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Reis J, Bogart A, Shivaram GM. Percutaneous Image-Guided Treatment of Pediatric Deep-Vein Occlusions. Tech Vasc Interv Radiol 2024; 27:100963. [PMID: 39168552 DOI: 10.1016/j.tvir.2024.100963] [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] [Indexed: 08/23/2024]
Abstract
Pediatric venous occlusions are a growing cause of morbidity and mortality, especially in hospitalized patients. Catheter-directed recanalization is a safe and effective treatment option in appropriately selected patients. Benefits of catheter directed therapies (CDTs) include the prevention of pulmonary embolism and end organ failure acutely as well as superior vena cava syndrome and post-thrombotic syndrome chronically. Timely diagnosis, recognition of underlying factors for thrombosis, and familiarity with the spectrum of tools and techniques for CDT are essential to optimizing outcomes in the acute setting. Recanalization of chronic venous occlusions can similarly provide symptomatic relief and achieve long term vessel patency. This review will detail the scope, techniques, and outcomes for CDT in the treatment of acquired systemic deep vein occlusions.
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Affiliation(s)
- Joseph Reis
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA.
| | - Aaron Bogart
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA
| | - Giri M Shivaram
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA
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Iwasawa S, Tamura M, Okamura T, Torikai H, Ito N, Inoue M, Yamada Y, Jinzaki M, Kuroda T, Nakatsuka S. A Case of Severe Biliary Anastomotic Stricture after Living Donor Liver Transplantation Successfully Treated Using the Modified Gunsight Technique with Two Balloon Catheters. INTERVENTIONAL RADIOLOGY 2021; 6:65-68. [PMID: 35909914 PMCID: PMC9327353 DOI: 10.22575/interventionalradiology.2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/08/2021] [Indexed: 11/03/2022]
Abstract
Biliary stricture is a serious postoperative complication of liver transplantation. We report the case of a 2-year-old boy with severe biliary anastomotic stricture after left lobe living donor liver transplantation. As cannulation from the occluded B3 into the jejunum was impossible using the conventional technique, a gunsight approach was utilized. By puncturing balloons dilated at the occluded site of B3 and the proximal end of the non-occlusive B2, a tract between B3 and B2 was created, and the catheter was finally successfully inserted from B3 into the jejunum through the dilated tract and B2. The gunsight approach is an option for severe biliary strictures when the conventional approach proves impossible.
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Affiliation(s)
- Sayuri Iwasawa
- Department of Radiology, Tokyo Saiseikai Central Hospital, Tokyo
| | - Masashi Tamura
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Teppei Okamura
- Department of Diagnostic Radiology, KKR-Tachikawa Hospital, Tokyo
| | - Hideyuki Torikai
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Nobutake Ito
- Department of Radiology, Tokyo Saiseikai Central Hospital, Tokyo
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo
| | - Seishi Nakatsuka
- Department of Radiology, Keio University School of Medicine, Tokyo
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Moussa AM, Sofocleous CT. Iliac-enteric fistula managed by endovascular covered stent placement using extra-vascular microwire snaring: a case report. CVIR Endovasc 2020; 3:18. [PMID: 32201930 PMCID: PMC7085988 DOI: 10.1186/s42155-020-00109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background Although snaring technique is a commonly used tool in the interventional radiologists’ armamentarium, there are no reports of its use in an extra-vascular space to achieve access across a pseudoaneurysm that was otherwise non-traversable. Case presentation We describe a case of an iliac-enteric fistula between a ruptured pseudoaneurysm of the external iliac artery and a surrounding contained colonic perforation, where access across the pseudoaneurysm was achieved only after snaring of the microwire from within the contained colonic perforation and back into the intra-vascular space, allowing the placement of a covered stent and control of the bleeding. Conclusions The described technique may be useful in situations where other, more conventional, endovascular techniques fail to achieve access across the bleeding pseudoaneurysm. While it was life-saving in this case, this technique should only be used in very limited scenarios, specifically in the palliative setting and when surgical management is not an option.
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González Canga C, Busto Suárez S, Camblor Santervás LA, Vega García F, Zanabili Al-Sibbai A, Álvarez Marcos F, Alonso Pérez M. Endovascular Treatment of a Traumatic Axillary Artery Rupture Using the Dual Bull's-Eye Technique. Ann Vasc Surg 2020; 69:447.e17-447.e21. [PMID: 32474146 DOI: 10.1016/j.avsg.2020.05.025] [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: 01/21/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our purpose is to report a case of an axillary artery rupture treated by endovascular means using the dual bull's-eye technique. An 83-year-old woman with multiple comorbidities was diagnosed with axillary artery rupture after the reduction of a shoulder dislocation. METHODS An endovascular repair attempt was made, but, despite the use of a double approach (antegrade and retrograde), reconnecting both ends of the severed artery was deemed not possible. 5-mm Amplatz GooseNeck snares were advanced from each access and superposed in a perpendicular plane. A percutaneous infraclavicular puncture with a lumbar needle was made through both snares, and a V14 guidewire was subsequently introduced. The guidewire was recovered through femoral and brachial accesses, and a 7 × 100 mm covered self-expandable stent was deployed. RESULTS The final angiographic control did not show further hemorrhage, and the patient recovered radial pulse. Follow-up showed complete patency and no complications at 9 months after the procedure. CONCLUSIONS The dual bull's-eye technique can be used as a resource tool in cases of arterial rupture, when the arterial continuity cannot be re-established by conventional approaches.
