Embolización de arterias geniculares en pacientes con osteoartrosis de rodilla como alternativa de tratamiento del dolor. Una revisión sistemática / Embolization of genicular arteries in patients with knee osteoarthritis as an alternative for refractory pain treatment: A systematic review

Introducción: La embolización de arterias geniculares emerge como una técnica innovadora para el tratamiento del dolor refractario en pacientes con osteoartrosis (OA) de rodilla. Se exponen los datos disponibles sobre su eficacia en pacientes con OA de rodilla y dolor persistente, como tratamiento alternativo o asociado a tratamiento farmacológico.MétodosRevisión según estándares PRISMA® sobre embolización de arterias geniculares y OA de rodilla.ResultadosSe analizaron 13 publicaciones según criterios de inclusión, de un total de 63 estudios obteniendo datos de 914 pacientes. Las indicaciones de embolización se realizaron en pacientes con dolor crónico severo refractario a tratamiento conservador y con OA de rodilla moderada a severa. Solo se han reportado complicaciones menoresConclusiónLa embolización de arterias geniculares es una alternativa posible y potencialmente muy eficaz en el tratamiento del dolor articular crónico en pacientes con OA de rodilla, y sin complicaciones graves descritas. Todos los estudios concluyen a su favor en el tratamiento del dolor articular en estos pacientes. (AU)

Background: Genicular artery embolization emerges as an innovative technique described for the treatment of refractory pain in patients with knee osteoarthritis. This review summarizes the available data on the efficacy of genicular artery embolization in patients with knee osteoarthritis (OA) and refractory pain as an alternative treatment or associated with pharmacological treatment.MethodsReview according to PRISMA® standards on genicular artery embolization and knee osteoarthritis.ResultsThirteen publications out of a total of 63 studies reporting data from 914 patients were analyzed according to inclusion criteria. The indication of embolization was performed in patients with severe chronic pain refractory to conservative treatment and moderate-to-severe knee OA. Only minor complications have been reported.ConclusionGenicular artery embolization is a possible and potentially very effective alternative in the treatment of chronic refractory pain in patients with knee OA, without serious complications. All studies conclude in favor of embolization of the genicular arteries in the treatment of chronic refractory pain in patients with knee OA. (AU)

[Embolization of genicular arteries in patients with knee osteoarthritis as an alternative for refractory pain treatment: A systematic review]. / Embolización de arterias geniculares en pacientes con osteoartrosis de rodilla como alternativa de tratamiento del dolor. Una revisión sistemática.

BACKGROUND: Genicular artery embolization emerges as an innovative technique described for the treatment of refractory pain in patients with knee osteoarthritis. This review summarizes the available data on the efficacy of genicular artery embolization in patients with knee osteoarthritis (OA) and refractory pain as an alternative treatment or associated with pharmacological treatment. METHODS: Review according to PRISMA® standards on genicular artery embolization and knee osteoarthritis. RESULTS: Thirteen publications out of a total of 63 studies reporting data from 914 patients were analyzed according to inclusion criteria. The indication of embolization was performed in patients with severe chronic pain refractory to conservative treatment and moderate-to-severe knee OA. Only minor complications have been reported. CONCLUSION: Genicular artery embolization is a possible and potentially very effective alternative in the treatment of chronic refractory pain in patients with knee OA, without serious complications. All studies conclude in favor of embolization of the genicular arteries in the treatment of chronic refractory pain in patients with knee OA.

