1
|
Abramowitz SD, Kado H, Schor J, Annambhotla S, Mojibian H, Marino AG, Maldonado TS, Gandhi S, Paulisin J, Bunte MC, Angel W, Roberts J, Veerina K, Long D, Elmasri F, Shaikh A, Beasley RE, Dexter D. Six-Month Deep Vein Thrombosis Outcomes by Chronicity: Analysis of the Real-World ClotTriever Outcomes Registry. J Vasc Interv Radiol 2023; 34:879-887.e4. [PMID: 37105663 DOI: 10.1016/j.jvir.2022.12.480] [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: 06/09/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To analyze the first 250 patients from the prospective, multicenter, industry-sponsored ClotTriever Outcomes (CLOUT) registry, assessing the safety and effectiveness of mechanical thrombectomy for acute, subacute, and chronic deep vein thrombosis (DVT). MATERIALS AND METHODS Real-world patients with lower extremity DVT were treated with the ClotTriever System (Inari Medical, Irvine, California). Adjuvant venoplasty, stent placement, or both were performed at the physician's discretion. Thrombus chronicity was determined by visual inspection of removed thrombus, categorizing patients into acute, subacute, and chronic subgroups. Serious adverse events (SAEs) were assessed through 30 days. Clinical and quality-of-life (QoL) outcomes are reported through 6 months. RESULTS Thrombus chronicity was designated for 244 of the 250 patients (acute, 32.8%; subacute, 34.8%; chronic, 32.4%) encompassing 254 treated limbs. Complete or near-complete (≥75%) thrombus removal was achieved in 90.8%, 81.9%, and 83.8% of the limbs with acute, subacute, and chronic thrombus, respectively. No fibrinolytics were administered, and 243 (99.6%) procedures were single sessions. One (0.4%) patient in the subacute group experienced a device-related SAE, a fatal pulmonary embolism. On comparing baseline and 6-month data, improvements were demonstrated in median Villalta scores (acute, from 10 to 1; subacute, from 9 to 1; chronic, from 10 to 3; for all, P < .0001) and mean EuroQol group 5-dimension (EQ-5D) self-report questionnaire scores (acute, 0.58 to 0.89; subacute, 0.65 to 0.87; chronic, 0.58 to 0.88; for all, P < .0001). There were no significant differences in outcomes across the subgroups. CONCLUSIONS Mechanical thrombectomy using the ClotTriever System with adjunctive venoplasty and stent placement is safe and similarly effective for acute, subacute, and chronic DVT.
Collapse
Affiliation(s)
| | - Herman Kado
- Ascension Providence Hospital, Farmington Hills, Michigan; William Beaumont Hospital, Royal Oak, Michigan
| | | | | | | | | | | | - Sagar Gandhi
- Prisma Health Upstate, Greenville, South Carolina
| | | | - Matthew C Bunte
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Wesley Angel
- Methodist Healthcare Foundation, Germantown, Tennessee
| | - Jon Roberts
- Methodist Healthcare Foundation, Germantown, Tennessee
| | | | | | | | - Abdullah Shaikh
- Allegheny Health Network Research Institute, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|
2
|
Dexter DJ, Kado H, Schor J, Annambhotla S, Olivieri B, Mojibian H, Maldonado TS, Gandhi S, Paulisin J, Bunte MC, Angel W, Roberts J, Veerina K, Abramowitz S, Elmasri F, Hnath J, Jung M, Long D, Sanchez L, Cosme O, Skripochnik E, Lodha A, Shaikh A, King C, Bisharat M, Beasley RE. Interim Outcomes of Mechanical Thrombectomy for Deep Vein Thrombosis from the All-Comer CLOUT Registry. J Vasc Surg Venous Lymphat Disord 2022; 10:832-840.e2. [PMID: 35218955 DOI: 10.1016/j.jvsv.2022.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 11/01/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The multicenter, prospective, single arm CLOUT registry assesses the safety and effectiveness of the ClotTriever System (Inari Medical, Irvine, CA) for the treatment of acute and non-acute lower extremity deep vein thrombosis (DVT) in all-comer patients. Reported here are the outcomes of the first 250 patients. METHODS All-comer patients with lower extremity DVT were enrolled, including those with bilateral DVT, those with previously failed DVT treatment, and regardless of symptom duration. The primary effectiveness endpoint is complete, or near-complete (≥75%) thrombus removal determined by independent core laboratory-adjudicated Marder scores. Safety outcomes include serious adverse events (SAEs) through 30 days and clinical outcomes include PTS severity, symptoms, pain, and quality of life through 6 months. RESULTS The median age was 62 years and 40% of patients had contraindications to thrombolytics. A range of thrombus chronicity (33% acute, 35% subacute, 32% chronic) was observed. No patients received thrombolytics and 99.6% were treated in a single session. Median thrombectomy time was 28 minutes. The primary effectiveness endpoint was achieved in 86% of limbs. Through 30 days, one device-related SAE occurred. At 6 months, 24% of patients had PTS. Significant and sustained improvements were observed in all clinical outcomes including rVCSS, NPRS, and EQ-5D. CONCLUSIONS 6-month outcomes from the all-comer CLOUT registry with a range of thrombus chronicity demonstrate favorable effectiveness, safety, and sustained clinical improvements.
Collapse
Affiliation(s)
| | - Herman Kado
- Ascension Providence Hospital, Farmington Hills, MI; William Beaumont Hospital, Royal Oak, MI
| | - Jonathan Schor
- Northwell Health, Staten Island University Hospital, Staten Island, NY
| | | | | | | | | | | | | | | | | | - Jon Roberts
- Methodist Healthcare Foundation, Germantown, TN
| | | | | | | | | | | | | | - Luis Sanchez
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Toma C, Bunte MC, Cho KH, Jaber WA, Chambers J, Stegman B, Gondi S, Leung DA, Savin M, Khandhar S, Kado H, Koenig G, Weinberg M, Beasley RE, Roberts J, Angel W, Sarosi MG, Qaqi O, Veerina K, Brown MA, Pollak JS. Percutaneous mechanical thrombectomy in a real-world pulmonary embolism population: Interim results of the FLASH registry. Catheter Cardiovasc Interv 2022; 99:1345-1355. [PMID: 35114059 PMCID: PMC9542558 DOI: 10.1002/ccd.30091] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/15/2021] [Accepted: 01/09/2022] [Indexed: 11/30/2022]
Abstract
Objectives The FlowTriever All‐Comer Registry for Patient Safety and Hemodynamics (FLASH) is a prospective multi‐center registry evaluating the safety and effectiveness of percutaneous mechanical thrombectomy for treatment of pulmonary embolism (PE) in a real‐world patient population (NCT03761173). This interim analysis reports outcomes for the first 250 patients enrolled in FLASH. Background High‐ and intermediate‐risk PEs are characterized by high mortality rates, frequent readmissions, and long‐term sequelae. Mechanical thrombectomy is emerging as a front‐line therapy for PE that enables immediate thrombus reduction while avoiding the bleeding risks inherent with thrombolytics. Methods The primary endpoint is a composite of major adverse events (MAE) including device‐related death, major bleeding, and intraprocedural device‐ or procedure‐related adverse events at 48 h. Secondary endpoints include on‐table changes in hemodynamics and longer‐term measures including dyspnea, heart rate, and cardiac function. Results Patients were predominantly intermediate‐risk per ESC guidelines (6.8% high‐risk, 93.2% intermediate‐risk). There were three MAEs (1.2%), all of which were major bleeds that resolved without sequelae, with no device‐related injuries, clinical deteriorations, or deaths at 48 h. All‐cause mortality was 0.4% at 30 days, with a single death that was unrelated to PE. Significant on‐table improvements in hemodynamics were noted, including an average reduction in mean pulmonary artery pressure of 7.1 mmHg (22.2%, p < 0.001). Patient symptoms and cardiac function improved through follow‐up. Conclusions These interim results provide preliminary evidence of excellent safety in a real‐world PE population. Reported outcomes suggest that mechanical thrombectomy can result in immediate hemodynamic improvements, symptom reduction, and cardiac function recovery.
