Impact of the first year of the COVID-19 pandemic on an interventional radiology unit.

OBJECTIVES: To describe the impact of the Covid-19 pandemic on the interventional radiology unit at our hospital in the first year of the pandemic. MATERIAL AND METHODS: This prospective observational study included 83 consecutive patients with confirmed SARS-CoV-2 infections who underwent an interventional radiology procedure in the period comprising March 13, 2020 through March 13, 2021. We describe the repercussions of the situation on the unit's total activity, as well as on its activity during the different phases of the pandemic. RESULTS: Technical and clinical success were achieved in 96.43% and 82.14% of cases, respectively. During follow-up throughout the year, 68 patients remained alive and 15 died from their underlying disease. No complications related with interventional procedures occurred, and activity declined by only 12% in comparison with the same period in the previous year (2019-2020, without COVID). Similarly, the decrease in relative value units and radiology activity units was only 13% and 12%, respectively. CONCLUSION: The Covid-19 pandemic has been a challenge in our daily work, leading to an overall decrease in the number of procedures. Nevertheless, the interventional radiology unit has been actively involved in caring for Covid-19 patients, performing a wide variety of necessary procedures. Following a series of specific measures and protocols has enabled us to perform interventional radiology procedures safely during the pandemic.

Un año completo de pandemia COVID-19 y su impacto en la Unidad de Radiología Intervencionista / Impact of the first year of the COVID-19 pandemic on an interventional radiology unit

Objetivos: Describir el impacto que la pandemia de COVID-19ha supuesto en la Unidad de Radiología Intervencionista de nuestro hospital a lo largo de un año. Materiales y métodos: Se ha realizado un estudio observacional prospectivo en 83 pacientes consecutivos con infección confirmada por COVID-19 a los cuales se les realizó algún tipo de procedimiento de radiología intervencionista durante el periodo comprendido entre el 13 de marzo del 2020 y el 13 de marzo de 2021. Se describe la repercusión de la situación en la actividad total de la unidad, así como en las diferentes fases de la pandemia. Resultados: Se alcanzó el éxito técnico y clínico en el 96,43% y 82,14% de los casos, respectivamente. Durante el seguimiento a lo largo de un año, 68 pacientes seguían vivos y 15 fallecieron a causa de su enfermedad de base. No se produjeron complicaciones relacionadas con los procedimientos intervencionistas y nuestra actividad decayó solo un 12% en comparación con el mismo período del año 2019-2020 (no-COVID). Asimismo, solo se produjo una reducción en unidades relativas de valor y unidades de actividad radiológica del 13% y del 12%, respectivamente. Conclusión: La pandemia de COVID-19ha supuesto un desafío en nuestro trabajo diario condicionando una reducción general en el número de procedimientos. No obstante, la radiología intervencionista ha participado activamente en la atención de los pacientes con COVID-19 mediante la realización de una amplia variedad de intervenciones necesarias. La atención de la radiología intervencionista pudo realizarse de forma segura durante la pandemia, siguiendo una serie de medidas y protocolos específicos.(AU)

Objectives: To describe the impact of the Covid-19 pandemic on the interventional radiology unit at our hospital in the first year of the pandemic. Material and methods: This prospective observational study included 83 consecutive patients with confirmed SARS-CoV-2 infections who underwent an interventional radiology procedure in the period comprising March 13, 2020 through March 13, 2021. We describe the repercussions of the situation on the unit's total activity, as well as on its activity during the different phases of the pandemic. Results: Technical and clinical success were achieved in 96.43% and 82.14% of cases, respectively. During follow-up throughout the year, 68 patients remained alive and 15 died from their underlying disease. No complications related with interventional procedures occurred, and activity declined by only 12% in comparison with the same period in the previous year (2019-2020, without COVID). Similarly, the decrease in relative value units and radiology activity units was only 13% and 12%, respectively. Conclusion: The Covid-19 pandemic has been a challenge in our daily work, leading to an overall decrease in the number of procedures. Nevertheless, the interventional radiology unit has been actively involved in caring for Covid-19 patients, performing a wide variety of necessary procedures. Following a series of specific measures and protocols has enabled us to perform interventional radiology procedures safely during the pandemic.(AU)

