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Tuifua TS, Kapoor B, Partovi S, Shah SN, Bullen JA, Enders J, Laique S, Levitin A, Gadani S. Prediction of Mortality and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement: Baseline and Longitudinal Body Composition Measurement. J Vasc Interv Radiol 2024:S1051-0443(24)00025-3. [PMID: 38244917 DOI: 10.1016/j.jvir.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
PURPOSE To investigate effects of baseline and early longitudinal body composition changes on mortality and hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS This is a case-control study with analysis of a TIPS registry (1995-2020) including data from patients with cirrhosis with computed tomography (CT) scans obtained within 1 month before and 3 months after TIPS. Core muscle area (CMA), macroscopic subcutaneous adipose tissue (mSAT), macroscopic visceral adipose tissue (mVAT) area, and muscle adiposity index (MAI) on CT were obtained. Multipredictor Cox proportional hazards models were used to assess the effect of body composition variables on mortality or HE. RESULTS In total, 280 patients (158 men; median age, 57.0 years; median Model for End-stage Liver Disease-sodium [MELD-Na] score, 14.0) were included. Thirty-four patients had post-TIPS imaging. Median baseline CMA was 68.3 cm2 (interquartile range, 57.7-83.5 cm2). Patients with higher baseline CMA had decreased risks of mortality (hazard ratio [HR]: 0.82; P = .04) and HE (HR: 0.82; P = .009). It improved prediction of mortality over MELD-Na and post-TIPS right atrial pressure alone (confidence interval = 0.729). An increase in CMA (HR: 0.60; P = .043) and mSAT (HR: 0.86; P = .022) or decrease in MAI (HR: 1.50; P = .049) from before to after TIPS was associated with a decreased risk of mortality. An increase in mSAT was associated with an increased risk of HE (HR: 1.11; P = .04). CONCLUSIONS CMA on CT scan 1 month before TIPS placement predicts mortality and HE in patients with cirrhosis. Changes in body composition on CT measured 3 months after TIPS placement independently predict mortality and HE.
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Affiliation(s)
- Tisileli S Tuifua
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, EC-10 Cleveland Clinic, Cleveland, Ohio; Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Sasan Partovi
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shetal N Shah
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jennifer A Bullen
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jacob Enders
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, EC-10 Cleveland Clinic, Cleveland, Ohio; Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sobia Laique
- Digestive Diseases and Surgery Institute, Section of Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Abraham Levitin
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sameer Gadani
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Gadani S, Kapoor B. Invited Commentary: Pre-existing Hepatic Encephalopathy: Really a Contraindication to Elective TIPS? by Torkian etal. Cardiovasc Intervent Radiol 2024; 47:78-79. [PMID: 38087055 DOI: 10.1007/s00270-023-03627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Sameer Gadani
- Staff Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Baljendra Kapoor
- Professor of Radiology, University of Michigan Hospitals, Ann Arbor, MI, USA.
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Tuifua TS, Partovi S, Remer EM, Ragheb J, Bullen JA, Kattan MW, Kapoor B. Assessment of Clinical Outcomes, Clinical Manifestations, and Risk Factors for Hepatic Infarction After Transjugular Intrahepatic Portosystemic Shunt Placement (TIPS): A Retrospective Comparative Study. Cardiovasc Intervent Radiol 2022; 45:1512-1523. [DOI: 10.1007/s00270-022-03219-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
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Tuifua T, Partovi S, Shah S, Bullen J, Enders J, Kapoor B, Gadani S. Abstract No. 222 Pre-TIPS body composition measurements as predictors for long-term mortality after TIPS placement. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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McDaniel C, Bell R, Farha N, Vozzo C, Bullen J, Rosen M, Romero-Marrero C, Partovi S, Kapoor B. Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000876. [PMID: 35318192 PMCID: PMC8943763 DOI: 10.1136/bmjgast-2022-000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Transjugular intrahepatic portosystemic shunt (TIPS) placement is used to treat the sequelae of portal hypertension, including refractory variceal bleeding, ascites and hepatic hydrothorax. However, hernia-related complications such as incarceration and small bowel obstruction can occur after TIPS placement in patients with pre-existing hernias. The aim of this study was to determine the incidence of hernia complications in the first year after TIPS placement and to identify patient characteristics leading to an increased risk of these complications. Design This retrospective analysis included patients with pre-existing abdominal hernias who underwent primary TIPS placement with covered stents at our institution between 2004 and 2018. The 1-year hernia complication rate and the average time to complications were documented. Using a Wilcoxon rank-sum test, the characteristics of patients who developed hernia-related complications versus the characteristics of those without complications were compared. Results A total of 167 patients with pre-existing asymptomatic abdominal hernias were included in the analysis. The most common reason for TIPS placement was refractory ascites (80.6%). A total of 36 patients (21.6%) developed hernia-related complications after TIPS placement, including 20 patients with acute complications and 16 with non-acute complications. The mean time to presentation of hernia-related complications was 66 days. Patients who developed hernia-related complications were more likely than those without complications to have liver cirrhosis secondary to alcohol consumption (p=0.049), although this association was no longer significant after multivariate analysis. Conclusion Within 1 year after TIPS placement, approximately 20% of patients with pre-existing hernias develop hernia-related complications, typically within the first 2 months after the procedure. Patients with pre-existing hernia undergoing TIPS placement should be educated regarding the signs and symptoms of hernia-related complications, including incarceration and small bowel obstruction.
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Affiliation(s)
- Charles McDaniel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Bell
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Natalie Farha
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Catherine Vozzo
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jennifer Bullen
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Rosen
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Sasan Partovi
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
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Li X, Partovi S, Coronado WM, Gadani S, Martin C, Thompson D, Levitin A, Kapoor B. Hepatic Encephalopathy After TIPS Placement: Predictive Factors, Prevention Strategies, and Management. Cardiovasc Intervent Radiol 2022; 45:570-577. [PMID: 34981195 DOI: 10.1007/s00270-021-03045-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022]
Abstract
Hepatic encephalopathy (HE) is a challenging complication after transjugular intrahepatic portosystemic shunt (TIPS) placement. Despite recent advances, much is still uncertain regarding risk factors, preventative measures, and the management of HE after TIPS placement. Appropriate patient selection and pre-procedural risk stratification remain areas of focus. In this manuscript, we discuss the current state of research related to HE after TIPS placement, including information regarding risk stratification, complication prevention, and treatment options.
