[Selective embolization of post-traumatic renal pseudoaneurysm in monorenal patient]. / Embolización selectiva de pseudoaneurisma renal post-traumático en paciente monorreno.

Presentation of one case of a patient who presented two non-penetrating abdominal traumatism along a year period. In the first incident it was necessary to practice a left nefrectomy and in the second one the therapeutic opcion was a superselective embolization of a pseudoameurism communicated with urinary tract.

Embolización selectiva de pseudoaneurisma renal post-traumático en paciente monorreno / Superselective embolization of post-traumatic pseudoaneurysm renal un a monorrenal pacient

Presentamos el caso de un paciente que en el intervalo de un año había sufrido dos traumatismos abdominales no penetrantes. En el primer episodio fue necesario practicar nefrectomía izquierda y en el segundo la opción terapéutica llevada a cabo fue la embolización selectiva de un pseudoaneurisma comunicado a la vía urinaria (AU)

CO(2) wedged hepatic venography in the evaluation of portal hypertension.

BACKGROUND/AIMS/METHODS: During hepatic vein catheterisation, in addition to measurement of hepatic venous pressure gradient (HVPG), iodine wedged retrograde portography can be easily obtained. However, it rarely allows correct visualisation of the portal vein. Recently, CO(2) has been suggested to allow better angiographic demonstration of the portal vein than iodine. In this study we investigated the efficacy of CO(2) compared with iodinated contrast medium for portal vein imaging and its role in the evaluation of portal hypertension in a series of 100 patients undergoing hepatic vein catheterisation, 71 of whom had liver cirrhosis. RESULTS: In the overall series, CO(2) venography was markedly superior to iodine, allowing correct visualisation of the different segments of the portal venous system. In addition, CO(2), but not iodine, visualised portal-systemic collaterals in 34 patients. In cirrhosis, non-visualisation of the portal vein on CO(2) venography occurred in 11 cases; four had portal vein thrombosis and five had communications between different hepatic veins. Among non-cirrhotics, lack of portal vein visualisation had a 90% sensitivity, 88% specificity, 94% negative predictive value, and 83% positive predictive value in the diagnosis of pre-sinusoidal portal hypertension. CONCLUSIONS: Visualisation of the venous portal system by CO(2) venography is markedly superior to iodine. The use of CO(2) wedged portography is a useful and safe complementary procedure during hepatic vein catheterisation which may help to detect portal thrombosis. Also, lack of demonstration of the portal vein in non-cirrhotic patients strongly suggests the presence of pre-sinusoidal portal hypertension.

[Cost-effectiveness of and morbidity from digital subtraction angiography. A study of 5,817 cases]. / Coût--effectivité--morbidité de l'angiographie par soustraction numérique. Etude de 5817 cas.

This study was based on 5,817 patients examined by digital subtraction angiography (DSA) between 1984 and 1990. 5,209 patients received an intravenous injection of contrast agent and 608 received an intra-arterial injection. Digital subtraction angiography has become a routine procedure for the diagnosis of vascular disease in the various fields studied, as it provides images of diagnostic quality in 97% of cases: diagnostic quality of 95% after intravenous injection and 99% after intra-arterial injection. The morbidity is 1.65% for the intravenous route and 4.8% for the intra-arterial route. The morbidity of brachial artery catheterization is 5.5% DSA by intravenous injection is a low-risk angiographic technique which represents a major economy in terms of the cost of the examination and the examination time, a reduction of hospital stay and waiting lists; these advantages are very important in the current context of public health.

Treatment of hemobilia with selective hepatic artery embolization.

PURPOSE: To evaluate retrospectively the results of selective transcatheter embolization in the treatment of hemobilia. PATIENTS AND METHODS: Twelve patients with hemobilia (mean age, 43 years) underwent embolotherapy. Causes of hepatic vascular injury were iatrogenic trauma, blunt external trauma, septic emboli, and lupus vasculitis. A 5-F cobra catheter or a 5-F non-tapered Simmons shaped catheter passed over a hydrophilic guide wire, or a Tracker 18 catheter forming a coaxial system was used. Embolic agents included gelatin sponge or polyvinyl alcohol fragments used alone or with coils. RESULTS: Hepatic artery pseudoaneurysms were found in 10 patients, ruptured hepatic artery aneurysm was found in one, and arterioportal fistula was found in two (with pseudoaneurysm in one). Bleeding was immediately controlled in 11 of 12 patients after embolization; one patient rebled and underwent surgery. Two patients underwent repeat embolization (2 weeks and 2 months later). Two patients died, one of biliary sepsis and liver insufficiency 24 hours after embolization and the other of gangrenous cholecystitis. CONCLUSION: Transcatheter embolization is an effective treatment of hemobilia. It allows control of bleeding and identification of the origin of the hemorrhage.

Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever.

BACKGROUND/AIMS: The aim of this prospective randomized controlled trial was to investigate the need for prophylactic antibiotherapy in patients with cirrhosis and hepatocellular carcinoma who underwent transarterial embolization and to establish the parameters that determine the development of fever > 38 degrees C after this procedure. METHODS: Sixty-one consecutive patients with cirrhosis undergoing 75 procedures were randomized into Group I [(n = 37) allocated to receive prophylactic antibiotics (Cefotaxime + Metronidazole)] and Group II [(n = 38) allocated to receive no antibiotic treatment]. RESULTS: Twelve of the 37 patients (32%) in Group I and 13 of the 38 patients (34%) in Group II developed fever > 38 degrees C after treatment. However, none of them developed bacterial infection, and all biological fluid cultures were negative. A logistic regression analysis disclosed that the obtention of an extensive tumor necrosis was the unique parameter independently associated with the development of fever. CONCLUSIONS: Antibiotic prophylaxis is therefore not necessary in patients with cirrhosis and hepatocellular carcinoma undergoing transarterial embolization. The appearance of fever after this procedure does not indicate bacterial infection; it rather represents a clinical marker of extensive tumor necrosis and thus of a favorable response to treatment.

Phase II study of transarterial embolization in European patients with hepatocellular carcinoma: need for controlled trials.

Our uncontrolled phase II study was aimed at assessing the efficacy of transarterial embolization in patients with hepatocellular carcinoma and to determine the parameters associated with a favorable response to treatment, improved survival or both. Fifty consecutive patients (25 corresponding to Okuda's stage I and 25 to stage II) with hepatocellular carcinoma (41 being multinodular or massive) were included. Transarterial embolization induced a self limited postembolization syndrome that was well tolerated. Nevertheless, three patients died shortly after the procedure because of tumor progression (two cases) or progressive liver failure. A favorable response (extensive necrosis with reduction of tumor area greater than 50%) was achieved in 81% of the cases, and this result was independently (p < 0.05) related to a preserved performance status and to a lower alpha-fetoprotein concentration. The survival of the patients at 1 and 2 yr was 65% and 38%, respectively, better than the expected survival according to a mathematical model obtained from a historical series of untreated cases (42% and 20%, respectively). Cox regression analysis disclosed that both a favorable therapeutic response and a preserved physical condition (reflected by performance status of 0 or 1) were independently associated with better survival (regression coefficient -2.248 and 0.869, respectively). These data indicate that transarterial embolization has a marked antitumoral effect in patients with inoperable hepatocellular carcinoma and that the therapeutic success is associated with improved survival. Nevertheless, because the potential benefit for survival observed in this uncontrolled study appears to be moderate, prospective controlled trials to ascertain the real usefulness of this therapeutic approach are mandatory.

Percutaneous transluminal angioplasty in the treatment of renovascular hypertension.

In this study we report our experience in 74 patients with hypertension and renal artery stenosis (42 with atherosclerotic stenosis, 32 with fibromuscular dysplasia) who were followed-up for a mean observation period of 21.7 months after percutaneous transluminal angioplasty (PTA). Stenosis was unilateral in 45 cases, bilateral in 16 and located in the renal artery of a solitary functioning kidney in 13 cases. Ostial involvement was observed in 26 cases. A total of 24 patients showed impaired renal function before PTA. Overall results for BP control were 8 cures (13%), 29 improvements (48%) and 24 (39%) who remained unchanged. Five of the 24 patients (21%) with impaired renal function showed improvement with a decrease in serum creatinine levels of more than 30%. Complications of PTA were rare, being limited to two haematomas at the puncture site which resolved spontaneously. These results emphasize that PTA, an easily repeatable procedure of relatively low risk, short hospital stay and low cost, is a first choice technique in the management of renovascular hypertension.