Dealing with Prostatic Arteries-How Many Roads Must a Man Walk Down?

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Prostatic Artery Embolization and the Median Lobe: Stuck in the Middle with You?

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Caso Clínico ARP nº 21: Qual o seu Diagnóstico?

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Diagnostic Accuracy of CT Angiography for A Infrapopliteal Lesions in Patientes with Diabetic Foot Ulcers Undergoing Endovascular Revascularization

Introdução: A angiografia por tomografia computorizada (AngioTC) é aceite como técnica para seleção de doentes com doença arterial periférica candidatos a terapêutica endovascular ou cirúrgica. Não existe suficiente evidencia em relação à sua acuidade em doentes com pé diabético e patologia infrapopliteia. Objetivo: Avaliar a acuidade diagnóstica da AngioTC nas artérias infrapopliteias em doentes com pé diabético. Métodos: Estudo unicêntrico retrospetivo dos achados AngioTC e da angiografia digital de subtração em 14 doentes submetidos a revascularização endovascular periférica com pé diabético. A sensibilidade e especificidade da AngioTC foram calculadas para cada segmento arterial de acordo com uma classificação modificada da classificação de Rutherford. Resultados: A sensibilidade e especificidade global da AngioTC na deteção de lesões estenóticas significativas foi de 1 (95% C.I. 0.89-1) e 0.7 (95% C.I. 0.35-0.93), respetivamente. Por segmento arterial a sensibilidade e especificidade foram de 0.96 (95% C.I. 0.88-0.99) e 0.86 (95% C.I. 0.57-0.98) na artéria tibial anterior, de 0.98 (95% C.I. 0.90-0.99) e 0.93 (95% C.I. 0.66-0.99) na artéria tibial posterior, de 0.93 (95% C.I. 0.83-0.98) e 0.72 (95% C.I. 0.42-0.92) na artéria peroneal, respetivamente. Conclusão: A AngioTC tem excelente acuidade diagnóstica e permite a triagem de doentes diabéticos com doença arterial periférica infrapopliteia.info:eu-repo/semantics/publishedVersio

Lesão de Dieulafoy: Papel do Mapeamento por Ecoendoscopia

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Renal Arteriovenous Malformation Managed with Embolization - Case Report and Review of Literature

As malformações vasculares do rim são processos patológicos que envolvem as veias e as artérias renais incluindo-se neste grupo as malformações arterio-venosas e as fístulas arterio-venosas. Estas lesões podem apresentar-se clinicamente por um grande espectro de sinais e sintomas que variam desde a hipertensão, a hematúria ou por massas renais. A presença de um shunt arterio-venoso caracteriza quer as malfomações quer as fístulas. Reportamos um caso de uma mulher com uma malformação arterio-venosa congénita desconhecida, que se apresentou inicialmente no serviço de urgência com hematúria, tendo sido tratada com sucesso por embolização endovascular. A lesão foi cateterizada selectivamente com um microcateter tendo a embolização sido realizada pela injecção de uma mistura contendo N–butil-2-cianoacrilato e lipiodol. São discutidas as diferentes técnicas de diagnóstico radiológico assim como a técnica de embolização.info:eu-repo/semantics/publishedVersio

Tumor Inflamatório Miofibroblástico da Via Biliar Principal

Inflammatory myofibroblastic tumour is a rare entity of indeterminate biological potential with a reduced tendency for recurrence and metastasis. Although it can arise from multiple organs, the bile duct is a very rare site of origin. We report the case of a 75-year-old asymptomatic male with elevated gamma-glutamyl transferase [1575 U/L (12 - 64 U/L)] and alkaline phosphatase [271 U/L (40 - 150 U/L)]. Computed tomography showed a 17 mm hypervascular lesion in the confluence of the right and left hepatic ducts, with bile duct ectasia and right liver lobe atrophy. The patient was initially managed as having a Klatskin tumour and underwent right hepatectomy. Histology showed a spindle cell proliferation with an inflammatory infiltrate of lymphocytes, plasma cells and collagen-rich stroma, consistent with an inflammatory myofibroblastic tumour. He was discharged 30 days after admission, and nine months later remains asymptomatic. His liver function tests have normalized and follow-up tests are unremarkable.info:eu-repo/semantics/publishedVersio