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Affiliation(s)
- Xin Li
- Department of Radiology, Hospital of The University of Pennsylvania, Philadelphia, PA, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA.
| | | | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Charles Martin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Dustin Thompson
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Abraham Levitin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
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Partovi S, Li X, Shwaiki O, Rashwan B, Ruff C, Grozinger G, Gadani S, Szaflarski D, Thompson D, D'Amico G, Levitin A, Kapoor B. Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000815. [PMID: 34952851 PMCID: PMC8710864 DOI: 10.1136/bmjgast-2021-000815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/16/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established but technically challenging procedure for the management of sequelae of end-stage liver disease. Performed essentially blindly, traditional fluoroscopically guided TIPS placement requires multiple needle passes and prolonged radiation exposure to achieve successful portal venous access, thus increasing procedure time and the risk of periprocedural complications. Several advanced image-guided portal access techniques, including intracardiac echocardiography (ICE)-guided access, cone-beam CT (CBCT)-guided access and wire-targeting access techniques, can serve as alternatives to traditional CO2 portography-based TIPS creation. Methods A literature search was performed on the electronic databases including MEDLINE and Embase, from 2000 to the present to identify all relevant studies. The reference list also included studies identified manually, and studies referenced for other purposes. Findings The main benefit of these advanced access techniques is that they allow the operator to avoid essentially blind portal punctures, and the ability to visualise the target, thus reducing the number of required needle passes. Research has shown that ICE-guided access can decrease the radiation exposure, procedure time and complication rate in patients undergoing TIPS placement. This technique is particularly useful in patients with challenging portal venous anatomy. However, ICE-guided access requires additional equipment and possibly a second operator. Other studies have shown that CBCT-guided access, when compared with traditional fluoroscopy-guided access, provides superior visualisation of the anatomy with similar amount of radiation exposure and procedure time. The wire-targeting technique, on the other hand, appears to offer reductions in procedure time and radiation exposure by enabling real-time guidance. However, this technique necessitates percutaneous injury to the liver parenchyma in order to place the target wire. Conclusion Advanced portal access techniques have certain advantages over the traditional fluoroscopically guided TIPS access. To date, few studies have compared these advanced guided access options, and further research is required.
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Affiliation(s)
- Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Xin Li
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar Shwaiki
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Basem Rashwan
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Christer Ruff
- Section of Interventional Radiology, Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Gerd Grozinger
- Section of Interventional Radiology, Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Diane Szaflarski
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Dustin Thompson
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Guiseppe D'Amico
- Department of Transplant Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Abraham Levitin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Abstract
BACKGROUND Portal vein thrombosis (PVT) is a rare but severe entity that can cause clinically significant sequela such as worsening portal hypertension or mesenteric ischemia. Those cases refractory to medical management may be referred for endovascular intervention. Several technical considerations have been described in the literature, but a cohesive comparison of these multiple techniques is lacking. METHODS The purpose of this article is to review the diagnosis and endovascular management of PVT, including areas in which further research is warranted. RESULTS Cases of PVT can be readily diagnosed using ultrasound, computed tomography, or magnetic resonance imaging. Treatment often begins with systemic anticoagulation and endovascular interventions may be used in selected cases. Determining the optimal approach to accessing the portal venous system depends on the underlying disease and chronicity of the thrombus and the degree of occlusion. Once access to the portal venous system is established, catheter-directed therapy may be performed to achieve recanalization. CONCLUSION Despite the heterogeneity in patient presentation, cases of PVT can be readily diagnosed across several imaging modalities. Strategizing interventional approaches involves evaluation of the underlying disease and the chronicity of the thrombus. KEY POINTS · This review will enable interventionalists to establish a framework for treating portal vein thrombosis by identifying patient risk factors and thrombus characteristics that determine patient management.. · The unique risks and benefits for transhepatic, transsplenic, and transmesenteric approaches for establishing portal venous access will be discussed.. · Advantages and complications of thrombolysis, thrombectomy, and transjugular intrahepatic portosystemic shunt creation for treating portal vein thrombosis will be reviewed in detail based on our extensive institutional experience.. CITATION FORMAT · Ju C, Li X, Gadani S et al. Portal Vein Thrombosis: Diagnosis and Endovascular Management. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1642-0990.
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Affiliation(s)
- Connie Ju
- Radiology, University of California Los Angeles Health System, Los Angeles, United States
| | - Xin Li
- Radiology, University of Pennsylvania Health System, Philadelphia, United States
| | - Sameer Gadani
- Interventional Radiology, Cleveland Clinic Foundation, Cleveland, United States
| | - Baljendra Kapoor
- Interventional Radiology, Cleveland Clinic Foundation, Cleveland, United States
| | - Sasan Partovi
- Interventional Radiology, Cleveland Clinic Foundation, Cleveland, United States
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Lang M, Lang AL, Tsui BQ, Wang W, Erly BK, Shen B, Kapoor B. Renal-function change after transjugular intra-hepatic portosystemic shunt placement and its relationship with survival: a single-center experience. Gastroenterol Rep (Oxf) 2021; 9:306-312. [PMID: 34567562 PMCID: PMC8460113 DOI: 10.1093/gastro/goaa081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 01/06/2023] Open
Abstract
Background The effect of transjugular intra-hepatic portosystemic shunt (TIPS) placement on renal function and the correlation of post-TIPS Cr with mortality remain unclear. This study aimed to assess the effect of TIPS placement on renal function and to examine the relationship between post-TIPS Cr and mortality risk. Methods A total of 593 patients who underwent de novo TIPS placement between 2004 and 2017 at a single institution were included in the study. The pre-TIPS Cr level (T0; within 7 days before TIPS placement) and post-TIPS Cr levels, at 1–2 days (T1), 5–12 days (T2), and 15–40 days (T3), were collected. Predictors of Cr change after TIPS placement and the 1-year mortality rate were analysed using multivariable linear-regression and Cox proportional-hazards models, respectively. Results Overall, 21.4% of patients (n = 127) had elevated baseline Cr (≥1.5 mg/dL; mean, 2.51 ± 1.49 mg/dL) and 78.6% (n = 466) had normal baseline Cr (<1.5 mg/dL; mean, 0.92 ± 0.26 mg/dL). Patients with elevated pre-TIPS Cr demonstrated a decrease in post-TIPS Cr (difference, −0.60 mg/dL), whereas patients with normal baseline Cr exhibited no change (difference, <0.01 mg/dL). The 30-day, 90-day, and 1-year mortality rates were 13%, 20%, and 32%, respectively. Variceal bleeding as a TIPS-placement indication (hazard ratio = 1.731; P = 0.036), higher T0 Cr (hazard ratio = 1.834; P = 0.012), and higher T3 Cr (hazard ratio = 3.524; P < 0.001) were associated with higher 1-year mortality risk. Conclusion TIPS placement improved renal function in patients with baseline renal dysfunction and the post-TIPS Cr level was a strong predictor of 1-year mortality risk.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angela L Lang
