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Enbucrilato , Hemorragia Gastrointestinal , Adhesivos Tisulares , Várices , Humanos , Enbucrilato/administración & dosificación , Enbucrilato/efectos adversos , Várices/terapia , Várices/complicaciones , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Adhesivos Tisulares/administración & dosificación , Recto/irrigación sanguínea , Masculino , Hemostasis Endoscópica/métodos , Persona de Mediana Edad , Femenino , Colonoscopía/métodosRESUMEN
OBJECTIVE: A type 2 endoleak (T2EL) is the most frequently occurring endoleak type after endovascular aneurysm repair (EVAR). Residual T2ELs may cause aneurysm rupture; however, the management of a T2EL remains controversial. This study evaluated sac branch preemptive embolization using N-butyl-2-cyanoacrylate, aiming to prevent T2ELs and sac shrinkage. METHODS: Twelve consecutive patients underwent elective preemptive embolization during EVAR at our hospital between August 2018 to March 2019. Their demographic information, operative details, and sac diameters were examined at 6 months after EVAR. RESULTS: No procedural complications were observed. There were no in-hospital deaths among the 12 patients. Sac shrinkage was observed in this cohort (53.8-52.1 mm, p = 0.01). A total of 33 lumbar arteries were occluded with this procedure, and 2 patients had residual T2ELs at 6 months. CONCLUSIONS: A T2EL in preemptive sac branch embolization during EVAR has advantages in terms of safety and reduction. Although no clear evidence is available for the management of T2ELs, this study proposes a new standard to prevent it and improve the long-term outcomes after EVAR. However, embolization remains imperfect and further research is necessary.
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Aneurisma de la Aorta Abdominal , Embolización Terapéutica , Enbucrilato , Endofuga , Procedimientos Endovasculares , Humanos , Embolización Terapéutica/métodos , Enbucrilato/administración & dosificación , Procedimientos Endovasculares/métodos , Masculino , Femenino , Anciano , Endofuga/prevención & control , Endofuga/etiología , Anciano de 80 o más Años , Resultado del Tratamiento , Aneurisma de la Aorta Abdominal/cirugía , Reparación Endovascular de AneurismasRESUMEN
Percutaneous transhepatic lymphatic embolization (PTLE) and peroral esophagogastroduodenoscopy (EGD) duodenal mucosal radiofrequency (RF) ablation were performed to manage protein-losing enteropathy (PLE) in patients with congenital heart disease. Five procedures were performed in 4 patients (3 men and 1 woman; median age, 49 years; range, 31-71 years). Transhepatic lymphangiography demonstrated abnormal periduodenal lymphatic channels. After methylene blue injection through transhepatic access, subsequent EGD evaluation showed methylene blue extravasation at various sites in the duodenal mucosa. Endoscopic RF ablation of the leakage sites followed by PTLE using 3:1 ethiodized oil-to-n-butyl cyanoacrylate glue ratio resulted in improved symptoms and serum albumin levels (before procedure, 2.6 g/dL [SD ± 0.2]; after procedure, 3.5 g/dL [SD ± 0.4]; P = .004) over a median follow-up of 16 months (range, 5-20 months). Transhepatic lymphangiography and methylene blue injection with EGD evaluation of the duodenal mucosa can help diagnose PLE. Combined PTLE and EGD-RF ablation is an option to treat patients with PLE.
