Artery Embolization Research Articles

#598 Successful application of allo-hemodialysis in a porcine model of embolization-induced acute kidney injury

Abstract Background and Aims Annually, millions of kidney patients, primarily in low- and low-middle income nations, die prematurely due to the lack of affordable kidney replacement therapy. We propose a novel, low-cost alternative dialysis modality called allo-hemodialysis (alloHD), where blood of a patient with kidney failure flows counter-current to the blood of a healthy subject (“buddy”) through the dialyzer [1]. Uremic solutes and excess fluid are then excreted by the buddy's healthy kidneys. We have already demonstrated the technical feasibility of alloHD in pigs with acute kidney injury (AKI) induced by renal artery ligation [2]. In this study, we explored alloHD in a less invasive porcine model of AKI induced by renal artery embolization. Method The protocol was approved by the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA), New Delhi, India. We studied two female Yorkshire pigs (weight 80-90 kg) with central venous catheter as vascular access. AKI was induced by embolization of both kidneys by transcatheter deployment of Contour™ Poly Vinyl Alcohol particles (Boston Scientific, Marlborough, MA, USA). The AKI pig and the buddy pig were connected to the dialysate and blood compartments, respectively, of a Nipro Cellentia 17H dialyzer. The AKI pig was then dialyzed for 4 hours against the healthy buddy pig. During alloHD, both pigs were anticoagulated with heparin (5,000 IU/h) and the buddy pig was sedated with 1-2% isoflurane gas. Blood samples were collected before, during, and after alloHD for measurements of blood urea nitrogen (BUN) and creatinine. Results We performed nine alternate day alloHD sessions with the same pair of pigs. During alloHD, BUN and Creatinine levels declined in the AKI pig (Fig. 1) and increased—as expected—transiently above baseline in the buddy pig and then trended towards baseline post-dialysis (Fig. 1). We found no indication of hemolysis or coagulation of the extracorporeal circuit in any of the nine alloHD sessions. The animals were sacrificed after the 9th session. Conclusion We demonstrated the feasibility of alloHD in a porcine embolization AKI model. This study corroborates and complements our previous experience with alloHD in a porcine model of AKI induced by renal artery ligation. Given these promising results, we are investigating the potential for advancing to a clinical trial.

Alternative treatments of adenomyosis - an update in procedural management and clinical outcomes.

Adenomyosis is a common cause of abnormal uterine bleeding (AUB), dysmenorrhea, and pelvic pain. Definitive diagnosis and treatment have historically been by uterine histopathology at time of hysterectomy; however, advances in imaging have supported earlier diagnosis and subsequent conservative treatment. This review aims to update the evidence supporting the uterine-sparing, procedural management options with a focus on clinical outcomes. Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy. This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility.

Hemorrhage Sites and Mitigation Strategies After Pancreaticoduodenectomy

Postpancreatectomy hemorrhage is an uncommon but highly morbid complication of pancreaticoduodenectomy. Clinical evidence often draws suspicion to the gastroduodenal artery stump, even without a clear source. To determine the frequency of gastroduodenal artery bleeding compared to other sites and the results of mitigation strategies. This cohort study involved a retrospective analysis of data for consecutive patients who had pancreaticoduodenectomy from 2011 to 2021 at Memorial Sloan Kettering Cancer Center (MSK) and Thomas Jefferson University Hospital (TJUH). Demographic, perioperative, and disease-related variables. The incidence, location, treatment, and outcomes of primary (initial) and secondary (recurrent) hemorrhage requiring invasive intervention were analyzed. Imaging studies were re-reviewed by interventional radiologists to confirm sites. Inclusion criteria were met by 3040 patients (n = 1761 MSK, n = 1279 TJUH). Patients from both institutions were similar in age (median [IQR] age at MSK, 67 [59-74] years, and at TJUH, 68 [60-75] years) and sex (at MSK, 814 female [46.5%] and 947 male [53.8%], and at TJUH, 623 [48.7%] and 623 male [51.3%]). Primary hemorrhage occurred in 90 patients (3.0%), of which the gastroduodenal artery was the source in 15 (16.7%), unidentified sites in 24 (26.7%), and non-gastroduodenal artery sites in 51 (56.7%). Secondary hemorrhage occurred in 23 patients; in 4 (17.4%), the gastroduodenal artery was the source. Of all hemorrhage events (n = 117), the gastroduodenal artery was the source in 19 (16.2%, 0.63% incidence in all pancreaticoduodenectomies). Gastroduodenal artery hemorrhage was more often associated with soft gland texture (14 [93.3%] vs 41 [62.1%]; P = .02) and later presentation (median [IQR], 21 [15-26] vs 10 days [5-18]; P = .002). Twenty-three patients underwent empirical gastroduodenal artery embolization or stent placement, 7 (30.4%) of whom subsequently experienced secondary hemorrhage. Twenty percent of all gastroduodenal artery embolizations/stents (8/40 patients), including 13% (3/13 patients) of empirical treatments, were associated with significant morbidity (7 hepatic infarction, 4 biliary stricture), with a 90-day mortality rate of 38.5% (n = 5) for patients with these complications vs 7.8% without (n = 6; P = .008). Ninety-day mortality was 12.2% (n = 11) for patients with hemorrhage (3 patients [20%] with primary gastroduodenal vs 8 [10.7%] for all others; P = .38) compared with 2% (n = 59) for patients without hemorrhage. In this study, postpancreatectomy hemorrhage was uncommon and the spectrum was broad, with the gastroduodenal artery responsible for a minority of bleeding events. Empirical gastroduodenal artery embolization/stent without obvious sequelae of recent hemorrhage was associated with significant morbidity and rebleeding and should not be routine practice. Successful treatment of postpancreatectomy hemorrhage requires careful assessment of all potential sources, even after gastroduodenal artery mitigation.

