Rainer Schmitt, Andreas Steven Kunz, Paul Reidler, Henner Huflage, Nina Hesse
The TFCC consists of several components whose functional significance has been recognized in detail in recent years. Existing classifications are partly incomplete. In addition, the TFCC requires specific and dedicated imaging techniques.This review describes the anatomy and pathoanatomy of the TFCC. The different types of TFCC lesions on MRI as well as MR and CT arthrography are explained and compared with the current literature. In addition, the novel CUP classification is presented and illustrated with image examples.Anatomically and functionally, the articular disc and radioulnar ligaments with their ulnar insertions and the inhomogeneously structured TFCC periphery must be differentiated. For accurate imaging, thin slices with high in-plane resolution and techniques to optimize contrast are required. Plain MRI is exclusively dependent on T2 contrast, while gadolinium-enhanced MRI offers the additional benefit of focal contrast enhancement, e.g., of fibrovascular repair tissue at the lesion site. However, the reference standard continues to be MR and CT arthrography, which should be used for focused indications. The CUP classification, which allows a comprehensive description and categorization of TFCC lesions, is presented and illustrated. · Anatomically, the TFCC consists of the central ulnocarpal disc, the dorsal and palmar radioulnar ligaments, and the ulnocarpal joint capsule including intracapsular ligaments and the meniscus homologue.. · The most important restraining structure of the TFCC is the lamina fovealis, which stabilizes the DRUJ. This structure constitutes the proximal (deep) continuation of the radioulnar ligaments at the ulnar insertion.. · Imaging of the TFCC requires high spatial and contrast resolution due to its minute structures. MR and CT arthrography are the reference standard in imaging.. · The CUP classification clearly describes all structures of the TFCC with the categorization of individual or combined lesion patterns.. · Schmitt R, Kunz AS, Reidler P et al. Triangular Fibrocartilage Complex (TFCC) - Anatomy, Imaging, and Classifications with Special Focus on the CUP Classification. Fortschr Röntgenstr 2024; DOI 10.1055/a-2411-8444.
{"title":"Triangular Fibrocartilage Complex (TFCC) - Anatomy, Imaging, and Classifications with Special Focus on the CUP Classification.","authors":"Rainer Schmitt, Andreas Steven Kunz, Paul Reidler, Henner Huflage, Nina Hesse","doi":"10.1055/a-2411-8444","DOIUrl":"https://doi.org/10.1055/a-2411-8444","url":null,"abstract":"<p><p>The TFCC consists of several components whose functional significance has been recognized in detail in recent years. Existing classifications are partly incomplete. In addition, the TFCC requires specific and dedicated imaging techniques.This review describes the anatomy and pathoanatomy of the TFCC. The different types of TFCC lesions on MRI as well as MR and CT arthrography are explained and compared with the current literature. In addition, the novel CUP classification is presented and illustrated with image examples.Anatomically and functionally, the articular disc and radioulnar ligaments with their ulnar insertions and the inhomogeneously structured TFCC periphery must be differentiated. For accurate imaging, thin slices with high in-plane resolution and techniques to optimize contrast are required. Plain MRI is exclusively dependent on T2 contrast, while gadolinium-enhanced MRI offers the additional benefit of focal contrast enhancement, e.g., of fibrovascular repair tissue at the lesion site. However, the reference standard continues to be MR and CT arthrography, which should be used for focused indications. The CUP classification, which allows a comprehensive description and categorization of TFCC lesions, is presented and illustrated. · Anatomically, the TFCC consists of the central ulnocarpal disc, the dorsal and palmar radioulnar ligaments, and the ulnocarpal joint capsule including intracapsular ligaments and the meniscus homologue.. · The most important restraining structure of the TFCC is the lamina fovealis, which stabilizes the DRUJ. This structure constitutes the proximal (deep) continuation of the radioulnar ligaments at the ulnar insertion.. · Imaging of the TFCC requires high spatial and contrast resolution due to its minute structures. MR and CT arthrography are the reference standard in imaging.. · The CUP classification clearly describes all structures of the TFCC with the categorization of individual or combined lesion patterns.. · Schmitt R, Kunz AS, Reidler P et al. Triangular Fibrocartilage Complex (TFCC) - Anatomy, Imaging, and Classifications with Special Focus on the CUP Classification. Fortschr Röntgenstr 2024; DOI 10.1055/a-2411-8444.</p>","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-02-19DOI: 10.1055/a-2254-5824
Roman Fischbach, Maximilian Peller, Daniel Perez, Christopher Pohland, Raphael Gübitz
Background: Partial pancreatic resections are among the most complex surgical procedures in visceral tumor medicine and are associated with a high postoperative morbidity with a complication rate of 40-50 % of patients even in specialized centers.
