Search

PURPOSEThe study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding.METHODSNine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed.RESULTSThe angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE.CONCLUSIONTAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.

Aneurysmal bone cyst is a benign highly vascular lesion that occurs in children. Traditionally ABCs were treated by surgical resection. However, lesions at difficult to access anatomical locations such as the pelvis have higher morbidity when treated surgically. Recently with the advances in endovascular treatment selective arterial embolization became a promising option for primary treatment of ABC. The authors present a case of a 14-year-old female with a pelvic ABC that was successfully treated by selective arterial embolization. Selective arterial embolization is a cost-efficient way of managing ABC especially in cases where surgical treatment carries high risk.

Context: No study has investigated the awareness of uterine artery embolization (UAE) as a treatment option for uterine fibroids among Saudi women. Aims: The aim of this study was to investigate Saudi women's awareness of UAE as a therapeutic modality for uterine fibroids Settings and Design: This was a cross-sectional study conducted in Hail and Riyadh. Subjects and Methods: In 2019, an anonymous online questionnaire was sent via social media to women residing in Hail and Riyadh. The questionnaire contained 11 multiple-choice questions divided into two parts. The first part contained questions about demographic characteristics and one question about their history of fibroids. The second part contained items pertaining to awareness of treatment options for uterine fibroids and whether they were aware of UAE. Statistical Analysis Used: The Chi-square test was used for statistical analysis. Results: Eight hundred and forty-five responses have been received. Overall, 76.1% of the respondents had never heard of UAE. Awareness of treatment options for uterine fibroids was significantly associated with education level and participants' involvement in a medical field (P < 0.05; Chi-squared test). 9.2% were from respondents who reported a history of fibroids. Among them, 71.7% had never heard of UAE; 9% had heard about it from an obstetrician or gynecologist. Only 6.4% of the participants were aware of all the treatment options for uterine fibroids; 28.2% believed that hysterectomy was the only treatment for uterine fibroids. Conclusions: This study highlights the need for public awareness of the treatment options for uterine fibroids to appropriate candidates.

Aim: The aim of the study was to assess clinical outcomes following uterine artery embolization (UAE) in the treatment of dysmenorrhea and menorrhagia related to pure adenomyosis. Materials and Methods: This was a retrospective analysis of 14 patients with dysmenorrhea and menorrhagia related to pure adenomyosis treated with UAE using polyvinyl alcohol (PVA) between January 2017 and September 2019. The baseline and 3-month and 12-month postintervention outcomes were assessed using Uterine Fibroid Symptom-Health-Related Quality of Life Questionnaire (UFS-QOL), Symptom Severity Score (SSS), and magnetic resonance imaging findings. The median age of the patients was 47 years (28–55). The main clinical presentation was dysmenorrhea and menorrhagia, with a median duration of symptom of 24 (12–84) months. All patients received combined estrogen-progestin and nonsteroidal anti-inflammatory drugs prior to UAE without clinical improvement. Results: According to UFS-QOL and SSS results, the score for distress level was statistically significantly reduced from baseline 4.6 (3.6–5) to 2.25 (1–3.37) (P = 0. 018) after 3 months, and remained stable 12 months later. The score of symptom level was statistically significantly reduced from 4 (3.6–5) at baseline to 1.6 (1–3.58) (P = 0. 018) after 3 months with maintained clinical satisfaction after 12-month follow-up. The junctional zone was statistically significantly reduced from baseline with a median of 33.5 mm (19–79 mm) to 25 mm (8–77 mm) after 3 and 12 months (P = 0.046). The incidence of post-UAE permanent amenorrhea is 71% with a mean age of 49 years. No patient underwent hysterectomy during the follow-up period. Conclusion: UAE using PVA can improve the quality of life in patients with menorrhagia and dysmenorrhea related to adenomyosis. However, larger prospective studies are needed to establish the long-term outcomes and risk of amenorrhea.

Aim: The aim of this study was to evaluate awareness and knowledge about radiation risks and safety principles among medical students at the College of Medicine, University of Hail, Hail, Saudi Arabia, in their clinical years. Materials and Methods: In this cross-sectional study, an anonymous electronic questionnaire was sent to 174 randomly selected students in clinical years 4–6. The questionnaire contained 38 questions. The respondents’ answers to these questions were used to classify them according to their demographic characteristics and to evaluate their knowledge about common imaging modalities, radiation risks, and safety measures. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 22. Results: Seventy-five (51.7%) of 145 respondents were female and 70 (48.3%) were male. Fifty-five respondents (37.9%) were in year 4, 38 (26.2%) were in year 5, and 52 (35.9%) were in year 6. The mean score for knowledge about common imaging modalities was 4.10 ± 2.030 of 10, that for knowledge about the risks of radiation was 3.17 ± 1.954 (range, 0–8) of 13, and that for knowledge about radiation protection measures was low at 0.79 ± 0.922 (range, 0–4) of 8. Overall, there was an improvement in knowledge about the imaging modalities and the risks of radiation as the number of clinical years increased (P = 0.000), but it was still unsatisfactory. Conclusion: The results of this study indicate that the medical students at the University of Hail have very limited knowledge about radiation risks and safety measures. These findings highlight the need for urgent action to improve students’ knowledge of these topics.

A 58-year-old male presented with chronic abdominal pain lasting 5 years and a 15 × 6-cm multicystic thoracic duct cyst with three compartments, located in the right retrocrural and retrocardiac regions from T5/T6 to T12/L1. A transhepatic route was selected to sclerose the middle and lower compartments. Subsequent contrast injection showed minimal contrast passage into the upper compartment through a narrow neck, but the guidewire could not pass into this compartment. The contrast-filled upper compartment was punctured with a 22-g Chiba needle using a translumbar approach under cone-beam computed tomography (CT) guidance and ethanol sclerotherapy was performed. Six-month follow-up CT revealed decreased thoracic duct cyst size (5×3 cm) and no pain. This case illustrates successful percutaneous transhepatic and translumbar sclerotherapy for retrocardiac and retrocrural thoracic duct cysts, which are very difficult to remove surgically.

Plummer–Vinson syndrome is known as the association of dysphagia, upper esophageal web, weight loss, and iron-deficiency anemia. Esophageal dilation therapy is usually necessary to remove webs and to relieve dysphagia in order to encourage oral intake. We report two cases of Plummer–Vinson syndrome. Both patients presented with significant and longstanding dysphagia, sideropenia, and painful swallowing. Patients’ esophagograms revealed the presence of tight stenosis in the high cervical esophagus. Both patients were treated with fluoroscopically guided balloon dilation and iron supplementation. These patients were followed up after the initial treatment and showed improvement of dysphagia and iron-deficiency anemia.

Context: One of the most important challenges facing the evolution of modern interventional radiology is its lack of awareness among medical students. Aims: This study aimed to determine the knowledge, perception, and views of the University of Hail clinical year medical students and medical interns regarding various interventional radiology topics. Settings and Design: A cross-sectional study on 244 clinical years' medical students and 87 medical interns from the University of Hail. Materials and Methods: A validated anonymous electronic questionnaire regarding awareness of various interventional radiology topics was sent to all clinical years' students and medical interns, and the results were analyzed. Statistical Analysis Used: The sample size was calculated through the Raosoft sample size calculator website. Data analysis was performed using SPSS statistics. Results: We received 200 responses. Majority of the participants (45%) agreed that their knowledge and information regarding interventional radiology was poor. Few participants (17%) were interested in considering a career in diagnostic radiology or interventional radiology. The most common reported reason for not considering radiology as a career option was lack of adequate knowledge about the subject (27.5%). Majority of participants (72.5%) had not been exposed to interventional radiology. Only 36.5% of participants were interested in doing a 2-week interventional radiology elective during their internship year. Conclusions: This study demonstrated that the majority of undergraduates and interns lack basic knowledge of interventional radiology. About one-third of the respondents were interested in doing their elective term in interventional radiology, and more than half of the participants were not interested or were unsure.

