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Objectives: To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA).Methods: DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides.Results: The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%).Conclusions: Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation. [ABSTRACT FROM AUTHOR]

Background: Prostatic artery embolisation (PAE) has been associated with an improvement of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH), but conclusive evidence of efficacy from randomised controlled clinical trials has been lacking., Objective: To assess the safety and efficacy of PAE compared with a sham procedure in the treatment of LUTS/BPH., Design, Setting, and Participants: A randomised, single-blind, sham-controlled superiority clinical trial was conducted in 80 males ≥45yr with severe LUTS/BPH refractory to medical treatment from 2014 to 2019 in a private clinic, with efficacy assessments at 6 and 12 mo after randomisation. One patient in the PAE group and three in the sham group did not complete the study., Intervention: Patients were randomised 1:1 upon successful catheterisation of a prostatic artery to either PAE or a sham PAE procedure without embolisation. After 6 mo, all 38 patients randomised to the sham group who completed the single-blind period underwent PAE, and both groups completed a 6-mo open period., Outcome Measurements and Statistical Analysis: An intention-to-treat analysis of all randomised patients was performed. The coprimary outcomes were the change from baseline to 6 mo in the International Prostate Symptom Score (IPSS) and the quality of life (QoL) score at 6 mo, analysed with analysis of covariance and t test, respectively., Results and Limitations: Mean age was 63.8±6.0yr, baseline IPSS 26.4±3.87, and QoL score 4.43±0.52. At 6 mo, patients in the PAE arm had a greater improvement in IPSS, with a difference in the change from baseline of 13.2 (95% confidence interval [CI] 10.2-16.2, p<0.0001), and a better QoL score at 6 mo (difference: 2.13; 95% CI 1.57-2.68, p<0.0001) than the patients in the sham arm. The improvements in IPSS and QoL in the sham group 6 mo after they performed PAE were, respectively, 13.6±9.19 (p<0.0001) and 2.05 ± 1.71 (p<0.0001). Adverse events occurred in 14 (35.0%) patients after PAE and in 13 (32.5%) after sham, with one serious adverse event in the sham group during the open period. No treatment failures occurred. Limitations include a single-centre trial, only severe LUTS/BPH, and follow-up limited to 12 mo., Conclusions: The improvements in subjective and objective variables after PAE are far superior from those due to the placebo effect., Patient Summary: Clearly superior efficacy of prostatic artery embolisation (PAE) compared with a sham procedure was found in this study, which supports the use of PAE in patients with typical symptoms associated with benign prostatic hyperplasia., (Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: We wanted to examine whether the apparent diffusion coefficient values obtained by diffusion-weighted imaging techniques could indicate an early prognostic assessment for patients with Invasive Ductal Carcinoma and, therefore, influence the treatment decision making., Objective: The main objective was to evaluate the correlation between the apparent diffusion coefficient values obtained by diffusion-weighted imaging and the key prognostic factors in breast invasive ductal carcinoma. Secondary objectives were to analyze the eventual correlations between magnetic resonance imaging findings and prognostic factors in breast cancer; and to perform a comparison between results in 1.5 and 3.0 T scanners., Methods: Breast magnetic resonance imaging with diffusion-weighted imaging sequence was performed on 100 patients, who were proven histopathologically to have breast invasive ductal carcinoma. We compared the apparent diffusion coefficient values, obtained previous to biopsy, with the main prognostic factors in breast cancer: tumor size, histologic grade, hormonal receptors, Ki67 index, human epidermal growth factor receptor type 2, and axillary lymph node status. The Mann-Whitney U test and the Kruskal-Wallis analysis were used to establish these correlations., Results: The mean apparent diffusion coefficient value was inferior in the estrogen receptor-positive group than in the estrogen receptor-negative group (1.04 vs 1.17 × 10 -3  mm 2 /s, P  = .004). Higher histologic grade related to larger tumor size ( P  = .002). We found association between spiculated margins and positive axillary lymph node status [odds ratio = 4.35 (1.49-12.71)]. There were no differences in apparent diffusion coefficient measurements between 1.5 and 3.0 T magnetic resonance imaging scanners ( P  = .513)., Conclusions: Low apparent diffusion coefficient values are related with positive expression of estrogen receptor. Larger tumors and spiculated margins are associated to worse prognosis. Rim enhancement is more frequently observed in estrogen receptor-negative tumors. There are no differences in apparent diffusion coefficient measurements between different magnetic resonance imaging scanners., Competing Interests: The authors declare that they have no competing interests in this study. All authors read and approved the final manuscript., (Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of PBJ-Associação Porto Biomedical/Porto Biomedical Society. All rights reserved.)

