|
1
|
The Anh N, Dang Khoa T, Hoai Linh V, Huy Phuong N, Ngoc Duong V, Quang Loc T, Le HD. Endovascular interventional treatment of patients with gastrointestinal bleeding after dual antiplatelet therapy: A case report. Radiol Case Rep 2024; 19:6157-6160. [PMID: 39376955 PMCID: PMC11456794 DOI: 10.1016/j.radcr.2024.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 08/23/2024] [Accepted: 08/24/2024] [Indexed: 10/09/2024] Open
Abstract
Dual antiplatelet therapy is commonly used to treat or prevent thromboembolic events in patients with deep vein thrombosis, pulmonary embolism, atrial fibrillation, in patients after coronary artery stenting, cerebral artery stenting or artificial heart valves, etc. Although they significantly reduce the morbidity and mortality from thromboembolic events, dual antiplatelet therapy is associated with the risk of bleeding, which can be life-threatening. Gastrointestinal bleeding is one of the most common and dangerous events when using dual antiplatelet therapy for a long time. According to studies, nearly half of the major bleeding cases related to dual antiplatelet therapy arise from the gastrointestinal (GI) tract. We report the case of a 74-year-old female patient with lower gastrointestinal bleeding after using dual antiplatelet therapy that was successfully treated endovascularly with a coil.
Collapse
Affiliation(s)
- Nguyen The Anh
- Intensive Care Unit, Friendship Hospital, Hanoi, Vietnam
| | - Tran Dang Khoa
- Department of Radiology, Friendship Hospital, Hanoi, Vietnam
| | - Vu Hoai Linh
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
| | | | - Vu Ngoc Duong
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Tran Quang Loc
- Department of Radiology, University of Medicine and Pharmacy (VNU-UMP), Vietnam National University, Hanoi, Vietnam
| | - Hoang Dat Le
- Department of Radiology, Friendship Hospital, Hanoi, Vietnam
| |
Collapse
|
|
2
|
Whalen S, Tanious M. Temporary Embolic Agents. Semin Intervent Radiol 2024; 41:226-232. [PMID: 38993593 PMCID: PMC11236451 DOI: 10.1055/s-0044-1786708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Affiliation(s)
- Sydney Whalen
- University of Illinois College of Medicine, Chicago, Illinois
| | - Michael Tanious
- Department of Radiology, University of Illinois Health, Chicago, Illinois
| |
Collapse
|
|
3
|
Alonso Sánchez J, Parra DA, Parra-Fariñas C. Paediatric interventional radiology: it's not child's play. RADIOLOGIA 2024; 66:181-185. [PMID: 38614533 DOI: 10.1016/j.rxeng.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 04/15/2024]
Abstract
Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials pose significant challenges and opportunities.
Collapse
Affiliation(s)
- J Alonso Sánchez
- Division of Imaged Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada.
| | - D A Parra
- Division of Imaged Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | - C Parra-Fariñas
- Divisions of Neuroradiology and Imaged Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
|
4
|
Adam A, Kenny L. Interventional Radiology Should Establish Its Own Identity it Should be a Primary Specialty Separate from Diagnostic Radiology. Cardiovasc Intervent Radiol 2024; 47:287-290. [PMID: 38168827 DOI: 10.1007/s00270-023-03643-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Andreas Adam
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- School of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Lizbeth Kenny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- School of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| |
Collapse
|
|
5
|
Swersky A, Knight G, Salem R. Interventional radiology and the liver vasculature: A personal perspective. Clin Liver Dis (Hoboken) 2024; 23:e0239. [PMID: 38919865 PMCID: PMC11199010 DOI: 10.1097/cld.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 06/27/2024] Open
|
|
6
|
Tsurkan VA, Shabunin AV, Grekov DN, Bedin VV, Arablinskiy AV, Yakimov LA, Shikov DV, Ageeva AA. [Endovascular technologies in the treatment of patients with blunt abdominal trauma]. Khirurgiia (Mosk) 2024:108-117. [PMID: 39140952 DOI: 10.17116/hirurgia2024081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Trauma is one of the leading causes of disability and mortality in working-age population. Abdominal injuries comprise 20-30% of traumas. Uncontrolled bleeding is the main cause of death in 30-40% of patients. Among abdominal organs, spleen is most often damaged due to fragile structure and subcostal localization. In the last two decades, therapeutic management has become preferable in patients with abdominal trauma and stable hemodynamic parameters. In addition to clinical examination, standard laboratory tests and ultrasound, as well as contrast-enhanced CT of the abdomen should be included in diagnostic algorithm to identify all traumatic injuries and assess severity of abdominal damage. Development of interventional radiological technologies improved preservation of damaged organs. Endovascular embolization can be performed selectively according to indications (leakage, false aneurysm, arteriovenous anastomosis) and considered for severe damage to the liver and spleen, hemoperitoneum or severe polytrauma. Embolization is essential in complex treatment of traumatic vascular injuries of parenchymal abdominal organs. We reviewed modern principles and methods of intra-arterial embolization for the treatment of patients with traumatic injuries of the liver and spleen.
Collapse
Affiliation(s)
- V A Tsurkan
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - A V Shabunin
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - D N Grekov
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - V V Bedin
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A V Arablinskiy
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - L A Yakimov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - D V Shikov
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - A A Ageeva
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| |
Collapse
|
|
7
|
Loffroy R, Chevallier O, Mazit A, Malakhia A, Midulla M. Amplatzer ™ Vascular Plugs for Embolisation: A 10-Year Single-Centre Retrospective Study. J Clin Med 2023; 12:6790. [PMID: 37959254 PMCID: PMC10647837 DOI: 10.3390/jcm12216790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Our objective was to investigate the indications, effectiveness, and safety of Amplatzer™ Vascular Plugs (AVPs) in clinical practice. To retrospectively identify patients managed with AVPs at the Dijon University Hospital between January 2011 and April 2021, we searched materials vigilance registries and procedure reports. The 110 identified patients underwent 111 procedures with delivery of 202 AVPs into 118 vessels; 84% of the procedures were performed by radiologists with over 10 years' experience and 67% were scheduled. Varicocele, haemostasis, pelvic varicose veins, and arterio-venous dialysis fistulas accounted for 69% of procedures. The technical and clinical success rates were 99% and 97%, respectively. The single major complication was AVP migration in a high-flow internal iliac vein, with no residual abnormalities after successful device retrieval. Several AVPs and/or concomitant injection of coils or liquid agents were used in 80% of cases. The use of AVPs alone occurred chiefly for splenic artery embolisation in trauma patients and for collateral vein occlusion in dysfunctional arterio-venous dialysis fistulas. No cases of recanalisation occurred during the 19 ± 29 month follow-ups. Based on their good safety and effectiveness profile, AVPs deserve to be part of the therapeutic armamentarium of every interventional radiologist.
Collapse
Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
- ICMUB Laboratory, UMR CNRS 6302, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
- ICMUB Laboratory, UMR CNRS 6302, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Amin Mazit
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
| | - Alexandre Malakhia
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
- ICMUB Laboratory, UMR CNRS 6302, 9 Avenue Alain Savary, 21000 Dijon, France
| |
Collapse
|
|
8
|
Psilopatis I, Fleckenstein FN, Gebauer B, David M. Medical historical notes on myoma treatment by uterine artery embolization on the occasion of its introduction 30 years ago. ROFO-FORTSCHR RONTG 2023; 195:890-895. [PMID: 37467778 DOI: 10.1055/a-2077-1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Since its development, uterine artery embolization (UAE) for the treatment of symptomatic fibroids has become an established minimally invasive alternative to surgical myoma treatment. Currently, more than 25,000 myoma patients worldwide are likely to be treated with UAE annually. METHOD Thirty years ago, Jacques-Henri Ravina (b. 1930) and his Paris team first performed this therapy as a "substitute" for gynecologic surgery. We contacted him as part of the preparation of the present review. In addition, we performed a literature search with the aim of summarizing the current literature and data in addition to a historical account of the development of UAE. RESULTS AND CONCLUSION On the occasion of this anniversary, we would like to recall the interdisciplinary roots and some facets of the history of the development of this relatively young myoma treatment method. KEY POINTS · UAE is an established minimally invasive alternative to surgical myoma treatment.. · UAE was first developed 30 years ago.. · UAE has continuously increased in importance in recent years.. CITATION FORMAT · Psilopatis I, Fleckenstein FN, Gebauer B et al. Medical historical notes on myoma treatment by uterine artery embolization on the occasion of its introduction 30 years ago. Fortschr Röntgenstr 2023; 195: 890 - 895.