- Department of Anesthesia, Critical Care, and Pain Management, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Q Tsui
- Department of Radiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Weiping Wang
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Brian K Erly
- Colorado School of Public Health, Aurora, Colorado, USA
| | - Bo Shen
- The Inflammatory Bowel Disease Center at Columbia, Columbia University Irving Medical Center, New York, NY, USA
| | - Baljendra Kapoor
- Division of Vascular and Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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Lang M, Lang, Coronado W, Kapoor B. Abstract No. 236 Comparison of 30-day readmission rate and mortality risk using a controlled expansion endoprosthesis or a conventional covered endoprosthesis: a single-center, retrospective study. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kiran M, Alsousou J, Dalal N, Ralte P, Kumar G, Kapoor B. Is a single dose of preoperative antibiotic therapy effective for patients treated with megaendoprosthesis after metastatic bone tumour resection? Musculoskelet Surg 2021; 106:187-193. [PMID: 33400185 DOI: 10.1007/s12306-020-00692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Purpose The timing and number of doses of antibiotics required for megaendoprosthetic replacement (MPR) in metastatic bone disease (MBD) is a matter of debate. The aim of our study is to present the results of a prospective cohort of MPR for MBD receiving a single dose of antibiotic at induction of anaesthesia. METHODS All patients who underwent primary MPR in MBD were included in this prospective study. All penicillin-sensitive patients received one dose of cefuroxime 1.5gm intravenous at induction. In penicillin-allergic patients, teicoplanin 1.2gm and ciprofloxacin 500 mg intravenous was administered. The patients were followed up in the wound clinic and the specialist MBD clinic at 2 weeks, 3 months, 6 months and then annually. Data collected included demographics, primary tumours, surgical procedures, complications and duration of follow-up. All calculations were performed using SPSS® 25(IBM, USA). A p value ≤ 0.05 was considered to be significant. RESULTS There were 51 patients with a mean age of 65.4 years. Procedures included proximal femoral replacement (35), distal femoral replacement (7), proximal humeral replacement (4), distal humeral replacement (3) and total femoral replacement (2). Thirty-seven patients received cefuroxime, and fourteen patients received teicoplanin and ciprofloxacin at induction of anaesthesia. The deep infection rate was 1.9%. Thirty-seven patients died with a median survival of 10 months (1 to 51 months). Mean follow-up was 18.9 months (1 to 70 months). CONCLUSION Single dose of preoperative antibiotics at anaesthetic induction seems to be safe and effective for preoperative prophylaxis in orthopaedic oncology.
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Affiliation(s)
- M Kiran
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK.
| | - J Alsousou
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - N Dalal
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - P Ralte
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - G Kumar
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - B Kapoor
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
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Coronado WM, Ju C, Bullen J, Kapoor B. Predictors of Occurrence and Risk of Hepatic Encephalopathy After TIPS Creation: A 15-Year Experience. Cardiovasc Intervent Radiol 2020; 43:1156-1164. [PMID: 32435836 DOI: 10.1007/s00270-020-02512-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/29/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To identify clinical variables, including use of newer Viatorr TIPS endoprosthesis with controlled expansion (VCX) that may affect the occurrence and risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) creation. METHODS A total of 376 patients who underwent TIPS creation at our institution between 2003 and 2018 were retrospectively identified. Of these patients, 71 received a Viatorr controlled expansion endoprosthesis and 305 received a Viatorr TIPS endoprosthesis (older version without controlled expansion). Multivariate regression analysis was used to identify factors predicting the occurrence of hepatic encephalopathy after TIPS creation; a Cox proportional hazard model was used to assess risk of HE through time to HE onset RESULTS: A total of 194 patients (52%) developed hepatic encephalopathy after TIPS creation, including 28 of 71 patients (39%) who received a VCX endoprosthesis. Older patient age and the use of Viatorr endoprosthesis without controlled expansion were significantly associated with the development of hepatic encephalopathy overall. Pre-TIPS pressure variables, patient age, plasma international normalized ratio, and model for end-stage liver disease score were risk factors for time to hepatic encephalopathy. CONCLUSION Several variables are mild predictors of early hepatic encephalopathy development after TIPS creation, and the use of VCX endoprosthesis in TIPS creation is associated with a modest lower risk of hepatic encephalopathy. These preliminary findings should be considered in regard to patient selection, endoprosthesis selection, and post-transjugular intrahepatic portosystemic shunt creation monitoring for the development of hepatic encephalopathy.
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Affiliation(s)
| | - Connie Ju
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Vozzo CF, Singh T, Bullen J, Sarvepalli S, McCullough A, Kapoor B. Hospital readmission following transjugular intrahepatic portosystemic shunt: a 14-year single-center experience. Gastroenterol Rep (Oxf) 2019; 8:98-103. [PMID: 32280469 PMCID: PMC7136714 DOI: 10.1093/gastro/goz062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/01/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is a relatively common procedure used to treat complications of portal hypertension. However, only limited data exist regarding the hospital-readmission rate after TIPS placement and no studies have addressed the causes of hospital readmission. We therefore sought to identify the 30-day hospital-readmission rate after TIPS placement at our institution and to determine potential causes and predictors of readmission. Methods We reviewed our electronic medical-records system at our institution between 2004 and 2017 to identify patients who had undergone primary TIPS placement with polytetrafluoroethylene-covered stents and to determine the 30-day readmission rate among these patients. A series of univariable logistic-regression models were fit to assess potential predictors of 30-day readmission. Results A total of 566 patients were included in the analysis. The 30-day readmission rate after TIPS placement was 36%. The most common causes for readmission were confusion (48%), infection (15%), bleeding (11%), and fluid overload (7%). A higher Model for End-Stage Liver Disease (MELD) score corresponded with a higher rate of readmission (odds ratio associated with each 1-unit increase in MELD score: 1.06; 95% confidence interval: 1.02–1.09; P = 0.001). Other potential predictors, including indication for TIPS placement, were not significantly associated with a higher readmission rate. Conclusions The 30-day readmission rate after TIPS placement with covered stents is high, with nearly half of these readmissions due to hepatic encephalopathy—a known complication of TIPS placement. Novel interventions to help reduce the TIPS readmission rate should be prioritized in future research.
