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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024:10.1007/s00261-024-04381-x. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Lim JS, Jung GS, Oh KS, Seo KW, Jung K, Yun JH. Percutaneous radiologic gastrostomy with single gastropexy using balloon-assisted tract dilatation: comparison with peel-away sheath. Diagn Interv Radiol 2023; 29:813-818. [PMID: 37650523 PMCID: PMC10679556 DOI: 10.4274/dir.2023.232342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous radiologic gastrostomy (PRG) with balloon-assisted tract dilatation (BATD) using a single gastropexy. METHODS This retrospective study was approved by the institutional review board. From August 2018 to October 2022, 61 patients (53 male and 8 female, mean age 67 years, age range 27-90 years) underwent PRG with balloon-retained tubes for enteral nutrition. Single gastropexy was performed in all cases. Patients were divided into two groups based on the tract dilatation technique used. In the first group, BATD (n = 48) was performed. In the second group, a 24-Fr peel-away sheath (PAS) was used for tract dilatation (n = 13). Patient demographics, technical success rate, clinical success rate, fluoroscopy time, cumulative radiation dose, and complications were retrospectively evaluated. The Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables were performed to compare the two groups. RESULTS All procedures were successfully performed with 100% technical and clinical success rates in both groups. The mean fluoroscopy time for the BATD group vs. the PAS group (1.68 ± 0.93 min vs. 3.56 ± 2.41 min, P < 0.001) and mean cumulative radiation dose (12.98 ± 9.28 mGy vs. 33.01 ± 15.14 mGy, P < 0.001) were significantly lower in the BATD group compared with the PAS group. There was one major complication of peritonitis that led to death in the PAS group (1/13, 7.7%) and no major complications in the BATD group. Minor complications such as pneumoperitoneum, abdominal pain, leakage, and balloon deflation occurred in 16 patients: 12 (12/48, 25.0%) patients in the BATD group and 4 (4/13, 38.5%) patients in the PAS group. The overall rate of major and minor complications was higher in the PAS group but did not show statistically significant differences (odds ratio: 1.875, 95%; confidence interval: 0.514-6.841, P = 0.486). CONCLUSION BATD using a single gastropexy is a safe and effective technique for PRG.
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Affiliation(s)
- Ji Su Lim
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
| | - Gyoo Sik Jung
- Department of Radiology, Ulsan Hospital, Ulsan, Korea
| | - Kyung Seung Oh
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jong Hyouk Yun
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
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Hu HT, Yuan H, Guo CY, Yao QJ, Geng X, Cheng HT, Ma JL, Zhao Y, Jiang L, Zhao YQ, Li HL. Radiological gastrostomy: A comparative analysis of different image-guided methods. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hong-Tao Hu
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hang Yuan
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Chen-Yang Guo
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Quan-Jun Yao
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang Geng
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hong-Tao Cheng
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun-Li Ma
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhao
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Jiang
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu-Qing Zhao
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-Liang Li
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Ma S, Lamparello NA, Paik H, Nadolski G, Stavropoulos W, Tischfield D, Gade T, Shlansky-Goldberg RD. Single-Step Method for Pull-Type Gastrostomy Tube Placement. J Vasc Interv Radiol 2019; 31:473-477. [PMID: 31542269 DOI: 10.1016/j.jvir.2019.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
Single-step pull-type gastrostomy tube (PGT) placement is a method involving gastric puncture with a curved 18-gauge trocar needle allowing retrograde cannulation of the gastroesophageal junction without use of a sheath or snare. This retrospective review of 102 patients who underwent single-step PGT placement demonstrated 91% success in advancing the wire up the esophagus using only the curved trocar. Successful placement of a gastrostomy tube was 100%. Two major and 2 minor complications occurred within 30 days, all unrelated to the single-step technique. Mean fluoroscopy time for all patients was 5.1 min (range, 1.5-19.2 min). Single-step PGT placement is an effective, safe, fast, and equipment-sparing method for gastrostomy placement.
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Affiliation(s)
- Shawn Ma
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Nicole A Lamparello
- Interventional Radiology, Weill Cornell Imaging at New York-Presbyterian, New York, New York
| | - Helen Paik
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Gregory Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - David Tischfield
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Terence Gade
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Richard D Shlansky-Goldberg
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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Retrospective comparison of outcomes and associated complications between large bore radiologically inserted gastrostomy tube types. Abdom Radiol (NY) 2019; 44:318-326. [PMID: 30073401 DOI: 10.1007/s00261-018-1717-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Multiple approaches to radiologically inserted gastrostomy (RIG) exist. The goal of this study was to compare 30-day outcomes and associated complications between large bore balloon-retained (BR), loop-retained (LR), and pull-type (PT) RIG devices. METHODS Data on 1477 patients who underwent RIG between January 1, 2005 and December 31, 2016 were collected retrospectively using a dedicated interventional radiology database and electronic medical record. Statistical analysis was performed to compare complication rates between BR, LR, and PT devices. RESULTS Ninety-eight percent (1477/1507) of the procedures were successfully performed. A total of 752 BR, 323 LR, and 402 PT gastrostomy tubes were placed. The overall complication rate for BR catheters was 5.7% (25 major [3.3%] and 18 minor [2.4%]). The overall complication rate for PT catheters was 3.7% (8 major [2.0%] and 7 minor [1.7%]). The overall complication rate for LR catheters was 1.6% (4 major [1.4%] and 1 minor [0.8%]). Compared to BR catheters, LR catheters had significantly fewer total complications (P = 0.01) but not minor complications (P = 0.052). There were no significant differences in the number of complications between LR and PT catheters or between BR and PT catheters. CONCLUSIONS Use of BR, LR, and PT devices for RIG is safe with a low incidence of complications. Compared to BR catheters, primary insertion of a LR gastrostomy was associated with significantly fewer overall complications within the first 30 days. Therefore, for initial tube placement, large bore LR catheters may be preferred over BR devices.
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