Abordaje inusual en el tratamiento de las endofugas aórticas tipo II / Unusual approach for the treatment of a type II endoleak

Presentamos un paciente masculino de 88 años con antecedente de reparación endovascular de aneurisma aórtico y endofuga aórtica tipo II (EA2). Se consideró la cateterización directade la arteria lumbar como la alternativa para solucionar la EA2 de la endoprótesis aórtica, cuando otras alternativas (embolización transarterial) fracasaron en el control del crecimiento del aneurisma aórtico. Se decidió un abordaje translumbar mediante punción de la arteria lumbar (L4) izquierda. Previamente, se valoraron las arterias lumbares (L4) con TC abdominal en fase arterial,y así guiar el acceso bajo control fluoroscópico. La angiografía diagnóstica demostró la entrada de arterias sacra media y lumbar derecha en el saco aneurismático. La embolización transcatéter de la arteria sacra media y las arterias lumbares izquierda y derecha (L4) con microcoils de fibras de platino permitió la devascularización satisfactoria de la endofuga (AU)

This case presentation is about an 88 years-old male patient with previous endovascular aortic aneurysm repairment history and aortic endoleak type II (EL2). The direct lumbar artery catheterization was considered an alternative to solve EL2, associated with aortic endovascular prosthesis and due to an incomplete sealing or exclusion of the aneurysmal sac or a vascular segment demonstrated by imaging studies, when other treatment alternative failed (transarterial embolization) to control the aneurysm growing. Performing translumbar approach was decided by puncturing the artery lumbar (L4) left, previously the lumbar arteries (L4) were evaluated in the abdominal CT arterial phase to guide a puncture/access under flouroscopy control. Diagnostic angiogram clearly demonstrated the median sacral and right lumbar arteries inflow into the aneurysm sac. Transcatheter embolization with fibered platinum microcoils was performed of the median sacral artery and lumbar left and right arteries (L4), showing satisfactory endoleak devascularization (AU)

Unusual approach for the treatment of a type II endoleak. / Abordaje inusual en el tratamiento de las endofugas aórticas tipo II.

This case presentation is about an 88 years-old male patient with previous endovascular aortic aneurysm repairment history and aortic endoleak type II (EL2). The direct lumbar artery catheterization was considered an alternative to solve EL2, associated with aortic endovascular prosthesis and due to an incomplete sealing or exclusion of the aneurysmal sac or a vascular segment demonstrated by imaging studies, when other treatment alternative failed (transarterial embolization) to control the aneurysm growing. Performing translumbar approach was decided by puncturing the artery lumbar (L4) left, previously the lumbar arteries (L4) were evaluated in the abdominal CT arterial phase to guide a puncture/access under flouroscopy control. Diagnostic angiogram clearly demonstrated the median sacral and right lumbar arteries inflow into the aneurysm sac. Transcatheter embolization with fibered platinum microcoils was performed of the median sacral artery and lumbar left and right arteries (L4), showing satisfactory endoleak devascularization.

Quimioembolización de hepatocarcinoma mediante TACE-precisión: resultados al 2° año en un hospital general / Treatment of hepatocellular carcinoma using Precision Transcatheter Arterial Chemoembolization (TACE): results of two years’ experience in a general hospital

