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Hussain O, DeGroot A, Treffy R, Bakhaidar M, Zenga J, Shabani S. Large cervical spinal schwannoma requiring anterior and posterior decompression and fusion with careful dissection of the vertebral artery. World Neurosurg 2024:S1878-8750(24)00568-0. [PMID: 38599373 DOI: 10.1016/j.wneu.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
We report a challenging case of a high cervical schwannoma with involvement of the right vertebral artery that could not be sacrificed. We discuss the clinical presentation, surgical approach/techniques, and brief literature review of cervical schwannomas. Our case includes a 58-year-old male referred to neurosurgery due to worsening pain and ataxia, who was found to have a large right sided cervical mass. Early challenges such as C4 vertebral body erosion and vertebral artery encasement were demonstrated on imaging. While vertebral artery endovascular sacrifice was considered[1], a balloon occlusion test elicited significant neurologic deficits for our patient, making potential sacrifice high risk. He underwent resection of the tumor with careful dissection of the tumor off the vertebral artery, thus allowing for its preservation, followed by spinal fixation. Schwannomas are a benign tumor of Schwann Cells and can be insidious in onset with the capability to cause serious neurologic deficits if unchecked[2]. The surgical treatment of such masses is classically done with resection and fixation with instrumentation if necessary[3]. Safe access to the tumor without avulsing nerve roots requires extensive bony resection, often times necessitating facetectomies and pediculectomies[4]. A series evaluating similar tumors determined that the extent of involvement of the vertebral artery predicts the extent of resection[5]. Our case demonstrates the key steps required for dissecting the vertebral artery in order to safely achieve gross total resection. The patient provided consent for treatment and to allow his interesting case to be utilized for scientific review and publication.
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Affiliation(s)
- Omar Hussain
- Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, USA, 53226.
| | - Andrew DeGroot
- Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, USA, 53226
| | - Randall Treffy
- Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, USA, 53226
| | - Mohamad Bakhaidar
- Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, USA, 53226
| | - Joseph Zenga
- Department of Otolaryngology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, USA, 53226
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, USA, 53226
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Bessar AA, Heraiz AI, Ibrahim AG, Salem MMA, Zaitoun MM, Aboelfateh AMK, Gad AH. Prophylactic common iliac artery temporary clamping versus balloon occlusion for management of placenta accreta spectrum disorders: A prospective clinical trial. J Obstet Gynaecol Res 2024; 50:373-380. [PMID: 38109908 DOI: 10.1111/jog.15856] [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: 12/15/2022] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The present study aims to compare prophylactic common iliac artery (CIA) temporary clamping and preoperative balloon occlusion for managing placenta accreta spectrum (PAS) disorders. STUDY DESIGN Between January 2019 and June 2020, 46 patients with PAS disorders were included. Of them, 26 patients were offered CIA balloon occlusion (Group A), while temporary CIA clamping was done for the other 20 patients (Group B). Primary outcomes were procedure-related complications, and secondary outcomes included intraoperative and postoperative complications, reoperation rates, total procedure time, blood loss, and amount of blood transfusion. RESULTS Blood loss was statistically non-significant higher in group B than in group A (p-value = 0.143). Only one patient in group A and three in group B needed reoperation. The bleeding continued for a mean of 1.6 days in group A and 1.7 days in group B, with non-significant statistical differences between both groups p value = 0.71. Nine patients in group A (34.6%) and four in group B (20%) required ICU admission. The mean Apgar score was 7 and 6.6 in babies of group A and group B patients, respectively. The median number of allogeneic blood transfusions performed was two in patients in group A and 1 in group B (p-value = 0.001). CONCLUSION Both techniques offer good choices for patients with PAS to decrease mortality and morbidity rates. The selection of a better technique depends on institutional references and physicians' experience.
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Affiliation(s)
- Ahmed Awad Bessar
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Ismail Heraiz
- Department of Obstetrics and Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Gamil Ibrahim
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud M A Salem
- Department of Vascular Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Moustafa Zaitoun
- Department of Obstetrics and Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Abdalla Hassan Gad
- Department of Obstetrics and Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Warisawa T, Matsumoto T, Katsura A, Ando J. Distal Coronary Flow Assessment During Perfusion Balloon Occlusion in Left Main Coronary Artery in Humans. JACC Cardiovasc Interv 2024:S1936-8798(24)00406-0. [PMID: 38573251 DOI: 10.1016/j.jcin.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024]
Affiliation(s)
| | - Takuya Matsumoto
- Department of Cardiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Aritomo Katsura
- Department of Cardiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Jiro Ando
- Department of Cardiology, NTT Medical Center Tokyo, Tokyo, Japan
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Roberts SH, Zaghloul MS, Ismail U, Rowe RA, Engel C, Meade R, Elizondo-Benedetto S, Genin GM, Zayed MA. In Vivo Porcine Model of Acute Iliocaval Deep Vein Thrombosis. J Endovasc Ther 2024:15266028241231513. [PMID: 38357736 DOI: 10.1177/15266028241231513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
CLINICAL IMPACT The study establishes a rapid, technically straightforward, and reproducible porcine large animal model for acute iliocaval deep vein thrombosis (DVT). The procedure can be performed with basic endovascular skillsets. With its procedural efficiency and consistency, the platform is promising for comparative in vivo testing of venous thrombectomy devices in a living host, and for future verification and validation studies to determine efficacy of novel thrombectomy devices relative to predicates.
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Affiliation(s)
- Sophia H Roberts
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Mohamed S Zaghloul
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | | | - Connor Engel
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rodrigo Meade
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Santiago Elizondo-Benedetto
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Guy M Genin
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Caeli Vascular, Inc., St. Louis, MO, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA
- NSF Science and Technology Center for Engineering Mechanobiology, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardiovascular Research Innovation in Surgery and Engineering Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Caeli Vascular, Inc., St. Louis, MO, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA
- Division of Molecular Cell Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Zhang K, Cheng S, Zhi Y, Lu L, Yi M, Cui S. Application of Uterine Artery Embolization in Patients With Placenta Accreta Spectrum After Abdominal Aortic Balloon Occlusion. Vasc Endovascular Surg 2024:15385744241229596. [PMID: 38252516 DOI: 10.1177/15385744241229596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To evaluate the application of different uterine artery embolization procedures under balloon occlusion of the abdominal aorta in patients with Placenta Accreta Spectrum (PAS) undergoing cesarean section. MATERIALS AND METHODS A retrospective analysis was performed on clinical data from 72 patients who underwent uterine artery embolization for hemostasis during cesarean section with PAS. The patients were divided into two groups according to the embolization method used during surgery: group A (n = 43) underwent uterine artery embolization by withdrawing the balloon and inserting a Cobra catheter into the uterine artery for embolization, while group B (n = 29) underwent uterine artery embolization with a Cobra catheter inserted via contralateral puncture of the femoral artery and balloon occlusion. General information, surgical data, and postoperative recovery were compared between the 2 groups. RESULTS The bleeding and transfusion volumes were lower in group B than in group A and the differences between the 2 groups were statistically significant. There were no significant differences in surgical duration, number of embolized vessels, length of hospital stay, postoperative complications, or menstrual recovery between the 2 groups. CONCLUSION For patients with PAS undergoing cesarean section, uterine artery embolization for hemostasis is preferably performed by inserting a Cobra catheter via contralateral puncture of the femoral artery under abdominal aortic balloon occlusion.
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Affiliation(s)
- Kai Zhang
- Department of Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuqin Cheng
- Department of Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunxiao Zhi
- Department of Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Lu
- Department of Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingsheng Yi
- Department of Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shihong Cui
- Department of Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kim J, Gwon DI, Kim Y, Kim GH, Kim SH, Chu HH, Kim JH, Shin JH, Ko GY, Yoon HK. Preoperative Balloon-Occluded Transcatheter Arterial Chemoembolization Followed by Surgical Resection: Pathological Evaluation of Necrosis. Diseases 2023; 11:149. [PMID: 37987260 PMCID: PMC10660476 DOI: 10.3390/diseases11040149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023] Open
Abstract
This study investigates the clinical and pathological outcomes of preoperative balloon-occluded transcatheter arterial chemoembolization (B-TACE) in patients with single hepatocellular carcinoma (HCC). The data are from 25 consecutive patients who underwent sequential treatment of subsegmental B-TACE and hepatic surgery for single HCC. Radiological and pathological evaluation of oily subsegmentectomy, defined as the iodized oil-laden necrotic area that includes the entire HCC and surrounding liver parenchyma, were performed. Subsegmental B-TACE was technically successful in all patients. The major and minor complication rates were 8% and 24%, respectively. On the first follow-up computed tomography (CT), oily subsegmentectomy was observed in 18 (72%) out of 25 patients. Apart from one patient showing a partial response, the remaining 24 (96%) patients showed a complete response. Pathological complete necrosis of the HCC was observed in 18 (72%) out of 25 patients with complete or extensive necrosis of the peritumoral liver parenchyma. The remaining seven patients without peritumoral parenchymal necrosis had extensive necrosis of the HCCs. In conclusion, preoperative B-TACE can be a safe and effective method for the treatment of single HCC and a good bridge treatment for subsequent surgical resection. In addition, oily subsegmentectomy itself on the CT can be a good predictor of pathological complete necrosis of the HCC. The findings obtained from this study would provide a potential role of B-TACE in the treatment strategy for single HCC.
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Affiliation(s)
- Jihoon Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
- Ajou University Hospital, College of Medicine, Ajou University, Suwon 16499, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Yonghun Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Gun Ha Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Seong Ho Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Hee Ho Chu
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Jin Hyoung Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Ji Hoon Shin
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Gi-Young Ko
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Hyun-Ki Yoon
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
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Machado M, Dionísio T, Rocha D, Campos M, Sousa P. Placenta Accreta: A Case Report on the Role of Interventional Radiology. Cureus 2023; 15:e47680. [PMID: 38022115 PMCID: PMC10673647 DOI: 10.7759/cureus.47680] [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] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Placenta accreta spectrum disorder is a pregnancy-related disorder responsible for important post-partum morbimortality, associated with intractable or massive hemorrhage, leading to uterine loss in up to 64% of women. Despite international recommendations advocating planned preterm cesarean hysterectomy for the management of these patients, uterus preservation management is being continuously reported with the implementation of minimally invasive bleeding reduction strategies, such as prophylactic balloon-assisted occlusion. We present the case of a 40-year-old pregnant woman with a previous cesarean, diagnosed with placenta previa and suspected placenta accreta on magnetic resonance after having second-trimester vaginal bleeding. A peri-operative multidisciplinary panel was involved, in collaboration with the interventional radiologist, and the c-section was scheduled for 36 weeks of gestation. The prophylactic balloon-assisted occlusion was successfully performed, minimizing the blood loss and allowing a uterus-preserving approach.
