RESUMO
CT angiography prior to endovascular aortic surgery is the standard non-invasive imaging method for evaluation of aortic dimensions and access sites. A detailed report is crucial to a proper planning. We assessed Artificial Intelligence (AI)-algorithm accuracy to measure vessels diameters at CT prior to transcatheter aortic valve implantation (TAVI). CT scans of 50 patients were included. Two Radiologists with experience in vascular imaging together manually assessed diameters at nine landmark positions according to the American Heart Association guidelines: 450 values were obtained. We implemented TOST (Two One-Sided Test) to determine whether the measurements were equivalent to the values obtained from the AI algorithm. When the equivalence bound was a range of ± 2 mm the test showed equivalence for every point; if the range was equal to ± 1 mm the two measurements were not equivalent in 6 points out of 9 (p-value > 0.05), close to the aortic valve. The time for automatic evaluation (average 1 min 47 s) was significantly lower compared with manual measurements (5 min 41 s) (p < 0.01). In conclusion, our results indicate that AI-algorithms can measure aortic diameters at CT prior to endovascular surgery with high accuracy. AI-assisted reporting promises high efficiency, reduced inter-reader variabilities and time saving. In order to perform optimal TAVI procedure planning aortic root analysis could be improved, including annulus dimensions.
Assuntos
Inteligência Artificial , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Humanos , Feminino , Masculino , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Substituição da Valva Aórtica Transcateter , Aorta/diagnóstico por imagem , Aorta/cirurgiaRESUMO
This report demonstrates the successful treatment of a carotid artery pseudoaneurysm using percutaneous thrombin injection. The patient, a 62-year-old woman with multiple comorbidities, experienced a pseudoaneurysm following an unintentional carotid artery puncture during a failed attempt to place a triple lumen catheter in the right jugular vein. Percutaneous thrombin injection was chosen as the treatment method, with Doppler ultrasound monitoring. Follow-up examinations showed no signs of recurrence, and the patient was discharged after nine days without complications.
Assuntos
Lesões das Artérias Carótidas , Doença Iatrogênica , Punções , Trombina , Lesões do Sistema Vascular , Humanos , Trombina/administração & dosagem , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/tratamento farmacológico , Lesões das Artérias Carótidas/etiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/tratamento farmacológico , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/etiologia , Hemostáticos/administração & dosagem , Hemostáticos/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Veias Jugulares/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Ultrassonografia DopplerRESUMO
Persistent left superior vena cava (SVC) is a rare congenital malformation of the thoracic venous system. We report a case involving a 7-year-old boy, who was admitted to our CT scanning room because of an incidental discovery of low blood-oxygen levels (90-94% in good health). A persistent left SVC was depicted, with drainage in the left atrium and a resultant right-to-left shunt;right SVC was present, draining to the right atrium. A small bridging vein was depicted. A comprehensive cardiological assessment with echocardiography was performed, but no other anomalies were found. He was successfully treated with a percutaneous endovascular approach and vascular plug deployment. A complete occlusion of the left SVC was obtained, with normalization of the oxygen saturation. Persistent left SVC is a rare vascular anomaly, often incidentally detected. Physicians should be aware because it may have significant clinical implications, especially during catheterization procedures or when associated with other cardiac malformations.
Assuntos
Adenoma/induzido quimicamente , Adenoma/patologia , Terapia de Reposição de Estrogênios/efeitos adversos , Neoplasias Hepáticas/induzido quimicamente , Neoplasias Hepáticas/patologia , Adenoma/diagnóstico por imagem , Síndrome de Aicardi , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Adulto JovemAssuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Terapia Combinada/métodos , Idoso , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Masculino , Ablação por Radiofrequência , Resultado do TratamentoRESUMO
A 78-year-old male patient was admitted to our hospital after abdominal trauma. Contrast-enhanced computed tomography (CT) scan demonstrated a horseshoe kidney with a perinephric hematoma and evidence of arterial hemorrhage. An anomalous renal arterial anatomy was noted as well, with a renal artery originating from the left common iliac artery. He was successfully treated via an endovascular approach. Varying forms of vascularization may complicate angiographic treatment of patients with abdominal trauma in a setting of kidney anomalies. Obtaining and evaluating contrast-enhanced CT angiography can identify anomalous vessels and can be invaluable when deciding on the most appropriate interventional approach.
Assuntos
Traumatismos Abdominais/terapia , Acidentes por Quedas , Embolização Terapêutica , Procedimentos Endovasculares , Rim Fundido/complicações , Rim/lesões , Lacerações/terapia , Artéria Renal/lesões , Lesões do Sistema Vascular/terapia , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Idoso , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Rim Fundido/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Lacerações/diagnóstico por imagem , Lacerações/etiologia , Masculino , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologiaRESUMO
BACKGROUND & AIMS: The main stages of cirrhosis (compensated and decompensated) have been sub-staged based on clinical, endoscopic, and portal pressure (determined by the hepatic venous pressure gradient [HVPG]) features. Vasodilation leading to a hyperdynamic circulatory state is central in the development of a late decompensated stage, with inflammation currently considered a key driver. We aimed to assess hepatic/systemic hemodynamics and inflammation (by C-reactive protein [CRP]) among the different sub-stages of cirrhosis and to investigate their interrelationship and prognostic relevance. METHODS: A single center, prospective cohort of patients with cirrhosis undergoing per protocol hepatic and right-heart catheterization and CRP measurement, were classified into recently defined prognostic stages (PS) of compensated (PS1: HVPG ≥6â¯mmHg but <10â¯mmHg; PS2: HVPG ≥10â¯mmHg without gastroesophageal varices; PS3: patients with gastroesophageal varices) and decompensated (PS4: diuretic-responsive ascites; PS5: refractory ascites) disease. Cardiodynamic states based on cardiac index (L/min/m2) were created: relatively hypodynamic (<3.2), normodynamic (3.2-4.2) and hyperdynamic (>4.2). RESULTS: Of 238 patients, 151 were compensated (PS1â¯=â¯25; PS2â¯=â¯36; PS3â¯=â¯90) and 87 were decompensated (PS4â¯=â¯48; PS5â¯=â¯39). Mean arterial pressure decreased progressively from PS1 to PS5, cardiac index increased progressively from PS1-to-PS4 but decreased in PS5. HVPG, model for end-stage liver disease (MELD), and CRP increased progressively from PS1-to-PS5. Among compensated patients, age, HVPG, relatively hypodynamic/hyperdynamic state and CRP were predictive of decompensation. Among patients with ascites, MELD, relatively hypodynamic/hyperdynamic state, post-capillary pulmonary hypertension, and CRP were independent predictors of death/liver transplant. CONCLUSIONS: Our study demonstrates that, in addition to known parameters, cardiopulmonary hemodynamics and CRP are predictive of relevant outcomes, both in patients with compensated and decompensated cirrhosis. LAY SUMMARY: There are two main stages in cirrhosis, compensated and decompensated, each with a main relevant outcome. In compensated cirrhosis the main relevant outcome is the development of ascites, while in decompensated cirrhosis it is death. Major roles of cardiac dysfunction and systemic inflammation have been hypothesized in the evolution of the disease in decompensated patients. In this study, we have shown that these factors were also involved in the progression from compensated to decompensated stage.