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Affiliation(s)
- Catherine F Vozzo
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Tavankit Singh
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Bullen
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - Arthur McCullough
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.,Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
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Kiran M, Donnelly TD, Armstrong C, Kapoor B, Kumar G, Peter V. Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria. Bone Joint J 2019; 101-B:910-914. [PMID: 31362552 DOI: 10.1302/0301-620x.101b8.bjj-2018-0929.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. PATIENTS AND METHODS A total of 130 painful unilateral cemented THAs with a mean follow-up of 5.17 years (sd 1.12) were included in this prospective study. The mean patient age was 67.5 years (sd 4.85). Preoperative evaluation with inflammatory markers, aspiration, and an F18 FDG PET scan were performed. Diagnostic utility tests were also performed, based on the MSIS criteria for PJI and three samples positive on culture alone. RESULTS The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. CONCLUSION FDG PET has a definitive role in the preoperative evaluation of suspected PJI. This the first study to evaluate its utility based on MSIS criteria and compare it with microbiology results alone. However, FDG PET has a high false-positive rate. Therefore, we suggest that F18 FDG PET is useful in confirming the absence of infection, but if positive, may not be confirmatory of PJI. Cite this article: Bone Joint J 2019;101-B:910-914.
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Affiliation(s)
- M Kiran
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - T D Donnelly
- Trauma and Orthopaedics, Royal Liverpool University Hospital, Liverpool, UK
| | - C Armstrong
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - B Kapoor
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - G Kumar
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - V Peter
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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15
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Kapoor B, Contreras F, Katz M, Arepally A, Fischman A, Rose S, Kim A, Ferraro J. 3:18 PM Abstract No. 133 Surefire Infusion System (SIS) hepatocellular carcinoma registry study interim results: a multicenter study of the safety, feasibility, and outcomes of the SIS expandable-tip microcatheter in DEB-TACE. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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16
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Abstract
AbstractIntraprocedural three-dimensional imaging and guidance tools, such as cone-beam CT (CBCT), provide valuable guidance in navigating through challenging vascular and nonvascular structures while performing complex hepatobiliary and portal venous interventions, especially in patients with unconventional anatomy and technically difficult pathology. With the advent of these tools, many of the procedures that were once considered contraindicated can now be performed due to improved safety profile and operator confidence. This review describes application of these tools in various oncologic and nononcologic hepatobiliary and portal venous interventions.
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Affiliation(s)
- Baljendra Kapoor
- Imaging Institute, Vascular & Interventional Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Nikunj Chauhan
- Imaging Institute, Vascular & Interventional Radiology, Cleveland Clinic, Cleveland, Ohio
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17
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Gutierrez D, Gurajala RK, Kapoor B, Setser R, Karuppasamy K. Relationship between cone-beam CT technique and diagnostic usefulness in patients undergoing embolotherapy for hepatocellular carcinoma. Clin Radiol 2017; 72:993.e1-993.e6. [DOI: 10.1016/j.crad.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/18/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
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18
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Gupta AC, Wang W, Shah C, Sands MJ, Bullen J, Remer EM, Bayona PM, Carey W, Kapoor B. Added Value of Covered Stents in Transjugular Intrahepatic Portosystemic Shunt: A Large Single-Center Experience. Cardiovasc Intervent Radiol 2017; 40:1723-1731. [PMID: 28512687 DOI: 10.1007/s00270-017-1694-1] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/08/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE Transjugular intrahepatic portosystemic shunts (TIPS) were historically placed using uncovered bare-metal stents. Current practice has now shifted toward the use of polytetrafluoroethylene (PTFE)-covered stents, given the improved primary patency seen with these stents. The aim of this study was to determine whether there is any added value, such as overall survival or stent patency, when using covered stents versus uncovered stents in TIPS placement in a large cohort. MATERIALS AND METHODS From April 1995 to June 2012, a total of 744 consecutive adult patients underwent de novo TIPS placement (378 receiving uncovered stents, 366 receiving covered stents). Information was obtained on demographics, baseline clinical variables, and outcomes after TIPS placement. Data were collected, compared, and analyzed to assess outcomes including mortality, primary patency (determined via repeat intervention), and secondary patency (determined via ultrasound parameters). RESULTS Covered stents were associated with significantly improved primary patency (P < 0.001) and secondary patency (P < 0.001) when compared with uncovered stents in TIPS procedures. Additionally, covered stents were associated with higher estimated overall survival rates and higher survival rates when TIPS was performed emergently and in patients with higher Model for End-Stage Liver Disease (MELD) scores. For example, in patients with MELD scores between 11 and 18, there was a predicted survival of 59.2% with covered stents versus 42.8% with uncovered stents at 1 year. CONCLUSION This study demonstrated that covered stents offer the additional value of higher estimated overall survival and higher estimated survival in patients undergoing TIPS emergently and in those with higher MELD scores when compared to uncovered stents.
