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Duc Tin L, Van Nut L, Abdalla AS, Duc H, Kwaah PA, Le TTB, Vy TTT, Le T, Anh PM, Kim Que D, Huy NT. Outcomes of balloon angioplasty and stent placement for iliac artery lesions classified as TASC II A, B: a single-center study. Front Surg 2024; 11:1366338. [PMID: 38601876 PMCID: PMC11004440 DOI: 10.3389/fsurg.2024.1366338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/08/2024] [Indexed: 04/12/2024] Open
Abstract
Background Iliac artery stenosis or occlusion is a critical condition that can severely impact a patient's quality of life. The effectiveness of balloon angioplasty and intraluminal stenting for the treatment of iliac artery lesions classified as TASC II A and B was evaluated in this single-center prospective study. Methods Conducted between October 2016 and September 2020 at Cho Ray Hospital's Vascular Surgery Department, this prospective study involved PAD patients categorized by TASC II A and B classifications who underwent endovascular intervention. Intervention outcomes were assessed peri-procedure and during short-term and mid-term follow-ups. Results Of the total of 133 patients, 34.6% underwent balloon angioplasty, while 65.4% received stenting. The immediate technical success rate was 97.7%, while the clinical success rate was 62.4%. Complications were minimal, with major limb amputation reported in 1.5% of the cases. There was a significant improvement in Rutherford classification and ABI at short-term follow-up, with a patency rate of 90.2%. The mid-term post-intervention follow-up yielded similar results with an 86.1% patency rate. The mortality rates associated with arterial occlusion were 2.3% during short-term follow-up and 1.7% during mid-term follow-up. Conclusion Balloon angioplasty and stent placement are effective and safe interventions for TASC II A and B iliac artery occlusions with favorable short and mid-term outcomes. Further, multi-center studies with larger sample sizes are recommended for more comprehensive conclusions, including long-term follow-up assessment.
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Affiliation(s)
- Le Duc Tin
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
- Department of Thoracic and Vascular Surgery, Nam Can Tho University, Can Tho, Vietnam
| | - Lam Van Nut
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Hoang Duc
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
- Cardiovascular Research, Methodist Hospital, Merrillville, IN, United States
| | - Patrick A. Kwaah
- Department of Internal Medicine, Yale School of Medicine, Yale-Waterbury Internal Medicine Program, Waterbury, CT, United States
| | - Trang T. B. Le
- Cardiovascular Research, Methodist Hospital, Merrillville, IN, United States
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thi Thuy Vy
- Department of Internal Medicine, Minh Anh International Hospital, Ho Chi Minh City, Vietnam
| | - Thoa Le
- Cardiovascular Research, Methodist Hospital, Merrillville, IN, United States
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Pham Minh Anh
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Do Kim Que
- Department of Thoracic and Cardiovascular Surgery, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- School of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Xu Y, Ai T. Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature. Medicine (Baltimore) 2024; 103:e37144. [PMID: 38306542 PMCID: PMC10843307 DOI: 10.1097/md.0000000000037144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION A complete disruption of main pancreatic duct (MPD) presents a significant challenge to the surgeon. Historically, the standard surgical approach for addressing a complete disruption of the MPD involved distal pancreatic resection and pancreaticojejunostomy Roux-en-Y anastomosis. Nevertheless, there have been no reported cases of hybrid surgery being employed for the complete disruption of the MPD. PATIENT CONCERNS A 63-year-old male patient presented with blunt trauma in the upper abdomen and was transferred to our trauma center 10 hours after injury. Upon arrival at the emergency department, he was conscious, hemodynamically stable, and complained of upper abdominal pain and distention. Physical examination revealed right upper abdominal tenderness and slight abdominal tension. Abdominal contrast-enhanced CT scan revealed a complete transection of pancreatic parenchyma at the junction of the head and neck. DIAGNOSES Complete transection of pancreatic parenchyma at the junction of the head and neck combined with complete disruption of the MPD, AIS grade IV. INTERVENTIONS The hybrid surgery was initially utilized for complete MPD disruption, incorporating endoscope-assisted stent placement in the MPD along with primary repair of the pancreatic parenchyma and duct. OUTCOMES The postoperative period went smoothly, and the patient recovered and was discharged 4 weeks after operation. The MPD stent was removed under endoscope 4 months after operation, and Endoscopic Retrograde Pancreatography examination showed that the MPD was patency and slight MPD stenosis without pancreatic leakage. At the most recent follow-up, the patient had returned to normal life and work without any pancreatic endocrine or exocrine dysfunction. LESSONS The hybrid surgery, incorporating endoscope-assisted MPD stent placement and primary repair of the pancreatic parenchyma and duct, emerges as a promising alternative for complete MPD disruption in hemodynamically stable patients. The challenge in this hybrid surgery is the precise localization of the distal end of the MPD.
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Affiliation(s)
- Yanan Xu
- Department of Traumatology, Chongqing Emergency Medical Center/Chongqing University Central Hospital, Chongqing, China
| | - Tao Ai
- Department of Traumatology, Chongqing Emergency Medical Center/Chongqing University Central Hospital, Chongqing, China
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Wojtas A, Kunitsky KD, Cavayero C, Salami A. Renal Abscess Drainage Using a Novel Transgastric Endoscopic Approach: A Case Report. Cureus 2023; 15:e51294. [PMID: 38283446 PMCID: PMC10822679 DOI: 10.7759/cureus.51294] [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: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Renal and perinephric abscesses are rare purulent infections within or around renal parenchyma, typically treated with antibiotics or various procedural approaches depending on abscess size. In this case report, we describe the novel use of a transgastric endoscopic ultrasound (EUS)-guided technique with placement of a stent for drainage between a renal abscess and the stomach in a patient who had failed attempted percutaneous drainage twice and where an open surgical approach was deemed inappropriate. The patient presented with a chief complaint of left flank pain, with CT revealing a ~4 x 4 cm renal abscess in the upper pole of the left kidney. Urology, Infectious Disease, and Interventional Radiology were consulted. Following two failed attempts at percutaneous drain placement, the patient elected for EUS-guided transgastric stent placement for drainage. The stent was removed by postoperative day two after significant decompression of the abscess. He was advised to follow up outpatient with Urology to confirm full renal abscess resolution.
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Affiliation(s)
- Abby Wojtas
- Department of Gastroenterology, Kansas City University, Kansas City, USA
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Nakashima S, Hata S, Shinohara M, Ando T, Shin T, Mimata H. External iliac arterial dissection after robot-assisted radical cystectomy with an intracorporeal ileal conduit and extended pelvic lymph node dissection. IJU Case Rep 2023; 6:468-470. [PMID: 37928311 PMCID: PMC10622215 DOI: 10.1002/iju5.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction External iliac arterial dissection after robot-assisted laparoscopic procedures is an extremely rare complication. It may cause severe adverse outcomes, such as lower limb necrosis. Case presentation A 73-year-old man was diagnosed with cT2 ≤ N0M0 bladder cancer and underwent robot-assisted radical cystectomy. After surgery, he complained of severe left lower leg pain. Computed tomography showed external iliac arterial occlusion. Furthermore, the emergency operation revealed external iliac arterial dissection and occlusion. Conclusion The robot arm does not have any sense of force or touch. Thus, it is necessary to pay sufficient attention to the traction of blood vessels and contact with major organs.
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Affiliation(s)
| | - Shinro Hata
- Department of UrologyOita University Faculty of MedicineYufuOitaJapan
| | - Mayuka Shinohara
- Department of UrologyOita University Faculty of MedicineYufuOitaJapan
| | - Tadasuke Ando
- Department of UrologyOita University Faculty of MedicineYufuOitaJapan
| | - Toshitaka Shin
- Department of UrologyOita University Faculty of MedicineYufuOitaJapan
| | - Hiromitsu Mimata
- Department of UrologyOita University Faculty of MedicineYufuOitaJapan
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5
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Wang H, Tao W. Efficacy of a patient with scar constitution combined with corrosive esophageal strictures after different endoscopic therapies. Clin Case Rep 2023; 11:e8156. [PMID: 38028050 PMCID: PMC10654552 DOI: 10.1002/ccr3.8156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Oral corrosive substances can cause esophageal or gastrointestinal strictures, leading to malnutrition and gastrointestinal dysfunction, directly affecting the patients' quality of life. The aim of the case was to compare the efficacy of different endoscopic therapy methods.
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Affiliation(s)
- Haixia Wang
- Department of GastroenterologyZigong First People's HospitalZigongChina
| | - Wei Tao
- Department of GastroenterologyGeneral Hospital of Ningxia Medicale'YinchuanChina
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Tang T, Wu C, Wang Z, Wei J, Zhang D, Sheng W. Treatment of syphilitic aortitis with coronary artery bypass grafting and "open" stent placement. J Int Med Res 2023; 51:3000605231204496. [PMID: 37862785 PMCID: PMC10590048 DOI: 10.1177/03000605231204496] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/13/2023] [Indexed: 10/22/2023] Open
Abstract
Cardiovascular syphilis manifests many years after primary infection. Here, we report the successful treatment of a patient who developed syphilitic aortitis with bilateral coronary ostial stenosis and aortic insufficiency. The patient underwent right coronary artery bypass grafting, left main coronary ostial "open" stent placement, and mechanical aortic valve placement during open-heart surgery.
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Affiliation(s)
- Tiansheng Tang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| | - Changjuan Wu
- Department of Pharmacy, Wannan Medical College, No. 22 Wenchang West Road, Wuhu, Anhui, China
| | - Ziao Wang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| | - Jun Wei
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| | - Dafa Zhang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| | - Weiyong Sheng
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
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7
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Niu Q, Hou K, Wu Y, Wang Y. Mesenteric ischaemia in a case of acute anterior myocardial infarction: overlap of ischaemic types. Clin Med (Lond) 2023; 23:521-524. [PMID: 37775160 PMCID: PMC10541272 DOI: 10.7861/clinmed.2023-0271] [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] [Indexed: 10/01/2023]
Abstract
Acute mesenteric ischaemia is divided into different clinical entities which are usually considered separately. Here we report a case of acute mesenteric ischaemia complicated with acute anterior myocardial infarction. The clinical picture suggested that non-occlusive mesenteric ischaemia and acute mesenteric arterial thrombosis were both present in this case. Thus, non-occlusive and occlusive ischaemia may coexist in a coordinated and perceptible pattern.
