scholarly journals Successful treatment of gastric bleeding due to left-sided portal hypertension by transcatheter arterial embolization (clinical case report)

2021 ◽  
Vol 24 (1) ◽  
pp. 4-9
Author(s):  
Georgy I. Sinenchenko ◽  
Vladimir G. Verbitsky ◽  
Andrey E. Demko ◽  
Aleksey N. Sekeev ◽  
Sergey A. Alentyev ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
High Risk ◽  
Transcatheter Arterial Embolization ◽  
Varicose Veins ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Recurrent Bleeding ◽  
Gastric Bleeding ◽  
Stomach Fundus

Objective: to evaluate the results of transcatheter arterial embolization in patients with acute and chronic pancreatitis complicated by left-sided portal hypertension and bleeding from varicose veins of the stomach fundus and body. Materials and methods: 5 patients with left-sided portal hypertension were treated. Patients were admitted with a clinical picture of gastrointestinal bleeding, which was confirmed by laboratory and instrumental methods of research. Fibrogastroduodenoscopy revealed bleeding from varicose veins of the fundus and body of the stomach in all patients. The average age was 55.4±3.1 years. Results. All patients showed varicose veins of the fundus and body of the stomach, with signs of bleeding. Due to the high risk of recurrent bleeding, subtractive digital angiography with no signs of contrast agent extravasation was performed, followed by spiral embolization of the splenic artery in the proximal third until the blood flow was stopped. The technical and clinical success rate was 100%. Conclusion. Endovascular methods of treatment for left-sided portal hypertension syndrome are minimally invasive but highly effective methods of hemostasis. The indication for their use is unsuccessful endoscopic hemostasis or high risk of recurrence of bleeding from varicose veins of the fundus and body of the stomach.

scholarly journals Ultraselective transcatheter arterial embolization with small-sized microcoils for acute lower gastrointestinal bleeding

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Mitsuhiro Kinoshita ◽  
Hiroshi Kondo ◽  
Suguru Hitomi ◽  
Takuya Hara ◽  
Ryusei Zako ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Lower Gastrointestinal Bleeding ◽  
Recurrent Bleeding ◽  
Major Complications ◽  
Vasa Recta

Abstract Purpose To evaluate the clinical outcome of ultraselective transcatheter arterial embolization (TAE) with small-sized microcoils for acute lower gastrointestinal bleeding (LGIB). Materials and methods The subjects were 17 consecutive patients (mean age, 69 years) with LGIB who were treated with ultraselective TAE using small-sized microcoils between December 2013 and December 2019. Ultraselective TAE was defined as embolization of one or both of the long or short branches of the vasa recta. The etiologies of bleeding were colonic diverticulosis in 16 patients (94%) and malignancy in one patient (6%). The bleeding foci were in the ascending colon in 11 patients (65%), transverse colon in 2 patients (12%), and sigmoid colon in 4 patients (23%). A total of 18 branches (diameter: range 0.5–1.5 mm, mean 1.1 mm) of the vasa recta in 17 patients were embolized with small-sized microcoils (size range 1–3 mm, mean combined lengths of all microcoils 7.6 cm). The mean follow-up period was 19 months (range 1–80 months). The technical and clinical success rate, recurrent bleeding rate, major complications and long-term clinical outcomes were retrospectively evaluated. Results Technical and clinical success was achieved in all patients (17/17). The rates of early recurrent bleeding (within 30 days of TAE) and major complications were 0% (0/17). Recurrent bleeding occurred in one patient at 2 months after TAE, but was stopped with conservative treatment. There were no other bleeding episodes or complications in the follow-up period. Conclusion Ultraselective TAE with small-sized microcoils is a highly effective and safe treatment modality for LGIB.

scholarly journals Minimally invasive surgical interventions in the treatment and prevention of bleeding from varicose veins of the esophagus and stomach

2020 ◽  
Vol 39 (3) ◽  
pp. 65-73
Author(s):  
Bogdan N. Kotiv ◽  
Ilya I. Dzidzava ◽  
Sergey A. Alentyev ◽  
Petr N. Zubarev ◽  
Igor E. Onnicev ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Varicose Veins ◽  
Clinical Situation ◽  
Cirrhosis Of The Liver ◽  
Recurrent Bleeding ◽  
Gastric Bleeding ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Treatment And Prevention ◽  
Minimally Invasive Surgical

