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Reimer P, Vilgrain V, Arnold D, Balli T, Golfieri R, Loffroy R, Mosconi C, Ronot M, Sengel C, Schaefer N, Maleux G, Munneke G, Peynircioglu B, Sangro B, Kaufmann N, Urdaniz M, Pereira H, de Jong N, Helmberger T. Factors Impacting Survival After Transarterial Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: A Combined Analysis of the Prospective CIRT Studies. Cardiovasc Intervent Radiol 2024; 47:310-324. [PMID: 38321223 PMCID: PMC10920466 DOI: 10.1007/s00270-023-03657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is a treatment option for patients with intrahepatic cholangiocarcinoma (ICC). However, optimising the timing of TARE in relation to systemic therapies and patient selection remains challenging. We report here on the effectiveness, safety, and prognostic factors associated with TARE for ICC in a combined analysis of the prospective observational CIRT studies (NCT02305459 and NCT03256994). METHODS A combined analysis of 174 unresectable ICC patients enrolled between 2015 and 2020 was performed. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every follow-up visit. Log-rank tests and a multivariable Cox proportional hazard model were used to identify prognostic factors. RESULTS Patients receiving a first-line strategy of TARE in addition to any systemic treatment had a median OS and PFS of 32.5 months and 11.3 months. Patients selected for first-line TARE alone showed a median OS and PFS of 16.2 months and 7.4 months, whereas TARE as 2nd or further treatment-line resulted in a median OS and PFS of 12 and 9.3 months (p = 0.0028), and 5.1 and 3.5 months (p = 0.0012), respectively. Partition model dosimetry was an independent predictor for better OS (HR 0.59 [95% CI 0.37-0.94], p = 0.0259). No extrahepatic disease, no ascites, and < 6.1 months from diagnosis to treatment were independent predictors for longer PFS. CONCLUSION This combined analysis indicates that in unresectable ICC, TARE in combination with any systemic treatment is a promising treatment option. LEVEL OF EVIDENCE level 3, Prospective observational.
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Affiliation(s)
- Peter Reimer
- Städtisches Klinikum Karlsruhe, Institute for Diagnostic and Interventional Radiology, Academic Teaching Hospital the University of Freiburg, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Valérie Vilgrain
- Université Paris Cité, CRI, INSERM, 1149, Paris, France
- Department of Radiology, Hôpital Beaujon APHP Nord, Clichy, France
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, AK Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany
| | - Tugsan Balli
- Radiology Department, Çukurova University, Balcalı Hospital, 01330, Adana, Turkey
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, CHU Dijon Bourgogne, François-Mitterrand University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Maxime Ronot
- Université Paris Cité, CRI, INSERM, 1149, Paris, France
- Department of Radiology, Hôpital Beaujon APHP Nord, Clichy, France
| | - Christian Sengel
- Interventional Radiology, Centre Hospitalier Universitaire de Grenoble, Boulevard de La Chantourne, 38100, Grenoble, France
| | - Niklaus Schaefer
- Service de Médecine Nucléaire Et Imagerie Moléculaire, CHUV, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, 06100, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Avda. Pio XII 36, 31008, Pamplona, Spain
| | - Nathalie Kaufmann
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Maria Urdaniz
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France
- INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria.
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
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Rossi M, Krokidis M, Kashef E, Peynircioglu B, Tipaldi MA. CIRSE Standards of Practice for the Endovascular Treatment of Visceral and Renal Artery Aneurysms and Pseudoaneurysms. Cardiovasc Intervent Radiol 2024; 47:26-35. [PMID: 38030849 PMCID: PMC10770226 DOI: 10.1007/s00270-023-03620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms is an effective, minimally invasive treatment that has been successfully used since the early 1990s, with refined and expanded techniques and tools currently offering excellent outcomes. Due to increased detection of such lesions in recent years, many of which are asymptomatic, revision of the indications for intervention and the correct endovascular treatment approaches has become essential. PURPOSE This document will presume that the indication for treatment is clear and approved by the multidisciplinary team and will define the standards required for the performance of each intervention, as well as their relative advantages and limitations. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of the endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in endovascular treatments. The writing group reviewed the existing literature on visceral and renal artery aneurysms and pseudoaneurysms, performing an evidence search using PubMed to identify publications in English and relating to human subjects from 1990 to 2022. The final recommendations were formulated through consensus. RESULTS Endovascular treatment has an established role in the successful management of visceral and renal artery aneurysms and pseudoaneurysms, and this Standards of Practice document provides up-to-date recommendations for its safe performance.
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Affiliation(s)
- Michele Rossi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome-Sant'Andrea University Hospital, Rome, Italy.
| | - Miltiadis Krokidis
- National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Elika Kashef
- Imperial College Healthcare NHS Trust, London, UK
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marcello Andrea Tipaldi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome-Sant'Andrea University Hospital, Rome, Italy
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Seidensticker M, Öcal O, Schütte K, Malfertheiner P, Berg T, Loewe C, Klümpen HJ, van Delden O, Ümütlü MR, Ben Khaled N, de Toni EN, Seidensticker R, Aghdassi A, Tran A, Bronowicki JP, Peynircioglu B, Sangro B, Pech M, Ricke J. Impact of adjuvant sorafenib treatment after local ablation for HCC in the phase II SORAMIC trial. JHEP Rep 2023; 5:100699. [PMID: 36968218 PMCID: PMC10031000 DOI: 10.1016/j.jhepr.2023.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 03/29/2023] Open
Abstract
Background & Aims The aim of the study was to evaluate the efficacy and safety of adjuvant sorafenib treatment compared with placebo in patients with hepatocellular carcinoma who underwent local ablation. Methods The SORAMIC trial is a randomised controlled trial with diagnostic, local ablation, and palliative sub-study arms. After initial imaging within the diagnostic study, patients were assigned to local ablation or palliative arms. In the local ablation cohort, patients were randomised 1:1 to local ablation + sorafenib vs. local ablation + placebo. The primary endpoint was time-to-recurrence (TTR). Secondary endpoints were local control rate and safety in terms of adverse events and quality-of-life. Results The recruitment was terminated prematurely after 104 patients owing to slow recruitment. One patient was excluded because of a technical failure. Fifty-four patients were randomised to local ablation + sorafenib and 49 to local ablation + placebo. Eighty-eight patients who underwent standardised follow-up imaging comprised the per-protocol population. The median TTR was 15.2 months in the sorafenib arm and 16.4 months in the placebo arm (hazard ratio 1.1; 95% CI 0.53-2.2; p = 0.82). Out of 136 lesions ablated within the trial, there was no difference in local recurrence rate between sorafenib (6/69, 8.6%) and placebo groups (5/67, 5.9%; p = 0.792).Overall (92.5% vs. 71.4%, p = 0.008) and drug-related (81.4% vs. 55.1%, p = 0.003) adverse events were more common in the sorafenib arm compared with the placebo arm. Dose reduction because of adverse events were common in the sorafenib arm (79.6% vs. 30.6%, p <0.001). Conclusions Adjuvant sorafenib did not improve in TTR or local control rate after local ablation in patients with hepatocellular carcinoma within the limitations of an early terminated trial. Impact and implications Local ablation is the standard of care treatment in patients with early stages of hepatocellular carcinoma, along with surgical therapies. However, there is a risk of disease recurrence during follow-up. Sorafenib, an oral medication, is a routinely used treatment for patients with advanced hepatocellular carcinoma. This study found that sorafenib treatment after local ablation in people with early hepatocellular carcinoma did not significantly improve the disease-free period compared with placebo. Clinical trial number EudraCT 2009-012576-27, NCT01126645.
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Key Words
- Adjuvant
- BCLC, Barcelona Clinic Liver Cancer
- CONSORT, Consolidated Standards of Reporting Trials
- CT, computed tomography
- ECOG PS, Eastern Cooperative Oncology Group Performance Status
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hepatocellular carcinoma
- ITT, intention-to-treat
- Local ablation
- MRI, magnetic resonance imaging
- MWA, microwave ablation
- PP, per protocol
- RFA, radiofrequency ablation
- RFS, relapse-free survival
- SIRT, selective internal radiation therapy
- SORAMIC, SORAfenib in combination with local MICro-therapy guided by gadolinium-EOB-DTPA-enhanced MRI
- Sorafenib
- TTR, time-to-recurrence
- Time-to-recurrence
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Affiliation(s)
- Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, Osnabrück, Germany
| | | | - Thomas Berg
- Klinik und Poliklinik für Gastroenterologie, Sektion Hepatologie, Universitätsklinikum Leipzig, Germany
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Heinz Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Albert Tran
- Pôle Appareil Digestif, Hôpital l'Archet 2, CHU Nice, Route Saint-Antoine de Ginestière - BP 3079, Nice, France
| | - Jean-Pierre Bronowicki
- Department of Hepatology, INSERM U1254, Hôpital de Brabois, CHU de Nancy, University of Lorraine, Nancy, France
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Corresponding author. Address: Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany. Tel: +49-4400-72750..