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Affiliation(s)
| | | | - Yan Wu
- Shidong Hospital, Shanghai, China
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8
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Zhen L, Wang X, Li W, Shi S, Zhao X, Ai H, Que B, Wang M, Wang C, Li Q, Li Z, Li T, Wang L, Jiang X, Liu Q, Nie S. Comparison between a dedicated stent positioning system and conventional stenting of aorto-ostial lesions: a prospective, multi-center, randomized controlled study. Cardiovasc Diagn Ther 2023; 13:650-659. [PMID: 37675095 PMCID: PMC10478020 DOI: 10.21037/cdt-22-542] [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: 10/26/2022] [Accepted: 06/28/2023] [Indexed: 09/08/2023]
Abstract
Background The accurate placement of stents for treatment of coronary aorto-ostial lesions (AOLs) is technically challenging. The purpose of this study was to evaluate the efficacy and safety of a stent positioning system with a dedicated nitinol device and compare them with those of the conventional approach for stenting of coronary AOLs. Methods In this prospective, multi-center, open-label, randomized study, conducted from November 2015 to April 2019, patients with coronary AOLs that underwent percutaneous coronary intervention (PCI) were randomly allocated (allocation ratio 1:1) using block randomization method to either a stent positioning system group or a conventional technique group. The primary endpoint was the range of stent slippage when positioning. The following secondary endpoints were applied: (I) the extent of swing of the guiding catheters during stent positioning; (II) the rate of accurate stent placement; (III) the procedure time; and (IV) the incidence of major adverse cardiovascular events (MACEs) including cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis. Results During the study period, 139 patients with aorto-ostial coronary artery stenosis were included at 5 centers. A total of 69 patients were allocated to the stent positioning system group and 70 patients to the conventional technique group. Angiographic and clinical success were achieved in 100% of the patients included in both groups. The range of stent slippage was significantly shorter in the stent positioning system group than it was in the conventional technique group [0.64 (0.22; 1.35) vs. 1.11 (0.48; 1.72) mm, P=0.01]. The rate of accurate placement of stents was higher in the stent positioning system group than it was in the conventional technique group (74.6% vs. 57.1%, P=0.03). The extent of guiding catheter swing during the stent positioning [0.24 (0.19; 0.53) vs. 0.23 (0.19; 0.53) mm; P=0.95] and the MACEs rates (1.4% vs. 2.9%, P>0.99) were similar between the 2 groups. The procedural time of the stent positioning system was longer than that of the conventional approach [1.00 (0.50; 1.50) vs. 0.80 (0.50; 1.50) min, P=0.09]. Conclusions The dedicated stent positioning system was is safer and provides more accurate placement of stents for coronary AOLs than the conventional approach, and the associated prolongation of procedure time is insignificant. Trial Registration Chinese Clinical Trial Registry (ChiCTR), Unique identifier: ChiCTR2100053869. URL: https://www.chictr.org.cn/showproj.html?proj=133280.
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Affiliation(s)
- Lei Zhen
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shutian Shi
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xuedong Zhao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mei Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunmei Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qingxiang Li
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhanquan Li
- The People’s Hospital of Liaoning Province, Shenyang, China
| | - Tianchang Li
- The Six Medical Center of PLA General Hospital, Beijing, China
| | - Lefeng Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xuejun Jiang
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Liu
- Beijing Advanced Medical Technologies, Ltd. Inc., Beijing, China
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Hosna A, Haseeb Ul Rasool M, Noff NC, Makhoul K, Miller D, Umar Z, Ghallab M, Hasan R, Ashfaq S, Parikh A, Lopez R. Cryotherapy for the Treatment of Tracheal Stenosis: A Systematic Review. Cureus 2023; 15:e41012. [PMID: 37519508 PMCID: PMC10372464 DOI: 10.7759/cureus.41012] [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: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Tracheal stenosis (TS) is an iatrogenic sequela after intubation or tracheostomy that is increasing despite technological improvement and skilled respiratory care in the ICU. According to the studies, the rate of TS varies from 10 to 22%, but only 1-2% of these stenoses are severe and present with inspiratory dyspnea that does not respond to medical management. Bronchoscopy is considered the most appropriate diagnostic test, and laser surgery and tracheobronchial stenting are the most commonly performed procedures for tracheal stenosis. However, alternative treatment options, including cryotherapy for inoperable patients, have yet to be studied widely. As the number of patients requiring ICU admission with mechanical intubation is increasing, it is crucial to acknowledge this complication and consider alternative management options. Here we present a review of the use of cryotherapy for post-intubation tracheal stenosis. Pubmed, Cochrane, and EMBASE databases were inquired for studies performed using the keywords 'airway stricture' OR 'airway obstruction' AND 'post-intubation' OR 'post-extubation' OR 'tracheostomy' AND 'cryotherapy'. After the primary and secondary screening, five studies were included in the analysis. We included 67 patients were included in the analysis, with a mean age of 50.2 (range: 42-55) years. Tracheal stenosis and subglottic stricture were the most common sites of stenosis. Twenty-nine patients were treated with cryotherapy only, while the rest 38 patients had cryotherapy followed by balloon dilation. After the intervention, 48 patients experienced improvement, five experienced no change in the symptoms, 13 patients were asymptomatic before the treatment, and one died. No complication was reported in 65 patients, with only minor complications reported in rest. Although, there is no clear treatment protocol for patients with inoperable tracheal stenosis. Our review demonstrates that cryotherapy for inoperable tracheal stenosis can be an acceptable alternative treatment with significant clinical improvement. Additionally, cryotherapy has fewer adverse effects compared to other treatment options.
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Affiliation(s)
- Asma Hosna
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | | | - Nicole C Noff
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | | | - Daniel Miller
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Zaryab Umar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Muhammad Ghallab
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals, New York City, USA
| | - Rockyb Hasan
- Internal Medicine, Texas Tech University Health Sciences Center - Amarillo Campus, Lubbock, USA
| | - Salman Ashfaq
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Avish Parikh
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Ricardo Lopez
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
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Li W, Wang A, Ma C, Wang Y, Zhao Y, Zhang Y, Wang K, Zhang Y, Wang Y, Yang X, Liu J, Liu X. Antiplatelet therapy adjustment improved the radiomic characteristics of acute silent cerebral infarction after stent-assisted coiling in patients with high on-treatment platelet reactivity: A prospective study. Front Neurosci 2023; 17:1068047. [PMID: 36845416 PMCID: PMC9948085 DOI: 10.3389/fnins.2023.1068047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
Background We aimed to investigate the effects of high on-treatment platelet reactivity (HPR) and antiplatelet therapy adjustment on high-risk radiomic features in patients with antiplatelet therapy adjustment on acute silent cerebral infarction (ASCI) who had unruptured intracranial aneurysms (UIA) after stent placement. Methods This single-institution study prospectively included 230 UIA patients who had ACSI after stent placement in our hospital between January 2015 and July 2020. All patients underwent magnetic resonance imaging with diffusion-weighted imaging (MRI-DWI) after stent placement and 1,485 radiomic features were extracted from each patient. The least absolute shrinkage and selection operator regression methods were used for selection of high-risk radiomic features associated with clinical symptoms. In addition, 199 patients with ASCI were classified into three groups: controls without HPR (n = 113), HPR patients with standard antiplatelet therapy (n = 63) and HPR patients with antiplatelet therapy adjustment (n = 23). We compared high-risk radiomic features between three groups. Results Of the patients who had acute infarction after MRI-DWI, 31 (13.5%) exhibited clinical symptoms. Eight risk radiomic features associated with clinical symptoms were selected, and the radiomics signature exhibited good performance. In ASCI patients, compared with controls, the radiomic characteristics of ischemic lesion in HPR patients were consistent with the following high-risk radiomic features associated with clinical symptoms: higher gray-level values, greater variance in intensity values, and greater homogeneity. However, the adjustment of antiplatelet therapy in HPR patients modified the high-risk radiomic features, which showed lower gray-level values, less variance in intensity values, and more heterogeneous texture. The radiomic shape feature of elongation showed no notable difference between three groups. Conclusion Adjustment of antiplatelet therapy might reduce the high-risk radiomic features of UIA patients with HPR after stent placement.
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Affiliation(s)
- Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanmin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yapeng Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yisen Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kun Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China,*Correspondence: Xinjian Yang,
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Jian Liu,
| | - Xianzhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Xianzhi Liu,
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Kashiwabara K, Fujii S, Tsumura S, Sakamoto K. Difference in the Overall Survival Between Malignant Central Airway Obstruction Patients Treated by Transbronchial Microwave Ablation and Stent Placement: A Single-institution Retrospective Study. Anticancer Res 2022; 42:3125-3131. [PMID: 35641276 DOI: 10.21873/anticanres.15801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Transbronchial microwave ablation (MWA) can be performed safely in patients with malignant central airway obstruction (MCAO), under moderate sedation and a high fraction of inspired oxygen. PATIENTS AND METHODS We retrospectively evaluated the difference in the overall survival (OS) after transbronchial interventions (TBIs) between MCAO patients with endoluminal or mixed-type obstruction who were treated by MWA (MWA group, n=34) and those with extraluminal obstruction who were treated by stent placement (STP) (STP group, n=27). RESULTS The OS was longer in the MWA group than in the STP group (10.2 months vs. 4.5 months, p=0.001). A significant difference in the OS between the two groups was observed in the patients who received post-TBI anticancer therapy (27.2 months vs. 6.0 months, p=0.002). The OS tended to be longer in the MWA group than in the STP group, among the patients who received best supportive care alone (3.8 months vs. 1.8 months, p=0.068). Nine patients (26%) of the MWA group underwent additional MWA when tumor regrowth into the airway lumen was noted (median of TBI sessions, 3). Multivariate analysis identified the adoption of MWA as the initial treatment procedure to be independently associated with a reduced risk of death in patients with MCAO (hazard ratio=0.473, p=0.031). CONCLUSION Adoption of MWA as the initial treatment procedure is beneficial in MCAO patients with endoluminal or mixed-type obstruction, regardless of whether patients receive post-TBI anticancer therapy or not.
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Affiliation(s)
- Kosuke Kashiwabara
- Department of Respiratory Medicine, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Shinji Fujii
- Department of Respiratory Medicine, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Shinsuke Tsumura
- Department of Respiratory Medicine, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Kazuhiko Sakamoto
- Department of Respiratory Medicine, Kumamoto Regional Medical Center, Kumamoto, Japan
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Yamauchi Y, Takahara M, Iida O, Shintani Y, Sugano T, Yamamoto Y, Kawasaki D, Fujihara M, Soga Y, Hirano K, Yamaguchi T, Yokoi H, Miyamoto A, Nakamura M. Independent predictors of major adverse cardiovascular events at 3 years after aortoiliac stent implantation. J Vasc Interv Radiol 2022; 33:826-833.e1. [PMID: 35398480 DOI: 10.1016/j.jvir.2022.03.602] [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: 07/13/2021] [Revised: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To identify risk factors for major adverse cardiovascular events (MACE) in real-world practice for symptomatic peripheral artery disease (PAD) in Japan. MATERIALS AND METHODS Data on Japanese patients (N=880) from the Observational prospective Multicenter registry study on Outcomes of peripheral arTErial disease patieNts treated by AngioplaSty tHerapy for aortoIliac artery (OMOTENASHI) who underwent de novo aortoiliac stent placement. The 3-year risk of incident MACE was investigated. RESULTS The median age of the patients was 72.6 years (range, 34-97 years), and 83.1% were male. Patients had the following conditions: smoking, 35.6%; hypertension, 94.1%; dyslipidemia, 81.7%; diabetes, 48.0%; renal failure on dialysis, 12.6%; myocardial infarction, 12.7%; stroke, 15.8%; and chronic limb-threatening ischemia (CLTI), 7.1%. Femoropopliteal lesions were present in 38.8% of the limbs with aortoiliac lesions. The 3-year rate of freedom from MACE was 89.1%. The baseline characteristics age, renal failure on dialysis, myocardial infarction, stroke, and femoropopliteal lesions were independently associated with the risk of incident MACE. When the study population was stratified according to these risk factors, the rate of MACE was highest in patients with at least 3 risk factors (32.9% at 3 years). CONCLUSION The 3-year rate of freedom from MACE was reported. The baseline characteristics age, renal failure on dialysis, myocardial infarction, stroke, and femoropopliteal lesions are independent risk factors for MACE after aortoiliac stent placement.