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Duodeno , Embolización Terapéutica , Mucosa Intestinal , Linfografía , Enteropatías Perdedoras de Proteínas , Humanos , Enteropatías Perdedoras de Proteínas/terapia , Enteropatías Perdedoras de Proteínas/etiología , Enteropatías Perdedoras de Proteínas/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Resultado del Tratamiento , Duodeno/diagnóstico por imagen , Duodeno/irrigación sanguínea , Mucosa Intestinal/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/terapia , Enbucrilato/administración & dosificación , Ablación por Radiofrecuencia , Aceite Etiodizado/administración & dosificación , Endoscopía del Sistema Digestivo , Terapia Combinada , Azul de Metileno/administración & dosificación , Vasos Linfáticos/diagnóstico por imagenRESUMEN
BACKGROUND: Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual, difficult to treat, and often fatal manifestation of portal hypertension. So far, no treatment guidelines have been established. CASE SUMMARY: We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death. CONCLUSION: We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
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Coledocostomía , Hemorragia Gastrointestinal , Yeyuno , Escleroterapia , Várices , Humanos , Masculino , Várices/terapia , Várices/cirugía , Coledocostomía/métodos , Coledocostomía/efectos adversos , Escleroterapia/métodos , Escleroterapia/efectos adversos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/diagnóstico , Yeyuno/cirugía , Yeyuno/irrigación sanguínea , Persona de Mediana Edad , Resultado del Tratamiento , Femenino , Anciano , Enbucrilato/administración & dosificación , Enbucrilato/efectos adversos , Hipertensión Portal/cirugía , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico , Soluciones Esclerosantes/administración & dosificación , Soluciones Esclerosantes/efectos adversos , Polidocanol/administración & dosificación , Polidocanol/uso terapéutico , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/métodos , Endoscopía Gastrointestinal/métodosAsunto(s)
Aneurisma Falso , Embolización Terapéutica , Enbucrilato , Humanos , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/instrumentación , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Enbucrilato/administración & dosificación , Enbucrilato/efectos adversos , Resultado del Tratamiento , Masculino , Factores de Tiempo , Femenino , Remoción de Dispositivos , Persona de Mediana EdadRESUMEN
PURPOSE: To investigate the safety and efficacy of microballoon-occluded transcatheter embolization using n-butyl-2-cyanoacrylate (NBCA) in patients with a single pulmonary arteriovenous malformation (PAVM). METHODS: From November 2017 to November 2020, this retrospective study included 38 previously untreated patients with a single PAVM who underwent microballoon-occluded transcatheter embolization using NBCA. All 38 patients had follow-up that included simple chest radiography and contrast-enhanced chest computed tomography (CT). RESULTS: A microballoon was successfully placed in a feeding artery of the PAVM to control the delivery of the NBCA cast in all 38 patients, with complete embolization of sacs and the feeding artery achieved in all cases. The mean diameters of the feeding artery, sac, and draining vein were 3.9 ± 0.9 mm, 7.5 ± 2.6 mm, and 4.6 ± 1.3 mm, respectively. A fixed 1:2 NBCA/Lipiodol ratio was used, and the mean amount of embolic mixture per patient was 1.4 mL (range 0.6-2.2 mL). There were no complications related to microballoon adhesion and non-target embolization of the systemic circulation. Follow-up CT in all 38 patients with a mean delay of 34.5 ± 8.8 months (range 20.7-56.5 months) showed no continued perfusion of the PAVM. CONCLUSION: In our hands, microballoon-occluded n-butyl-2-cyanoacrylate embolization seemed to be safe and appeared to be clinically effective in patients with simple and complex types of single PAVM. Therefore, the present technique has the potential to become a standard treatment for a single PAVM.
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Malformaciones Arteriovenosas , Embolización Terapéutica , Enbucrilato , Arteria Pulmonar , Venas Pulmonares , Humanos , Masculino , Femenino , Enbucrilato/uso terapéutico , Enbucrilato/administración & dosificación , Estudios Retrospectivos , Embolización Terapéutica/métodos , Adulto , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/anomalías , Persona de Mediana Edad , Venas Pulmonares/anomalías , Venas Pulmonares/diagnóstico por imagen , Malformaciones Arteriovenosas/terapia , Malformaciones Arteriovenosas/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven , Adolescente , Anciano , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Gastrointestinal tumors bleeding remains a significantly clinical challenge due to its resistance to conventional endoscopic hemostasis methods. While the efficacy of endoscopic tissue adhesives (ETA) in variceal bleeding has been established, its role in gastrointestinal tumor bleeding (GITB) remains ambiguous. AIMS: This study aims to assess the feasibility and effectiveness of ETA in the treatment of GITB. METHODS: The study enrolled 30 patients with GITB who underwent hemostasis through Histoacryl® tissue glue injection. Hemostasis success rates, ETA-related adverse events, and re-bleeding rates were evaluated. RESULTS: ETA application achieved successful hemostasis at all tumor bleeding sites, with immediate hemostasis observed in all 30 (100.0%) patients. Among the initially hemostasis cases, 5 patients (17.0%) experienced re-bleeding within 30 days, and the 60 day re-bleeding rate was 20.0% (6/30). Expect for one case of vascular embolism, no adverse events related with ETA application were reported. The 6 month survival was 93%. CONCLUSION: ETA demonstrated excellent immediate hemostasis success rate in GITB cases and showed promising outcomes in prevention re-bleeding.
