Quantification and Reduction of Reflux during Embolotherapy Using an Antireflux Catheter and Tantalum Microspheres: Ex Vivo Analysis

PurposeTo demonstrate in a porcine model that reflux during embolotherapy can be relatively quantified (ie, as embolization efficiency) and that nontarget embolization can be eliminated by using an antireflux microcatheter.Materials and MethodsRenal artery embolization was performed with radiopaque tantalum microspheres (concentration of 1 g/20 mL) in three swine. Second-order right renal arteries (n = 3) underwent embolization with a 3-F antireflux catheter, and second-order left renal arteries (n = 3) underwent embolization with a 4-F end-hole catheter as a control. After embolization, kidneys were explanted and underwent micro–computed tomographic (microCT) imaging. Three-dimensional volumetric and multiplanar imaging of the kidneys was performed to assess vascular distribution. Digital Imaging and Communications in Medicine data were analyzed, with a threshold algorithm used to create binary images. The number of positive values in a region of interest in the target embolized tissue (upper pole or lower pole) and the nontarget adjacent tissue was determined, and embolization efficiency was calculated. Wilcoxon rank-sum statistical analysis was performed to compare nontarget embolization between infusion catheters.ResultsAll renal arteries underwent successful embolization with tantalum microspheres, with 20 mL (1 g) administered in all dose deliveries. MicroCT provided high-resolution visualization of the renal parenchyma at 70-μm resolution. In control renal arteries, a standard 4-F end-hole catheter had an embolization efficiency of 72%±13. In experimental renal arteries, the antireflux microcatheter had an embolization efficiency of 99.9%±1.0 (P< . 05).ConclusionsA significant decrease in nontarget embolization (ie, reduction in reflux) was possible with an antireflux microcatheter compared with a conventional end-hole catheter.     

动脉栓塞治疗子宫肌瘤

目的观察动脉栓塞治疗子宫肌瘤的临床效果.方法采用Seldinger方法动脉栓塞治疗86例子宫肌瘤患者.经股动脉穿刺,将导管选择性插入双侧子宫动脉,经导管注入PVA和平阳霉素,阻断肌瘤血供.动脉栓塞6个月后对患者的临床症状和超声检查结果进行分析,同时还分析了该方法的并发症和失败原因.结果经血管造影发现,子宫肌瘤血供丰富,均由双侧子宫动脉供血,栓塞双侧子宫动脉后,子宫肌瘤血供可完全阻断,治疗后6个月的随访结果表明月经量及月经周期恢复正常,疼痛明显改善,肌瘤和子宫明显缩小.临床有效率91%.结论动脉栓塞治疗子宫肌瘤是一种创伤小,临床治疗效果好的新方法.     

Anastomoses of the Ovarian and Uterine Arteries: A Potential Pitfall and Cause of Failure of Uterine Embolization

Four women with symptomatic uterine fibroids were treated by uterine artery embolization (UAE). In all cases both uterine arteries were embolized via a single femoral puncture with polyvinyl alcohol using a selective catheter technique. In three cases, the ovarian artery was not visible on the initial angiogram before embolization, but appeared after the second uterine artery had been treated. In one case of clinical failure following UAE, a repeat angiogram demonstrated filling of the fibroids from the ovarian artery. Anastomoses between uterine and ovarian arteries may cause problems for radiologists performing UAE and are a potential cause of treatment failure.     

选择性子宫动脉栓塞治疗子宫肌瘤的临床研究

目的 研究用选择性子宫动脉栓塞治疗子宫肌瘤的临床效果。方法 采用Seldinger方法作选择性子宫动脉栓塞治疗15例子宫肌瘤患者。经股动脉穿刺,将导管选择性进入双侧子宫动脉,经导管注入真丝线段和明胶海绵,阻断肌瘤血供。结果 经血管造影发现,子宫肌瘤血供丰富,均由双侧子宫动脉供血,栓塞双侧子宫动脉后,子宫肌瘤血供可完全阻断,治疗后6个月的随访结果表明：月经量及月经周期恢复正常,疼痛明显改善,肌瘤和子宫体积明显缩小。临床有效率达86．67％。结论 选择性子宫动脉栓塞治疗子宫肌瘤是一种创伤小,临床效果好的新方法。     