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Affiliation(s)
- Mafalda Machado
- Radiology, Centro Hospitalar Universitário do Algarve, Faro, PRT
| | - Teresa Dionísio
- Radiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, PRT
| | - Diogo Rocha
- Radiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, PRT
| | - Marta Campos
- Obstetrics and Gynaecology, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, PRT
| | - Pedro Sousa
- Radiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, PRT
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Lu T, Wu M, Wang Y, Li M, Li H, Zhang F, Yi Y, Zhu M, Zhao X. Association of MRI Features and Adverse Maternal Outcome in Patients With Placenta Accreta Spectrum Disorders After Abdominal Aortic Balloon Occlusion. J Magn Reson Imaging 2023; 58:817-826. [PMID: 36606736 DOI: 10.1002/jmri.28591] [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: 09/13/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND MRI features may be associated with adverse maternal outcome in patients with placenta accreta spectrum (PAS) disorders even with abdominal aortic balloon occlusion (AABO). PURPOSE This study aimed to identify risk factors of MRI for association with adverse maternal outcome in patients with PAS disorders after AABO. STUDY TYPE Retrospective. POPULATION Clinical and MRI features of 80 patients were retrospectively reviewed from October 2016 to August 2021. A total of 40 patients had adverse maternal outcomes including intrapartum/peripartum bleeding >1000 mL and/or emergency hysterectomy after AABO. SEQUENCE Half-Fourier acquisition single-shot turbo spin echo and gradient echo imaging True fast imaging with steady-state precession (True-FISP) at 1.5T MR scanner. ASSESSMENT MRI features were evaluated by three radiologists and were tested for any association with adverse maternal outcome. STATISTICAL TESTS Interobserver agreement was calculated with kappa (k) statistics. Association between MRI features and adverse maternal outcomes were evaluated by univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. RESULTS The interobserver agreement ranged from fair to substantial (k = 0.379-0.783). Multivariate analyses revealed that short cervical length (OR: 4.344), abnormal intraplacental vascularity (OR: 6.005), placental bulge (OR: 9.085), and myometrial interruption (OR: 9.550) were independent risk factors for adverse maternal outcomes. The combination of four risk factors together demonstrated the highest AUC of 0.851 (95% CI 0.769-0.933) with a sensitivity and specificity of 77.5% and 72.5%, respectively and then a nomogram composed of the above four risk factors was constructed to represent the probability of adverse maternal outcome. DATA CONCLUSION The nomogram demonstrated the association between MRI features and patient's poor outcome after undergoing AABO and C-section delivery for PAS. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingpeng Wu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mou Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hang Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Zhang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Yi
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Meilin Zhu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyi Zhao
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Xie LF, Lin Y, Chen MF, Zhang GC. Complete Transthoracic Echocardiography for the Assessment and Guidance of Percutaneous Atrial Septal Defect Closure in Adults without Balloon Sizing: An Observed Study with a 10-Year Follow-Up. J Cardiovasc Dev Dis 2023; 10:321. [PMID: 37623334 PMCID: PMC10455240 DOI: 10.3390/jcdd10080321] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES This study aims to determine if complete transthoracic echocardiography (TTE)-guided percutaneous atrial septal defect (ASD) closure without balloon sizing could be safe and efficacious in adult patients. METHODS A total of 551 patients with ASDs were enrolled in this study, of which 438 patients underwent percutaneous ASD closure. Patients who received TTE-guided percutaneous ASD closure were classified into group T, and those who underwent a procedure that was guided by transesophageal echocardiography (TEE) were classified into group E. The clinical characteristics and the outcomes of the patients were analyzed. RESULTS The characteristics were comparable at baseline, except for the body mass index (BMI) (21.6 ± 5.3 vs. 23.8 ± 7.1, p < 0.001) between group T and group E. No significant difference was observed between the two groups regarding in-hospital outcomes, except for the duration of the procedure (29.8 ± 15.3 min vs. 41.5 ± 20.4 min), the length of stay in the hospital (2.1 ± 2.3 d vs. 2.9 ± 2.6 d), and hospital costs (USD 6233.3 ± 312.4 vs. USD 6673.7 ± 446.9). There were no significant differences in the incidences of long-term complications, cardiac chamber sizes, and tricuspid regurgitation severity between the patients in the two groups during the 10-year follow-up period. CONCLUSION TTE may be as safe and efficacious as TEE for the assessment and guidance of percutaneous ASD closure without balloon sizing in adult patients with lower BMIs who are commonly found in East Asia.
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Affiliation(s)
- Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou 350000, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Yong Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou 350000, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Mei-Fang Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
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Kang BM, Yi HJ, Shin DS, Kim BT. Effect of Early Balloon Inflation of Balloon Guide Catheter in Mechanical Thrombectomy for Large Vessel Occlusion. Curr Neurovasc Res 2023:CNR-EPUB-130687. [PMID: 37021421 DOI: 10.2174/1567202620666230404125627] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE A balloon guide catheter (BGC) is widely used in mechanical thrombectomy (MT). However, the balloon inflation timing of BGC has not been clearly established. We evaluated whether balloon inflation timing of BGC affects the results of MT. METHODS Patients who underwent MT with BGC for anterior circulation occlusion were enrolled. Patients were dichotomized into early and late balloon inflation groups, according to the timing of BGC inflation. Angiographic and clinical outcomes were compared between the two groups. Multivariable analyses were performed to evaluate the predictive factors for first-pass reperfusion (FPR) and successful reperfusion (SR). RESULTS Of 436 patients, the early balloon inflation group showed a shorter procedure time (21 min [11-37] vs. 29 min [14-46], P = 0.014), a higher rate of SR with aspiration only (64.0% vs. 55.4%, P=0.016), a lower aspiration catheter delivery failure rate (11.1% vs. 19.4%, P = 0.005), less frequent technique conversion (36.0% vs. 44.5%, P = 0.009), higher rate of FPR (58.2% vs. 50.2%, P = 0.011), and a lower rate of distal embolization (7.9% vs. 11.7%, P = 0.006), compared to the late balloon inflation group. In multivariate analysis, early balloon inflation was an independent predictor for FPR (odds ratio, OR 1.53, 95% confidence interval, CI 1.37-2.57; P = 0.011) and SR (OR 1.26, 95% CI 1.18-1.64; P = 0.018). CONCLUSION Early balloon inflation of BGC enables an effective procedure than late balloon inflation. Early balloon inflation was associated with higher rates of FPR and SR.
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Affiliation(s)
- Beom Mo Kang
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Ho Jun Yi
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Dong-Seong Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Alves ÁLL, da Silva JB, de Oliveira Santos M, Lopes AVB, Silva RBV, Senra JC. Uterine tamponade in postpartum hemorrhage with handmade balloons: Comparison of manufacturing, infusion, and total times. Int J Gynaecol Obstet 2023. [PMID: 36728548 DOI: 10.1002/ijgo.14711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the manufacturing, infusion, and total times of handmade balloons for uterine tamponade using the El Hennawy and Alves techniques, given the failure of initial measures and uterotonic therapy to control postpartum hemorrhage. METHODS An open clinical trial (clinical article) was conducted among 30 physicians, residents, and assistants in an Obstetrics Department. Each participant manufactured and infused one of two different balloons compared in the study, in a randomly predefined sequence. The manufacturing and infusion times were timed by the researchers and their medians were compared using the t test or Mann-Whitney U test. RESULTS The manufacturing time of the El Hennawy balloon was 72 s lower in relation to the Alves balloon (P < 0.010). Regarding the infusion time, the Alves balloon was filled faster than the El Hennawy balloon (P < 0.010). The total time (manufacturing and infusion) of Alves balloon was also lower than the El Hennawy device (P < 0.010). CONCLUSIONS Although the El Hennawy balloon was manufactured more quickly, the total time of manufacturing and infusing the Alves balloon was much faster, which makes it the most suitable device to be used in critical situations of postpartum hemorrhage.
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Affiliation(s)
- Álvaro Luiz Lage Alves
- Department of Obstetrics and Gynecology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jane Braga da Silva
- Department of Obstetrics and Gynecology, Sofia Feldman Hospital, Belo Horizonte, Brazil
| | | | - Andrezza Vilaça Belo Lopes
- Department of Obstetrics and Gynecology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Janaína Campos Senra
- Department of Obstetrics and Gynecology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
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12
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Takizawa A, Matsushima T, Harigane E, Suzuki S, Kawamata H. Hysteroscopic resection of retained products of conception combined with uterine artery balloon occlusion: A novel case report. J Obstet Gynaecol Res 2023; 49:1295-1299. [PMID: 36650752 DOI: 10.1111/jog.15561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
Retained products of conception can cause massive bleeding that can be prevented by uterine artery embolization before resection; however, uterine artery balloon occlusion is less invasive. While scattered reports of its use for postpartum hemorrhage exist, no indications have been described. We report a case of hysteroscopic resection of retained products of conception using uterine artery balloon occlusion instead of uterine artery embolization. A 29-year-old woman, gravida 2 para 0, noted an intrauterine mass after an abortion at 7 weeks' gestation. Follow-up visits showed insufficient lowering of human chorionic gonadotropin levels, necessitating surgical treatment. Considering the patient's desire to conceive, we performed uterine artery balloon occlusion to reduce the risk of perinatal complications associated with uterine artery embolization. The operation was completed without complications. The patient conceived spontaneously and had a live baby 7 months after surgery, thus proving the benefits of uterine artery balloon occlusion before hysteroscopic resection.
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Affiliation(s)
- Ayako Takizawa
- Department of Obstetrics and Gynecology, University of Nippon Medical School, Kawasaki, Kanagawa, Japan
| | - Takashi Matsushima
- Department of Obstetrics and Gynecology, University of Nippon Medical School, Kawasaki, Kanagawa, Japan
| | - Eika Harigane
- Department of Obstetrics and Gynecology, University of Nippon Medical School, Kawasaki, Kanagawa, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, University of Nippon Medical School, Kawasaki, Kanagawa, Japan
| | - Hiroshi Kawamata
- Department of Interventional Radiology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
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13
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Habibollahi P, Odisio BC, Gurusamy V, Kuban JD, Avritscher R, Abdelsalam ME, Chasen BA, Murthy R, Mahvash A. Temporary Reversal of Hepatoenteric Collaterals during (90)Y Radioembolization Planning and Administration. Curr Oncol 2022; 29:9582-92. [PMID: 36547167 DOI: 10.3390/curroncol29120753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This paper aims to evaluate the safety and efficacy of the temporary redirection of blood flow of hepatoenteric collaterals using a balloon catheter in the common hepatic artery (CHA) to prevent the nontarget deposition of 90Y microspheres. MATERIALS AND METHODS In this retrospective single-center study of patients who received 90Y radioembolization (RE) from September 2010 to September 2015, diagnostic (67 patients) or treatment (72 patients) angiograms with the attempted use of a balloon catheter in the CHA to temporarily direct blood flow away from the hepatoenteric arteries were analyzed. SPECT/CT nuclear scintigraphy was performed after both diagnosis and treatment. RESULTS Overall, only 12 hepatoenteric arteries in 11 patients required embolization due to persistent hepatoenteric flow despite the use of the balloon occlusion technique in a total of 86 patients. Physicians performed the 90Y RE using balloon occlusion with glass (n = 22) or resin (n = 50) microspheres. Over 80% administration of the prescribed 90Y dose was accomplished in 34 (67%) resin and 20 (95%) glass microsphere patients. Post-treatment 90Y RE scintigraphy confirmed the absence of extrahepatic activity in all patients. One grade 2 gastrointestinal ulcer was present after 90 days of follow-up. CONCLUSION Temporary CHA occlusion with a balloon catheter is a reliable and reproducible alternative to the conventional coil embolization of hepatoenteric arteries during diagnostic Tc-99m macroaggregated albumin and therapeutic 90Y RE delivery.