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Hemorragia Gastrointestinal , Neoplasias Gastrointestinales , Hemostasis Endoscópica , Adhesivos Tisulares , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adhesivos Tisulares/uso terapéutico , Adhesivos Tisulares/administración & dosificación , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Neoplasias Gastrointestinales/complicaciones , Hemostasis Endoscópica/métodos , Adulto , Resultado del Tratamiento , Enbucrilato/administración & dosificación , Anciano de 80 o más Años , Estudios de Factibilidad , Estudios RetrospectivosRESUMEN
PURPOSE: To assess the different adjunctive catheter techniques required to achieve complete occlusion of renal arteriovenous malformations (rAVMs) of different angioarchitectural types. MATERIALS AND METHODS: Overall, data on 18 patients with rAVM (Type 1, n = 7; Type 2, n = 2; Type 3, n = 9; mean age, 53.8 years) who underwent 25 procedures between 2011 and 2022 were reviewed. The clinical presentations, endovascular techniques, arteriovenous malformation (AVM) occlusion rate, adverse events (including the incidence of renal infarction), and clinical symptoms and outcomes (including recurrence/increase of AVM) were analyzed according to the Cho-Do angioarchitectural classification. Posttreatment renal infarction was classified as no infarction, small infarction (<12.5%), medium infarction (12.5%-25%), and large infarction (>25%) using contrast-enhanced computed tomography or magnetic resonance imaging. RESULTS: Hematuria and heart failure were presenting symptoms in 10 and 2 patients, respectively. The embolic materials used were as follows: Type 1 rAVM, coils alone or with n-butyl-2-cyanoacrylate (nBCA); Type 2 rAVM, nBCA alone or with coils; and Type 3 rAVMs, nBCA alone. Fourteen patients underwent adjunctive catheter techniques, including flow control with a balloon catheter and multiple microcatheter placement, alone or in combination. Immediate postprocedural angiography revealed complete occlusion in 15 patients (83%) and marked regression of rAVM in 3 (17%). Small asymptomatic renal infarctions were observed in 6 patients with Type 3 rAVMs without any decrease in renal function. No major adverse events were observed. All symptomatic patients experienced symptom resolution. Recurrence/increase of rAVM was not observed during the mean 32-month follow-up period (range, 2-120 months). CONCLUSIONS: Transarterial embolization using adjunctive catheter techniques according to angioarchitectural types can be an effective treatment for rAVMs.
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Malformaciones Arteriovenosas , Embolización Terapéutica , Arteria Renal , Venas Renales , Humanos , Persona de Mediana Edad , Femenino , Masculino , Embolización Terapéutica/efectos adversos , Malformaciones Arteriovenosas/terapia , Malformaciones Arteriovenosas/diagnóstico por imagen , Resultado del Tratamiento , Adulto , Estudios Retrospectivos , Anciano , Arteria Renal/diagnóstico por imagen , Arteria Renal/anomalías , Venas Renales/diagnóstico por imagen , Venas Renales/anomalías , Angiografía por Tomografía Computarizada , Valor Predictivo de las Pruebas , Recurrencia , Factores de Tiempo , Adulto Joven , Factores de Riesgo , Enbucrilato/administración & dosificación , Infarto/diagnóstico por imagen , Infarto/etiología , Infarto/terapia , Angiografía por Resonancia MagnéticaRESUMEN
PURPOSE: To evaluate midterm results of whether the strategy to occlude target lumbar arteries using n-butyl-2-cyanoacrylate (nBCA) injection during endovascular aneurysm repair (EVAR) reduced the incidence of Type II endoleak (T2EL) after EVAR. MATERIALS AND METHODS: Between 2013 and 2020, 187 patients underwent EVAR; 106 in the treatment group received nBCA injection during EVAR, whereas 81 in the historical control group did not. The incidence of T2EL at 7 days, need for reintervention, and post-EVAR aneurysmal shrinkage were compared between the groups. RESULTS: Between the treatment group and the control group, significant differences were achieved in the incidence of T2EL (2.8% vs 28.4%; P < .0001) and decreased aneurysmal diameter was observed at 1 year after EVAR (-5.2 vs -3.8 mm; P = .034). In multivariate analysis, nBCA injection (odds ratio [OR], 0.04; P = .001) and younger age (OR, 0.92; P = .036) were significantly associated with a reduced incidence of T2EL. As a possible adverse event associated with nBCA injection, 2 cases of transient lower-limb motor dysfunction (1.9%) were observed. Propensity score analysis revealed that the treatment group had a significantly lower incidence of T2EL than that in the control group (P = .0002) even though there was no difference in the incidence of inferior mesenteric artery coil embolization between the groups. The survival rate without aneurysm sac enlargement (100.0% vs 69.8%; P = .014) and the reintervention-free rate (100.0% vs 63.1%; P = .034) in the treatment group were significantly higher than those in the control group. CONCLUSIONS: Concomitant nBCA injection can provide durable EVAR without T2EL, as supported by the avoidance of reintervention associated with aneurysm sac enlargement.