Endovascular Management of Iatrogenic Renal Vascular Injuries: Case Series and Systematic Review

Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is rare, but must be treated quickly given its severity. Iatrogenic renal vascular injuries (IRVI) resulting from these procedures include active bleeding, arterial pseudoaneurysms, and arteriovenous fistulas. Renal artery embolization (RAE) is the main pillar in the treatment of this type of complications. Objective: To assess the results of RAE for the treatment of IRVI and its impact on the renal function of patients. Method: Retrospective analysis of all patients who presented vascular complications after renal procedures and who were referred for management by RAE, between August 2012 and December 2020. Results: 18 patients were included. 4 patients presented with pseudoaneurysm, 10 patients with active bleeding, and 1 patient with arteriovenous fistula; 2 patients had a combination of different IRVI; 1 patient did not present any findings at the time of renal angiography in dissonance with her computed tomography angiography. Technical and clinical success was achieved in all patients. One renal artery dissection was the only complication. No differences were found in serum creatinine (p = 0.51), urea (p = 0.37), hemoglobin (p = 0.26) and hematocrit (p = 0.24) after embolization. Conclusion: EAR is a safe and effective method for the treatment of IRVI, achieving a very high technical and clinical success rate with a low incidence of complications and without significant repercussions on the renal function of patients (AU)

Las técnicas miniinvasivas para tratamiento y diagnóstico de la patología renal, buscan preservar la mayorcantidad de parénquima. Los sangrados posteriores a estasprácticas son de rara presentación, pero deben ser tratadosrápidamente dada su gravedad. Las lesiones iatrogénicasvasculares (LIV) renales derivadas de estos procedimientos incluyen sangrados activos, pseudoaneurismas arteriales y fistulas arteriovenosas. La embolización arterial renal (EAR) es el principal pilar en el tratamiento de este tipode complicaciones.Objetivo: Evaluar los resultados de la EAR para eltratamiento de LIV y su impacto en la función renal de lospacientes.Método: Análisis retrospectivo de todos los pacientesque presentaron complicaciones vasculares posteriores aprocedimientos renales y que fueron derivados para manejomediante EAR, entre agosto de 2012 y diciembre de 2020.Resultados: Se incluyeron 18 pacientes. 4 pacientesdebutaron con pseudoaneurisma, 10 pacientes con sangradoactivo y 1 paciente con fístula arteriovenosa; 2 pacientestenían combinación de diferentes LIV; 1 paciente no presento ningún hallazgo al momento de la angiografía renalen disonancia con su angio-TC. El éxito técnico y clínicose logró en todos los pacientes. Una disección de arteriarenal fue la única complicación. No se encontraron diferencias en la creatinina sérica (p = 0,51), urea (p = 0,37),hemoglobina (p = 0,26) y hematocrito (p = 0,24) despuésde la embolización.Conclusión: La EAR es un método segúro y eficazpara el tratamiento de LIV, alcanzando una tasa de éxitotécnico y clínico muy alta con una baja incidencia de complicaciones y sin repercusiones significativas sobre la función renal de los pacientes. (AU)

Quiste óseo aneurismático en el sacro: caso clínico y revisión de la literatura / Aneurysmal bone cyst in the sacrum: Case report and literature review

Los quistes óseos aneurismáticos son lesiones óseas benignas infrecuentes, de localización inusual en el sacro. Sintomatológicamente son inespecíficas. Tras un traumatismo aparece dolor, pudiendo acompañarse de complicaciones de estructuras adyacentes por edema asociado. Los hallazgos de las imágenes suelen ser característicos, aunque el diagnóstico debe confirmarse por biopsia y realizar diagnóstico diferencial con otros tumores. El tratamiento a aplicar en huesos largos consiste en legrado y relleno con material de reemplazo óseo. En el sacro pueden conllevar complicaciones neurológicas, siendo la embolización arterial selectiva una alternativa en su manejo. Describimos un caso de quistes óseos aneurismáticos en el sacro en un varón de 71 años con antecedente de leucemia linfoide crónica e hiperplasia benigna de próstata. El informe incluye la presentación clínica, los hallazgos de imagen y la evolución tras el tratamiento mediante embolización arterial selectiva. Este caso destaca las opciones terapéuticas y las dificultades encontradas en el manejo de estas lesiones en el sacro que complican su tratamiento habitual. La embolización arterial selectiva es una opción terapéutica en pacientes con quistes óseos aneurismáticos en el sacro, permitiendo tratamientos menos agresivos y prósperos resultados (AU)

Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results (AU)

[Aneurysmal bone cyst in the sacrum: Case report and literature review]. / Quiste óseo aneurismático en el sacro: caso clínico y revisión de la literatura.

Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results.

Management of severe and/or refractory epistaxis. / Manejo de las epistaxis graves y/o refractarias.

OBJECTIVE: The objective was to determine the results of the treatment of severe and/or refractory epistaxis requiring hospital admission. In addition, the results of arterial ligation versus embolization were compared. MATERIAL AND METHOD: Sixty-three patients with severe and/or refractory epistaxis requiring hospital admission between August 2014 and December 2016 were included prospectively. RESULTS: Eleven patients (17%) underwent embolization, 5 (8%) endoscopy ligation and the remaining 47 (75%) underwent conservative treatment with tamponade. The mean age of the patients in which conservative measures were sufficient was 72 years, while the age of those treated with embolization was 71 years and of those who underwent surgery was 53 years. For the patients who underwent conservative treatment or surgery, the average stay was 6 days, compared to 9 days for those who underwent embolization. One patient suffered a hemispheric stroke after embolization. No post-surgical complications were observed. CONCLUSIONS: Most cases of severe and/or refractory epistaxis are resolved by conventional tamponade. Endoscopy ligation is associated with a decrease in hospital stay, without serious complications. It is advisable to have all the possible therapeutic options available, for which the presence of interventional radiologists and experienced surgeons is essential to avoid complications and decide the treatment to be performed individually for each patient.

Massive spontaneous hemothorax in patients with neurofibromatosis type 1. / Hemotórax masivo espontáneo en pacientes con neurofibromatosis tipo 1.

OBJECTIVES: Spontaneous hemothorax is an uncommon event that can occur in patients with a history of neurofibromatosis type 1 because of intrathoracic vascular malformations that predispose to aneurysms or bleeding from thoracic tumors. Only 53 cases of this rare association have been reported in the literature since 1975. We described 2 cases: one patient was a 73-year-old man with a right hemothorax secondary to an intercostal neurofibroma; the other was a 35-year-old woman with a left hemothorax secondary to a neurofibroma that compromised the internal mammary artery. Our review of the literature found that 61.8% of cases involved women with a mean age of 43.9 years. There was a certain tendency toward left-sided (56.4%) hemothorax, and the intercostal space was the most common site of bleeding. Treatment was most often surgical (58.2%) in reported cases, although selective artery embolization is also a valid choice. Exitus occurred during 30.9% of the reported episodes, and survival was higher in patients who were treated with surgery or arterial embolization than in those in whom only a thoracic drain was placed or who received no invasive treatment (P=.02).

ES: El hemotórax espontáneo es una entidad poco frecuente que en los pacientes con antecedentes de neurofibromatosis tipo 1 (NF1) puede ser debido a malformaciones vasculares intratorácicas que predisponen a formaciones aneurismáticas o bien a sangrado de tumores torácicos. Esto ocurre en muy raras ocasiones, con solo 53 casos reportados en la bibliografía desde 1975. Presentamos dos casos: el primero, un varón de 73 años con hemotorax derecho secundario a un neurofibroma intercostal; el segundo, una mujer de 35 años con hemotórax izquierdo secundario a un neurofibroma que lesionaba la arteria mamaria interna. Revisando la bibliografía, el 61,8% son mujeres con una edad media de 43,9 años, y con cierta predisposición a la localización en el hemitórax izquierdo (56,4%). El paquete intercostal es el más frecuentemente involucrado en el sangrado. La cirugía ha sido el tratamiento realizado con mayor frecuencia (58,2%), si bien la embolización a través de arteriografía selectiva es un tratamiento válido. Un 30,9% fallecieron durante el episodio y aquellos tratados con cirugía o embolización arteriográfica tienen una mayor supervivencia que aquellos pacientes a los que no recibieron tratamiento invasivo o bien solo se les colocó un drenaje torácico (p = 0,02).

