Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

Abstract Background Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications. Results Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications. Conclusion Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

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Self-Expanding Metallic Stents in Malignant Biliary Obstruction-Patency and Clinical Efficacy: A Prospective Study from North India Tertiary Center

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_52_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 033-038

Author(s):

Ankit Gupta ◽

Gaurav Kumar Gupta ◽

Atul Gawande ◽

Manoj Kumar ◽

Vijyant Tak ◽

...

Keyword(s):

Clinical Efficacy ◽

Biliary Obstruction ◽

Biliary Stricture ◽

Clinical Success ◽

Malignant Biliary Obstruction ◽

Metallic Stent ◽

Technical Success ◽

Sems Placement ◽

Tertiary Center ◽

Hilar Biliary Stricture

ABSTRACT Background and Aims: Endoscopic insertion of self-expandable metallic stent (SEMS) is now accepted as first line modality of treatment for palliation in unresectable extra-hepatic biliary obstructive jaundice. This study was done to assess the clinical efficacy and duration of patency of endoscopically inserted metallic stent in un-resectable malignant biliary obstruction. Materials and Methods: Between 2015 to 2017, 101 patients who underwent ERCP and SEMS placement for palliation of malignant biliary obstruction were included prospectively. Main outcome measures were technical success, clinical success, mean duration of SEMS patency, clinical efficacy, rate of biliary re-intervention and survival of patients. Results: Overall technical success and clinical success was achieved in 93% and 82.2% respectively. Mean duration of SEMS patency was 109 days. Analysis in subgroup of patients classified according to site of obstruction (Hilar -68, Distal CBD-33) showed that median duration of stent patency was significantly better in distal biliary stricture (135 days vs 95 days), whereas re-intervention rates were higher in higher biliary stricture than distal stricture (41% Vs 6%). Seven patients with hilar biliary stricture suffered post-SEMS insertion cholangitis. Conclusion: SEMS placement is feasible palliative method for un-resectable malignant biliary obstruction with acceptable technical and clinical success. The duration of SEMS patency and clinical efficacy is significantly better in distal biliary stricture whereas re-intervention rate is higher in hilar biliary stricture.

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Prolonged international normalized ratio and vascular injury at divisional level predict embolization failures of patients with iatrogenic renal vascular injuries

Scientific Reports ◽

10.1038/s41598-019-53561-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Shen-Yang Lee ◽

Mei-Lin Wang ◽

Yon-Cheong Wong ◽

Cheng-Hsian Wu ◽

Li-Jen Wang

Keyword(s):

Vascular Injury ◽

Clinical Success ◽

Arterial Embolization ◽

International Normalized Ratio ◽

Technical Failure ◽

Clinical Failure ◽

Technical Success ◽

Inadequate Information ◽

Renal Function Deterioration ◽

Renal Vascular

AbstractTranscatheter arterial embolization (TAE), as an alternative to surgery for iatrogenic renal vascular injury (IRVI), may have unsatisfactory outcomes. Nonetheless, there is inadequate information regarding the predictors of TAE outcomes for IRVI in the literature. The aim of this retrospective study was to investigate the predictors of TAE outcomes for IRVI. Of 47 patients, none had major complications, 17 (36.2%) patients had minor complications, and none suffered significant renal function deterioration after TAE. Technical success and clinical success were 91.5% and 93.6%, respectively. Technical failure was associated with older age, thrombocytopenia, prolonged international normalized ratio (INR) and divisional IRVI. Clinical failure was associated with kidney failure, use of steroids, prolonged INR, and divisional IRVI. In addition, prolonged INR was a significant predictor of technical failure. This implies that aggressive measures to control the INR prior to TAE are warranted to facilitate technical success, and technical success could then be validated on post-TAE images. Furthermore, divisional IRVI was a predictor of clinical failure. Thus, divisional IRVI should undergo surgery first since TAE is prone to clinical failure. The avoidance of clinical failure is validated if divisional IRVI does not need further intervention.