Collapse
Affiliation(s)
- Catalin Toma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Matthew C Bunte
- Vascular Medicine and Interventional Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kenneth H Cho
- Interventional Radiology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Wissam A Jaber
- Division of Cardiology, Emory University Hospital, Atlanta, Georgia, USA
| | - Jeffrey Chambers
- Interventional Cardiology, Metropolitan Heart and Vascular Institute, Minneapolis, Minnesota, USA
| | - Brian Stegman
- Interventional Cardiology, CentraCare Heart and Vascular Center, St. Cloud, Minnesota, USA
| | - Sreedevi Gondi
- Interventional Cardiology, Baptist Health, Louisville, Kentucky, USA
| | - Daniel A Leung
- Vascular Interventional Radiology, Christiana Care Health System, Newark, Delaware, USA
| | - Michael Savin
- Interventional Radiology, Beaumont Health, Royal Oak, Michigan, USA
| | - Sameer Khandhar
- Division of Cardiology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Herman Kado
- Interventional Cardiology, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Gerald Koenig
- Interventional Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mitchell Weinberg
- Interventional Cardiology, Staten Island University Hospital, Northwell Health, New York, New York, USA
| | - Robert E Beasley
- Vascular Interventional Radiology, Palm Vascular Centers, Miami Beach, Florida, USA
| | - Jon Roberts
- Interventional Radiology, Methodist Healthcare Foundation, Germantown, Tennessee, USA
| | - Wesley Angel
- Interventional Radiology, Methodist Healthcare Foundation, Germantown, Tennessee, USA
| | - Michael G Sarosi
- Interventional Radiology, St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA
| | - Osama Qaqi
- Interventional Cardiology, Ascension Providence Rochester Hospital, Rochester, Michigan, USA
| | - Kalyan Veerina
- Interventional Cardiology, Opelousas General Health System, Opelousas, Louisiana, USA
| | - Michael A Brown
- Interventional Cardiology, Boone Hospital Center, Columbia, Missouri, USA
| | - Jeffrey S Pollak
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
4
|
Satapathy SK, Gonzalez HC, Vanatta J, Dyer A, Angel W, Nouer SS, Kocak M, Kedia SK, Jiang Y, Clark I, Yadak N, Nezakagtoo N, Helmick R, Horton P, Campos L, Agbim U, Maliakkal B, Maluf D, Nair S, Halford HH, Eason JD. A pilot study of ex-vivo MRI-PDFF of donor livers for assessment of steatosis and predicting early graft dysfunction. PLoS One 2020; 15:e0232006. [PMID: 32407331 PMCID: PMC7224456 DOI: 10.1371/journal.pone.0232006] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background The utility of ex vivo Magnetic resonance imaging proton density fat fraction (MRI-PDFF) in donor liver fat quantification is unknown. Purpose To evaluate the diagnostic accuracy and utility in predicting early allograft dysfunction (EAD) of ex vivo MRI-PDFF measurement of fat in deceased donor livers using histology as the gold standard. Methods We performed Ex vivo, 1.5 Tesla MRI-PDFF on 33 human deceased donor livers before implantation, enroute to the operating room. After the exclusion of 4 images (technical errors), 29 MRI images were evaluable. Histology was evaluable in 27 of 29 patients. EAD was defined as a peak value of aminotransferase >2000 IU/mL during the first week or an INR of ≥1.6 or bilirubin ≥10 mg/dL at day 7. Results MRI-PDFF values showed a strong positive correlation (Pearson’s correlation coefficient) when histology (macro-steatosis) was included (r = 0.78, 95% confidence interval 0.57‐0.89, p<0.0001). The correlation appeared much stronger when macro plus micro-steatosis were included (r = 0.87, 95% confidence interval 0.72‐0.94, p<0.0001). EAD was noted in 7(25%) subjects. AUC (Area Under the Curve) for macro steatosis (histology) predicted EAD in 73% (95% CI: 48–99), micro plus macro steatosis in 76% (95% CI: 49–100). AUC for PDFF values predicted EAD in 67(35–98). Comparison of the ROC curves in a multivariate model revealed, adding MRI PDFF values to macro steatosis increased the ability of the model in predicting EAD (AUC: 79%, 95% CI: 59–99), and addition of macro plus micro steatosis based on histology predicted EAD even better (AUC: 90%: 79–100, P = 0.054). Conclusion In this pilot study, MRI-PDFF imaging showed potential utility in quantifying hepatic steatosis ex-vivo donor liver evaluation and the ability to predict EAD related to severe allograft steatosis in the recipient.
Collapse
Affiliation(s)
- Sanjaya K. Satapathy
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
- Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases, Northwell Health/ North Shore University Hospital, Manhasset, New York, United States of America
- * E-mail:
| | - Humberto C. Gonzalez
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
- Wayne State University School of Medicine/Henry Ford Health System, Detroit, MI, United States of America
| | - Jason Vanatta
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
- Center for Abdominal Transplantation, Cleveland Clinic Florida, Weston, FL, United States of America
| | - Andrew Dyer
- Department of Radiology, Methodist University Hospital, Memphis, TN, United States of America
| | - Wesley Angel
- Department of Radiology, Methodist University Hospital, Memphis, TN, United States of America
| | - Simonne S. Nouer
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Knoxville, Tennessee, United States of America
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Knoxville, Tennessee, United States of America
| | - Satish K. Kedia
- School of Public Health, University of Memphis, Memphis, TN, United States of America
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, TN, United States of America
| | - Ian Clark
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Nour Yadak
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Nosratollah Nezakagtoo
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Ryan Helmick
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Peter Horton
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Luis Campos
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Uchenna Agbim
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Benedict Maliakkal
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Daniel Maluf
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Satheesh Nair
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Hollis H. Halford
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - James D. Eason
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| |
Collapse
|
5
|
Abstract
Spigelian hernias are uncommon lateral ventral wall hernias with a significant rate of incarceration; these hernias often produce nonspecific clinical signs and symptoms as well as elusive imaging findings. Although there are reported cases of incarcerated appendices within Spigelian hernias, this case specifically illustrates the diagnostic difficulty these hernias present to both surgeons and radiologists. Additionally, we discuss important anatomy, demographics and risk factors, clinical symptoms, imaging pitfalls and recommendations for repair based on a review of literature.