Objetivos. Presentar nuestra experiencia a 2 años con el uso de microesferas precargadas de adriamicina (DC Bead(R)) en la quimioembolización (TACE) de hepatocarcinoma, en un estudio prospectivo, consecutivo y multidisciplinar, valorando la eficacia, seguridad y tolerancia de este procedimiento. Material y métodos. Desde mayo 2007 hasta enero 2010 se han realizado 30 procedimientos de TACE en 17 pacientes (media de procedimientos:1,76), 3 mujeres/14 varones, con una edad media de 68 años (56–85 años) mediante el protocolo TACE de precisión, valorando los resultados con los criterios RECIST-EASL, controles TC/RM y clinicoanalíticos al mes, 3 y 6 meses, y luego al año. Resultados. Éxito técnico inicial en todos los casos. Se empleó la dosis total en 7 casos, y en el resto no se llegó a esta, con una media de 80mg. Se obtuvo una respuesta completa en el 29,41% de los pacientes, una respuesta parcial en el 35,29%, estabilización de la enfermedad en el 23,52% y progresión de la enfermedad en el 11,76%; con una respuesta objetiva de 64,7%. Hemos recogido 2 casos de absceso/necrosis, una colecistitis isquémica y ningún fallecimiento ni fallo hepático relacionado con el procedimiento. Conclusiones. La TACE con microesferas precargadas de adriamicina (DC Bead(R)) es un procedimiento seguro y efectivo, dada la baja tasa de complicaciones, buena tolerancia de los pacientes y aumento de la tasa de respuesta tumoral (AU)

Objectives. To present our experience in the use of microspheres preloaded with adriamycin (DC Bead(R)) in the transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma, in a two-year prospective multidisciplinary study in consecutive patients to evaluate the efficacy, safety, and tolerance of this procedure. Material and methods. From May 2007 to January 2010, we performed 30 TACE procedures in 17 patients (3 women and 14 men; mean age, 68 years; age range, 56–85 years). We performed a mean of 1.76 procedures per patient using the precision TACE protocol. Outcomes were evaluated using the RECIST-EASL criteria by clinical, laboratory, CT, and MRI follow-up at 1, 3, 6, and 12 months. Results. The procedure was considered an initial technical success in all cases. The total dose was delivered in seven cases; in the remaining cases, the total dose was not reached (mean dose, 80mg). An objective response was observed in 64.7% of patients: a complete response was observed in 29.41% and a partial response in 35.29%. Disease was stabilized in 23.52% and progressed in 11.76%. We observed two cases of abscess/necrosis and one of ischemic cholecystitis. There were no deaths or cases of liver failure related with the procedure. Conclusions. TACE using microspheres preloaded with adriamycin (DC Beads(R)) is safe and effective, given the low rate of complications, good tolerance in patients, and increased tumor response (AU)

[Treatment of hepatocellular carcinoma using precision transcatheter arterial chemoembolization (TACE): results of two years' experience in a general hospital]. / Quimioembolización de hepatocarcinoma mediante TACE-precisión: resultados al 2.° año en un hospital general.

OBJECTIVES: To present our experience in the use of microspheres preloaded with adriamycin (DC Bead(®)) in the transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma, in a two-year prospective multidisciplinary study in consecutive patients to evaluate the efficacy, safety, and tolerance of this procedure. MATERIAL AND METHODS: From May 2007 to January 2010, we performed 30 TACE procedures in 17 patients (3 women and 14 men; mean age, 68 years; age range, 56-85 years). We performed a mean of 1.76 procedures per patient using the precision TACE protocol. Outcomes were evaluated using the RECIST-EASL criteria by clinical, laboratory, CT, and MRI follow-up at 1, 3, 6, and 12 months. RESULTS: The procedure was considered an initial technical success in all cases. The total dose was delivered in seven cases; in the remaining cases, the total dose was not reached (mean dose, 80mg). An objective response was observed in 64.7% of patients: a complete response was observed in 29.41% and a partial response in 35.29%. Disease was stabilized in 23.52% and progressed in 11.76%. We observed two cases of abscess/necrosis and one of ischemic cholecystitis. There were no deaths or cases of liver failure related with the procedure. CONCLUSIONS: TACE using microspheres preloaded with adriamycin (DC Beads®) is safe and effective, given the low rate of complications, good tolerance in patients, and increased tumor response.