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14
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Parsons HM, Wood A, Milne A. Resuscitative endovascular balloon occlusion of the aorta. BJA Educ 2022; 22:412-415. [PMID: 36304909 PMCID: PMC9596283 DOI: 10.1016/j.bjae.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Andrew Wood
- Barts Health NHS Trust, Royal London Hospital, London, UK
- London's Air Ambulance, Royal London Hospital, London, UK
| | - Andrew Milne
- Barts Health NHS Trust, Royal London Hospital, London, UK
- Greater Sydney Area Helicopter Emergency Service, New South Wales Ambulance Service, Rozelle, NSW, Australia
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15
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Tanaka M, Hirayama T, Fujihara R, Fujino K, Terao Y, Itakura A. A case of a large solitary fibrous tumor arising from the retroperitoneum resected completely using an intra-aortic balloon. J Obstet Gynaecol Res 2022; 48:2647-2651. [PMID: 35799348 DOI: 10.1111/jog.15353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
Solitary fibrous tumors (SFTs) are rare mesenchymal cell-derived tumors that can cause substantial bleeding during surgery due to hyper-vascularization. We report a case of a large retroperitoneal SFT resected completely using an intra-aortic balloon. A 71-year-old female with a history of type 2 diabetes mellitus presented with a tumor that was diagnosed as an insulin-like growth factor-II-producing benign SFT using computed tomography-guided biopsy. The tumor had grown from 6 to 20 cm in diameter within 4 years, with concurrent and severe hypoglycemia. Preoperative computed tomography findings showed substantial blood flow toward the tumor. The retroperitoneal tumor was observed to be widely attached. Substantial hemorrhaging during tumor resection was observed despite vascular embolism. We inflated the intra-aortic balloon for 45 min and resected the tumor completely. In conclusion, large SFT resection requires preoperative tumor blood flow evaluation and preparation of both a vascular embolism and an intra-aortic balloon.
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Affiliation(s)
- Motoki Tanaka
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takashi Hirayama
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Risa Fujihara
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazunari Fujino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yasuhisa Terao
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
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16
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Zhao H, Zhao X, Chen C, Tao Y, Guo R. Effects and Long-Term Outcomes of a Modified Triple-P Procedure in Patients With Severe PAS: A Retrospective Cohort Study. Front Med (Lausanne) 2022; 9:839716. [PMID: 35433716 PMCID: PMC9005881 DOI: 10.3389/fmed.2022.839716] [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: 12/20/2021] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background The distinguished Triple-P procedure has been reported as a conservative surgical alternative to peripartum hysterectomy for placental accreta spectrum (PAS). In this study, we modified the procedure combined with prophylactic abdominal aorta balloon occlusion and/or tourniquet and evaluated the effect and long-term outcomes. Methods This was a retrospective study involving pregnant patients with clinically confirmed severe PAS (including placenta increta and percreta) between January 1st, 2017 and June 30th, 2020 in the First Affiliated Hospital of Zhengzhou University. A total of 334 pregnant women were recruited in this study. The 142 women that were subjected to modified Triple P Procedure were regarded as the observation group while 194 pregnant women that were treated with other sutures were regarded as the control group. Demographic characteristics, placental accreta spectrum score (PAS score), estimated blood loss (EBL), operative time, blood transfusion rate and volume, neonatal weight, post-operative hospital stays and costs were evaluated. Short-term complications, including fever, hematoma, thrombus, bladder rupture and intensive care unit (ICU) transfer rate, as well as long-term outcomes including breast feeding, menstruation, intrauterine adhesion, and chronic abdominal pain among others were followed up in the outpatient clinic and by phone calls. Results For all cases, EBL was lower in the observation group than in the control group, 1,200 (687–1,812) ml and 1,300 (800–2,500) ml, respectively. The difference was statistically significant (P < 0.05). Operative time were statistically significantly shorter in the observation group [99.5 (84.0–120.0) min and 109.0 (83.8–143.0) min, P < 0.05]. Lengths of postoperative hospital stays were 4 (4–7) and 5 (4–7) days in the observation and control group, which was significantly shorter in the observation group (P < 0.05). There were no significant differences in PAS scores, blood transfusion volume, neonatal weight, fever, hematoma, thrombus, bladder rupture and ICU transfer rates between the two groups. All patients, except one in control group, had preserved uterus. There were no statistically significant differences in short-term and long-term complications between two groups. Conclusion In summary, when combined with tourniquet and/or prophylactic abdominal aorta balloon occlusion, modified Triple-P procedure may be effective in reducing intraoperative blood loss and hysterectomy in patients with placenta increta/percreta. It is a safe and effective surgical alternative to peripartum hysterectomy. However, the complications associated with interventional radiology service should be evaluated furthermore.
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Affiliation(s)
- Huidan Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Xianlan Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Chen Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Ya Tao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Ruixia Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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17
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Barboza L, Tanzola R. Transesophageal Echocardiography Guided Partial Right Atrial Inflow Occlusion - A Case Study. POCUS J 2022; 7:212-215. [PMID: 36896388 PMCID: PMC9983715 DOI: 10.24908/pocus.v7i2.15663] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Deployment of stent-grafts and other endovascular devices is a common technique for various vascular repair procedures. Induced, transient, periods of hypotension are essential to the precise deployment of a device as this minimizes displacement that can result from high pressure aortic flow. Partial inflow occlusion of the right atrium is a reliable, precise, and safe method of achieving this. We present a case where intraoperative transesophageal echocardiography (TEE) was used to guide and confirm balloon placement for right atrium inflow occlusion during a thoracic endovascular aneurysm repair (TEVAR) procedure for repair of an aortic dissection in a 67 year old male. This highlights a novel use of TEE in the context of endovascular surgery, and showcases an alternative method of reliably achieving transient hypotension.
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Affiliation(s)
- Lucas Barboza
- Queen's School of Medicine, Queen's University Kingston, Ontario Canada
| | - Rob Tanzola
- Department of Anesthesiology and Perioperative Medicine, Queen's University Kingston, Ontario Canada
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18
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Negmadjanov U, Motta JC, De Grandis E, Lee WA. A Hybrid Approach in the Management of a Large Pancreaticoduodenal Artery Aneurysm. Ann Vasc Surg 2021; 79:441.e1-441.e5. [PMID: 34653641 DOI: 10.1016/j.avsg.2021.07.041] [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] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/01/2022]
Abstract
Pancreaticoduodenal artery aneurysms (PDAA) are rare and represent a small fraction of known visceral aneurysms. We describe a case of a 79-year-old male with an 82 mm PDAA in the setting of chronic celiac artery occlusion. The patient was treated with an open repair. Due to the large size of the aneurysm and the dense adhesions to the surrounding tissues, vascular control of the superior mesenteric artery (SMA) was achieved by endovascular balloon occlusion and the aneurysm repaired with resection and primary aneurysmorrhaphy. The patient had an uneventful postoperative course.
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Affiliation(s)
- Ulugbek Negmadjanov
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - John C Motta
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Eileen De Grandis
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - W Anthony Lee
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL.
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19
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Tone O, Sato Y, Tamaki M, Takada Y. Bleb Embolization of Ruptured Cerebral Aneurysms with Coils and n-Butyl Cyanoacrylate Following Proximal Flow Control: Two Case Reports. J Neuroendovasc Ther 2021; 16:313-319. [PMID: 37501897 PMCID: PMC10370545 DOI: 10.5797/jnet.cr.2021-0082] [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] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/14/2021] [Indexed: 07/29/2023]
Abstract
Objective Morphologically challenging cerebral aneurysms cannot be treated through standard endovascular procedures. We report two cases of ruptured aneurysms treated using coils and n-butyl cyanoacrylate (NBCA). Case Presentations Case 1 was an 80-year-old woman diagnosed with a subarachnoid hemorrhage (SAH). An angiogram revealed a large and wide-necked basilar artery bifurcation aneurysm. Bilateral superior cerebellar and posterior cerebral arteries (PCAs) originated from the aneurysmal wall. A 3-mm-diameter bleb was detected on the aneurysmal fundus. The bleb enlarged 1 month following coil insertion. During the second treatment, we infused a small volume of 33% NBCA into the coil-framed bleb following proximal flow control of the bilateral vertebral arteries (VAs). The complete bleb obliteration was confirmed by the angiogram at 6 months later. The coil shape was followed up via plane X-ray for 5 years. No rebleeding occurred. Case 2 was a 41-year-old woman diagnosed with SAH. An angiogram revealed a dissecting aneurysm of the left PCA (P1 and P2 segments) accompanying a bleb on the P1 segment. Endovascular treatment was performed, and a coil was inserted into the bleb, infusing 33% NBCA into the coil frame following proximal flow control of bilateral VAs and the right internal carotid artery. Angiograms conducted at 3 months, 1 year, and 9 years and an MRA conducted 12 years later revealed a lack of bleb recanalization. Conclusion We developed a Coil and NBCA technique to obliterate ruptured blebs following proximal flow control. This technique can be considered an effective alternative for treating morphologically challenging cerebral aneurysms.
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Affiliation(s)
- Osamu Tone
- Stroke Center, Ome Municipal General Hospital, Ome, Tokyo, Japan
| | - Yohei Sato
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Masashi Tamaki
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Yoshiaki Takada
- Department of Neurosurgery, Ome Municipal General Hospital, Ome, Tokyo, Japan
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20
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Nozawa Y, Ashida H, Michimoto K, Kisaki S, Kano R, Ojiri H, Ikegami T. Efficacy of Portal Vein Embolization with a Procedure of Sheath Injection and Balloon Occlusion with Gelatin Sponge. J Belg Soc Radiol 2021; 105:42. [PMID: 34568747 DOI: 10.5334/jbsr.2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/10/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: To evaluate the efficacy, safety, and associated complications of a novel and simple approach to portal vein embolization that utilizes sheath injection and balloon occlusion (PVE-SIBO) with gelatin sponge (GS) for the purpose of increasing future liver remnant (FLR) volume. Methods: Between 1 January, 2006, and 31 August, 2020, 20 patients (15 men, 5 women, aged 64.6 ± 10.2 years) diagnosed with hepatobiliary malignancy underwent presurgical PVE-SIBO at our institution via a percutaneous transhepatic approach to the right portal vein and embolization of the portal vein with GS. We evaluated the increased ratio of FLR volume, operation duration, recanalization rate, and complications following this procedure. Results: All procedures were successful and without complications such as subcapsular hematoma, intra-abdominal bleeding, and bile leakage. The increased ratio of FLR volume was 34.7 ± 23.7% after a mean of 14.3 ± 2.57 days, and there was a significant difference in the FLR volume before and after PVE (P < 0.01). Procedure time was 52.7 ± 11.4 minutes. Conclusion: PVE-SIBO with GS is a simple, effective, and safe procedure to increase the ratio of FLR volume prior to hepatic surgeries.