Collapse
Affiliation(s)
| | - Florian Nima Fleckenstein
- Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Germany
- BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charite, Berlin, Germany
| | - Bernhard Gebauer
- Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Germany
| | | |
Collapse
|
|
9
|
Mailli R, Chevallier O, Mazit A, Malakhia A, Falvo N, Loffroy R. Embolisation Using Microvascular Plugs for Peripheral Applications: Technical Results and Mid-Term Outcomes. Biomedicines 2023; 11:2172. [PMID: 37626671 PMCID: PMC10452264 DOI: 10.3390/biomedicines11082172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
The Micro Vascular Plug® (MVP, Medtronic) is a mechanical embolic agent available in small sizes that allows for distal embolisation. The objective of this retrospective observational single-centre study was to assess MVP embolisation procedures performed at a university hospital. The 33 patients who underwent MVP embolisation in 2021 were included (mean age, 64; 24 males and 9 females). The primary endpoint was technical success, which was defined as a full first-attempt occlusion with one or more MVPs, as documented on the end-of-procedure angiogram. In all patients, 51 MVPs were used overall, with other embolic agents in 23 of the 33 cases (usually coils and/or glue); 22 of the 33 procedures were emergent for bleeding and 11 were planned for other indications. Of the three technical failures, two were due to an angled target artery configuration precluding microcatheterisation and one to failure of the device to release from its wire. The technical success rate was thus 90.9%. No patient experienced MVP migration or other major complications. Five patients had recurrent clinical symptoms; in four cases, the cause was collateral development, and in one case, the cause was incomplete initial embolisation. No instances of recanalisation were documented during the short follow-up of 12 months, for a 100% secondary clinical success rate. At our tertiary-level centre, the MVP was both effective and safe for peripheral applications. Interventional radiologists should be conversant with the techniques and indications of MVP embolisation.
Collapse
Affiliation(s)
- Rémy Mailli
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, Francois-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (R.M.); (O.C.); (A.M.); (A.M.); (N.F.)
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, Francois-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (R.M.); (O.C.); (A.M.); (A.M.); (N.F.)
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Amin Mazit
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, Francois-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (R.M.); (O.C.); (A.M.); (A.M.); (N.F.)
| | - Alexandre Malakhia
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, Francois-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (R.M.); (O.C.); (A.M.); (A.M.); (N.F.)
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, Francois-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (R.M.); (O.C.); (A.M.); (A.M.); (N.F.)
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, Francois-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (R.M.); (O.C.); (A.M.); (A.M.); (N.F.)
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
| |
Collapse
|
|
10
|
Ahmad H, Khan U, Jannat H, Ahmad N. Recurrent Gastrointestinal Bleeding in an Elderly Patient With Peptic Ulcer Disease: Successful Management Through Multidisciplinary Intervention and Close Monitoring. Cureus 2023; 15:e41468. [PMID: 37546113 PMCID: PMC10404137 DOI: 10.7759/cureus.41468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Upper gastrointestinal bleeding (UGIB) is a medical emergency with substantial morbidity and mortality worldwide. It is defined as bleeding originating in the gastrointestinal (GI) tract proximal to the ligament of Treitz and can be caused by various conditions, including peptic ulcers, gastritis, esophageal varices, Mallory-Weiss tears, and malignancies. Common complications include anemia, hemodynamic instability, perforation, and rebleeding. It is associated with high mortality and a poor prognosis, especially in high-risk populations. Management includes medical treatment, endoscopic intervention, endovascular arterial embolization, and surgery. We present an interesting case of an 87-year-old male with a history of duodenal ulcers who presented with a bleeding duodenal ulcer complicated by recurrent bleeding despite multiple hemostatic endoscopic interventions and arterial embolization. This case highlights the complexities involved in managing recurrent upper GI bleeding and emphasizes the significance of multidisciplinary approaches, timely interventions, and close monitoring.
Collapse
Affiliation(s)
- Hamad Ahmad
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Urooj Khan
- Internal Medicine, Khyber Medical University, Peshawar, PAK
| | - Hoore Jannat
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Noaman Ahmad
- Internal Medicine, Huntsville Hospital, Huntsville, USA
| |
Collapse
|
|
11
|
White SB, Wissing ER, Van Alstine WG, Trerotola SO. Comparison of Fibered versus Nonfibered Coils for Venous Embolization in an Ovine Model. J Vasc Interv Radiol 2023; 34:888-895. [PMID: 37105664 DOI: 10.1016/j.jvir.2022.12.481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To compare nylon fibered (F) with nonfibered (NF) coils for embolization in an ovine venous model. MATERIALS AND METHODS Four- to 8-mm-diameter, 0.035-inch F and NF coils were deployed in 24 veins in 6 sheep. The number of coils, total length of the coils, and length of implanted coil pack required to achieve complete stasis were recorded, as were vessel diameter, radiation dose, ease of packing, damage to embolized vessel, and time to stasis. Venography at 1 and 3 months was used to assess the migration and durability of vessel occlusion. Veins were harvested at 3 months. RESULTS F and NF coils were deployed in 24 veins, and stasis was achieved, without immediate coil migration or vessel damage. The mean numbers of F and NF coils per vein were 5 and 8.75, respectively (P = .007). The vessel diameter between the groups was not statistically different. The total coil length (F, 70 cm vs NF, 122.5 cm; P = .0007), coil pack length (F, 29.3 mm vs NF, 39.4 mm; P = .003), time to stasis (F, 5.3 minutes vs NF, 9.0 minutes; P = .008), and radiation dose (F, 25.3 mGy vs NF, 34.9 mGy; P = .037) were significantly different between the groups. Challenges with the animal model prevented conclusive long-term results. Migration occurred with 8 of 11 (72%) coil packs in the femoral veins and 0 of 13 (0%) coil packs in the internal iliac and deep femoral veins. Venography demonstrated that of 16 remaining coil packs, 11 were occluded at 1 month and 10 remained occluded at 3 months. CONCLUSIONS Fibers allow for significantly fewer coils to achieve immediate venous occlusion.
Collapse
Affiliation(s)
- Sarah B White
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | | | | | - Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
|
12
|
Ini' C, Distefano G, Sanfilippo F, Castiglione DG, Falsaperla D, Giurazza F, Mosconi C, Tiralongo F, Foti PV, Palmucci S, Venturini M, Basile A. Embolization for acute nonvariceal bleeding of upper and lower gastrointestinal tract: a systematic review. CVIR Endovasc 2023; 6:18. [PMID: 36988839 DOI: 10.1186/s42155-023-00360-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Acute non-variceal gastrointestinal bleedings (GIBs) are pathological conditions associated with significant morbidity and mortality. Embolization without angiographic evidence of contrast media extravasation is proposed as an effective procedure in patients with clinical and/or laboratory signs of bleeding. The purpose of this systematic review is to define common clinical practice and clinical and technical outcomes of blind and preventive embolization for upper and lower gastrointestinal bleeding. MAIN BODY Through the PubMed, Embase and Google Scholar database, an extensive search was performed in the fields of empiric and preventive embolization for the treatment of upper and lower gastrointestinal bleedings (UGIB and LGIB). Inclusion criteria were: articles in English for which it has been possible to access the entire content; adults patients treated with empiric or blind transcatheter arterial embolization (TAE) for UGIB and/or LGIB. Only studies that analysed clinical and technical success rate of blind and empiric TAE for UGIB and/or LGIB were considered for our research. Exclusion criteria were: recurrent articles from the same authors, articles written in other languages, those in which the entire content could not be accessed and that articles were not consistent to the purposes of our research. We collected pooled data on 1019 patients from 32 separate articles selected according to the inclusion and exclusion criteria. 22 studies focused on UGIB (total 773 patients), one articles focused on LGIB (total 6 patients) and 9 studies enrolled patients with both UGIB and LGIB (total 240 patients). Technical success rate varied from 62% to 100%, with a mean value of 97.7%; clinical success rate varied from 51% to 100% with a mean value of 80%. The total number of complications was 57 events out of 1019 procedures analysed. CONCLUSION TAE is an effective procedure in the treatment of UGIB patients in which angiography does not demonstrate direct sign of ongoing bleeding. The attitude in the treatment of LGIBs must be more prudent in relation to poor vascular anastomoses and the high risk of intestinal ischemia. Blind and preventive procedures cumulatively present a relatively low risk of complications, compared to a relatively high technical and clinical success.
Collapse
Affiliation(s)
- Corrado Ini'
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Giulio Distefano
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Davide Giuseppe Castiglione
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Daniele Falsaperla
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Francesco Tiralongo
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, Viale Luigi Borri 57, 21100, Varese, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| |
Collapse
|
|
13
|
Perekhodov SN, Karpun NA, Snitsar AV, Zelenin DA, Varfalomeev SI, Martyntsov AA, Matkov IV, Pankratov AA. [Endovascular embolization for prevention of recurrent bleeding from the upper gastrointestinal tract]. Khirurgiia (Mosk) 2023:30-38. [PMID: 36583491 DOI: 10.17116/hirurgia202301130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the results of preventive endovascular hemostasis in patients with high risk of recurrent bleeding from the upper gastrointestinal tract. MATERIAL AND METHODS We analyzed treatment outcomes in 158 patients with ulcerative gastroduodenal bleeding and high risk of recurrence (≥17 scores), Forrest 1-2 A/B and mortality (SAPS II score ≥30). Endovascular embolization of the left gastric or gastroduodenal artery was performed to prevent recurrent bleeding. RESULTS Endovascular hemostasis was technically successful in 94.4% of cases (153 patients). Embolization could not be performed due to technical reasons in 5 patients. One patient developed retroperitoneal hematoma as a complication after transcatheter angiography and embolization that required surgical intervention. Recurrent bleeding after technically successful embolization occurred in 11 (7%) patients. The PVA microemboli and spirals were used for embolization of the left gastric and gastroduodenal arteries, respectively. Additional PVA microemboli were also used in gastroduodenal artery in some cases. Twenty-six (16.5%) patients died. CONCLUSION Endovascular hemostasis in patients with severe comorbidities (SAPS II score ≥30) and high risk of recurrent bleeding (≥17 scores) reduced the incidence of recurrent bleeding to 6.96% and mortality to 17%.
