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Rosenberg A, Trebska-McGowan K, Reichman T, Sharma A, Cotterell A, Strife B, Khan AA, Kumaran V, Bruno DA, Levy MF, Bhati CS. Management of hepatic artery aneurysm: A case series. Ann Hepatobiliary Pancreat Surg 2020; 24:333-338. [PMID: 32843601 PMCID: PMC7452805 DOI: 10.14701/ahbps.2020.24.3.333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/29/2020] [Revised: 06/16/2020] [Accepted: 07/09/2020] [Indexed: 01/17/2023] Open
Abstract
Hepatic artery aneurysms are rare, but their diagnosis is important because of high mortality and complications. Common risk factors for developing these aneurysms include hypertension, vascular disease, pancreatitis, diabetes, tobacco use, autoimmune diseases, and previous transplantation. Frequent imaging for trauma and tumor surveillance has increased the incidence of naive hepatic aneurysms. These aneurysms can be difficult to manage, and it can be challenging to decide the correct treatment modality for the patient. Hereby, we present four cases of hepatic artery aneurysm and discuss various treatment options. Patient 1 suffered from a proper and right hepatic artery aneurysm discovered incidentally; repaired with an endovascular intervention later complicated by an endoleak which was further managed by another stenting. Patient 2 had a common hepatic artery aneurysm followed with serial imaging without any intervention. Patient 3 had a hepatic artery aneurysm and liver mass diagnosed concurrently. The patient underwent an open surgical repair of his aneurysm with graft and liver resection which was complicated later with rupture of aneurysm followed by surgical bypass repair. Patient 4 suffered from a large hepatic artery aneurysm causing bile duct compression. Her aneurysm was repaired open with splenic artery grafting. Patients were managed from careful observation to surgery with different outcomes.
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Affiliation(s)
- Ashley Rosenberg
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | | | - Trevor Reichman
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Amit Sharma
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Adrian Cotterell
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Brian Strife
- Departments of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Aamir A Khan
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Vinay Kumaran
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - David A Bruno
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Marlon F Levy
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Chandra Shekhar Bhati
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
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Al-Kawas F, Aslanian H, Baillie J, Banovac F, Buscaglia JM, Buxbaum J, Chak A, Chong B, Coté GA, Draganov PV, Dua K, Durkalski V, Elmunzer BJ, Foster LD, Gardner TB, Geller BS, Jamidar P, Jamil LH, Keswani RN, Khashab MA, Lang GD, Law R, Lichtenstein D, Lo SK, McCarthy S, Melo S, Mullady D, Nieto J, Bayne Selby J, Singh VK, Spitzer RL, Strife B, Tarnaksy P, Taylor JR, Tokar J, Wang AY, Williams A, Willingham F, Yachimski P. Percutaneous transhepatic vs. endoscopic retrograde biliary drainage for suspected malignant hilar obstruction: study protocol for a randomized controlled trial. Trials 2018; 19:108. [PMID: 29444707 PMCID: PMC5813390 DOI: 10.1186/s13063-018-2473-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 07/08/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
Background The optimal approach to the drainage of malignant obstruction at the liver hilum remains uncertain. We aim to compare percutaneous transhepatic biliary drainage (PTBD) to endoscopic retrograde cholangiography (ERC) as the first intervention in patients with cholestasis due to suspected malignant hilar obstruction (MHO). Methods The INTERCPT trial is a multi-center, comparative effectiveness, randomized, superiority trial of PTBD vs. ERC for decompression of suspected MHO. One hundred and eighty-four eligible patients across medical centers in the United States, who provide informed consent, will be randomly assigned in 1:1 fashion via a web-based electronic randomization system to either ERC or PTBD as the initial drainage and, if indicated, diagnostic procedure. All subsequent clinical interventions, including crossover to the alternative procedure, will be dictated by treating physicians per usual clinical care. Enrolled subjects will be assessed for successful biliary drainage (primary outcome measure), adequate tissue diagnosis, adverse events, the need for additional procedures, hospitalizations, and oncological outcomes over a 6-month follow-up period. Subjects, treating clinicians and outcome assessors will not be blinded. Discussion The INTERCPT trial is designed to determine whether PTBD or ERC is the better initial approach when managing a patient with suspected MHO, a common clinical dilemma that has never been investigated in a randomized trial. Trial registration ClinicalTrials.gov, Identifier: NCT03172832. Registered on 1 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2473-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Firas Al-Kawas
- Division of Gastroenterology, Johns Hopkins Sibley Memorial Hospital, Washington, DC, USA
| | - Harry Aslanian
- Division of Gastroenterology, Yale University, New Haven, CT, USA
| | - John Baillie
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA
| | - Filip Banovac
- Division of Interventional Radiology, Vanderbilt University, Nashville, TN, USA
| | | | - James Buxbaum
- Division of Gastroenterology, University of Southern California, Los Angeles, CA, USA
| | - Amitabh Chak
- Division of Gastroenterology, Case Western Reserve University, Cleveland, OH, USA
| | - Bradford Chong
- Division of Gastroenterology, University of Southern California, Los Angeles, CA, USA
| | - Gregory A Coté
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | - Kulwinder Dua
- Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Valerie Durkalski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA.
| | - Lydia D Foster
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy B Gardner
- Division of Gastroenterology, Dartmouth University, Lebanon, NH, USA
| | - Brian S Geller
- Division of Interventional Radiology, University of Florida, Gainesville, FL, USA
| | - Priya Jamidar
- Division of Gastroenterology, Yale University, New Haven, CT, USA
| | - Laith H Jamil
- Division of Gastroenterology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Northwestern University, Chicago, IL, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Gabriel D Lang
- Division of Gastroenterology, Washington University, St. Louis, MO, USA
| | - Ryan Law
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | | | - Simon K Lo
- Division of Gastroenterology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sean McCarthy
- Division of Gastroenterology, Ohio State University, Columbus, OH, USA
| | - Silvio Melo
- Division of Gastroenterology, University of Florida-Jacksonville, Jacksonville, FL, USA
| | - Daniel Mullady
- Division of Gastroenterology, Washington University, St. Louis, MO, USA
| | - Jose Nieto
- The Borland-Groover Clinic, Jacksonville, FL, USA
| | - J Bayne Selby
- Division of Interventional Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Rebecca L Spitzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Brian Strife
- Division of Interventional Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul Tarnaksy
- Division of Gastroenterology, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Jason R Taylor
- Division of Gastroenterology, Saint Louis University, St. Louis, MO, USA
| | - Jeffrey Tokar
- Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andrew Y Wang
- Division of Gastroenterology, University of Virginia, Charlottesville, VA, USA
| | - April Williams
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Field Willingham
- Division of Gastroenterology, Emory University, Atlanta, GA, USA
| | - Patrick Yachimski
- Division of Gastroenterology, Vanderbilt University, Nashville, TN, USA
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Sydnor M, Mavropoulos J, Slobodnik N, Wolfe L, Strife B, Komorowski D. A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein. Phlebology 2016; 32:415-424. [PMID: 27422781 DOI: 10.1177/0268355516658592] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.
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Affiliation(s)
- Malcolm Sydnor
- 1 Section of Interventional Radiology, Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - John Mavropoulos
- 2 Department of Dermatology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Natalia Slobodnik
- 1 Section of Interventional Radiology, Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Luke Wolfe
- 3 Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Brian Strife
- 1 Section of Interventional Radiology, Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Daniel Komorowski
- 1 Section of Interventional Radiology, Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
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