A. Ierardi, G. Colletti, P. Biondetti, M. Dessy, G. Carrafiello
PURPOSE Evaluation of safety and efficacy of percutaneous sclerotherapy using gelified ethanol in patients with low-flow malformations. METHODS A retrospective study was performed, analyzing treatment and outcome data of 6 patients that presented with 7 low-flow malformations (LF-Ms) (3 lymphatic and 3 venous). Median diameter of LF-Ms was 6 cm (iqr 4.5-8.5 cm). Data regarding pain, functional and/or cosmetic issues were assessed. Diagnosis was performed clinically and confirmed Doppler Ultrasound, while extension of disease was assessed by Magnetic Resonance Imaging (MRI). Percutaneous puncture was performed with 23G needle directly or with ultrasound guidance. All the LF-Ms were treated with gelified ethanol injection. The median volume injected per treatment session resulted 4.4 mL. RESULTS Technical and clinical success were obtained in all cases. No recurrences were registered during a median follow up of 17 months (iqr 12-19 months). Among the 6 patients, 83% of the patients had complete relief (5/6) and the other showed improvement of symptoms. The median VAS score was 7 (iqr 6-7.5) before and 0 (iqr 0-0) after treatment. All patients had functional and aesthetic improvement (100%). Four patients (66.7%) had a very good acceptance and two patients (33.3%) a good acceptance. No major complications neither systemic side effects were observed. CONCLUSION Gelified ethanol may be considered easy to handle, well-tolerated, safe and effective in the short-term follow up. Longer follow up efficacy is mandatory for further conclusions.
{"title":"Percutaneous sclerotherapy with gelified ethanol of low-flow vascular malformations of the head and neck region: preliminary results.","authors":"A. Ierardi, G. Colletti, P. Biondetti, M. Dessy, G. Carrafiello","doi":"10.5152/dir.2019.18542","DOIUrl":"https://doi.org/10.5152/dir.2019.18542","url":null,"abstract":"PURPOSE\u0000Evaluation of safety and efficacy of percutaneous sclerotherapy using gelified ethanol in patients with low-flow malformations.\u0000\u0000\u0000METHODS\u0000A retrospective study was performed, analyzing treatment and outcome data of 6 patients that presented with 7 low-flow malformations (LF-Ms) (3 lymphatic and 3 venous). Median diameter of LF-Ms was 6 cm (iqr 4.5-8.5 cm). Data regarding pain, functional and/or cosmetic issues were assessed. Diagnosis was performed clinically and confirmed Doppler Ultrasound, while extension of disease was assessed by Magnetic Resonance Imaging (MRI). Percutaneous puncture was performed with 23G needle directly or with ultrasound guidance. All the LF-Ms were treated with gelified ethanol injection. The median volume injected per treatment session resulted 4.4 mL.\u0000\u0000\u0000RESULTS\u0000Technical and clinical success were obtained in all cases. No recurrences were registered during a median follow up of 17 months (iqr 12-19 months). Among the 6 patients, 83% of the patients had complete relief (5/6) and the other showed improvement of symptoms. The median VAS score was 7 (iqr 6-7.5) before and 0 (iqr 0-0) after treatment. All patients had functional and aesthetic improvement (100%). Four patients (66.7%) had a very good acceptance and two patients (33.3%) a good acceptance. No major complications neither systemic side effects were observed.\u0000\u0000\u0000CONCLUSION\u0000Gelified ethanol may be considered easy to handle, well-tolerated, safe and effective in the short-term follow up. Longer follow up efficacy is mandatory for further conclusions.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46696783","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}
Calcific tendinitis is a well-documented and extensively studied disease in the literature. Intramuscular and intraosseous migration are rare complications, which may present diagnostic challenges. This pictorial essay illustrates the imaging findings of these complications. Considering that neoplastic processes and infectious diseases are included in the differential diagnosis, recognizing the imaging findings of these complications is of critical importance.