Mesoiliac shunts in the absence of liver cirrhosis are rarely reported as a cause of hyperammonemia with encephalopathy. Here, we report the case of a 65-year-old female patient with no history of liver disease, who developed significant confusion. Workup showed hyperammonemia and encephalopathy due to spontaneous mesoiliac shunt with no imaging signs of portal hypertension. Liver biopsy showed no evidence of cirrhosis. The shunt was occluded using a vascular plug, resulting in complete resolution of symptoms with no recurrence at 8-year follow-up.

A combination of transarterial chemoembolization (TACE) plus sorafenib or radiotherapy (RT) has demonstrated efficacy in patients with advanced hepatocellular carcinoma (HCC). Here, the two combined treatment approaches were compared in patients with HCC and portal vein tumor thrombus (PVTT). Data from 307 patients treated with TACE plus RT (n = 203) or TACE plus sorafenib (n = 104) as first-line treatment for HCC with PVTT were retrospectively evaluated. Using the propensity model to correct selection bias, 87 patients were included from each treatment group. During follow up (median, 12 months) in the entire study population, the median progression-free survival (PFS) and overall survival (OS) were significantly longer in the TACE plus RT group than in the TACE plus sorafenib group (6.5 vs. 4.3 months, respectively; p = 0.017 and 16.4 vs. 12 months, respectively; p = 0.007). Following propensity score matching, the median PFS and OS in the two groups showed no statistically significant difference. Multivariable analysis found no significant association between PFS or OS and the treatment type. In conclusion, this retrospective study of data from patients with advanced HCC with PVTT shows that PFS and OS did not differ significantly in patients treated with TACE plus RT and TACE plus sorafenib.

We report a case of uterine artery embolization (UAE) of endometrial polyposis in a 42-year-old virgin female who had a 10-year history of menorrhagia resulting in with chronic anemia. Endometrial polyps resolved and patient's symptoms improved with no recurrence at 18-month follow-up pelvic magnetic resonance imaging. This case presents UAE as an alternative option for the management of endometrial polyps in patients who decline surgical or hysteroscopic options.

Background: Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy.Purpose: To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases.Material and Methods: This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020.Results: The median interval between surgery and angiography was one day (range = 0-82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient.Conclusions: TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall. [ABSTRACT FROM AUTHOR]

Background: When antegrade ureteral intervention fails due to severe ureteral stricture or tortuosity, a longer sheath can be used to facilitate ureteral catheterization. Purpose: To evaluate the feasibility and effectiveness of the use of a long sheath in antegrade ureteral stent placement after failure of antegrade ureteral stent placement using a short sheath. Material and Methods: Among 1284 procedures in 934 patients who received ureteral stent placement, a long sheath was used after stricture negotiation failure using a short sheath in 57 (4.4%) procedures in 53 patients. The data of these 53 patients were retrospectively reviewed. Results: The most common reasons for long sheath use were failure of balloon catheter (59.6%) or guidewire (29.8%) advancement across the stricture. Technical success, successful stricture negotiation after using a long sheath, was achieved in 50/57 (87.7%) procedures. In two of seven failed procedures, an additional TIPS sheath was used and the technical success rate improved to 91.2% (52/57). The technical success rate was significantly higher in the patients who have failed balloon catheter advancement (97.1%, 33/34) than the patients who have failed guidewire advancement (64.7%, 11/17) (Fisher's exact test, P = 0.004). Self-limiting hematoma occurred in one patient after use of the long sheath and was considered a minor complication. Conclusion: Ureteral catheterization using a long sheath is feasible and effective when antegrade ureteral intervention using a short sheath fails. When using a long sheath, the technical success rate was higher when advancing the balloon catheter over the guidewire than when advancing the guidewire through tight stricture. [ABSTRACT FROM AUTHOR]