Purpose To determine pregnancy rates after conventional and partial uterine fibroid embolization (UFE). Materials and Methods The study received institutional review board approval and all patients gave written informed consent. A retrospective analysis of data collected prospectively was performed between June 2004 and June 2014 in a cohort of 359 women (mean age, 35.9 years ± 4.8) with uterine fibroids and/or adenomyosis who were unable to conceive. The median follow-up period was 69 months (range, 6-126 months). Under local anesthesia, both uterine arteries were embolized. In 160 patients, partial embolization was intentionally performed to preserve fertility, which may be decreased after conventional UFE. In partial UFE, only the small arterial vessels to the fibroids were embolized, leaving the large vessels of the fibroids patent. The Kaplan-Meier method and Cox regression were used for the statistical analysis. Results During follow-up, 149 women became pregnant, 131 women had live births, and 16 women had several pregnancies, resulting in a total of 150 live newborns. It was the first pregnancy for 85.5% (112 of 131) of women. Spontaneous pregnancy rates at 1 year and 2 years after UFE were 29.5% and 40.1%, respectively. The probability of successful pregnancy with live birth at 1 year and 2 years was 24.4% and 36.7%, respectively. Clinical success for fibroid-related symptoms was 78.6% (282 of 359). A dominant submucosal fibroid and ischemia greater than or equal to 90% had greater likelihood of spontaneous pregnancy. Complication rates in patients treated with partial UFE (14.6%) were not greater than rates in patients treated with conventional UFE (23.1%, P = .04). Conclusion Conventional and partial UFE may be safe and effective outpatient procedures for women with uterine fibroids who want to conceive. © RSNA, 2017.

