic dissections who have undergone conservative treatment, with very high sensitivity and specificity. The use of MRA is restricted by the long time needed for an examination, metal artifacts and limited availability. DSA has been largely superseded in the diagnosis of aortic pathologies by CTA, but as yet retains its role in intraoperative imaging of the anchorage regions of endoprostheses. Selective demonstration of postoperative internal leaks with subsequent therapeutic embolization is a further area of use for DSA. CTA, including so-called image postprocessing, has taken over the prime role in imaging of the aorta. Disease-specific diagnostic algorithms are useful and necessary in day-to-day clinical practice.
Asunto(s)
Aneurisma de la Aorta/diagnóstico , Disección Aórtica/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Disección Aórtica/diagnóstico por imagen , Angiografía de Substracción Digital , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aortografía , Implantación de Prótesis Vascular , Ecocardiografía Transesofágica , Estudios de Seguimiento , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Radiografía Torácica , Sensibilidad y Especificidad , Ultrasonografía Doppler en Color , Ultrasonografía IntervencionalRESUMEN
INTRODUCTION: Acute pancreatitis (AP) is a rare complication after liver embolization (LE) of primary and secondary liver tumors (approximately 1.7%), but it has a significant morbidity and mortality potential if associated with other complications. It usually develops early within 24 h after the LE procedure. STUDY PURPOSE: To calculate the frequency of AP after LE in our institution and to analyze the factors involved in this procedure (anatomical features, embolization materials, cytostatic drugs, technical factors). MATERIALS AND METHODS: 118 LE (bland embolization and transarterial chemoembolization) were performed in our institution. The study group included 59 patients who met the following inclusion criteria: one or more LE events, with complete pre- and post-interventional laboratory studies including: serum Ca(2+), creatinine, blood urea nitrogen, glucose, lactate dehydrogenase, aminotransferases, alkaline phosphatase, amylase, lipase, C-reactive protein, hematocrit and leukocytes. The diagnosis of AP was established according to the criteria of the Atlanta system of classification. For the statistical analysis the association between two response variables (e.g. AP after embolization and risk factor during the embolization, AP after embolization and volume of embolic material) was evaluated using Pearson's chi(2) test and Fisher's exact test. RESULTS: The calculated frequency of AP after LE in our series was 15.2%. Amylase and lipase were elevated up to 8.7 and 20.1 times, respectively, 24 h after LE. We observed a statistically significantly lower incidence of AP in those patients who received 2 ml or less of embospheres compared with those with an embolization volume of >2 ml (Pearson's chi(2) = 4.5000, Pr = 0.034, Fisher's exact test = 0.040). Although carboplatin was administered to 7 of 9 of the patients who developed AP after the embolization procedure, there was no statistical significance (Fisher's exact test = 0.197) for carboplatin as an AP risk factor when compared with all the patients who received this drug (n = 107). CONCLUSION: Although AP after LE seems to have a multifactorial etiology, both the toxicity of the antineoplastic drugs (carboplatin-related toxicity) as well as direct ischemic mechanisms (non-target embolization, reflux mechanisms) may be the most important causes of the inflammatory pancreatic reaction after LE. We suggest that systematic measurement of serum pancreatic enzymes should be performed in cases of abdominal pain following selective LE and transarterial chemoembolization in order to confirm acute pancreatitis after embolization, which can clinically mimic a postembolization syndrome.
Asunto(s)
Embolización Terapéutica/efectos adversos , Neoplasias Hepáticas/terapia , Pancreatitis/etiología , Enfermedad Aguda , Anciano , Medios de Contraste/efectos adversos , Femenino , Humanos , Aceite Yodado/efectos adversos , Masculino , Persona de Mediana Edad , Pancreatitis/diagnóstico por imagen , Tamaño de la Partícula , Radiografía Abdominal , Factores de RiesgoRESUMEN
Acute gastrointestinal bleeding in patients with liver cirrhosis is associated with a high mortality. Ileal varices and collaterals from ectopic vessels are extremely rare, encountered in less than 5% of the cirrhotic patients. The diagnosis is frequently delayed because the regular diagnostic methods such as gastroscopy or colonoscopy are unsuccessful in accurate the source of bleeding in the majority of the cases. We report an unusual case of massive and uncontrollable lower intestinal bleeding from ileal varices with right ovarian vein anastomosis in a 56 year-old female patient with liver cirrhosis and previous history of abdominal and pelvic surgery. The accurate angiographic and computed tomography diagnosis allowed fast decompression of the portal venous system using a transjugular intrahepatic portosystemic shunt.
Asunto(s)
Hemorragia Gastrointestinal , Íleon/irrigación sanguínea , Cirrosis Hepática/complicaciones , Derivación Portosistémica Intrahepática Transyugular , Várices/complicaciones , Enfermedad Aguda , Anastomosis Quirúrgica , Angiografía de Substracción Digital , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Íleon/cirugía , Persona de Mediana Edad , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Várices/diagnóstico por imagen , Várices/cirugíaRESUMEN
Percutaneous transcatheteral embolizations of primary and secondary bone tumors are important minimal invasive angiographic interventions of the skeletal system. In most of the cases embolization is performed for preoperative devascularization or as a palliative measure to treat tumor-associated pain or other tumor bulk symptoms. The transarterial embolization of primary and secondary tumors of the skeletal system has been developed to a safe and very effective method. Indications, techniques, results and complications of this minimal invasive interventional therapy for treatment of primary and secondary bone tumors are described and discussed and compared with the newer literature and our own results.
Asunto(s)
Neoplasias Óseas/terapia , Carcinoma/terapia , Embolización Terapéutica , Neoplasias Renales/patología , Neoplasias de la Columna Vertebral/terapia , Vértebras Torácicas/patología , Neoplasias de la Tiroides/patología , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Neoplasias Óseas/irrigación sanguínea , Neoplasias Óseas/secundario , Carcinoma/irrigación sanguínea , Carcinoma/secundario , Femenino , Humanos , Masculino , Microesferas , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/irrigación sanguínea , Neoplasias de la Columna Vertebral/secundario , Vértebras Torácicas/irrigación sanguíneaRESUMEN
This paper gives an overview of experience and success of percutaneous transhepatic interventions in malignant biliary obstruction. Even after exhaustion of surgical and endoscopic therapy options, the percutaneously inserted stents provide effective palliation. The palliative treatment of malignant jaundice using a stent is an established procedure in clinical practice, particularly whenever the endoscopic, transpapillary approach is not possible due to high obstructions or previous surgery. The technical success rate is very high (about 95-100%), and the complication rate is about 10-30%. Since the patency rate of stents is higher than that of plastic endoprostheses, their primary use is justified despite higher costs, provided the patients are adequately selected.
Asunto(s)
Ictericia Obstructiva/terapia , Drenaje , Humanos , Ictericia Obstructiva/diagnóstico por imagen , Ictericia Obstructiva/etiología , Neoplasias/complicaciones , Cuidados Paliativos , Selección de Paciente , Implantación de Prótesis , Radiografía , Stents , Resultado del TratamientoRESUMEN
In this report, we describe successful treatment of a patient with hemoptysis by false lumen embolization of a type B aortic dissection.