Search Results (73)

Background/Objectives: This study aims to identify baseline imaging parameters, across various imaging modalities, that can predict the response to bleomycin sclerotherapy in patients with head and neck lymphatic–venous malformations (LVMs). Methods: A retrospective analysis of 80 patients (85 lesions) treated at a tertiary care center between January 2018 and December 2022 was conducted. Imaging modalities, including CT, MRI, ultrasonography, and dynamic digital radiographic images, were reviewed for lesion characteristics. Factors including lesion type, volume, morphology, location, and contrast opacification patterns were analyzed for their association with treatment response, defined as a >50% reduction in lesion size and symptom improvement. Univariable and multivariable logistic regression analyses were performed. Results: Of 85 lesions, 45 (52.9%) responded to treatment. Univariable analysis showed that pure lymphatic malformations (OR = 6.12, p = 0.004), macrocystic components (OR = 10, p = 0.016), cavitary morphology on dynamic digital radiographic images (OR = 8.90, p < 0.001), neck location (OR = 4, p = 0.03), and deep-seated lesions (OR = 3.69, p = 0.03) were significantly associated with better outcomes. Multivariable analysis identified cavitary morphology as the strongest predictor (p = 0.04). A combination of cavitary morphology, macrocystic components, and pure LM type yielded the highest predictive accuracy (AUC = 0.80, p = 0.03). Conclusions: The presence of lymphatic channels or large cystic venous spaces—such as macrocystic features on imaging or cavitary morphology—along with neck or deep-seated lesion location, predicts a favorable response to bleomycin sclerotherapy in head and neck LVMs. Full article

Current therapeutic approaches for prostatic cysts and abscesses involve surgical methods like reduction and omentalization. This retrospective study evaluates the effectiveness and safety of ultrasound-guided percutaneous drainage combined with alcoholization as a minimally invasive treatment for prostatic cysts and abscesses in dogs. Forty-three male dogs with a single prostatic cavity (1–6 cm) were enrolled and categorized into two groups: group A (twenty-two dogs with prostatic abscesses treated via alcoholization) and group B (twenty-one dogs with BPH-associated cysts). Group B was further subdivided into three subgroups: B1 (finasteride only), B2 (alcoholization only), and B3 (combined finasteride and alcoholization). Alcoholization involved sedation, drainage of the cavity, and two ethanol instillations (first: 1/3–1/4 of aspirated volume; second: 1/10 after 25 min). Ultrasound evaluations were performed at scheduled intervals of up to 150 days. In group A, 76.19% of abscesses were resolved within 30 days, with complete resolution in all dogs by day 150. In group B, the combined treatment (group B3) showed superior outcomes, with significant cyst diameter reduction observed in all dogs within 30 days and complete resolution in 62.5% by day 150. These findings support alcoholization as an effective, low-complication alternative to surgery for selected prostatic lesions in dogs. Full article

Background: Treating varicosities originating from a popliteal fossa perforating vein (PFPV) is challenging due to their proximity to nerves and complex morphology. Data on endovenous laser ablation (EVLA) for PFPV varicosis are limited. Methods: This retrospective, single-center study reviewed all primary varicose vein surgeries from May 2021 to December 2024. Only primary PFPV varicosis cases with CEAP stage C2s or higher were included. Patients with recurrent disease or primary truncal insufficiency due to reflux from the saphenopopliteal junction were excluded. EVLA was performed using 1470 nm radial laser catheters, targeting the reflux source and downstream varicose segments. Tumescent solution was applied to protect the surrounding structures. The primary outcome was early technical success via duplex ultrasound; the secondary outcome was the complication rate. Results: Of the 2375 limbs treated, 44 (1.9%) involved PFPV. The cohort included 16 men (36%) and 28 women (64%), with a mean age of 54. The median follow-up was 14 days. Technical success was achieved in 41 cases (93.2%). Foam sclerotherapy with polidocanol was performed in eight patients (18.2%), exclusively for superficial residual varicosities and never simultaneously with EVLA. Three treatment failures required re-operation, two of which were successfully re-treated. Minor postoperative complications occurred in two patients (4.5%). No nerve injuries or thrombotic events were observed. Conclusions: EVLA shows promising very early technical efficacy, with low morbidity, for treating PFPV varicosis. Based on our findings, prospective studies investigating the mid- and long-term outcomes of this technique are warranted to further validate its clinical utility. Full article

