The COVID-19 pandemic and its repercussions in our interventional radiology unit. / La pandemia COVID-19 y su repercusión en la unidad de radiología intervencionista: nuestra experiencia.

This paper aims to describe our experience in an interventional radiology unit in a hospital in Spain that was severely affected by the COVID-19 pandemic. To this end, we did a prospective observational study of 20 consecutive patients with COVID-19 who underwent 21 interventional radiology procedures between March 13, 2020 and May 11, 2020. We describe the measures taken to reorganize the work and protective measures, as well as the repercussions of the situation on our unit's overall activity and activity in different phases. The COVID-19 pandemic has represented a challenge in our daily work, but learning from our own experience and the recommendations of the Spanish radiological societies (SERVEI and SERAM) has enabled us to adapt successfully. Our activity dropped only 22% compared to the same period in 2019.

Embolización de arterias prostáticas en la hiperplasia benigna de la próstata en pacientes no quirúrgicos / Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients

OBJETIVO: Presentar los resultados de un estudio multidisciplinar de dos hospitales terciarios, junto a los servicios de urología, sobre 102 pacientes consecutivos no candidatos a cirugía tratados durante más de 6 años, en los que se realizó embolización de arterias prostáticas para el tratamiento de la hiperplasia benigna. MATERIAL Y MÉTODOS: Desde diciembre de 2012 a febrero de 2019, 102 pacientes con síntomas de hiperplasia benigna de la próstata (HBP) no candidatos a cirugía o que la rechazaron explícitamente, con una edad media de 73,9 años (rango 47,5-94,5), fueron sometidos a embolización prostática. Se llevó a cabo un seguimiento de estos a través de cuestionarios sobre la sintomatología urinaria, función sexual e impacto en la calidad de vida, así como la medición del volumen prostático, uroflujometría y antígeno prostático específico (PSA) al mes, 3 y 6 meses y al año del procedimiento. RESULTADOS: La técnica fue exitosa en un 96% de los pacientes (76,2% bilateral y 19,8% unilateral). El tiempo de duración media del procedimiento fue de 92 minutos y el de radioscopia, de 35,2 minutos. Se demostraron cambios estadísticamente significativos (p < 0,05) en el PSA, el flujo urinario pico (Qmáx), el cuestionario QoL (Quality of life) y el International Index of Erectile Function (IPSS). El PSA disminuyó un 58% a los 3 meses respecto al valor inicial. Asimismo, el Qmáx aumentó de manera significativa en un 63% al tercer mes tras la embolización. Se obtuvo una mejoría significativa en los test QoL e IPSS, con una disminución de 3,7 puntos y 13,5 puntos de media, respectivamente, al año de seguimiento. El volumen prostático mostró una disminución no estadísticamente significativa al año, tras el tratamiento. Se han recogido una serie de complicaciones menores, que en ningún caso requirieron ingreso hospitalario. CONCLUSIONES: La embolización prostática para el tratamiento de la HPB demostró ser una técnica eficaz y segura en pacientes no candidatos a cirugía

OBJECTIVE: To present the results of a multidisciplinary study of two tertiary hospitals, together with urology services, on 102 consecutive patients not candidates for surgery treated for more than 6 years, in whom prostatic arteries were embolised for the treatment of benign hyperplasia. MATERIAL AND METHODS: From December 2012 to February 2019, 102 patients with symptoms of benign prostatic hyperplasia (BPH) not candidates for surgery or who explicitly rejected surgery, with an average age of 73.9 years (range 47.5-94.5), underwent prostatic artery embolisation. The patients were followed up by questionnaires on urinary symptoms, sexual function and impact on quality of life, as well as measurement of prostate volume, uroflowmetry and prostate specific antigen (PSA) at one, 3 and 6 months and one year following the procedure. RESULTS: The technique was successful in 96% of patients (76.2% bilateral and 19.8% unilateral). The mean duration of the procedure was 92minutes and of the radioscopy 35.2minutes. Statistically significant changes were demonstrated (p <.05) in PSA, peak urinary flow, QoL (quality of life) questionnaire and the International Index of Erectile Function (IPSS). PSA had reduced by 58% from baseline at 3 months. Similarly, the Qmax had increased significantly by 63% in the third month following embolisation. A significant improvement in the QoL and IPSS tests was achieved, with a reduction of 3.7 points and a mean 13.5 points, respectively, at one year's follow-up. Prostate volume showed a non-statistically significant decrease at follow-up of one year following treatment. A series of minor complications was collected, no case of which required hospital admission. CONCLUSIONS: Prostatic embolisation for the treatment of BPH proved an effective and safe technique in patients who were not candidates for surgery

Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. / Embolización de arterias prostáticas en la hiperplasia benigna de la próstata en pacientes no quirúrgicos.

