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Smith TP, Kim CY, Smith AD, Janas G, Miller MJ, Sopko DR, Suhocki PV. Hepatic venous pressure measurements: comparison of end-hole and balloon catheter methods. J Vasc Interv Radiol 2011; 23:219-26.e6. [PMID: 22209265 DOI: 10.1016/j.jvir.2011.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 09/18/2011] [Accepted: 09/21/2011] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine the difference in hepatic venous pressures measured with the use of an end-hole diagnostic catheter versus a balloon catheter. MATERIALS AND METHODS A total of 92 patients underwent transjugular hepatic venous pressure measurements with a 5-F diagnostic end-hole catheter and a balloon catheter, with the catheter type used initially determined randomly. With both catheters, free and wedged systolic, diastolic, and mean pressures were collected. Hepatic venous pressure gradients were calculated from each pressure set. Eighty-five patients (92%) also underwent concurrent transjugular biopsy after pressures were recorded. Demographic, histologic, and specific procedural information were also collected. RESULTS The study included 47 men and 45 women, with a mean age of 52.7 years (range, 19-84 y). For the entire population, there were statistically significant differences in mean measurements between the two catheters in wedged systolic (P = .004), diastolic (P = .021), and mean (P = .036) pressures. However, the differences between the means were only 0.783, 0.609, and 0.207 mm Hg, respectively. A subanalysis based on histologic stage revealed no difference between catheter types for normal or cirrhotic livers, but a significant (P = .017) difference in systolic wedged pressure (absolute difference of 0.67 mm Hg) in patients with mild to moderate fibrosis (stages 1-3). In all differences, the balloon catheter had the greater pressure reading. CONCLUSIONS There was a significant difference in wedged pressure measurements between the two catheter systems in the overall population and among patients with a histologic grade indicating fibrosis. However, the absolute value differences between the two systems were comparatively small (< 1 mm Hg).
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Kim CY, Patel MB, Miller MJ, Suhocki PV, Balius A, Smith TP. Gastrostomy-to-gastrojejunostomy tube conversion: impact of the method of original gastrostomy tube placement. J Vasc Interv Radiol 2010; 21:1031-7. [PMID: 20538477 DOI: 10.1016/j.jvir.2010.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 10/28/2009] [Accepted: 04/03/2010] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the outcome of gastrostomy tube-to-gastrojejunostomy tube conversion on the basis of the method of original gastrostomy tube placement. MATERIALS AND METHODS One hundred twenty-four patients (age range, 13-87 years; 72 male and 52 female patients) underwent conversion of a primarily placed gastrostomy tube to a gastrojejunostomy tube at the authors' institution between January 2000 and December 2008. The method of original gastrostomy tube placement was radiologic (n = 27), endoscopic (n = 75), laparoscopic (n = 2), or open surgery (n = 20). The method of placement was correlated with the success rates of gastrostomy-to-gastrojejunostomy tube conversion. Medical records and radiologic images were reviewed to determine the frequency of proximal migration of the jejunostomy tube into the stomach. Follow-up data were available for an average of 136 days after gastrostomy-to-gastrojejunostomy tube conversion (median, 63 days; range, 1-1,300 days). RESULTS Of 124 gastrostomy tube-to-gastrojejunostomy tube conversions, 109 (87.9%) were successfully performed. Procedural conversion failure occurred in one of the 27 radiologically inserted gastrostomy tubes (3.7%) compared to 14 of the 97 (14%) nonradiologically inserted gastrostomy tubes (P = .19), of which 12 were inserted endoscopically and two were inserted surgically. Of the 109 patients with successful tube conversion, jejunal tip malposition occurred at follow-up in 18 (16.5%). Of these, four patients developed aspiration pneumonia (22%), which contributed to patient death in two. The frequency of jejunal tip malposition was 3.8% (one of 26 patients) for radiologically placed gastrostomy tubes and 20% (17 of 83 patients) for nonradiologically placed gastrostomy tubes (P = .07). Combined, 32% of gastrostomy tubes placed nonradiologically resulted in either procedural failure or eventual jejunal tip malposition, compared to 7.4% of radiologically placed gastrostomy tubes (P = .01). CONCLUSIONS The frequency of procedural failure or eventual jejunal tip malposition with conversion of radiologically placed gastrostomy tubes to gastrojejunostomy tubes is significantly lower with radiologically placed gastrostomy tubes than with nonradiologically inserted gastrostomy tubes.
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Hirasaki KK, Watts JA, Suhocki PV. Wireless surveillance for transjugular intrahepatic portosystemic shunts (TIPS): a feasibility study. Acad Radiol 2010; 17:418-20. [PMID: 20207314 DOI: 10.1016/j.acra.2010.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/25/2010] [Accepted: 01/26/2010] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Shunt surveillance is a critical component of follow-up for patients with cirrhosis with transjugular intrahepatic portosystemic shunts (TIPS). Transabdominal Doppler ultrasound analysis of the shunt has been used as a noninvasive means of assessing shunt function. Doppler ultrasound analysis of the shunt is less sensitive than direct transjugular portosystemic pressure gradient measurement for detecting shunt failure. A wireless, noninvasive means of measuring the portosystemic pressure gradient in the clinic may facilitate follow-up in this group of patients. The aim of this study was to determine if two implanted wireless pressure sensors could accurately transmit a portosystemic pressure gradient across a TIPS. MATERIALS AND METHODS Two wireless microelectromechanical system pressure sensors were placed in a swine model for measuring the portosystemic pressure gradient across a TIPS. Catheter-based pressure transducers were also placed and used as the gold standard. Pressures from both systems were measured concurrently. RESULTS Wireless microelectromechanical system portal and systemic pressure measurements were accurate within +/-2 mm Hg (mean, 0.86 mm Hg) of the gold standard. CONCLUSION The use of wireless sensors may facilitate the surveillance of shunt function in patients with portal hypertension who have undergone placement of TIPS.
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Kim CY, Suhocki PV, Miller MJ, Khan M, Janus G, Smith TP. Provocative Mesenteric Angiography for Lower Gastrointestinal Hemorrhage: Results from a Single-institution Study. J Vasc Interv Radiol 2010; 21:477-83. [DOI: 10.1016/j.jvir.2009.11.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 10/26/2009] [Accepted: 11/30/2009] [Indexed: 12/21/2022] Open
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Suhocki PV, Smith AD, Tendler DA, Sexton DJ. Treatment of TIPS/biliary fistula-related endotipsitis with a covered stent. J Vasc Interv Radiol 2008; 19:937-9. [PMID: 18503911 DOI: 10.1016/j.jvir.2008.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 01/24/2008] [Accepted: 01/24/2008] [Indexed: 12/15/2022] Open
Abstract
"Infective endotipsitis" describes a recurrent bacteremia or fungemia in patients with a transjugular intrahepatic portosystemic shunt (TIPS) in place and no other identifiable source of infection. The present report describes a patient who developed polymicrobial endotipsitis 6 years after TIPS creation. Blood cultures remained positive for polymicrobial growth despite long courses of antibiotic therapy. Communication between the TIPS and an infected biliary tree, precipitated by cholecystitis, was ultimately recognized. The biliary/TIPS fistula was closed with a polytetrafluoroethylene-covered stent. The patient remains asymptomatic and follow-up blood cultures remain negative with a low dose of oral antibiotics 2 years after the procedure.
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Stavas JM, Smith TP, DeLong DM, Miller MJ, Suhocki PV, Newman GE. Radiation hand exposure during restoration of flow to the thrombosed dialysis access graft. J Vasc Interv Radiol 2007; 17:1611-7. [PMID: 17057002 DOI: 10.1097/01.rvi.0000236842.49430.bd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine radiation dose to the hands of interventional radiologists during restoration of flow to thrombosed dialysis access grafts. MATERIALS AND METHODS Sixty-two procedures were performed in 54 patients with thrombosed synthetic arteriovenous hemodialysis access grafts. For each procedure, five staff interventional radiologists wore thermoluminescent ring dosimeters on each hand. Overall hand doses were obtained, and patient and graft factors as well as technical factors were analyzed to determine the effects on hand exposure. RESULTS The mean right hand and left hand exposures were 0.78 mSv and 0.55 mSv (78 and 55 mrem), respectively, and there was a significant difference between the two (P = .01). There was a significant difference among the interventionalists, mostly based on the lower doses associated with a single operator (P < .01). Not unexpectedly, fluoroscopy times (P < .01) and, to a lesser degree, the number of angiographic runs (P = .05) were significant factors influencing hand radiation dose. Patient sex, age and location of the graft, previous thrombosis, the number of previous interventions, and success or failure of the procedure were not significant factors in hand dose. CONCLUSIONS Hand exposure during the restoration of flow to thrombosed dialysis access grafts is relatively high and is greater for the right hand than for the left. The exposures are dependent on technical factors, most notably fluoroscopy times, not on patient- or graft-related factors.
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Shetzline MA, Suhocki PV, Agrawal N. Direct percutaneous endoscopic jejunal feeding tube placement. Am J Gastroenterol 2005; 100:1627-8; author reply 1628. [PMID: 15985001 DOI: 10.1111/j.1572-0241.2005.50006_11.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Suhocki PV. Commentary on "Long-term outcome of percutaneous transhepatic cholangioscopic lithotomy for hepatolithiasis". Am J Gastroenterol 2003; 98:2589-90. [PMID: 14687802 DOI: 10.1111/j.1572-0241.2003.08773.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Suhocki PV. Provocative angiography for obscure gastrointestinal bleeding. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2003. [DOI: 10.1053/s1096-2883(03)00037-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Heneghan MA, Tuttle-Newhall JE, Suhocki PV, Muir AJ, Morse M, Bornstein JD, Sylvestre PB, Collins B, Kuo PC, Rockey DC. De-novo cholangiocarcinoma in the setting of recurrent primary sclerosing cholangitis following liver transplant. Am J Transplant 2003; 3:634-8. [PMID: 12752322 DOI: 10.1034/j.1600-6143.2003.00110.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Orthotopic liver transplantation is the only definitive therapeutic option in patients with primary sclerosing cholangitis (PSC) and end-stage liver disease. However, PSC recurs in up to 20% of patients transplanted for this indication. To date, no patient has been reported to develop cholangiocarcinoma (CCA) post-transplant, without biliary tract cancer having been present pretransplant. Here, we report recurrent PSC complicated by de-novo CCA in a 31-year-old man transplanted for PSC 8 years earlier. Cholangiocarcinoma was confirmed using a combination of computed tomography, cholangiography, positron emission tomography and histological examination of biliary cytology. He has since been successfully re-transplanted following preoperative chemo-radiotherapy. No viable tumor was identified in the explanted liver. This case establishes that long-term complications associated with PSC and biliary-enteric surgery such as CCA may become apparent in new grafts post-transplant.
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Lin S, Suhocki PV, Ludwig KA, Shetzline MA. Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan. South Med J 2002; 95:1338-41. [PMID: 12540005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Obscure gastrointestinal (GI) bleeding is often challenging for the primary care physician, but with improved diagnostic testing the cause of this blood loss is determined in most patients. However, approximately 5% of the time no underlying cause is found. One common etiology in patients younger than 40 years of age is a Meckel's diverticulum. The technetium 99m pertechnetate scan is the standard test for making this diagnosis. However, the sensitivity of the scan is only 62% in the adult population. In this case report, a patient with profound, hemodynamically significant GI blood loss had multiple negative studies. Subsequently, an abnormal vascular lesion was detected and during exploratory laparotomy, a Meckel's diverticulum was found and removed. Although the technetium pertechnetate scan is falsely negative in a number of cases, there are ways to increase its sensitivity and possibly avoid repeated testing.
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Clavien PA, Kang KJ, Selzner N, Morse MA, Suhocki PV. Cryosurgery after chemoembolization for hepatocellular carcinoma in patients with cirrhosis. J Gastrointest Surg 2002; 6:95-101. [PMID: 11986024 DOI: 10.1016/s1091-255x(01)00037-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Most cirrhotic patients with hepatocellular carcinoma (HCC) are not candidates for resection. Transarterial chemoembolization (TACE) may ablate a significant portion of the tumor but has a high rate of recurrence. Cryosurgery may permit successful ablation of hepatic tumors but can be complicated by postoperative hemorrhage and is also associated with a significant risk of recurrence. The combination of the two techniques might be beneficial. We evaluated in a prospective study the safety and efficacy of this combination in cirrhotic patients with unresectable HCC. Fifteen patients were included in this study. All but one patient underwent one or several sessions of TACE before cryosurgery. Cryoablation was successfully performed in each patient. The patient who did not undergo preoperative TACE required reoperation for hemorrhage. Another patient with Child-Pugh class B cirrhosis died postoperatively of hepatic and multiorgan failure. At a mean follow-up of 2.5 years, three patients had recurrence of disease, and 13 of 15 patients were alive with the longest survival time being 5 years. The actuarial survival rate at 5 years was 79%. Cryosurgery after TACE is feasible in cirrhotic livers with HCC and can increase the cure rate in large tumors. TACE may reduce the risk of hemorrhage after cryosurgery but can increase the risk of hepatic failure in patients with poor hepatic function.
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Shetzline MA, Suhocki PV, Workman MJ. Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy. Gastrointest Endosc 2001; 53:633-8. [PMID: 11323594 DOI: 10.1067/mge.2001.114420] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Approaches to the creation of a percutaneous jejunostomy (PEJ) include enteroscopy with jejunal transillumination, fluoroscopy with small bowel distension and tract dilation, and jejunal enteral tube placement through a percutaneous endoscopic gastrostomy. Although all have been successful, the combination of enteroscopy and fluoroscopy may improve visualization and the success of PEJ placement. This is a description of such a technique and its successful use in 7 patients. METHODS The procedure was performed with the patient under conscious sedation in a manner similar to standard PEG placement. The proximal jejunum was visualized and a standard snare was passed though the enteroscope and was opened. A needle and guidewire were directed percutaneously though the snare by using fluoroscopic guidance. Under direct endoscopic visualization the snare was closed around the guidewire. A standard 20F push-type "gastrostomy" tube was passed over the guidewire and through the mouth and the dome seated in the jejunum. A bumper was passed externally over the tube and tightened at the skin. RESULTS PEJ placement was successful in all 7 patients. The average length of the procedure was 40 minutes (range 22-64 minutes). There were no major complications. Mean follow-up was 124 days (range 28-308 days). Feeding tubes remained functional until removal (2), death (1), or surgical removal for an unrelated reason (1). Three tubes are still in use. CONCLUSIONS Percutaneous endoscopic jejunostomy tube placement can be performed successfully with enteroscopy and fluoroscopy. This technique is safe and efficient and provides distal enteral nutritional support for patients in whom PEG cannot be used.
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Baron PW, Heneghan MA, Suhocki PV, Nuckols JD, Tuttle-Newhall JE, Howell DN, Clavien PA. Biliary stricture secondary to donor B-cell lymphoma after orthotopic liver transplantation. Liver Transpl 2001; 7:62-7. [PMID: 11150426 DOI: 10.1053/jlts.2001.20781] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biliary complications after orthotopic liver transplantation (OLT) lead to considerable morbidity and occasional mortality after surgery. Bile duct strictures secondary to localized lymphoproliferative disorder of the porta hepatis is rare, with only 12 cases reported in the English literature. Posttransplant lymphoproliferative disorder develops in up to 9% of liver allograft recipients. We describe 2 adult patients who developed Epstein-Barr virus-associated localized B-cell lymphoma of donor-tissue origin confined to the porta hepatis 3 and 5 months after OLT. Both patients were administered cyclosporine (CyA) and prednisone as primary immunosuppression. One patient was administered basiliximab as induction therapy. Neither patient had CyA trough levels greater than 250 ng/mL. Both patients were treated with a hepatojejunostomy, 75% reduction in immunosuppression therapy, and acyclovir. One patient had complete involution of the tumor, and the second patient had an 80% reduction of the tumor at the 2-year follow-up visit. This report illustrates the need to consider localized lymphoma post-OLT as a cause of obstructive jaundice even within the first 6 months after surgery. Aggressive reduction of immunosuppression in conjunction with acyclovir remains a highly effective therapy.
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Brodwater BK, Silber JS, Smith TP, Chao NJ, Suhocki PV, Ryan JM, Newman GE. Conversion of indwelling chest port catheters to tunneled central venous catheters. J Vasc Interv Radiol 2000; 11:1137-42. [PMID: 11041469 DOI: 10.1016/s1051-0443(07)61354-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the safety and efficacy of the conversion of subcutaneous chest wall infusion ports to tunneled central venous catheters. MATERIALS AND METHODS During a period of 34 months, 67 patients were referred for conversion of indwelling subcutaneous chest wall ports to tunneled central venous catheters as part of a bone marrow transplant protocol. Six patients were deemed unacceptable for conversion and the remaining 61 underwent successful conversion. All patients had functioning surgically placed single-lumen (n = 50) or double-lumen (n = 11) chest ports, which were removed to maintain the original venous access sites for placement of a tunneled central venous catheter, incorporating the chest wall pocket for tunneling, in 46 patients (75%). A new tunnel was created in the other 15 patients. There were no immediate complications and all patients were followed until catheter removal or patient demise with the catheter in place. RESULTS 57 of 61 (93%) catheters were used without evidence of infection for 23-164 days (mean, 57 d) after placement. Two (3%) were removed (both at 26 days) because of persistent neutropenic fever without physical signs or laboratory evidence of catheter infection, and two (3%) were removed (at 11 and 77 days) because of proven catheter infection, yielding an overall infection rate of 1.2 per 1,000 catheter days. Two catheters required exchange and two required stripping because of decreased function, resulting in an overall catheter-related complication rate of 2.4 per 1,000 catheter days. CONCLUSIONS Indwelling subcutaneous chest wall infusion ports can be safely converted to tunneled central venous catheters, even in an immunocompromised patient population, with a low risk of complications such as infection.
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Suhocki PV, Berend KR, Trotter JF. Idiopathic splenic vein stenosis: a cause of gastric variceal hemorrhage. South Med J 2000; 93:812-4. [PMID: 10963517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We report the case of a patient with isolated gastric variceal bleeding. Obesity precluded the use of noninvasive means for assessing splenic vein patency. Splenic vein stenosis was diagnosed by transhepatic portal and splenic venography with pressure measurements. A cause for the stenosis could not be found. Splenectomy was used as a curative measure.
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Ryan JM, Suhocki PV, Smith TP. Coil embolization of segmental arterial mediolysis of the hepatic artery. J Vasc Interv Radiol 2000; 11:865-8. [PMID: 10928523 DOI: 10.1016/s1051-0443(07)61802-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Kliewer MA, Hertzberg BS, Heneghan JP, Suhocki PV, Sheafor DH, Gannon PA, Paulson EK. Transjugular intrahepatic portosystemic shunts (TIPS): effects of respiratory state and patient position on the measurement of Doppler velocities. AJR Am J Roentgenol 2000; 175:149-52. [PMID: 10882265 DOI: 10.2214/ajr.175.1.1750149] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this prospective study was to examine the effects of patient position and respiratory state on the measurements of Doppler velocities in transjugular intrahepatic portosystemic shunts. SUBJECTS AND METHODS Thirty-eight transjugular intrahepatic portosystemic shunts in 34 consecutive patients were studied using Doppler sonography. Peak velocities were measured in the mid shunt with the patient in three positions (supine, sitting upright, and left lateral decubitus) and two respiratory states (deep inspiration and quiet respiration). A mixed linear regression model was used to assess statistically significant differences among the six velocity measurements. RESULTS Peak velocities in the mid stent averaged 22 cm/sec greater in quiet respiration than in deep inspiration, which was a significant difference (p < 0.00001). Differences in velocities in the three patient positions were not significant (p = 0.53). Using 90-190 cm/sec as the normal range, the peak velocity shifted from normal to abnormal levels by changing respiratory state in 17 (45%) of 38 studies. Using 60 cm/sec as the lower normal limit, the peak velocity fell below the normal range with inspiration in 10 (26%) of 38 studies. In 12 (32%) of 38 studies, a decline in peak velocity exceeding 50 cm/sec could be induced by inspiration. CONCLUSION Peak systolic velocity in transjugular intrahepatic portosystemic shunts is substantially altered by the respiratory state of the patient at the time of the measurement, but not by the patient position. Respiratory state must be taken into account in the interpretation of peak velocity for shunt stenosis.
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Trotter JF, Suhocki PV. Incarceration of umbilical hernia following transjugular intrahepatic portosystemic shunt for the treatment of ascites. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1999; 5:209-10. [PMID: 10226112 DOI: 10.1002/lt.500050317] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for patients with medically refractory ascites. Many patients with refractory ascites have umbilical herniation. Incarceration of umbilical hernia has been reported following diuresis, paracentesis, and peritoneovenous shunting. We report 2 cases of umbilical hernia incarceration following resolution of ascites after TIPS.