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Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | | | - Teruyasu Sugano
- Department of Cardiovascular Medicine, Yokohama City University Hospital, Kanagawa, Japan
| | - Yoshito Yamamoto
- Department of Cardiovascular Medicine, Iwaki Kyoritsu General Hospital, Fukushima, Japan
| | - Daizo Kawasaki
- Department of Internal Medicine, Morinomiya Hospital, Osaka, Japan
| | | | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Keisuke Hirano
- Division of Cardiology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Akira Miyamoto
- Cardiovascular Center, Takatsu General Hospital, Kanagawa, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan
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13
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Xie X, Meng Q, Lu Q, Zhang YW, Wang L, Zhang HB. [Clinical Value of Ultrasound in Evaluating Stent Placement for Managing Graft Stenosis after Meso-rex Bypass]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2021; 43:886-891. [PMID: 34980327 DOI: 10.3881/j.issn.1000-503x.13712] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective To explore the feasibility of using ultrasound to evaluate stent placement for managing graft stenosis after Meso-rex bypass for cavernous transformation of the portal vein in adults. Methods This study enrolled the patients who underwent Meso-rex bypass due to cavernous transformation of the portal vein,were diagnosed graft stenosis by postoperative ultrasound,and then underwent percutaneous portal vein puncture portography and stent placement.We then compared the ultrasonic measurement indicators and sonographic manifestations before and after stent placement,and evaluated the alleviation of portal hypertension symptoms after stent placement and related clinical indexes. Results Finally,8 patients were enrolled in this study,including 5 males and 3 females,with an average age of(32.4±14.7)years.The median duration of follow-up was 26 months after stent placement.The mean diameter of graft stenosis was(2.74±0.23)mm after Meso-rex bypass and became wider[(7.23±0.68)mm]after stent placement(P=0.000).The mean maximum velocity at graft stenosis was(195.88±30.83)cm/s after Meso-rex bypass and became lower[(72.75±29.94)cm/s]after stent placement(P=0.000).The color Doppler flow imaging at graft stenosis presented colorful blood flow,and presented regular near laminar flow within the stent and characteristic reverse flow within the left portal vein after stent placement.No gastrointestinal bleeding or ascites occurred after interventional therapy,and the mean thickness of spleen decreased from 6.0 cm before stent placement to 5.4 cm(P=0.018).After stent placement,the platelet count increased from(51.57±18.83)×109/L to(149.00±58.96)×109/L(P=0.002),and the serum ammonia level decreased from(66.25±21.78)μmol/L to(44.88±10.60)μmol/L(P=0.012). Conclusions Ultrasound can accurately assess graft patency before and after stent placement in patients with stenosis after Meso-rex bypass,and effectively monitor the hemodynamic changes in the portal venous system.The clinical symptoms can be relieved after interventional therapy.
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Affiliation(s)
- Xia Xie
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,Tsinghua University,Beijing 102218,China
| | - Qi Meng
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,Tsinghua University,Beijing 102218,China
| | - Qian Lu
- Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,Tsinghua University,Beijing 102218,China
| | - Yue-Wei Zhang
- Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,Tsinghua University,Beijing 102218,China
| | - Liang Wang
- Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,Tsinghua University,Beijing 102218,China
| | - Hua-Bin Zhang
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,Tsinghua University,Beijing 102218,China
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Liu Q, Liu F, Lü P, Wu HX, Ye P, You Y, Yao Z. Current Status and Prospect of Stent Placement for May-Thurner Syndrome. Curr Med Sci 2021; 41:1178-1186. [PMID: 34918176 DOI: 10.1007/s11596-021-2481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
Stent implantation has been proven to be safe and has become the first-line intervention for May-Thurner syndrome (MTS), with satisfactory mid-term patency rates and clinical outcomes. Recent research has demonstrated that catheter-directed thrombolysis is the preferred strategy when MTS is combined with deep vein thrombosis after self-expanding stent placement. However, the stent used for the venous system was developed based on the experience obtained in the treatment of arterial disease. Consequently, relatively common corresponding complications may come along later, which include stent displacement, deformation, and obstruction. Different measures such as adopting a stent with a larger diameter, improving stent flexibility, and increasing stent strength have been employed in order to prevent these complications. The ideal venous stent is presently being evaluated and will be introduced in detail in this review.
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Affiliation(s)
- Qin Liu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ping Lü
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Hong-Xiao Wu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Pin Ye
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yun You
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhong Yao
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario, M5S 2E8, Canada
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15
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Rai V, Agrawal DK. Immunomodulation of IL-33 and IL-37 with Vitamin D in the Neointima of Coronary Artery: A Comparative Study between Balloon Angioplasty and Stent in Hyperlipidemic Microswine. Int J Mol Sci 2021; 22:8824. [PMID: 34445530 DOI: 10.3390/ijms22168824] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/28/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 12/15/2022] Open
Abstract
Inflammation is a major contributor to the development and progression of atherosclerosis. Interleukin (IL)-33 and IL-37, members of the IL-1 family, modulate inflammation, with IL-33 having a pro-inflammatory effect and IL-37 having anti-inflammatory properties. IL-37 is constitutively expressed at low levels but upregulated in inflammatory contexts. The aim of this study was to evaluate the effect of vitamin D on the expression of IL-33, IL-37, macrophages, and caspase-1 in the neointimal tissue of coronary artery in Yucatan microswine with vitamin D deficient, sufficient, and supplemented status. The intimal injury was induced by balloon angioplasty and stenting in the coronary artery, and tissues were harvested after 6 months. The expression of various proteins of interest was evaluated by immunostaining. Increased expression of IL-33 and IL-37 in the neointimal tissue of the vitamin D deficient, as compared to the sufficient and supplemented microswine, as revealed by histological evaluation and semi-quantitative analysis, suggested the immunomodulatory effect of vitamin D on the expression of IL-33 and IL-37. The minimal expression or absence of IL-33 and IL-37 expression in stented arteries is suggestive of an attenuated inflammatory response in stented arteries, compared to balloon angioplasty. The decreased IL-33 expression in the sufficient and supplemented microswine could be a potential mechanism for controlling the inflammatory process and neointima formation leading to attenuated luminal narrowing of the coronary artery. Overall, these results support supplementation of vitamin D to attenuate inflammation, neointima formation, and restenosis.
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Saiga A, Koizumi J, Osumi K, Ota J, Kubota Y, Wada T, Akutsu A, Watanabe M, Murai S, Masuda M, Uno T. Celiac Artery Dissection and Retroperitoneal Hemorrhage in Median Arcuate Ligament Syndrome Treated With a Stent and Transcatheter Arterial Embolization: Preprocedural 4-Dimensional Computed Tomography Angiography Assessment. Vasc Endovascular Surg 2021; 56:75-79. [PMID: 34293967 DOI: 10.1177/15385744211028738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 61-year-old man presented with retroperitoneal hemorrhage caused by an aneurysm rupture of the pancreaticoduodenal arcade (PDA), and acute celiac artery dissection distal to celiac axis stenosis. Owing to the gradual growth of the false lumen, we planned to deploy a stent to the celiac artery dissection and embolize the PDA aneurysm. Prior to stent placement, we assessed the acute celiac artery dissection distal to the stenosis using four-dimensional computed tomography (CT) angiography through expiration/inspiration/expiration cycle. We diagnosed median arcuate ligament syndrome considering that the celiac axis showed a hooked narrowing at end-expiration, and the compression decreased at end-inspiration. Additionally, the true lumen distal to the stretched axis dilated in the inspiration phase. Therefore, we could advance a catheter into the true lumen during inspiration and successfully deploy a stent. Subsequently, laparoscopic median arcuate ligament release was performed after the stent deployment. A postoperative CT scan showed good patency in the stent, with disappearance of the blood filling the false lumen and with reduced celiac axis stenosis.