Embolización selectiva en un paciente con hemoptisis secundaria a tuberculosis pulmonar / Selective embolization in a patient with hemoptysis secondary to pulmonary tuberculosis

Resumen La tuberculosis pulmonar es una infección frecuente en nuestro medio. Generalmente se presenta con síntomas sistémicos como tos, expectoración, fiebre y diaforesis. En algunos casos puede presentarse con hemoptisis cuyo espectro va desde leve hasta masiva. Una vez iniciado el tratamiento, los síntomas de sangrado generalmente resuelven. Presentamos el caso de un paciente masculino de 38 años, con hemoptisis secundaria a una tuberculosis pulmonar, el cual a pesar del inicio del tratamiento, continuó con sangrado activo, por lo que fue llevado a embolización arterial selectiva como alternativa terapéutica con resolución del sangrado. (Acta Med Colom 2018; 43: 45-48).

Abstract Pulmonary tuberculosis is a frequent infection in our environment. It usually presents with systemic symptoms such as cough, expectoration, fever and diaphoresis. In some cases it can present with hemoptysis whose spectrum ranges from mild to massive. Once the treatment is started, the symptoms of bleeding usually resolve. The case of a 38-year-old male patient with hemoptysis secondary to pulmonary tuberculosis is presented. Despite the initiation of treatment, he continued with active bleeding, which led to selective arterial embolization as a therapeutic alternative with resolution of bleeding. (Acta Med Colom 2018; 43: 45-48).

Fibroangioma nasofaríngeo juvenil: experiencia de 15 años en el Hospital Barros Luco Trudeau / Juvenile nasopharyngeal fibroangioma: the experience of 15 years in Hospital Barros Luco Trudeau

Introducción: El fibroangioma nasofaríngeo juvenil es un tumor vascular benigno localmente agresivo, que afecta casi exclusivamente la nasofaringe de adolescentes de sexo masculino. Su manejo es complejo dada su extensión, naturaleza vascular y sus frecuentes recurrencias. Objetivo: Mostrar la experiencia de 15 años en fibroangioma juvenil en nuestro centro. Material y método: Estudio descriptivo retrospectivo de los pacientes con diagnóstico de ingreso de fibroangioma nasofaríngeo juvenil al Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau entre los años 1997 y 2011, caracterizando al grupo de estudio en cuanto a características clínico-demográficas, vasos aferentes, relación entre etapa tumoral y vascularización, manejo terapéutico, complicaciones y recurrencias. Resultados: Se obtuvo un total de 20 pacientes, todos de sexo masculino, con un promedio de edad de 13,9 años. El síntoma de presentación más frecuente fue la epistaxis a repetición y obstrucción nasal presente en el 90% y 80%, respectivamente. Todos los pacientes se estudiaron con tomografia computarizada y recibieron embolización arterial preoperatoria. La mayoría de los tumores fueron de tipo II (65%) y III (20%), según clasificación de Radkowski. La técnica quirúrgica más empleada fue abierta (57,8%). Radioterapia en un caso. El vaso aferente principal fue la maxilar interno ipsilateral en el 100%. Todos los fibroangiomas etapa III eran además irrigados por la arteria carótida interna. Se encontró 20% de persistencia y 15% de recidiva. Conclusión: Nuestros resultados concuerdan con la gran mayoría de las series publicadas en la literatura. Epistaxis recurrente, obstrucción nasal y tumor nasal unilateral deben hacernos sospechar de esta patología en un adolescente masculino. El tratamiento de elección es la cirugía con embolización preoperatoria. La vía de abordaje endoscópica presenta menor morbilidad posoperatoria en pacientes con estadios I y II de Radkowski. Todos los fibroangiomas con compromiso intracraneano, presentan irrigación también del sistema carotideo interno.

