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Resume Les hematomes musculaires spontanes sont une complication frequente et grave des traitements anticoagulants. L’incidence suit l’augmentation du nombre de patients sous anticoagulants. Leur prise en charge radiologique est a la fois diagnostique et interventionnelle. En effet, la performance de l’angioscanner dans la detection des hemorragies en fait l’outil pivot du diagnostic positif, topographique et de severite. La detection d’une fuite active de produit de contraste, a la phase arterielle ou veineuse, permet de poser l’indication d’une arteriographie embolisation. En outre, l’angioscanner permet la planification du geste radiologique interventionnel. L’embolisation arterielle des pedicules responsables de l’hemorragie est une technique efficace. Les taux de succes technique et clinique sont respectivement de 90 % et de 86 %.

Spontaneous muscle hematomas are a common and serious complication of anticoagulant treatment. The incidence of this event has increased along with the rise in the number of patients receiving anticoagulants. Radiological management is both diagnostic and interventional. Computed tomography angiography (CTA) is the main tool for the detection of hemorrhage to obtain a positive, topographic diagnosis and determine the severity. Detection of an active leak of contrast material during the arterial or venous phase is an indication for the use of arterial embolization. In addition, the interventional radiological procedure can be planned with CTA. Arterial embolization of the pedicles that are the source of the bleeding is an effective technique. The rate of technical and clinical success is 90% and 86%, respectively.

A 67-year-old man diagnosed with HER2 overexpression advanced gastric adenocarcinoma and metastasis to liver and lungs was admitted for tertiary care. He received a third line chemotherapy that consists of trastuzumab combined with FOLFIRI regimen (irinotecan plus 5-FU/LV) following a disease relapse after an initial successful response to a combination of 5FU + oxaliplatin and trastuzumab. The patient showed a favorable and prolonged response to it. In addition the chemotherapy was well tolerated and devoid of remarkable side effects. The response to trastuzumab + FOLFIRI was assessed clinically and through CT scan imaging and upper gastrointestinal endoscopy. This case report shows that firstly the combination of FOLFIRI and trastuzumab could be tested as another regimen in metastatic gastric cancer, and, secondly, that in this disease, like in metastatic breast cancer, the continuation of trastuzumab after an initial progression under this antibody could be tested in order to improve the efficacy of the treatment Trastuzumab re-introduction with FOLFIRI for treatment of HER2 overexpression-advanced gastric adenocarcinoma following failure of other trastuzumab-based chemotherapy regimens.

Les traitements locaux des metastases hepatiques (MH) des adenocarcinomes colorectaux (CCR) prennent une place de plus en plus importante dans les strategies therapeutiques des patients ayant des MH non resecables limitees ou predominantes au foie. La chimiotherapie intraarterielle hepatique (CIAH) a demontre tres tot son efficacite. Sa combinaison avec des polychimiotherapies systemiques a permis de doubler les taux de reponse et d’augmenter les taux de resection secondaires et la survie des patients. L’efficacite des chimioembolisations (CE) et des radioembolisations (RE) a surtout ete etablie a partir d’etudes de phase II ou de phase III les ayant evaluees a des stades tres avances, ou la survie sans progression et la survie globale etaient augmentees. La place de ces traitements a des stades plus precoces est en cours d’evaluation, et devrait permettre d’optimiser la prise en charge des patients avec MH. Ces traitements locaux doivent etre aujourd’hui utilises en combinaison avec des traitements systemiques efficaces et/ou des resections, et le choix des meilleures strategies et protocoles doit etre fait en RCP specialisees.

The ‘emborrhoid’ technique consists of the embolization of the hemorrhoidal arteries. The endovascular arterial occlusion is performed using coils placed in the terminal branches of the superior rectal arteries. The emborrhoid technique has been modeled after elective transanal Doppler-guided hemorrhoidal artery ligation which has been shown to be effective in hemorrhoidal disease. We report the first 14 cases of our experience with emborrhoid technique. Fourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique (3 women, 11 men). The stage of the hemorrhoidal disease was II (10 patients), III (3), and IV (1). This treatment was decided by a multidisciplinary team (proctologist, visceral surgeon, and radiologist). Seven patients underwent previous proctological surgery. Ten patients had coagulation disorders (anticoagulants or cirrhosis). Superior rectal arteries were embolized with pushable microcoils (0.018). Technical success of the embolization procedure was 100 %. Clinical success at 1 month was 72 % (10/14). Of the 4 patients who experienced rebleeding, two underwent additional embolization of the posterior rectal arteries with success. No pain or ischemic complications were observed in 13 patients. One patient experienced a temporary painful and edematous, perianal reaction. Our case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new ‘emborrhoid’ technique in the management of hemorrhoidal disease.

