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PURPOSE: Rectum sheath hematoma (RSH) is a rare and often misdiagnosed disease. We aimed to determine outcomes of patients affected by RSH and identify variables associated with the need of prompt intervention. METHODS: Patients diagnosed with RSH during the period 2012-2020 were retrospectively identified. Demographics, diagnostic, and therapeutic variables were evaluated. RSH was classified with computed tomography (CT) according to the Berna system. An artificial neural network (ANN) model including 12 variables was used to identify patients that might require a prompt endovascular or surgical treatment. RESULTS: A total of 20 patients were included for analysis; mean age was 69 (35-98) years and 14 (70%) were females. Iatrogenic injury and forceful contraction of the abdominal wall were the leading causes of RSH. Eleven (55%) patients were anticoagulated or antiaggregated. There were 3 (15%) grade 1, 5 (25%) grade 2, and 12 (60%) grade 3 RSH; 6 (30%) were treated conservatively, 10 (50%) with artery embolization, and 4 (20%) with surgery. Overall morbidity was 45% and there was no mortality in the series. According to the ANN, patients at high risk of requiring an invasive treatment were those with active extravasation on CT angiography, Berna grade III, age ≥ 65 years, hemodynamic instability, chronic use of corticosteroids, hematoma volume ≥ 1000 mL, and/or transfusion of ≥ 4 units of red blood cells. CONCLUSION: Conservative treatment might be effective in selected patients with RSH. Our artificial neural network analysis might help selecting patients who require endovascular or surgical treatment.

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OBJECTIVE: To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rezum); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. RESULTS: We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (3-month) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. CONCLUSIONS: Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short-term follow-up.

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Primary or secondary bone tumors can manifest in different ways, from simple bone pain to possible pathological fractures. Hypervascularized tumors are of greatest concern, with increased incidence of complications. Preoperative embolization of the bone tumor is an effective measure for reducing blood loss during open surgery to excise the tumor. With appropriate experience, the risks of the procedure are minimal and final outcomes are highly satisfactory. The purpose of this paper is to describe the case of a 43-year-old male patient with a metastatic renal cell tumor in the left proximal femur (seen on lower limb computed tomography) who underwent selective preoperative embolization. The procedure resulted in a remarkable absence of bleeding and successful response to subsequent onco-orthopedic surgery.

Os tumores ósseos, primários ou secundários, podem se manifestar de várias formas, desde dor óssea até fraturas patológicas. A preocupação maior repousa sobre tumores hipervascularizados, com maior incidência de complicações. A embolização pré-operatória do tumor ósseo é uma medida eficaz para reduzir a perda sanguínea durante a exérese tumoral em cirurgia aberta. Com uma experiência apropriada, os riscos do procedimento são mínimos, com resultados finais bastante satisfatórios. O presente artigo tem por finalidade descrever o caso de um paciente do sexo masculino, de 43 anos, com tumor metastático de células renais em fêmur proximal esquerdo (visualizado por angiotomografia de membro inferior), submetido à embolização arterial seletiva pré-operatória. O procedimento resultou em ausência de sangramento e ótima resposta à cirurgia onco-ortopédica realizada.

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PURPOSE: An increasing number of polytraumatized patient presenting with active abdominal pelvic bleeding (APB) have been treated by endovascular selective embolization. However, reports on evaluate the efficacy, safety and complications caused by this technique have been limited. The aim of this study was to assess the safety and efficacy of embolization of APB using N-butyl cyanoacrylate glue (NBCA). MATERIALS AND METHODS: Single center retrospective study, that included consecutive 47 patients presenting with traumatic APB treated by embolization with NBCA between January 2013 and June 2019. The efficacy endpoint was defined as the absence of contrast extravasation immediately after procedure and clinical stabilization in the following 24 h after procedure. Clinical stabilization was defined as no rebleeding after embolization or the need for a surgical approach until the patient is discharged. Safety endpoint were any technical or clinical complications related to the embolization procedure. RESULTS: The mean age of patients was 38.6 years (3-81), with a predominance of males (87.2%). The major causal factor of APB being involvement in a car accident, accounting for 68% of cases. Of the 47 cases, 29.8% presented pelvic trauma and the remaining (70.2%) presented abdominal trauma. The efficacy rate was 100%, while no complications related to the procedure were observed. The mortality rate was 14.8% (7/47) due to neurologic decompensation and other clinical causes. CONCLUSION: Endovascular embolization of traumatic abdominopelvic bleedings appear to be a highly safe and effective treatment, while avoiding emergent exploratory open surgeries.