Introduction: Nasopharyngeal Fibroangioma is a locally aggressive benign vascular tumor. Its management is complex given its size, vascular nature and its frequent recurrences. Aim: To show the experience of 15 years in Juvenile Fibroangioma in our center. Material and method: Retrospective descriptive study of patients admitted with a diagnosis of Juvenile Fibroangioma Nasopharyngeal in the Department of Otolaryngology Hospital Barros Luco Trudeau between 1997 and 2011. Results: A total of 20 patients was obtained. The most common presenting symptom was recurrent epistaxis and nasal obstruction present in 90% and 80% respectively. The most common surgical technique was open (57.8%). Radiotherapy in one case. The main afferent vessel was the ipsilateral internal maxillary in 100%. All Fibroangioma stage III were also supplied by the internal carotid artery. 20% of persistence and 15% of recurrence was found. Conclusion: Recurrent epistaxis, nasal obstruction and unilateral nasal tumor should raise the suspicion of this disease in a male teenager. The treatment of choice is surgery with preoperative embolization. The route of endoscopic approach has less postoperative morbidity in patients with stage I and II of Radkowski. All Fibroangioma with intracranial commitment, have also the internal carotid irrigation system.

Role of selective intra-arterial embolization in benign liver tumors. / Papel de la embolización selectiva intraarterial en los tumores hepáticos benignos.

OBJECTIVE: To present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery. MATERIAL AND METHODS: We present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas. Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500µm-700µm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4 to 7 days after embolization. RESULTS: All 7 patients were women (age range, 23-74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred. CONCLUSIONS: Provided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors.

Tratamiento quirúrgico conservador en paciente monorrenal con esclerosis tuberosa y angiomiolipoma complicado: presentación de caso y revisión bibliográfica / Conservative surgical treatment in monorrenal patient with sclerosis and complicated tuberous angiomyolipom: case report and literature review

Los angiomiolipomas renales son formaciones renales que se presentan de forma aislada o asociadas con otras patologías como esclerosis tuberosa o enfermedad de Von Hippel Lindau. Los angiomiolipomas renales se pueden presentar clínicamente con un shock hipovolémico por lesión de uno de sus vasos o con dolor abdominal por efecto masa debido a su tamaño. La resolución de los angiomiolipomas puede ser de manera programada o de urgencia, siendo las vías elegidas la nefrectomía parcial o la embolización arterial selectiva, dependiendo siempre de los recursos que se tengan y la experiencia del equipo quirúrgico.

Renal angiomyolipomas are kidney formations presented in isolation or associated with other diseases such as tuberous sclerosis or Von Hippel Lindau disease. Renal angiomyolipoma may present clinically with hypovolemic shock due to injury of one of its vessels or with abdominal pain due to mass effect because of its size. Angiomyolipomas can be resolved on scheduled basis or emergency, where the chosen ways are partial nephrectomy or selective arterial embolization, always depending on the resources you count on and the experience of the surgical team.

Embolización transcatéter / Transcatheter Embolization

Emboloterapia, embolización o embolización transcatéter son nombres que actualmente se le asignan al mismo procedimiento, conocido desde comienzos del siglo XX, que tomó fuerza y se difundió desde principios de 1970 cuando se impulsó su aplicación por medio de catéteres. Desde entonces, la evolución de las técnicas y el continuo desarrollo de materiales han convertido esta terapia en una herramienta de utilidad excepcional en el control de la hemorragia y el tratamiento de diferentes neoplasias.

Embolotherapy, embolization or transcatheter embolization are names that today are assigned for the same procedure, known since the early twentieth century and that took force spreading from the beginning of the 1970s when its application was promoted through catheters. Since then the evolution of techniques and the continuous development of materials have made this technique an exceptional tool in the control of hemorrhage and treatment of different neoplasms.

