Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient ...Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient diplopia caused by inadvertent embolization of the lacrimal artery via a dynamic middle meningeal–ophthalmic anastomosis.This correspondence advances three critical innovations in MMAE safety.First,intraoperative anastomotic unmasking—exposing occult middle meningeal-ophthalmic collaterals during particle injection—reveals dynamic vascular behavior missed by preoperative angiography,underscoring the need for adaptive imaging protocols.Second,hybrid embolization(liquid agents for proximal occlusion+particles for distal control)balances precision and safety,reducing reflux risks compared to monotherapy.Third,a 108-day follow-up establishes a benchmark for functional recovery,challenging assumptions about irreversible cranial nerve injuries and emphasizing structured postprocedural care.Collectively,these findings advocate for procedural agility,multimodal embolic strategies,and sustained rehabilitation to optimize MMAE outcomes while minimizing iatrogenic harm.展开更多
The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleedin...The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleeding.Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event,and the resulting leaked blood is engulfed by soft tissues,forming a cavity that is in communication with the vessel.It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures.Remarkably,an undetermined percentage of pseudoaneurysms are asymptomatic,and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow,which depends on several factors,such as,the size and location of the vessel involved,changes in the size of the pseudoaneurysm,or the available therapeutic resources to be offered to patients,among others circumstances.The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence,but it seems that,regardless of the associated circumstances,the pseudoaneurysm could be treated at least initially,and mainly,through endovascular procedures,as done by Kakinuma et al.展开更多
BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on pati...BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.展开更多
BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early...BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early detection and intervention in EHPSS may improve patient outcomes.AIM To evaluate the effects of shunt embolization on mortality and HE recurrence.METHODS In this retrospective case-control study,16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included.Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization.Data on baseline characteristics,HE recurrence,and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests.RESULTS Baseline characteristics were comparable between the groups.The 1-year overall survival rate was significantly higher in the treatment group(0.50)than in the control group(0.33).The HE recurrence-free rate was also higher in the treatment group(1.00)than in the control group(0.17).The median survival duration was longer in the treatment group{not reached[95%confidence interval(CI):23.84 to not available(NA)]}than in the control group[15.02 months(95%CI:9.86 to NA)](P=0.006).Similarly,the recurrence-free duration was longer in the treatment group[63.09 months(95%CI:63.09 to NA)]than in the control group[9.21 months(95%CI:4.47 to NA)](P=0.006).EHPSS embolization significantly reduced 1-year HE recurrence(hazard ratio=0.09;95%CI:0.01-0.75;P=0.026).CONCLUSION EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients.Routine computed tomography and early embolization are clinically beneficial.展开更多
Objective Tumour cells in a hypoxic state are more invasive,have stronger self-renewal capabilities,and are difficult to treat because of their ability to promote tumour recurrence and metastasis.The glycolysis inhibi...Objective Tumour cells in a hypoxic state are more invasive,have stronger self-renewal capabilities,and are difficult to treat because of their ability to promote tumour recurrence and metastasis.The glycolysis inhibitor 3-bromopyruvic acid(3-BrPA)can completely inactivate glycolytic enzymes at extremely low drug concentrations,thereby exerting a strong inhibitory effect on the glucose energy metabolism of tumor cells.Therefore,we tested the inhibitory effect of 3-BrPA on hepatocellular carcinoma cells(HepG2)in vitro;then,we used the VX2 liver cancer model to study the antitumour effect of 3-BrPA combined with interventional embolization on liver cancer.Methods In vitro,a CCK-8 assay was used to detect the inhibitory effect of different concentrations of 3-BrPA on HepG2 cells,and light microscopy confirmed that the HepG2 cells were completely dead.Western blotting was used to detect the expression of key proteins involved in apoptosis.A total of 30 New Zealand white rabbits were used to establish a liver cancer model and were randomly divided into 3 groups 2 weeks after tumor establishment:the control group was perfused with saline in the hepatic artery;the transcatheter arterial embolization(TAE)group was given TAE;and the experimental group was perfused with 3-BrPA combined with TAE.The tumor-bearing rabbits were killed one week after surgery.The tumor volume and tumor necrosis ratio were calculated via the histopathological examination.Results In vitro,the inhibitory effect of 3-BrPA on HepG2 cells increased with increasing concentration.3-BrPA(100μmol/L)could induce the necrosis of HepG2 cells.Stimulation with 50μmol/L 3-BrPA could activate the tumor cell apoptosis pathway.3-BrPA combined with TAE treatment could significantly inhibit tumor growth and cause more complete tumor necrosis.Conclusion 3-BrPA not only has antitumour effects in vitro but can also significantly improve antitumour effects in the hypoxic microenvironment after embolization in vivo.展开更多
Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosi...Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosis,aspergillosis,and vascular malformations.^([1-3]) A metaanalysis involving patients with massive hemoptysis reported a mortality rate of 3.5%.^([4])This underscores the critical importance of prompt and eff ective embolization of the responsible artery to improve outcomes,particularly in patients presenting with life-threatening hemoptysis.展开更多
BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment...BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.展开更多
BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial emboli...BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial embolization(SAE)and covered stent implantation(CSI)is the treatment of choice.However,in certain cases,both SAE and CSI become infeasible.AIM To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate(NBCA)embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE is infeasible.METHODS Ninety-eight continuous patients(n=105 cases;mean age,58.4 years)with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization(NBCA group,n=45)and/or CSI(CSI group,n=60)were retrospectively evaluated between March 2014 and December 2023.Data on technical and clinical success,30-day mortality,and severe intervention-related adverse events were collected and analyzed.RESULTS The technical and clinical success rates in the NBCA group(100%and 93.3%,respectively)were significantly higher than those in the CSI group(88.3%and 73.3%,respectively),with a statistically significant difference between the two groups(P=0.019 and 0.010,respectively).The 30-day mortality rates and major intervention-related complications were 17.8%and 0%,respectively,in the NBCA group and 18.3%and 1.7%in the CSI group,respectively,with no statistically significant difference between the two groups.CONCLUSION In terms of technical and clinical success,coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE was not feasible.展开更多
Transcatheter arterial embolization(TAE)is the mainstay for treating advanced hepatocellular carcinoma(HCC),and the performance of the embolization material is crucial in TAE.With the development of medical imaging an...Transcatheter arterial embolization(TAE)is the mainstay for treating advanced hepatocellular carcinoma(HCC),and the performance of the embolization material is crucial in TAE.With the development of medical imaging and the birth of“X-ray-free”technologies,we designed a new dual-mode imaging material of dimethoxy tetraphenyl ethylene(DMTPE)via emulsification by mixing poly(N-isopropylacrylamide-co-acrylic acid)(PNA)with lipiodol and fluorocarbons,which was evaluated for temperature sensitivity,stability,and dual-mode visualization in vitro.Additionally,blood vessel casting embolization and renal artery imaging were assessed in healthy rabbits.In a rabbit model with a VX2 tumor,the effectiveness of TAE for treating HCC was examined,with an emphasis on evaluating long-term outcomes of embolization and its effects on tumor growth,necrosis,and proliferation through imaging techniques.In vitro experiments confirmed that the temperature-sensitive dual-oil-phase Pickering emulsion had good flow,stable contrast,and embolism when the oil-to-oil ratio and water-to-oil ratio were both 7:3(v/v)and stabilized with 8%PNA.Similarly,in vivo,arterial embolization confirmed the excellent properties of DMTPE prepared at the abovementioned ratios.It was observed that DMTPE not only has an antitumor effect but can also achieve dual imaging using X-rays and ultrasound,making it a promising excellent vascular embolization material for TAE in tumor treatment.展开更多
BACKGROUND Although transarterial chemoembolization(TACE)is an effective treatment for liver cancer,clinical practice has shown that many patients experience significant psychological distress following the procedure,...BACKGROUND Although transarterial chemoembolization(TACE)is an effective treatment for liver cancer,clinical practice has shown that many patients experience significant psychological distress following the procedure,which can hinder postoperative recovery and prognosis.Therefore,effective and evidence-based interventions are urgently needed to address this issue.AIM To evaluate the impact of nursing quality-sensitive indicators combined with mindfulness-based stress reduction(MBSR)interventions in patients undergoing TACE.METHODS A total of 84 patients who underwent TACE from June 2022 to March 2024 were enrolled in the study.They were randomly assigned to either the observation group(n=42),which received nursing quality-sensitive indicator-based care combined with MBSR intervention,or the control group(n=42),which received routine care combined with MBSR intervention.Psychological stress response levels[assessed using the Trait Meta-Mood Scale(TMMS)],coping strategies[measured with the Jalowiec Coping Scale(JCS)],quality of care[evaluated using the Perceived Nursing Service Quality(PNSQ)scale],and overall patient satisfaction were compared between the two groups.RESULTS After 4 weeks,the observation group demonstrated significantly higher TMMS scores,as well as increased optimism,support-seeking,bravery,PNSQ scores,and satisfaction(P<0.05).In contrast,scores for selfdependence,conservatism,resignation,and avoidance in the JCS were significantly lower in the observation group than in the control group(P<0.05).CONCLUSION The combination of nursing quality-sensitive indicators and MBSR intervention in TACE patients not only reduces psychological stress and encourages a more positive attitude toward illness but also enhances nursing quality and improves the overall patient experience.展开更多
BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Us...BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Usually,conservative management is sufficient for complete recovery of patients who develop this complication.If conservative treatment is ineffective,urgent surgical inter-vention may be required to prevent the progression of complications.CASE SUMMARY This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis,which was initially treated conservatively but eventually necessitated emergency laparotomy.The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention,which worsened at the two weeks mark along with emergence of signs of peritonitis.This was managed by emergency laparotomy and cholecystostomy,allowing rapid symptom relief.The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.CONCLUSION After cholecystostomy,the patient showed symptom relief and was discharged,surviving 11 months post-stage IIIB liver cancer diagnosis.展开更多
Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to ...Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to traction,frequently associated with fractures near the middle meningeal artery.This case highlights the typical clinical presentation,diagnostic approaches,and therapeutic management of TCCAVF,emphasizing the challenges in treating this condition.Transcatheter embolization proved effective in occluding the fistula,underscoring its role as a key intervention for traumatic meningeal arteriovenous fistulas.展开更多
BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and...BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still hav...BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still have to wait for long periods.Locoregional therapies(LRTs)are employed as bridging therapies in patients with HCC awaiting LT.Although largely used in the past,transarterial embolization(TAE)has been replaced by transarterial chemoembolization(TACE).However,the superiority of TACE over TAE has not been consistently shown in the literature.AIM To compare the outcomes of TACE and TAE in patients with HCC awaiting LT.METHODS All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included.All patients underwent LRT with either TACE or TAE.Some patients also underwent percutaneous ethanol injection(PEI),concom-itantly or in different treatment sessions.The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus.The primary outcome was waitlist dropout due to tumor progression,and the secondary outcome was the occurrence of adverse events.In the subset of patients who underwent LT,complete pathological response and post-transplant recurrence-free survival were also assessed.RESULTS Twelve(18.5%)patients in the TACE group(only TACE and TACE+PEI;n=65)and 3(7.9%)patients in the TAE group(only TAE and TAE+PEI;n=38)dropped out of the waitlist due to tumor progression(P log-rank test=0.29).Adverse events occurred in 8(12.3%)and 2(5.3%)patients in the TACE and TAE groups,respectively(P=0.316).Forty-eight(73.8%)of the 65 patients in the TACE group and 29(76.3%)of the 38 patients in the TAE group underwent LT(P=0.818).Among these patients,complete pathological response was detected in 7(14.6%)and 9(31%)patients in the TACE and TAE groups,respectively(P=0.145).Post-LT,HCC recurred in 9(18.8%)and 4(13.8%)patients in the TACE and TAE groups,respectively(P=0.756).Posttransplant recurrence-free survival was similar between the groups(P log-rank test=0.71).CONCLUSION Dropout rates and posttransplant recurrence-free survival of TAE were similar to those of TACE in patients with HCC.Our study reinforces the hypothesis that TACE is not superior to TAE as a bridging therapy to LT in patients with HCC.展开更多
BACKGROUND Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal(GI)bleeding.Here,we present a minimally invasive therapy with selective embolization.CASE SUMMARY A 21-year-old mal...BACKGROUND Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal(GI)bleeding.Here,we present a minimally invasive therapy with selective embolization.CASE SUMMARY A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis.Diagnostic studies later revealed specific characteristics for vascular lesions-anorectal hemangiomas.The severity of rectal bleeding caused symptomatic anemia and possible surgical treatment was asso-ciated with a high risk of fecal incontinence.Here,we present selective emboli-zation,a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice.The patient significantly improved temporarily and had a small ischemic ulcer,which healed with a control colonoscopy and deve-loped no stenosis.CONCLUSION Awareness of the clinical and radiological features of GI hemangiomas may help improve diagnostics and avoid inappropriate therapeutic procedures.展开更多
BACKGROUND While gelatin sponge particles and calibrated microspheres are commonly used as embolic materials in conventional transarterial chemoembolization(cTACE),direct comparisons between these embolic agents are r...BACKGROUND While gelatin sponge particles and calibrated microspheres are commonly used as embolic materials in conventional transarterial chemoembolization(cTACE),direct comparisons between these embolic agents are rare.AIM To compare the efficacy and safety of superselective cTACE using Embosphere®or Marine gel®in patients with early-stage hepatocellular carcinoma(HCC).METHODS This retrospective study included 70 patients with small(<4 cm)HCC who underwent cTACE with Embosphere®(n=33)or Marine gel®(n=37)as the embolic agent at a single center between March 2021 and July 2022.The radiologic images and clinical data were retrospectively reviewed,with an emphasis on tumor response,procedure-related complications,and local tumor recurrence.The primary index tumor was assessed on a 1-mo follow-up image,and local progression-free survival was obtained using the Kaplan-Meier method and was compared by the log-rank test.RESULTS The median tumor size of both groups was 1.5 cm,and 69 patients achieved a complete response one month after cTACE.The cumulative local recurrence rate at 12 mo was 15.5%in the Embosphere®group and 14.4%in the Marine gel®group.The local progression-free survival was not significantly different between the two groups(P=0.83).In the multivariate analysis,high serum alphafetoprotein was the only significant poor prognostic factor for local tumor progression(P=0.01).Postembolization syndrome occurred in 36.4%of the Embosphere®group and 35.1%of the Marine gel®group,and there were no cases of biloma,biliary duct dilation,or liver abscess in either group.CONCLUSION Calibrated gelatin sponge particles(Marine gel®)and calibrated microspheres(Embosphere®)have similar outcomes in terms of tumor response for superselective cTACE of small HCC.展开更多
Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a si...Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection.The degree of hypertrophy obtained after PVE is variable and depends on multiple factors.Up to 20%of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure(usually 6-8 wk are needed before surgery).The management of PVE failure is still debated,with a lack of consensus regarding the best clinical strategy.Different additional techniques have been proposed,such as sequential transarterial chemoembolization followed by PVE,segment 4 PVE,intra-portal administration of stem cells,dietary supplementation,and hepatic vein embolization.The aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.展开更多
This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expe...This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expected to reduce its incidence and degree in clinical treatment,and to improve the quality of treatment of Hepatocellular Carcinoma Carcinoma(HCC).展开更多
Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence ...Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence of a sac necessitate a more stringent and rigorous management approach. Objective: The primary aim of this study is to delve into the morphological features of ruptured aneurysms situated in distinct regions of the brain. Furthermore, we endeavor to assess the degree of safety and efficacy associated with stent-assisted embolization as a treatment modality for these ruptured aneurysms. Methods: This retrospective study encompassed a cohort of 467 patients who presented with intracranial ruptured aneurysms and were diagnosed through a combination of computed tomography (CT) and digital subtraction angiography (DSA) at Nanfang Hospital of Southern Medical University, spanning from January 2009 to December 2019. The following clinical parameters were meticulously recorded: aneurysm height, width, neck measurements, immediate Raymond grade assessments, and any perioperative complications experienced. Results: Within the study population, the average dimensions of ruptured aneurysms were found to be 4.26 ± 2.10 mm (width), 4.86 ± 2.38 mm (height), and 4.04 ± 1.87 mm (neck). Categorically, the most prevalent types of aneurysms were 170 cases of anterior communicating artery aneurysms (accounting for 36.4%), followed by 161 cases of posterior communicating artery aneurysms (34.5%), 56 cases of middle cerebral artery aneurysms (12.0%), 13 cases of anterior cerebral artery aneurysms (2.8%), 45 cases of paraclinoid aneurysms (9.6%), 6 cases of superior pituitary artery aneurysms (1.3%), 7 cases of anterior choroidal artery aneurysms (1.5%), and 9 cases of vertebrobasilar artery aneurysms (2.0%). Notably, 18 patients (3.9%) presented with ruptured aneurysms coexisting with ascus. Regarding treatment approaches, 228 cases (48.8%) underwent stent-assisted embolization, 234 cases (50.1%) received coils embolization, and 5 cases (1.1%) were treated with the dual-catheter technique. Immediately post-treatment, 422 patients (90.4%) attained a Raymond Class I status, with a procedure-related complication rate of 0.9%. Importantly, no statistically significant differences were observed in the incidence of perioperative complications across the three distinct treatment groups (P = 0.505). Conclusion: The outcomes of this study affirm the safety and efficacy of stent-assisted embolization as a treatment modality for ruptured aneurysms.展开更多
This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology.Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment,but i...This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology.Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment,but inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications.In this article,the most appropriate candidate patients,embolization materials,embolization methods,and clinical evaluation methods are discussed to improve the safety and effectiveness of the procedure.展开更多
文摘Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient diplopia caused by inadvertent embolization of the lacrimal artery via a dynamic middle meningeal–ophthalmic anastomosis.This correspondence advances three critical innovations in MMAE safety.First,intraoperative anastomotic unmasking—exposing occult middle meningeal-ophthalmic collaterals during particle injection—reveals dynamic vascular behavior missed by preoperative angiography,underscoring the need for adaptive imaging protocols.Second,hybrid embolization(liquid agents for proximal occlusion+particles for distal control)balances precision and safety,reducing reflux risks compared to monotherapy.Third,a 108-day follow-up establishes a benchmark for functional recovery,challenging assumptions about irreversible cranial nerve injuries and emphasizing structured postprocedural care.Collectively,these findings advocate for procedural agility,multimodal embolic strategies,and sustained rehabilitation to optimize MMAE outcomes while minimizing iatrogenic harm.