Background/Objectives: Bleomycin electrosclerotherapy (BEST), which combines intralesional bleomycin administration with electroporation, enhances drug uptake and has shown efficacy in treating vascular malformations resistant to conventional therapies. While BEST is increasingly used in various anatomical sites, its application in the upper aerodigestive tract remains underexplored. This study evaluates the safety and effectiveness of BEST in managing slow-flow vascular malformations of the oral cavity, tongue, larynx, and hypopharynx. Methods: In this retrospective, multicenter study, 20 patients with symptomatic slow-flow vascular malformations of the upper aerodigestive tract were treated with BEST. Clinical and radiological assessments were used to evaluate the treatment response, categorized as “significantly reduced”, “reduced”, “stable disease”, or “lesion growth”. Postprocedural complications and functional outcomes were systematically recorded. Results: A total of 29 BEST sessions were performed. Lesions of the tongue (n = 8) and combined oral cavity and tongue (n = 6) showed the highest response rates, with significant symptom reduction in five out of eight and five out of six patients, respectively. Among isolated oral cavity lesions (n = 4), one out of four demonstrated a significant reduction. In contrast, laryngeal and hypopharyngeal lesions (n = 2) had limited response, with one case showing partial reduction and the other remaining stable. Severe complications, including bleeding and dyspnea requiring tracheostomy, limited further treatment in these locations. No systemic adverse events, such as pulmonary toxicity, were observed. Conclusions: BEST is effective for treating vascular malformations of the upper aerodigestive tract, particularly in the tongue and oral cavity, but presents significant risks in laryngeal and hypopharyngeal lesions. A multidisciplinary approach is required to optimize treatment protocols for these challenging locations. Full article

Extra-pelvic varicose veins (VVs), originating from incompetent pelvic veins, present a significant clinical challenge, due to their complex anatomy, etiology, and symptomatology. This review aims at providing a comprehensive overview of the diagnostic and therapeutic strategies for these cases and emphasizes the importance of a tailored, evidence-based approach to the effective management of these varicosities, particularly regarding the interplay between the pelvic and extra-pelvic venous systems. Diagnostic workup should be multifaceted, incorporating patient-reported symptoms, physical examinations, and duplex ultrasound imaging. Specific diagnostic assessments include evaluation of the pelvic escape points and the transvaginal and transabdominal ultrasonography, to analyze venous hemodynamics and identify anatomical abnormalities in the pelvic floor and pelvis. In patients presenting with additional pelvic venous insufficiency (PVI)-related pelvic symptoms, advanced diagnostic techniques, such as cross-sectional imaging, venography, and intravascular ultrasound can be valuable to confirm and establish the appropriate treatment strategy. Since most patients with extra-pelvic VVs of pelvic origin do not report pelvic symptoms, minimally invasive procedures, using the “bottom-up” approach, such as ultrasound-guided foam sclerotherapy of the pelvic escape points and extra-pelvic VVs, or surgical ligation and miniphlebectomy for these incompetent veins, are usually sufficient. There are several advantages of these local procedures: they are simple, radiation exposure and injection contrast agents are avoided, they are convenient for the patient since they are performed on an outpatient basis, and they can be easily repeated, if required. When the “bottom-up” treatment fails and the extra-pelvic VVs recur quickly or the patient develops pelvic symptoms, management of the pelvic veins including embolization of the ovarian veins or stenting of the iliac veins should be considered. Careful patient selection is essential to avoid overtreatment and achieve optimal clinical outcomes. Full article

The central conducting lymphatics (CCL) and mesenteric lymphatic systems are responsible for lipid absorption, fluid regulation, and protein delivery into the bloodstream. Disruptions in these systems can result in debilitating conditions such as chylothorax, plastic bronchitis, post-operative lymphocele, protein-losing enteropathy (PLE), and chylous ascites. Advances in imaging techniques, including magnetic resonance lymphangiography (MRL), computed tomography lymphangiography (CTL), and fluoroscopic lymphangiography, allow for detailed anatomic and functional evaluation of the lymphatic system, facilitating accurate diagnosis and intervention by interventional radiologists. This review explores the embryology, anatomy, and pathophysiology of the lymphatic system and discusses imaging modalities and interventional techniques employed to manage disorders of the conducting lymphatics in the chest and abdomen. Thoracic duct embolization (TDE), percutaneous transhepatic lymphatic embolization (PTLE), and sclerotherapy are highlighted as effective, minimally invasive approaches to treat lymphatic leaks and obstructions and have shown high success rates in reducing symptoms and improving patient outcomes, particularly when medical management fails. This review seeks to demonstrate how anatomical imaging can facilitate minimally invasive procedures to rectify disorders of lymphatic flow. Full article