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Is radiofrequency ablation safe and effective in treating osteoid osteomas? A prospective single-center study with atypical cases

Journal of Orthopaedic Surgery ◽

10.1177/2309499020960555 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096055

Author(s):

Gokhan Yuce ◽

Nedim Aytekin ◽

Serhan Eren ◽

Birgul Genç ◽

Ömer Faruk Ateş ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Osteoid Osteoma ◽

Rating Scale ◽

Clinical Success ◽

Numeric Rating Scale ◽

Radiology Department ◽

Surgical Removal ◽

Single Center ◽

Technical Success ◽

Technical Success Rate

Purpose: Osteoid osteomas are benign and nonprogressive lesions. The clinical presentation of osteoid osteoma is typical with night pain responsive to nonsteroidal anti-inflammatory agents. The typical radiological appearance is lucent nidus and adjacent reactive sclerosis. The most traditional management of osteoid osteoma is surgical removal which is associated with significant morbidity. This article aims to demonstrate our single-center experience of 55 patients with osteoid osteoma treated with percutaneous radiofrequency ablation (RFA). Methods: Fifty-five symptomatic patients who were seen at our orthopedics outpatient clinics, diagnosed with osteoid osteoma, and referred to interventional radiology department between May 2015 and April 2019 were enrolled. The nidus size, pain numeric rating scale score, and intramedullary edema diameter before and after RFA were compared. Clinical and technical success, intervention-related complications, and need for subsequent ablation were recorded. Results: Of the 55 patients, including 12 pediatric cases, 6 had atypical locations such as metatarsal, vertebra, and scapula, while 1 case had osteoid osteoma with multiple nidus. The mean age was 18.5 ± 9.6 years. Preintervention maximum nidus diameter, pain score, and edema diameter were significantly lower in postintervention measurements ( p < 0.001). Technical success rate was 98.1%, and clinical success was 96.36%. Severe complication occurred in one patient with soft tissue burn and osteomyelitis. Conclusion: This is one of the largest series of osteoid osteoma treated with RFA done in a single center with atypical cases. In conclusion, RFA is safe and effective in both pediatric and adult patients with rare complications even in challenging cases with atypical locations.

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Safety and efficacy of digital single-operator pancreatoscopy for obstructing pancreatic ductal stones

Endoscopy International Open ◽

10.1055/a-0889-7743 ◽

2019 ◽

Vol 07 (07) ◽

pp. E896-E903 ◽

Cited By ~ 6

Author(s):

Olaya I. Brewer Gutierrez ◽

Isaac Raijman ◽

Raj J. Shah ◽

B. Joseph Elmunzer ◽

George J.M. Webster ◽

...

Keyword(s):

Combined Treatment ◽

The United States ◽

Laser Lithotripsy ◽

Technical Failure ◽

Single Session ◽

Technical Success ◽

Safety And Efficacy ◽

Single Operator ◽

Pancreatic Duct Stones

Abstract Background and study aims The role of the digital single-operator pancreatoscopy (D-SOP) with electrohydraulic (EHL) or laser lithotripsy (LL) in treating pancreatic ductal stones is unclear. We investigated the safety and efficacy of D-SOP with EHL or LL in patients with obstructing pancreatic duct stones. Patients and methods Retrospective analysis of 109 patients who underwent D-SOP for pancreatic stones at 17 tertiary centers in the United States and Europe from February 2015 to September 2017. Logistic regression was performed to identify factors associated with the need for more than one D-SOP with EHL/LL. Results Most patients were males (70.6 %),mean age 54.7 years. Fifty-nine (54.1 %) underwent EHL and 50 (45.9 %) underwent LL. Mean procedure time was longer in the EHL group (74.4 min vs 53.8 min; P < 0.001). Ducts were completely cleared (technical success) in 89.9 % of patients (94.1 % in EHL vs 100 % in LL; P = 0.243), achieved in a single session in 73.5 % of patients (77.1 % by EHL and 70 % by LL; P= 0.5).D-SOP failed in 11 patients (10.1 %); 6 patients were treated with extracorporeal shockwave lithotripsy (ESWL), 1 with surgery,1 with combined treatment (ESWL + D-SOP EHL) and 3 with other. Fourteen adverse events occurred in 11 patients (10.1 %). Patients with more than three ductal stones were more likely to have technical failure compared to those with less than three stones (17 % vs. 4.8 %; P = 0.04). Having more than three stones was independently associated with the need for more than one D-SOC EHL/LL session (OR 2.94, 95 % CI 1.13 – 7.65). Conclusion D-SOP with EHL or LL is effective and safe in patients with pancreatic ductal stones.

