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Galastri FL, Valle LGM, Cunha MJS, Schmid BP, Garcia RG, Lewi DS, Affonso BB, Nasser F. A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient. J Vasc Bras 2023; 22:e20230018. [PMID: 38021280 PMCID: PMC10647909 DOI: 10.1590/1677-5449.202300182] [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: 02/12/2023] [Accepted: 05/09/2023] [Indexed: 12/01/2023] Open
Abstract
A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.
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Affiliation(s)
| | | | | | | | | | | | | | - Felipe Nasser
- Hospital Israelita Albert Einstein – HIAE, São Paulo, SP, Brasil.
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2
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Schmid BP, Gilberto GM, Cunha MJS, Valle LGM, Foronda G, Arrieta SR, Nasser F, Garcia RG. The essential role of thoracic duct embolization in management of traumatic iatrogenic chylothorax. J Vasc Bras 2023; 22:e20230101. [PMID: 38021278 PMCID: PMC10647881 DOI: 10.1590/1677-5449.20230101] [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: 06/27/2023] [Accepted: 08/10/2023] [Indexed: 12/01/2023] Open
Abstract
This study aims to describe a case series of patients who underwent thoracic duct embolization (TDE) to treat traumatic iatrogenic chylothorax (TIC). Three patients were included: Case #1, a 49-year-old woman with follicular lymphoma developed a TIC following video-assisted thoracoscopic surgery to resect a solid right paravertebral mass and was treated with TDE using microcoils and N-butyl cyanoacrylate (NBCA) glue. Case #2, a 68-year-old man with cardiac amyloidosis developed a TIC following heart transplantation and was treated with TDE using microcoils and ethylene vinyl alcohol copolymer. Case#3: A 6-year-old patient with congenital heart disease developed a TIC following a Fontan procedure and was treated with TDE using NBCA glue. All lesions were identified during lymphangiography and TDE was successfully performed in all cases. TDE is a safe and valuable technique that provides minimally invasive treatment for TCI.
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Affiliation(s)
| | | | | | | | - Gustavo Foronda
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil.
| | | | - Felipe Nasser
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil.
- Hospital Santa Marcelina, São Paulo, SP, Brasil.
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3
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Valle LGM, Cunha MJS, Schmid BP, Falsarella PM, de Rezende MB, Felga GEG, Ogawa RE, Garcia RG, Affonso BB, Nasser F, Galastri FL. Radiological characteristics of hepatocellular carcinoma that achieved complete response after chemoembolization with drug-eluting beads for liver transplantation planning. Einstein (Sao Paulo) 2023; 21:eAO0307. [PMID: 37909650 PMCID: PMC10586851 DOI: 10.31744/einstein_journal/2023ao0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/22/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To describe the radiological characteristics of hepatocellular carcinoma (HCC) lesions that achieved a complete response following drug-eluting bead transarterial chemoembolization (DEB-TACE) preceding liver transplantation. METHODS This single-center case-control study enrolled patients with hepatocellular carcinoma who underwent neoadjuvant DEB-TACE therapy, were followed up with contrast-enhanced magnetic resonance imaging or computed tomography, and were successively evaluated according to the modified Response Evaluation Criteria in Solid Tumors. The HCCs were divided into two groups based on their diameter (Group A: ≤3cm; Group B: 3cm). Viability was assessed using the Kaplan-Meier method according to tumor size categories. The relationship between tumor variables was analyzed using bivariate Cox regression. RESULTS Three-hundred and twenty-eight patients with 667 hepatocellular carcinomas who underwent their first DEB-TACE session were enrolled. A total of 105 hepatocellular carcinomas in 59 patients exhibited complete response after the initial DEB-TACE session and were divided into Group A (92 HCCs) and Group B (13 HCCs). The diameter in Group A decreased significantly compared to the pre-procedure size until the second assessment (p<0.001), with no subsequent reduction in diameter, despite maintaining a complete response. In Group B, the reduction in diameter remained significant compared with the initial value until the sixth imaging evaluation (p=0.014). The average reduction was 45.1% for Group B and a maximum of 14.9% in Group A. CONCLUSION HCCs >3cm exhibited a greater reduction in size and a longer time to recurrence. HCCs ≤3cm had a shorter relapse time. The recurrence rates were similar. These findings may aid in planning for liver transplantation.