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Affiliation(s)
- Carmen González Canga
- Vascular Surgery Department, Asturias University Central Hospital (HUCA), Oviedo, Spain.
| | - Sara Busto Suárez
- Vascular Surgery Department, Asturias University Central Hospital (HUCA), Oviedo, Spain
| | | | - Florentino Vega García
- Vascular & Interventional Radiology Department, Asturias University Central Hospital (HUCA), Oviedo, Spain
| | | | | | - Manuel Alonso Pérez
- Vascular Surgery Department, Asturias University Central Hospital (HUCA), Oviedo, Spain
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Bundy JJ, Shin DS, Chick JFB, Monsky WL, Jones ST, List J, Hage AN, Vaidya SS. Percutaneous Extra-Anatomic Lymphovenous Bypass Creation: Toward Treatment of Central Conducting Lymphatic Obstructions. Cardiovasc Intervent Radiol 2020; 43:1392-1397. [PMID: 32444921 DOI: 10.1007/s00270-020-02457-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/12/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Protein-losing enteropathy manifests as a loss of serum proteins through the gastrointestinal tract, resulting in hypoproteinemia, extravascular fluid retention, and edema. Management consists of nutritional maintenance in conjunction with interventions targeted at treating the underlying etiology. MATERIALS AND METHODS This report describes a patient with protein-losing enteropathy from a central conducting lymphatic obstruction who was treated with percutaneous extra-anatomic lymphovenous bypass creation. RESULTS A modified gun-sight technique was used to create a lymphovenous bypass between an occluded terminal thoracic duct and the left internal jugular vein. CONCLUSION A percutaneous technique to reconstruct the terminal thoracic duct via lymphovenous bypass creation was feasible.
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Affiliation(s)
- Jacob J Bundy
- Division of Interventional Radiology, Wake Forest Baptist HealthOne Medical Center Boulevard, Winston-Salem, NC, USA
| | - David S Shin
- Division of Interventional Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
| | - Wayne L Monsky
- Division of Interventional Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Sean T Jones
- Division of Interventional Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Jeb List
- Division of Interventional Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Anthony N Hage
- Division of Interventional Radiology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, USA
| | - Sandeep S Vaidya
- Division of Interventional Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
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Wong YT. Endovascular treatment of diabetic foot ischemic ulcer - Technical review. J Interv Med 2020; 3:17-26. [PMID: 34805901 PMCID: PMC8562255 DOI: 10.1016/j.jimed.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This article is a technical review of the common techniques used in the treatment of lower-limb occlusive arterial disease associated with diabetes. The techniques described here reflect the author’s own practice and are methods that the author finds helpful in avoiding complications and in making the technical aspects of the procedures easier.
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Affiliation(s)
- Yew Toh Wong
- Flinders Medical Centre, Bedford Park, South Australia, Australia
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Ysa A, Lobato M, Mikelarena E, Arruabarrena A, Gómez R, Apodaka A, Metcalfe M, Fonseca JL. Homemade Device to Facilitate Percutaneous Venous Arterialization in Patients With No-Option Critical Limb Ischemia. J Endovasc Ther 2019; 26:213-218. [PMID: 30764701 DOI: 10.1177/1526602819830983] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe a maneuver to facilitate percutaneous arteriovenous fistula creation during venous arterialization procedures in patients with no-option critical limb ischemia. TECHNIQUE Following a failed arterial recanalization attempt, a balloon catheter is passed up to the tip of the guidewire. Venous access is gained distally, a 4-F sheath is antegradely passed, and a 4-mm GooseNeck snare is advanced through it. A fluoroscopic view that overlaps the snare and the inflated balloon is obtained. If the vein remains anterior with respect to the artery, a needle is inserted across the vein, passing through the snare loop and puncturing the intra-arterial balloon. A wire is inserted and placed inside the punctured balloon. The balloon is retrieved and the wire externalized through the femoral access. A catheter is advanced antegradely over this wire from the artery into the vein. If the vein remains posterior to the artery, a needle is inserted, puncturing the balloon and thereafter the vein (crossing through the snare). A wire is inserted, captured by the snare, and externalized through the vein sheath. A catheter is finally advanced over this wire from the vein into the artery. CONCLUSION This maneuver is a simple alternative to create an arteriovenous fistula during venous arterialization procedures in patients with no-option critical limb ischemia.
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Affiliation(s)
- August Ysa
- 1 Vascular Surgery Department, Hospital de Cruces, Barakaldo, Spain
| | - Marta Lobato
- 1 Vascular Surgery Department, Hospital de Cruces, Barakaldo, Spain
| | | | | | - Roberto Gómez
- 1 Vascular Surgery Department, Hospital de Cruces, Barakaldo, Spain
| | - Ana Apodaka
- 1 Vascular Surgery Department, Hospital de Cruces, Barakaldo, Spain
| | | | - Juan L Fonseca
- 1 Vascular Surgery Department, Hospital de Cruces, Barakaldo, Spain
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Sangiorgi G, Martelli E, De Luca F, Biondi-Zoccai G. Commentary: IVUS-Guided Recanalization of Peripheral CTOs: No More Eyes Wide Shut for Physicians? J Endovasc Ther 2017; 24:727-730. [PMID: 28830276 DOI: 10.1177/1526602817727280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Sangiorgi
- 1 Department of Cardiology, Cardiac Catheterization Laboratory, University of Rome Tor Vergata, Rome, Italy
| | - Eugenio Martelli
- 2 Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Sassari, Italy
| | - Fabio De Luca
- 3 Department of Cardiothoracic Surgery, Istituto Clinico Gavazzeni Humanitas, Bergamo, Italy
| | - Giuseppe Biondi-Zoccai
- 4 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,5 Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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