Background: While removing urinary tract foreign bodies is mostly performed through retrograde cystoscopy, antegrade removal using interventional procedures is reported less frequently. Purpose: To evaluate the safety and effectiveness of percutaneous antegrade removal of urinary tract foreign bodies. Material and Methods: A total of 14 consecutive patients (age range 9–80 years) who percutaneous antegrade removal of urinary tract foreign bodies between January 2001 and March 2020 were reviewed. Detailed removal procedures and complications were reviewed retrospectively. Results: Types of foreign bodies were sheared percutaneous nephrostomy (PCN) catheters (n = 5), sheared double J stents (n = 3), migrated ureteral catheters (n = 3), embolization coils (n = 2), and a 0.018-inch guide wire (n = 1). The mean and median indwelling times (range 0–306 days) of the foreign bodies were 58.3 and 1.5 days, respectively. Computed tomography (CT) scans were conducted in six patients, and the extent and nature of the foreign bodies were well-visualized on CT scans. The removal access was new PCN access (n = 8), the tract missing PCN catheter (n = 3), pre-existing PCN access (n = 2), and percutaneous dissection (n = 1). The removal success rate was 92.9% (13/14) with either a simple (n = 8) or modified (n = 4; combination of a snare and guide wire is used) snare technique or a direct forceps grasp (n = 1). The mean procedure time for successful cases was 14.2 min (range 7–25 min). Procedure-related hematoma with (n = 2) or without (n = 1) renal pelvis injury occurred in three patients, which were all self-limited within one week. Conclusion: Percutaneous antegrade removal is safe and effective for urinary tract foreign bodies. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and effectiveness of transcatheter arterial embolization for controlling spontaneous hemorrhage in patients with acquired cystic kidney disease (ACKD). Methods: This retrospective study included 18 patients with ACKD (M:F=13:5; mean age, 56 years) who underwent renal artery embolization to control spontaneous hemorrhage between January 2001 and September 2020. The underlying etiology and clinical presentations were reviewed and previous computed tomography (CT) findings were analyzed. Furthermore, angiographic and embolization details, technical and clinical successes, and complications were assessed. Results: Subcapsular, perirenal, and pararenal hematomas were observed on CT scans for all patients. Contrast extravasation was observed in 15 / 17 patients (88%) on contrast-enhanced CT scans. Angiography showed active bleeding in 14 patients (78%; contrast extravasation [n=6], pseudoaneurysm [n=3], and both [n=5]), suspicious bleeding in 1 (5%), and no bleeding in 3 (17%). The technical and clinical success rates were 100% and 94% (17/18), respectively. Total and partial embolization was performed in 14 (78%) and 4 (22%) cases, respectively. Subsequent surgical nephrectomy was required for one patient with clinical failure due to recurrent bleeding despite total embolization. Procedure-related complications included mild post-embolization syndrome in one patient and contrast-induced nephropathy in five patients (28%) without long-term complications. Conclusions: Renal artery embolization is safe and effective for controlling spontaneous renal hemorrhage in patients with ACKD. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and effectiveness of transcatheter arterial embolization for controlling spontaneous hemorrhage in patients with acquired cystic kidney disease (ACKD)., Methods: This retrospective study included 18 patients with ACKD (M:F=13:5; mean age, 56 years) who underwent renal artery embolization to control spontaneous hemorrhage between January 2001 and September 2020. The underlying etiology and clinical presentations were reviewed and previous computed tomography (CT) findings were analyzed. Furthermore, angiographic and embolization details, technical and clinical successes, and complications were assessed., Results: Subcapsular, perirenal, and pararenal hematomas were observed on CT scans for all patients. Contrast extravasation was observed in 15 / 17 patients (88%) on contrast-enhanced CT scans. Angiography showed active bleeding in 14 patients (78%; contrast extravasation [n=6], pseudoaneurysm [n=3], and both [n=5]), suspicious bleeding in 1 (5%), and no bleeding in 3 (17%). The technical and clinical success rates were 100% and 94% (17/18), respectively. Total and partial embolization was performed in 14 (78%) and 4 (22%) cases, respectively. Subsequent surgical nephrectomy was required for one patient with clinical failure due to recurrent bleeding despite total embolization. Procedure-related complications included mild post-embolization syndrome in one patient and contrast-induced nephropathy in five patients (28%) without long-term complications., Conclusions: Renal artery embolization is safe and effective for controlling spontaneous renal hemorrhage in patients with ACKD., Competing Interests: Conflict of interest: The authors declare that they have no conflict of interest., (Copyright: © Pakistan Journal of Medical Sciences.)