Prostatic Arterial Embolization to Treat Benign Prostatic Hyperplasia

PURPOSE: To evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Fifteen patients (age range, 62-82 years; mean age, 74.1 y) with symptomatic BPH after failure of medical treatment were selected for PAE with nonspherical 200-μm polyvinyl alcohol particles. The procedure was performed by a single femoral approach. Technical success was considered when selective prostatic arterial catheterization and embolization was achieved on at least one pelvic side. RESULTS: PAE was technically successful in 14 of the 15 patients (93.3%). There was a mean follow-up of 7.9 months (range, 3-12 months). International Prostate Symptom Score decreased a mean of 6.5 points (P = .005), quality of life improved 1.14 points (P = .065), International Index of Erectile Function increased 1.7 points (P = .063), and peak urinary flow increased 3.85 mL/sec (P = .015). There was a mean prostate-specific antigen reduction of 2.27 ng/mL (P = .072) and a mean prostate volume decrease of 26.5 mL (P = .0001) by ultrasound and 28.9 mL (P = .008) by magnetic resonance imaging. There was one major complication (a 1.5-cm(2) ischemic area of the bladder wall) and four clinical failures (28.6%). CONCLUSIONS: In this small group of patients, PAE was a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, associated with a reduction in prostate volume

Fatores de Risco para o Desenvolvimento de Síndrome Pós-Quimioembolização após Quimioembolização Hepática para Tratamento de Hepatocarcinoma

Introduction: Hepatic transarterial chemoembolization is a widely used technique for the treatment of hepatocellular carcinoma. The most common complication of this procedure is postembolization syndrome. The main objective of this study was to assess risk factors for the development of postembolization syndrome. Material and Methods: Single-centre retrospective analysis of 563 hepatic transarterial chemoembolization procedures from January 1st, 2014 – December 31st, 2015. Hepatic transarterial chemoembolization was performed with ½ - 2 vials of 100 - 300 μm microspheres loaded with doxorubicin. Patients who experienced postembolization syndrome were identified based on prolongation of hospitalization due to pain, fever, nausea and/or vomiting. A control group with the patients who did not have postembolization syndrome was randomly created (three controls for one case). Descriptive analysis and multivariate logistic regression were performed. Results: The overall prevalence of postembolization syndrome was 6.2%. Hepatic transarterial chemoembolization with doxorubicin dosage above 75 mg (more than one vial), the size of the largest nodule and female gender had statistically significant relation with development of postembolization syndrome (p = 0.030, p = 0.046 and p = 0.037, respectively). Discussion: Doxorrubicin dosage above 75 mg is associated with a higher risk of postembolization syndrome. This result can be helpful for decision-making in clinical practice, whenever it is possible to avoid a higher dose without compromising the efficacy of the treatment. The size of the largest nodule and female gender also constitute risk factors for postembolization syndrome. The other variables studied were not related to the development of postembolization syndrome. Conclusion: The dose of doxorrubicin, the size of the largest nodule treated and female gender are potential risk factors for the development of postembolization syndrome after hepatic transarterial chemoembolization for hepatocellular carcinoma.info:eu-repo/semantics/publishedVersio

Randomized Clinical Trial of Balloon Occlusion versus Conventional Microcatheter Prostatic Artery Embolization for Benign Prostatic Hyperplasia

Purpose: To compare balloon occlusion prostatic artery embolization (bPAE) with conventional microcatheter PAE (cPAE). Materials and methods: In this single-center trial, between November 2017 and November 2018, 89 patients with symptomatic benign prostatic hyperplasia were randomly assigned to cPAE (n = 43) or bPAE (n = 46). All patients received embolization with 300-500 μm Embosphere microspheres and were evaluated before and 1 and 6 months after PAE. Primary outcome measure was change from baseline in International Prostate Symptom Score (IPSS). Student t test was used for between-group comparisons of change from baseline, and paired t test was used for within-group comparisons. Results: At baseline, groups were identical (P > .05). Unilateral PAE was performed in 4 patients receiving cPAE and 3 patients receiving bPAE (9.30% and 6.52%, P = .708). Procedural and fluoroscopy times, dose area product, air kerma, embolic volume, and mean prostate-specific antigen (PSA) 24 hours after PAE did not differ between groups (P > .05). Coils were used in 6 patients receiving cPAE and 4 patients receiving bPAE (14.0% and 8.70%, P = .51). Assessments at 6 months after PAE showed mean IPSS reduction was 7.58 ± 6.88 after cPAE and 8.30 ± 8.12 after bPAE (P = .65); mean prostate volume reduction was 21.9 cm3 ± 51.6 (18.2%) after cPAE and 6.15 cm3 ± 14.6 (7.3%) after bPAE (P = .05); mean PSA reduction was 0.9 ng/mL ± 2.22 after cPAE and 0.22 ng/mL ± 1.65 after bPAE (P = .10). Penile skin lesions (n = 3) and rectal bleeding (n = 2) were documented only in patients receiving cPAE (11.9%, P = .01). No major adverse events occurred. Conclusions: bPAE is as effective as cPAE in treating benign prostatic hyperplasia with a potential to reduce nontarget embolization.info:eu-repo/semantics/publishedVersio