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Mol BM, Verwer MC, Fijnheer R, Florie J, Groot OA, Hietbrink F, Nijkeuter M, Vonken EJPA, van Weel V, de Kleijn DPV, de Borst GJ. Predictors of bleeding complications during catHeter-dirEcted thrombolysis for peripheral arterial occlusions (POCHET). PLoS One 2024; 19:e0302830. [PMID: 38722842 PMCID: PMC11081216 DOI: 10.1371/journal.pone.0302830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/13/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION The risk of major bleeding complications in catheter directed thrombolysis (CDT) for acute limb ischemia (ALI) remains high, with reported major bleeding complication rates in up to 1 in every 10 treated patients. Fibrinogen was the only predictive marker used for bleeding complications in CDT, despite the lack of high quality evidence to support this. Therefore, recent international guidelines recommend against the use of fibrinogen during CDT. However, no alternative biomarkers exist to effectively predict CDT-related bleeding complications. The aim of the POCHET biobank is to prospectively assess the rate and etiology of bleeding complications during CDT and to provide a biobank of blood samples to investigate potential novel biomarkers to predict bleeding complications during CDT. METHODS The POCHET biobank is a multicentre prospective biobank. After informed consent, all consecutive patients with lower extremity ALI eligible for CDT are included. All patients are treated according to a predefined standard operating procedure which is aligned in all participating centres. Baseline and follow-up data are collected. Prior to CDT and subsequently every six hours, venous blood samples are obtained and stored in the biobank for future analyses. The primary outcome is the occurrence of non-access related major bleeding complications, which is assessed by an independent adjudication committee. Secondary outcomes are non-major bleeding complications and other CDT related complications. Proposed biomarkers to be investigated include fibrinogen, to end the debate on its usefulness, anti-plasmin and D-Dimer. DISCUSSION AND CONCLUSION The POCHET biobank provides contemporary data and outcomes of patients during CDT for ALI, coupled with their blood samples taken prior and during CDT. Thereby, the POCHET biobank is a real world monitor on biomarkers during CDT, supporting a broad spectrum of future research for the identification of patients at high risk for bleeding complications during CDT and to identify new biomarkers to enhance safety in CDT treatment.
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Affiliation(s)
- Barend M. Mol
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten C. Verwer
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rob Fijnheer
- Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands
| | - Jasper Florie
- Department of Interventional Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Oscar A. Groot
- Intensive Care Department, Meander Medical Center, Amersfoort, The Netherlands
| | - Falco Hietbrink
- Department Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathilde Nijkeuter
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evert-Jan P. A. Vonken
- Department of Interventional Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vincent van Weel
- Department of Vascular Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | | | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Smits MLJ, Bruijnen RCG, Tetteroo P, Vonken EJPA, Meijerink MR, Hagendoorn J, de Bruijne J, Prevoo W. Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation. Cardiovasc Intervent Radiol 2023; 46:1365-1374. [PMID: 37704863 PMCID: PMC10547639 DOI: 10.1007/s00270-023-03545-4] [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: 04/23/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE We present a technique that combines Hepatic Arteriography with C-arm CT-Guided Ablation (HepACAGA) to improve tumor visualization, navigation and margin confirmation for percutaneous ablation of liver tumors. MATERIALS AND METHODS All consecutive patients scheduled for HepACAGA between April 20th, 2021, and November 2nd, 2021, were included in this retrospective, cohort study. HepACAGA was performed in an angiography-suite under general anesthesia. The hepatic artery was catheterized for selective contrast injection. C-arm CT and guidance software were then used to visualize the tumor and the microwave antenna was inserted during apnea. Pre- and post-ablation C-arm CTs were performed and ablation margins assessed. Technical success, antenna placement deviation, number of repositions, tumor recurrence, and safety were evaluated. Technical success was defined as a tumor that was ablated according to the HepACAGA technique. RESULTS A total of 21 patients (28 tumors) were included. The main tumor type was colorectal cancer liver metastases (11/21, 52%), followed by hepatocellular carcinoma (7/21, 33%), neuroendocrine tumor metastases (1/21, 5%), and other tumor types (2/21, 10%). The technical success rate was 93% (26/28 tumors) with two small hypovascular lesions unable to be identified. A single microwave antenna was used in all patients. The median antenna placement deviation was 1 mm (range 0-6 mm). At a median follow-up time of 16 months (range 5-22 months), there was no tumor recurrence in any patient. Safety analysis showed a complication rate of 5% grade 2 and 5% grade 3. CONCLUSION HepACAGA was demonstrated to be a safe and effective percutaneous ablation technique, without any local tumor recurrence in this study.
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Affiliation(s)
- Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Rutger C G Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Philip Tetteroo
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joep de Bruijne
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Warner Prevoo
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Didden P, Bruijnen RCG, Vonken EJPA, Vleggaar FP. Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl. Endoscopy 2023; 55:484-485. [PMID: 37105159 PMCID: PMC10139763 DOI: 10.1055/a-2017-9651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/29/2023]
Affiliation(s)
- Paul Didden
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
| | - Rutger C G Bruijnen
- University Medical Center Utrecht, Department of Radiology, Utrecht, Netherlands
| | - Evert-Jan P A Vonken
- University Medical Center Utrecht, Department of Radiology, Utrecht, Netherlands
| | - Frank P Vleggaar
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
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Deckers PT, Kronenburg A, van den Berg E, van Schooneveld MM, Vonken EJPA, Otte WM, van Berckel BNM, Yaqub M, Klijn CJM, van der Zwan A, Braun KPJ. Clinical Outcome, Cognition, and Cerebrovascular Reactivity after Surgical Treatment for Moyamoya Vasculopathy: A Dutch Prospective, Single-Center Cohort Study. J Clin Med 2022; 11:jcm11247427. [PMID: 36556043 PMCID: PMC9786028 DOI: 10.3390/jcm11247427] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background: It remains unclear whether revascularization of moyamoya vasculopathy (MMV) has a positive effect on cognitive function. In this prospective, single-center study, we investigated the effect of revascularization on cognitive function in patients with MMV. We report clinical and radiological outcome parameters and the associations between clinical determinants and change in neurocognitive functioning. Methods: We consecutively included all MMV patients at a Dutch tertiary referral hospital who underwent pre- and postoperative standardized neuropsychological evaluation, [15O]H2O-PET (including cerebrovascular reactivity (CVR)), MRI, cerebral angiography, and completed standardized questionnaires on clinical outcome and quality of life (QOL). To explore the association between patient characteristics, imaging findings, and change in the z-scores of the cognitive domains, we used multivariable linear- and Bayesian regression analysis. Results: We included 40 patients of whom 35 (27 females, 21 children) were treated surgically. One patient died after surgery, and two withdrew from the study. TIA- and headache frequency and modified Rankin scale (mRS) improved (resp. p = 0.001, 0.019, 0.039). Eleven patients (seven children) developed a new infarct during follow-up (31%), five of which were symptomatic. CVR-scores improved significantly (p < 0.0005). The language domain improved (p = 0.029); other domains remained stable. In adults, there was an improvement in QOL. We could not find an association between change in imaging and cognitive scores. Conclusion: In this cohort of Western MMV patients, TIA frequency, headache, CVR, and mRS improved significantly after revascularization. The language domain significantly improved, while others remained stable. We could not find an association between changes in CVR and cognitive scores.