Collapse
Affiliation(s)
- S N Perekhodov
- Demikhov Moscow City Clinical Hospital, Moscow, Russian Federation
| | - N A Karpun
- Demikhov Moscow City Clinical Hospital, Moscow, Russian Federation
| | - A V Snitsar
- Demikhov Moscow City Clinical Hospital, Moscow, Russian Federation
| | - D A Zelenin
- Demikhov Moscow City Clinical Hospital, Moscow, Russian Federation
| | - S I Varfalomeev
- Demikhov Moscow City Clinical Hospital, Moscow, Russian Federation
| | - A A Martyntsov
- Demikhov Moscow City Clinical Hospital, Moscow, Russian Federation
| | - I V Matkov
- Demikhov Moscow City Clinical Hospital, Moscow, Russian Federation
| | - A A Pankratov
- Demikhov Moscow City Clinical Hospital, Moscow, Russian Federation
| |
Collapse
|
|
14
|
Ephraim Joseph K, Devane AM, Abrams GA. Patient and endoscopic characteristics and clinical outcomes in subjects with non-variceal GI bleeding referred for transarterial embolization: a single-center experience. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3883-3891. [PMID: 36031627 DOI: 10.1007/s00261-022-03650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Management of massive non-variceal upper gastrointestinal bleeding (NV-UGIB) can be challenging. Transarterial Embolization (TAE) is often the first therapeutic approach when endoscopic therapy fails before surgery. The purpose of this study is to analyze the technical success, and outcome for our patients with an NV-UGIB referred for TAE. METHOD This retrospective analysis included 74 consecutive patients with an NV-UGIB in whom TAE was performed after endoscopic treatment between February 2016 to May 2019 at Prisma Health-Upstate Greenville Memorial Hospital. RESULTS TAE was 98.7% technically successful, with a failure due to severe celiac stenosis, and 85.1% clinically successful. Most TAEs were performed empirically due to lack of extravasation yet were clinically as effective as targeted TAE. We noted a 30-day rebleeding rate and mortality rate of 14.8% and 13.5%, respectively. No complications were reported during the angiographic procedure. Subjects with coagulopathy had more rebleeding (45.5% vs. 17.5%, p = 0.040), and mortality (30% vs 7.4%, p = 0.012). Mortality was also associated with the number of transfused packed blood cells (13.6 ± 8.4 vs. 6.1 ± 5.4, p = 0.020) units and hypotension on admission (27.8% vs. 8.9%, p = 0.043). Interestingly, subjects that underwent left gastric artery (LGA) compared to non-LGA embolization had a higher rebleeding rate of (37.5% vs. 8.6%, p = 0.004) and a greater mortality rate of (37.5% vs. 6.9%, p = 0.002). CONCLUSION TAE is clinically effective in the presence or absence of contrast extravasation to treat uncontrolled or high-risk NV-UGIB. Less effective clinical outcomes regarding TAE targeting the LGA warrant further investigation.
Collapse
Affiliation(s)
- Kripalini Ephraim Joseph
- Department of Medicine, Gastroenterology & Liver Center, Prisma Health- Upstate, Greenville, SC, 29605, USA.
| | - Aron M Devane
- Department of Diagnostic and Interventional Radiology, University of South Carolina SOM - Greenville, Prisma Health -Upstate, Greenville, SC, 29605, USA
| | - Gary A Abrams
- Department of Medicine, Gastroenterology & Liver Center, University of South Carolina SOM - Greenville, Prisma Health- Upstate, Greenville, SC, 29605, USA
| |
Collapse
|
|
15
|
Stallwood-Hall C, Anderson J, Ebeid A. Systematic review and meta-analysis of arterial embolization compared with traditional management on outcomes of traumatic massive facial haemorrhage. ANZ J Surg 2022; 92:988-993. [PMID: 34984779 DOI: 10.1111/ans.17448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maxillofacial trauma accounts for ~10% of trauma presentations to most centres, with massive haemorrhage occurring in 1.2-4.5% of cases. Despite its infrequent presentation, there is significant associated morbidity and mortality. Transcatheter arterial embolization (TAE) is playing an increasingly prominent role in trauma presentations. The aim of this article was to compare outcomes of TAE with more traditional management methods for the treatment of massive facial haemorrhage following maxillofacial trauma. METHODS A database and Google Scholar search was performed, with articles discussing massive facial haemorrhage secondary to maxillofacial trauma and its management included. RESULTS Twenty-seven articles were found that met inclusion criteria, encompassing 384 patients. Statistical testing comparing mortality between TAE and non-TAE groups did not find a significant difference, with a mortality rate of 30.2% in the TAE group and 38.9% in the non-TAE group. Assessment of morbidity directly related to interventions was difficult, as many of the included participants had significant associated injuries which contributed an indeterminate degree to morbidity. There was a 10% rate of adverse events associated with TAE, most commonly puncture site haematomas and soft tissue swelling, with more significant adverse events including cerebrovascular accidents and blindness. CONCLUSION Embolization was correlated with increased rates of haemorrhage control when compared with other interventions. Overall, despite no significant impact on mortality, embolization is recommended in the management of massive haemorrhage following maxillofacial trauma due to improved success rates at haemorrhage control and a low rate of significant adverse events.
Collapse
Affiliation(s)
- Catrin Stallwood-Hall
- Queen Mary University of London, Blizard Institute School of Medicine and Dentistry, London, UK
| | - Jordan Anderson
- Queen Mary University of London, Blizard Institute School of Medicine and Dentistry, London, UK
| | - Annelize Ebeid
- Queen Mary University of London, Blizard Institute School of Medicine and Dentistry, London, UK
| |
Collapse
|
|
16
|
Cheraghali R, Salimi J, Omrani Z. Endovascular treatment of penetrating vascular injuries. J Surg Case Rep 2021; 2021:rjab486. [PMID: 34804479 PMCID: PMC8599047 DOI: 10.1093/jscr/rjab486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
Endovascular treatment of vascular injuries has resulted in reduced operating time, blood loss, hospital mortality and sepsis. The purpose of this study was to evaluate the success and complication rate of the endovascular management of penetrating peripheral vascular injuries during 5 years. In this observational study, the clinical records and imaging features of 22 penetrating trauma injuries of 276 penetrating vascular trauma patients (8%), which were repaired using endovascular stent-grafts or coil embolization, between April 2013 and August 2018, included in the study. The median age of patients was 43 years (Range, 20–78 years). There were 17 stab wounds (77.3%), 2 shotgun war remnants (9.1%) and 2 iatrogenic post-surgical lesions. Eleven stent-grafts (50%) and nine coil embolizations (40.9%) were deployed. Endovascular interventions in the management of peripheral vascular injuries can be efficient in definitive repair, damage control and hemorrhage control in severely ill trauma patients.
Collapse
Affiliation(s)
- Roozbeh Cheraghali
- Vascular and Endovascular Surgery, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Javad Salimi
- Vascular and Endovascular Surgery, Liver Transplantation Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Omrani
- Department of Surgery, Iran University of Medical Sciences (IUMS), Tehran, Iran
| |
Collapse
|
|
17
|
Syed M, Efridi W, Khan T, Deek F, Kurian M, Shaikh A. A Novel approach to catheterizing the Left Gastric Artery for bariatric embolization. Radiol Case Rep 2021; 16:3574-3576. [PMID: 34584594 PMCID: PMC8455695 DOI: 10.1016/j.radcr.2021.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 45 Y/o morbidly obese male who - unable to lose weight despite extensive lifestyle interventions, presented to us for an experimental procedure known as bariatric embolization. This arterial embolization procedure was performed targeting the left gastric artery with aims to restrict blood flow to the gastric fundus, and lowering serum ghrelin levels. In this case the left gastric artery arose cephalad from the celiac, earlier than where it normally branches; a variation known as a “false tripod”, causing some initial difficulty with selection. We describe how introducing a tertiary curve on the guidewire proved successful. Adapting the guidewire for difficult anatomy is an often a very underutilized skillset for many interventionalists - but led to success in this rather nascent procedure.