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Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Enbucrilato , Endofuga , Reparación Endovascular de Aneurismas , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversos , Embolización Terapéutica/efectos adversos , Enbucrilato/administración & dosificación , Enbucrilato/efectos adversos , Endofuga/etiología , Endofuga/prevención & control , Inyecciones Intraarteriales , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia. PURPOSE: To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia. MATERIAL AND METHODS: Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients' baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed. RESULTS: Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3-24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications. CONCLUSION: NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.
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Embolización Terapéutica/métodos , Enbucrilato/administración & dosificación , Hemobilia/terapia , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Catéteres , Embolización Terapéutica/efectos adversos , Enbucrilato/efectos adversos , Aceite Etiodizado/administración & dosificación , Femenino , Hemobilia/diagnóstico por imagen , Hemobilia/etiología , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/lesiones , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents , Resultado del TratamientoRESUMEN
Several transport vectors, including nanoparticles, have been reported to be used for the delivery of therapeutic medicines crossing the impermeable blood-brain barrier (BBB) to treat the diseases in the central nerve system (CNS), such as traumatic brain injury (TBI). Poly(n-butyl-2-cyanoacrylate) (PBCA) nanoparticles, made from biocompatible material, are regarded as a better potential delivery tool than others such as gold nanoparticles due to their degradabilityin vivo. However, little is known whether PBCA nanoparticles can be used to deliver neurotrophic factors into the brain to treat TBI. In this study, we first synthesized PBCA-carriedß-nerve growth factor, a neurotrophic agent with a large molecular weight, and then intravenously injected the compound into TBI rats. We found that despite undergoing several synthesis steps and host circulation,ß-NGF was able to be successfully delivered into the injured brain by PBCA nanoparticles, still maintain its neurotrophic activity for neurite outgrowth, and reduce the mortality of TBI rats. Our findings indicate that PBCA nanoparticles, with Tween 80, are an efficient delivery vector and a protective reservoir for large molecular therapeutic agents to treat TBI intravenously.
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Lesiones Traumáticas del Encéfalo/tratamiento farmacológico , Sistemas de Liberación de Medicamentos , Enbucrilato/administración & dosificación , Nanopartículas/administración & dosificación , Factor de Crecimiento Nervioso/administración & dosificación , Proyección Neuronal/efectos de los fármacos , Animales , Células Cultivadas , Enbucrilato/química , Masculino , Nanopartículas/química , Células PC12 , Ratas , Ratas Sprague-DawleyAsunto(s)
Embolización Terapéutica/métodos , Enbucrilato/administración & dosificación , Procedimientos Endovasculares/métodos , Ovario/irrigación sanguínea , Ovario/cirugía , Dolor Pélvico/terapia , Femenino , Humanos , Dolor Pélvico/diagnóstico por imagen , Estudios Prospectivos , Síndrome , Útero/irrigación sanguínea , Várices/terapiaRESUMEN
Although the use of topical skin adhesives has increased as an alternative to conventional skin closure methods, studies on the incidence and risk factors of allergic contact dermatitis (ACD) to topical skin adhesives have been limited. The purpose of this study was to investigate the incidence and risk factors of ACD after the use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. We retrospectively reviewed 1145 patients (739 patients with 2-octyl cyanoacrylate and 406 patients with n-butyl cyanoacrylate) who underwent skin closure with topical skin adhesives. Variables suspected to correlate with ACD were retrieved from medical records and analyzed to determine risk factors. The incidence of ACD from the use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives was 2.7% and 2.2%, respectively. There was no statistically significant difference in the incidence between the two ingredients. In logistic regression analysis, none of the variables were found to increase the risk of ACD in both 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. As ACD occurs without risk factors in 2-3% of patients who used 2-octyl cyanoacrylate or n-butyl cyanoacrylate topical skin adhesives, clinicians and patients should be aware of these facts before using topical skin adhesives.