Purpose: To perform meta-analysis of available data on prostatic artery embolization (PAE)., Materials and Methods: Meta-analysis was conducted on articles published between November 2009 and December 2015. Peer-reviewed studies with > 5 patients and standard deviations and/or individual-level data on one or more of the following outcomes were included: prostate volume (PV), peak flow rate (Qmax), postvoid residual (PVR), International Prostate Symptom Score (IPSS), quality of life (QOL) score, International Index of Erectile Function (IIEF) score, and prostate-specific antigen (PSA) level. A random-effects meta-analysis was performed on the outcomes at 1, 3, 6, and 12 months after PAE compared with baseline values, with a P < .05 decision rule as the null hypothesis rejection criterion., Results: Nineteen of 268 studies were included in data collection, with 6 included in the meta-analysis. At 12 months, PV decreased by 31.31 cm 3 (P < .001), PSA remained unchanged (P = .248), PVR decreased by 85.54 mL (P < .001), Qmax increased by 5.39 mL/s (P < .001), IPSS improved by 20.39 points (P < .001), QOL score improved by -2.49 points (P < .001), and IIEF was unchanged (P = 1.0). There were a total of 218 adverse events (AEs) among 662 patients (32.93%), with 216 being Society of Interventional Radiology class A/B (99%). The most common complications were rectalgia/dysuria (n = 60; 9.0%) and acute urinary retention (n = 52; 7.8%). No class D/E complications were reported., Conclusions: PAE provided improvement in Qmax, PVR, IPSS, and QOL endpoints at 12 months, with a low incidence of serious AEs (0.3%), although minor AEs were common (32.93%). There was no adverse effect on erectile function., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To confirm that prostatic artery embolization (PAE) has a positive medium- and long-term effect in symptomatic benign prostatic hyperplasia (BPH)., Materials and Methods: Between March 2009 and October 2014, 630 consecutive patients with BPH and moderate-to-severe lower urinary tract symptoms refractory to medical therapy for at least 6 months or who refused any medical therapy underwent PAE. Outcome parameters were evaluated at baseline; 1, 3, and 6 months; every 6 months between 1 and 3 years; and yearly thereafter up to 6.5 years., Results: Mean patient age was 65.1 years ± 8.0 (range, 40-89 y). There were 12 (1.9%) technical failures. Bilateral PAE was performed in 572 (92.6%) patients and unilateral PAE was performed in 46 (7.4%) patients. The cumulative clinical success rates at medium- and long-term follow-up were 81.9% (95% confidence interval [CI], 78.3%-84.9%) and 76.3% (95% CI, 68.6%-82.4%). There was a statistically significant (P < .0001) change from baseline to last observed value in all clinical parameters: International Prostate Symptom Score (IPSS), quality-of-life (QOL), prostate volume, prostate-specific antigen, urinary maximal flow rate, postvoid residual, and International Index of Erectile Function. There were 2 major complications without sequelae., Conclusions: PAE had a positive effect on IPSS, QOL, and all objective outcomes in symptomatic BPH. The medium- (1-3 y) and long-term (> 3-6.5 y) clinical success rates were 81.9% and 76.3%, with no urinary incontinence or sexual dysfunction reported., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this article is to review the CT angiographic and digital subtraction angiographic features of the male pelvic arteries., Conclusion: An increasing number of vascular procedures are being performed in the male pelvis that require profound knowledge of the angiographic anatomy of the internal iliac artery (IIA). The major branches of the IIA in men can be used to classify the branching patterns. After the larger IIA branches are identified, identification of the smaller arteries or relevant anatomic variants becomes easier.

Objectives: To evaluate the short- and medium-term results of prostatic arterial embolisation (PAE) for benign prostatic hyperplasia (BPH)., Methods: This was a prospective non-randomised study including 255 patients diagnosed with BPH and moderate to severe lower urinary tract symptoms after failure of medical treatment for at least 6 months. The patients underwent PAE between March 2009 and April 2012. Technical success is when selective prostatic arterial embolisation is completed in at least one pelvic side. Clinical success was defined as improving symptoms and quality of life. Evaluation was performed before PAE and at 1, 3, 6 and every 6 months thereafter with the International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), uroflowmetry, prostatic specific antigen (PSA) and volume. Non-spherical polyvinyl alcohol particles were used., Results: PAE was technically successful in 250 patients (97.9 %). Mean follow-up, in 238 patients, was 10 months (range 1-36). Cumulative rates of clinical success were 81.9 %, 80.7 %, 77.9 %, 75.2 %, 72.0 %, 72.0 %, 72.0 % and 72.0 % at 1, 3, 6, 12, 18, 24, 30 and 36 months, respectively. There was one major complication., Conclusions: PAE is a procedure with good results for BPH patients with moderate to severe LUTS after failure of medical therapy., Key Points: • Prostatic artery embolisation offers minimally invasive therapy for benign prostatic hyperplasia. • Prostatic artery embolisation is a challenging procedure because of vascular anatomical variations. • PAE is a promising new technique that has shown good results.