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21
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Maleckis K, Keiser C, Jadidi M, Anttila E, Desyatova A, MacTaggart J, Kamenskiy A. Safe balloon inflation parameters for resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg 2021; 91:302-309. [PMID: 34039932 PMCID: PMC8375400 DOI: 10.1097/ta.0000000000003276] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Noncompressible hemorrhage is a leading cause of preventable death in civilian and military trauma populations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a promising method for controlling noncompressible hemorrhage, but safe balloon inflation parameters are not well defined. Our goal was to determine the balloon inflation parameters associated with benchtop flow occlusion and aortic/balloon rupture in ex vivo human aortas and test the hypothesis that optimal balloon inflation characteristics depend on systolic pressure and subject demographics. METHODS Aortic occlusion parameters in human thoracic aortas (TAs) and abdominal aortas (AAs) from 79 tissue donors (median ± SD age, 52 ± 18 years [range, 13-75 years]; male, 52; female, 27) were recorded under 100/40, 150/40, and 200/40 mm Hg flow pressures for ER-REBOA and Coda balloons. Rupture tests were done with Coda balloons only without flow. RESULTS In the TA, the average balloon inflation volumes and pressures resulting in 100/40 mm Hg flow occlusion were 11.7 ± 3.8 mL and 174 ± 65 mm Hg for the ER-REBOA, and 10.6 ± 4.3 mL and 94 ± 57 mm Hg for the Coda balloons. In the AA, these values were 6.2 ± 2.6 mL and 110 ± 47 mm Hg for the ER-REBOA, and 5.9 ± 2.2 mL and 71 ± 30 mm Hg for the Coda. The average balloon inflation parameters associated with aortic/Coda balloon rupture were 39.1 ± 6.5 mL and 1,284 ± 385 mm Hg in the TA, and 27.7 ± 7.7 mL and 1,410 ± 483 mm Hg in the AA. Age, sex, and systolic pressure all had significant effects on balloon occlusion and rupture parameters. CONCLUSION Optimal balloon inflation parameters depend on anatomical, physiological, and demographic characteristics. Pressure-guided rather than volume-guided balloon inflation may reduce the risk of aortic rupture. These results can be used to help improve the safety of REBOA procedures and devices.
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Affiliation(s)
- Kaspars Maleckis
- Department of Biomechanics, University of Nebraska Omaha, Nebraska 68182, United States
| | - Courtney Keiser
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska 68588, United States
| | - Majid Jadidi
- Department of Biomechanics, University of Nebraska Omaha, Nebraska 68182, United States
| | - Eric Anttila
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska 68588, United States
| | - Anastasia Desyatova
- Department of Biomechanics, University of Nebraska Omaha, Nebraska 68182, United States
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska Omaha, Nebraska 68182, United States
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22
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García A, Millán M, Ordoñez CA, Burbano D, Parra MW, Caicedo Y, González Hadad A, Herrera MA, Pino LF, Rodríguez-Holguín F, Salcedo A, Franco MJ, Ferrada R, Puyana JC. Damage control surgery in lung trauma. Colomb Med (Cali) 2021; 52:e4044683. [PMID: 34188322 PMCID: PMC8216053 DOI: 10.25100/cm.v52i2.4683] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.
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Affiliation(s)
- Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Daniela Burbano
- Fundación Valle del Lili, Departamento de Urgencias Adultos. Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Adolfo González Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Maria Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Ricardo Ferrada
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
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Serna C, Serna JJ, Caicedo Y, Padilla N, Gallego LM, Salcedo A, Rodríguez-Holguín F, González-Hadad A, García A, Herrera MA, Parra MW, Ordoñez CA. Damage control surgery for splenic trauma: "preserve an organ - preserve a life". Colomb Med (Cali) 2021; 52:e4084794. [PMID: 34188324 PMCID: PMC8216056 DOI: 10.25100/cm.v52i2.4794] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.
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Affiliation(s)
- Carlos Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - José Julián Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
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24
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Luo Y, Jiang M, Fang J, Min L, Zhou Y, Tang F, Lu M, Wang Y, Duan H, Tu C. Prolonged balloon occlusion of the lower abdominal aorta during pelvic or sacral tumor resection. Ann Transl Med 2021; 9:416. [PMID: 33842637 PMCID: PMC8033300 DOI: 10.21037/atm-21-138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To explore the efficacy of lower abdominal aorta balloon occlusion technology in pelvis and sacral tumor surgery and to assess the safety of prolonged balloon occlusion. Methods From January 2008 to January 2017, 81 patients were diagnosed with sacrum or pelvic tumor and underwent surgery in our institution. Balloon catheters were placed through the femoral artery to occlude the abdominal aorta of the pelvic tumor and sacrum region undergoing tumor resection. These patients were divided into two group based on single balloon blocking time. Group A had a balloon blocking time of 60 minutes or less, and group B had a balloon occlusion time greater than 60 minutes. The patients in the two groups were compared with regards to operation time, intraoperative blood loss, blood transfusion volume, average length of hospital stay, and postoperative complications. Results No balloon displacement or leakage of the abdominal aorta occurred during the operations. The difference in operation time between the two groups was statistically significant (P≤0.05), and the differences in intraoperative blood loss, blood transfusion volume, and average hospital stay between groups A and B were not significant (P>0.05). The incidence of postoperative complications was 12% in group A, and 22.6% in group B, with no statistically significant differences (P>0.05). Conclusions Prolonged balloon occlusion was safe and effective in the surgical treatment of complicated pelvic and sacral tumors. It did not increase the incidence of postoperative complications such as distal limb paralysis, arterial thrombosis, or ischemic necrosis.
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Affiliation(s)
- Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyan Jiang
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Jianguo Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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25
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Mochida Y, Miyakuni Y, Kaita Y, Yamaguchi Y. Resuscitative endovascular balloon occlusion of the aorta for ruptured pancreaticoduodenal artery aneurysm. Clin Case Rep 2021; 9:686-688. [PMID: 33598226 PMCID: PMC7869346 DOI: 10.1002/ccr3.3618] [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: 09/07/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/27/2022] Open
Abstract
Resuscitative endovascular balloon occlusion of the aorta is useful as a troubleshooting response to hemorrhage and a temporary method for maintaining patient hemodynamics.
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Affiliation(s)
- Yuki Mochida
- Department of Trauma and Critical Care MedicineKyorin University School of MedicineTokyoJapan
| | - Yasuhiko Miyakuni
- Department of Trauma and Critical Care MedicineKyorin University School of MedicineTokyoJapan
| | - Yasuhiko Kaita
- Department of Trauma and Critical Care MedicineKyorin University School of MedicineTokyoJapan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care MedicineKyorin University School of MedicineTokyoJapan
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26
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Ordoñez CA, Parra MW, Caicedo Y, Padilla N, Rodríguez-Holguín F, Serna JJ, Salcedo A, García A, Orlas C, Pino LF, Del Valle AM, Mejia D, Salamea-Molina JC, Brenner M, Hörer T. REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients. Colomb Med (Cali) 2020; 51:e4064506. [PMID: 33795901 PMCID: PMC7968426 DOI: 10.25100/cm.v51i4.4422.4506] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.
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Affiliation(s)
- Carlos A Ordoñez
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Claudia Orlas
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, USA.,Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | | | - David Mejia
- Hospital Pablo Tobon Uribe, Department of Surgery, Medellin, Colombia.,Universidad de Antioquia, Department of Surgery, Medellin, Colombia
| | - Juan Carlos Salamea-Molina
- Hospital Vicente Corral Moscoso, Division of Trauma and Acute Care Surgery. Cuenca, Ecuador.,Universidad del Azuay, Escuela de Medicina. Cuenca, Ecuador
| | - Megan Brenner
- University of California, Department of Surgery Riverside University Health Systems. Riverside, CA, USA
| | - Tal Hörer
- 15 Örebro University Hospital, Faculty of Medicine, Department of Cardiothoracic and Vascular Surgery, Örebro, Sweden
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27
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Asano N, Yamauchi T, Ota K, Niimi K, Saito M, Gon S, Torikai K, Ban S, Takano H. Open Surgical Repair for a Giant Common Hepatic Artery Aneurysm with Difficulty in Proximal Arterial Clamping: A Case Report. Ann Vasc Dis 2020; 13:430-433. [PMID: 33391564 PMCID: PMC7758582 DOI: 10.3400/avd.cr.20-00070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Hepatic artery aneurysm has been considered as a rare, life-threatening disease. In this study, we report on a patient requiring surgical treatment for a giant hepatic artery aneurysm by aneurysmectomy without revascularization. A 70-year-old woman who complained of epigastric pain was referred to our hospital. Enhanced computed tomography scan has revealed a giant (11×9 cm) common hepatic artery aneurysm. She then underwent emergency surgery; the intra-aortic balloon occlusion technique was applied in order to control the blood inflow into the aneurysm. The aneurysm was then incised, and direct closure of the inflow and outflow orifices was performed safely without evidence of ischemic change in the liver.