Treatment and prevention of complications of portal hypertension today is a complex and unsolved problem of hepatosurgery. Mortality from esophageal-gastric bleeding (ESH) of portal genesis ranges from 22 to 100%. The aim of the study is to improve the results of the treatment and prevention of digestive haemorrhage in portal hypertension by optimize using of miniinvasive interventions. A retrospective analysis of the treatment results of 128 patients with cirrhosis of the liver, in which the predominant complication of portal hypertension resulted in bleeding from varicose veins of the esophagus and the stomach, and a high risk of its occurrence or recidivism have been carried out. Gastric laparoscopic devascularization with endoscopic ligation reduces the lethality from esophageal-gastric bleeding, compared to only ligation, for six months after the operation by 21.8% (2 = 2.61; p = 0.106), 25.5% within a year (2 = 2.75; p = 0.091), for two years after the 25.4% operation (2 = 1.47; p = 0.225), for three years 25.5% (2 = 0.43; p = 0.051). There is a statistically reliable lack of differences in the groups of patients after the traditional and endovideoxyric operations of the portocal bypass in terms of the reduction of the degree of VDEV (84.3 and 86.7%), which indicates the equivalent effect of the performed operations. A comparative study of selective portocaval anastomoses and TIPS found no reliable difference in the frequency of recurrent bleeding. Post-shunt encephalopathy, thrombosis, and stenosis of the shunt were more common in the transjugular intrahepatic portosistame shunt (p 0.001), and survival in the group of surgical anastomosis was superior to that of TIPS. The above data indicate that the use of endoscopic, endovascular, endovision and endovision surgery, extracorporeal miniinvasive techniques is an integral part of the complex surgical treatment of patients with portal hypertension. Miniinvasive surgical treatments are required depending on the current clinical situation and the degree of liver-cell failure. Flexible and selective tactics make it possible to improve the results of treatment of patients with cirrhosis of the liver, complicated by portal hypertension (6 figs, bibliography: 14 refs).

scholarly journals Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or following Pancreatic Surgery

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2733
Author(s):  
Isao Numoto ◽  
Masakatsu Tsurusaki ◽  
Teruyoshi Oda ◽  
Yukinobu Yagyu ◽  
Kazunari Ishii ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Bleeding Complications ◽  
Visceral Artery ◽  
Recurrent Bleeding ◽  
Success Rates ◽  
Embolization Treatment ◽  
Clinically Significant ◽  
Ischemic Events

Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33–80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy.

scholarly journals Trans-arterial embolization of malignant tumor-related gastrointestinal bleeding: technical and clinical efficacy

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Ali H. Elmokadem ◽  
Hassan Abdelsalam ◽  
Ahmed El-Morsy ◽  
Ahmed Elsabbagh
Keyword(s):  
Mortality Rate ◽  
Success Rate ◽  
Clinical Efficacy ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Symptomatic Treatment ◽  
Recurrent Bleeding ◽  
Gi Bleeding

Abstract Background Gastrointestinal (GI) tract bleeding is a major cause of mortality among patients with GI malignancies. We aimed to assess the technical and clinical efficacy of trans-arterial embolization (TAE) as a symptomatic treatment of tumor-related GI bleeding. This study was conducted for patients with GI bleeding secondary to histopathologically proven different GI malignancies. Fourteen patients underwent trans-arterial embolization. Patients were followed up clinically for any complications or episodes of recurrent bleeding. Results Fourteen patients were included (9 males and 5 females) with mean age 55.5 years (range 42–69 years). All procedures were technically successful with post-procedural hemorrhage control and no immediate complication. The 30-day post-procedural clinical success rate was 78.4%. Three repeated clinically successful TAE sessions were done for recurrent bleeding. The median post-procedural follow-up duration was 241 days. The 30-day mortality rate was 7.1%, while the overall mortality rate was 35.7%. Conclusion Trans-arterial embolization of tumor-related GI bleeding controlled hemorrhage with acceptable clinical success rate and without complication in this small group of patients.

scholarly journals Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery

2021 ◽  
Author(s):  
Koji Sasaki ◽  
Takuya Okada ◽  
Masato Yamaguchi ◽  
Mostafa Ahmed ◽  
Tomoyuki Gentsu ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Iliac Artery ◽  
Transcatheter Arterial Embolization ◽  
Postpartum Hemorrhage ◽  
Genital Tract ◽  
Internal Iliac Artery ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Internal Iliac

Abstract Purpose To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery. Methods We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups. Results The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003). Conclusion S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.

scholarly journals Endovascular Therapy of Severe Non-Variceal Gastrointestinal Bleeding – One Decade Experience.