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Affiliation(s)
- Atsushi Saiga
- Department of Radiology, 92154Chiba University Hospital, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Jun Koizumi
- Department of Radiology, 92154Chiba University Hospital, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Koji Osumi
- Department of Surgery, Ogikubo Hospital, Imagawa, Suginami-ku, Tokyo, Japan
| | - Joji Ota
- Department of Radiology, 92154Chiba University Hospital, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yoshihiro Kubota
- Department of Radiology, 92154Chiba University Hospital, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Takeshi Wada
- Department of Radiology, 92154Chiba University Hospital, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Akira Akutsu
- Department of Radiology, 92154Chiba University Hospital, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Michiko Watanabe
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Shinji Murai
- Department of Surgery, Ogikubo Hospital, Imagawa, Suginami-ku, Tokyo, Japan
| | - Makiko Masuda
- Department of Radiology, Ogikubo Hospital, Imagawa, Suginami-ku, Tokyo, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba City, Chiba, Japan
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Giusca S, Lichtenberg M, Eisenbach C, Korosoglou G. Clinical safety of low-dose anticoagulation with fondaparinux in patients undergoing peripheral endovascular treatment due to critical limb-threatening ischaemia - a pilot study. Acta Cardiol 2021; 76:365-372. [PMID: 32167029 DOI: 10.1080/00015385.2020.1737782] [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: 12/24/2022]
Abstract
AIMS To evaluate the safety and effectiveness of fondaparinux in addition to dual antiplatelet therapy (DAPT) in patients with critical limb-threatening ischaemia (CLTI). METHODS Fondaparinux (2.5 mg/d) was administered for 1-4 weeks after endovascular procedures together with DAPT (fondaparinux arm). Patients who received standard DAPT were retrospectively matched and generated the control arm. Demographic, angiographic and follow-up data, including (i) clinically relevant bleeding and (ii) target vessel revascularisation or major amputation after 12 months was analysed. RESULTS Twenty-four patients (78.7 ± 6.9 years, 14 [58%] female, 4 TASC B, 10 TASC C and 10 TASC D lesions, total lesion length = 210 ± 98 mm, mean Rutherford class = 4.7 ± 0.6) received fondaparinux (over a period of 22 ± 9 d, range 7-28 d) and DAPT versus 24 control patients who received standard DAPT (78.3 ± 8.4 years, 14 [58%] female, 4 TASC B, 8 TASC C and 12 TASC D lesions, total lesion length = 204 ± 73 mm, mean Rutherford class = 4.6 ± 0.6). During follow-up, 3(13%) patients in the fondaparinux arm exhibited significant bleeding versus 5 (21%) in the control arm (p = ns). Four (17%) patients of the fondaparinux arm underwent target vessel revascularisation or major amputation versus 6 (25%) in the control group (p = ns). CONCLUSIONS Adding fondaparinux to DAPT does not seem to result in excess of clinically relevant bleeding. Our preliminary data suggest that prospective studies are now warranted in larger patient cohorts. GERMAN CLINICAL TRIALS REGISTER DRKS00015856.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology, Vascular Medicine, Pneumology, Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Christoph Eisenbach
- Department of Cardiology, Vascular Medicine, Pneumology, Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine, Pneumology, Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim, Germany
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Rebizant B, Koleśnik A, Grzyb A, Chaberek K, Sękowska A, Witwicki J, Szymkiewicz-Dangel J, Dębska M. Fetal Cardiac Interventions-Are They Safe for the Mothers? J Clin Med 2021; 10:jcm10040851. [PMID: 33669554 PMCID: PMC7922873 DOI: 10.3390/jcm10040851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/29/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/28/2022] Open
Abstract
The aim of fetal cardiac interventions (FCI), as other prenatal therapeutic procedures, is to bring benefit to the fetus. However, the safety of the mother is of utmost importance. The objective of our study was to evaluate the impact of FCI on maternal condition, course of pregnancy, and delivery. 113 mothers underwent intrauterine treatment of their fetuses with critical heart defects. 128 percutaneous ultrasound-guided FCI were performed and analyzed. The patients were divided into four groups according to the type of FCI: balloon aortic valvuloplasty (fBAV), balloon pulmonary valvuloplasty (fBPV), interatrial stent placement (IAS), and balloon atrioseptoplasty (BAS). Various factors: maternal parameters, perioperative data, and pregnancy complications, were analyzed. There was only one major complication—procedure-related placental abruption (without need for blood products transfusion). There were no cases of: procedure-related preterm prelabor rupture of membranes (pPROM), chorioamnionitis, wound infection, and anesthesia associated complications. Tocolysis was only necessary only in two cases, and it was effective in both. None of the patients required intensive care unit admission. The procedure was effective in treating polyhydramnios associated with fetal heart failure in six out of nine cases. Deliveries occurred at term in 89%, 54% were vaginal. The results showed that FCI had a negligible impact on a further course of pregnancy and delivery.
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Affiliation(s)
- Beata Rebizant
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (K.C.); (A.S.)
- Correspondence: Correspondence: (B.R.); (M.D.); Tel.: +48-508130737 (B.R.); +48-607449302 (M.D.)
| | - Adam Koleśnik
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, US Clinic Agatowa, 03-680 Warsaw, Poland; (A.K.); (A.G.); (J.S.-D.)
- Cardiovascular Interventions Laboratory, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 02-004 Warsaw, Poland
| | - Agnieszka Grzyb
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, US Clinic Agatowa, 03-680 Warsaw, Poland; (A.K.); (A.G.); (J.S.-D.)
- Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | - Katarzyna Chaberek
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (K.C.); (A.S.)
| | - Agnieszka Sękowska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (K.C.); (A.S.)
- Pain Clinic, Department of Anesthesiology and Intensive Care, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland
| | - Jacek Witwicki
- Department of Neonatology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland;
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, US Clinic Agatowa, 03-680 Warsaw, Poland; (A.K.); (A.G.); (J.S.-D.)
| | - Marzena Dębska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (K.C.); (A.S.)
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland
- Correspondence: Correspondence: (B.R.); (M.D.); Tel.: +48-508130737 (B.R.); +48-607449302 (M.D.)
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Chen SJ, Liu RR, Shang YR, Xie YJ, Guo XH, Huang MJ, Yang XF, Fu QZ, Qi JS, Shen DY, Li JY. An Ultrasound Model to Predict the Short-Term Effects of Endovascular Stent Placement in the Treatment of Carotid Artery Stenosis. Front Cardiovasc Med 2021; 7:607367. [PMID: 33553258 PMCID: PMC7862114 DOI: 10.3389/fcvm.2020.607367] [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: 09/17/2020] [Accepted: 12/21/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose: The present study aimed to explore the predictive ability of an ultrasound linear regression equation in patients undergoing endovascular stent placement (ESP) to treat carotid artery stenosis-induced ischemic stroke. Methods: Pearson's correlation coefficient of actual improvement rate (IR) and 10 preoperative ultrasound indices in the carotid arteries of 64 patients who underwent ESP were retrospectively analyzed. A predictive ultrasound model for the fitted IR after ESP was established. Results: Of the 10 preoperative ultrasound indices, peak systolic velocity (PSV) at stenosis was strongly correlated with postoperative actual IR (r = 0.622; P < 0.01). The unstable plaque index (UPI; r = 0.447), peak eccentricity ratio (r = 0.431), and plaque stiffness index (β; r = 0.512) moderately correlated with actual IR (P < 0.01). Furthermore, the resistance index (r = 0.325) and the dilation coefficient (r = 0.311) weakly correlated with actual IR (P < 0.05). There was no significant correlation between actual IR and the number of unstable plaques, area narrowing, pulsatility index, and compliance coefficient. In combination, morphological, hemodynamic, and physiological ultrasound indices can predict 62.39% of neurological deficits after ESP: fitted IR = 0.9816 – 0.1293β + 0.0504UPI – 0.1137PSV. Conclusion: Certain carotid ultrasound indices correlate with ESP outcomes. The multi-index predictive model can be used to evaluate the effects of ESP before surgery.
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Affiliation(s)
- Sheng-Jiang Chen
- Department of Ultrasound, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Rui-Rui Liu
- Department of Ultrasound, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yi-Ran Shang
- Department of Ultrasound, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yu-Juan Xie
- Department of Ultrasound, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiao-Han Guo
- Department of Ultrasound, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Meng-Jiao Huang
- Department of Ultrasound, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiao-Feng Yang
- Department of Ultrasound, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Qi-Zhi Fu
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Ji-Sheng Qi
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Dong-Yan Shen
- Department of Vascular Surgery, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jia-Yan Li
- Department of Ultrasound, Luoyang Dongfang Hospital, The Third Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
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20
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Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, Chevallier O. Intravascular Ultrasound in the Endovascular Treatment of Patients With Peripheral Arterial Disease: Current Role and Future Perspectives. Front Cardiovasc Med 2020; 7:551861. [PMID: 33344512 PMCID: PMC7738328 DOI: 10.3389/fcvm.2020.551861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Over the last decade, intravascular ultrasound (IVUS) has emerged as a useful adjunctive tool to angiography in an increasing number of catheter-based procedures for peripheral arterial disease (PAD). IVUS catheters offer accurate cross-sectional imaging of arterial vessels with high dimensional accuracy and provide accurate information about lesion morphology. IVUS enables assessment of the plaque morphology, vessel diameter, and the presence of arterial dissections. Furthermore, IVUS is able to properly guide the best choice of appropriate percutaneous transluminal angioplasty (PTA) technique, guide the delivery of different devices, and assess the immediate result of any endovascular intervention. In the present review, the role of IVUS for PAD will be discussed, specifically the applications of IVUS technology during interventional procedures including PTA, stent sizing, crossing total occlusion, assessing residual narrowing and stent apposition and expansion, and atherectomy. Future perspectives of IVUS-guided treatments and cost-effectiveness of the systematic use of IVUS during endovascular interventions will be also discussed.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Christophe Galland
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Léo Fréchier
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Frédérik Ledan
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
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21
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Morita S, Sugawara S, Suda T, Prasetyo D, Kobayashi Y, Hoshi T, Abe S, Yagi K, Terai S. Stent Placement for Malignant Inferior Vena Cava Syndrome in a Patient with Recurrent Colon Cancer. Intern Med 2020; 59:2885-2890. [PMID: 32727985 PMCID: PMC7725633 DOI: 10.2169/internalmedicine.5033-20] [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: 02/05/2023] Open
Abstract
A 70-year-old man was admitted to our hospital with gait disturbance due to marked edema of the lower limbs for more than 6 months. He had been receiving systemic chemotherapy over two years for multiple recurrence after sigmoid colon cancer resection. Contrast-enhanced computed tomography demonstrated severe inferior vena cava (IVC) stenosis due to compression by lymph node metastases, i.e. IVC syndrome. As increased doses of diuretic agents failed to improve the edema, IVC stent placement was performed. This led to significant improvement of the edema and complete gait normalization. This case demonstrates the efficacy of IVC stent placement for IVC syndrome.
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Affiliation(s)
- Shinichi Morita
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Takeshi Suda
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Didik Prasetyo
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Yuka Kobayashi
- Department of Gastroenterology and Hepatology, Nagaoka Central General Hospital, Japan
| | - Takahiro Hoshi
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Satoshi Abe
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Kazuyoshi Yagi
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
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Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, Chevallier O. Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes. Front Cardiovasc Med 2020; 7:557420. [PMID: 33195452 PMCID: PMC7642033 DOI: 10.3389/fcvm.2020.557420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/24/2020] [Indexed: 01/14/2023] Open
Abstract
Acute and subacute ischemia of lower limbs is associated with high risk of amputation and potential severe life-threatening complications. Despite a lack of clear therapeutic recommendations, surgical treatments such as thrombectomy or bypass and/or catheter-directed thrombolysis (CDT) have been first-line procedures in both acute and subacute limb ischemia, but each therapy may lead to significant morbidity and mortality. Such situations demand fast restoration of appropriate flow to preclude limb loss and other complications. Percutaneous mechanical atherectomy plus thrombectomy (MATH) represents a minimally invasive approach for quickly recanalizing thrombus-containing lesions whatever the age of thrombus. Indeed, many chronic patients can present with critical limb ischemia, with thrombus-containing occlusive lesions triggered by underlying atherosclerotic disease. MATH offers various advantages over surgery and CDT, with lower invasiveness, faster recanalization, and the possibility to immediately treat the underlying lesions, with a lower rate of bleeding complications and no need for intensive care unit stay. Currently, several mechanical thrombectomy devices are offered as an alternative therapy and can be divided into pure rotational MATH systems and rheolytic thrombectomy devices. The only pure rotational MATH device currently available on the market is the Rotarex S device. We aimed to review contemporary clinical data regarding the safety, efficacy, and outcomes of MATH therapy using Rotarex S catheter in acute and subacute thrombus-containing arterial lesions of lower limbs. Future perspectives of Rotarex S MATH treatment and cost-effectiveness of its routine use will be also discussed.