Congenital cystic adenomatoid malformation (CCAM) is a rare fetal lung anomaly characterized by benign multicystic masses that can lead to severe complications, such as pulmonary hypoplasia, fetal hydrops, and neonatal death. This literature review examines current knowledge on antenatal therapies for CCAM, focusing on pharmacological, procedural, and surgical interventions. Betamethasone, the first-line pharmacological treatment, has shown efficacy in reducing lesion size and resolving hydrops, particularly in microcystic CCAM. Procedural options, such as thoracoamniotic shunting, are effective for macrocystic lesions but carry risks including preterm labor and thoracic deformities. Open fetal surgery remains a last-resort intervention for severe cases, while emerging techniques, like percutaneous laser ablation and sclerotherapy, offer promising minimally invasive alternatives. A proposed treatment algorithm emphasizes individualized care based on lesion type, gestational age, and the presence of complications. The authors searched the US National Library of Medicine Database, Google Scholar, and PubMed Central to gather information on antenatal therapies for CCAM. This review emphasizes that, despite significant advancements, considerable challenges persist, underscoring the need for prospective studies to refine therapeutic protocols and assess long-term outcomes. Full article

Background/Objectives: Vascular malformations form masses in subcutaneous and muscular tissues throughout the body and are occasionally misdiagnosed as subcutaneous nonvascular tumors. Understanding and differentiating their clinical and imaging features are crucial due to their different treatments and prognoses. This study aimed to report cases of nonvascular tumors that were initially misdiagnosed and treated as vascular malformations. Methods: In this retrospective observational study, we enrolled 14 (1.8%) patients with pathologically diagnosed nonvascular tumors from among 536 patients with 759 lesions of clinically diagnosed vascular malformations. Results: The average age at the initial visit was 41.9 years, with a male-to-female ratio of 3:11. Tumor locations included the lower limb in seven patients, the upper limb in five patients, and the trunk and head in one patient each. Ultrasound evaluation revealed 12 lesions of low-flow vascular malformations and two lesions of high-flow vascular malformations. These findings led to an initial diagnosis of venous or lymphatic malformations in 12 patients and arteriovenous malformations in two patients. Based on the clinical diagnosis, treatments administered before tumor resection included sclerotherapy in four patients and transcatheter arterial embolization in one patient. All patients underwent tumor resection. The final histopathological diagnoses included schwannoma in six patients, epidermal cyst and angiomyoma in two patients each, and other types of tumors in four patients. The average time from initial diagnosis to final histopathological diagnosis was 370 days. Conclusions: Multimodal diagnostic strategies, especially the use of ultrasound, enhance the differentiation between vascular malformations and nonvascular tumors. Full article

Ectopic varices account for 5% of variceal bleeding cases but carry high mortality due to their concealed nature and diagnostic challenges. A 46-year-old man with hepatitis C cirrhosis and prior gastroesophageal variceal bleeding presented with fatigue and dark red stools. Initial gastroscopy revealed moderate gastric–oesophageal varices without active bleeding, treated with preventive sclerotherapy and cyanoacrylate injection. Persistent bleeding and a worsening condition led to his transfer to our hospital. Clinical evaluation suggested lower gastrointestinal bleeding. Imaging and colonoscopy confirmed ascending colon ectopic varices with recent thrombotic bleeding, while a repeated gastroscopy showed evidence of prior therapeutic interventions for gastric–oesophageal varices, which were stable. A titanium clip was placed for temporary hemostasis, but further vascular embolization was halted due to extensive variceal involvement and risk of bowel necrosis. A multidisciplinary team recommended a transjugular intrahepatic portosystemic shunt, although the patient declined. This case underscores the importance of identifying the primary bleeding source to prevent exacerbation caused by unnecessary interventions. A stepwise diagnostic approach is put forward, highlighting that multidisciplinary care is crucial, with personalized, minimally invasive strategies to manage fragile vascular anatomy. Early detection and increased awareness of ectopic varices can facilitate timely and appropriate therapeutic interventions, ultimately improving patient care and outcomes. Full article

