Christine Lagrange

Reperfusion of Complex Pulmonary Arteriovenous Malformations After Embolization: Report of Three Cases

The purpose of this report is to discuss the different mechanisms of reperfusion of pulmonary arteriovenous malformations (PAVMs) after embolization. Transcatheter embolotherapy is currently the first-line treatment of PAVMs to prevent neurologic complications or pulmonary hemorrhage. Initial good results can be expected but we report three cases of reperfusion of complex large PAVMs after coil embolization. After adequate embolization, reperfusion of PAVMs may occur by several mechanisms including recanalization of embolized arteries, recruitment of normal arterial branches, growth or enlargment and development of a systemic arterial supply.

TRANSCATHETER ETHANOL RENAL ABLATION IN 20 PATIENTS WITH PERSISTENT URINE LEAKS: AN ALTERNATIVE TO SURGICAL NEPHRECTOMY

PURPOSEnWe evaluate the efficacy of transcatheter ethanol renal ablation for destruction of a unilateral, poorly functioning kidney with persistent urinary leaks from fistulas or a nephrostomy tube.nnnMATERIALS AND METHODSnFrom January 1992 to January 1999, 19 females and 1 male with a history of pelvic neoplasms, which were responsible for ureteral leaks through the nephrostomy tube in 13 cases or fistulas in 7, were treated with transcatheter ethanol renal ablation. Serum creatinine ranged from 60 to 140 micromol./l. (mean 90), and function of the involved kidney determined by diethylenetetraminepentaacetic acid scintigraphy in 16 patients or by morphological imaging in 4 was low. Drainage of the renal cavities and antibiotic therapy preceded renal ablation. After epidural anesthesia or intravenous sedation renal ablation was performed by catheterization of the renal artery and injection of 1. 5 to 12 ml. (mean 4.6) absolute ethanol, and completed by proximal occlusion with coils and absorbable gelatin sponge.nnnRESULTSnArterial flow was interrupted in all cases. Urinary flow ceased in 2 days in 18 of 20 patients, and drains were removed. Two patients had residual urine that was successfully treated with additional embolization. No complications occurred.nnnCONCLUSIONSnTranscatheter ethanol renal ablation is safe and effective, and permits an in situ nephrectomy that can replace surgical nephrectomy for treatment of urinary leaks.

Percutaneous mitoxantrone injection for primary and secondary liver tumors: Preliminary results

AbstractPurpose: To determine the effects of percutaneous intratumoral chemotherapy with mitoxantrone (PIM) in the palliative treatment of malignant liver lesions.n Methods: We treated 15 progressive lesions in nine patients in whom either previous therapy failed or serious complications developed as a result. Seven lesions were metastatic and eight were due to foci of hepatocellular carcinoma. Under computed tomography (CT) guidance, we percutaneously injected 10–20 mg of mitoxantrone mixed with 0.5 ml of contrast medium into the tumor, performing one to three treatments at intervals of 1 month.n Results: There were no complications. The morphologic responses of the tumors after treatment were: minor response in one case, no change in 11 cases, progressive disease in three cases. Mitoxantrone induced tumor necrosis with no viable cancer tissue in eight of 11 biopsies. Recurrence was observed in nine of the treated lesions 2–9 months after treatment. New lesions were observed in five of nine patients 1–9 months after treatment.n Conclusion: In patients with malignant liver lesions with no other therapeutic possibilities, minimally invasive intratumoral mitoxantrone injection was carried out safely with good tumor delivery of chemotherapy, and tumor necrosis was demonstrated at biopsy. We feel this approach warrants further investigation.

Combined percutaneous antegrade and cystoscopic retrograde approach in the treatment of distal ureteric fistulae

PurposeTo determine the efficacy of a cystoscopic approach, as definitive treatment of ureteral fistulae, after failure of antegrade ureteral stent insertion.MethodsOf 43 ureter fistulae encountered over 4 years, 10 postoperative and/or postradiotherapy fistulae could not be stented via an antegrade approach alone. A cystoscopic approach was used, with the antegrade approach available as back-up, if necessary.ResultsIn two patients the ureteral orifice could not be visualized cystoscopically, thus precluding the retrograde approach. In the eight remaining patients, the retrograde approach alone never allowed successful stenting. In six patients, combined antegrade and retrograde approaches permitted stent insertions. In three of those six patients, a complex catheterization procedure was necessary. In two patients the combined approach failed altogether. Therefore, 6 of 10 patients underwent a successful stenting procedure with the combined approach; all ultimately closed the fistula.ConclusionAntegrade stent insertion remains the treatment of choice for ureteral leaks. If the antegrade approach fails, the retrograde approach alone is not likely to be successful. Instead, a combination of both approaches often does succeed.

Erratum to: Chemoembolization of Neuroendocrine Liver Metastases Using Streptozocin and Tris-acryl Microspheres: Embozar (EMBOsphere + ZAnosaR) Study

Purpose nThe purpose of this prospective observational study was to evaluate the efficacy and tolerability of transarterial chemoembolization (TACE) for neuroendocrine liver metastases using a combination of streptozocin, Lipiodol, and tris-acryl microspheres.

Cystogastric transmural drainage for the treatment of symptomatic cystic metastases from ovarian carcinoma.

Approximately 80% of ovarian cancers are discovered when they have already progressed to stage III or IV lesions. The prognosis is, therefore, poor despite intensive treatment. Intraperitoneal dissemination is one of the most frequent pathways of distant spread ovarian cancer and pseudocystic metastases usually occur. When such cystic metastases remain symptomatic despite antitumor treatment, viable options are limited because palliative surgery generates high operative morbidity and mortality. For many years, in patients in whom the risks associated with surgery are high, percutaneous drainage and sclerosis under radiologic guidance has been performed as an effective alternative option for various forms of abdominal fluid collection. Such a collection in pancreatic pseudocyst benefits from cystogastric transmural drainage to avoid external drainage and achieves the same results as surgical cystogastrostomy. We report this transmural drainage technique under image guidance used to drain a symptomatic cystic metastasis, which was compressing the stomach.