The "Intermediate" CD14++CD16+ monocyte subset increases in severe peripheral artery disease in humans.

Monocytes are key players in atherosclerotic. Human monocytes display a considerable heterogeneity and at least three subsets can be distinguished. While the role of monocyte subset heterogeneity has already been well investigated in coronary artery disease (CAD), the knowledge about monocytes and their heterogeneity in peripheral artery occlusive disease (PAOD) still is limited. Therefore, we aimed to investigate monocyte subset heterogeneity in patients with PAOD. Peripheral blood was obtained from 143 patients suffering from PAOD (Rutherford stage I to VI) and three monocyte subsets were identified by flow cytometry: CD14++CD16- classical monocytes, CD14+CD16++ non-classical monocytes and CD14++CD16+ intermediate monocytes. Additionally the expression of distinct surface markers (CD106, CD162 and myeloperoxidase MPO) was analyzed. Proportions of CD14++CD16+ intermediate monocyte levels were significantly increased in advanced stages of PAOD, while classical and non-classical monocytes displayed no such trend. Moreover, CD162 and MPO expression increased significantly in intermediate monocyte subsets in advanced disease stages. Likewise, increased CD162 and MPO expression was noted in CD14++CD16- classical monocytes. These data suggest substantial dynamics in monocyte subset distributions and phenotypes in different stages of PAOD, which can either serve as biomarkers or as potential therapeutic targets to decrease the inflammatory burden in advanced stages of atherosclerosis.

Increased intermediate CD14++CD16++ monocyte subset levels associate with restenosis after peripheral percutaneous transluminal angioplasty.

BACKGROUND AND AIMS: We aimed at studying the association of three major human monocyte subsets after percutaneous transluminal angioplasty (PTA) in patients with femoropopliteal disease. METHODS: We prospectively studied 67 sequential patients (40 male, 27 female; mean age 71 ± 11 years) treated with femoropopliteal angioplasty. Multi-color flow cytometry characterized monocyte subsets from venous blood for expression of CD14 and CD16 and intracellular myeloperoxidase (MPO) prior to, and 3, 6 and 12 months post PTA. Analyses tested associations between monocyte subsets and risk for restenosis. RESULTS: 16/67 patients (24%) developed restenosis within 12 months after PTA. Patients with hyperlipidemia had increased risk for restenosis (HR = 1.7, 95% CI 0.7-2.9, p = 0.001). Increased baseline monocytes associated with an increased risk of late restenosis (HR = 4.9, 95% CI: 1.3-18.6, p = 0.047). CD14++CD16++ 'intermediate' monocytes assessed at baseline, and after 3, 6, and 12 months significantly associated with the risk for subsequent restenosis: HR = 3.9 (95% CI: 2.4-6.5, p = 0.029), HR = 5.7 (95% CI = 0.7-44.7, p = 0.013), HR = 6.5 (95% CI: 2.5-16.9, p = 0.001) and HR = 1.5 (95% CI = 1.4-15.5 p = 0.001), respectively. Moreover, the probability for freedom of restenosis decreased with increased levels of intermediate subsets at 12 months after PTA. Additionally, intracellular MPO expression in CD14++CD16++ measured at 3, 6 and 12 months associated with an increased restenosis risk (HR = 1.5, 95% CI: 0.8-2.1, p = 0.214, HR = 1.9, 95% CI: 1.0-2.3 p = 0.051 and HR = 1.4, 95% CI: 1.0-1.8, p = 0.052). CONCLUSIONS: Our results imply altered innate immunity after angioplasty. Elevated CD14++CD16++ intermediate monocyte frequencies and increased MPO expression may identify individuals at heightened risk for restenosis.

Mechanic and surface properties of central-venous port catheters after removal: A comparison of polyurethane and silicon rubber materials.

