1
|
Yeon SK, Ahn Y, Shin JH, Oh SY, Kim GH. Efficacy and safety of transcatheter arterial embolization for hemodynamically unstable bleeding after percutaneous transthoracic needle biopsy. Diagn Interv Radiol 2023; 29:819-825. [PMID: 37650514 PMCID: PMC10679561 DOI: 10.4274/dir.2023.232253] [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: 04/17/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in controlling hemodynamically unstable bleeding following a percutaneous transthoracic needle biopsy (PTNB). METHODS A total of seven patients (four men and three women; mean age, 62 ± 12 years) who received TAE for post-PTNB bleeding between May 2007 and March 2022 were included. The observed types of bleeding were hemothorax (n = 3), hemoptysis (n = 2), and a combination of both (n = 2). In patients with active bleeding, the technical success of TAE was defined as superselective embolization of the target artery with no active bleeding visible on post-TAE angiography. Clinical success was defined as sustained cessation of bleeding without hemodynamic instability, requirement of repeat TAE, or the need for post-TAE hemostatic surgery during the initial admission. The metrics analyzed included technical and clinical success rates, complications, and 30-day mortality. RESULTS All seven patients achieved technical success, with a clinical success rate of 86% (6/7). Six patients were discharged alive, while one patient died of respiratory failure accompanied by hemothorax 19 days post-biopsy. The angiographic findings associated with bleeding were contrast media extravasation or pseudoaneurysm (n = 3) and vascular hypertrophy with tortuosity (n = 2). The implicated bleeding arteries included the intercostal artery (n = 2), bronchial artery (n = 2), and internal thoracic artery (n = 1). In two cases, no clear bleeding foci were identified; nonetheless, prophylactic embolization was performed on the right intercostal artery (n = 1) and right intercostobronchial trunk (n = 1). The embolic agents utilized included microcoils (n = 1), gelatin sponge particles (n = 2), polyvinyl alcohol (PVA) with gelatin sponge particles (n = 1), PVA with microcoils (n = 1), microcoils with gelatin sponge particles (n = 1), and microcoils with n-butyl-2-cyanoacrylate and gelatin sponge particles (n = 1). The 30-day mortality rate was 14% (1/7). No ischemic complications related to TAE were observed. CONCLUSION The study suggests that TAE is safe and effective for controlling hemodynamically unstable bleeding following a PTNB.
Collapse
Affiliation(s)
- Su Kyeong Yeon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| |
Collapse
|
2
|
Almeida AM, Rocha HAL, Araújo DABS, de Barros Silva PG, de Melo Filho LP, de Oliveira Borges GC. Development and validation of a video-assisted liver biopsy technique using a minimally-invasive device. BMC Gastroenterol 2023; 23:120. [PMID: 37041464 PMCID: PMC10091625 DOI: 10.1186/s12876-023-02740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 03/22/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Percutaneous liver biopsy is the gold standard technique for establishing the cause of cirrhosis and liver disease activity assessment. However, some cases of steatohepatitis or other chronic liver diseases show a high number of false negative results in samples obtained via the percutaneous route. This fact justifies performing a liver biopsy via the laparoscopic route. However, this is an expensive technique, with morbidities associated with pneumoperitoneum and anesthetic complications. The main objective of this study is to develop a video-assisted technique that uses only a minimally-invasive device for the liver biopsy and the optical trocar. Without additional trocars, this technique constitutes a less invasive procedure than the existing techniques in clinical practice. METHODS This is a device development and validation study and patients submitted to abdominal laparoscopic surgery and required liver biopsy for moderate to severe steatosis were recruited. The patients were randomized into two groups: laparoscopic liver biopsy technique (n = 10, control group) and mini-laparoscopic liver biopsy technique (n = 8, experimental group). The times associated with procedure performance in both groups were evaluated using the Mann-Whitney or Kruskal-Wallis tests according to data distribution. RESULTS At baseline, there was no statistical difference regarding gender and type of surgery. The experimental group had a significantly shorter time compared with the group that underwent the traditional procedure in mean procedure time (p = 0.003), biopsy time (p = 0.002) and hemostasis time (p = 0.003). CONCLUSIONS The mini-laparoscopic biopsy device and technique showed to be capable of safely obtaining sufficient tissue samples, which was minimally invasive and in a shorter time than the classic technique.
Collapse
Affiliation(s)
| | - Hermano Alexandre Lima Rocha
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil.
| | | | | | | | | |
Collapse
|
3
|
Watanabe Y, Osaki A, Yamazaki S, Yamazaki H, Kimura K, Takaku K, Sato M, Waguri N, Terai S. Two cases of portal-systemic encephalopathy caused by multiple portosystemic shunts successfully treated with percutaneous transhepatic obliteration. Clin J Gastroenterol 2022; 15:968-974. [DOI: 10.1007/s12328-022-01671-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
|
4
|
Chen CS, Cho YJ, Shin JH, Kim JH, Park S, Jeon GS, Ibrahim A, Li HL, Jeong B. Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study. Acta Radiol 2022; 63:822-827. [PMID: 33878930 DOI: 10.1177/02841851211010395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. PURPOSE To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. MATERIAL AND METHODS This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. RESULTS The median interval between surgery and angiography was one day (range = 0-82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. CONCLUSIONS TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.
Collapse
Affiliation(s)
- Cheng Shi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Young-Jong Cho
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Gangwon Province, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Suyoung Park
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Alrashidi Ibrahim
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Boryeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
5
|
Impact of risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy of space-occupying lesions. RADIOLOGIA 2022; 64:497-505. [DOI: 10.1016/j.rxeng.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022]
|
6
|
Elieh Ali Komi D, Rahimi Y, Asghari R, Jafari R, Rasouli J, Mohebalizadeh M, Abbasi A, Nejadrahim R, Rezazadeh F, Shafiei-Irannejad V. Investigation of the Molecular Mechanism of Coagulopathy in Severe and Critical Patients With COVID-19. Front Immunol 2021; 12:762782. [PMID: 34975853 PMCID: PMC8716500 DOI: 10.3389/fimmu.2021.762782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/26/2021] [Indexed: 01/22/2023] Open
Abstract
Coagulopathy is a frequently reported finding in the pathology of coronavirus disease 2019 (COVID-19); however, the molecular mechanism, the involved coagulation factors, and the role of regulatory proteins in homeostasis are not fully investigated. We explored the dynamic changes of nine coagulation tests in patients and controls to propose a molecular mechanism for COVID-19-associated coagulopathy. Coagulation tests including prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FIB), lupus anticoagulant (LAC), proteins C and S, antithrombin III (ATIII), D-dimer, and fibrin degradation products (FDPs) were performed on plasma collected from 105 individuals (35 critical patients, 35 severe patients, and 35 healthy controls). There was a statically significant difference when the results of the critical (CRT) and/or severe (SVR) group for the following tests were compared to the control (CRL) group: PTCRT (15.014) and PTSVR (13.846) (PTCRL = 13.383, p < 0.001), PTTCRT (42.923) and PTTSVR (37.8) (PTTCRL = 36.494, p < 0.001), LACCRT (49.414) and LACSVR (47.046) (LACCRL = 40.763, p < 0.001), FIBCRT (537.66) and FIBSVR (480.29) (FIBCRL = 283.57, p < 0.001), ProCCRT (85.57%) and ProCSVR (99.34%) (ProCCRL = 94.31%, p = 0.04), ProSCRT (62.91%) and ProSSVR (65.06%) (ProSCRL = 75.03%, p < 0.001), D-dimer (p < 0.0001, χ2 = 34.812), and FDP (p < 0.002, χ2 = 15.205). No significant association was found in the ATIII results in groups (ATIIICRT = 95.71% and ATIIISVR = 99.63%; ATIIICRL = 98.74%, p = 0.321). D-dimer, FIB, PT, PTT, LAC, protein S, FDP, and protein C (ordered according to p-values) have significance in the prognosis of patients. Disruptions in homeostasis in protein C (and S), VIII/VIIIa and V/Va axes, probably play a role in COVID-19-associated coagulopathy.
