A. Fohlen

Place de l’embolisation artérielle en cas d’hémorragie du post-partum

OBJECTIVES To provide recommendations regarding the use of arterial embolization in the management of post partum hemorrhage. METHODS A literature search was conducted using the Pubmed, Medline and Embase databases and the Cochrane Library (study period 1979 to June 2014). RESULTS Selective embolization of both uterine arteries without microcatheter is recommended (professional consensus). Embolization should be performed using gelatin sponge pledgets rather than gelatin sponge slurry or powder (grade C). Control of hemorrhage can be expected in 70 to 100% of cases after embolization (EL3). Control of hemorrhage is obtained in 85 to 100% of cases (EL3). Arterial embolization is recommended in case of uterine atony after failure of uterotonic drugs particularly after vaginal delivery, in case of cervical hemorrhage, vaginal thrombus of cervico-vaginal tear in case of failed surgical repair or if surgery is not feasible (grade C). Pseudoaneurysm of the uterine artery is a good indication for embolization. Major complications related to embolization are reported in 5% of cases (EL4). The presence of coagulation disorders is not a contraindication to embolization (professional consensus). Embolization remains feasible after failed arterial ligations (selective or proximal) or after hysterectomy even if technically more challenging (professional consensus). Embolization can be performed in case of post partum hemorrhage related to abnormal placentation (professional consensus). Prophylactic embolization with the placenta left in place is not routinely recommended (professional consensus). The systematic preoperative placement of arterial occlusion balloons is not recommended in the management of abnormal placentation (professional consensus). Secondary post partum hemorrhage is a good indication for arterial embolization (grade C). After embolization, fertility can be spared (EL3). The risk of recurrent post partum hemorrhage does not seem different after arterial ligations or arterial embolization (EL3).

Idarubicin-Loaded ONCOZENE Drug-Eluting Embolic Agents for Chemoembolization of Hepatocellular Carcinoma: In Vitro Loading and Release and In Vivo Pharmacokinetics

PURPOSE To present in vitro loading and release characteristics of idarubicin with ONCOZENE (CeloNova BioSciences, Inc, San Antonio, Texas) drug-eluting embolic (DEE) agents and in vivo pharmacokinetics data after transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents in patients with hepatocellular carcinoma. MATERIALS AND METHODS Loading efficacy of idarubicin with ONCOZENE DEE agents 100 µm and DC Bead (Biocompatibles UK Ltd, Farnham, United Kingdom) DEE agents 100-300 µm was monitored at 10, 20, and 30 minutes loading time by high-pressure liquid chromatography. A T-apparatus was used to monitor the release of idarubicin from the two types of DEE agents over 12 hours. Clinical and 24-hour pharmacokinetics data were recorded after transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents in four patients with unresectable hepatocellular carcinoma. RESULTS Idarubicin loading in ONCOZENE DEE agents was > 99% at 10 minutes. Time to reach 75% of the release plateau level was 37 minutes ± 6 for DC Bead DEE agents and 170 minutes ± 19 for ONCOZENE DEE agents both loaded with idarubicin 10 mg/mL. After transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents, three partial responses and one complete response were observed with only two asymptomatic grade 3 biologic adverse events. Median time to maximum concentration for idarubicin in patients was 10 minutes, and mean maximum concentration was 4.9 µg/L ± 1.7. Mean area under the concentration-time curve from 0-24 hours was equal to 29.5 µg.h/L ± 20.5. CONCLUSIONS ONCOZENE DEE agents show promising results with very fast loading ability, a favorable in vivo pharmacokinetics profile with a sustained release of idarubicin during the first 24 hours, and encouraging safety and responses. Histopathologic and clinical studies are needed to evaluate idarubicin release around the DEE agents in tumor tissue and to confirm safety and efficacy.

Hepatic involvement in HELLP syndrome: an update with emphasis on imaging features

HELLP syndrome, which consists of hemolysis, elevated liver enzymes, and low platelet count is an unusual complication of pregnancy that is observed in only 10% to 15% of women with preeclampsia. Hepatic involvement in HELLP syndrome may present with various imaging features depending on the specific condition that includes nonspecific abnormalities such as perihepatic free fluid, hepatic steatosis, liver enlargement, and periportal halo that may precede more severe conditions such as hepatic hematoma and hepatic rupture with hemoperitoneum. Maternal clinical symptoms may be nonspecific and easily mistaken for a variety of other conditions that should be recognized. Because hepatic hematoma occurring in association with preeclampsia and HELLP syndrome is a potentially life-threatening complication, prompt depiction is critical and may help reduce morbidity and mortality. This review provides an update on demographics, risk factors, pathophysiology, and clinical features of hepatic complications due to HELLP syndrome along with a special emphasis on the imaging features of these uncommon conditions.

Traitement des corps etrangers endovasculaires et des problemes de points de ponction

Objectifs pedagogiques Connaitre les differents materiels susceptibles de migrer en intravasculaire, leurs retentissements. Decrire les techniques radiologiques de recuperation par voie endovasculaire. Connaitre les differentes complications des abords vasculaires percutanes (radial, brachial, femoral, veines). Decrire les traitements de ces complications. Messages a retenir Les migrations de corps etrangers se font essentiellement dans les cavites cardiaques et le reseau arteriel pulmonaire, parfois aussi dans les arteres distales. Les materiels dedies ou « home made » permettent une recuperation de ces corps etrangers migres dans la majorite des cas. Les complications des points de ponctions sont l’hematome, le faux anevrisme, la dissection, l’occlusion. Ces complications peuvent se traiter chirurgicalement ou par des techniques radiologiques endovasculaires.