Trends and outcomes of hospitalized patients with priapism in Germany: results from the GRAND study.

We aimed to provide evidence on the trends and in-hospital outcomes of patients with low- and high-flow priapism through the largest study in the field. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2008-2021), and performed multiple patient-level analyses. We included 6,588 men with low-flow and 729 with high-flow priapism. Among patients with low-flow priapism, 156 (2.4%) suffered from sickle cell disease, and 1,477 (22.4%) patients required shunt surgery. Of them, only 37 (2.5%) received a concomitant penile prosthesis implantation (30 inflatable and 7 semi-rigid prosthesis). In Germany, the total number of patients with low-flow priapism requiring hospital stay has steadily increased, while the number of patients with high-flow priapism requiring hospital stay has decreased in the last years. Among patients with high-flow priapism, 136 (18.7%) required selective artery embolization. In men with low-flow priapism, sickle cell disease was associated with high rates of exchange transfusion (OR: 21, 95% CI: 14-31, p < 0.001). The length of hospital stay (p = 0.06) and the intensive care unit admissions (p = 0.9) did not differ between patients with low-flow priapism due to sickle cell disease versus other causes of low-flow priapism. Accordingly, in men with high-flow priapism, embolization was not associated with worse outcomes in terms of length of hospital stay (p > 0.9), transfusion (p = 0.8), and intensive care unit admission (p = 0.5). Low-flow priapism is an absolute emergency that requires shunt surgery in more than one-fifth of all patients requiring hospital stay. On the contrary, high-flow priapism is still managed, in most cases, conservatively.

Scimitar Syndrome in a Pediatric Cohort.

Scimitar syndrome is a rare form of congenital heart disease (CHD) characterized by anomalous pulmonary venous drainage of the right lung to the inferior vena cava. We describe the presentation, diagnosis, therapeutic management and long-term follow-up of 10 pediatric patients with Scimitar Syndrome. We performed a retrospective observational study of all pediatric patients from our institution with scimitar syndrome (March 1996-July 2023). Patients underwent systematic evaluation including medical and family history, chest x-ray, 12-lead electrocardiogram, echocardiogram, angiography and/or computed tomography; or magnetic resonance angiography. Ten patients with scimitar syndrome were included. The median age at diagnosis was 10.4 [0.1-150.2] months and the median follow-up time was 7.7 [1.3-15.3] years. Eight patients presented with aortopulmonary collateral arteries which were embolized. Two patients had dual connections to the inferior vena cava and left atrium; embolization of the inferior vena cava connection was only feasible in one of them. No patients underwent surgery of the scimitar vein. Three patients had surgical correction of CHDs. There were no deaths related to scimitar syndrome during follow-up. All patients with scimitar syndrome need prompt cardiovascular evaluation and follow-up. Our study demonstrates that a conservative approach with aortopulmonary collateral artery embolization, scimitar vein embolization when dual drainage to the left atrium is identified, along with correction of concomitant CHDs might have good results in patients with scimitar syndrome in order to postpone surgical correction of the anomalous pulmonary venous return to an older age when clinically or hemodynamically indicated. Further studies with longer-term follow-up and a larger sample size are needed to more effectively determine treatment strategy.

