BACKGROUND: Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal (GI) bleeding. Here, we present a minimally invasive therapy with selective embolization.
METHODS: A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis. Diagnostic studies later revealed specific characteristics for vascular lesions-anorectal hemangiomas. The severity of rectal bleeding caused symptomatic anemia and possible surgical treatment was associated with a high risk of fecal incontinence. Here, we present selective embolization, a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice. The patient significantly improved temporarily and had a small ischemic ulcer, which healed with a control colonoscopy and developed no stenosis.
CONCLUSIONS: Awareness of the clinical and radiological features of GI hemangiomas may help improve diagnostics and avoid inappropriate therapeutic procedures.

While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012 and 2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p = 0.04). Only operative length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p = 0.53). RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p = 0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-ups is warranted. This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.

Angiomyolipomas are benign renal hamartomas with - fat, smooth muscle, and abnormal blood vessel (tortuous, dysmorphic) components. The risk of hemorrhage is related to size of the tumor, presence of aneurysm, associations with tuberous sclerosis. In this case report we review the case of a 42-year-old woman presenting with acute flank pain and decreased hemoglobin, who was diagnosed with AML with right renal artery pseudo aneurysm on CT. Subsequent coil embolization of feeding vessels and using PVA particles was successfully done. Selective embolization remains a minimally invasive, attractive option, and a nephron sparing approach.

BACKGROUND: Mediastinal hemangiomas are rare, and their etiology remains unclear. Most patients affected have no pathognomonic clinical symptoms, and the diagnosis is often incidental. Due to the paucity of the available literature regarding the management of this disease, the choice and timing of treatment remains controversial.
METHODS: Herein, we report the case of a hemangioma of the azygos vein arch in a 66-year-old woman who presented with dyspnea, chest discomfort, dysphagia, and weight loss. A simultaneous right chylothorax refractory to conservative management was found. A CT-guided biopsy of the mass was performed, and it confirmed the vascular nature of the lesion. Therefore, the patient underwent an angiography followed by endo-vascular embolization. Three days later, thoracoscopic surgical resection of the mass and the repair of the chyle leakage were performed safely. The patient was discharged uneventfully on postoperative day seven, with complete resolution of all the presenting symptoms.
CONCLUSIONS: Treatment of symptomatic mediastinal hemangiomas could be mandatory, but a thorough multidisciplinary approach to these rare malformations is essential. Despite the risk of intraoperative bleeding, selective endovascular embolization followed by thoracoscopic surgery allowed for a complete and safe resection with a good outcome.

A rectus sheath hematoma, which is mostly encountered due to abdominal traumas or anticoagulant use, can be challenging, and a delayed diagnosis may lead to hypovolemic shock and even death. In this study, we aimed to present the management of a case of rectus sheath hematoma that developed in a patient who was hospitalized and under coronavirus disease 2019 (COVID-19) treatment. A 70-year-old female patient was admitted to the intensive care unit (ICU) due to respiratory failure and developed a sudden onset of tachycardia and hypotension. The patient was then diagnosed with a rectus sheath hematoma and after ensuring hemodynamic stability she was treated with angiographic embolization. Following the treatment, the patient remained hemodynamically stable and a control computed tomography (CT) revealed regression in the hematoma. Rectus sheath hematomas especially accompanied by additional comorbidities or aggressive surgical interventions may result in high mortality rates in the early period. It should also be kept in mind that during the COVID-19 pandemic, which has affected the world in the last two years, rectus sheath hematomas may be the underlying cause of sudden hypotension and abdominal distension, and it should not be forgotten that angiographic embolization performed by experienced interventional radiologists is the mainstay of treatment in cases where hemodynamic stability can\'t be achieved.