文摘The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleeding.Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event,and the resulting leaked blood is engulfed by soft tissues,forming a cavity that is in communication with the vessel.It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures.Remarkably,an undetermined percentage of pseudoaneurysms are asymptomatic,and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow,which depends on several factors,such as,the size and location of the vessel involved,changes in the size of the pseudoaneurysm,or the available therapeutic resources to be offered to patients,among others circumstances.The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence,but it seems that,regardless of the associated circumstances,the pseudoaneurysm could be treated at least initially,and mainly,through endovascular procedures,as done by Kakinuma et al.
文摘BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.
基金approved by Chungbuk National University Hospital Institutional Review Board in Cheongju,Chugbuk,South Korea(No.CBNUH2022-09-013-HE001).
文摘BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early detection and intervention in EHPSS may improve patient outcomes.AIM To evaluate the effects of shunt embolization on mortality and HE recurrence.METHODS In this retrospective case-control study,16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included.Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization.Data on baseline characteristics,HE recurrence,and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests.RESULTS Baseline characteristics were comparable between the groups.The 1-year overall survival rate was significantly higher in the treatment group(0.50)than in the control group(0.33).The HE recurrence-free rate was also higher in the treatment group(1.00)than in the control group(0.17).The median survival duration was longer in the treatment group{not reached[95%confidence interval(CI):23.84 to not available(NA)]}than in the control group[15.02 months(95%CI:9.86 to NA)](P=0.006).Similarly,the recurrence-free duration was longer in the treatment group[63.09 months(95%CI:63.09 to NA)]than in the control group[9.21 months(95%CI:4.47 to NA)](P=0.006).EHPSS embolization significantly reduced 1-year HE recurrence(hazard ratio=0.09;95%CI:0.01-0.75;P=0.026).CONCLUSION EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients.Routine computed tomography and early embolization are clinically beneficial.
基金National Natural Science Foundation of China(No.82202281)for the funding support,and Yu-miao Wei for his review of the manuscript.
文摘Objective Tumour cells in a hypoxic state are more invasive,have stronger self-renewal capabilities,and are difficult to treat because of their ability to promote tumour recurrence and metastasis.The glycolysis inhibitor 3-bromopyruvic acid(3-BrPA)can completely inactivate glycolytic enzymes at extremely low drug concentrations,thereby exerting a strong inhibitory effect on the glucose energy metabolism of tumor cells.Therefore,we tested the inhibitory effect of 3-BrPA on hepatocellular carcinoma cells(HepG2)in vitro;then,we used the VX2 liver cancer model to study the antitumour effect of 3-BrPA combined with interventional embolization on liver cancer.Methods In vitro,a CCK-8 assay was used to detect the inhibitory effect of different concentrations of 3-BrPA on HepG2 cells,and light microscopy confirmed that the HepG2 cells were completely dead.Western blotting was used to detect the expression of key proteins involved in apoptosis.A total of 30 New Zealand white rabbits were used to establish a liver cancer model and were randomly divided into 3 groups 2 weeks after tumor establishment:the control group was perfused with saline in the hepatic artery;the transcatheter arterial embolization(TAE)group was given TAE;and the experimental group was perfused with 3-BrPA combined with TAE.The tumor-bearing rabbits were killed one week after surgery.The tumor volume and tumor necrosis ratio were calculated via the histopathological examination.Results In vitro,the inhibitory effect of 3-BrPA on HepG2 cells increased with increasing concentration.3-BrPA(100μmol/L)could induce the necrosis of HepG2 cells.Stimulation with 50μmol/L 3-BrPA could activate the tumor cell apoptosis pathway.3-BrPA combined with TAE treatment could significantly inhibit tumor growth and cause more complete tumor necrosis.Conclusion 3-BrPA not only has antitumour effects in vitro but can also significantly improve antitumour effects in the hypoxic microenvironment after embolization in vivo.