Methods: Description of typical surgical resection procedures and the resulting postoperative anatomy, typical normal postoperative findings, common postoperative complications, and radiological findings.
Results and conclusion: CT is the most appropriate imaging technique for rapid and standardized visualization of postoperative anatomy and detection of clinically suspected complications after partial pancreatic resections. The most common complications are delayed gastric emptying, pancreatic fistula, acute pancreatitis, bile leakage, abscess, and hemorrhage. Radiologists must identify the typical surgical procedures, the postoperative anatomy, and normal postoperative findings as well as possible postoperative complications and know interventional treatment methods for common complications.
Key points: · Morbidity after pancreatic surgery remains high.. · CT is the best method for visualizing postoperative anatomy and is used for early detection of complications.. · Pancreatic fistula is the most common relevant complication after pancreatic resection.. · The ability of a center to manage complications is crucial to ensure the success of therapy..
Citation format: · Fischbach R, Peller M, Perez D et al. The postsurgical pancreas. Fortschr Röntgenstr 2024; 196: 1037 - 1045.
背景:胰腺部分切除术是内脏肿瘤医学中最复杂的外科手术之一,术后发病率高,即使在专业中心,并发症发生率也高达 40%-50%:方法:描述典型的手术切除程序和由此产生的术后解剖结构、典型的正常术后结果、常见的术后并发症以及放射学结果:结果和结论:CT 是胰腺部分切除术后快速、标准化观察术后解剖结构和发现临床疑似并发症的最合适影像技术。最常见的并发症是胃排空延迟、胰瘘、急性胰腺炎、胆汁渗漏、脓肿和出血。放射医师必须识别典型的手术过程、术后解剖、正常的术后结果以及可能出现的术后并发症,并了解常见并发症的介入治疗方法:- 胰腺手术后的发病率仍然很高。- CT是观察术后解剖结构的最佳方法,可用于早期发现并发症。- 胰瘘是胰腺切除术后最常见的相关并发症。- 中心处理并发症的能力是确保治疗成功的关键:- Fischbach R, Peller M, Perez D et al.手术后的胰腺Fortschr Röntgenstr 2024; DOI: 10.1055/a-2254-5824.
{"title":"The postsurgical pancreas.","authors":"Roman Fischbach, Maximilian Peller, Daniel Perez, Christopher Pohland, Raphael Gübitz","doi":"10.1055/a-2254-5824","DOIUrl":"10.1055/a-2254-5824","url":null,"abstract":"<p><strong>Background: </strong> Partial pancreatic resections are among the most complex surgical procedures in visceral tumor medicine and are associated with a high postoperative morbidity with a complication rate of 40-50 % of patients even in specialized centers.</p><p><strong>Methods: </strong> Description of typical surgical resection procedures and the resulting postoperative anatomy, typical normal postoperative findings, common postoperative complications, and radiological findings.</p><p><strong>Results and conclusion: </strong> CT is the most appropriate imaging technique for rapid and standardized visualization of postoperative anatomy and detection of clinically suspected complications after partial pancreatic resections. The most common complications are delayed gastric emptying, pancreatic fistula, acute pancreatitis, bile leakage, abscess, and hemorrhage. Radiologists must identify the typical surgical procedures, the postoperative anatomy, and normal postoperative findings as well as possible postoperative complications and know interventional treatment methods for common complications.</p><p><strong>Key points: </strong> · Morbidity after pancreatic surgery remains high.. · CT is the best method for visualizing postoperative anatomy and is used for early detection of complications.. · Pancreatic fistula is the most common relevant complication after pancreatic resection.. · The ability of a center to manage complications is crucial to ensure the success of therapy..</p><p><strong>Citation format: </strong>· Fischbach R, Peller M, Perez D et al. The postsurgical pancreas. Fortschr Röntgenstr 2024; 196: 1037 - 1045.</p>","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":" ","pages":"1037-1045"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Hibernoma of the lower extremity: a rare lipomatous tumor that can mimic liposarcoma on PET/CT imaging].","authors":"Manoj Kakkassery, Susanne Weber-Kuhn, Maya Niethard","doi":"10.1055/a-2289-4370","DOIUrl":"10.1055/a-2289-4370","url":null,"abstract":"","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":" ","pages":"1071-1073"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-02-19DOI: 10.1055/a-2254-5536