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Cianoacrilatos/efectos adversos , Dermatitis Alérgica por Contacto/epidemiología , Dermatitis Alérgica por Contacto/etiología , Enbucrilato/efectos adversos , Adhesivos Tisulares/efectos adversos , Adulto , Anciano , Cianoacrilatos/administración & dosificación , Dermatitis Alérgica por Contacto/diagnóstico , Susceptibilidad a Enfermedades , Hipersensibilidad a las Drogas/epidemiología , Hipersensibilidad a las Drogas/etiología , Enbucrilato/administración & dosificación , Femenino , Encuestas de Atención de la Salud , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Piel/patología , Adhesivos Tisulares/administración & dosificaciónRESUMEN
OBJECTIVE: The long-term success of endovascular aneurysm repair (EVAR) is limited by complications, most importantly endoleaks. In case of (persistent) type I endoleak (T1EL), secondary intervention is indicated to prevent secondary aneurysm rupture. Different treatment options are suggested for T1ELs, such as endo anchors, (fenestrated) cuffs, embolization, or open conversion. Currently, the treatment of T1EL with liquid embolic agents is available; however, results are not yet addressed. This review presents the safety and efficacy of embolization with liquid embolic agents for treatment of T1ELs after EVAR. METHODS: A systematic literature search was performed for all studies reporting the use of liquid embolic agents as monotherapy for treatment of T1ELs after EVAR. Patient numbers, technical success (successful delivery of liquid embolics in the T1EL) and clinical success (absence of aneurysm related death, endoleak recurrence or additional interventions during follow-up) were examined. RESULTS: Of 1604 articles, 10 studies met the selection criteria, including 194 patients treated with liquid embolics; 73.2% of the patients were male with a median age of 71 years. The overall technical success was 97.9%. Clinical success was 87.6%. Because the median follow-up was only 13.0 months (range, 1-89 months), data on long-term success are almost absent. Four cases (2.1%) of secondary aneurysm rupture after embolization owing to endoleak recurrence were reported. All ruptures occurred in aneurysms exceeding initial treatment diameter of 70 mm. CONCLUSIONS: Initial technical success after liquid embolization for T1EL is high, although long-term clinical success rates are lacking. Within this review, the risk of secondary rupture is comparable with untreated T1EL at 2% with a median follow-up of 13 months, regardless of the initial success of embolization. In general, no decrease in secondary aneurysm rupture after embolization of T1EL after EVAR is demonstrated, although the results of late embolization are debated.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Embolización Terapéutica , Endofuga/terapia , Procedimientos Endovasculares/efectos adversos , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/mortalidad , Dimetilsulfóxido/administración & dosificación , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/mortalidad , Enbucrilato/administración & dosificación , Endofuga/diagnóstico por imagen , Endofuga/etiología , Endofuga/mortalidad , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Masculino , Polivinilos/administración & dosificación , Medición de Riesgo , Factores de Riesgo , Trombina/administración & dosificación , Factores de Tiempo , Resultado del TratamientoRESUMEN
ABSTRACT: There might be a thick "protrusion" in the visceral surface of hepatic quadrate lobe during the laparoscopic cholecystectomy (LC), which affects the surgical fields and consequently triggers high risks of biliary tract injury. Although n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery for liver retraction, there is still no consensus on its safety and feasibility in LC. In this study, we investigated the safety, feasibility, and effectiveness of liver retraction using NBCA glue for these patients which have the thick "protrusion" on the square leaf surface of the liver during LC.Fifty-seven patients presenting thick "protrusion" hepatic quadrate lobe were included in our retrospective study. We performed LC in the presence of NBCA glue (nâ=â30, NBCA group) and absence of NBCA glue (nâ=â27, non-NBCA group), respectively. NBCA was used to fix the thick "protrusion" of the liver leaves to the hepatic viscera surface, which contributed to the revelation of the gallbladder triangle. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the 2 groups.Both the groups' patients accomplished the operation in the laparoscopy. There was no mortality and no additional incision during operation. No severe complications including bile duct injury were available after surgery and no postoperative NBCA-related complications occurred after 9- to 30âmonths' follow-up. The time of operation in NBCA group showed significant decrease compared with that of non-NBCA group (48.33â±â16.15 vs 65.00â±â22.15âminutes, Pâ<â.01). There were no significant differences in blood loss, postoperative hospital stays, and the preoperative and postoperative liver function between the two groups (Pâ>â.05). Besides, no significant differences were noticed in major clinical characteristics between the 2 groups (Pâ>â.05).Liver retraction using NBCA during LC for thick "protrusion" hepatic quadrate lobe patients is safe, effective, and feasible.
