RESUMO
Peripheral arterial disease (PAD) is a common condition, which significantly impacts the quality and length of life. In recent years, drug-eluting devices have demonstrated improved clinical effectiveness for treating peripheral arterial disease in the femoropopliteal arteries compared to traditional stents and angioplasty balloons. However, recent controversial studies have called the safety of this technology into question, leading to confusion as to if, when, and how these devices should be used. This article focuses on the underlying pathophysiology and pharmacology, the clinical benefits and potential harms, as well as expected future developments affecting the use of these drug-eluting technologies in treating peripheral arterial disease of the superficial femoral arteries.
Assuntos
Angioplastia com Balão , Doença Arterial Periférica , Angioplastia com Balão/efeitos adversos , Materiais Revestidos Biocompatíveis , Constrição Patológica , Artéria Femoral/diagnóstico por imagem , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Stents , Tecnologia , Resultado do TratamentoRESUMO
OBJECTIVE: The Simon Nitinol filter is a bi-level filtration device designed for permanent implantation that is no longer commercially available, but may result in similar complications to current commercially available long term indwelling temporary or permanent filters. Complications related to indwelling inferior vena cava filters include inferior vena cava thrombosis, inferior vena cava penetration, filter migration, and filter fracture. There is a paucity of reports describing the technical aspects related to retrieval of Simon Nitinol filters. MATERIALS AND METHODS: This study consisted of five patients with Simon Nitinol filters and describes the indication for retrieval, the retrieval techniques used to remove the filters, technical success, complications, and clinical course. RESULTS: The indications for retrieval included: abdominal pain (n = 2; 40%), iliocaval thrombosis (n = 1; 20%), identification of an intracardiac filter fragment (n = 1; 20%), and recurrent venous thromboembolic events (n = 1; 20%). Retrieval techniques included: biopsy forceps (n = 3; 60%), excimer laser extraction sheaths (n = 3; 60%), hangman modified loop snares (n = 3; 60%), rigid endobronchial forceps (n = 2; 40%), and balloon deflection (n = 2; 40%). All filters were successfully retrieved. One patient developed a post-procedural intramuscular hematoma near the site of right internal jugular sheath placement. CONCLUSIONS: Simon Nitinol filters may be retrieved safely and effectively using advanced inferior vena cava filter retrieval techniques.
Assuntos
Embolia Pulmonar , Filtros de Veia Cava , Ligas , Remoção de Dispositivo , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgiaRESUMO
Smoking is highly associated with pancreatic cancer. Nicotine, the addictive component of tobacco, is involved in pancreatic cancer tumorigenesis, metastasis, and chemoresistance. This work aimed to describe the role of nicotine within the pancreatic cancer tumor microenvironment. Nicotine treatment was used in vitro to assess its effect on tumor-associated stromal cells and pancreatic cancer cells. Nicotine treatment was then used in a pancreatic cancer patient-derived xenograft model to study the effects in vivo. Nicotine induced secretion of interleukin 8 (IL-8) by tumor-associated stroma cells in an extracellular signal-regulated kinase (ERK)-dependent fashion. The secreted IL-8 and nicotine acted on the pancreatic cancer cell, resulting in upregulation of IL-8 receptor. Nicotine treatment of mice bearing pancreatic cancer patient-derived xenografts had significantly increased tumor mass, increased tumor-free weight loss, and decreased muscle mass. These represent important pathways through which nicotine acts within the tumor microenvironment and worsens pancreatic cancer-induced cachexia, potentially representing future therapeutic targets.
RESUMO
Between September 2008 and August 2017, 36 patients (mean age 56 y; range, 30-89 y) underwent transvenous biopsy of suspected tumor thrombus or perivascular tumor. Intravascular biopsy was pursued because of inaccessible percutaneous access in 9 patients (25%) and as part of a planned revascularization procedure in 27 patients (75%). Histopathologic results showed malignancy in 26 patients (72%) and benign etiologies in 10 patients (28%). No patients required repeat biopsy. There were no complications related to the biopsy procedure. The present series suggests that transvenous biopsy is a safe and accurate method of intravascular and perivascular mass tissue sampling.