Collapse
Affiliation(s)
- Daniel Elieh Ali Komi
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Yaghoub Rahimi
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Rahim Asghari
- Hematology, Immune Cell Therapy, and Stem Cells Transplantation Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Reza Jafari
- Hematology, Immune Cell Therapy, and Stem Cells Transplantation Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
- Nephrology and Kidney Transplant Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Rasouli
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mehdi Mohebalizadeh
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Ata Abbasi
- Department of Pathology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Rahim Nejadrahim
- Department of Infectious Diseases, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Farzin Rezazadeh
- Department of Emergency Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Vahid Shafiei-Irannejad
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
- *Correspondence: Vahid Shafiei-Irannejad,
| |
Collapse
|
7
|
Durhan G, Demirkazık F. Breast involvement of hematological malignancies: imaging and clinical findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast involvement of hematological malignancies is a very rare entity. Accurate diagnosis is essential for appropriate treatment. The aim of this study was to clarify the clinical and radiological findings of hematological malignancy breast involvement and to describe possible pitfalls in diagnosis.
Results
The images of 20 patients with breast involvement of hematological malignancies were retrospectively evaluated on ultrasonography, mammography, and magnetic resonance imaging (MRI) and the findings were reported. Bilaterality was seen only in cases with secondary involvement, and there was no marked difference between primary and secondary breast involvement of hematological malignancies. All patients underwent ultrasonography examination. According to ultrasonography, breast masses were most frequently irregular in shape (11/20, 55%) with non-circumscribed margins (11/20, 55%). Posterior acoustic enhancement was noted in 14 cases (70%). Posterior shadowing was not observed in any of the patients. Mammography was available in 10 patients. Microcalcification was not observed in any patient on mammography. MRI was available in four patients. Hyperintensity in T2-weighted images, type 2 or type 3 dynamic curve, and diffusion restriction were observed in all cases.
Conclusions
Hematological malignancies may mimic both benign breast lesions and breast carcinoma. Familiarity with the radiological features of hematological malignancies can help accurate diagnosis.
Collapse
|
8
|
Granata A, Distefano G, Pesce F, Battaglia Y, Suavo Bulzis P, Venturini M, Palmucci S, Cantisani V, Basile A, Gesualdo L. Performing an Ultrasound-Guided Percutaneous Needle Kidney Biopsy: An Up-To-Date Procedural Review. Diagnostics (Basel) 2021; 11:diagnostics11122186. [PMID: 34943422 PMCID: PMC8700183 DOI: 10.3390/diagnostics11122186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Ultrasound-guided percutaneous renal biopsy (PRB) has revolutionized the clinical practice of nephrology in the last decades. PRB remains an essential tool for the diagnosis, prognosis, and therapeutic management of several renal diseases and for the assessment of renal involvement in systemic diseases. In this study, we examine the different applications and provide a review of the current evidence on the periprocedural management of patients. PRB is recommended in patients with significant proteinuria, hematuria, acute kidney injury, unexpected worsening of renal function, and allograft dysfunction after excluding pre- and post-renal causes. A preliminary ultrasound examination is needed to assess the presence of anatomic anomalies of the kidney and to identify vessels that might be damaged by the needle during the procedure. Kidney biopsy is usually performed in the prone position on the lower pole of the left kidney, whereas in patients with obesity, the supine antero-lateral position is preferred. After preparing a sterile field and the injection of local anesthetics, an automatic spring-loaded biopsy gun is used under ultrasound guidance to obtain samples of renal parenchyma for histopathology. After the procedure, an ultrasound scan must be performed for the prompt identification of potential early bleeding complications. As 33% of complications occur after 8 h and 91% occur within 24 h, the ideal post-procedural observation time is 24 h. PRB is a safe procedure and should be considered a routine part of the clinical practice of nephrology.
Collapse
Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, “Cannizzaro” Hospital, 95126 Catania, Italy;
| | - Giulio Distefano
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (S.P.); (A.B.)
- Correspondence:
| | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70121 Bari, Italy; (F.P.); (P.S.B.); (L.G.)
| | - Yuri Battaglia
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
| | - Paola Suavo Bulzis
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70121 Bari, Italy; (F.P.); (P.S.B.); (L.G.)
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy;
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (S.P.); (A.B.)
| | - Vito Cantisani
- Department of Radiology, Policlinico Umberto I, Sapienza Rome University, 00161 Rome, Italy;
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (S.P.); (A.B.)
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70121 Bari, Italy; (F.P.); (P.S.B.); (L.G.)
| |
Collapse
|
9
|
Alrashidi I, Kim TH, Shin JH, Alreshidi M, Park M, Jang EB. Efficacy and safety of transcatheter arterial embolization for active arterial esophageal bleeding: a single-center experience. ACTA ACUST UNITED AC 2021; 27:519-523. [PMID: 34313237 DOI: 10.5152/dir.2021.20253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding. METHODS Nine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed. RESULTS The angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE. CONCLUSION TAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.
Collapse
Affiliation(s)
- Ibrahim Alrashidi
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Tae-Hyung Kim
- Department of Radiological Science, College of Health Science, Kangwon National University, Samcheok-si, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | - Minho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Bee Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
10
|
Chen CS, Ahn H, Shin JH, Li HL, Kim JW, Ibrahim A, Chu HH. Renal artery embolization for spontaneous hemorrhage in patients with acquired cystic kidney disease: A 20-year single-center experience. Pak J Med Sci 2021; 37:1111-1117. [PMID: 34290792 PMCID: PMC8281160 DOI: 10.12669/pjms.37.4.3999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/15/2020] [Accepted: 02/25/2021] [Indexed: 01/20/2023] Open
Abstract
Objectives To evaluate the safety and effectiveness of transcatheter arterial embolization for controlling spontaneous hemorrhage in patients with acquired cystic kidney disease (ACKD). Methods This retrospective study included 18 patients with ACKD (M:F=13:5; mean age, 56 years) who underwent renal artery embolization to control spontaneous hemorrhage between January 2001 and September 2020. The underlying etiology and clinical presentations were reviewed and previous computed tomography (CT) findings were analyzed. Furthermore, angiographic and embolization details, technical and clinical successes, and complications were assessed. Results Subcapsular, perirenal, and pararenal hematomas were observed on CT scans for all patients. Contrast extravasation was observed in 15 / 17 patients (88%) on contrast-enhanced CT scans. Angiography showed active bleeding in 14 patients (78%; contrast extravasation [n=6], pseudoaneurysm [n=3], and both [n=5]), suspicious bleeding in 1 (5%), and no bleeding in 3 (17%). The technical and clinical success rates were 100% and 94% (17/18), respectively. Total and partial embolization was performed in 14 (78%) and 4 (22%) cases, respectively. Subsequent surgical nephrectomy was required for one patient with clinical failure due to recurrent bleeding despite total embolization. Procedure-related complications included mild post-embolization syndrome in one patient and contrast-induced nephropathy in five patients (28%) without long-term complications. Conclusions Renal artery embolization is safe and effective for controlling spontaneous renal hemorrhage in patients with ACKD.
Collapse
Affiliation(s)
- Cheng Shi Chen
- Cheng Shi Chen, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hyemin Ahn
- Hyemin Ahn, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Ji Hoon Shin, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Hai-Liang Li
- Hai-Liang Li, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jong Woo Kim
- Jong Woo Kim, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Alrashidi Ibrahim
- Alrashidi Ibrahim, MD. Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hee Ho Chu
- Hee Ho Chu, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| |
Collapse
|
11
|
Park S, Jeong B, Shin JH, Jang EH, Hwang JH, Kim JH. Transarterial embolisation for gastroduodenal bleeding following endoscopic resection. Br J Radiol 2021; 94:20210062. [PMID: 33861138 DOI: 10.1259/bjr.20210062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. METHODS Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. RESULTS Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1-30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. CONCLUSIONS TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. ADVANCES IN KNOWLEDGE This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.
Collapse
Affiliation(s)
- Suyoung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Boryeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Eun Ho Jang
- Department of Radiology, Ulsan City Hospital, 1007, Saneop-ro, Buk-gu, Ulsan, Republic of Korea
| | - Jung Han Hwang
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| |
Collapse
|
12
|
Platelet safety range before splenectomy for hypersplenism: based on 244 cases of splenectomy in hepatolenticular degeneration patients. Acta Gastroenterol Belg 2021; 84:51-56. [PMID: 33639693 DOI: 10.51821/84.1.943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and study aims To investigate the safety and efficacy of splenectomy for hepatolenticular degeneration (HLD) patients with PLT less than 20 × 109/L. Patients and methods A total of 244 HLD patients with hypersplenism underwent splenectomy. According to the preoperative PLT values, the patients were divided into three groups : group A of 53 patients with PLT < 20 × 109/L ; group B of 92 patients with 20 × 109/L ≤ PLT ≤ 30 × 109/L ; group C of 99 patients with PLT > 30 × 109/L. General information including : blood cell counts, liver function , coagulation function 1 day before sugery and 1, 7, 14 days after surgery ; intraoperative blood loss ; operation time ; vital signs at the beginning, at 60 minutes and the end of the operation. Pressure and blood oxygen ; postoperative drainage ; postoperative complications and mortality. Results Blood cell counts, liver function, and coagulation function were improved after splenectomy in three groups (P<0.05) ; there was no significant difference in blood loss, operation time, vital signs during the operation, postoperative drainage, postoperative complications and mortality between three groups (P>0.05). Conclusion For HLD patients with hypersplenism, it is safe and effective to conduct splenectomy under PLT < 20 × 109/L.
