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1.
Cardiovasc Intervent Radiol ; 42(11): 1530-1536, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31338552

RESUMO

PURPOSE: This retrospective study was conducted to compare the clinical outcomes of transcatheter arterial embolisation for chronic knee pain in patients with mild-to-moderate versus severe knee osteoarthritis. MATERIALS AND METHODS: This study included patients (n = 41) who were refractory to conservative treatments and who underwent transcatheter arterial embolisation using imipenem/cilastatin sodium between June 2017 and July 2018. A total of 71 knees, including 30 bilateral cases, were treated and categorised into two groups according to the Kellgren-Lawrence grade: mild-to-moderate osteoarthritis (n = 59, Kellgren-Lawrence grade 1-3) and severe osteoarthritis (n = 12, Kellgren-Lawrence grade 4). The clinical outcomes were measured by the visual analogue scale score. RESULTS: There were no significant differences in age, body mass index or baseline visual analogue scale scores between the two groups. The mean visual analogue scale scores in the mild-to-moderate osteoarthritis group were significantly decreased at 1 day, 1 week, 1 month, 3 months, and 6-months (5.5 at baseline vs. 3.2, 3.1, 2.9, 2.2, and 1.9, after treatment; all P = .00). These improvements were maintained at a mean of 10 ± 3 months (range 6-19 months) post-treatment. The visual analogue scale scores were significantly decreased in the severe osteoarthritis group for 1 month post-treatment (6.3 at baseline vs. 4.1, 4.1, and 4.4 at 1 day, 1 week, and 1 month; all P < .01). However, a decrease in pain was not statistically significant from 3 to 6 months (5.4 and 5.9 at 3 months and 6 months, respectively). CONCLUSION: Transcatheter arterial embolisation effectively relieved pain in patients with mild-to-moderate osteoarthritis. In patients with severe osteoarthritis, pain severity decreased for 1 month but gradually increased to the initial severity score within 3 months. LEVEL OF EVIDENCE: 4, Case series.


Assuntos
Artralgia/terapia , Dor Crônica/terapia , Embolização Terapêutica/métodos , Osteoartrite do Joelho/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/etiologia , Dor Crônica/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
2.
J Vasc Access ; 20(6): 725-732, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31094648

RESUMO

PURPOSE: To evaluate the technical and clinical results of endovascular recanalization of thrombosed native hemodialysis fistula and the factors influencing patency. METHODS: A retrospective study was conducted with 73 patients who had thrombosed arteriovenous fistulas and were treated with endovascular methods. Patient characteristics, arteriovenous fistula-related characteristics, and endovascular procedures were analyzed. Technical and clinical results and patency rates were evaluated. The factors influencing patency were analyzed using a univariate and multivariate Cox proportional hazards model. RESULTS: Technical and clinical success rates were 93% (68/73) and 85% (62/73), respectively. At 3, 6, and 12 months, the primary patency rates were 87.9%, 73.3%, and 64.8%; assisted primary patency rates were 89.2%, 78.6%, and 70.7%; and secondary patency rates were 90.8%, 87.2%, and 83.1%, respectively. Previous intervention and cephalic arch stenosis were risk factors for lower primary and assisted primary patency (p < 0.05 for all). Cephalic arch stenosis was the only risk factor for lower secondary patency (p < 0.05). No major complications associated with the procedures were noticed. CONCLUSION: Endovascular treatment was effective for the immediate recanalization of thrombosed arteriovenous fistula. In addition, previous intervention and cephalic arch stenosis were significantly related to lower arteriovenous fistula patency.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Procedimentos Endovasculares , Oclusão de Enxerto Vascular/terapia , Diálise Renal , Trombose/terapia , Grau de Desobstrução Vascular , Idoso , Procedimentos Endovasculares/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
3.
Ann Vasc Surg ; 58: 331-337, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769062