Katja Döring, Philipp Ivanyi, Heinrich Lanfermann, Athanasia Warnecke, Anja Giesemann
Purpose: With an incidence between 1-9/100 000 per year, Langerhans cell histiocytosis (LCH) is a rather rare disease from the hemato-oncologic disease spectrum (Hayes et al. 2009). The tumorlike disease with proliferation of histiocytic cells may manifest as localized to one organ or disseminated with infiltration of a wide variety of organs. Approximately 25-30 % of these cases show involvement of the temporal bone (Ni et al. 2017).
Case description: With vertigo persisting for three years, chronic mastoiditis, and acute progressive hearing loss bilaterally (r > l) for three weeks, a 41-year-old woman presented at an emergency department. The DVT showed extensive bony destruction of large parts of the temporal bone on both sides, involving the vestibular organ, the cochlea, and the internal auditory canal. To confirm the suspicion of a systemic inflammatory process, a PE was performed from the mastoid with bioptic confirmation of an LCH. Systemic therapy was initiated. Post-therapeutic imaging showed almost complete remission with reossification of the preexisting defect zones and the internal auditory canal and labyrinth structures again showed bony margins. Clinically, there was an improvement of the vegetative symptoms with remaining bilateral sensorineural hearing loss.
Discussion: LCH of the temporal bone is a rare and often misdiagnosed disease due to its nonspecific clinical presentation. Awareness of temporal bone LCH and its occurrence in adults is essential for accurate and consistent diagnosis.
Key points: · LCH is a rather rare disease from the hemato-oncological spectrum. · Affection of the temporal bone, especially such an extensive one (as in this case report), is rather atypical in adulthood. · Use of systemic therapy resulted in remission. · There was complete reossification of the osseous structures post-therapy. · A cochlear implant was able to be implanted to compensate for hearing loss.
{"title":"Langerhans cell histiocytosis involving the temporal bone with destruction and subsequent reossification of the bony labyrinth boundaries.","authors":"Katja Döring, Philipp Ivanyi, Heinrich Lanfermann, Athanasia Warnecke, Anja Giesemann","doi":"10.1055/a-2254-5536","DOIUrl":"10.1055/a-2254-5536","url":null,"abstract":"<p><strong>Purpose: </strong> With an incidence between 1-9/100 000 per year, Langerhans cell histiocytosis (LCH) is a rather rare disease from the hemato-oncologic disease spectrum (Hayes et al. 2009). The tumorlike disease with proliferation of histiocytic cells may manifest as localized to one organ or disseminated with infiltration of a wide variety of organs. Approximately 25-30 % of these cases show involvement of the temporal bone (Ni et al. 2017).</p><p><strong>Case description: </strong> With vertigo persisting for three years, chronic mastoiditis, and acute progressive hearing loss bilaterally (r > l) for three weeks, a 41-year-old woman presented at an emergency department. The DVT showed extensive bony destruction of large parts of the temporal bone on both sides, involving the vestibular organ, the cochlea, and the internal auditory canal. To confirm the suspicion of a systemic inflammatory process, a PE was performed from the mastoid with bioptic confirmation of an LCH. Systemic therapy was initiated. Post-therapeutic imaging showed almost complete remission with reossification of the preexisting defect zones and the internal auditory canal and labyrinth structures again showed bony margins. Clinically, there was an improvement of the vegetative symptoms with remaining bilateral sensorineural hearing loss.