Diagnóstico y embolización con cianoacrilato de pseudoaneurismas de origen ginecológico / Diagnosis of gynecological pseudoaneurysms and embolization with cyanoacrylate

Los pseudoaneurismas de la arteria uterina son una causa infrecuente, pero muy grave, de hemorragia ginecológica como consecuencia de la manipulación quirúrgica pélvica o de partos instrumentalizados. Las distintas técnicas de imagen tienen vital importancia en el diagnóstico. La arteriografía es la prueba de confirmación y en muchos casos terapéutica. El tratamiento endovascular mediante embolización del pseudoaneurisma se ha consolidado como terapia de elección, lo que evita en muchos casos la histerectomía a mujeres en edad fértil. El objetivo de nuestro trabajo es presentar dos casos de hemorragia ginecológica por pseudoaneurismas, posquirúrgico y posparto, embolizados de manera novedosa con cianoacrilato (AU)

Pseudoaneurysms of the uterine artery are an uncommon cause of severe gynecological bleeding secondary to surgical manipulation of the pelvis or to instrumental delivery. The different imaging techniques are of vital importance in the diagnosis. Angiography is the technique used for confirmation and also for treatment in many cases. Endovascular treatment by embolizing the pseudoaneurysm has become established as the treatment of choice, making it possible to avoid hysterectomy in women of childbearing age. This article presents two cases of gynecological bleeding due to pseudoaneurysms (one secondary to surgery and one secondary to childbirth) that were embolized in a novel way using cyanoacrylate (AU)

Diagnosis of gynecological pseudoaneurysms and embolization with cyanoacrylate. / Diagnóstico y embolización con cianoacrilato de pseudoaneurismas de origen ginecológico.

Pseudoaneurysms of the uterine artery are an uncommon cause of severe gynecological bleeding secondary to surgical manipulation of the pelvis or to instrumental delivery. The different imaging techniques are of vital importance in the diagnosis. Angiography is the technique used for confirmation and also for treatment in many cases. Endovascular treatment by embolizing the pseudoaneurysm has become established as the treatment of choice, making it possible to avoid hysterectomy in women of childbearing age. This article presents two cases of gynecological bleeding due to pseudoaneurysms (one secondary to surgery and one secondary to childbirth) that were embolized in a novel way using cyanoacrylate.

Eficacia y complicaciones en el empleo de prótesis autoexpandibles de colon: análisis de un periodo de 15 años / Efficacy and complications in the use of self-expanding colonic stents: an analysis of 15 years’ experience

Objetivo. Analizar la eficacia y seguridad del procedimiento para colocar las prótesis autoexpandibles de colon. Evaluar los factores asociados a complicaciones. Realizar un análisis dosimétrico del procedimiento. Material y métodos. Realizamos un estudio descriptivo retrospectivo unicéntrico de 478 procedimientos para colocar prótesis metálicas autoexpandibles de colon. Se insertaron 423 prótesis de nitinol y 79 de acero inoxidable. Incluimos todas las obstrucciones de colon, 446 de etiología maligna y 8 de causa benigna. Excluimos los pacientes con perforación intestinal, hemorragia grave del colon, esperanza de vida corta y lesiones situadas a menos de 5 cm del ano. Analizamos el éxito técnico, éxito clínico, las complicaciones durante el seguimiento y recogimos los datos dosimétricos. Resultados. Se obtuvo éxito técnico en un 92,26% (n = 441), éxito clínico en un 78,45% (n = 375) y un porcentaje de complicaciones durante el seguimiento del 18,5%. Las prótesis de acero tuvieron más complicaciones (OR: 3,2; IC 95%: 1,8-5,7). El valor medio de producto dosis por área fue 35 Gy.cm2. El de tiempo de fluoroscopia (p = 0,001), producto dosis por área (p = 0,029) y kerma (p = 0,001) fueron mayores si el procedimiento fue realizado exclusivamente por fluoroscopia, en vez de conjuntamente por el endoscopista y el radiólogo intervencionista. Conclusión. El procedimiento para colocar prótesis autoexpandibles de colon es eficaz y seguro, con una tasa aceptable de complicaciones. Las dosis de radiación fueron bajas, con menos dosis y tiempos de fluoroscopia cuando el procedimiento se realizó de manera conjunta con el endoscopista (AU)