Collapse
Affiliation(s)
- Michael Bevilacqua
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Saif Ahmed
- Department of Surgery, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Mark Miller
- Methodist - LeBonheur Healthcare, Methodist Germantown Hospital, Memphis, TN, USA
| | - David Sallee
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Wesley Angel
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
6
|
Angel W, Hawkins CM, Wang JM, Hughes DR, Duszak R. Percutaneous Hepatic and Renal Biopsy Procedures: An 18-Year Analysis of Changing Utilization, Specialty Roles, and Sites of Service. J Vasc Interv Radiol 2015; 26:680-5. [DOI: 10.1016/j.jvir.2015.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/24/2014] [Accepted: 01/09/2015] [Indexed: 12/13/2022] Open
|
7
|
Abstract
While the clinical findings of cocaine-induced enteropathy from mesenteric ischemia are fairly well understood, there is a paucity of imaging description and detail in the literature that describes these findings. Imaging characteristics of cocaine-induced mesenteric ischemia on CT examination include bowel edema, mucosal enhancement, venous engorgement, mesenteric free fluid, and dilatation of the small bowel lumen. A thorough history, physical examination, and laboratory testing are critical for the diagnosis and prompt surgical intervention may be necessary. We present a case of cocaine-induced mesenteric ischemia in a 49 year old male which resolved within 24 hours of supportive therapy.
Collapse
Affiliation(s)
- Wesley Angel
- University of Tennessee Health Science Center, Regional Medical Center, Memphis, TN, USA.
| | | | | |
Collapse
|
8
|
Morales CH, Villegas MI, Angel W, Vásquez JJ. Value of digital exploration for diagnosing injuries to the left side of the diaphragm caused by stab wounds. Arch Surg 2001; 136:1131-5. [PMID: 11585504 DOI: 10.1001/archsurg.136.10.1131] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS The digital exploration of stab wounds in the left thoracoabdominal region allows the early diagnosis of diaphragmatic lesions. DESIGN Diagnostic test study. The digital exploration of the diaphragm was compared with laparotomy (the gold standard) and thoracoscopy. SETTING The study setting was the Hospital Universitario San Vicente de Paúl (Medellín, Colombia). This is a referral trauma center for the general community. PATIENTS The study included 82 consecutive patients who were admitted to our institution during a 12-month period with injuries caused by stab wounds to the left thoracoabdominal region and who did not have indications for immediate surgery. Digital exploration of the wound was performed by the attending surgeon in the emergency department. If a lesion of the diaphragm was identified, a laparotomy was performed; if no diaphragmatic lesion was found, a diagnostic left thoracoscopy and/or laparotomy was performed. Results of the laparotomy (n = 63) or thoracoscopy (n = 19) were used as the standard of reference for the determination of sensitivity, specificity, and predictive values of digital exploration. INTERVENTION The integrity of the diaphragm was determined by digital exploration through the stab wound. MAIN OUTCOME MEASURES Sensitivity, specificity, predictive value, and likelihood ratio were calculated. RESULTS For the detection of diaphragmatic lesions, digital exploration demonstrated a sensitivity of 96%, a specificity of 83.3%, a positive predictive value of 91%, and a negative predictive value of 93.7%. CONCLUSION Digital exploration is a reliable method for the detection of injuries to the left side of the diaphragm caused by stab wounds.
Collapse
Affiliation(s)
- C H Morales
- Departamento de Cirugía, Universidad de Antioquia, AA 1226 Postal 229, Ciudad Universitaria, Medellín, Colombia.
| | | | | | | |
Collapse
|
9
|
Hodgson HW, Angel W, Glover JH. Apparatus. Analyst 1951. [DOI: 10.1039/an9517600379] [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: 11/21/2022]
|