2021 ◽  
Author(s):  
Martin Vorčák ◽  
Ján Sýkora ◽  
Martin Ďuriček ◽  
Peter Bánovčin ◽  
Marian Grendár ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
Favorable Outcome ◽  
Recurrent Bleeding ◽  
Clinical Effects ◽  
Technical Success ◽  
Technical Success Rate

Abstract Introduction Severe non-variceal gastrointestinal bleeding is a life-threatening condition with complicated treatment if endoscopic rescue fails. In that case, transcatheter arterial embolization is recommended to stop the bleeding. The technical and clinical effects of this technique were analyzed in this group of patients, as well as its complication rate and 30-day mortality.Method Patient data of the one-decade period (from 2010 to 2019) were analyzed retrospectively. Twenty-seven patients (18 men and nine women, median age 61 years) treated by endovascular embolization in our institution with clinically significant gastrointestinal hemorrhage after unsuccessful or impossible endoscopic treatment were identified.Results The source of bleeding was found in 88% of patients, but embolization was performed in 96% of them. The technical success rate in the sample was 100%, and the clinical favorable outcome rate was 88.5%. The bleeding recurrence occurred in eight cases, five of whom had technically successful re-embolization in four cases. The incidence of recurrent bleeding was significantly higher in patients with two or more comorbidities with (p = 0.043). There was one serious complication (4%) in the group and minor difficulties occurred in 18% of patients; 30-day mortality reached 22%. Mortality was significantly higher in the group of patients with re-bleeding (p = 0.044).Discussion Our documented results in common are in the established rank of previously published results, which range from 62-100% for technical success, 52-94% for the clinical favorable outcome, 9-66% for re-bleeding and 4-46% for 30-day mortality.Conclusion Transcatheter arterial embolization is a safe mini-invasive method with high technical and clinical success in patients with endoscopically untreatable gastrointestinal bleeding. It is also suitable for high-risk cases. Mortality (to a significant extent) typically depends on the re-bleeding presence and the patient's comorbidity.

scholarly journals Transcatheter arterial embolization for unruptured renal angiomyolipoma using a 1.8-Fr tip microballoon catheter with a mixture of ethanol and Lipiodol

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Kosuke Tomita ◽  
Tomohiro Matsumoto ◽  
Shunsuke Kamei ◽  
Shota Yamamoto ◽  
Satoshi Suda ◽  
...  
Keyword(s):  
Success Rate ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Renal Angiomyolipoma ◽  
Technical Success ◽  
Technical Success Rate ◽  
Median Volume ◽  
Estimated Glomerular Filtration Rates

Abstract Background To evaluate the efficacy and safety of transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter and a mixture of ethanol and Lipiodol. Methods Seven consecutive patients with total of eight angiomyolipomas underwent this procedure between June 2014 and June 2017. A 1.8-French tip microballoon catheter was advanced to the feeding artery of the angiomyolipoma, and transcatheter arterial embolization was performed with a mixture of ethanol and Lipiodol under microballoon inflation. We retrospectively evaluated the characteristics of angiomyolipomas, technical success rate, clinical success rate, renal function, and adverse events. Technical success and clinical success were defined as complete embolization of all feeding arteries and reduction of tumor size, respectively. Results The median size of the angiomyolipomas was 46 mm (range, 40–64 mm). Transcatheter arterial embolization was successful in all eight angiomyolipomas. The median volume of the mixture of ethanol and Lipiodol was 6.0 ml (range, 2.0–14 ml). The median ratio of ethanol to Lipiodol was 71% (range, 71–75%). All eight angiomyolipomas shrank with a median shrinkage rate of 34% in diameter (range, 9–63%) and 77% in volume (range, 48–94%). The median follow-up period was 13 months (range, 9–54 months). Clinical success was achieved in all cases. Serum creatinine concentrations and the pre- and post-procedural estimated glomerular filtration rates did not change notably, and there were no major complications. Conclusion Transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter with a mixture of ethanol and Lipiodol is effective and safe.