Gastrointestinal Complications and Visceral Circulation Changes After Intentional Celiac Artery Embolization During Complex Endovascular Aortic Aneurysm Repair

Gastrointestinal Complications and Visceral Circulation Changes After Intentional Celiac Artery Embolization During Complex Endovascular Aortic Aneurysm Repair

Treatment strategy for splenic artery aneurysms and novel classification based on imaging

ObjectiveThe incidence of splenic artery aneurysms (SAAs) has increased with advances in imaging techniques, necessitating a comprehensive classification to guide treatment strategies. This study aims to propose a novel classification system for SAAs based on aneurysm characteristics and to review treatment outcomes at our center. MethodsThis retrospective study included 113 patients with SAAs admitted to Peking Union Medical College Hospital from January 2019 to December 2023, assessed using computed tomography angiography or digital subtraction angiography. A new classification system was devised based on the aneurysm location, morphology, integrity, and parent artery anatomy. Treatment strategies were determined based on these characteristics, with interventions ranging from endovascular therapy to laparoscopic and open surgery. Patients were followed up after the intervention to assess mortality, complications, reinterventions, and aneurysm-related outcomes. ResultsThe study cohort of 113 patients with 127 SAAs had a predominance of female patients (63.7%) and a mean age of 52.7 years. The SAAs were classified into five types, with type I being the most common. The intervention techniques varied across types, with sac embolization, covered stent implantation, and artery embolization being the most frequently used. The overall technical success rate was 94.7%, with perioperative complication and reintervention rates of 25.0% and 0.9%, respectively, and no deaths within 30 days after the intervention. The median follow-up duration was 21 months, with overall complications rate of 3.5% and no aneurysm-related complications or deaths. ConclusionsThe proposed classification system effectively guides the selection of treatment strategies for SAAs, incorporating key anatomical and morphological features. This system facilitated high technical success and low complication rates, underscoring the importance of tailored techniques in managing SAAs.

Investigating the Influence of Preoperative Trans Arterial Embolization (TAE) and Predictive Potential of Circulating Tumor Cells (CTCs) in Prognosis of Hepatocellular Carcinoma

IntroductionCirculating Tumor Cells are a promising biomarker in many malignancies. CTC dissemination during the operative procedure can lead to disease recurrence. The effect of preoperative Transarterial Embolization on the release of CTCs and miRNA panels and oncological outcomes in large hepatocellular carcinomas has been evaluated. Materials and MethodsThe study included non-metastatic HCC >5cm in size, that were completely resected after TAE (n=10). Blood was collected pre-TAE, post-TAE, postoperative (day 2,30 and 180) and analyzed for the presence of CTC and miRNA (miR885-5p, miR22-3p, miR 642b-5p). The samples were subjected to CTC enrichment, isolation and staining using the markers CD45, EpCAM and Cytokeratin (CK). The data was analyzed using Gene Expression Suite software. ResultsThe CTC enumeration resulted in three groups: Group 1- CTC present at both Pre TAE and postoperative day 30 (n=4), Group 2- CTC present Pre-TAE and clearing at postoperative day 30 (n=2), Group 3- No CTC detected at any stages (n=3). Group 2 patients had better survival as compared to the other groups. Downregulation of miRNA 22-3p also had favourable prognostic implications. ConclusionWhile preoperative TAE does not seem to impact CTC shedding, CTC clearance may prove to be a valuable biomarker in prognosticating HCC. A larger study to evaluate the significance of CTCs as a prognostic marker is warranted to further evaluate these findings.

Case report: the role of transcatheter arterial embolization in the management of gastrointestinal bleeding

Introduction: Rectal bleeding is a common cause of chronic bleeding in hospitals. It can lead to anemia and affect a person's quality of life. To treat chronic hemorrhoidal disease, rectal artery embolization is safe, efficient, and minimally invasive, allowing for arterial rectal embolization. In this case report, we aimed to present a rectal bleeding case that has been well managed by using transcatheter arterial embolization. Case Presentation: A 20-year-old male patient came with complaints of haematochezia and anemia that had been felt for 2 days. The patient came to the emergency department of Prof. Ngoerah General Hospital, and lab tests and vital signs were carried out, which resulted in a hemoglobin of around 2.5 g/dl and a significantly decreased blood pressure of 95/65mmHg. If necessary, the patient was referred to interventional radiology for digital subtraction angiography and embolization. Conclusion: Transcatheter arterial embolization is an effective treatment option. It has few side effects, causes minimal blood loss, and shortens hospital stays.