Objective. To analyze the efficacy and safety of the procedure for placing self-expanding stents in the colon. To evaluate the factors associated with complications. To analyze the dose of radiation delivered in the procedure. Material and methods. This was a retrospective descriptive study of 478 procedures done at a single center to place self-expanding metallic stents in the colon. A total of 423 nitinol stents and 79 stainless steel stents were placed. We included all colonic obstructions, of which 446 had malignant causes and 8 had benign causes. We excluded patients with intestinal perforation, severe colonic bleeding, short life expectancy, or lesions located less than 5 cm from the anus. We collected the dosimetric data and analyzed the technical success, clinical success, and complications during follow-up. Results. The procedure was a technical success in 92.26% of cases (n = 441) and a clinical success in 78.45% (n = 375); complications occurred during follow-up in 18.5% of cases. Complications occurred more frequently with the stainless steel stents than with the nitinol stents (OR: 3.2; 95% CI: 1.8-5.7). The mean value of the dose area product was 35 Gy*cm2. When instead of being done by the interventional radiologist working together with an endoscopist the procedure was done exclusively by the interventional radiologist, the time under fluoroscopy (p = 0.001), dose area product (p = 0.029), and kinetic energy released per unit mass (p = 0.001) were greater. Conclusion. The procedure for placing self-expanding colonic stents is efficacious and safe with an acceptable rate of complications. The doses of radiation delivered were low, and the radiation doses and time under fluoroscopy were lower when the procedure was done together with an endoscopist (AU)

Efficacy and complications in the use of self-expanding colonic stents: an analysis of 15 years' experience.

OBJECTIVE: To analyze the efficacy and safety of the procedure for placing self-expanding stents in the colon. To evaluate the factors associated with complications. To analyze the dose of radiation delivered in the procedure. MATERIAL AND METHODS: This was a retrospective descriptive study of 478 procedures done at a single center to place self-expanding metallic stents in the colon. A total of 423 nitinol stents and 79 stainless steel stents were placed. We included all colonic obstructions, of which 446 had malignant causes and 8 had benign causes. We excluded patients with intestinal perforation, severe colonic bleeding, short life expectancy, or lesions located less than 5 cm from the anus. We collected the dosimetric data and analyzed the technical success, clinical success, and complications during follow-up. RESULTS: The procedure was a technical success in 92.26% of cases (n=441) and a clinical success in 78.45% (n=375); complications occurred during follow-up in 18.5% of cases. Complications occurred more frequently with the stainless steel stents than with the nitinol stents (OR: 3.2; 95% CI: 1.8-5.7). The mean value of the dose area product was 35 Gy*cm(2). When instead of being done by the interventional radiologist working together with an endoscopist the procedure was done exclusively by the interventional radiologist, the time under fluoroscopy (p=0.001), dose area product (p=0.029), and kinetic energy released per unit mass (p=0.001) were greater. CONCLUSION: The procedure for placing self-expanding colonic stents is efficacious and safe with an acceptable rate of complications. The doses of radiation delivered were low, and the radiation doses and time under fluoroscopy were lower when the procedure was done together with an endoscopist.

[Lacunar infarcts. A comparative study of risk factors and carotid stenosis]. / Infartos lacunares. Estudio comparativo de factores de riesgo y estenosis carotídea.

OBJECTIVE: In order to evaluate the pathogenic role of carotid atheromatosis and risk factors for the lacunar type of cerebral ischaemia a comparative analysis was made between a group of patients with this type of stroke and other with non-lacunar infarctions. Unlike previous works, patients with clinical-radiological criteria for ischaemia in the carotid territory were included in both groups. METHODS: Ninety-eight patients with a first episode of stroke were selected prospectively. Strokes were classified as lacunar (52 patients) and non-lacunar (46 patients). The following risk factors were evaluated: age, sex, increased blood pressure, left ventricle enlargement, smoking, alcohol intake, lipid profile, history of previous transient stroke, arterial retinopathy, diabetes, ischaemic heart disease and presence of peripheral arteriopathy. The narrowing degree of the carotid artery was determined by means of Doppler ultrasonography. RESULTS: Significant differences were found for the presence of two variables: hypertensive retinopathy was more prevalent in the lacunar group (p = 0.003) and history of transient ischaemic stroke was recorded more frequently in association with non-lacunar infarction (p = 0.01). A 50%-70% degree of narrowing in the upper carotid artery was observed more frequently in association with non-lacunar infarctions (p < 0.001) in the ipsilateral artery to the symptomatic hemisphere. In the heterolateral artery the narrowing degree was similar for both groups (p = 0.87). CONCLUSIONS: Lacunar and non-lacunar infarctions share the same risk factors; nevertheless, the distribution of atheromatous lesions was different. The presence of hypertensive retinopathy is an excellent marker for perforant arterial disease. The carotid stenosis is an unusual pathogenic mechanism for the development of ischaemic lacunar syndrome with an appropriate injury visualized by CT.