经导管栓塞子宫动脉治疗子宫肌瘤（附8例报告）

目的 评价经导管栓塞子宫动脉治疗子宫肌瘤的疗效。方法8例肌壁间子宫肌瘤,经右股动脉穿刺,运用seldinger技术,将4-5F cobra导管送至双侧髂内动脉行造影,观察子宫动脉肌瘤供血染色情况。确认子宫动脉后,将导管超选至子宫动脉内,行明胶海绵颗粒栓塞,阻断肌瘤血供。结果8例肌壁问子宫肌瘤,7例双侧子宫动脉供血,1例单侧子宫动脉供血．经100％明胶海绵颗粒栓塞后造影复查,瘤体血供完全阻断,染色消失。8例术后3-4个月月经正常。术后1个月“B超”复查。证实肌瘤似较前缩小。术后3个月“B超”复查,3例肌瘤消失,术后半年“B超”复查,只有一例未完全消失,进一步证实为子宫腺肌症。术后8个月“B超”复查,腺肌症病变仍存在,但范围明显缩小,子宫大小趋于正常,临床症状完全消失。结论经导管栓塞子宫动脉是一种创伤小,治疗效果肯定的新型治疗方法。     

无痛性子宫动脉栓塞术介入治疗子宫肌瘤48例临床观察

目的探讨无痛性子宫动脉栓塞术介入治疗子宫肌瘤的临床效果。 方法选取2013年1月—2014年6月在我院行介入治疗的子宫肌瘤患者48例,经右侧股动脉,在数字减影血管造影（DSA）指引下,选用4F或5F Cobra导管及超滑导丝植入髂内动脉后对子宫动脉超选择插管、造影,在透视下注入710～1000 μm大颗粒聚乙烯醇（PVA）栓塞剂。 结果手术成功率为100%（48/48),介入治疗后随访6个月,月经恢复正常者46例,术前贫血者28例,术后6个月,26例恢复正常;肌瘤体积缩小量<20%者3例,肌瘤体积缩小量20%～50%者10例,肌瘤体积缩小量>50%者33例,肌瘤消失者2例。下腹胀痛及压迫症状均有所好转。 结论无痛性子宫动脉栓塞术治疗子宫肌瘤临床疗效显著,术后无严重并发症发生,值得在临床上推广应用。     

Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage

AIM: To present the findings of uterine artery embolization (UAE) in the management of obstetric haemorrhage. MATERIALS AND METHODS: From October 1999 to February 2003, 10 women with postpartum haemorrhage (n=7) and post-abortion haemorrhage with placenta accreta (n=3), were referred to our department for pelvic angiography and possible arterial embolization. RESULTS: Angiography revealed engorged and tortuous uterine arteries in all patients; and contrast medium extravasation in three patients. Eight patients (three with and five without detectable active bleeding) then underwent bilateral UAE. Medium-sized (250-355 microm) polyvinyl alcohol particles were injected via a coaxial catheter into the uterine arteries, followed by gelatin sponge pieces via a 4F Cobra catheter. Microcoil devascularization was also performed in the two patients with visible, active bleeding. The vaginal bleeding resolved in all patients, without any ischaemic complications. At follow-up, all patients who underwent UAE had normal menstruation; three of them subsequently gave birth to full-term healthy babies. CONCLUSION: Selective UAE by the coaxial method is safe and effective to control obstetric haemorrhage, with the potential to preserve fertility.     

真丝线段颗粒栓塞双侧子宫动脉治疗子宫肌瘤(附300例报告)

目的：探讨治疗子宫肌瘤的新方法,方法：首次以真丝线段颗粒为栓塞剂,运用介入血管插管技术超选择栓塞双侧子宫动脉治疗300例子中肌瘤。（1）两次栓塞法：分次栓塞双侧子宫动脉。（2）一次栓塞法;一次穿刺同时栓塞双侧子宫动脉。结果：（1）子宫肌瘤血管造影表现：小肌瘤无阳性征象,大肌瘤血供非常丰富,部分肌瘤血供来自肌瘤侧子宫动脉,部分肌瘤双侧子宫动脉的参与供血,另外,发现10例患者一侧子宫动脉发育缺如,此种变异尚未见报道,（2）肌瘤较术前明显缩小,临床有效率98.4%。（3）贫血明显改善。（4）月经量减少,经期恢复正常。结论：真丝线段颗粒栓塞双侧子宫动脉治疗子宫肌瘤是一种疗效好、创新小的新方法,值得应用和推广。     

Implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths in antegrade and crossover procedures: midterm results

The aim of this study was to evaluate the technical performance of the implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths. Thirty-three lesions (24 stenoses, 9 occlusions) in 32 patients (mean age 67 years) were stented. Selective stent implantation was performed after unsatisfactory percutaneous transluminal angioplasty result with an antegrade access in 21 patients and through a crossover sheath in 11 patients. A total of 36 stents were implanted. Stent delivery was successful in all cases (stent diameter 5 or 6 mm, stent length 11–38 mm). In none of the cases was stent dislodgement from the balloon observed. Stent placement was optimal without residual stenosis in 30 cases. In 1 case the stent was chosen too short requiring implantation of a second stent. In 1 patient distal embolization was observed which was treated with catheter embolectomy. Nine-month primary and secondary patency rates were 79±8.7 and 86±7.7%, respectively. Implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths is safe in antegrade and crossover procedures. Presented at ECR 2002.     