</p><p><strong>Discussion: </strong> LCH of the temporal bone is a rare and often misdiagnosed disease due to its nonspecific clinical presentation. Awareness of temporal bone LCH and its occurrence in adults is essential for accurate and consistent diagnosis.</p><p><strong>Key points: </strong> · LCH is a rather rare disease from the hemato-oncological spectrum. · Affection of the temporal bone, especially such an extensive one (as in this case report), is rather atypical in adulthood. · Use of systemic therapy resulted in remission. · There was complete reossification of the osseous structures post-therapy. · A cochlear implant was able to be implanted to compensate for hearing loss.</p>","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":" ","pages":"1063-1067"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-09-18DOI: 10.1055/a-2374-3707
{"title":"Fit fürs Radiologie-PJ: Ein innovatives Filmprojekt für Medizinstudierende.","authors":"","doi":"10.1055/a-2374-3707","DOIUrl":"10.1055/a-2374-3707","url":null,"abstract":"","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":"196 10","pages":"1076-1077"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-09-18DOI: 10.1055/a-2374-3407
{"title":"RÖKO 2025 – Abstract-Einreichung bis 4. November 2024 geöffnet!","authors":"","doi":"10.1055/a-2374-3407","DOIUrl":"10.1055/a-2374-3407","url":null,"abstract":"","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":"196 10","pages":"1074"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-09-18DOI: 10.1055/a-2374-3470
{"title":"Neue Anforderungen an den ärztlichen Leiter im Medizinischen Versorgungszentrum (Ergänzung zu RöFo 04/2024).","authors":"","doi":"10.1055/a-2374-3470","DOIUrl":"10.1055/a-2374-3470","url":null,"abstract":"","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":"196 10","pages":"1081-1083"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-09-18DOI: 10.1055/a-2374-4005
{"title":"Strahlenschutzkurse.","authors":"","doi":"10.1055/a-2374-4005","DOIUrl":"10.1055/a-2374-4005","url":null,"abstract":"","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":"196 10","pages":"1078"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-02-26DOI: 10.1055/a-2238-6462
Marius Horger, Georg Gohla, Eva-Maria Konrad, David Baur, Markus Kowarik, Nick Farhang, Christer Ruff, Stefan Heckl
{"title":"[The many different faces of MOGAD in the MRI: From FUEL to FLAMES].","authors":"Marius Horger, Georg Gohla, Eva-Maria Konrad, David Baur, Markus Kowarik, Nick Farhang, Christer Ruff, Stefan Heckl","doi":"10.1055/a-2238-6462","DOIUrl":"10.1055/a-2238-6462","url":null,"abstract":"","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":" ","pages":"1005-1009"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-03-13DOI: 10.1055/a-2234-0333
Annette Thurner, Dominik Peter, Giulia Dalla Torre, Sven Flemming, Ralph Kickuth
Purpose: To evaluate the efficacy and safety of percutaneous rotational thrombectomy-assisted endovascular revascularization of acute thromboembolic superior mesenteric artery occlusions in acute mesenteric ischemia.
Materials and methods: Fifteen cases of percutaneous rotational thrombectomy- assisted (Rotarex S, BD, USA) revascularization were retrospectively analyzed. The etiology was embolic in 40 % of cases and thrombotic in 60 %. A "Thrombectomy in Visceral Ischemia" (TIVI) 5-point score determined vessel patency at presentation, after percutaneous rotational thrombectomy, and after adjunctive technologies. TIVI 3 indicated nearly complete revascularization (minimal residual side branch thrombus). TIVI 4 indicated complete revascularization. Technical success was defined as successful device application and a final TIVI score of 3/4 after adjunctive technologies. Safety and outcome were also analyzed.