RESUMO

BACKGROUND: The aim of this study is to investigate the effect of preexisting calcification in the inflow artery on maturation and flow volume of an arteriovenous fistula (AVF). METHODS: Patients who underwent AVF creation for hemodialysis were prospectively recruited between March and November 2017. On preoperative duplex ultrasound, calcification in the arterial media within 5 cm of the planned anastomosis area was assessed. Clinical maturation was defined as the successful use of the fistula for ≥75% of the dialysis sessions during a month within 6 months after surgery. Radiological maturation was defined as a venous diameter of ≥0.4 cm and a flow volume of ≥500 mL/min. Flow volumes of the inflow artery and the cephalic vein were measured at 6 and 12 weeks after AVF creation. RESULTS: Eighteen patients with calcification and 29 patients without calcification were enrolled in this study. There was no significant difference in the clinical and radiological maturation between the groups. The flow volume of the inflow artery, measured at 6 weeks postoperatively, was significantly higher in the noncalcification group than in the calcification group (P = 0.042). The flow volume of the inflow artery in the noncalcification group was increased at 12 weeks postoperatively (P = 0.091). Flow volume of the vein was higher in the noncalcification group than in the calcification group, although it did not reach statistical significance. CONCLUSIONS: In conclusions, preexisting arterial calcification did not adversely affect the AVF maturation. However, arterial calcification correlated with the flow volume of the inflow artery of AVF.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Artéria Radial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Calcificação Vascular/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Calcificação Vascular/diagnóstico por imagem , Grau de Desobstrução Vascular
4.
J Hepatol ; 70(3): 412-422, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30389550

RESUMO

BACKGROUND & AIMS: Non-selective beta-blockers (NSBBs) are the mainstay of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. We investigated whether non-invasive markers of portal hypertension correlate with hemodynamic responses to NSBBs in cirrhotic patients with esophageal varices. METHODS: In this prospective cohort study, 106 cirrhotic patients with high-risk esophageal varices in the derivation cohort received carvedilol prophylaxis, and completed paired measurements of hepatic venous pressure gradient, liver stiffness (LS), and spleen stiffness (SS) at the beginning and end of dose titration. LS and SS were measured using acoustic radiation force impulse imaging. A prediction model for hemodynamic response was derived, and subject to an external validation in the validation cohort (63 patients). RESULTS: Hemodynamic response occurred in 59 patients (55.7%) in the derivation cohort, and in 33 patients (52.4%) in the validation cohort, respectively. Multivariate logistic regression analysis identified that ΔSS was the only significant predictor of hemodynamic response (odds ratio 0.039; 95% confidence interval 0.008-0.135; p <0.0001). The response prediction model (ModelΔSS = 0.0490-2.8345 × ΔSS; score = (exp[ModelΔSS])/(1 + exp[ModelΔSS]) showed good predictive performance (area under the receiver-operating characteristic curve [AUC] = 0.803) using 0.530 as the threshold value. The predictive performance of the ModelΔSS in the validation set improved using the same threshold value (AUC = 0.848). CONCLUSION: A new model based on dynamic changes in SS exhibited good performance in predicting hemodynamic response to NSBB prophylaxis in patients with high-risk esophageal varices. LAY SUMMARY: Non-selective beta-blockers are the mainstay of primary prophylaxis to prevent variceal bleeding in patients with cirrhosis and high-risk esophageal varices. This prospective study showed that a prediction model based on changes in spleen stiffness before vs. after dose titration might be a non-invasive marker for response to prophylactic non-selective beta-blocker (carvedilol) therapy in patients with cirrhosis and high-risk esophageal varices. ClinicalTrials.gov Identifier: NCT01943318.

5.
Ann Thorac Cardiovasc Surg ; 24(1): 43-46, 2018 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-29343674

RESUMO

Pseudoaneurysms are vascular spaces vulnerable to pressure, and expansion or rupture of these spaces may occur during embolization. Here, we describe the case of a transcatheter embolization of a spontaneous aortic pseudoaneurysm, which showed gradual expansion during n-butyl cyanoacrylate embolization. This pseudoaneurysm was successfully embolized with an adjuvant coil.


Assuntos
Falso Aneurisma/terapia , Aneurisma da Aorta Abdominal/terapia , Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Falso Aneurisma/diagnóstico por imagem , Angiografia Digital , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
6.
Acta Radiol ; 59(8): 932-938, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29065701

RESUMO

Background Identification of the source of postpartum hemorrhage (PPH) is important for embolization because PPH frequently originates from non-uterine arteries. Purpose To evaluate the clinical importance of identifying the non-uterine arteries causing the PPH and the results of their selective embolization. Material and Methods This retrospective study enrolled 59 patients who underwent embolization for PPH from June 2009 to July 2016. Angiographic findings and medical records were reviewed to determine whether non-uterine arteries contributed to PPH. Arteries showing extravasation or hypertrophy accompanying uterine hypervascular staining were regarded as sources of the PPH. The results of their embolization were analyzed. Results Of 59 patients, 19 (32.2%) underwent embolization of non-uterine arteries. These arteries were ovarian (n = 7), vaginal (n = 5), round ligament (n = 5), inferior epigastric (n = 3), cervical (n = 2), internal pudendal (n = 2), vesical (n = 1), and rectal (n = 1) arteries. The embolic materials used included n-butyl cyanoacrylate (n = 9), gelatin sponge particles (n = 8), gelatin sponge particles with microcoils (n = 1), and polyvinyl alcohol particles (n = 1). In 13 patients, bilateral uterine arterial embolization was performed. Re-embolization was performed in two patients with persistent bleeding. Hemostasis was achieved in 17 (89.5%) patients. Two patients underwent immediate hysterectomy due to persistent bleeding. One patient experienced a major complication due to pelvic organ ischemia. One patient underwent delayed hysterectomy for uterine infarction four months later. Conclusion Non-uterine arteries are major sources of PPH. Detection and selective embolization are important for successful hemostasis.


