Incidence and evolution of venous thrombosis during the first 3 months after irreversible electroporation of malignant hepatic tumours.

The incidence and evolution of venous thrombosis adjacent to the ablation zone after percutaneous irreversible electroporation (IRE) were evaluated to identify potential risk factors in patients with hepatic malignancies. 205 venous structures (in 87 patients) within a ≤1.0 cm radius of the ablation zone were assessed after IRE of 112 hepatic lesions (74 primary, 38 secondary hepatic malignancies) by pre-interventional and post-interventional (1-3 days, 6 weeks and 3 months after IRE) contrast-enhanced magnetic resonance imaging. The relationships between venous thrombosis and clinical features were analysed using a binary logistic regression model. In 27 of 87 patients (31%), a total of 67 venous complications were noted during the 3 months follow-up. Thrombosis represented the most frequently observed complication (n = 47; 70.1%), followed by vessel narrowing (n = 20; 29.9%). 5 (10.6%) of 47 thromboses showed spontaneous regression 3 months after IRE. A small vessel diameter (p = 0.011) and post-interventional vessel narrowing (p = 0.006) were independently associated with delayed post-ablative thrombosis. Delayed venous thrombosis frequently occurs after IRE of hepatic malignancies. Pre-existing vessel narrowing and a small vessel diameter represent significant risk factors that require further surveillance and potentially therapeutic intervention.

Kidney Failure After Occlusion of Accessory Renal Arteries in Endovascular Abdominal Aneurysm Repair.

PURPOSE: To evaluate the incidence of acute renal failure and chronic kidney disease due to occlusion of accessory renal arteries during endovascular aneurysm repair of infrarenal abdominal aortic aneurysm. MATERIAL AND METHODS: We retrospectively reviewed the course of 181 patients (mean age, 71, SD ± 9  years) who underwent EVAR of infrarenal abdominal aortic aneurysm. The renal vessel anatomy was analyzed in all pre- and postoperative CT scans. Diameter and origin of accessory renal arteries were evaluated. Renal function was determined by pre- and postoperative serum creatinine and eGFR levels. Long-term follow-up (>3 months) of patients was available in 121 cases (66.9%). Acute kidney injury and chronic kidney failure were defined according to guidelines of "Kidney Disease: Improving Global Outcomes" (KDIGO). RESULTS: In 65 of 181 patients (33.9%), 82 accessory renal arteries were identified preoperatively. In 19 of 181 patients (10.5%), one or more accessory renal arteries were covered and subsequently occluded by the implanted stent-graft device. Neither acute kidney injury (10.3% vs 12.5%; p = .785) nor chronic kidney disease (10.7% vs 15.38%; p = .452) was detected significantly more often in patients with covered accessory renal artery. The only significant predictor of acute kidney injury was the preoperative serum creatinine level (1.12 mg/dl vs. 0.98 mg/dl; p = .03). Significant predictors for chronic kidney disease were preoperative serum creatinine, eGFR, and impaired renal function (p < .001). CONCLUSION: Coverage of accessory renal artery due to stent-graft does not lead either to temporary acute kidney injury after endovascular aneurysm repair or to chronic kidney disease. LEVEL OF EVIDENCE: Level II b.

Stereotactically navigated percutaneous microwave ablation (MWA) compared to conventional MWA: a matched pair analysis.

PURPOSE: To compare CT-navigated stereotactic microwave ablation (SMWA) to non-navigated conventional MWA (CMWA) for percutaneous ablation of liver malignancies. METHODS: A matched pair analysis of 36 patients who underwent MWA of primary or secondary liver malignancies (10 hepatocellular carcinoma and 8 metastases) was conducted. A total of 18 patients undergoing SMWA were included in this prospective study. Patients were matched in terms of tumor size, liver segment and entity to retrospective CMWA procedures. The endpoints were procedure time, accuracy of needle placement, technical success rate, complication rate and dose-length product (DLP). RESULTS: The procedure durations were 23.9 min (SD 3.7) for CMWA and 21.8 min (SD 16.3) for SMWA (p = 0.22). The procedural accuracy for SMWA and CMWA was identical for both groups (3.7 mm). The total DLP was significantly lower for SMWA than for CMWA (2115 mGy cm (SD 276) vs. 3109 mGy cm (SD 1137), respectively; p < 0.01). Complete ablation without residual tumor was observed in 94% (17 of 18) of SMWA and in 83% (15 of 18) of CMWA patients (p = 0.31). No complications occurred. CONCLUSIONS: SMWA is highly accurate and reduces the radiation dose without increasing the procedure time.

[Expert assessment of nursing care need according to SGB XL. Trigger for intervention programs in geriatric rehabilitation]. / Begutachtung von Pflegebedürftigkeit nach SGB XI. Weichenstellung für Interventionsprogramme der geriatrischen Rehabilitation.

"Rehabilitation instead of nursing care" is one of the most important entitlements of the social welfare legislation to long-term care. In Germany 1.2 million evaluations per year are done by the experts of the medical review boards of the health insurance funds. As a part of those evaluations the experts also have to discuss the necessity of any kind of rehabilitation procedures. In 1999 according to the experts' opinion only about 12% of the patients need such special support. At first this number seems much too low. We discuss the problems in that social field: Does the demand of the social welfare legislation "prevention and rehabilitation instead of nursing care" not correspond to the real needs or are the circumstances of social policy and medical supply responsible for that low recommendation of rehabilitation programs. This discussion leads to the following consequences: The patients, the members of their family but also the treating physicians must be informed much better than today about diagnostic and therapeutic possibilities for the special diseases of elderly people. All in the game have to prepare concepts, pilot projects and then common solutions for geriatric rehabilitation programs as soon as possible. Politicians, physicians, nursing staff, rehabilitation staff, patients, family members and any other caregivers all have to take responsibility, maybe the liability. Not only German people will be growing older than ever before, which everyone has to recognize as one of the most important facts of our welfare state. To handle this development will be the most serious duty of our community in the future. Therefore, geriatrics has to receive high public attention.