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A systematic review and meta-analysis of the safety and efficacy of uterine artery embolization vs. surgery for symptomatic uterine fibroids

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Journal of Interventional Medicine 2018年第2期1卷 112-120页

作者： Shiwei Tang Mingxin Kong XinjianZhao Jun Chen Chen Wang Haibin Zhang Zhongmin Wang Department of Interventional Radiology Weifang People's Hospital Department of Interventional Radiology The Frist Affiliated Hospital of the MedicalCollege of Shihezi University Department of Vascular and Interventional Radiology The Third Affiliated Hospital of the Medical College of Shihezi University Department of Interventional Radiology Affiliated Ruijin Hospital Shanghai Jiaotong University School of Medicine

Purpose: The aim of this study was to systematically review the safety and efficacy of uterine artery embolization(UAE) versus surgery for symptomatic uterine fibroids. Materials and Methods: An electronic search of the Cochrane Library, PubMed, Embase and Web of Science databases was conducted from their inception to May 2017 for randomized controlled trials(RCTs) that assessed UAE versus surgery for the treatment of symptomatic uterine fibroids. The references of the included studies were also retrieved. Two reviewers independently screened the studies based on the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality. The meta-analysis was conducted using RevMan 5.3 software. Results: A total of seven RCTs involving 859 patients were included. The results of the meta-analysis showed a shorter hospital stay and recovery time for UAE as compared to surgery. Surgery was not reported to be better for improving health-related quality of life in any of the included studies. There were no significant differences in patient satisfaction(1-2 and 5 years), and intra-procedural complications or major complications(1 year). However, the rates of minor complications(1 year) and further interventions(2 and 5 years) were significantly higher in patients who underwent UAE rather than surgery. The rates of pregnancy and live births were significantly lower among patients who underwent UAE than surgery. Conclusion: UAE is safe and effective, and has the advantages of shorter hospital stay and recovery time as compared to surgery. However, UAE has the risk of re-intervention, and lower pregnancy and live birth rates.

关键词： uterine artery embolization surgery meta-analysis

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Evaluation of the safety and efficacy of a Pipeline Flex embolization device for treatment of large, wide-necked intracranial aneurysms

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Journal of Interventional Medicine 2018年第4期1卷 229-233页

作者： Qiao Deng Wenfeng Feng Huanqi Hai Jianming Liu Department of Neurosurgery Nanfang Hospital Southern Medical University Department of Neurosurgery Changhai Hospital Second military Medical University

Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device(PFED) in the treatment of large and wide-necked aneurysms in the internal carotid artery(ICA). Methods: The clinical data of 78 cases of large and wide-necked aneurysms in the ICA treated with this Pipeline Flex embolization device in Shanghai Hospital of the Second Military Medical University and Southern Hospital of Southern Medical University from February 2017 to June 2018 were retrospectively analyzed. Results: A total of 66 cases were treated with a Pipeline Flex embolization device, 10 with a pipeline flex embolization device, and 2 with a double tubride stent(10 patients were treated with a pipeline stent-assisted coil embolization in; and 2 patients were treated with two pipeline stents). The patients were followed up for 3 to 18 months(average, 9.25 months). Among them, 63 cases had complete occlusion of the neck of the aneurysm(Raymondl Class I; MRS score 0; 80.8%). Aneurysms recurred in 12 cases(Raymondl Class Ⅱ; MRS score 1; 15.4%). Delayed ischemic complications were observed in 1 case(MRS score >2; 0.13%). There was 1 case of poor release of stent and 1 case of stent stenosis(0.13%). Conclusion: The treatment of large, wide-necked aneurysms in the ICA with PFED has a high total occlusion rate and good prognosis was better than coil embolization, but the placement of PFED still has some neurological complications.

关键词： Pipeline Flex embolization device vascular reconstruction device large,wide-necked aneurysms neurological complications curative effect

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Preoperative embolization of skull-base tumors: Indications, utility, and concerns

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Journal of Acute Disease 2019年第3期8卷 89-94页

作者： Luis Rafael Moscote-Salazar Ali Adnan Dolachee Alexis Narvaez-Rojas Hayder Ali Al-Saadi Arjan A.Najim Aysar Khudhair jassam Alyaa Khadim Abdulreda Ali Odai Mahmood Haya Jasim Mohammed Samer S.Hoz University of Cartagena Cartagena de IndiasColombia Department of Surgery College of MedicineUniversity of Al-QadisiyahIraq Department of Neurosurgery Universidad Nacional Autonoma de NicaraguaManaguaNicaragua Department of Neurosurgery Neurosurgery Teaching HospitalBaghdadIraq

Skull-base tumors are generally difficult to access compared with many other cranial lesions. Usually surgery remains the gold standard treatment for the majority of these tumors. However, in many cases, surgical resection is a challenge because the disease usually is already in the advanced stage by the time of diagnosis. Additionally, there are hypervascular lesions which cause excessive loss of blood, then results in multiple blood transfusions and prolonged operative time, increases the risk of neural injury and prevents complete excision. In order to reduce blood loss intraoperatively, many alternatives were available with the neurosurgical armamentarium, such as head elevation, intravenous use of tranexamic acid, total intravenous anesthesia and even preoperative embolization of tumors. However, preoperative embolization carries variable results, potentially aggravating edema and increasing tumor size. To ascertain the current status and the up-to-date indications, an evaluation of the therapeutic role of preoperative embolization was performed in the current study.

