ABSTRACT
Objective To evaluate the technical feasibility and safety of a single-incision technique via axillary vein (AV) for placement of totally implantable venous access port (TIVAP) guided by ultrasound combined with DSA in clinical application. Methods We retrospectively analyzed clinical data of 240 patients who received TIVAP by single incision technique via AV access guided by ultrasound combined with DSA. We observed and recorded operation-related information such as AV width, AV puncture success rate, implantation success rate, ultrasound-guided puncture time, operation time and intraoperative and postoperative complications, etc. Results All 240 patients were successfully implanted with TIVAP, and the success rate was 100%. In 229 cases, TIVAP was implanted through single-incision AV puncture under the guidance of ultrasound combined with DSA, and the success rate of AV puncture was 95.42% (229/240). In 11 cases, TIVAP was implanted through the ipsilateral internal jugular vein (IJV) under the guidance of ultrasound combined with DSA due to the failure of AV puncture. In the 240 patients, the average width of AV of the intended puncture segment was (7.56±1.26) mm measured by preoperative ultrasound exploration and positioning, in which 195 cases were successfully punctured once, 26 cases were successfully punctured twice, and 8 cases were successfully punctured three times, with the success rate of 81.25%, 10.83% and 3.34%, respectively. The average puncture time under ultrasound guidance was (0.85±0.52) min, and the average operation time was (25.9±4.8) min. The incidence of intraoperative complications was 1.67% (4/240). No hemothorax, hemopneumothorax or serious fatal complications occurred. The incidence of complications during TIVAP retention was 2.92% (7/240). No complication such as catheter-related bloodstream infection, catheter-related venous thrombosis, catheter rupture/displacement, clipping syndrome or drug extravasation was observed. Conclusion Ultrasound combined with DSA guided single-incision technique via AV access in the implantation of TIVAP is a feasible and safe implantation method with high technical success rate, short operation time and low risk of complications. It can be used as another choice of TIVAP implantation method.
ABSTRACT
Objective To compare the concordance among RECIST, EASL and modified RECIST criteria for the evaluation of tumor response after transarterial chemoembolization of primary liver cancer.Methods Fifty patients with primary liver cancer underwent 2 TACE cycles separated by 30-40 days.Triphasic helical CT or MRI scans were performed at baseline, at 4 weeks after TACE procedure, and 2 independent radiologists evaluated tumor response according to above-mentioned three different criteria. Chisquare test was used to compare the response rate, and kappa coefficients were used to evaluate the coherence. Results When tumor responses were evaluated using the RECIST-EASL and modified RECIST criteria, the numbers of the patients achieved complete response, partial response, stable disease,progressive disease were 0, 10, 30, 10; 6,21,14,9; 6,21,13,10 respectively. The objective response rates for three different criteria were 20%, 54%, 54% respectively ( P ＜ 0. 01 ). Kappa coefficients between RECIST and EASL, between RECIST and modified RECIST, between EASL and modified RECIST were 0. 382, 0. 170, and 0. 857 (P = 0. 000). Conclusions RECIST criteria underestimates the extent of tumor response after TACE in primary liver cancer. Both EASL and modified RECIST criteria appear to agree with each other in determining treatment response. Furthermore, the modified RECIST is more convenient in clinical practice compared with EASL criteria.
ABSTRACT
Objective To explore the application value of VCT 64-row with 128-layer spiral extremities arterial imaging techniques and methods in the double lower limb artery.Methods 60 patients on lower limbs MSCTA angiography after Saul,flat on intravenous regiment note contrast agents CT angiography,image the maximum intensity projection(MIP),curved planner reconstruction(CPR),volume rendering(VR)after-treatment technology reconstructed vessels.Results All 60 patients showed the lower limb arterial and main branch.Conclusion 64-row helical VCT angiographic with 128-layer could clearly show that lower limb artery and pathological changes,and become main methods of preoperative evaluation and selection for the lower limb artery disease.