文摘Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosis,aspergillosis,and vascular malformations.^([1-3]) A metaanalysis involving patients with massive hemoptysis reported a mortality rate of 3.5%.^([4])This underscores the critical importance of prompt and eff ective embolization of the responsible artery to improve outcomes,particularly in patients presenting with life-threatening hemoptysis.
文摘BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.
基金Supported by Tengfei Project of Third Affiliated Hospital of the Naval Medical University,No.TF2024TJYQ02.
文摘BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial embolization(SAE)and covered stent implantation(CSI)is the treatment of choice.However,in certain cases,both SAE and CSI become infeasible.AIM To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate(NBCA)embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE is infeasible.METHODS Ninety-eight continuous patients(n=105 cases;mean age,58.4 years)with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization(NBCA group,n=45)and/or CSI(CSI group,n=60)were retrospectively evaluated between March 2014 and December 2023.Data on technical and clinical success,30-day mortality,and severe intervention-related adverse events were collected and analyzed.RESULTS The technical and clinical success rates in the NBCA group(100%and 93.3%,respectively)were significantly higher than those in the CSI group(88.3%and 73.3%,respectively),with a statistically significant difference between the two groups(P=0.019 and 0.010,respectively).The 30-day mortality rates and major intervention-related complications were 17.8%and 0%,respectively,in the NBCA group and 18.3%and 1.7%in the CSI group,respectively,with no statistically significant difference between the two groups.CONCLUSION In terms of technical and clinical success,coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE was not feasible.
基金supported by the Hubei Province Nature Science Foundation of China(Grant No.:2023AFB1077)the National Natural Science Foundation of China(Grant No.:82003308)+2 种基金the Doctoral Start-up Fund Project of Hubei University of Science and Technology,China(Grant No.:BK202118)the Innovation team and Medical research program of Hubei University of Science and Technology,China(Grant Nos.:2023T10 and 2022YKY05)the Hubei Province Key R&D Plan Big Health Local Special Project,China(Grant No.:2022BCE042).
文摘Transcatheter arterial embolization(TAE)is the mainstay for treating advanced hepatocellular carcinoma(HCC),and the performance of the embolization material is crucial in TAE.With the development of medical imaging and the birth of“X-ray-free”technologies,we designed a new dual-mode imaging material of dimethoxy tetraphenyl ethylene(DMTPE)via emulsification by mixing poly(N-isopropylacrylamide-co-acrylic acid)(PNA)with lipiodol and fluorocarbons,which was evaluated for temperature sensitivity,stability,and dual-mode visualization in vitro.Additionally,blood vessel casting embolization and renal artery imaging were assessed in healthy rabbits.In a rabbit model with a VX2 tumor,the effectiveness of TAE for treating HCC was examined,with an emphasis on evaluating long-term outcomes of embolization and its effects on tumor growth,necrosis,and proliferation through imaging techniques.In vitro experiments confirmed that the temperature-sensitive dual-oil-phase Pickering emulsion had good flow,stable contrast,and embolism when the oil-to-oil ratio and water-to-oil ratio were both 7:3(v/v)and stabilized with 8%PNA.Similarly,in vivo,arterial embolization confirmed the excellent properties of DMTPE prepared at the abovementioned ratios.It was observed that DMTPE not only has an antitumor effect but can also achieve dual imaging using X-rays and ultrasound,making it a promising excellent vascular embolization material for TAE in tumor treatment.
文摘BACKGROUND Although transarterial chemoembolization(TACE)is an effective treatment for liver cancer,clinical practice has shown that many patients experience significant psychological distress following the procedure,which can hinder postoperative recovery and prognosis.Therefore,effective and evidence-based interventions are urgently needed to address this issue.AIM To evaluate the impact of nursing quality-sensitive indicators combined with mindfulness-based stress reduction(MBSR)interventions in patients undergoing TACE.METHODS A total of 84 patients who underwent TACE from June 2022 to March 2024 were enrolled in the study.They were randomly assigned to either the observation group(n=42),which received nursing quality-sensitive indicator-based care combined with MBSR intervention,or the control group(n=42),which received routine care combined with MBSR intervention.Psychological stress response levels[assessed using the Trait Meta-Mood Scale(TMMS)],coping strategies[measured with the Jalowiec Coping Scale(JCS)],quality of care[evaluated using the Perceived Nursing Service Quality(PNSQ)scale],and overall patient satisfaction were compared between the two groups.RESULTS After 4 weeks,the observation group demonstrated significantly higher TMMS scores,as well as increased optimism,support-seeking,bravery,PNSQ scores,and satisfaction(P<0.05).In contrast,scores for selfdependence,conservatism,resignation,and avoidance in the JCS were significantly lower in the observation group than in the control group(P<0.05).CONCLUSION The combination of nursing quality-sensitive indicators and MBSR intervention in TACE patients not only reduces psychological stress and encourages a more positive attitude toward illness but also enhances nursing quality and improves the overall patient experience.