To compare outcomes of percutaneous robot-assisted uterine fibroid embolization (UFE) using two different endovascular robotic catheters. Twenty-one patients with a symptomatic uterine fibroid were prospectively enrolled in a single-center study to be treated with a percutaneous robot-assisted embolization using the Magellan system. Fourteen patients were treated using a first generation steerable robotic catheter, version 1.0 (group 1), and seven were treated using the new version 1.1 (group 2). Demographic, pathologic, and procedural variables were recorded. Dose Area Product (DAP) and physician equivalent doses were registered for each procedure. Procedural related complications and clinical midterm outcomes were also evaluated. Successful robot-assisted UFE was obtained in eight patients (57.1%) in group 1 and 7 patients (100%) in group 2 (p = 0.01). A successful robot-assisted catheterization of the internal iliac artery anterior branch was performed in all patients of both groups. Median selective target vessel catheterization time was 21.0 ± 12.8 vs 13.4 ± 7 min (p = 0.04) and total fluoroscopy time was 30.3 ± 11.2 vs 19.3 ± 5.9 min, respectively, in group 1 and 2. Mean DAP decreased from 18472.6 ± 15622 to 5469.1 ± 4461.0 cGy·cm2 (p = 0.04). All patients obtained a symptoms relief at 6 months follow-up. Robot-assisted uterine fibroid embolization is safe and effective. New version of steerable robotic catheter allows performing a faster procedure without related adverse events compared to old version.

Aim The aim of this study was to assess the safety and efficacy of the emborrhoid technique (embolization of the superior hemorrhoidal arteries) in patients ineligible for surgery. Materials And Methods Between January 2014 and April 2015, 30 consecutive patients (average age 58 years) suffering from disabling chronic bleeding due to haemorrhoidal disease and with a contraindication for surgery (n= 23) or with a failure of instrumental or surgical treatment (n=7) underwent embolization. All cases were discussed at multidisciplinary meetings including a proctology specialist or a surgeon and an interventional radiologist. We performed super selective micro coil embolization (pushable 2-3 mm fibre coils) of the distal branches of the superior rectal arteries with a microcatheter, via a right femoral approach, under local anaesthesia. We assessed clinical outcome by evaluating bleeding and specific clinical scores relating to bleeding and changes in quality of life. Results Immediate technical success, with no complication, was achieved in 93% of cases. A mean of 3.1 arteries per patient were embolized, with a mean of 7.6 coils per patient. Median follow-up was five months. Clinical score improvement was observed in 72%, in 17 patients after a single embolization session, and in 4 additional patients after a second embolization session. No improvement in bleeding was observed in 8 patients (28%). Conclusion Distal coil embolization of the superior rectal arteries for disabling chronic bleeding due to haemorrhoidal disease is safe and effective in patients untreatable by surgery. This article is protected by copyright. All rights reserved.

Purpose Partial nephrectomy (PN) is an accepted alternative to radical nephrectomy for nephron sparing surgery to treat renal tumors. Although complications are relatively rare after PN, they may include renal hemorrhage that can be massive and life threatening. Artery embolization can have a major role in the management of these cases and to avoid radical nephrectomy. Materials and methods We report four consecutive patients with massive hemorrhage after PN, treated by arterial embolization and review the literature to discuss the clinical presentation, imaging evaluation and clinical outcome. All patients developed arteriovenous fistula and one a pseudoaneurysm. Results After selective catheterization and identification of the bleeding site, we used microcoils as embolization material. Immediate technical and clinical success was achieved in all cases. Conclusion Superselective artery embolization of renal hemorrhage is a simple, safe and efficient procedure. It has a high clinical success and should be considered as an alternative to nephrectomy, minimizing the morbidity and preserving renal tissue.

To classify the renal artery (RA) anatomy based on specific requirements for endovascular renal artery denervation (RDN) in patients with drug-resistant hypertension (RH).The RA anatomy of 122 consecutive RH patients was evaluated by computed tomography angiography and classified as two types: A (main RA ≥20 mm in length and ≥4.0 mm in diameter) or B (main RA20 mm in length or main RA4.0 mm in diameter). The A type included three subtypes: A1 (without accessory RAs), A2 (with accessory RAs3.0 mm in diameter), and A3 (with accessory RAs ≥3.0 mm in diameter]. A1 and A2 types were eligible for RDN with the Simplicity Flex catheter. Type B included twi subtypes based on the main RA length and diameter. Patients were accordingly classified into three eligibility categories: complete (CE; both RAs were eligible), partial (PE; one eligible RA), and noneligibility (NE; no eligible RA).Bilateral A1 type was the most prevalent and was observed in 48.4 % of the patients followed by the A1/A2 type (18 %). CE, PE, and NE were observed in 69.7, 22.9, and 7.4 % of patients, respectively. The prevalence of accessory RAs was 41 %.Of RH patients, 30.3 % were not eligible for bilateral RDN with the current Simplicity Flex catheter. This classification provides the basis for standardized reporting to allow for pooling of results of larger patient cohorts in the future.

Resume Objectif Comparer l’efficacite diagnostique de l’angioscanner multibarrettes (angio-TDM) a celle de l’arteriographie renale dans la detection des stenoses de l’artere renale de plus de 50 % en presence d’une suspicion d’hypertension renovasculaire. Materiels et methodes De janvier 2005 a janvier 2010, nous avons entrepris une analyse retrospective de 92 angio-TDM et arteriographies renales. Les arteriographies renales ont ete lues par un radiologue interventionnel. Trois lecteurs independants (deux radiologues experimentes et un technicien) ont cote en aveugle les angio-TDM selon trois approches differentes. Le lecteur no 1 a cote la stenose uniquement a partir des reconstructions MPR et MIP. Le lecteur no 2 (technicien) a utilise uniquement le logiciel de segmentation arterielle automatique. Le lecteur no 3 a egalement utilise ce logiciel mais en mesurant manuellement les diametres. Resultats Sur les 92 patients evalues (235 arteres renales), l’arteriographie a retrouve 48 stenoses significatives. La sensibilite et la specificite de l’angio-TDM et de l’arteriographie renale etaient respectivement, dans l’analyse par patient, pour le lecteur no 1 : (88 % ; 80 %) ; pour le lecteur no 2 : (58 % ; 80 %) ; pour le lecteur no 3 : (96 % ; 90 %) (p Conclusion L’analyse des vaisseaux effectuee par le logiciel automatique puis corrigee par un radiologue confere aux examens d’angio-TDM une sensibilite/specificite de 96 %/90 % dans la detection des stenoses de l’artere renale de plus de 50 %.

