OBJECTIVES: Postpartum haemorrhage is the most common cause of mortality among women after childbirth. Therefore, this work aims to highlight the possibility of endovascular treatment of postpartum haemorrhage due to remnants in patients with placenta accreta spectrum disorders (PAS disorders) using selective UAE after failure of the standard management. This procedure is a relatively safe and technically nondemanding, with a low risk of recurrent vaginal bleeding. MATERIALS AND METHODS: This article presents an evaluation of the results of eight patients (age between 19-39 years) who underwent selective transarterial embolisation of uterine arteries from January 2022 to August 2023 at the angio-interventional department of our university hospital center. Based on a multidisciplinary consensus of sonographically detected residues of placenta accreta with typical hypervascularisation, unilateral/bilateral embolisation of the uterine artery was performed with a microcatheter using polyvinyl alcohol embolisation particles, possibly in combination with gelatine foam. RESULTS: There were no periprocedural complications during embolisation, nor were there episodes of repeated bleeding or other postprocedural complications during the follow-up. Two patients underwent surgical revision of the uterine cavity with extirpation of devascularised residual tissue. CONCLUSIONS: Thus far, this procedure has proven to be a safe and relatively technically nondemanding method supplementing the management of symptomatic patients with PAS disorders with a low risk of rebleeding.

• Klíčová slova
• endovascular treatment, placenta accrete, postpartum haemorrhage, retained placenta, uterine artery embolisation,
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To describe management of a spontaneus rupture of renal angiomyolipoma after cesarean section. DESIGN: Case report. SETTING: Department of Gynaecology and Obstetrics, Hospital Šternbek; Department of Obstetrics and Gynaecology, Palacky University and University Hospital, Olomouc. CASE REPORT: 29-year-old patient underwent acute cesarean section at 35 weeks of gestation for pPROM, placenta praevia marginalis, suspicion of placenta accreta by ultrasound and MRI and transverse position of the fetus. The next morning was found out a spontaneus rupture of renal angiomyolipoma causing progressive anemisation. We describe the following management. CONCLUSION: Incidention of tumors complicating gravidity may occur more often due to changes in population characteristics. Methods of interventional radiology are ordinarily used for severe hemorrage postpartum or for prophylactic occlusion of illiac arteries before cesarean section with morbidly adherent placenta. We show here usage of selective embolisation in not so common obstetrical complications.

• Klíčová slova
• angiomyolipoma, bleeding, cesarean section, embolisation, placenta praevia, puerperium, tamponade,
• MeSH
• angiomyolipom * komplikace   chirurgie   MeSH
• císařský řez * MeSH
• dospělí MeSH
• krvácení * etiologie   chirurgie   MeSH
• lidé MeSH
• placenta accreta MeSH
• placenta praevia MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Insufficient future liver remnant volume (FLRV) is the main cause of low resectability of liver metastases from colorectal cancer (CLMs). One option for enhancing FLVR growth is the use of portal vein embolisation (PVE) with the application of autologous haematopoietic stem cells (HSCs). PATIENTS AND METHODS: PVE with the application of HSCs was used in 11 patients (group 1) with primarily non-resectable CLMs due to insufficient FLRV without signs of extrahepatic metastases. The control group (group 2) consisted of 14 patients in whom only PVE was performed. We evaluated the product quality, FLRV growth, CLM volume, median survival and progression-free survival (PFS). RESULTS: Product quality was achieved in all collections. In all group-I patients, sufficient FLRV growth occurred within three weeks. In the first and second weeks, FLRV increased optimally in most patients (p<0.006). In 13 out of the 14 group-2 patients, optimum FLVR growth was observed within three weeks following PVE (p<0.002). More rapid FLVR growth was observed in group 1 patients (p<0.01). CLM volume was significantly increased in both the group-2 (p<0.0005) and group-1 (p<0.008) patients at the time of liver resection. There was no significant difference in the growth of the CLM volume between the groups (p<0.18). The median survival was 7.3 and 6.8 months for group 1 and 2 patients, respectively, and the two-year PFS was 28% and 22% (p<0.18), respectively. CONCLUSION: PVE with HSC application is a promising method for effectively stimulating FLRV growth in patients with primarily non-resectable CLMs.

• Klíčová slova
• Colorectal liver metastases, future liver remnant volume, haematopoietic stem cells, portal vein embolisation,
• MeSH
• hematopoetické kmenové buňky MeSH
• hepatektomie MeSH
• játra krevní zásobení   patologie   chirurgie   MeSH
• kolorektální nádory mortalita   patologie   terapie   MeSH
• leukaferéza MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory jater mortalita   sekundární   terapie   MeSH
• přežití bez známek nemoci MeSH
• regenerace jater * MeSH
• senioři MeSH
• terapeutická embolizace * MeSH
• transplantace hematopoetických kmenových buněk metody   MeSH
• vena portae MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

High-flow priapism is a rare condition mainly caused by perineal trauma. Laceration of cavernosal artery results in a formation of arterial-lacunar fistula with unregulated blood flow causing prolonged erection. We present a case of a 25-year-old man with high-flow priapism and concurrent erectile dysfunction treated with repeated selective embolisation with only a partial effect. When no further embolisation was possible, we assumed on conservative management even through the fistula was still present. Spontaneous detumescence occurred 9 months, and erectile function has fully restored 24 months after the injury. To the best of our knowledge, spontaneous detumescence with full restoration of erection even through the persistent arterial-lacunar fistula has not been reported previously. Therefore, we propose conservative approach after embolisation to be an option.

