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Aubert M, Tradi F, Chopinet S, Duclos J, Le Huu Nho R, Hardwigsen J, Pirro N, Mege D. Acute diverticulitis with extraluminal air: is conservative treatment sufficient? A single-center retrospective study. Tech Coloproctol 2024; 28:50. [PMID: 38661970 DOI: 10.1007/s10151-024-02928-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Acute diverticulitis with extraluminal air constitutes a heterogeneous condition whose management is controversial. The aims of this study are to report the failure rate of conservative treatment for diverticulitis with extraluminal air and to report risk factors of conservative treatment failure. METHODS A retrospective study was performed from an institutional review board-approved database of patients admitted with acute diverticulitis with extraluminal air from 2015 to 2021 at a tertiary referral center. All patients managed for acute diverticulitis with covered perforation (without intraabdominal abscess) were included. The primary endpoint was failure of medical treatment, defined as a need for unplanned surgery or percutaneous drainage within 30 days after admission. RESULTS Ninety-three patients (61% male, mean age 57 ± 17 years) were retrospectively included. Ten patients had failure of conservative treatment (11%). These patients were significantly older than 50 years (n = 9/10, 90% versus n = 47/83, 57%, p = 0.007), associated with cardiovascular disease (n = 6/10, 60% versus n = 10/83, 12%, p = 0.002), American Society of Anesthesiologists (ASA) score of 3-4 (n = 4/7, 57% versus 6/33, 18%, p = 0.05), under anticoagulant and antiplatelet (n = 6/10, 60% versus n = 11/83, 13%, p = 0.04) and steroid or immunosuppressive therapy (n = 3/10, 30% versus 5/83, 6%, p = 0.04), and with distant pneumoperitoneum location (n = 7/10, 70% versus n = 14/83, 17%, p = 0.001) compared with those with successful conservative treatment. On multivariate analysis, only distant pneumoperitoneum was an independent risk factor of failure (odds ratio (OR) 6.5, 95% confidence interval (CI) [2-21], p = 0.002). CONCLUSIONS Conservative treatment with antibiotics for acute diverticulitis with extraluminal air is safe with a success rate of 89%. Patients with distant pneumoperitoneum should be carefully monitored.
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Affiliation(s)
- M Aubert
- Department of Digestive Surgery, Aix Marseille Univ, APHM, CHU Timone, Marseille, France.
| | - F Tradi
- Department of Radiology, Aix Marseille Univ, APHM, CHU Timone, Marseille, France
| | - S Chopinet
- Department of Digestive Surgery, Aix Marseille Univ, APHM, CHU Timone, Marseille, France
| | - J Duclos
- Department of Digestive Surgery, Aix Marseille Univ, APHM, CHU Timone, Marseille, France
| | - R Le Huu Nho
- Department of Digestive Surgery, Aix Marseille Univ, APHM, CHU Timone, Marseille, France
| | - J Hardwigsen
- Department of Digestive Surgery, Aix Marseille Univ, APHM, CHU Timone, Marseille, France
| | - N Pirro
- Department of Digestive Surgery, Aix Marseille Univ, APHM, CHU Timone, Marseille, France
| | - D Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, CHU Timone, Marseille, France
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Botsford A, Tradi F, Loubet A, Tantawi S, Soulez G, Giroux MF, Faughnan ME, Gauthier A, Perreault P, Bouchard L, Holderbaum do Amaral R, Chartrand-Lefebvre C, Therasse E. Transarterial Embolization of Simple Pulmonary Arteriovenous Malformations: Long-Term Outcomes of 0.018-Inch Coils versus Vascular Plugs. J Vasc Interv Radiol 2024; 35:349-360. [PMID: 38013007 DOI: 10.1016/j.jvir.2023.11.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/24/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To compare the safety, effectiveness, and persistence rates of 0.018-inch coils with those of Amplatzer vascular plugs (AVPs; Abbott Vascular, Abbott Park, Illinois) for the treatment of pulmonary arteriovenous malformations (PAVMs) in response to a growing concern that 0.018-inch coil embolization would increase the long-term persistence rate. MATERIALS AND METHODS This is a retrospective, single-center study of a database (2002-2020) of 633 PAVM embolizations. Complex PAVMs and those not embolized with 0.018-inch coils or plugs were excluded. PAVM embolization material was classified into 4 groups: (a) 0.018-inch nonfibered coils (NFCs), (b) 0.018-inch fibered coils (FCs), (c) NFCs and FCs, or (d) plugs. Persistence was defined as flow through the PAVM on digital subtraction angiography (DSA) or as <30% diameter reduction of the aneurysmal sac on unenhanced computed tomography (CT). Kaplan-Meier analysis and Cox regression were used to assess PAVM's persistence-free survival. RESULTS A total of 312 PAVM embolizations with NFCs (43 PAVMs), FCs (127 PAVMs), NFCs and FCs (12 PAVMs), or plugs (130 PAVMs) in 109 patients (28% men; mean age = 49 years) were included. All PAVM embolizations were technically successful without any major adverse events. PAVM persistence-free survival rates at 10 years' follow-up were 40.8% versus 44.7% in the NFC and FC groups (P = .22) and 47.3% versus 81.0% in the 0.018-inch coil (NFC or FC) and plug groups (P < .0001), respectively. There were 0.43 (79/182) and 0.08 (10/130) re-embolization procedures per PAVM in the 0.018-inch coil and plug groups, respectively (P < .001). CONCLUSIONS PAVM embolization with 0.018-inch coils was safe, but persistence rate with PAVM embolization was significantly higher than that with plugs, with no significant differences between FCs and NFCs.
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Affiliation(s)
- Alexander Botsford
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Farouk Tradi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Assistance publique-hôpitaux de Marseille, Hôpital de la Timone, Service d'imagerie diagnostic et interventionnelle, Marseille, France; Laboratoire d'imagerie interventionnelle expérimentale (LIIE), Faculté de Médecine, CERIMED, Université Aix-Marseille Marseille, France
| | - Antoine Loubet
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, Université de Montpellier, France
| | - Suhad Tantawi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Centre de recherche du CHUM (CRCHUM), Pavillon R, Montréal Quebec, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Marie E Faughnan
- Montreal HHT Centre, Division of Pneumology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital and Li Ka Shing Knowledge Institute Toronto, Ontario, Canada
| | - Andréanne Gauthier
- Montreal HHT Centre, Division of Pneumology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada
| | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | | | - Carl Chartrand-Lefebvre
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Centre de recherche du CHUM (CRCHUM), Pavillon R, Montréal Quebec, Canada.
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Cadour F, Tradi F, Bartoli A, Duffaud F, Gaubert JY. Diffusion weighted imaging changes in extra-abdominal desmoid tumor after cryotherapy. Ann Med 2023; 55:521-525. [PMID: 36724758 PMCID: PMC10132216 DOI: 10.1080/07853890.2023.2174589] [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] [Indexed: 02/03/2023] Open
Abstract
Desmoid tumors (DT) are rare benign tumors with a local invasion potential and recurrence. It is characterized on histology by an abnormal fibroblastic proliferation in a collagenous stroma, in variable proportions leading to heterogeneity of the lesion signal on magnetic resonance imaging (MRI). Current guidelines propose watchful waiting but in case of progression or symptoms, cryotherapy may be a therapeutic option in its extra-abdominal form. Tumor recurrence is mostly detected based on post-contrast magnetic resonance imaging (MRI). Although DWI sequence is the key-sequence for tumor detection in oncologic imaging, there are very few data in literature on diffusion weighted imaging (DWI) in DT generally and even fewer on DT after cryotherapy. DWI changes after cryotherapy may be confusing and suspicious of residual tumor or tumor recurrence when displaying low ADC values; thus knowledge of possible DWI patterns after cryotherapy of DT seem paramount. We found that the early changes of DT after cryotherapy are hyperintensity on DWI sequence with low ADC values (<1.00 × 10-3mm2/s), without corresponding enhancement and a later decrease in signal of the treated lesion on DWI. The freezing-thawing cycles of cryotherapy turn DT into gelatinous necrosis with a slow resorption rate, as reported in the only few studies referring of changes of DWI signals after cryotherapy, which are on renal and prostate models. Hyperintensity on DWI with low ADC values may be seen in early MRI follow-up after cryotherapy of extra-abdominal DT, corresponding with tumor necrosis changes and should not be mistaken with recurrence.KEY MESSAGESMagnetic resonance imaging is the modality of choice for desmoid tumor (DT) follow-up, mainly based on contrast uptake which make data on diffusion weighted imaging (DWI) very rare.Cryotherapy is an accepted therapeutic option for DT that will lead to tumor necrosis.Hyperintensity on DWI with low apparent diffusion coefficient values is a possible expected early pattern on DWI after cryotherapy of DT.
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Affiliation(s)
- Farah Cadour
- Department of Radiology, La Timone Hospital, Marseille, France
| | - Farouk Tradi
- Department of Radiology, La Timone Hospital, Marseille, France
| | - Axel Bartoli
- Department of Radiology, La Timone Hospital, Marseille, France
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De Pietro R, Martin J, Tradi F, Chopinet S, Barraud M, Gaudry M, Bourenne J, Nafati C, Boussen S, Guidon C, Bartoli M, Mege D. Prognostic factors after acute mesenteric ischemia: which patients require specific management? Int J Colorectal Dis 2023; 38:242. [PMID: 37777708 DOI: 10.1007/s00384-023-04540-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE Diagnosis and treatment of AMI are a real issue for implicating physicians. In the literature, only one AMI stroke center has reported its results so far, with increasing survival rates. Our aim was to analyze acute mesenteric ischemia (AMI) related mortality and predictive factors, in a single academic center, before creating a dedicated intestinal stroke center. METHODS All the patients with an AMI, between January 2015 and December 2020, were retrospectively included. They were divided into 2 groups according to the early mortality: death during the first 30 days and alive. The 2 groups were compared. RESULTS 173 patients (57% of men), were included, with a mean age of 68 ± 16 years. Overall mortality rate was 61%. Mortality occurred within the first 30 days in 78% of dead cases. Dead patients were significantly older, more frequently admitted from intensive care, with more serious clinical, laboratory and radiological characteristics. We have identified 3 protective factors - history of abdominal surgery (Odd Ratio = 0.1; 95%CI = 0.01-0.8, p = 0.03), medical management with curative anticoagulation (OR = 0.09; 95%CI = 0.02-0.5, p = 0.004) and/or antiplatelets (OR = 0.04; 95%CI = 0.006-0.3, p = 0.001)-, and 2 predictive factors of mortality - age > 70 years (OR = 7; 95%CI = 1.4-37, p = 0.02) and previous history of coronaropathy (OR = 13; 95%CI = 1.7-93, p = 0.01). CONCLUSIONS AMI is a severe disease with high morbidity and mortality rates. Even if its diagnosis is still difficult because of non-specific presentation, its therapeutic management needs to be changed in order to improve survival rates, particularly in patients older than 70 years with history of coronaropathy. Developing a dedicated organization would improve the diagnosis and the management of patients with AMI.
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Affiliation(s)
- Remi De Pietro
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Julie Martin
- Department of Emergency, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Farouk Tradi
- Department of Radiology, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Sophie Chopinet
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Marine Barraud
- Department of Gastro-enterology, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Marine Gaudry
- Department of Vascular Surgery, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Jeremy Bourenne
- Department of Emergency Critical Care Medicine, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Cyril Nafati
- Department of Intensive Care of Liver Diseases, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Salah Boussen
- Department of Intensive Care and Anesthesiology Department2, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Catherine Guidon
- Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Michel Bartoli
- Department of Vascular Surgery, Aix Marseille Univ, APHM, Timone University, Marseille, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University, 264 rue Saint-Pierre, 13005, Marseille, France.
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Thiery L, Carle X, Testud B, Boulouis G, Habert P, Tradi F, Reyre A, Lehmann P, Dory-Lautrec P, Stellmann JP, Girard N, Brunel H, Hak JF. Distal cerebral vasospasm treatment following aneurysmal subarachnoid hemorrhage using the Comaneci device: technical feasibility and single-center preliminary results. J Neurointerv Surg 2023; 15:325-329. [PMID: 35584908 DOI: 10.1136/neurintsurg-2022-018699] [Citation(s) in RCA: 2] [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: 01/26/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Balloon-assisted mechanical angioplasty for cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) has a number of limitations, including transient occlusion of the spastic blood vessel. Comaneci is an FDA-approved device for temporary coil embolization assistance which has recently also been approved for the treatment of distal symptomatic refractory vasospasm. We aimed to report the feasibility, efficacy and safety of our experience with Comaneci angioplasty for refractory distal vasospasm (up to the second segment of the cerebral arteries) following aSAH. METHODS This is a retrospective analysis of a prospective series of 18 patients included between April 2019 and June 2021 with aSAH and symptomatic vasospasm refractory to medical therapy, who were treated using Comaneci-17-asssisted mechanical distal angioplasty. Immediate angiographic results, procedure-related complications, and clinical outcomes were assessed. Inter-rater reliability of the scores was determined using the intraclass correlation coefficient. RESULTS Comaneci-assisted distal angioplasty was performed in 18 patients, corresponding to 31 target arteries. All distal anterior segments were easily accessible with the Comaneci-17 device. Vasospasm improvement after Comaneci mechanical angioplasty was seen in 22 distal arteries (71%) (weighted Cohen's kappa (κw) 0.73, 95% CI 0.69 to 0.93). Vasospasm recurrence occurred in three patients (16.67%) and delayed cerebral infarction in three patients (16.67%), with a mean±SD delay between onset of symptoms and imaging follow-up (MRI/CT) of 32.61±8.93 days (κw 0.98, 95% CI 0.88 to 1). CONCLUSION This initial experience suggests that distal mechanical angioplasty performed with the Comaneci-17 device for refractory vasospasm following aSAH seems to be safe, with good feasibility and efficacy.
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Affiliation(s)
- Louis Thiery
- Department of Neuroradiology, APHM La Timone, Marseille, France
| | - Xavier Carle
- Department of Neuroradiology, APHM La Timone, Marseille, France
| | - Benoit Testud
- Department of Neuroradiology, APHM La Timone, Marseille, France.,CEMEREM, Aix Marseille University, Marseille, France.,CNRS, CRMBM, Aix Marseille University, Marseille, France
| | | | - Paul Habert
- Department of Medical Imaging, APHM La Timone, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Farouk Tradi
- Department of Medical Imaging, APHM La Timone, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Anthony Reyre
- Department of Neuroradiology, APHM La Timone, Marseille, France
| | - Pierre Lehmann
- Department of Neuroradiology, APHM La Timone, Marseille, France
| | | | - Jan-Patrick Stellmann
- Department of Neuroradiology, APHM La Timone, Marseille, France.,CEMEREM, Aix Marseille University, Marseille, France.,CNRS, CRMBM, Aix Marseille University, Marseille, France
| | - Nadine Girard
- Department of Neuroradiology, APHM La Timone, Marseille, France
| | - Herve Brunel
- Department of Neuroradiology, APHM La Timone, Marseille, France
| | - Jean-Francois Hak
- Department of Neuroradiology, APHM La Timone, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
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Bentridi A, Hazout S, Tradi F, Hadjadj A, Gilbert P, Therasse E, Giroux M, Soulez G. Abstract No. 150 Endovascular Treatment of Pelvic Congestion Syndrome (PCS) in 246 women, Long Term Results, and Analysis of Patient Satisfaction. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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7
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Cadour F, Quemeneur M, Biere L, Donal E, Bentatou Z, Eicher JC, Roubille F, Lalande A, Giorgi R, Rapacchi S, Cortaredona S, Tradi F, Bartoli A, Willoteaux S, Delahaye F, Biene SM, Mangin L, Ferrier N, Dacher JN, Bauer F, Leurent G, Lentz PA, Kovacsik H, Croisille P, Thuny F, Bernard M, Guye M, Furber A, Habib G, Jacquier A. Prognostic value of cardiovascular magnetic resonance T1 mapping and extracellular volume fraction in nonischemic dilated cardiomyopathy. J Cardiovasc Magn Reson 2023; 25:7. [PMID: 36747201 PMCID: PMC9900939 DOI: 10.1186/s12968-023-00919-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Heart failure- (HF) and arrhythmia-related complications are the main causes of morbidity and mortality in patients with nonischemic dilated cardiomyopathy (NIDCM). Cardiovascular magnetic resonance (CMR) imaging is a noninvasive tool for risk stratification based on fibrosis assessment. Diffuse interstitial fibrosis in NIDCM may be a limitation for fibrosis assessment through late gadolinium enhancement (LGE), which might be overcome through quantitative T1 and extracellular volume (ECV) assessment. T1 and ECV prognostic value for arrhythmia-related events remain poorly investigated. We asked whether T1 and ECV have a prognostic value in NIDCM patients. METHODS This prospective multicenter study analyzed 225 patients with NIDCM confirmed by CMR who were followed up for 2 years. CMR evaluation included LGE, native T1 mapping and ECV values. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE) which was divided in two groups: HF-related events and arrhythmia-related events. Optimal cutoffs for prediction of MACE occurrence were calculated for all CMR quantitative values. RESULTS Fifty-eight patients (26%) developed a MACE during follow-up, 42 patients (19%) with HF-related events and 16 patients (7%) arrhythmia-related events. T1 Z-score (p = 0.008) and global ECV (p = 0.001) were associated with HF-related events occurrence, in addition to left ventricular ejection fraction (p < 0.001). ECV > 32.1% (optimal cutoff) remained the only CMR independent predictor of HF-related events occurrence (HR 2.15 [1.14-4.07], p = 0.018). In the arrhythmia-related events group, patients had increased native T1 Z-score and ECV values, with both T1 Z-score > 4.2 and ECV > 30.5% (optimal cutoffs) being independent predictors of arrhythmia-related events occurrence (respectively, HR 2.86 [1.06-7.68], p = 0.037 and HR 2.72 [1.01-7.36], p = 0.049). CONCLUSIONS ECV was the sole independent predictive factor for both HF- and arrhythmia-related events in NIDCM patients. Native T1 was also an independent predictor in arrhythmia-related events occurrence. The addition of ECV and more importantly native T1 in the decision-making algorithm may improve arrhythmia risk stratification in NIDCM patients. Trial registration NCT02352129. Registered 2nd February 2015-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02352129.
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Affiliation(s)
- Farah Cadour
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Morgane Quemeneur
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Loic Biere
- Department of Cardiology, University Hospital of Angers, 49000 Angers, France
- UMR CNRS 6015-INSERMU1083, Institut Mitovasc, University of Angers, 49000 Angers, France
| | - Erwan Donal
- Department of Cardiology, Inserm, LTSI–UMR 1099, CHU Rennes, Univ Rennes, 35000 Rennes, France
| | - Zakarya Bentatou
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | | | - François Roubille
- PhyMedExp, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Alain Lalande
- ImViA Laboratory, University of Burgundy, 7 Bld Jeanne d’arc, 21000 Dijon, France
- Medical Imaging Department, University Hospital of Dijon, 21000 Dijon, France
| | - Roch Giorgi
- APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Hop Timone, BioSTICBiostatistique et Technologies de l’Information et de la Communication, Aix Marseille Univ, Marseille, France
| | - Stanislas Rapacchi
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Sébastien Cortaredona
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - Farouk Tradi
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Axel Bartoli
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Serge Willoteaux
- UMR CNRS 6015-INSERMU1083, Institut Mitovasc, University of Angers, 49000 Angers, France
| | - François Delahaye
- Department of Cardiology, Hospices civils de Lyon, 69002 Lyon, France
| | | | - Lionel Mangin
- Department of Cardiology, CH d’Annecy, 74370 Annecy, France
| | - Nadine Ferrier
- Department of Cardiology, CH de Vichy, 03207 Vichy, France
| | - Jean-Nicolas Dacher
- Department of Radiology, UNIROUEN, Inserm U1096, CHU de Rouen, 76000 Rouen, France
| | - Fabrice Bauer
- INSERM U 1096, Cardiovascular Surgery Department, Pulmonary Hypertension and Advanced Heart Failure Clinic, Rouen University Hospital, Rouen, France
| | - Guillaume Leurent
- Department of Cardiology, Inserm, LTSI–UMR 1099, CHU Rennes, Univ Rennes, 35000 Rennes, France
| | - Pierre-Axel Lentz
- Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Hélène Kovacsik
- Departement of Cardiovascular Imaging, Chu Montpellier, Montpellier, France
| | - Pierre Croisille
- Department of Radiology, University Hospital Saint-Etienne, Saint-Étienne, France
- CNRS UMR 5520, INSERM U1294, CREATIS, INSA-Lyon, Univ Lyon, UJM-Saint-Etienne, 42023 Saint-Étienne, France
| | - Franck Thuny
- Unit of Heart Failure and Valvular Heart Diseases, Inserm 1263, Inrae 1260, Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), University Mediterranean Center of Cardio-Oncology, Aix-Marseille University, Marseille, France
| | - Monique Bernard
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
- Faculté de Médecine, CNRS, Aix-Marseille Université, 27 Bd Jean Moulin, 13385 Marseille cedex 5, France
| | - Maxime Guye
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Alain Furber
- Department of Cardiology, University Hospital of Angers, 49000 Angers, France
- UMR CNRS 6015-INSERMU1083, Institut Mitovasc, University of Angers, 49000 Angers, France
| | - Gilbert Habib
- Cardiology Department, IRD, APHM, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Aix Marseille Univ, Marseille, France
| | - Alexis Jacquier
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
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Khati I, Jacquier A, Cadour F, Bartoli A, Graber M, Hardwigsen J, Tradi F, Barral PA. Endovascular therapies for hepatic artery stenosis post liver transplantation. CVIR Endovasc 2022; 5:63. [PMID: 36478229 PMCID: PMC9729479 DOI: 10.1186/s42155-022-00338-7] [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: 06/27/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate primary patency at 12 months after endovascular therapies in hepatic artery stenosis. METHODS A retrospective review of all endovascular interventions for hepatic artery stenosis (HAS) after liver transplantation that occurred between June 2013 and November 2020 was performed at a single institution in France. Follow up occurred from 1 month to 4 years (median 15 months). The treatment consisted of dilation with a balloon or stent. We analyzed short-term (technical success and complications) and long-term outcomes (liver function, arterial patency, graft survival at 12 months (GS), and reintervention). We also compared percutaneous balloon angioplasty (PBA) with stent placement. PBA alone was used if < 30% residual stenosis of the hepatic artery was achieved. Stenting was performed if there was greater than 30% residual stenosis and in the case of complications (dissection or rupture). RESULTS A total of 18 stenoses were suspected on the basis of routine surveillance duplex ultrasound imaging (peak systolic velocity > 200 cm/s, systolic accelerating time > 10 ms and resistive index < 0.5), all of which were confirmed by angio CT, but only 17 were confirmed by angiography. Seventeen patients were included (14 males, mean age 57 years; and three females, mean age 58 years). Interventions were performed in 17 cases (95%) with PBA only (5/17), stent only (5/17) or both (4/17). Immediate technical success was 100%. Major complications occurred in 1 of 17 cases (5.8%), consisting of target vessel dissection. The analysis of the three (groups PBA only, stent only or both) showed the same procedural success (100%), GS (100%) and normal liver function after the procedures but different rates of complications (20% vs. 0% vs. 0%), arterial patency at 12 months (60% vs. 80% vs. 85%) (p = 0.4), early stenosis (40% vs. 80% vs. 0%) or late stenosis (60% vs. 20% vs. 100%) and requirement for reintervention (40% vs. 20% vs. 14%) (p = 0.56). CONCLUSION This study suggests that PBA, stent, or both procedures show the same primary patency at 12 months. It is probably not a definitive answer, but these treatments are safe and effective for extending graft survival in the context of graft shortages.
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Affiliation(s)
- I. Khati
- grid.411266.60000 0001 0404 1115Department of Radiology, CHU Timone 2, Marseille APHM, Marseille, France
| | - A. Jacquier
- grid.411266.60000 0001 0404 1115Department of Radiology, CHU Timone 2, Marseille APHM, Marseille, France
| | - F. Cadour
- grid.411266.60000 0001 0404 1115Department of Radiology, CHU Timone 2, Marseille APHM, Marseille, France
| | - A. Bartoli
- grid.411266.60000 0001 0404 1115Department of Radiology, CHU Timone 2, Marseille APHM, Marseille, France
| | - M. Graber
- grid.411266.60000 0001 0404 1115Department of Radiology, CHU Timone 2, Marseille APHM, Marseille, France
| | - J. Hardwigsen
- grid.411266.60000 0001 0404 1115Department of Surgery, CHU Timone 2, Marseille APHM, Marseille, France
| | - F. Tradi
- grid.411266.60000 0001 0404 1115Department of Radiology, CHU Timone 2, Marseille APHM, Marseille, France
| | - P.-A. Barral
- grid.411266.60000 0001 0404 1115Department of Radiology, CHU Timone 2, Marseille APHM, Marseille, France
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Barral PA, De Masi M, Bartoli A, Beunon P, Gallon A, Tradi F, Hak JF, Gaudry M, Jacquier A. Angio Cone-Beam CT (Angio-CBCT) and 3D Road-Mapping for the Detection of Spinal Cord Vascularization in Patients Requiring Treatment for a Thoracic Aortic Lesion: A Feasibility Study. J Pers Med 2022; 12:1890. [PMID: 36422066 PMCID: PMC9692974 DOI: 10.3390/jpm12111890] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Spinal cord ischemia is a major complication of treatment for descending thoracic aorta (DTA) disease. Our objectives were (1) to describe the value of angiographic cone-beam CT (angio-CBCT) and 3D road-mapping to visualize the Adamkiewicz artery (AA) and its feeding artery and (2) to evaluate the impact of AA localization on the patient surgical strategy. METHODS Between 2018 and 2020, all patients referred to our institution for a surgical DTA disorder underwent a dedicated AA evaluation by angio-CBCT. If the AA feeding artery was not depicted on angio-CBCT, selective artery catheterization was performed, guided by 3D road-mapping. Intervention modifications, based on AA location and one month of neurologic follow-up after surgery, were recorded. RESULTS Twenty-one patients were enrolled. AA was assessable in 100% of patients and in 15 (71%) with angio-CBCT alone. Among them, 10 patients needed 3D road-mapping-guided DSA angiography to visualize the AA feeding artery. The amount of contrast media, irradiation dose, and intervention length were not significantly different whether the AA was assessable or not by angio-CBCT. AA feeding artery localization led to surgical sketch modification for 11 patients. CONCLUSIONS Angio-CBCT is an efficient method for AA localization in the surgical planning of DTA disorders.
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Affiliation(s)
- Pierre-Antoine Barral
- Department of Radiology, CHU Timone, AP-HM, 264, Rue Saint-Pierre, 13005 Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, CHU Timone, 264, Rue Saint-Pierre, AP-HM, 13005 Marseille, France
- Aortic Center, CHU Timone, AP-HM, 264, Rue Saint-Pierre, 13005 Marseille, France
| | - Axel Bartoli
- Department of Radiology, CHU Timone, AP-HM, 264, Rue Saint-Pierre, 13005 Marseille, France
- CRMBM-UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France
| | - Paul Beunon
- Department of Radiology, CHU Timone, AP-HM, 264, Rue Saint-Pierre, 13005 Marseille, France
| | - Arnaud Gallon
- Department of Visceral and Vascular Radiology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France Aortic Center, CHU Timone, AP-HM, 264, Rue Saint-Pierre, CEDEX 1, 13005 Marseille, France
| | - Farouk Tradi
- Department of Radiology, CHU Timone, AP-HM, 264, Rue Saint-Pierre, 13005 Marseille, France
| | - Jean-François Hak
- Department of Neuroradiology, CHU Timone, AP-HM, 264, Rue Saint-Pierre, 13005 Marseille, France
| | - Marine Gaudry
- Department of Vascular Surgery, CHU Timone, 264, Rue Saint-Pierre, AP-HM, 13005 Marseille, France
- Aortic Center, CHU Timone, AP-HM, 264, Rue Saint-Pierre, 13005 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, CHU Timone, AP-HM, 264, Rue Saint-Pierre, 13005 Marseille, France
- CRMBM-UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France
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10
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Panneau J, Mege D, Di Bisceglie M, Duclos J, Habert P, Bartoli A, Vidal V, Tradi F. Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques. Radiographics 2022; 42:E226. [DOI: 10.1148/rg.229013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Panneau J, Mege D, Di Biseglie M, Duclos J, Habert P, Bartoli A, Vidal V, Tradi F. Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques. Radiographics 2022; 42:1829-1844. [DOI: 10.1148/rg.220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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12
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Tradi F, Vidal V. Hemorrhoid Embolization: Is it Time for Standardization? Cardiovasc Intervent Radiol 2022; 45:1362-1363. [PMID: 35915268 DOI: 10.1007/s00270-022-03205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Farouk Tradi
- Department of Interventional Radiology, Marseille Public University Hospital System, La Timone University Hospital, Service de radiologie - Hôpital Timone, 264 Rue Saint Pierre, 13385, Marseille CEDEX 05, France.
| | - Vincent Vidal
- Department of Interventional Radiology, Marseille Public University Hospital System, La Timone University Hospital, Service de radiologie - Hôpital Timone, 264 Rue Saint Pierre, 13385, Marseille CEDEX 05, France
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13
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Panneau J, Mege D, Biseglie MD, Duclos J, Habert P, Vidal V, Tradi F. Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease. Semin Intervent Radiol 2022; 39:194-202. [PMID: 35781988 DOI: 10.1055/s-0042-1745800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Julien Panneau
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Diane Mege
- Department of Visceral Surgery, Aix-Marseille University, Hôpital de la Timone, Marseille, France
| | - Mathieu Di Biseglie
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Julie Duclos
- Department of Visceral Surgery, Aix-Marseille University, Hôpital de la Timone, Marseille, France
| | - Paul Habert
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Farouk Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
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14
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Bartoli A, Fournel J, Ait-Yahia L, Cadour F, Tradi F, Ghattas B, Cortaredona S, Million M, Lasbleiz A, Dutour A, Gaborit B, Jacquier A. Automatic Deep-Learning Segmentation of Epicardial Adipose Tissue from Low-Dose Chest CT and Prognosis Impact on COVID-19. Cells 2022; 11:cells11061034. [PMID: 35326485 PMCID: PMC8947414 DOI: 10.3390/cells11061034] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To develop a deep-learning (DL) pipeline that allowed an automated segmentation of epicardial adipose tissue (EAT) from low-dose computed tomography (LDCT) and investigate the link between EAT and COVID-19 clinical outcomes. Methods: This monocentric retrospective study included 353 patients: 95 for training, 20 for testing, and 238 for prognosis evaluation. EAT segmentation was obtained after thresholding on a manually segmented pericardial volume. The model was evaluated with Dice coefficient (DSC), inter-and intraobserver reproducibility, and clinical measures. Uni-and multi-variate analyzes were conducted to assess the prognosis value of the EAT volume, EAT extent, and lung lesion extent on clinical outcomes, including hospitalization, oxygen therapy, intensive care unit admission and death. Results: The mean DSC for EAT volumes was 0.85 ± 0.05. For EAT volume, the mean absolute error was 11.7 ± 8.1 cm3 with a non-significant bias of −4.0 ± 13.9 cm3 and a correlation of 0.963 with the manual measures (p < 0.01). The multivariate model providing the higher AUC to predict adverse outcome include both EAT extent and lung lesion extent (AUC = 0.805). Conclusions: A DL algorithm was developed and evaluated to obtain reproducible and precise EAT segmentation on LDCT. EAT extent in association with lung lesion extent was associated with adverse clinical outcomes with an AUC = 0.805.
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Affiliation(s)
- Axel Bartoli
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
- Correspondence: ; Tel.: +33-6-64-53-16-82
| | - Joris Fournel
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
| | - Léa Ait-Yahia
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
| | - Farah Cadour
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
| | - Farouk Tradi
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
| | - Badih Ghattas
- I2M—UMR CNRS 7373, Luminy Faculty of Sciences, Aix-Marseille University, 163 Avenue de Luminy, Case 901, 13009 Marseille, France;
| | - Sébastien Cortaredona
- IHU Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005 Marseille, France; (S.C.); (M.M.)
- VITROME, SSA, IRD, Aix-Marseille University, 13005 Marseille, France
| | - Matthieu Million
- IHU Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005 Marseille, France; (S.C.); (M.M.)
- MEPHI, IRD, AP-HM, Aix Marseille University, 13005 Marseille, France
| | - Adèle Lasbleiz
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Anne Dutour
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Bénédicte Gaborit
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
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Belfil N, Tradi F, Haffner A, Mege D. An unusual para-rectal tumour. ANZ J Surg 2022; 92:2361-2362. [PMID: 35041235 DOI: 10.1111/ans.17483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nadiya Belfil
- Department of Digestive Surgery, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Farouk Tradi
- Department of Radiology, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Aurelie Haffner
- Department of Pathology, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
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16
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Tradi F, Panneau J, Brige P, Mege D, Habert P, Hak JF, Di Bisceglie M, Vidal V. Evaluation of Multiple Embolic Agents for Embolization of the Superior Rectal Artery in an Animal Model. Cardiovasc Intervent Radiol 2022; 45:510-519. [PMID: 34988702 DOI: 10.1007/s00270-021-03041-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To prospectively compare the safety of transcatheter embolization of superior rectal arteries in healthy pigs with multiple agents such as coils, spheres and liquids. MATERIALS AND METHODS Nine adult domestic pigs (three males, mean weight: 60 kg [50-70]) were randomly assigned to the embolization group: copolymer of ethylene vinyl alcohol (EVOH)-Onyx® (group 1, n = 3), microspheres 500 µ (group 2, n = 3), 2-mm micro-coils (group 3, n = 3). After a selective angiogram has been acquired, the embolic agent was infused at the distal part of rectal arteries. An angio-CT was performed before and after each embolization. After one week, angiography was repeated prior to euthanasia. At necropsy, the anorectal juncture was removed for histopathologic examination. RESULTS At necropsy, 100% of animals embolized with Onyx developed a significant necrosis zone of the distal part of the rectum. Histological examination revealed a mural infarction. For the micro-coil and microsphere groups, gross examination of the intestines did not reveal any evidence of ischaemia. The coils were found in the distal arterial vasculature of the meso-rectum, allowing a downstream revascularization by collaterals. The microspheres and onyx in the rectal wall, more distally. CONCLUSION Microspheres appear to induce fewer histologic complications than the liquid embolic agent and provide a more distal occlusion than micro-coils. These results suggest that, for superior rectal artery embolization, a super-selective embolization using spheres in human clinical conditions should be more effective and as safe as coil embolization. EVOH might be an unsafe embolization agent for haemorrhoids.
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Affiliation(s)
- Farouk Tradi
- Department of Interventional Radiology, Marseille Public University Hospital System (APHM), La Timone University Hospital, 264 Rue Saint Pierre, 13385, Marseille, Cedex 05, France.
- Experimental Interventional Imaging Laboratory (LIIE), UR 4264, Aix Marseille University, 27 boulevard Jean Moulin, 13005, Marseille, France.
| | - Julien Panneau
- Experimental Interventional Imaging Laboratory (LIIE), UR 4264, Aix Marseille University, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Pauline Brige
- Experimental Interventional Imaging Laboratory (LIIE), UR 4264, Aix Marseille University, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Diane Mege
- Department of General and Visceral Surgery, APHM, La Timone University Hospital, 264 Rue Saint Pierre, 13385, Marseille, Cedex 05, France
- Vascular Research Center of Marseille (VRCM), INSERM UMR-S 1076, Aix Marseille University, 27 Boulevard Jean Moulin 13005, Marseille, France
| | - Paul Habert
- Department of Interventional Radiology, Marseille Public University Hospital System (APHM), La Timone University Hospital, 264 Rue Saint Pierre, 13385, Marseille, Cedex 05, France
- Experimental Interventional Imaging Laboratory (LIIE), UR 4264, Aix Marseille University, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Jean Francois Hak
- Experimental Interventional Imaging Laboratory (LIIE), UR 4264, Aix Marseille University, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Mathieu Di Bisceglie
- Experimental Interventional Imaging Laboratory (LIIE), UR 4264, Aix Marseille University, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Vincent Vidal
- Department of Interventional Radiology, Marseille Public University Hospital System (APHM), La Timone University Hospital, 264 Rue Saint Pierre, 13385, Marseille, Cedex 05, France
- Experimental Interventional Imaging Laboratory (LIIE), UR 4264, Aix Marseille University, 27 boulevard Jean Moulin, 13005, Marseille, France
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17
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Chopinet S, Bollon E, Hak JF, Reydellet L, Blasco V, Tradi F, Louis G, Grégoire E, Hardwigsen J. The white test for intraoperative screening of bile leakage: a potential trigger factor for acute pancreatitis after liver resection-a case series. BMC Surg 2021; 21:356. [PMID: 34600501 PMCID: PMC8487543 DOI: 10.1186/s12893-021-01354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background Acute pancreatitis after liver resection is a rare but serious complication, and few cases have been described in the literature. Extended lymphadenectomy, and long ischemia due to the Pringle maneuver could be responsible of post-liver resection acute pancreatitis, but the exact causes of AP after hepatectomy remain unclear. Cases presentation We report here three cases of AP after hepatectomy and we strongly hypothesize that this is due to the bile leakage white test. 502 hepatectomy were performed at our center and 3 patients (0.6%) experienced acute pancreatitis after LR and all of these three patients underwent the white test at the end of the liver resection. None underwent additionally lymphadenectomy to the liver resection. All patient had a white-test during the liver surgery. We identified distal implantation of the cystic duct in these three patients as a potential cause for acute pancreatitis. Conclusion The white test is useful for detection of bile leakage after liver resection, but we do not recommend a systematic use after LR, because severe acute pancreatitis can be lethal for the patient, especially in case of distal cystic implantation which may facilitate reflux in the main pancreatic duct.
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Affiliation(s)
- Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 05, France. .,Aix Marseille Univ, LIIE, Marseille, France. .,Aix Marseille Univ, CERIMED, Marseille, France.
| | - Emilie Bollon
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix Marseille Univ, CERIMED, Marseille, France
| | - Jean-François Hak
- Department of Radiology, Hôpital de la Timone, Marseille, France.,Aix Marseille Univ, LIIE, Marseille, France.,Aix Marseille Univ, CERIMED, Marseille, France
| | - Laurent Reydellet
- Department of Anesthesiology, Hôpital la Timone, Marseille, France.,Aix Marseille Univ, CERIMED, Marseille, France
| | - Valéry Blasco
- Department of Anesthesiology, Hôpital la Timone, Marseille, France.,Aix Marseille Univ, CERIMED, Marseille, France
| | - Farouk Tradi
- Department of Radiology, Hôpital de la Timone, Marseille, France.,Aix Marseille Univ, LIIE, Marseille, France.,Aix Marseille Univ, CERIMED, Marseille, France
| | - Guillaume Louis
- Department of Radiology, Hôpital de la Timone, Marseille, France.,Aix Marseille Univ, CERIMED, Marseille, France
| | - Emilie Grégoire
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix Marseille Univ, LIIE, Marseille, France.,Aix Marseille Univ, CERIMED, Marseille, France
| | - Jean Hardwigsen
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix Marseille Univ, CERIMED, Marseille, France
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Vicenty T, Tradi F, Haffner A, Mege D. Unusual abdominal pain: A mesenteric plexiform neurofibroma. ANZ J Surg 2021; 92:900-901. [PMID: 34473877 DOI: 10.1111/ans.17186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/08/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Thibaud Vicenty
- Department of Digestive Surgery, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Farouk Tradi
- Department of Radiology, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Aurélie Haffner
- Department of Pathology, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
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Talaie R, Torkian P, Moghadam AD, Tradi F, Vidal V, Sapoval M, Golzarian J. Hemorrhoid embolization: A review of current evidences. Diagn Interv Imaging 2021; 103:3-11. [PMID: 34456172 DOI: 10.1016/j.diii.2021.07.001] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022]
Abstract
Hemorrhoids are local vascular structure dilations in the lower rectum, associated with morbidity and reduced quality of life. Endovascular coil or particle embolization of the superior rectal arteries, known as Emborrhoid technique, is a minimally invasive, image-guided therapy that targets the hemorrhoidal plexus and reduces hemorrhage. The purpose of this review was to analyze the results of published studies to determine the efficacy, clinical outcomes, and morbidities associated with the endovascular occlusion of hemorrhoidal arteries for the treatment of internal hemorrhoids. Current evidences suggest that hemorrhoids treated by Emborrhoid technique using microcoils, embolic particles or a combination is safe with no reported serious complications. Hemorrhoid embolization can preserve the anal tone without direct anorectal trauma and maintain the hemorrhoidal tissue in place requiring minimal local wound care on an outpatient basis. However, due to the paucity of high-quality trials, further research is warranted to evaluate its long-term outcomes, compare its efficacy with other treatment modalities, and fully assess its role in the treatment of hemorrhoid.
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Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA.
| | - Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA
| | - Arash Dooghaie Moghadam
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Farouk Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, 13005 Marseille, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, 13005 Marseille, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA
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Habert P, Di Bisceglie M, Bartoli A, Jacquier A, Brige P, Vidal V, Hak JF, Tradi F, Gaubert JY. Description of morphological evolution of lung tumors treated by percutaneous radiofrequency ablation: long term follow-up of 100 lesions with chest CT. Int J Hyperthermia 2021; 38:786-794. [PMID: 34032532 DOI: 10.1080/02656736.2021.1928773] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Radiofrequency ablation (RFA) is a safe and effective minimally invasive treatment for pulmonary tumors. Patterns on chest computed tomography (CT) after RFA are classified into five types; however, the follow-up has not been fully described. The objectives of this study were to describe (1) the CT pattern 3 years after RFA and (2) its evolution over 7 years. MATERIALS AND METHODS Lesions treated with RFA between 2009 and 2017 and with ≥3 years of follow-up CT data were included. Lesions with local recurrences were excluded from the study. The morphology of the ablation zone was classified as nodular, fibrotic, atelectatic, cavitary, and disappeared. Other initial anatomical parameters were recorded. Kruskal-Wallis or Chi-square tests were used to compare the groups. RESULTS One hundred lung RFA scars were included, and a retrospective longitudinal study was performed. Three years after RFA, nodular, fibrotic, atelectatic, and cavitary scars, and disappearance were observed in 49%, 36%, 5%, 3%, and 6% of the scars, respectively. Evolution over 7 years showed that the fibrosis, atelectasis, and disappearance remained stable over time, whereas 28% of nodular scars evolved into fibrotic scars. Additionally, 45% of cavitary scars evolved into nodular scars. Pleural contact was associated with disappearance, and the use of a 20-mm needle was associated with atelectasis. CONCLUSION Follow-up after RFA showed that fibrosis, disappearance, and atelectasis remained stable over time. Nodular scars could evolve into fibrotic scars, and cavitary scars could evolve into nodular scars.
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Affiliation(s)
- Paul Habert
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Mathieu Di Bisceglie
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Axel Bartoli
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,Centre d'exploration métabolique par résonnance magnétique CEMEREM, Aix-Marseille Université, Marseille, France
| | - Alexis Jacquier
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,Centre d'exploration métabolique par résonnance magnétique CEMEREM, Aix-Marseille Université, Marseille, France
| | - Pauline Brige
- LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Vincent Vidal
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Jean-François Hak
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Farouk Tradi
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Jean-Yves Gaubert
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
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Habert P, Tradi F, Greillier L, Gaubert JY. Successful Lung Cryoablation for a Bulky Lung Carcinoma. J Vasc Interv Radiol 2021; 32:610. [PMID: 33795075 DOI: 10.1016/j.jvir.2020.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 10/21/2022] Open
Affiliation(s)
- Paul Habert
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Univ, LIIE, and Aix Marseille Univ, CERIMED, Marseille, France.
| | - Farouk Tradi
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Univ, LIIE, and Aix Marseille Univ, CERIMED, Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and et Thérapeutic Innovations Department, Aix Marseille Univ, AP-HM, INSERM, CNRS, CRCM, Marseille, France
| | - Jean-Yves Gaubert
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Univ, LIIE, and Aix Marseille Univ, CERIMED, Marseille, France
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22
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Sapoval M, Vidal V, Déan C, Del Giudice C, Tradi F, Chevallier O, Charles-Nelson A, Pellerin O, Loffroy R. Safety and Efficacy of Peripheral Embolization with EASYX Liquid Embolic Agent: A Multicenter Prospective Study. J Vasc Interv Radiol 2021; 32:1136-1143. [PMID: 34098072 DOI: 10.1016/j.jvir.2021.05.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the clinical safety and efficacy of EASYX, a new nonadhesive precipitating liquid embolic agent based on a polyvinyl alcohol ether polymer labeled with iodine molecules, for peripheral embolization. MATERIALS AND METHODS This open-label prospective multicenter study was conducted on 50 consecutive patients treated with embolization using EASYX in 3 academic hospitals from April 2018 to July 2019. Indications for embolization were symptomatic varicocele (n = 15), type II endoleak (n = 8), acute hemorrhage (n = 16), portal vein embolization (PVE; n = 9), or angiomyolipoma (AML; n = 2). Patient characteristics, technical and clinical success rates, pain at injection, and satisfaction of the interventional radiologists were assessed. Follow-up imaging was performed using ultrasound for varicoceles (at 1 month) and computed tomography (CT) for the other indications (at 3 or 6 months). RESULTS The immediate technical success rate was 98%. The clinical success rates were 100% for acute hemorrhage and type II endoleaks, 89% for PVE, 86% for varicoceles, and 50% for AMLs. Patients who underwent PVE showed significant hypertrophy of the future liver remnant at follow-up (P < .001), and 55.6% of patients proceeded to hepatectomy. The absence of artifacts on imaging allowed improved monitoring of the aneurysmal sac in patients with type II endoleaks. The satisfaction rate of the interventional radiologists was >90% for 5 of 7 items. CONCLUSIONS EASYX as a novel copolymer liquid embolic agent was safe and efficient for peripheral embolization. The absence of tantalum allowed reduced CT artifacts on imaging follow-up, which was especially useful in patients with type II endoleaks.
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Affiliation(s)
- Marc Sapoval
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France; LiiE, Aix Marseille University, Marseille, France; CERIMED, Aix Marseille University, Marseille, France
| | - Carole Déan
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Costantino Del Giudice
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Farouk Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France; LiiE, Aix Marseille University, Marseille, France; CERIMED, Aix Marseille University, Marseille, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Anaïs Charles-Nelson
- Unité d'Épidémiologie et de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, Paris, France
| | - Oliver Pellerin
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
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23
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Di Bisceglie M, Hak JF, Diop AD, Salazar G, Brige P, Panneau J, Tradi F, Habert P, Campion JY, Diop AN, Soulez G, Guillet B, Vidal V. FairEmbo Concept for Arterial Embolizations: In Vivo Feasibility and Safety Study with Suture-Based Microparticles Compared with Microspheres. Cardiovasc Intervent Radiol 2020; 44:625-632. [PMID: 33099701 DOI: 10.1007/s00270-020-02678-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/03/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Microspheres are effective embolic agents, especially for the management of bleeding and oncologic lesions. The first FairEmbo study reported the effectiveness of embolization using suture fragments. The effectiveness and safety of arterial embolization with suture-based microparticles (SBM) were assessed in a swine model. MATERIALS AND METHODS In this ethical-approved animal study, a polar artery in each kidney was embolized in four swine: one side with hand-cut non-absorbable SBM (Flexocrin 2®) and the contralateral side with Embozene® 900 for comparison. Swine were followed for 3 months (M3) to evaluate the effectiveness and the safety of SBM. Follow-up protocol included clinical monitoring, computed tomography (CT) control and digital subtraction angiography (DSA), followed by histological analyses. The SBM confection parameters were evaluated by automatic microscopic sizer. RStudio software and Mann-Whitney test (significance at P < 0.05) were used for statistics. RESULTS The average size of SBM was 1002 μm (SD = 258). All targets were effectively embolized by SBM with an angiogram defect estimated at 45.6% (95% CI [35.9-55.2]), compared to 40.5% (95% CI [30.6-55.5]) for Embozene® group (P = 0.342). The average duration of SBM embolization procedure was significantly increased compared to Embozene® embolization (1202 s versus 222 s, P = 0.029). There were no statistical differences in M3 DSA and CT for SBM and Embozene®, with persistence of partial arterial occlusion and atrophic embolized area. No postoperative complications were observed on clinical and CT controls. CONCLUSION This experimental study suggests that embolization with SBM is feasible, safe and effective in short- and medium-term follow-up as compared to microspheres.
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Affiliation(s)
- Mathieu Di Bisceglie
- Interventional Radiololy Section, Department of Medical Imaging, University Hospital Timone, APHM, Marseille, France.
- LiiE, Aix Marseille University, Marseille, France.
- CERIMED, Aix Marseille University, 27 Bd Jean Moulin 13005, Marseille, France.
| | - Jean-Francois Hak
- Interventional Radiololy Section, Department of Medical Imaging, University Hospital Timone, APHM, Marseille, France
- LiiE, Aix Marseille University, Marseille, France
- CERIMED, Aix Marseille University, 27 Bd Jean Moulin 13005, Marseille, France
| | - Abdoulaye Dione Diop
- Diagnostic and Medical Imaging Center, Fann National University Hospital Center, 5035, Dakar, Senegal
| | - Gloria Salazar
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Pauline Brige
- LiiE, Aix Marseille University, Marseille, France
- CERIMED, Aix Marseille University, 27 Bd Jean Moulin 13005, Marseille, France
| | - Julien Panneau
- Interventional Radiololy Section, Department of Medical Imaging, University Hospital Timone, APHM, Marseille, France
- LiiE, Aix Marseille University, Marseille, France
- CERIMED, Aix Marseille University, 27 Bd Jean Moulin 13005, Marseille, France
| | - Farouk Tradi
- Interventional Radiololy Section, Department of Medical Imaging, University Hospital Timone, APHM, Marseille, France
- LiiE, Aix Marseille University, Marseille, France
- CERIMED, Aix Marseille University, 27 Bd Jean Moulin 13005, Marseille, France
- Department of Radiology, University Hospital Center of Montreal, Montreal, Canada
| | - Paul Habert
- Interventional Radiololy Section, Department of Medical Imaging, University Hospital Timone, APHM, Marseille, France
- LiiE, Aix Marseille University, Marseille, France
- CERIMED, Aix Marseille University, 27 Bd Jean Moulin 13005, Marseille, France
| | | | | | - Gilles Soulez
- Department of Radiology, University Hospital Center of Montreal, Montreal, Canada
| | - Benjamin Guillet
- CERIMED, Aix Marseille University, 27 Bd Jean Moulin 13005, Marseille, France
- INSERM1263, INRA 1260, C2VN, Aix Marseille University, Marseille, France
- Department of Radiopharmacy, APHM, Marseille, France
| | - Vincent Vidal
- Interventional Radiololy Section, Department of Medical Imaging, University Hospital Timone, APHM, Marseille, France
- LiiE, Aix Marseille University, Marseille, France
- CERIMED, Aix Marseille University, 27 Bd Jean Moulin 13005, Marseille, France
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Habert P, Capron T, Hubert S, Bentatou Z, Bartoli A, Tradi F, Renard S, Rapacchi S, Guye M, Bernard M, Habib G, Jacquier A. Quantification of right ventricular extracellular volume in pulmonary hypertension using cardiac magnetic resonance imaging. Diagn Interv Imaging 2020; 101:311-320. [DOI: 10.1016/j.diii.2019.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/30/2022]
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Izaaryene J, Tradi F, Vidal V, Bartoli JM, Delarue A, Petit P. Transjugular intrahepatic portosystemic shunt placement in an infant weighing less than 22 pounds. Diagn Interv Imaging 2020; 101:685-687. [PMID: 32307283 DOI: 10.1016/j.diii.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- J Izaaryene
- Department of Radiology, Hopital de la Timone, 13005 Marseille, France; University of-Aix Marseille, Jardin du Pharo, 13007 Marseille, France.
| | - F Tradi
- Department of Radiology, Hopital de la Timone, 13005 Marseille, France; University of-Aix Marseille, Jardin du Pharo, 13007 Marseille, France
| | - V Vidal
- Department of Radiology, Hopital de la Timone, 13005 Marseille, France; University of-Aix Marseille, Jardin du Pharo, 13007 Marseille, France
| | - J-M Bartoli
- Department of Radiology, Hopital de la Timone, 13005 Marseille, France; University of-Aix Marseille, Jardin du Pharo, 13007 Marseille, France
| | - A Delarue
- University of-Aix Marseille, Jardin du Pharo, 13007 Marseille, France; Department of Pediatric Surgery, Hopital de la Timone, 13005 Marseille, France
| | - P Petit
- Department of Radiology, Hopital de la Timone, 13005 Marseille, France; University of-Aix Marseille, Jardin du Pharo, 13007 Marseille, France
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Donghi V, Tradi F, Carbone A, Viala M, Gaubert G, Nguyen K, Reant P, Donal E, Eicher JC, Selton-Suty C, Huttin O, Resseguier N, Michel N, Guazzi M, Jacquier A, Habib G. Left-ventricular non-compaction-comparison between different techniques of quantification of trabeculations: Should the diagnostic thresholds be modified? Arch Cardiovasc Dis 2020; 113:321-331. [PMID: 32249166 DOI: 10.1016/j.acvd.2020.01.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diagnosis of left ventricular non-compaction (LVNC) is challenging, and different imaging techniques propose different criteria. AIM To compare the value of two-dimensional transthoracic echocardiography (2D-TTE) and cardiac magnetic resonance (CMR) criteria in diagnosing LVNC, and to test a new trabecular quantification method obtained by 2D-TTE, exploring its relationship with CMR non-compacted mass quantification. METHODS From a multicentre French study, we selected 48 patients with LVNC and 20 with dilated cardiomyopathy (DCM) who underwent 2D-TTE and CMR. Current 2D-TTE (Jenni et al.) and CMR criteria (Petersen et al., Jacquier et al.), were tested. A new 2D-TTE method of trabecular quantification (percentage of trabecular area) was also proposed, and compared with current criteria. RESULTS The best cut-off values for the diagnosis of LVNC were a non-compacted/compacted ratio≥2.3 (Petersen et al.), a trabeculated left ventricular mass≥20% (Jacquier et al.) and a non-compacted/compacted ratio≥1.8 (Jenni et al.). Lowering the threshold for the criterion of Jenni et al. from>2 to ≥1.8 improved its sensitivity from 69% to 98%. The 2D-TTE percentage of trabecular area was 25.9±8% in the LVNC group vs. 9.9±4.4% in the DCM group (P<0.05), and was well correlated with CMR non-compacted mass (r=0.65; P<0.05). A 15.8% threshold value for 2D-TTE percentage of trabecular area predicted LVNC diagnosis with a specificity of 95% and a sensitivity of 92%; its sensitivity was better than that for the criteria of Jenni et al. (P<0.01) and Petersen et al. (P=0.03). CONCLUSIONS Revision of the current threshold for the criterion of Jenni et al. from>2 to ≥1.8 is necessary to improve LVNC diagnosis in patients with left ventricular dysfunction. A new 2D-TTE trabecular quantification method improves TTE diagnosis of LVNC.