This work aimed to study the prevalence and radiologic anatomy of the middle rectal artery (MRA) using computed tomographic angiography (CTA) and digital subtraction angiography (DSA). The retrospective study (October 2010-February 2012) focused in 167 male patients with prostate enlargement (mean age 64.7 years, range 47-81 years) who underwent selective pelvic arterial embolization for the relief of lower urinary tract symptoms. All patients underwent CTA previously to DSA to evaluate the vascular anatomy of the pelvis and to plan the treatment. MRAs were identified and classified according to their origin, trajectory, termination and relationship with surrounding arteries. We found MRAs in 60 (35.9 %) patients (23.9 % of pelvic sides, n = 80) and of those, 20 (12 %) had bilateral MRAs; 24 MRAs (30 %) were independent of neighbouring arteries and 56 MRAs (70 %) had common origins with prostatic arteries (prostato-rectal trunk). The most frequent MRA origin was the internal pudendal artery (60 %, n = 48), followed by the inferior gluteal artery (21.3 %, n = 17) and common gluteal-pudendal trunk (16.2 %, n = 13). In 2 patients the MRA originated from the obturator artery (2.5 %). Anastomoses to the superior rectal and inferior mesenteric arteries were found in 87.5 % of cases (n = 70). We concluded that MRAs are anatomical variants present in less than half of male patients; have variable origins and frequently share common origins with prostatic arteries. Their correct identification is likely to contribute to improve interventional radiology procedures and prostatic or rectal surgeries.

Purpose: To describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH)., Materials and Methods: In a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries., Results: A total of 57% of pelvic sides (n = 86) had only one PA, and 43% (n = 64) had two independent PAs identified (mean PA diameter, 1.6 mm ± 0.3). PAs originated from the internal pudendal artery in 34.1% of pelvic sides (n = 73), from a common trunk with the superior vesical artery in 20.1% (n = 43), from the anterior common gluteal-pudendal trunk in 17.8% (n = 38), from the obturator artery in 12.6% (n = 27), and from a common trunk with rectal branches in 8.4% (n = 18). In 57% of pelvic sides (n = 86), anastomoses to adjacent arteries were documented. There were 30 pelvic sides (20%) with accessory pudendal arteries in close relationship with the PAs. No correlations were found between PA diameter and patient age, prostate volume, or prostate-specific antigen values on multivariate analysis with logistic regression., Conclusions: PAs have highly variable origins between the left and right sides and between patients, and most frequently arise from the internal pudendal artery., (Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the outcome of pregnancy after uterine fibroid embolization (UFE)., Design: Retrospective study., Setting: Private hospital affiliated with a university., Patient(s): In a single center, UFE was performed in 74 patients who wanted to become pregnant., Intervention(s): Polyvinyl alcohol particles (PVA) or embozene microspheres were used to embolize the uterine arteries. Enhanced pelvic magnetic resonance was performed before UFE and 6 months after UFE in all patients., Main Outcome Measure(s): The number of pregnancies and their development., Result(s): Of the 74 women who wanted to become pregnant, 44 of them became pregnant (59.5%). There are five (11.3%) ongoing pregnancies and 39 (88.7%) finished pregnancies, with 33 successful live births (84.6%), four spontaneous abortions (10.3%), one induced abortion, and one stillbirth. There were 22 cesarean deliveries (66.6%), two preterm deliveries at 36 weeks (6.1%), and five low birth weights., Conclusion(s): Pregnancy after UFE appears to be safe., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to establish the imaging findings of the main branching patterns of the male internal iliac arteries, using different imaging modalities (angio MR, angio CT and digital angiography). Twenty-one males (mean age 73.2 years) underwent imaging evaluation with angio MR, angio CT and digital angiography to define the internal iliac artery anatomy before selective embolization of the pelvic arteries. All three modalities were used in 3 patients, angio MR and digital angiography in 17 patients, angio CT and digital angiography in 6 patients and only angio CT in 1 patient. Internal iliac arteries were classified into four groups using the Yamaki classification (modified from the Adachi's classification). Twenty-six pelvic sides were classified as Group A (61.9%), 13 as Group B (31%) and 3 as Group C (7.1%) with no cases of Group D found. Angio MR, angio CT and digital angiography were able to detect most branches of the internal iliac artery. Group A was the most frequent internal iliac artery branching pattern. Angio CT showed better detailed anatomy than angio MR and digital angiography was considered the gold-standard. Non-invasive vascular imaging with angio MR or angio CT is essential before invasive interventions, allowing better planning of the procedure.

