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1.
Semin Intervent Radiol ; 36(2): 137-141, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31123387

RESUMO

Percutaneous thermal ablation of hepatic tumors continues to play an integral role in the treatment of early-stage primary or secondary hepatic malignancies. Interventional radiologists must be familiar with potential complications of this procedure, associated risk factors, and methods for prevention. The authors report a devastating case of septic shock and death following percutaneous microwave ablation of a solitary hepatocellular carcinoma in a liver transplant patient with a bilioenteric anastomosis (BEA). We review the literature regarding prophylactic antibiotic regimens and bowel preparation prior to performing thermal ablation in patients with BEAs.

2.
J Am Coll Radiol ; 16(5S): S214-S226, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31054748

RESUMO

Venous thromboembolism (VTE)-deep vein thrombosis and pulmonary embolism-is a common cause of morbidity and mortality. The mainstay of VTE prophylaxis and therapy is anticoagulation. In select patients with VTE, inferior vena cava (IVC) filters are used to prevent pulmonary embolism by trapping emboli as they pass from the lower extremity venous system through the IVC. These guidelines review the indications for placement of IVC filters in acute and chronic VTE, as well as the indications for retrieval of implanted IVC filters. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

3.
Clin Neurol Neurosurg ; 179: 30-34, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30802675

RESUMO

OBJECTIVE: To assess inferior vena cava (IVC) filter retrieval rates and clinical outcomes in neurosurgical patients and to determine patient characteristics associated with filter retrieval. PATIENTS AND METHODS: This single-center retrospective study included 204 consecutive neurosurgical patients (120 men, 84 women; mean age 60 ± 13 years) who underwent retrievable IVC filter insertion between 1/2011-9/2013. Institutional IVC filter database review was used to identify demographic and clinical data, indication for IVC filtration, and IVC filter type. Patients were followed clinically by the neurosurgical, hematology, and interventional radiology services until removal or conversion to a permanent device. Measured outcomes included filter retrieval rates and parameters associated with device removal. RESULTS: The majority of filters were placed for venous thromboembolism (200/204, 98%). Of 204 filters, 38(19%) were retrieved at median 186 days post-placement (range 3-665 days), 112(55%) converted to permanent devices, 44(22%) patients were deceased, and 10(5%) patients were lost to follow-up after transfer to an outside healthcare facility. Patients with subarachnoid hemorrhage (18% vs. 35%, p = 0.025) and malignancy (5% vs. 25%, p = 0.009) were less likely to have filters removed. Filter type (p = 0.475), gender (p = 0.221), neurosurgical procedure (p = 0.639), and insurance status (p = 0.207) did not demonstrate a significant association with filter retrieval. CONCLUSION: IVC filter retrieval rates in neurosurgical patients are low despite tracking patients clinically in a multidisciplinary setting. Those neurosurgical patients with intracranial hemorrhage or malignancy requiring IVC filters have a lower likelihood of filter retrieval and may benefit from use of permanent devices.

4.
J Am Coll Radiol ; 15(5S): S104-S115, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29724414

RESUMO

Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or occlusion of previously treated vessels remains a pervasive issue in the postoperative setting. A variety of different imaging options are available to evaluate patients and are reviewed within the context of asymptomatic and symptomatic patients with PAD who have previously undergone endovascular or surgical revascularization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Extremidade Inferior/irrigação sanguínea , Doenças Vasculares Periféricas/diagnóstico por imagem , Doenças Vasculares Periféricas/cirurgia , Procedimentos Endovasculares , Medicina Baseada em Evidências , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Recidiva , Retratamento , Sociedades Médicas , Estados Unidos
5.
Abdom Radiol (NY) ; 43(1): 203-217, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29230556

RESUMO

Liver-directed therapy is a critical component of treatment strategies for hepatocellular carcinoma. These therapies included percutaneous image-guided ablation, transarterial chemoembolization, and transarterial radioembolization, and are administered by interventional radiologists. Depending on the stage of disease, a particular treatment modality, or a combination thereof, is expected to be most efficacious in achieving the goals of treatment for a particular patient. This article seeks to review the various liver-directed treatment modalities for treatment of hepatocellular carcinoma, with attention to their efficacy and patient selection criteria.


Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Braquiterapia/métodos , Carcinoma Hepatocelular/patologia , Ablação por Cateter/métodos , Quimioembolização Terapêutica/métodos , Humanos , Neoplasias Hepáticas/patologia , Estadiamento de Neoplasias , Seleção de Pacientes , Radiologia Intervencionista
6.
J Am Coll Radiol ; 14(11S): S506-S529, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29101989

RESUMO

Obtaining central venous access is one of the most commonly performed procedures in hospital settings. Multiple devices such as peripherally inserted central venous catheters, tunneled central venous catheters (eg, Hohn catheter, Hickman catheter, C. R. Bard, Inc, Salt Lake City UT), and implantable ports are available for this purpose. The device selected for central venous access depends on the clinical indication, duration of the treatment, and associated comorbidities. It is important for health care providers to familiarize themselves with the types of central venous catheters available, including information about their indications, contraindications, and potential complications, especially the management of catheters in the setting of catheter-related bloodstream infections. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Radiografia Intervencionista/métodos , Medicina Baseada em Evidências , Humanos , Sociedades Médicas , Estados Unidos
7.
J Am Coll Radiol ; 14(11S): S530-S539, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29101990

RESUMO

Iliac artery occlusive disease can present as a sudden-onset acute thrombotic or thromboembolic event or as a chronic progressive atherosclerotic process that presents as claudication progressing to rest pain. Depending on the clinical presentation, the diagnosis is usually confirmed through Doppler vascular ultrasound, CT angiography, or MR angiography; the choice of imaging is usually based on modality availability and the presence of patient comorbidities such as chronic kidney disease. The Trans-Atlantic Inter-Society Consensus II classification system is commonly used to describe the extent of the peripheral vascular disease. Depending on the pathophysiology, clinical presentation, and radiologic extent of the disease process, therapeutic options for acute thrombotic cases can include supportive care, anticoagulation, thrombolytic therapy, surgical or catheter-directed mechanical thrombectomy, and surgical bypass. Therapeutic options for atherosclerotic disease include supportive measures such as behavior modification, a supervised exercise program, adjunctive treatment with anticoagulation and antiplatelet medications, angioplasty, stent placement, stent-graft placement, surgical or catheter-directed endarterectomy or plaque excision, and surgical bypass. This document describes the appropriateness of imaging in this patient population, treatment procedures for specific clinical scenarios, and the likely prognosis for these patients. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Artéria Ilíaca , Medicina Baseada em Evidências , Humanos , Prognóstico , Sociedades Médicas , Estados Unidos
8.
J Am Coll Radiol ; 14(5S): S118-S126, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28473067

RESUMO

Chylothorax is an uncommon but serious medical condition, which arises when intestinal lymphatic fluid leaks into the pleural space. Treatment strategies depend on the daily output and underlying etiology, which may be due to direct injury to lymphatic vessels or a nontraumatic disorder. Chest radiographs confirm the presence of pleural fluid and lateralize the process. In the setting of direct injury, lymphangiography can often be both diagnostic and facilitate a minimally invasive attempt at therapy. CT and MRI in this setting may be appropriate for cases when lymphangiography is not diagnostic. When the etiology is nontraumatic or unknown, CT or MRI can narrow the differential diagnosis, and lymphangiography is useful if a minimally invasive approach to treatment is desired. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Quilotórax/diagnóstico por imagem , Quilotórax/terapia , Quilotórax/etiologia , Diagnóstico por Imagem/métodos , Humanos , Linfografia , Imagem por Ressonância Magnética , Radiografia Torácica , Radiologia , Sociedades Médicas , Tomografia Computadorizada por Raios X , Estados Unidos
9.
J Am Coll Radiol ; 14(5S): S266-S271, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28473083