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Affiliation(s)
- Amar C Gupta
- Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Weiping Wang
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Chintan Shah
- Department of Diagnostic Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Sands
- Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Bullen
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Erick M Remer
- Department of Abdominal Imaging, Cleveland Clinic, Cleveland, OH, USA
| | - Pilar M Bayona
- Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - William Carey
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Baljendra Kapoor
- Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
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19
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Li C, Kapoor B, Moon E, Quintini C, Wang W. Current understanding and management of splenic steal syndrome after liver transplant: A systematic review. Transplant Rev (Orlando) 2017; 31:188-192. [PMID: 28254530 DOI: 10.1016/j.trre.2017.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/30/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Splenic steal syndrome (SSS) is a condition that can occur after orthotopic liver transplant (OLT). However, limited information is available about this condition. METHODS A systematic literature search of studies performed through May 2016 was conducted to identify reports of angiographically confirmed SSS and its variants. All of the factors relevant to this disorder were collected and analyzed. RESULTS A total of 219 cases of SSS and its variants were identified. The condition occurred in 4.7% of patients after OLT, and 93.7% of cases were diagnosed within the first 2 months after OLT. Conventional arteriography demonstrated nonocclusive hepatic artery hypoperfusion in all affected patients. Abnormal liver function was the most common clinical presentation, reported in 71.9% of cases. Less common presentations included thrombocytopenia, acute graft failure, and persistent ascites. On Doppler ultrasound, a high resistance index of the hepatic artery was present in 84.1% of patients. Increased spleen volume (≥829 mL) before OLT was suggestive of a potential risk for SSS. Splenic artery embolization (SAE) was performed in 94.7% of cases; this procedure immediately reversed flow abnormalities on Doppler ultrasound and improved liver function tests in 96.3% of cases. CONCLUSIONS The risk factors and potential etiologies of SSS remain largely unknown. Future studies should investigate the possible role of pre-OLT portal hypertension and portal hyperperfusion after OLT in the development of this syndrome. Collecting intraoperative hemodynamic data and performing Doppler ultrasound screening after OLT could potentially help clinicians to identify patients at high risk of arterial hypoperfusion and prevent potential complications from hepatic artery hypoperfusion.
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Affiliation(s)
- Chaolun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Baljendra Kapoor
- Imaging Institute, Cleveland Clinic, Section of Interventional Radiology, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Eunice Moon
- Imaging Institute, Cleveland Clinic, Section of Interventional Radiology, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Cristiano Quintini
- Department of General Surgery, Liver Transplant Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Weiping Wang
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
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20
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Tsui B, Zeng J, Moon E, Kapoor B, Sands M, Wang W. Retrospective review of 594 Trapease filter placements at a single healthcare institution. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Buethe J, Farrell J, Partovi S, Bochnakova T, Robbin M, McDaniel J, Kang P, Kapoor B, Tavri S, Patel I. Medical student (MS) interventional radiology (IR) symposium: raising awareness and interest in pursuing IR residency. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Halabi SA, Sawas T, Sadat B, Jandali A, Halabi HA, Halabi FA, Kapoor B, Carey WD. Early TIPS versus endoscopic therapy for secondary prophylaxis after management of acute esophageal variceal bleeding in cirrhotic patients: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2016; 31:1519-26. [PMID: 26858143 DOI: 10.1111/jgh.13303] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS American College of Gastroenterology and American Association for the Study of Liver Disease guidelines recommend endoscopic and pharmacologic treatment for esophageal variceal bleed. Transjugular intrahepatic portosystemic shunt (TIPS) placement is reserved for cases of therapeutic failure. Several studies have suggested improved prevention of rebleeding and improved survival without excess hepatic encephalopathy in patients who receive TIPS within the first 5 days after bleeding (early TIPS). In this meta-analysis, we evaluated the safety and efficacy of early TIPS versus endoscopic therapy for secondary prophylaxis after acute esophageal variceal bleeding in cirrhotic patients. METHODS Pubmed, Medline, Embase, ClinicalTrials.gov, and ISI Web of Science were searched for randomized controlled trials that compared early TIPS to endoscopic therapy. The primary outcome was mortality at 1 year; secondary outcomes were rebleeding and hepatic encephalopathy at 1 year. RESULTS Nine randomized controlled trials involving 608 cirrhotic patients were identified. Early TIPS was associated with a significant risk reduction in 1-year mortality (RR, 0.68; 95% CI, 0.49-0.96; P = 0.03) and 1-year incidence of variceal rebleeding (RR, 0.28; 95% CI, 0.20-0.40; P < 0.001) without significant heterogeneity among studies (I(2) = 30% and 47%, respectively). No significant difference in the incidence of hepatic encephalopathy at 1 year was observed (RR, 1.36; 95% CI, 0.72-2.56; P = 0.34); however, there was significant heterogeneity among studies (I(2) = 68%). CONCLUSION TIPS placed within 5 days after a major esophageal variceal hemorrhage is superior to endoscopic treatment in reducing subsequent bleeding. Early TIPS placement is also associated with superior 1-year survival without significantly increasing the incidence of hepatic encephalopathy.
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Affiliation(s)
- Shadi Al Halabi
- Internal Medicine Department, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tarek Sawas
- Department of Medicine, Michigan State School of Medicine, East Lansing, Michigan, USA.
| | - Besher Sadat
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Aiyah Jandali
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hadi Al Halabi
- Internal Medicine Department, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fadi Al Halabi
- Internal Medicine Department, Cleveland Clinic, Cleveland, Ohio, USA
| | - Baljendra Kapoor
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William D Carey
- Internal Medicine Department, Cleveland Clinic, Cleveland, Ohio, USA.