基金National Natural Science Foundation of China,No.82200686Shaanxi Provincial People's Hospital Incubation Project,No.2022YJY-14.
文摘BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Usually,conservative management is sufficient for complete recovery of patients who develop this complication.If conservative treatment is ineffective,urgent surgical inter-vention may be required to prevent the progression of complications.CASE SUMMARY This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis,which was initially treated conservatively but eventually necessitated emergency laparotomy.The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention,which worsened at the two weeks mark along with emergence of signs of peritonitis.This was managed by emergency laparotomy and cholecystostomy,allowing rapid symptom relief.The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.CONCLUSION After cholecystostomy,the patient showed symptom relief and was discharged,surviving 11 months post-stage IIIB liver cancer diagnosis.
文摘Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to traction,frequently associated with fractures near the middle meningeal artery.This case highlights the typical clinical presentation,diagnostic approaches,and therapeutic management of TCCAVF,emphasizing the challenges in treating this condition.Transcatheter embolization proved effective in occluding the fistula,underscoring its role as a key intervention for traumatic meningeal arteriovenous fistulas.
基金This study is registered at clinicaltrials.gov.The registration identification number is NCT05627999.
文摘BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes.
基金Supported by Financiamento e IncentivoàPesquisa(FIPE/HCPA)of Hospital de Clínicas de Porto Alegre,No.2020-0473.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still have to wait for long periods.Locoregional therapies(LRTs)are employed as bridging therapies in patients with HCC awaiting LT.Although largely used in the past,transarterial embolization(TAE)has been replaced by transarterial chemoembolization(TACE).However,the superiority of TACE over TAE has not been consistently shown in the literature.AIM To compare the outcomes of TACE and TAE in patients with HCC awaiting LT.METHODS All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included.All patients underwent LRT with either TACE or TAE.Some patients also underwent percutaneous ethanol injection(PEI),concom-itantly or in different treatment sessions.The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus.The primary outcome was waitlist dropout due to tumor progression,and the secondary outcome was the occurrence of adverse events.In the subset of patients who underwent LT,complete pathological response and post-transplant recurrence-free survival were also assessed.RESULTS Twelve(18.5%)patients in the TACE group(only TACE and TACE+PEI;n=65)and 3(7.9%)patients in the TAE group(only TAE and TAE+PEI;n=38)dropped out of the waitlist due to tumor progression(P log-rank test=0.29).Adverse events occurred in 8(12.3%)and 2(5.3%)patients in the TACE and TAE groups,respectively(P=0.316).Forty-eight(73.8%)of the 65 patients in the TACE group and 29(76.3%)of the 38 patients in the TAE group underwent LT(P=0.818).Among these patients,complete pathological response was detected in 7(14.6%)and 9(31%)patients in the TACE and TAE groups,respectively(P=0.145).Post-LT,HCC recurred in 9(18.8%)and 4(13.8%)patients in the TACE and TAE groups,respectively(P=0.756).Posttransplant recurrence-free survival was similar between the groups(P log-rank test=0.71).CONCLUSION Dropout rates and posttransplant recurrence-free survival of TAE were similar to those of TACE in patients with HCC.Our study reinforces the hypothesis that TACE is not superior to TAE as a bridging therapy to LT in patients with HCC.
文摘BACKGROUND Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal(GI)bleeding.Here,we present a minimally invasive therapy with selective embolization.CASE SUMMARY A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis.Diagnostic studies later revealed specific characteristics for vascular lesions-anorectal hemangiomas.The severity of rectal bleeding caused symptomatic anemia and possible surgical treatment was asso-ciated with a high risk of fecal incontinence.Here,we present selective emboli-zation,a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice.The patient significantly improved temporarily and had a small ischemic ulcer,which healed with a control colonoscopy and deve-loped no stenosis.CONCLUSION Awareness of the clinical and radiological features of GI hemangiomas may help improve diagnostics and avoid inappropriate therapeutic procedures.