OBJECTIVE: To present the results of a multidisciplinary study of two tertiary hospitals, together with urology services, on 102 consecutive patients not candidates for surgery treated for more than 6 years, in whom prostatic arteries were embolised for the treatment of benign hyperplasia. MATERIAL AND METHODS: From December 2012 to February 2019, 102 patients with symptoms of benign prostatic hyperplasia (BPH) not candidates for surgery or who explicitly rejected surgery, with an average age of 73.9 years (range 47.5-94.5), underwent prostatic artery embolisation. The patients were followed up by questionnaires on urinary symptoms, sexual function and impact on quality of life, as well as measurement of prostate volume, uroflowmetry and prostate specific antigen (PSA) at one, 3 and 6 months and one year following the procedure. RESULTS: The technique was successful in 96% of patients (76.2% bilateral and 19.8% unilateral). The mean duration of the procedure was 92minutes and of the radioscopy 35.2minutes. Statistically significant changes were demonstrated (p <.05) in PSA, peak urinary flow, QoL (quality of life) questionnaire and the International Index of Erectile Function (IPSS). PSA had reduced by 58% from baseline at 3 months. Similarly, the Qmax had increased significantly by 63% in the third month following embolisation. A significant improvement in the QoL and IPSS tests was achieved, with a reduction of 3.7 points and a mean 13.5 points, respectively, at one year's follow-up. Prostate volume showed a non-statistically significant decrease at follow-up of one year following treatment. A series of minor complications was collected, no case of which required hospital admission. CONCLUSIONS: Prostatic embolisation for the treatment of BPH proved an effective and safe technique in patients who were not candidates for surgery.

La pandemia COVID-19 y su repercusión en la unidad de radiología intervencionista: nuestra experiencia / The COVID-19 pandemic and its repercussions in our interventional radiology unit

El objetivo del presente trabajo es mostrar la experiencia en una unidad de radiología intervencionista de un hospital de nuestro país muy afectado por la pandemia COVID-19. Para ello se ha realizado un estudio observacional prospectivo de una serie de casos consecutivos (n=20) de pacientes COVID-19, sometidos a 21 procedimientos intervencionistas, durante el periodo de 2 meses de estudio (13 marzo -11 mayo de 2020). Se exponen las medidas de reorganización del trabajo, medidas de protección; así como la repercusión de la situación en la actividad de la unidad total y por fases. La pandemia COVID-19ha supuesto un reto para el trabajo diario en nuestra unidad, pero siguiendo nuestra propia experiencia y las recomendaciones de SERVEI y SERAM, nos hemos adaptado a la situación de forma exitosa. Se ha observado una disminución de la actividad de tan sólo un 22% sobre el mismo periodo del año 2019

This paper aims to describe our experience in an interventional radiology unit in a hospital in Spain that was severely affected by the COVID-19 pandemic. To this end, we did a prospective observational study of 20 consecutive patients with COVID-19 who underwent 21 interventional radiology procedures between March 13, 2020 and May 11, 2020. We describe the measures taken to reorganize the work and protective measures, as well as the repercussions of the situation on our unit's overall activity and activity in different phases. The COVID-19 pandemic has represented a challenge in our daily work, but learning from our own experience and the recommendations of the Spanish radiological societies (SERVEI and SERAM) has enabled us to adapt successfully. Our activity dropped only 22% compared to the same period in 2019

Uso de un nuevo dispositivo para la prevención de embolias pulmonares previo a una trombectomía farmacomecánica / Using a new device to prevent pulmonary embolisms during pharmacomechanical thrombectomy

Hemos empleado un nuevo dispositivo para prevenir la tromboembolia pulmonar (TEP) durante una trombectomía farmacomecánica en una mujer puérpera de 25 años. El catéter Angel(R) (BiO2 Medical Inc. Golden, CO) es un dispositivo temporal que combina la función de filtro de vena cava (FVC) con la de un catéter venoso central de triple luz. Normalmente, la prevención de la TEP durante la trombectomía farmacomecánica se realiza implantando un FVC. Las complicaciones asociadas al FVC aumentan con el tiempo de implantación. Su recuperabilidad no es total y la iatrogenia es posible tanto al implantarlo como al retirarlo. En nuestra experiencia, este nuevo dispositivo puede ser implantado y extraído de forma mucho más sencilla. Creemos interesante dar a conocer este dispositivo como una posible alternativa al FVC para prevenir la TEP durante la trombectomía farmacomecánica, como exponemos en este caso

We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel(R) catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy

Using a new device to prevent pulmonary embolisms during pharmacomechanical thrombectomy. / Uso de un nuevo dispositivo para la prevención de embolias pulmonares previo a una trombectomía farmacomecánica.

We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel® catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy.

La radiología intervencionista en España ¿camina hacia la superespecialización? / Is interventional radiology in Spain walking towards superspecialization?