Collapse
|
13
|
Alhazemi AA, Park S, Shin JH, Cho YC, Kim Y, Lee J, Kim PH, Kim JW, Chu HH. Safety and efficacy of transarterial embolisation for treatment of dorsal pancreatic artery haemorrhage. Clin Radiol 2020; 76:314.e9-314.e15. [PMID: 33334554 DOI: 10.1016/j.crad.2020.11.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the safety and efficacy of transarterial embolisation (TAE) of dorsal pancreatic artery (DPA) haemorrhage. MATERIALS AND METHODS Nineteen consecutive patients (M:F = 16:3, mean age 59.6 years) who underwent TAE of DPA in three tertiary medical centres between January 2001 to January 2020 were reviewed retrospectively. Angiographic features and the technical and clinical outcomes of TAE were analysed. RESULTS The clinical presentations were a bloody drain from the Jackson-Pratt drainage tube (n=8), melaena (n=7), abdominal pain (n=4), and haematochezia (n=3). Angiographic findings included pseudoaneurysm (n=14), contrast media extravasation (n=4), or abrupt cut-off of the arterial branch (n=1). The NBCA (N-butyl-cyanoacrylate; n=4), microcoils (n=4), and a combination of these agents (n=7) were used as embolic agents. The most common origin of the DPA in the present study cohort was the splenic artery (n=7), followed by the coeliac trunk (n=4), common hepatic artery (n=4), and superior mesenteric artery (n=4). Technical and clinical success rates were 100% and 84.2% (16/19), respectively. Of the three clinically unsuccessful cases, two patients were revealed to have newly developed bleeding from another artery. The other patient expired 1 day after the TAE procedure due to a progression of hepatic failure. In one patient, an asymptomatic non-target embolisation occurred in the right posterior tibial artery as a procedure-related complication. No major complications were observed. CONCLUSION TAE is safe and effective for the management of bleeding from the DPA. It is important to be aware of the DPA as a potential bleeding source, including the relevant clinical characteristics.
Collapse
Affiliation(s)
- A A Alhazemi
- Department of Radiology, King Fahd Central Hospital, Jazan 45196, Saudi Arabia
| | - S Park
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, Incheon, Republic of Korea
| | - J H Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Y C Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y Kim
- Department of Radiology Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - J Lee
- Department of Radiology Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - P H Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J W Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H H Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
14
|
Varela-Ponte R, Martínez-Lago N, Vieito-Villar M, Carreira-Villamor JM. Impact of risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy of space-occupying lesions. RADIOLOGIA 2020; 64:S0033-8338(20)30141-7. [PMID: 33257053 DOI: 10.1016/j.rx.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/30/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Ultrasound-guided percutaneous liver biopsy is considered the technique of choice for the histological diagnosis of space-occupying lesions, given its high level of safety and diagnostic performance. However, since it is an invasive diagnostic procedure, complications can occur. Various clinical and radiological parameters have been analyzed as factors related with the efficacy of the technique or with its complications; however, the results have been contradictory. Thus, we aimed to evaluate the impact of various risk factors on the efficacy and complications of ultrasound-guided percutaneous liver biopsy in the diagnosis of space-occupying lesions in ordinary clinical practice. MATERIAL AND METHODS This retrospective observational study included all patients who underwent real-time ultrasound-guided percutaneous biopsies of space-occupying liver lesions with the free-hand technique between December 2012 and February 2018 in the diagnostic imaging department at the Hospital Clínico Universitario de Santiago de Compostela. We analyzed the following risk factors: location of the lesion in upper liver segments (II, IVa, VII, or VIII); proximity to the liver capsule, distance from the skin > 100mm, interposition of osseus or vascular structures, inability to go through healthy parenchyma, and lack of patient cooperation during the procedure. Efficacy was analyzed in terms of the number of cylinders obtained and the percentage of adequate biopsies; safety was analyzed in terms of the percentage of complications, which were classified as major or minor. RESULTS We included 295 biopsies in 278 patients (median age, 69 years; 64.1% male; 44.7% had prior neoplasms). In 61.4%, the biopsy was indicated for the initial diagnosis; 82.4% of biopsies were done in hospitalized patients, and 65% of the lesions were located in the right liver lobe. The median number of cylinders obtained was 3 (range 1-6); 91.2% of the biopsies were adequate and 92.2% were considered clinically useful. These percentages did not differ significantly according to the presence of risk factors. Complications occurred in 10 (3.4%) patients. Complications were considered major in 3 (0.9%) patients (2 (0.6%) bleeding complications and 1 (0.3%) infectious complication) and minor in 7 (2.4%). The percentage of complications was significantly higher in patients who did not cooperate during the procedure (p=0.04). CONCLUSIONS Ultrasound-guided percutaneous liver biopsy is an efficacious and safe technique for the histological diagnosis of space-occupying liver lesions. Our results confirm the increased rate of complications when patients fail to cooperate during the procedure.
Collapse
Affiliation(s)
- R Varela-Ponte
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España.
| | - N Martínez-Lago
- Servicio de Oncología Médica, Complexo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M Vieito-Villar
- Unidad de Sacorma y Neuroncología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - J Martin Carreira-Villamor
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Over the past decade, imaging modalities and serological tests have emerged as important tools in the evaluation of liver diseases, in many cases supplanting the use of liver biopsy and histological examination. Nonetheless, the accuracy and diagnostic value of these methods may not always be conclusive and the assessment of liver histology often remains the gold standard for diagnostic evaluation. The purpose of this review is to summarize the current role of liver biopsy in contemporary hepatology practice. RECENT FINDINGS Technical factors were found to influence the diagnostic value of liver biopsy and histological examination of the liver, including specimen number and size (preferably ≥3 nonfragmented specimens of >20 mm in length), needle diameter (1.6 mm Menghini), number of passes (mean 2.5), imaging-guidance, and operator experience. Liver biopsy was demonstrated to be diagnostically valuable in the evaluation of persistently abnormal liver tests of unclear cause, with histology pointing to a specific diagnosis in 84% of patients. Although coagulation abnormalities continue to be an important concern when performing liver biopsy, their influence on complication risk remains unclear. Implementation of less stringent preprocedural coagulation thresholds decreased preprocedural transfusions without increasing the bleeding rate. Serious complications associated with percutaneous liver-biopsy (PLB) and transjugular liver-biopsy are similar, but pain appears to be more common with PLB. SUMMARY Histopathological evaluation continues to be fundamentally important in assessing hepatic disease, and liver histology remains the most accurate approach to assess fibrosis and assign prognosis.
Collapse
Affiliation(s)
- Ali Khalifa
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | | |
Collapse
|
16
|
Outcome of Rectal Arterial Embolization for Rectal Bleeding in 34 Patients: A Single-Center Retrospective Study over 20 Years. J Vasc Interv Radiol 2020; 31:576-583. [DOI: 10.1016/j.jvir.2019.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 12/27/2022] Open
|
17
|
Incidence of major hemorrhage after aggressive image-guided liver mass biopsy in the era of individualized medicine. Abdom Radiol (NY) 2019; 44:2067-2073. [PMID: 29774381 DOI: 10.1007/s00261-018-1637-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To analyze a large volume of image-guided liver mass biopsies to assess for an increased incidence of major hemorrhage after aggressive liver mass sampling, and to determine if coaxial technique reduces major hemorrhage rate. METHODS Patients who underwent image-guided liver mass biopsy over a 15-year period (December 7, 2001-September 22, 2016) were retrospectively identified. An aggressive biopsy was defined as a biopsy event in which ≥ 4 core needle passes were performed. Association of major hemorrhage after aggressive liver mass biopsy and other potential risk factors of interest were assessed using logistic regression analysis. For the subset of aggressive biopsies, Fisher's exact test was used to compare the incidence of major hemorrhage using coaxial versus noncoaxial techniques. RESULTS Aggressive biopsies constituted 11.6% of biopsy events (N =579/5011). The incidence of major hemorrhage with <4 passes was 0.4% (N =18/4432) and with ≥4 passes 1.2% (N =6/579). In univariable models, aggressive biopsy was significantly associated with major hemorrhage (OR 3.0, 95% CI 1.16-6.92, p =0.025). After adjusting for gender and platelet count, the association was not significant at the p =0.05 level (OR 2.58, 95% CI 0.927-6.24, p =0.067). The rate of major hemorrhage in the coaxial biopsy technique group was 1.4% (N =3/209) compared to 1.1% (N =4/370) in the noncoaxial biopsy technique group, which was not a significant difference (p =0.707). CONCLUSIONS Although aggressive image-guided liver mass biopsies had an increased incidence of major hemorrhage, the overall risk of bleeding remained low. The benefit of such biopsies will almost certainly outweigh the risk in most patients.
