James S. Newman

Effectiveness of Coil Embolization in Angiographically Detectable versus Non-detectable Sources of Upper Gastrointestinal Hemorrhage

PURPOSE To determine whether the effectiveness of arterial embolization in patients with acute upper gastrointestinal hemorrhage is related to the visualization of contrast medium extravasation at angiography. MATERIALS AND METHODS Transcatheter embolization was performed in 108 patients who experienced acute upper gastrointestinal hemorrhage during a 5-year period. Patient charts were retrospectively reviewed. Thirty-six patients who underwent embolization after angiography demonstrated active contrast medium extravasation from an involved artery. Seventy-two patients underwent embolization in the absence of contrast medium extravasation into a bowel lumen. Embolization technique, requirement for further blood products, need for further surgery, and 30-day mortality were recorded. RESULTS The gastroduodenal artery (GDA) was embolized in 26 of the 36 patients (72%) with extravasation, and the left gastric artery was embolized in 10 (28%). The GDA was embolized in 64 of the 72 patients (89%) without extravasation, and the left gastric artery was embolized in 13 (18%). After embolization, 23 of the 36 patients (64%) with extravasation and 44 of the 72 (61%) without extravasation required additional blood product transfusions. Seven of the 36 patients (19%) with extravasation and 16 of the 72 (22%) without extravasation required subsequent surgery secondary to bleeding. Thirty-day hemorrhage-related mortality was 17% (six of 36 patients) in the positive extravasation group and 22% (16 of 72 patients) in the negative extravasation group. The treatment success rate was 44% (16 of 36 patients) in the positive extravasation group and 44% (32 of 72 patients) in the negative extravasation group. CONCLUSIONS In patients with acute upper gastrointestinal hemorrhage, arterial embolization is equally effective in patients who demonstrate active contrast medium extravasation at angiography as in those who do not show contrast extravasation.

Incidence and risk factors for surgical intervention after uterine artery embolization

OBJECTIVE To determine the incidence and risk factors for surgical intervention after uterine artery embolization for symptomatic uterine fibroids. STUDY DESIGN Electronic medical records of all patients who underwent uterine artery embolization for symptomatic uterine leiomyomata were reviewed. Logistic regression was used to identify independent risk factors for any surgical intervention and for hysterectomy alone after uterine artery embolization. RESULTS Uterine artery embolization was performed in 454 patients during the study period, with a median follow-up time (range) of 14 (0-128) months. Overall, 99 patients (22%) underwent any surgical intervention after uterine artery embolization in the operating room. Risk factors for any surgical intervention included younger age (P < .003), bleeding as an indication for uterine artery embolization (P < .01), presence of significant collateral ovarian vessel contribution to the uterus (P < .01), or use of 355-500 mum particles (P < .008). CONCLUSION Patients undergoing uterine artery embolization have a 22% risk for requiring additional surgical intervention, but overall uterine artery embolization is an effective minimally invasive option.

Use of subcutaneous venous access ports to treat refractory ascites.

To assess the feasibility of peritoneal ports for management of patients with cirrhotic refractory ascites, 10 ports were placed in nine patients for frequent outpatient paracentesis. Retrospective review and telephone interviews were used to assess port performance. Kaplan-Meier analysis revealed a median duration of port patency of 255 days. In 1,557 port days, four access problems prompted further interventional evaluation. Three cases of bacterial peritonitis and one catheter obstruction developed. The use of subcutaneous venous access ports to allow control of ascites by nursing personnel is a promising alternative for management of patients with refractory ascites. Additional studies are needed to determine long-term effectiveness and safety.

Patent ductus venosus in an adult presenting as pulmonary hypertension, right-sided heart failure, and portosystemic encephalopathy.

Ductus venosus is a normal fetal structure connecting the portal and umbilical veins with the inferior vena cava, allowing a fraction of the umbilical vein blood to bypass the liver and reach the central circulation. Patent ductus venosus is the persistence of this embryonic portosystemic shunt. It is rarely seen in adults. Fewer than 20 cases of patent ductus venosus have been reported in the literature (1–13), presenting as portosystemic hepatic encephalopathy and hyperammonemia (1,2,4). We describe adult patent ductus venosus presenting not only with portosystemic encephalopathy, but also with pulmonary hypertension and right-sided heart failure.

Challenges in interventional radiology: the pregnant patient.

A pregnant patient presenting to interventional radiology (IR) has a different set of needs from any other patient requiring a procedure. Often, the patients care can be in direct conflict with the growth and development of the fetus, whether it be optimal fluoroscopic imaging, adequate sedation of the mother, or the timing of the needed procedure. Despite the additional risks and complexities associated with pregnancy, IR procedures can be performed safely for the pregnant patient with knowledge of the special and general needs of the pregnant patient, use of acceptable medications and procedures likely to be encountered during pregnancy, in addition to strategies to protect the patient and her fetus from the hazards of radiation.

Uterine artery embolization for the treatment of uterine fibroids

Abstract Uterine leiomyomata are a frequent finding in a gynecologist’s practice. Until recently, options for management have been limited. A relatively new procedure is gaining popularity as another option for a select group of patients. The treatment of choice for definitive management remains hysterectomy. However, uterine artery embolization (UAE) can be considered in certain women. We discuss the indications, benefits, risks, and potential complications of UAE. We review recent literature including results and complication rates. A proposed protocol is introduced for patient selection, preoperative assessment, and postprocedural follow-up. A coordinated effort is recommended, including incorporating a multiteam approach with the interventional radiologist, pain management service, and gynecologist. A brief technical review of the procedure is included. (Primary Care Update Ob/Gyns 2001;8:232–239

Patent ductus venosus in an adult presenting as pulmonary hypertension, right side heart failure and portosystemic encephalopathy

Patent ductus venosus in an adult presenting as pulmonary hypertension, right side heart failure and portosystemic encephalopathy