文摘BACKGROUND While gelatin sponge particles and calibrated microspheres are commonly used as embolic materials in conventional transarterial chemoembolization(cTACE),direct comparisons between these embolic agents are rare.AIM To compare the efficacy and safety of superselective cTACE using Embosphere®or Marine gel®in patients with early-stage hepatocellular carcinoma(HCC).METHODS This retrospective study included 70 patients with small(<4 cm)HCC who underwent cTACE with Embosphere®(n=33)or Marine gel®(n=37)as the embolic agent at a single center between March 2021 and July 2022.The radiologic images and clinical data were retrospectively reviewed,with an emphasis on tumor response,procedure-related complications,and local tumor recurrence.The primary index tumor was assessed on a 1-mo follow-up image,and local progression-free survival was obtained using the Kaplan-Meier method and was compared by the log-rank test.RESULTS The median tumor size of both groups was 1.5 cm,and 69 patients achieved a complete response one month after cTACE.The cumulative local recurrence rate at 12 mo was 15.5%in the Embosphere®group and 14.4%in the Marine gel®group.The local progression-free survival was not significantly different between the two groups(P=0.83).In the multivariate analysis,high serum alphafetoprotein was the only significant poor prognostic factor for local tumor progression(P=0.01).Postembolization syndrome occurred in 36.4%of the Embosphere®group and 35.1%of the Marine gel®group,and there were no cases of biloma,biliary duct dilation,or liver abscess in either group.CONCLUSION Calibrated gelatin sponge particles(Marine gel®)and calibrated microspheres(Embosphere®)have similar outcomes in terms of tumor response for superselective cTACE of small HCC.
文摘Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection.The degree of hypertrophy obtained after PVE is variable and depends on multiple factors.Up to 20%of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure(usually 6-8 wk are needed before surgery).The management of PVE failure is still debated,with a lack of consensus regarding the best clinical strategy.Different additional techniques have been proposed,such as sequential transarterial chemoembolization followed by PVE,segment 4 PVE,intra-portal administration of stem cells,dietary supplementation,and hepatic vein embolization.The aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.
文摘This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expected to reduce its incidence and degree in clinical treatment,and to improve the quality of treatment of Hepatocellular Carcinoma Carcinoma(HCC).
文摘Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence of a sac necessitate a more stringent and rigorous management approach. Objective: The primary aim of this study is to delve into the morphological features of ruptured aneurysms situated in distinct regions of the brain. Furthermore, we endeavor to assess the degree of safety and efficacy associated with stent-assisted embolization as a treatment modality for these ruptured aneurysms. Methods: This retrospective study encompassed a cohort of 467 patients who presented with intracranial ruptured aneurysms and were diagnosed through a combination of computed tomography (CT) and digital subtraction angiography (DSA) at Nanfang Hospital of Southern Medical University, spanning from January 2009 to December 2019. The following clinical parameters were meticulously recorded: aneurysm height, width, neck measurements, immediate Raymond grade assessments, and any perioperative complications experienced. Results: Within the study population, the average dimensions of ruptured aneurysms were found to be 4.26 ± 2.10 mm (width), 4.86 ± 2.38 mm (height), and 4.04 ± 1.87 mm (neck). Categorically, the most prevalent types of aneurysms were 170 cases of anterior communicating artery aneurysms (accounting for 36.4%), followed by 161 cases of posterior communicating artery aneurysms (34.5%), 56 cases of middle cerebral artery aneurysms (12.0%), 13 cases of anterior cerebral artery aneurysms (2.8%), 45 cases of paraclinoid aneurysms (9.6%), 6 cases of superior pituitary artery aneurysms (1.3%), 7 cases of anterior choroidal artery aneurysms (1.5%), and 9 cases of vertebrobasilar artery aneurysms (2.0%). Notably, 18 patients (3.9%) presented with ruptured aneurysms coexisting with ascus. Regarding treatment approaches, 228 cases (48.8%) underwent stent-assisted embolization, 234 cases (50.1%) received coils embolization, and 5 cases (1.1%) were treated with the dual-catheter technique. Immediately post-treatment, 422 patients (90.4%) attained a Raymond Class I status, with a procedure-related complication rate of 0.9%. Importantly, no statistically significant differences were observed in the incidence of perioperative complications across the three distinct treatment groups (P = 0.505). Conclusion: The outcomes of this study affirm the safety and efficacy of stent-assisted embolization as a treatment modality for ruptured aneurysms.
基金National Natural Science Foundation of China(General Program),No.82070540The Taishan Scholars Program of Shandong Province,No.tsqn202211309Program of Medical and Health Research Guidance in Qingdao City,No.2022-WJZD108.
文摘This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology.Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment,but inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications.In this article,the most appropriate candidate patients,embolization materials,embolization methods,and clinical evaluation methods are discussed to improve the safety and effectiveness of the procedure.