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Maleux G, Albrecht T, Arnold D, Bargellini I, Cianni R, Helmberger T, Kolligs F, Munneke G, Peynircioglu B, Sangro B, Schaefer N, Pereira H, Zeka B, de Jong N, Bilbao JI. Predictive Factors for Adverse Event Outcomes After Transarterial Radioembolization with Yttrium-90 Resin Microspheres in Europe: Results from the Prospective Observational CIRT Study. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03391-4. [PMID: 36914788 PMCID: PMC10322946 DOI: 10.1007/s00270-023-03391-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/08/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Using data collected in the prospective observational study CIRSE Registry for SIR-Spheres Therapy, the present study aimed at identifying predictors of adverse events (AEs) following transarterial radioembolization (TARE) with Yttrium-90 resin microspheres for liver tumours. METHODS We analysed 1027 patients enrolled between January 2015 and December 2017 and followed up for 24 months. Four hundred and twenty-two patients with hepatocellular carcinoma (HCC), 120 with intrahepatic carcinoma (ICC), 237 with colorectal liver metastases and 248 with liver metastases from other primaries were included. Prognostic factors were calculated with a univariable analysis by using the overall AEs burden score (AEBS). RESULTS All-cause AEs were reported in 401/1027 (39.1%) patients, with AEs associated with TARE, such as abdominal pain (16.6%), fatigue (17%), and nausea (11.7%) reported most frequently. Grade 3 or higher AEs were reported in 92/1027 (9%) patients. Reports on grade ≥ 3 gastrointestinal ulcerations (0.4%), gastritis (0.3%), radiation cholecystitis (0.2%) or radioembolization-induced liver disease (0.5%) were uncommon. Univariable analysis showed that in HCC, AEBS increased for Eastern Cooperative Oncology Group (ECOG) 0 (p = 0.0045), 1 tumour nodule (0.0081), > 1 TARE treatment (p = 0.0224), no prophylactic embolization (p = 0.0211), partition model dosimetry (p = 0.0007) and unilobar treatment target (0.0032). For ICC, > 1 TARE treatment was associated with an increase in AEBS (p = 0.0224), and for colorectal liver metastases, ECOG 0 (p = 0.0188), > 2 prior systemic treatments (p = 0.0127), and 1 tumour nodule (p = 0.0155) were associated with an increased AEBS. CONCLUSION Our study confirms that TARE is a safe treatment with low toxicity and a minimal impact on quality of life.
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Affiliation(s)
- Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Thomas Albrecht
- Department for Radiology and Interventional Therapy, Vivantes Klinikum Neukölln, Rudower Str. 48, 12351, Berlin, Germany
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, AK Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany
| | - Irene Bargellini
- Department of Vascular and Interventional Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Roberto Cianni
- Department of Interventional Radiology, S. Camillo Hospital, Circonvallazione Gianicolense, 85, 00149, Rome, Italy
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Frank Kolligs
- Department of Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, 06100, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Avda. Pio XII 36, 31008, Pamplona, Spain
| | - Niklaus Schaefer
- Service de Médecine Nucléaire et Imagerie Moléculaire, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France.,Centre d'Investigation Clinique 1418 (CIC1418), INSERM, Paris, France
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria.
| | - José I Bilbao
- Interventional Radiology, Clínica Universidad de Navarra, Avenida Pio XII, No 36, 31008, Pamplona, Spain
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Memarian S, Krokidis M, O'Sullivan G, Peynircioglu B, Rossi M, Kashef E. CIRSE Standards of Practice on Arterial Access for Interventions. Cardiovasc Intervent Radiol 2023; 46:302-309. [PMID: 36705706 DOI: 10.1007/s00270-022-03349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/20/2022] [Indexed: 01/28/2023]
Abstract
This CIRSE Standards of Practice document is aimed at healthcare professionals (including interventional radiologists) performing endovascular procedures to provide best practices for performing arterial access for interventions. It has been developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. This paper encompasses up-to-date clinical and technical aspects in performing safe and appropriate arterial access for interventions.
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Affiliation(s)
| | - Miltiadis Krokidis
- School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | | | - Bora Peynircioglu
- Department of Radiology, Hacettepe UTF, Sihhiye Campus, Ankara, Turkey
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Schaefer N, Grözinger G, Pech M, Pfammatter T, Soydal C, Arnold D, Kolligs F, Maleux G, Munneke G, Peynircioglu B, Sangro B, Pereira H, Zeka B, de Jong N, Helmberger T. Prognostic Factors for Effectiveness Outcomes After Transarterial Radioembolization in Metastatic Colorectal Cancer: Results From the Multicentre Observational Study CIRT. Clin Colorectal Cancer 2022; 21:285-296. [PMID: 36270925 DOI: 10.1016/j.clcc.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transarterial radioembolisation (TARE) with Yttrium-90 resin microspheres is a treatment option for patients with metastatic colorectal cancer in the liver (mCRC). A better understanding of the prognostic factors and treatment application can improve survival outcomes. METHODS We analysed the safety and effectiveness of 237 mCRC patients included in the prospective observational study CIRSE Registry for SIR-Spheres Therapy (CIRT) for independent prognostic factors for overall survival (OS), progression-free survival (PFS) and hepatic progression-free survival (hPFS) using the Cox proportional-hazard model. RESULTS The median OS was 9.8 months, median PFS was 3.4 months and median hPFS was 4.2 months. Independent prognostic factors for an improved overall survival were the absence of extra-hepatic disease (P= .0391), prior locoregional procedures (P= .0037), an Aspartate transaminase to Platelet Ratio Index (APRI) value of ≤0.40 (P< .0001) and International Normalized Ratio (INR) ≤1 (P= .0078). Partition model dosimetry resulted in improved OS outcomes compared to the body surface area model (P = .0120). Independent predictors for PFS were APRI >0.40 (P = .0416) and prior ablation (P = .0323), and for hPFS these were 2 to 5 tumor nodules (P = .0148), Albumin-bilirubin (ALBI) grade 3 (P = .0075) and APRI >0.40 (P = .0207). During the study, 95 of 237 (40.1%) patients experienced 197 adverse events, with 28 of 237 (11.8%) patients having a grade 3 or higher adverse events. CONCLUSION Including easy-to-acquire laboratory markers INR, APRI, ALBI and using partition model dosimetry can identify mCRC patients that may benefit from TARE.
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Affiliation(s)
- Niklaus Schaefer
- Service de médecine nucléaire et imagerie moléculaire, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Gerd Grözinger
- Eberhard Karls University, Department of Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Cigdem Soydal
- Ankara University, Medical School, Department of Nuclear Medicine, Cebeci, Ankara, Turkey
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Frank Kolligs
- Department of Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France; INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna Austria
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna Austria.
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Munich, Germany
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Kolligs F, Arnold D, Golfieri R, Pech M, Peynircioglu B, Pfammatter T, Ronot M, Sangro B, Schaefer N, Maleux G, Munneke G, Pereira H, Zeka B, de Jong N, Helmberger T, Neukölln VK, D’Archambeau O, Balli T, Bilgic S, Bloom A, Cioni R, Fischbach R, Altona AK, Flamen P, Gerard L, Grözinger G, Katoh M, Koehler M, Kröger JR, Kuhl C, Orsi F, Özgün M, Reimer P, Ronot M, Schmid A, Vit A. Factors impacting survival after transarterial radioembolization in patients with hepatocellular carcinoma: Results from the prospective CIRT study. JHEP Rep 2022; 5:100633. [PMID: 36593888 PMCID: PMC9804139 DOI: 10.1016/j.jhepr.2022.100633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background & Aims Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is an established treatment option for patients with hepatocellular carcinoma (HCC). However, optimising treatment application and patient selection remains challenging. We report here on the effectiveness, safety and prognostic factors, including dosing methods, associated with TARE for HCC in the prospective observational CIRT study. Methods We analysed 422 patients with HCC enrolled between Jan 2015 and Dec 2017, with follow-up visits every 3 months for up to 24 months after first TARE. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every 3-month follow-up visit. We used the multivariable Cox proportional hazard model and propensity score matching to identify independent prognostic factors for effectiveness outcomes. Results The median OS was 16.5 months, the median PFS was 6.1 months, and the median hepatic PFS was 6.7 months. Partition model dosimetry resulted in improved OS compared to body surface area calculations on multivariable analysis (hazard ratio 0.65; 95% CI 0.46-0.92; p = 0.0144), which was confirmed in the exact matching propensity score analysis (hazard ratio 0.56; 95% CI 0.35-0.89; p = 0.0136). Other independent prognostic factors for OS were ECOG-performance status >0 (p = 0.0018), presence of ascites (p = 0.0152), right-sided tumours (p = 0.0002), the presence of portal vein thrombosis (p = 0.0378) and main portal vein thrombosis (p = 0.0028), ALBI grade 2 (p = 0.0043) and 3 (p = 0.0014). Adverse events were recorded in 36.7% of patients, with 9.7% of patients experiencing grade 3 or higher adverse events. Conclusions This large prospective observational dataset shows that TARE is an effective and safe treatment in patients with HCC. Using partition model dosimetry was associated with a significant improvement in survival outcomes. Impact and implications Transarterial radioembolization (TARE) is a form of localised radiation therapy and is a potential treatment option for primary liver cancer. We observed how TARE was used in real-life clinical practice in various European countries and if any factors predict how well the treatment performs. We found that when a more complex but personalised method to calculate the applied radiation activity was used, the patient responded better than when a more generic method was used. Furthermore, we identified that general patient health, ascites and liver function can predict outcomes after TARE. Clinical trial number NCT02305459.