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Affiliation(s)
- Pieter Thomas Deckers
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
- Department of Radiology and Nuclear Medicine, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands
- Correspondence:
| | - Annick Kronenburg
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | | | | | - Willem M. Otte
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
| | - Bart N. M. van Berckel
- Department of Nuclear Medicine & PET Research, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Nuclear Medicine & PET Research, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Catharina J. M. Klijn
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Center for Neuroscience, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Albert van der Zwan
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
| | - Kees P. J. Braun
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, 3584 CG Utrecht, The Netherlands
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Didden P, Bruijnen RCG, Vonken EJPA, Vleggaar FP. Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl. Endoscopy 2022; 55:E268-E269. [PMID: 36427496 PMCID: PMC9831773 DOI: 10.1055/a-1974-9202] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Paul Didden
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
| | | | | | - Frank P. Vleggaar
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
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de Vries JC, van Gelder MK, Monninkhof AS, Ahmed S, Hazenbrink DHM, Nguyen TQ, de Kort GAP, Vonken EJPA, Vaessen KRD, Joles JA, Verhaar MC, Gerritsen KGF. A Uremic Pig Model for Peritoneal Dialysis. Toxins (Basel) 2022; 14:toxins14090635. [PMID: 36136573 PMCID: PMC9503030 DOI: 10.3390/toxins14090635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
With increasing interest in home dialysis, there is a need for a translational uremic large animal model to evaluate technical innovations in peritoneal dialysis (PD). To this end, we developed a porcine model with kidney failure. Stable chronic kidney injury was induced by bilateral subtotal renal artery embolization. Before applying PD, temporary aggravation of uremia was induced by administration of gentamicin (10 mg/kg i.v. twice daily for 7 days), to obtain uremic solute levels within the range of those of dialysis patients. Peritoneal transport was assessed using a standard peritoneal permeability assessment (SPA). After embolization, urea and creatinine concentrations transiently increased from 1.6 ± 0.3 to 7.5 ± 1.2 mM and from 103 ± 14 to 338 ± 67 µM, respectively, followed by stabilization within 1–2 weeks to 2.5 ± 1.1 mM and 174 ± 28 µM, respectively. Gentamicin induced temporary acute-on-chronic kidney injury with peak urea and creatinine concentrations of 16.7 ± 5.3 mM and 932 ± 470 µM respectively. PD was successfully applied, although frequently complicated by peritonitis. SPA showed a low transport status (D/P creatinine at 4 h of 0.41 (0.36–0.53)) with a mass transfer area coefficient of 9.6 ± 3.1, 4.6 ± 2.6, 3.4 ± 2.3 mL/min for urea, creatinine, and phosphate respectively. In conclusion, this porcine model with on-demand aggravation of uremia is suitable for PD albeit with peritoneal transport characterized by a low transport status.
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Affiliation(s)
- Joost C. de Vries
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Maaike K. van Gelder
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Anneke S. Monninkhof
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Sabbir Ahmed
- Department of Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Diënty H. M. Hazenbrink
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Tri Q. Nguyen
- Department of Pathology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Gèrard A. P. de Kort
- Department of Radiology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Evert-Jan P. A. Vonken
- Department of Radiology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Koen R. D. Vaessen
- Central Laboratory Animal Research Facility, Utrecht University, 3584 CJ Utrecht, The Netherlands
| | - Jaap A. Joles
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Karin G. F. Gerritsen
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-88-755-7329
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Lena B, Florkow MC, Ferrer CJ, van Stralen M, Seevinck PR, Vonken EJPA, Boomsma MF, Slotman DJ, Viergever MA, Moonen CTW, Bos C, Bartels LW. Synthetic CT for the planning of MR-HIFU treatment of bone metastases in pelvic and femoral bones: a feasibility study. Eur Radiol 2022; 32:4537-4546. [PMID: 35190891 PMCID: PMC9213310 DOI: 10.1007/s00330-022-08568-y] [Citation(s) in RCA: 1] [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: 11/18/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
Objectives Visualization of the bone distribution is an important prerequisite for MRI-guided high-intensity focused ultrasound (MRI-HIFU) treatment planning of bone metastases. In this context, we evaluated MRI-based synthetic CT (sCT) imaging for the visualization of cortical bone. Methods MR and CT images of nine patients with pelvic and femoral metastases were retrospectively analyzed in this study. The metastatic lesions were osteolytic, osteoblastic or mixed. sCT were generated from pre-treatment or treatment MR images using a UNet-like neural network. sCT was qualitatively and quantitatively compared to CT in the bone (pelvis or femur) containing the metastasis and in a region of interest placed on the metastasis itself, through mean absolute difference (MAD), mean difference (MD), Dice similarity coefficient (DSC), and root mean square surface distance (RMSD). Results The dataset consisted of 3 osteolytic, 4 osteoblastic and 2 mixed metastases. For most patients, the general morphology of the bone was well represented in the sCT images and osteolytic, osteoblastic and mixed lesions could be discriminated. Despite an average timespan between MR and CT acquisitions of 61 days, in bone, the average (± standard deviation) MAD was 116 ± 26 HU, MD − 14 ± 66 HU, DSC 0.85 ± 0.05, and RMSD 2.05 ± 0.48 mm and, in the lesion, MAD was 132 ± 62 HU, MD − 31 ± 106 HU, DSC 0.75 ± 0.2, and RMSD 2.73 ± 2.28 mm. Conclusions Synthetic CT images adequately depicted the cancellous and cortical bone distribution in the different lesion types, which shows its potential for MRI-HIFU treatment planning. Key Points • Synthetic computed tomography was able to depict bone distribution in metastatic lesions. • Synthetic computed tomography images intrinsically aligned with treatment MR images may have the potential to facilitate MR-HIFU treatment planning of bone metastases, by combining visualization of soft tissues and cancellous and cortical bone. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08568-y.