Litiasis de las vías biliares en manos del radiólogo intervencionista / Interventional radiology for bile duct stones

Objetivo: Presentar nuestra experiencia en el manejo de la litiasis biliar mediante la técnica de expulsión de cálculos al duodeno con dilatación de la papila con catéter-balón, en un estudio prospectivo y a largo plazo. Material y métodos: Se estudiaron 365 pacientes (173 varones y 192 mujeres), con una media de edad de 75 años (rango: 26–98 años), con litiasis única (n=213 ) y múltiple (n=152) . Litiasis residual en 102 casos (acceso por tubo en T) y 263 casos de litiasis nativa (acceso percutáneo transhepático o transcístico ). La técnica habitual ha sido la dilatación de la papila y posterior expulsión de cálculos al duodeno con balón oclusivo, complementándola con fragmentación mecánica en 48 ocasiones. Se ha dejado un drenaje biliar externo entre 2 y 8 días. Resultados: Éxito técnico inicial del 91,5%, incrementándose al 94,3% tras un segundo intento. Ha habido 16 fallos técnicos, la mayoría por excesivo tamaño del cálculo. Los casos de litiasis residual se han resuelto en un 99%, y un 91% en el grupo de litiasis nativa. Se han recogido 23 complicaciones mayores, con 6 casos de empeoramiento del estado clínico y fallecimiento (mortalidad a 30 días del 1,6%). Conclusiones: La evacuación percutánea de los cálculos biliares al duodeno empleando un catéter de angioplastia y balón oclusivo es un método eficaz, seguro y no traumático que mantiene la anatomía e integridad funcional del esfínter. Es una alternativa viable en las manos expertas de un radiólogo intervencionista (AU)

Objective: This article describes our experience in the percutaneous technique of expelling bile duct calculi into the duodenum by dilating the papilla with a balloon catheter. Material and methods: We prospectively studied 365 patients (173 men, 192 women; mean age, 75 years; range 26–98) with bile duct calculi (single = 213, multiple = 152). In 102 cases, residual stones were percutaneously expelled into the duodenum via an indwelling T-tube; in 263 cases, primary (non-residual) stones were expelled from the hepatic or cystic duct through the common bile duct into the duodenum. The technique consisted of dilating the papilla with an angioplasty catheter and expelling the stone into the duodenum with an occlusion balloon; prior mechanical fragmentation was performed in only 48 cases. Percutaneous biliary drainage to the exterior was maintained for 2 to 8 days. Results: The procedure was successful on the first attempt in 91.5% of cases and in 94.3% after the second attempt. The procedure failed in 16 cases, mainly due to the large size of the calculi. Residual lithiasis was resolved in 99% of cases and primary (non-residual) lithiasis was resolved in 91%. There were 23 major complications including 6 cases with poor clinical outcome and death (mortality at 30 days was 1.6%). Conclusions: Percutaneous anterograde evacuation of bile duct stones by dilating the papilla with an angioplasty catheter and expelling the stones with an occlusion balloon is effective, nontraumatic, and safe; this procedure maintains the anatomic and functional integrity of the sphincter. When performed by an experienced interventional radiologist, it is a viable alternative to choledochotomy (AU)

[Interventional radiology for bile duct stones]. / Litiasis de las vías biliares en manos del radiólogo intervencionista.