Collapse
|
18
|
Frequency of Bleeding Complications After Percutaneous Core Needle Biopsy and the Association With Aspirin Usage and Length of Aspirin Discontinuation. AJR Am J Roentgenol 2019; 213:211-215. [PMID: 30995091 DOI: 10.2214/ajr.18.20366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study is to report the frequency of major bleeding after percutaneous image-guided core biopsy and its association with aspirin usage and duration of prebiopsy aspirin abstinence. MATERIALS AND METHODS. A retrospective review of percutaneous image-guided core biopsies performed at our institution between September 1, 2005, and September 1, 2016, was performed (n = 30,966). Patients were excluded if aspirin usage data were missing (n = 633). Bleeding complications were defined using the Common Terminology Criteria for Adverse Events and were considered significant if they were grade 3 or higher. Multivariate models were adjusted for age, sex, platelet count, international normalized ratio, and biopsy target. Three categorizations of aspirin use were examined: any use within 10 days before biopsy, duration of abstinence (> 10 days or no aspirin, 8-10 days, 4-7 days, and 0-3 days before biopsy), and use on the day of biopsy. Associations with bleeding complications were modeled using logistic regression models. A p < 0.05 was considered significant. RESULTS. The study included 30,333 biopsies in 21,938 subjects (57% male; median age, 60 years; interquartile range, 49-70 years). Of the biopsies, 7921 (26.1%) were performed in patients who received aspirin within 10 days of biopsy, and 3761 (47.5%) of those biopsies were performed in patients who took aspirin within 3 days. Ninety-eight (0.32%) significant bleeding complications occurred overall, including 34 (0.43%) in patients who used aspirin within 10 days before biopsy (odds ratio, 1.5; 95% CI, 0.96-2.3; p = 0.08). Duration of abstinence was associated with a significantly increased bleeding risk only between 0-3 days versus more than 10 days or no aspirin (odds ratio, 2.1; 95% CI, 1.3-3.6; p = 0.004). Aspirin use on the day of biopsy showed the greatest increase in risk (1.9%; odds ratio, 6.6; 95% CI, 3.8-11.5; p < 0.001). CONCLUSION. Significant bleeding complications after biopsy remain rare even among patients with recent aspirin usage, although shorter duration of prebiopsy abstinence increases bleeding risk, most significantly if aspirin is taken the day of biopsy.
Collapse
|
19
|
Beatriz M, Beatriz P, Rita C, Helena A, Monica B. Effect of Pre-analytical Conditions on Prothrombin Time and Partial Activated Thromboplastin Time. Curr Pharm Biotechnol 2019; 20:327-331. [PMID: 30868948 DOI: 10.2174/1389201020666190314125918] [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: 06/12/2018] [Revised: 08/15/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical analysis often involves clotting assays. Although the guidelines suggest the storing and freezing of samples before these assays, there are contradictory results in the literature. The objective of this study was to analyse the effect of the temperature and the storage of plasma sample on Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) in clinical samples for 65 patients without coagulation disorders. MATERIALS AND METHODS After centrifugation, plasma of each patient was tested at arrival as part of their routine care and separately aliquoted. Three aliquots were stored at room temperature, 4°C and - 20°C for 24h after collection, two aliquots were stored at 4°C and -20°C for 1 week and one aliquot was stored at -70°C for 1 month. RESULTS PT from healthy patients was affected at room temperature for 24h and at 4°C for 1 week. For aPTT, the results were statistically different for all the conditions after 24h and at 4°C for 1 week. CONCLUSION Results indicate that PT and aPTT can be stored at -70ºC for at least 1 month without any significant changes in the assay result.
Collapse
Affiliation(s)
- Moutinho Beatriz
- ISEP, Instituto Superior de Engenharia do Porto, Instituto Politecnico do Porto, Porto, Portugal
| | - Pinto Beatriz
- ISEP, Instituto Superior de Engenharia do Porto, Instituto Politecnico do Porto, Porto, Portugal
| | - Cardoso Rita
- INSA, National Institute of Health Dr. Ricardo Jorge, Department of Health Promotion and Chronic Diseases, Rua Alexandre Herculano, 321, 4000-055 Porto, Portugal
| | - Alves Helena
- INSA, National Institute of Health Dr. Ricardo Jorge, Department of Health Promotion and Chronic Diseases, Rua Alexandre Herculano, 321, 4000-055 Porto, Portugal.,Fundação Professor Ernesto Morais, Porto, Portugal
| | - Botelho Monica
- INSA, National Institute of Health Dr. Ricardo Jorge, Department of Health Promotion and Chronic Diseases, Rua Alexandre Herculano, 321, 4000-055 Porto, Portugal.,i3S, Instituto de Investigação e Inovação da Universidade do Porto, Portugal Division of Endocrinology, Diabetes and Metabolism, Hospital, Porto, Portugal
| |
Collapse
|
20
|
Ng R, Shabani-Rad MT. Results of Octaplex for reversal of warfarin anticoagulation in patients with hip fracture. Can J Surg 2019; 62:14-19. [PMID: 30265643 PMCID: PMC6351252 DOI: 10.1503/cjs.018017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients with hip fracture who present anticoagulated with warfarin often require reversal of anticoagulation for safe hip fracture surgery. Vitamin K is typically administered for this, but requires 24-48 hours for maximal effect. These patients have an increased delay to surgery and increased mortality. Octaplex is a prothrombin complex concentrate (PCC) that reverses warfarin anticoagulation in less than an hour. This study assesses the effectiveness and safety of Octaplex for reversal of warfarin anticoagulation for hip fracture surgery. METHODS We reviewed the medical records of all patients with hip fracture in Calgary who received Octaplex between 2009 and 2015. Timing of admission, Octaplex administration and hip fracture surgery were recorded. Mortality and cardiac, thrombotic and orthopedic complications were assessed. RESULTS Median time from Octaplex administration to an international normalized ratio of 1.4 or lower was 1.1 hours. The median time from admission to surgery was 22 hours. Thirty-day mortality was 15.2%, with 4 cases of cardiac arrest and 1 respiratory arrest. Patients who received both Octaplex and fresh frozen plasma (FFP) had a lower rate of 30-day survival than those who received only Octaplex (95.7% v. 60.0%, p = 0.002). CONCLUSION There were significant rates of cardiac events and 30-day mortality among patients who received Octaplex, but this is unsurprising in this population with multiple medical comorbidities. We caution against administrering both FFP and a PCC in patients for warfarin reversal. Octaplex is effective for rapidly reversing warfarin anticoagulation and reducing delays to hip fracture surgery. Further study comparing Octaplex to reversal using only vitamin K is required.
Collapse
Affiliation(s)
- Richard Ng
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (Ng); and the Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta. (Shabani-Rad)
| | - Meer-Taher Shabani-Rad
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (Ng); and the Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta. (Shabani-Rad)
| |
Collapse
|
21
|
Kwon JH, Kim MD, Han K, Choi W, Kim YS, Lee J, Kim GM, Won JY, Lee DY. Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study. Eur Radiol 2018; 29:57-67. [PMID: 29926205 DOI: 10.1007/s00330-018-5587-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/25/2018] [Accepted: 06/04/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of transcatheter arterial embolisation (TAE) in the management of lower gastrointestinal bleeding (LGIB) and to identify predictors of clinical outcomes. METHODS Between December 2005 and April 2017, 274 patients underwent diagnostic angiography for signs and symptoms of LGIB; 134 patients with positive angiographic findings were retrospectively analysed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analysed. Predictors for clinical outcomes were evaluated using univariate and multivariate logistic regression analyses. RESULTS A total of 134 patients (mean age, 59.7 years; range, 14-82 years) underwent TAE for LGIB. The bleeding foci were in the small bowel in 74 patients (55.2%), colon in 35 (26.1%), and rectum in 25 (18.7%). Technical success was achieved in 127 patients (94.8%). The clinical success rate was 63% (80/127). The rates of recurrent bleeding, major complications, and in-hospital mortality were 27.9% (31/111), 18.5% (23/124), and 23.6% (33/127), respectively. Superselective embolisation and the use of N-butyl cyanoacrylate (NBCA) were significant prognostic factors associated with reduced recurrent bleeding (OR, 0.258; p = 0.004 for superselective embolisation, OR, 0.313; p = 0.01 for NBCA) and fewer major complications (OR, 0.087; p ˂ 0.001 for superselective embolisation, OR, 0.272; p = 0.007 for NBCA). CONCLUSIONS TAE is an effective treatment modality for LGIB. Superselective embolisation is essential to reduce recurrent bleeding and avoid major complications. NBCA appears to be a preferred embolic agent. KEY POINTS • Transcatheter arterial Embolisation (TAE) is a safe and effective treatment for lower gastrointestinal tract haemorrhage. • Superselective embolisation is essential to improve outcomes. • N-butyl cyanoacrylate (NBCA) appears to be a preferred embolic agent with better clinical outcomes.