scholarly journals Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

2020 ◽  
Author(s):  
Maofeng Gong ◽  
Xu He ◽  
Boxiang Zhao ◽  
Jie Kong ◽  
Tao Wang ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Hemodynamic Instability ◽  
Attractive Alternative ◽  
Safe Alternative ◽  
Renal Hemorrhage ◽  
Active Hemorrhage ◽  
Significant Difference

Abstract Background:The efficacy and safety of transcatheter arterial embolization (TAE) using the N-butyl-2 cyanoacrylate (NBCA) Glubran2 in the treatment of acute renal hemorrhage (RH) under coagulopathic conditionsarestill no consensus.Methods: Between February 2014 and June 2019, 8 patients underwent TAE with the NBCA Glubran2 for acute RH under coagulopathic conditions. Coagulopathy was defined as abnormal values of prothrombin time and activated partial thromboplastin time and/or a reduced platelet count.Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent hemorrhage after TAE, and follow-up outcomes were assessed.Results: Of note, one patient presented with severe coagulopathy, and three presented with severe RH and hemodynamic instability. The NBCA Glubran2 was employed as a sole embolic material in sixpatients. In the remaining two patients, it was employed for secondary embolization.Under coagulopathic conditions, due to the use of the NBCA Glubran2, both technical success and clinical success for acute RH were achieved in all patients. Duringa mean follow-up time of 30.1 months (range, 3-84 months), neither persistent nor recurrent active hemorrhage required repeat endovascular or surgical treatment for hemostasis. No Glubran2related complications occurred mid-TAE pro-cedure. In addition, renal function information was available for all patients, and there was no significant difference between the serum creatinine levels [(83.8 ± 15.5) vs (85.8 ± 32.2) μmol/L] before and one week after Glubran2 embolization (p=0.89; CI, -34.5 to 30.5).Conclusions: The present findings suggest that TAE with the NBCA Glubran2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when con-ventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

scholarly journals Selective Arterial Embolization of Renal Angiomyolipoma: Efficacy, Tumor Volume Reduction and Complications

2021 ◽  
Vol 73 (5) ◽  
Author(s):  
Walailak Chaiyasoot ◽  
Jirawadee Yodying ◽  
Thanita Limsiri
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Three Dimensional ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
P Value ◽  
Renal Angiomyolipoma ◽  
Tumor Rupture ◽  
Selective Arterial Embolization ◽  
Density Histogram

Objective: To evaluate the efficacy and complications of selective arterial embolization in renal angiomyolipoma and to identify predictive factors for tumor rupture.Materials and Methods: Overall, 21 patients with 25 renal angiomyolipoma (AML) underwent selective arterial embolization (SAE) between January 2008 and June 2019, comprising 15 cases involving prophylaxis embolization of a tumor >4 cm diameter and 10 involving embolization for a ruptured tumor. Multidetector computed tomography (MDCT) was performed pre- and post-SAE, using the 2D tumor diameter in the ruptured AMLs. Three-dimensional volumetry and density histogram were performed for determining the total tumor volume, fat, and angiomyogenic component reduction in the unruptured AMLs. The predictive factors for tumor rupture, the treatment outcome and complications were analyzed. Results: The clinical success rate was 84% (21/25 cases) and the technical success rate was 96% (24/25 cases). The 3D volume post-SAE within 1-3 months showed a greater decrement of the enhanced angiomyogenic component than the fat component, with median percentages of -62.2% and -18.4%, respectively (p-value = 0.333). Minor complications were post-embolization syndrome (5 case, 20%) and minimal renal infarction (4 cases, 16%). Renal abscesses were the major complications (3 cases, 12%). A factor associated with tumor rupture was the presence of an intra-tumoral aneurysm (p-value < 0.05).Conclusion: SAE is an effective treatment for renal AML with a high technical and clinical success rate and limited complications. Three-dimensional volume measurement and density histogram analysis might be better tools than two-dimensional CT to evaluate post-SAE response, which is crucial for management planning.

Sign in / Sign up

Export Citation Format

Share Document