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Key Words
- ALBI, albumin-bilirubin
- BCLC, Barcelona Clinic Liver Cancer
- BSA, body surface area
- CIRSE, Cardiovascular and Interventional Radiological Society of Europe
- CIRT, CIRSE Registry for SIR-Spheres Therapy
- ECOG, Eastern Cooperative Oncology Group
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- INR, international normalized ratio
- IPTW, inverse probability of treatment weighting
- OS, overall survival
- PFS, progression-free survival
- PVT, portal vein thrombosis
- REILD, radioembolization-induced liver disease
- SIRT
- TACE, transcatheter arterial chemoembolization
- TARE, transarterial radioembolization
- Y90, Yttrium-90
- dosimetry
- hPFS, hepatic progression-free survival
- liver
- mBSA, modified body surface area
- observational
- radioembolization
- registry
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Affiliation(s)
- Frank Kolligs
- Department of Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, Ankara, Turkey
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, Universitätsspital Zürich, Zürich, Switzerland
| | - Maxime Ronot
- Université Paris Cité, Paris & Service de Radiologie, APHP Nord, Hôpital Beaujon, Clichy, France
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Niklaus Schaefer
- Service de médecine nucléaire et imagerie moléculaire, CHUV, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France,INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria,Corresponding author. Address: Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna Austria; Tel.: +43 1904200347
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Munich, Germany
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Geyer T, Kazmierczak PM, Steffen IG, Malfertheiner P, Peynircioglu B, Loewe C, van Delden O, Vandecaveye V, Gebauer B, Pech M, Sengel C, Bargellini I, Iezzi R, Benito A, Zech CJ, Gasbarrini A, Schütte K, Ricke J, Seidensticker M. Extrahepatic Disease in Hepatocellular Carcinoma: Do We Always Need Whole-Body CT or Is Liver MRI Sufficient? A Subanalysis of the SORAMIC Trial. Biomedicines 2022; 10:biomedicines10051156. [PMID: 35625900 PMCID: PMC9139039 DOI: 10.3390/biomedicines10051156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To investigate whole-body contrast-enhanced CT and hepatobiliary contrast liver MRI for the detection of extrahepatic disease (EHD) in hepatocellular carcinoma (HCC) and to quantify the impact of EHD on therapy decision. Methods: In this post-hoc analysis of the prospective phase II open-label, multicenter, randomized controlled SORAMIC trial, two blinded readers independently analyzed the whole-body contrast-enhanced CT and gadoxetic acid-enhanced liver MRI data sets of 538 HCC patients. EHD (defined as tumor manifestation outside the liver) detection rates of the two imaging modalities were compared using multiparametric statistical tests. In addition, the most appropriate treatment recommendation was determined by a truth panel. Results: EHD was detected significantly more frequently in patients with portal vein infiltration (21% vs. 10%, p < 0.001), macrovascular infiltration (22% vs. 9%, p < 0.001), and bilobar liver involvement (18% vs. 9%, p = 0.006). Further on, the maximum lesion diameter in patients with EHD was significantly higher (8.2 cm vs. 5.8 cm, p = 0.002). CT detected EHD in significantly more patients compared to MRI in both reader groups (p < 0.001). Higher detection rates of EHD in CT led to a change in management only in one patient since EHD was predominantly present in patients with locally advanced HCC, in whom palliative treatment is the standard of care. Conclusions: Whole-body contrast-enhanced CT shows significantly higher EHD detection rates compared to hepatobiliary contrast liver MRI. However, the higher detection rate did not yield a significant impact on patient management in advanced HCC.
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Affiliation(s)
- Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
- Correspondence: ; Tel.: +49-89330073620
| | - Philipp M. Kazmierczak
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
| | - Ingo G. Steffen
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
| | - Peter Malfertheiner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, Ankara 06100, Turkey;
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, 1105 Amsterdam, The Netherlands;
| | | | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, 39106 Magdeburg, Germany;
| | - Christian Sengel
- Radiologie Interventionnelle Vasculaire et Percutanée, CHU de Grenoble, 38043 Grenoble, France;
| | - Irene Bargellini
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, 00168 Rome, Italy;
| | - Alberto Benito
- Abdominal Radiology Unit, Department of Radiology, Clínica Universidad de Navarra, Universidad de Navarra, 31008 Pamplona, Spain;
| | - Christoph J. Zech
- Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, 4001 Basel, Switzerland;
| | - Antonio Gasbarrini
- Fondazione Policlinico Gemelli IRCCS, Università’ Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-Von-Guericke University, 39106 Magdeburg, Germany
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, 49074 Osnabrueck, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
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Öcal O, Rössler D, Gasbarrini A, Berg T, Klümpen HJ, Bargellini I, Peynircioglu B, van Delden O, Schulz C, Schütte K, Iezzi R, Pech M, Malfertheiner P, Sangro B, Ricke J, Seidensticker M. Gadoxetic acid uptake as a molecular imaging biomarker for sorafenib resistance in patients with hepatocellular carcinoma: a post hoc analysis of the SORAMIC trial. J Cancer Res Clin Oncol 2022; 148:2487-2496. [PMID: 34541612 PMCID: PMC9349099 DOI: 10.1007/s00432-021-03803-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/11/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Gadoxetic acid uptake on hepatobiliary phase MRI has been shown to correlate with ß-catenin mutation in patients with HCC, which is associated with resistance to certain therapies. This study aimed to evaluate the prognostic value of gadoxetic acid uptake on hepatobiliary phase MRI in patients with advanced HCC receiving sorafenib. METHODS 312 patients with available baseline hepatobiliary phase MRI images received sorafenib alone or following selective internal radiation therapy (SIRT) within SORAMIC trial. The signal intensity of index tumor and normal liver parenchyma were measured on the native and hepatobiliary phase MRI images, and relative tumor enhancement higher than relative liver enhancement were accepted as high gadoxetic acid uptake, and its prognostic value was assessed using univariate and multivariate Cox proportional hazard models. RESULTS The median OS of the study population was 13.4 (11.8-14.5) months. High gadoxetic acid uptake was seen in 51 (16.3%) patients, and none of the baseline characteristics was associated with high uptake. In univariate analysis, high gadoxetic acid uptake was significantly associated with shorter overall survival (10.7 vs. 14.0 months, p = 0.005). Multivariate analysis confirmed independent prognostic value of high gadoxetic acid uptake (HR, 1.7 [1.21-2.3], p = 0.002), as well as Child-Pugh class (p = 0.033), tumor diameter (p = 0.002), and ALBI grade (p = 0.015). CONCLUSION In advanced HCC patients receiving sorafenib (alone or combined with SIRT), high gadoxetic acid uptake of the tumor on pretreatment MRI, a surrogate of ß-catenin mutation, correlates with shorter survival. Gadoxetic acid uptake status might serve in treatment decision-making process.
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Affiliation(s)
- Osman Öcal
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Antonio Gasbarrini
- Fondazione Policlinico Gemelli IRCCS, Università' Cattolica del Sacro Cuore, Roma, Italy
| | - Thomas Berg
- Klinik Und Poliklinik Für Gastroenterologie, Sektion Hepatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene Bargellini
- Department of Vascular and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | | | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian Schulz
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, Osnabrück, Germany
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-Von-Guericke University, Magdeburg, Germany
| | - Roberto Iezzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Di Radiologia, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Maciej Pech
- Departments of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | | | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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10
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Ricke J, Schinner R, Seidensticker M, Gasbarrini A, van Delden OM, Amthauer H, Peynircioglu B, Bargellini I, Iezzi R, De Toni EN, Malfertheiner P, Pech M, Sangro B. Liver function after combined selective internal radiation therapy or sorafenib monotherapy in advanced hepatocellular carcinoma. J Hepatol 2021; 75:1387-1396. [PMID: 34454995 DOI: 10.1016/j.jhep.2021.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS SORAMIC is a previously published randomised controlled trial assessing survival in patients with advanced hepatocellular carcinoma who received sorafenib with or without selective internal radiation therapy (SIRT). Based on the per-protocol (PP) population, we assessed whether the outcome of patients receiving SIRT+sorafenib vs. sorafenib alone was affected by adverse effects of SIRT on liver function. METHODS The PP population consisted of 109 (SIRT+sorafenib) vs. 173 patients (sorafenib alone). Comparisons were made between subgroups who achieved a significant survival benefit or trend towards improved survival with SIRT and the inverse group without a survival benefit: <65 years-old vs. ≥65 years-old, Child-Pugh 5 vs. 6, no transarterial chemoembolisation (TACE) vs. prior TACE, no cirrhosis vs. cirrhosis, non-alcohol- vs. alcohol-related aetiology. The albumin-bilirubin (ALBI) score was used to monitor liver function over time during follow-up. RESULTS ALBI scores increased in all patient groups during follow-up. In the PP population, ALBI score increases were higher in the SIRT+sorafenib than the sorafenib arm (p = 0.0021 month 4, p <0.0001 from month 6). SIRT+sorafenib conferred a survival benefit compared to sorafenib alone in patients aged <65 years-old, those without cirrhosis, those with Child-Pugh 5, and those who had not received TACE. A higher increase in ALBI score was observed in the inverse subgroups in whom survival was not improved by adding SIRT (age ≥65 years-old, p <0.05; cirrhosis, p = 0.07; Child-Pugh 6, p <0.05; prior TACE, p = 0.08). CONCLUSION SIRT frequently has a negative, often subclinical, effect on liver function in patients with hepatocellular carcinoma, which may impair prognosis after treatment. Careful patient selection for SIRT as well as prevention of clinical and subclinical liver damage by selective treatments, high tumour uptake ratio, and medical prophylaxis could translate into better efficacy. CLINICAL TRIAL NUMBER EudraCT 2009-012576-27, NCT01126645 LAY SUMMARY: This study of treatments in patients with hepatocellular carcinoma found that selective internal radiation therapy (SIRT) has an adverse effect on liver function that may affect patient outcomes. Patients should be carefully selected before they undergo SIRT and the treatment technique should be optimised for maximum protection of non-target liver parenchyma.