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Affiliation(s)
- Beatrice Lena
- Image Sciences Institute, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Q.02.4.45, 3584, CX, Utrecht, The Netherlands.
| | - Mateusz C Florkow
- Image Sciences Institute, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Q.02.4.45, 3584, CX, Utrecht, The Netherlands.
| | - Cyril J Ferrer
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan, 100 3584, CX, Utrecht, The Netherlands
| | - Marijn van Stralen
- Image Sciences Institute, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Q.02.4.45, 3584, CX, Utrecht, The Netherlands.,MRIguidance BV, Gildstraat 91-A, 3572, EL, Utrecht, The Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Q.02.4.45, 3584, CX, Utrecht, The Netherlands.,MRIguidance BV, Gildstraat 91-A, 3572, EL, Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- Division of Imaging and Oncology, Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan, 100 3584, CX, Utrecht, The Netherlands
| | - Martijn F Boomsma
- Department of Radiology, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands
| | - Derk J Slotman
- Department of Radiology, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Q.02.4.45, 3584, CX, Utrecht, The Netherlands
| | - Chrit T W Moonen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan, 100 3584, CX, Utrecht, The Netherlands
| | - Clemens Bos
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan, 100 3584, CX, Utrecht, The Netherlands
| | - Lambertus W Bartels
- Image Sciences Institute, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Q.02.4.45, 3584, CX, Utrecht, The Netherlands
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Wijnand JGJ, Zarkowsky D, Wu B, van Haelst STW, Vonken EJPA, Sorrentino TA, Pallister Z, Chung J, Mills JL, Teraa M, Verhaar MC, de Borst GJ, Conte MS. The Global Limb Anatomic Staging System (GLASS) for CLTI: Improving Inter-Observer Agreement. J Clin Med 2021; 10:jcm10163454. [PMID: 34441757 PMCID: PMC8396876 DOI: 10.3390/jcm10163454] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The 2020 Global Vascular Guidelines aim at improving decision making in Chronic Limb-Threatening Ischemia (CLTI) by providing a framework for evidence-based revascularization. Herein, the Global Limb Anatomic Staging System (GLASS) serves to estimate the chance of success and patency of arterial pathway revascularization based on the extent and distribution of the atherosclerotic lesions. We report the preliminary feasibility results and observer variability of the GLASS. GLASS is a part of the new global guideline and posed as a promising additional tool for EBR strategies to predict the success of lower extremity arterial revascularization. This study reports on the consistency of GLASS scoring to maximize inter-observer agreement and facilitate its application. Methods: GLASS separately scores the femoropopliteal (FP) and infrapopliteal (IP) segment based on stenosis severity, lesion length and the extent of calcification within the target artery pathway (TAP). In our stepwise approach, we used two angiographic datasets. Each following step was based on the lessons learned from the previous step. The primary outcome was inter-observer agreement measured as Cohen’s Kappa, scored by two (step 1 + 2) and four (step 3) blinded and experienced observers, respectively. Steps 1 (n = 139) and 2 (n = 50) were executed within a dataset of a Dutch interventional RCT in CLTI. Step 3 (n = 100) was performed in randomly selected all-comer CLTI patients from two vascular centers in the United States. Results: In step 1, kappa values were 0.346 (FP) and 0.180 (IP). In step 2, applied in the same dataset, the use of other experienced observers and a provided TAP, resulted in similar low kappa values 0.406 (FP) and 0.089 (IP). Subsequently, in step 3, the formation of an altered stepwise approach using component scoring, such as separate scoring of calcification and adding a ruler to the images resulted in kappa values increasing to 0.796 (FP) and 0.730 (IP). Conclusion: This retrospective GLASS validation study revealed low inter-observer agreement for unconditioned scoring. A stepwise component scoring provides acceptable agreement and a solid base for further prospective validation studies to investigate how GLASS relates to treatment outcomes.
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Affiliation(s)
- Joep G. J. Wijnand
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.T.W.v.H.); (M.T.); (G.J.d.B.)
- Correspondence: ; Tel.: +1-415-353-4366
| | - Devin Zarkowsky
- Department of Vascular Surgery, UCSF Medical Center, San Francisco, CA 94143, USA; (D.Z.); (B.W.); (T.A.S.); (M.S.C.)
| | - Bian Wu
- Department of Vascular Surgery, UCSF Medical Center, San Francisco, CA 94143, USA; (D.Z.); (B.W.); (T.A.S.); (M.S.C.)
| | - Steven T. W. van Haelst
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.T.W.v.H.); (M.T.); (G.J.d.B.)
| | - Evert-Jan P. A. Vonken
- Department of Radiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Thomas A. Sorrentino
- Department of Vascular Surgery, UCSF Medical Center, San Francisco, CA 94143, USA; (D.Z.); (B.W.); (T.A.S.); (M.S.C.)
| | - Zachary Pallister
- Department of Vascular Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (Z.P.); (J.C.); (J.L.M.)
| | - Jayer Chung
- Department of Vascular Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (Z.P.); (J.C.); (J.L.M.)
| | - Joseph L. Mills
- Department of Vascular Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (Z.P.); (J.C.); (J.L.M.)
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.T.W.v.H.); (M.T.); (G.J.d.B.)
| | - Marianne C. Verhaar
- Department of Nephrology & Hypertension, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.T.W.v.H.); (M.T.); (G.J.d.B.)
| | - Michael S. Conte
- Department of Vascular Surgery, UCSF Medical Center, San Francisco, CA 94143, USA; (D.Z.); (B.W.); (T.A.S.); (M.S.C.)
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Vonken EJPA, Bruijnen RCG, Snijders TJ, Seute T, Lam MGEH, de Keizer B, Braat AJAT. Intra-arterial administration boosts 177Lu-HA-DOTATATE accumulation in salvage meningioma patients. J Nucl Med 2021; 63:406-409. [PMID: 34301783 DOI: 10.2967/jnumed.121.262491] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/25/2021] [Revised: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION: Intravenous 177Lu-(HA-)DOTATATE has shown promising results for the treatment of surgery- and radiotherapy-refractory meningiomas. We aimed to investigate the added value of intra-arterial administration. METHODS: Patients underwent at least one intravenous 177Lu-HA-DOTATATE treatment first and subsequent intra-arterial cycles. In(tra)-patient comparison was based on post-treatment 177Lu-HA-DOTATATE imaging 24 hours post-injection. Technical success rates and adverse events were recorded. RESULTS: Four patients provided informed consent. Technical success rate was 100% and no angiography related or unexpected adverse events occurred. Intra-patient comparison showed an increased target lesion accumulation on both planar imaging (mean +220%) and SPECT/CT (mean +398%) after intra-arterial administration compared to intravenous. No unexpected adverse events during follow-up occurred. CONCLUSION: Intra-arterial PRRT significantly increases tracer accumulation, and is a safe and promising improvement for salvage meningioma patients. Future prospective studies on intra-arterial PRRT are needed to determine gain on efficacy and survival.
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Smits MLJ, Tetteroo PM, Vonken EJPA, Reinders MTM, Monkelbaan JF. [Radiologically inserted gastrostomy]. Ned Tijdschr Geneeskd 2020; 164:D5050. [PMID: 33651493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Radiologically inserted gastrostomy (RIG) is an alternative to percutaneous endoscopic gastrostomy (PEG) for patients with eating difficulties who need long-term enteral nutrition. This articles provides an overview of the technique of RIG as well as an analysis of the results of RIG at our institute over the last five years and a discussion of the literature. The number of centres in the Netherlands offering RIG is growing and therefore we want to raise awareness amongst colleagues who are not familiar with this alternative to PEG.
