Embolization for the treatment of posterior epistaxis. An analysis of 31 cases.

Thirty-one patients with posterior epistaxis refractory to nasal packing alone or in combination with surgical ligation (n = 8) underwent diagnostic angiography and therapeutic embolization of the internal maxillary artery. Embolization resulted in the cure of epistaxis in 22 cases (71.0%). Of the nine failures (29.0%), seven underwent successful surgical clipping of the ethmoid arteries, and two were treated conservatively and died of their primary hematologic disease within 33 days. Late rebleeding occurred in two patients: one underwent re-embolization and the other was treated surgically. No severe or permanent complications occurred. The results indicate that embolization is a feasible alternative to surgical intervention for patients with posterior epistaxis, and we recommend it as the treatment of choice in cases with high surgical risk or failure of prior arterial ligation.

Value of pre-operative embolization in surgery for nasopharyngeal angiofibroma.

The value of embolization in surgery for nasopharyngeal angiofibroma is a controversial matter. We analysed retrospectively the results of surgical treatment in ten patients with a nasopharyngeal angiofibroma, the last five of whom underwent pre-operative embolization with Gelfoam. Embolization reduced the intraoperative blood loss at primary surgery from an average of 1510 ml in the non-embolized patients to 510 ml in the embolized patients and transfusions from an average of 4.4 units to none. Seven reoperations were performed on four non-embolized patients on account of tumour recurrence, while no recurrences were diagnosed among the pre-operatively embolized patients. Blood loss in the reoperations averaged 4065 ml, and transfusions 7.1 units. The results indicate that embolization is effective in reducing intraoperative blood loss and contributes to improved surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.

Comparison of excretory urography, angiography, ultrasound and computed tomography for T category staging of renal cell carcinoma.

The diagnostic significance of excretory urography, renal angiography, ultrasound and computed tomography for predicting the stage of tumours was evaluated by comparing their results with peroperative and histopathological findings. Thirty-nine out of 178 patients operated on for renal cell carcinoma from 1981 to 1988 were subjected to all four diagnostic procedures. The T stage was determined correctly by computed tomography in 80% of the cases, by ultrasound in 74.5%, by renal angiography in 64% and by excretory urography in 56.5%. Excretory urography did not give any significant additional information on the T category compared with the other imaging methods. Angiography is still of value in that it gives preoperative information on the collateral circulation and the number of renal arteries and their location.

Hemangiopericytoma of the kidney: a case with preoperative ethanol embolization.

We report a case of a giant renal hemangiopericytoma that was embolized preoperatively with ethanol. Ultrasound and computerized tomography showed multiple smooth-walled cysts within the tumor. The tumor itself was hypervascular and a vascular pattern specific for hemangiopericytoma was noted upon reinterpretation of the angiograms. The diagnostic and therapeutic aspects are discussed, and the literature is reviewed.

Testicular infarction following ethanol embolization of a renal neoplasm.

A case of infarction of the left testis secondary to transcatheter embolization of a malignant left renal tumor with absolute ethanol is presented. The mechanism producing this complication was due to the anomalous nature of the left testicular artery, originating from the left renal artery distal to the site of the balloon occlusion catheter. The importance of this anomaly is discussed and the literature reviewed.