Early Results of Mechanochemical Ablation by Flebogrif and Radiofrequency Ablation in Treating Primary Varicose Veins of Lower Limb.

Introduction Chronic venous insufficiency is a common condition that leads to the development of incompetent great or short saphenous veins (GSV or SSV) resulting in varicose vein development. Conservative management is initially employed for its treatment; however, the varicosities that do not respond to conservative management may require intervention by surgery or endovenous routes. Radiofrequency ablation (RFA) and mechanochemical ablation (MOCA) are the two most common endovascular techniques available for the management of incompetent GSV or SSV. Clarivein and Flebogrif are two devices to treat incompetent GSV or SSV by MOCA. Mechanical ablation is provided by their flexible cutting elements and chemical ablation is provided by polidocanol or sodium tetradecyl sulfate (STS). RFA uses radiofrequency waves to treat venous insufficiency. Therefore, the aim of this study was to determine the early treatment outcome results for incompetent GSV or SSV treated with RFA or MOCA by Flebogrif. Materials and methods This was a retrospective cross-sectional study undertaken at the Radiology Department of Indus Hospital and Health Network. Electronic Medical Records of all the patients who underwent RFA or MOCA for GSV or SSV for venous insufficiency from January 2021 to December 2021 were included. Both male and female patients aged 18 years and above diagnosed with venous insufficiency having Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) scores of >1 were included. Statistical Package for Social Sciences (SPSS) v 22 (IBM Corp., Armonk, NY) was used for data entry and analysis. Results 137 patients were included in the present study with a mean age of 53.8 ± 12.1 years. Pre-procedure CEAP score was C3 in 59 (84.4%), C4 in four (5.7%), and C6 in seven (10.0%) patients in patients who underwent RFA, and it was successful in 69 (98.6%) patients. Pre-procedure CEAP score was C3 in 62 (92.5%), C4 in two (3.0%), and C6 in three (4.5%) patients who underwent MOCA, and it was successful in 59 (88.1%) patients. Pain was the most frequent complication observed in both RFA and MOCA. Conclusion RFA has a high success rate as compared to MOCA by Flebogrif in treating incompetent GSV or SSVs.

Comparison of the Treatment Response of Drug-Eluting Bead Transarterial Chemoembolization and Conventional Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma.

Introduction Hepatocellular carcinoma (HCC) is a common primary hepatic cancer. Its early diagnosis can aid in its treatment by curative means such as surgery or ablation. Advanced-stage diagnosis limits these treatment options, and such cases can be treated with transarterial chemoembolization (TACE). Conventional transarterial chemoembolization (cTACE) and drug-eluting bead transarterial chemoembolization (DEB-TACE) are usually used, and follow-up response is evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. This study was done to compare the treatment response of cTACE and DEB-TACE in patients with HCC. Materials and methods A retrospective review of electronic medical records of all patients diagnosed with HCC from January 2021 to August 2022 who underwent cTACE or DEB-TACE was undertaken at the Department of Interventional Radiology, Indus Hospital and Health Network. Both male and female patients aged 18 years or above with Child-Pugh class A and B were included. DEB-TACE or cTACE was performed by a fellowship-trained interventional radiologist, and the response was evaluated at six weeks follow-up using mRECIST criteria. Results A total of 129 patients were included in this study, with a mean age of 54.1 ± 10.8 years. The mean size of HCC was 3.1 ± 1.7 cm. Seventy-eight (60.5%) patients underwent cTACE, and 51 (39.5%) underwent DEB-TACE. Out of the 78 patients who underwent cTACE, complete response (CR) was found in 28 (35.9%), partial response (PR) was found in 33 (42.3%), stable disease (SD) was found in 12 (15.4%), and progressive disease (PD) was found in five (6.4%) patients. Of the 51 patients who underwent DEB-TACE, CR was found in 13 (25.5%), PR was found in 20 (39.2%), SD was found in 11 (21.6%), and PD was found in seven (13.7%) patients. Conclusion The response rate of TACE in the form of complete or partial response was higher with a lower frequency of stable or progressive disease. cTACE has a high response rate as compared to DEB-TACE.

Detection of Transition Zone in Bowel Obstruction via Curved Multiplanar Reformations with Multidetector Computed Tomography.

Objective We conducted this study to determine the added value of curved multiplanar reformations (CMPR) and multiplanar reformations (MPR) of multidetector computed tomography (MDCT) scan in the visualization and localization of the zone of transition in patients with intestinal obstruction. Materials and methods A total of 100 patients with suspected bowel obstruction were evaluated in a retrospective cross-sectional study from September 2016 to September 2018 at Dr. Ziauddin University Hospital, Clifton Campus. All patients underwent multidetector computed tomography (CT) scans with oral and intravenous contrast before surgical exploration. CMPR and MPR were acquired at the time of examination in each patient in addition to routine axial images. The CT scans were analyzed by two independent, experienced radiologists skilled at detecting the zones of transition in patients with bowel obstruction using the axial images alone, followed by axial images along with MPR, and then MPR plus CMPR. Patient data were masked to the radiologists. The CT scan findings were compared with surgical findings to determine the accuracy of CMPR in detecting the zone of transition between distended and collapsed bowel loops. The added CMPR showed high accuracy in the diagnosis of intestinal obstruction with a remarkable advantage over the conventional axial images. Data analysis was done on IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY). Cohen's kappa statistics were obtained to show the measure of agreement between the two readers. McNemar's test was also applied to determine the homogeneity. Results Two radiologists, one with two years of experience and the other with five years of experience were 80% and 81% accurate, respectively, in identifying the zones of transition using axial images alone. Using axial images plus MPR, their accuracy was 88% and 92%, respectively. Using MPR plus CMPR, their accuracy was 96% and 98%, respectively. The accuracy of MPR plus CMPR views was significantly increased when compared to the accuracy using axial images alone. CT findings were compared to surgical findings in terms of diagnostic performance. The kappa value of 0.6 indicates moderate association and substantial agreement between two radiologists. McNemar's test showed homogeneity in the number of valid cases. Conclusion CMPR is an important and accurate technique for evaluating intestinal obstruction in addition to MPR as it helps in better localization of the zone of transition and in determining the cause of obstruction. This insight provides guidance for the appropriate treatment.

Complications Associated with Permanent Internal Jugular Hemodialysis Catheter: A Retrospective Study.

Introduction A significant increase in patients with end-stage renal disease has been observed currently in our community. Kidney transplantation is the most promising cure but the problem is that large numbers of people are not good candidates for transplantation. Hemodialysis is the next appropriate medication for such patients and for patients with end-stage renal disease, who have no chance for transplantation. Morbidity and mortality are the consequences of vascular access complications. Local data related to the complication rate of permanent hemodialysis catheters is not available. The current study examines the complication rate in people due to permanent intrajugular hemodialysis catheterization. Materials and methods The study has been conducted in Dr Ziauddin University Hospital, Karachi. The dataset consists of 212 patients who had gone through jugular catheterizations for hemodialysis at this hospital from the year 2014 to the year 2015. A descriptive method has been chosen for obtaining appropriate results. Complications have also been categorized as early or late. Results Complications have been detected in around 24% of the patients from the dataset. Among these complications, infection has the highest percentage (around 13%) while 4% percent of patients have a failed puncture. The others have venous thrombosis, catheter thrombosis, hematoma, wrong canulation, and hemothorax and pneumothorax problems. Conclusion The study concludes that the placement of a permanent hemodialysis catheter in the internal jugular vein has a low complication rate. In addition, the method is safe and easy. So, it can be said that the internal jugular vein is a reliable and preferred route for hemodialysis catheterization.