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Affiliation(s)
- Maarten L J Smits
- UMC Utrecht, afd. Radiologie en Nucleaire geneeskunde,Utrecht
- Contact: Maarten L.J. Smits
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11
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van Herwaarden JA, Jansen MM, Vonken EJPA, Bloemert-Tuin T, Bullens RWM, de Borst GJ, Hazenberg CEVB. First in Human Clinical Feasibility Study of Endovascular Navigation with Fiber Optic RealShape (FORS) Technology. Eur J Vasc Endovasc Surg 2020; 61:317-325. [PMID: 33262088 DOI: 10.1016/j.ejvs.2020.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 04/22/2020] [Revised: 09/15/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Endovascular procedures are conventionally conducted using two dimensional fluoroscopy. A new technology platform, Fiber Optic RealShape (FORS), has recently been introduced allowing real time, three dimensional visualisation of endovascular devices using fiberoptic technology. It functions as an add on to conventional fluoroscopy and may facilitate endovascular procedures. This first in human study assessed the feasibility of FORS in clinical practice. METHODS A prospective cohort feasibility study was performed between July and December 2018. Patients undergoing (regular or complex) endovascular aortic repair (EVAR) or endovascular peripheral lesion repair (EVPLR) were recruited. FORS guidance was used exclusively during navigational tasks such as target vessel catheterisation or crossing of stenotic lesions. Three types of FORS enabled devices were available: a flexible guidewire, a Cobra-2 catheter, and a Berenstein catheter. Devices were chosen at the physician's discretion and could comprise any combination of FORS and non-FORS devices. The primary study endpoint was technical success of the navigational tasks using FORS enabled devices. Secondary study endpoints were user experience and fluoroscopy time. RESULTS The study enrolled 22 patients: 14 EVAR and eight EVPLR patients. Owing to a technical issue during start up, the FORS system could not be used in one EVAR. The remaining 21 procedures proceeded without device or technology related complications and involved 66 navigational tasks. In 60 tasks (90.9%), technical success was achieved using at least one FORS enabled device. Users rated FORS based image guidance "better than standard guidance" in 16 of 21 and "equal to standard guidance" in five of 21 procedures. Fluoroscopy time ranged from 0.0 to 52.2 min. Several tasks were completed without or with only minimal X-ray use. CONCLUSION Real time navigation using FORS technology is safe and feasible in abdominal and peripheral endovascular procedures. FORS has the potential to improve intra-operative image guidance. Comparative studies are needed to assess these benefits and potential radiation reduction.
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Affiliation(s)
- Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marloes M Jansen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Trijntje Bloemert-Tuin
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Leenstra BS, van Ginkel DJ, Hazenberg CEVB, Vonken EJPA, de Borst GJ. Heterogeneity in Standard Operating Procedures for Catheter Directed Thrombolysis for Peripheral Arterial Occlusions in The Netherlands: A Nationwide Overview. Eur J Vasc Endovasc Surg 2019; 58:564-569. [PMID: 31383585 DOI: 10.1016/j.ejvs.2019.02.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 02/26/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Catheter directed thrombolysis (CDT) for acute arterial occlusions of the lower extremities is associated with a risk of major bleeding complications. Strict monitoring of vital functions is advised for timely adjustment or discontinuation of thrombolytic treatment. Nevertheless, current evidence on the optimal application of CDT and use of monitoring during CDT is limited. In this study the different standard operating procedures (SOPs) for CDT in Dutch hospitals were compared against a national guideline in a nationwide analysis. METHODS SOPs, landmark studies, and national and international guidelines for CDT for acute lower extremity arterial occlusions were compared. The protocols of 34 Dutch medical centres where CDT is performed were assessed. Parameters included contraindications to CDT, co-administration of heparin, thrombolytic agent administration, angiographic control, and patient monitoring. RESULTS Thirty-four SOPs were included, covering 94% of medical centres performing CDT in the Netherlands. None of the SOPs had identical contraindications and a strong divergence in relative and absolute grading was found. Heparin and urokinase dosages differed by a factor of five. In 18% of the SOPs heparin co-administration was not mentioned. Angiographic control varied between once every 6 h to once every 24 h. In 76% of the SOPs plasma fibrinogen levels were used for CDT dose adjustments. However, plasma fibrinogen level threshold values for treatment adjustments varied between 2.0 g/L and 0.5 g/L. CONCLUSION The SOPs for CDT for acute arterial occlusions of the lower extremities differ greatly on five major operating aspects among medical centres in the Netherlands. None of the SOPs exactly conforms to current national or international guidelines. This study provides direction on how to increase homogeneity in guideline recommendations and to improve guideline adherence in CDT.
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Affiliation(s)
- Bernard S Leenstra
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Dirk-Jan van Ginkel
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
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13
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Prins FM, Stemkens B, Kerkmeijer LGW, Barendrecht MM, de Boer HJ, Vonken EJPA, Lagendijk JJW, Tijssen RHN. Intrafraction Motion Management of Renal Cell Carcinoma With Magnetic Resonance Imaging-Guided Stereotactic Body Radiation Therapy. Pract Radiat Oncol 2018; 9:e55-e61. [PMID: 30261329 DOI: 10.1016/j.prro.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/26/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE One of the major challenges in stereotactic body radiation therapy (SBRT) of renal cell carcinoma is internal motion during treatment. Previous literature has aimed to mitigate the effects of motion by expanding the treatment margins or respiratory tracking. Online magnetic resonance imaging (MRI)-guided radiation therapy has the potential to further improve the treatment of renal cell carcinoma by direct visualization of the tumor during treatment. The efficacy of 2 motion management techniques were assessed: tumor trailing and respiratory tracking. The simulation of a single-fraction, MRI-based SBRT was performed to quantify intrafraction motion and assess the efficacy of the different motion management strategies. METHODS AND MATERIALS Fifteen patients were included in the study. At the beginning and end of the scanning protocol, 2 cine-MRI scans were acquired to assess cyclic respiratory motion. In addition, 3-dimensional spoiled gradient echo scans were acquired at 4 different time points to assess the slow drifts over 25 minutes. The systematic and random errors owing to intrafraction drift were calculated, as well as the random error induced by respiratory motion. The motion margins were calculated for tumor trailing and respiratory tracking and compared with the margin when no motion compensation would be performed to assess the relative efficacy of each technique. RESULTS The largest respiratory tumor motion was observed along the caudo-cranial direction with a median 95% maximum amplitude of approximately 12 mm. ΣDRIFT, σDRIFT, and σRESP were determined to be 1.0 mm 1.8 mm, and 3.8 mm, respectively. Without mechanical immobilization, intrafraction drift accounted for 75% of the total intrafraction motion margin for online midposition-based SBRT treatments. CONCLUSIONS The contribution of intrafraction drift to the total internal motion margin is much larger than periodic respiratory motion. This makes tumor trailing a viable option to consider on the MRI linac because it allows for 3-dimensional MRI acquisitions during beam delivery, which simplifies the introduction of new techniques, such as dose accumulation and online intrafraction replanning.