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Affiliation(s)
| | - Marcela Juliano Silva Cunha
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Bruno Pagnin Schmid
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Priscila Mina Falsarella
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Marcelo Bruno de Rezende
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Renata Emy Ogawa
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Rodrigo Gobbo Garcia
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Breno Boueri Affonso
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Felipe Nasser
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Francisco Leonardo Galastri
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Schmid BP, Silva Cunha MJ, Moreira Valle LG, Galastri FL, Affonso BB, Falsarella PM, Kaliks Guendelmann RA, Garcia RG, Nasser F. Transarterial Selective Internal Radiation Therapy with Yttrium-90 for Liver Metastatic Urothelial Carcinoma of the Ureter as a Bridging Therapy to Immunotherapy: A Case Report with a 10-Year Follow-Up. Case Rep Oncol 2023; 16:711-717. [PMID: 37933309 PMCID: PMC10625822 DOI: 10.1159/000531787] [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: 09/26/2022] [Accepted: 06/16/2023] [Indexed: 11/08/2023] Open
Abstract
Primary transitional cell carcinoma of the ureter is a rare type of cancer with metastasis presented in approximately 25% at diagnosis. Due to its rarity and poor prognosis, the management of this neoplasm is still controversial, and the development of new therapies is of uttermost importance. Herein, we describe a case of a 54-year-old patient diagnosed with transitional cell carcinoma of the left ureter submitted to left nephroureterectomy (pT3N2M0) and methotrexate, vinblastine, doxorubicin, and cisplatin adjuvant chemotherapy. A single liver metastasis was detected and combination chemotherapy with gemcitabine and carboplatin was initiated along with stereotactic body radiation therapy. Despite these 2 previous chemotherapy regimens, the patient presented disease progression and transarterial selective internal radiation therapy (SIRT) with yttrium-90 was indicated. This locoregional treatment was performed with the administration of 1.2 GBq yttrium-90 resin microspheres (SIR-Spheres®, Sirtex Medical Limited, Sydney, NSW, Australia) into the right hepatic artery. Another systemic treatment was immunotherapy using nivolumab with excellent tolerability. After 10 years of follow-up, at the last clinical evaluation, the patient had no clinical symptoms and the last imaging follow-up using positron emission tomography-computed tomography scan showed complete response. This report introduces upper urinary tract urothelial carcinoma as a distinct type of malignancy in which SIRT can be safely implemented. As a transition method to nivolumab, it was successful. There might be a potential therapeutic synergism between these 2 treatment modalities.
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Affiliation(s)
- Bruno Pagnin Schmid
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | | | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Cunha MJS, da Silva MFA, Souza KP, Affonso BB, Galastri FL, Nasser F, Valle LGM, Garcia RG, Wolosker N. Effects of COVID-19 Outbreak in Image-Guided Biopsies in Brazil: An Epidemiological Study over 13 Years and 2 Million Biopsies. Cardiovasc Intervent Radiol 2022; 45:533-535. [PMID: 35112147 PMCID: PMC8809215 DOI: 10.1007/s00270-022-03062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Marcela Juliano Silva Cunha
- Vascular Surgery Department at Hospital Israelita Albert Einstein, Rua Vapabussu 66 ap 402 Jd Aeroporto CEP, São Paulo, SP, 04632-010, Brazil.
