RESUMEN
PURPOSE: To compare the technical and clinical effectiveness of ultrasound-accelerated endovascular thrombolysis (USAT) versus pigtail catheter-directed thrombolysis (PCDT) for the treatment of acute pulmonary embolism (PE). MATERIALS AND METHODS: A single-center retrospective study of patients treated with USAT or PCDT for acute massive or submassive PE between January 2010 and December 2016 was performed by reviewing electronic medical records. Sixty treatments were reviewed (mean patient age, 56.7 y ± 14.6), including 52 cases of submassive PE (21 treated with USAT, 31 with PCDT) and 8 cases of massive PE (3 treated with USAT, 5 with PCDT). Endpoints included pulmonary artery pressure (PAP), Miller PE severity index, tissue plasminogen activator (TPA) dose, infusion duration, procedural variables, and complications. RESULTS: Demographics, PE severity, and right:left ventricular diameter ratios were similar between groups. USAT and PCDT significantly reduced mean PAP (reductions of 7.4 mm Hg [P = .002] and 8.2 mm Hg [P < .001], respectively) and Miller index scores (reductions of 45.8% [P < .001] and 53% [P < .001], respectively) with similar effectiveness (P = .47 and P = .15, respectively). Procedure (P < .001) and fluoroscopy (P = .001) times were significantly longer in the USAT group. The USAT group underwent fewer sessions (2.2 ± 0.6 vs 2.4 ± 0.6; P = .17) with shorter infusion times (23.9 h ± 8.8 vs 30.4 h ± 12.6; P = .065) and a lower total dose of TPA (27.1 mg ± 11.3 vs 30.4 mg ± 12.6; P = .075) compared with the PCDT group, but the differences were not significant. Complications (P = .07) and 30-day mortality rates (P = .56) were not significantly different between groups. CONCLUSIONS: USAT and PCDT demonstrated comparable effectiveness and safety in the treatment of patients with acute PE.
Asunto(s)
Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Radiografía Intervencional , Terapia Trombolítica/métodos , Terapia por Ultrasonido/métodos , Angiografía de Substracción Digital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/terapia , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/terapia , Implantación de Prótesis Vascular/métodos , Embolización Terapéutica/métodos , Endofuga/diagnóstico por imagen , Endofuga/terapia , Angiografía por Resonancia Magnética , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Dimetilsulfóxido/administración & dosificación , Humanos , Masculino , Polivinilos/administración & dosificación , Recurrencia , Arteria Renal/diagnóstico por imagen , StentsRESUMEN
PURPOSE: To evaluate the safety and outcomes of endovascular recanalization of chronic total occlusions (CTOs) of the superior mesenteric artery (SMA) in patients with chronic mesenteric ischemia (CMI). MATERIALS AND METHODS: A single-institution retrospective review was performed of 47 consecutive patients (18 male, 29 female) who underwent endovascular stent placement for CTOs of the SMA between February 2006 and November 2012. All patients had symptoms of CMI. Procedural and follow-up data were collected for assessment of technical success, safety, and outcome. RESULTS: Technical success was achieved in 41 of 47 patients (87%). Forty-two of the 47 procedures were performed from a femoral approach. Fifteen patients underwent concurrent revascularization of the celiac artery. All patients who underwent successful recanalization reported symptomatic improvement. Kaplan-Meier analysis revealed primary freedom from symptomatic recurrence of 95% at 12 months and 78% at 24 months. Symptomatic recurrence was observed in seven patients, all of whom underwent successful assisted or secondary endovascular procedures. Secondary freedom from symptomatic recurrence rates were 100% at 12 months and 88% 24 months. There were three (7%) minor access-related complications and no major complications. CONCLUSIONS: Endovascular stent-assisted recanalization of chronic SMA occlusions is safe and effective, with an acceptable rate of technical success and excellent midterm clinical outcomes.
Asunto(s)
Procedimientos Endovasculares , Isquemia Mesentérica/terapia , Oclusión Vascular Mesentérica/terapia , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Enfermedad Crónica , Delaware , Supervivencia sin Enfermedad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Arteria Mesentérica Superior/fisiopatología , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/fisiopatología , Oclusión Vascular Mesentérica/diagnóstico , Oclusión Vascular Mesentérica/fisiopatología , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Stents , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler , Grado de Desobstrucción VascularRESUMEN
Cholecystoenteric fistulas are a complication of biliary disease, having an estimated incidence in the range of 0.1 - 0.5 percent. Roughly 8-27 percent of these are of the cholecystocolonic type,1 occurring most commonly at the hepatic flexure. An 82-year-old male presented to our tertiary hospital emergency department and was diagnosed with a cholecystocolonic fistula (CCF) by CT imaging. Surgical evaluation confirmed the CT diagnosis with subsequent removal of the fistula and gallbladder, which was curative.