Collapse
Affiliation(s)
- Mubin Syed
- Dayton Interventional Radiology, 3075 Governors Place Blvd., Ste. 120, Dayton, OH 45409, USA.,Samaritan Hospital, 2222 Philadelphia Dr., Dayton, OH 45406, USA.,Boonshoft School of Medicine at Wright State, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA.,Springfield Regional Medical Center, 100 Medical Center Drive, Springfield, OH 45504, USA
| | - Wajahat Efridi
- Dayton Interventional Radiology, 3075 Governors Place Blvd., Ste. 120, Dayton, OH 45409, USA.,Suny Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210
| | - Tanya Khan
- Dayton Interventional Radiology, 3075 Governors Place Blvd., Ste. 120, Dayton, OH 45409, USA.,Northeastern Ohio Medical University (NEOMED), 4209 OH-44, Rootstown, OH 44272,USA
| | - Feras Deek
- Dayton Interventional Radiology, 3075 Governors Place Blvd., Ste. 120, Dayton, OH 45409, USA
| | - Matthew Kurian
- Dayton Interventional Radiology, 3075 Governors Place Blvd., Ste. 120, Dayton, OH 45409, USA.,Northeastern Ohio Medical University (NEOMED), 4209 OH-44, Rootstown, OH 44272,USA
| | - Azim Shaikh
- Dayton Interventional Radiology, 3075 Governors Place Blvd., Ste. 120, Dayton, OH 45409, USA
| |
Collapse
|
|
18
|
Alrashidi I, Kim TH, Shin JH, Alreshidi M, Park M, Jang EB. Efficacy and safety of transcatheter arterial embolization for active arterial esophageal bleeding: a single-center experience. ACTA ACUST UNITED AC 2021; 27:519-523. [PMID: 34313237 DOI: 10.5152/dir.2021.20253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding. METHODS Nine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed. RESULTS The angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE. CONCLUSION TAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.
Collapse
Affiliation(s)
- Ibrahim Alrashidi
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Tae-Hyung Kim
- Department of Radiological Science, College of Health Science, Kangwon National University, Samcheok-si, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | - Minho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Bee Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
|
19
|
Razavilar N, Taleshi JM. Cost-Effectiveness Analysis of Transcatheter Arterial Embolization Techniques for the Treatment of Gastrointestinal Bleeding in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:477-485. [PMID: 33840425 DOI: 10.1016/j.jval.2020.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/04/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Gastrointestinal (GI) bleeding is a common medical emergency associated with significant mortality. Transcatheter arterial embolization first was introduced by Rosch et al as an alternative to surgery for upper GI bleeding. The clinical success in patients with GI bleeding treated with transcatheter arterial embolization previously has been reported. However, there are no cost-effectiveness analyses reported to date. Here we report cost-effectiveness analysis of N-butyl 2-cyanoacrylate glue (NBCA) and ethylene-vinyl alcohol copolymer (Onyx) versus coil (gold standard) for treatment of GI bleeding from a healthcare payer perspective. METHODS Fixed-effects modeling with a generalized linear mixed method was used in NBCA and coil intervention arms to determine the pooled probabilities of clinical success and mortality with complications with their confidence intervals, while the Clopper-Pearson model was used for Onyx to determine the same parameters. Models were provided by the "Meta-Analysis with R" software package. A decision tree was built for cost-effectiveness analysis, and Microsoft Excel was used for probabilistic sensitivity analysis. The cost-effective option was determined based on the incremental cost-effectiveness ratio and scatter plots of incremental cost versus incremental quality-adjusted life-years. RESULTS Comparing scatter plots and incremental cost-effectiveness ratio results, -$1024 and -$1349 per quality-adjusted life-year for Onyx and N-butyl 2-cyanoacrylate glue, respectively, Onyx was the least expensive and most effective intervention. CONCLUSION Onyx was the dominant strategy regardless of threshold values. Our analyses provide a framework for researchers to predict the target clinical effectiveness for early-stage TAE interventions and guide resource allocation decisions.
Collapse
Affiliation(s)
- Negin Razavilar
- RAZN Health Decision Modelling LTD, University of Alberta Health Accelerator, Edmonton, Canada; Faculty of Sciences, University of Alberta, Edmonton, Canada.
| | | |
Collapse
|
|
20
|
Mille M, Engelhardt T, Stier A. Bleeding Duodenal Ulcer: Strategies in High-Risk Ulcers. Visc Med 2021; 37:52-62. [PMID: 33718484 PMCID: PMC7923890 DOI: 10.1159/000513689] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/09/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Acute peptic ulcer bleeding is still a major reason for hospital admission. Especially the management of bleeding duodenal ulcers needs a structured therapeutic approach due to the higher morbidity and mortality compared to gastric ulcers. Patient with these bleeding ulcers are often in a high-risk situation, which requires multidisciplinary treatment. SUMMARY This review provides a structured approach to modern management of bleeding duodenal ulcers and elucidates therapeutic practice in high-risk situations. Initial management including pharmacologic therapy, risk stratification, endoscopy, surgery, and transcatheter arterial embolization are reviewed and their role in the management of bleeding duodenal ulcers is critically discussed. Additionally, a future perspective regarding prophylactic therapeutic approaches is outlined. KEY MESSAGES Beside pharmacotherapeutic and endoscopic advances, bleeding management of high-risk duodenal ulcers is still a challenge. When bleeding persists or rebleeding occurs and the gold standard endoscopy fails, surgical and radiological procedures are indicated to manage ulcer bleeding. Surgical procedures are performed to control hemorrhage, but they are still associated with a higher morbidity and a longer hospital stay. In the meantime, transcatheter arterial embolization is recommended as an alternative to surgery and more often replaces surgery in the management of failed endoscopic hemostasis. Future studies are needed to improve risk stratification and therefore enable a better selection of high-risk ulcers and optimal treatment. Additionally, the promising approach of prophylactic embolization in high-risk duodenal ulcers has to be further investigated to reduce rebleeding and improve outcomes in these patients.
Collapse
Affiliation(s)
- Markus Mille
- Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | | | | |
Collapse
|
|
21
|
Takaki K, Nitta N, Ota S, Inoue A, Watanabe Y. Fat tissue as an embolic material changes the embolization time in a size-dependent manner: a basic investigation using rabbits. Jpn J Radiol 2021; 39:503-510. [PMID: 33512652 DOI: 10.1007/s11604-020-01083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the usefulness of fat tissue as an embolic material and determine whether the embolization time depends on the size of the fat tissue. MATERIALS AND METHODS Inguinal fat tissues from 16 rabbits were processed as follows: (1) fat tissues were cut into 2-mm squares, and (2) fat tissue squares were dissociated 20 × through a syringe without a needle (1-139 μm in diameter). The distal main trunk of the right or left renal artery was completely embolized using one of the two types of fat tissue. After 1 or 7 days, renal angiography was performed. RESULTS On day 1 after embolization of the renal artery with 2-mm fat tissue squares (Group 1-1) and on day 7 (Group 1-2), the reperfusion rates were 4.0 ± 5.5% and 29.9 ± 6.9%, respectively. On day 1 after embolization of the renal artery with fat tissues dissociated using a 20 × pumping cycle (Group 2-1) and on day 7 (Group 2-2), the reperfusion rates were 59.9 ± 9.9% and 74.3 ± 26.0%, respectively. The reperfusion rates were significantly different between the two types of fat tissue. CONCLUSIONS Fat tissue serves as an embolic material that changes the embolization time in a size-dependent manner.
Collapse
Affiliation(s)
- Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Norihisa Nitta
- Department of Radiology, Kyoto Okamoto Memorial Hospital, 100 Sayama-Nishinokuchi, Kumiyama-cho, Kuze, Kyoto, 613-0034, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| |
Collapse
|
|
22
|
Chang JHE, Lye TJY, Zhu HZ, Syn NL, Tang SS, Gogna A, Chan WH, Ong HS, Tan JTH, Lim CH. Systematic Review and Meta-Analysis of Prophylactic Transarterial Embolization for High-Risk Bleeding Peptic Ulcer Disease. J Vasc Interv Radiol 2021; 32:576-584.e5. [PMID: 33526343 DOI: 10.1016/j.jvir.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
The present systematic review determined the role of transarterial embolization (TAE) as a prophylactic treatment in bleeding peptic ulcers after initial successful endoscopic hemostasis. PubMed and Ovid Medline databases were searched from inception until July 2019 for studies that included patients deemed high-risk based on Forrest Classification, Rockall score ≥ 5, or endoscopic evaluation in addition to those who underwent prophylactic TAE after initial successful endoscopic hemostasis. Meta-analysis was performed to compare patients who underwent endoscopic therapy (ET) and TAE with those who underwent ET alone. The primary outcomes measured included rates of rebleeding, reintervention, and 30-day mortality. Secondary outcome measures evaluated length of hospitalization, technical success rates, and complications associated with TAE. Of 916 publications, 5 were eligible for inclusion; 310 patients with high-risk peptic ulcer bleeding underwent prophylactic TAE, and 255 were compared against a control group of 580 patients that underwent standard treatment with ET alone. Patients who underwent ET with TAE had lower 30-day rebleeding rates (odds ratio [OR], 0.35; 95% confidence interval [CI] 0.15-0.85; P = .02; I2 = 50%). The ET with TAE group had a lower 30-day mortality rate (OR, 0.28; 95% CI, 0.10-0.83; P = .02; I2 = 58%). There was no difference in pooled reintervention rates (OR, 0.68; 95% CI, 0.43-1.08; P = .10; I2 = 0%) and length of hospitalization (mean difference, -0.32; 95% CI, -1.88 to 1.24; P = .69; I2 = 0%). Technical success rate of prophylactic TAE was 90.5% (95% CI, 83.09-97.98; I2 = 75.9%). Pooled proportion of overall complication rate was 0.18% (95% CI, 0.00-1.28; I2 = 0%). Prophylactic TAE has lower rebleeding and mortality with a good success rate and low complications. Prophylactic TAE after primary ET may be recommended for selected patients with high-risk bleeding ulcers; however, further studies should be performed to establish this as a routine tool in patients with bleeding peptic ulcer disease.