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Affiliation(s)
- Valeria Donghi
- Cardiology Department, La Timone Hospital, AP-HM, 13005 Marseille France; Heart Failure Unit, IRCCS Policlinico San Donato, University of Milan, 20097 San Donato Milinese, Milan, Italy
| | - Farouk Tradi
- Radiology Department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Andreina Carbone
- Cardiology Department, La Timone Hospital, AP-HM, 13005 Marseille France
| | - Marie Viala
- Cardiology Department, La Timone Hospital, AP-HM, 13005 Marseille France
| | | | - Karine Nguyen
- Departement de Genetique Medicale, La Timone Hospital, AP-HM, inserm, UMR_S 910, 13005 Marseille, France
| | | | - Erwan Donal
- Service de Cardiologie, Centre Hospitalier Regional Universitaire Pontchaillou, 35000 Rennes, France
| | - Jean-Christophe Eicher
- Service de Cardiologie, CHU Dijon Bourgogne - Hopital Francois Mitterrand, 21000 Dijon, France
| | - Christine Selton-Suty
- Service de Cardiologie, CHRU de Nancy - Hopitaux de Brabois, 54500 Vandoeuvre-lès- Nancy, France
| | - Olivier Huttin
- Service de Cardiologie, CHRU de Nancy - Hopitaux de Brabois, 54500 Vandoeuvre-lès- Nancy, France
| | | | - Nicolas Michel
- Cardiology Department, La Timone Hospital, AP-HM, 13005 Marseille France
| | - Marco Guazzi
- Heart Failure Unit, IRCCS Policlinico San Donato, University of Milan, 20097 San Donato Milinese, Milan, Italy
| | - Alexis Jacquier
- Radiology Department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Gilbert Habib
- Cardiology Department, La Timone Hospital, AP-HM, 13005 Marseille France; Aix Marseille Université, IRD, APHM, MEPHI, IHU - Méditerranée Infection, 13005 Marseille, France.
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Grange R, Tradi F, Izaaryene J, Daidj N, Brunelle S, Walz J, Gravis G, Piana G. Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes. Int J Hyperthermia 2020; 36:1065-1071. [PMID: 31648584 DOI: 10.1080/02656736.2019.1675913] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 01/20/2023] Open
Abstract
Purpose: To evaluate the safety, functional and oncological outcomes associated with percutaneous cryoablation of stage T1b renal cell carcinoma (RCC). Materials and methods: Institutional database was reviewed to identify patients treated by percutaneous CT-guidance cryoablation between 2013 and 2018 for biopsy-proven RCC tumors measuring 4.1-7.0 cm. The main outcome parameters analyzed were primary and secondary technique efficacy, progression-free survival (PFS), cancer-specific survival (CSS), loss of estimated glomerular filtration rate (eGFR) and complications. PFS and CSS were estimated by the Kaplan-Meier method. Complications were graded by the Clavien-Dindo system. Results: Twenty-three consecutive patients were included (mean tumor diameter: 45.6 ± 6.2 mm; mean RENAL score: 8.1 ± 1.8). The technical success rate was 95.7%. Primary and secondary technique efficacy rates were 86.3 and 100%, respectively. Three patients found to have incomplete ablations at 3 months were successfully treated by repeat cryoablation. Median duration follow-up was 11 months (range: 3-33). Imaging showed PFS to be 85.7% at 6 months, 66.7% at 12 months and 66.7% at 24 months. One patient with a local recurrence at 12 months was treated by radical nephrectomy. One patient died from progression of disease within 12 months. One patient reported a complication grade ≥ II (4.3%). Mean eGFR loss was 4.4 ± 8.5 ml/min/1.73m2, which was significantly higher among those treated for central tumors (p < .05). Conclusion: Cryoablation for stage T1b renal tumors is technically feasible, with favorable oncological and perioperative outcomes. Longer-term studies are needed to verify our findings.
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Affiliation(s)
- Rémi Grange
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Farouk Tradi
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Jean Izaaryene
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Nassima Daidj
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes , Marseille , France
| | - Gwenaëlle Gravis
- Department of Oncology, Institut Paoli-Calmettes , Marseille , France
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
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Di Bisceglie M, Hak J, Brige P, Tradi F, Bartoli J, Jacquier A, Moulin G, Guillet B, Vidal V. Abstract No. 404 Safety and efficacy of arterial embolization with permanent suture micro particles: the FAIR-Embo concept. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Habert P, Hak JF, Di Bisceglie M, Bartoli A, Gaubert JY, Vidal V, Tradi F. [Central venous access in interventional radiology]. Presse Med 2019; 48:1141-1145. [PMID: 31669005 DOI: 10.1016/j.lpm.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022] Open
Abstract
Some patients require iteratives intravenous administrations on a central catheter, for example in oncology or infectiology, which represents a challenge for ambulatory treatment. Interventional radiology could provide solutions with the implant and monitoring of PICC-lines and ports. These are implanted in sterile environment and under imaging guidance in an interventional radiology room by an operator and with a paramedical team that need to be experienced. This development focus on the interest of one method with respect to the other, as well as the differents ways to do, the complications that could arise and the monitoring of these devices.
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Affiliation(s)
- Paul Habert
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France.
| | - Jean-François Hak
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Mathieu Di Bisceglie
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Axel Bartoli
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Jean-Yves Gaubert
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Vincent Vidal
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Farouk Tradi
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
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Vidal V, Hak JF, Brige P, Chopinet S, Tradi F, Bobot M, Gach P, Haffner A, Soulez G, Jacquier A, Moulin G, Bartoli JM, Guillet B. In Vivo Feasibility of Arterial Embolization with Permanent and Absorbable Suture: The FAIR-Embo Concept. Cardiovasc Intervent Radiol 2019; 42:1175-1182. [PMID: 31025052 DOI: 10.1007/s00270-019-02211-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Arterial embolization has been shown to be effective and safe for the management of bleeding, especially for postpartum and pelvic traumatic bleeding. We propose to evaluate the proof of concept of feasibility and effectiveness of arterial embolization with absorbable and non-absorbable sutures in a porcine model. MATERIALS AND METHODS In the acute setting (n = 1), several different arteries (mesenteric, splenic, pharyngeal, kidney) were embolized using non-absorbable sutures (NAS): Mersutures™ braided sutures (polyethylene terephthalate). In the chronic setting (n = 3), only lower pole renal arteries were embolized. On the right side, NAS was used, whereas on the left side embolization was realized with absorbable suture (AS): Vicryl® braided suture (polyglactin 910). The chronic group was followed for 3 months. The pigs received contrast-enhanced CT the day before embolization (D-1), after the embolization (D0), at 1 month and 3 months after embolization (M1 and M3); digital subtraction angiography (DSA) was done at D0 and M3 and histological analysis at M3. RESULTS All vascular targets were effectively embolized without any pre- or postoperative complications. Both DSAs and CTs at M3 showed a 100% recanalization rate for the AS embolization and a partial reversal rate for the NAS embolization. A renal hypotrophy in the embolized region was observed during both the M1 and M3 scans for both sutures (AS and NAS) with a clear hypotrophy for the NAS embolized kidney. CONCLUSION Embolization by AS and NAS (FAIR-Embo) is a feasible and effective treatment which opens up the possibility of global use of this inexpensive and widely available embolization agent.