Purpose To compare the diagnostic performance of MDCTA versus renal angiography in the detection of > 50% renal artery stenosis in patients suspected of reno-vascular hypertension. Materials and methods Between January 2005 and January 2010, 92 MDCTA and renal arteriographies were retrospectively analysed. Renal angiographies were read by one interventional radiologist. Three blinded independent readers (two senior radiologists and one technician) scored MDCTA images using three different approaches. Reader 1 scored stenosis using only MPR and MIP. Reader 2 (technician) used only proprietary automatic arterial segmentation software. Reader 3 used the cited software, using manual diameter measurements. Results A total of 92 patients, (235 renal arteries) were assessed in which 48 significant stenosis were found by arteriography. Sensitivity, specificity, of MDCTA compared to renal arteriography were respectively per patient for reader 1: (88%; 80%); for reader 2: (58%; 80%); for reader 3: (96%; 90%) ( P Conclusion When using automated vessel analysis software edited by a radiologist, MDCTA studies had a Sensibility/Specificity of 96%/90% to detect > 50% renal artery stenosis.

To measure the impact on pain relief and patient quality of life using embolization radio-frequency ablation and cementoplasty (ERC) for local combination therapeutic management of painful pelvic bone metastasis of renal cell carcinoma (RCC). This prospective monocentric registry was approved by our Local Institutional Review Board. Between January 2008 and January 2013, all consecutive patients who fully met the inclusion criteria were enrolled in the ERC-procedure prospective registry. They were assigned to follow-up at discharge and again at 1 and 6 months. Efficacy was evaluated using a pain visual analog scale (VAS), and narcotic consumption and quality of life were assessed using the Brief Pain Inventory questionnaire. Fifty-two patients were enrolled, among whom 58 lesions were treated. Technical success was obtained in all procedures. The median VAS score decreased from 7 ± 1.4 (ranges 5–10) at baseline to 3 ± 1.5 (ranges 0–6) at discharge, 2 ± 1.5 (ranges 0–5) at 1 month (p

Radioembolization with yttrium-90 microspheres is a therapy that is used for hepatic tumors. 20-30 μm microspheres loaded with Y90 are supposedly occluding tumor vessels at the capillary level. Then, these spheres deliver high-dose radiation to the tumor. However, this theoretical embolic effect has never been appreciated in imaging. Dual-Phase cone-beam computed tomography (DPCBCT) is a multi-phasic intra-procedural scan that uses only one contrast media injection to visualize early (feeding vessel) and delayed (capillary level) tumor enhancement. The purpose of this study was to determine whether there is a micro-embolic effect induced by TheraSpheres® (MDS Nordion, Ottawa, Ontario, Canada) at the capillary level by using DPCBCT imaging.14 patients with 72 carcinoid or neuroendocrine tumors were treated with radioembolization, and all underwent DPCBCT (Allura Xper, Philips Healthcare) imaging before and immediately after radioembolization with TheraSpheres®. Tumor enhancement was measured in each phase by drawing a region of interest within the tumors.72 tumors were evaluated: average tumor density in the early arterial phase was 241 and 230 Hounsfield units (HU) (p0.001) before and after radioembolization, respectively; the average density in the delayed arterial phase was 226 and 161 HU (p0.001) before and after radioembolization, respectively. Average difference in tumor attenuation before and after radioembolization in early arterial and delayed phase was 11 HU and 64 HU (p0.001), respectively.The significant decrease in tumor enhancement in the DPCBCT delayed phase after TheraSpheres® injection indicates that there is an appreciable microembolic effect at the tumor capillary bed level.

To evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers-Danlos syndrome (vEDS) in a single tertiary referral center.We retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.Five consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1-74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).Embolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.

Resume Nous rapportons trois observations de fistules uretero-iliaques (FUI) chez des patients adresses pour prise en charge therapeutique d’une hematurie macroscopique. Bien qu’il s’agisse d’une etiologie classique d’hematurie, le diagnostic est souvent difficile et la prise en charge n’est pas encore standardisee. Un bilan diagnostique associe a une prise en charge multidisciplinaire ameliore le pronostic des patients. Le traitement curatif par voie endovasculaire est efficace et sure, avec une evolution rapidement favorable chez tous nos patients. L’utilisation de stent-couverts associes a l’Amplatzer™ vascular plug rende la procedure aisee et sure.