Gestación de curso fisiológico postembolización de fístula arteriovenosa uterina. Reporte de un caso / Normal pregnancy post-embolization of uterine arteriovenous fistula. Report of one case

Resumen ANTECEDENTES: las malformaciones arteriovenosas uterinas constituyen un conjunto de alteraciones de la vascularización endometrial y miometrial que se caracterizan por la formación de comunicaciones heterogéneas y aberrantes entre los territorios arteriales y venosos que tienen como consecuencia cuadros de sangrado genital abundante e inestabilidad hemodinámica. CASO CLÍNICO: paciente que luego de un legrado uterino hemostásico resultó con una fístula arteriovenosa uterina que se trató mediante embolización selectiva de la arteria uterina izquierda; quedó embarazada después de tres meses del procedimiento, no tuvo alteraciones y la evolución perinatal fue satisfactoria. CONCLUSIÓN: el diagnóstico de las malformaciones arteriovenosas es eminentemente clínico, aunque la confirmación depende de las pruebas de imagen. La ecografía con estudio Doppler y la angiografía son las técnicas de elección para el diagnóstico de las lesiones y la planificación del tratamiento a seguir, decisión que dependerá de los deseos reproductivos de la paciente. En la actualidad, el tratamiento de elección para las pacientes que desean embarazarse es la embolización endovascular selectiva, guiada radiológicamente. Los anticonceptivos orales, las técnicas histeroscópicas de resección o la histerectomía son otras opciones terapéuticas que pueden valorarse, en función de los parámetros indicados.

Abstract BACKGROUND: uterine arteriovenous malformations constitute a group endometrial and myometrial vascularization disorders characterized by the formation of heterogeneous and aberrant communications between the arterial and venous territories, producing abundant genital bleeding pictures as well as hemodynamic instability. CLINICAL CASE: a patient who underwent a hemostatic uterine D&C developed a uterine arteriovenous fistula that was treated through selective embolization of the left uterine artery; she became pregnant after three months of the procedure, she presented a normal pregnancy with satisfactory perinatal outcomes. CONCLUSION: the diagnosis of arteriovenous malformations is mainly clinical, although confirmation depends on imaging tests. A Doppler ultrasound and angiography are the preferred techniques to diagnose lesions and to plan subsequent treatment, a decision that will depend on the patient's reproductive wishes. Currently, the choice treatment for patients who want to become pregnant is a radiologically guided selective endovascular embolization. Oral contraceptives, resection hysteroscopy techniques or hysterectomy are other therapeutic options that may be considered based on the parameters indicated.

Spontaneous haematoma of the anterior rectus abdominis muscle. / Hematoma espontáneo del músculo recto anterior del abdomen.

INTRODUCTION: Spontaneous haematoma of the rectus abdominis muscle is an uncommon cause of abdominal pain. It occurs mostly in anticoagulated patients. The objective of this paper is to analyse the onset, diagnosis and treatment in patients under anticoagulant therapy. METHODS: A retrospective analysis of a prospectively maintained database of all patients with a diagnosis of spontaneous hematoma of the abdominal rectus muscle between March 2003 and December 2014. RESULTS: The study included 34 patients, of whom 28 were women, with an average age of 80 years old. All the patients showed a unilateral infraumbilical haematoma. Twenty- 8 patients had received long-term anticoagulant treatment (26 with acenocumarol and 2 low molecular weight heparin); and 6 patients were under anticoagulant prophylaxis with low molecular weight heparin. The diagnosis was performed with ultrasound in 7 cases, computed tomography angiography in 27 patients, and with both methods in 6 cases. The treatment consisted of stopping the anticoagulant drug, correcting haemostasis parameters and blood transfusion when required. Ten patients displayed active bleeding in the computed tomography angiography, and 8 underwent selective arterial embolization. The evolution was successful in 34 patients, however, 2 patients required surgery and, finally, died due to persistent haemorrhage. CONCLUSION: Spontaneous haematoma of the rectus abdominis muscle is more frequent in elderly women under oral anticoagulant treatment. Non-operative treatment is successful in most cases. Computed tomography angiography is useful to determine which patients could benefit from selective arterial embolization.

Severe complication during strabismus surgery.

