Long-term results of angioplasty and stent placement for treatment of central venous obstruction in 126 hemodialysis patients: a 10-year single-center experience.

OBJECTIVE: The objective of our study was to report and compare long-term results of percutaneous transluminal angioplasty and stenting of central venous obstruction in hemodialysis patients. MATERIALS AND METHODS: Hemodialysis patients who underwent successful endovascular treatment of central venous obstruction were retrospectively evaluated. Stenotic lesions greater than 50% or inducing extremity swelling were subject to treatment. The primary treatment was angioplasty, and stent placement was accomplished in angioplasty-resistant obstructions. Angioplasty was the primary treatment of recurrence after stent placement. Additional stenting was reserved for angioplasty-resistant recurrences. RESULTS: One hundred forty-seven veins in 126 patients (63 males, 63 females) between 15 and 82 years old primarily underwent 101 angioplasties and 46 stent placements. The mean follow-up was 22.1 +/- 16.3 (SD) months. The average number of interventions per vein in the stent group (2.7 +/- 2.4 interventions) was significantly higher than that in the angioplasty group (1.5 +/- 1.0 interventions). Primary patency was significantly higher in the angioplasty group (mean, 24.5 +/- 1.7 months) than that in the stent group (mean, 13.4 +/- 2.0 months). Assisted primary patency of the angioplasty group (mean, 31.4 +/- 2.0 months) and that of the stent group (mean, 31.0 +/- 4.7 months) were equivalent. The overall mean primary patency was 21.1 +/- 1.4 months, and the overall mean assisted primary patency was 31.7 +/- 2.5 months. There were no significant differences in patency rates with regard to patient sex, the type of stent used, the vein or veins treated, or the type of lesions. CONCLUSION: Endovascular treatment of central venous obstruction is a safe and effective procedure in hemodialysis patients. Stenting has a significantly lower primary patency rate than angioplasty but adds to the longevity of vein patency in angioplasty-resistant lesions; therefore, stent placement should be considered in angioplasty-resistant lesions.

Long-term results of endovascular treatment for arteriovenous dialysis access thrombosis in 143 patients: A single center experience.

OBJECTIVE: This study aimed to determine the long-term patency duration and rate of thrombosis of autologous arteriovenous fistulas and synthetic grafts treated with endovascular methods in a large patient population. METHODS: A total of 144 arteriovenous accesses (37 radiocephalic, 51 brachiobasilic, 41 brachiocephalic, and 15 femorofemoral) from 143 patients were included in the study. A total of 304 endovascular thrombolytic treatment procedures were performed for 94 (65%) arteriovenous fistula and 50 (35%) arteriovenous graft accesses. RESULTS: The procedural technical success rate was 98.7%. The mean follow-up duration was 32.5 (range, 3-132) months. The primary patency rates for arteriovenous fistulas and arteriovenous grafts were 78% and 78% at 6 months, 66% and 63% at 1 year, and 45% and 0% at 36 months, respectively. The assisted primary patency rates for arteriovenous fistulas and arteriovenous grafts were 82% and 84% at 6 months, 71% and 69% at 1 year, 51% and 29% at 36 months, and 30% and 1% at 60 months, respectively. The secondary patency rates for arteriovenous fistulas and arteriovenous grafts were 94% and 93% at 6 months, 85% and 85% at 1 year, 58% and 59% at 36 months, and 47% and 48% at 60 months, respectively. CONCLUSION: Although the primary patency durations for arteriovenous fistulas were better after endovascular thrombolytic treatment than those for arteriovenous grafts, the long-term outcomes of assisted primary and secondary patency durations after repeated procedures were similar for both types of arteriovenous accesses.

Percutaneous sonographic guidance for TIPS in Budd-Chiari syndrome: direct simultaneous puncture of the portal vein and inferior vena cava.

OBJECTIVE: Budd-Chiari syndrome (BCS) is a clinical condition characterized by hepatic venous outflow obstruction. A transjugular intrahepatic portosystemic shunt (TIPS) is an effective means of decompressing the portal system in patients unresponsive to traditional medical therapy. TIPS may be difficult in patients with BCS owing to the presence of hepatic venous occlusive disease. We present our experience using direct percutaneous simultaneous puncture of the portal vein and the inferior vena cava to place a TIPS in patients with BCS. MATERIALS AND METHODS: Between September 2003 and October 2006, percutaneous sonographically guided TIPS was performed on 11 patients (five women and a girl, four men and a boy; age range, 6-43 years). Indications for the TIPS procedure were intractable ascites in nine patients and intractable ascites and variceal bleeding in two patients. RESULTS: Technical success was achieved in all patients. The mean portosystemic pressure gradient was reduced from 23.5 to 9.8 mm Hg. The cumulative rate of primary patency was 60% at 1 year. Nine revisions were performed in five patients. In nine of the 11 patients, ascites resolved completely, and in two patients, it was relieved. CONCLUSION: Excellent technical and clinical success can be achieved with percutaneous sonographically guided direct simultaneous puncture of the portal vein and inferior vena cava in patients with BCS.

Percutaneous management of anastomotic bile leaks following liver transplantation.

PURPOSE: To review our experience with percutaneous internal-external biliary drainage in treating biliary anastomotic leaks following orthotopic liver transplantation. MATERIALS AND METHODS: Between September 1997 and June 2006, 157 liver transplantations were performed in our hospital. Percutaneous transhepatic biliary drainage was performed in 10 patients (9 males, 1 female; mean age, 32.9 years; age range, 2-62 years) with patent hepatic arterial systems to treat clinically significant anastomotic bile leaks. RESULTS: Bile leaks were resolved and anastomotic patency was restored in all patients. Massive hemobilia occurred in 1 patient due to arterial pseudoaneurysm and was treated with embolization. No major complications were seen in the other patients. During a mean follow-up of 19.5 months, anastomotic stricture occurred in 2 patients (1 in combination with a recurrent leak). Both patients were successfully treated with percutaneous methods. The remaining 8 patients had no biliary problems. CONCLUSION: When treating anastomotic bile leaks in liver transplant patients, percutaneous procedures may be performed with high technical success and low complication rates.

Transcatheter Arterial Embolization with N-Butyl-2-Cyanoacrylate in the Management of Spontaneous Hematomas.

INTRODUCTION: Spontaneous hematoma refractory to conservative management is a potentially serious condition that requires prompt diagnosis and intervention. The purpose of this study was to evaluate the performance of computed tomography (CT) in the treatment planning and to report the effectiveness of transcatheter embolization with N-butyl-2-cyanoacrylate (NBCA). MATERIALS AND METHODS: Forty-one interventions in 38 patients within a 12-year period were evaluated. CT and angiograms were reviewed for the location of the hematoma, the presence of extravasation, and the correlation of CT and angiography findings. RESULTS: Arterial extravasation was present on 34/39 CT scans. Angiograms confirmed the CT scans in 29 cases. Angiograms revealed extravasation in four cases which CT showed venous bleeding (n = 2) or no bleeding (n = 2). Five patients with arterial and 1 patient with venous extravasation on CT images had no extravasation on angiograms. Embolization was performed to all arteries with extravasation on angiograms. Empiric embolization of the corresponding artery on the CT was performed when there was no extravasation on angiograms. Embolization procedures were performed with 15 % NBCA diluted with iodized oil. Technical success was achieved in 40/41 (97.6 %) interventions. Clinical success was achieved in 35 patients with a single, in 1 patient with 2, and in 1 patient with 3 interventions. No complications related to embolization procedure occurred. None of the patients died due to a progression of the hematoma. CONCLUSION: NBCA is an effective and safe embolic agent to treat hematoma refractory to conservative management. Contrast-enhanced CT may provide faster and more effective intervention. LEVEL OF EVIDENCE III: Retrospective.

+H-proton-magnetic resonance spectroscopic findings in a patient with acute hemicerebellitis presenting without localized signs: a case report.

Acute cerebellitis (AC) is an inflammatory process involving the cerebellum. Usually, this pathology is bilateral; it is unusual to have a unilateral cerebellitis. Only seven cases of hemicerebellitis have been reported in the literature. Here, we review the literature and report the magnetic resonance imaging (MRI) and proton-magnetic resonance spectroscopic (+H-MRS) findings of a case of acute hemicerebellitis in a 15-year-old girl presenting with 15 days' history of headache.

MR imaging and ultrasound of fetal cervical cystic lymphangioma: utility in antepartum treatment planning.

We present a case of fetal cystic lymphangioma that was initially diagnosed by ultrasonography and further evaluated by prenatal MR imaging. MR imaging findings aided in improved delineation of the neck mass. T2-weighted MR images revealed partial compression of the airway by the neck mass. This information was useful in the decision to use ex utero intrapartum treatment (EXIT) and helped surgeons in planning their approach to establish airway control during delivery.

Ultrasound-guided brachiocephalic vein catheterization in infants weighing less than five kilograms.

PURPOSE: To describe our experience with the use of ultrasound-guided supraclavicular brachiocephalic vein approach for central vein catheterization in infants weighing less than 5 kg. METHODS: A retrospective review was performed for infants who underwent ultrasound-guided central vein catheterization from January 2012 to November 2014. Infants weighing less than 5 kg with supraclavicular brachiocephalic vein access were included in the study. Indications for central venous access, venous access side, catheter type and complications were evaluated. RESULTS: Thirty-four catheterizations in 34 infants weighing from 1.5 to 4.9 kg (median 3.48 kg) were included in the study (aged 11 days to 7 months and 10 days, weight range 1.5 to 4.9 kg). Technical success rate was 97% (33 of 34 infants). No technical or clinical major complications were observed. CONCLUSIONS: Ultrasound-guided supraclavicular brachiocephalic vein access is a favorable alternative for central venous catheterization in low-weight infants with regard to high technical success rate and absence of major complications.