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Affiliation(s)
- Naoki Asano
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Takashi Yamauchi
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kazunori Ota
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kazuho Niimi
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Masahito Saito
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Shigeyoshi Gon
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kei Torikai
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Shinichi Ban
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hiroshi Takano
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
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Sivakumar K, Qureshi S, Pavithran S, Vaidyanathan S, Rajendran M. Simple Diagnostic Tools May Guide Transcatheter Closure of Superior Sinus Venosus Defects Without Advanced Imaging Techniques. Circ Cardiovasc Interv 2020; 13:e009833. [PMID: 33233933 DOI: 10.1161/circinterventions.120.009833] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a recent interest in nonsurgical correction of superior sinus venosus defects. Patient selection is currently based on advanced imaging and printing technologies. Simple clinical tools to select patients will expand its applicability in developing countries. METHODS Defects caudally extending toward the oval fossa and right upper pulmonary veins draining beyond the cavoatrial junction on transesophageal echocardiography were excluded. Balloon interrogation of cavoatrial junction confirmed complete occlusion of the defect with unobstructed pulmonary venous drainage to left atrium. Single long covered stents or overlapping covered stents were used to exclude sinus venosus defects. Closure of left-to-right interatrial shunt without causing pulmonary vein occlusion was confirmed on follow-up imaging. RESULTS Forty-four patients selected after transesophageal echocardiography underwent balloon interrogation with monitoring of right upper pulmonary vein. Eighteen out of 44 patients were ineligible. Twenty-four eligible patients with closure of left-to-right interatrial shunt without pulmonary vein occlusion underwent covered stent exclusion using single long stents in 15 and overlapping stents in the rest, while 2 patients are awaiting the procedure. Four patients aged 6 to 16 years received stents that were 18 mm or larger. Three patients had stent embolization that required surgical correction in 2 but in the last patient was managed nonsurgically with an overlapping covered stent with good final outcomes. Procedure was successful in 22 patients. At a median follow-up of 20 months (range, 3-54 months), there were no adverse events. Follow-up imaging showed trivial left-to-right shunt in 4 and unobstructed pulmonary veins in all patients. CONCLUSIONS Transesophageal echocardiography and balloon interrogation identified 60% of the patients with sinus venosus defects to be eligible for catheter closure. Overlapping stents are an alternative to custom-made long stents. Transesophageal echocardiography confirms procedural success on follow-up. Advanced imaging and printing technologies are not essential for successful outcomes and thus simple tests increase the feasibility in developing countries.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Shakeel Qureshi
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (S.Q.)
| | - Sreeja Pavithran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Sunitha Vaidyanathan
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Monica Rajendran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
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29
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Campagna GA, Cunningham ME, Hernandez JA, Chau A, Vogel AM, Naik-Mathuria BJ. The utility and promise of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pediatric population: An evidence-based review. J Pediatr Surg 2020; 55:2128-2133. [PMID: 32061369 DOI: 10.1016/j.jpedsurg.2020.01.052] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 11/18/2022]
Abstract
Hemorrhage is the main cause of preventable death in both military and civilian trauma, and many of these patients die from non-compressible torso injuries. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive method used for hemodynamic control of the hemorrhaging patient and has been compared to resuscitative thoracotomy (RT) with cross clamping of the aorta. REBOA has received a great deal of attention in recent years for its applicability and promise in adult trauma and non-trauma settings, but its utility in children is mostly unknown. The purpose of this review article is to summarize and consolidate what is currently known about the use of REBOA in children. Some of the challenges in implementing REBOA in children include small vascular anatomy and lack of outcomes data. Although the evidence is limited, there are established instances in the literature of children and adolescents who have undergone endovascular occlusion of the aorta for hemorrhage control with positive outcomes and survival rates equivalent to their adult counterparts. There is a need for further formal evaluation of REBOA in pediatric patients with prospective studies to look at the safety, feasibility and efficacy of the technique. STUDY TYPE: Narrative Literature Review LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Giovanni A Campagna
- Baylor College of Medicine, School of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Megan E Cunningham
- Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, 6701 Fannin St, Houston, TX, 77030, USA
| | - Jose A Hernandez
- Texas Children's Hospital, Department of Radiology, Division of Pediatric Interventional Radiology, 6701 Fannin St, Houston, TX, 77030, USA
| | - Alex Chau
- Texas Children's Hospital, Department of Radiology, Division of Pediatric Interventional Radiology, 6701 Fannin St, Houston, TX, 77030, USA
| | - Adam M Vogel
- Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, 6701 Fannin St, Houston, TX, 77030, USA
| | - Bindi J Naik-Mathuria
- Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, 6701 Fannin St, Houston, TX, 77030, USA.
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30
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Ma Y, Luo X, Jiang X, Liu H, Wu L. Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa: A retrospective cohort analysis. Medicine (Baltimore) 2020; 99:e21916. [PMID: 32871925 PMCID: PMC7458170 DOI: 10.1097/md.0000000000021916] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS.This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), whereas 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin and hematocrit. In addition, the baseline conditions of mother and neonates were compared.EBL was significantly higher in the IIA group compared to the control group (2883.5 mL in the IIA group vs 1868.7 mL in the control group, P = .001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 mL, in the IIA group versus 20%, averaging 816.7 mL, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 mL. In the control group, 90% had salvaged blood returned, averaging 617.9 mL. No cases of amniotic fluid embolism were observed with leukocyte depletion filters.Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.
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Affiliation(s)
- Yushan Ma
- Anesthesiology Department of West China Second University Hospital, Sichuan University, Sichuan Province
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Xi Luo
- Intensive Care Unit of Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiaoqin Jiang
- Anesthesiology Department of West China Second University Hospital, Sichuan University, Sichuan Province
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Hui Liu
- Anesthesiology Department of West China Second University Hospital, Sichuan University, Sichuan Province
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Lan Wu
- Anesthesiology Department of West China Second University Hospital, Sichuan University, Sichuan Province
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
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Yamamoto R, Suzuki M, Funabiki T, Nishida Y, Maeshima K, Sasaki J. Resuscitative endovascular balloon occlusion of the aorta and traumatic out-of-hospital cardiac arrest: A nationwide study. J Am Coll Emerg Physicians Open 2020; 1:624-632. [PMID: 33000081 PMCID: PMC7493555 DOI: 10.1002/emp2.12177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 06/09/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive method for temporary hemostasis compared with cross-clamping the aorta through resuscitative thoracotomy (RT). Although the survival benefits of REBOA remained unclear, pathophysiological benefits were identified in patients with traumatic out-of-hospital cardiac arrest (t-OHCA). We examined the clinical outcomes of t-OHCA with the hypothesis that REBOA would be associated with higher survival to discharge compared with RT. METHODS A retrospective cohort study was conducted using the Japan Trauma Data Bank (2004-2019). Adult patients with t-OHCA who had arrived without a palpable pulse and undergone aortic occlusion were included. Patients were divided into REBOA or RT groups, and propensity scores were developed using age, mechanism of injury, presence of signs of life, presence of severe head and/or chest injury, Injury Severity Score, and transportation time. Inverse probability weighting by propensity scores was performed to compare survival to discharge between the 2 groups. RESULTS Among 13,247 patients with t-OHCA, 1483 were included in this study. A total of 144 (9.7%) patients were treated with REBOA, and 5 of 144 (3.5%) in the REBOA group and 10 of 1339 (0.7%) in the RT group survived to discharge. The use of REBOA was significantly associated with increased survival to discharge (odds ratio, 4.78; 95% confidence interval, 1.61-14.19), which was confirmed by inverse probability weighting (adjusted odds ratio, 3.73; 95% confidence interval, 1.90-7.32). CONCLUSIONS REBOA for t-OHCA was associated with higher survival to discharge. These results should be validated by further research.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care MedicineKeio University School of MedicineShinjukuTokyoJapan
| | - Masaru Suzuki
- Department of Emergency MedicineTokyo Dental CollegeIchikawa General HospitalIchikawaChibaJapan
| | - Tomohiro Funabiki
- Department of Trauma and Emergency SurgerySaiseikai Yokohamashi Tobu HospitalTsurumikuYokohamaKanagawaJapan
| | - Yusho Nishida
- Department of Emergency and Critical Care MedicineKeio University School of MedicineShinjukuTokyoJapan
| | - Katsuya Maeshima
- Department of Emergency and Critical Care MedicineKeio University School of MedicineShinjukuTokyoJapan
| | - Junichi Sasaki
- Department of Emergency and Critical Care MedicineKeio University School of MedicineShinjukuTokyoJapan
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32
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Soyer P, Barat M, Loffroy R, Barral M, Dautry R, Vidal V, Pellerin O, Cornelis F, Kohi MP, Dohan A. The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences. Quant Imaging Med Surg 2020; 10:1370-1391. [PMID: 32550143 DOI: 10.21037/qims-20-548] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abnormally invasive placenta (AIP) is a potentially severe condition. To date, arterial embolization in women with postpartum hemorrhage due to AIP is the treatment option for which highest degrees of evidence are available. However, other techniques have been tested, including prophylactic catheter placement, balloon occlusion of the iliac arteries and abdominal aorta balloon occlusion. In this systematic review, we provide an overview of the currently reported interventional radiology procedures that are used for the treatment of postpartum hemorrhage due to AIP and suggest recommendations based on current evidences. Owing to a high rate of adverse events, prophylactic occlusion of internal iliac arteries should be used with caution and applied when the endpoint is hysterectomy. On the opposite, when a conservative management is considered to preserve future fertility, uterine artery embolization should be the preferred option as it is associated with a hysterectomy rate of 15.5% compared to 76.5% with prophylactic balloon occlusion of the internal iliac arteries and does not result in fetal irradiation. Limited data are available regarding the application of systematic prophylactic embolization and no comparative studies with arterial embolization are available.
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Affiliation(s)
- Philippe Soyer
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
| | - Maxime Barat
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, UFR des Sciences de Santé, Université de Bourgogne/Franche-Comté, Dijon, France
| | - Matthias Barral
- Department of Radiology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Paris, France.,Sorbonne University, Paris, France
| | - Raphael Dautry
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, LIIE, CERIMED Aix Marseille Univ, Marseille, France
| | - Olivier Pellerin
- Université de Paris, Descartes-Paris 5, Paris, France.,Department of Interventional Radiology, Hopital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Francois Cornelis
- Department of Radiology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
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Cho S, Ryu JW, Chang SW. Resuscitative endovascular balloon occlusion of the aorta for retroperitoneal hemorrhage and shock after ipsilateral antegrade angioplasty with vascular closure device. Ann Transl Med 2020; 8:404. [PMID: 32355848 PMCID: PMC7186633 DOI: 10.21037/atm.2020.02.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Percutaneous intervention is widely used to treat peripheral vascular disease. Ipsilateral antegrade femoral arterial access for femoropopliteal disease provides a mechanical advantage with regard to wire and stent control; however, it is associated with vascular complications and significant morbidity and mortality secondary to retroperitoneal hemorrhage from a high puncture site or vascular closure device (VCD) failure. Currently, resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed as damage control surgery in patients with non-compressible torso hemorrhage. We describe a patient with hemorrhagic shock secondary to VCD failure, who was successfully treated by REBOA as damage control surgery. To our knowledge, this is the first reported case in the English literature of successful REBOA in a patient with hemorrhagic shock secondary to VCD failure.