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Colecistectomía Laparoscópica/métodos , Enbucrilato/administración & dosificación , Complicaciones Intraoperatorias/prevención & control , Adhesivos Tisulares/administración & dosificación , Adulto , Anciano , Conductos Biliares/lesiones , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Colecistectomía Laparoscópica/efectos adversos , Enbucrilato/efectos adversos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias/etiología , Tiempo de Internación/estadística & datos numéricos , Hígado , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Adhesivos Tisulares/efectos adversos , Resultado del TratamientoRESUMEN
PURPOSE: To compare hepatic hypertrophy in the contralateral lobe achieved by unilobar transarterial radioembolization (TARE) versus portal vein embolization (PVE) in a swine model. METHODS: After an escalation study to determine the optimum dose to achieve hypertrophy after unilobar TARE in 4 animals, 16 pigs were treated by TARE (yttrium-90 resin microspheres) or PVE (lipiodol/n-butyl cyanoacrylate). Liver volume was calculated based on CT before treatment and during 6 months of follow-up. Independent t-test (P < .05) was used to compare hypertrophy. The relationship between hypertrophy after TARE and absorbed dose was calculated using the Pearson correlation. RESULTS: At 2 and 4 weeks after treatment, a significantly higher degree of future liver remnant hypertrophy was observed in the PVE group versus the TARE group, with a median volume gain of 31% (interquartile range [IQR]: 16%-66%) for PVE versus 23% (IQR: 6%-36%) for TARE after 2 weeks and 51% (IQR: 47%-69%) for PVE versus 29% (IQR: 20%-50%) for TARE after 4 weeks. After 3 and 6 months, hypertrophy converged without a statistically significant difference, with a volume gain of 103% (IQR: 86%-119%) for PVE versus 82% (IQR: 70%-96%) for TARE after 3 months and 115% (IQR: 70%-46%) for PVE versus 86% (IQR: 58%-111%) for TARE after 6 months. A strong correlation was observed between radiation dose (median 162 Gy, IQR: 139-175) and hypertrophy. CONCLUSIONS: PVE resulted in rapid hypertrophy within 1 month of the procedure, followed by a plateau, whereas TARE resulted in comparable hypertrophy by 3-6 months. TARE-induced hypertrophy correlated with radiation absorbed dose.
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Embolización Terapéutica , Enbucrilato/administración & dosificación , Aceite Etiodizado/administración & dosificación , Arteria Hepática , Regeneración Hepática , Hígado/irrigación sanguínea , Vena Porta , Radiofármacos/administración & dosificación , Radioisótopos de Itrio/administración & dosificación , Animales , Embolización Terapéutica/efectos adversos , Enbucrilato/toxicidad , Aceite Etiodizado/toxicidad , Femenino , Arteria Hepática/diagnóstico por imagen , Hipertrofia , Inyecciones Intraarteriales , Inyecciones Intravenosas , Hígado/diagnóstico por imagen , Hígado/patología , Modelos Animales , Vena Porta/diagnóstico por imagen , Radiofármacos/efectos adversos , Porcinos , Porcinos Enanos , Factores de Tiempo , Radioisótopos de Itrio/toxicidadRESUMEN
Chyluria is the leakage of intestinal lymph (chyle) into the urine. Novel lymphatic intervention techniques, such as interstitial lymphatic embolization, proved to be a useful treatment option for chyluria. However, one of the challenges of this approach is the difficulty in identifying connections between the lymphatic system and kidney collecting system. Here, embolization of the abnormal lymphatic connection through retrograde thoracic duct access in 3 chyluria patients is introduced.