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Affiliation(s)
- Fieke M Prins
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Bjorn Stemkens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Hans J de Boer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan J W Lagendijk
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob H N Tijssen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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14
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Prins FM, Kerkmeijer LGW, Pronk AA, Vonken EJPA, Meijer RP, Bex A, Barendrecht MM. Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review. J Endourol 2017; 31:963-975. [PMID: 28741377 DOI: 10.1089/end.2017.0382] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 12/13/2022] Open
Abstract
BACKGROUND The standard treatment of T1 renal cell carcinoma (RCC) is (partial) nephrectomy. For patients where surgery is not the treatment of choice, for example in the elderly, in case of severe comorbidity, inoperability, or refusal of surgery, alternative treatment options are available. These treatment options include active surveillance (AS), radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), or stereotactic body radiotherapy (SBRT). In the present overview, the efficacy, safety, and outcome of these different options are summarized, particularly focusing on recent developments. MATERIALS AND METHODS Databases of MEDLINE (through PubMed), EMBASE, and the Cochrane Library were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was performed in December 2016, and included a search period from 2010 to 2016. The terms and synonyms used were renal cell carcinoma, active surveillance, radiofrequency ablation, microwave ablation, cryoablation and stereotactic body radiotherapy. RESULTS The database search identified 2806 records, in total 73 articles were included to assess the rationale and clinical evidence of alternative treatment modalities for small renal masses. The methodological quality of the included articles varied between level 2b and level 4. CONCLUSION Alternative treatment modalities, such as AS, RFA, CA, MWA, and SBRT, are treatment options especially for those patients who are unfit to undergo an invasive treatment. There are no randomized controlled trials available comparing surgery and less invasive modalities, leading to a low quality on the reported articles. A case-controlled registry might be an alternative to compare outcomes of noninvasive treatment modalities in the future.
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Affiliation(s)
- Fieke M Prins
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Linda G W Kerkmeijer
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Anne A Pronk
- 2 Department of Urology, Tergooi Hospital , Hilversum, The Netherlands
| | - Evert-Jan P A Vonken
- 3 Department of Radiology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Richard P Meijer
- 4 Department of Urology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Axel Bex
- 5 Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands
| | - Maurits M Barendrecht
- 6 Department of Urology, Tergooi Hospital, Hilversum and University Medical Center Utrecht , Utrecht, The Netherlands
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15
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Spreen MI, Martens JM, Knippenberg B, van Dijk LC, de Vries JPPM, Vos JA, de Borst GJ, Vonken EJPA, Bijlstra OD, Wever JJ, Statius van Eps RG, Mali WPTM, van Overhagen H. Long-Term Follow-up of the PADI Trial: Percutaneous Transluminal Angioplasty Versus Drug-Eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia. J Am Heart Assoc 2017; 6:JAHA.116.004877. [PMID: 28411244 PMCID: PMC5533004 DOI: 10.1161/jaha.116.004877] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 12/17/2022]
Abstract
BACKGROUND Clinical outcomes reported after treatment of infrapopliteal lesions with drug-eluting stents (DESs) have been more favorable compared with percutaneous transluminal angioplasty with a bailout bare metal stent (PTA-BMS) through midterm follow-up in patients with critical limb ischemia. In the present study, long-term results of treatment of infrapopliteal lesions with DESs are presented. METHODS AND RESULTS Adults with critical limb ischemia (Rutherford category ≥4) and infrapopliteal lesions were randomized to receive PTA-BMS or DESs with paclitaxel. Long-term follow-up consisted of annual assessments up to 5 years after treatment or until a clinical end point was reached. Clinical end points were major amputation (above ankle level), infrapopliteal surgical or endovascular reintervention, and death. Preserved primary patency (≤50% restenosis) of treated lesions was an additional morphological end point, assessed by duplex sonography. In total, 74 limbs (73 patients) were treated with DESs and 66 limbs (64 patients) were treated with PTA-BMS. The estimated 5-year major amputation rate was lower in the DES arm (19.3% versus 34.0% for PTA-BMS; P=0.091). The 5-year rates of amputation- and event-free survival (survival free from major amputation or reintervention) were significantly higher in the DES arm compared with PTA-BMS (31.8% versus 20.4%, P=0.043; and 26.2% versus 15.3%, P=0.041, respectively). Survival rates were comparable. The limited available morphological results showed higher preserved patency rates after DESs than after PTA-BMS at 1, 3, and 4 years of follow-up. CONCLUSIONS Both clinical and morphological long-term results after treatment of infrapopliteal lesions in patients with critical limb ischemia are improved with DES compared with PTA-BMS. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00471289.
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Affiliation(s)
- Marlon I Spreen
- Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jasper M Martens
- Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Bob Knippenberg
- Department of Vascular Surgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - Lukas C van Dijk
- Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Jan Albert Vos
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Jan J Wever
- Department of Vascular Surgery, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Willem P Th M Mali
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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16
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Baas AF, Spiering W, Moll FL, Page-Christiaens L, Beenakkers ICM, Dooijes D, Vonken EJPA, van der Smagt JJ, Knoers NV, Koenen SV, van Herwaarden JA, Sieswerda GT. Six uneventful pregnancy outcomes in an extended vascular Ehlers-Danlos syndrome family. Am J Med Genet A 2017; 173:519-523. [PMID: 28102592 DOI: 10.1002/ajmg.a.38033] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/10/2016] [Indexed: 01/28/2023]
Abstract
Vascular Ehlers-Danlos Syndrome (vEDS) is caused by heterozygous mutations in COL3A1 and is characterized by fragile vasculature and hollow organs, with a high risk of catastrophic events at a young age. During pregnancy and delivery, maternal mortality rates up until 25% have been reported. However, recent pedigree analysis reported a substantial lower pregnancy-related mortality rate of 4.9%. Here, we describe an extended vEDS family with multiple uneventful pregnancy outcomes. In the proband, a 37-year-old woman, DNA-analysis because of an asymptomatic iliac artery dissection revealed a pathogenic mutation in COL3A1 (c.980G>A; p. Gly327Asp). She had had three uneventful vaginal deliveries. At the time of diagnosis, her 33-year-old niece was 25 weeks pregnant. She had had one uneventful vaginal delivery. Targeted DNA-analysis revealed that she was carrier of the COL3A1 mutation. Ultrasound detected an aneurysm in the abdominal aorta with likely a dissection. An uneventful elective cesarean section was performed at a gestational age of 37 weeks. The 40-year-old sister of our proband had had one uneventful vaginal delivery and an active pregnancy wish. Cascade DNA-screening showed her to carry the COL3A1 mutation. Computed Tomography Angiography (CTA) of her aorta revealed a type B dissection with the most proximal entry tear just below the superior mesenteric artery. Pregnancy was therefore discouraged. This familial case illustrates the complexity and challenges of reproductive decision-making in a potentially lethal condition as vEDS, and highlights the importance of a multidisciplinary approach. Moreover, it suggests that previous pregnancy-related risks of vEDS may be overestimated. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Annette F Baas
- Department of Medical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Frans L Moll
- Department Vascular Surgery, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Lieve Page-Christiaens
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Ingrid C M Beenakkers
- Department of Anesthesiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Dennis Dooijes
- Department of Medical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Jasper J van der Smagt
- Department of Medical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Nine V Knoers
- Department of Medical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Steven V Koenen
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Joost A van Herwaarden
- Department Vascular Surgery, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Gertjan Tj Sieswerda
- Department of Cardiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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17
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Spreen MI, Martens JM, Hansen BE, Knippenberg B, Verhey E, van Dijk LC, de Vries JPPM, Vos JA, de Borst GJ, Vonken EJPA, Wever JJ, Statius van Eps RG, Mali WPTM, van Overhagen H. Percutaneous Transluminal Angioplasty and Drug-Eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia (PADI) Trial. Circ Cardiovasc Interv 2016; 9:e002376. [PMID: 26861113 PMCID: PMC4753788 DOI: 10.1161/circinterventions.114.002376] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [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: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Endovascular infrapopliteal treatment of patients with critical limb ischemia using percutaneous transluminal angioplasty (PTA) and bail-out bare metal stenting (BMS) is hampered by restenosis. In interventional cardiology, drug-eluting stents (DES) have shown better patency rates and are standard practice nowadays. An investigator-initiated, multicenter, randomized trial was conducted to assess whether DES also improve patency and clinical outcome of infrapopliteal lesions. Methods and Results— Adults with critical limb ischemia (Rutherford category ≥4) and infrapopliteal lesions were randomized to receive PTA±BMS or DES with paclitaxel. Primary end point was 6-month primary binary patency of treated lesions, defined as ≤50% stenosis on computed tomographic angiography. Stenosis >50%, retreatment, major amputation, and critical limb ischemia–related death were regarded as treatment failure. Severity of failure was assessed with an ordinal score, ranging from vessel stenosis through occlusion to the clinical failures. Seventy-four limbs (73 patients) were treated with DES and 66 limbs (64 patients) received PTA±BMS. Six-month patency rates were 48.0% for DES and 35.1% for PTA±BMS (P=0.096) in the modified-intention-to-treat and 51.9% and 35.1% (P=0.037) in the per-protocol analysis. The ordinal score showed significantly worse treatment failure for PTA±BMS versus DES (P=0.041). The observed major amputation rate remained lower in the DES group until 2 years post-treatment, with a trend toward significance (P=0.066). Less minor amputations occurred after DES until 6 months post-treatment (P=0.03). Conclusions— In patients with critical limb ischemia caused by infrapopliteal lesions, DES provide better 6-month patency rates and less amputations after 6 and 12 months compared with PTA±BMS. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00471289.