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Affiliation(s)
- Sungsoo Cho
- Division of Cardiovascular Medicine, Department of Internal Medicine, Trauma Center, Dankook University Hospital, Cheonan-si, Republic of Korea
| | - Jae-Wook Ryu
- Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan-si, Republic of Korea
| | - Sung Wook Chang
- Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan-si, Republic of Korea
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Liu J, Liu C, Zuo X, Teng Y. Pernicious placenta previa/placenta percreta complicating active systemic lupus erythematosus resulting in postoperative artery thrombosis. J Int Med Res 2019; 47:6365-6373. [PMID: 31773999 PMCID: PMC7045675 DOI: 10.1177/0300060519886991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Systemic lupus erythematosus (SLE) increases the risk of adverse pregnancy outcomes and fetal complications. Placenta percreta, involving placental attachment to another organ, is a rare but severe placental abnormality. We report a 26-year-old woman, G2P1, with a 6-year history of SLE with coexisting pernicious placenta previa and placenta percreta detected by second trimester ultrasound. She discontinued prednisone 5 months before admission, without consultation, and active SLE was diagnosed on admission. Because of her progressive condition, the patient underwent infrarenal abdominal aorta balloon occlusion and double J ureteral catheter placement, followed by elective cesarean at 27+6 weeks gestation. Despite aggressive management, she experienced severe bleeding requiring internal iliac artery ligation and peripartum hysterectomy. The placenta had penetrated the uterus walls and attached to the bladder apex, necessitating bladder repair. Thrombosis was detected in the common iliac artery and common femoral artery in the right leg 1 day postoperatively. Conservative antithrombotic therapy had little effect, and embolectomy by arteriotomy was performed on the 6th post-cesarean day, and an arterial thrombus was removed. Infrarenal abdominal aorta balloon occlusion may increase the risk of postoperative thrombosis in pregnant women with active SLE and coagulation disorders. These patients therefore require close monitoring and timely anticoagulation.
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Affiliation(s)
- Jiahuang Liu
- Department of General Surgery, The First Affiliated Hospital of Xi' an Jiaotong University, Xi'an, China
| | - Chao Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | - Yue Teng
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Thorn SL, Barlow SC, Feher A, Stacy MR, Doviak H, Jacobs J, Zellars K, Renaud JM, Klein R, deKemp RA, Khakoo AY, Lee T, Spinale FG, Sinusas AJ. Application of Hybrid Matrix Metalloproteinase-Targeted and Dynamic 201Tl Single-Photon Emission Computed Tomography/Computed Tomography Imaging for Evaluation of Early Post-Myocardial Infarction Remodeling. Circ Cardiovasc Imaging 2019; 12:e009055. [PMID: 31707811 PMCID: PMC7250243 DOI: 10.1161/circimaging.119.009055] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The induction of matrix metalloproteinases (MMPs) and reduction in tissue inhibitors of MMPs (TIMPs) plays a role in ischemia/reperfusion (I/R) injury post-myocardial infarction (MI) and subsequent left ventricular remodeling. We developed a hybrid dual isotope single-photon emission computed tomography/computed tomography approach for noninvasive evaluation of regional myocardial MMP activation with 99mTc-RP805 and dynamic 201Tl for determination of myocardial blood flow, to quantify the effects of intracoronary delivery of recombinant TIMP-3 (rTIMP-3) on I/R injury. METHODS Studies were performed in control pigs (n=5) and pigs following 90-minute balloon occlusion-induced ischemia/reperfusion (I/R) of left anterior descending artery (n=9). Before reperfusion, pigs with I/R were randomly assigned to intracoronary infusion of rTIMP-3 (1.0 mg/kg; n=5) or saline (n=4). Three days post-I/R, dual isotope imaging was performed with 99mTc-RP805 and 201Tl along with contrast cineCT to assess left ventricular function. RESULTS The ischemic to nonischemic ratio of 99mTc-RP805 was significantly increased following I/R in saline group (4.03±1.40), and this ratio was significantly reduced with rTIMP-3 treatment (2.22±0.57; P=0.03). This reduction in MMP activity in the MI-rTIMP-3 treatment group was associated with an improvement in relative MI region myocardial blood flow compared with the MI-saline group and improved myocardial strain in the MI region. CONCLUSIONS We have established a novel hybrid single-photon emission computed tomography/computed tomography imaging approach for the quantitative assessment of regional MMP activation, myocardial blood flow, and cardiac function post-I/R that can be used to evaluate therapeutic interventions such as intracoronary delivery of rTIMP-3 for reduction of I/R injury in the early phases of post-MI remodeling.
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Affiliation(s)
- Stephanie L. Thorn
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, School of Medicine, New Haven, CT
- Yale Translational Research Imaging Center, New Haven, CT
| | - Shayne C. Barlow
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, SC
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, School of Medicine, New Haven, CT
- Yale Translational Research Imaging Center, New Haven, CT
| | - Mitchel R. Stacy
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, School of Medicine, New Haven, CT
- Yale Translational Research Imaging Center, New Haven, CT
| | - Heather Doviak
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, SC
| | - Julia Jacobs
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, SC
| | - Kia Zellars
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, SC
| | | | - Ran Klein
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - TaeWeon Lee
- Amgen, CardioMetabolic Disorders, South San Francisco, CA
| | - Francis G. Spinale
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and the WJB Dorn Veteran Affairs Medical Center, Columbia, SC
| | - Albert J. Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, School of Medicine, New Haven, CT
- Yale Translational Research Imaging Center, New Haven, CT
- Department of Radiology and Biomedical Imaging, Yale University, School of Medicine, New Haven, CT
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36
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Rottmann M, Kleber AG, Barkagan M, Sroubek J, Leshem E, Shapira-Daniels A, Buxton AE, Anter E. Activation During Sinus Rhythm in Ventricles With Healed Infarction: Differentiation Between Arrhythmogenic and Nonarrhythmogenic Scar. Circ Arrhythm Electrophysiol 2019; 12:e007879. [PMID: 31597477 DOI: 10.1161/circep.119.007879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In infarct-related ventricular tachycardia (VT), the circuit often corresponds to a location characterized by activation slowing during sinus rhythm (SR). However, the relationship between activation slowing during SR and vulnerability for reentry and correlation to components of the VT circuit are unknown. This study examined the relationship between activation slowing during SR and vulnerability for reentry and correlated these areas with components of the circuit. METHODS In a porcine model of healed infarction, the spatial distribution of endocardial activation velocity was compared between SR and VT. Isthmus sites were defined using activation and entrainment mapping as areas exhibiting diastolic activity within the circuit while bystanders were defined as areas displaying diastolic activity outside the circuit. RESULTS Of 15 swine, 9 had inducible VT (5.2±3.0 per animal) while in 6 swine VT could not be induced despite stimulation from 4 RV and LV sites at 2 drive trains with 6 extra-stimuli down to refractoriness. Infarcts with VT had a greater magnitude of activation slowing during SR. A minimal endocardial activation velocity cutoff ≤0.1 m/s differentiated inducible from noninducible infarctions (P=0.015). Regions of maximal endocardial slowing during SR corresponded to the VT isthmus (area under curve=0.84 95% CI, 0.78-0.90) while bystander sites exhibited near-normal activation during SR. VT circuits were complex with 41.7% exhibiting discontinuous propagation with intramural bridges of slow conduction and delayed quasi-simultaneous endocardial activation. Regions forming the VT isthmus borders had faster activation during SR while regions forming the inner isthmus were activated faster during VT. CONCLUSIONS Endocardial activation slowing during SR may differentiate infarctions vulnerable for VT from those less vulnerable for VT. Sites of slow activation during SR correspond to sites forming the VT isthmus but not to bystander sites.
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Affiliation(s)
- Markus Rottmann
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andre G Kleber
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael Barkagan
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jakub Sroubek
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eran Leshem
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ayelet Shapira-Daniels
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alfred E Buxton
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Elad Anter
- Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Usman M, Critchley G, Koumellis P, Poitelea M. Interval growth in an ICA bifurcation aneurysm treated with balloon occlusion, and possible contribution of vasa vasorum hypertrophy. Br J Neurosurg 2019:1-3. [PMID: 31035805 DOI: 10.1080/02688697.2019.1594690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present a rare case of an ICA aneurysm recurrence despite treatment with ICA balloon occlusion. There was evidence of ICA recanalization bypassing the balloons on a catheter angiogram follow-up 1 year post-procedure. Although initially stable in size, at 5 years after the original procedure, the aneurysm demonstrated evidence of enlargement and on angiography there was further enlargement of the recanalized ICA around the occluding balloons. We postulate that this has been caused by increasing antegrade flow through hypertrophied vasa vasorum in response to persistently increased demand for blood flow by the ipsilateral hemisphere; this indirectly may have also contributed to some extent to the aneurysm enlargement.
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Affiliation(s)
- Muhammad Usman
- a South East Neurosurgery and Spinal surgery , Royal Sussex County Hospital , Brighton , UK
| | - Giles Critchley
- a South East Neurosurgery and Spinal surgery , Royal Sussex County Hospital , Brighton , UK
| | | | - Marius Poitelea
- b Department of Neuroradiology , Royal Sussex County Hospital , Brighton , UK
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Quinn C, Tummala R, Anderson J, Dahlheimer T, Nascene D, Jagadeesan B. Effectiveness of alternative routes of intra-arterial chemotherapy administration for retinoblastoma: Potential for response and complications. Interv Neuroradiol 2019; 25:556-561. [PMID: 30931673 DOI: 10.1177/1591019919831953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Intra-arterial chemotherapy (IAC) is now the first line treatment for selected patients with retinoblastoma (Rb). Typically, IAC is infused following the selective catheterization of the ophthalmic artery (OA) on the affected side. However, in some patients, the OA alone may not provide vascular supply to the tumor, whereas in other instances the efficacy of IAC could be compromised due to the presence of prominent collateral vessels from the external carotid artery (ECA). We report our experience with catheterizing vessels other than the OA for IAC treatment for Rb. METHODS After institutional review board approval, a retrospective analysis was conducted of electronic medical records and imaging of our Rb population. RESULTS We identified 13 patients who received IAC for Rb treatment. Of these, five patients required alternative methods of chemotherapy delivery other than through the OA, totaling 17 treatments. Two patients needed balloon-assisted occlusion of the ECA, two patients required selective catheterization of the middle meningeal artery, and one patient had no internal carotid artery supply to the choroidal blush, thus the superficial temporal artery provided access for IAC. Total globe salvage rate was 76% and 80% with the alternative route subset. CONCLUSIONS Alternatives to the OA may be necessary to deliver IAC for selected cases of Rb. These routes can be safe and effective. However, thorough understanding of the orbital blood supply is essential. Whether these alternative IAC methods result in similar outcomes to OA infusions has not been established.