RESUMO

Mesenteric vascular insufficiency is a serious medical condition that may lead to bowel infarction, morbidity, and mortality that may approach 50%. Recommended therapy for acute mesenteric ischemia includes aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting for the treatment of underlying arterial stenosis. Nonocclusive mesenteric ischemia may respond to transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1. Recommended therapy for chronic mesenteric ischemia includes angioplasty with or without stent placement and, if an endovascular approach is not possible, surgical bypass or endarterectomy. The diagnosis of median arcuate ligament syndrome is controversial, but surgical release may be appropriate depending on the clinical situation. Venous mesenteric ischemia may respond to systemic anticoagulation alone. Transhepatic or transjugular superior mesenteric vein catheterization and thrombolytic infusion can be offered depending on the severity of symptoms, condition of the patient, and response to systemic anticoagulation. Adjunct transjugular intrahepatic portosystemic shunt creation can be considered for outflow improvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/terapia , Angioplastia/métodos , Anticoagulantes/uso terapêutico , Endarterectomia , Medicina Baseada em Evidências , Humanos , Derivação Portossistêmica Transjugular Intra-Hepática , Radiologia , Sociedades Médicas , Stents , Estados Unidos , Vasodilatadores/uso terapêutico
10.
Radiology ; 282(1): 281-288, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27440733

RESUMO

Purpose To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods Retrospective data were analyzed from 606 patients (62% men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S. centers. Institutional review board exemptions were granted prior to the collection of data at each site. Overall survival was estimated by using Kaplan-Meier survival and univariate Cox proportional hazards models to examine the effect of LSF on survival and to compare this to other potential prognostic indicators. Multivariate analysis was also performed to determine whether LSF is an independent risk factor for poor survival. Results LSF higher than 10% was predictive of significantly decreased survival (median, 6.9 months vs 10.0 months; hazard ratio, 1.60; P < .001) and demonstrated a mild but significant correlation to serum carcinoembryonic antigen levels and tumor-to-liver volume ratio (Pearson correlation coefficients, 0.105 and 0.113, respectively; P < .05). A progressive decrease in survival was observed as LSF increased from less than 5% to more than 20% (P < .05). LSF did not correlate with the presence of extrahepatic metastases or prior administration of bevacizumab. Conclusion Increased LSF is an independent prognostic indicator of worse survival in patients undergoing radioembolization for liver-dominant metastatic colorectal adenocarcinoma. High LSF correlates poorly to other potential markers of tumor size, such as tumor-to-liver volume ratio or serum carcinoembryonic antigen level, and does not correlate to the presence of extrahepatic metastases. © RSNA, 2016 Online supplemental material is available for this article.


Assuntos
Adenocarcinoma/radioterapia , Fístula Arteriovenosa/complicações , Neoplasias Colorretais/radioterapia , Embolização Terapêutica/métodos , Radioisótopos de Ítrio/uso terapêutico , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adulto , Idoso , Angiografia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Feminino , Humanos , Fígado/irrigação sanguínea , Pulmão/irrigação sanguínea , Imagem por Ressonância Magnética , Masculino , Microesferas , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
BJR Case Rep ; 3(1): 20150439, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-30363307

RESUMO

Angiomyolipoma (AML) is the most common benign mesenchymal tumour of the kidney. Classically, AML can readily be diagnosed by identifying the negatively attenuating intratumoral macroscopic fat component on non-enhanced CT scans. However, intratumoral macroscopic fat may not be visible on CT scans, mimicking renal cell carcinoma. We report a case of renal AML with CT scan evidence of macroscopic intratumoral fat that was not readily visible on subsequent CT or MRI, presumably owing to a generalized rapid loss of adipose tissue due to cachexia in a patient with pancreatic adenocarcinoma. Radiologists should be aware that AML may lose its intratumoral fat on follow-up imaging and may simulate renal cell carcinoma.

12.
Tech Vasc Interv Radiol ; 19(3): 211-7, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27641455

RESUMO

Renal artery stenosis is a potentially reversible cause of hypertension, and transcatheter techniques are essential to its treatment. Angioplasty remains a first-line treatment for stenosis secondary to fibromuscular dysplasia. Renal artery stenting is commonly used in atherosclerotic renal artery stenosis, although recent trials have cast doubts upon its efficacy. Renal denervation is a promising procedure for the treatment of resistant hypertension, and in the future, its indications may expand.