Purpose To determine whether diffusion-weighted imaging (DWI) characteristics could predict the effectiveness of uterine arterial embolization in treatment of fibroids. Methods This retrospective study included 17 women (27 fibroids) who underwent uterine arterial embolization for fibroids. MR imaging (1.5 T) was performed before, 1 week and 6 months after uterine arterial embolization. The volume, T2 signal, T1 signal, enhancement after contrast media injection, DWI signal (b = 500 s/mm2) and apparent diffusion coefficient (ADC) were assessed for fibroids. Results DWI signal or ADC, whether before or 1 week after the procedure, did not show a statistical relationship to success of uterine arterial embolization. On the 1-week follow-up, 22% of fibroids enhanced vs. 85% on baseline, P < 0.0001 and DW signal intensity increased. ADC values in fibroids decreased between baseline and 1-week (1.61 vs. 1.53 × 10−3 mm2/s, P = 0.13). On 6-months, ADC continued to decrease compared with baseline (1.27 × 10−3 mm2/s, P = 0.002), but with a lower signal on DWI. No changes were observed in myometrium ADC at any time point. Conclusion Our study demonstrated that DWI and ADC reflected early and delayed changes in fibroids after embolization; however, we were not able to demonstrate a statistically significant relationship with outcome. Magn Reson Med 70:1739–1747, 2013. © 2013 Wiley Periodicals, Inc.

Purpose To prospectively evaluate the outcomes of ALN inferior vena cava (IVC) filter extractions after long-term implantation (ie,>1 y). Materials and Methods Between November 2004 and January 2011, 503 retrievable ALN IVC filters were implanted, but only 188 (37%) were addressed for removal. Because it was suspected that a subset of patients had not been referred for IVC filter retrievals, between November 2008 and January 2011, all patients who still had an ALN filter that had been implanted at least 1 year previously were systematically recalled. For those patients, the relative benefits and risks of filter removal were evaluated by a multidisciplinary conference. If deemed necessary by the conference, filter removals were performed. The endpoints were the feasibility and safety of filter retrieval, which were based on an evaluation of the success rates, pre- and postprocedure complications, and dosimetric assessments. Results Twenty-nine patients still retained their filters at least 1 year following implantation. The mean interval between implantation and retrieval was 25.6 months (range, 14.8–40.8 mo), and extractions were performed on eight patients who had received a filter at least 2 years earlier. The longest dwell time was 40 months. All filters were extracted successfully without complications. Conclusions Optional ALN filter retrievals can be performed safely after more than 1 year following implantation.

Purpose To show that hepatic tumor volume and enhancement pattern measurements can be obtained in a time-efficient and reproducible manner on a voxel-by-voxel basis to provide a true three-dimensional (3D) volumetric assessment. Materials and Methods Magnetic resonance (MR) imaging data obtained from 20 patients recruited for a single-institution prospective study were retrospectively evaluated. All patients had a diagnosis of hepatocellular carcinoma (HCC) and underwent drug-eluting beads (DEB) transcatheter arterial chemoembolization for the first time. All patients had undergone contrast-enhanced MR imaging before and after DEB transcatheter arterial chemoembolization; poor image quality excluded 3 patients, resulting in a final count of 17 patients. Volumetric RECIST (vRECIST) and quantitative EASL (qEASL) were measured, and segmentation and processing times were recorded. Results There were 34 scans analyzed. The time for semiautomatic segmentation was 65 seconds±33 (range, 40–200 seconds). vRECIST and qEASL of each tumor were computed Conclusions Semiautomatic quantitative tumor enhancement (qEASL) and volume (vRECIST) assessment is feasible in a workflow-efficient time frame. Clinical correlation is necessary, but vRECIST and qEASL could become part of the assessment of intraarterial therapy for interventional radiologists.

The objective of the treatment of colorectal cancer patients with unresectable liver metastases should be clearly defined at the outset. Potentially resectable patients should be distinguished from clearly unresectable patients. In defining resectability, it is important to take into account both anatomic characteristics and patient characteristic (comorbidities, symptoms, age). According to this evaluation, treatment should be tailored to each patient. The most widely accepted standard is doublet cytotoxic regimen plus biotherapy (anti-EGFR or anti-VEGF antibodies according to RAS status, but some patients could benefit from an intensified regimen, as triplet chemotherapy ± bevacizumab, or intraarterial treatments (hepatic arterial infusion, radioembolization or chemoembolization), in order to allow resectability. It is therefore very important to discuss the treatments with a multidisciplinary team, including an experienced surgeon, an interventional radiologist and an oncologist. On the other hand, some patients could benefit in terms of quality of life and decreased toxicity from less intense treatment when resection is not an objective. First-line monotherapy or a maintenance strategy with biotherapy and/or cytotoxics could be discussed with these patients, and treatment holidays should be considered in selected patients. Finally, in patients with secondary resection of liver metastases, specificity should be considered in choosing the best adjuvant treatment, such as response to preoperative treatment and individual risk of relapse, which many in some cases justify intensification with hepatic arterial infusion in an adjuvant setting.

Peri-prostatic shunts are frequent during PAE, carrying the risk of non-target embolization of penis/corpus cavernosum or rectum but also the potential advantage to irrigate the contralateral lobe. Sometimes, bilateral embolization is impossible, carrying the risk of limited clinical success. The possibility to reach contralateral prostatic territory from the ipsilateral prostatic artery (PA) and embolize it via peri/intra-prostatic anastomoses could be of interest in this situation. We describe a series of three consecutive patients (among 89 consecutive patients treated by PAE for symptomatic BPH) who underwent successful embolization of both prostatic lobes through catheterization of a PA on only one side. All patients had clinical success after a mean follow-up of 3.3 months. Dosimetry of these three procedures indicates that there may be radiation dose savings.