Variability of the origin and course of the uterine artery in clinical practice

In 2020, approximately 287,000 mothers died during pregnancy or childbirth, with one of the leading causes of maternal mortality being peripartum hemorrhage. It can be treated both pharmacologically and procedurally, for example, through uterine artery ligation, embolization, or hysterectomy. In case of procedural treatment, it is essential for the medical team to familiarize themselves with the anatomical structure of the patient's uterine arteries. Various variations in the course of this vessel are distinguished, such as the uterine artery branching as a bifurcation with the inferior gluteal artery, a common trunk of the uterine artery with another vessel, or even its duplication. Using radiological techniques such as angiography, it is possible to visualize vessels and their variations, which can allow for better patient care. Unfamiliarity with the departure and trajectory of the uterine artery may be associated with an increased risk of postoperative complications, especially after hysterectomy, where the uterine arteries close at the level of the uterus or at the beginning of their departure from the internal iliac artery. Ligating them in other place may result in ischemia of an area that should be continuously supplied with blood. Also, during surgery, special attention should be paid to possible anatomical variations of the patient's uterine artery, which, although rare, can cause intraoperative complications. A thorough analysis of the departure and trajectory of the uterine artery by physicians can prevent postoperative complications and also allow for the safe conduct of embolization procedures. The following article presents a literature review on the departure and course of the uterine artery and its variations, as well as procedural interventions related to this vessel.

Proton pump inhibitor therapy after transcatheter angiography in refractory nonvariceal acute upper gastrointestinal bleeding patients: a cohort study.

Transcatheter angiography (TA) could help to diagnose and treat refractory nonvariceal upper gastrointestinal bleeding (NVUGIB). Proton pump inhibitors (PPIs) are the key medication for reducing the rebleeding rate and mortality and are usually continued after TA. It is unknown whether high-dose PPIs after TA are more effective than the standard regimen. We retrospectively collected data from patients who received TA because of refractory NVUGIB from 2010 to 2020 at West China Hospital. 244 patients were included and divided into two groups based on the first 3 days of PPIs treatment. All baseline characteristics were balanced using the inverse probability of treatment weighting method. The 30-day all-cause mortality, rebleeding rate and other outcomes were compared. The propensity score matching method was also used to verify the results. There were 86 patients in the high-dose group and 158 in the standard group. The average daily doses of PPI were 192.1 ± 17.9mg and 77.8 ± 32.0mg, respectively. Cox regression analysis showed no difference in the 30-day all-cause mortality (aHR 1.464, 95% CI 0.829 to 2.584) or rebleeding rate (aHR 1.020, 95% CI 0.693 to 1.501). There were no differences found in red blood cell transfusion, hospital stay length and further interventions, including endoscopy, repeating TA, surgery and ICU admission. The results were consistent in the subgroup analysis of patients with transcatheter arterial embolization. In refractory NVUGIB patients who received TA, regardless of whether embolization was performed, high-dose PPI treatment did not provide additional benefits compared with the standard regimen.

A case of non-traumatic rectus sheath hematoma in a post-kidney transplant patient undergoing catheter embolization during anticoagulation treatment for atrial fibrillation.

A 65-year-old man, a post living donor kidney transplant patient, was admitted to the intensive care unit (ICU) with a severe bacterial infection. He also tested positive for coronavirus disease and had a cough. On admission, heparin was administered for atrial fibrillation. On the third day of hospitalization, his general condition had recovered, and he was discharged from the ICU to the general ward. On the fourth day of hospitalization, he experienced abdominal pain, and a hard mass was palpated in the left lower abdomen. On the fifth day of hospitalization, contrast-enhanced computed tomography showed an extensive rectus sheath hematoma (RSH) extending from the left lower abdominal wall to the left side of the bladder, with extravasation from a small branch of the left inferior epigastric artery. Heparin was discontinued, and transcatheter arterial embolization was performed to control the bleeding. RSH is a rare disease, and cases of extensive hematoma in post-kidney transplant patients occur even less frequently. Patients taking anticoagulants and those with chronic kidney disease are at high risk for RSH, so physicians should be cognizant of this disease when these patients develop abdominal pain.