Assuntos
Angioplastia , Ablação por Cateter , Hipertensão Renovascular/terapia , Rim/irrigação sanguínea , Radiografia Intervencionista/métodos , Obstrução da Artéria Renal/terapia , Artéria Renal/inervação , Simpatectomia/métodos , Idoso , Angiografia Digital , Angioplastia/efeitos adversos , Angioplastia/instrumentação , Pressão Sanguínea , Ablação por Cateter/efeitos adversos , Angiografia por Tomografia Computadorizada , Feminino , Displasia Fibromuscular/complicações , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/instrumentação , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/fisiopatologia , Fatores de Risco , Stents , Simpatectomia/efeitos adversos , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular
13.
Semin Intervent Radiol ; 33(2): 65-70, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27247472

RESUMO

Vena caval interruption, currently accomplished by percutaneous image-guided insertion of an inferior vena cava (IVC) filter, is an important therapeutic option in the management of selected patients with venous thromboembolism. The availability of optional (or retrievable) filters, in particular, has altered the practice patterns for IVC filters, with a shift to these devices and expansion of indications for filter placement. As new devices have become available and clinicians have become more familiar and comfortable with IVC filters, the indications for filter placement have continued to evolve and expand. This article reviews current guidelines and expanding indications for IVC filter placement.

14.
J Vasc Interv Radiol ; 27(8): 1148-53, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27052948

RESUMO

PURPOSE: To assess whether intravascular ultrasound (US) guidance impacts number of needle passes, contrast usage, radiation dose, and procedure time during creation of transjugular intrahepatic portosystemic shunts (TIPS). MATERIALS AND METHODS: Intravascular US-guided creation of TIPS in 40 patients was retrospectively compared with conventional TIPS in 49 patients between February 2010 and November 2015 at a single tertiary care institution. Patient sex and age, etiology of liver disease (hepatitis C virus, alcohol abuse, nonalcoholic steatohepatitis), severity of liver disease (mean Model for End-Stage Liver Disease score), and indications for TIPS (variceal bleeding, refractory ascites, refractory hydrothorax) in conventional and intravascular US-guided cases were recorded. RESULTS: The two groups were well matched by sex, age, etiology of liver disease, Child-Pugh class, Model for End-Stage Liver Disease scores, and indication for TIPS (P range = .19-.94). Fewer intrahepatic needle passes were required in intravascular US-guided TIPS creation compared with conventional TIPS (2 passes vs 6 passes, P < .01). Less iodinated contrast material was used in intravascular US cases (57 mL vs 140 mL, P < .01). Radiation exposure, as measured by cumulative dose, dose area product, and fluoroscopy time, was reduced with intravascular US (174 mGy vs 981 mGy, P < .01; 3,793 µGy * m(2) vs 21,414 µGy * m(2), P < .01; 19 min vs 34 min, P < .01). Procedure time was shortened with intravascular US (86 min vs 125 min, P < .01). CONCLUSIONS: Intravascular US guidance resulted in fewer intrahepatic needle passes, decreased contrast medium usage, decreased radiation dosage, and shortened procedure time in TIPS creation.


Assuntos
Hipertensão Portal/cirurgia , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática , Doses de Radiação , Radiografia Intervencionista , Ultrassonografia de Intervenção , Adulto , Idoso , California , Meios de Contraste/administração & dosagem , Fluoroscopia , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/etiologia , Hipertensão Portal/fisiopatologia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Pessoa de Meia-Idade , Agulhas , Duração da Cirurgia , Pressão na Veia Porta , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/instrumentação , Punções , Exposição à Radiação , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos
15.
AJR Am J Roentgenol ; 206(3): 645-54, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26901023