Central venous port devices made of two different polymeric materials, thermoplastic polyurethane (TPU) and silicone rubber (SiR), were compared due their material properties. Both naïve catheters as well as catheters after removal from patients were investigated. In lab experiments the influence of various chemo-therapeutic solutions on material properties was investigated, whereas the samples after removal were compared according to the implanted time in patient. The macroscopic, mechanical performance was assessed with dynamic, specially adapted tests for elasticity. The degradation status of the materials was determined with common tools of polymer characterisation, such as infrared spectroscopy, molecular weight measurements and various methods of thermal analysis. The surface morphology was analysed using scanning electron microscopy. A correlation between material properties and clinical performance was proposed. The surface morphology and chemical composition of the polyurethane catheter materials can potentially result in increased susceptibility of the catheter to bloodstream infections and thrombotic complications. The higher mechanic failure, especially with increasing implantation time of the silicone catheters is related to the lower mechanical performance compared to the polyurethane material as well as loss of barium sulphate filler particles near the surface of the catheter. This results in preformed microscopic notches, which act as predetermined sites of fracture.

Polyurethane versus silicone catheters for central venous port devices implanted at the forearm.

PURPOSE: We aimed to analyse short and long-term complications of polyurethane (PU) versus silicone catheters used in totally implantable venous-access ports (TIVAPs) implanted at the forearm. METHODS: Retrospective analysis of 698 consecutively implanted TIVAPs was performed. Primary end-points were defined as rates of major complications associated with either type of central venous port catheter. Technical success rate, device service interval as well as minor complications not requiring port explantation were defined as secondary end-points. RESULTS: A total of 698 port devices were implanted in 681 patients, 396 equipped with a PU catheter, 302 with a silicone catheter. The technical success rate was 99.9% with no major periprocedural complications. During follow-up a total of 211 complications in 146 patients were observed (1.0/1000 catheter days), 183 occurred associated with PU catheters (1.8/100 catheter days), 28 (0.3/1000 catheter days) with silicone catheters (log rank test p < 0.0001). Catheter-related bloodstream infections as well as thrombotic complications occurred significantly more frequently with PU catheters, while silicone catheters exhibited a trend towards a higher rate of mechanical failure such as disconnection or catheter rupture. Major complications requiring explantation of the device occurred more frequently with PU-based catheters (10.6%) compared to silicone catheter carrying ports (4.6%, log rank test p < 0.001). CONCLUSION: PU catheters are more susceptible to catheter-related infections and exhibit a higher thrombogenicity, compared to silicone catheters. Silicone catheters instead exhibit a trend towards decreased mechanical stability.

Short-term and long-term outcome of radiological-guided insertion of central venous access port devices implanted at the forearm: a retrospective monocenter analysis in 1704 patients.

OBJECTIVES: The objectives are to analyze the technical success rate as well as the short-term and long-term complications of totally implantable venous access ports (TIVAPs) at the forearm. METHODS: Retrospective analysis of 1,704 consecutively implanted TIVAPs was performed. Primary endpoints were defined as technical success rate, clinical outcome, device service interval, and rates of major complications. Minor complications not requiring port explantation were defined as secondary endpoints. RESULTS: The technical success rate was 99.2 % with no major complications. During follow-up, a total of 643,200 catheter-days were documented, the mean device service interval was 380.6 days/patient. A total of 243 complications (14.4 %) in 226 patients were observed (0.4/1000 catheter-days), in 140 patients (8.3 %) the port device had to be explanted. Disconnection between the port device and the catheter (1.6 %) was more frequent than fracture (0.8 %) and leakage (0.6 %) of the catheter, which occurred more frequently when the catheter was inserted via the cephalic versus the brachial vein. CONCLUSION: TIVAP implantation at the forearm is a simple and safe procedure with a low rate of early and late complications.

The effects of transjugular intrahepatic portosystemic stent shunt on systemic cardiocirculatory parameters.

PURPOSE: We aimed to evaluate the effects of transjugular intrahepatic portosystemic stent shunt (TIPS) on systemic cardiocirculatory parameters in patients treated with TIPS for portal hypertension-associated complications. MATERIALS AND METHODS: This prospective study was conducted in an intensive care unit of a German university hospital (October 2010-July 2013). We assessed hemodynamic parameters before and after TIPS placement using single-indicator transpulmonary thermodilution and pulse contour analysis. After exclusion of 5 patients treated with vasoactive agents during study measurements, 15 patients were included in the final statistical analysis. RESULTS: Transjugular intrahepatic portosystemic stent shunt induced a statistically significant decrease in portal pressure (median, 29 [25%-75% percentile range, 23-37] mm Hg before TIPS vs 21 [18-27] mm Hg after TIPS; P<.01) in parallel with a statistically significant increase in central venous pressure (10 [6-15] mm Hg before TIPS vs 13 [9-16] mm Hg after TIPS; P=.01), cardiac index (3.8 [2.9-4.6] L min(-1) m(-2) before TIPS vs 4.5 [3.8-5.4] L min(-1) m(-2) 14 hours after TIPS; P=.01), and stroke volume index (54 [42-60] mL/m2 before TIPS vs 60 [47-63] mL/m2 14 hours after TIPS; P=.03). Arterial blood pressure and systemic vascular resistance index were statistically significantly lower after TIPS. CONCLUSIONS: Transjugular intrahepatic portosystemic stent shunt placement is associated with an increase in central venous pressure and an improvement of global blood flow (cardiac index and stroke volume index) in patients with portal hypertension.

