Asunto(s)
Carcinoma de Células Renales/cirugía , Criocirugía/normas , Neoplasias Renales/cirugía , Microondas/uso terapéutico , Ablación por Radiofrecuencia/normas , Radiografía Intervencional/normas , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/secundario , Toma de Decisiones Clínicas , Consenso , Criocirugía/efectos adversos , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Microondas/efectos adversos , Selección de Paciente , Ablación por Radiofrecuencia/efectos adversos , Radiografía Intervencional/efectos adversos , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Carga TumoralRESUMEN
PURPOSE: To evaluate and compare the rates of complications on follow-up computed tomography (CT) studies of patients with Celect, Günther Tulip, and Greenfield inferior vena cava (IVC) filters. MATERIALS AND METHODS: Retrospective review of CT studies obtained 0-1,987 days after infrarenal placement of an IVC filter identified 255 Celect, 160 Tulip, and 50 Greenfield filters. Follow-up CT studies were independently evaluated by two observers for IVC perforation, contact with adjacent organs, and filter fracture. Multivariate analysis was performed to identify factors associated with higher rates of IVC perforation, including age, IVC diameter, sex, and history of malignancy. RESULTS: IVC perforation was observed in 126 of 255 Celect filters (49%) with a mean follow-up of 277 days, 69 of 160 Tulip filters (43%) with a mean follow-up of 437 days, and one of 50 Greenfield filters (2%) with a mean follow-up of 286 days. A significantly higher IVC perforation rate was observed in women (45.5%) compared with men (30.8%; P = .002) and in patients with a history of malignancy (43.7%) compared with patients with no history of malignancy (29.9%; P < .001). Filter fracture was rare, observed in two of 255 Celect filters (0.8%), one of 160 Tulip filters (0.6%), and none of 50 Greenfield filters. CONCLUSIONS: No significant difference was observed in IVC perforation rate between Celect and Tulip filters. Greenfield filters had a significantly lower rate of IVC perforation than Celect and Tulip filters. Higher IVC perforation rates were observed in women and patients with a history of malignancy.
Asunto(s)
Falla de Prótesis , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Lesiones del Sistema Vascular/etiología , Filtros de Vena Cava , Vena Cava Inferior/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Humanos , Incidencia , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Variaciones Dependientes del Observador , Ohio , Flebografía/métodos , Valor Predictivo de las Pruebas , Diseño de Prótesis , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tomografía Computarizada por Rayos X , Lesiones del Sistema Vascular/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Adulto JovenRESUMEN
The American Association for the Study of Liver Diseases recognizes large volume paracentesis as draining greater than 5 liters of ascites and states there is no limit in the amount of ascites drained with appropriate replacement of albumin. For many practitioners performing safe large volume paracentesis between 5 and 10 liters or even 20 liters is not an uncommon practice. However, drainage of higher volumes outside common practice may raise concerns of patient intolerance and complication. The largest volume paracentesis reported in the literature to date is 41 liters. However, few other reports approach this volume. This case report demonstrates patient tolerance of a 39.5-liter paracentesis performed with close monitoring and hypertonic albumin replacement in a patient with chylous ascites due to high-grade follicular lymphoma.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Quilotórax/terapia , Procedimientos Endovasculares , Síndrome de la Vena Cava Superior/terapia , Vena Cava Superior , Anemia de Células Falciformes/diagnóstico por imagen , Angiografía de Substracción Digital , Quilotórax/diagnóstico por imagen , Quilotórax/etiología , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Persona de Mediana Edad , Flebografía/métodos , Stents , Síndrome de la Vena Cava Superior/complicaciones , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Resultado del Tratamiento , Vena Cava Superior/diagnóstico por imagenAsunto(s)
Catéteres Venosos Centrales/efectos adversos , Cuerpos Extraños/etiología , Cuerpos Extraños/cirugía , Embolia Intracraneal/etiología , Embolia Intracraneal/cirugía , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/cirugía , Remoción de Dispositivos , Diagnóstico Diferencial , Falla de Equipo , Cuerpos Extraños/diagnóstico por imagen , Humanos , Embolia Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Accidente Cerebrovascular/diagnóstico por imagen , SíndromeRESUMEN
The combination of anatomic and metabolic information provided by positron emission tomography (PET)/computed tomography makes it an important imaging modality to be obtained in conjunction with percutaneous ablation of primary and secondary malignancies of the lungs and liver. Advantages include more accurate preprocedural staging to determine appropriate treatment options, intraprocedural guidance to target difficult-to-see lesions, and postprocedural detection of residual or recurrent disease. Future applications of PET include strategies for intraprocedural guidance with real-time determination of incompletely ablated tumor, and combined PET/magnetic resonance imaging before, during, and after ablation for greater sensitivity to detect disease.