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Affiliation(s)
- Jens Ricke
- Department of Radiology, Ludwig Maximilan University Munich, München, Germany.
| | - Regina Schinner
- Department of Radiology, Ludwig Maximilan University Munich, München, Germany
| | - Max Seidensticker
- Department of Radiology, Ludwig Maximilan University Munich, München, Germany
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Medicina interna e gastroenterologia, Roma, Italy
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Holger Amthauer
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Irene Bargellini
- Department of Vascular and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Roberto Iezzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Peter Malfertheiner
- Department of Radiology and Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Maciej Pech
- Departments of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain
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Öcal O, Eldem G, Karagoz AH, Kılıçkap S, Yalcin S, Balkanci F, Peynircioglu B. Initiation of Chemosaturation With Percutaneous Hepatic Perfusion Program in Interventional Radiology Department. Cureus 2021; 13:e17880. [PMID: 34660079 PMCID: PMC8502519 DOI: 10.7759/cureus.17880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Chemosaturation with percutaneous hepatic perfusion (PHP) is a relatively new minimally-invasive liver-directed therapy, which aims to deliver high-dose chemotherapy into the liver with low systemic side effects. Initial studies showed promising results, especially in the treatment of metastatic uveal melanoma. But unfamiliarity of the interventional radiologists prevents its widespread implantation in clinical routine. This study aimed to outline how to initiate a PHP program and report initial results. Methods We retrospectively reviewed all patients who underwent chemosaturation with PHP in our institution between March 2016 and February 2017 and their follow-up results till October 2018. Patient demographics, procedural characteristics, clinical and imaging results, and complications were evaluated. Additionally, modifications regarding infrastructure and procedure techniques were described. Results A total of three patients (two females and one male) with a mean age of 59 underwent six PHP procedures. The primary disease was colorectal carcinoma in one patient and uveal melanoma in two patients. The technical success rate was 100% and the mean melphalan dose was 190.8 mg. No procedural death was observed. Patients were hospitalized for a mean of 3.3 days after procedures. Grade 3 and 4 complications were seen after 50% and 33.3% of procedures, respectively. Two patients showed partial response and the other patient showed stable disease after procedures. Mean hepatic progression-free survival was 10.8 months. Overall survival from the first procedure was 14.8 months in our cohort. Conclusion Our results show that chemosaturation with PHP offers a promising minimally invasive treatment option in patients with unresectable liver metastases. The technical challenges of PHP can be easily handled by an experienced interventional radiology (IR) team. It is a relatively safe procedure and its toxicities are usually hematological and can be manageable with close surveillance and appropriate medical therapies.
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Affiliation(s)
- Osman Öcal
- Radiology, Hacettepe University, Ankara, TUR
| | - Gonca Eldem
- Radiology, Hacettepe University, Ankara, TUR
| | - Ayse H Karagoz
- Anesthesiology and Reanimation, Hacettepe University, Ankara, TUR
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Öcal O, Peynircioglu B, Loewe C, van Delden O, Vandecaveye V, Gebauer B, Zech CJ, Sengel C, Bargellini I, Iezzi R, Benito A, Schütte K, Gasbarrini A, Seidensticker R, Wildgruber M, Pech M, Malfertheiner P, Ricke J, Seidensticker M. Correlation of liver enhancement in gadoxetic acid-enhanced MRI with liver functions: a multicenter-multivendor analysis of hepatocellular carcinoma patients from SORAMIC trial. Eur Radiol 2021; 32:1320-1329. [PMID: 34467453 PMCID: PMC8795026 DOI: 10.1007/s00330-021-08218-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/01/2021] [Accepted: 07/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the correlation between liver enhancement on hepatobiliary phase and liver function parameters in a multicenter, multivendor study. METHODS A total of 359 patients who underwent gadoxetic acid-enhanced MRI using a standardized protocol with various scanners within a prospective multicenter phase II trial (SORAMIC) were evaluated. The correlation between liver enhancement on hepatobiliary phase normalized to the spleen (liver-to-spleen ratio, LSR) and biochemical laboratory parameters, clinical findings related to liver functions, liver function grading systems (Child-Pugh and Albumin-Bilirubin [ALBI]), and scanner characteristics were analyzed using uni- and multivariate analyses. RESULTS There was a significant positive correlation between LSR and albumin (rho = 0.193; p < 0.001), platelet counts (rho = 0.148; p = 0.004), and sodium (rho = 0.161; p = 0.002); and a negative correlation between LSR and total bilirubin (rho = -0.215; p < 0.001) and AST (rho = -0.191; p < 0.001). Multivariate analysis confirmed independent significance for each of albumin (p = 0.022), total bilirubin (p = 0.045), AST (p = 0.031), platelet counts (p = 0.012), and sodium (p = 0.006). The presence of ascites (1.47 vs. 1.69, p < 0.001) and varices (1.55 vs. 1.69, p = 0.006) was related to significantly lower LSR. Similarly, patients with ALBI grade 1 had significantly higher LSR than patients with grade 2 (1.74 ± 0.447 vs. 1.56 ± 0.408, p < 0.001); and Child-Pugh A patients had a significantly higher LSR than Child-Pugh B (1.67 ± 0.44 vs. 1.49 ± 0.33, p = 0.021). Also, LSR was negatively correlated with MELD-Na scores (rho = -0.137; p = 0.013). However, one scanner brand was significantly associated with lower LSR (p < 0.001). CONCLUSIONS The liver enhancement on the hepatobiliary phase of gadoxetic acid-enhanced MRI is correlated with biomarkers of liver functions in a multicenter cohort. However, this correlation shows variations between scanner brands. KEY POINTS • The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid-enhanced MRI and liver function is consistent in a multicenter-multivendor cohort. • Signal intensity-based indices (liver-to-spleen ratio) can be used as an imaging biomarker of liver function. • However, absolute values might change between vendors.
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Affiliation(s)
- Osman Öcal
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Bernhard Gebauer
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Christoph J Zech
- Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sengel
- Radiology Department, Grenoble University Hospital, La Tronche, France
| | - Irene Bargellini
- Department of Vascular and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Rome, Italy
| | - Alberto Benito
- Abdominal Radiology Unit, Deparment of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, Osnabrück, Germany
| | - Antonio Gasbarrini
- Fondazione Policlinico Gemelli IRCCS, Università' Cattolica del Sacro Cuore, Rome, Italy
| | - Ricarda Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Maciej Pech
- Departments of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | | | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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Schütte K, Schinner R, Fabritius MP, Möller M, Kuhl C, Iezzi R, Öcal O, Pech M, Peynircioglu B, Seidensticker M, Sharma R, Palmer D, Bronowicki JP, Reimer P, Malfertheiner P, Ricke J. Impact of Extrahepatic Metastases on Overall Survival in Patients with Advanced Liver Dominant Hepatocellular Carcinoma: A Subanalysis of the SORAMIC Trial. Liver Cancer 2020; 9:771-786. [PMID: 33442545 PMCID: PMC7768116 DOI: 10.1159/000510798] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/28/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Extrahepatic spread is reported as a prognostic factor in patients with advanced hepatocellular carcinoma (HCC) receiving systemic therapy. However, clinical studies have reported conflicting results for the clinical impact of the pattern of tumor progression during treatment and the role of new extrahepatic metastases in length of survival. OBJECTIVE To evaluate the impact of extrahepatic metastases on survival in patients with HCC treated with sorafenib or with a combination of sorafenib and selective internal radiation treatment (SIRT). METHODS SORAMIC is a randomized, controlled trial comprising diagnostic, local ablation, and palliative cohorts. In the palliative cohort, patients not eligible for transarterial chemoembolization (TACE) were randomized 11:10 to SIRT plus sorafenib (SIRT + sorafenib) or sorafenib alone. This exploratory subanalysis evaluated the impact of extrahepatic metastases on survival. RESULTS In the intent-to-treat cohort, 216 patients were randomized to SIRT + sorafenib and 208 to sorafenib alone. Seventeen patients with distant organ metastases (bone, n = 11; adrenal glands, n = 5; peritoneum, n = 1) and 262 without distant metastases at study entry were analyzed in this substudy. Patients with (Group A) and without (Group B) distant organ metastases at study entry presented with a median survival of 11.3 and 14.8 months, respectively (p = 0.2807). During follow-up of patients with no organ metastases at baseline, extrahepatic disease progression occurred in 50 patients (19.1%). No statistically significant difference in survival was observed between patients without extrahepatic progression and those with new extrahepatic disease during treatment (14.8 vs. 14.9 months; p = 0.6483). Development of new pulmonary metastases during treatment significantly shortened median survival (7.6 vs. 15.0 months, p = 0.0060). CONCLUSIONS This subanalysis of the SORAMIC trial suggests that in patients with liver-dominant advanced HCC, metastases to distant organs with the exception of pulmonary metastases do not in general exert a negative impact on patient prognosis. The choice of palliative treatment should incorporate a personalized analysis of the pattern of tumor distribution.
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Affiliation(s)
- Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany,Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, Osnabrück, Germany
| | - Regina Schinner
- Department of Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Mathias P. Fabritius
- Department of Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Melina Möller
- Department of Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Christiane Kuhl
- Department of Radiology, Universitätsklinikum Aachen, Aachen, Germany
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia − Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Osman Öcal
- Department of Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
| | - Max Seidensticker
- Department of Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Rohini Sharma
- Department of Surgery & Cancer, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Daniel Palmer
- Molecular and Clinical Cancer Medicine, University Hospitals & Clatterbridge, University of Liverpool, Liverpool, United Kingdom
| | - Jean-Pierre Bronowicki
- Department of Hepatology, INSERM U1254, Hôpital de Brabois, CHU de Nancy, University of Lorraine, Nancy, France
| | - Peter Reimer
- Institute for Diagnostic and Interventional Radiology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Peter Malfertheiner
- Department of Internal Medicine II, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany,*Jens Ricke, Department of Radiology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, DE–81377 Munich (Germany),
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14
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Koc NS, Yilmaz R, Yildirim T, Eldem G, Peynircioglu B, Erdem Y. A New Approach to Tertiary Hyperparathyroidism: Percutaneous Embolization: Two Case Reports. Transplant Proc 2020; 53:1010-1013. [PMID: 32951863 DOI: 10.1016/j.transproceed.2020.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022]
Abstract
Secondary hyperparathyroidism is one of the most common complications of chronic kidney failure. If prolonged, parathyroid hormone release gains autonomy and tertiary hyperparathyroidism with parathyroid adenoma or hyperplasia can be develop. Tertiary hyperparathyroidism is associated with increased risk of mortality and morbidity; thus, treatment is recommended. Medical treatment includes phosphate binders, vitamin D analogues, and calcimimetic agents. Most cases of tertiary hyperparathyroidism can be controlled with medical treatment. When medical treatment options prove insufficient, parathyroidectomy is recommended. However, recurrence after parathyroidectomy is possible, which requires an alternative treatment. We present our percutaneous embolization experience, which has not been tried in the treatment of tertiary hyperparathyroidism in renal transplantation patients diagnosed with tertiary hyperparathyroidism.