Dissection of the hepatic artery and the celiac trunk after a liver transplant: description of a complication and endovascular management.

Dissection of the common hepatic artery is a rare complication after orthotopic liver transplant. Subsequent thrombosis and occlusion of the transplant artery can result in graft failure requiring retransplant. We describe a case of hepatic artery dissection, occurring on the basis of primary vasculopathy, extending into the celiac trunk, with subtotal occlusion of the vessel through accompanying thrombosis. An attempt of endovascular rescue led to successful recanalization of the vessel and graft survival.

Transjugular intrahepatic porto-systemic stent-shunt for therapy of bleeding esophageal varices due to extramedullary hematopoiesis in primary myelofibrosis: a case report.

BACKGROUND: Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. PATIENT AND METHODS: We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). RESULTS: Therapy of variceal bleeding by TIPS insertion was successful. During a 29-month follow-up, no hepatic failure, hepatic encephalopathy, or further variceal bleeding episode occurred. CONCLUSION: TIPS placement is a well-established procedure for the treatment of complications due to portal hypertension mainly due to liver cirrhosis. This report illustrates that TIPS placement can also be a promising treatment option in patients with primary myelofibrosis and portal hypertension due to extramedullary hematopoiesis.

Neovascularization and angiogenic factors in advanced human carotid artery stenosis.

BACKGROUND: Most atherosclerotic lesions are vascularized, so neovessels may also contribute to plaque progression and vulnerability, but their precise role of neovessels in atherosclerosis is still unknown. The aim of this study was to analyze the possible relationships among neovascularization, relevant angiogenic factors, and plaque vulnerability in patients with advanced carotid artery stenosis. METHODS AND RESULTS: The study group comprised 56 patients (stable: n=28, unstable: n=28) with advanced carotid artery stenosis (>70%). Immunohistochemistry was performed for smooth muscle, endothelial, and inflammatory cells, macrophages, vascular endothelial growth factor (VEGF), VEGF receptor-2 (VEGFR-2), platelet-derived growth factor (PDGF), and angiopoietin-1,-2 (Ang-1,-2). Furthermore, the concentrations of angiogenic factors were measured in serum. Quantitative expression analysis was performed by SYBR-Green-based real-time polymerase chain reaction. Compared with stable carotid lesions, unstable carotid lesions showed 1.8-fold increase in neovascularization (P=0.013), which significantly correlated with accumulation of inflammatory cells (factor 1.9, P<0.001). In unstable lesions, compared with stable lesions, VEGF was 1.7-fold increased (P=0.032) and Ang-1 was 1.9-fold reduced (P=0.029). Furthermore, VEGF was higher in the blood of patients with unstable plaques than in stable plaques (0.32 ± 0.22 vs. 0.22 ± 0.16 ng/ml; P=0.002). Significant correlations were observed between plaque vulnerability, VEGF, neovascularization and inflammatory cells. CONCLUSIONS: Our results show a close association between neovascularization, expression of angiogenic factors, inflammation, and plaque vulnerability in patients with advanced carotid stenosis.

Advanced hemodynamic monitoring before and after transjugular intrahepatic portosystemic shunt: implications for selection of patients--a prospective study.