• Klíčová slova
• arterial-lacunar fistula, conservative management, high-flow priapism, persistent fistula,
• MeSH
• arterie MeSH
• dospělí MeSH
• erekce penisu MeSH
• erektilní dysfunkce etiologie   terapie   MeSH
• lidé MeSH
• penis krevní zásobení   MeSH
• píštěle MeSH
• priapismus komplikace   terapie   MeSH
• regionální krevní průtok MeSH
• terapeutická embolizace MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Pneumatic weapons rarely cause severe trauma. However, pellet embolisation can cause severe and unexpected injuries. REPORT: This is the case study of a 32 year old man, who was shot in the chest with a pneumatic rifle. Initially, urgent damage control surgery was performed to resolve pneumothorax and pericardial tamponade, but no projectile was found. Subsequent atypical symptomatology led to more extensive imaging that found a pellet embolised into the right carotid artery, thrombosis of the middle cerebral artery, and development of a large right hemispheric ischaemic area. After an unsuccessful endovascular intervention, the projectile was removed during an open surgical procedure. The right hemisphere oedema required decompressive hemicraniectomy, but long term intensive care and physiotherapy resulted in a satisfactory recovery with moderate neurological sequelae. CONCLUSION: An unusual clinical presentation in combination with an absent exit wound might be symptomatic of projectile embolisation and should lead to a search for it. When the projectile position is convenient, surgical removal is the treatment of choice while an endovascular approach should be reserved for inaccessible locations or asymptomatic cases.

• Klíčová slova
• Bullet embolisation, Decompressive craniectomy, Firearm injury, Stroke,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Malignant fibrous histiocytoma (MFH) represents a rare malignant affection of heart and aorta. Its clinical presentation depends on the localisation, size, degree of invasion and metastasis. Previously, relatively few cases of acute tumour mass embolisation into the visceral and limb arterial system were described in the literature. In the present case study we describe a case of acute ischemia of both lower extremities caused by thromboembolic mass of MFH cells. According to literary sources this tumour type is characterized by poor prognosis as it was in the case of our patient.

• Klíčová slova
• acute limb ischemia peripheral embolisation Fogarty embolectomy malignant fibrous histiocytoma.,
• MeSH
• ischemie * etiologie   MeSH
• lidé MeSH
• maligní fibrózní histiocytom * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

CONTEXT: Little is known about the natural history of sporadic angiomyolipomas (AMLs); there is uncertainty regarding the indications of treatment and treatment options. OBJECTIVE: To evaluate the indications, effectiveness, harms, and follow-up of different management modalities for sporadic AML to provide guidance for clinical practice. EVIDENCE ACQUISITION: A systematic review of the literature was undertaken, incorporating Medline, Embase, and the Cochrane Library (from 1 January 1990 to 30 June 2017), in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No restriction on study design was imposed. Patients with sporadic AML were included. The main interventions included active surveillance, surgery (nephron-sparing surgery and radical nephrectomy), selective arterial embolisation, and percutaneous or laparoscopic thermal ablations (radiofrequency, microwaves, or cryoablation). The outcomes included indications for active treatment, AML growth rate, AML recurrence rate, risk of bleeding, post-treatment renal function, adverse events of treatments, and modalities of follow-up. Risk of bias assessment was performed using standard Cochrane methods. EVIDENCE SYNTHESIS: Among 2704 articles identified, 43 were eligible for inclusion (zero randomised controlled trials, nine nonrandomised comparative retrospective studies, and 34 single-arm case series). Most studies were retrospective and uncontrolled, and had a moderate to high risk of bias. CONCLUSIONS: In active surveillance series, spontaneous bleeding was reported in 2% of patients and active treatment was undertaken in 5%. Active surveillance is the most chosen option in 48% of the cases, followed by surgery in 31% and selective arterial embolisation in 17% of the cases. Selective arterial embolisation appeared to reduce AML volume but required secondary treatment in 30% of the cases. Surgery (particularly nephron-sparing surgery) was the most effective treatment in terms of recurrence and need for secondary procedures. Thermal ablation was an infrequent option. The association between AML size and the risk of bleeding remained unclear; as such the traditional 4-cm cut-off should not per se trigger active treatment. In spite of the limitations and uncertainties relating to the evidence base, the findings may be used to guide and inform clinical practice, until more robust data emerge. PATIENT SUMMARY: Sporadic angiomyolipoma (AML) is a benign tumour of the kidney consisting of a mixture of blood vessels, fat, and muscle. Large tumours may have a risk of spontaneous bleeding. However, the size beyond which these tumours need to be treated remains unclear. Most small AMLs can be monitored without any active treatment. For those who need treatment, options include surgical removal of the tumour or stopping its blood supply (selective embolisation). Surgery has a lower recurrence rate and lower need for a repeat surgical procedure.