Patients with breast cancer liver metastasis have a poor prognosis. Local therapy for liver metastasis increases survival. The purpose of this pilot prospective study was to evaluate the efficacy and safety of doxorubicin drug-eluting beads chemoembolization for liver-dominant breast cancer metastasis (LdBM) refractory to chemotherapy. All patients with LdBM refractory to of two or more lines of systemic chemotherapy were screened. Two chemoembolizations at 1-month intervals were scheduled for each patient. Tumor responses were evaluated by MRI every 3 months until progression or death. Adverse events were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.02) 1 month after each chemoembolization. All patients were free from systemic treatment until progression. Patients with hormone-positive receptors and/or HER-positive disease status continued their targeted therapy. Out of 23 patients enrolled (mean age: 57.5 ± 11.5 years), 17 completed two chemoembolizations and six underwent only one because of severe adverse events. At 3-month follow-up, the disease control rate was 83 %. The median progression-free survival from the first chemoembolization was 8 months, and the median overall survival was 17 months. Nineteen patients remained free from any systemic chemotherapy for a mean of 209 ± 92 days until progression. Eight grade 3 (asthenia n = 3, anemia n = 2, thrombocythemia n = 2, liver toxicity n = 1) (Rev 1 Comment 1) occurred after the first procedure. No patient died directly due to the procedure. While chemoembolization with doxorubicin eluding beads for refractory LdBM leads to an 83 % disease control rate, it also causes severe side effects that need to be adequately managed.

Resume L’application recente des techniques de traitement endovasculaire aux pathologies d’origine veineuse a permis d’offrir de nouvelles solutions therapeutiques aux patients souffrant de syndrome post-thrombotique. Cette affection souvent sous evaluee complique de facon frequente les thromboses veineuses profondes, traitees ou non. Elle entraine une symptomatologie clinique chronique invalidante (œdemes, claudication, douleurs, ulceres veineux…) par l’association de phenomenes physiopathologiques a type d’obstruction et de reflux. Ces signes cliniques sont faiblement ameliores par le traitement medical classique, veino-toniques et compression veineuse. Nous rapportons le cas de deux patients souffrant d’obstruction veineuse chronique post-thrombotique des membres inferieurs chez qui le traitement endovasculaire a permis une amelioration clinique nette et durable.

Colorectal carcinoma is a major public health concern with its yearly mondial incidence of about one million cases and yearly mortality of 500,000 cases. The liver is the organ most frequently affected by metastases with a frequency of 40 to 60% (contemporaneous in 25% of cases). While surgical resection is the only curative therapy, many patients are not such candidates due to the infiltrative nature of the liver metastases. Systemic chemotherapy and biotherapy regimens are the conventional treatment options for patients with multiple liver metastases. Under such circumstances, intra-arterial therapy may play a major role. We will review the main types of endovascular therapies for liver metastases from colorectal carcinoma including indications, results and potential complications.

El trasplante renal es en la actualidad el tratamiento de eleccion de la insuficiencia renal terminal. Existen muchas complicaciones que pueden provocar la perdida funcional del injerto u obligar a su extraccion y comprometer el pronostico vital del receptor. Entre ellas, las complicaciones vasculares son frecuentes y conllevan una morbilidad elevada. El papel de las tecnicas endoluminales en el tratamiento de estas complicaciones aumenta de forma constante. Aunque las complicaciones vasculares precoces, como la trombosis de la arteria o de la vena del injerto suelen requerir un tratamiento quirurgico urgente, la mayor parte de las complicaciones vasculares tardias, como la estenosis de la arteria del injerto o las complicaciones iatrogenicas post-biopsia se tratan con exito mediante tecnicas de radiologia intervencionista.

Retrieval of removable inferior vena cava (IVC) filters in selected patients is widely practiced. The purpose of this multicenter study was to evaluate the feasibility and results of percutaneous removal of the ALN removable filter in a large patient cohort. Between November 2003 and June 2006, 123 consecutive patients were referred for percutaneous extraction of the ALN filter at three centers. The ALN filter is a removable filter that can be implanted through a femoral/jugular vein approach and extracted by the jugular vein approach. Filter removal was attempted after an implantation period of 93 +/- 15 days (range, 6-722 days) through the right internal jugular vein approach using the dedicated extraction kit after control inferior vena cavography. Following filter removal, vena cavograms were obtained in all patients. Successful extraction was achieved in all but one case. Among these successful retrievals, additional manipulation using a femoral approach was needed when the apex of the filter was close to the IVC wall in two patients. No immediate IVC complications were observed according to the postimplantation cavography. Neither technical nor clinical differences between early and late filter retrieval were noticed. Our data confirm the safety of ALN filter retrieval up to 722 days after implantation. In infrequent cases, additional endovenous filter manipulation is needed to facilitate extraction.