OBJECTIVE: This article describes our experience in the percutaneous technique of expelling bile duct calculi into the duodenum by dilating the papilla with a balloon catheter. MATERIAL AND METHODS: We prospectively studied 365 patients (173 men, 192 women; mean age, 75 years; range 26-98) with bile duct calculi (single=213, multiple=152). In 102 cases, residual stones were percutaneously expelled into the duodenum via an indwelling T-tube; in 263 cases, primary (non-residual) stones were expelled from the hepatic or cystic duct through the common bile duct into the duodenum. The technique consisted of dilating the papilla with an angioplasty catheter and expelling the stone into the duodenum with an occlusion balloon; prior mechanical fragmentation was performed in only 48 cases. Percutaneous biliary drainage to the exterior was maintained for 2 to 8 days. RESULTS: The procedure was successful on the first attempt in 91.5% of cases and in 94.3% after the second attempt. The procedure failed in 16 cases, mainly due to the large size of the calculi. Residual lithiasis was resolved in 99% of cases and primary (non-residual) lithiasis was resolved in 91%. There were 23 major complications including 6 cases with poor clinical outcome and death (mortality at 30 days was 1.6%). CONCLUSIONS: Percutaneous anterograde evacuation of bile duct stones by dilating the papilla with an angioplasty catheter and expelling the stones with an occlusion balloon is effective, nontraumatic, and safe; this procedure maintains the anatomic and functional integrity of the sphincter. When performed by an experienced interventional radiologist, it is a viable alternative to choledochotomy.

[Amaurosis after lachrymo-nasal stent surgery]. / Amaurosis tras implante de stent lacrimonasal.

CLINICAL CASE: A 74 year old woman with lachrymo nasal stent introduced three days before referring periocular pain and loss of visual acuity in left eye. With aggressive treatment the inflammatory illness improved but not the visual acuity (no light perception). The lachrymal stent was removed and, later, the lachrymal sack. DISCUSSION: Orbital cellulitis is an inflammation of fat and intraorbital structures that needs aggressive treatment in order to prevent serious complications.

Amaurosis tras implante de stent lacrimonasal / Amaurosis after lachrymo-nasal stent surgery

Caso clínico: Se realizó un implante de stent orbitario (prótesis recta de Wacrees) por dacriocistitis crónica de ojo izquierdo (OI) en una mujer de 74 años. El tercer día acudió a urgencias por dolor orbitario y pérdida de agudeza visual en el OI de 24 horas de evolución, presentando una celulitis orbitaria y neuritis óptica OI. Con la instauración de un tratamiento con corticoides y antibióticos sistémicos, el cuadro inflamatorio orbitario mejoró, pero sin recuperación de visión. Se decide retirar las prótesis lacrimonasal y posteriormente se realizó una dacriocistectomía izquierda por piocele. Discusión: La celulitis orbitaria es una inflamación de la grasa y de las estructuras infraorbitarias, que precisa tratamiento rápido y eficaz para prevenir serias complicaciones(AU)

Clinical case: A 74 year old woman with lachrymo nasal stent introduced three days before referring periocular pain and loss of visual acuity in left eye. With aggressive treatment the inflammatory illness improved but not the visual acuity (no light perception). The lachrymal stent was removed and, later, the lachrymal sack. Discussion: Orbital cellulitis is an inflammation of fat and intraorbital structures that needs aggressive treatment in order to prevent serious complications(AU)

Treatment of superior and inferior vena cava syndromes of malignant cause with Wallstent catheter placed percutaneously.

Superior vena cava syndrome (SVCS) and inferior vena cava syndrome (IVCS) represent a severe symptomatic complication of some malignant tumors. Although radiation therapy and chemotherapy are elective, symptomatic relief takes 7-10 days to be achieved, and poor symptomatic benefit can be obtained in relapsed or resistant tumors. We report on a palliative approach using Wallstent catheters placed percutaneously in a series of 16 patients. Results obtained in relief of symptoms were excellent (complete response of cephalea, jugular enlargement, and collateral circulation achieved in 100% [16/16] of patients; complete response of edema obtained in 93% [15/16] of patients). Achievement of symptomatic response was obtained for all symptoms during the first 24 h poststenting, except for edema and dyspnea. Mean duration of patency of the stents was 6.4 months (range 2-17 months). Rates of morbidity and complications were very low. Dyspnea was a quite resistant symptom, and only four of 13 patients (31%) obtained complete response, while partial improvement was obtained in the other nine (79%). However, placement of the stents does not preclude the use of radiation therapy or chemotherapy. We think that these results and those from other studies warrant larger multicentric trials.