关键词： Pre-operative embolization Skull-base tumors

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Partial splenic artery embolization in cirrhotic patients

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World Journal of Radiology 2014年第5期6卷 160-168页

作者： Tyson A Hadduck Justin P McWilliams Department of Interventional Radiology David Geffen School of Medicine UCLALos Angeles CA 90095 United States

Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization(PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in re-gards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications.

关键词： Partial splenic embolization Cirrhosis Liver disease Thrombocytopenia Leukopenia

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Absolute ethanol embolization for treatment of peripheral arteriovenous malformations

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中国整形与重建外科(英文) 2023年第3期5卷 136-140页

作者： Jingwei Zhou Chen Hua Xi Yang Yuxi Chen Yunbo Jin Xiaoxi Lin Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China

Arteriovenous malformations(AVMs)are aggressive congenital high-flow vascular anomalies,in which the feeding artery and draining vein are connected through fistulas without normal capillary networks.In severe cases,the condition may cause swelling,ulceration,bleeding,and even heart failure.Various treatment options are available for AVMs,including laser,surgical resection,embolization,and targeted drug therapy.With the development of endovascular treatment technology,absolute ethanol embolization of AVMs has become one of the first-line therapies owing to its sustained efficacy and low recurrence rate.However,administration of this therapy is challenging and may lead to serious complications if inappropriately managed.In this article,we reviewed and summarized previous clinical articles,literature reviews,and clinical trial data to comprehensively describe clinical manifestations of AVMs,the mechanism of ethanol embolotherapy,key points in treatment and management of complications,and issues that need to be addressed.We expect to provide a reliable information reference source for clinical physicians and researchers.

关键词： Arteriovenous malformation embolization Ethanol

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Perioperative impact of liver venous deprivation compared with portal venous embolization in patients undergoing right hepatectomy: preliminary results from the pioneer center

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Hepatobiliary Surgery and Nutrition 2019年第4期8卷 329-337页

作者： Fabrizio Panaro Fabio Giannone Benjamin Riviere Olivia Sgarbura Caterina Cusumano Emmanuel Deshayes Francis Navarro Boris Guiu Francois Quenet Division of HBP Surgery and Transplantation Department of SurgerySt.Eloi Hospital2Department of PathologyGui de Celiac HospitalMontpellier University Hospital-School of Medicine34090 MontpellierFrance Department of Surgical Oncology 4Department of Nuclear MedicineCancer Institute of Montpellier(ICM)20834298 MontpellierFrance Division of Interventional Radiology Department of RadiologySt.Eloi HospitalMontpellier University Hospital-School of Medicine34090 MontpellierFrance

Background: Preoperative portal vein embolization (PVE) is currently the standard technique used routinely to increase the size of the future remnant liver (FRL) before major hepatectomies. The degree of hypertrophy (DH) is approximatively 10% and requires on average six weeks. ALPPS is faster and achieves a good DH but with a higher morbidity and mortality. One method recently proposed to increase the FRL is liver venous deprivation (LVD), but its clinical and operative impact is still unknown. The aim of this study is to compare intra- and postoperative morbidity/mortality and the histological evaluation of the liver parenchyma between PVE and LVD in patients undergoing anatomic right hepatectomy. Methods: Fifty-three consecutive patients undergoing PVE and LVD before a major hepatectomy were retrospectively analysed between 2015 and 2017. In order to reduce the bias, only potential standard right hepatectomies were selected. Surgical resections and the radiologic procedures were performed by the same Institution. Intra-operative parameters (transfusions, perfusions, bleeding, operative time), postoperative complications (Clavien-Dindo and ISGLS criteria), and histological findings were compared. Results: To induce FRL growth 16 patients underwent PVE and 13 LVD. One patient of the PVE group was not resected due to peritoneal metastases. Surgery was performed for hepatocellular carcinoma (PVE =9, LVD=3), metastases (PVE =5, LVD =10), or others diseases (PVE =2, LVD =0). Per- and post-operative morbidity/mortality rates after PVE and LVD procedures were null. No differences between the two groups were found in terms of intraoperative bleeding (median: 550 vs. 1,200 mL;P=0.36), hepatic pedicle clamping (5 vs. 3 patients;P=0.69), intraoperative red blood cells transfusions (median: 622 vs. 594;P=0.42) and operative time (median:270 vs. 330 min;P=0.34). Post-operative course was similar when comparing both medical and surgical complications in the two arms (PVE n=7, LVD n=10, P=0.1). Major complications (Clavien-Di

关键词： Liver venous deprivation (LVD) portal embolization liver failure hepatectomy

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在 transcatheter 以后的征兆的 arterioportal 管的临床的结果动脉的 embolization

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World Journal of Radiology 2013年第2期5卷 33-40页

作者： Masakazu Hirakawa Akihiro Nishie Yoshiki Asayama Kousei Ishigami Yasuhiro Ushijima Nobuhiro Fujita Hiroshi Honda Department of Radiology Kyushu University Beppu Hospital Oita 874-0838Japan Department of Clinical Radiology Graduate School of Medical Sciences Kyushu University Hospital Fukuoka 812-8582 Japan

AIM: To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs). METHODS: Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n=5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n=1) underwent TAE for symptoms related to severe APFs [refractory ascites (n=4), hemorrhoidal hemorrhage (n=1), and hepatic encephalopathy (n=1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo). RESULTS: In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n=4) and both MCs and n-butyl cyanoacrylate (n=2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients. CONCLUSION: Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs.