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Affiliation(s)
- Neriman Sila Koc
- Department of Nephrology, Hacettepe University Faculty of Medicine, Altındag, Ankara, Turkey.
| | - Rahmi Yilmaz
- Department of Nephrology, Hacettepe University Faculty of Medicine, Altındag, Ankara, Turkey
| | - Tolga Yildirim
- Department of Nephrology, Hacettepe University Faculty of Medicine, Altındag, Ankara, Turkey
| | - Gonca Eldem
- Department of Radiology, Hacettepe University Faculty of Medicine, Altındag, Ankara, Turkey
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University Faculty of Medicine, Altındag, Ankara, Turkey
| | - Yunus Erdem
- Department of Nephrology, Hacettepe University Faculty of Medicine, Altındag, Ankara, Turkey
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15
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Helmberger T, Arnold D, Bilbao JI, de Jong N, Maleux G, Nordlund A, Peynircioglu B, Sangro B, Sharma RA, Walk A. Clinical Application of Radioembolization in Hepatic Malignancies: Protocol for a Prospective Multicenter Observational Study. JMIR Res Protoc 2020; 9:e16296. [PMID: 32319960 PMCID: PMC7203613 DOI: 10.2196/16296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/30/2020] [Accepted: 02/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background Radioembolization, also known as transarterial radioembolization or selective internal radiation therapy with yttrium-90 (90Y) resin microspheres, is an established treatment modality for patients with primary and secondary liver tumors. However, large-scale prospective observational data on the application of this treatment in a real-life clinical setting is lacking. Objective The main objective is to collect data on the clinical application of radioembolization with 90Y resin microspheres to improve the understanding of the impact of this treatment modality in its routine practice setting. Methods Eligible patients are 18 years or older and receiving radioembolization for primary and secondary liver tumors as part of routine practice, as well as have signed informed consent. Data is collected at baseline, directly after treatment, and at every 3-month follow-up until 24 months or study exit. The primary objective of the Cardiovascular and Interventional Radiological Society of Europe Registry for SIR-Spheres Therapy (CIRT) is to observe the clinical application of radioembolization. Secondary objectives include safety, effectiveness in terms of overall survival, progression-free survival (PFS), liver-specific PFS, imaging response, and change in quality of life. Results Between January 2015 and December 2017, 1047 patients were included in the study. The 24-month follow-up period ended in December 2019. The first results are expected in the third quarter of 2020. Conclusions The CIRT is the largest observational study on radioembolization to date and will provide valuable insights to the clinical application of this treatment modality and its real-life outcomes. Trial Registration ClinicalTrials.gov NCT02305459; https://clinicaltrials.gov/ct2/show/NCT02305459 International Registered Report Identifier (IRRID) DERR1-10.2196/16296
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Affiliation(s)
- Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, München, Germany
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | - José I Bilbao
- Interventional Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Niels de Jong
- Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
| | - Geert Maleux
- Radiologie, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Pamplona, Spain
| | - Ricky A Sharma
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Cancer Institute, University College London, London, United Kingdom
| | - Agnes Walk
- Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
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16
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Peker O, Aki FT, Kumbasar U, Guvener M, Yılmaz M, Dogan R, Ozaltin F, Duzova A, Topaloglu R, Peynircioglu B, Demircin M. Surgical management of renovascular hypertension in children and young adults: a 13-year experience. Interact Cardiovasc Thorac Surg 2019; 29:746-752. [DOI: 10.1093/icvts/ivz157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
In this study, we aimed to evaluate the early and mid-term outcomes of surgery for renovascular hypertension (RVH) at our institution, within the last 13 years.
METHODS
We retrospectively reviewed 19 patients who underwent surgery for RVH, between 2005 and 2017. The age at operation, clinical characteristics, cause of arterial stenosis, diagnostic workup, surgical management and outcomes during the follow-up were analysed. The continuous variables were expressed as mean ± standard deviation.
RESULTS
Twelve female and 7 male patients underwent surgery for RVH. Their mean age was 17.07 ± 11.9 years (range 4–42 years). Nine patients had renal arterial stenosis, and 10 patients had midaortic syndrome (MAS). Aortorenal bypass with the saphenous vein was performed in 6 patients with renal arterial stenosis and 1 patient with MAS. An isolated thoracic aorta-abdominal aortic bypass was performed in 1 patient with MAS, and thoracic aorta-abdominal aortic bypass combined with unilateral aortarenal bypass was performed in 9 patients with MAS. The other surgical procedures performed were 2 autotransplantations and 2 unilateral nephrectomies. Among the patients with MAS, 4 underwent reoperation. The mean follow-up duration was 45.58 ± 32.7 months. Hypertension was cured in 3 patients and improved in 14 patients. The postoperative follow-up creatinine levels were similar to preoperative creatinine levels. All bypasses were patent on mid-term follow-up. One patient who underwent aortorenal bypass died 14 months postoperatively.
CONCLUSIONS
Surgical management is a suitable option for patients with RVH, who were unresponsive to medical and/or endovascular management. Surgical methods are safe and effective in children and young adults with RVH.
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Affiliation(s)
- Oktay Peker
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Fazil Tuncay Aki
- Department of Urology, Hacettepe University Hospital, Ankara, Turkey
| | - Ulas Kumbasar
- Department of Cardiothoracic Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Murat Guvener
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Mustafa Yılmaz
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Rıza Dogan
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Fatih Ozaltin
- Department of Pediatric Nephrology, Hacettepe University Hospital, Ankara, Turkey
| | - Ali Duzova
- Department of Pediatric Nephrology, Hacettepe University Hospital, Ankara, Turkey
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University Hospital, Ankara, Turkey
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
| | - Metin Demircin
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
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Ocal O, Yilmaz M, Peynircioglu B, Bilginer B, Peker A, Arat A. Hybrid vascular intervention for a giant cervical carotid artery aneurysm in a clopidogrel-hyporesponsive child. J Neurosurg Pediatr 2018; 22:265-269. [PMID: 29932366 DOI: 10.3171/2018.3.peds17669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysms of the extracranial internal carotid artery (ICA) in pediatric patients are rare and mostly treated surgically. The authors present the case of a child with a giant extracranial ICA aneurysm presenting with gradual airway compression. A plan was made to explore the aneurysm surgically and straighten the associated carotid artery kinks during the operation to enable further endovascular treatment if primary reconstruction of the carotid artery proved not to be possible. Finally, the aneurysm was successfully treated with staged hybrid intervention, which consisted of surgical correction of parent artery kinks followed by endovascular implantation of stent grafts. The child tolerated the procedure well without adverse events. A craniocervical CT angiogram at 5 months showed patency of the stent construct and relief of airway compression. However, a follow-up CT angiogram at 14 months showed total occlusion of the ipsilateral carotid artery without clinical sequelae and complete cessation of airway compression. The management of this was unique since the patient is the first reported case of clopidogrel hyporesponsiveness in a child undergoing neurovascular intervention with prasugrel monotherapy. Point-of-care testing-based adjustment of prasugrel necessitated education of the patient's family regarding the loss of effect of the prasugrel tablets upon crushing and contact with air.
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Affiliation(s)
| | | | | | - Burcak Bilginer
- 3Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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18
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Cil B, Topcuoglu OM, Peynircioglu B, Arat A, Vargel I. Percutaneous Treatment of Scalp Arteriovenous Fistulas by Direct Puncture and Polydocanol Sclerotherapy. Clin Neuroradiol 2017; 28:609-612. [DOI: 10.1007/s00062-017-0653-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
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19
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Ocal O, Peynircioglu B, Eldem G, Akpinar E, Onur MR, Kabakci G. Iliac arteriovenous fistulas after lumbar spinal surgery. Turk J Emerg Med 2017; 17:109-111. [PMID: 28971159 PMCID: PMC5608595 DOI: 10.1016/j.tjem.2017.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 11/30/2022] Open
Abstract
Iatrogenic arteriovenous fistula (AVF) is an unusual and potentially fatal complication of lumbar spinal surgery. The presentation of these injuries is usually late, with symptoms such as leg swelling or cardiac failure. It is crucial to suspect AVF in the patient which presents to emergency with lumbar spinal surgery history. The diagnosis is often based on imaging studies such as computed tomography (CT) or magnetic resonance (MR) angiography. Surgery was the first choice of treatment, but with recent advances in stent technology endovascular approach has become widely popular. We present two cases of AVF secondary to lumbar spinal surgery, one of them presenting with overt heart failure and the other one with leg swelling.
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Affiliation(s)
- Osman Ocal
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bora Peynircioglu
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gonca Eldem
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erhan Akpinar
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Giray Kabakci
- Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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20
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Ozturk O, Eldem G, Peynircioglu B, Kav T, Görmez A, Cil BE, Balkancı F, Sokmensuer C, Bayraktar Y. Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension. World J Gastroenterol 2016; 22:9623-9630. [PMID: 27920483 PMCID: PMC5116606 DOI: 10.3748/wjg.v22.i43.9623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/11/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the outcomes of partial splenic embolization (PSE) for massive splenomegaly due to idiopathic portal hypertension (IPH).
METHODS In this prospective study, we evaluated the characteristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes.
RESULTS A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm (21-28 cm), and severe hypersplenism was diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred.
CONCLUSION Our findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.