| | | | - Kaue Polizel Souza
- Vascular Surgery Department at Hospital Israelita Albert Einstein, Rua Vapabussu 66 ap 402 Jd Aeroporto CEP, São Paulo, SP, 04632-010, Brazil
| | - Breno Boueri Affonso
- Vascular Surgery Department at Hospital Israelita Albert Einstein, Rua Vapabussu 66 ap 402 Jd Aeroporto CEP, São Paulo, SP, 04632-010, Brazil
| | - Francisco Leonardo Galastri
- Vascular Surgery Department at Hospital Israelita Albert Einstein, Rua Vapabussu 66 ap 402 Jd Aeroporto CEP, São Paulo, SP, 04632-010, Brazil
| | - Felipe Nasser
- Vascular Surgery Department at Hospital Israelita Albert Einstein, Rua Vapabussu 66 ap 402 Jd Aeroporto CEP, São Paulo, SP, 04632-010, Brazil
| | - Leonardo Guedes Moreira Valle
- Vascular Surgery Department at Hospital Israelita Albert Einstein, Rua Vapabussu 66 ap 402 Jd Aeroporto CEP, São Paulo, SP, 04632-010, Brazil
| | - Rodrigo Gobbo Garcia
- Interventional Radiology Department at Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Vascular Surgery Department at Hospital Israelita Albert Einstein, Rua Vapabussu 66 ap 402 Jd Aeroporto CEP, São Paulo, SP, 04632-010, Brazil
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Sanches LP, Rahal Júnior A, Falsarella PM, Carvalho VDO, Valle LGM, Francisco Neto MJ, Garcia RG, Funari MBDG. Caecal appendix lipomatosis in a pregnant patient mimicking acute appendicitis. Einstein (Sao Paulo) 2020; 18:eRC5415. [PMID: 33295432 PMCID: PMC7690936 DOI: 10.31744/einstein_journal/2020rc5415] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/05/2020] [Indexed: 11/11/2022] Open
Abstract
A 34-years-old pregnant woman admitted in the emergency unit complaining about worsening right iliac fossa pain for 2 days. Acute appendicitis was the suspected diagnosis. Laboratory exams were ordered and results were within normal limits for infectious and inflammatory aspects. Ultrasound scan revealed a pregnancy in course without alterations and a thickness of the appendix wall without inflammatory signs in the surrounding tissue. Because the suspicion of acute appendicitis remained, a magnetic resonance was done and confirmed the diagnosis of a cecal appendix lipomatosis.
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Galastri FL, Gilberto GM, Affonso BB, Valle LGM, Falsarella PM, Caixeta AM, Lima CA, Silva MJ, Pinheiro LL, Baptistella CDPA, Almeida MDD, Garcia RG, Wolosker N, Nasser F. Diagnosis and management of hepatic artery in-stent restenosis after liver transplantation by optical coherence tomography: A case report. World J Hepatol 2020; 12:399-405. [PMID: 32821338 PMCID: PMC7407914 DOI: 10.4254/wjh.v12.i7.399] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/02/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous transluminal angioplasty and stenting represent an effective treatment for hepatic artery stenosis after liver transplantation. In the first year after stenting, approximately 22% of patients experience in-stent restenosis, increasing the risk of artery thrombosis and related complications, and 50% experience liver failure. Although angiography is an important tool for diagnosis and the planning of therapeutic interventions, it may raise doubts, especially in small-diameter arteries, and it provides low resolution rates compared with newer intravascular imaging methods, such as optical coherence tomography (OCT).
CASE SUMMARY A 64-year-old male developed hepatic artery stenosis one year after orthotropic liver transplantation and was successfully treated with percutaneous transluminal angioplasty with stenting. Five months later, the Doppler ultrasound results indicated restenosis. Visceral arteriography confirmed hepatic artery tortuosity but was doubtful for significant in-stent restenosis (ISR) and intrahepatic flow reduction. To confirm ISR, identify the etiology and guide treatment, OCT was performed. OCT showed severe stenosis due to four mechanisms: Focal and partial stent fracture, late stent malapposition, in-stent neointimal hyperplasia, and neoatherosclerosis.
CONCLUSION Intravascular diagnostic methods can be useful in evaluating cases in which initial angiography results are not sufficient to provide a proper diagnosis of significant stenosis, especially with regard to ISR. A wide range of diagnoses are provided by OCT, resulting in different treatment options. Interventional radiologists should consider intravascular diagnostic methods as additional tools for evaluating patients when visceral angiography results are unclear.
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Affiliation(s)
| | | | - Breno Boueri Affonso
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | | | - Priscila Mina Falsarella
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | - Adriano Mendes Caixeta
- Hospital Israelita Albert Einstein, Department of Interventional Cardiology, São Paulo 0562900, Brazil
| | - Camila Antunes Lima
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | - Marcela Juliano Silva
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | - Lucas Lembrança Pinheiro
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | | | - Márcio Dias de Almeida
- Hospital Israelita Albert Einstein, Department of Liver Transplant, São Paulo 05652900, Brazil
| | - Rodrigo Gobbo Garcia
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Department of Vascular Surgery, São Paulo 05652-000, Brazil
| | - Felipe Nasser
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
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Galastri FL, Valle LGM, Affonso BB, Silva MJ, Garcia RG, Junior MR, Ferraz LJR, de Matos GFJ, de la Cruz Scarin FC, Nasser F. COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy. VASA 2020; 49:333-337. [DOI: 10.1024/0301-1526/a000880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.