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Affiliation(s)
- Romaric Loffroy
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Christophe Galland
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Léo Fréchier
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Frédérik Ledan
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
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Shahanavaz S, Aldoss O, Carr K, Gordon B, Seckeler MD, Hiremath G, Seaman C, Zablah J, Morgan G. Acute and medium term results of balloon expandable stent placement in the transverse arch-a multicenter pediatric interventional cardiology early career society study. Catheter Cardiovasc Interv 2020; 96:1277-1286. [PMID: 32902911 DOI: 10.1002/ccd.29248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES AND BACKGROUND Coarctation of the aorta represents 5-8% of all congenital heart disease. Although balloon expandable stents provide an established treatment option for native or recurrent coarctation, outcomes from transverse arch (TAO) stenting, including resolution of hypertension have not been well studied. This study aims to evaluate immediate and midterm results of TAO stenting in a multi-center retrospective cohort. METHODS TAO stenting was defined as stent placement traversing any head and neck vessel, with the primary intention of treating narrowing in the transverse aorta. Procedural details, complications and medications were assessed immediately post procedure, at 6 month follow-up and at most recent follow-up. RESULTS Fifty-seven subjects, 12 (21%) native, and 45 (79%) surgically repaired aortic arches, from seven centers were included. Median age was 14 years (4 days-42 years), median weight 54 kg (1.1-141 kg). After intervention, the median directly measured arch gradient decreased from 20 mmHg (0-57 mmHg) to 0 mmHg (0-23 mmHg) (p < .001). The narrowest arch diameter increased from 9 mm (1.4-16 mm) to 14 mm (2.9-25 mm) (p < .001), with a median increase of 4.9 mm (1.1-10.1 mm). One or more arch branches were covered by the stent in 55 patients (96%). There were no serious adverse events. Two patients warranted stent repositioning following migration during deployment. There were no late complications. There were 8 reinterventions, 7 planned, and 1 unplanned (6 catheterizations, 2 surgeries). Antihypertensive management was continued in 19 (40%) at a median follow-up of 3.2 years (0.4-7.3 years). CONCLUSIONS TAO stenting can be useful in selected patients for resolution of stenosis with minimal complications. This subset of patients are likely to continue on antihypertensive medications despite resolution of stenosis.
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Affiliation(s)
- Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, ST Louis, Missouri, USA
| | - Osamah Aldoss
- Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Kaitlin Carr
- Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Brent Gordon
- Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona, USA
| | - Gurumurthy Hiremath
- Pediatrics, Division of Pediatric Cardiology, University of Minnesota, Masonic Children's Hospital, Pediatric Heart Center, Minneapolis, Minnesota, USA
| | - Cameron Seaman
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jenny Zablah
- The Heart Institute, Children's Hospital of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Gareth Morgan
- The Heart Institute, Children's Hospital of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
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Pan T, Li MA, Mu LW, Zhu D, Qian JS, Li ZR. Stent placement with iodine-125 seeds strand effectively extends the duration of stent patency and survival in patients with unresectable malignant obstructive jaundice. Scand J Gastroenterol 2020; 55:123-128. [PMID: 31906735 DOI: 10.1080/00365521.2019.1707275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: This study aimed to compare the treatment outcomes and safety between stent placement with or without Iodine-125 (125I) seeds strand for patients with unresectable malignant obstructive jaundice (MOJ).Methods: A total of 84 patients with unresectable MOJ treated in our hospital were retrospectively included and divided into the stent group (n = 54) undergoing biliary stent placement and the stent + seeds group (n = 30) receiving stent placement with 125I seeds strand. The therapeutic outcome, postoperative complications, duration of patient survival and stent patency were compared between groups. Kaplan-Meier survival analysis was performed to compare the duration of patient survival and stent patency between groups. Cox-regression analysis was performed to investigate predictive factors for disease-free survival and overall survival.Results: The stent + seeds group had significantly longer duration of patency (231.57 ± 256.54 vs. 110.37 ± 120.52) and overall survival (310.57 ± 330.54 vs. 173.15 ± 219.40) than the stent group (both p < .05). In addition, Kaplan-Meier survival analysis confirmed that the stent + seeds group had longer duration of patency (log-rank test, p = .001) and higher overall survival rate (log-rank test, p = .020) than the stent group. Furthermore, Cox-regression analysis demonstrated that treatment methods was an independent factor associated with disease-free survival (HR: 0.36, 95% CI: 0.19-0.70; p = .003) and overall survival (HR: 1.01, 95% CI: 1.00-1.01; p < .001).Conclusion: The stent placement with 125I seeds strand can significantly improve the primary patency rate and overall survival time in MOJ patients.
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Affiliation(s)
- Tao Pan
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming-An Li
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lu-Wen Mu
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Duo Zhu
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie-Sheng Qian
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Vascular Surgery, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zheng-Ran Li
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Vascular Surgery, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Shimata K, Sugawara Y, Honda M, Ikeda O, Tamura Y, Hayashida S, Ohya Y, Yamamoto H, Yamashita Y, Inomata Y, Hibi T. Efficacy of repeated balloon venoplasty for treatment of hepatic venous outflow obstruction after pediatric living-donor liver transplantation: A single-institution experience. Pediatr Transplant 2019; 23:e13522. [PMID: 31210388 DOI: 10.1111/petr.13522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/18/2019] [Accepted: 05/20/2019] [Indexed: 12/19/2022]
Abstract
HVOO is a rare complication after LT and an important cause of graft failure. Balloon venoplasty is the first-line treatment for HVOO, but the effect of repeated balloon venoplasty and stent placement for HVOO recurrence after pediatric LDLT remains unclear. Between 1998 and 2016, 147 pediatric patients underwent LDLT in our institution. Among them, the incidence of HVOO and the therapeutic strategy were retrospectively reviewed. Ten patients were diagnosed with HVOO. All the patients underwent LLS grafts. Median age at the initial endovascular intervention was 2.7 years (range, 5 months-8 years). The median interval between the LDLT and the initial interventional radiology was 2.7 months (range, 29 days-35.7 months). Four patients experienced no recurrence after a single balloon venoplasty; 6 underwent balloon venoplasty more than 3 times because of HVOO recurrence; and 2 underwent stent placement due to the failure of repeated balloon venoplasty. All patients are alive with no symptoms of HVOO. The HVOO recurrence-free period after the last intervention ranged from 20 days to 15.5 years (median, 8.9 years). Repeated balloon venoplasty may prevent unnecessary stent placement to treat recurrent HVOO after pediatric LDLT.
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Affiliation(s)
- Keita Shimata
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Yasuhiko Sugawara
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Osamu Ikeda
- Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshitaka Tamura
- Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Shintaro Hayashida
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Yuki Ohya
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Hidekazu Yamamoto
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yukihiro Inomata
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Taizo Hibi
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
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Ference EH, Badran KW, Kuan EC, Bergsneider M, Heaney AP, Wang MB. Bioabsorbable Steroid Eluting Stents in the Treatment of Recurrent Rathke's Cleft Cyst. J Neurol Surg B Skull Base 2018; 80:505-510. [PMID: 31534893 DOI: 10.1055/s-0038-1675558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives Bioabsorbable steroid eluting stents may prevent the stenosis of ostia after sinus surgery. We describe a technique utilizing this technology to prevent the reformation of Rathke's cleft cysts (RCC) after transnasal transsphenoidal surgical drainage. Design This study is based on retrospective review. Setting The research took place at Tertiary academic medical center. Participants Patients who underwent endoscopic marsupialization of RCC with stent placement were participated in this study. Main Outcome Measures Demographics, surgical history, outcomes, and complications were primary measures of this study. Results Four patients underwent drainage of a recurrent RCC with subsequent stent placement. All patients consented to off-label use of the stent. The mean age of patients was 42 years old and the number of prior drainage procedures ranged from 1 to 3. The stent was placed directly into the opening of the cyst after drainage with no other tissue placed into the cyst cavity or opening. The stents are bioabsorbable and were not removed after surgery but were evaluated endoscopically at 2 and 6 weeks after surgery. The patients have been followed for a mean of 14 months after surgery with no evidence of recurrence on endoscopic exam or imaging. No patient had cerebrospinal fluid leak during or after the operation or permanent endocrinopathy. Conclusion The use of a bioabsorbable steroid eluting stent had no unanticipated consequences and all drainage pathways of all the RCCs remain patent. The use of this technology may decrease recurrence rates in revision or complex cases where patients have extensive scarring of the operative field from prior drainage procedures. Further follow-up of the current cases and study in a larger cohort are warranted.
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Affiliation(s)
- Elisabeth H Ference
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States
| | - Karam W Badran
- Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, United States
| | - Edward C Kuan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, United States
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
| | - Anthony P Heaney
- Department of Endocrinology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, United States
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Abstract
BACKGROUND Isolated superior mesenteric artery dissection (ISMAD) is rare, especially when associated with intestinal ischaemia. We report our clinical experience managing this condition. PATIENTS AND METHODS Medical records from 22 patients with ISMAD and intestinal ischaemia were retrospectively analysed. Conservative treatment was given to all patients as first line therapy. Subsequently, 15 patients received endovascular stent placement and three patients received endovascular stent placement plus intestinal resection and anastomosis. RESULTS After conservative treatment, the symptoms of three patients were remarkably relieved; however, a repeat contrast CT showed that stenosis was aggravated. Hence, endovascular stent placement was performed in all 15 patients. Enteral nutrition was successfully restored in 12 patients. Three patients showed signs of chronic intestinal ischaemia, including peritonitis and ileus. These patients underwent intestinal resection and anastomosis. Enteral nutrition was restored at postoperative week two. No signs of intestinal ischaemia recurred during two-years of follow-up. CONCLUSIONS We recommend endovascular stent placement as a feasible, effective, and minimally invasive procedure in patients with ISMAD and symptoms of intestinal ischaemia.
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Affiliation(s)
- Baochen Liu
- a These authors contributed equally to this paper
| | - Chengnan Chu
- a These authors contributed equally to this paper
| | - Xinxin Fan
- 1 Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiwei Ding
- 1 Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xingjiang Wu
- 1 Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Hsieh KH, Soong WJ, Jeng MJ, Lee YS, Tsao PC, Chou YL. Flexible endoscopic diagnosis and treatment of esophageal stenosis in children with noninvasive ventilation support. Pediatr Neonatol 2018; 59:31-34. [PMID: 28587747 DOI: 10.1016/j.pedneo.2016.11.003] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/27/2016] [Accepted: 11/09/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Esophageal stenosis (ES) is characterized by dysphagia, failure to thrive, and long-term disability. It requires repeated management because it is refractory. Traditionally, these procedures are performed under general anesthesia with airway intubation. PURPOSE This study investigated the safety and efficacy of the management of interventional flexible endoscopy (IFE) performed with a novel noninvasive ventilation (NIV) support. METHODS Use of a short-length flexible endoscope with NIV of pharyngeal oxygen, nose closure, and abdominal compression during IFE was investigated. Medical charts of patients aged ≤10 years with a diagnosis of ES in our hospital between 1990 and 2014 were reviewed and analyzed. The outcome measurement included the number of IFE with balloon dilatation (BD), laser therapy (LT), stent placement, procedural complications, and the success rate. RESULTS Ten patients were enrolled. The most common etiologies were esophageal atresia with/without tracheoesophageal fistula (n = 6), followed by caustic injury (n = 2), and unknown etiology (n = 2). Nine patients who were considered successfully managed received an average of 2.8 BD sessions and 1.6 LT sessions. The complication rate of IFE in this study was 1.08% (1/93). One esophageal perforation developed after BD (1/63) and none after LT (0/30). CONCLUSION In this study, IFE with this NIV support is a safe, feasible and valuable modality which could rapidly examine and manage ES.