OBJECTIVE: To improve treatment outcomes in victims with kidney damage following blunt and stab abdominal trauma by using of minimally invasive methods of diagnosis and treatment.
METHODS: About 1.2-3.5% of all victims arrived to the Dzhanelidze St. Petersburg Research Institute for Emergency Care have kidney injuries. We analyzed the results of treatment of 117 patients with isolated and combined blunt and stab abdominal injuries. The retrospective (2014-2017) group included 62 victims, and the prospective (2018-2021) group enrolled 55 patients who were treated according to the new algorithm. This algorithm included non-surgical and minimally invasive management for patients with systolic blood pressure >90 mm Hg after contrast-enhanced CT. Angiography with selective embolization was required for ongoing bleeding. We analyzed incidence of open interventions, organ-sparing procedures, complications, duration of treatment and mortality. Between-group differences were assessed using the χ2 test and Student\'s test.
RESULTS: In both groups, kidney damage in most victims with abdominal trauma was due to road accident and catatrauma. Most patients had combined abdominal injuries, mainly in combination with head and chest lesions. Severity of injuries and clinical condition were similar in both groups. In the retrospective group, there were 9 laparotomies with nephrectomy. Nephrorraphy was performed in 8 cases, kidney vessel suture - in 4 patietns. In the prospective group, nephrectomy was performed in 3 patients with unstable hemodynamics and injuries AAST grade V. Nephrorraphy was performed in 4 victims. In one case, vascular suture was applied for tangential vein damage. All laparoscopies in both groups were diagnostic without nephrectomy. We used non-surgical treatment in 34 patients of the prospective group. One patient underwent angiography and selective embolization of renal artery branches. There were no significant between-group differences in the incidence of infectious and non-infectious complications. Mortality rate was 30.6% (n=19) and 27.3% (n=15) in the retrospective and prospective groups, respectively.
CONCLUSIONS: The proposed algorithm for kidney injury made it possible to reduce the incidence of laparoscopies and laparotomies by 2 times, preserve the damaged kidney in 94.5% of cases and avoid invasive treatment in 62% of victims.
UNASSIGNED: Оценка и улучшение результатов лечения пострадавших с повреждением почек путем применения высокотехнологичных малоинвазивных методов диагностики и консервативного лечения.
UNASSIGNED: Ежегодно в травмоцентр I уровня СПб НИИ скорой помощи имени И.И. Джанелидзе с повреждением почки поступает 1,2—3,5% всех пострадавших. Проведен анализ результатов лечения 117 пациентов с повреждениями почек при сочетанных и изолированных травмах и ранениях живота, находившихся на лечении в травмоцентре I уровня. В ретроспективную (2014—2017 гг.) группу вошли 62 пострадавших, в проспективную (2018—2021 гг.) — 55 пациентов, которым лечение проводили в соответствии с новым алгоритмом. Последний включал проведение консервативного и малоинвазивного лечения при стабильной гемодинамике после проведения МСКТ. При выявлении признаков продолжающегося кровотечения выполняли ангиографию с селективной ангиоэмболизацией. Сравнивали результаты лечения по частоте открытых оперативных вмешательств, применения органосохраняющих методов лечения, осложнений, продолжительности лечения и уровня летальности. Степень достоверности различий показателей рассчитывали по критерию χ2 и критерию Стьюдента.
UNASSIGNED: В обеих группах большинство пострадавших с повреждением почки при травме живота поступили в травмоцентр после дорожно-транспортных происшествий и кататравм. У большинства пациентов были сочетанные повреждения живота, преимущественно в сочетании с травмами головы и груди. Статистически значимых различий тяжести травмы по шкалам AIS, ISS, Ю.Н. Цибина, ВПХ-П и ВПХ-П(Р), тяжести состояния (ВПХ-СП) не выявлено. В ретроспективной группе нефрэктомию выполнили в 9 случаях во время лапаротомий вне зависимости от показателей гемодинамики и состояния пострадавших. Ушивание повреждений почки выполнено у 8 пострадавших, шов сосудов почек — у 4. В проспективной группе почка удалена при ее повреждении V степени в 3 случаях при нестабильной гемодинамике. Ушиты повреждения почки у 4 пострадавших. В одном случае при краевом ранении почечной вены наложен сосудистый шов. Все видеолапароскопии в обеих группах носили диагностический характер и произведены без удаления почек. Тактика неоперативного лечения применена у 34 пострадавших проспективной группы. Ангиография и селективная эмболизация ветвей почечной артерии выполнены одному пациенту. Статистически значимых различий между группами по частоте инфекционных и неинфекционных осложнений не выявлено. В ретроспективной группе умерли 19 (30,6%) пострадавших, в проспективной — 15 (27,3%).
UNASSIGNED: Использование предложенного лечебно-диагностического алгоритма при травме почек позволило в 2 раза снизить частоту видеолапароскопий и лапаротомий, в 94,5% случаях сохранить поврежденную почку и избежать проведения инвазивных методов лечения у 62% пострадавших.