Collapse
Affiliation(s)
- Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Woosun Choi
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Yong Seek Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Do Yun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| |
Collapse
|
22
|
Kitchin DR, del Rio AM, Woods M, Ludeman L, Hinshaw JL. Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience. Abdom Radiol (NY) 2018; 43:1494-1501. [PMID: 28929196 DOI: 10.1007/s00261-017-1319-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To retrospectively review revised pre-procedural coagulation guidelines for percutaneous liver biopsy to determine whether their implementation is associated with increased hemorrhagic complications on a departmental scale. Secondary endpoints were to determine the effect of this change on pre-procedural blood product (FFP and platelet) utilization, to evaluate the impact of administered blood products on hemorrhagic complications, and to determine whether bleeding complications were related to INR and platelet levels. MATERIALS AND METHODS This IRB-approved, HIPAA-compliant, retrospective study reviewed 1846 percutaneous liver biopsies in 1740 patients, comparing biopsies performed, while SIR consensus pre-procedural coagulation guidelines were in place (INR ≤ 1.5, platelets ≥50,000 µL) to those performed after departmental implementation of revised, less stringent guidelines (INR ≤ 2.0, platelets ≥25,000 µL). RESULTS On a departmental scale, there were significantly fewer hemorrhagic complications in the population of patients treated after adoption of less stringent guidelines as compared to those treated under the SIR guidelines (1.6% vs. 3.4%, p = 0.0192) despite a significant decrease in pre-procedural FFP (0.8% vs. 3.9%, p < 0.001) and platelet transfusions (0.3% vs. 1.2%, p = 0.021). Individual patient hemorrhagic complication rates significantly increased as INR increased (p = 0.006) and platelet counts decreased (p = 0.004), but pre-procedural FFP (p = 0.64) and/or platelet transfusion (p = 0.5) did not have a significant impact on hemorrhagic complication rates. CONCLUSION Implementation of less stringent pre-procedural coagulation parameter guidelines for percutaneous liver biopsy (INR ≤ 2.0, platelets ≥25,000 µL) did not result in an increase in departmental hemorrhagic complication rates but did significantly decrease pre-procedural FFP/platelet administration. An individual patient's bleeding risk does increase as INR increases and platelets decrease, but pre-procedural FFP and/or platelet transfusion did not mitigate that increased risk.
Collapse
|
23
|
Kriegshauser JS, Osborn HH, Naidu SG, Huettl EA, Patel MD. Developing Interventional Radiology Anticoagulation Guidelines: Process and Benefits †. J Clin Med 2018; 7:jcm7040085. [PMID: 29677117 PMCID: PMC5920459 DOI: 10.3390/jcm7040085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 03/30/2018] [Accepted: 04/17/2018] [Indexed: 01/22/2023] Open
Abstract
We created, posted, and updated radiology department anticoagulation guidelines and identified various steps in the process, including triggering events, consensus building, legal analysis, education, and distribution of the guidelines to nurses and clinicians. Supporting data collected retrospectively, before and after implementation, included nursing satisfaction survey results and the number of procedure cancellations. After the guidelines were developed and posted, significantly fewer procedures were cancelled, nursing satisfaction was higher, and radiologists performed procedures with less variability. Anecdotally, radiologists had fewer queries about anticoagulation. The development and dissemination of radiologic procedure anticoagulation guidelines should be considered as a departmental quality improvement project.
Collapse
Affiliation(s)
- J Scott Kriegshauser
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Howard H Osborn
- Department of Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA.
| | - Sailen G Naidu
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Eric A Huettl
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Maitray D Patel
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
| |
Collapse
|
24
|
Han K, Ahmed BM, Kim MD, Won JY, Lee DY, Kim GM, Kwon JH, Park SI, Hoon Noh S, Hyung WJ. Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding. Gastric Cancer 2017; 20:887-894. [PMID: 28194589 DOI: 10.1007/s10120-017-0700-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to retrospectively investigate the feasibility and safety of transcatheter arterial embolization in the management of postgastrectomy arterial bleeding. METHODS Between January 2004 and July 2015, 13,246 patients underwent total or subtotal gastrectomy at our institution, and 24 patients (18 men; mean age 66.8 years; range 42-80 years) underwent transcatheter arterial embolization for postoperative arterial bleeding identified on angiography. RESULTS Postgastrectomy arterial bleeding occurred after subtotal gastrectomy in 14 patients (58%) and after total gastrectomy in 10 patients (42%), after a mean of 17 days (range 1-57 days). It manifested itself as luminal bleeding in 10 patients and as abdominal bleeding in 14 patients. Technical success was achieved in all 24 patients (100%). The clinical success rate was 79% (19-24); there were three transcatheter-arterial-embolization-related major complications that resulted in death within 30 days (12%), one case of recurrent bleeding, and one case of persistent bleeding. The cause of death included infarctions in the spleen and/or remnant stomach (n = 2) and bowel perforation (n = 1). The commonest bleeding focus was the gastroduodenal artery (46%, 11 patients), followed by the splenic artery (29%, 7 patients). By surgery type, the gastroduodenal artery was the commonest site of bleeding in subtotal gastrectomy (64%, 9/14) and the splenic artery was commonest site of bleeding in total gastrectomy (50%, 5/10). CONCLUSIONS Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.
Collapse
Affiliation(s)
- Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Bestun Mustafa Ahmed
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Do Yun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Sung Il Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea
| | - Sung Hoon Noh
- Department of Surgery, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea
| |
Collapse
|
25
|
Kim JW, Shin SS. Ultrasound-Guided Percutaneous Core Needle Biopsy of Abdominal Viscera: Tips to Ensure Safe and Effective Biopsy. Korean J Radiol 2017; 18:309-322. [PMID: 28246511 PMCID: PMC5313519 DOI: 10.3348/kjr.2017.18.2.309] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/09/2016] [Indexed: 12/13/2022] Open
Abstract
Ultrasound-guided percutaneous core needle biopsy (USPCB) is used extensively in daily clinical practice for the pathologic confirmation of both focal and diffuse diseases of the abdominal viscera. As a guidance tool, US has a number of clear advantages over computerized tomography or magnetic resonance imaging: fewer false-negative biopsies, lack of ionizing radiation, portability, relatively short procedure time, real-time intra-procedural visualization of the biopsy needle, ability to guide the procedure in almost any anatomic plane, and relatively lower cost. Notably, USPCB is widely used to retrieve tissue specimens in cases of hepatic lesions. However, general radiologists, particularly beginners, find USPCB difficult to perform in abdominal organs other than the liver; indeed, a full understanding of the entire USPCB process and specific considerations for specific abdominal organs is necessary to safely obtain adequate specimens. In this review, we discuss some points and techniques that need to be borne in mind to increase the chances of successful USPCB. We believe that the tips and considerations presented in this review will help radiologists perform USPCB to successfully retrieve target tissue from different organs with minimal complications.