RESUMO

OBJECTIVE: The purpose of this study is to investigate the outcomes of conventional transarterial chemoembolization (TACE) treatment of hepatocellular carcinoma (HCC) in contemporary clinical practice. MATERIALS AND METHODS: In this single-institution retrospective study, 188 patients underwent conventional TACE for HCC between 2007 and 2013. Medical record and imaging review was used to collect baseline demographic and disease data, tumor response, time to progression (TTP), and progression-free survival (PFS) outcomes, as well as transplant-free survival, calculated from the time of the first conventional TACE treatment. Data were censored in April 2014. RESULTS: The study cohort included 140 men and 48 women (mean age, 60 years; Barcelona Clinic Liver Cancer [BCLC] stage 0 = 5%, BCLC stage A = 41%, BCLC stage B = 28%, BCLC stage C = 15%, and BCLC stage D = 11%) with 207 index tumors (mean size, 4.0 cm; 11% with portal vein invasion) treated with a mean of 1.6 selective (79%) or lobar (21%) conventional TACE sessions. Concurrent thermal ablation was performed for 19% of patients. Objective response rates included size response in 29% (World Health Organization) and 28% (Response Evaluation Criteria for Solid Tumors [RECIST]) of patients, and necrosis response in 79% (European Association for the Study of the Liver) and 70% (modified RECIST) of patients. Median local TTP, distant site TTP, local PFS, and other site PFS were 51.7, 11.2, 10.8, and 10.5 months. Eighteen percent of patients underwent liver transplantation; 48% of United Network for Organ Sharing stage T3 tumors were downstaged to stage T2. Transplant-free survival for the entire cohort was 16.8 months (not reached, 33.9, 16.0, 4.4, and 6.9 months for BCLC stages 0, A, B, C, and D, respectively). Postembolization syndrome requiring extended hospital stay or readmission occurred in only 6% of patients. CONCLUSION: Conventional TACE is effective and safe for HCC therapy and may confer a survival benefit. The current data are in line with reported conventional TACE outcomes, and the minor postembolization syndrome incidence supports the low morbidity of this approach.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Óleo Etiodado/administração & dosagem , Neoplasias Hepáticas/terapia , Idoso , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Estudos de Coortes , Feminino , Humanos , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento
16.
Radiol Clin North Am ; 53(5): 1077-88, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26321455

RESUMO

Locoregional therapies (LRTs) have proved valuable in the treatment of patients with cancer, most commonly in the liver. Accurate assessment of response to these therapies is crucial because objective response can be a surrogate of improved survival. Imaging plays an essential role in the objective evaluation of tumor response to most cancer therapies, including LRTs. Assessing imaging response to LRTs, however, can be challenging and is evolving. This article reviews the different criteria used to assess radiologic response to LRTs, with special attention to imaging assessment following treatment of hepatocellular carcinoma.


Assuntos
Carcinoma Hepatocelular/terapia , Diagnóstico por Imagem , Neoplasias Hepáticas/terapia , /métodos , Carcinoma Hepatocelular/patologia , Humanos , Neoplasias Hepáticas/patologia
17.
J Vasc Interv Radiol ; 26(10): 1444-53, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26239896

RESUMO

PURPOSE: To identify fundamental causes underlying recurrent variceal hemorrhage (VH) after transjugular intrahepatic portosystemic shunt (TIPS) to ascertain opportunities for improvement of TIPS-based management of VH and prevention of rebleeding. MATERIALS AND METHODS: This single-center retrospective study comprised 166 patients (male-to-female ratio 101:65; median age, 52 y; median Model for End-Stage Liver Disease score, 14) who had TIPS created for VH in 1998-2014. Medical record review was used to identify patients who had recurrent VH events, and root cause analysis allowed identification of the most probable causal factors. A 5-person interventional radiology physician group generated quality improvement (QI) recommendations for process changes to address causal factors, with consensus achieved using a modified Delphi method. RESULTS: Variceal rebleeding occurred after TIPS in 25 (15%) patients. The 1-, 3-, and 5-year variceal rebleeding incidence was 17%, 21%, and 21%, respectively. Variceal rebleeding was associated with high 90-day all-cause mortality incidence (10/25; 40%). Male sex (P = .018) and Model for End-Stage Liver Disease score (P = .009) were statistically associated with variceal rebleeding. The most common primary and secondary causes of recurrent VH were lack of or insufficient variceal embolization (64%). Other causal factors included TIPS stenosis or occlusion (28%) with recurrent portosystemic gradient (PSG) elevation (20%), severe coagulopathy (20%), inadequate portosystemic gradient reduction (12%), and TIPS underdilation (4%). To potentially address variceal rebleeding, 14 preventive QI recommendations were developed. CONCLUSIONS: Although recurrent VH rates after TIPS are not trivial, rebleeding may be related to addressable underlying causal factors. Further investigation may assess the efficacy of QI-based procedure methodologic enhancements in reducing rebleeding incidence after TIPS.