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23
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Alian A, McLennan G, Bennett S, Kapoor B, Gill A, Levitin A, Sands M, Obuchowski N, Aucejo F, Menon K, Estfan B, Pillai A, Kalva S. Yttrium-90 radioembolization versus doxorubicin-eluting beads chemoembolization in patients with infiltrative hepatocellular carcinoma: single center comparison of survival and toxicity. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Wang W, Erly B, Tsui B, Bradford R, McKinney J, Moon E, Kapoor B. Renal function change following transjugular intrahepatic portosystemic shunt (TIPS): a clinical retrospective study of 516 cases. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Erly B, Carey WD, Kapoor B, McKinney JM, Tam M, Wang W. Hepatorenal Syndrome: A Review of Pathophysiology and Current Treatment Options. Semin Intervent Radiol 2015; 32:445-54. [PMID: 26622108 PMCID: PMC4640915 DOI: 10.1055/s-0035-1564794] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Brian Erly
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - William D. Carey
- Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Mathew Tam
- Department of Radiology, Southend University Hospital, Essex, United Kingdom
| | - Weiping Wang
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
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26
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Amladi A, Kapoor B, Jain M, Shivpuje S. Use of tenecteplase in treatment of thrombotic prosthetic mitral valves. Indian Heart J 2015. [DOI: 10.1016/j.ihj.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Kapoor B. Introduction. Tech Vasc Interv Radiol 2015; 18:183. [PMID: 26615157 DOI: 10.1053/j.tvir.2015.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Abstract
A biloma is a well-demarcated collection of bile outside the biliary tree. Traumatic and iatrogenic injuries, most commonly secondary to cholecystectomy, are the usual causes. Although bilomas are relatively uncommon, this pathologic entity may lead to significant morbidity and mortality if not promptly diagnosed and properly managed. As clinical signs and symptoms of bilomas are often nonspecific and laboratory values may be unremarkable, imaging modalities including ultrasound, computed tomography, magnetic resonance imaging, and hepatobiliary cholescintigraphy play a crucial role in the diagnosis of this condition. It is paramount that interventional radiologists not only be well versed in the management of bilomas but also be knowledgeable in the diagnosis as well as key imaging findings that dictate the interventional management. The purpose of this article is to review the etiology, pathophysiology, and clinical presentation of bilomas to primarily focus on the relevant multimodal imaging findings and the minimally invasive management options.
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Affiliation(s)
- Alexander Copelan
- Department of Radiology and Diagnostic Imaging, Beaumont Health System, Royal Oak, MI.
| | - Lawrence Bahoura
- Department of Radiology and Diagnostic Imaging, Beaumont Health System, Royal Oak, MI
| | - Frances Tardy
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Matthias Kirsch
- Department of Radiology and Diagnostic Imaging, Beaumont Health System, Royal Oak, MI
| | - Farnoosh Sokhandon
- Body Imaging, Department of Radiology and Diagnostic Imaging, Beaumont Health System, Royal Oak, MI
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29
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Faramarzalian A, Armitage KB, Kapoor B, Kalva SP. Medical management of tumor lysis syndrome, postprocedural pain, and venous thromboembolism following interventional radiology procedures. Semin Intervent Radiol 2015; 32:209-16. [PMID: 26038627 DOI: 10.1055/s-0035-1549379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The rapid expansion of minimally invasive image-guided procedures has led to their extensive use in the interdisciplinary management of patients with vascular, hepatobiliary, genitourinary, and oncologic diseases. Given the increased availability and breadth of these procedures, it is important for physicians to be aware of common complications and their management. In this article, the authors describe management of select common complications from interventional radiology procedures including tumor lysis syndrome, acute on chronic postprocedural pain, and venous thromboembolism. These complications are discussed in detail and their medical management is outlined according to generally accepted practice and evidence from the literature.
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Affiliation(s)
- Ali Faramarzalian
- Department of Internal Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Keith B Armitage
- Department of Internal Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
| | | | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
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30
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Copelan A, George D, Kapoor B, Nghiem HV, Lorenz JM, Erly B, Wang W. Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol 2015; 32:133-55. [PMID: 26038621 DOI: 10.1055/s-0035-1549842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As advances in surgical techniques and postoperative care continue to improve outcomes, the use of solid organ transplants as a treatment for end-stage organ disease is increasing. With the growing population of transplant patients, there is an increasing need for radiologic diagnosis and minimally invasive procedures for the management of posttransplant complications. Typical complications may be vascular or nonvascular. Vascular complications include arterial stenosis, graft thrombosis, and development of fistulae. Common nonvascular complications consist of leaks, abscess formation, and stricture development. The use of interventional radiology in the management of these problems has led to better graft survival and lower patient morbidity and mortality. An understanding of surgical techniques, postoperative anatomy, radiologic findings, and management options for complications is critical for proficient management of complex transplant cases. This article reviews these factors for kidney, liver, pancreas, islet cell, lung, and small bowel transplants.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Daniel George
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hahn Vu Nghiem
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jonathan M Lorenz
- Section of Interventional Radiology, The University of Chicago, Chicago, Illinois
| | - Brian Erly
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio ; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Weiping Wang
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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31
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Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) insertion has been well established as an effective treatment in the management of sequelae of portal hypertension. There are a wide variety of complications that can be encountered, such as hemorrhage, encephalopathy, TIPS dysfunction, and liver failure. This review article summarizes various approaches to preventing and managing these complications.
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Affiliation(s)
- Paul V Suhocki
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Matthew P Lungren
- Department of Radiology, Stanford University Medical Center, Palo Alto, California
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
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32
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Abstract
Iatrogenic hepatopancreaticobiliary injuries occur after various types of surgical and nonsurgical procedures. Symptomatically, these injuries may lead to a variety of clinical presentations, including tachycardia and hypotension from hemobilia or hemorrhage. Iatrogenic injuries may be identified during the intervention, immediately afterwards, or have a delayed presentation. These injuries are categorized into nonvascular and vascular injuries. Nonvascular injuries include biliary injuries such as biliary leak or stricture, pancreatic injury, and the development of fluid collections such as abscesses. Vascular injuries include pseudoaneurysms, arteriovenous fistulas, dissection, and perforation. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and digital subtraction angiography are critical for proper diagnosis of these conditions. In this article, we describe the clinical and imaging presentations of these iatrogenic injuries and the armamentarium of minimally invasive procedures (percutaneous drainage catheter placement, balloon dilatation, stenting, and coil embolization) that are useful in their management.
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Affiliation(s)
| | - Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Erick M Remer
- Department of Abdominal Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Baljendra Kapoor
- Department of Interventional Radiology, Cleveland Clinic, Cleveland, Ohio
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33
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Ling L, Bulik D, Duffner J, Shimizu C, Sarvaiya H, Kapoor B, Brown J, Markowitz L, Arevalo E, Schultes B, Capila I, Saldova R, Stockmann H, Albrecht S, McManus C, Rudd P, Kaudinya G, Manning A, Tremoulet A, Bosques C, Burns J. OP0197 High-Resolution, Integrated Molecular Profiling Reveals Persistent Inflammation in Kawasaki Disease Patients with Coronary Artery Aneurysms. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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34
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Abstract
Iatrogenic injury to the urinary tract, including the kidneys, ureters, bladder, and urethra, is a potential complication of surgical procedures performed in or around the retroperitoneal abdominal space or pelvis. While both diagnostic and interventional radiologists often play a central and decisive role in the identification and initial management of a variety of iatrogenic injuries, discussions of these injuries are often directed toward specialists such as urologists, obstetricians, gynecologists, and general surgeons whose procedures are most often implicated in iatrogenic urinary tract injuries. Interventional radiologic procedures can also be a source of an iatrogenic urinary tract injury. This review describes the clinical presentation, risk factors, imaging findings, and management of iatrogenic renal vascular and urinary tract injuries, as well as the radiologist's role in the diagnosis, treatment, and cause of these injuries.