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Affiliation(s)
- V Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. .,LIIE, Aix Marseille Univ, Marseille, France. .,CERIMED, Aix Marseille Univ, Marseille, France.
| | - J F Hak
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. .,LIIE, Aix Marseille Univ, Marseille, France. .,CERIMED, Aix Marseille Univ, Marseille, France.
| | - P Brige
- LIIE, Aix Marseille Univ, Marseille, France.,CERIMED, Aix Marseille Univ, Marseille, France
| | - S Chopinet
- LIIE, Aix Marseille Univ, Marseille, France.,CERIMED, Aix Marseille Univ, Marseille, France.,Department of Digestive Surgery, University Hospital Timone APHM, Marseille, France
| | - F Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France.,LIIE, Aix Marseille Univ, Marseille, France.,CERIMED, Aix Marseille Univ, Marseille, France
| | - M Bobot
- CERIMED, Aix Marseille Univ, Marseille, France.,Department of Nephrology, University Hospital Conception APHM, Marseille, France.,INSERM 1263, INRA 1260, C2VN, Aix Marseille Univ, Marseille, France
| | - P Gach
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France.,LIIE, Aix Marseille Univ, Marseille, France.,CERIMED, Aix Marseille Univ, Marseille, France
| | - A Haffner
- Department of Pathological Anatomy, University Hospital Timone APHM, Marseille, France
| | - G Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East, Montreal, H2L 4M1, Canada
| | - A Jacquier
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France
| | - G Moulin
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France
| | - J M Bartoli
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France
| | - B Guillet
- CERIMED, Aix Marseille Univ, Marseille, France.,INSERM 1263, INRA 1260, C2VN, Aix Marseille Univ, Marseille, France.,Department of Radiopharmacy, APHM, Marseille, France
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Tradi F, Mege D, Louis G, Bartoli JM, Sielezneff I, Vidal V. Emborrhoïd : traitement des hémorroïdes par embolisation des artères rectales. Presse Med 2019; 48:454-459. [DOI: 10.1016/j.lpm.2019.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 01/01/2023] Open
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Barral PA, Saeed-Kilani M, Tradi F, Dabadie A, Izaaryene J, Soussan J, Bartoli JM, Vidal V. Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations. Diagn Interv Imaging 2017; 98:415-421. [DOI: 10.1016/j.diii.2016.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/05/2016] [Accepted: 09/17/2016] [Indexed: 12/11/2022]
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Moussa N, Sielezneff I, Sapoval M, Tradi F, Del Giudice C, Fathallah N, Pellerin O, Amouyal G, Pereira H, de Parades V, Vidal V. Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease. Colorectal Dis 2017; 19:194-199. [PMID: 27338153 DOI: 10.1111/codi.13430] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/09/2016] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to assess the safety and efficacy of the emborrhoid technique (embolization of the superior haemorrhoidal arteries) in patients ineligible for surgery. METHODS Between January 2014 and April 2015, 30 consecutive patients (average age 58 years) suffering from disabling chronic bleeding due to haemorrhoidal disease and with a contraindication for surgery (n = 23) or with a failure of instrumental or surgical treatment (n = 7) underwent embolization. All cases were discussed at multidisciplinary meetings including a proctology specialist or a surgeon and an interventional radiologist. We performed super selective micro coil embolization (pushable 2-3 mm fibre coils) of the distal branches of the superior rectal arteries with a microcatheter, via a right femoral approach, under local anaesthesia. We assessed clinical outcome by evaluating bleeding and specific clinical scores relating to bleeding and changes in quality of life. RESULTS Immediate technical success, with no complication, was achieved in 93% of cases. A mean of 3.1 arteries per patient was embolized, with a mean of 7.6 coils per patient. Median follow-up was 5 months. Clinical score improvement was observed in 72%, in 17 patients after a single embolization session, and in four additional patients after a second embolization session. No improvement in bleeding was observed in eight patients (28%). CONCLUSION Distal coil embolization of the superior rectal arteries for disabling chronic bleeding due to haemorrhoidal disease is safe and effective in patients untreatable by surgery.
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Affiliation(s)
- N Moussa
- Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.,Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France
| | - I Sielezneff
- Department of Digestive and General Surgery, La Timone Hospital, Marseille, France.,Aix-Marseille University, Marseille, France.,INSERM, UMR-S 1076 VRCM (Vascular Research Centre of Marseille), Marseille, France
| | - M Sapoval
- Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.,Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France.,INSERM U970, Paris, France
| | - F Tradi
- Aix-Marseille University, Marseille, France.,Department of Radiology, La Timone Hospital, Marseille, France
| | - C Del Giudice
- Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.,Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France
| | - N Fathallah
- Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.,Assistance Publique - Hôpitaux de Paris, Georges Pompidou European Hospital, Gastro-enterology Department, Paris, France
| | - O Pellerin
- Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.,Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France.,INSERM U970, Paris, France
| | - G Amouyal
- Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.,Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France
| | - H Pereira
- Assistance Publique - Hôpitaux de Paris, Georges Pompidou European Hospital, Unité d'Épidémiologie et de Recherche Clinique, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, Module d'Épidémiologie Clinique, Paris, France
| | - V de Parades
- Department of Proctology, Saint Joseph Hospital, Paris, France
| | - V Vidal
- Aix-Marseille University, Marseille, France.,Department of Radiology, La Timone Hospital, Marseille, France
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Zakharchenko A, Kaitoukov Y, Vinnik Y, Tradi F, Sapoval M, Sielezneff I, Galkin E, Vidal V. Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique). Diagn Interv Imaging 2016; 97:1079-1084. [PMID: 27597728 DOI: 10.1016/j.diii.2016.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 04/14/2016] [Revised: 06/23/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to comprehensively evaluate the short-term outcomes after percutaneous embolization of the superior rectal artery (SRA) with metallic coils and particles for the management of hemorrhoids. MATERIALS AND METHODS Forty patients (15 men, 25 women) with a mean age of 35±5 years (SD) (range: 25-65 years) were prospectively enrolled. All patients had symptomatic hemorrhoids. The distribution of internal hemorrhoids was as follows: grade I (n=6, 16%); grade II (n=28, 69%) and grade III (n=6; 15%). All patients had percutaneous embolization of the SRA with metallic coils and synthetic polyvinyl alcohol particles. Follow-up evaluation included clinical examination, rectoscopy, histopathological analysis of rectal mucosa, duplex Doppler blood flow quantification, electromyography, sphincterometry of the anal sphincter and analysis of patient satisfaction. RESULTS No immediate complications were observed and no patients had anal pain syndrome after embolization. Hemorrhoids showed a 43% size reduction after embolization (P<0.05). Taking into account the symptom resolutions such as irritation, discomfort, bloody discharge and pain, satisfaction was observed in 5/6 (83%) patients with grade III hemorrhoids and 32/34 patients (94%) with grades I-II hemorrhoids. One month after embolization, anal sphincter contractility normalized and no changes in anal electromyography were observed. Blood flow in the hemorrhoidal plexus dropped from 109±1.2ml/min/100g (SD) before treatment to 60.2±4.4ml/min/100g (SD) (P<0.05) the day after embolization and remained unchanged one month after embolization. CONCLUSION Our study demonstrates that embolization of SRA with particle and coils does not lead to ischemia in patients with symptomatic hemorrhoids. Short-term results with regard to symptom management for hemorrhoidal disease are very encouraging and should stimulate further prospective and multicenter studies.
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Affiliation(s)
- A Zakharchenko
- Department of general surgery, Krasnoyarsk state medical university, Krasnoyarsk Railwey clinical hospital, Krasnoyarsk, Russia
| | - Y Kaitoukov
- Department of diagnostic radiology and radio-oncology, centre hospitalier de l'université de Montréal, Montreal, Canada
| | - Y Vinnik
- Department of general surgery, Krasnoyarsk state medical university, Krasnoyarsk Railwey clinical hospital, Krasnoyarsk, Russia
| | - F Tradi
- Department of vascular and interventional radiology, hôpital de la Timone, 13005 Marseille, France
| | - M Sapoval
- Department of interventional radiology, hôpital Georges-Pompidou, 75015 Paris, France
| | - I Sielezneff
- Department of visceral surgery, Aix-Marseille university, hôpital de la Timone, 13005 Marseille, France
| | - E Galkin
- Department of vascular surgery and interventional radiology, Siberian clinical center FMBA, Krasnoyarsk, Russia
| | - V Vidal
- Department of vascular and interventional radiology, hôpital de la Timone, 13005 Marseille, France.
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Tradi F, Vidal V, Bartoli J. Rectal artery embolizaton for hemorrhoidal disease:mechanisms of action. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Vidal V, Sapoval M, Sielezneff Y, De Parades V, Tradi F, Louis G, Bartoli JM, Pellerin O. Emborrhoid: a new concept for the treatment of hemorrhoids with arterial embolization: the first 14 cases. Cardiovasc Intervent Radiol 2014; 38:72-8. [PMID: 25366092 DOI: 10.1007/s00270-014-1017-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 07/29/2014] [Accepted: 10/09/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE The 'emborrhoid' technique consists of the embolization of the hemorrhoidal arteries. The endovascular arterial occlusion is performed using coils placed in the terminal branches of the superior rectal arteries. The emborrhoid technique has been modeled after elective transanal Doppler-guided hemorrhoidal artery ligation which has been shown to be effective in hemorrhoidal disease. We report the first 14 cases of our experience with emborrhoid technique. MATERIALS AND METHODS Fourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique (3 women, 11 men). The stage of the hemorrhoidal disease was II (10 patients), III (3), and IV (1). This treatment was decided by a multidisciplinary team (proctologist, visceral surgeon, and radiologist). Seven patients underwent previous proctological surgery. Ten patients had coagulation disorders (anticoagulants or cirrhosis). Superior rectal arteries were embolized with pushable microcoils (0.018). RESULTS Technical success of the embolization procedure was 100 %. Clinical success at 1 month was 72 % (10/14). Of the 4 patients who experienced rebleeding, two underwent additional embolization of the posterior rectal arteries with success. No pain or ischemic complications were observed in 13 patients. One patient experienced a temporary painful and edematous, perianal reaction. CONCLUSION Our case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new 'emborrhoid' technique in the management of hemorrhoidal disease.
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Affiliation(s)
- V Vidal
- Department of Radiology, Hôpital de la Timone, 264 rue Saint Pierre, 13385, Marseille, Cedex 05, France,
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