{"title":"Calcific tendinitis: intramuscular and intraosseous migration.","authors":"C. Kalaycı, E. Kızılkaya","doi":"10.5152/DIR.2019.18593","DOIUrl":"https://doi.org/10.5152/DIR.2019.18593","url":null,"abstract":"Calcific tendinitis is a well-documented and extensively studied disease in the literature. Intramuscular and intraosseous migration are rare complications, which may present diagnostic challenges. This pictorial essay illustrates the imaging findings of these complications. Considering that neoplastic processes and infectious diseases are included in the differential diagnosis, recognizing the imaging findings of these complications is of critical importance.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/DIR.2019.18593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45470671","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}
M. Kamo, R. Miyazawa, Tomoya Nisiyama, Kenji Nakamura, Kunihiro Yagihashi
Pancreaticojejunal anastomotic leakage is one of the severe complications after pancreaticoduodenectomy and is often difficult to manage. A 64-year-old man status post pancreaticoduodenectomy had the gastroduodenal artery stump bleeding caused by the pancreaticojejunal anastomotic leakage, successfully treated by placing a covered stent. To control the leakage, subsequent percutaneous transgastric pancreatic duct puncture was performed under fluoroscopic guidance, targeting a surgically placed pancreaticojejunal internal drainage catheter. A 5 F catheter with side holes was inserted into the main pancreatic duct, the tip of which was placed in the anastomosed jejunum. The leak was successfully treated using this catheter. Percutaneous transgastric pancreatic duct drainage might be a useful and feasible option to resolve the condition.
{"title":"Percutaneous transgastric pancreatic-duct drainage for pancreaticojejunal leak after pancreaticoduodenectomy.","authors":"M. Kamo, R. Miyazawa, Tomoya Nisiyama, Kenji Nakamura, Kunihiro Yagihashi","doi":"10.5152/DIR.2019.19038","DOIUrl":"https://doi.org/10.5152/DIR.2019.19038","url":null,"abstract":"Pancreaticojejunal anastomotic leakage is one of the severe complications after pancreaticoduodenectomy and is often difficult to manage. A 64-year-old man status post pancreaticoduodenectomy had the gastroduodenal artery stump bleeding caused by the pancreaticojejunal anastomotic leakage, successfully treated by placing a covered stent. To control the leakage, subsequent percutaneous transgastric pancreatic duct puncture was performed under fluoroscopic guidance, targeting a surgically placed pancreaticojejunal internal drainage catheter. A 5 F catheter with side holes was inserted into the main pancreatic duct, the tip of which was placed in the anastomosed jejunum. The leak was successfully treated using this catheter. Percutaneous transgastric pancreatic duct drainage might be a useful and feasible option to resolve the condition.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/DIR.2019.19038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41432220","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}
Acutely ruptured atherosclerotic plaques with adjacent floating clot within the internal carotid artery in patients suffering from extra-/intracranial tandem lesions are often treated with stent-assisted balloon angioplasty. We present a strategy to retrieve the extracranial thrombus using the "stent retriever assisted vacuum-locked extraction" (SAVE) method, which initially was described for the intracranial vasculature. The extracranial SAVE (eSAVE) method could be an additional tool for the treatment of acute tandem lesions.