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Affiliation(s)
- Anthony M. Esparaz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Brian R. Herts
- Department of Abdominal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin LeBlanc
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Baljendra Kapoor
- Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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35
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Kochhar GS, Navaneethan U, Hartman J, Mari Parungao J, Lopez R, Gupta R, Kapoor B, Mehta P, Sanaka M. Comparative study of endoscopy vs. transjugular intrahepatic portosystemic shunt in the management of gastric variceal bleeding. Gastroenterol Rep (Oxf) 2015; 3:75-82. [PMID: 25673803 PMCID: PMC4324874 DOI: 10.1093/gastro/gou095] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background and Aim: Gastric varices are associated with high mortality. There have been conflicting reports on whether endoscopic treatment with cyanoacrylate or the placement of a transjugular intrahepatic portosystemic shunt (TIPS) is more effective in the treatment of gastric varices. We compared the outcomes of patients treated with cyanoacrylate glue or TIPS for the management of acute gastric variceal bleeding. Methods: The study was designed as a retrospective cohort analysis of patients undergoing either TIPS or endoscopic treatment with cyanoacrylate for acute gastric variceal bleeding at our institution from 2001 to 2011. Primary compared to studied between the two treatment modalities were the short-term treatment outcomes, including re-bleeding within 30 days, length of hospital stay and in-hospital mortality. Kaplan-Meier survival analysis was performed to assess factors associated with in-hospital mortality. Results: A total of 169 patients were included in the analysis. The TIPS arm contained 140 patients and the cyanoacrylate arm contained 29 patients. There was no evidence to suggest any significant differences in demographics or disease severity. There were no differences between the TIPS arm and the cyanoacrylate armtwo groups in treatment outcomes including re-bleeding within 30 days (17.4% vs. 17.2%; P = 0.98), median length of stay in the hospital (4.5 days vs. 6.0 days; P = 0.35) or in-hospital mortality (9.0% vs. 11.1%; P = 0.74). In-hospital mortality was evaluated for 149 patients and lower albumin (P = 0.015), higher MELD score (P < 0.001), higher CTP score (P = 0.005) and bleeding (P = 0.008) were all significantly associated with in-hospital death. Conclusion: These findings suggest that both treatments are equally effective. Cyanoacrylate offers a safe, effective alternative to TIPS for gastric varices, and physician may choose the best therapy for each patient, factoring in the availability of TIPS or cyanoacrylate, the individual patient’s presentation, and cost.
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Affiliation(s)
- Gursimran Singh Kochhar
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Udayakumar Navaneethan
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jason Hartman
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jose Mari Parungao
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rocio Lopez
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ranjan Gupta
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Baljendra Kapoor
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Paresh Mehta
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Madhu Sanaka
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA, Case Western School of Medicine, Cleveland, OH, USA and Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Abstract
The transjugular intrahepatic portosystemic shunt (TIPS) procedure is effective in achieving portal decompression and in managing some of the major complications of portal hypertension. While many clinicians are familiar with the two most common indications for TIPS placement, secondary prophylaxis of esophageal variceal hemorrhage and treatment of refractory ascites, evidence for its usefulness is growing in other entities, where it has been less extensively studied but demonstrates promising results. Newer indications include early utilization in the treatment of esophageal variceal hemorrhage, Budd-Chiari syndrome, ectopic varices, and portal vein thrombosis. The referring clinician and interventionist must remain cognizant of the contraindications to the procedure to avoid complications and potential harm to the patient. This review is designed to provide an in-depth analysis of the most common as well as less typical indications for TIPS placement, and to discuss the contraindications and appropriate patient evaluation for this procedure.
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Affiliation(s)
- Alexander Copelan
- Diagnostic Radiology Department, William Beaumont Hospital, Royal Oak, Michigan
| | | | - Mark Sands
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Copelan A, Remer EM, Sands M, Nghiem H, Kapoor B. Diagnosis and management of Budd Chiari syndrome: an update. Cardiovasc Intervent Radiol 2014; 38:1-12. [PMID: 24923240 DOI: 10.1007/s00270-014-0919-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 04/23/2014] [Indexed: 12/16/2022]
Abstract
Imaging plays a crucial role in the early detection and assessment of the extent of disease in Budd Chiari syndrome (BCS). Early diagnosis and intervention to mitigate hepatic congestion is vital to restoring hepatic function and alleviating portal hypertension. Interventional radiology serves a key role in the management of these patients. The interventionist should be knowledgeable of the clinical presentation as well as key imaging findings, which often dictate the approach to treatment. This article concisely reviews the etiology, pathophysiology, and clinical presentation of BCS and provides a detailed description of imaging and treatment options, particularly interventional management.
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Affiliation(s)
- Alexander Copelan
- Diagnostic Radiology Department, William Beaumont Hospital, 3601 W 13 Mile Rd., Royal Oak, MI, 48073, USA,
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An T, Moon E, Bullen J, Kapoor B, Wu A, Sands M, Wang W. Prevalence and Clinical Consequences of Fracture and Fragment Migration of the Bard G2 Filter: Imaging and Clinical Follow-up in 684 Implantations. J Vasc Interv Radiol 2014; 25:941-8. [DOI: 10.1016/j.jvir.2014.01.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 11/25/2022] Open
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Gupta A, Kapoor B, Schneider E, McLennan G, Levitin A, Sands M. Detachable hydrocoils in visceral and peripheral embolization: technical success and difficulties in a 61 patients series. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gurajala R, Kapoor B, Thompson D, Michael G, Sands M, McLennan G. Cone beam CT planning and guidance for TIPS in patients with portal vein thrombosis. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Benzimra JD, Kapoor B, Edmeades N, Burger A, Simcock PR. Surgical repair of bilateral full thickness macular holes in a patient with blue sclera secondary to osteogenesis imperfecta. Eye (Lond) 2012; 26:1023-4. [PMID: 22498800 DOI: 10.1038/eye.2012.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Vortex vein ampulla varicosities are asymptomatic, harmless, findings in the retina. They are incidentally picked up on routine eye examination or when presenting for unrelated ocular symptoms. Clinicians and other eye care professionals unaware of this condition may be alarmed and may subject patients to unnecessary anxiety and expensive investigations. We present a rare case of varicosity of two vortex veins involving one quadrant of the retina. We have also shown simple clinical methods of establishing the diagnosis of vortex vein varicosity.