Assuntos
Embolização Terapêutica/métodos , Hemorragia Pós-Parto/terapia , Adulto , Angiografia , Artérias Epigástricas/diagnóstico por imagem , Artérias Epigástricas/fisiopatologia , Feminino , Genitália Feminina/irrigação sanguínea , Genitália Feminina/diagnóstico por imagem , Genitália Feminina/fisiopatologia , Humanos , Hemorragia Pós-Parto/diagnóstico por imagem , Nervo Pudendo/irrigação sanguínea , Nervo Pudendo/diagnóstico por imagem , Nervo Pudendo/fisiopatologia , Reto/irrigação sanguínea , Reto/diagnóstico por imagem , Reto/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Adulto Jovem
7.
Liver Int ; 38(2): 331-341, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28796410

RESUMO

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) includes a wide spectrum of heterogeneous metabolic subtypes. This study compared the diagnostic performances of noninvasive fibrosis tests in predicting advanced fibrosis among patients with NAFLD and examined the effects of the subgroups on their diagnostic performances. METHODS: Three hundred fifteen patients with biopsy-proven NAFLD were prospectively enrolled. Acoustic radiation force impulse imaging (ARFI) was performed to obtain liver stiffness measurements (LSMs). The aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis 4 index (FIB-4), NAFLD fibrosis score (NFS) and BARD score were calculated. The diagnostic performances of noninvasive fibrosis tests were evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS: Fibrosis 4 index (FIB-4) showed the highest AUROC for advanced fibrosis (0.866; 95% CI, 0.811-0.922). AUROC subgroup analyses were performed to assess the effects of the subgroups on diagnostic performance. For patients with advanced fibrosis, the APRI, BARD, FIB-4 and NFS AUROCs were significantly different among the radiological steatosis grades. Additionally, the AUROC of ARFI tended to decrease with increasing radiological steatosis severity. FIB-4 and NFS showed significantly lower AUROCs for advanced fibrosis in obese NAFLD than in nonobese NAFLD (P = .002 and P < .001 respectively). However, only radiological steatosis severity was independently associated with advanced fibrosis in multivariable analysis. CONCLUSIONS: Steatosis severity may affect the diagnostic performances of noninvasive fibrosis tests in patients with NAFLD. The application of different tools should be tailored for various NAFLD subgroups to optimize noninvasive fibrosis assessments.


Assuntos
Cirrose Hepática/diagnóstico , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Adulto , Idoso , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Biópsia , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/complicações , Contagem de Plaquetas , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
9.
Invest Radiol ; 52(2): 128-133, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27977466

RESUMO

OBJECTIVE: The aim of this study was to evaluate an extremely small pseudoparamagnetic iron oxide nanoparticle (ESPIO), KEG3, as a potential blood pool agent in 3 T coronary magnetic resonance angiography (MRA) in canine models and compare its efficacy to that of a gadolinium-based contrast agent. MATERIALS AND METHODS: Nine mongrel dogs were subjected to whole-heart coronary MRA in 2 separate sessions at 7-day intervals with a 3 T scanner using the FLASH sequence with either gadoterate meglumine (Gd-DOTA) or the ESPIO (KEG3). Coronary MRA was performed twice at each MR examination: the first scan during the administration of the contrast agent and the subsequent second scan at 15 minutes after contrast injection. Objective measurements of the Gd-DOTA and ESPIO images, including the signal-to-noise ratios (SNRs) for the coronary arteries and cardiac veins, contrast-to-noise ratios (CNRs) between the vessels and fat (CNRfat) and the vessels and the myocardium (CNRmyocardium), and subjective image quality scores on a 4-point scale were evaluated and compared. RESULTS: The mean SNRs and CNRs of all vascular regions in the ESPIO images were similar to those of the corresponding regions in the Gd-DOTA images in the first scan (98.1 ± 32.5 vs 79.1 ± 38.4 for SNR of coronary arteries, P = 0.3; 74.2 ± 30.1 vs 61.4 ± 38.5 for CNR, P = 0.7) and more than 2 times higher than the latter in the second scan (95.2 ± 31.3 vs 32.1 ± 8.1 for SNR of coronary arteries, P = 0.008; 76.1 ± 35.8 vs 17.6 ± 19.2 for CNR, P 0.008). Similarly, the mean values of the subjective measurements of the ESPIO images were similar to those of the Gd-DOTA images (3.9 ± 0.3 vs 3.3 ± 0.8 for coronary arteries, P = 0.1) in the first scan and significantly better than the latter in the second scan (3.9 ± 0.2 vs 2.1 ± 0.6 for coronary arteries, P = 0.007). CONCLUSIONS: The experimental blood pool agent KEG3 offers equivalent image quality for whole-heart coronary MRA at 3 T upon contrast administration and persistent better quality in the subsequent scans, compared with a traditional extracellular gadolinium-based contrast agent.