{"title":"Retrieval of floating clot in the internal carotid artery: extracranial SAVE technique (eSAVE).","authors":"M. Psychogios, V. Maus","doi":"10.5152/dir.2019.19093","DOIUrl":"https://doi.org/10.5152/dir.2019.19093","url":null,"abstract":"Acutely ruptured atherosclerotic plaques with adjacent floating clot within the internal carotid artery in patients suffering from extra-/intracranial tandem lesions are often treated with stent-assisted balloon angioplasty. We present a strategy to retrieve the extracranial thrombus using the \"stent retriever assisted vacuum-locked extraction\" (SAVE) method, which initially was described for the intracranial vasculature. The extracranial SAVE (eSAVE) method could be an additional tool for the treatment of acute tandem lesions.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.19093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46130377","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}
PURPOSE Percutaneous cementoplasty is a minimally invasive treatment modality for painful osteoporotic and pathologic sacral and supra-acetabular iliac fractures. This study compares the use of low-dose CT guidance with CT/CT fluoroscopy in sacral and supra-acetabular cementoplasty. METHODS A retrospective review of patients who had undergone sacral or supra-acetabular cementoplasty was performed with patients grouped by use of CT/CT Fluoroscopy or low-dose CT guidance during the procedure. Parameters evaluated included type of fracture, laterality of lesions, pain scores, pain medication use, imaging parameters, procedure time, dose length product, effective dose, cement volume, and complications. RESULTS There were 17 patients identified who underwent cementoplasty utilizing dual CT/CT Fluoroscopy, while 13 patients had their procedures performed with low-dose CT. There was a statistically significant decrease in radiation dose in the low-dose CT group (1481 mGy-cm) compared to the CT/CT Fluoroscopy group (2809mGy-cm) (P = 0.013). There was a significant decrease in procedure time with low-dose CT for bilateral lesions (P = 0.016). There was no significant difference between groups in complication rate (P = 0.999). Non-clinically significant cement extravasation occurred in two patients (10%) in the CT/CT Fluoroscopy group and in one patient (8%) in the low-dose CT group (P = 0.999). There was a significant decrease in pain scores compared to baseline on the Visual Analogue Scale in both groups at 1 week (low-dose CT P = 0.002, CT/CTF P = 0.008) and 1 month post-procedure (low dose CT P = 0.014, CT/CTF P = 0.004), but no difference between groups at 1 day (P = 0.196), 1 week (P = 0.368), or 1 month (P = 0.514). CONCLUSION Sacral and supra-acetabular cementoplasties can be performed safely and precisely using low dose multiple-acquisition CT guidance while providing significant radiation dose reduction with no difference in extravasation rates, post-procedural pain reduction and complications compared to CT/CT Fluoroscopy.
{"title":"Comparison of low-dose CT with CT/CT Fluoroscopy guidance in percutaneous sacral and supra-acetabular cementoplasty.","authors":"Veer A Shah, T. Hillen, J. Jennings","doi":"10.5152/dir.2019.18362","DOIUrl":"https://doi.org/10.5152/dir.2019.18362","url":null,"abstract":"PURPOSE\u0000Percutaneous cementoplasty is a minimally invasive treatment modality for painful osteoporotic and pathologic sacral and supra-acetabular iliac fractures. This study compares the use of low-dose CT guidance with CT/CT fluoroscopy in sacral and supra-acetabular cementoplasty.\u0000\u0000\u0000METHODS\u0000A retrospective review of patients who had undergone sacral or supra-acetabular cementoplasty was performed with patients grouped by use of CT/CT Fluoroscopy or low-dose CT guidance during the procedure. Parameters evaluated included type of fracture, laterality of lesions, pain scores, pain medication use, imaging parameters, procedure time, dose length product, effective dose, cement volume, and complications.