Prostatic artery embolization (PAE) has been performed for a few years, but there is no report on PAE using the PErFecTED technique outside from the team that initiated this approach. This single-center retrospective open label study reports our experience and clinical results on patients suffering from symptomatic BPH, who underwent PAE aiming at using the PErFecTED technique. We treated 32 consecutive patients, mean age 65 (52–84 years old) between December 2013 and January 2015. Patients were referred for PAE after failure of medical treatment and refusal or contra-indication to surgery. They were treated using the PErFecTED technique, when feasible, with 300–500 µm calibrated microspheres (two-night hospital stay or outpatient procedure). Follow-up was performed at 3, 6, and 12 months. We had a 100 % immediate technical success of embolization (68 % of feasibility of the PErFecTED technique) with no immediate complications. After a mean follow-up of 7.7 months, we observed a 78 % rate of clinical success. Mean IPSS decreased from 15.3 to 4.2 (p = .03), mean QoL from 5.4 to 2 (p = .03), mean Qmax increased from 9.2 to 19.2 (p = .25), mean prostatic volume decreased from 91 to 62 (p = .009) mL. There was no retrograde ejaculation and no major complication. PAE using the PErFecTED technique is a safe and efficient technique to treat bothersome LUTS related to BPH. It is of interest to note that the PErFecTED technique cannot be performed in some cases for anatomical reasons.

Prostate artery embolization (PAE) is a new approach to improve lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. PAE results in global reduction of prostate volume (PV). There are no data available on the efficacy of PAE in reducing intra-vesical prostatic protrusion (IPP), an anatomic feature that is clinically related with bladder outlet obstruction and LUTS. To assess the results of PAE in patients with significant IPP due to median lobe hyperplasia and to compare the IPSS decrease and IPP change. Prospective analysis of 18 consecutive patients with significant IPP (>5 mm) related to median lobe hyperplasia undergoing PAE using 30–500-μm-calibrated trisacryl microspheres. We measured IPP on sagittal T2-weighted images before and 3 months after PAE. IPSS and clinical results were also evaluated at 3 months. PAE resulted in significant IPP reduction (1.57 cm ± 0.55 before PAE and 1.30 cm ± 0.46 after PAE, p = 0.0005) (Fig. 1) with no complication. IPSS, quality of life (QoL), total prostate-specific antigen (PSA) level, and PV showed significant reduction after PAE, and maximum urinary flow rate (Q max) showed significant increase after PAE. No significant change of International Index of Erectile Function (IIEF) for clinical evaluation after PAE. A significant correlation was found between the IPP change and the IPSS change (r = 0.636, p = 0.0045). Patients had significant IPP reduction as well as significant symptomatic improvement after PAE, and these improvements were positively correlated.

OBJECTIVE. The purpose of this study was to report the effectiveness and safety of selective arterial embolization for the management of anticoagulation-related soft-tissue bleeding. MATERIALS AND METHODS. All consecutive patients from June 1, 2003, to June 1, 2010, with intractable anticoagulation-related soft-tissue bleeding treated by embolization were included. The clinical files, MDCT angiographic examinations, and procedure details were reviewed. The primary goal of this study was to report the safety and efficacy of embo lization for the management of anticoagulation-related soft-tissue bleeding. The secondary goal was to evaluate the correlation between the MDCT angiography (MDCTA) findings and conventional catheter angiography. RESULTS. Thirty-six consecutive patients were included. All patients were under anticoagulant therapy. Overdosage of the anticoagulant was found in 12 (33%) patients. MDCT was performed with multiphasic contrast media injection in 30 patients (83%) and showed extravasation in 22 (73.3%) of those 30 patients. Catheter angiography revealed extravasation in 27 of 36 (75%) patients, and no active bleeding was observed in nine patients who were empirically embolized. The sensitivity of MDCTA for depicting ongoing active bleeding was 87%. The transfusion requirement for RBC units decreased from 4.0 (range, 0–12.0) before to 0 (range, 0–4.0) after embolization. Nine patients underwent a second embolization but only one in the same vascular territory. Eleven patients died within 30 days despite the embolization. No complications related to embolization were reported. CONCLUSION. Anticoagulation-related soft-tissue bleeding can be efficiently and safely treated by selective arterial embolization. However, this serious pathologic condition may be fatal in many cases, and rebleeding is not rare. MDCTA could help to guide treatment.

Importance Although retrievable inferior vena cava filters are frequently used in addition to anticoagulation in patients with acute venous thromboembolism, their benefit-risk ratio is unclear. Objective To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence. Design, Setting, and Participants Randomized, open-label, blinded end point trial (PREPIC2) with 6-month follow-up conducted from August 2006 to January 2013. Hospitalized patients with acute, symptomatic pulmonary embolism associated with lower-limb vein thrombosis and at least 1 criterion for severity were assigned to retrievable inferior vena cava filter implantation plus anticoagulation (filter group; n = 200) or anticoagulation alone with no filter implantation (control group; n = 199). Initial hospitalization with ambulatory follow-up occurred in 17 French centers. Interventions Full-dose anticoagulation for at least 6 months in all patients. Insertion of a retrievable inferior vena cava filter in patients randomized to the filter group. Filter retrieval was planned at 3 months from placement. Main Outcomes and Measures Primary efficacy outcome was symptomatic recurrent pulmonary embolism at 3 months. Secondary outcomes were recurrent pulmonary embolism at 6 months, symptomatic deep vein thrombosis, major bleeding, death at 3 and 6 months, and filter complications. Results In the filter group, the filter was successfully inserted in 193 patients and was retrieved as planned in 153 of the 164 patients in whom retrieval was attempted. By 3 months, recurrent pulmonary embolism had occurred in 6 patients (3.0%; all fatal) in the filter group and in 3 patients (1.5%; 2 fatal) in the control group (relative risk with filter, 2.00 [95% CI, 0.51-7.89]; P = .50). Results were similar at 6 months. No difference was observed between the 2 groups regarding the other outcomes. Filter thrombosis occurred in 3 patients. Conclusions and Relevance Among hospitalized patients with severe acute pulmonary embolism, the use of a retrievable inferior vena cava filter plus anticoagulation compared with anticoagulation alone did not reduce the risk of symptomatic recurrent pulmonary embolism at 3 months. These findings do not support the use of this type of filter in patients who can be treated with anticoagulation. Trial Registration clinicaltrials.gov Identifier:NCT00457158