Safety and efficacy of airway stent placement following bronchial artery embolization: A retrospective study at a single institute

BackgroundAirway stenting is an established procedure for treating oncological emergencies in patients with airway disorders. In patients with airway hemorrhage, respiratory conditions may worsen during stenting. Bronchial artery embolization (BAE) is useful to prevent bleeding from the bronchus. We aimed to evaluate the efficacy and safety of airway stenting after BAE in patients with malignant airway disorders. MethodsThe medical records of all patients who underwent airway stenting following BAE at the National Hospital Organization Okayama Medical Center between 2016 and 2023 were retrospectively reviewed. ResultsThirteen procedures (11 silicone Y stents, one hybrid stent, and one self-expandable metallic stent) were performed. The median duration from BAE to airway stenting was one day (range: 1–5 days). Nine patients experienced tumor shrinkage, and none experienced severe bleeding after BAE during the stent procedure. No other major complications were associated with the stent placement. The median survival time after stenting was 169 days (range; 24–1086). No serious complications caused by BAE, such as spinal cord infarction, were observed. ConclusionsAirway stent placement was safely performed after BAE without severe bleeding or acute respiratory failure. BAE, followed by airway stenting, is useful.

Role of pre-operative endovascular embolization of a giant sacrococcygeal teratoma in neonate: a case report

BackgroundGiant sacrococcygeal teratomas (SCTs) are at risk of perinatal morbidity and mortality due to their high vascularity. Pre-operative embolization of the feeding arteries, prior to complete surgical resection, may assist in minimizing the intraoperative blood loss by occluding these feeding arteries.Case presentationWe present a case of a highly vascular giant SCT in a neonate, which was successfully embolized through an endovascular approach prior to surgery. The femoral artery approach was chosen, with access established using a Micropuncture introducer as a sheath. Embolization was performed using a combination of microcoils, Gelfoam slurry, and polyvinyl alcohol particles. The patient developed femoral artery spasm post-procedure, which resolved with the application of a glyceryl trinitrate patch.ConclusionsPerforming pre-operative endovascular embolization on a giant sacrococcygeal teratoma presents particular challenges, primarily due to the difficulty in assessing small vessels and the potential complications associated with this procedure. Nevertheless, this technique proves exceptionally valuable in helping the surgeon minimize blood loss during surgery, thereby reducing the risks of morbidity and mortality. Comprehensive planning for the embolization procedure is essential, encompassing the identification of potential vascular access points and alternatives, along with careful selection of the appropriate catheter.

Uterine Artery Embolization Versus Hysterectomy in Postpartum Hemorrhage: A Systematic Review With Meta-Analysis.

The objective of this study is to perform a meta-analysis comparing the effectiveness of uterine artery embolization (UAE) versus peripartum hysterectomy for acute refractory postpartum hemorrhage (PPH) control. We systematically searched 6 medical databases for studies comparing UAE and hysterectomy in PPH. Outcomes examined were mortality, hospitalization duration (HD) in days, and red blood cells (RBC) units utilization. Statistical analysis used RevMan 5.1.7 and random-effects models. Odds ratios (OR) and mean differences (MDs) with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. We included 833 patients from 4 cohort studies, with 583 (70%) undergoing UAE. The UAE population required fewer RBC units (MD: -7.39; 95% CI: -14.73 to -0.04; p=0.05) and had shorter HD (MD: -3.22; 95% CI: -5.42 to -1.02; p=0.004). Lower mortality rates were noted for UAE in the pooled analysis, but no statistical significance. Uterine artery embolization demonstrated lower procedural complications (16.45% vs. 28.8%), in which UAE had less ureter and bladder lesions (OR: 0.05; 95% CI: 0.01-0.38; p=0.004 and OR: 0.02; 95% CI: 0.00-0.15; p<0.001, respectively). Only 35 (6%) required conversion to hysterectomy, while 27 (4.6%) underwent re-embolization with 100% bleeding control. Uterine artery embolization did not hinder fertility, with normal menstruation restored in 19 patients with postoligomenorrhea. Uterine artery embolization for the control of PPH is associated with lower use of RBC units and HD, but similar rates of mortality are noted when compared to hysterectomy. These results associated with uterine preservation could support its importance for refractory PPH management. Uterine Artery Embolization is associated with a shorter hospitalization duration and reduced use of red blood cell units when compared with hysterectomy in refractory postpartum hemorrhage. Although demonstrating similar mortality rates, these findings, together with fertility preservation, support the method incorporation as a valuable option in obstetric services.