Asunto(s)
Quilo , Embolización Terapéutica , Enbucrilato/administración & dosificación , Enfermedades Linfáticas/terapia , Conducto Torácico , Adulto , Anciano , Quilo/diagnóstico por imagen , Femenino , Humanos , Enfermedades Linfáticas/diagnóstico por imagen , Enfermedades Linfáticas/orina , Linfografía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Conducto Torácico/diagnóstico por imagen , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
BACKGROUND: Recurrent bleeding from gastroesophageal varices is the most common life-threatening complication of portal hypertension. According to guidelines, transjugular intrahepatic portosystemic shunt (TIPS) should not be used as a first-line treatment and should be limited to those bleedings which are refractory to pharmacologic and endoscopic treatment (ET). To our knowledge, long-term studies evaluating the role of elective TIPS in comparison to ET in patients with recurrent variceal bleeding episodes are rare. PATIENTS AND METHODS: This study was designed as a retrospective single-institution analysis of 70 patients treated with TIPS and 56 with ET. Patients were followed-up from inclusion in the study until death, liver transplantation, the last follow-up observation or until the end of our study. RESULTS: Recurrent variceal bleeding was significantly more frequent in ET group compared to patients TIPS group (66.1% vs. 21.4%, p < 0.001; χ2-test). The incidence of death secondary to recurrent bleeding was higher in the ET group (28.6% vs. 10%). Cumulative survival after 1 year, 2 years and 5 years in TIPS group compared to ET group was 85% vs. 83%, 73% vs. 67% and 41% vs. 35%, respectively. The main cause of death in patients with cumulative survival more than 2 years was liver failure. Median observation time was 47 months (range; 2-194 months) in the TIPS group and 40 months (range; 1-168 months) in the ET group. CONCLUSIONS: In present study TIPS was more effective in the prevention of recurrent variceal bleeding and had lower mortality due to recurrent variceal bleeding compared to ET.
Asunto(s)
Endoscopía/métodos , Várices Esofágicas y Gástricas/complicaciones , Hemorragia Gastrointestinal/prevención & control , Hipertensión Portal/complicaciones , Derivación Portosistémica Intrahepática Transyugular/métodos , Prevención Secundaria/métodos , Causas de Muerte , Enbucrilato/administración & dosificación , Várices Esofágicas y Gástricas/mortalidad , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/mortalidad , Encefalopatía Hepática/epidemiología , Humanos , Fallo Hepático/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Soluciones Esclerosantes/uso terapéutico , StentsAsunto(s)
Angioplastia de Balón/instrumentación , Fístula Bronquial/terapia , Embolización Terapéutica/instrumentación , Enbucrilato/administración & dosificación , Metales , Arteria Pulmonar , Stents , Fístula Vascular/terapia , Anciano , Fístula Bronquial/diagnóstico por imagen , Humanos , Masculino , Diseño de Prótesis , Arteria Pulmonar/diagnóstico por imagen , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagenRESUMEN
RATIONALE: Traumatic arteriovenous fistulas (AVFs) of the pelvis are uncommon and present with a variety of clinical manifestations; their detection may be difficult. An endovascular approach is usually the first choice of treatment, because surgical intervention is complicated due to the location of the lesions. PATIENT CONCERNS: A 68-year-old man was admitted with severe pelvic pain following a fall. DIAGNOSIS: A pelvic bone fracture (Young and Burgess Classification, lateral compression type II) was revealed on pelvic computed tomography (CT), while a pelvic sidewall hematoma, unaccompanied by any vascular injury, was detected on multidetector CT. INTERVENTIONS: Pelvic angiography revealed an AVF between the internal iliac artery and vein, which was undetected by MDCT. The AVF was successfully treated using transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA). OUTCOMES: The patient recovered well and was discharged 4 weeks later. No complications were noted at the 8-month follow-up. LESSONS: AVF may occur as a complication of blunt pelvic bone fracture. A high index of suspicion, angiography, and prompt diagnosis resulted in the successful management of our patient who presented with risk factors. Furthermore, TAE using NBCA enables a minimally invasive and effective treatment of traumatic pelvic AVF.