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Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study

Acta Radiologica ◽

10.1177/02841851211010395 ◽

2021 ◽

pp. 028418512110103

Author(s):

Cheng Shi Chen ◽

Young-Jong Cho ◽

Ji Hoon Shin ◽

Jeong Ho Kim ◽

Suyoung Park ◽

...

Keyword(s):

Multicenter Study ◽

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Arterial Embolization ◽

Exploratory Laparotomy ◽

Hemodynamic Instability ◽

Active Bleeding ◽

Success Rates ◽

Contrast Extravasation ◽

Anterior Division

Background Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. Purpose To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. Material and Methods This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. Results The median interval between surgery and angiography was one day (range = 0–82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. Conclusions TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.

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An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak

Journal of Endovascular Therapy ◽

10.1177/15266028211031933 ◽

2021 ◽

pp. 152660282110319

Author(s):

Aleksandra C. Zoethout ◽

Shirley Ketting ◽

Clark J. Zeebregts ◽

Dimitri Apostolou ◽

Barend M.E. Mees ◽

...

Keyword(s):

Clinical Outcomes ◽

Clinical Success ◽

Technical Failure ◽

Technical Success ◽

Technical Success Rate ◽

Type Iii ◽

Type Iiia ◽

Postoperative Myocardial Infarction ◽

Type Ia

Introduction: Type III endoleaks post-endovascular aortic aneurysm repair (EVAR) warrant treatment because they increase pressure within the aneurysm sac leading to increased rupture risk. The treatment may be difficult with regular endovascular devices. Endovascular aneurysm sealing (EVAS) might provide a treatment option for type III endoleaks, especially if located near the flow divider. This study aims to analyze clinical outcomes of EVAS for type III endoleaks after EVAR. Methods: This is an international, retrospective, observational cohort study including data from 8 European institutions. Results: A total of 20 patients were identified of which 80% had a type IIIb endoleak and the remainder (20%) a type IIIa endoleak. The median time between EVAR and EVAS was 49.5 months (28.5–89). Mean AAA diameter prior to EVAS revision was 76.6±19.9 mm. Technical success was achieved in 95%, 1 patient had technical failure due to a postoperative myocardial infarction resulting in death. Mean follow-up was 22.8±15.2 months. During follow-up 1 patient had a type Ia endoleak, and 1 patient had a new type IIIa endoleak at an untreated location. There were 5 patients with aneurysm growth. Five patients underwent AAA-related reinterventions indications being: growth with type II endoleak (n=3), type Ia endoleak (n=1), and iliac aneurysm (n=1). At 1-year follow-up, the freedom from clinical failure was 77.5%, freedom from all-cause mortality 94.7%, freedom from aneurysm-related mortality 95%, and freedom from aneurysm-related reinterventions 93.8%. Conclusion: The EVAS relining can be safely performed to treat type III endoleaks with an acceptable technical success rate, a low 30-day mortality rate and no secondary ruptures at short-term follow-up. The relatively low clinical success rates, related to reinterventions and AAA enlargement, highlight the need for prolonged follow-up.

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Safety and efficacy of thoracoscopic sympathectomy for control of recurrent ventricular tachycardia in patients mainly with Chagas disease.

10.22541/au.161963766.64479743/v1 ◽

2021 ◽

Author(s):

Rodrigo Kulchetscki ◽

Felipe Alexandre ◽

Marina Mayrink ◽

Carina Hardy ◽

Sissy de Melo ◽

...

Keyword(s):