Results: Device application via femoral access was feasible in 100 % of cases and improved flow in 86.7 % of cases (1 × TIVI 0→1, 11 × TIVI 0→2, 1 × TIVI 1→2). There was no change in 13.3 % of cases (2 × TIVI 2→2). Additional devices resulted in further flow improvement in 93.3 % of cases (8 × TIVI 3, 6 × TIVI 4). One recanalization failed (TIVI 2→2→2). After adjunctive technologies (10 × manual aspiration, 11 × angioplasty, 9 × stenting), the technical success rate was 93.3 %. The mean procedure time was 40.5(± 14) minutes for embolism and 72.1(± 20) minutes for thrombosis. There was one device-related major complication (catheter tip fracture) resulting in a device-related safety rate of 93.3 %. The overall major complication rate was 20 %. Surgical exploration (13 ×), bowel resection (9 ×) and Fogarty embolectomy/bypass (3 ×) were also performed. The 30-day mortality rate was 40 %.
Conclusion: Percutaneous rotational thrombectomy is an effective adjunct for rapid endovascular recanalization of acute thromboembolic superior mesenteric artery occlusions with an acceptable rate of major procedural complications.
Key points: · Percutaneous rotational thrombectomy-assisted superior mesenteric artery revascularization in acute occlusive mesenteric ischemia is feasible and effective.. · Percutaneous rotational thrombectomy facilitates rapid flow restoration in native and stented superior mesenteric artery segments.. · Brachial access should be considered in the case of steep take-off angles of the superior mesenteric artery..
{"title":"Safety, Efficacy and Outcome of Rotational Thrombectomy assisted Endovascular Revascularisation of the Superior Mesenteric Artery in Acute Thromboembolic Mesenteric Ischaemia.","authors":"Annette Thurner, Dominik Peter, Giulia Dalla Torre, Sven Flemming, Ralph Kickuth","doi":"10.1055/a-2234-0333","DOIUrl":"10.1055/a-2234-0333","url":null,"abstract":"<p><strong>Purpose: </strong> To evaluate the efficacy and safety of percutaneous rotational thrombectomy-assisted endovascular revascularization of acute thromboembolic superior mesenteric artery occlusions in acute mesenteric ischemia.</p><p><strong>Materials and methods: </strong> Fifteen cases of percutaneous rotational thrombectomy- assisted (Rotarex S, BD, USA) revascularization were retrospectively analyzed. The etiology was embolic in 40 % of cases and thrombotic in 60 %. A \"Thrombectomy in Visceral Ischemia\" (TIVI) 5-point score determined vessel patency at presentation, after percutaneous rotational thrombectomy, and after adjunctive technologies. TIVI 3 indicated nearly complete revascularization (minimal residual side branch thrombus). TIVI 4 indicated complete revascularization. Technical success was defined as successful device application and a final TIVI score of 3/4 after adjunctive technologies. Safety and outcome were also analyzed.</p><p><strong>Results: </strong> Device application via femoral access was feasible in 100 % of cases and improved flow in 86.7 % of cases (1 × TIVI 0→1, 11 × TIVI 0→2, 1 × TIVI 1→2). There was no change in 13.3 % of cases (2 × TIVI 2→2). Additional devices resulted in further flow improvement in 93.3 % of cases (8 × TIVI 3, 6 × TIVI 4). One recanalization failed (TIVI 2→2→2). After adjunctive technologies (10 × manual aspiration, 11 × angioplasty, 9 × stenting), the technical success rate was 93.3 %. The mean procedure time was 40.5(± 14) minutes for embolism and 72.1(± 20) minutes for thrombosis. There was one device-related major complication (catheter tip fracture) resulting in a device-related safety rate of 93.3 %. The overall major complication rate was 20 %. Surgical exploration (13 ×), bowel resection (9 ×) and Fogarty embolectomy/bypass (3 ×) were also performed. The 30-day mortality rate was 40 %.</p><p><strong>Conclusion: </strong> Percutaneous rotational thrombectomy is an effective adjunct for rapid endovascular recanalization of acute thromboembolic superior mesenteric artery occlusions with an acceptable rate of major procedural complications.</p><p><strong>Key points: </strong> · Percutaneous rotational thrombectomy-assisted superior mesenteric artery revascularization in acute occlusive mesenteric ischemia is feasible and effective.. · Percutaneous rotational thrombectomy facilitates rapid flow restoration in native and stented superior mesenteric artery segments.. · Brachial access should be considered in the case of steep take-off angles of the superior mesenteric artery..</p>","PeriodicalId":21490,"journal":{"name":"Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren","volume":" ","pages":"1055-1062"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}