Assuntos
Cateterismo Periférico , Procedimentos Endovasculares , Trombose/patologia , Neoplasias Vasculares/patologia , Veias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Cateterismo Periférico/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Humanos , Michigan , Pessoa de Meia-Idade , Invasividade Neoplásica , Flebografia/métodos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Trombose/diagnóstico por imagem , Ultrassonografia de Intervenção , Neoplasias Vasculares/diagnóstico por imagem , Veias/diagnóstico por imagemRESUMO
Endovascular treatment of malignant intrahepatic inferior vena cava stenosis involves venoplasty and stenting. Intravascular migration is a complication associated with stents. This technical report describes the retrieval of migrated intracardiac Gianturco Z-stents using rigid endobronchial forceps.
Assuntos
Remoção de Dispositivo/instrumentação , Procedimentos Endovasculares/instrumentação , Migração de Corpo Estranho/cirurgia , Átrios do Coração , Stents , Instrumentos Cirúrgicos , Doenças Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Angiografia por Tomografia Computadorizada , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Resultado do Tratamento , Ultrassonografia de Intervenção , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologiaRESUMO
Acute traumatic injury of the thoracic aorta is a highly lethal condition, with many afflicted patients expiring before hospital arrival. While previously these conditions were managed with open surgery, endovascular repair has rapidly evolved and is now considered the standard of care for certain patterns of aortic injury at centers with appropriate expertise. The development of newer branched devices has allowed these techniques to be utilized further and further proximally into the aorta. Through minimally invasive techniques, many aortic injuries can now be treated percutaneously with shorter recovery time and less perioperative complications.
Assuntos
Aorta Torácica/lesões , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/métodos , Stents , Lesões do Sistema Vascular/cirurgia , Doença Aguda , Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Meios de Contraste , Humanos , Complicações Pós-Operatórias , Ultrassonografia de Intervenção , Lesões do Sistema Vascular/diagnóstico por imagemAssuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Criocirurgia , Procedimentos Endovasculares , Hemorragia/cirurgia , Técnicas Hemostáticas , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Aorta Abdominal/diagnóstico por imagem , Aortografia , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Sarcoma/complicações , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Resultado do TratamentoRESUMO
Acute dissection of the thoracic aorta is a potentially life-threatening condition which requires collaborative treatment from multiple specialties for optimal patient outcomes. Dissections involving the ascending aorta and aortic arch have traditionally been managed entirely by surgery, while dissections beyond the arch vessels have most commonly been relegated to medical management. This algorithm has been undergoing a paradigm shift over the past two decades due to improvements in stent graft technology, better understanding of the hemodynamic interactions of the true and false lumen and their influence on organ and limb perfusion, and improvements in medical management and long term surveillance for dissection-related complications. This manuscript includes a brief discussion of the pathogenesis and etiology of dissection, followed by an in-depth review of the medical and endovascular techniques utilized to treat patients afflicted by this condition.
RESUMO
Iliocaval thrombosis, or thrombosis of the inferior vena cava and iliac veins, is associated with significant morbidity in the form of limb-threatening compromise from phlegmasia cerulean dolens, development of post-thrombotic syndrome, and death secondary to pulmonary embolism. Endovascular iliocaval reconstruction is an effective treatment for iliocaval thrombosis with high levels of technical success, favorable clinical outcomes and stent patency rates, and few complications. It is often able to relieve the debilitating symptoms experienced by affected patients and is a viable option for patients who fail conservative management. This article presents an approach to endovascular iliocaval stent reconstruction in patients suffering from chronic iliocaval thrombosis that takes into consideration background, patient selection and indications, timing of intervention, procedural steps, technical considerations, postprocedural care, and outcomes, along with providing schematic illustrations that serve to outline iliocaval stent reconstruction and management of chronic venous occlusions.
Assuntos
Angioplastia com Balão/métodos , Veia Ilíaca , Trombectomia/métodos , Veia Cava Inferior , Trombose Venosa/terapia , Adulto , Idoso , Angiografia Digital , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Doença Crônica , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Flebografia/métodos , Fatores de Risco , Stents , Trombectomia/efeitos adversos , Trombectomia/instrumentação , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologiaRESUMO
Resection of the inferior vena cava (IVC) is a rare surgical technique that is occasionally combined with nephrectomy in the setting of renal malignancy with intravascular tumor extension. While this may be fairly well tolerated in some patients due to extensive collateralization in the venous system, there is a clear potential for lower extremity venous insufficiency and deep vein thrombosis (DVT). This report describes a patient who underwent right nephrectomy and segmental IVC resection from the subhepatic space to the iliac confluence, which was complicated by profoundly symptomatic lower extremity DVT and gastrointestinal hemorrhage due to system-to-portal shunting. After performing sharp recanalization through the retroperitoneum, iliocaval reconstruction was accomplished utilizing covered stent-grafts, with complete resolution of symptoms.Level of Evidence Case Report, Level 5.
Assuntos
Procedimentos Endovasculares/métodos , Politetrafluoretileno , Complicações Pós-Operatórias/cirurgia , Stents , Veia Cava Inferior/cirurgia , Idoso , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/terapiaRESUMO
Thrombosis of the inferior vena cava and iliac veins, known as iliocaval thrombosis, is a common cause of significant morbidity. Patients with chronic iliocaval obstruction often present with life-limiting occlusive symptoms secondary to recurrent lower extremity deep venous thrombosis, swelling, pain, venous stasis ulcers, or phlegmasia. Endovascular iliocaval reconstruction is a technically successful procedure that results in favorable clinical outcomes and stent patency rates with few complications and is often able to relieve debilitating symptoms in affected patients. This review presents an approach to endovascular iliocaval stent reconstruction in patients suffering from chronic iliocaval thrombosis, including background, patient selection, timing of intervention, procedural steps, technical considerations, patient follow-up, and a brief review of outcomes. Schematic illustrations and clinical cases outlining iliocaval stent reconstruction and crossing chronic venous occlusions have been provided.
Assuntos
Procedimentos Endovasculares , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Constrição Patológica/cirurgia , Procedimentos Endovasculares/métodos , Humanos , Veia Ilíaca/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular/fisiologia , Trombose Venosa/diagnóstico por imagemRESUMO
Biliary stent placement is an adjunct for complex biliary intervention. Patients with benign biliary strictures or aversion to external drainage may benefit from placement of retrievable biliary stents. This report describes a patient with a working diagnosis of benign biliary stricture who underwent interventional radiology-operated endoscopy-guided transnasal placement of a fully covered retrievable biliary stent.
RESUMO
BACKGROUND: Interventional radiology treatment of chylothorax is well described in adults, with high technical and clinical success that decreases patient morbidity and mortality. However there is limited experience in children. OBJECTIVE: To report the technical and clinical success of lymphangiography, thoracic duct embolization and thoracic duct disruption in the pediatric population. MATERIALS AND METHODS: We studied 11 pediatric patients (7 boys, 4 girls; median weight 6.0 kg) who underwent lymphangiography and thoracic duct embolization from November 2015 to May 2017. All 11 (100%) children presented with chylothorax, with 1 (9%) having concomitant chylous ascites and 1 (9%) having concomitant chylopericardium. Ten (91%) children had traumatic chylothorax and one (9%) had congenital chylothorax. We recorded technical success, clinical success and complications. RESULTS: Twelve procedures were completed in 11 children. Bilateral intranodal lymphangiography was technically successful in all (100%) patients. Central lymphatics were visualized in eight (67%) procedures. Access to central lymphatics was attempted in eight procedures and successful in five (63%). In three (37%) of the eight procedures, disruption was performed when the central lymphatics could not be accessed. Clinical success was achieved in 7/11 (64%) children. Three minor complications were reported. No major complications were encountered. CONCLUSION: Lymphangiography, thoracic duct embolization and thoracic duct disruption are successful interventional strategies in children with chylothorax and should be considered as viable treatment options at any age.
Assuntos
Quilotórax/congênito , Embolização Terapêutica/métodos , Ducto Torácico , Adolescente , Criança , Pré-Escolar , Quilotórax/diagnóstico por imagem , Quilotórax/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Linfografia , Masculino , Radiografia Intervencionista , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of our study was to describe an association between the radiographic appearance of distressed intravascular implants and venous stenosis or occlusion and to determine the success of reparative endovascular procedures. MATERIALS AND METHODS: Seventy-eight patients with distressed stents or inferior vena cava (IVC) filters characterized by pursing (short-axis contracture), straightening, longitudinal contraction (long-axis contracture), or fracture were identified from retrospective review of a venous registry for the period from February 2004 to October 2016. Patients originally presented with superior vena cava (SVC) syndrome (n = 25), arm swelling (n = 16), iliocaval thrombosis (n = 21), and lower extremity deep venous thrombosis (n = 16), and stents were initially placed in 65 and filters in 13. Implants were located in the IVC (n = 24), subclavian vein (n = 16), brachiocephalic vein (n = 15), common iliac vein (n = 10), multiple veins (n = 4), axillary vein (n = 4), common femoral vein (n = 3), SVC (n = 1), and internal jugular vein (n = 1). Implants included Wallstents in 63 patients; Smart stents in two patients; and Celect Platinum, Denali, Greenfield, and Trapease IVC filters in two, three, two, and six patients, respectively. Venographic indication, distress type, time from initial normal placement to identification of distress, venographic finding (patent, mild stenosis, high-grade stenosis, or occlusion), treatment, revascularization outcome, and complications were recorded. RESULTS: The mean time to distress was 23 months. Fifty-two (67%) patients underwent venography for symptoms and 26 (33%) for surveillance. Forty-five (58%) implants were pursed; 19 (24%), straightened; nine (12%), contracted; and five (6%), fractured. Venography depicted 48 (62%) high-grade stenoses, 19 (24%) complete occlusions, and six (8%) mild stenoses. Of the 73 patients who underwent an intervention, 29 (40%) underwent angioplasty, 15 (21%) underwent angioplasty and stenting, 15 (21%) underwent sharp recanalization, and five (7%) underwent thrombolysis. Revascularization was successful in 67 (92%). Three minor complications occurred. CONCLUSION: Distressed intravascular implants are associated with high-grade venous stenosis or occlusion. Reparative interventions are usually technically successful.
Assuntos
Oclusão de Enxerto Vascular/diagnóstico por imagem , Stents , Filtros de Veia Cava , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/etiologia , Trombose Venosa/terapia , Adulto JovemRESUMO
INTRODUCTION/PURPOSE: Sharp recanalization of chronic venous occlusions is usually performed with targeting of wire-capture devices like loop snares or balloons. We describe sharp recanalization of chronic venous occlusions using self-expanding stents and vascular plugs. MATERIAL AND METHODS: We retrospectively reviewed all sharp venous recanalization procedures performed over an 11-month period and found Wallstent and Amplatzer vascular plug (AVP) targeting was performed in 16 patients. Patient demographics, occlusion site, targeting device, technical success of the targeting, and overall procedural success were recorded. RESULTS: Technical success was achieved in twelve (86%) Wallstent and two (67%) AVP deployments. Procedural success was achieved in 15 (94%). Three minor complications occurred. CONCLUSION: Wallstent and AVP targeting may be a useful technique when performing sharp recanalization for chronic venous occlusions. These devices expand the target space and present the same cross section viewed from any angle and can directly capture and extract the wire, features helpful in regions with crowded vascular anatomy.
Assuntos
Dispositivo para Oclusão Septal , Stents , Doenças Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Veia Cava Superior/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Superior vena cava (SVC) syndrome, characterized by facial and arm swelling, is most frequently caused by intrathoracic malignancies. Decompression may be achieved with endovenous stent placement. Polytetrafluoroethylene-covered stents have shown to have higher long-term cumulative patency rates compared with uncovered stents for the treatment of malignant SVC syndrome. Unfortunately, polytetrafluoroethylene-covered stents are not readily available worldwide. Moreover, the existing armamentarium, including balloon-expandable iCAST stents (maximum diameter 10 mm) and heparin-coated Viabahn stent-graft endoprostheses (maximum diameter 13 mm), is too small to adequately treat malignant obstruction of the SVC. This report describes a patient with SVC syndrome and SVC tumor thrombus secondary to recurrent nonseminomatous germ cell carcinoma of the mediastinum treated with a Gianturco Z-stent-fixed modified EXCLUDER abdominal aortic aneurysm iliac limb endoprosthesis.
Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Neoplasias do Mediastino/complicações , Neoplasias Embrionárias de Células Germinativas/complicações , Stents , Síndrome da Veia Cava Superior/cirurgia , Neoplasias Testiculares/complicações , Implante de Prótese Vascular/métodos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/métodos , Humanos , Masculino , Neoplasias do Mediastino/secundário , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/secundário , Flebografia/métodos , Desenho de Prótese , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Neoplasias Testiculares/patologia , Resultado do TratamentoRESUMO
Type II Abernethy malformations, characterized by side-to-side portosystemic shunting with preserved intrahepatic portal venous system, have been treated with shunt closure surgically and endovascularly. Three-dimensional printing has been used to develop highly accurate patient-specific representations for surgical and endovascular planning and intervention. This innovation describes 3-dimensional printing to successfully close a flush-oriented type II Abernethy malformation with discrepant dimensions on computed tomography, conventional venography, and intravascular ultrasound, using a 12-mm Amplatzer atrial septal occluder device.
Assuntos
Procedimentos Endovasculares/instrumentação , Modelos Anatômicos , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Veia Porta/anormalidades , Impressão Tridimensional , Dispositivo para Oclusão Septal , Malformações Vasculares/terapia , Angiografia Digital , Criança , Angiografia por Tomografia Computadorizada , Humanos , Circulação Hepática , Masculino , Flebografia/métodos , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Desenho de Prótese , Resultado do Tratamento , Ultrassonografia de Intervenção , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologiaRESUMO
Percutaneous image-guided biopsies of pancreatic malignancies may prove challenging and nondiagnostic due to a variety of anatomic considerations. For patients with complex post-surgical anatomy, such as a Roux-en-Y gastric bypass, diagnosis via endoscopic ultrasound with fine-needle aspiration may not be possible because of an inability to reach the proximal duodenum. This report describes the first diagnostic case of transbiliary intravascular ultrasound-guided biopsy of a pancreatic head mass in a patient with prior Roux-en-Y gastric bypass for which a diagnosis could not be achieved via percutaneous and endoscopic approaches. Transbiliary intravascular ultrasound-guided biopsy resulted in a diagnosis of pancreatic adenocarcinoma, allowing the initiation of chemotherapy.
RESUMO
Aortoenteric fistulae are life-threatening conditions characterized by abnormal communications between the aorta and gastrointestinal tract. Aortoenteric fistulae may be characterized by the triad of bleeding, abdominal pain, or a pulsatile abdominal mass. Although hemorrhage is the most common presentation, it does not always occur; thus, patients may present with nonspecific symptoms. Computed tomography angiography findings suggestive of aortoenteric fistulae include ectopic gas within or adjacent to the aorta, discontinuity of the aortic wall, bowel wall thickening, and extravasation of contrast into the bowel. Endovascular treatments include retrograde balloon occlusion of the aorta and stent-graft deployment as well as coil, fibrin, and glue embolization of the fistulous tract. This report describes 3 cases of aortoenteric fistulae temporized and treated by interventional radiology and vascular and cardiac surgery at a single institution in an effort to increase awareness of this important clinical condition.