Lymphatic malformations (LMs) are benign, congenital vascular anomalies caused by abnormal lymphangiogenesis during embryology, often presenting as fluid-filled cystic lesions. Though LMs can affect any part of the body except the brain, they primarily manifest in the head and neck or axilla regions of children. With a prevalence of approximately 1 in 4000 births, LMs are commonly diagnosed by age two, with symptoms varying based on lesion location and size. This paper reviews the classification of LMs and discusses the de Serres staging system, which aids in assessing prognosis based on lesion site. Mutations in the (PIK3CA) gene are implicated in most cases, and LMs are also associated with syndromic conditions like Turner and Noonan syndromes. They are diagnosed by ultrasound (USS) or magnetic resonance imaging (MRI), while a histologic analysis can confirm lymphatic origin. Treatment options range from conservative approaches, such as observation, to sclerotherapy, pharmacotherapy, and surgery. Sclerotherapy, particularly with agents like OK-432, bleomycin, and doxycycline, has shown significant efficacy in reducing LM size and symptoms with minimal side effects. Pharmacological therapies, such as sirolimus, that target the mTOR pathway are also increasingly being used, with a good effect on the burden of disease. While surgical excision remains a choice for symptomatic or large lesions, minimally invasive approaches are often preferred due to lower morbidity. Emerging techniques include gravity-dependent sclerotherapy, electrosclerotherapy, alpelisib, everolimus, and Wnt/β-catenin pathway stimulators (e.g., tankyrase inhibitors, porcupine inhibitors). Computational atomistic molecular dynamics (MD) and density functional tight binding (DFTB) techniques may offer an experimental approach to future therapeutic targets. This paper highlights a multidisciplinary approach to LM management, emphasising individualised treatment based on lesion characteristics and patient needs. Full article

Background/Aims: Double balloon enteroscopy (DBE) is an innovative method for the diagnosis and management of small bowel (SB) diseases. SB varices are rare disorders, and their diagnosis and treatment can be challenging for clinicians. This study evaluates the use of double balloon enteroscopy (DBE) in diagnosing and treating small bowel varices. Materials and Methods: SB varices were detected in 28 out of 900 double balloon enteroscopy procedures over an 18-year period. Eleven cases of SB varices of various etiologies, diagnosed via DBE, are described. The characteristics of SB varices and endoscopic procedural details were evaluated. Results: A retrospective investigation of 750 patients identified eleven patients (eight males and three females; median age 59 years, range 40–80 years) with small bowel varices. The most common site of SB varices was the jejunum. At least one abdominopelvic surgical procedure had been previously performed on five patients. Endotherapy by DBE was administered to nine patients (seven emergent and two prophylactic). Post-endotherapy, three patients experienced bleeding that required re-endotherapy. Endoscopic therapy for small bowel varices included injection sclerotherapy in eight cases (six with cyanoacrylate and two with polidocanol) and injection sclerotherapy plus hemoclipping in one case. Conclusions: SB varices can present a diagnostic challenge for clinicians. DBE is a valuable tool for both the diagnosis and management of small bowel varices. Full article

Background/Objectives: The therapeutic efficacy of percutaneous sclerotherapy (PS) for venous malformations (VMs) based on volumetric magnetic resonance imaging (MRI) measurements and its association with early post-treatment coagulation markers remains unexplored. This study evaluates the therapeutic efficacy of 5% monoethanolamine oleate (EO)-based PS in treating difficult-to-resect VMs using volumetric MRI and investigates its association with early changes in coagulation markers. Methods: This post-hoc analysis utilized data from a prospective, open-label, multicenter clinical trial initiated on 1 January 2021. The correlation between MRI-determined volume reduction and post-sclerotherapy changes in coagulation markers was assessed. Results: Between January 2021 and April 2023, 44 patients underwent EO-based PS. Based on a ≥ 20% VM volume reduction, patients were classified into “achieved” (n = 26; 59.1%) and “non-achieved” (n = 18; 40.9%) groups. D-dimer levels significantly increased on postoperative day 1 (POD1) compared with pretreatment screening (p < 0.001), whereas fibrinogen and prothrombin international normalized ratio levels remained unchanged. In the achieved group, a significant correlation was observed between the volume reduction rate and the administered EO dose per lesion volume (mL/cm³; Spearman’s ρ = 0.43, p = 0.03). The non-achieved group showed significantly higher D-dimer elevation than the achieved group (p = 0.03). Conclusions: This is the first multicenter study to evaluate EO-based PS efficacy for VMs using volumetric MRI and explore its relationship with early post-treatment coagulation markers. Elevated D-dimer levels on POD1 were not predictive of treatment efficacy, highlighting their limited clinical utility in assessing therapeutic response. Full article