Assuntos
Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/cirurgia , Varizes Esofágicas e Gástricas/mortalidade , Hemorragia Gastrointestinal/mortalidade , Derivação Portossistêmica Transjugular Intra-Hepática/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Diagnóstico Diferencial , Varizes Esofágicas e Gástricas/prevenção & controle , Feminino , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Illinois/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Recidiva , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
18.
Ann Hepatol ; 14(3): 380-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25864219

RESUMO

UNLABELLED: BACKGROUND AND RATIONALE FOR THE STUDY: The Model for End Stage Liver Disease (MELD) score has not been derived and validated for the emergent transjugular intrahepatic portosystemic shunt (TIPS) population. We sought to identify predictive factors for survival among emergent TIPS patients, and to substantiate MELD for outcomes prognostication in this population. RESULTS: 101 patients with acute life threatening variceal hemorrhage underwent emergent TIPS (defined by failed endoscopic therapy for active bleeding, acute hemoglobin drop, ≥ 2-unit transfusion requirement, and/or vasopressor need) at between 1998-2013. Demographic, clinical, laboratory, and procedure parameters were analyzed for correlation with mortality using Cox proportional hazards regression to derive the prognostic value of MELD constituents. Area under receiver operator characteristic (AUROC) curves was used to assess the capability of MELD prediction of mortality. TIPS were created 119 ± 167 h after initial bleeding events. Hemodynamic success was achieved in 90%. Median final portosystemic pressure gradient was 8 mmHg. Variceal rebleeding incidence was 21%. The four original MELD components showed significant correlation with mortality on multivariate Cox regression: baseline bilirubin (regression coefficient 0.366), creatinine (0.621), international normalized ratio (1.111), and liver disease etiology (0.808), validating the MELD system for emergent cases. No other significant predictive parameters were identified. MELD was an excellent predictor of 90-day mortality in the emergent TIPS population (AUROC = 0.842, 95% CI 0.755-0.928). CONCLUSIONS: Based on independent derivation of prognostic constituents and confirmation of predictive accuracy, MELD is a valid and reliable metric for risk stratification and survival projection after emergent TIPS.


Assuntos
Emergências , Doença Hepática Terminal/mortalidade , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática , Doença Aguda , Doença Hepática Terminal/complicações , Varizes Esofágicas e Gástricas/complicações , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Illinois/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências
19.
Semin Intervent Radiol ; 32(1): 10-3, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25762841

RESUMO

Intranodal lymphangiography (IL) has supplanted pedal lymphangiography (PL) as an easier and more practical approach to opacifying lymphatic vessels for interventional radiologists treating refractory chyle leaks. As more interventional radiologists-many of who are not trained in or have not performed PL-incorporate IL into their practice, it is imperative that they be familiar with the risks of lymphangiography, including pulmonary and systemic embolization of oily contrast material. Herein, the authors report a devastating case of cerebral embolization of ethiodized oil following IL and review the literature regarding systemic embolization following lymphangiography.

20.
J Clin Imaging Sci ; 5: 5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25806140

RESUMO

Catheter-based interventions play an important role in the multidisciplinary management of renal pathology. The array of procedures available to interventional radiologists (IRs) includes established techniques such as angioplasty, stenting, embolization, thrombolysis, and thrombectomy for treatment of renovascular disease, as well as embolization of renal neoplasms and emerging therapies such as transcatheter renal artery sympathectomy for treatment of resistant hypertension. Here, we present an overview of these minimally invasive therapies, with an emphasis on interventional technique and clinical outcomes of the procedure.

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