Transarterial embolization in acute colonic bleeding: review of 11years of experience and long-term results

Background: Lower gastrointestinal bleeding represents 20% of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding. Methods: From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. Results: Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80years (range, 42-94years). The underlying etiologies included diverticular disease (41.9%), post-polypectomy bleeding (16.7%), malignancy (8.2%), hemorrhoid (4.1%), and angiodysplasia (4.1%). In 23 patients, bleeding stopped (95.8%) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7%). One patient died of ileal ischemia (mortality, 4.1%). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18days (range, 9-44days). After a mean follow-up of 28.6months (range, 4-108months), no other ischemic events occurred. Conclusion: In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21% risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operatio

Role of abdominal and interventional radiology in multidisciplinary management of alcohol-related liver disease

Alcohol-related liver disease is a major health problem, cause of extensive morbidity and mortality. From illness diagnosis to interventional treatment and imaging follow-up, radiology participates actively in the management of this disease, usually as part of a multidisciplinary medical staff. This thesis encloses a compilation of relevant scientific studies formulated, designed and conducted by the author in the field of diagnostic and interventional radiology for alcohol-related liver disease. The compilation demonstrates high quality of technical development for diagnostic improvement as well as innovations for disease-related interventional procedures. The author’s studies contributed to radiology by providing new imaging features that represent additional patients’ prognostic factors. Furthermore, the author also provided novelty in embolization material and endovascular technique for interventional procedures of patients with alcohol-related liver diseases. The relevance of these studies was confirmed by publication in prominent scientific medical journals. Researches similar to those presented in this thesis are essential to the progress of this medical specialty. Moreover, they are proof of the indispensable role of radiology for the management of this common disease

Rôle de la thrombolyse in situ dans les ischémies aiguës du membre supérieur après injection artérielle accidentelle

Les ponctions artérielles accidentelles du membre supérieur responsables d'une ischémie sont rares mais peuvent avoir des conséquences dramatiques pour les patients. Elles sont dues à l'injection dans une artère de substances qui ne sont pas prévues pour cette voie d'administration, entrainant des lésions vasculaires rapides. La nature de ces substances et leurs effets sur la paroi artérielle sont très variables, limitant ainsi la possibilité de réaliser des études homogènes à grande échelle. Par conséquent, il n'existe à ce jour aucun consensus sur leur prise en charge thérapeutique. Le but de cette thèse, en plus d'une revue de la littérature sur le sujet, est d'évaluer le bénéfice de la thrombolyse in situ combinée à une anticoagulation systémique chez ces patients, et de proposer un algorithme de prise en charge

Embolization of a Jejunal Artery Pseudoaneurysm via Collateral Vessels

Visceral artery pseudoaneurysms are rare and only few cases have been reported. They are considered to be life threatening in case of rupture. Rapid treatment is mandatory and endovascular procedure is recommended as the treatment of choice. Occasionally, endovascular approach is difficult to achieve, owing to unusual vascular anatomy. Whenever it is the case, an alternative method has to be considered. We report the case of a jejunal artery pseudoaneurysm that required an access via collateral vessels to accomplish complete occlusion in a 34-year-old woman who presented with a sudden epigastric pain 14 days after a cephalic duodenopancreatectomy

Hernies géantes avec perte de droit de cité : comment préparer au mieux les patients ?

Giant hernias with loss of domain induce physiological modifications that impair quality of life and make more complex their surgical management. A good preparation of patients before surgery is the key to an eventless postoperative course. The progressive pre-operative pneumoperitoneum (PPP) is one of the described abdominal augmentation protocols which can help patients to tolerate hernia content reintegration and avoid components separation technique during hernia repair. This article describes the management of these complex patients. We also report the case of a patient who follows successfully a PPP protocol

Acute hand ischemia after unintentional intraarterial injection of drugs: is catheter-directed thrombolysis useful?

Unintentional intraarterial injections are rare but may have devastating consequences. No consensus on treatment has been established owing to the wide variety of possible injected substances, incomplete understanding of the underlying pathophysiology, and the absence of case-controlled, prospective human studies. The aim of the present study and literature review was to evaluate the benefit of intraarterial thrombolysis combined with systemic anticoagulation therapy when an artery of the upper extremity is accidentally punctured and ischemia of the hand ensues

Hepatic lymphatics: anatomy and related diseases

The liver normally produces a large amount of lymph. It is estimated that between 25% and 50% of the lymph received by the thoracic duct comes from the liver. In normal conditions, hepatic lymphatics are not depicted on cross-sectional imaging. They are divided in lymphatics of deep system (lymphatics following the hepatic veins and the portal tract) and those of superficial system (convex surface and inferior surface). A variety of diseases may affect hepatic lymphatics and in general they manifest as lymphedema, lymphatic mass, or cystic lesions. Abnormal distended lymphatics are especially seen in periportal spaces as linear hypoattenuations on CT or strong linear hyperintensities on heavily T2-weighted MR imaging. Lymphatic tumor spread as in lymphoma and lymphangitic carcinomatosis manifests as periportal masses and regional lymph node enlargement. Lymphatic disruption after trauma or surgery is depicted as perihepatic fluid collections of lymph (lymphocele). Lymphatic malformation such as lymphangioma is seen on imaging as cystic spaces of variable size

Hepatic lymphatics: anatomy and related diseases

The liver normally produces a large amount of lymph. It is estimated that between 25% and 50% of the lymph received by the thoracic duct comes from the liver. In normal conditions, hepatic lymphatics are not depicted on cross-sectional imaging. They are divided in lymphatics of deep system (lymphatics following the hepatic veins and the portal tract) and those of superficial system (convex surface and inferior surface). A variety of diseases may affect hepatic lymphatics and in general they manifest as lymphedema, lymphatic mass, or cystic lesions. Abnormal distended lymphatics are especially seen in periportal spaces as linear hypoattenuations on CT or strong linear hyperintensities on heavily T2-weighted MR imaging. Lymphatic tumor spread as in lymphoma and lymphangitic carcinomatosis manifests as periportal masses and regional lymph node enlargement. Lymphatic disruption after trauma or surgery is depicted as perihepatic fluid collections of lymph (lymphocele). Lymphatic malformation such as lymphangioma is seen on imaging as cystic spaces of variable size