Endometriosis is a multifaceted gynecological disorder defined by endometrium-like tissue outside the uterine cavity. It is mainly localized in the pelvis and creates a local inflammatory environment responsible for its manifestations and complications. In 30–50% of cases, endometriosis is associated with infertility. In 17–44% of cases, the ovaries are affected in the form of ovarian endometriomas (OEs). The symptoms of OEs are not very pronounced. The development is slow. Diagnosis is difficult because OEs resemble cystic ovarian pathology, which is so diverse. The actual diagnosis is possible through direct visualization or laparoscopy. Surgical treatment by cystectomy is common for OEs. Recently, other therapeutic modalities have emerged that have less impact on ovarian reserves and pregnancy rates. In this context, the review attempts to shed light on the best diagnostic and treatment methods for an insidious pathology with a major impact on fertility. Full article

Background: Endometriosis is characterized by the presence of endometrial tissue outside the uterus. Beyond medical treatment, surgical intervention is also a viable consideration. However, current guidelines do not clearly indicate whether laparoscopic cystectomy, ablative methods (CO₂ laser vaporization, plasma energy), or sclerotherapy is the preferred option. Methods: We conducted searches in two databases (PubMed and Europe PMC) to retrieve articles containing the keywords ‘surgical intervention for Endometrioma, ovarian reserve, pregnancy rates, fertility’, published between 1 January 2000 and 31 December 2023. We included articles presenting information on surgical intervention for endometrioma and its correlation with infertility parameters. Articles describing conservative treatment were excluded. Data were extracted by two authors using predefined criteria. Results: The initial database search produced 1376 articles, which were narrowed down to 41 relevant articles meeting the eligibility criteria. Conclusions: Laparoscopic cystectomy appears to impact postoperative anti-mullerian hormone levels, showing a stronger correlation with larger cysts and individual factors. CO₂ laser vaporization demonstrates favorable results compared to traditional cystectomy. Combining GnRH agonist treatment with assisted reproduction treatment after cystectomy could be considered an alternative method. Plasma energy causes less damage to ovarian function, with pregnancy outcomes comparable to cystectomy. Sclerotherapy shows promising results for ovarian reserve preservation, recurrence rates, and safety. Further studies comparing these techniques are necessary to provide guidance to clinicians. Full article

Ethanol sclerotherapy (EST) has gained attention as a minimally invasive treatment option for ovarian endometriomas, particularly in infertile women with endometrioma undergoing in vitro fertilization (IVF). Endometriomas are associated with decreased ovarian reserve and impaired fertility outcomes, and traditional surgical approaches, such as cystectomy, often lead to further reductions in ovarian reserve. Ethanol sclerotherapy offers a potential alternative that preserves ovarian function while effectively managing endometriomas. This review examines the safety, efficacy, and impact of EST on ovarian reserve, IVF outcomes, and recurrence rates. Comparative studies suggest that pregnancy rates following EST are similar to or better than those after cystectomy, with the added benefit of more oocytes retrieved, which may lead to higher cumulative live birth rates. Despite these promising results, challenges such as recurrence and complications, particularly with prolonged ethanol exposure, remain. The use of transvaginal versus laparoscopic approaches and optimal ethanol exposure protocols are areas of ongoing research. The need for further large-scale, prospective studies is highlighted to refine the EST protocol and better understand the long-term outcomes. Sclerotherapy presents a feasible option for preserving fertility in women with endometriomas, with positive implications for IVF success and ovarian reserve preservation. Full article