Assuntos
Centers for Medicare and Medicaid Services, U.S. , Comportamento Cooperativo , Comunicação Interdisciplinar , Medicare , Defesa do Paciente , Doença Arterial Periférica/terapia , Parcerias Público-Privadas , Sociedades Médicas , Consenso , Medicina Baseada em Evidências , Coalizão em Cuidados de Saúde , Humanos , Equipe de Assistência ao Paciente , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Estados UnidosRESUMO
PURPOSE: To compare the prevalence (cadaveric vs. living donor transplants), clinical features, and the effectiveness of endovascular management of significant arterio-portal fistulae (APF) in liver transplant recipients. METHODS: A retrospective audit of liver transplant recipients in two institutions was performed (1996-2009). Significant APF were included and were defined as symptomatic and/or hemodynamically significant (causing graft dysfunction and/or having abnormal Doppler findings in the portal vein). Patients with significant APF were evaluated for presenting symptoms, imaging features, size/branch order portal vein involvement, and effectiveness of the endovascular management (coil embolization). RESULTS: Four significant APF were found in 1992 (0.2%) liver transplants. Two were symptomatic and two were asymptomatic but were hemodynamically significant with liver function test abnormalities. All four APF were found in cadaveric donor graft recipients (0.23%, N = 4/1753) and none in 239 living donor graft recipients. However, there was no statistical difference between cadaveric and living donor graft recipients (p = 1.0, odds ratio = 1.23). Coil embolization was technically and clinically successful in all 4 without complications and causing normalization of the abnormal Doppler findings. CONCLUSION: Significant APF are a rare diagnosis (0.2% of transplants). Coil embolization is a safe and effective treatment option for APF in transplants.
Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/epidemiologia , Procedimentos Endovasculares , Artéria Hepática/diagnóstico por imagem , Transplante de Fígado/efeitos adversos , Veia Porta/diagnóstico por imagem , Doadores de Tecidos/estatística & dados numéricos , Adulto , Angiografia , Fístula Arteriovenosa/etiologia , Cadáver , Criança , Pré-Escolar , Gerenciamento Clínico , Embolização Terapêutica , Feminino , Seguimentos , Hemodinâmica , Humanos , Incidência , Lactente , Hepatopatias/cirurgia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Ultrassonografia Doppler , Adulto JovemRESUMO
PURPOSE: To evaluate inferior vena cava (IVC) venograms (ie, cavograms) before filter retrieval to determine the incidence and volume of filter thrombus relative to filter dwell time and evaluate subsequent changes in thrombus volume with additional anticoagulation. MATERIALS AND METHODS: IVC filter retrieval attempts between December 2002 and June 2010 were retrospectively reviewed to determine the incidence of filter thrombus and estimate thrombus volume on a preretrieval cavogram. Correlation between filter dwell times (assessed at 30-d intervals) and incidence and volume of thrombus was assessed. Follow-up images and management of filters with thrombus that were not initially removed were analyzed. RESULTS: A total of 463 retrieval attempts were performed in 440 patients, with a mean filter dwell time of 95 days ± 145 (SD; range, 0-1,762 d). Thirty (6.5%) had filter thrombus on initial cavograms, with a mean thrombus volume of 2.8 cm(3) ± 7.3 (range, 0.04-40.02 cm(3)). Incidence rate and estimated thrombus volume were highest in the 0-30-day dwell interval (8.0% and 6.3 cm(3), respectively) and decreased at subsequent time intervals. On linear regression analysis, incidence of filter thrombus was inversely related to dwell time (P < .05; correlation coefficient, -0.86). Seven patients with thrombus underwent additional anticoagulation for a mean of 48 days ± 25 (range, 14-90 d); thrombus resolved completely in five (71%) and partially in one (14%), and increased in one (14%). CONCLUSIONS: The incidence of filter thrombus at the time of filter retrieval appears to decrease with dwell time. If thrombus is detected, an additional period of anticoagulation is likely to reduce the thrombus burden and facilitate later retrieval.
Assuntos
Anticoagulantes/uso terapêutico , Remoção de Dispositivo , Trombose/tratamento farmacológico , Trombose/etiologia , Filtros de Veia Cava/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Distribuição de Qui-Quadrado , Feminino , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Flebografia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombose/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Endovascular stent-grafts are increasingly being used for treatment of abdominal and thoracic aortic aneurysms. Postprocedural complications include development of endoleaks. Recently, an embolic agent known as Onyx has been employed to treat type II endoleaks. Onyx is a biocompatible copolymer dissolved in dimethyl sulfoxide (DMSO). Although DMSO is known to damage some angiographic catheters, little is known concerning whether this compound damages stent-graft material. The current study was undertaken to directly explore this issue. MATERIALS AND METHODS: Four stent-grafts were evaluated: the Excluder, Zenith, AneuRx, and Talent. Stent-grafts were incubated for 24 hours at 37 degrees C under each of the following conditions: DMSO alone, 50/50 mixture of DMSO/Onyx, mixture of 1 part 50/50 DMSO/Onyx and 9 parts whole blood, and untreated control. Stent-grafts were microdissected into 15-mm sections, after which they were evaluated with scanning electron microscopy. RESULTS: No appreciable differences between stent-grafts exposed to DMSO and untreated controls were seen. Although liquid embolic agent was seen coating stent-grafts exposed to a 50/50 mixture of DMSO and Onyx, no evidence of fiber breakdown was noted. Stent-grafts exposed to DMSO/Onyx/whole blood demonstrated a thin coating of clot and Onyx without visual evidence of fiber compromise. CONCLUSIONS: The current study provides compelling evidence that short-term exposure of endograft material to DMSO, DMSO/Onyx, or DMSO/Onyx/whole blood is not associated with acute structural compromise of four commonly used aortic endografts. Future in vivo studies will help to further establish the safety of this agent.