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Affiliation(s)
- Coridon Quinn
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Jill Anderson
- Department of Ophthalmology, University of Minnesota, Minneapolis, MN, USA
| | - Tambra Dahlheimer
- Department of Pediatric Hematology, University of Minnesota, Minneapolis, MN, USA
| | - David Nascene
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Zeng YM, Chen YF, Lin HH, Zhang XB. Use of endo-bronchial end-tidal CO 2 test for location of the pleural air leakage in patients with intractable pneumothorax. Ther Adv Respir Dis 2019; 12:1753465818756564. [PMID: 29480071 PMCID: PMC5937148 DOI: 10.1177/1753465818756564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 11/17/2022] Open
Abstract
Background: Location of the affected bronchus of pleural air leaks is the most important step of trans-bronchoscopic bronchial occlusion for the treatment of intractable pneumothorax. The balloon occlusion test is the most commonly used technique, but has failed in some cases. The aim of the present study was: (1) to determine if endo-bronchial end-tidal CO2 (EtCO2) measurement can identify the affected bronchus that is the source of a persistent pleural air leak; and (2) to establish a methodology for endo-bronchial EtCO2 testing in locating affected bronchus in intractable pneumothorax. Methods: A total of 28 patients with intractable pneumothorax underwent bronchoscopy with (1) the balloon occlusion test for the identification of the affected bronchus; and (2) endo-bronchial EtCO2 measurement (EtCO2 test) at the orifices of the bronchus of the affected lung. The effectiveness of these two methods of affected bronchus identification were compared. The threshold EtCO2 (T-EtCO2) was determined. Results: The positive rates of locating the affected bronchus by the endo-bronchial EtCO2 test, balloon occlusion test, and combination of the two techniques were 60.7% (17/28), 64.3% (18/28) and 96.4% (27/28), respectively. The average differences in EtCO2 between the affected bronchus and the main carina, main bronchus, and non-affected bronchus were (in mmHg) 4.41 ± 1.99 (95% confidence interval: 3.5, 5.3), 4.73 ± 2.10 (3.80, 5.66 ) and 5.57 ± 2.53 (4.45, 6.69), respectively. Conclusions: (1) The endo-bronchial EtCO2 test is complementary to the balloon occlusion test of the leading bronchus. (2) A threshold (T-EtCO2) value of >5 mmHg is optimal for this technique.
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Affiliation(s)
- Yi-Ming Zeng
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, No. 34, Zhongshanbei Road, Licheng District, Quanzhou 362000, Fujian Province, China
| | - Yun-Feng Chen
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, China
| | - Hui-Huang Lin
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, China
| | - Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, China
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Peng ZH, Xiong Z, Zhao BS, Zhang GB, Song W, Tao LX, Zhang XZ. Prophylactic abdominal aortic balloon occlusion: An effective method of controlling hemorrhage in patients with placenta previa or accreta. Exp Ther Med 2018; 17:1492-1496. [PMID: 30680033 DOI: 10.3892/etm.2018.7066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/07/2018] [Indexed: 11/06/2022] Open
Abstract
Postpartum hemorrhage is considered to be a serious complication in patients with pernicious placenta. Approaches employing abdominal aortic balloon occlusion to control hemorrhage are extremely effective for such patients. The present study analyzed 9 patients with pernicious placenta previa in a single hospital from June 2016 to November 2017. Prior to cesarean hysterectomy, an abdominal aortic balloon catheter was placed in all patients. The balloon was inflated and evacuated alternately using saline following delivery of the fetal head. The X-ray dose, bleeding volume and complications during the procedure were observed. Balloon catheterization was successfully performed in all 9 patients. The dose of X-rays ranged from 15.8 to 24.5 mGy, with a mean of 19.3±2.7 mGy; the volume of blood loss ranged from 50 to 4,000 ml, with a mean of ~1,800 ml. Uterine artery embolization was successfully performed in 2 cases due to bleeding following the cesarean hysterectomy, and every uterus was retained. Abdominal aortic balloon occlusion can effectively reduce the amount of bleeding during cesarean hysterectomy in patients with pernicious placenta previa. This may serve as technical support for patients in whom retention of the uterus is expected. However, it is necessary to identify any abnormal uterine tissue above the level of the renal artery in order to avoid ineffective balloon occlusion.
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Affiliation(s)
- Zhao Hong Peng
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Zhuang Xiong
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Ben Sheng Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Guo Bing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Wen Song
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Long Xiang Tao
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Xiu Ze Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Kong L, Yu Y, Li F, Cui H. Intra-Aortic Balloon Occlusion Decreases Blood Loss During Open Reduction and Internal Fixation for Delayed Acetabular Fractures: A Retrospective Study of 43 Patients. J INVEST SURG 2020; 33:468-73. [PMID: 30395741 DOI: 10.1080/08941939.2018.1516837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: It is difficult to treat delayed acetabular fractures due to massive blood loss during operation. Temporary balloon occlusion of the abdominal aorta was introduced into sacral tumor surgery to reduce intraoperative hemorrhage. The aim of this study was to investigate the effect of this method on reduction of intraoperative blood loss and analyze the complications of this technique in the treatment of delayed acetabular fracture. Methods: We retrospectively reviewed 43 patients with delayed acetabular fracture who were surgically treated through combined approaches. Nineteen patients underwent temporary balloon occlusion of the abdominal aorta; 10 patients had type B fracture and 9 patients had type C fracture according to the Müller AO classification. The remaining 24 patients were classified into a control group; 14 patients had type B fracture and 10 patients had type C fracture. Surgical time, intraoperative blood loss, blood transfusion, satisfactory reduction rate, and functional recovery were recorded and compared between two groups. Merle d'Aubigné and Postel scoring was applied to evaluate the patients. Results: The patients treated with intra-aortic balloon occlusion had a shorter surgical time (p = 0.008), less intraoperative blood loss (p = 0.005), and less transfused blood units (p = 0.001). No complications caused by balloon occlusion. No significant difference were observed in the outcomes and the complications related to acetabular fractures between two groups. Conclusions: Temporary balloon occlusion of the abdominal aorta is a reliable technique to control bleeding for the surgery of delayed acetabular fracture.
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Kim DH, Chang SW, Matsumoto J. The utilization of resuscitative endovascular balloon occlusion of the aorta: preparation, technique, and the implementation of a novel approach to stabilizing hemorrhage. J Thorac Dis 2018; 10:5550-5559. [PMID: 30416806 DOI: 10.21037/jtd.2018.08.71] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Noncompressible torso hemorrhage (NCTH), if not controlled promptly, leads to death. In the acute setting, aortic occlusion can be performed as damage control surgery (DCS) for hemorrhage originating from the abdomen and pelvis. With the development of endovascular technology, an intra-aortic balloon can be used to achieve aortic occlusion and decrease hemorrhage. Recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been accepted as a salvage technique for the temporary stabilization of patients with NCTH. However, balloon occlusion is not easily performed in trauma patients. In this article, we described preparation, technical description, and conceptual understanding of REBOA.
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Affiliation(s)
| | | | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
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Kawase Y, Omori H, Kawasaki M, Tanigaki T, Hirata T, Okamoto S, Ota H, Kikuchi J, Okubo M, Kamiya H, Hirakawa A, Suzuki T, Matsuo H. Postocclusional Hyperemia for Fractional Flow Reserve After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005674. [PMID: 29246913 DOI: 10.1161/circinterventions.117.005674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postocclusional hyperemia caused by balloon occlusion is a potential alternative method of inducing hyperemia for measuring post-percutaneous coronary intervention fractional flow reserve (FFR). The aim of this study was to investigate postocclusional hyperemia as a method of inducing hyperemia. METHODS AND RESULTS FFR measured by postocclusional hyperemia (FFRoccl) caused by balloon occlusion after percutaneous coronary intervention was compared with FFR measured by drug-induced hyperemia (FFR measured by intravenous ATP; and FFR measured by intracoronary papaverine injection [FFRpap]) in 98 lesions from 98 patients. The hyperemia duration was also measured for FFRoccl and FFRpap. The correlation coefficient between FFRoccl, FFR measured by intravenous ATP (r=0.973; P<0.01), and FFRpap (r=0.975; P<0.01) showed almost identical values to those obtained for the correlation coefficient between FFR measured by intravenous ATP and FFRpap (r=0.967; P<0.01). No clear difference was observed on Bland-Altman analysis. Hyperemia duration was significantly longer with FFRoccl than with FFRpap (70±22 versus 51±25 s; P<0.01). CONCLUSIONS Strong correlations were found between FFRoccl and FFR measured by intravenous ATP and FFRoccl and FFRpap. Hyperemia caused by FFRoccl was significantly longer than that caused by FFRpap.
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Affiliation(s)
- Yoshiaki Kawase
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.).
| | - Hiroyuki Omori
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Masanori Kawasaki
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Toru Tanigaki
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Tetsuo Hirata
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Syuuichi Okamoto
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Hideaki Ota
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Jun Kikuchi
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Munenori Okubo
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Hiroki Kamiya
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Akihiro Hirakawa
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Takahiko Suzuki
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
| | - Hitoshi Matsuo
- From the Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Y.K., H.O., T.T., T.H., S.O., H.O., J.K., M.O., H.K., T.S., H.M.); Department of Cardiology, Gifu University Graduate School of Medicine, Japan (M.K.); and Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Japan (A.H.)
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Wan L, Wang H, Xu K, Yang L. Internal iliac artery balloon occlusion as a hemostatic method for spontaneous rupture of vulvar hematoma during delivery: A case report. J Int Med Res 2018; 46:2994-2999. [PMID: 29808742 PMCID: PMC6124277 DOI: 10.1177/0300060518774228] [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] [Indexed: 11/17/2022] Open
Abstract
Spontaneous rupture of a vulvar hematoma during delivery is a relatively uncommon event and may cause excessive hemorrhage. Exact identification of anatomic structures and bleeding points is challenging. We herein present a case involving a pregnant woman at 39 weeks’ gestation with a large vulvar hematoma that spontaneously ruptured during the second stage of labor, likely due to rupture of varices in the vulva or vagina. It was difficult to accurately expose and suture the deep bleeding points. The estimated blood loss volume was 1591 mL, and the hemoglobin concentration dropped from 132 g/L before delivery to 84 g/L after delivery. To prevent hemorrhagic shock, bilateral internal iliac artery balloon occlusion was performed and proved to be an effective way to achieve hemostasis. Once hemostasis was established, ligation of the bleeding sites and suturing of all dead space were rapidly completed. Bilateral internal iliac artery balloon occlusion can be used as an effective treatment for excessive vaginal bleeding. The presence of varices or hemangiomas in the vulva or vagina should be carefully checked during antenatal care.