关键词： Arterioportal fistula Iatrogenic Portal hypertension Portal thrombosis Transcatheter arterial embolization

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Effect of partial splenic embolization on the immune function of cirrhosis patients with hypersplenism

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Asian Pacific Journal of Tropical Medicine 2016年第7期9卷 688-692页

作者： Gui-Yun Jin Chuan-Zhu Lv Tang Deng Shao-Wen Cheng Chao-Qian Li Guangxi Medical University Hainan Medical University the Affiliate Hospital of Hainan Medical College

Objective:To discover the effect of partial splenic embolization on the immune function of cirrhotic patients with hypersplenism.Methods:Patients involved in the study were enrolled and divided into three groups,including control group,experimental group,and complication group.Numbers of CD3^+,CD4^+ and CD8^+ T cells and CD4^+CD25^+CDl27^(low/-) Treg cells in the peripheral blood of patients before surgery,1 month,6 months,1 year,and 2 years after surgery were analyzed by fluorescence active cell sorting(FACS).Contents of immunoglobulins(IgA,IgG and IgM) were analyzed by auto immunoassay analyzer.Results:In the peripheral blood of patients from experimental group,numbers of CD3^+,CD4^+ and CD8^+ T cells initially declined,but afterwards increased to normal level;in the peripheral blood of patients from complication group,CD3^+ and CD8^+ T cells showed the same trend,but the number of CD4^+ T cells was below normal level at all detection times.Furthermore,CD3^+,CD4^+ and CD8^+ T cells in the peripheral blood of patients from complication group were initially less than those in experimental group,and afterwards were comparable between two groups.In patients from both experimental group and complication group,the number of CD4^+CD25^+CDl27^(low/-)Treg cells increased 1 month and 6 months after surgery,and gradually restored to normal level.CD4^+CD25^+CDl27^(low/-)Treg cell counts in patients from complication group were initially more than those in patients from experimental group 1 month and 6 months after surgery,but then they were comparable.Furthermore,contents of immunoglobulins(IgA,IgG and IgM) were comparable in three groups at all detection times.Conclusion:Partial splenic embolization influenced the immune function of cirrhotic patients with hypersplenism in the short term but the immune function could afterwards gradually restore to normal.Our results implicated that measures that prevent infection and improve immune function were necessary in early stage after undergoing PSE in order to reduce complicatio

关键词： Viral hepatitis type B Cirrhosis Hypersplenism Partial splenic embolization Immune function

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Ileus caused by cholesterol crystal embolization: A case report

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World Journal of Gastroenterology 2016年第12期22卷 3502-3505页

作者： Shunjiro Azuma Maiko Ikenouchi Takuji Akamatsu Takeshi Seta Shunji Urai Yoshito Uenoyama Yukitaka Yamashita Department of Gastroenterology Japan Red Cross Society Wakayama Medical Center

Cholesterol crystal embolization(CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or endovascular catheter manipulation, or due to anticoagulation or thrombolytic therapy. We report a rare case of intestinal obstruction caused by spontaneous CCE. An 81-year-old man with a history of hypertension was admitted for complaints of abdominal pain, bloating, and anorexia persisting for 4 mo. An abdominal computed tomography revealed intestinal ileus. His symptoms were immediately relieved by an ileus tube insertion, and he was discharged 6 d later. However, these symptoms immediately reappeared and persisted, and partial resection of the small intestine was performed. A histopathological examination indicated that small intestine obstruction was caused by CCE. At the 12-mo follow-up, the patient showed no evidence of CCE recurrence. Thus, in cases of intestinal obstruction, CCE should also be considered.

关键词： Cholesterol crystal embolization Ileus Intestinal obstruction Vascular manipulation Catheter manipul

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Transvenous embolization of cavernous dural arteriovenous fistula:report of 28 cases

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Chinese Medical Journal 2007年第24期120卷 2229-2232页

作者： HE Hong-wei JIANG Chu-han WU Zhong-xue LI You-xiang WANG Zhong-cheng Department of Neuroradiosurgery Beijing Neurosurgery InstituteBeijing Tiantan Hospital Capital Medical University Beijing100050 China

Background Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization. Methods From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils （GDC, EDC, Matrix, Orbit or free coil） or coils plus silk. The patients were followed up for 3 to 26 months. Results All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus （2 patients） or the inferior petrosal sinus （1） after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus. Conclusions Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural

关键词： transvenous cavernous sinus dural arteriovenous fistula embolization

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