CLINICAL CASE: A 4-year-old patient, who presented with an immediate orbital haematoma as a result of a subtenon injection of triamcinolone in the trochlear region of the right eye on finishing a surgical procedure for Brown's syndrome. After one week, when it could be examined better, the presence of a cherry red spot was observed due to the embolisation of the central artery of the retina by triamcinolone crystals. DISCUSSION: Triamcinolone is an anti-inflammatory drug currently used in Ophthalmology for the treatment of various conditions. Although exceptional, it has been described that its use may provoke embolisations due to the entry of the steroid into the circulation.

Hematuria incoercible en poliquistosis renal: tratamiento exitoso mediante embolización arterial superselectiva incoercible / Hematuria in polycystic kidney disease: successful treatment using superselective artery embolization

Se presenta el caso de un paciente de 81 años de edad, con riñones poliquísticos de gran tamaño, enfermedad renal crónica en estadío 3, y un quiste polar derecho sangrante que provocaba severa anemización. Previa aplicación de un protocolo de nefroprotección, se cateterizó la arteria renal derecha, accediéndose al ramo polar inferior de la arteria retropiélica e identificando angiográficamente el sitio de sangrado; desde este punto se realizó la embolización arterial superselectiva con fragmentos de Spongostan. Finalizado el procedimiento, se comprobó la interrupción del sangrado luego de dos horas y el examen del sedimento urinario a los noventa días de seguimiento, mostraba entre 6 a 10 hematíes por campo. Se discute el rol de la red vascular en poliquistosis, la expansión celular en la pared quística, y la provocación de isquemia mediante tratamiento intervencionista ultraselectivo, a fin de preservar la función renal y prevenir complicaciones.

A patient of 81 years old, with oversized polycystic kidneys, chronic kidney disease in stage 3, and a bleeding right polar cyst, that caused severe anemia, is presented. First, a nephroprotective protocol was applied. Then, the right renal artery was catheterized, accessing the polar lower branch of the retro-pyelic artery and angiographically identified the bleeding area, and the superselective arterial embolization was performed with fragments of Spongostan. When the procedure concluded, the stopping of the bleeding was proved after two hours. The urinary sediment examination after ninety days of monitoring showed between 6 and 10 red cells per field. The function of the vascular network in polycystic disease, the cell expansion in the cyst wall, and the induced ischemia through the ultraselective interventionist treatment, is discussed in order to preserve kidney function and prevent any complications.

Embolización prostática: un nuevo campo de actuación de la radiología intervencionista

Objetivos: Presentar nuestra experiencia inicial con la embolización prostática como tratamiento para la hiperplasia prostática benigna (HPB) desde la perspectiva técnica, y establecer la contribución del Diagnóstico por Imágenes. Materiales y métodos: Dieciséis pacientes con trastornos del tracto urinario inferior debidos a HPB realizaron embolización prostática. Todos respondieron cuestionarios específicos para determinar la severidad de la sintomatología y su impacto en la calidad de vida y función eréctil. Además, fueron evaluados con ecografía y resonancia magnética de pelvis, flujometría urinaria y antígeno prostático específico (PSA) antes y 30 días después del procedimiento. Resultados: La embolización fue exitosa en todos los pacientes (10 en forma bilateral y 6 en unilateral). El tiempo medio de duración del procedimiento fue de 82 minutos y el de la radioscopia de 38,5 min. Todos los procedimientos se llevaron a cabo en forma ambulatoria, con un tiempo medio de estancia hospitalaria de 6,4 h. El consumo medio de contraste radiológico fue de 175 ml. A los 30 días se verificó una reducción media de volumen prostático del 21%. Adicionalmente, se constató una mejoría clínica caracterizada, en promedio, por una disminución de 8 puntos en el cuestionario que mide los síntomas prostáticos, de 2 puntos en el cuestionario que calcula la calidad de vida y de 4 puntos en el cuestionario que sondea la función eréctil. La flujometría mejoró un 39% y el PSA se redujo un 26%. No hubo complicaciones mayores y solo se observaron efectos adversos menores en 9 pacientes. Conclusión: La embolización prostática para el tratamiento de la HPB demostró ser segura y eficiente en esta serie preliminar de pacientes.(AU)