Purpose: To evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH)., Materials and Methods: Fifteen patients (age range, 62-82 years; mean age, 74.1 y) with symptomatic BPH after failure of medical treatment were selected for PAE with nonspherical 200-μm polyvinyl alcohol particles. The procedure was performed by a single femoral approach. Technical success was considered when selective prostatic arterial catheterization and embolization was achieved on at least one pelvic side., Results: PAE was technically successful in 14 of the 15 patients (93.3%). There was a mean follow-up of 7.9 months (range, 3-12 months). International Prostate Symptom Score decreased a mean of 6.5 points (P = .005), quality of life improved 1.14 points (P = .065), International Index of Erectile Function increased 1.7 points (P = .063), and peak urinary flow increased 3.85 mL/sec (P = .015). There was a mean prostate-specific antigen reduction of 2.27 ng/mL (P = .072) and a mean prostate volume decrease of 26.5 mL (P = .0001) by ultrasound and 28.9 mL (P = .008) by magnetic resonance imaging. There was one major complication (a 1.5-cm(2) ischemic area of the bladder wall) and four clinical failures (28.6%)., Conclusions: In this small group of patients, PAE was a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, associated with a reduction in prostate volume., (Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of uterine artery embolization (UAE)., Materials and Methods: This randomized prospective study comprised 160 patients with symptomatic leiomyomas undergoing UAE with PVA particles from January to August 2008. In 80 patients in group A, UAE was started with 350-500 μm particles; in 80 patients in group B, UAE was started with 500-700 μm particles. UAE was finished with larger particles when necessary (500-700 μm and 700-900 μm for group A; 700-900 μm for group B). Visual analogue scales were used to measure pain during and in the 4-8 hours after embolization. The outcome of UAE was evaluated at 6 months by pelvic magnetic resonance (MR) imaging, clinical observation, and response to questionnaires., Results: In group A, PVA particle sizes were as follows: 350-500 μm in 45 patients; 350-500 μm and 500-700 μm in 24 patients; and 350-500 μm, 500-700 μm, and 700-900 μm in 11 patients. In group B, PVA particle sizes were as follows: 500-700 μm in 66 patients and 500-700 μm and 700-900 μm in 14 patients. Mean pain scores during embolization were 1.44 (group A) and 0.97 (group B); after embolization, mean pain scores were 4.71 (group A) and 3.42 (group B) (P < .0001). At 6 months, there were no statistically significant differences in decrease in size of uterus and dominant leiomyoma, in dominant leiomyoma ischemia (P = .31; P = .32), or in the clinical outcome between the two groups., Conclusions: The initial use of PVA particle sizes 350-500 μm was associated with a higher mean pain score during and after UAE, although the outcome at 6 months was similar compared with the initial use of particle sizes 500-700 μm., (Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.)

Uterine artery embolization (UAE) is usually a very painful procedure. Although pain after the procedure can occur as a single symptom, it usually is associated with other symptoms such as nausea, vomiting, pelvic pain, general malaise, fever and leukocytosis that characterize the post-embolization syndrome. Management of the post-embolization symptoms and of pain in particular, is paramount if UAE is to be performed as an outpatient procedure. Different protocols have used analgesic and/or anti-inflammatory agents to control these symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in association with analgesic drugs to control post-embolization symptoms. In our institution the patients start oral medication with NSAIDs the day before the procedure and continue it during and after UAE. We also mix NSAIDs with the embolizing particles. This enables a reduction in the inflammation present in the uterine fibroids and helps controlling the pain. The purpose of this paper is to review the importance of NSAIDs in the management of the post-embolization symptoms. We describe the protocol that we use in our institution that enables us to perform the procedure on an outpatient basis with same day discharge and good control of the post-embolization symptoms with oral NSAIDs and analgesics.