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Affiliation(s)
| | | | - Breno Boueri Affonso
- Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcela Juliano Silva
- Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Gobbo Garcia
- Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | - Felipe Nasser
- Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Carvalho VDO, Galastri FL, Affonso BB, Falsarella PM, Valle LGM, Ferraz-Neto BH, Rezende MBD, Motta-Leal-Filho JMD, Garcia RG, Nasser F. Transarterial radioembolization for liver tumors as neoadjuvant therapy: three case reports. Einstein (São Paulo) 2020; 18:eRC4990. [PMID: 32130329 PMCID: PMC7032884 DOI: 10.31744/einstein_journal/2020rc4990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 10/03/2019] [Indexed: 01/06/2023] Open
Abstract
Transarterial radioembolization (TARE) with yttrium-90 microspheres is a palliative locoregional treatment, minimally invasive for liver tumors. The neoadjuvant aim of this treatment is still controversial, however, selected cases with lesions initially considered unresectable have been enframed as candidates for curative therapy after hepatic transarterial radioembolization. We report three cases in which the hepatic transarterial radioembolization was used as neoadjuvant therapy in an effective way, allowing posterior potentially curative therapies.
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Galastri FL, Nasser F, Affonso BB, Valle LGM, Odísio BC, Motta-Leal Filho JM, Salvalaggio PR, Garcia RG, de Almeida MD, Baroni RH, Wolosker N. Imaging response predictors following drug eluting beads chemoembolization in the neoadjuvant liver transplant treatment of hepatocellular carcinoma. World J Hepatol 2020; 12:21-33. [PMID: 31984118 PMCID: PMC6946627 DOI: 10.4254/wjh.v12.i1.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/02/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Drug-eluting bead transarterial chemoembolization (DEB-TACE) is an endovascular treatment to release chemotherapeutic agents within a target lesion, minimizing systemic exposure and adverse effects to chemotherapeutics. Therefore, identifying which patient characteristics may predict imaging response to DEB-TACE can improve treatment results while selecting the best candidates. Predictors of the response after DEB-TACE still have not been fully elucidated. This is the first prospective study performed with standardized DEB-TACE technique that aim to identify predictors of radiological response, assessing patients clinical and laboratory characteristics, diagnostic imaging and intraprocedure data of the hepatocellular carcinoma treated in the neoadjuvant context for liver transplantation.
AIM To identify pre- and intraoperative clinical and imaging predictors of the radiological response of drug-eluting bead transarterial chemoembolization (DEB-TACE) for the neoadjuvant treatment of hepatocellular carcinoma (HCC).
METHODS This is prospective, cohort study, performed in a single transplant center, from 2011 to 2014. Consecutive patients with HCC considered for liver transplant who underwent DEB-TACE in the first session for downstaging or bridging purposes were recruited. Pre and post-chemoembolization imaging studies were performed by computed tomography or magnetic resonance. The radiological response of each individual HCC was evaluated by objective response using mRECIST and the percentage of necrosis.
RESULTS Two hundred patients with 380 HCCs were examined. Analysis of the objective response (nodule-based analysis) demonstrated that HCC with pseudocapsules had a 2.01 times greater chance of being responders than those without pseudocapsules (P = 0.01), and the addition of every 1mg of chemoembolic agent increased the chance of therapeutic response in 4% (P < 0.001). Analysis of the percentage of necrosis through multiple linear regression revealed that the addition of each 1mg of the chemoembolic agent caused an average increase of 0.65% (P < 0.001) in necrosis in the treated lesion, whereas the hepatocellular carcinoma with pseudocapsules presented 18.27% (P < 0.001) increased necrosis compared to those without pseudocapsules.
CONCLUSION The presence of a pseudocapsule and the addition of the amount of chemoembolic agent increases the chance of an objective response in hepatocellular carcinoma and increases the percentage of tumor necrosis following drug-eluting bead chemoembolization in the neoadjuvant treatment, prior to liver transplantation.