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Affiliation(s)
- Kao-Hsian Hsieh
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Jue Soong
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Mei-Jy Jeng
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Sheng Lee
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Chen Tsao
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Ling Chou
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Zhang YF, Ning SB, Li BR, Zhang J, Li J, Tang J, Zhu M, Jin XW, Zhao Q, Mao GP. Combined use of single-balloon enteroscope and colonoscope for self-expandable metal stent placement in patients with malignant small intestinal obstruction: a single-center comparative clinical observation. ACTA ACUST UNITED AC. 2017;37:357-361. [PMID: 28585148 DOI: 10.1007/s11596-017-1740-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/22/2017] [Indexed: 12/31/2022]
Abstract
Small intestinal obstruction is a common complication of primary gastrointestinal cancer or metastatic cancers. Patients with this condition are often poor candidates for surgical bypasses, and placement of self-expanding metal stent (SEMS) can be technically challenging. In this study, we examined the feasibility of combined application of single-balloon enteroscope (SBE) and colonoscope for SEMS placement in patients with malignant small intestinal obstruction. Thirty-four patients were enrolled in this study, among which 22 patients received SEMS placement by using SBE and colonoscope, while the other 12 patients received conservative medical treatment. The patients were followed up for one year. Stent placement was technically feasible in 95.5% (21/22). Clinical improvement was achieved in 86.4% (19/22). For the 19 clinical success cases, the average time of benefits from a gastric outlet obstruction scoring system (GOOSS) increase ≥1 was 111.9±89.5 days. For the 12 patients receiving conservative medical treatment, no significant improvement in GOOSS score was observed. Moreover, a significant increase of Short-Form-36 health survey score was observed in the 19 patients at time of 30 days after stent placement. By Kaplan-Meier analysis, a significant survival improvement was observed in patients with successful SEMS placement, compared with patients receiving conservative medical treatment. Taken together, combined use of SBE and colonoscope makes endoscopic stent placement feasible in patients with malignant small intestinal obstruction, and patients can benefit from it in terms of prolonged survival and improved quality of life.
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Abstract
Coarctation of the abdominal aorta is a rare condition with a handful of cases reported in infancy. We report the case of a 4-month-old infant with severe abdominal coarctation who presented with dilated cardiomyopathy. Following successful transcatheter-based stenting of her abdominal aorta, her cardiomyopathy resolved.
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Oki H, Kawasaki R, Sugimoto K. Percutaneous retrograde recanalization of an occluded celiac artery complicating acute aortic dissection. Acta Chir Belg 2017; 117:45-48. [PMID: 27426665 DOI: 10.1080/00015458.2016.1181325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 79-year-old woman with a complaint of persistent upper abdominal pain was admitted to our hospital for the treatment of thrombosed acute type B aortic dissection. Computed tomography showed the complete static occlusion of the celiac artery. Because of progressive symptom with elevation of liver enzymes and metabolic acidosis 11 h after admission, endovascular revascularization was attempted on an emergent basis. After a failed catheterization of the celiac ostium in an antegrade fashion due to a hard occlusion, we succeeded in a retrograde recanalization through the pancreaticoduodenal arcade via the superior mesenteric artery with stent placement using a pull-through technique. This technique is useful and safe when an antegrade approach seems difficult.
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Dziedzic D, Prokopowicz J, Orlowski T. Open surgery versus stent placement in failed primary surgical treatment of esophageal perforation - a single institutional experience. Scand J Gastroenterol 2016; 51:1031-6. [PMID: 27199109 DOI: 10.1080/00365521.2016.1175025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical treatment is an accepted method to manage esophageal perforation, but in many cases it may result in failure. This paper compares the efficacy of surgical treatment and stenting in patients after previous surgical intervention for esophageal perforation. METHODS A single-institution retrospective study was performed in a group of patients treated for esophageal perforation admitted to our centre from 2010 to 2015. Seventy eight patients (76.5%) with esophageal perforation received surgical treatment. In this group of patients, the mean time between perforation and treatment was 80.6 h (24-240 h). Spontaneous and iatrogenic perforation was observed in 33 (42.3%) and 45 (57.7%) patients, respectively. Partial esophageal resection was performed in 11 cases (14.1%). The perforation site was sutured in the remaining 67 patients (85.9%). Surgical treatment failed in 29 cases (37.2%). RESULTS In patients with failed previous surgical treatment, revision surgery was performed in 14 patients (48.3%) (group A), and a large-diameter self-expandable stent was implanted in 15 cases (51.7%) (group B). Perforation in the thoracic and distal esophagus was observed in 5 (35.7%) and 9 (64.3%) patients from group A, and in 7 (46.7%) and 8 (53.3%) patients from group B, respectively. The mean intubation time in both groups was 30.3 and 12.5 days (p < 0.001), respectively. The mean daily drainage within five days after the intervention was 350 mL in group A, and 500 mL in group B (p < 0.02). In both groups hospitalisation time was 41.5 and 19.4 days, respectively (p < 0.001). Six patients died (42.8%) following revision surgery, and 2 (13.3%) patients died after stent implantation (p < 0.001). CONCLUSIONS Intubation time, hospitalization, and the rate of fatal complications in patients who underwent stent implantations were significantly lower compared to reoperated patients; however, the rate of prolonged drainage was lower in patients who underwent revision surgery. In conclusion, stent implantation is a significantly superior method to treat persistent leakage following failure of previous surgical treatment.
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Affiliation(s)
- Dariusz Dziedzic
- a Department of Thoracic Surgery , National Research Institute of Chest Diseases , Warsaw , Poland
| | - Jacek Prokopowicz
- b Department of Anesthesiology , National Research Institute of Chest Diseases , Warsaw , Poland
| | - Tadeusz Orlowski
- c Department of Thoracic Surgery , National Research Institute of Chest Diseases , Warsaw , Poland
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Falcoz MT, Falvo N, Aho-Glélé S, Demaistre E, Galland C, Favelier S, Pottecher P, Chevallier O, Bonnotte B, Audia S, Samson M, Terriat B, Midulla M, Loffroy R. Endovascular stent placement for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions: a single-center study of safety, efficacy and quality-of-life improvement. Quant Imaging Med Surg 2016; 6:342-352. [PMID: 27709070 DOI: 10.21037/qims.2016.07.07] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 11/06/2022]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a frequent complication of deep vein thrombosis (DVT) despite adequate treatment. Venous angioplasty and stent placement has been progressively used to restore and maintain venous patency in PTS patients. This study reports our single-center experience with the use of endovascular treatment for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions. METHODS A prospective mono-centric observational cohort study of PTS patients with chronic symptomatic ilio-femoral venous obstructive lesions referred for endovascular treatment was conducted from March 2012 to April 2016. Procedure consisted in recanalization, pre-dilation and self-expandable stenting of stenotic or occluded iliac and/or femoral veins. Severity of PTS, quality-of-life and treatment outcomes were assessed using Villalta scale and Chronic Venous Insufficiency Questionnaire (CIVIQ-20) at baseline and 3 months after the procedure. Imaging follow-up was based on duplex ultrasound (US) and computed tomography (CT). RESULTS Twenty-one patients (11 females, 10 males; median age, 41 years; range, 32-60) were included. Recanalization and stenting was successfully accomplished in all prime procedures, 4 patients benefitted from an additional procedure. Immediate technical success rate was 96% considering 25 procedures, performed without any complications. Median follow-up was 18 months (range, 6-30 months) with a 90.5% stent patency rate. Villalta score significantly decreased from baseline compared with 3 months after the procedure [14 (range, 11-22) and 5 (range, 1-10), respectively, P<0.0001], showing a significant decrease in the severity of PTS. CIVIQ-20 score significantly decreased from baseline compared with 3 months after stenting [48.5 (range, 39-73) and 26.5 (range, 21-45), respectively, P<0.0001] thus showing a significant improvement of quality-of-life. Post-procedural CIVIQ-20 score was significantly associated with Villalta score (95% CI, 1.53-2.95; P<0.0001). CONCLUSIONS Our results confirm the high clinical success rate and safety of endovascular PTS treatment and highlight the significant impact of stenting on the quality of life of patients with chronic symptomatic ilio-femoral venous obstructive lesions.
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Affiliation(s)
- Marie-Tiphaine Falcoz
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Nicolas Falvo
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Serge Aho-Glélé
- Department of Epidemiology, Statistics and Clinical Research, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Emmanuel Demaistre
- Department of Biological Haemostasis and Thrombosis Treatment, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Christophe Galland
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Sylvain Favelier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Pierre Pottecher
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Béatrice Terriat
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
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Abstract
Background Cockett and Thomas described and named Cockett's syndrome in 1965, commonly referred to as iliac vein compression syndrome (IVCS). It is often found as underlying cause in iliofemoral deep venous thrombosis (DVT). They described the syndrome mostly seen on the left side and predominantly in women during the second to the fourth decade of life. In this article, we present a patient with a Cockett's syndrome on the right side. Case presentation Our patient is a 52-year old female with edema of the right leg since 4 months. She had no signs of a DVT and did not benefit from a 3-month compression therapy. She was diagnosed using a CT-scan. Endovascular treatment was performed with a venous stent in the right common iliac vein (CIV). No postoperative complications were seen. After a 6-month follow-up, patient was free of pain and had no residual edema of the right leg. Conclusions Our patient presented with a non-complicated right-sided Cockett's syndrome. She was successfully treated with balloon dilatation and additional stenting of the right common iliac vein. Because of the clinical improvement of the patient together with the excellent long-term results and good patency results of the stenting, guidelines nowadays advise more and more venous stenting to prevent DVT and to relieve symptoms in case of vein compression syndromes.
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Qureshi AI, Chughtai M, Khan AA, Suri MFK, Sherr GT. Stent-Assisted Clip Placement for Complex Internal Carotid Artery Intracranial Aneurysms. J Vasc Interv Neurol 2016; 8:23-29. [PMID: 26958150 PMCID: PMC4762408] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND We report two procedures using a stent-assisted microsurgical clip placement to treat complex intracranial aneurysms originating from supraclinoid segment of the internal carotid artery. CASE DESCRIPTIONS In both procedures, primary clip placement was considered technically difficult due to either complex morphology or inferior protrusion of aneurysm fundus within the interclinoid space. A nitinol self-expanding stent was placed across the neck of the aneurysm either preoperatively or intraoperatively. Obliteration of aneurysm and patency of the artery was confirmed by angiography after clip placement. CONCLUSION Description of an integrated open microsurgical and endovascular approach and review of literature pertaining to considerations for treatment approach are discussed.