Purpose: To evaluate whether electroacupuncture is a safe and effective alternative to pharmacologic sedation/analgesia in uterine artery embolization (UAE) for leiomyomas., Materials and Methods: A nonrandomized prospective study was undertaken in 70 consecutive patients (mean age, 39.5 years) undergoing UAE with polyvinyl alcohol (PVA) particles between August 2006 and January 2007. Thirty-three patients chose to undergo UAE under electroacupuncture anesthesia (EAA; group A) and 37 were treated under local pharmacologic anesthesia (group B). Pain scores (rated from 0 to 10) in both groups were compared during and after the procedure. The outcome of UAE was evaluated at 6 months., Results: Mean pain scores during embolization were 0.36 in group A and 0.84 in group B; scores after embolization and before discharge were 3.00 in group A and 4.49 in group B; and scores at discharge were 0.97 in group A and 2.11 in group B. These differences were statistically significant after embolization and at hospital discharge (P= .02 and P= .0001, respectively). All patients except one in each group were discharged from the hospital 4-8 hours after UAE; the two who remained longer had severe pain. There were no significant differences in clinical outcomes, nor in uterine and leiomyoma volumes, at discharge and at 6 months (P > 0.99 and P= .72, respectively)., Conclusions: There was a statistically significant postembolization pain reduction in patients treated under EAA versus local pharmacologic anesthesia and no differences in UAE outcomes between groups at 6 months.

Purpose: To evaluate whether it is safe to perform uterine artery embolization (UAE) as an outpatient procedure., Materials and Methods: This retrospective study was approved by the institutional review board and included 234 patients (age range, 24-58 years; mean age, 40.5 years) who underwent UAE as an outpatient procedure with polyvinyl alcohol particles between January 2007 and March 2008. Patients were given acid-suppressing drugs, nonsteroidal anti-inflammatory drugs, anti-histaminic drugs, and laxatives twice on the day before UAE and once on the morning of UAE. Pain score, rated from 0 to 10, was evaluated by using a numeric pain scale during UAE, after the procedure, at discharge, at the night of discharge, and on the following morning. The outcome of UAE was evaluated at 6 months by means of pelvic magnetic resonance imaging and clinical observation., Results: The mean pain score was 0.9 during embolization, 2.5 4-8 hours after embolization, 0.9 at discharge, 1.1 the first night after discharge, and 0.7 the next morning. All patients were discharged from the hospital 4-8 hours after the procedure, with no overnight hospital admissions. At 6 months, 146 of 158 patients (92.4%) reported an improvement in menorrhagia, 39 of 44 (88.6%) reported an improvement in bulk symptoms, and 20 of 25 (80%) reported an improvement in pain. The volumes of the uterus and the dominant fibroid decreased 33.7% and 39.3%, respectively., Conclusions: With acid-suppressing, anti-inflammatory, and anti-histaminic drugs started on the day before UAE, the procedure can be performed safely as an outpatient procedure.

Purpose: To evaluate whether pelvic pain following uterine artery embolization (UAE) can be decreased by using ketoprofen mixed with polyvinyl alcohol (PVA)., Materials and Methods: A randomized prospective study was performed in 80 patients (age range, 25-52 years; mean age, 41 years) undergoing UAE with PVA between March and August 2006. Forty patients received PVA particles mixed with ketoprofen, and 40 received bland PVA particles. Fifty-three patients who were asymptomatic 8 hours after embolization were discharged. Pain scores were compared during the first 8 hours after the procedure, at discharge, and the following day. The results were evaluated after 6 months., Results: Eight hours after UAE, 13 of the 40 patients in the group without ketoprofen (32%) reported severe or very severe pain, whereas none of the patients in the group receiving ketoprofen reported severe or very severe pain, as determined with a numeric pain score scale (P = .0015). Nineteen of the 40 patients without ketoprofen (48%) were treated as inpatients, but only 10 in the ketoprofen group (25%) were treated as inpatients. The differences in the clinical outcome, as well in the uterus and fibroid sizes at discharge and at 6 months, were not statistically significant (P > .05)., Conclusions: The use of PVA particles mixed with ketoprofen resulted in a statistically significant reduction in pelvic pain during the first 8 hours after UAE as compared to the use of PVA alone. However, no significant differences in pain scores were seen after 8 hours. These findings may lead to a reduction in inpatient management for UAE; however, further study of this approach is warranted.