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21
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Aydin AM, Eldem G, Peynircioglu B, Baydar DE, Bilen CY. Local recurrence of renal cell carcinoma that simulated multiple renal arteriovenous fistulas after laparoscopic partial nephrectomy: Report of a rare case. Int J Urol 2016; 23:888-891. [PMID: 27416885 DOI: 10.1111/iju.13165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/14/2016] [Indexed: 11/30/2022]
Abstract
Herein we report a patient who was initially thought to have renal arteriovenous fistulas 3 months after laparoscopic partial nephrectomy for a small renal mass. After timely intervention using selective renal artery embolization, computed tomography 9 months post-surgery showed persistent renal arteriovenous fistulas and nodular lesions in the perirenal fat. The patient then underwent radical nephrectomy, and histopathological examination showed underlying recurrent clear cell renal cell carcinoma invading the intraparenchymal arteries and veins, which was simulating multiple high-flow renal arteriovenous fistulas.
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Affiliation(s)
- Ahmet Murat Aydin
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gonca Eldem
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bora Peynircioglu
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilek Ertoy Baydar
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cenk Yucel Bilen
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Ozturk O, Koklu S, Peynircioglu B, Eldem G. An unusual cause of massive gastrointestinal bleeding. Dig Liver Dis 2015; 47:e11. [PMID: 25818252 DOI: 10.1016/j.dld.2015.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Omer Ozturk
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Seyfettin Koklu
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gonca Eldem
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Hızarcioglu-Gulsen H, Aydemir Y, Gucer S, Berberoglu-Ates B, Hizal G, Peynircioglu B, Saltik-Temizel IN, Chawla H, Schwartzberg P, Nakhleh N, Loveridge-Lenza B, Ballance C, Sultan R, Naganathan S, Ngido F, Misra S. Index of suspicion. Pediatr Rev 2014; 35:531-7. [PMID: 25452662 DOI: 10.1542/pir.35-12-531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Yusuf Aydemir
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | | | | | - Gulin Hizal
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Bora Peynircioglu
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | | - Paul Schwartzberg
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune, NJ
| | - Nader Nakhleh
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune, NJ
| | | | - Cathleen Ballance
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune, NJ
| | - Richard Sultan
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune, NJ
| | | | - Fabian Ngido
- Department of Pediatrics, East Carolina University-Brody School of Medicine, Greeneville, NC
| | - Sudipta Misra
- Department of Pediatrics, East Carolina University-Brody School of Medicine, Greeneville, NC
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Ricke J, Schuette K, Rosmorduc O, Peck-Radosavljevic M, Verslype C, Sangro B, Walecki J, Klumpen HJ, Peynircioglu B, Yalcin S, Bartolozzi C, Amthauer H, Malfertheiner P. Sorafenib in combination with local microtherapy guided by gadolinium-EOB-DTPA enhanced MRI in patients with inoperable hepatocellular carcinoma (SORAMIC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps4154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jens Ricke
- Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | | | | | | | | | - Bruno Sangro
- Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Jerzy Walecki
- Centralny Szpital Kliniczny, MSWiA, Warszawa, Poland
| | | | | | | | | | - Holger Amthauer
- Otto von Guericke University of Magdeburg, Magdeburg, Germany
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Idilman IS, Vesnic S, Cil B, Peynircioglu B. Giant renal artery pseudoaneurysm caused by rupture of renal angiomyolipoma following pregnancy: endovascular treatment and review of the literature. Saudi J Kidney Dis Transpl 2014; 25:385-9. [PMID: 24626009 DOI: 10.4103/1319-2442.128570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal angiomyolipoma is a hamartomatous, benign tumor composed of blood vessels, fatty tissue and smooth muscle cells, and is often detected incidentally. It can also be associated with the tuberous-sclerosis complex (TSC). Pregnancy and use of oral contraceptives are known to be associated with an increased risk of tumoral rupture and bleeding. Herein, we report a unique case of renal angiomyolipoma associated with TSC who presented with hypovolemic shock as a result of spontaneous rupture of a giant renal pseudoaneurysm, immediately after pregnancy. Emergency endovascular treatment was successful with sparing of most of the affected kidney as demonstrated by follow-up computed tomography imaging.
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Affiliation(s)
- Ilkay S Idilman
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Yesilkaya Y, Peynircioglu B, Gulek B, Topcuoglu M, Inci K. Autologous blood-clot embolisation of cavernosal artery pseudoaneurysm causing delayed high-flow priapism. Pol J Radiol 2013; 78:54-6. [PMID: 23807886 PMCID: PMC3693838 DOI: 10.12659/pjr.883946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 02/20/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND High-flow priapism is a rare condition characterized by a prolonged and painless erection. Since it may permanently impair erectile function, it must be managed and treated as soon as possible, in order to restore potency. The case we are presenting here was successfully treated by embolizing the penile artery using an autologous clot. CASE REPORT A case of delayed painless high-flow priapism that occured after blunt straddle-type perineal trauma, that was persistent for more than 30 days is being presented. Doppler ultrasonographic examination of the cavernosal artery revealed a 1.5 cm-diameter pseudoaneurysm at the right cavernosal artery, together with a high-velocity shunt between the two cavernous arteries. Extravasation from the proximal sites of both of the cavernous arteries and a right cavernosal artery pseudoaneurysm was detected on angiography. The patient was successfully treated by embolization of the penile artery with an autologous clot in two sessions with a 3-day interval. CONCLUSIONS This experience along with a survey of the literature made us conclude that embolization of cavernous artery by means of an autologous clot is a very effective procedure and a method of choice for treatment of high-flow priapism and for restoration of penile erectile function. What makes our case even more interesting and important, is the fact that priapism of one month's duration could well be treated by means of this method.
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Kalyoncu U, Peynircioglu B, Ertenli I, Er G, Er E, Karadag O, Kilic L, Bilgen S, Akdogan A, Cil B, Ozen S, Kiraz S. SAT0176 Long Term Successful Results of Medical (Steroid, Cyclophosphamide With/Without Interferon Alpha) and/or Endovascular Intervention for Aneurysm of Behcet Disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ozkan F, Peynircioglu B, Canyigit M, Ergun O, Cil BE, Cekirge S. Disintegration of a Balloon-Expandable Stent in the Iliac
Artery Upon Delivery. Electron J Gen Med 2013. [DOI: 10.29333/ejgm/82348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cil B, Peynircioglu B, Geyik FD, Citak N. Endovascular aortic repair for a pulmonary aspergilloma fistulized into the descending aorta: selective intubation with a single-lumen tube under fluoroscopic guidance. Eur J Cardiothorac Surg 2012; 44:182. [PMID: 23242989 DOI: 10.1093/ejcts/ezs639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Barbaros Cil
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
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Piskinpasa S, Altun B, Akoglu H, Yildirim T, Agbaht K, Yilmaz R, Peynircioglu B, Cil B, Aytemir K, Turgan C. An uninvestigated risk factor for contrast-induced nephropathy in chronic kidney disease: proteinuria. Ren Fail 2012; 35:62-5. [PMID: 23176376 DOI: 10.3109/0886022x.2012.741646] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is one of the most frequent causes of acute renal failure in hospitalized patients with the incremental use of contrast media. We aimed to investigate whether proteinuria may act as a risk factor for CIN in patients with chronic kidney disease. METHODS Seventy hospitalized patients (37 men, 33 women) with chronic kidney disease, proteinuria, and/or estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2, who were exposed to contrast media were investigated prospectively. Thirty patients were diabetic. All patients received prophylaxis against CIN with acetylcysteine and 0.9% intravenous saline. CIN is defined as either a 25% higher increase in serum creatinine (sCr) from the baseline levels or a 0.5 mg/dL increase in sCr at 72 h after contrast media exposure. RESULTS CIN was detected in 26 (37.1%) patients. Advanced age, diabetes, heart failure, anemia, baseline sCr of >1.5 mg/dL, baseline eGFR of <60 mL/min/1.73 m(2), proteinuria of ≥1 g/day, hypoalbuminemia, and the volume of contrast media of ≥100 mL correlated significantly with CIN. The frequency of CIN was significantly higher in patients with proteinuria of ≥1 g/day compared to patients with proteinuria of <1 g/day (p = 0.009). CONCLUSION Proteinuria may be a new risk factor for the development of CIN in patients with chronic kidney disease.
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Affiliation(s)
- Serhan Piskinpasa
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Ricke J, Schuette K, Rosmorduc O, Jakob A, Verslype C, Sangro B, Walecki J, Klumpen HJ, Peynircioglu B, Yalcin B, Bartolozzi C, Amthauer H, Malfertheiner P. Sorafenib in combination with local microtherapy guided by gadolinium-EOB-DTPA enhanced MRI in patients with inoperable hepatocellular carcinoma (HCC) (SORAMIC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps4148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4148 Background: HCC is a leading cause of cancer-related mortality in both men and women. It represents the fifth most common cancer worldwide with an increasing incidence. For the individual patient tumor stage at diagnosis (number and size of nodules, presence or absence of vascular invasion, presence or absence of extrahepatic spread), liver function and general health status are the principal prognostic factors. The clinical management of HCC requires a comprehensive, multidisciplinary approach. In early HCC curative treatment can be achieved by local ablation, resection or liver transplantation. In intermediate stages patients (pts) are offered locoregional treatment with palliative intent (transarterial chemoembolisation (TACE), Yttrium-90-radioembolisation (SIRT)). In advanced disease systemic therapy with sorafenib (sor) has the potential to prolong survival of pts and is standard of care in pts with preserved liver function. Studies on the combined use of locoregional and systemic therapy with their potential of a beneficial synergism are few and conducted in a small number of pts. Methods: This phase II-study is composed of three substudies with the following primary objectives: 1. In pts in whom local ablation is appropriate to determine if sor in combination with RFA prolongs the time-to-recurrence in comparison with RFA plus placebo. Primary endpoint (PEP): time to recurrence, n = 290 pts 2. In pts in whom RFA is not appropriate (palliative treatment group) to determine if the combination of SIRT and sor improves the overall survival in comparison to sor alone. PEP: overall survival, n = 375 pts 3. To confirm in a 2-step procedure that Gd-EOB-DTPA enhanced MRI is non-inferior or superior compared with contrast-enhanced multislice CT for stratification of pts to a palliative or a local ablation treatment strategy. PEP: correct stratification of pts to a palliative versus local ablation treatment strategy; n = 830 pts The trial has started in December 2010 as a multinational and multicentric study. 90 pts have been enrolled until January 31st 2012 with 51 pts randomized in the palliative arm and 14 pts treated in the curative arm.