\u0000\u0000\u0000RESULTS\u0000There were 17 patients identified who underwent cementoplasty utilizing dual CT/CT Fluoroscopy, while 13 patients had their procedures performed with low-dose CT. There was a statistically significant decrease in radiation dose in the low-dose CT group (1481 mGy-cm) compared to the CT/CT Fluoroscopy group (2809mGy-cm) (P = 0.013). There was a significant decrease in procedure time with low-dose CT for bilateral lesions (P = 0.016). There was no significant difference between groups in complication rate (P = 0.999). Non-clinically significant cement extravasation occurred in two patients (10%) in the CT/CT Fluoroscopy group and in one patient (8%) in the low-dose CT group (P = 0.999). There was a significant decrease in pain scores compared to baseline on the Visual Analogue Scale in both groups at 1 week (low-dose CT P = 0.002, CT/CTF P = 0.008) and 1 month post-procedure (low dose CT P = 0.014, CT/CTF P = 0.004), but no difference between groups at 1 day (P = 0.196), 1 week (P = 0.368), or 1 month (P = 0.514).\u0000\u0000\u0000CONCLUSION\u0000Sacral and supra-acetabular cementoplasties can be performed safely and precisely using low dose multiple-acquisition CT guidance while providing significant radiation dose reduction with no difference in extravasation rates, post-procedural pain reduction and complications compared to CT/CT Fluoroscopy.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42220139","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}
J. Omari, R. Drewes, Max Othmer, P. Hass, M. Pech, M. Powerski
PURPOSE To evaluate the safety and efficacy of image guided high-dose-rate interstitial brachytherapy (IBT) concerning the treatment of patients with hepatic, lymphatic and pancreatic metastases originating from gastric cancer - an entity rarely surgically treatable with curative intent. METHODS Twelve patients with a cumulative number of 36 metastases (liver: 29, pancreatic: 2, lymph nodes: 5) from histologically proven gastric adenocarcinoma received treatment with IBT between 2010 and 2016 and were retrospectively analyzed. Every patient underwent palliative chemotherapy prior to the IBT procedure. IBT employs a temporarily, intratumorally placed 192iridium source in a single fraction with the goal of tumor cell eradication. Efficacy was assessed clinically and by acquisition of CT/MRI every three months. RESULTS Local tumor control (LTC) was achieved in 32 (89%) of all treated metastases. Four lesions showed a local recurrence after 7 months. Lesion sizes varied from 9 to 102 mm with a median of 20 mm. The median progression free survival was 6.6 months (range 1.8-46.8 months). The median overall survival was 11.4 months (range 5-47 months). One patient suffered a major complication following IBT - hepatic hematoma and abscess (Common Terminology Criteria for Adverse Events grade 3), successfully dealt with by transcutaneous drainage. CONCLUSION IBT is an overall safe procedure, which facilitates high rates of local tumor control in treatment of metastatic gastric adenocarcinoma. Compared to surgical metastasectomy, similar overall survival rates could be achieved in our patient collective after IBT application.
{"title":"Treatment of metastatic gastric adenocarcinoma with image guided high-dose-rate, interstitial brachytherapy as second line or salvage therapy.","authors":"J. Omari, R. Drewes, Max Othmer, P. Hass, M. Pech, M. Powerski","doi":"10.5152/dir.2019.18390","DOIUrl":"https://doi.org/10.5152/dir.2019.18390","url":null,"abstract":"PURPOSE\u0000To evaluate the safety and efficacy of image guided high-dose-rate interstitial brachytherapy (IBT) concerning the treatment of patients with hepatic, lymphatic and pancreatic metastases originating from gastric cancer - an entity rarely surgically treatable with curative intent.\u0000\u0000\u0000METHODS\u0000Twelve patients with a cumulative number of 36 metastases (liver: 29, pancreatic: 2, lymph nodes: 5) from histologically proven gastric adenocarcinoma received treatment with IBT between 2010 and 2016 and were retrospectively analyzed. Every patient underwent palliative chemotherapy prior to the IBT procedure. IBT employs a temporarily, intratumorally placed 192iridium source in a single fraction with the goal of tumor cell eradication. Efficacy was assessed clinically and by acquisition of CT/MRI every three months.\u0000\u0000\u0000RESULTS\u0000Local tumor control (LTC) was achieved in 32 (89%) of all treated metastases. Four lesions showed a local recurrence after 7 months. Lesion sizes varied from 9 to 102 mm with a median of 20 mm. The median progression free survival was 6.6 months (range 1.8-46.8 months). The median overall survival was 11.4 months (range 5-47 months). One patient suffered a major complication following IBT - hepatic hematoma and abscess (Common Terminology Criteria for Adverse Events grade 3), successfully dealt with by transcutaneous drainage.\u0000\u0000\u0000CONCLUSION\u0000IBT is an overall safe procedure, which facilitates high rates of local tumor control in treatment of metastatic gastric adenocarcinoma. Compared to surgical metastasectomy, similar overall survival rates could be achieved in our patient collective after IBT application.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48514254","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}
