Cervical ectopic pregnancy is associated with high risk for massive bleeding conditions. Cervical ectopic pregnancy can usually be treated by methotrexate injection or surgery. We present 4 cases of cervical ectopic pregnancy that were treated successfully with different uterine-conserving methods. By comparing our experience of 4 cases managed in different ways, we found that laparoscopic uterine artery occlusion before cervical curettage is more effective method for preventing massive bleeding.
Curettage* ; Female ; Hemorrhage* ; Hemostatic Techniques ; Laparoscopy ; Methotrexate ; Pregnancy ; Pregnancy, Ectopic* ; Therapeutic Occlusion ; Uterine Artery Embolization ; Uterine Artery*

Duodenal variceal bleeding in patients with portal hypertension due to cirrhosis or other causes is uncommon. We report on a case of a 55-year-old male with an ectopic variceal rupture at the distal fourth part of the duodenum who presented with massive hematochezia and shock. Shortly after achievement of hemodynamic stability, due to the limitation of an endoscopic procedure, we initially attempted to find the bleeding focus by abdominal computed tomography, which showed tortuous duodenal varices that drained into the left gonadal vein. He was treated with first-line balloon-occluded retrograde transvenous obliteration (BRTO), resulting in a favorable long-term outcome without rebleeding three years later. This case suggests that BRTO may be a first-line therapeutic option for control of ruptured duodenal varices, especially at a distal location.
Balloon Occlusion ; Duodenal Diseases/*diagnosis/radiography/therapy ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/therapy ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

Transjugular intrahepatic portosystemic shunts (TIPS) are widely used in the management of bleeding gastric varices (GV). More recently, several studies have demonstrated balloon-occluded retrograde transvenous obliteration (BRTO) as an effective treatment method for bleeding isolated GV, especially in patients with contraindications for a TIPS placement. Both TIPS and BRTO can effectively treat bleeding GV with low rebleeding rates. Careful patient selection for TIPS and BRTO procedures is required to best treat the patient's individual clinical situation.
Balloon Occlusion ; Embolization, Therapeutic ; Esophageal and Gastric Varices* ; Hemorrhage ; Humans ; Methods ; Patient Selection ; Portasystemic Shunt, Surgical* ; Portasystemic Shunt, Transjugular Intrahepatic

Angiography ; Balloon Occlusion ; Embolization, Therapeutic ; Fractures, Bone ; surgery ; Hemostasis, Surgical ; methods ; Humans ; Iliac Artery ; surgery ; Ligation ; Pelvic Bones ; injuries

Gross hematuria secondary to vesical varices is an unusual presentation. We report such a case recurrent gross hematuria in a male patient who had a history of bladder substitution with ileal segments that had been treated by balloon-occluded percutaneous transhepatic obliteration of vesical varices.
Balloon Occlusion/*adverse effects ; Contrast Media/diagnostic use ; Embolization, Therapeutic/*methods ; Hematuria/*etiology ; Humans ; Male ; Middle Aged ; Phlebography ; Recurrence ; Tomography, X-Ray Computed ; Varicose Veins/*complications/*therapy

PURPOSE: To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. MATERIALS AND METHODS: From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. RESULTS: All technical and clinical success-i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control-was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12-32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. CONCLUSION: Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding.
Aged ; Ascites/complications ; Balloon Occlusion ; Embolization, Therapeutic ; *Emergency Medical Services ; Esophageal and Gastric Varices/*complications ; Feasibility Studies ; Female ; Gastrointestinal Hemorrhage/*complications/*therapy ; Humans ; Male ; Middle Aged

OBJECTIVETo retrospectively analyze 95 cases of traumatic carotid cavernous fistula treated by endovascular embolization.

METHODSFrom January 1994 to December 2008, 95 patients with traumatic carotid cavernous fistula were treated in our hospital. All patients received selective cerebral angiography through femoral artery catheterization. Accordingly, 89 cases were treated by detachable balloon embolization, 5 by platinum microcoils and 1 by covered-stent, respectively.

RESULTSIn the study, 61 cases achieved successful balloon embolization at the first time. Fifty-six cases had multiple balloons due to the big fistula. Nine cases received balloon embolization twice. But among the 5 patients treated with platinum microcoils, one developed slight brainstem ischemia. After operation the patient had hemiparesis and swallow difficulty, but gradually recovered 3 months later. No neurological deficits were observed in other cases. All the cases recovered. Eighty-five cases were followed up for 1-15 years and no recurrence was found.

CONCLUSIONSThe endovascular embolization for traumatic carotid cavernous fistula is minimally invasive, safe, effective and reliable. The detachable balloon embolization is the first choice in the treatment of TCCF.

Adolescent ; Adult ; Aged ; Balloon Occlusion ; methods ; Carotid-Cavernous Sinus Fistula ; diagnosis ; therapy ; Child ; Embolization, Therapeutic ; methods ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents

The most common complication of coil embolization for cerebral aneurysms is thrombo-embolic stroke; in rare cases, these strokes, can present with central retinal artery occlusion. At our institution, a 53-year-old woman underwent stent-assisted coiling of the aneurysm. The patient's vision was improved immediately after intra-arterial thrombolysis and had further improved 8 months later. This report describes our experience of a rare case of central retinal artery occlusion after coil embolization that was successfully treated by intra-arterial thrombolysis.
Aneurysm* ; Embolization, Therapeutic* ; Female ; Humans ; Intracranial Aneurysm ; Middle Aged ; Retinal Artery Occlusion* ; Retinal Artery* ; Stroke

Ruptured vertebral artery- dissecting aneurysms (VADAs) must be treated as early as possible due to frequent rebleeding in the early stage. We have reported herein two patients with VADAs who were treated using internal trapping using detachable coils. Both patients were young females in their 40's. They had been admitted to the emergency clinic due to severe headaches and mental deterioration. Brain computed tomography (CT) scans revealed a subarachnoid hemorrhages in the posterior fossa, and transfemoral catheter cerebral angiography revealed dissecting aneurysms at the dominant vertebral arteries. Under general anesthesia, embolization of the parent artery, including the aneurysmal portion, using Guglielmi detachable coils was performed without any procedural complications. Before the induction of general anesthesia, a balloon test occlusion was done on both patients. Both patients improved well after surgery. One patient underwent cerebral angiography at six months after surgery and showed no recurrence of the aneurysm or recanalization of the parent artery. Both patients were free of neurologic findings on follow-up at the 6- and 12- month. Based on these results, patients with ruptured VADAs, located in the dominant vertebral arteries, may be successfully treated with urgent internal trapping using an endovascular technique in selected cases.
Anesthesia, General ; Aneurysm ; Aneurysm, Dissecting ; Arteries ; Balloon Occlusion ; Brain ; Catheters ; Cerebral Angiography ; Embolization, Therapeutic ; Emergencies ; Endovascular Procedures ; Female ; Follow-Up Studies ; Headache ; Humans ; Neurologic Manifestations ; Parents ; Recurrence ; Subarachnoid Hemorrhage ; Vertebral Artery

OBJECTIVE: To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. MATERIALS AND METHODS: From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. RESULTS: Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. CONCLUSION: PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.
Aged ; Balloon Occlusion ; Embolization, Therapeutic ; Endoscopy, Digestive System ; Esophageal and Gastric Varices/complications/radiography/*therapy ; Female ; Gastrointestinal Hemorrhage/therapy ; Gelatin Sponge, Absorbable/chemistry ; Humans ; Hypertension, Portal/complications ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed