Operative ligation of portosystemic shunts is effective in controlling chronic portosystemic encephalopathy (CPSE) but is associated with significant mortality. Review of the records of five patients with CPSE treated with radiologic occlusion procedures showed that these are suitable alternatives to surgery. Three patients had alcoholic cirrhosis, one had hepatic fibrosis from schistosomiasis, and one had post-necrotic cirrhosis. All had CPSE with progressive, severe cerebral impairment refractory to clinical treatment. Four patients had a spontaneous splenorenal shunt, and one had a surgically created mesocaval shunt (MCS). Partial splenic embolization was performed in two patients, direct shunt embolization was performed via percutaneous transhepatic portography in two other patients, and an MCS embolization was performed in one patient through the inferior vena cava. In four patients embolization controlled the CPSE. In the remaining patient it could not be evaluated because of his premature death from intraabdominal bleeding, a late complication of the procedure. Interventional radiologic procedures are effective in the control of CPSE in selected patients.
Eight patients with life-threatening hemobilia were treated by percutaneous transcatheter occlusive therapy. The bleeding was caused by a traumatic pseudoaneurysm of the hepatic artery in 6 cases (auto accident in 4, surgery in 1, biliary drainage in 1) and a true aneurysm of the hepatic artery in 2 (unknown etiology in 1 and mycotic in 1). Arterial catheterization was used in all cases except for one in which a direct percutaneous puncture was performed. Gelfoam alone was used as embolic material in 3 patients. In 1 patient each, the material used was gelfoam plus coils, coils alone, blood clot, n-butyl-cyanoacrylate and an occluding balloon catheter. In all cases the bleeding stopped and did not recur during the follow-up period which ranged from 9 months to 14 years. This experience indicates that transcatheter occlusive therapy is an effective method for the treatment of severe hemobilia.
Intraarterial injection of Lipiodol has been recommended to differentiate hepatocellular carcinoma from benign lesions such as cavernous hemangioma, because uptake and prolonged retention of the contrast medium is a characteristic of the malignant tumors. In two cases of cavernous hemangioma of the liver in which we injected Lipiodol, uptake and retention up to 3 months was demonstrated. We conclude that the intraarterial injection of Lipiodol may not be reliable in differentiating hepatocellular carcinoma from cavernous hemangioma of the liver.
Embolization therapy is reported in 2 patients who had vascular complications following percutaneous subclavian vein catheterization. One had an arteriovenous fistula between the right internal mammary artery (IMA) and the brachiocephalic vein. The other patient presented with a pseudo-aneurysm of the IMA with life-threatening hemorrhage and a large thoracic hematoma. A detachable latex balloon was used for occlusion of the arteriovenous fistula in the first patient and a steel spring coil was used to embolize the IMA and the pseudo-aneurysm in the second patient. The lesions were successfully treated on follow-up of 30 months for the first patient and 37 months for the other.
RESUMO -Objetivo: Descrever a técnica de proteção cerebral usada na angioplastia com colocação de "stent" para tratamento de lesões estenóticas da bifurcação carotídea, mostrando sua eficiência em evitar a embolia durante o procedimento. Métodos: Quarenta e dois pacientes (47 artérias) foram tratados com a técnica de proteção cerebral que consistiu na oclusão temporária da carótida interna acima da estenose, fazendo-se aspiração e injeção de solução de glicose a 5% na carótida interna após a colocação de "stent" e angioplastia, para remover eventuais fragmentos da placa. Resultados: A angioplastia foi eficiente em todos os casos. Não ocorreu embolia nos pacientes deste estudo nos quais se utilizou a técnica de proteção cerebral na sua versão completa. Embolia ocorreu em um paciente, durante pré-dilatação da estenose, antes de se usar a técnica de proteção cerebral. Conclusão: A técnica de proteção cerebral foi eficiente em evitar a embolia nos procedimentos realizados. Esses dados concordam com os da literatura e o uso desta técnica amplia as indicações da angioplastia carotídea.PALAVRAS-CHAVE: carótida, estenose, doença ateromatosa, angioplastia, "stent", proteção cerebral, embolia cerebral, acidente vascular cerebral.The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against cerebral embolism cerebral embolism cerebral embolism cerebral embolism cerebral embolism ABSTRACT -Objective: To describe the cerebral protection technique used in the angioplasty and stenting to treat stenotic lesions of carotid artery bifurcation, showing its efficiency in avoiding cerebral emboli during the procedure. Method: Forty two patients (47 arteries) were treated with the cerebral protection technique, which consists in the temporary occlusion of the internal carotid artery, above the stenotic lesion, performing the aspiration and flushing of glucose solution into the internal carotid artery after the delivery of the stent and the angioplasty, to remove any atherosclerotic plaque's fragments. Results: The angioplasty was efficient in all cases. There were no cerebral emboli in the patients in whom the complete cerebral protection technique was used, showing its efficiency . Distal embolism occurred in one patient, during pre angioplasty and before the use of cerebral protection. Conclusion: The cerebral protection technique was efficient to avoid cerebral emboli in the procedures performed. This data is in agreement with the literature and the use of this technique increases the indications of carotid angioplasty.KEY WORDS: carotid, stenoses, atherosclerotic disease...
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