Additive value of transarterial embolization to systemic sirolimus treatment in kaposiform hemangioendothelioma.

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor in children, which can be accompanied by life-threatening thrombocytopenia, referred to as Kasabach-Merritt phenomenon (KMP). The mTOR inhibitor sirolimus is emerging as targeted therapy in KHE. As the sirolimus effect on KHE occurs only after several weeks, we aimed to evaluate whether additional transarterial embolization is of benefit for children with KHE and KMP. Seventeen patients with KHE and KMP acquired from 11 hospitals in Germany were retrospectively divided into two cohorts. Children being treated with adjunct transarterial embolization and systemic sirolimus, and those being treated with sirolimus without additional embolization. Bleeding grade as defined by WHO was determined for all patients. Response of the primary tumor at 6 and 12 months assessed by magnetic resonance imaging (MRI), time to response of KMP defined as thrombocyte increase >150 × 103 /µL, as well as rebound rates of both after cessation of sirolimus were compared. N = 8 patients had undergone additive embolization to systemic sirolimus therapy, sirolimus in this group was started after a mean of 6.5 ± 3 days following embolization. N = 9 patients were identified who had received sirolimus without additional embolization. Adjunct embolization induced a more rapid resolution of KMP within a median of 7 days vs 3 months; however, tumor response as well as rebound rates were similar between both groups. Additive embolization may be of value for a more rapid rescue of consumptive coagulopathy in children with KHE and KMP compared to systemic sirolimus only.

Future liver remnant growth after various portal vein embolization regimens: a quantitative comparison.

Purpose: To compare the efficacy of right portal vein embolization using ethylene vinyl alcohol (EVOH-PVE) compared to other embolic agents and surgical right portal vein ligation (PVL).Material and methods: Patients with right sided liver malignancies scheduled for extensive surgery and receiving induction of liver hypertrophy via right portal vein embolization/ligature between 2010-2016 were retrospectively evaluated. Treatments included were ethylene vinyl alcohol copolymer (Onyx®, EVOH-PVE), ethiodized oil (Lipiodol®, Lipiodol/PVA-PVE), polyvinyl alcohol (PVA-PVE) or surgical ligature (PVL). Liver segments S2/3 were used to assess hypertrophy. Primary outcome was future liver remnant growth in ml/day.Results: Forty-one patients were included (EVOH-PVE n = 11; Lipiodol/PVA-PVE n = 10; PVA-PVE n = 8; PVL n = 12), the majority presenting with cholangiocarcinoma and colorectal metastases (n = 11; n = 27). Pre-interventional liver volumes were comparable (p = .095). Liver hypertrophy was successfully induced in all but one patient receiving Lipiodol/PVA-PVE. Liver segment S2/3 growth was largest for EVOH-PVE (5.38 ml/d) followed by PVA-PVE (2.5 ml/d), with significantly higher growth rates than PVL (1.24 ml/d; p < .001; p = .007). No significant difference was evident for Lipiodol/PVA-PVE (1.43 ml/d, p = .809).Conclusions: Portal vein embolization using EVOH demonstrates fastest S2/3 growth rates compared to other embolic agents and PVL, potentially due to its permanent portal vein embolization and induction of hepatic inflammation.

CT after Endovascular Repair of Abdominal Aortic Aneurysms: Diagnostic Accuracy of Diameter Measurements for the Detection of Aneurysm Sac Enlargement.

PURPOSE: To evaluate the diagnostic accuracy of diameter measurements for the detection of aneurysm volume increase during follow-up after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs). MATERIALS AND METHODS: This retrospective study analyzed 100 pairs of follow-up computed tomography scans randomly selected from an EVAR database (male/female ratio, 91/9; mean age, 71 y; bifurcated and aortouniiliac stent grafts, 96% and 4%, respectively; mean interval, 359 d). Five maximum diameter (Dmax) values were measured (anteroposterior, transverse, axial, coronal, and perpendicular). Aneurysm sac volume was measured by manual segmentation and used as the standard of reference. Overall, 37% of patients had a persistent type II endoleak. RESULTS: The anteroposterior, transverse, axial, coronal, and perpendicular Dmax values increased in 39 patients (mean, 4.3 mm), 30 patients (mean, 4.0), 35 patients (mean, 3.9 mm), 43 patients (mean, 3.9 mm), and 41 patients (mean, 4.3 mm), respectively. Aneurysm sac volume increased in 39 patients (mean, 25.7 cm3). The cutoff levels according to the reporting standard for aneurysm sac enlargement (diameter ≥ 5.0 mm, volume ≥ 5.0%) had sensitivity/specificity rates of 29%/95%, 33%/97%, 29%/99%, 33%/93%, and 38%/96%, respectively, for the five Dmax values. The reference standards failed to detect aneurysm volume increase in 72%, 67%, 72%, 61%, and 67% of patients, respectively, with persistent type II endoleak. CONCLUSIONS: Depending on the chosen cutoff value, diameter measurements showed low to moderate sensitivity for the detection of aneurysm volume increase. The diameter measurements failed to detect aneurysm enlargement in a large number of patients with persistent type II endoleak after EVAR of AAA.

Ethanolgel sclerotherapy of venous malformations improves health-related quality-of-life in adults and children - results of a prospective study.

OBJECTIVES: To assess the treatment-induced changes of health-related quality-of-life (HRQoL) in patients with venous malformations (VM) who underwent ethanol gel sclerotherapy. METHODS: The prospective study in children and adults was approved by the local ethics committee. 31 patients (mean age 23.42 years, range 6.6 - 46.5; 26 female, 5 male) with VM were included. Patients' self-assessed HRQoL was measured before and after treatment using psychometrically validated questionnaires for adults and children. Differences were analysed with a paired t test. RESULTS: 58 sclerotherapy sessions were performed. The Physical Component Summary (PCS) at baseline was 43.69 and increased significantly (p = 0.01122) to 48.95 after treatment. The bodily pain (BP) scale increased significantly from 37.94 to 48.56 (p = 0.00002), the general health (GH) scale increased significantly from 46.69 to 52.17 (p = 0.00609). Baseline Physical Summary Score (PHS) in children increased significantly after treatment (p < 0.00001) from 25.25 to 45.89. The baseline Psychosocial Summary Score (PSS) in children was 51.08 and increased significantly (p = 0.00031) after treatment to 58.84. CONCLUSION: Paediatric and adult patients with VM suffer from bodily pain with overall reduced physical functioning. After sclerotherapy, these restrictions are successfully returning to normal levels with a positive effect on mental and psychosocial domains. KEY POINTS: • Sclerotherapy in venous malformation patients has an unknown effect on health-related quality-of-life • Prospective study showed improvements in bodily pain and general health in adults • Children and adults improved from treatment with ethanol gel • Sclerotherapy is an appropriate therapy.

Treatment of Acute Hemoptysis by Bronchial Artery Embolization with the Liquid Embolic Agent Ethylene Vinyl Alcohol Copolymer.

PURPOSE: To determine the technical and clinical success of bronchial artery embolization (BAE) with the liquid embolic agent ethylene vinyl alcohol (EVOH) copolymer in patients with acute hemoptysis. MATERIALS AND METHODS: Thirty-four patients (25 male; mean age, 58 y; range, 13-78 y) who underwent BAE with EVOH were retrospectively reviewed. Reasons for acute hemoptysis included lung cancer (44%), pulmonary metastases (12%), bronchiectasis (21%), arteriovenous malformation (5%), tuberculosis (6%), aspergilloma (3%), acute respiratory distress syndrome (3%), anticoagulant overdose (3%), and scar tissue (3%). Technical and clinical success of BAE were retrospectively assessed. RESULTS: Embolization was technically successful in 94% of patients. Additional embolization material was needed in 4 patients (12%). The immediate clinical success rate was 94% (32 of 34); in 2 patients (6%), hemoptysis recurred immediately after the intervention or could not be stopped. Periinterventional minor complications included headache (n = 1), fever (n = 1), and acute renal failure (n = 1). During follow-up (mean, 8.8 mo), 5 patients had a recurrence of hemoptysis (15%). CONCLUSIONS: The use of EVOH copolymer for BAE in patients with acute hemoptysis is technically successful and safe and has a good clinical outcome with a low number of recurrences.

Ethanol-Gel Sclerotherapy of Venous Malformations: Effectiveness and Safety.

OBJECTIVE: In the treatment of venous malformations, ethanol may be administered in a gelified form to increase local effects and reduce systemic ones. The purpose of this prospective study was to evaluate the efficacy and safety of a commercially available viscous ethanol gel in the treatment of venous malformations. SUBJECTS AND METHODS: Thirty-one patients (mean age, 23.4 years; age range, 6.6-46.5 years) with venous malformations were prospectively scheduled for two ethanol-gel sclerotherapy sessions. Venous malformations were located at the lower extremity (n = 18), the upper extremity (n = 9), and the face (n = 4). Questionnaires to assess pain, clinical examinations, professional photographs, and contrast-enhanced MRI of the venous malformations were performed before and after therapy to measure therapy-induced changes. Two experienced radiologists blinded to the examination date and clinical status compared photographs and MR images before and after treatment. RESULTS: A mean of 4.2 mL of ethanol gel were administered per session. The technical success rate was 100%. Clinical success, defined as improvement or resolution of symptoms, was noted in 81% of patients. Mean pain score decreased, and the difference was statistically significant (3.9 vs 3.1, p = 0.005). In 54 treatment sessions where follow-up was available, four minor complications occurred. Comparison of photographs and MR images before and after treatment showed improvement in 35% and 93% of patients, respectively. CONCLUSION: Ethanol gel is an effective and safe sclerosing agent in the treatment of venous malformations.

Outcome of primary percutaneous stent-revascularization in patients with atherosclerotic acute mesenteric ischemia.

Background Patients with acute mesenteric ischemia (AMI) often exhibit severe co-morbidities and significant surgical risks, leading to high perioperative morbidity. Purpose To investigate the feasibility of primary percutaneous stent-revascularization (PPSR) in atherosclerotic AMI and its impact on patients' outcome. Material and Methods Retrospective analysis of 19 consecutive patients (7 women, 12 men; median age, 69 years) with AMI caused by atherosclerotic, non-embolic stenoses/occlusions of the splanchnic arteries and PPSR. Alternative minimally invasive techniques were excluded. Clinical characteristics including the Charlson Comorbidity Index adjusted by age (CCIa) and symptom duration, technical and clinical success of PPSR, clinical course, 30-day mortality, and follow-up were evaluated and compared to literature data for surgical approaches. Technical success was defined as residual stenosis of <30% in diameter. Clinical success was defined as resolution of symptoms of AMI and/or normalization of serum lactate after sole PPSR. Results The majority of patients presented with severe co-morbidities (CCIa >4 in 17 of 19 patients, 89%). Median symptom duration was 50 h. Technical and clinical success rates of PPSR were 95% (21 of 22 arteries) and 53% (10 of 19 patients). Seven patients underwent subsequent laparotomy with bowel resection in four cases. Thirty-day mortality was 42% (8 of 19 patients). Conclusion In our study population of patients with atherosclerotic AMI, severe co-morbidities, prolonged acute symptoms, and significant perioperative risks PPSR of splanchnic stenoses were technically feasible and the clinical outcome was acceptable.

CT features of early type II endoleaks after endovascular repair of abdominal aortic aneurysms help predict aneurysm sac enlargement.

PURPOSE: To determine computed tomographic (CT) features of early type II endoleaks associated with aneurysm sac enlargement after endovascular aortic aneurysm repair (EVAR) of abdominal aortic aneurysm. MATERIALS AND METHODS: Institutional review board approval was not required for this retrospective study. The authors reviewed imaging and clinical data from 56 patients (seven women, 49 men; mean age ± standard deviation, 71 years ± 7.9; age range, 52-85 years) with early type II endoleak who had undergone EVAR between December 2002 and December 2011 and who had been followed up with imaging and clinical evaluation for at least 6 months. The number and diameter of all feeding and/or draining arteries were measured, and endoleaks were classified according to their sources into simple inferior mesenteric artery (IMA), simple lumbar artery (LA), complex LA, and complex IMA-LA type II endoleaks. Volume and attenuation of the nidus were measured. Aneurysm enlargement was defined as an increase in the aneurysm volume of more than 5% during follow-up. Simple and multivariate logistic regression analyses were performed to identify independent clinical and imaging variables associated with aneurysm enlargement. RESULTS: Twenty-three of the 56 patients (41%) showed aneurysm sac enlargement during follow-up (mean follow-up, 3.0 years ± 2.0). With the multivariate model, the variables that showed the strongest indicators for aneurysm sac enlargement were complex IMA-LA type II endoleak (odds ratio [OR] = 10.29, P = .004) and the diameter of the largest feeding and/or draining artery (OR = 4.55, P = .013). Patients without complex IMA-LA type II endoleak in whom the largest feeding and/or draining artery was larger than 3.8 mm and patients with a complex IMA-LA type II endoleak in whom the largest feeding and/or draining artery was larger than 2.2 mm were at high risk for aneurysm sac enlargement. CONCLUSION: The strongest indicators for aneurysm sac enlargement are complex IMA-LA type II endoleak and the diameter of the largest feeding and/or draining artery.

Inferior mesenteric arterial type II endoleaks after endovascular repair of abdominal aortic aneurysm: are they predictable?

PURPOSE: To evaluate the association of inferior mesenteric arterial (IMA) type II endoleaks in patients undergoing endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm with several morphologic parameters. MATERIALS AND METHODS: Approval of the institutional ethical review committee was not required. This was a retrospective review of 322 computed tomographic angiographic studies that were performed in patients before they underwent elective EVAR for infrarenal abdominal aortic aneurysm. Morphologic parameters evaluated were IMA patency, origin of the IMA in relation to the aneurysm sac, diameter of the IMA, the cross-sectional area of the contrast material-enhanced aortic lumen at the level of the IMA ostium, and the number of additional patent aortic side branches from the aneurysm sac. The association of IMA type II endoleaks with each variable was analyzed by using univariate and multivariate logistic regression models. RESULTS: The diameter of the IMA did not influence the development of IMA type II endoleaks (P = .51). The incidence of these endoleaks was significantly higher in patients with greater cross-sectional area of the aortic lumen at the IMA ostium (P < .001). Patients with an IMA type II endoleak had significantly more patent aortic side branches before EVAR than did patients without an endoleak (3.6 ± 1.7 vs 2.2 ± 1.4; P < .001). According to the final logistic regression model that included cross-sectional area of the aortic lumen at the IMA and the number of aortic side branches as independent predictors, risk for IMA type II endoleaks was determined with a sensitivity of 78% (39 of 50) and a specificity of 79% (92 of 116). CONCLUSION: Cross-sectional area of the contrast-enhanced aortic lumen at the level of the IMA ostium and the number of additional patent aortic side branches are associated with the development of IMA type II endoleaks.

Irreversible electroporation ablation of malignant hepatic tumors: subacute and follow-up CT appearance of ablation zones.

PURPOSE: To describe findings on contrast-enhanced computed tomography (CT) images of malignant hepatic tumors 24-72 hours after percutaneous ablation by irreversible electroporation (IRE) and at midterm follow-up. MATERIALS AND METHODS: Retrospective analysis of 52 malignant liver tumors-30 primary hepatic tumors and 22 hepatic metastases-in 34 patients (28 men and 6 women, mean age 64 y) treated by IRE ablation was performed. Ablation zones were evaluated by two examiners in a consensus reading by means of a dual-phase CT scan (consisting of a hepatic arterial and portal venous phase) performed 24-72 hours after IRE ablation and at follow-up. RESULTS: During the portal venous phase, ablation zones either were homogeneously hypoattenuating (n = 36) or contained heterogeneously isoattenuating or hyperattenuating (n = 16) foci, or both, in a hypoattenuating area. Of 52 lesions, 38 included gas pockets. Peripheral contrast enhancement of the ablation defect was evident in 23 tumors during the arterial phase and in 36 tumors during the portal venous phase. Four tumors showed intralesional abscesses after the intervention. At follow-up (mean, 4.7 mo), the mean volume of the ablation defects was reduced to 29% of their initial value. CONCLUSIONS: Because normal findings on contrast-enhanced CT images after IRE ablation may be very similar to the typical characteristics of potential complications following ablation, such as liver abscesses, CT scans must be carefully analyzed to distinguish normal results after intervention from complications requiring further treatment.

Preliminary results of the austrian national registry with the novel iCover bridging stentgraft in fenestrated endovascular aortic repair.

OBJECTIVE: Bridging stentgrafts (BSGs) are one of the primary limiting factors regarding long-term results after fenestrated endovascular aortic repair (fEVAR). This study aims to report for the first time the outcome of a novel BSG called iCover from a national, multicentric retrospective database. METHODS: A cohort of 58 patients received 212 BSGs for the renovisceral arteries in fEVAR. Patients were followed-up clinically and with computed-tomography angiography. Study end points were mortality, occurrence of complications, technical success of the BSG implantation, defined as successful deployment with vessel patency and absence of type 1c, 3b, and 3c endoleak, and stability over the follow-up. RESULTS: Three BSG unrelated mortalities (5.1 %), four BSG unrelated major complications (6.8 %) and five minor complications (8.6 %) occurred. The technical success of iCover was 207/212 (97.6 %), target vessel patency was 100 % over a follow-up of 4.0 months, and no late BSG related endoleak was detected. In two cases, the BSG was dislodged from the balloon and could be parked in a safe position without further sequelae (0.9 %). CONCLUSION: The iCover represents a feasible BSG for fEVAR with an excellent safety profile and technical success rate in the early phase. Prudent post-dilatation and monitoring of the proximal and distal stent ends can potentially further improve outcome. Longer follow-up series are necessary.

Added value of Gd-EOB-DTPA-enhanced Hepatobiliary phase MR imaging in evaluation of focal solid hepatic lesions.

BACKGROUND: Correct characterization of focal solid hepatic lesions has always been a challenge and is of great diagnostic and therapeutic relevance. The purpose of this study was to determine the added value of hepatobiliary phase images in Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for differentiating focal solid hepatic lesions. METHODS: In this retrospective trial 84 consecutive patients underwent Gd-EOB-DTPA-enhanced MR examinations. MRI was conducted for 64 patients with malignant focal hepatic lesions (34 hepatocellular carcinoma (HCC), 30 metastases) and for 20 patients with benign hepatic lesions (14 focal nodular hyperplasia (FNH), 3 adenoma, 3 hemangioma). Five radiologists independently reviewed three sets of MR images by means of a 5-point confidence scale from score 1 (definitely benign) to score 5 (definitely malignant): set 1: unenhanced images; set 2: unenhanced and Gd-EOB-DTPA-enhanced dynamic images; set 3: hepatobiliary phase images in addition to set 2. Accuracy was assessed by the alternative free-response receiver operating characteristic curve (Az) and the index of diagnostic performance was calculated. RESULTS: Diagnostic accuracy was significantly improved by the addition of Gd-EOB-DTPA-enhanced dynamic images: Az in set 1 was 0.708 and 0.833 in set 2 (P = 0.0002). The addition of hepatobiliary phase images increased the Az value to 0.941 in set 3 (set 3 vs set 2, P < 0.0001; set 3 vs set 1, P < 0.0001). The index of diagnostic performance was lowest in set 1 (45%), improved in set 2 (71%), and highest in set 3 (94%). CONCLUSIONS: Hepatobiliary phase images obtained after Gd-EOB-DTPA-enhanced dynamic MRI improve the differentiation of focal solid hepatic lesions.

Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis: A case report and literature review.

BACKGROUND: Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for treatment are lacking, splenectomy or splenic artery embolization are often used to treat bleeding. Splenic vein stenting has been shown to be a safe option. CASE SUMMARY: A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding. She was anemic with a hemoglobin of 8.0 g/dL. As a source of bleeding, CV were identified. Computed tomography scans revealed thrombotic occlusion of the splenic vein, presumably as a result of a severe acute pancreatitis 8 years prior. In a selective angiography, a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed. The hepatic venous pressure gradient was within normal range. In an interdisciplinary board, transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting, as well as coiling of the aberrant veins was discussed and successfully performed. Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up. CONCLUSION: Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV. However, a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.

Multidetector computed tomography for detection and characterization of pulmonary hypertension in consideration of WHO classification.

OBJECTIVE: We evaluated the reliability of various multidetector computed tomography (MDCT) parameters for diagnosis and severity assessment of pulmonary hypertension (PH) with consideration of World Health Organization (WHO) classification. METHODS: A total of 172 patients were included in this retrospective study. One hundred fourteen patients had a diagnosis of PH (mean pulmonary artery pressure ≥25 mm Hg), and 58 patients without PH (mean pulmonary artery pressure <20 mm Hg) served as control subjects. The patients with PH were grouped according to the WHO classification based on PH etiology. RESULTS: The patients with PH had significantly greater main, left, and right pulmonary artery diameters than the control subjects (P < 0.001). No significant differences within the PH subgroups were found. Receiver operating characteristic analysis showed reasonable sensitivity and specificity for selected MDCT parameters. The severity of PH did not correlate with MDCT parameters. CONCLUSIONS: Easy-to-determine MDCT parameters allow detection of PH independent of the WHO group. In patients with dilated aorta, the vertebra can be an alternative internal standard. Severity of PH cannot be estimated by MDCT parameters.

Assessment of Rib Fracture in Acute Trauma Using Automatic Rib Segmentation and a Curved, Unfolded View of the Ribs: Is There a Saving of Time?

Introduction: The fast and accurate diagnosis of rib fractures in polytrauma patients is important to reduce the mortality rate and relieve long-term pain and complications. Aim: To evaluate the diagnostic accuracy and potential time savings using automatic rib segmentation and a curved, unfolded view for the detection of rib fractures in trauma patients. Methods: The multidetector computed tomography raw data of 101 consecutive polytrauma patients (72 men; mean age 45 years, age range 17 to 84 years) admitted to a university hospital were retrospectively post-processed to generate a curved, unfolded view of the rib cage. No manual corrections were performed. Patients with reconstruction errors and movement artifacts were excluded from further analysis. All fractures were identified and classified by the study coordinator using the original data set. Two readers (reader 1 and reader 2) evaluated the original axial sections and the unfolded view, separately. The fracture locations, fracture type, and reading times were recorded. Sensitivity and specificity were calculated on a per-rib basis using a ratio estimator. Cohen's Kappa was calculated as an index of inter-rater agreement. Results: 26 of 101 patients (25.7%) were excluded from further analysis owing to breathing artifacts (6.9%) or incorrect centerline computation in the unfolded view (18.8%). In total, 107 (5.9%) of 1800 ribs were fractured in 25 (33%) of 75 patients. The unfolded view had a sensitivity/specificity of 81%/100% (reader 1) and 71%/100% (reader 2) compared to 94%/100% (reader 1; p = 0.002/p = 0.754) and 63%/99% (reader 2; p < 0.001/p = 0.002). The sensitivity (reader 1; reader 2) was poor for buckled fractures (31%; 38%), moderate for undislocated fractures (78%; 62%), and good for dislocated fractures (94%; 90%). The assessment of the unfolded view was performed significantly faster than that of the original layers (19.5 ± 9.4 s vs. 68.6 ± 32.4 s by reader 1 (p < 0.001); 24.1 ± 9.5 s vs. 40.2 ± 12.7 s by reader 2 (p < 0.001)). Both readers demonstrated a very high interobserver agreement for the unfolded view (κ = 0.839) but only a moderate agreement for the original view (κ = 0.529). Conclusion: Apart from a relatively high number of incorrect centerline reconstructions, the unfolded view of the rib cage allows a faster diagnosis of dislocated rib fractures.

Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn's disease.

PURPOSE: Severe postoperative intra-abdominal septic complications (IASC) such as an anastomotic leak, intra-abdominal abscess, and fistula are significantly associated with the presence of spontaneous intra-abdominal abscess at the time of laparotomy in patients with Crohn's disease (CD). The purpose of this study was to compare the incidence of severe postoperative IASC in patients undergoing intestinal resections with and without preoperative percutaneous abscess drainage (PAD) before definitive surgery. METHODS: Using a prospective surgical database, we searched for patients with CD and spontaneous intra-abdominal abscesses who underwent intestinal resection at our hospital from May 2005 to February 2009. Postoperative IASC were defined as anastomotic leaks, abscess, and fistula within 1 month after surgery. We compared the incidence of postoperative IASC in patients with (group I) and without (group II) preoperative PAD (Fisher's exact test). RESULTS: We identified 25 patients (15 men, 10 women; mean age, 31 years) with spontaneous intra-abdominal abscesses. PAD was performed in 12 of 25 patients (48%), with an average of 37 days before surgery (range, 6-83 days). The overall rate of postoperative IASC was 48% (12 of 25 patients). In group I, postoperative IASC occurred in 3 of 12 patients (25%). In group II, postoperative IASC were assessed in 9 of 13 patients (69%). The differences between these two groups were considered to be statistically significant (p = 0.04). CONCLUSION: PAD of intra-abdominal abscesses before surgery could significantly reduce the occurrence of severe postoperative IASC in patients with CD.

Bleomycin electrosclerotherapy in therapy-resistant venous malformations of the body.

OBJECTIVE: Bleomycin is one of the most commonly used agents in sclerotherapy for slow-flow vascular malformations worldwide. However, its efficiency remains unknown. The objective of the present study was to assess whether reversible electroporation combined with bleomycin would increase the sclerotherapy effect in patients with previously unsuccessfully treated venous malformations (VMs). METHODS: We performed, to the best of our knowledge, the first retrospective observational case series from January 2019 to January 2020 of 17 patients (20 lesions) with symptomatic VMs, who had previously undergone at least two unsuccessful invasive treatments. Reversible electroporation was performed with various electrodes and directly injected bleomycin. All patient records, magnetic resonance imaging data, documentation of previous treatments, and data regarding the intervention, complications, and clinical symptoms were analyzed. RESULTS: The 17 VM patients (mean age, 20.8 ± 8.2 years; 9 females) had previously undergone an average of 4.2 invasive treatments. These patients had subsequently undergone 22 electrosclerotherapy sessions of 20 lesions. The median dose of bleomycin was 3 mg. The median magnetic resonance imaging-derived lesion volume before treatment was 24.9 cm3, which had decreased by 86% to 3.5 cm3 after treatment. After 3.7 months, eight patients were asymptomatic without residual symptoms and nine patients showed improvement. CONCLUSIONS: Bleomycin electrosclerotherapy appears to be an effective therapy for patients with VMs resistive to previous invasive therapy. Because of the small sample size and short follow-up period, our results should be examined further using a larger patient population.

Optimized multidetector computed tomographic protocol for the diagnosis of active obscure gastrointestinal bleeding: a feasibility study.

OBJECTIVE: The purpose of this feasibility study was to prospectively evaluate an optimized multidetector computed tomographic protocol for the diagnosis of active obscure gastrointestinal bleeding (OGIB). METHODS: Between October 2006 and February 2008, patients admitted for active OGIB were included in this prospective unicenter study. Water was administered orally and rectally as neutral luminal contrast material. A contrast-enhanced 16-row multidetector computed tomography (MDCT) was performed in the arterial and venous phases. Mesenteric digital subtraction angiography was carried out immediately after MDCT as standard of reference. RESULTS: Six patients were included in this study. Multidetector computed tomography identified the bleeding site and source in 5 (83%) of the patients. Digital subtraction angiography was performed in 4 patients, and the result was positive in 1 (25%) of the patients. Multidetector computed tomography detected the site and source of bleeding in 2 patients whose digital subtraction angiographic result was negative. CONCLUSIONS: The results of this feasibility study indicate that optimized MDCT is an excellent diagnostic tool for the diagnosis of active OGIB.

[Interventional therapies of vascular malformations]. / Interventionelle Behandlungsoptionen bei vaskulären Malformationen.

Vascular malformations can appear at any age and in every region of the body. Due to their rare appearance and differences in clinical manifestations the appropriate diagnosis and subsequent classification remains challenging. Once the diagnosis is established, various treatment options exist, requiring an interdisciplinary approach. This review provides an overview over state-of-the-art interventional therapies of vascular malformations.