Collapse
Affiliation(s)
- Jasmine H E Chang
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital
| | - Tiffany J Y Lye
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital.
| | - Hong Zhi Zhu
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Sarah S Tang
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital
| | - Hock Soo Ong
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital
| | - Jeremy Tian Hui Tan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital
| |
Collapse
|
|
23
|
Spiliopoulos S, Katsanos K, Paraskevopoulos I, Mariappan M, Festas G, Kitrou P, Papageorgiou C, Reppas L, Palialexis K, Karnabatidis D, Brountzos E. Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis. CVIR Endovasc 2020; 3:95. [PMID: 33301058 PMCID: PMC7728894 DOI: 10.1186/s42155-020-00186-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We retrospectively investigated outcomes of emergency TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding diathesis. MATERIALS AND METHODS This multicenter, retrospective, study, was designed to investigate the safety and efficacy of percutaneous TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding disorder at the time of embolization. All consecutive patients with uncorrected coagulation who underwent TAE for the treatment of haemorrhage, between January 1st and December 31th 2019 in three European centers were included. Inclusion criteria were thrombocytopenia (platelet count < 50,000/mL) and/or International Normalized Ratio (INR) ≥2.0, and/or activated partial thromboplastin time (aPTT) > 45 s, and/or a pre-existing underlying blood-clotting disorder such as factor VIII, Von Willebrand disease, hepatic cirrhosis with abnormal liver function tests. Primary outcome measures were technical success, rebleeding rate and clinical success. Secondary outcome measures included patients' 30-day survival rate, and procedure-related complications. RESULTS In total, 134 patients underwent TAE for bleeding control. A subgroup of 17 patients with 18 procedures [11 female, mean age 70.5 ± 15 years] which represent 12.7% of the total number of patients, presented with pathological coagulation parameters at the time of TAE (haemophilia n = 3, thrombocytopenia n = 1, cirrhosis n = 5, anticoagulants n = 7, secondary to bleeding n = 1) and were analyzed. Technical success was 100%, as in all procedures the bleeding site was detected and successfully embolised. Clinical success was 100%, as none of the patients died of bleeding during hospitalization, nor was surgically treated for bleeding relapse. Only one rebleeding case was noted (5.9%) that was successfully treated with a second TAE. No procedure-related complications were noted. According to Kaplan-Meier analysis the estimated 30-day survival rate was 84.2%. CONCLUSION TAE in selected patients with uncorrected bleeding diathesis should be considered as a suitable individualized management approach. Emergency TAE for life threatening haemorrhage in patients with coagulation cascade disorders should be used as an aid in realistic clinical decision making.
Collapse
Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Konstantinos Katsanos
- Department of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Ioannis Paraskevopoulos
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Martin Mariappan
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Georgios Festas
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Panagiotis Kitrou
- Department of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Christos Papageorgiou
- Department of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Dimitrios Karnabatidis
- Department of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| |
Collapse
|
|
24
|
Loffroy R, Desmyttere AS, Mouillot T, Pellegrinelli J, Facy O, Drouilllard A, Falvo N, Charles PE, Bardou M, Midulla M, Aho-Gléglé S, Chevallier O. Ten-year experience with arterial embolization for peptic ulcer bleeding: N-butyl cyanoacrylate glue versus other embolic agents. Eur Radiol 2020; 31:3015-3026. [PMID: 33128601 DOI: 10.1007/s00330-020-07427-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/01/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare our experience with N-butyl cyanoacrylate glue as the primary embolic agent versus other embolic agents for transcatheter arterial embolization (TAE) in refractory peptic ulcer bleeding and to identify factors associated with early rebleeding and 30-day mortality. METHODS Retrospective study of 148 consecutive patients comparing the clinical success rate in 78 patients managed with Glubran®2 N-butyl cyanoacrylate metacryloxysulfolane (NBCA-MS) alone or with other agents and 70 with other embolic agents only (coils, microspheres, ethylene-vinyl alcohol copolymer, or gelatin sponge) at a university center in 2008-2019. Univariate and multivariate logistic regression analyses were done to identify prognostic factors. RESULTS The technical success rate was 95.3% and the primary clinical success was 64.5%. The early rebleeding and day-30 mortality rates were 35.4% and 21.3%, respectively. Rebleeding was significantly less common with than without Glubran®2 (OR, 0.47; 95% CI, 0.22-0.99; p = .047) and significantly more common with coils used alone (OR, 20.4; 95% CI, 10.13-50.14; p = .024). The only other factor independently associated with early rebleeding was having two or more comorbidities (OR, 20.14; 95% CI, 10.01-40.52; p = .047). Day-30 mortality was similar in the two treatment groups. A lower initial hemoglobin level was significantly associated with higher day-30 mortality (OR, 10.38; 95% CI, 10.10-10.74; p = .006). Fluoroscopy time was significantly shorter with Glubran®2 (20.8 ± 11.5 min vs. 35.5 ± 23.4 min, p = .002). Both groups (Glubran®2 vs. other agents) had similar rates of overall complications (10.7% vs. 9.1%, respectively, p = .786). CONCLUSIONS Glubran®2 NBCA-MS as the primary agent allowed for faster and better clinical success compared to other embolic agents when used for TAE to safely stop refractory peptic ulcer bleeding. KEY POINTS • Choice of embolic agent for arterial embolization of refractory peptic ulcer bleeding is still debated. We compared our experience with N-butyl cyanoacrylate (NBCA) glue vs. other embolic agents. • The use of Glubran®2 NBCA glue in the endovascular management of refractory peptic ulcer bleeding was significantly faster and more effective, and at least as safe compared to other embolic agents. • NBCA glue offers several advantages compared to other embolic agents and provides rapid hemostasis when used for arterial embolization to treat refractory peptic ulcer bleeding. It should be the first-line therapy.
Collapse
Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France. .,Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079, Dijon Cedex, France.
| | - Anne-Solène Desmyttere
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Thomas Mouillot
- Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France
| | - Julie Pellegrinelli
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Facy
- Department of Digestive and Visceral Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Antoine Drouilllard
- Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Pierre-Emmanuel Charles
- Department of Anesthesia and Intensive Care, François-Mitterrand University Hospital, Dijon, France
| | - Marc Bardou
- Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Serge Aho-Gléglé
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| |
Collapse
|
|
25
|
Darmon I, Rebibo L, Diouf M, Chivot C, Riault C, Yzet T, Le Mouel JP, Regimbeau JM. Management of bleeding peptic duodenal ulcer refractory to endoscopic treatment: surgery or transcatheter arterial embolization as first-line therapy? A retrospective single-center study and systematic review. Eur J Trauma Emerg Surg 2020; 46:1025-1035. [PMID: 32246169 DOI: 10.1007/s00068-020-01356-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/25/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The objective of this study was to compare the results of transcatheter arterial embolization (TAE) with surgery in terms of efficacy in the context of bleeding duodenal ulcer (BDU) refractory to endoscopic treatment. MATERIALS AND METHODS From January 2006 to December 2016, all patients treated for a BDU refractory to endoscopic treatment were included in this observational, comparative, retrospective, single-center study. Primary endpoint was the overall success of treatment of BDU requiring surgical and/or TAE. The secondary endpoints were pre-interventional data, recurrence rates, feasibility of secondary treatment, morbidity and mortality of surgical and radiological treatment, intensive care unit and length of stay. A systematic review of the literature was performed to compare results of surgery and TAE. RESULTS 59 out of 396 patients (14.9%) treated for BDU required embolization and/or surgery: 15 patients underwent surgery (group S) including 7 patients after embolization failure and 44 patients underwent TAE (group TAE). The overall treatment success in intention to treat (85.7% vs 67.3%), per protocol (80% vs 79.5%) and bleeding recurrence rates (20% vs 15.9%) were also identical. Mortality (14.2% vs 15.3%) was similar between the two groups. Our study data were pooled with data from eight published studies and suggest that surgery have significant increased overall success (68.3% vs. 55.4%, p < 0.005). CONCLUSION The overall success rate was in favour of surgery according our meta-analysis. Our single-center study highlights the fact that predictive factors for recurrent bleeding after TAE must be identified to select good candidates for TAE and/or surgery.
Collapse
Affiliation(s)
- Ilan Darmon
- Department of Digestive Surgery, Amiens University Medical Center, Avenue René Laennec, 80054, Amiens cedex 01, France
| | - Lionel Rebibo
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, 46 rue Henri Huchard, 75018, Paris, France
- Université de Paris, Inserm UMR 1149, 75018, Paris, France
| | - Momar Diouf
- Biostatistics Unit, Clinical Research and Innovation Department, Amiens-Picardie University Hospital, 80054, Amiens, France
| | - Cyril Chivot
- Department of Radiology, Amiens University Medical Center, Avenue René Laennec, 80054, Amiens cedex 01, France
| | - Clémentine Riault
- Department of Gastroenterology, Amiens University Medical Center, Avenue René Laennec, 80054, Amiens cedex 01, France
| | - Thierry Yzet
- Department of Radiology, Amiens University Medical Center, Avenue René Laennec, 80054, Amiens cedex 01, France
| | - Jean Philippe Le Mouel
- Department of Gastroenterology, Amiens University Medical Center, Avenue René Laennec, 80054, Amiens cedex 01, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Avenue René Laennec, 80054, Amiens cedex 01, France.