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Affiliation(s)
- Marlon I Spreen
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jasper M Martens
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bettina E Hansen
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bob Knippenberg
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elke Verhey
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas C van Dijk
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jean-Paul P M de Vries
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan-Albert Vos
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert Jan de Borst
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan J Wever
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Randolph G Statius van Eps
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem P Th M Mali
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans van Overhagen
- From the Departments of Radiology (M.I.S., J.M.M., L.C.v.D., H.v.O.) and Vascular Surgery (B.K., J.J.W., R.G.S.v.E.), Haga Teaching Hospital, The Hague, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (B.E.H., E.V.); Departments of Vascular Surgery (J.-P.P.M.d.V.) and Radiology (J.-A.V.), Sint Antonius Hospital, Nieuwegein, The Netherlands; and Departments of Vascular Surgery (G.J.d.B.) and Radiology (E.-J.P.A.V., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, The Netherlands.
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van Breugel JMM, Nijenhuis RJ, Ries MG, Toorop RJ, Vonken EJPA, Wijlemans JW, van den Bosch MAAJ. Non-invasive magnetic resonance-guided high intensity focused ultrasound ablation of a vascular malformation in the lower extremity: a case report. J Ther Ultrasound 2015; 3:23. [PMID: 26719802 PMCID: PMC4696245 DOI: 10.1186/s40349-015-0042-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 09/21/2015] [Accepted: 12/10/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction Therapy of choice for symptomatic vascular malformations consists of surgery, sclerotherapy, or embolization. However, these techniques are invasive with possible complications and require hospitalization. We present a novel non-invasive technique, i.e., magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, for the treatment of a vascular malformation in a patient. This technique applies high-intensity sound waves transcutaneously to the body and is fully non-invasive. MRI guidance is the novel aspect of HIFU treatments and is used for exquisite delineation and localization of the lesion and accurate real-time temperature monitoring during tissue ablation. MR-HIFU is a well-established treatment option for uterine fibroids and is currently being investigated for, e.g., bone tumors, breast cancer, prostate cancer, and liver cancer. MR-HIFU of vascular malformations has not been a topic of research yet. Case description Volumetric MR-HIFU ablation of a vascular malformation in the lower extremity of an 18-year-old male patient was performed. Temperatures of 62–80 °C were reached in the target lesion with sonications of 4 × 4 × 8 mm using powers of 200 W for <20 s. At 1-month follow-up, the patient reported qualitatively sustained reduction of pain and normal motor function. Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume. After 13 months, pain score was reduced to <2 after extreme exertion for several hours and to 0 for daily activities. Discussion and evaluation Radiofrequency ablation and cryoablation are minimally invasive techniques that have been tried on low-flow vascular malformations with inconsistent results. Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization. Since MR-HIFU is truly non-invasive, these risks are negligible. Conclusions In conclusion, we reported a successful non-invasive treatment of a vascular malformation with MR-HIFU in a clinical patient including long-term follow-up data for the first time. The patient reported qualitatively sustained pain reduction up to 13 months post treatment.
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Affiliation(s)
| | - Robbert J Nijenhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mario G Ries
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Raechel J Toorop
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost W Wijlemans
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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de Jonge JC, Zandvoort HJA, Vonken EJPA, Moll FL, van Herwaarden JA. Through-Plane Movement at Multiple Aortic Levels on Dynamic Computed Tomography Angiography Is Limited in Patients With an Abdominal Aortic Aneurysm. J Endovasc Ther 2015; 22:765-9. [PMID: 26276554 DOI: 10.1177/1526602815601402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/15/2022]
Abstract
PURPOSE To analyze the movement of the aorta in the craniocaudal direction (through-plane movement) during the cardiac cycle at several levels to determine any potential impact on endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS For this study, 30 patients (median age 73.0 years; 27 men) with an infrarenal AAA were randomly selected from a prospectively maintained EVAR database. All patients had undergone preoperative electrocardiogram-gated computed tomography angiography consisting of 8 phases. After semiautomatic segmentation, a 3-dimensional location probe was placed in the center of the aorta (center point) on the orthogonal slices at 12 different levels along the aorta and iliac arteries for all 8 phases. Movement of the center point during the cardiac cycle was analyzed for each level. Values are given as the median and interquartile range (IQR). RESULTS The median through-plane movement of all levels was 3.0 mm (IQR 2.8-3.2) and appeared to be lower in the region of the celiac and renal arteries: 2.6 mm (IQR 1.7-3.1) at 3 cm proximal to the most distal renal artery and 2.4 mm (IQR 1.9-2.9) at 1 cm distal to the most distal renal artery, respectively. The thoracic part of the aorta showed the largest through-plane motion: 4.1 mm (IQR 2.7-4.6). CONCLUSION This study quantifies aortic through-plane motion in the craniocaudal direction. Since through-plane movement appears to be limited, findings of previous studies investigating pulsatile in-plane distension seem to be representative for aortic distension.