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Affiliation(s)
- K Vahdani
- Royal Eye Infirmary, Plymouth Hospital NHS Trust, Plymouth, UK
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Kumar R, Tandon VR, Bano G, Kapoor B, Sharma S, Gupta Y. Comparative study of proton pump inhibitors for triple therapy in H. pylori eradication. Indian J Gastroenterol 2007; 26:100-1. [PMID: 17558084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kapoor B, Panu A, Berscheid B. Angio-Seal in Antegrade Endovascular Interventions: Technical Success and Complications in a 55-Patient Series. J Endovasc Ther 2007; 14:382-6. [PMID: 17723019 DOI: 10.1583/06-2050.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the technical success and complications of Angio-Seal vascular closure device in antegrade common femoral artery (CFA) punctures. METHODS Over a 14-month period, 55 patients (37 men; age range 37-94 years) underwent antegrade CFA Angio-Seal placement at a single center; the clinical data and angiograms were reviewed retrospectively. A total of 56 antegrade CFA punctures were made for hemostasis; 6-F Angio-Seal devices (40 model STS and 12 model VIP) were deployed in 52 CFAs, and 8-F Angio-Seal devices were deployed in 4. RESULTS The technical success rate was 98.2% (55/56). Two (3.6%) patients developed small, non-expanding hematomas (<5 cm) during deployment of the device. There was 1 episode of device/operator failure, presumably due to extravascular deployment within soft tissue. None of the patients developed pseudoaneurysm, arterial injury, or large hematomas requiring transfusion. Small calcified plaques at the puncture site did not influence the outcome. CONCLUSION This series suggests that Angio-Seal may be a safe and effective device for hemostasis in antegrade CFA punctures. Further randomized trials testing its risk-benefit balance in comparison to standard manual compression are warranted.
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Affiliation(s)
- Baljendra Kapoor
- Vascular and Interventional Radiology, The University of Alabama at Birmingham, Birmingham, Alabama 35249, USA.
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Gupta S, Gupta V, Kapoor B, Kapoor V. Pyrazinamide induced hyperuricaemia presenting as severe bilateral leg cramps. J Indian Med Assoc 2007; 105:341-342. [PMID: 18232182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pyrazinamide is one of the first line drugs used for the treatment of tuberculosis. Hepatotoxicity and hyperuricaemia are important and common untoward effects seen after administration of pyrazinamide. The drug inhibits elimination of urates resulting in hyperuricaemia, the presenting features of which are arthralgia, arthritis or even gout. A-case of bilateral leg cramps due to hyperuricaemia following pyrazinamide therapy is reported here.
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Affiliation(s)
- Seema Gupta
- Postgraduate Department of Pharmacology and Therapeutics, Government Medical College, Jammu
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Kumar A, Khajuria V, Tandon VR, Kapoor B, Singh R. Comparative effects of conventional B-blockers and nebivolol on psychomotor performances in healthy volunteers: a preliminary report. Indian J Physiol Pharmacol 2007; 51:183-188. [PMID: 18175665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The present study was under taken to assess the comparative effects of nebivolol with propranolol and atenolol on psychomotor performances. Thirty healthy volunteers were randomized into three groups with n=10 in each group. Each subject received single dose of one of the three medications (nebivolol 5 mg, atenolol 50 mg and propranolol 40 mg) in morning (9:00 AM). Just before administering the drug, the pre-drug scores were taken, followed by post drug score obtained for consecutive six hours. Psychomotor assessment was carried out by three tests Simple Reaction Timer (SRT), Critical Flicker Fusion Frequent Threshold (CFFT) and Digit Cancellation Test (DCT). The results of present study indicate that single doses of atenolol and propranolol produced significant impairment of psychomotor performance. Nebivolol also impaired psychomotor performance tests in the similar fashion to atenolol and propranolol. Hence, the findings of the present study correlate with the lipophilic nature of the nebivolol.
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Affiliation(s)
- A Kumar
- Post Graduate Department of Pharmacology & Therapeutics, Government Medical College, Jammu
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Gupta S, Tandon VR, Kapoor B, Gupta A, Gupta GD, Khajuria V. Effects of tamoxifen therapy on plasma lipid profile in patients of breast cancer. J Assoc Physicians India 2006; 54:183-6. [PMID: 16800341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
AIM To evaluate the effects of tamoxifen therapy on plasma lipid profile in patients of breast cancer. METHOD A total of 55 postoperative patients of breast cancer were given tablet tamoxifen 20mg orally daily for 6 months. Estimation of plasma lipid by standard method was carried out in both pre-menopausal and postmenopausal new patients of early stage breast cancer at 0 day, 3rd month and 6th months of therapy. RESULTS Suggested that in pre-menopausal and postmenopausal patient's TC and LDL-c levels were reduced significantly, whereas, TG, VLDL-c and HDL-c were not altered. Comparison of the effects of tamoxifen in pre-menopausal and postmenopausal patients on lipid profile revealed that fall in TC and LDL-c was significantly higher at both 3 and 6 months in postmenopausal patients. CONCLUSION The study demonstrates that tamoxifen to favorably alter the markers of cardiovascular risk in both pre-menopausal and postmenopausal patients of breast cancer.
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Affiliation(s)
- Sapna Gupta
- Post Graduate Department of Pharmacology and Therapeutics, Government Medical College, Jammu (J&K) India 180001
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Tandon VR, Kapoor B, Gupta A, Gupta GD, Khajuria V, Gupta S. Effects of tamoxifen therapy on the endometrium in postmenopausal patients of breast cancer. Indian J Pharmacol 2006. [DOI: 10.4103/0253-7613.27030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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