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Affiliation(s)
| | | | - Asif A. Khan
- Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA
- Department of Neurosurgery, CentraCare Health, St. Cloud, MN, USA
| | - M. Fareed K. Suri
- Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA
- Department of Neurosurgery, CentraCare Health, St. Cloud, MN, USA
| | - Gregory T. Sherr
- Department of Neurosurgery, CentraCare Health, St. Cloud, MN, USA
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Wan YF, Ma XL, Yuan C, Fei L, Yang J, Zhang J. Impact of daily lifestyle on coronary heart disease. Exp Ther Med 2015; 10:1115-1120. [PMID: 26622449 DOI: 10.3892/etm.2015.2646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 03/05/2015] [Indexed: 11/06/2022] Open
Abstract
Limited data are available with regard to the impact of daily lifestyle choices in patients with coronary heart disease (CHD) who have undergone stent placement. Thus, the aim of the present study was to investigate the impact of daily lifestyle factors in patients with CHD following stent implantation. Between March 2005 and March 2006, 129 consecutive patients with CHD were admitted to Cangzhou Central Hospital at Hebei Medical University (Cangzhou, China). The patients underwent coronary stenting and participated in a 7-year clinical follow-up that analyzed the impact of their daily lifestyle choices on CHD following the stent placement. Rates of dinner satiety [95% confidence interval (CI), 1.121-10.97, P=0.005], smoking (95% CI, 4.05-34.90, P=2.01×10-7) and heavy alcohol use (95% CI, 1.32-11.05, P=0.006) were significantly higher in the repeated (re)-revascularization group when compared with the non-revascularization group. In addition, the exercise rate was significantly lower in the re-revascularization group when compared with the non-revascularization group (95% CI, 0.02-0.65, P=0.005). However, no statistically significant differences were observed between the groups with regard to sleeping patterns (95% CI, 0.03-0.71, P=0.270) or anxiety rates (P=0.289). A coronary angiography performed during re-revascularization revealed in-stent restenosis in 26% of the patients, stenoses at the entrance to or exit from the stent in 29% of the patients and new lesions in 19% of the patients. Furthermore, original lesions exhibited deterioration in 26% of the patients. The clinical endpoint was reached in 55% of the patients between 3 and 5 years of the follow-up period. In conclusion, poor daily lifestyle habits can increase the in-stent restenosis rate, accelerate the progression of the original lesion and promote the emergence of new lesions in patients with CHD following stent placement.
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Affiliation(s)
- Yan-Fang Wan
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, Hebei 061001, P.R. China
| | - Xiao-Li Ma
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, Hebei 061001, P.R. China
| | - Chen Yuan
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, Hebei 061001, P.R. China
| | - Ling Fei
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, Hebei 061001, P.R. China
| | - Jing Yang
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, Hebei 061001, P.R. China
| | - Jun Zhang
- Department of Cardiology, Cangzhou Central Hospital, Hebei Medical University, Cangzhou, Hebei 061001, P.R. China
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Ohshima T, Nagakura M, Nishizawa T, Kato K. Alpha horizontal stent delivery for coil embolization of a broad-necked large basilar apex aneurysm: a case report. Nagoya J Med Sci 2015; 77:659-65. [PMID: 26663945 PMCID: PMC4664598] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Here we describe a novel technique for single stent horizontal reconstruction and coil embolization for a broad-necked large basilar artery (BA) apex aneurysm. A previously healthy 77-year-old woman presented with a broad-necked large BA apex aneurysm. Due to difficulty accessing the right posterior cerebral artery (PCA), we abandoned the Y-stent technique. Instead, we decided to navigate the stent through the BA to the left PCA making a loop of the stent delivery catheter inside the aneurysm in an "alpha" fashion. The procedure outcome was excellent without any complications. Alpha horizontal stent delivery via an antegrade approach for coil embolization of broad-necked large BA apex aneurysms may provide an effective therapeutic alternative, if other techniques are not feasible.
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Affiliation(s)
- Tomotaka Ohshima
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Masamune Nagakura
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | | | - Kyozo Kato
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
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Szegedi L, Dandé G, Ágoston S, Kovács J, Rácz F, Vén L. [Palliative endoscopic treatment of malignant gastroduodenal obstructions with uncovered enteral stents]. Orv Hetil 2015; 156:1778-81. [PMID: 26498897 DOI: 10.1556/650.2015.30278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Palliative treatment of malignant gastroduodenal obstructions with enteral stents is an effective and safe method, and a viable alternative to gastroenterostomy. AIM The authors present the most common malignancies behind gastroduodenal obstructions, the aspects of stent selections, insertion techniques, technical and clinical success rates, and possible procedure-related complications. METHOD Between 1 March, 2013 and 9 April, 2015 nineteen patients were treated with uncovered, self-expandable enteral stents. Out of the 19 patients, 6 were females and 13 males, with an average age of 67 years. Indications of stenting were peripyloric ventricular tumour in five cases, malignancies of the duodenum, gastroenteralis anastomosis, Vater papilla and gallbladder in one case respectively, pancreatic tumor in seven cases and bile duct malignancies in three cases. RESULTS The technical success rate of stent placement was 100%. The evaluation of clinical success was analised on the basis of the Gastric Outlet Obstruction Scoring System. CONCLUSIONS The use of enteral stents in malignant gastroduodenal obstructions is a reliable and safe method, which promptly decreases symptoms of the patients and improves their quality of life.
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Affiliation(s)
- László Szegedi
- I. Belgyógyászat, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház Nyíregyháza, Szent István u. 68., 4400
| | - Gábor Dandé
- I. Belgyógyászat, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház Nyíregyháza, Szent István u. 68., 4400
| | - Sándor Ágoston
- I. Belgyógyászat, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház Nyíregyháza, Szent István u. 68., 4400
| | - János Kovács
- I. Belgyógyászat, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház Nyíregyháza, Szent István u. 68., 4400
| | - Ferenc Rácz
- I. Belgyógyászat, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház Nyíregyháza, Szent István u. 68., 4400
| | - László Vén
- I. Belgyógyászat, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház Nyíregyháza, Szent István u. 68., 4400
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Li H, Zhang X, Li XF, He XY, Zhu GH, Fang QR, Wang ZQ, Duan CZ. Predictors of Favorable Outcome of Intracranial Basilar Dissecting Aneurysm. J Stroke Cerebrovasc Dis 2015; 24:1951-6. [PMID: 26082343 DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/08/2015] [Accepted: 05/13/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Management of intracranial basilar dissecting aneurysms has been controversial and challenging, and surgical and conservative treatments usually have a bad prognosis. Our study aimed at evaluating the outcomes of endovascular treatment for these lesions and exploring the predictors of favorable outcome. METHODS We retrospectively reviewed 50 consecutive patients with basilar dissecting aneurysms from January 2006 to January 2013. Twenty-four patients underwent stent-assisted coiling whereas 26 patients underwent conservative treatment. Follow-up outcomes were evaluated using modified Rankin Scale (mRS) score. RESULTS Of the patients treated with stent-assisted coiling, 20 patients had a favorable outcome (mRS score, 0-1), post-treatment recurrence occurred in 3 patients, 1 had rebleeding, and 2 had no rebleeding. Of the patients treated with conservative therapy (observation or anticoagulation), 10 patients had an unfavorable outcome, 2 patients with ruptured aneurysms developed rebleeding, and 8 patients had poor outcome because of infarct progression. Stent-assisted coiling group had a more favorable outcome than the conservatively treated group (83.3% versus 55.2%, P = .019). Initial complete obliteration was related to the favorable outcome in endovascular-treated group (P = .042). Stent placement was the only independent predictor of favorable outcome in the logistic regression analysis (P = .030; odds ratio = 5.828; 95% confidence interval, 1.192-28.503). CONCLUSIONS Patients with basilar artery dissecting aneurysms treated with stent-assisted coiling had a more favorable outcome than the conservatively treated patients. Stent placement and initial complete occlusion were the favorable factors in patients with basilar dissecting aneurysm.
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Affiliation(s)
- Hui Li
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, China
| | - Xin Zhang
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, China
| | - Xi-Feng Li
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, China
| | - Xu-Ying He
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, China
| | - Guo-Hui Zhu
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, China
| | - Qin-Rui Fang
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, China
| | - Ze-Qun Wang
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, China
| | - Chuan-Zhi Duan
- Department of Neurosurgery/Neurosurgery Institute/Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Southern Medical University, Zhujiang Hospital, Guangzhou, Guangdong, China.
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Abstract
Benign esophageal strictures arise from a diversity of causes, for example esophagogastric reflux, esophageal resection, radiation therapy, ablative therapy, or the ingestion of a corrosive substance. Most strictures can be treated successfully with endoscopic dilation using bougies or balloons, with only a few complications. Nonetheless, approximately one third of patients develop recurrent symptoms after dilation within the first year. The majority of these patients are managed with repeat dilations, depending on their complexity. Dilation combined with intra lesional steroid injections can be considered for peptic strictures, while incisional therapy has been demonstrated to be effective for Schatzki rings and anastomotic strictures. When these therapeutic options do not resolve the stenosis, stent placement should be considered. Self bougienage can be proposed to a selected group of patients with a proximal stenosis. As a final step surgery is an option, but even then the risk of stricture formation at the anastomotic site remains. This chapter reviews refractory benign esophageal strictures and the treatment options that are currently available.
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Affiliation(s)
- Petra G A van Boeckel
- Department of Gastroenterology and Hepatology, HP: F02.618, University Medical Center, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands,
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Takada S, Isaka F, Nakakuki T, Mitsuno Y, Kaneko T. Torcular dural arteriovenous fistula treated via stent placement and angioplasty in the affected straight and transverse sinuses: case report. J Neurosurg 2015; 122:1208-13. [PMID: 25679278 DOI: 10.3171/2014.12.jns141374] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The successful obliteration of torcular dural arteriovenous fistula (DAVF) with a diffuse shunt in the affected sinus may require complex treatment strategies. Therapeutic goals include the preservation of normal venous drainage and complete obliteration of shunt flow. The authors report the case of a torcular DAVF. The treatment of this type of AVF may require a combined approach with transarterial and transvenous embolization, open surgery, or radiosurgery and is associated with many problems. Stent placement and angioplasty in the affected sinus result in compression of the fistulous dural wall of the sinus and decrease shunt flow. In cases in which there is a diffuse shunt in the affected sinus and no evident shunt point, such as in AVFs involving venous pouches and parasinuses, sealing the fistula orifice with self-expandable stents and angioplasty (balloon inflation) is considered the best treatment option to preserve normal cerebral venous sinus drainage and obliterate shunt flow. In such cases, the authors recommend using one or more self-expandable and closed-cell stents and using angioplasty to avoid endoleakage into the gap between the stent graft and the vessel wall.