Surgical treatment and reproductive outcomes in caesarean scar pregnancy at a single center

BackgroundTo investigate factors associated with different reproductive outcomes in patients with Caesarean scar pregnancies (CSPs).MethodsBetween May 2017 and July 2022, 549 patients underwent ultrasound-guided uterine aspiration and laparoscopic scar repair at the Gynaecology Department of Hubei Maternal and Child Health Hospital. Ultrasound-guided uterine aspiration was performed in patients with type I and II CSPs, and laparoscopic scar repair was performed in patients with type III CSP. The reproductive outcomes of 100 patients with fertility needs were followed up and compared between the groups.ResultsOf 100 patients, 43% had live births (43/100), 19% had abortions (19/100), 38% had secondary infertility (38/100), 15% had recurrent CSPs (RCSPs) (15/100). The reproductive outcomes of patients with CSPs after surgical treatment were not correlated with age, body mass index, time of gestation, yields, abortions, Caesarean sections, length of hospital stay, weeks of menopause during treatment, maximum diameter of the gestational sac, thickness of the remaining muscle layer of the uterine scar, type of CSP, surgical method, uterine artery embolisation during treatment, major bleeding, or presence of uterine adhesions after surgery. Abortion after treatment was the only risk factor affecting RCSPs (odds ratio 11.25, 95% confidence interval, 3.302–38.325; P < 0.01) and it had a certain predictive value for RCSP occurrence (area under the curve, 0.741).ConclusionsThe recurrence probability of CSPs was low, and women with childbearing intentions after CSPs should be encouraged to become pregnant again. Abortion after CSP is a risk factor for RCSP. No significant difference in reproductive outcomes was observed between the patients who underwent ultrasound-guided uterine aspiration and those who underwent laparoscopic scar repair for CSP.

Nephrotransplantectomy Using Radiosurgical Techniques

Introduction. Aſter the loss of kidney transplant function, patient curation can be a difficult task. Nephrotransplantectomy (NTE) is the method of choice between reduction of immunosuppression with the abandonment of a non-functioning kidney transplant and embolization. This is an operation with potentially significant indicators of blood loss, complications and mortality. Along with traditional NTE, we began to use endovascular isolation of the allograſt as a method of preoperative preparation before its removal.The aim of the work is to investigate the effect of the use of radiosurgical minimally invasive techniques on the surgical tactics of nephrotransplantectomy, the degree of blood loss, the frequency of complications and blood transfusion.Materials and methods. A retrospective analysis of the data of 52 patients aſter NTE was performed. Depending on the method, patients are divided into two groups. In group 1 (main, n = 22), the operation was performed with pre-performed endovascular embolization of the graſt arteries (EEAT), in group 2 (control, n = 30) — without EEAT. The analysis of the results of the examination, intra- and postoperative indicators in patients by groups was carried out.Results. In group 1, intraoperative blood loss was 10–80 ml, on average (35.4±19.9) ml; in group 2 — from 100 to 600 ml, on average (289.7±138.4) ml (p &lt; 0.001). In group 2, damage to the main vessels occurred more oſten (n = 4) (13.3 % vs. 0 %), hemotransfusion was performed in 53.3 % of cases (n = 16) to correct posthemorrhagic anemia. Postoperative complications in the control group were recorded in 8 patients (26.7 %).Discussion. Preventive endovascular embolization of the arteries of a kidney transplant significantly reduces the frequency ofintra- and postoperative complications, allows nephrectomy to be performed on a planned basis andin a delayed manner.