R. Iezzi, A. Posa, B. Merlino, M. Pompili, E. Annicchiarico, E. Rodolfino, M. Basso, A. Cassano, A. Gasbarrini, R. Manfredi
PURPOSE To analyze transradial approach (TRA) learning curve on patients undergoing hepatic chemoembolization, investigating the relationship between procedural volumes and various benchmarks of procedural success. METHODS We enrolled sixty consecutive patients who received two unilobar hepatic chemoembolization within a 4-week interval performed by a single interventional radiologist, highly-trained in conventional transfemoral procedures (TFA), but without any previous practical experience in TRA procedures and with a preliminary 2-days theoretical training only. We divided the study population, prospectively consecutively random-enrolled, into 3 groups: A (case 1 to 20), B (case 21 to 40), and C (case 41 to 60), using all TFA procedures performed by the same operator in the same series of patients as the control group. Primary endpoint was to analyze the relationship between TRA procedure operator experience and benchmarks of procedural success, to define the optimal procedural learning curve. RESULTS Technical success was obtained in all patients, with a cross-over rate (radial to femoral access) of 0%. An association between incremental TRA operator experience (in terms of performed procedures) and decrease of preparation, puncture, fluoroscopy, and total examination times was observed. Similarly, inverse associations between incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 0.001) were also observed. Compared to TFA, CM volumes and RD values were significantly higher only in group A (1-20). Procedure success remained high in all TRA groups and no significant association between TRA incremental experience and post-procedural outcomes was found. Higher post-procedural complaints at the access route and more limitations in performing basic activities were recorded in TFA vs TRA patients (P < 0.001). CONCLUSION TRA catheterizations can be safely performed in patients treated for liver cancer embolization after a relatively short training in controlled conditions and with a better performance in comparison with TFA. Operator proficiency improves with greated TRA experience, with a threshold needed to overcome the learning curve represented by about 20 procedures.
{"title":"Operator learning curve for transradial liver cancer embolization: implications for the initiation of a transradial access program.","authors":"R. Iezzi, A. Posa, B. Merlino, M. Pompili, E. Annicchiarico, E. Rodolfino, M. Basso, A. Cassano, A. Gasbarrini, R. Manfredi","doi":"10.5152/dir.2019.18437","DOIUrl":"https://doi.org/10.5152/dir.2019.18437","url":null,"abstract":"PURPOSE\u0000To analyze transradial approach (TRA) learning curve on patients undergoing hepatic chemoembolization, investigating the relationship between procedural volumes and various benchmarks of procedural success.\u0000\u0000\u0000METHODS\u0000We enrolled sixty consecutive patients who received two unilobar hepatic chemoembolization within a 4-week interval performed by a single interventional radiologist, highly-trained in conventional transfemoral procedures (TFA), but without any previous practical experience in TRA procedures and with a preliminary 2-days theoretical training only. We divided the study population, prospectively consecutively random-enrolled, into 3 groups: A (case 1 to 20), B (case 21 to 40), and C (case 41 to 60), using all TFA procedures performed by the same operator in the same series of patients as the control group. Primary endpoint was to analyze the relationship between TRA procedure operator experience and benchmarks of procedural success, to define the optimal procedural learning curve.