Chagas Disease ◽

Ventricular Arrhythmias ◽

Structural Heart Disease ◽

Hemodynamic Instability ◽

Safety And Efficacy ◽

Alternative Approach ◽

Tertiary Center ◽

Before And After

Introduction: The autonomous system plays an important role as a trigger of cardiac arrhythmias. Cardiac sympathetic denervation (CSD) achieved by stellate and proximal thoracic ganglia resection has been reported as an alternative approach for the management of ventricular arrhythmias (VA) in structural heart disease (SHD) patients. Insufficient data regarding Chagas Disease (ChD) is available. Methods: Patients who underwent CSD for better management of ventricular arrhythmias (VA) in SHD, mainly ChD, in a single tertiary center in Brazil were evaluated for safety and efficacy outcomes. Results: Between June 2014 and March 2020, fourteen patients (age 59±7.5, 85% male, mean ejection fraction 30.5±7.9%) were submitted to left or bilateral CSD. In a median follow-up time of 143 (Q1: 30; Q3: 374) days, eight patients (57,2%) presented VT recurrence. A significant reduction in the median burden of ventricular arrhythmias comparing six months before and after procedure (10 to 0; p=0.004). For the nine ChD patients, the median burden of appropriate therapies was also reduced (11 to 0; p=0.008). There were two cases of clinically relevant pneumothorax and three cases of transient hemodynamic instability, but no direct procedure-related deaths occurred. Additionally, there was no long-term adverse events, Conclusion: CSD is safe and seems to be effective in reducing the burden of VT/VT storm in SHD patients, including ChD patients. Randomized trials are needed to clarify its role in the management of these patients.

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Transcatheter Embolization of the Inferior Epigastric Artery: Technique and Clinical Outcomes

Vascular and Endovascular Surgery ◽

10.1177/1538574420980576 ◽

2020 ◽

pp. 153857442098057

Author(s):

Athanasios Diamantopoulos ◽

Douglas Mulholland ◽

Konstantinos Katsanos ◽

Irfan Ahmed ◽

Andrew McGrath ◽

...

Keyword(s):

Clinical Success ◽

Rectus Muscle ◽

Transcatheter Embolization ◽

Technical Success ◽

Inferior Epigastric Artery ◽

Percutaneous Embolization ◽

Major Complications ◽

Epigastric Artery ◽

Active Extravasation ◽

Muscle Sheath

Purpose: Symptomatic rectus muscle sheath hematoma may be the result of bleeding originating from the inferior epigastric artery. We report the technique and the results from a series of consecutive patients treated by transcatheter embolization, evaluating both ipsilateral and contralateral retrograde approaches. Methods: This was a retrospective study including patients with verified rectus muscle sheath hematoma as a result of active extravasation from the inferior epigastric artery referred for transcatheter embolization. Technical success, clinical success and major complications were calculated. In addition, minor complications, blood transfusions required after a technically successful embolization, length of stay, peri-procedural and 30-day mortality and overall survival at 6 months were obtained. All statistical analysis was performed using SPSS. Results: Twenty-one patients (mean age = 59.67 ± 19.51 years old) were included. The cause of the bleeding in the vast majority was iatrogenic trauma (n = 12/21, 57.14%). Both contralateral (n = 12/21, 57.14%%) and ipsilateral (n = 9/21, 42.86%) retrograde approaches were used. Embolic materials included micro-coils (n = 13/20, 65%), microspheres (PVA) (n = 1/20, 5%), a combination of PVA and micro-coils (n = 5/20, 25%) and gel-foam (n = 1/20, 5%). Overall technical success was 95.2% (n = 20/21) while clinical success was achieved in all but one of the technically successful cases 95% (n = 19/20). One patient died peri-procedurally due to profound hemodynamic shock. There were no other major complications. Additional transfusion was necessary in 7 patients (n = 7/21, 33.33%). There was a significant increase in the hemoglobin levels after the embolization (7.03 ± 1.78 g/dL pre-procedure Vs 10.91 ± 1.7 g/dL post-procedure, p = 0.048). The median hospital stay was 8 days. The peri-procedure and 30-day mortality was 4.8% (n = 1/21) and 28.6% (n = 6/21) respectively. The 6-month survival was 61.9% (13/21). Conclusion: Percutaneous embolization of the inferior epigastric artery is a minimally invasive method with satisfactory results. Both ipsilateral and contralateral retrograde approaches are feasible.

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Transarterial embolization of acute iatrogenic hemorrhages: predictive factors for mortality and outcome

British Journal of Radiology ◽

10.1259/bjr.20190413 ◽

2020 ◽

Vol 93 (1110) ◽

pp. 20190413

Author(s):

Maciej Pech ◽

Zbigniew Serafin ◽

Frank Fischbach ◽

Robert Damm ◽

Tomasz Jargiełło ◽

...

Keyword(s):

Mortality Rate ◽

Blood Cell ◽

Red Blood Cell ◽

Clinical Success ◽

Transarterial Embolization ◽

Hemoglobin Concentration ◽

Female Gender ◽

Technical Failure ◽

Success Rates ◽

Shock State

Objective: Iatrogenic hemorrhages occur in 0.5–16% of medical procedures. A retrospective study was conducted to analyze technical and clinical outcome of transarterial embolization (TAE) used for acute iatrogenic hemorrhage and to identify factors predicting outcome. Methods: All patients undergoing TAE for acute iatrogenic bleeding from 2006 to 2013 were retrospectively analyzed. Primary end points were technical and clinical success or failure and 30 day mortality. Results: A total of 153 patients underwent 182 TAEs. Factors associated with clinical failure were lower blood hemoglobin concentration, use of higher number of units of red blood cell concentrate, TAE performed at night or weekend, embolization of more than one vessel, shock state before digital subtraction angiography (DSA), and intensive care before TAE. In multivariate analysis, independent factors for clinical success were hemoglobin concentration, number of units of red blood cell concentrate, and TAE of more than one vessel. Technical failure was associated with female gender, failure to detect signs of bleeding in DSA, TAE of more than one vessel, and shock state before DSA. Bleeding related to anticoagulation medication resulted in a significantly higher mortality rate compared with bleeding due to the remaining causes (30% vs 15%, p < 0.05). Conclusion: Despite excellent technical success, the mortality rate was significant. The only factors affecting clinical success were bleeding intensity and extent of injury. Bleeding attributed to anticoagulation is related to high mortality and therefore requires special attention. Advances in knowledge: This study gives insights into morbidity and mortality of iatrogenic bleedings and the technical and clinical success rates of TAE in a large study population.

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Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study

Endoscopy International Open ◽

10.1055/s-0043-114665 ◽

2017 ◽

Vol 05 (09) ◽

pp. E861-E867 ◽

Cited By ~ 12

Author(s):

Fateh Bazerbachi ◽

Jason Heffley ◽

Barham Abu Dayyeh ◽

Jose Nieto ◽

Eric Vargas ◽

...

Keyword(s):

Adverse Events ◽

Clinical Success ◽

Stent Migration ◽

Metal Stents ◽

Technical Success ◽

Novel Therapy ◽

Safety And Efficacy ◽

Anastomotic Strictures ◽

The Mean

Abstract Background and aims Benign gastrointestinal (GI) strictures are often refractory to standard endoscopic interventions. Fully covered coaxial lumen-apposing metal stents (LAMS) have emerged as a novel therapy for these strictures. The aim of this study was to evaluate the safety and efficacy of LAMS for refractory GI strictures. Patients and methods A retrospective analysis was performed for patients who underwent LAMS placement for benign luminal strictures in three US centers between January 2014 and December 2016. The primary outcomes were technical success and initial clinical success of LAMS placement. Secondary outcomes were stent migration, rate of re-intervention, and adverse events. Results A total of 49 patients underwent 56 LAMS placement procedures. Previous treatment had failed in 39 patients (79.6 %), and anastomotic strictures were the indication in 77.6 % (38/49), with the most common site being gastrojejunal (34.7 % [17/49]). Technical success was achieved in all procedures and initial clinical success was achieved in 96.4 % of all procedures (54/56). Patient initial clinical success was 95.9 % (47/49). Stent migration occurred in 17.9 % of procedures, and was more likely to occur at sites in the lower GI tract (P = 0.02). The mean stent dwell time was 100.6 days, and the mean follow-up was 169.8 days. Minor adverse events, not requiring hospitalization, occurred in 33.9 % of procedures, including subsequent stricture progression (10.7 %). In cases where LAMS were removed, mean follow-up time was 102.2 days. The re-intervention rate was 75 % at 300 days follow-up after stent removal. Of the LAMS placed at anastomotic strictures, 36.4 % required re-intervention, with approximately two-thirds of these re-interventions requiring placement of a new stent or surgery. Conclusion LAMS placement was successful for the management of refractory GI strictures, with good technical and initial clinical success rates. However, re-intervention rates after LAMS removal were high, and many strictures were not resolved by an extended period of stenting with these coaxial stents. LAMS placement offers additional therapeutic options and in selected cases might be considered a destination therapy for patients with recalcitrant benign strictures.

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