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Affiliation(s)
- Shigeki Takada
- Department of Neurosurgery, Hikone Municipal Hospital, Hikone, Japan
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Kobayashi D, Turner DR, Delius RE, Aggarwal S. Hybrid procedure of bilateral pulmonary artery banding and bilateral ductal stenting in an infant with aortic atresia and interrupted aortic arch. Catheter Cardiovasc Interv 2014; 84:1157-62. [PMID: 24510548 DOI: 10.1002/ccd.25424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 12/18/2013] [Accepted: 02/05/2014] [Indexed: 11/06/2022]
Abstract
We report an infant with aortic valve atresia, interrupted aortic arch, ventricular septal defect, confluent pulmonary arteries, bilateral arterial ducts, absent common carotid arteries, and anomalous coronary arteries arising from main pulmonary artery. Hybrid procedure consisting of bilateral pulmonary artery banding and bilateral arterial duct stenting was performed at 4 weeks of age. Hybrid procedure can be an alternative palliative approach in an infant with this complex cardiac anatomy.
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Affiliation(s)
- Daisuke Kobayashi
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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OCCHIONORELLI S, TARTARINI D, CAPPELLARI L, STANO R, VASQUEZ G. Colonic stent placement as a bridge to surgery in patients with left-sided malignant large bowel obstruction. An observational study. G Chir 2014; 35:283-289. [PMID: 25644730 PMCID: PMC4321507] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Acute left-sided malignant colonic obstruction is common in elderly patients, in which emergency surgery is related with high morbidity and mortality rates, and often necessitates a two-step resection. Although the use of self-expanding metallic stents (SEMS) in elderly patients has not been adequately described yet, there are almost two international important trials which are still in progress, the stenting technique is established to be, by the international literature, an useful treatment with low morbidity and mortality. It's also a bridge to surgery, since the insertion of a SEMS can decompress the obstruction, making bowel and patient preparation possible and facilitating singlestage surgical resection. Palliative stenting can improve quality of life when compared to surgery in patients with metastasis or high co-morbidity. The aim of this study is to analyze mortality, avoidance of stoma, short- and long-term survival in patient with malignant left-sided large bowel obstruction who underwent to stent placement in our Emergency Surgery Unit, which is operative since November 2010 in our city Hospital in Ferrara. PATIENTS AND METHODS Between November 2010 and December 2012 a total of 15 patients with acute left-sided malignant large bowel obstruction suitable for colonic stent application were admitted to Emergency Surgery Unit. Among these patients, 9 underwent to self-expanding metallic stent placement (group A), the other (group B) 6 patient underwent to emergency surgery. In this observational not-randomized study we analyzed the efficacy and safety of SEMS placement for patients either as a bridge to surgery or as a palliation, beside the short term and long term outcomes, versus those patients operated straight. RESULTS Self-expanding metallic stents were successfully implanted in 9 of the 15 patients with acute left-sided malignant large bowel obstruction. No acute procedure-related complication was observed. All the patients in group A kept the stent in place for an average of 7,7 days, then everyone underwent to surgery. A large bowel resection with one-time recanalization was performed in 8 of the 9 patients. None Hartmann resection was necessary. Only one underwent again to surgery because of a dehiscence, a stoma was necessary. Between the other 6 patients in group B who underwent directly to surgery, In one case was necessary an Hartmann resection, another one incurred in dehiscence of the anastomosis that required reoperation with stoma creation. CONCLUSIONS Placement of SEMS seems to be an useful alternative to emergent surgery in the management of acute left-sided bowel obstruction, both as a bridge to surgery and as a palliative procedure. SEMS can provide an effective and safe therapeutic option compared to emergency surgery, most of all in elderly patients, with a lower mortality rate, a significantly higher rate of primary anastomosis and the avoidance of stoma. However, to fully determine their role for these indications, more data and more high level evidence is required.
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Affiliation(s)
- S. OCCHIONORELLI
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - D. TARTARINI
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - L. CAPPELLARI
- Emergency Surgery Service, “AOU S. Anna”, Ferrara, Italy
| | - R. STANO
- Emergency Surgery Service, “AOU S. Anna”, Ferrara, Italy
| | - G. VASQUEZ
- Emergency Surgery Service, “AOU S. Anna”, Ferrara, Italy
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Kim SK, Lee J, Duncan JR, Picus DD, Darcy MD, Sauk S. Endovascular treatment of superior mesenteric artery pseudoaneurysms using covered stents in six patients. AJR Am J Roentgenol 2014; 203:432-8. [PMID: 25055281 DOI: 10.2214/AJR.13.11644] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate our experience with the use of endovascular treatments for superior mesenteric artery (SMA) pseudoaneurysms using covered stents. MATERIALS AND METHODS Between 2002 and 2011, six patients (mean age, 41.7 years; range, 23-65 years) with SMA pseudoaneurysms were treated percutaneously with the placement of covered stents at our institution. The causes of SMA pseudoaneurysms were penetrating trauma (n = 2), blunt trauma (n = 1), and previous surgical procedures (n = 3). The mean diameter of the SMA pseudoaneurysms was 16 mm (range, 4-24 mm). Technical success and clinical success were retrospectively analyzed. RESULTS Immediate technical success, defined as exclusion of the pseudoaneurysm and lack of active extravasation, was achieved in all six patients. Secondary balloon angioplasty was needed in one patient with residual narrowing. There was a small dissection of the proximal SMA necessitating placement of a second bare stent across the dissection. A second covered stent (Fluency stent, 8 mm) was placed in the same patient because of recurrent bleeding due to a type II endoleak 5 days after the first covered stent had been placed. This patient had no subsequent episodes of bleeding or bowel ischemia. Follow-up CT in the remaining five patients (mean, 21 months; range, 1-58 months) confirmed stent patency and preserved distal arterial flow to the bowel without episodes of bleeding or bowel ischemia during follow-up (mean, 27 months; range, 11-58 months). CONCLUSION Percutaneous endovascular treatment using a covered stent may be a safe and feasible tool for SMA pseudoaneurysms.
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Wada T, Takayama K, Taoka T, Nakagawa H, Myouchin K, Miyasaka T, Akashi T, Sakamoto M, Kichikawa K. Long-term treatment outcomes after intravascular ultrasound evaluation and stent placement for atherosclerotic subclavian artery obstructive lesions. Neuroradiol J 2014; 27:213-21. [PMID: 24750712 DOI: 10.15274/nrj-2014-10023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 02/07/2014] [Indexed: 11/12/2022] Open
Abstract
The objective of this study was to determine long-term outcomes after stent placement for subclavian artery (SA) obstructive lesions assisted by intraoperative intravascular ultrasound (IVUS). The study included 25 lesions in 24 patients who underwent stent placement assisted by intraoperative IVUS for subclavian artery stenosis or obstruction at our hospital between January 2003 and August 2010. Outcome was evaluated based on the results within 30 postoperative days (technical success rate, improvement in upper extremity ischemia, steal syndrome, left-right blood pressure difference, and perioperative complications) and the results after 30 postoperative days (incidence of vertebrobasilar artery territory infarction and restenosis). Stent placement and vessel dilatation were successful in all patients, without perioperative complications. Upper extremity ischemia, steal syndrome, and left-right blood pressure difference disappeared in all cases. During follow-up observation (6-96 months; median 51 months), no restenosis occurred at the stent placement site in any patient. In one case, four years after initial treatment, stenosis was noted proximal to the stent placement site. Satisfactory long-term as well as short-term outcomes were achieved after stent placement for SA obstructive lesions assisted by intraoperative IVUS evaluation.
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Affiliation(s)
- Takeshi Wada
- Department of Radiology, Nara Medical University; Kashihara, Nara, Japan -
| | - Katsutoshi Takayama
- Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital; Yao, Osaka, Japan
| | - Toshiaki Taoka
- Department of Radiology, Nara Medical University; Kashihara, Nara, Japan
| | - Hiroyuki Nakagawa
- Department of Radiology, Nara Medical University; Kashihara, Nara, Japan
| | - Kaoru Myouchin
- Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital; Yao, Osaka, Japan
| | - Toshiteru Miyasaka
- Department of Radiology, Nara Medical University; Kashihara, Nara, Japan
| | - Toshiaki Akashi
- Department of Radiology, Nara Medical University; Kashihara, Nara, Japan
| | - Masahiko Sakamoto
- Department of Radiology, Nara Medical University; Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University; Kashihara, Nara, Japan
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Hurley WL, Comins SA, Green RM, Canizzaro J. Atraumatic subclavian vein thrombosis in a collegiate baseball player: a case report. J Athl Train 2006; 41:198-200. [PMID: 16791307 PMCID: PMC1472647] [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] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To introduce the case of a collegiate baseball player who suffered an atraumatic subclavian vein thrombosis. This case presents an opportunity to discuss the diagnosis and treatment of a 22-year-old male with a thrombosis of his right subclavian vein. BACKGROUND Upper extremity deep venous thrombosis is an uncommon vascular problem, occurring primarily in young, healthy, active people. Although the history and symptoms are often unremarkable, the condition can lead to complications if not correctly recognized and appropriately treated. In this case, the athlete reported tightness in his right biceps muscle and upper back after sleeping on his shoulder. The patient denied substance abuse or illegal anabolic steroid use, and these possibilities were ruled out as factors in the diagnosis and treatment. DIFFERENTIAL DIAGNOSIS Shoulder tendinitis, thoracic outlet syndrome, primary upper extremity thrombosis of the right subclavian vein. TREATMENT After diagnosis, the patient was placed on blood thinners to dissolve the clot and referred to a vascular surgeon. The patient underwent a balloon angioplasty and later had the first rib removed. A second clot formed, and a stent was placed in the vein after the clot was removed by medication and another angioplasty procedure. He developed a pulmonary embolism during the stent procedure and was sent postoperatively to the intensive care unit, where he underwent therapeutic anticoagulation. After 10 weeks of therapy, the patient stopped all anticoagulant medication and returned to school to play baseball. UNIQUENESS We present the atraumatic pathogenesis of a subclavian venous thrombosis in a young, active, and otherwise healthy college athlete with unremarkable predisposing factors. Within 24 hours after rib resection, the subclavian vein rethrombosed. The patient was thought to have experienced a small pulmonary embolus. CONCLUSIONS Individuals who participate in athletics can develop atraumatic upper extremity deep venous thrombosis. Therefore, it is important that team physicians and certified athletic trainers be prepared to recognize the signs and symptoms of this condition to institute prompt, appropriate treatment.
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Affiliation(s)
- Wendy L Hurley
- Exercise Science and Sport Studies Department, State University of New York College at Cortland, Cortland, NY 13045, USA.
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