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Affiliation(s)
| | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil
| | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil
| | | | - Bruno Calazans Odísio
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, United States
| | | | - Paolo Rogério Salvalaggio
- Teaching and Research Institute, São Paulo, Brazil, Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil
| | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil
| | - Márcio Dias de Almeida
- Department of Liver Transplant, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Ronaldo Hueb Baroni
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil
| | - Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil
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Affonso BB, Galastri FL, da Motta Leal Filho JM, Nasser F, Falsarella PM, Cavalcante RN, de Almeida MD, Felga GEG, Valle LGM, Wolosker N. Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging. World J Gastroenterol 2019; 25:5687-5701. [PMID: 31602168 PMCID: PMC6785514 DOI: 10.3748/wjg.v25.i37.5687] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prospective study of 200 patients with hepatocellular carcinoma (HCC) that underwent liver transplant (LT) after drug-eluting beads transarterial chemoembolization (DEB-TACE) for downstaging versus bridging. Overall survival and tumor recurrence rates were calculated, eligibility for LT, time on the waiting list and radiological response were compared. After TACE, only patients within Milan Criteria (MC) were transplanted. More patients underwent LT in bridging group. Five-year post-transplant overall survival, recurrence-free survival has no difference between the groups. Complete response was observed more frequently in bridging group. Patients in DS group can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.
AIM To determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging vs bridging.
METHODS Prospective cohort study of 200 patients included from April 2011 through June 2014. Bridging group included patients within MC. Downstaging group (out of MC) was divided in 5 subgroups (G1 to G5). Total tumor diameter was ≤ 8 cm for G1, 2, 3, 4 (n = 42) and was > 8 cm for G5 (n = 22). Downstaging (n = 64) and bridging (n = 136) populations were not significantly different. Overall survival and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, eligibility for LT, time on the waiting list until LT and radiological response were compared.
RESULTS After TACE, only patients within MC were transplanted. More patients underwent LT in bridging group 65.9% (P = 0.001). Downstaging population presented: higher number of nodules 2.81 (P = 0.001); larger total tumor diameter 8.09 (P = 0.001); multifocal HCC 78% (P = 0.001); more post-transplantation recurrence 25% (P = 0.02). Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT (P = 0.005). Median time on the waiting list was significantly longer in downstaging group 10.6 mo (P = 0.028). Five-year post-transplant overall survival was 73.5% in downstaging and 72.3% bridging groups (P = 0.31), and recurrence-free survival was 62.1% in downstaging and 74.8% bridging groups (P = 0.93). Radiological response: complete response was observed more frequently in bridging group (P = 0.004).
CONCLUSION Tumors initially exceeding the MC down-staged after DEB-TACE, can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.
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Affiliation(s)
- Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | - Francisco Leonardo Galastri
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | | | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | - Priscila Mina Falsarella
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | - Rafael Noronha Cavalcante
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | - Marcio Dias de Almeida
- Department of Liver Transplant, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | | | | | - Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
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Valle LGM, Rahal A, Falsarella PM, de Andrade JR, Smaletz O, Osawa A, Garcia RG. Prostate cancer recurrence in vas deferens - fusion image guide as an important tool in dignosis. Int Braz J Urol 2017; 44:192-195. [PMID: 29064653 PMCID: PMC5815551 DOI: 10.1590/s1677-5538.ibju.2017.0071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/17/2017] [Indexed: 11/22/2022] Open
Abstract
The biochemical recurrence after local treatment for prostate cancer is an often challenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites. An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA- 68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence. The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously. High resolution acquired in PET / MR associated with image fusion allows orientation procedures, even in areas of difficult access, with greater accuracy than conventional techniques.
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Affiliation(s)
| | - Antônio Rahal
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Priscila Mina Falsarella
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | | | - Oren Smaletz
- Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Akemi Osawa
- Departamento de Medicina Nuclear e Radiologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Rodrigo Gobbo Garcia
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
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Affiliation(s)
| | - Rafael Dahmer Rocha
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - José Ernesto Succi
- Departamento de Cirurgia Torácica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Valle LGM, Rochal RD, Rahal A, Garcia RG. Percutaneous CT-Guided Ablation in the Hepatic Dome: Artificially Induced Pneumothorax for Safe Transpleural Access. J Clin Imaging Sci 2015; 5:63. [PMID: 26713179 PMCID: PMC4683791 DOI: 10.4103/2156-7514.170732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/06/2015] [Indexed: 11/04/2022] Open
Abstract
Ablative therapies have become a great alternative to surgical treatment of hepatic nodules. Some technical difficulties may negatively influence the effectiveness of this therapy, such as lesions located near the diaphragm. The transthoracic approach is commonly used to access these lesions. However, it is associated with an increased risk of complications, such as pneumothorax, hemothorax, alveolar bleeding, and others. We report a case of a radiofrequency ablation of a lesion in the hepatic dome, where an artificially induced pneumothorax was performed to guarantee a safe and effective access. The air was easily injected by a spinal needle and later aspirated by a single-lumen catheter. Induced pneumothorax shoud be considered in ablation of hepatic dome lesions, mainly when the transhepatic access is not appropriate.