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Abstract Primary or secondary bone tumors can manifest in different ways, from simple bone pain to possible pathological fractures. Hypervascularized tumors are of greatest concern, with increased incidence of complications. Preoperative embolization of the bone tumor is an effective measure for reducing blood loss during open surgery to excise the tumor. With appropriate experience, the risks of the procedure are minimal and final outcomes are highly satisfactory. The purpose of this paper is to describe the case of a 43-year-old male patient with a metastatic renal cell tumor in the left proximal femur (seen on lower limb computed tomography) who underwent selective preoperative embolization. The procedure resulted in a remarkable absence of bleeding and successful response to subsequent onco-orthopedic surgery.

Resumo Os tumores ósseos, primários ou secundários, podem se manifestar de várias formas, desde dor óssea até fraturas patológicas. A preocupação maior repousa sobre tumores hipervascularizados, com maior incidência de complicações. A embolização pré-operatória do tumor ósseo é uma medida eficaz para reduzir a perda sanguínea durante a exérese tumoral em cirurgia aberta. Com uma experiência apropriada, os riscos do procedimento são mínimos, com resultados finais bastante satisfatórios. O presente artigo tem por finalidade descrever o caso de um paciente do sexo masculino, de 43 anos, com tumor metastático de células renais em fêmur proximal esquerdo (visualizado por angiotomografia de membro inferior), submetido à embolização arterial seletiva pré-operatória. O procedimento resultou em ausência de sangramento e ótima resposta à cirurgia onco-ortopédica realizada.

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OBJECTIVES: Arterial embolization of myomas (AEM) is controversial because of the changes that occur in the extracellular matrix (ECM) of the endometrium and its effect on gestational success in infertile patients desiring reproductive capability. Therefore, we performed this study on the expression of genes in the ECM of the endometrium, such as those coding metalloproteinases (MMP), before and 6 months after embolization of the uterine arteries. METHODS: Seven women with leiomyomas were evaluated, and MMP3 and MMP10 levels were measured. The women underwent pelvic nuclear magnetic resonance (NMR), examination, and endometrial biopsy between the 20th and 24th day of the menstrual cycle, and pre- and post-AEM (after 6 months). For data analysis, the Cq comparative method, also known as the 2-ΔΔCT method, was used to calculate the relative quantities of MMP gene expression among the samples collected. RESULTS: There was a significant decrease by 9.52 times in the expression of MMP3 (p=0.007), and a non-significant change in the expression of MMP10 (p=0.22) in post-AEM-treated women than pre-AEM-treated women. CONCLUSIONS: The results suggest that ECM continues to undergo tissue remodeling 6 months after AEM, at least with regard to MMP3 expression, suggesting that AEM affects the ECM for at least 6 months after the procedure.

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

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

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PURPOSE: Transcatheter arterial embolization (TAE) has been widely used in treating non-curative hepatocellular carcinoma (HCC). However, it is noticed that TAE may cause invasion of some cancer cells into circulation, resulting in distal metastasis and poor therapeutic outcome. Here, we aimed to reduce the side effects of TAE using the inhibitors for epidermal growth factor receptor (EGFR). METHODS: Transient hepatic artery ligation (HAL) was used as a mouse model for TAE. EGFR inhibitors were applied. Tumor size, presence of tumor cells in circulation, distal tumor formation, and activation of genes associated with tumor cell invasion and metastasis were analyzed. RESULTS: Inhibitors for EGFR significantly reduced the size of primary tumor, presence of tumor cells in circulation, and distal tumor formation after HAL. Further studies showed that EGFR inhibition suppressed several genes associated with tumor cell invasion and metastasis, such as vascular endothelial growth factor-A, stromal cell-derived factor 1, and Slug. CONCLUSION: EGFR inhibitor application may reduce circulating cancer cells during TAE and thus improve the therapy for advanced HCC.