- SSPC (Simplification of Surgical Patients Care), Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens Cedex 01, France.
- Service de Chirurgie Digestive, CHU Amiens-Picardie, Site Sud, 1 Rond-Point du Professeur Christian Cabrol, 80054, Amiens Cedex 1, France.
| |
Collapse
|
|
26
|
Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma. Radiol Oncol 2020; 54:253-262. [PMID: 32463389 PMCID: PMC7409609 DOI: 10.2478/raon-2020-0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background Severe bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce. Patients and methods PubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories. Results and conclusions Based on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.
Collapse
|
|
27
|
Elshaer AR, Abdelsalam AA, Elgeyoushi FA, Allam AR. Managing post-traumatic gunshot thoraco-abdominal bleeding by intervention embolisation: A case report. J Taibah Univ Med Sci 2019; 14:193-198. [PMID: 31555071 PMCID: PMC6708075 DOI: 10.1016/j.jtumed.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 11/14/2022] Open
Abstract
We report an interesting life-threating case of post-traumatic severe bleeding in the thoraco-abdominal region. The patient was initially treated by open surgery, which failed to control bleeding in the intrahepatic and sub-diaphragmatic regions of the liver with associated haematoma collection. As bleeding continued, on the 2nd post-operative day, the patient underwent super-selective embolisation of the bleeding vessels to cease serious bleeding. The pre-embolisation arterial feeders with active bleeding and post-embolisation images by computed tomography subtraction angiography showed complete cessation of haemorrhage. Torrential haemorrhage in the thoraco-abdominal regions can be successfully managed by trained interventional radiologists in highly specialised centres.
Collapse
Affiliation(s)
- Anas R Elshaer
- Department of Diagnostic and Interventional Radiology, King Fahad Hospital Madinah, KSA
| | | | | | | |
Collapse
|
|
28
|
Foltz G, Khaddash T. Embolization of Nonvariceal Upper Gastrointestinal Hemorrhage Complicated by Bowel Ischemia. Semin Intervent Radiol 2019; 36:76-83. [PMID: 31123376 DOI: 10.1055/s-0039-1688419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Over the past three decades, transcatheter arterial embolization has become the first-line therapy for the management of acute nonvariceal upper gastrointestinal bleeding refractory to endoscopic hemostasis. Overall, transcatheter arterial interventions have high technical and clinical success rates. This review will focus on patient presentation and technical considerations as predictors of complications from transcatheter arterial embolization in the management of acute upper gastrointestinal hemorrhage.
Collapse
Affiliation(s)
- Gretchen Foltz
- Section of Interventional Radiology, Department of Radiology, Washington University St. Louis - School of Medicine, St. Louis, Missouri
| | - Tamim Khaddash
- Section of Interventional Radiology, Department of Radiology, Washington University St. Louis - School of Medicine, St. Louis, Missouri
| |
Collapse
|
|
29
|
Nouri Y, Shin JH, Ko HK, Kim JW, Yoon HK. Embolization of procedure-related upper gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii170028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Yasir Nouri
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
|
30
|
Embolisation d’hémostase du thorax, de l’abdomen et du pelvis. Presse Med 2019; 48:398-410. [DOI: 10.1016/j.lpm.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/22/2019] [Indexed: 11/21/2022] Open
|
|
31
|
Abstract
Nonvariceal upper gastrointestinal (GI) bleeds are a common emergency. Mortality in patients with an upper GI bleed has been reported to be as high as 30% for those who bleed inpatient. Definitive management after resuscitation can be done with endoscopy, transcatheter arterial embolization (TAE), and/or surgery. A 55-year-old female with multiple comorbidities presented with a refractory second episode of an acute nonvariceal upper GI bleed that required an interdisciplinary approach with the following interventions: endoscopy, embolization, and ultimately surgery. In this case report, the discussion is about the management algorithm of nonvariceal upper GI bleeds as well as the literature on prophylactic embolization and GI rebleeding. This unusual case presented with continued bleeding despite embolization, which led to the emergent rescue surgery that was necessary for this patient. Important take-home points are that patients with therapeutic hemostasis of upper GI bleeds may have rebleeding, a second attempt at therapeutic endoscopy after rebleeding may be limited due to a brisk bleed, the literature about prophylactic embolization is controversial, and one should involve both interventional radiology and surgery early on to assess a patient’s clinical picture for further definitive interventions from both specialties.
Collapse
Affiliation(s)
- Edmund Hsu
- Emergency Medicine, Mount Sinai St. Lukes - Roosevelt Hospital Center, New York, USA
| | - Singwu D Law
- Pulmonology, Mount Sinai St. Lukes and West Hospital Center, New York, USA
| |
Collapse
|
|
32
|
Sverdén E, Mattsson F, Lindström D, Sondén A, Lu Y, Lagergren J. Transcatheter Arterial Embolization Compared With Surgery for Uncontrolled Peptic Ulcer Bleeding: A Population-based Cohort Study. Ann Surg 2019; 269:304-309. [PMID: 29064894 DOI: 10.1097/sla.0000000000002565] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare key outcomes after transcatheter arterial embolization (TAE) with conventional surgery for peptic ulcer bleeding when endoscopic intervention fails to achieve hemostasis. BACKGROUND Mortality in peptic ulcer bleeding remains high, especially in patients who require surgical treatment. METHODS A population-based cohort study in Stockholm, Sweden, in 2000 to 2014, assessing the main outcome all-cause mortality and the secondary outcomes re-bleeding, re-intervention, length of hospitalization, and complications, was conducted. Data were taken from well-maintained registries and medical records. Multivariable Cox-regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, sex, ulcer history, comorbidity, and calendar period were considered. RESULTS Included were 282 patients, 97 in the TAE group and 185 in the surgery group. Compared with the surgery group, the overall hazard of death was 34% decreased in the TAE group (adjusted HR 0.66, 95% CI 0.46-0.96). The corresponding HRs for mortality within 30 days, 90 days, 1 year, and 5 years were 0.70 (95% CI 0.37-1.35), 0.69 (95% CI 0.38-1.26), 0.88 (95% CI 0.53-1.47), and 0.67 (95% CI 0.45-1.00), respectively. The risk of re-bleeding was higher after TAE compared with surgery (HR 2.48, 95% CI 1.33-4.62). The median length of hospital stay was shorter in the TAE group-8 versus 16 days-acceleration factor 0.59 (95% CI 0.45-0.77) and the risk of complications was lower (8.3% vs 32.2%; P < 0.0001). CONCLUSIONS This study indicates that TAE compares favorably with surgery regarding prognosis after refractory peptic ulcer bleeding, and the shorter length of hospital stay and fewer complications outweigh a higher risk of re-bleeding. TAE could be recommended as first-line treatment for these patients.