Collapse
Affiliation(s)
- Jin Woong Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea.; Center for Aging and Geriatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea
| |
Collapse
|
26
|
Kim JW, Shin JH, Kim PN, Shin YM, Won HJ, Ko GY, Yoon HK. Embolization for Bleeding after Hepatic Radiofrequency Ablation. J Vasc Interv Radiol 2016; 28:356-365.e2. [PMID: 28012690 DOI: 10.1016/j.jvir.2016.09.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate safety and clinical efficacy of embolization for management of bleeding after hepatic radiofrequency (RF) ablation. MATERIALS AND METHODS From January 2000 to December 2014, 5,196 patients with 9,743 tumors underwent 8,303 RF ablation sessions. Of these patients, 62 experienced bleeding after hepatic RF ablation; 15 patients (12 men and 3 women; mean age 62 y; range, 49-76 y) underwent embolization and composed the final study cohort. Tumors were hepatocellular carcinomas in 13 (87%) patients and metastatic adenocarcinomas from colorectal cancer in 2 (13%) patients. Mean number of tumors was 1.5 (22 nodules; range, 1-3). Tumor locations were segment I (n = 1), segment II (n = 2), segment III (n = 1), segment IV (n = 1), segment V (n = 3), segment VI (n = 5), segment VII (n = 1), and segment VIII (n = 9). Mean tumor size was 2.3 cm (range, 0.9-5 cm). RESULTS Median time interval between presentation and angiography was 22 hours (mean 38.4 h; range, 3-168 h). On angiography, contrast extravasation with or without pseudoaneurysm was seen in all 15 patients; 14 patients underwent transarterial embolization, and 1 patient underwent percutaneous transhepatic portal vein embolization. Successful hemostasis was achieved in all patients. There was no rebleeding within 30 days after embolization. No embolization-related major complications were observed. CONCLUSIONS Embolization is safe and effective for controlling bleeding related to hepatic RF ablation without the need for surgery.
Collapse
Affiliation(s)
- Jong Woo Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea; Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea.
| | - Pyo Nyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| |
Collapse
|
27
|
Bleeding Risk and Management in Interventional Procedures in Chronic Liver Disease. J Vasc Interv Radiol 2016; 27:1665-1674. [PMID: 27595469 DOI: 10.1016/j.jvir.2016.05.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 12/14/2022] Open
Abstract
The coagulopathy of liver disease is distinctly different from therapeutic anticoagulation in a patient. Despite stable elevated standard clot-based coagulation assays, nearly all patients with stable chronic liver disease (CLD) have normal or increased clotting. Common unfamiliarity with the limitations of these assays in CLD may lead to inappropriate and sometimes harmful interventions, including blood product transfusions before a procedure. Knowledge of the distinct hemostatic alterations in CLD can allow identification of the small subset of patients with clinically significant coagulopathy who can benefit from hematologic optimization before invasive procedures.
Collapse
|
28
|
Plett SK, Poder L, Brooks RA, Morgan TA. Transvaginal Ultrasound-Guided Biopsy of Deep Pelvic Masses: How We Do It. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1113-1122. [PMID: 27091918 DOI: 10.7863/ultra.15.08002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/11/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this review is to discuss the rationale and indications for transvaginal ultrasound-guided biopsy. Transvaginal ultrasound-guided biopsy can be a helpful tool for diagnosis and treatment planning in the evaluation of pelvic masses, particularly when the anatomy precludes a transabdominal or posterior transgluteal percutaneous biopsy approach. A step-by-step summary of the technique with preprocedure and postprocedure considerations is included.
Collapse
Affiliation(s)
- Sara K Plett
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California USA.
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California USA
| | - Rebecca A Brooks
- Department of Obstetrics and Gynecology, University of California, San Francisco, California USA
| | - Tara A Morgan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California USA
| |
Collapse
|
29
|
Zabala Landa RM, Korta Gómez I, Del Cura Rodríguez JL. Interventional radiology neck procedures. RADIOLOGIA 2016; 58 Suppl 2:2-14. [PMID: 27138033 DOI: 10.1016/j.rx.2016.04.004] [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: 11/09/2015] [Revised: 03/22/2016] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation.
Collapse
Affiliation(s)
- R M Zabala Landa
- Servicio de Radiología, Hospital Universitario Basurto, Bilbao (Vizcaya), España.
| | - I Korta Gómez
- Servicio de Radiología, Hospital Universitario Basurto, Bilbao (Vizcaya), España
| | | |
Collapse
|
30
|
Abstract
Determining practice parameters for interventional procedures is challenging due to many factors including unreliable laboratory tests to measure bleeding risk, variable usage of standardized terminology for adverse events, poorly defined standards for administration of blood products, and the growing numbers of anticoagulant and antiplatelet medications. We aim to address these and other issues faced by radiologists performing invasive procedures through a review of available literature, and experiential guidance from three academic medical centers. We discuss the significant limitations with respect to using prothrombin-time and international normalized ratio to measure bleeding risk, especially in patients with synthetic defects due to liver function. Factors affecting platelet function including the impact of uremia; recent advances in laboratory testing, including platelet function testing; and thromboelastography are also discussed. A review of the existing literature of fresh-frozen plasma replacement therapy is included. The literature regarding comorbidities affecting coagulation including malignancy, liver failure, and uremia are also reviewed. Finally, the authors present a set of recommendations for laboratory thresholds, corrective transfusions, as well as withholding and restarting medications.
Collapse
|
31
|
Carberry GA, Lubner MG, Wells SA, Hinshaw JL. Percutaneous biopsy in the abdomen and pelvis: a step-by-step approach. Abdom Radiol (NY) 2016; 41:720-42. [PMID: 26883783 DOI: 10.1007/s00261-016-0667-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Percutaneous abdominal biopsies provide referring physicians with valuable diagnostic and prognostic information that guides patient care. All biopsy procedures follow a similar process that begins with the preprocedure evaluation of the patient and ends with the postprocedure management of the patient. In this review, a step-by-step approach to both routine and challenging abdominal biopsies is covered with an emphasis on the differences in biopsy devices and imaging guidance modalities. Adjunctive techniques that may facilitate accessing a lesion in a difficult location or reduce procedure risk are described. An understanding of these concepts will help maintain the favorable safety profile and high diagnostic yield associated with percutaneous biopsies.
Collapse
|
32
|
Boyum JH, Atwell TD, Schmit GD, Poterucha JJ, Schleck CD, Harmsen WS, Kamath PS. Incidence and Risk Factors for Adverse Events Related to Image-Guided Liver Biopsy. Mayo Clin Proc 2016; 91:329-35. [PMID: 26837481 DOI: 10.1016/j.mayocp.2015.11.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the incidence of major adverse events related to a large volume of image-guided liver biopsies performed at our institution over a 12-year period and to identify risk factors for major bleeding events. PATIENTS AND METHODS A retrospective analysis of an internally maintained biopsy registry was performed. The analysis revealed that 6613 image-guided liver biopsies were performed in 5987 adult patients between December 7, 2001, and December 31, 2013. Liver biopsies were performed using real-time ultrasound guidance and a spring-loaded biopsy device, with rare exceptions. Adverse events considered major and included in this study were hematoma, infection, pneumothorax, hemothorax, and death. Using data from the biopsy registry, we evaluated statistically significant risk factors (P<.05) for hematoma related to image-guided liver biopsy, including coagulation status, biopsy technique, and medications. RESULTS A total of 49 acute and delayed major adverse events (0.7%) occurred after 6613 liver biopsy events. The incidence of hematoma requiring transfusion and/or angiographic intervention was 0.5% (34 of 6613). The incidence of infection was 0.1% (8 of 6613), and that of hemothorax was 0.06% (4 of 6613). No patient (0%) incurred a pneumothorax after biopsy. Three patients (0.05%) died within 30 days of liver biopsy, 1 being directly related to biopsy. Thirty-eight of 46 major adverse events (83%) presented acutely (within 24 hours). More than 2 biopsy passes, platelets 50,000/μL or less, and female sex were statistically significant risk factors for postbiopsy hemorrhage. CONCLUSION Image-guided liver biopsy performed by subspecialized interventionalists at a tertiary medical center is safe when the platelet count is greater than 50,000/μL. With appreciation of specific risk factors, safety outcomes of this procedure can be optimized in both general and specialized centers.