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

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

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OBJECTIVES: Priapism is a persistent erection of the penis not associated with sexual stimulation. High-flow priapism is caused by unregulated arterial inflow, usually preceded by perineal or penile blunt trauma and formation of an arterial-lacunar fistula. We present a case of high-flow priapism in a 13-year-old patient managed with polyvinyl alcohol particles. METHODS: After obtaining informed consent of the parents of the minor, diagnosis was made with penile Color Doppler Ultrasound and confirmed with flush angiography. Selective arterial embolization was performed with the use of polyvinyl alcohol particles. RESULTS: Complete detumescence was achieved without compromising the patient's erectile function. CONCLUSIONS: The use of permanent occlusive agents like polyvinyl alcohol particles for embolization shows good occlusion rates compared to temporary agents. More studies are needed to find the safer and better agent for the treatment of high flow priapism without compromising erectile function.

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

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

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

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

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

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

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Hemobilia é rara e potencialmente fatal. A suspeita de sangramento em trato biliar é maior em casos recentes de trauma hepático ou cirurgia hepatobiliar. Ruptura de pseudoaneurisma de artéria hepática é causa comum de hemobilia. Relatamos 3 casos de hemobilia em indivíduos jovens, acometidos por trauma abdominal, que evoluíram com ruptura de pseudoaneurisma e necessidade de embolização angiográfica de vaso sangrante.

Hemobilia is rare and potentially fatal. Suspect bleeding in the biliary tract is higher in recent cases of liver trauma or hepatobiliary surgery. Rupture of hepatic artery pseudoaneurysm is a common cause of hemobilia. We report 3 cases of hemobilia in young individuals suffering from abdominal trauma, who developed pseudoaneurysm rupture and need for angiographic embolization of bleeding vessel.

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Hemangiomas hepáticos gigantes são incomuns no fígado. Sexo feminino e uso prolongado de anticoncepcionais orais têm sido associados com alto risco de desenvolvimento de hemangiomas. Ruptura de hemangioma é extremamente rara, grave e requer intervenção cirúrgica. Embolização arterial transcateter pode ser utilizada antes da cirurgia para controle do sangramento e redução do volume do hemangioma, facilitando a hepatectomia. Relatamos um caso de mulher de meia-idade em uso crônico de anticoncepcionais orais, com ruptura espontânea de duplo hemangioma hepático gigante.

Giant hepatic hemangiomas are uncommon in the liver. Female and prolonged use of oral contraceptives have been associated with a high risk of developing hemangiomas. Rupture of hemangioma is extremely rare, serious and requires surgical intervention. Transcatheter arterial embolization may be used before surgery to control bleeding and reducing the volume of the hemangioma, facilitating hepatectomy. We report a case of a middle-aged woman with chronic use of oral contraceptives and spontaneous rupture of double giant hepatic hemangioma.

