Abstract: PURPOSE: To describe the imaging work-up and management of type III endoleaks detected after covered stent-graft treatment of descending thoracic aortic aneurysms. PATIENTS AND METHODS: Retrospective study of circumstances surrounding the diagnosis, management and outcome type III endoleaks occuring in 3 of 18 patients following covered stent-graft treatment of descending thoracic aortic aneurysms between April 1998 and July 2005. The endoleaks were detected at a mean follow-up of 22 months (19-24 months) after stent-graft placement. RESULTS: The type III endoleaks were detected on scheduled follow-up CT examinations in asymptomatic patients. Endovascular management was proposed at a mean interval time of 4.4 months (1 week - 11 months) after diagnosis of the endoleak, and was successful in all 3 cases. One patient died 1 month after endovascular repeai of the leak, 1 patient required surgical management at 14 months for new recurrence, and 1 patient had a favorable outcome at 2 months. CONCLUSION: Follow-up of patients after covered stent-graft treatment of descending thoracic aortic aneurysms is required. Prompt endovascular repair of delayed complications may be possible, but surgical management may become necessary.
Abstract: OBJECTIVES: The aim of this study is to evaluate immediate technical and clinical results of palliative transarterial renal embolization in patients with symptomatic renal tumors. METHODS: Parenchymal embolization of 20 renal tumors was performed in 20 symptomatic patients with hematuria and/or lumbar pain and/or para-neoplastic syndrome. Seven patients were inoperable because of poor general condition, and 15 patients had metastatic lesions. RESULTS: Immediate technical success was observed, with post-infarction pain in all patients requiring analgesia in 12 cases (which was successful in 90%); 8 patients had transitory fever. With a median follow up of 8.1 (range 4-27) months, recurrent hematuria was noted in two patients for which partial embolization was initially chosen; pain did not recur in any patients. CONCLUSIONS: Palliative embolization of advanced symptomatic renal tumors is easy to accomplish with low morbidity. It helps to alleviate invalidating symptoms in a multidisciplinary management of advanced renal tumors.
Abstract: We report functionally successful hepatic and left adrenal embolization with particles to treat Cushing's syndrome associated with a medullary thyroid carcinoma.
Abstract: Indications for interventional radiology have increased, and various arterial and venous procedures are nowadays possible in oncology. Besides emergency procedures, scheduled palliative or curative procedures require multidisciplinary cooperation emphasizing on cautions related to iodine contrast media and concerning immunosuppresion, hemostasis disorders, analgesia, and the choice of the adequate approach. Diagnostic endovascular biopsies and venous sampling may be performed. Embolisation procedures are useful for achieving hemostasis, tumor devascularisation, or chemo-embolisation. Revascularisation procedures concern central vein obstructions, catheter occlusion or arterial stenoses and occlusions. Vena cava filtering, retrieval of intravascular foreign bodies and percutaneous implantation of ports can also be indicated, as well other treatments of central venous access complications. The principles, technical aspects, results, and indications of these various endovascular procedures are described in this review.
Abstract: PURPOSE: To evaluate the potential of uterine artery embolization to minimize blood loss and facilitate easier removal of fibroids during subsequent myomectomy. METHODS: This retrospective study included 22 patients (median age 37 years), of whom at least 15 wished to preserve their fertility. They presented with at least one fibroid (mean diameter 85.6 mm) and had undergone preoperative uterine artery embolization (PUAE) with resorbable gelatin sponge. RESULTS: No complication or technical failure of embolization was identified. Myomectomies were performed during laparoscopy (12 cases) and laparotomy (9 cases). One hysterectomy was performed. The following were noted: easier dissection of fibroids (mean 5.6 per patient, range 1-30); mean intervention time 113 min (range 25-210 min); almost bloodless surgery, with a mean peroperative blood loss of 90 ml (range 0-806 ml); mean hemoglobin pretherapeutically 12.3 g/dl (range 5.9-15.2 g/dl) and post-therapeutically 10.3 g/dl (range 5.6-13.3 g/dl), with no blood transfusion needed. Patients were discharged on day 4 on average and the mean sick leave was 1 month. CONCLUSION: Preoperative embolization is associated with minimal intraoperative blood loss. It does not increase the complication rate or impair operative dissection, and improves the chances of performing conservative surgery.
Abstract: We report two cases of percutaneous transhepatic stenting of the portal vein to treat stenosis and occlusion disclosed 5 and 18 months, respectively, after orthotopic liver transplantation in two adult patients. If long-term patency is satisfactory, this technique should allow long-term management of portal vein stenosis and occlusion without the use of thrombolysis.
Abstract: PURPOSE: To retrospectively assess the value of MRI in long-term follow-up of aortic dissection (AD) and its impact on therapy. MATERIALS AND METHODS: Comparison of clinical progression and analysis of 215 MRI examinations performed on 56 patients in our center from 1991 to 2002. RESULTS: Twenty-six patients (46%) had AD complications: 14 (54%) were asymptomatic and eight (31%) had subsequent surgical repair (native aorta upstream prosthesis disease in three patients and aneurismal dilatation of false lumen in five cases). Of the eight patients with secondary surgery, five (63%) were clinically asymptomatic. The delay between initial dissection and secondary surgery was less than 5 years in five patients and exceeded 10 years in three cases. The remaining 30 patients (54%) had unmodified radiological findings after a mean follow-up of 3.5 years (6 months to 9 years). CONCLUSION: MRI depicted AD complications in long-term follow-up of sometimes asymptomatic patients, allowing for adaptation of surgical treatment in 26 cases (46%).
Abstract: OBJECTIVE: To evaluate immediate results, clinical improvement, long-term patency and predictive factors of long-term outcome after superficial femoral artery percutaneous angioplasty. PATIENTS AND METHODS: Restrospective monocentric study of 101 patients (142 lesions: 105 stenoses and 37 occlusions) technical results, long-term patency (19 months), and clinical improvement (27,5 months) were analyzed. A multifactorial analysis was performed. RESULTS: Technical success was obtained in 99%, complications and mortality rates were respectively 3% and 2%. At the end of follow-up, 55 patients were clinically improved (20 lost to follow-up), and femoral artery remained patent in 62 patients (10 to follow-up). Statistical analyses revealed 8 significant predictive factors of a good outcome (P<0.05): female gender, non-diabetic, at least one patent artery below the knee, AHA classification <2, no stent, treatment of an occlusion, number of dilatations<3, treatment by statins for hypercholesterolemia. CONCLUSION: Femoral superficial artery angioplasty is usually achieved with low complication rate. We found eight factors predictive of long-term outcome, to keep in mind when indications are discussed.