Collapse
Affiliation(s)
| | | | | | - John J Poterucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Cathy D Schleck
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - W Scott Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| |
Collapse
|
33
|
|
34
|
Kurup AN, Lekah A, Reardon ST, Schmit GD, McDonald JS, Carter RE, Kamath PS, Callstrom MR, Atwell TD. Bleeding Rate for Ultrasound-Guided Paracentesis in Thrombocytopenic Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1833-1838. [PMID: 26362144 DOI: 10.7863/ultra.14.10034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the rate of major bleeding complications for ultrasound-guided paracentesis performed in thrombocytopenic patients. METHODS We retrospectively reviewed the electronic medical records of patients with platelet counts of less than 50,000/μL who had ultrasound-guided paracenteses performed in the Department of Radiology without correcting preprocedural platelet transfusions between 2005 and 2011. Medical records were evaluated for evidence of major bleeding complications (grade 3 or higher as defined by the National Institutes of Health's Common Terminology Criteria for Adverse Events, version 4.03) and their clinical sequelae. Platelet count and bleeding complications were evaluated for an association, and a sensitivity analysis was performed to determine whether analysis of a control group of patients without thrombocytopenia would yield added confidence in this assessment. RESULTS Among 304 procedures in 205 thrombocytopenic patients (69% male; mean age ± SD, 56.6 ± 11.9 years), the mean platelet count was 38,400 ± 9300/μL (range, 9000-49,000/μL). Three major bleeding complications requiring red blood cell transfusion were observed in patients with platelet counts of 41,000 to 46,000/μL, for a complication rate of 0.99% (95% confidence interval, 0.3%-2.9%). No patient required an additional procedure or died because of the bleeding complication. There was no association of platelet count with bleeding complications. The sensitivity analysis showed that further evaluation of patients with normal platelet counts would not add to the conclusion. CONCLUSIONS The risk of major bleeding after ultrasound-guided paracentesis in thrombocytopenic patients is very low. In most patients, routine assessment of the preprocedural serum platelet concentration is not necessary, and correction of such an abnormal laboratory value is not indicated.
Collapse
Affiliation(s)
- A Nicholas Kurup
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
| | - Alexander Lekah
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.)
| | - Scott T Reardon
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.)
| | - Grant D Schmit
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.)
| | - Jennifer S McDonald
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.)
| | - Rickey E Carter
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.)
| | - Patrick S Kamath
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.)
| | - Matthew R Callstrom
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.)
| | - Thomas D Atwell
- Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.)
| |
Collapse
|
35
|
Koo HJ, Shin JH, Shin S, Yoon HK, Ko GY, Gwon DI. Efficacy and Clinical Outcomes of Transcatheter Arterial Embolization for Gastrointestinal Bleeding from Gastrointestinal Stromal Tumor. J Vasc Interv Radiol 2015; 26:1297-304.e1. [PMID: 26190186 DOI: 10.1016/j.jvir.2015.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy and clinical outcomes of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding from gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS TAE was performed in 20 referred patients (male:female = 13:7; median age, 56.3 y) for GI bleeding from GISTs. The locations of GISTs were assessed using contrast-enhanced computed tomography (CT) and catheter angiography. The technical and clinical success of TAE and clinical outcomes including procedure-related complications, recurrent bleeding, 30-day and overall mortality, and cumulative survival were evaluated. RESULTS The sites of GIST-related bleeding or tumor staining were the jejunum (n = 9), stomach (n = 5), ileum (n = 3), duodenum (n = 2), and jejunum and colon (n = 1). Angiography showed bleeding from GIST in 5 patients, and tumor staining was noted in only 15 patients. TAE was performed for patients with and without contrast medium extravasation on angiography. Technical and clinical success rates of TAE were 95% (19 of 20 patients) and 90% (18 of 20 patients), respectively. Recurrent bleeding was noted in 1 patient. There were no procedure-related complications. In 15 patients, surgical resection of the tumors was performed after TAE. The 30-day and overall mortality rates were 10% (2 of 20 patients) and 30% (6 of 20 patients), respectively. CONCLUSIONS TAE is a safe and effective method for controlling GI bleeding from the GIST.
Collapse
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea.
| | - Sooyoung Shin
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea
| |
Collapse
|
36
|
Clinical outcome of transcatheter arterial embolization with N-butyl-2-cyanoacrylate for control of acute gastrointestinal tract bleeding. AJR Am J Roentgenol 2015; 204:662-8. [PMID: 25714300 DOI: 10.2214/ajr.14.12683] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE. The purpose of this article is to evaluate the clinical effectiveness of trans-catheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA), with or without other embolic materials for acute nonvariceal gastrointestinal tract bleeding, and to determine the factors associated with clinical outcomes. MATERIALS AND METHODS. TAE using NBCA only or in conjunction with other materials was performed for 102 patients (80 male and 22 female patients; mean age, 61.3 years) with acute nonvariceal gastrointestinal tract bleeding. Technical success, clinical success, and clinical factors, including age, sex, bleeding tendency, endoscopic attempts at hemostasis, number of transfusions, and bleeding causes (i.e., cancer vs noncancer), were retrospectively evaluated. Univariate and multivariable logistic regression analyses were performed to evaluate clinical factors and their ability to predict patient outcomes. Survival curves were obtained using Kaplan-Meier analyses and log-rank tests. RESULTS. There were 36 patients with cancer-related bleeding and 66 with non-cancer-related bleeding. Overall technical and clinical success rates were 100% (102/102) and 76.5% (78/102), respectively. Procedure-related complications included bowel infarction, which was noted in two patients. Recurrent bleeding and bleeding-related 30-day mortality rates were 15.7% (16/102) and 8.8% (9/102), respectively. Cancer-related bleeding increased clinical failure significantly (p = 0.003) and bleeding-related 30-day mortality with marginal significance (p = 0.05). Overall survival was poorer in patients with cancer-related bleeding. CONCLUSION. TAE with NBCA with or without other embolic agents showed high technical and clinical effectiveness in the management of acute nonvariceal gastrointestinal tract bleeding. Cancer-related bleeding was the only factor related to clinical failure, and possibly related to bleeding-related 30-day mortality.
Collapse
|
37
|
Kyaw Tun J, Khwaja S, Flanagan S, Fotheringham T, Low D. Current practice of periprocedural haematological management for patients undergoing image-guided procedures. Br J Radiol 2015; 88:20140778. [PMID: 25587917 DOI: 10.1259/bjr.20140778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate current UK practice of periprocedural haematological management for image-guided procedures in relation to Cardiovascular and Interventional Radiological Society guidelines, which provide recommendations according to bleeding risk of procedures from Category 1 (lowest) to 3 (highest). METHODS Survey of practice in UK radiology departments conducted over a 1-year period RESULTS 48 radiology departments responded. The percentage of departments that stop antithrombotics pre-procedurally are as follows (for Category 1, 2 and 3, respectively): aspirin (31.3%, 43.8%, 54.2%); clopidogrel (54.2%, 68.8%, 72.9%); therapeutic low-molecular-weight heparin (56.3%, 77.1%, 75.0%). The percentage of departments that perform pre-procedural laboratory testing are as follows (for Category 1, 2 and 3, respectively): international normalized ratio (INR; 81.3%, 95.8%, 93.8%); activated partial thrombin time ratio (APTTR; 60.4%, 75.0%, 93.8%); platelet (77.1%, 91.7%, 95.7%); haemoglobin (70.8%, 85.4%, 87.5%). Mean threshold (standard deviation) of laboratory results for conducting procedures (Level 1, 2 and 3, respectively) are as follows: INR [1.53 (0.197), 1.47 (0.186), 1.47 (0.188)]; APTTR [1.50 (0.392), 1.50 (0.339), 1.48 (0.344)]; platelet count (x10(3) cells per microlitre) [74.4 (28.7), 79.9 (29.1), 80.5 (29.3)]; haemoglobin (grams per decilitre) [9.05 (1.40), 9.00 (1.33), 8.92 (1.21)]. No department practices conformed to current recommendations for (1) pre-procedural cessation of antithrombotics and (2) pre-procedural laboratory testing. Two (4.2%) department practices conformed to recommendations for thresholds of haematological parameters. CONCLUSION Current peri-procedural haematological management is variable and often does not conform to existing recommendations. Further research into the impact of this variation in practice on patient outcome is required. ADVANCES IN KNOWLEDGE This study demonstrates wide variation in practice in haematological management for image-guided procedures.