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

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

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Introducción: El fibroangioma juvenil es un tumor vascular que afecta casi exclusivamente la nasofaringe de adolescentes de sexo masculino. Su manejo es complejo dada su naturaleza vascular y sus frecuentes recurrencias. Objetivo: Mostrar la experiencia de 12 años en fibroangioma juvenil Material y método: Estudio descriptivo retrospectivo de los pacientes que ingresaron con diagnóstico de fibroangioma nasofaríngeo juvenil al Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile entre los años 1996 y 2008, caracterizando al grupo de estudio en cuanto a clínica, diagnóstico, manejo terapéutico, complicaciones y recurrencias. Resultados: Se obtuvo un total de 22 pacientes, todos de sexo masculino, con un promedio de edad de 17,7 años. El síntoma de presentación más frecuente fue la epistaxis a repetición presente en el 81,8 por ciento de los casos. Todos los pacientes se estudiaron con tomografia computarizada y recibieron embolización arterial preoperatoria. La mayoría de los tumores fueron de tipo IIByllC (68,1 por ciento) según Radkowski y la técnica quirúrgica más empleada fue la endoscópica (54,5 por ciento). Hubo sólo una complicación mayor, pero derivada del procedimiento de embolización y no de la cirugía propiamente tal. Se encontró 22,7 por ciento de recurrencias (n =5, todas endoscópicas), con un tiempo libre de enfermedad de 8,2 meses promedio. Discusión y conclusión: Nuestros resultados concuerdan con la gran mayoría de las series publicadas en la literatura. La decisión terapéutica se basa en la determinación del tamaño tumoral y su extensión, prefiriendo inicialmente un abordaje endoscópico por su carácter poco invasivo y por presentar menor sangrado, tiempo quirúrgico y estadía hospitalaria; siempre que el estadio tumoral lo permita. La embolización arterial, independiente de la vía de abordaje, debe ser de rutina.

Introduction: Juvenile nasopharyngeal angiofibroma is a vascular tumor that occurs almost exclusively in the nasopharynx of adolescent males. Its management is complex because of its vascular nature and frequent recurrence. Aim: To review the experience of 12 years in juvenile nasopharyngeal angiofibroma. Material and method: Retrospective study of patients admitted with diagnosis of juvenile nasopharyngeal angiofibroma at the Otorhinolaryngology Department, University of Chile Clinical Hospital, between 1996 and 2008, characterizing the study group in terms of clinical features, diagnosis, treatment, complications and recurrences. Results: We obtained 22 patients, all male, with an average age of 17.7 years. The most common presenting symptom was recurrent epitasis, present in up to 81.8 percent of cases. All patients were studied with computed tomography and received preoperative arterial embolization. Most tumors were type IIB and C (68.1 percent) and the endoscopic surgical technique was predominant. There was only one major complication, but derived from the embolization procedure and not the surgery itself. There was a 22.7 percent recurrence, with disease-free time of 8.2 months on average. Discussion and Conclusion: Our results agree with most of the series published in the literature. The therapeutic decision is based on the determination of tumor size and extension, preferring an initial endoscopic approach, for its minimally invasive nature and because they present less bleeding, surgical time and hospital stay if the tumor stage allows. Arterial embolization, regardless of the surgical approach, should be routine.

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BACKGROUND: Intractable epistaxis is treated by ipsilateral trans-arterial embolization of the internal maxillary artery, but there is 13-26% recurrence of bleeding. Preemptive embolization of both internal maxillary arteries along with the ipsilateral facial artery could provide maximal protection against recurrent epistaxis. We report our experience with 8 patients treated with bilateral tri-arterial embolization. METHODS: We performed a retrospective review of the patients who were treated with bilateral internal maxillary artery and ipsilateral facial artery embolization from January 2005 to January 2007. All patients had bleeding that was refractory to nasal packing. RESULTS: Eight patients were treated with bilateral tri-arterial embolization. The median age was 65 years (range, 35-90 years). Risk factors included hypertension (n=4), smoking (n=2), alcohol (n=2), and use of anticoagulation (n=2). All but 2 of the patients were treated under local anesthesia. All patients had complete obliteration of bleeding during the procedure, with no residual vascular blush. No major peri- or post-procedural complications were noted. Patients stayed in the hospital for 2-4 days (average 2.6 days). One patient developed ipsilateral temporofacial pain which resolved during hospitalization. Another patient had minor recurrent epistaxis on post operative day 2 which resolved with temporary repacking and the patient was discharged the next day. CONCLUSION: In our experience with 8 cases, bilateral internal maxillary artery and/or ipsilateral facial artery embolization was achieved without complication and was associated with complete obliteration of vascular blush and no significant recurrent epistaxis.