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Affiliation(s)
- Jeroen C de Jonge
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | - Herman J A Zandvoort
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | | | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
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20
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van den Hoven AF, Prince JF, de Keizer B, Vonken EJPA, Bruijnen RCG, Verkooijen HM, Lam MGEH, van den Bosch MAAJ. Use of C-Arm Cone Beam CT During Hepatic Radioembolization: Protocol Optimization for Extrahepatic Shunting and Parenchymal Enhancement. Cardiovasc Intervent Radiol 2015; 39:64-73. [PMID: 26067803 PMCID: PMC4689758 DOI: 10.1007/s00270-015-1146-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/31/2015] [Accepted: 05/02/2015] [Indexed: 12/17/2022]
Abstract
Purpose To optimize a C-arm computed tomography (CT) protocol for radioembolization (RE), specifically for extrahepatic shunting and parenchymal enhancement. Materials and Methods A prospective development study was performed per IDEAL recommendations. A literature-based protocol was applied in patients with unresectable and chemorefractory liver malignancies undergoing an angiography before radioembolization. Contrast and scan settings were adjusted stepwise and repeatedly reviewed in a consensus meeting. Afterwards, two independent raters analyzed all scans. A third rater evaluated the SPECT/CT scans as a reference standard for extrahepatic shunting and lack of target segment perfusion. Results Fifty scans were obtained in 29 procedures. The first protocol, using a 6 s delay and 10 s scan, showed insufficient parenchymal enhancement. In the second protocol, the delay was determined by timing parenchymal enhancement on DSA power injection (median 8 s, range 4–10 s): enhancement improved, but breathing artifacts increased (from 0 to 27 %). Since the third protocol with a 5 s scan decremented subjective image quality, the second protocol was deemed optimal. Median CNR (range) was 1.7 (0.6–3.2), 2.2 (−1.4–4.0), and 2.1 (−0.3–3.0) for protocol 1, 2, and 3 (p = 0.80). Delineation of perfused segments was possible in 57, 73, and 44 % of scans (p = 0.13). In all C-arm CTs combined, the negative predictive value was 95 % for extrahepatic shunting and 83 % for lack of target segment perfusion. Conclusion An optimized C-arm CT protocol was developed that can be used to detect extrahepatic shunts and non-perfusion of target segments during RE.
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Affiliation(s)
- Andor F van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Jip F Prince
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rutger C G Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Saleem BR, Berger P, Vaartjes I, de Keizer B, Vonken EJPA, Slart RHJA, de Borst GJ, Zeebregts CJ. Modest utility of quantitative measures in (18)F-fluorodeoxyglucose positron emission tomography scanning for the diagnosis of aortic prosthetic graft infection. J Vasc Surg 2014; 61:965-71. [PMID: 25498161 DOI: 10.1016/j.jvs.2014.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The clinical dilemma in suspected aortic graft infection (AGI) is how to noninvasively obtain a reliable proof of infection. In addition to confirming the presence of infection, obtaining information regarding the extent of infection to select a proper strategy for reoperation is also necessary. Therefore, developing a more reliable noninvasive physiologic approach to detect infected prostheses is required. (18)F-fluorodeoxyglucose positron emission tomography scanning ((18)F-FDG PET) has been suggested to have a pivotal role in the detection of AGI. In this study, we assessed the contribution of two (semi) quantitative parameters-maximal standardized uptake value (SUVmax) and tissue-to-background ratio (TBR)-and of two visual parameters-fluorodeoxyglucose (FDG) distribution patterns and visual grading scale-in the final confirmation of the diagnosis of AGI. METHODS Patients with a central aortic prosthetic graft and symptoms clinically suggestive of AGI were gathered from a prospectively maintained database. Included were those who underwent (18)F-FDG PET scanning combined with computed tomography angiography and in whom periprosthetic samples were taken at some stage in the diagnostic process. AGI was considered proven in case of a positive culture and compared with a group with negative cultures. Positive predictive values (PPVs) and negative predictive values (NPVs) were calculated. Receiver operating characteristics curves were used to assess the ability of SUVmax and TBR to identify the presence and absence of AGI (ie, accuracy). RESULTS In 37 of 77 patients with suspected AGI, (18)FDG-PET and perigraft material for culturing was obtained. The tissue culture was positive in 21 of these 37 patients (56.7%). Mean ± standard deviation SUVmax for proven infection was 8.1 ± 3.7 (range, 3.6-18.5) and TBR was 5.9 ± 2.7 (range, 1.7-13.0). The area under the curve for SUVmax was 0.78 (95% confidence interval, 0.63-0.93). A cutoff value of 8 yielded a PPV of 80% and a NPV of 54%. The area under the curve for TBR was 0.70 (95% confidence interval, 0.52-0.87). A cutoff value of 6 yielded a PPV of 73% and NPV of 52%. The PPVs for the visual grading scale and (18)F-FDG distribution patterns were 75% and 61%, respectively; the NPVs were 77% and 67%, respectively. CONCLUSIONS Our study, performed in a small sample of patients suspected of AGI, showed that the diagnostic abilities of quantitative and visual (18)F-FDG PET parameters are modest.
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Affiliation(s)
- Ben R Saleem
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul Berger
- Division of Vascular Surgery, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gert Jan de Borst
- Division of Vascular Surgery, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Prince JF, Smits MLJ, van Herwaarden JA, Arntz MJ, Vonken EJPA, van den Bosch MAAJ, de Borst GJ. Endovascular treatment of internal iliac artery stenosis in patients with buttock claudication. PLoS One 2013; 8:e73331. [PMID: 23951349 PMCID: PMC3738523 DOI: 10.1371/journal.pone.0073331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/23/2013] [Indexed: 11/19/2022] Open
Abstract
Aim To assess the technical feasibility and clinical outcome of percutaneous transluminal angioplasty (PTA) with and without stent placement for treatment of buttock claudication caused by internal iliac artery (IIA) stenosis. Methods Between September 2001 and July 2011, thirty-four patients with buttock claudication underwent endovascular treatment. After angiographic lesion evaluation PTA with or without stent placement was performed. Technical success was recorded. Clinical outcome post-treatment was assessed at three months post-intervention and was classified as: 1) complete relief of symptoms, 2) partial relief, or 3) no relief of symptoms. Complications during follow-up were recorded. Results Forty-four lesions in 34 symptomatic patients were treated with PTA. Eight lesions were treated with additional stent placement. Technical success was achieved in 40/44 lesions (91%). Three procedure-related minor complications occurred, i.e. asymptomatic conservatively treated intimal dissections. After a median of 2.9 months, patients experienced no relief of symptoms in 7/34 cases (21%), partial relief in 14/34 cases (41%), and complete relief in 13/34 cases (38%). Six patients required a reintervention during follow-up. Conclusion Endovascular treatment of IIA stenosis has a high technical success rate and a low complication rate. Complete or partial relief of symptoms is achieved in the majority (79%) of patients.