RESUME L’ischemie critique est un probleme croissant de sante publique, par le nombre de patients concernes et les couts engendres. L’amputation primaire qui est encore la regle dans une majorite de pays et d’institutions est non seulement humainement desastreuse mais est reconnue comme plus couteuse. On sait maintenant que si l’on associe les techniques de radiologie interventionnelle et la chirurgie de pontage distal, on est capable de sauver le membre plus de neuf fois sur dix. La gravite et l’etendue des lesions atheromateuses en particulier coronarienne ou carotidienne, recommande une surveillance serree et une prise en charge agressive des facteurs de risque, avant, pendant et apres le geste. Dans un premier temps, le bilan anatomique permet de decider de toute la prise en charge. Celui-ci repose encore en 2006 sur l’arteriographie. Elle seule est assez precise pour permettre le choix eclaire du traitement adapte, et dans le meme temps et sous anesthesie locale, de revasculariser le membre par technique interventionnelle dans la plupart des cas et apres accord du medecin referent. Les techniques adoptees varient en fonction du profil lesionnel allant de la simple angioplastie conventionnelle par ballon a la pose de stent, la recanalisation sous intimale ou les ballons coupants. Ce travail presente une revue des possibilites de la radiologie interventionnelle dans cette pathologie et une synthese de ses resultats compares a ceux de la chirurgie en 2006.

CIRSE established a registry of retrievable filter use with the primary aim of determining the success of IVC Filter retrieval and associated complications. Secondary endpoints included filter indications, imaging strategies before retrieval, filter dwell times, and anticoagulation status. A web-based electronic registry was hosted between 01/12/2010 and 30/06/2012. Data entry occurred at the date of IVC filter retrieval and included items such as filter type, indication for filter insertion, access route, dwell time, retrieval success, complications, reasons for failed retrieval, and anticoagulation status. 671 filter retrievals were entered (male:female 333:295, mean age 55, median 57). Retrieval data were not entered in 43/671 leaving 628 patients for analysis. The 4 commonest retrievable filters used were the Celect in 182 patients, the OPTEASE in 161, ALN in 120, and Gunther Tulip in 98. Filters were inserted for absolute indications 40 %, relative indications in 31 %, and prophylactic in 24 %, with 5 % missing. Mean filter dwell time was 90 days. Filters were successfully retrieved in 576/628 patients (92 %). The mean dwell time for successful retrievals was 85 days versus 145 days for unsuccessful retrievals (p = 0.001). Major complications occurred in 2 patients (0.03 %). In summary, the CIRSE retrievable filter registry demonstrates a retrieval rate of 92 % across a range of filter types, with a low major complication rate, reflecting current practice. There is an increase in trend of retrievable filter use for relative and prophylactic indications.

e15061 Background: Hepatic arterial infusion (HAI) chemotherapy of oxaliplatin is an option in the management of metastatic colorectal cancers (mCRC) with dominant liver metastases (LM). However, despite prolonged control some patients (pts) experience disease progression or dose-limiting toxicity. In these cases, the use of a second-line HAI with an alternative drug has never been reported to date. This pilot study is evaluating treatment outcomes in pts receiving HAI of 5-FU or mitomycine C (MMC), after HAI oxaliplatin (HAI-ox) in heavily pretreated pts. Methods: 24 pts with unresectable mCRC were enrolled, metastases were exclusively or dominant in the liver (≥80% of overall total metastatic tumour burden in the liver), all pts received prior HAI-ox. They were treated with either biweekly HAI 5-FU with dose ranging from 600 to 1200mg/m2 over 2 hours (17 patients), or monthly MMC 7mg/m2 over 1 hour (7 patients). Results: Mean age was 62 years. 42% of pts (10/24) had extra-hepatic metastases and 75% (18/24) had 8 LM or more. Including prior HAI-ox, pts had previously received a median of 3 prior lines of treatment (range:2 to 5). Previous HAI-ox was stopped for toxicity in 17 pts (allergy, neuropathy or abdominal pain) or progression in 7 pts. At baseline, 62% of pts had progressive disease. All pts but one received concomitant systemic therapies together with HAI 5FU or MMC. The overall RECIST V1.1 objective response rate and disease control rate were respectively 42% (10/24) and 71% (17/24). Median progression free survival (PFS) and overall survival (OS) were respectively 5.6 and 25.8 months; hepatic PFS was 8.5 months. 3 pts benefited from further curative intent treatments after 2nd line HAI (2 radiofrequency, 1 surgery). No toxic death occurred and toxicity profile was acceptable, with only 2 grade 3 events reported (diarrhea and thrombocytopenia). Conclusions: 2nd line HAI with 5-FU or MMC seems feasible and efficient in heavily pretreated mCRC with liver dominant disease when progressing or not tolerating oxaliplatin HAI. A phase II study is going to be performed to confirm these first results.