Microcatheter placement through a side hole created in a 5-F catheter into proximal subclavian arterial branches causing hemoptysis

Five patients with moderate to massive hemoptysis who had a bronchial artery of anomalous origin or a nonbronchial systemic artery originating from the proximal subclavian artery underwent microcatheter placement through a created side hole of a 5-F catheter. All patients had pulmonary tuberculosis and had undergone bronchial artery embolization for hemoptysis. The side holes were made in the lesser (n = 2) or greater curvature sides (n = 3) of 5-F nonbraided Headhunter catheters. A microcatheter was passed through the side hole of the 5-F catheter into the target artery for embolization. Polyvinyl alcohol particles were used as the embolic material. The technical success rate was 100%, and immediate control of hemoptysis was achieved in all patients without complication.     

子宫动脉栓塞术治疗子宫腺肌病临床观察

目的 探讨经导管子宫动脉栓塞术治疗子宫腺肌病的临床效果。方法 选择15例子宫腺肌病患者，采用Seldinger技术行双侧子宫动脉插管，造影确诊后注入携带有抗生素的聚乙烯醇(PVA)栓塞颗粒进行栓塞，术后l、3、6、12个月观察其疗效。结果 子宫动脉栓塞治疗后，月经恢复正常，贫血症状改善；子宫、病灶体积缩小显著；14例患者术后3个月内痛经消失，1例明显缓解；彩超示病灶内血流信号明显减少。结论 子宫动脉栓塞治疗子宫腺肌病是一种微创、疗效显著的治疗方法。     

Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow-up

PURPOSE: To prospectively evaluate the effectiveness and safety of selective embolization of the uterine arteries in the management of symptomatic uterine leiomyoma. MATERIALS AND METHODS: Eighty consecutive women (mean age, 44.7 years) with symptomatic uterine leiomyoma, none of whom desired future pregnancy, underwent superselective embolization of the uterine arteries with polyvinyl alcohol particles. In all women, arterial embolization was performed because of persistent, fibroid-related menorrhagia after failure of hormonal therapy. Follow-up consisted of office visits at 2, 6, 12, and 24 months and of ultrasonography at 2 and 6 months after the procedure. RESULTS: Bilateral embolization of the uterine arteries was performed in 76 women; unilateral embolization, in four women. Menorrhagia disappeared in 72 (90%) women. In five (6%) women (including three women with unilateral embolization), clinical improvement was not observed, and myomectomy was needed. In one woman with a large submucosal uterine leiomyoma, hysterectomy was needed because of septic uterine necrosis. Normal menstruation resumed in all but six women. Full-term pregnancy occurred in three women after the procedure. CONCLUSION: Superselective arterial embolization of the uterine arteries is an effective means of controlling symptomatic uterine leiomyoma. However, the ideal embolic regimen remains to be determined.     

Efficacy of embolization in traumatic uterine vascular malformations

PURPOSE: To evaluate the efficacy of embolotherapy in patients with bleeding traumatic uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS: A retrospective review of all patients who underwent pelvic arterial embolization at our institution between July 1992 and September 2002 was performed. Fifteen patients were diagnosed with a uterine vascular malformation on duplex ultrasonography and correlative MR imaging. Serial beta-human chorionic gonadotropin levels were measured to exclude gestational trophoblastic neoplasia. All patients underwent transcatheter embolization of the uterine arteries. Embolizations were performed with use of standard 4-5-F catheters and microcatheters when necessary. Embolic agents in the 25 procedures included glue only (n = 13), polyvinyl alcohol (PVA) particles and glue (n = 4), PVA particles (n = 2), Gelfoam (n = 2), coils (n = 1), PVA particles and coils (n = 1), glue and Gelfoam (n = 1), and glue and coils (n = 1). PVA particle size ranged from 350 to 1,000 micro m. Outcomes assessed were cessation of bleeding, persistence or resolution of the AVM, complications, and pregnancy after embolization. These were assessed by chart, laboratory, and imaging reviews. RESULTS: A total of 25 embolization procedures were performed in 15 patients. Six patients required repeat embolization (one patient underwent embolization on six occasions; five patients had two embolization procedures each) for recurrence of bleeding. Sixteen procedures were performed on an elective basis and nine were performed on an emergent basis. The technical success rate of embolization was 100%. The clinical success rate was 93%: bleeding was controlled in 14 of 15 patients and one patient underwent a hysterectomy. Four of the 15 patients subsequently had a total of five uneventful intrauterine pregnancies carried to term. The 14 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 3-124 months) after treatment. Three patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred. CONCLUSION: Percutaneous embolotherapy is a safe and effective treatment for traumatic AVMs. This procedure allows for preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.     

Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate

PURPOSE: To evaluate the clinical efficacy of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA) for ruptured pseudoaneurysms, which are difficult to control by coil embolization alone. MATERIALS AND METHODS: Ruptured pseudoaneurysms developed at the celiac trunk (n = 1), gastroduodenal artery (n = 2), pancreatic arcade (n = 1), hepatic artery (n = 3), renal artery (n = 1), and intercostal artery (n = 1) in nine patients. NBCA was mixed with iodized-oil (1:2) and injected via the 3-F microcatheter under fluoroscopic guidance, after the catheter was advanced close to the pseudoaneurysm. Coil embolization was performed to control blood flow before administration of NBCA in seven patients. NBCA was injected immediately after coil embolization in four patients. Embolization with NBCA was performed for recurrent bleeding that occurred within 1-21 days (mean, 10.7 days) after initial coil embolization in three patients. Two patients with peripheral pseudoaneurysms underwent embolization with NBCA alone. RESULTS: The NBCA mixture was visible under fluoroscopy, and was useful in monitoring the embolization process and deciding the endpoint. Embolization was technically successful without major complications in all patients. Pseudoaneurysms and afferent and efferent arteries were eliminated immediately after embolization. Bleeding was stopped after embolization in all cases. Rebleeding did not occur in any patient during their follow-up periods of 0.7-69.5 months (mean, 17.9 months). CONCLUSION: Embolization with NBCA is a feasible and useful treatment for ruptured pseudoaneurysms, which are difficult to control by coil embolization alone.     

中药组方作为血管栓塞剂栓塞肝动脉的实验研究

目的研究中药组方作为血管栓塞剂的有效性、安全性及相关特性,以期获得理想的肿瘤血管栓塞剂。方法根据药典提供的数味具有抗癌和促凝作用的中草药,制备成栓塞剂。对其进行一系列有关特性的研究和鉴定,并应用其进行8头健康猪的肝动脉栓塞实验。结果中药组方栓塞剂为一种混悬剂,有一定黏滞性,不透X线,易经各种介入用导管注射;该栓塞剂具有良好的血液相容性和组织相容性,无致热原性及毒性作用;栓塞部位主要是末梢小动脉,栓塞牢靠,维持时间可达5周,不易形成侧支循环;经光镜和电镜观察其对正常肝组织损伤轻微,仅出现栓塞部位的肝细胞变性和胞质灶性坏死。结论中药组方栓塞剂具有良好的血管栓塞作用,使用方便、安全,是一种较理想的末梢型血管栓塞剂。     

Effects of utero-ovarian anastomoses on clinical outcomes and repeat intervention rates after uterine artery embolization

PURPOSE: To assess the prevalence of anastomoses between uterine and ovarian arteries on angiography and their association with clinical outcome after uterine artery embolization (UAE). MATERIALS AND METHODS: Consecutive patients who underwent UAE for symptomatic uterine leiomyomata according to a uniform embolization technique by a single operator at a single institution were included in the study. Patients' angiographic images, pre- and postoperative magnetic resonance (MR) images, and clinical symptom evaluations were reviewed. MR imaging was performed 6 months after UAE, and clinical evaluation with symptom severity score (SSS) measurement was performed at 6-month and yearly intervals afterward. Leiomyomata volume change, SSS, and repeat intervention rates were compared for patients with and without anastomoses between uterine and ovarian arteries on angiography. RESULTS: Of 288 consecutive patients in the study (mean age, 43.8 +/- 6.4 y), patent anastomoses between the uterine and ovarian arteries were detected in 116 patients (40.3%) by angiography. On follow-up, there was a mean leiomyomata volume reduction of 50.4% and an improvement in mean transformed SSS of 38.2 points. In patients with anastomoses, mean leiomyomata volume reduction was 49.5% and mean transformed SSS improvement was 38.1 points. In patients without anastomoses, mean leiomyomata volume reduction was 50.4% and mean transformed SSS improvement was 38.4 points. At a mean follow-up of 21.5 months, 16 patients (5.6%) elected to undergo further therapy for residual symptoms, including seven hysterectomies, four myomectomies, and five repeat UAE procedures. There were statistically significant differences in repeat intervention rates between the two groups: 14 patients with anastomoses (12.1%) underwent five hysterectomies, four myomectomies, and five repeat UAE procedures, whereas two patients without anastomoses (1.2%) elected to undergo hysterectomy (P < .0001). CONCLUSION: Anastomoses between the uterine artery and ovarian artery were demonstrated on angiography in 40.3% of 288 consecutive patients studied. Although the overall repeat intervention rate after initial UAE is only 5.6%, UAE in patients with anastomoses is associated with a significantly higher incidence of repeat intervention than UAE in patients without anastomoses.     