Pulmonary Embolism is often considered a difficult diagnosis to establish. It is important to recognise clinical situations that leads to it. There are a few laboratory and imaging tests, that should be tailored to the available facilities in each institution.

The female varicocile is associated to the pelvic congestion syndrome that is described. Five patients 31 to 52 years old are presented. Four of them have continuous pelvic pain and the fifth had huge vaginal and vulvar varices. Flebography of the left ovarian vein showed retrograde flux of the dilated vein. Sclerotherapy with Aethoxysklerol 3% was performed. There was an immediate relief of symptoms. During the follow up period between 9 and 12 months the five patients were asymptomatic. There are publications of embolization of the ovarian vein, however the present cases are the first ones in which the selective Sclerotherapy was the only treatment used with good results.

The endovascular treatment (percutaneous transluminal angioplasty and stent placement) is an option to surgical treatment in patients with abdominal angor, with good results by a less invasive way. A case of a patient with superior mesenteric artery occlusion and severe stenosis of celiac axis is presented that was treated by endovascular treatment and stenting, with resolution of the abdominal angor.

The authors report a case of an aneurysm of the common iliac artery of atherosclerotic etiology, treated by percutaneous endoluminal stent-graft placement. They describe the technique and review the medical literature.

Stents were placed in the renal artery in 6 patients, with renal artery stenosis and hypertension, 2 of them had azotemia. The indications were residual stenosis greater than 30% (4 cases) and restenosis following angioplasty (2 cases). The technique and results are described. Cure or improvement of arterial hypertension was obtained in 5 patients and normalization of creatinine in 2 patients with azotemia. We conclude that stent placement improve the immediate and late results of renal angioplasty.

A case of complicated renal angiomyolipoma with tumoral bleeding in a 44-year-old woman is presented. The contribution of angiography to the diagnosis helped clarify the degree of vascularity, and the contribution of embolization treatment (safe and well tolerated) is discussed.

We present six cases of superior vena cava syndrome caused by a malignant tumor that were treated by percutaneous endoprostheses. The technique is described and the results evaluated. In one case there was acute thrombosis of the endoprosthesis that was treated by urokinase. No other complications were observed. A patient died one month later due to progression of the tumor. The remaining cases were asymptomatic for longer than 6 months. It was concluded that endoprostheses for superior vena cava syndrome are efficient, with quick improvement of the symptomatology.

The thoracic outlet syndrome is a changeable clinical syndrome caused by compression of the neurovascular bundle of the upper extremity, within the cervicoaxillary channel. From April 1980 through May 1995, 24 patients with clinical thoracic outlet syndrome were evaluated by selective arteriography. The diagnosis was confirmed in seven patients, in 14 the exam was normal and in the last three cases another arterial pathology was detected--subclavian artery occlusion, subclavian artery kinking and vertebral steal syndrome. The authors' aim is to emphasize arteriography as a diagnostic exam for thoracic outlet syndrome, very useful in the detection and localization of arterial compression. It also allows the diagnosis of other arterial entities.