Synthesis and characterization of 5a-d. CCDC-221834 contains the supplementary crystallographic data for this paper. These data can be obtained free of charge from The Cambridge Crystallographic Data Centre via: www.ccdc.cam.ac.uk/data_request.cif.; International audience; Phenylisocyanate reacts with palladium(II) bis-acetate phenanthroline complexes to give six-membered palladacycles in nearly quantitative yields. In this new reaction, the acetate ligands act as decarbonylating agents toward the isocyanate functionality by possibly forming the isolated palladacycles via an intramolecular rearrangement.

Arterial skeletonization before radioembolization or hepatic artery port catheter placement for chemotherapy is a crucial step to prevent side effects. Coils are commonly used as an embolic material for hepatoenteric arterial occlusion. Herein is reported for the first time the clinical use of a new detachable microvascular plug (MVP) suitable for occlusion of 1–3 mm diameter vessels. The MVP allows vessel embolization even in challenging anatomy such as the right gastric artery. Furthermore, immediate and stable vessel occlusion was observed in our pilot study of 16 MVP placements.

Patrick Mismetti, MD, PhD; Silvy Laporte, MS, PhD; Olivier Pellerin, MD, MSc; Pierre-Vladimir Ennezat, MD, PhD; Francis Couturaud, MD, PhD; Antoine Elias, MD, PhD; Nicolas Falvo, MD; Nicolas Meneveau, MD, PhD; Isabelle Quere, MD, PhD; Pierre-Marie Roy, MD, PhD; Olivier Sanchez, MD, PhD; Jeannot Schmidt, MD, PhD; Christophe Seinturier, MD; Marie-Antoinette Sevestre, MD; Jean-Paul Beregi, MD, PhD; Bernard Tardy, MD, PhD; Philippe Lacroix, MD; Emilie Presles, MSc; Alain Leizorovicz, MD; Herve Decousus, MD; Fabrice-Guy Barral, MD; GuyMeyer, MD; for the PREPIC2 Study Group

The purpose of this study was to compare tumor volume in a VX2 rabbit model as calculated using semiautomatic tumor segmentation from C-arm cone-beam computed tomography (CBCT) and multidetector computed tomography (MDCT) to the actual tumor volume.Twenty VX2 tumors in 20 adult male New Zealand rabbits (one tumor per rabbit) were imaged with CBCT (using an intra-arterial contrast medium injection) and MDCT (using an intravenous contrast injection). All tumor volumes were measured using semiautomatic three-dimensional volumetric segmentation software. The software uses a region-growing method using non-Euclidean radial basis functions. After imaging, the tumors were excised for pathologic volume measurement. The imaging-based tumor volume measurements were compared to the pathologic volumes using linear regression, with Pearson's test, and correlated using Bland-Altman analysis.Average tumor volumes were 3.5 ± 1.6 cm(3) (range, 1.4-7.2 cm(3)) on pathology, 3.8 ± 1.6 cm(3) (range, 1.3-7.3 cm(3)) on CBCT, and 3.9 ± 1.6 (range, 1.8-7.5 cm(3)) on MDCT (P.001). A strong correlation between volumes on pathology and CBCT and also with MDCT was observed (Pearson's correlation coefficient = 0.993 and 0.996, P.001, for CBCT and MDCT, respectively). Bland-Altman analysis showed that MDCT tended to overestimate tumor volume, and there was stronger agreement for tumor volume between CBCT and pathology than with MDCT, possibly because of the intra-arterial contrast injection.Tumor volume as measured using semiautomatic tumor segmentation software showed a strong correlation with the "real volume" measured on pathology. The segmentation software on CBCT and MDCT can be a useful tool for volumetric hepatic tumor assessment.

Background Chronic mesenteric ischemia is a rare disease with nonspecific clinical symptoms, such as chronic postprandial abdominal pain and weight loss. Diagnostic modalities and revascularization techniques have evolved during the past 20 years. The significance of stenosis in a single splanchnic vessel remains unclear. Our aims were to assess the outcomes of 2 revascularization techniques and report on the diagnostic modalities of splanchnic vessel stenoses. Methods The demographic data, medical history, technical characteristics, and outcomes of the revascularization procedures were recorded for all of the patients admitted for endovascular revascularization or open surgical revascularization of the splanchnic vessels as treatment for chronic mesenteric ischemia in our tertiary referral center since 2000. Results Fifty-four patients were included in this study: 43 received endovascular revascularization, and 11 had open surgical revascularization. The symptoms were abdominal pain, weight loss, and diarrhea in 98%, 53%, and 25% of the cases, respectively. Computed tomography angiography was the key diagnostic tool for 60% of the patients. A single-vessel stenosis was found in one-third of the patients. Endovascular and open revascularization had similar early and late outcomes, and no 30-day mortality was observed. However, we did observe higher morbidity in the open revascularization group (73% vs 19%, P Conclusions Chronic mesenteric ischemia may be diagnosed in the presence of a splanchnic syndrome and stenosis of a single splanchnic vessel, typically assessed using computed tomography angiography. In selected patients, endovascular revascularization had similar efficacy as, and lower complication rates than open revascularization.

To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage. Between November 2004 and January 2011, a total of 44 consecutive women (median ± standard deviation age 34 ± 3 years, range 23–41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 × 5 × 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination. Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean ± standard deviation [SD]) 6 ± 1.2 (range 3–8) U and 2 ± 0.7 (range 2–4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular. This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.