Several publications show that superselective conventional TransArterial ChemoEmbolization (cTACE), meaning cTACE performed selectively with a microcatheter positioned as close as possible to the tumor, improves outcomes, maximizing the anti-tumoral effect and minimizing the collateral damages of the surrounding liver parenchyma. Recent recommendations coming from the European Association for the Study of the Liver (EASL) and European Society of Medical Oncology (ESMO) highlighted that TACE must be used in Hepatocellular Carcinoma (HCC) \"selectively targetable\" and \"accessible to supraselective catheterization.\" The goal of the manuscript is to better define such population and to standardize superselective cTACE (ss-cTACE) technique. An expert panel with extensive clinical-procedural experience in TACE, have come together in a virtual meeting to generate recommendations and express their consensus. Experts recommend that anytime cTACE is proposed, it should be ss-cTACE, preferably with a 1.5-2.0 Fr microcatheter. Ideally, ss-cTACE should be proposed to patients with less than five lesions and a maximum number of two segments involved, with largest tumor smaller than 5 cm. Angio Cone-Beam Computed Tomography (CBCT) should be used to detect enhancing tumors, tumor feeders and guide tumor targeting. Whole tumor volume should be covered to obtain the best response. Adding peritumoral margins is encouraged but not mandatory. The treatment should involve a water-in-oil emulsion, whose quality is assessable with the \"drop test.\" Additional particulate embolization should be systematically performed, as per definition of cTACE procedure. Non-contrast CBCT or Multi-Detector Computed Tomography (MDCT) combined with angiography has been considered the gold standard for imaging during TACE, and should be used to assess tumor coverage during the procedure. Experts convene that superselectivity decreases incidence of adverse effects and improves tolerance. Experts recommend contrast-enhanced Computed Tomography (CT) as initial imaging on first follow-up after ss-cTACE, and Magnetic Resonance Imaging (MRI) if remaining tumor viability cannot be confidently assessed on CT. If no response is obtained after two ss-cTACE sessions within six months, patient must be considered unsuitable for TACE and proposed for alternative therapy. Patients are best served by multidisciplinary decision-making, and Interventional Radiologists should take an active role in patient selection, treatment allocation, and post-procedural care.

True deep femoral artery aneurysms are a rare abnormality of the human vascular system and account for approximately 0.13% of all peripheral arterial aneurysms. We report a 66-year-old man with a ruptured deep femoral artery aneurysm and a pulsating hematoma. The patient underwent urgent endovascular embolization of the aneurysm-supplying artery. Then, 4 days later, in connection with the residual hematoma, which caused severe discomfort to the patient, and also due to the high risk of septic complications in the area of the hematoma, it was decided to perform an open aneurysmectomy and deep femoral artery ligation.
A deep femoral artery aneurysm (a bulge in a blood vessel caused by a weakness in the blood vessel wall) is a rare abnormality of the human vascular system. A ruptured aneurysm can cause serious health problems such as bleeding, hemorrhagic shock and even death. We report a 66-year-old man with a ruptured femoral artery aneurysm. The patient underwent urgent intravascular plugging of the artery supplying the aneurysm. Then, 4 days later, in connection with the residual hematoma, which caused severe discomfort to the patient, and also due to the high risk of complications, it was decided to perform an open operative excision of the aneurysm. The postoperative period and 2-year follow-up were uneventful.

We report the case of a 14-year-old man who arrived at the emergency department affected by a high-flow priapism due to a traumatic left arterial-sinusoidal fistula. After clinical examination, a colour Doppler ultrasound of the penis was performed which showed a left arterial-sinusoidal fistula measuring 7×16×30mm, with high-speed and turbulent flow. The fistula was successfully treated by three highly selective endovascular embolizations and at the 20days follow-up, clinical examination resulted normal.

The development of an arteriovenous fistula (AVF) after renal graft biopsy is a rare complication, it is associated in most cases with spontaneous resolution. However, interventional therapies are required in some cases, to prevent graft loss. Selective embolization has been described as an alternative treatment. In the present study, we describes our experience on AVF after biopsy in kidney transplant patients, which was managed with selective embolization. From 2005 to 2015, a total of 452 kidney transplant biopsies were performed, 12 had an AVF requiring embolization. In 92% of cases, this was successful. Beforehand, mean serum creatinine levels were 2.45 mg/dL, after the procedure, that increased to 3.05, however, 3 months later, mean creatinine levels dropped to 1.85 mg/dL. Graft survival after 2 follow-up years was 72%. Our experience demonstrates that selective embolization of the AVF after kidney transplant biopsy is a safe procedure, and that transplant function can be maintained in patients with this complication.