Purposes: To present the initial experience with prostatic embolization as an alternative treatment for benign prostatic hyperplasia (BPH) from a technical perspective to establish the contribution provided by diagnostic imaging. Materials and methods: Sixteen patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent prostatic embolization. All patients were evaluated with specific questionnaires to determine the severity of symptoms, impact on quality of life and erectile function, ultrasound and MRI of the pelvis, urinary flowmetry and PSA before and 30 days after the procedure. Results: Embolization was successful in all patients; in 10 cases the procedure was performed bilaterally and in six, only one side was embolized. The average time for completion of the procedure was 82 minutes and the average fluoroscopy time was 38.5 minutes. All procedures were performed on an outpatient basis with an average hospital stay of 6.4 hours. The mean contrast medium used was 175 ml. At 30 days there was a mean reduction on prostate volume of 21%. Clinical improvement was characterized by a mean 8-point improvement on IPSS, 2 points on QOL and 4 points on IIEF. The uroflowmetry improved 39% and PSA dropped 26%. No major complications that implied unscheduled hospitalization or performing additional surgical procedures were seen. Minor adverse events were verifi ed in 9 patients. Conclusion: The initial results of prostatic embolization as an alternative treatment for BPH indicate that it is a safe and effective procedure to be consolidated as a new field of action of interventional radiology.(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.

Predictors of recanalization in patients with life-threatening hemoptysis requiring artery embolization.

INTRODUCTION: Artery embolization (AE) is a safe and useful procedure in the management of massive hemoptysis. The objective of our study was to describe the experience of AE in a tertiary referral center, to characterize angiographic findings at the time of recurrence, and to analyze factors associated with these findings. MATERIAL AND METHODS: Observational retrospective study of patients presenting with life-threatening hemoptysis. All consecutive patients with at least one episode of hemoptysis that required AE during a 13-year period were included. The effects of i)time to recurrence; ii)use of coils, and iii)number of arteries embolized on the likelihood that the recurrence was secondary to recanalization were assessed. RESULTS: One hundred seventy-six patients were included in the study. Twenty-two patients (12.5%) died due to hemoptysis. Probability of recurrence-free survival at one month was 0.91 (95%CI: 0.87 to 0.95), at 12months was 0.85 (95%CI: 0.79 to 0.91), and after 3 years was 0.75 (95%CI: 0.66 to 0.83). A longer time to recurrence was associated with a higher probability that the hemorrhage affected the same artery (estimate=0.0157, z-value=2.41, p-value=0.016). CONCLUSION: AE is a safe and useful technique in the management of massive and recurrent hemoptysis. Nevertheless, recurrence after embolization is not uncommon. Recurring hemoptysis due to recanalization is related to time to recurrence, but not to the use of coils or number of arteries embolized.

Reembolización de arterias uterinas por hemorragia posparto en una segunda gestación / Uterine artery embolization for postpartum hemorrhage in a second pregnancy

La hemorragia posparto es la principal causa de muerte obstétrica. Presentamos el caso de una gestación y parto normales tras la embolización bilateral de ambas arterias uterinas, por hemorragia posparto en la gestación anterior. La paciente requirió de una nueva embolización bilateral de arterias uterinas en esta segunda gestación con buen resultado obstétrico. La embolización arterial pélvica en el manejo de la hemorragia posparto refractaria al tratamiento médico, permite en ocasiones evitar el tratamiento quirúrgico, conservando la fertilidad de la paciente.

The postpartum hemorrhage is the main cause of obstetric death. We report a case of normal pregnancy and delivery after bilateral embolization of uterine arteries due to postpartum hemorrhage in a previous pregnancy. A new bilateral embolization of uterine arteries was needed in this second pregnancy with good obstetric results. The pelvic arterial embolization in the management of postpartum hemorrhage refractory to medical treatment, avoids the surgical treatment, preserving fertility.