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Affiliation(s)
- Jens Ricke
- Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | | | | | - Chris Verslype
- Digestive Oncology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - Bruno Sangro
- Liver Unit, Clinica Universitaria and CIBEREHD, Pamplona, Spain
| | - Jerzy Walecki
- Centralny Szpital Kliniczny, MSWiA, Warszawa, Poland
| | - Heinz-Josef Klumpen
- Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, Netherlands
| | | | - Bulent Yalcin
- Ankara University School of Medicine, Ankara, Turkey
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Peynircioglu B, Yurttutan N, Gulek B, Cil B, Yilmaz M. Vertebral artery occlusion with Amplatzer vascular plug 4 to prevent subsequent endoleak in stent-graft treatment of subclavian artery gunshot injury. Acta Radiol 2011; 52:850-3. [PMID: 21724841 DOI: 10.1258/ar.2011.110129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endovascular treatment options have evolved in many ways and become an important alternative for open surgical repairs in various vascular territories. Herein, we present a case of an 18-year-old man with complex injury to the left subclavian artery and vein caused by a gunshot 4 months ago. After the gunshot, a high-flow fistula between the left subclavian artery and the vein occurred with pseudoaneurysm formation. This fistula led to a significant left subclavian steal phenomenon. A stent-graft was deployed along the injured left subclavian artery after embolization of the left vertebral artery by Amplatzer vascular plug 4 (AVP-4) in order to prevent subsequent endoleak due to the subclavian steal syndrome.
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Affiliation(s)
- Bora Peynircioglu
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara
| | - Nursel Yurttutan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara
| | | | - Barbaros Cil
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara
| | - Mustafa Yilmaz
- Department of Cardiovascular Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Ricke J, Schuette K, Graziadei IW, Jakob A, Verslype C, Sangro B, Walecki J, Klümpen HJ, Peynircioglu B, Yalcin S, Bartolozzi C, Amthauer H, Malfertheiner P. Evaluation of sorafenib in combination with local microtherapy guided by gadolinium-EOB-DTPA enhanced MRI in patients with inoperable hepatocellular carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ozer C, Peynircioglu B, Cil B, Demirkazik F, Ariyurek M. Transcatheter Management of Non-Bronchial Systemic Arteries Causing Hemoptysis in a Patient with Tuberculosis. Turk Thorac J 2010. [DOI: 10.5152/ttd.2010.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Yilmaz S, Atinkaya C, Aktas A, Peynircioglu B. Giant arteriovenous malformation located on the chest wall - diagnosis and endovascular treatment: report of a case. Surg Today 2010; 40:1164-8. [PMID: 21110162 DOI: 10.1007/s00595-009-4249-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 11/12/2009] [Indexed: 11/29/2022]
Abstract
Congenital arteriovenous malformations are usually found in the lower extremities, but a chest wall location is extremely rare. Extensive vascular malformations present difficulties for patients because of severe unsightliness and life-threatening bleeding. Surgical planning and therapeutic indications in vascular malformations are still a difficult problem. This report describes the case of a 27-year-old woman with a congenital giant arteriovenous malformation of the left chest wall. Preoperative embolization was planned prior to surgical intervention because of the increased risk of massive bleeding, and the malformation was completely embolized with absolute alcohol.
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Affiliation(s)
- Sevda Yilmaz
- Department of Radiology, University of Kirikkale, Kirikkale, Turkey
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Peynircioglu B, Shorbagi AI, Balli O, Cil B, Balkanci F, Bayraktar Y. Is there an alternative to TIPS? Ultrasound-guided direct intrahepatic portosystemic shunt placement in Budd-Chiari syndrome. Saudi J Gastroenterol 2010; 16:315-8. [PMID: 20871209 PMCID: PMC2995113 DOI: 10.4103/1319-3767.70633] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Budd-Chiari syndrome is a spectrum of manifestations which develops as a result of hepatic venous outflow obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive vascular and interventional radiological procedure indicated in the management of refractory ascites in such patients. Conventional TIPS requires the presence of a patent hepatic vein and reasonable accessibility to the portal vein, and in patients with totally occluded hepatic veins, this procedure is technically challenging. Direct intrahepatic portosystemic shunt (DIPS) or so called "percutaneous TIPS" involves ultrasound-guided percutaneous simultaneous puncture of the portal vein and inferior vena cava followed by introduction of a guidewire through the portal vein into the inferior vena cava, as a deviation from conventional TIPS. Described here is our experience with DIPS. Three patients with BCS who had refractory ascites but were unsuitable for conventional TIPS due to occlusion of the hepatic veins were chosen to undergo the DIPS procedure. Our technical success was 100%. The shunts placed in two patients remain patent to date, while the shunt in a third patient with underlying antiphospholipid syndrome was occluded a month after the procedure. The percutaneous TIPS procedure seems to be technically feasible and effective in the management of refractory ascites as a result of BCS, particularly in the setting of occluded hepatic veins.
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Affiliation(s)
- Bora Peynircioglu
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ali Ibrahim Shorbagi
- Department of Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey,Address for correspondence: Dr. Ali Shorbagi, Department of Gastroenterology, Hacettepe University, School of Medicine, Sihhiye, Ankara, Turkey 06100. E-mail:
| | - Omur Balli
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Barbaros Cil
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ferhun Balkanci
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Yusuf Bayraktar
- Department of Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey
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Oto A, Aytemir K, Okutucu S, Peynircioglu B, Cil B, Deniz A, Aksoy H, Yorgun H, Kaya EB, Kabakci G, Tokgozoglu L, Ozkutlu H. OP-007 APPROACH FOR SEPTAL ABLATION IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY BY CYANOACRYLATE. Int J Cardiol 2010. [DOI: 10.1016/s0167-5273(10)70010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Inci K, Cil B, Yazici S, Peynircioglu B, Tan B, Sahin A, Bilen CY. Renal artery pseudoaneurysm: complication of minimally invasive kidney surgery. J Endourol 2010; 24:149-54. [PMID: 19954351 DOI: 10.1089/end.2009.0342] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We retrospectively reviewed the charts of patients with renal artery pseudoaneurysms (RAPs) to document their clinical presentation, surgical background, and outcome. MATERIALS AND METHODS In all, 7 of the 1965 patients who underwent percutaneous stone surgery and 3 of the 25 patients who underwent laparoscopic nephron-sparing surgery had a diagnosis of RAP and were treated accordingly. The most common symptom was hematuria, which was classified as early or delayed according to the time of presentation, as mild, moderate, or severe according to the hemodynamics of the patient. In addition, angiographic images were reviewed, and the correlation between the clinical presentation of RAP and its location was investigated. RESULTS In the percutaneous stone surgery group, four patients experienced early mild to moderate hematuria and three experienced late moderate hematuria. All of the RAPs were located on the interlobar and arcuate arteries. In the laparoscopic nephron-sparing surgery group, one patient was asymptomatic, with diagnosis of renal-cell cancer recurrence at the 3-month follow-up, and had radical nephrectomy. Two patients presented with delayed moderate hematuria with lesions that were located on the interlobar, arcuate, and segmentary arteries. Two sessions of embolization were sufficient to stop bleeding in one patient with a segmentary artery aneurysm that had unfortunately lost kidney function during follow-up. CONCLUSION There is no predictive factor for patients undergoing percutaneous nephrolithotomy procedure yet, but laparoscopic partial nephrectomy for tumors localized in the central portion of kidney may end up with RAP especially if no adjuvant sealing agents are used. The outcome of RAPs depends primarily on early recognition and a high index of suspicion, which facilitates correct diagnosis and appropriate management. Selective angiography and embolization together is the gold standard, both for diagnosis and treatment.
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Affiliation(s)
- Kubilay Inci
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Peynircioglu B, Cil B. Invisible venous ports from Medcomp. Cardiovasc Intervent Radiol 2010; 33:1291-2. [PMID: 20186544 DOI: 10.1007/s00270-010-9823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hazirolan T, Turkbey B, Akpinar E, Canyigit M, Karcaaltincaba M, Peynircioglu B, Balkanci ZD, Akata D, Balkanci F. The impact of warmed intravenous contrast material on the bolus geometry of coronary CT angiography applications. Korean J Radiol 2009; 10:150-5. [PMID: 19270861 PMCID: PMC2651444 DOI: 10.3348/kjr.2009.10.2.150] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 11/18/2008] [Indexed: 11/18/2022] Open
Abstract
Objective This study was designed to investigate the effect of administration of warmed contrast material (CM) on the bolus geometry and enhancement as depicted on coronary CT angiography. Materials and Methods A total of 64 patients (42 men, 22 women; mean age, 56 years) were randomly divided into two groups. Group 1 included 32 patients administered CM (Omnipaque [Iohexol] 350 mg I/ mL; Nycomed, Princeton, NJ) saline solutions kept in an incubator at a constant temperature (37℃). Group 2 included 32 patients administered the CM saline solutions kept at constant room temperature (24℃). Cardiac CT scans were performed with a dual source computed tomography (DSCT) scanner. For each group, region of interest curves were plotted inside the ascending aorta, main pulmonary artery and descending aorta on test bolus images. Using enhancement values, time/enhancement diagrams were produced for each vessel. On diagrams, basal Hounsfield unit (HU) values were subtracted from sequentially obtained values. A value of 100 HU was accepted as a cut-off value for the beginning of opacification. The time to peak, the time required to reach 100 HU opacification, maximum enhancement and duration of enhancement above 100 HU were noted. DSCT angiography studies were evaluated for coronary vessel enhancement. Results Maximum enhancement values in the ascending aorta, descending aorta and main pulmonary artery were significantly higher in group 1 subjects. In the ascending aorta, the median time required to reach 100 HU opacification during the test bolus analysis was significantly shorter for group 2 subjects than for group 1 subjects. In the ascending aorta, the descending aorta and main pulmonary artery, for group 1 subjects, the bolus geometry curve shifted to the left and upwards as compared with the bolus geometry curve for group 2 subjects. Conclusion The use of warmed CM yields higher enhancement values and a shorter time to reach maximum enhancement duration, resulting in a shift of the bolus geometry curve to the left that may provide optimized image quality.