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Affiliation(s)
- Li Wan
- 1 Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,2 Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hongjing Wang
- 1 Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,2 Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ke Xu
- 2 Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.,3 Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingyun Yang
- 1 Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,2 Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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Strauss S, Engels P, Harlock J. Distal Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to Restore Hemodynamic Stability in a Patient With Proximal Aortic Rupture. J Endovasc Ther 2018; 25:257-260. [PMID: 29409382 DOI: 10.1177/1526602818757012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report unconventional use of the resuscitative endovascular balloon occlusion of the aorta (REBOA) technique to restore hemodynamic stability in a patient who was hemorrhaging from aortic injury proximal to the target zone of occlusion. CASE REPORT A 72-year-old woman underwent urgent thoracic stent-graft repair of a ruptured 8×8-cm mycotic pseudoaneurysm. Two months later, follow-up imaging revealed that the proximal aortic stent seal zone had degenerated, so a percutaneous procedure was performed 2 months later to preemptively reinforce the segment of stented aorta. Shortly after obtaining femoral access, the patient's condition abruptly deteriorated with profound hypotension, presumably a result of an access complication. REBOA was established in the supraceliac aorta, which sustained the mean arterial pressure while the anesthesiologist resuscitated the patient. Unexpectedly, angiography showed a rupture of the descending thoracic aorta immediately proximal to the upper stent-graft. Balloon inflation distal to the rupture site was maintained while the patient's hypotension was treated. Another stent-graft was quickly placed over the area of concern, overlapping proximal to the prior grafts. Once the aortic perforation was sealed, the patient stabilized hemodynamically. Inotropic support was weaned, and the REBOA occlusion catheter was deflated. Final angiograms of the arch and thoracic aorta confirmed no extravasation; angiograms of the infrarenal aorta and iliac arteries showed no evidence of injury. CONCLUSION This case illustrates that applying REBOA distal to the injury site in certain clinical scenarios may sufficiently increase peripheral resistance to compensate temporarily for cardiovascular collapse secondary to aortic injury.
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Affiliation(s)
- Shira Strauss
- 1 Michael G. Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Engels
- 2 Divisions of General Surgery and Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - John Harlock
- 1 Michael G. Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,3 Division of Vascular Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Ono Y, Murayama Y, Era S, Matsunaga S, Nagai T, Osada H, Takai Y, Baba K, Takeda S, Seki H. Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta. J Obstet Gynaecol Res 2018; 44:456-462. [PMID: 29297951 PMCID: PMC5873444 DOI: 10.1111/jog.13550] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/08/2017] [Indexed: 11/28/2022]
Abstract
Aims We investigated whether common iliac artery balloon occlusion (CIABO) was effective for decreasing blood loss during cesarean hysterectomy (CH) in patients with placenta previa with accreta and was safe for mothers and fetuses. Methods Of the 67 patients who underwent CH for placenta previa with accreta at our facility from 1985 to 2014, 57 patients were eligible for the study. The amount of intraoperative bleeding during CH was compared between three groups: surgery without blood flow occlusion (13 patients), internal iliac artery ligation (15 patients) and CIABO (29 patients). Additionally, multivariate analysis was performed to assess risk factors for massive bleeding during CH. Results The mean blood loss in the CIABO group (2027 ± 1638 mL) was significantly lower than in the other two groups (3787 ± 2936 mL in the no occlusion, 4175 ± 1921 mL in the internal iliac artery ligation group; P < 0.05). Multivariate analysis showed that spontaneous placental detachment during surgery (odds ratio [OR] 49.174, 95% confidence interval [CI] 4.98–1763.67), a history of ≥ 2 cesarean sections (OR 9.226, 95% CI 1.07–231.15) and no use of CIABO (OR 26.403, 95% CI 3.20–645.17) were significantly related to massive bleeding during surgery. There was no case of necrosis resulting from ischemia. The mean radiation dose during balloon placement never exceeded the threshold value for fetal exposure. Conclusion Bleeding during CH for placenta previa with accreta can be decreased by CIABO. This study also confirmed the safety of CIABO in regard to maternal lower limb ischemia and fetal radiation exposure during balloon placement.
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Affiliation(s)
- Yoshihisa Ono
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yoshihiko Murayama
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Sumiko Era
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Shigetaka Matsunaga
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Tomonori Nagai
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hisato Osada
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yasushi Takai
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kazunori Baba
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Satoru Takeda
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hiroyuki Seki
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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Abstract
BACKGROUND To evaluate the clinical efficacy of prophylactic temporary balloon occlusion of the abdominal aorta in patients with placenta previa accretism during cesarean section. METHODS Twenty-three consecutive patients, prenatally confirmed with placenta previa accretism were retrospectively analyzed in our center from August 2012 to October 2014. All 23 subjects underwent cesarean section with prophylactic balloon occlusion of the abdominal aorta. RESULTS All of the 23 subjects experienced singleton pregnancies leading to the birth of live infants. Of these subjects, the following problems were diagnosed: placenta accrete (n = 10), placenta increte (n = 10), and placenta precrete (n = 3). Mean intraoperative hemorrhage was 1170.0 mL. Fifteen patients received red blood cell transfusion with a mean transfusion volume of 2.3 units. The incidence of hysterectomy was 21.74% (5/23) with blood loss ranging from 2000 to 5000 mL (mean 3360.0 mL). One complication encountered in this retrospective study was lower extremity arterial thrombosis. Eighteen patients were followed-up by telephone to 14 months following discharge, all babies were noted to be healthy. CONCLUSION Prophylactic abdominal aorta balloon occlusion (ABO) was relatively safe in the treatment of patients with placenta previa accretism. This approach could represent a key aspect in a multidisciplinary algorithm in reducing hemorrhage in abnormal placentation.
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Affiliation(s)
- Zhongyuan Qiu
- Obstectic & Gynecology, Fujian Medical University Union Hospital
- Obstectic & Gynecology, the Third Affiliated Hospital of Fujian Medical University
| | - Jifen Hu
- Obstetrics & Gynecology, the First Affiliated Hospital of Fujian Medical University, China
| | - Jianbo Wu
- Obstetrics & Gynecology, the First Affiliated Hospital of Fujian Medical University, China
| | - Lihong Chen
- Obstetrics & Gynecology, the First Affiliated Hospital of Fujian Medical University, China
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Inoue A, Ohta S, Nitta N, Tsuboi S, Sonoda A, Tomozawa Y, Watanabe S, Mukaisho K, Murata K. Adrenal obliteration by balloon-occluded retrograde venous ethanol injection in a swine model. MINIM INVASIV THER 2017; 26:322-330. [PMID: 28521609 DOI: 10.1080/13645706.2017.1326386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effects of adrenal obliteration by balloon-occluded retrograde venous ethanol injection. MATERIAL AND METHODS We inserted a micro-balloon catheter into the left adrenal vein of six pigs and retrogradely injected absolute ethanol (0.06 ml/kg) under balloon occlusion. Two pigs were sacrificed on day 3, 7, and 14 after the procedure, respectively. We evaluated adrenal cortical and medullary hormones of the left renal vein, venograms, magnetic resonance imaging scans obtained before and after the procedure, autopsy and microscopic findings, and the weight of the bilateral adrenal glands. RESULTS The hormone levels were extremely high on day 3 after the procedure. Post-procedure, partially-enhanced parenchyma and shaggy veins were observed. On the post-mortem examination, the left adrenal glands showed hemorrhage and adhesion on the third and seventh day and fatty proliferation 14 days after the procedure. Microscopic examination revealed hemorrhagic necrosis on day 3, inflammatory cell infiltration on day 7, and partial fibrosis 14 days after the procedure. The weight of the left adrenal gland on day 14 was lower than that of the right gland. CONCLUSIONS This procedure elicited partial adrenal infarction with a high catecholamine concentration in the left renal vein.
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Affiliation(s)
- Akitoshi Inoue
- a Department of Radiology , Shiga University of Medical Science , Shiga , Japan
| | - Shinichi Ohta
- a Department of Radiology , Shiga University of Medical Science , Shiga , Japan
| | - Norihisa Nitta
- a Department of Radiology , Shiga University of Medical Science , Shiga , Japan
| | - Shizuka Tsuboi
- a Department of Radiology , Shiga University of Medical Science , Shiga , Japan
| | - Akinaga Sonoda
- a Department of Radiology , Shiga University of Medical Science , Shiga , Japan
| | - Yuki Tomozawa
- a Department of Radiology , Shiga University of Medical Science , Shiga , Japan
| | - Shobu Watanabe
- a Department of Radiology , Shiga University of Medical Science , Shiga , Japan
| | - Kenichi Mukaisho
- b Division of Molecular and Diagnostic Pathology , Shiga University of Medical Science , Shiga , Japan
| | - Kiyoshi Murata
- a Department of Radiology , Shiga University of Medical Science , Shiga , Japan
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DemiropoulosF U, Papazoglou K, Miliaras D. The effect of thoracic aortic balloon occlusion during hemorrhagic shock on spinal cord and visceral organ damage. Hippokratia 2016; 20:255. [PMID: 29097900 PMCID: PMC5654451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Undefined DemiropoulosF
- 5 Department of Surgery, Medical Faculty, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Papazoglou
- 5 Department of Surgery, Medical Faculty, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Miliaras
- Laboratory of Histology and Embryology, Medical Faculty, Aristotle University of Thessaloniki, Thessaloniki, Greece
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50
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Ogawa M, Takayasu K, Hirayama M, Miura T, Shiozawa K, Abe M, Matsumoto N, Nakagawara H, Ohshiro S, Yamamoto T, Tanaka N, Moriyama M, Mutou H, Yamamoto Y, Irie T. Efficacy of a microballoon catheter in transarterial chemoembolization of hepatocellular carcinoma using miriplatin, a lipophilic anticancer drug: Short-term results. Hepatol Res 2016; 46:E60-9. [PMID: 25974615 DOI: 10.1111/hepr.12527] [Citation(s) in RCA: 32] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 04/14/2015] [Accepted: 04/18/2015] [Indexed: 12/14/2022]
Abstract
AIM The goal of the study was to evaluate the efficacy and safety of balloon-occluded transarterial chemoembolization (B-TACE) of hepatocellular carcinoma (HCC) using miriplatin (a lipophilic anticancer drug) and gelatin particles. METHODS B-TACE was performed for 62 HCC nodules in 33 patients who could not be treated by surgical resection or radiofrequency ablation. All 33 patients had a history of transarterial chemoembolization (TACE) treatment prior to B-TACE. As a historical comparison, we investigated 40 nodules in 28 patients treated by TACE using a conventional microcatheter (C-TACE), miriplatin and gelatin particles. The therapeutic effect per tumor was compared between the groups based on the Response Evaluation Criteria in Cancer Study Group of Japan (RECICL) and side-effects were compared based on the Common Terminology Criteria for Adverse Events (ver. 4.0). RESULTS The therapeutic efficacy after 4-12 weeks was evaluated in 59 nodules in the B-TACE group and in 37 nodules in the C-TACE group. Of these nodules, TE4 occurred in 29 (49.2%) in the B-TACE group and in 10 (27%) in the C-TACE group. Local efficacy was significantly higher in nodules treated by B-TACE than by C-TACE. The side-effects on hepatic function were similar in the two groups. CONCLUSION Our results suggest that B-TACE with miriplatin is a useful treatment for hepatocellular carcinoma.
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Affiliation(s)
| | | | | | - Takao Miura
- Department of Gastroenterology and Hepatology
| | | | | | | | | | - Shu Ohshiro
- Department of Gastroenterology and Hepatology
| | | | | | | | | | | | - Toshiyuki Irie
- Department of Radiology, Hitachi General Hospital, Hitachi, Japan
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