[Embolization in peripheral artery bleeding with Onyx]. / Embolización de sangrados arteriales periféricos con Onyx.

OBJECTIVE: This study describes use of ethylene vinyl alcohol copolymer (EVOH) dissolved in anhydrous dimethyl sulfoxide (DMSO) and mixed with tantalum powder to achieve radiopacity as an effective, safe, and manageable embolic agent in endovascular treatment of artery haemorrhages. MATERIALS AND METHODS: Twenty patients with pseudoaneurysms secondary to biopsy, or surgery were treated, 11 musculoskeletal arteries, 9 visceral (4 gastroduodenal arteries). A diagnostic angiographic procedure that showed the artery lesion was always performed. Embolization was performed immediately, followed by post-embolization angiographic control. Transcatheter embolization was always performed, using a coaxial system consisting of a 4F hydrophilic guide catheter with 0.038" diameter, a microcatheter compatible with DMSO administration (Rebar microcatheter), and a microguide. All cases progressed with acute hemorrhagic syndrome of variable intensity. There were nine cases with hemorrhagic shock. RESULTS: All cases were satisfactorily resolved without recurrence of bleeding during follow-up. CONCLUSIONS: Our experience with selective embolization of spontaneous or traumatic artery bleeding with Onyx has been excellent due to its simple, rapid, and safe use.

Embolización de sangrados arteriales periféricos con Onyx / Embolization in peripheral artery bleeding with Onyx

Objetivo. Describimos el uso del copolímero de alcohol etilen-vinílico (EVOH), disuelto en sulfóxido de dimetilo (DMSO) y mezclado con polvo de tantalio para hacerlo radioopaco, como agente embolígeno en el tratamiento endovascular de los traumatismos arteriales. Material y métodos. Hemos tratado 20 pacientes con pseudoaneurismas secundarios a biopsias o cirugía en 11 arterias musculoesqueléticas y 9 arterias viscerales (4 gastroduodenales). En todos los casos se realizó un estudio angiográfico diagnóstico que demostró la lesión arterial y de forma inmediata se realizó la embolización, así como el control angiográfico posembolización. La embolización se ha realizado con un sistema coaxial compuesto por un catéter guía hidrofílico del 4F con luz 0,038", un microcatéter compatible con la administración de DMSO y una microguía. Todos los casos han cursado con un síndrome hemorrágico agudo de diferente intensidad, 9 de ellos con shock hemorrágico. Resultados. El éxito técnico y clínico fue del 100%, sin recidivas del sangrado durante el seguimiento. Conclusiones. La embolización selectiva de sangrados arteriales con Onyx es eficaz, fácil, rápida y segura dadas sus propiedades, que lo hacen sencillo en el manejo

Objective. This study describes use of ethylene vinyl alcohol copolymer (EVOH) dissolved in anhydrous dimethyl sulfoxide (DMSO) and mixed with tantalum powder to achieve radiopacity as an effective, safe, and manageable embolic agent in endovascular treatment of artery haemorrhages. Materials and methods. Twenty patients with pseudoaneurysms secondary to biopsy, or surgery were treated, 11 musculoskeletal arteries, 9 visceral (4 gastroduodenal arteries). A diagnostic angiographic procedure that showed the artery lesion was always performed. Embolization was performedimmediately, followed by post-embolization angiographiccontrol. Transcatheter embolization was always performed,using a coaxial system consisting of a 4F hydrophilicguide catheter with 0.038” diameter, a microcatheter compatible with DMSO administration (Rebar microcatheter), and a microguide. All cases progressed with acute hemorrhagic syndrome of variable intensity. There were nine cases with hemorrhagic shock.Results. All cases were satisfactorily resolved without recurrence of bleeding during follow-up. Conclusions. Our experience with selective embolization of spontaneous or traumatic artery bleeding with Onyx hasbeen excellent due to its simple, rapid, and safe use

[Computerized axial tomography, ultrasonography and percutaneous drainage in the diagnosis and treatment of pyogenic abscess of the liver]. / La tomografía axial computerizada, la ultrasonografía y el drenaje percutáneo en el diagnóstico y el tratamiento del absceso hepático piógeno.

Pyogenic liver abscesses in 20 adult patients were reviewed to evaluate if computed tomography (CT), ultrasonography (US) and percutaneous catheter drainage have improved prognosis of this disease. The average delay in diagnosis was 16 days. The CT sensitivity was 94% while the US sensitivity was 78%. The response to treatment with open surgery was compared to percutaneous drainage. Eleven patients were surgically drained with complications in 58% of them. Eight were treated with percutaneous drainage and no complication appeared as a result of treatment. One was found at autopsy. Days of hospitalization in surgically drained patients were significantly higher (p less than 0.01) than percutaneous drained patients. Percutaneous catheter drainage is recommended as method of choice for treating patients with pyogenic liver abscesses.