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Affiliation(s)
- Jip F. Prince
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten L. J. Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Mark J. Arntz
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
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de Heer LM, Budde RPJ, Vonken EJPA, Baaijens FPT, Gründeman PF, van Herwerden LA, Hoerstrup SP, Kluin J. Computed tomography detects tissue formation in a stented engineered heart valve. Ann Thorac Surg 2011; 92:344-5. [PMID: 21718873 DOI: 10.1016/j.athoracsur.2010.12.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/29/2010] [Revised: 12/21/2010] [Accepted: 12/27/2010] [Indexed: 11/25/2022]
Abstract
Tissue-engineered heart valves (TEHV) are being explored as an alternative to conventional heart valve prostheses. Using the classic tissue engineering paradigm, a stented tri-leaflet valve is fabricated. Subsequently, the construct is implanted into the pulmonary position in a sheep. Follow-up by means of computed tomography, magnetic resonance imaging, and echocardiography was used to assess tissue formation. After 4 weeks, the scaffold of the TEHV has degraded and new tissue is formed. However, small areas without tissue formation were present at macroscopic inspection. This phenomenon was only visible on computed tomographic images. Therefore, computed tomography appears a promising technique for in vivo follow-up of tissue formation in tissue-engineered heart valves.
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Affiliation(s)
- Linda M de Heer
- Department of Cardio-Thoracic Surgery, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
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Cornelissen SA, van der Laan MJ, Vincken KL, Vonken EJPA, Viergever MA, Bakker CJ, Moll FL, Bartels LW. Use of Multispectral MRI to Monitor Aneurysm Sac Contents After Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2011; 18:274-9. [DOI: 10.1583/10-3271.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cocosco CA, Niessen WJ, Netsch T, Vonken EJPA, Lund G, Stork A, Viergever MA. Automatic image-driven segmentation of the ventricles in cardiac cine MRI. J Magn Reson Imaging 2008; 28:366-74. [PMID: 18666158 DOI: 10.1002/jmri.21451] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To propose and to evaluate a novel method for the automatic segmentation of the heart's two ventricles from dynamic ("cine") short-axis "steady state free precession" (SSFP) MR images. This segmentation task is of significant clinical importance. Previously published automated methods have various disadvantages for routine clinical use. MATERIALS AND METHODS The proposed method is primarily image-driven: it exploits the spatiotemporal information provided by modern 3D+time SSFP cardiac MRI, and makes only few and plausible assumptions about the image acquisition and about the imaged heart. Specifically, the method does not require previously trained statistical shape models or gray-level appearance models, as often used by other methods. RESULTS The performance of the segmentation method was demonstrated through a qualitative visual validation on 32 clinical exams: no gross failures for the left-ventricle (right-ventricle) on 31 (29) of the exams were found. A validation of resulting quantitative cardiac functional parameters showed good agreement with a manual quantification of 19 clinical exams. CONCLUSION The proposed method is feasible, fast, and robust against anatomical variability and image contrast variations.
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Prakken NHJ, Vonken EJPA, Velthuis BK, Doevendans PAFM, Cramer MJM. 3D MR coronary angiography: optimization of the technique and preliminary results. Int J Cardiovasc Imaging 2006; 22:477-87. [PMID: 16538433 DOI: 10.1007/s10554-005-9053-8] [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] [Received: 09/07/2005] [Accepted: 11/08/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Current clinical full MR angiography with multiple breathhold multiple thin slab acquisition (MTS) is difficult and arduous. This study describes the optimisation of the whole heart free - breathing balanced turbo field echo (B-TFE) protocol. A high-resolution image of the whole heart is produced in less or comparable time to MTS acquisition and allows for reconstruction afterwards to visualise the individual coronary arteries. The scan is easily performed because the volume has to be targeted only once. DESIGN AND SETTING Eighteen healthy adults without a history of cardiovascular disease underwent free-breathing 3D MR angiography with the B-TFE protocol. The whole-heart data set was reformatted in identical orientations in all subjects to visualise the major coronary arteries. MAIN OUTCOME MEASURES Vessel length, signal and contrast to noise ratio were determined and compared for each vessel. RESULTS Mean visible vessel lengths were 116 mm for the right, 102 mm for the left main and left descending and 76 mm for the left circumflex coronary artery. The average signal to noise ratio was 7.5 and contrast to noise ratio was 4.9. Because of the need for synchronised cardiac and respiratory triggering the coronaries could not be judged in 25% of the subjects. CONCLUSIONS The optimised B-TFE protocol had equal judgeability and vessels could be judged over longer contiguous distances compared to earlier implementations of the B-TFE protocol. We conclude whole heart free breathing navigator-gated and slice-tracked 3D coronary MR angiography with use of the adjusted B-TFE protocol is possible, but still suboptimal for clinical use.
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van Bemmel CM, Elgersma OEH, Vonken EJPA, Fiorelli M, van Leeuwen MS, Niessen WJ. Evaluation of Semiautomated Internal Carotid Artery Stenosis Quantification from 3-Dimensional Contrast-Enhanced Magnetic Resonance Angiograms. Invest Radiol 2004; 39:418-26. [PMID: 15194913 DOI: 10.1097/01.rli.0000129469.56134.3a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The performance of a semiautomatic technique for internal carotid artery (ICA) stenosis quantification of the internal carotid artery in contrast-enhanced magnetic resonance angiography was evaluated. MATERIALS AND METHODS The degree of stenosis of 52 ICAs was quantified by measuring the cross-sectional area along the center lumen line. This was performed both by 3 independent observers and the semiautomated method. The degree of stenosis was defined as the amount of cross-sectional lumen reduction. RESULTS Agreement between the method and observers was good (weighted-kappa, kappaW = 0.89). Reproducibility of measurements of the semiautomated technique was better (kappaW = 0.97) than that of the observers (kappaW = 0.76), and the evaluated technique was considerably less time-consuming. CONCLUSIONS Because the user interaction is limited, this technique can be used to replace an expert observer in 3-dimensional stenosis quantification of the ICA at CE-MRA in clinical practice.
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van Osch MJP, Vonken EJPA, Wu O, Viergever MA, van der Grond J, Bakker CJG. Model of the human vasculature for studying the influence of contrast injection speed on cerebral perfusion MRI. Magn Reson Med 2003; 50:614-22. [PMID: 12939770 DOI: 10.1002/mrm.10567] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [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: 11/08/2022]
Abstract
Simulations of dynamic susceptibility contrast (DSC) MRI are frequently performed by assuming a certain shape for the input function and the microvascular response function. However, to investigate the influence of parameters that will affect the shape of the input function, a more complex model of the human vasculature is required. In this study, a model of the human vasculature is proposed that consists of a network of vascular operators based on physiological data typical of a 35-year-old male subject. The simulated contrast passage curves were found to be within the range of observed contrast passage curves in a population of patients without vascular disease. The model was used to predict the effect of different injection speeds of the contrast agent on the accuracy of the perfusion experiment. It was found that injection speeds of <3 ml/s lead to an underestimation of the observed cerebral blood flow (CBF). Additionally, it was determined that decreasing the temporal resolution of the acquisition results in an underestimation of the CBF values, and an increase of the standard deviation (SD) of CBF measurements.
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Affiliation(s)
- Matthias J P van Osch
- Department of Radiology, Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
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