\u0000\u0000\u0000RESULTS\u0000Technical success was obtained in all patients, with a cross-over rate (radial to femoral access) of 0%. An association between incremental TRA operator experience (in terms of performed procedures) and decrease of preparation, puncture, fluoroscopy, and total examination times was observed. Similarly, inverse associations between incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 0.001) were also observed. Compared to TFA, CM volumes and RD values were significantly higher only in group A (1-20). Procedure success remained high in all TRA groups and no significant association between TRA incremental experience and post-procedural outcomes was found. Higher post-procedural complaints at the access route and more limitations in performing basic activities were recorded in TFA vs TRA patients (P < 0.001).\u0000\u0000\u0000CONCLUSION\u0000TRA catheterizations can be safely performed in patients treated for liver cancer embolization after a relatively short training in controlled conditions and with a better performance in comparison with TFA. Operator proficiency improves with greated TRA experience, with a threshold needed to overcome the learning curve represented by about 20 procedures.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42821766","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}
Percutaneous transluminal angioplasty (PTA) is a routine procedure for the treatment of peripheral arterial disease. However, its main limitation is late restenosis occurring at a 1-year rate of 6%-60%. Restenosis arises from injury to the arterial wall including overstretching, compression and rupture of the atherosclerotic plaque during balloon inflation. It is hypothesized that better long-term angioplasty results are observed if atherosclerotic plaques are removed rather than compressed and fractured. Laser angioplasty is one method to remove atherosclerotic plaques. We discuss the principles of lasers, physical properties of laser light, history of laser angioplasty and effects of laser radiation on tissues. Large clinical studies using laser angioplasty are critically assessed. In comparison to conventional PTA, there are some advantages of laser angioplasty: easier passage through chronic and calcified occlusions and according to some studies, better short- and medium-term results regarding limb salvage and management of in-stent restenoses. The main drawback of laser angioplasty is that current laser catheters are not able to create a sufficiently wide channel in the occlusion, meaning that adjunctive balloon dilatation is still required. Thus, long-term data may be misleading. Basic and applied research should continue to focus on enlargement of plaque ablation.
{"title":"Laser angioplasty of peripheral arteries: basic principles, current clinical studies, and future directions.","authors":"F. Stanek","doi":"10.5152/dir.2019.18515","DOIUrl":"https://doi.org/10.5152/dir.2019.18515","url":null,"abstract":"Percutaneous transluminal angioplasty (PTA) is a routine procedure for the treatment of peripheral arterial disease. However, its main limitation is late restenosis occurring at a 1-year rate of 6%-60%. Restenosis arises from injury to the arterial wall including overstretching, compression and rupture of the atherosclerotic plaque during balloon inflation. It is hypothesized that better long-term angioplasty results are observed if atherosclerotic plaques are removed rather than compressed and fractured. Laser angioplasty is one method to remove atherosclerotic plaques. We discuss the principles of lasers, physical properties of laser light, history of laser angioplasty and effects of laser radiation on tissues. Large clinical studies using laser angioplasty are critically assessed. In comparison to conventional PTA, there are some advantages of laser angioplasty: easier passage through chronic and calcified occlusions and according to some studies, better short- and medium-term results regarding limb salvage and management of in-stent restenoses. The main drawback of laser angioplasty is that current laser catheters are not able to create a sufficiently wide channel in the occlusion, meaning that adjunctive balloon dilatation is still required. Thus, long-term data may be misleading. Basic and applied research should continue to focus on enlargement of plaque ablation.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18515","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47948316","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}
F. Kuo, Jonathan K. Park, Kira Chow, Alice Chen, M. Walsworth
Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually are not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arteria access sites to avoid injury.
