Gastric Embolization as Treatment for Overweight Patients; Efficacy and Safety.

OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of left gastric artery (LGA) embolization for the treatment of overweight patients who weren't candidates for bariatric surgery. MATERIALS AND METHODS: We retrospectively collected data of 16 patients who underwent a selective embolization of the LGA. The mean body mass index (BMI) before intervention was 28.9 kg/m2 ± 2.5, and therefore, patients were not candidates for bariatric surgery in Belgium. The embolization was realized with 500-700 µm particles via the right common femoral artery approach. Before and following the intervention, an upper endoscopy was performed. Patient demographics, weight loss, hunger sensation and a satisfactory scale were reviewed. RESULTS: Between February 2015 and May 2017, 16 overweight patients were treated, one embolization was unsuccessful. Four (25%) patients were lost in follow-up. Nine (56%) patients showed early weight loss, one (6%) maintained his bodyweight and one (6%) patient underwent bariatric surgery 2 years after consultation. Only one (6%) patient had a gastric ulceration on control endoscopy. One (6%) patient ended in the intensive care unit for pancreatitis and gastric perforation. The mean weight loss was 8 kg ± 5.12, reducing their mean BMI to 25.5 ± 3.5. The hunger sensation was decreased, and patients were satisfied. CONCLUSION: This is a preliminary study in an overweight population that appears to induce weight loss and appetite suppression. Larger studies are needed to confirm these preliminary findings.

Which is currently the best strategy for treatment of SFA in-stent restenosis?

Stents have been created to prevent vessel recoil after percutaneous transluminal angioplasty (PTA). Despite the evolution in stent design, intimal hyperplasia and stent fractures and the resulting in-stent restenosis (ISR) still occur. Different strategies to treat ISR have been described with variable results in patency rates in the short and the long-term. PTA only in the treatment of ISR showed high procedural success, but the mid and long-term patency rates were very disappointing. Atherectomy devices have showed same insufficient results. If stent fracture is the cause of the ISR, the fracture has to be overstent. The best two options are covered stents and drug eluting stents (DES). Drug eluting devices like DES and drug eluting balloons (DEBs) showed promising results, with patency rates up to over 90% after one year. DEBs have the advantage of leaving nothing behind. Combined treatment of ISR with atherectomy and DEB has a similar good result. Endovascular brachytherapy showed high patency rates after one year but this technique is limited due to the time-consuming nature of the procedure, complex radiation safety measurements, and staffing requirements. Overall drug-eluting devices are emerging as the best treatment of SFA ISR with patency rates over 90% after 2 years.

Arterioureteral fistula. An unusual cause of aortofemoral bypass infection. A case report.

We report a case of arterioureteral fistula after aortobifemoral bypass surgery and prolonged bilateral double J stents due to ureteral stenosis. A 70-year-old woman presented with a non-tender mass in the left groin and a single episode of haematuria 2 months earlier. A Computed Tomography (CT) revealed a pseudoaneurysm of the left distal suture of the graft. Surgical repair was performed. Because of suspicion of infection the entire aortobifemoral graft was removed and replaced by an autologous venous aortofemoral bypass to the right groin and femorofemoral crossover bypass from the right to the left. During surgery an arterioureteral fistula could be visualized. The urologists performed a left nephroureterectomy of the afunctional left kidney. The further postoperative course was uneventful during the 10 months of follow up.