Collapse
Affiliation(s)
- J Kyaw Tun
- 1 Department of Diagnostic Imaging, Barts Health NHS Trust, London, UK
| | | | | | | | | |
Collapse
|
38
|
Shaw, C, Shamimi‐Noori S. Ultrasound and CT-directed liver biopsy. Clin Liver Dis (Hoboken) 2014; 4:124-127. [PMID: 30992938 PMCID: PMC6448750 DOI: 10.1002/cld.437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/03/2014] [Accepted: 10/05/2014] [Indexed: 02/04/2023] Open
Affiliation(s)
- Colette Shaw,
- the Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Susan Shamimi‐Noori
- the Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| |
Collapse
|
39
|
|
40
|
Franchi F, Hammad JS, Rollini F, Tello-Montoliu A, Patel R, Darlington A, Kraemer DF, Cho JR, DeGroat C, Bhatti M, Taha M, Angiolillo DJ. Role of thromboelastography and rapid thromboelastography to assess the pharmacodynamic effects of vitamin K antagonists. J Thromb Thrombolysis 2014; 40:118-25. [DOI: 10.1007/s11239-014-1130-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
41
|
Hibbert RM, Atwell TD, Lekah A, Patel MD, Carter RE, McDonald JS, Rabatin JT. Safety of Ultrasound-Guided Thoracentesis in Patients With Abnormal Preprocedural Coagulation Parameters. Chest 2013; 144:456-463. [DOI: 10.1378/chest.12-2374] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
42
|
Hematoma Formation During Breast Core Needle Biopsy in Women Taking Antithrombotic Therapy. AJR Am J Roentgenol 2013; 201:215-22. [DOI: 10.2214/ajr.12.9930] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
43
|
Tonolini M, Ippolito S, Patella F, Petullà M, Bianco R. Hemorrhagic complications of anticoagulant therapy: role of multidetector computed tomography and spectrum of imaging findings from head to toe. Curr Probl Diagn Radiol 2013; 41:233-47. [PMID: 23009773 DOI: 10.1067/j.cpradiol.2012.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Highly effective in preventing and treating thromboembolic conditions in acute and chronic settings, anticoagulant therapy is associated with a non-negligible risk of hemorrhagic complications with a considerable clinical impact. Advanced age and comorbidities further increase the risk of bleeding during heparinization, treatment with low-molecular-weight heparins or long-term oral warfarin anticoagulation. Multidetector computed tomography represents the mainstay diagnostic technique to image-suspected hemorrhages in anticoagulated patients, as it can quickly assess presence, site, and extent of hemorrhage, identify active bleeding, and possible underlying diseases. Cross-sectional imaging appearances of the wide spectrum of anticoagulant therapy-related bleeding complications are hereby presented, including peripheral and thoracic-abdominal wall muscular hematomas, intrathoracic, abdominal, retroperitoneal genitourinary, gastrointestinal, and brain hemorrhages. Prompt recognition and comprehensive diagnostic assessment with multidetector computed tomography allow clinicians to correctly choose treatment modification or withdrawal, surgery, or interventional procedures as needed, with the aim to reduce the associated morbidity and mortality.
Collapse
Affiliation(s)
- Massimo Tonolini
- Department of Radiology, Luigi Sacco University Hospital, Milan, Italy.
| | | | | | | | | |
Collapse
|
44
|
Abstract
With increasing recognition of the complications related to coagulopathies, it is of paramount importance for all orthopedic surgeons to possess a basic knowledge of common bleeding disorders. The evaluation of the coagulopathic patient requires a careful history, physical examination, and laboratory evaluation. Bleeding disorders commonly include quantitative and qualitative platelet and coagulation factor disorders and coagulation inhibitors. The management of these coagulopathies that can be encountered in elective and nonelective practice is often ignored. With appropriate knowledge and a multidisciplinary approach with hematologists and cardiologists, surgeons can perform minor and major orthopedic procedures safely and effectively.
Collapse
Affiliation(s)
- John Mansour
- Department of Orthopaedic Trauma, Cooper University Hospital, Camden, New Jersey, USA.
| | | | | |
Collapse
|
45
|
Sankarankutty A, Nascimento B, Teodoro da Luz L, Rizoli S. TEG® and ROTEM® in trauma: similar test but different results? World J Emerg Surg 2012; 7 Suppl 1:S3. [PMID: 23531394 PMCID: PMC3424963 DOI: 10.1186/1749-7922-7-s1-s3] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Transfusion in trauma is often empiric or based on traditional lab tests. Viscoelastic tests such as thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) have been proposed as superior to traditional lab tests. Due to the similarities between the two tests, general opinion seems to consider them equivalent with interchangeable interpretations. However, it is not clear whether the results can be similarly interpreted. This review evaluates the comparability between TEG and ROTEM and performs a descriptive review of the parameters utilized in each test in adult trauma patients. Methods PUBMED database was reviewed using the keywords “thromboelastography” and “compare”, between 2000 and 2011. Original studies directly comparing TEG® with ROTEM® in any area were retrieved. To verify the individual test parameter used in studies involving trauma patients, we further performed a review using the keywords “thromboelastography” and “trauma” in the PUBMED database. Results Only 4 studies directly compared TEG® with ROTEM®. One in liver transplantation found that transfusion practice could differ depending on the device in use. Another in cardiac surgery concluded that all measurements are not completely interchangeable. The third article using commercially available plasma detected clinically significant differences in the results from the two devices. The fourth one was a head-to-head comparison of the technical aspects. The 24 articles reporting the use of viscoelastic tests in trauma patients, presented considerable heterogeneity. Conclusion Both tests are potentially useful as means to rapidly diagnose coagulopathy, guide transfusion and determine outcome in trauma patients. Differences in the activators utilized in each device limit the direct comparability. Standardization and robust clinical trials comparing the two technologies are needed before these tests can be widely recommended for clinical use in trauma.
Collapse
Affiliation(s)
- Ajith Sankarankutty
- Departments of Surgery and Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
| | | | | | | |
Collapse
|
46
|
Kluft C, Burggraaf J. Introduction to haemostasis from a pharmacodynamic perspective. Br J Clin Pharmacol 2012; 72:538-46. [PMID: 21342216 DOI: 10.1111/j.1365-2125.2011.03946.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Biochemical characterization of the haemostatic system has advanced significantly in the past decades. Sub-systems, such as coagulation, fibrinolysis, blood cells and platelets and the vessel wall have been studied by specialists, mostly separately and independently. The time has come to integrate the approaches, and, in particular, to develop tests to document the state of the whole system and to have available adequate pharmacodynamic tests to evaluate treatments. Many examples are available to show that traditional general methods of clotting and lysis do not provide the information that is desired. The present tendency is to use specific methods for specific factors or effects which are very limited in pharmacological information. There is also increasing awareness of the occurrence of rather broad interindividual variability in the haemostatic system. This suggests that individually tailored treatments are required. This is the more relevant since haemostasis is a balance and treatment should be positioned between efficacy and safety. The conclusion is reached that there is a need for integrated or global methods or sets of methods that reflect the complexity and individual status appropriately and allow the practitioner to judge the effects of interventions and their individual aspects.
Collapse
Affiliation(s)
- Cornelis Kluft
- Centre of Human Drug Research, Zernikedreef 10, 2333 CL, Leiden, The Netherlands.
| | | |
Collapse
|
47
|
|
48
|
Abnormal preprocedural international normalized ratio and platelet counts are not associated with increased bleeding complications after ultrasound-guided thoracentesis. AJR Am J Roentgenol 2011; 197:W164-8. [PMID: 21700980 DOI: 10.2214/ajr.10.5589] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to identify differences in hemorrhagic complications after ultrasound-guided thoracentesis on the basis of patient coagulation parameters. MATERIALS AND METHODS The records of consecutive patients who underwent ultrasound-guided thoracentesis between January 1, 2008 and April 30, 2010 were reviewed to document the international normalized ratio (INR) and platelet count obtained within 72 hours before thoracentesis and to identify bleeding complications that occurred after the procedure. The observed complication rates and 95% CIs for differences in complication rates were calculated. RESULTS There were 1076 procedures performed during the study period with no hemorrhagic complications identified (0% complication rate; 95% CI, 0.00-0.34%). INR values before thoracentesis were available for 822 procedures: INR exceeded 2.0 in 139 cases (17%), 2.5 in 59 cases (7%), and 3.0 in 32 cases (4%). The 95% CI for the 0% difference in complications observed between two groups of patients determined by specific INR values was -0.008 to 0.014 (INR, 1.5), -0.007 to 0.026 (INR, 2.0), -0.007 to 0.061 (INR, 2.5), and -0.009 to 0.11 (INR, 3.0). Platelet values before thoracentesis were available for 953 procedures; the platelet count was less than 100,000/μL for 148 procedures (16%), less than 50,000/μL for 58 procedures (6%), and less than 25,000/μL for 12 procedures (1%). The 95% CI for the 0% difference in complications between two groups of patients determined by a platelet count threshold of 50,000/μL was -0.007 to 0.062. CONCLUSION The risk of bleeding after ultrasound-guided thoracentesis performed by radiologists is low even if the preprocedural INR and platelet count are abnormal. An approach in which no coagulation testing or correction is performed before thoracentesis may be justified.
Collapse
|
49
|
Nascimento B, Al Mahoos M, Callum J, Capone A, Pacher J, Tien H, Rizoli S. Vitamin K-dependent coagulation factor deficiency in trauma: a comparative analysis between international normalized ratio and thromboelastography (CME). Transfusion 2011; 52:7-13. [DOI: 10.1111/j.1537-2995.2011.03237.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
50
|
|