产后大出血急诊栓塞治疗的不良反应及并发症探讨

目的:探讨动脉栓塞法治疗急诊产后大出血的不良反应及并发症及其防治。方法:对57例急诊产后大出血患者的双侧子宫动脉或和髂内动脉以及部分患者的卵巢动脉用明胶海绵颗粒进行栓塞。结果:所有病例均出现有栓塞术后综合征;1例患者出现血尿(1.8%);13例患者出现髋部及下肢疼痛、麻木(22.8%);19例患者出现臀部疼痛、红肿、硬结(33.3%);1例患者出现子宫性闭经(1.8%);全组病例未出现子宫坏死或卵巢功能减退等其它严重并发症。结论:产后大出血急诊栓塞治疗会出现一定的不良反应及并发症,在治疗过程中进行超选择性栓塞,不进行过度栓塞,严防栓塞剂返流,可避免大部分严重并发症的发生。     

妇产科难治性出血超选择动脉插管栓塞治疗临床观察

目的：总结16例严重子宫出血介入栓塞治疗的疗效，评价动脉超选择动脉插管栓塞术在妇产科难治性出血治疗中的价值。方法：采用Seldinger技术对16例妇产科难治性出血患者，经皮股动脉穿刺，双髂动脉置管或超选择插管，应用数字减影血管造影（DSA）技术，明确出血部位后，以明胶海绵颗粒、丝线段或无水酒精栓塞。栓塞后再造影直至靶动脉血流停滞为止。结果：16例患者中栓塞髂内动脉6例，栓塞子宫动脉10例，均一次栓塞止血成功，无1例并发症，随访3－69月，均无复发及并发症。结论：应用动脉插管栓塞治疗妇产科难治性出血快捷、彻底、安全可靠、疗效肯定、并发症少，值得临床推广。     

A 5-F needle-sheath system for translumbar catheter angiography

A 5-F needle-sheath catheter delivery system allows translumbar introduction and interchange of 4-F-catheters with various lengths and shapes. The system was used in 236 patients. In 227 cases, a pigtail catheter was introduced for outflow studies of the lower extremities or visualization of the aortic arch. In 9 cases a selective catheter (sidewinder, headhunter, cobra) for angiography of a total of 19 vessels (carotid arteries, visceral arteries, renal arteries) was used. No major complications related to aortic puncture or catheter manipulation occured, no relevant retroperitoneal hematomas were observed. The 5-F needle-sheath system is a safe and simple alternative to the more precarious transbrachial technique. Offprint requests to: Edgar A. Rinast     

胎盘植入的影像学表现及介入治疗临床研究

目的探讨胎盘植入的影像学表现及介入治疗方法和疗效。资料与方法本组11例患者,术前作CT平扫、术前术后作超声检查、查血绒毛膜促性腺激素(HCG),行双侧子宫动脉造影。治疗采用改良式Seldinger技术穿刺插管行盆腔动脉造影,明确出血血管后将5 F Cobra导管超选择插入出血侧子宫动脉,立即用明胶海绵颗粒和明胶海绵条栓塞。栓塞前经导管注入甲氨喋呤(MTX)200 mg。结果 CT发现11例患者均有盆腔软组织包块,造影示子宫动脉异常增粗、迂曲,并见粗条状血窦及包块染色;11例患者栓塞治疗后植入性胎盘均在3～28天(平均12.3天)内自行剥离、脱落,其中3例1年后自然怀孕。结论胎盘植入通过CT、超声及子宫动脉造影可明确诊断,经导管超选择性子宫动脉栓塞术是治疗胎盘植入安全性高、疗效肯定的方法。