After a brief reference to the most important pioneers of angiography, the author describes the techniques performed, lesions treated and future perspectives. The following techniques are performed: embolizations, selective infusion of drugs, placement of inferior vena cava filter, removal of intra-vascular bodies, revascularisation techniques and porta-cava shunt. Reference was made to the following lesions treated: tumours, hemorrhages, arteriovenous malformations, hypersplenism, pulmonary embolism, varicocele, ischemic lesions and portal hypertension.

A case of hemangiopericytoma located in the left upper thigh is presented. The literature is reviewed, particularly the clinical aspects and reference is made to arteriography and preoperative embolization.

Purpose: To investigate the effects of percutaneous transluminal angioplasty on the vasa vasorum in dogs with experimentally created abdominal aortic stenoses., Materials and Methods: Two stenoses were created in the abdominal aorta in each of 21 dogs. After 6 weeks, the more cephalic stenosis was dilated; the other stenosis served as an untreated control. Groups of three dogs were killed at 24 hours, 3 and 6 weeks, and 4, 8, 12, and 18 months after angioplasty. The aortae were studied by means of histologic examination, microangiography, scanning electron microscopy, and the Spalteholz technique., Results: At nondilated stenoses, the vasa vasorum was interrupted in the outer adventitia and unchanged in the outer media. At dilated stenoses, the number of precapillary arterioles in the outer media progressively increased up to 8 months; thereafter, the number of precapillary arterioles began to decrease. At 18 months, the number was normal., Conclusion: Angioplasty brings about changes in the number of precapillary arterioles in the outer media of the aorta in our canine model of focal abdominal aortic stenosis.

The case of a 66-year-old woman with several episodes of hemorrhage by esophageal varices and ascites due to portal hypertension is presented. Despite 4 sessions of endoscopic sclerotherapy bleeding recurred. A transjugular intrahepatic portosystemic shunt was performed. In the 10 months following the intervention, there was no further hemorrhage, the ascites disappeared and the shunt is open.

Purpose: Experimental stenoses were created in canine aortae to compare the effects of stent placement and balloon angioplasty on the vasa vasorum., Materials and Methods: A balloon-expandable Palmaz stent was placed in the proximal stenosis, and angioplasty was performed in the distal stenosis in each of eight dogs. Two dogs were killed at 4, 8, 12, and 18 months, respectively. Specimens were studied by means of microangiography, histology, scanning electronic microscopy, and Spalteholz technique., Results: At up to 12 months, there was proliferation of the vasa vasorum and a rich plexus formed in each of the animals at each treated site. More vasa vasorum were seen after stent placement than after angioplasty. The new vessels were mainly venules located in the media. At 18 months, there was regression of the venules and the vasa vasorum distribution returned to baseline., Conclusion: The authors conclude that the effects of stents on the vasa vasorum are temporary.

Pulmonary embolism is a serious and difficult problem. Many approaches for the prevention of recurrent pulmonary embolism have been tried. Percutaneous placement of inferior vena cava filters is an easy, safe, available and well established procedure for the prevention of pulmonary embolism. The authors review the indications for use of IVC filters, and they review the main filters available in terms of ease of use, the physical characteristics, the technique of introduction, the efficacy and morbidity, and the potential complications associated with their use. Insertion of IVC filters by percutaneous approach was successfully performed in 6 patients with recurrent pulmonary embolism. Following the intervention procedure without complication there were no further pulmonary emboli.

Percutaneous sclerotherapy of varicocele was considered in 21 patients with left sided varicocele, 16 of whom had recurrences after left spermatic vein ligation in the past. Percutaneous sclerotherapy was possible in 17 patients (80.9%). There were no serious complications with venography or sclerotherapy, and the recurrence rate was 17.6%. Percutaneous sclerotherapy is therefore a simple, safe and effective treatment of testicular vein insufficiency.

Percutaneous splenectomy was performed in 6 patients with hypersplenism. Peripheral blood cell counts improved in 5 of the patients. The authors review the indications, technique and complications of percutaneous splenic embolization. It is concluded that medical splenectomy is an effective method particularly to alleviate symptoms of hypersplenism.