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Affiliation(s)
| | - Rafael Dahmer Rochal
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Antônio Rahal
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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15
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Nasser F, Rocha RD, Falsarella PM, da Motta-Leal-Filho JM, Azevedo AA, Valle LGM, Cavalcante RN, Garcia RG, Affonso BB, Galastri FL. Percutaneous Treatment of Intrahepatic Biliary Leak: A Modified Occlusion Balloon Technique. Cardiovasc Intervent Radiol 2015; 39:773-777. [PMID: 26542028 DOI: 10.1007/s00270-015-1234-9] [Citation(s) in RCA: 3] [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: 07/22/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To report a novel modified occlusion balloon technique to treat biliary leaks. METHODS A 22-year-old female patient underwent liver transplantation with biliary-enteric anastomosis. She developed thrombosis of the common hepatic artery and extensive ischemia in the left hepatic lobe. Resection of segments II and III was performed and a biliary-cutaneous leak originating at the resection plane was identified in the early postoperative period. Initial treatment with percutaneous transhepatic drainage was unsuccessful. Therefore, an angioplasty balloon was coaxially inserted within the biliary drain and positioned close to the leak. RESULTS The fistula output abruptly decreased after the procedure and stopped on the 7th day. At the 3-week follow-up, cholangiography revealed complete resolution of the leakage. CONCLUSION This novel modified occlusion balloon technique was effective and safe. However, greater experience and more cases are necessary to validate the technique.
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Affiliation(s)
- Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Rafael Dahmer Rocha
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil.
| | - Priscila Mina Falsarella
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | | | - André Arantes Azevedo
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Leonardo Guedes Moreira Valle
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Rafael Noronha Cavalcante
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Francisco Leonardo Galastri
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
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Serpa Neto A, Rossi FMB, Valle LGM, Teixeira GK, Rossi M. Relation of uric acid with components of metabolic syndrome before and after Roux-en-Y gastric bypass in morbidly obese subjects. ACTA ACUST UNITED AC 2011; 55:38-45. [DOI: 10.1590/s0004-27302011000100005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 11/16/2010] [Indexed: 02/05/2023]
Abstract
OBJECTIVE: The purpose of the study was to investigate the prevalence of hyperuricemia in morbidly obese subjects before and after Roux-en-Y gastric bypass (RYGBP) and its relationship with metabolic syndrome abnormalities. SUBJECTS AND METHOD: We evaluated 420 morbidly obese patients. Pre and postoperative (8 months after RYGBP) blood samples were drawn. Obese patients underwent laparoscopic RYGBP and after eight months all the tests were repeated. RESULTS: The overall prevalence of hyperuricemia was 34.28%. Hyperuricemia was more common in men than in women (51.72 vs. 29.72%; p = 0.0002). Men with hyperuricemia were more likely to have diabetes (p = 0.034) and more elevated fasting plasma glucose levels (p = 0.027). Women with hyperuricemia were more likely to have hypertension (p = 0.003), metabolic syndrome (p = 0.001), elevated triglycerides (p = 0.001) and GGT (p = 0.009), and decreased HDL (p = 0.011). After surgery, uric acid levels decreased from 5.60 ± 1.28 to 4.23 ± 1.20 (p < 0.0001). The prevalence of hyperuricemia decreased from 33.6% to 6.4% (p < 0.0001), in men from 48.3% to 17.2% (p < 0.0001) and in women from 29.7% to 3.6% (p < 0.0001). CONCLUSION: Concentrations of uric acid were associated with the prevalence of metabolic abnormalities in this sample of morbidly obese patients. Also, weight loss after RYGBP can reduce uric acid levels and the prevalence of hyperuricemia.
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Affiliation(s)
| | | | | | | | - Marçal Rossi
- Sociedade Brasileira de Cirurgia Bariátrica e Metabólica, Brazil
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