PURPOSE: To investigate immediate and short-term effects of transjugular intrahepatic portosystemic shunt (TIPS) on cardiocirculatory, hepatic, and renal function and characterize predictors for TIPS outcome in terms of organ function after TIPS. MATERIALS AND METHODS: This prospective study was approved by the ethics committee at a university hospital and was conducted in a medical intensive care unit. Informed consent was obtained. Twenty patients with indication for TIPS were enrolled. Monitoring of hemodynamic and hepatic function (transpulmonary thermodilution, indocyanine green plasma disappearance rate [ICG-PDR]) was performed. Biochemical markers of organ function were obtained. Statistical analysis (Wilcoxon test, Spearman correlation, multivariate linear regression analysis, receiver operating characteristic [ROC] analysis) was performed. RESULTS: After TIPS, central venous pressure (median, 11 vs 15 cm H(2)O; P < .001), cardiac index (3.4 vs 3.8 L/min/m(2); P = .001), and global end-diastolic volume index (GEDVI) (726 vs 775 mL/m(2); P = .003) increased significantly. Portosystemic pressure gradient (28 vs 11 cm H(2)O; P < .001) and systemic vascular resistance index (1610 vs 1384 dyn · sec · cm(-5) · m(2); P = .015) decreased significantly. Creatinine (1.1 vs 1.1 mg/dL; P = .008) and blood urea nitrogen (BUN) (27 vs 21 mg/dL; P = .006) decreased significantly. Bilirubin (1.8 vs 2.2 mg/dL; P = .032) and international normalized ratio (1.4 vs 1.5; P = .022) increased significantly. ICG-PDR significantly deteriorated after TIPS (P = .006). Higher baseline creatinine was independently associated with a decrease in creatinine after TIPS (R = 0.816, P < .001). ROC analysis identified baseline BUN (P = .026, area under ROC curve [AUC] = 0.818), cystatin C (P = .033, AUC = 0.805), and creatinine (P = .052, AUC = 0.779) as predictors of a decrease in creatinine of 0.5 mg/dL or greater and/or 25% or greater. An increase in bilirubin of 1 mg/dL or greater 1 week after TIPS was significantly associated with high baseline BUN (P = .007, AUC = 0.893) and high central venous pressure (P = .040, AUC = 0.800). Lower baseline alanine aminotransferase (P = .002, AUC = 1.000) and cardiac power index · GEDVI (P = .005, AUC = 0.960) predicted favorable TIPS outcome (creatinine decrease of ≥ 0.2 mg/dL without model for end-stage liver disease score increase of more than one point). CONCLUSION: Patients with renal insufficiency, compensated hepatocellular function, decreased cardiac preload, and decreased cardiac performance benefit most from TIPS.

Effects of TIPS on global end-diastolic volume and cardiac output and renal resistive index in ICU patients with advanced alcoholic cirrhosis.

The transjugular porto-systemic stent-shunt (TIPS) reduces portal pressure in cirrhotic patients and is used as a nonsurgical treatment for refractory ascites, recurrent variceal hemorrhage or hepatorenal syndrome. There are concerns regarding a negative impact on cirrhotic cardiomyopathy and deterioration of hyperkinetic circulatory dysfunction. We analyzed a prospectively maintained database containing hemodynamic data on cirrhotic ICU patients. Hemodynamic monitoring was performed using transpulmonary thermodilution (PiCCO, Pulsion Medical Systems, Munich, Germany). Renal perfusion was assessed by Doppler ultrasound during studies of portal and TIPS perfusion before and after the procedure. Complete data sets of 8 patients (4 male, 4 female, age 60 years (52-67), Child-Pugh-Turcotte score 10 (8-12)) were available. After TIPS, there was a substantial increase of GEDVI (646 ml/m2 (580-737) to 663 mL/m2 (643-792); p=0.036) that was even more pronounced at 24 hours (716 mL/m2 (663-821); P=0.012). CI increased from 3.3 L/min/m2 (3.1-4.2) to 3.9 L/min/m2 (3.6-5.3) (p=0.012) and 3.9 L/min/m2 (3.7-5.2) (p=0.017), respectively. There was a significant decrease of renal RI from 0.810 (0.781-0.864) to 0.746 (0.710-0.798) (p=0.028) and a transient increase of fractional excretion of sodium. SVRI (1737 dyn*s/cm5/m2 (1088 . 2115) vs. 1917 dyn*s/cm5/m2 (1368-2177) was not significantly altered immediately after TIPS but decreased to 1495 dyn*s/cm5/m2 (833- 1765) at 24 hours (p=0.036). There were no significant changes of mean arterial pressure (MAP). In conclusion, TIPS resulted in a pronounced increase of central blood volume. The observed hemodynamic effects are compatible with a preload driven increase of cardiac output and secondary decreases in SVRI and RI.

Floating caval thrombus arising from the ovarian vein.

We describe the case of a 37-year-old pregnant woman, who was admitted to hospital for suspicion of chorioamnionitis. An emergency C-section was performed. Four days later, the patient suffered from abdominal pain and fever. Computed tomographic scanning demonstrated only a thrombosis of the right ovarian vein. Anticoagulation and antibiotic therapy was started immediately. Color duplex imaging performed 3 days later revealed a free-floating caval thrombus reaching the confluence of hepatic veins while the patient was fully anticoagulated. Emergency thrombectomy was performed by laparotomy, and the thrombus was removed by caval incision during suprahepatic clamping of the inferior vena cava. The patient recovered rapidly from surgery and was discharged on the tenth postoperative day.

Improvement of microcirculation after percutaneous transluminal angioplasty in the lower limb with prostaglandin E1.

OBJECTIVE: The aim of the study was to investigate prospectively the microcirculation after angioplasty and its improvement with additional Prostaglandin E1 (PGE1) therapy assessed by transcutaneous pressure of oxygen. PATIENTS AND METHODS: 45 patients with intermittent claudication eligible for angioplasty were enrolled in a prospective randomised controlled clinical trial. Patients received either intra-arterial bolus of 40 microg PGE1 in addition to angioplasty or a 40 microg PGE1 intravenous infusion. Control group received no trial medication. Additional 15 patients undergoing intra-arterial angiography were also investigated. tcpO(2) values were recorded distal to the PTA region before, during the intervention, 24h, 2 and 4 weeks after intervention. Clinical endpoint was the change of tcpO(2) values 4 weeks after intervention. RESULTS: During the 4 week follow-up tcpO(2) values decreased in patients treated with angioplasty. At the same time tcpO(2) increased significantly in those patients additionally treated with intra-arterial PGE1 bolus injection as well as with intravenous PGE1 infusion. CONCLUSIONS: Impaired microcirculation after angioplasty can be improved with additional intravenous as well as intra-arterial PGE1 administration.

Cryoplasty for the prevention of arterial restenosis.

Restenosis after percutaneous transluminal angioplasty remains the limiting factor for the long-term benefit of endovascular therapies of peripheral arterial occlusive disease. Despite a variety of modifications and adjuncts to angioplasty such as bare metal stents, covered stents, and drug-eluting stents as well as a number of new technologies like laser angioplasty and cutting balloon angioplasty, restenosis rates have not been significantly affected and remain inferior to those for surgery for long lesions in the femoropopliteal segment. Cryoplasty, which combines balloon angioplasty with the application of cryothermal energy to the vessel wall, was suggested as a promising approach to prevent the formation of neointimal hyperplasia after angioplasty procedures. This review discusses the basic principles of cryoplasty, summarizes the current data on restenosis rates after cryoplasty treatment, and evaluates cryoplasty as a new treatment method to solve the problems associated with restenosis development. The results of the clinical studies suggest that cryoplasty is a feasible and safe technique in the treatment of femoropopliteal disease, however, they have failed to prove any superiority of cryoplasty over conventional angioplasty.

Transcutaneous oximetry compared to ankle-brachial-index measurement in the evaluation of percutaneous transluminal angioplasty.

OBJECTIVE: To investigate transcutaneous oximetry as parameter of the microcirculation is correlated to ankle-brachial-index as parameter of the macrocirculation after peripheral angioplasty procedures. DESIGN: Prospective study. MATERIALS AND METHODS: 60 patients suffering from intermittent claudication were scheduled for angioplasty treatment. 45 patients were considered as eligible for angioplasty after angiographic evaluation, 15 patients underwent angiography only. Transcutaneous oximetry measurements were performed before the procedure, at the end of intervention, 24h as well as 2 and 4 weeks after percutaneous transluminal angioplasty. Ankle-brachial-indices were obtained before intervention, 24h as well as 2 and 4 weeks later. RESULTS: Ankle-brachial-indices increased significantly at 24h after angioplasty in patients being treated with angioplasty. Transcutaneous oximetry values dropped significantly at the end of the procedure and returned close to the baseline levels at 2 and 4 weeks after angioplasty. Ankle-brachial-indices and transcutaneous oximetry were positively correlated before (r=0.3833, p=0.009) as well as 4 weeks after angioplasty (r=0.4596, p=0.001). Immediately after radiological interventions, ankle-brachial-indices and transcutaneous oximetry are not positively correlated. In patients undergoing angiography only, transcutaneous oximetry levels drop significantly immediately after angiography and remain at decreased levels even at 4 weeks after intervention. CONCLUSION: Transcutaneous oximetry as parameter of the microcirculation is positively correlated with ankle-brachial-index as parameter of the macrocirculation before and at 4 weeks after angioplasty. Intraarterial angiography leads to a sudden decrease in skin microcirculation without affecting macrocirculation. As indicated by a lack of recovery in transcutaneous oximetry levels after 4 weeks, angiography alone results in a prolonged impaired microcirculation which may reflect endothelial dysfunction caused by contrast material. The recovery of transcutaneous oximetry levels following angioplasty is counterbalanced by the adverse effects of the contrast material. Ankle-brachial-indices remains the most favourable parameter in evaluating the success of angioplasty procedures while transcutaneous oximetry serves as an indirect method in assessing endothelial dysfunction caused by contrast material.

Role of adhesion molecules in the induction of restenosis after angioplasty in the lower limb.

OBJECTIVE: The adhesion molecules P selectin, E selectin, intercellular adhesion molecule, vascular cellular adhesion molecule (VCAM), and monocyte chemoattractant protein 1 play a important role in the development of arteriosclerotic lesions and are considered main contributors to restenosis after angioplasty. We expected that the serum levels of these markers would increase in the early phase of the first few weeks after angioplasty. METHODS: We assessed prospectively the levels of soluble forms of adhesion molecules on the day before and then 24 hours and 2 and 4 weeks after angioplasty in arteries of the lower limb by using enzyme-linked immunosorbent assays. We investigated the distribution pattern of these markers in 44 patients (25 male and 19 female; age, 67.7 +/- 8.5 years [mean +/- SD]) presenting with intermittent claudication (Fontaine stage IIb). Twelve patients (27.3%) underwent diagnostic angiography, 32 (72.2%) received interventional treatment, 22 (68.8%) received balloon angioplasty, and 10 (31.2%) required stent placement. RESULTS: Ten (31.3%) of the treated patients developed restenosis within 6 months. These patients had significantly higher levels of P selectin (P = .034), E selectin (P = .006), and VCAM (P = .050) at all time points. E selectin, VCAM, and monocyte chemoattractant protein 1 levels increased between 24 hours and 4 weeks after angiographic procedures, thus indicating that the angiographic procedure itself leads to activation and inflammation of the endothelium. CONCLUSIONS: This study emphasizes a meaningful role of the adhesion molecules E selectin, P selectin, and VCAM as interesting contributors to restenosis formation after percutaneous transluminal angioplasty.

Current concepts of percutaneous abscess drainage in postoperative retention.

In recent years, percutaneous abscess drainage (PAD) of intraabdominal abscesses has become an important tool with regard to the treatment of intraabdominal sepsis. The aim of this study is to assess the value of PAD in the treatment of postoperative retentions. Between 1995 and 1999, the postoperative course of 3346 patients undergoing major abdominal surgery was analyzed. Mortality, morbidity, and comparison of different locations of intraabdominal abscesses were assessed. PAD was considered successful when the patient improved clinically within 24 hours, a decrease in the size of the abscess formation was noted, and complete recovery without further surgical intervention occurred. Out of 3346 operated patients, 174 (5.2%) were diagnosed as having an intraabdominal abscess formation and were treated by PAD. In 63 patients the abscess developed within the upper quadrants, in 66 patients the abscess developed within the lower quadrants, and in the remaining 45 patients the abscess developed within the retroperitoneal cavity or pelvis. The success rate of PAD was 85.6% with a morbidity rate of 4.6%. The least successful location for PAD was the left upper quadrant. Patients with abscess drainage in the right upper and lower quadrant experienced a high success rate. One patient died due to the PAD procedure. Unsuccessful PAD was closely related to an increase in mortality. In the case of intraabdominal abscess formation after visceral surgery, PAD should be the primary procedure. Attention should be paid to abscess formations in the left upper quadrant because there is an increased likelihood of complications caused by PAD.