• Klíčová slova
• Active surveillance, Angiomyolipoma, Kidney, Nephron-sparing surgery, Selective arterial embolisation, Systematic review,
• MeSH
• angiomyolipom patologie   terapie   MeSH
• karcinom z renálních buněk patologie   terapie   MeSH
• ledviny patologie   MeSH
• lidé MeSH
• nádory ledvin patologie   terapie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice MeSH
• systematický přehled MeSH
• Geografické názvy
• Evropa MeSH

The authors present a case of a patient with non-traumatic right-sided chylothorax which was successfully treated by thoracic duct embolization. The procedure was performed through the cisterna chyli which was visualised by intranodal lymphography. The coils and acrylic tissue glues were used for embolization. The patient has been followed for 5 months and is free of recurrence of chylothorax.

• Klíčová slova
• chylothorax, embolisation, embolization, intranodal, lymphography, thoracic duct,
• MeSH
• chylotorax * diagnostické zobrazování   etiologie   terapie   MeSH
• ductus thoracicus diagnostické zobrazování   MeSH
• lidé MeSH
• lymfografie metody   MeSH
• terapeutická embolizace * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Early postoperative wound complications in revascularization procedures in the groin very often include complications associated with injury to the lymphatic system such as lymphocele and lymphorrhea with subsequent local infectious complications and the risk of infection of prosthetic grafts. We present a case report of successful treatment of postoperative lymphocele with subsequent lymphatic fistula and dehiscence of the surgical wound by intranodal embolization of the injured lymph node with Histoacryl tissue glue.

• Klíčová slova
• embolisation, embolization, lymphocele, lymphography,
• MeSH
• enbukrylát terapeutické užití   MeSH
• lidé MeSH
• lymfatické uzliny transplantace   MeSH
• lymfokela * etiologie   terapie   MeSH
• pooperační komplikace terapie   MeSH
• terapeutická embolizace * metody   MeSH
• tkáňová adheziva terapeutické užití   MeSH
• třísla * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• enbukrylát MeSH
• tkáňová adheziva MeSH

CONTEXT: Overall, 4-10% of patients with renal cell carcinoma (RCC) present with venous tumour thrombus. It is uncertain which surgical technique is best for these patients. Appraisal of outcomes with differing techniques would guide practice. OBJECTIVE: To systematically review relevant literature comparing the outcomes of different surgical therapies and approaches in treating vena caval thrombus (VCT) from nonmetastatic RCC. EVIDENCE ACQUISITION: Relevant databases (Medline, Embase, and the Cochrane Library) were searched to identify relevant comparative studies. Risk of bias and confounding assessments were performed. A narrative synthesis of the evidence was presented. EVIDENCE SYNTHESIS: The literature search identified 824 articles. Fourteen studies reporting on 2262 patients were included. No distinct surgical method was superior for the excision of VCT, although the method appeared to be dependent on tumour thrombus level. Minimal access techniques appeared to have better perioperative and recovery outcomes than traditional median sternotomy, but the impact on oncologic outcomes is unknown. Preoperative renal artery embolisation did not offer any oncologic benefits and instead resulted in significantly worse perioperative and recovery outcomes, including possibly higher perioperative mortality. The comparison of cardiopulmonary bypass versus no cardiopulmonary bypass showed no differences in oncologic outcomes. Overall, there were high risks of bias and confounding. CONCLUSIONS: The evidence base, although derived from retrospective case series and complemented by expert opinion, suggests that patients with nonmetastatic RCC and VCT and acceptable performance status should be considered for surgical intervention. Despite a robust review, the findings were associated with uncertainty due to the poor quality of primary studies available. The most efficacious surgical technique remains unclear. PATIENT SUMMARY: We examined the literature on the benefits of surgery to remove kidney cancers that have spread to neighbouring veins. The results suggest such surgery, although challenging and associated with high risk of complications, appears to be feasible and effective and should be contemplated for suitable patients if possible; however, many uncertainties remain due to the poor quality of the data.

• Klíčová slova
• Circulatory bypass and preoperative embolisation, Nonmetastatic renal cell carcinoma, Surgical management of tumour thrombus, Systematic review, Thrombectomy, Vena caval thrombus,
• MeSH
• chirurgie operační * škodlivé účinky   metody   MeSH
• karcinom z renálních buněk komplikace   patologie   MeSH
• lidé MeSH
• nádory ledvin komplikace   patologie   MeSH
• staging nádorů MeSH
• vaskulární nádory * etiologie   patologie   chirurgie   MeSH
• venae cavae * patologie   chirurgie   MeSH
• zohlednění rizika MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH