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1.
Asian J Surg ; 2024 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-38627118

RESUMEN

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.

2.
World J Gastroenterol ; 29(24): 3922-3931, 2023 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-37426315

RESUMEN

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.


Asunto(s)
Várices Esofágicas y Gástricas , Hemorragia Gastrointestinal , Pancreatitis , Várices , Femenino , Humanos , Persona de Mediana Edad , Enfermedad Aguda , Várices Esofágicas y Gástricas/diagnóstico por imagen , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Pancreatitis/complicaciones , Vena Porta/diagnóstico por imagen , Enfermedades del Bazo , Vena Esplénica/diagnóstico por imagen , Várices/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Tomografía Computarizada por Rayos X
3.
J Clin Med ; 11(9)2022 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-35566629

RESUMEN

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.

4.
Int J Cancer ; 148(9): 2345-2351, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33231291

RESUMEN

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.


Asunto(s)
Embolización Terapéutica/métodos , Hemangioendotelioma/tratamiento farmacológico , Síndrome de Kasabach-Merritt/tratamiento farmacológico , Sarcoma de Kaposi/tratamiento farmacológico , Sirolimus/uso terapéutico , Femenino , Humanos , Masculino , Estudios Retrospectivos , Sirolimus/farmacología
5.
J Vasc Surg Venous Lymphat Disord ; 9(3): 731-739, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33045393

RESUMEN

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.


Asunto(s)
Bleomicina/administración & dosificación , Soluciones Esclerosantes/administración & dosificación , Escleroterapia , Malformaciones Vasculares/terapia , Venas/anomalías , Adolescente , Adulto , Bleomicina/efectos adversos , Niño , Resistencia a Medicamentos , Electroquimioterapia/efectos adversos , Femenino , Humanos , Masculino , Estudios Retrospectivos , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Resultado del Tratamiento , Malformaciones Vasculares/diagnóstico por imagen , Venas/diagnóstico por imagen , Adulto Joven
7.
Minim Invasive Ther Allied Technol ; 29(2): 98-106, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30821547

RESUMEN

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.


Asunto(s)
Embolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Vena Porta/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Aceite Etiodizado/administración & dosificación , Femenino , Hepatectomía , Humanos , Hipertrofia , Ligadura , Masculino , Persona de Mediana Edad , Alcohol Polivinílico/administración & dosificación , Polivinilos/administración & dosificación , Estudios Retrospectivos
8.
Dtsch Med Wochenschr ; 144(24): 1675-1680, 2019 12.
Artículo en Alemán | MEDLINE | ID: mdl-31791070

RESUMEN

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.


Asunto(s)
Malformaciones Vasculares/terapia , Técnicas de Ablación , Embolización Terapéutica , Humanos , Escleroterapia , Malformaciones Vasculares/clasificación , Malformaciones Vasculares/diagnóstico
9.
Insights Imaging ; 10(1): 30, 2019 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-30868300

RESUMEN

Malignant vascular tumors as part of the vascular anomalies spectrum are extremely rare in children and young adults. Instead, benign vascular neoplasias are frequently encountered in the pediatric patient population. While vascular malformations are congenital vascular lesions, originating from a mesenchymal stem cell defect, vascular tumors are neoplastic transformations of endothelial and other vascular cells. The appropriate differential diagnosis and nomenclature according to the classification of the International Society for the Study of Vascular Anomalies (ISSVA) is decisive to initiate correct therapy. While infantile hemangioma can be routinely diagnosed by clinical means and rarely require therapy, more rare vascular tumors are frequently difficult to diagnose, require dedicated cross-sectional imaging, and benefit from an interdisciplinary treatment approach. The focus of this review is to provide an overview over the spectrum of vascular tumors, typical imaging characteristics, and summarize treatment options including interventional radiology approaches.

10.
Rofo ; 191(8): 716-724, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30703822

RESUMEN

PURPOSE: Evaluation of the prevalence and significance of unsuspected extravascular findings on computed tomography angiography (CTA) of the body before endovascular or surgical treatment in vascular patients. MATERIALS AND METHODS: This study was approved by the local institutional review board. Radiology reports of 806 patients who underwent CTA of the body during January 2004 until December 2014 before endovascular or surgical treatment of vascular diseases were retrospectively reviewed. All unexpected extravascular abnormalities were classified as clinically non-significant (requiring no follow-up) or clinically significant (requiring further follow-up/immediate treatment). The course of patients with significant extravascular findings was retrospectively evaluated. RESULTS: Overall 806 patients were included in this study (592 men; mean age: 67 years). In 778 (96.5 %) of 806 patients 3293 incidental extravascular findings were diagnosed. There were 259 suspicious findings in 205 patients (25.4 %) that required further follow-up or immediate treatment. A previously unknown malignant tumor was diagnosed in 23 (2.9 %) patients. 10 patients (1.2 %) were diagnosed with lung cancer. Malignant tumors were detected more often in men than in women (3.5 % versus 0.9 %). Patients with an incidental tumor were significantly older than patients without a tumor (mean age: 72.3 vs. 67.5 years). CONCLUSION: Clinically significant unexpected extravascular findings are common in vascular patients. Especially noteworthy are malignant tumors of the lung. KEY POINTS: · Clinically relevant extravascular findings were detected in 25.4 % of the patients.. · The incidence of malignant tumors was 2.9 %.. · Lung cancer had the highest incidence among all malignancies (1.2 %).. CITATION FORMAT: · Turowski LS, Dollinger M, Wohlgemuth WA et al. Preoperative computed tomography angiography (CTA) of the body in vascular patients: prevalence and significance of unsuspected extravascular findings. Fortschr Röntgenstr 2019; 191: 716 - 724.


Asunto(s)
Angiografía por Tomografía Computarizada , Hallazgos Incidentales , Neoplasias/diagnóstico por imagen , Cuidados Preoperatorios , Enfermedades Vasculares/diagnóstico por imagen , Factores de Edad , Anciano , Comorbilidad , Estudios Transversales , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Factores Sexuales , Enfermedades Vasculares/epidemiología
11.
Rofo ; 190(9): 825-835, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29874693

RESUMEN

BACKGROUND: Vascular anomalies are a diagnostic and therapeutic challenge. They require dedicated interdisciplinary management. Optimal patient care relies on integral medical evaluation and a classification system established by experts in the field, to provide a better understanding of these complex vascular entities. METHOD: A dedicated classification system according to the International Society for the Study of Vascular Anomalies (ISSVA) and the German Interdisciplinary Society of Vascular Anomalies (DiGGefA) is presented. The vast spectrum of diagnostic modalities, ranging from ultrasound with color Doppler, conventional X-ray, CT with 4 D imaging and MRI as well as catheter angiography for appropriate assessment is discussed. RESULTS: Congenital vascular anomalies are comprised of vascular tumors, based on endothelial cell proliferation and vascular malformations with underlying mesenchymal and angiogenetic disorder. Vascular tumors tend to regress with patient's age, vascular malformations increase in size and are subdivided into capillary, venous, lymphatic, arterio-venous and combined malformations, depending on their dominant vasculature. According to their appearance, venous malformations are the most common representative of vascular anomalies (70 %), followed by lymphatic malformations (12 %), arterio-venous malformations (8 %), combined malformation syndromes (6 %) and capillary malformations (4 %). CONCLUSION: The aim is to provide an overview of the current classification system and diagnostic characterization of vascular anomalies in order to facilitate interdisciplinary management of vascular anomalies. KEY POINTS: · Vascular anomalies are comprised of vascular tumors and vascular malformations, both considered to be rare diseases.. · Appropriate treatment depends on correct classification and diagnosis of vascular anomalies, which is based on established national and international classification systems, recommendations and guidelines.. · In the classification, diagnosis and treatment of congenital vascular anomalies, radiology plays an integral part in patient management.. CITATION FORMAT: · Sadick M, Müller-Wille R, Wildgruber M et al. Vascular Anomalies (Part I): Classification and Diagnostics of Vascular Anomalies. Fortschr Röntgenstr 2018; 190: 825 - 835.


Asunto(s)
Enfermedades Raras , Malformaciones Vasculares/clasificación , Malformaciones Vasculares/diagnóstico por imagen , Neoplasias Vasculares/diagnóstico por imagen , Anomalías Múltiples/clasificación , Anomalías Múltiples/diagnóstico por imagen , Anomalías Múltiples/terapia , Adulto , Malformaciones Arteriovenosas/clasificación , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/terapia , Niño , Diagnóstico Diferencial , Diagnóstico por Imagen/métodos , Humanos , Anomalías Linfáticas/clasificación , Anomalías Linfáticas/diagnóstico por imagen , Anomalías Linfáticas/terapia , Síndrome , Malformaciones Vasculares/terapia , Neoplasias Vasculares/clasificación , Neoplasias Vasculares/terapia
12.
Eur J Radiol ; 100: 1-6, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29496066

RESUMEN

PURPOSE: To evaluate the effects of lowering the detector entrance exposure in children undergoing interventional radiology procedures. MATERIALS AND METHODS: The study retrospectively investigated radiation dose levels in pediatric patients aged 0-18 years before (n = 39) and after (n = 26) lowering detector entrance dose, undergoing embolization of peripheral Arteriovenous malformations, Portal Vein Interventions or Percutaneous Transhepatic Cholangio Drainage (PTCD) between 2014 and 2017. Patient characteristics, fluoroscopy time, protocols used as well as resulting Skin Dose and Dose Area Product (DAP) were compared in each cohort. Image quality was assessed by two independent readers. RESULTS: The two patient cohorts did not differ in terms of patient demographics. Similarly, fluoroscopy time did not differ before and after implementation of the low dose settings. An overall reduction of skin dose of 75.1% for AVM embolizations, 80.5% for Portal Vein Interventions and 85.3% for PTCD placement was observed. The DAP decrease was 82.5% for AVM embolizations, 72.2% for Portal Vein Interventions and 79.8% for PTCD placement. Image quality was generally considered to be good with an insignificant difference between pre and post implementation of the low dose approach and good agreement between the two readers. Manual inroom-switching to higher dose levels was possible, however this was not performed more frequently after implementation of the low dose settings. CONCLUSION: Lowering the detector entrance dose in pediatric interventional radiology procedures results in a significant decrease of the radiation dose burden.


Asunto(s)
Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/terapia , Embolización Terapéutica/métodos , Dosis de Radiación , Exposición a la Radiación/estadística & datos numéricos , Radiografía Intervencional/métodos , Adolescente , Niño , Preescolar , Femenino , Fluoroscopía/métodos , Humanos , Lactante , Masculino , Vena Porta/diagnóstico por imagen , Estudios Retrospectivos
13.
Rofo ; 190(4): 327-333, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29514382

RESUMEN

OBJECTIVES: To determine the rate at which original studies presented orally at the European Congress of Radiology (ECR) 2010 were published in Medline-indexed journals and to identify factors predictive of publication. METHODS: A total of 869 abstracts were included in the study. A Medline search of articles published between March 2010 and February 2015 was conducted to identify articles written by the first, second, and/or last authors of all abstracts published in the Scientific Program of ECR 2010. The publication year, journal, country of origin, subspecialty and nature of the research (i. e., human, animal or technical) were recorded. RESULTS: Between March 2010 and February 2015 a total of 450 abstracts (publication rate, 51.8 %) were subsequently published in 125 Medline-indexed journals, chiefly in European Radiology (11.1 %). 443/450 (98.4 %) articles were published in English language. The subspecialties of molecular imaging and cardiac imaging had the highest publication rates (75.0 % and 62.0 %, respectively), while computer application studies had the lowest (27.6 %). The nature of research, origin of the abstract and subspecialty significantly influenced the subsequent publication rate. CONCLUSION: More than half of the original studies presented orally at ECR 2010 were subsequently published in Medline-indexed journals. More articles were published in the journal European Radiology than in any other identified journal. KEY POINTS: · ECR 2010 had a high subsequent publication rate. · Most subsequently published articles were published in radiology journals. · Nearly all articles were published in the English language. CITATION FORMAT: · Dollinger M, Zeman F, Müller-Wille R et al. Presentation of Original Research at the European Congress of Radiology 2010: Frequency of Publication in Medline-Indexed Journals Within 5 Years After Presentation. Fortschr Röntgenstr 2017; 190: 327 - 333.


Asunto(s)
Indización y Redacción de Resúmenes/estadística & datos numéricos , Congresos como Asunto/estadística & datos numéricos , MEDLINE/estadística & datos numéricos , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Publicaciones/estadística & datos numéricos , Radiología/estadística & datos numéricos , Investigación/estadística & datos numéricos , Europa (Continente) , Humanos , Estados Unidos
14.
Rofo ; 2018 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-29415296

RESUMEN

BACKGROUND: The International Society for the Study of Vascular Anomalies (ISSVA) categorizes vascular anomalies into vascular tumors and vascular malformations. Vascular malformations are further divided into slow-flow (venous, lymphatic, and capillary malformation) and fast-flow malformations (arteriovenous malformation and arteriovenous fistula). This interdisciplinary classification has therapeutic implications. METHODS: The objective of this article is to provide concise information about the current terminology and treatment strategies of peripheral vascular malformations, based on the currently available literature, with a focus on interventional therapy of venous malformations (VM), lymphatic malformations (LM), arteriovenous malformations (AVM) and arteriovenous fistulae (AVF). RESULTS AND CONCLUSION: Accurate classification is crucial for appropriate therapy of peripheral vascular malformations. Modern imaging technologies and refined interventional treatment strategies are now central parts in the multidisciplinary management of these patients. Slow-flow and fast-flow vascular malformations can be treated successfully by percutaneous sclerotherapy and endovascular embolotherapy as first-line interventions. KEY POINTS: · The ISSVA classification is essential for the correct diagnosis of vascular malformations. · The Schobinger classification as well as the Cho classification should be used for description of arteriovenous malformations (AVM). · Sclerotherapy and embolotherapy are the primary treatments of choice for vascular malformations. CITATION FORMAT: · Müller-Wille R, Wildgruber M, Sadick M et al. Vascular Anomalies (Part II): Interventional Therapy of Peripheral Vascular Malformations. Fortschr Röntgenstr 2018; DOI: 10.1055/s-0044-101266.

15.
J Vasc Interv Radiol ; 29(2): 178-187.e3, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29217411

RESUMEN

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.


Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Endofuga/diagnóstico por imagen , Procedimientos Endovasculares , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Implantación de Prótesis Vascular , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
16.
Cardiovasc Intervent Radiol ; 41(2): 277-283, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29075878

RESUMEN

PURPOSE: To evaluate survival of patients with localized T1a clear cell renal cell carcinoma (ccRCC) who received cryosurgery or thermal ablation compared to deferred therapy. MATERIALS AND METHODS: We included 733 patients with histopathologically confirmed localized T1a ccRCC who either received cryosurgery (n = 315) or thermal ablation (n = 155), as well as patients who deferred therapy (n = 263) from the 2000-2013 Surveillance, Epidemiology, and End Results Program urinary cancer file. Cox proportional hazard models were used to compare cancer-specific survival (CSS) across subgroups. Sensitivity analyses were conducted to assess potential unmeasured confounding by comorbidities. RESULTS: Patients treated with cryosurgery and thermal ablation had a statistically significant CSS benefit compared to those who deferred therapy (cryosurgery HR 0.25, 95% CI 0.14-0.45, p < 0.001; thermal ablation HR 0.27, 95% CI 0.13-0.55, p < 0.001, after adjustment for age at diagnosis, tumor grade, and size). There was no significant difference in CSS comparing cryosurgery to thermal ablation (HR 1.03, 95% CI 0.45-2.3, p = 0.95, after adjustment for age at diagnosis, tumor grade, and size). These results proved robust upon sensitivity analyses: After adjustment for comorbidities with varying prevalence assumptions, the corrected hazard ratio (cHR) of cryosurgery versus deferred therapy ranged between HR 0.09 and 0.68. CONCLUSION: Local ablative techniques provide relevant survival benefit and are preferable alternatives over deferred therapy. Cryosurgery and thermal ablation yield comparable outcomes. LEVEL OF EVIDENCE: 2b according to the Oxford Centre for evidence-based medicine levels of evidence.


Asunto(s)
Carcinoma de Células Renales/cirugía , Ablación por Catéter/métodos , Criocirugía/métodos , Neoplasias Renales/cirugía , Anciano , Femenino , Humanos , Masculino , Modelos de Riesgos Proporcionales , Análisis de Supervivencia , Factores de Tiempo
17.
AJR Am J Roentgenol ; 209(6): 1390-1395, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28929808

RESUMEN

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.


Asunto(s)
Etanol/uso terapéutico , Geles/uso terapéutico , Soluciones Esclerosantes/uso terapéutico , Escleroterapia/métodos , Malformaciones Vasculares/terapia , Adolescente , Adulto , Niño , Medios de Contraste , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Resultado del Tratamiento , Malformaciones Vasculares/diagnóstico por imagen
18.
J Vasc Interv Radiol ; 28(6): 825-831, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28279585

RESUMEN

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.


Asunto(s)
Arterias Bronquiales , Embolización Terapéutica/métodos , Hemoptisis/terapia , Polivinilos/uso terapéutico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Femenino , Hemoptisis/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
19.
Eur J Radiol ; 88: 8-14, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28189213

RESUMEN

PURPOSE: The diagnostic yield of computed tomography angiography (CTA) compared to digital subtraction angiography (DSA) for major obscure gastrointestinal bleeding (OGIB) is not known. Aim of the study was to prospectively evaluate the diagnostic yield of CTA versus DSA for the diagnosis of major OGIB. MATERIAL AND METHODS: The institutional review board approved the study and informed consent was obtained from each patient. Patients with major OGIB were prospectively enrolled to undergo both CTA and DSA. Two blinded radiologists each reviewed the CTA and DSA images retrospectively and independently. Contrast material extravasation into the gastrointestinal lumen was considered diagnostic for active bleeding. Primary end point of the study was the diagnostic yield, defined as the frequency a technique identified an active bleeding or a potential bleeding lesion. The diagnostic yield of CTA and DSA were compared by McNemar's test. RESULTS: 24 consecutive patients (11 men; median age 64 years) were included. CTA and DSA identified an active bleeding or a potential bleeding lesion in 92% (22 of 24 patients; 95% CI 72%-99%) and 29% (7 of 24 patients; 95% CI 12%-49%) of patients, respectively (p<0.001). CTA and DSA identified an active bleeding in 42% (10 of 24; 95% CI 22%-63%) and 21% (5 of 24; 95% CI 7%-42%) of patients, respectively (p=0.06). CONCLUSION: Due to the lower invasiveness and higher diagnostic yield CTA should be favored over DSA for the diagnosis of major OGIB.


Asunto(s)
Angiografía de Substracción Digital/métodos , Angiografía por Tomografía Computarizada/métodos , Hemorragia Gastrointestinal/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Tracto Gastrointestinal/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad
20.
Eur Radiol ; 27(6): 2482-2488, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27699470

RESUMEN

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.


Asunto(s)
Etanol/administración & dosificación , Soluciones Esclerosantes/administración & dosificación , Escleroterapia/métodos , Malformaciones Vasculares/terapia , Actividades Cotidianas , Adolescente , Adulto , Niño , Femenino , Geles , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/prevención & control , Estudios Prospectivos , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto Joven
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