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Affiliation(s)
- Tuncay Hazirolan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Aydemir E, Çil B, Peynircioglu B, Balkanci F. Abstract No. 254: Venous Port Implantation on the Trapezius Muscle. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Koc O, Cil BE, Peynircioglu B, Emlik D, Ozbek O. Complementary Use of NBCA with the Amplatzer Vascular Plug for Embolization of a High-Flow Traumatic Hepatic Arteriovenous Fistula. Cardiovasc Intervent Radiol 2009; 32:1105-7. [DOI: 10.1007/s00270-009-9505-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 12/24/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
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Abstract
BACKGROUND The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitoneal bleedings. METHODS A total of 16 patients with retroperitoneal bleeding who underwent angiography followed by transcatheter embolization within a 4-year period in a single centre were reviewed retrospectively. Electronic charts as well as procedural reports were reviewed to assess immediate angiographic findings and results of embolization. RESULTS Computed tomography was carried out in eight patients. All computed tomography scans showed retroperitoneal haematoma. In addition, contrast material extravasation consistent with active bleeding was seen in two patients and pseudoaneurysm in one. In the remaining eight patients, diagnosis of retroperitoneal bleeding was established based on combined ultrasound and clinical findings. The technical success rate for selective embolotherapy was 100%. Five of these 16 patients (three women and 13 men) had lumbar artery injury; 10 patients were associated with renal artery injury and one had bilateral internal iliac artery injury. Angiography showed active extravasation, pseudoaneurysm and arteriovenous fistula. For embolization, coils were used in six patients and N-butyl-2-cyanoacrylate in the remaining 10 patients. Four patients died within 1 month of embolotherapy. CONCLUSION Transcatheter embolotherapy appears to be a life-saving, safe and effective treatment for retroperitoneal bleedings that may be carried out in emergency situations in haemodynamically unstable patients.
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Affiliation(s)
- Erhan Akpinar
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Cil BE, Vargel I, Geyik S, Peynircioglu B, Cavusoglu T. Venous vascular malformations of the craniofacial region: pre-operative embolisation with direct percutaneous puncture and N-butyl cyanoacrylate. Br J Radiol 2008; 81:935-9. [PMID: 18824500 DOI: 10.1259/bjr/66893325] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Craniofacial venous vascular malformations cause severe cosmetic problems and yet these lesions are not candidates for transcatheter embolisation owing to the lack of arterial feeders. The purpose of this study was to evaluate the effectiveness of pre-operative embolisation of these lesions with N-butyl 2-cyanoacrylate (NBCA) via direct puncture. Between September 2003 and April 2006, 13 patients (7 female; age range, 6-64 years; mean, 16.7 years) were embolised with direct puncture and injection of NBCA. All of the patients were referred from plastic surgery with an operational plan. Angiography performed in all patients showed no or little arterial staining. NBCA diluted with iodized oil at a ratio of 1:6 (18%) was injected via a percutaneously placed 21 gauge needle. Complete embolisation was achieved in 8 patients and partial embolisation in the remaining 5. A total of 18 sessions of embolisation were performed on 13 patients. Nine patients underwent only one embolisation session, three patients underwent two sessions and only one patient underwent three sessions. The mean volume of NBCA used per session was 5.8 ml, ranging from 1-12 ml. All patients underwent a successful surgical resection to improve cosmetic disfigurement within 10-15 days after the embolisation procedure. Mean follow-up time was 22 months. One patient experienced skin necrosis on her nose after embolisation. No other complications related to the procedure were observed. In conclusion, pre-operative NBCA embolisation with direct puncture is a safe and easy procedure. It can increase the success of the surgical treatment of these lesions.
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Affiliation(s)
- B E Cil
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye 06100, Ankara, Turkey.
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Akoglu H, Yilmaz R, Peynircioglu B, Arici M, Kirkpantur A, Cil B, Altun B, Turgan C. A rare complication of hemodialysis catheters: superior vena cava syndrome. Hemodial Int 2007; 11:385-91. [PMID: 17922732 DOI: 10.1111/j.1542-4758.2007.00205.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Central venous catheters in hemodialysis patients may result in superior vena cava (SVC) syndrome. With the increasing use of these catheters, the SVC syndrome will probably be more common among hemodialysis patients. This report describes 3 cases of SVC syndrome due to central venous catheters that developed in hemodialysis patients with previous multiple catheter placements.
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Affiliation(s)
- Hadim Akoglu
- Nephrology Unit, Hacettepe University School of Medicine, Ankara, Turkey
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Abstract
Takayasu arteritis is a rare, large-vessel vasculitis in which the nonspecific systemic inflammatory symptoms are followed by inflammation of the aorta and its major branches. The inflammation of this vessel leads to progressive luminal stenosis or aneurysm formation resulting in limb or organ ischemia. Although conventional angiography is still accepted as the gold standard modality, the information obtained is limited to the vessel lumen. Multidetector computed tomographic angiography and magnetic resonance angiography can provide valuable information not only regarding intraluminal pathologies but also concerning the thickening of the vessel wall, which may be the earliest manifestation of the disease.
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Affiliation(s)
- Murat Canyigit
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
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Arat A, Cil BE, Vargel I, Turkbey B, Canyigit M, Peynircioglu B, Arat YO. Embolization of high-flow craniofacial vascular malformations with onyx. AJNR Am J Neuroradiol 2007; 28:1409-14. [PMID: 17698554 PMCID: PMC7977660 DOI: 10.3174/ajnr.a0547] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Various techniques and materials have been used for the endovascular treatment of craniofacial high-flow arteriovenous vascular malformations, because their rarity precludes standardization of their treatment. The aim of this retrospective review is to assess Onyx as the primary embolic agent in the treatment of these vascular malformations. MATERIALS AND METHODS Six patients with arteriovenous fistulas and 3 with arteriovenous malformations (AVMs) of the head and neck region were treated with intra-arterial (IA)/direct percutaneous injections of Onyx. Adjunctive maneuvers used during embolization included external compression of the arterial feeders or venous outflow (6 patients), balloon assist (4 patients), and direct embolization of the draining vein remote to the fistula site (1 patient). n-butyl-2-cyanoacrylate (n-BCA) was used in addition to Onyx for rapid induction of thrombosis in a large venous pouch (1 patient) and for cost containment purposes (1 patient). Four patients were treated surgically after the embolization. RESULTS There were no neurologic complications secondary to the embolization procedure. The arteriovenous shunt was eliminated in all of the fistulous lesions and 2 of the 3 AVMs. The embolization was incomplete in 1 patient with a large AVM who declined further endovascular or surgical procedures. Untoward events included 2 instances of catheter entrapment (of 9 IA injections), blackish skin discoloration necessitating surgical revision in 1 patient, and difficulty of balloon deflation/wire withdrawal during a balloon-assisted embolization. CONCLUSION Onyx appears to be a safe and effective liquid embolic agent for use in the treatment of craniofacial high-flow vascular malformations with distinct advantages and disadvantages compared with n-BCA.
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Affiliation(s)
- A Arat
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA, and Hacettepe University Hospitals, Ankara, Turkey.
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Peynircioglu B, Arslan EB, Cil BE, Geyik S, Hazirolan T, Konan A, Balkanci F. Subcutaneous venous port implantation in patients with bilateral breast surgery. Cardiovasc Intervent Radiol 2007; 30:405-9. [PMID: 17278032 DOI: 10.1007/s00270-006-0301-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to evaluate the long-term follow-up results of subcutaneous venous ports implanted in patients with bilateral mastectomies. We retrospectively reviewed the hospital charts and the electronic database of 17 patients with bilateral mastectomies whom had venous port implantation in our interventional radiology suit. A total of 17 ports were implanted to the paramedian (n = 3) and anterolateral (standard; n = 12) chest wall, on the trapezius muscle (n = 1), and to the antecubital fossa (n = 1). The mean age was 48.29 years (range: 35-60 years). The mean time interval from time of surgery to port implantation was 34 months (range: 1-84 months). The mean follow-up time was 15 months (range: 7-39 months). Follow-up parameters and classification of the complications was defined according to the SIR guidelines. No procedure-related complication occurred. A single case of mild late infection was noted and the infection rate was 0.19/1000 catheter days. Infusion chemotherapy administration was still going on in eight patients. Two patients died during the follow-up and four patients were lost after 6 months. Port removal was performed in three patients at follow-up because of the end of treatment. One trapezius port and one paramedian port weres among the removed ports without any problem. Although we have a limited number of patients, port placement to the anterior chest wall, either paramedian or anterolateral, on the trapezius muscle or to the antecubital fossa depending on the extent of the bilateral breast surgeries that can be performed with low complication rates by a careful patient and anatomical location selection by involving the patients in the decision-making process. We believe that patient education and knowledge of possible complications have high importance in follow-up.
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Affiliation(s)
- Bora Peynircioglu
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey.
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Peynircioglu B, Cil BE, Karcaaltincaba M. Standing or Stationary Arterial Waves of the Superior Mesenteric Artery at MR Angiography and Subsequent Conventional Arteriography. J Vasc Interv Radiol 2007; 18:1329-30. [PMID: 17911528 DOI: 10.1016/j.jvir.2007.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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