Pulmonary vein thrombosis: Clinical presentation and outcomes

BackgroundPulmonary vein thrombosis (PVT) is a rare thromboembolic disease with potential high-risk complications related to arterial embolization, but little is known regarding risk factors and outcomes. ObjectiveTo describe the etiology, management, and clinical course of PVT. MethodsInstitutional health records were queried (1/1/2001–12/30/2023) to identify patients ≥18 years of age diagnosed with PVT. Thrombosis, bleeding, respiratory failure, and all-cause mortality were analyzed. Suspected tumor thrombus cases were excluded. Results72 patients with PVT were identified (median age 62 years, 50 % female), and PVT was overall rare at 3.1 diagnosed cases per year at our institution. PVT primarily affected a single vein (89 %), most commonly the left upper PV (40 %). Of these, 37 % occurred while on therapeutic anticoagulation. The most common risk factors included cancer (55 %) and related surgical lobectomy (21 %). Extrinsic vein compression (17 %) and recent surgery (19 %) were also common; 19 % were deemed idiopathic. Most patients (76 %) were treated with anticoagulation and frequently indefinite duration (80 %). During a median follow-up of 11.7 months (IQR 39.5 months), serial imaging (available for 68 %) revealed PVT resolution in 64 %. Four-year Kaplan-Meier probability of outcome included: left atrial thrombus (21 %), need for mechanical ventilation (14 %), pneumonia (9 %), and ischemic stroke (9 %). The mortality rate was 46 % with median survival 14 months after PVT diagnosis. ConclusionPVT is often associated with active malignancy, lobectomy, recent surgery, and extrinsic vein compression; 1 in 5 cases were idiopathic. Notable complications include left atrial thrombus with arterial embolism including stroke. With anticoagulation, most thrombi resolve over time. Mortality rates are high, reflecting the high the prevalence of cancer.

Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female

Dysfunctional uterine bleeding (DUB), a serious clinical challenge caused by incomplete abortion in female, calls for efficient and minimally invasive therapies to treat symptoms and protect reproductive health. Uterine artery embolization (UAE) has been discovered as a viable therapeutic strategy to treat DUB following an incomplete abortion. The existing information and clinical experience of UAE for this particular indication were thoroughly reviewed. A female’s quality of life may be negatively affected by incomplete abortion, which is defined as residual fetal tissue inside the uterine cavity. This frequently results in heavy and continuous uterine bleeding. Medical procedures and traditional management techniques such as dilatation and curettage (D&amp;C) do not always produce the desired effects or might have inherent dangers. UAE, a less invasive technique first developed for treating uterine fibroids, has shown promise as a substitute solution for DUB caused by an incomplete abortion.

Uterine artery embolization in the treatment of uterine fibroids and the preservation of reproductive health in women 40 years of age and older: A retrospective study

Aim. To evaluate the effect of uterine artery embolization (UAE) on reproductive health in women 40 years and older. Materials and methods. A retrospective study was conducted at the perinatal center of the District Clinical Hospital of Khanty-Mansiysk. Patients were divided into two groups: the main group (group 1; n=57) included women with uterine fibroids after UAE, and the control group (group 2; n=42) included women without a history of uterine fibroids. Results. Women with uterine fibroids were statistically more likely to have grade 1 obesity (χ2=4.39; p=0.04) and less likely to have normal body weight (χ2=8.73; p=0.00) compared to women without fibroids. Smoking increased the risk of uterine fibroids twofold (χ2=4.49; p=0.03; odds ratio 1.97; confidence interval 0.64-6.11). More women with uterine fibroids had a history of abortions (n=42; 73.7%) than those without uterine fibroids (n=19; 45.2%; χ2=8.27; p=0.01). The most common gynecological comorbidities in women with uterine fibroids included inflammatory disease of the uterus (N71), endometrial polyp (N84), and endometriosis (N80); p0.05. The most common extragenital diseases in patients with uterine fibroids included thyroid disease, hypertension, and iron deficiency anemia (p0.05). Contour SE embolization agent with spherical particles was more often associated with pain (χ2=0.18; p=0.67) and less often with fever (χ2=4.47; p=0.03). There was a decrease in the number of short menstrual cycles (less than 24 days) from the moment before surgical treatment and after 24 months (χ2=34.580; p0.001) and an increase in the number of cycles of 24–38 days (χ2=14.887; p=0.005). At 24 months after UAE, there were more women with a menstrual period of less than 3 days (χ2=10.385; p=0.035) and fewer with a menstrual period of more than 8 days (χ2=34.573; p0.001). Ultrasound showed a decreased ovarian reserve at 6, 12 and 24 months after UAE (p0.05). Conclusion. When assessing the reproductive health of women 40 years and older after embolization of the uterine arteries, it was found that this method of treatment of symptomatic uterine fibroids leads to a decrease in the duration and heaviness of menstruation but increases the risk of an ovarian reserve decrease.