{"title":"Avoiding peripheral nerve injury in arterial interventions.","authors":"F. Kuo, Jonathan K. Park, Kira Chow, Alice Chen, M. Walsworth","doi":"10.5152/dir.2019.18296","DOIUrl":"https://doi.org/10.5152/dir.2019.18296","url":null,"abstract":"Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually are not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arteria access sites to avoid injury.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48936009","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}
M. Perelló, Javier Pueyo Mur, M. Vives, Juan Manuel Martinez Riutort, Asuncion Pastor Artigues, C. Garcia, Maria Lucia Bonet Vidal, Ana Escarda Gelabet, M. Garau
PURPOSE We aimed to retrospectively evaluate the long-term clinical and patency results after the placement of transjugular intrahepatic portosystemic shunts (TIPS) using stent-graft. Many studies show the clinical results and the patency follow-up of TIPS with stent-graft in the short and medium term. However, few studies show long-term results. METHODS Between 2002 and 2016, TIPS with stent-grafts were placed in 132 patients. The median age was 59.5 years. The median Model for End-stage Liver Disease (MELD) score was 13, and 71% were Child-Pugh B. Indications for TIPS were bleeding (83%) and ascites or hydrothorax (17%). The technical and clinical success rates were calculated, as were the rates of patency, survival and complications. The median follow-up period was 43 months. RESULTS The technical success rate was 98%, and the clinical success rates were 85% in patients with indication for bleeding and 95% in patients with indication for ascites or hydrothorax. Primary patency did not decrease from 66% after 6 years (95% confidence interval [CI], 56.2%-75.8%) primary assisted patency remained stable at 87% after 6 years (95% CI, 77.2%-96.8%) and secondary patency did not decrease from 98% after 4 years (95% CI, 95.1%-100%). The median overall survival was 42.8 months (95% CI, 33.8-51.8 months). A total of 54 patients suffered some type of complication, minor (28 patients) or major (26 patients), during the follow-up. CONCLUSION The clinical success rate was high. The choice of the maximum initial limit of portosystemic gradient and the diameter of the post-TIPS shunt, together with the number of shunt reductions, are important to be able to compare results between publications. In our study, the patency rates did not decrease after 6 years; hence, long-term follow-up of these patients may not be necessary.
{"title":"Long-term follow-up of transjugular intrahepatic portosystemic shunt (TIPS) with stent-graft.","authors":"M. Perelló, Javier Pueyo Mur, M. Vives, Juan Manuel Martinez Riutort, Asuncion Pastor Artigues, C. Garcia, Maria Lucia Bonet Vidal, Ana Escarda Gelabet, M. Garau","doi":"10.5152/dir.2019.18416","DOIUrl":"https://doi.org/10.5152/dir.2019.18416","url":null,"abstract":"PURPOSE\u0000We aimed to retrospectively evaluate the long-term clinical and patency results after the placement of transjugular intrahepatic portosystemic shunts (TIPS) using stent-graft. Many studies show the clinical results and the patency follow-up of TIPS with stent-graft in the short and medium term. However, few studies show long-term results.\u0000\u0000\u0000METHODS\u0000Between 2002 and 2016, TIPS with stent-grafts were placed in 132 patients. The median age was 59.5 years. The median Model for End-stage Liver Disease (MELD) score was 13, and 71% were Child-Pugh B. Indications for TIPS were bleeding (83%) and ascites or hydrothorax (17%). The technical and clinical success rates were calculated, as were the rates of patency, survival and complications. The median follow-up period was 43 months.\u0000\u0000\u0000RESULTS\u0000The technical success rate was 98%, and the clinical success rates were 85% in patients with indication for bleeding and 95% in patients with indication for ascites or hydrothorax. Primary patency did not decrease from 66% after 6 years (95% confidence interval [CI], 56.2%-75.8%) primary assisted patency remained stable at 87% after 6 years (95% CI, 77.2%-96.8%) and secondary patency did not decrease from 98% after 4 years (95% CI, 95.1%-100%). The median overall survival was 42.8 months (95% CI, 33.8-51.8 months). A total of 54 patients suffered some type of complication, minor (28 patients) or major (26 patients), during the follow-up.\u0000\u0000\u0000CONCLUSION\u0000The clinical success rate was high. The choice of the maximum initial limit of portosystemic gradient and the diameter of the post-TIPS shunt, together with the number of shunt reductions, are important to be able to compare results between publications. In our study, the patency rates did not decrease after 6 years; hence, long-term follow-up of these patients may not be necessary.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48355243","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}
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