Collapse
Affiliation(s)
- Emma Sverdén
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Upper Gastrointestinal Surgery, South Hospital, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - David Lindström
- Vascular Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Sondén
- Department of Upper Gastrointestinal Surgery, South Hospital, Stockholm, Sweden
| | - Yunxia Lu
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Vascular Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Division of Cancer Studies, King's College London, and Guy's and St Thomas' NHS Foundation Trust, UK
| |
Collapse
|
|
33
|
Tarasconi A, Baiocchi GL, Pattonieri V, Perrone G, Abongwa HK, Molfino S, Portolani N, Sartelli M, Di Saverio S, Heyer A, Ansaloni L, Coccolini F, Catena F. Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis. World J Emerg Surg 2019; 14:3. [PMID: 30733822 PMCID: PMC6359767 DOI: 10.1186/s13017-019-0223-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/22/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nowadays, very few patients with non-variceal upper gastrointestinal bleeding fail endoscopic hemostasis (refractory NVUGIB). This subset of patients poses a clinical dilemma: should they be operated on or referred to transcatheter arterial embolization (TAE)? OBJECTIVES To carry out a systematic review of the literature and to perform a meta-analysis of studies that directly compare TAE and surgery in patients with refractory NVUGIB. MATERIALS AND METHODS We searched PubMed, Ovid MEDLINE, and Embase. A combination of the MeSH terms "gastrointestinal bleeding"; "gastrointestinal hemorrhage"; "embolization"; "embolization, therapeutic"; and "surgery" were used (("gastrointestinal bleeding" or "gastrointestinal hemorrhage") and ("embolization" or "embolization, therapeutic") and "surgery")). The search was performed in June 2018. Studies were retrieved and relevant studies were identified after reading the study title and abstract. Bibliographies of the selected studies were also examined. Statistical analysis was performed using RevMan software. Outcomes considered were all-cause mortality, rebleeding rate, complication rate, and the need for further intervention. RESULTS Eight hundred fifty-six abstracts were found. Only 13 studies were included for a total of 1077 patients (TAE group 427, surgery group 650). All selected papers were non-randomized studies: ten were single-center and two were double-center retrospective comparative studies, while only one was a multicenter prospective cohort study. No comparative randomized clinical trial is reported in the literature.Mortality. Pooled data (1077 patients) showed a tendency toward improved mortality rates after TAE, but this trend was not statistically significant (OD = 0.77; 95% CI 0.50, 1.18; P = 0.05; I 2 = 43% [random effects]). Significant heterogeneity was found among the studies.Rebleeding rate. Pooled data (865 patients, 211 events) showed that the incidence of rebleeding was significantly higher for patients undergoing TAE (OD = 2.44; 95% CI 1.77, 3.36; P = 0.41; I 2 = 4% [fixed effects]).Complication rate. Pooling of the data (487 patients, 206 events) showed a sharp reduction of complications after TAE when compared with surgery (OD = 0.45; 95% CI 0.30, 0.47; P = 0.24; I 2 = 26% [fixed effects]).Need for further intervention. Pooled data (698 patients, 165 events) revealed a significant reduction of further intervention in the surgery group (OD = 2.13; 95% CI 1.21, 3.77; P = 0.02; I 2 = 56% [random effects]). A great degree of heterogeneity was found among the studies. CONCLUSIONS The present study shows that TAE is a safe and effective procedure; when compared to surgery, TAE exhibits a higher rebleeding rate, but this tendency does not affect the clinical outcome as shown by the comparison of mortality rates (slight drift toward lower mortality for patients undergoing TAE). The present study suggests that TAE could be a viable option for the first-line therapy of refractory NVUGIB and sets the foundation for the design of future randomized clinical trials. LIMITATIONS The retrospective nature of the majority of included studies leads to selection bias. Furthermore, the decision of whether to proceed with surgery or refer to TAE was made on a case-by-case basis by each attending surgeon. Thus, external validity is low. Another limitation involves the variability in etiology of the refractory bleeding. TAE techniques and surgical procedure also differ consistently between different studies. Frame time for mortality detection differs between the studies. These limitations do not impair the power of the present study that represents the largest and most recent meta-analysis currently available.
Collapse
Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| | - Gian Luca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Vittoria Pattonieri
- Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| | - Gennaro Perrone
- Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| | - Hariscine Keng Abongwa
- Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| | - Sarah Molfino
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | | | - Salomone Di Saverio
- Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Arianna Heyer
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Fausto Catena
- Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy
| |
Collapse
|
|
34
|
Orron DE, Bloom AI, Neeman Z. The Role of Transcatheter Arterial Embolization in the Management of Nonvariceal Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2018; 28:331-349. [PMID: 29933779 DOI: 10.1016/j.giec.2018.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nearly 50 years ago, catheter angiography was introduced as a means of both diagnosing and treating nonvariceal upper gastrointestinal bleeding. Technological advances and innovations have resulted in the introduction of microcatheters that, using a coaxial technique, are capable of selecting third-order arterial branches and of delivering a wide array of embolic agents. This article reviews the imaging diagnosis of nonvariceal upper gastrointestinal bleeding, the techniques of diagnostic and therapeutic angiography, the angiographic appearance of the various etiologies of nonvariceal upper gastrointestinal bleeding, the rationale behind case-specific selection of embolic agents as well as the anticipated outcome of transcatheter arterial embolization.
Collapse
Affiliation(s)
- Dan E Orron
- Department of Radiology, Carmel Medical Center, Michal Street, Haifa 34362, Israel
| | - Allan I Bloom
- Department of Radiology, Hadassah University Medical Center, Ein Karem, Jerusalem 91120, Israel
| | - Ziv Neeman
- Medical Imaging Institute, Haemek Medical Center, Izhak Rabin Boulevard, Afula 1834111, Israel.
| |
Collapse
|
|
35
|
Grosse U, Syha R, Ketelsen D, Hoffmann R, Partovi S, Mehra T, Nikolaou K, Grözinger G. Cone beam computed tomography improves the detection of injured vessels and involved vascular territories in patients with bleeding of uncertain origin. Br J Radiol 2018; 91:20170562. [PMID: 29848014 DOI: 10.1259/bjr.20170562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The purpose of this preliminary retrospective study was to analyse if cone beam CT (CBCT) is able to identify more bleeding sites and corresponding feeding arteries in patients with haemorrhage of uncertain origin. METHODS In 18 vascular territories (16 patients), pre-interventional CT angiography (CTA) and selective angiograms resulted in discordant information regarding the suspected bleeding site and hence received CBCT. Image data of CTA and selective angiograms in comparison to CBCT were independently reviewed by two interventional radiologists. Image quality, diagnostic confidence, number of bleeding sites and involved vascular territories were investigated. Additionally, the correlation between number of bleeding sites and involved vascular territories with a clinical gold-standard (super-selective angiographic findings and definitive clinical outcomes) was analysed. RESULTS Overall, subjective image quality did not significantly differ between investigated imaging modalities. However, CBCT significantly improved diagnostic confidence in both readers in detecting bleeding vessel (s) (p = 0.0024/0.0005; Reader 1/Reader2). High correlation coefficients regarding the number of bleeding sites (r = 0.9163/0.7692) in contrast to the number of involved vascular territories (r = 0.2888/0.0105) were observed for CTA in comparison to clinical gold-standard. In this context, CBCT demonstrated a very strong correlation for both parameters, the number of bleeding vessels (r = 0.9720/0.9721) and the number involved vascular territories (r = 0.9441/0.9441). CONCLUSION In complex cases of suspected haemorrhage, CBCT images can aid the interventionalist in detecting bleeding sites as well as narrowing down the number of involved vascular territories and thereby identifying feeding arteries of the bleeding source. Advances in knowledge: (1) CBCT showed no improvement in image quality. However, in complex bleeding cases CBCT information might aid in treatment planning. (2) CBCT improves visualization of bleeding vessels and involved feeding arteries. (3) Particularly, less experienced interventionalists might benefit from the three-dimensional information gathered by CBCT.
Collapse
Affiliation(s)
- Ulrich Grosse
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Roland Syha
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Dominik Ketelsen
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Rüdiger Hoffmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Sasan Partovi
- 2 Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University , Cleveland, OH , USA
| | - Tarun Mehra
- 3 Medical Directorate, University Hospital Zurich , Zurich , Switzerland
| | - Konstantin Nikolaou
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Gerd Grözinger
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen , Tuebingen , Germany
| |
Collapse
|
|
36
|
Abstract
Non-variceal upper gastrointestinal bleeding continues to be an important cause of morbidity and mortality. The most common causes include peptic ulcer disease, Mallory-Weiss syndrome, erosive gastritis, duodenitis, esophagitis, malignancy, angiodysplasias and Dieulafoy's lesion. Initial assessment and early aggressive resuscitation significantly improves outcomes. Upper gastrointestinal endoscopy continues to be the gold standard for diagnosis and treatment. We present a comprehensive review of literature for the evaluation and management of non-variceal upper gastrointestinal bleeding.
Collapse
Affiliation(s)
- Ronald Samuel
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, University of Texas Medical Branch, 7400 Jones Drive, Apt 724, Galveston, TX 77551.
| | - Obada Tayyem
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Praveen Guturu
- Division of Gastroenterology & Hepatology, University of Texas Medical Branch, 7400 Jones Drive, Apt 724, Galveston, TX 77551
| |
Collapse
|
|
37
|
Transcatheter arterial embolization for upper gastrointestinal tract bleeding. Wideochir Inne Tech Maloinwazyjne 2017; 12:385-393. [PMID: 29362654 PMCID: PMC5776486 DOI: 10.5114/wiitm.2017.72319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/15/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment. Aim To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality. Material and methods A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization. Results The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01). Conclusions In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.
Collapse
|
|
38
|
Alturki F, Ponette V, Boucher LM. Spontaneous Retroperitoneal Hematomas Following Uncomplicated Vaginal Deliveries: A Case Report and Literature Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:712-715. [PMID: 29274933 DOI: 10.1016/j.jogc.2017.08.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Retroperitoneal hematomas are rare in obstetrics. CASE PRESENTATION A 36-year-old female presented two days following uncomplicated non-traumatic spontaneous vaginal delivery with an acute onset of severe left lower quadrant abdominal pain. The patient was hypotensive, tachycardic, and febrile. The hemoglobin dropped post delivery to 75 g/L. A non-contrast CT scan revealed a retroperitoneal hematoma. MANAGEMENT AND OUTCOME Conservative management approaches resulted in spontaneous remission of the retroperitoneal hematoma.
Collapse
Affiliation(s)
- Faisal Alturki
- Department of Obstetrics and Gynecology, McGill University, Montréal, QC.
| | - Vincent Ponette
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montréal, QC
| | - Louis-Martin Boucher
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montréal, QC
| |
Collapse
|
|
39
|
Martin JG, Miller MJ. Introduction. Tech Vasc Interv Radiol 2017; 20:229. [DOI: 10.1053/j.tvir.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
|
40
|
Ray DM, Srinivasan I, Tang SJ, Vilmann AS, Vilmann P, McCowan TC, Patel AM. Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology. World J Radiol 2017; 9:97-111. [PMID: 28396724 PMCID: PMC5368632 DOI: 10.4329/wjr.v9.i3.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/12/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient’s work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.