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Suhocki PV, Meyers WC. Injury to aberrant bile ducts during cholecystectomy: a common cause of diagnostic error and treatment delay. AJR Am J Roentgenol 1999; 172:955-9. [PMID: 10587128 DOI: 10.2214/ajr.172.4.10587128] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of injured aberrant bile ducts in a population with complications after cholecystectomy and to determine whether such injury resulted in significant delay in the diagnosis and treatment of bile duct injuries. MATERIALS AND METHODS The cholangiograms of 82 patients who sustained bile duct injury during cholecystectomy were reviewed. Prevalence of aberrant bile duct anatomy in the injured ducts was noted. The time periods from injury to diagnosis and treatment of bile duct leaks in patients with aberrant bile duct anatomy were compared with those in patients with normal anatomy. RESULTS Seventeen percent (14/82) of the patients were found to have aberrant bile duct anatomy. Fifteen percent (12/82) were found to have had an aberrant bile duct involved in the injury. Eleven of the patients had an aberrant bile duct leak, and one patient had an aberrant bile duct clipping injury. The time period required for diagnosis and treatment of a leaking aberrant bile duct was significantly longer (p < .005) than that required for a bile leak in an anatomically normal bile duct. CONCLUSION Aberrant bile ducts are present in a significant number of patients who sustain bile duct injuries during cholecystectomy. Diagnosis of an aberrant bile duct leak may be delayed because of nonfilling of the bile duct during standard cholangiographic techniques. Careful examination of cholangiograms for nonfilling segments and contrast material injection of biloma drains and T tubes may shorten the time to definitive treatment for this group of patients.
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Suhocki PV, Clavien PA. Percutaneous transhepatic creation of a choledochojejunostomy between an excluded aberrant bile duct and a Roux-en-Y limb. AJR Am J Roentgenol 1999; 172:655-7. [PMID: 10063854 DOI: 10.2214/ajr.172.3.10063854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Trotter JF, Suhocki PV, Rockey DC. Transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites: effect on body weight and Child-Pugh score. Am J Gastroenterol 1998; 93:1891-4. [PMID: 9772050 DOI: 10.1111/j.1572-0241.1998.00544.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study suggests that patients with medically refractory ascites treated with transjugular intrahepatic portosystemic shunt (TIPS) may have improved in overall clinical status. METHODS We performed a retrospective study of 35 patients with medically refractory ascites treated with TIPS. Body weight, ascites, and Child-Pugh score were assessed at baseline, at 2 months, and after a mean 8.8-month follow-up interval. RESULTS After TIPS, there was significant improvement in Child-Pugh score from 9.7+/-1.5 to 8.2+/-2.3. Ascites completely resolved or improved in 23 of 24 patients (96%) who had long term follow-up. Two months after TIPS, there was a significant decrease in weight of 6.1 kg corresponding to a loss of ascites. Between 2 and 8.8 months, there was a significant mean weight gain of 5.5 kg. CONCLUSION This study suggests that patients treated with medically refractory ascites with TIPS may have improvement in overall clinical status, as measured by increase in lean body mass and improvement in Child-Pugh score.
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Trotter JF, Suhocki PV, Lina JR, Martin LW, Parrish JL, Swantkowski T. Hereditary hemorrhagic telangiectasia causing high output cardiac failure: treatment with transcatheter embolization. Am J Gastroenterol 1998; 93:1569-71. [PMID: 9732949 DOI: 10.1111/j.1572-0241.1998.00486.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report a case of hereditary hemorrhagic telangiectasia complicated by high output heart failure caused by intrahepatic arteriovenous malformations. This patient was treated using transcatheter embolization of the intrahepatic arteriovenous malformations with concurrent measurement of cardiac output to monitor progress of the embolization.
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Suhocki PV, Trotter JF. Percutaneous hepatic vein reconstruction for Budd-Chiari syndrome. AJR Am J Roentgenol 1998; 171:189-91. [PMID: 9648786 DOI: 10.2214/ajr.171.1.9648786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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