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Embolización selectiva como tratamiento de la hemorragia obstétrica / Selective embolization to treat obstetric hemorrhage

Objetivo: Describir los casos de hemorragias obstétricas que han precisado embolización selectiva intraarterial, referir las diferentes técnicas de embolización empleadas, valorar los resultados clínicos y la fertilidad posterior. Material y métodos: Se estudiaron 27 mujeres con hemorragia obstétrica. La embolización se realizó cateterizando ambas arterias uterinas en 24 pacientes y solo una arteria uterina en 2 (pseudoaneurisma), en 17/27 se embolizó con Espongostán®, en 9/27 con partículas y un paciente con coils. Se realizó un seguimiento clínico de las pacientes analizando la aparición de complicaciones inmediatas y tardías, y la posterior fertilidad. Resultados: Las hemorragias fueron primarias (25/27) y secundarias (2/27).Las causas fueron: partos vaginales (20), cesáreas (5), aborto (1) y embarazo ectópico cervical (1).El éxito técnico inicial fue del 100% y el éxito clínico del 92,6% (25/27) de las pacientes, El resultado fue satisfactorio en 25 pacientes cesando la hemorragia. Se realizó seguimiento clínico entre 1 y 7 años tras la embolización, en 23 pacientes se constataron menstruaciones normales y se produjeron 7 embarazos a término en 6 pacientes. Conclusión: La embolización intraarterial en la hemorragia obstétrica ofrece buenos resultados, pocas complicaciones y preserva la fertilidad (AU)

Objective: To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. Material and methods: We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. Results: Hemorrhage was classified as primary (25/27) or secondary (2/27).The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1).The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients).Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. Conclusion: Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility (AU)

[Selective embolization to treat obstetric hemorrhage]. / Embolización selectiva como tratamiento de la hemorragia obstétrica.

OBJECTIVE: To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. MATERIAL AND METHODS: We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. RESULTS: Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. CONCLUSION: Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility.

Stenting as first option for endovascular treatment of malignant superior vena cava syndrome.

OBJECTIVE: Endoprostheses were inserted in cancer patients with superior vena cava syndrome to assess their effectiveness as first-choice, initial treatment for relief of symptoms. SUBJECTS AND METHODS: Wallstent prostheses (n = 73) of various lengths (5-14 cm; median, 7 cm) and diameters (10-16 mm; median, 16 mm) were inserted in 52 cancer patients (51 men, 1 woman; age range, 44-78 years; mean, 63 years) who were diagnosed and confirmed by cavography or phlebography as having superior vena cava syndrome. A single stent was sufficient in 37 patients, two stents were required in 11, three stents in two, and four stents in another two patients. Contraindications for the procedure were severe cardiopathy or coagulopathy. RESULTS: Resolution of symptoms was achieved in all patients within 72 hr. At follow-up, six obstructions, one partial migration to the right atrium, two incorrect placements, and four stent "shortenings" were noted. All were successfully resolved by repeated stenting. Symptom-free survival ranged from 2 days to 17 months (mean, 6.4 months). At the time of this writing, eight patients are alive and have patent stents. The rest have died from their cancer. CONCLUSION: The Wallstent vascular endoprosthesis is an effective initial treatment in superior vena cava syndrome of neoplastic origin. Morbidity and complications are minimal. Clinical relief of symptoms is rapid; therefore, the Wallstent endoprosthesis is highly recommended as the first choice for palliative treatment of superior vena cava syndrome, especially because the clinical decision for subsequent chemotherapy or radiotherapy or surgery is not in any way prejudiced.

Nasolacrimal stents in the management of epiphora: medium-term results of a multicenter prospective study.

PURPOSE: To evaluate in a prospective multicenter setting the clinical utility of polyurethane stents in the percutaneous management of epiphora. MATERIALS AND METHODS: Patients (N = 163; age range = 22-85 y, mean = 52 y; 29 men, 134 women) with severe epiphora had stents (n = 183) inserted under fluoroscopic guidance in 180 lacrimal systems (unilateral = 146; bilateral = 17) to treat complete (n = 172) or partial (n = 8) obstruction of the nasolacrimal duct or sac. The junction between sac and duct was the most frequent location (n = 102), followed by the sac alone (n = 48), and the duct alone (n = 30). The etiology of the obstruction was idiopathic in 113 cases (63%) and chronic dacryocystitis in 67 (37%). The set designed by Song was used in all patients and the original technique was slightly modified by the authors. All patients were treated on an outpatient basis. Average time of the procedure was 14 minutes (range = 3-70 min). RESULTS: Initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 175 eyes and partial in five. On follow-up (mean = 450 d; range = 8-730 d), 157 of 183 stents remained patent (85.8%). Of the 24 obstructed, 19 were easily withdrawn and 17 of these patients remained asymptomatic for a mean of 15 months (secondary patency rate = 89.5%). CONCLUSIONS: The procedure is simple and safe. It can be performed on an outpatient basis and the original technique could be improved with some technical modifications. It is well tolerated by patients and may be considered as a valid alternative technique for the resolution of epiphora.