Collapse
|
|
41
|
Kickuth R, Hoppe H, Saar B, Inderbitzin D, Triller J, Raessler S, Gschossmann J. Superselective transcatheter arterial embolization in patients with acute peripancreatic bleeding complications: review of 44 cases. Abdom Radiol (NY) 2016; 41:1782-92. [PMID: 27188888 DOI: 10.1007/s00261-016-0772-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) in the treatment of acute peripancreatic bleeding complications. METHODS During a 9-year period, 44 patients with acute bleeding of the peripancreatic arteries underwent TAE in our institution. Thirty-eight patients were treated using microcatheters and 6 patients with a diagnostic catheter. Embolic agents included coils (n = 38), polyvinyl alcohol (PVA) particles (n = 2), isobutyl cyanoacrylate (n = 2), coils plus PVA particles (n = 1), and coils plus isobutyl cyanoacrylate (n = 1). Outcome measures included technical success, clinical success, and the rate of complications. RESULTS Identified bleeding sources included gastroduodenal artery (n = 14), splenic artery (n = 9), pancreaticoduodenal artery (n = 6), common hepatic artery (n = 5), superior mesenteric artery branches (n = 4), proper hepatic artery (n = 3), and dorsal/transverse pancreatic artery (n = 3). Technical success with effective control of active bleeding was achieved in 41/44 patients (93 %). Clinical success attributed to TAE alone was documented in 40/44 patients (91 %). The rate of major complications was 2 % including death in one patient. CONCLUSIONS Superselective TAE allows effective, minimally invasive control of acute peripancreatic bleeding complications with a low rate of therapeutically relevant complications.
Collapse
|
|
42
|
Farouk O, Elbasuony W, Elbohouty A. Uterine artery embolization versus surgical management in primary atonic postpartum hemorrhage: A randomized clinical trial. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
|
43
|
Outcomes and complications of angioembolization for hepatic trauma: A systematic review of the literature. J Trauma Acute Care Surg 2016; 80:529-37. [PMID: 26670113 DOI: 10.1097/ta.0000000000000942] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The liver is one of the most frequently injured abdominal organs. Hepatic hemorrhage is a complex and challenging complication following hepatic trauma. Significant shifts in the treatment of hepatic hemorrhage, including the increasing use of angioembolization, are believed to have improved patient outcomes. We aimed to describe the efficacy of angioembolization in the setting of acute hepatic arterial hemorrhage as well as the complications associated with this treatment modality. METHODS A systematic review of published literature (MEDLINE, SCOPUS, and Cochrane Library) describing hepatic angioembolization in the setting of trauma was performed. Articles that fulfilled the predetermined inclusion and exclusion criteria were included. We analyzed the efficacy rate of angioembolization in the setting of traumatic hepatic hemorrhage as well as the complications associated with hepatic angioembolization. RESULTS Four hundred fifty-nine articles were identified in the literature search. Of these, 10 retrospective studies and 1 prospective study met inclusion and exclusion criteria. Efficacy rate of angioembolization was 93%. The most frequently reported complications following hepatic angioembolization included hepatic necrosis (15%), abscess formation (7.5%), and bile leaks. CONCLUSION Although the outcomes of hepatic angioembolization were generally favorable with a high success rate, the treatment modality is not without associated morbidity. The most frequently associated major complication was hepatic necrosis. Rates of complications were affected by study heterogeneity and should be better defined in future studies. LEVEL OF EVIDENCE Systematic review, level III.
Collapse
|
|
44
|
Jones JP, Sima M, O’Hara RG, Stewart RJ. Water-Borne Endovascular Embolics Inspired by the Undersea Adhesive of Marine Sandcastle Worms. Adv Healthc Mater 2016; 5:795-801. [PMID: 26806763 PMCID: PMC5703062 DOI: 10.1002/adhm.201500825] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/30/2015] [Indexed: 12/23/2022]
Abstract
Transcatheter embolization is used to treat vascular malformations and defects, to control bleeding, and to selectively block blood supply to tissues. Liquid embolics are used for small vessel embolization that require distal penetration. Current liquid embolic agents have serious drawbacks, mostly centered around poor handling characteristics and toxicity. In this work, a water-borne in situ setting liquid embolic agent is described that is based on electrostatically condensed, oppositely charged polyelectrolytes-complex coacervates. At high ionic strengths, the embolic coacervates are injectable fluids that can be delivered through long narrow microcatheters. At physiological ionic strength, the embolic coacervates transition into a nonflowing solid morphology. Transcatheter embolization of rabbit renal arteries demonstrated capillary level penetration, homogeneous occlusion, and 100% devascularization of the kidney, without the embolic crossing into venous circulation. The benign water-borne composition and setting mechanism avoids many of the problems of current liquid embolics, and provides precise temporal and spatial control during endovascular embolization.
Collapse
Affiliation(s)
- Joshua P. Jones
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112
| | - Monika Sima
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112
| | - Ryan G. O’Hara
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT 84112
| | - Russell J. Stewart
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112
| |
Collapse
|
|
45
|
Abusedera M, Ramzen M, Ebrahim W. Predictors of positive angiography and evaluation of the outcome of transcatheter control of non variceal upper gastrointestinal hemorrhage. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
|
46
|
Loffroy R, Favelier S, Pottecher P, Estivalet L, Genson P, Gehin S, Cercueil J, Krausé D. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging 2015; 96:731-44. [DOI: 10.1016/j.diii.2015.05.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/06/2015] [Indexed: 02/08/2023]
|
|
47
|
Abstract
The evolution of modern interventional radiology began over half century ago with a simple question. Was it possible to use the same diagnostic imaging tools that had revolutionized the practice of medicine to guide the real-time treatment of disease? This disruptive concept led to rapid treatment advances in every organ system of the body. It became clear that by utilizing imaging some patients could undergo targeted procedures, eliminating the need for major surgery, while others could undergo procedures for previously unsolvable problems. The breadth of these changes now encompasses all of medicine and has forever changed the way we think about disease. In this brief review article, major advances in the field, as chronicled in the pages of Radiology, will be described.
Collapse
Affiliation(s)
- Richard A Baum
- From the Department of Interventional Radiology, Brigham and Women's Hospital, Boston, Mass (R.A.B.); and Department of Radiology, University of Pennsylvania, 3600 Market St, Suite 370, Philadelphia, PA 19104 (S.B.)
| | | |
Collapse
|
|
48
|
Slovenian experience from diagnostic angiography to interventional radiology. Radiol Oncol 2014; 48:416-25. [PMID: 25435857 PMCID: PMC4230564 DOI: 10.2478/raon-2014-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/25/2013] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of writing this article is to document the important events and people in the first 50 years of diagnostic angiography and interventional radiology in Slovenia. During this period not only did the name of the institutions and departments change, but also its governance. Conclusions This depicted the important roles different people played at various times in the cardiovascular divisions inside and outside of the diagnostic and interventional radiology. Historical data show that Slovenian radiology has relatively immediately introduced the new methods of interventional radiology in clinical practice.
Collapse
|
|
49
|
Nanavati SM. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am 2014; 43:739-52. [PMID: 25440922 DOI: 10.1016/j.gtc.2014.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Since the 1960s, interventional radiology has played a role in the management of gastrointestinal bleeding. What began primarily as a diagnostic modality has evolved into much more of a therapeutic tool. And although the frequency of gastrointestinal bleeding has diminished thanks to management by pharmacologic and endoscopic methods, the need for additional invasive interventions still exists. Transcatheter angiography and intervention is a fundamental step in the algorithm for the treatment of gastrointestinal bleeding.
Collapse
Affiliation(s)
- Sujal M Nanavati
- Interventional Radiology, Department of Radiology and Biomedical Imaging, UCSF, 1001 Potrero Avenue, Rm. 1x55, San Francisco, CA 94110, USA.
| |
Collapse
|
|
50
|
Sorkin GC, Dumont TM, Eller JL, Mokin M, Snyder KV, Levy EI, Siddiqui AH, Hopkins LN. Cerebrovascular neurosurgery in evolution: the endovascular paradigm. Neurosurgery 2014; 74 Suppl 1:S191-7. [PMID: 24402487 DOI: 10.1227/neu.0000000000000222] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Endovascular technique represents an important, minimally invasive approach to treating cerebrovascular disease. In this article, we discuss the origins of endovascular neurosurgery as a discipline in the context of important technical milestones, evidence-based medicine, and future cerebrovascular neurosurgical training. Cerebrovascular neurosurgery has seen a steady, convergent evolution toward the surgeon capable of seamless incorporation of open and endovascular approaches to any complex vascular disease affecting the central nervous system. Neurosurgery must assume the leadership role in the multidisciplinary neurovascular team.
Collapse
Affiliation(s)
- Grant C Sorkin
- Departments of *Neurosurgery, §Radiology, and ¶Neurology, School of Medicine and Biomedical Sciences, and ‖Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York; ‡Department of Neurosurgery, Gates Vascular Institute, Kaleida Health Buffalo, New York; #Jacobs Institute, Buffalo, New York
| | | | | | | | | | | | | | | |
Collapse
|