Assuntos
Meios de Contraste , Vasos Coronários/diagnóstico por imagem , Compostos Férricos , Aumento da Imagem/métodos , Angiografia por Ressonância Magnética/métodos , Meglumina , Compostos Organometálicos , Animais , Cães , Injeções Intravenosas , Modelos Animais , Nanopartículas , Razão Sinal-Ruído
11.
Korean J Radiol ; 16(2): 349-56, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25741197

RESUMO

OBJECTIVE: To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. MATERIALS AND METHODS: Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. RESULTS: The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. CONCLUSION: Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.


Assuntos
Aneurisma/cirurgia , Fístula Arteriovenosa/cirurgia , Trombectomia/métodos , Trombose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma/complicações , Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Constrição Patológica/complicações , Procedimentos Endovasculares , Falha de Equipamento , Feminino , Fibrinolíticos/uso terapêutico , Heparina/uso terapêutico , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Trombectomia/instrumentação , Trombose/etiologia , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Grau de Desobstrução Vascular , Veias
12.
Korean J Radiol ; 15(5): 622-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25246823

RESUMO

OBJECTIVE: We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. MATERIALS AND METHODS: Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly and evaluated microscopically. RESULTS: The animals were sacrificed at two (n = 3), six (n = 3), and eight months (n = 2) after endovascular repair. In two dogs, the aortic lumen was occluded at two months after the placement. On gross inspection of specimens from the other six dogs with a patent aortic lumen, stent grafts placed over the normal aortic wall were covered by glossy white neointima, whereas, stent grafts placed over the aneurysmal aortic wall were covered by brownish neointima. On microscopic inspection, stent grafts placed over the normal aortic wall were covered by thin neointima (0.27 ± 0.05 mm, mean ± standard deviation) with an endothelial layer, and stent grafts placed over the aneurysmal aortic wall were covered by thick neointima (0.62 ± 0.17 mm) without any endothelial lining. Transgraft cell migration at the normal aortic wall was more active than that at the aneurysmal aortic wall. CONCLUSION: Close contact between the stent and the graft, which was achieved with stent grafts with endo-exo-skeleton, could not enhance endothelial covering on the stent graft placed over the aneurysms.


Assuntos
Aneurisma da Aorta Abdominal/terapia , Stents , Animais , Aneurisma da Aorta Abdominal/patologia , Implante de Prótese Vascular , Modelos Animais de Doenças , Cães , Endotélio Vascular/citologia , Endotélio Vascular/patologia , Tomografia Computadorizada por Raios X
13.
Obstet Gynecol Sci ; 57(2): 168-71, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24678493

RESUMO

Vulvar hematomas are uncommon outside of the obstetric population and may be the result of trauma to the perineum. Vulvar hematomas most often present with low abdominal pain and urologic and neurologic symptoms. The vulva has rich vascularization that is supplied by the pudendal artery, a branch of the anterior division of the internal iliac artery. We describe a rare case of a 15-cm-sized vulvar hematoma with the suggested rupture of a pseudoaneurysm of the left pudendal artery without trauma injury. A 14-year-old girl presented with sudden pain and swelling in her left labium and was successfully treated with selective arterial embolization and surgical evacuation. We provide a literature review and discuss patient treatment and management strategies.

14.
Thromb Res ; 133(4): 538-43, 2014 04.
Artigo em Inglês | MEDLINE | ID: mdl-24448057

RESUMO

RATIONALE: The use of inferior vena cava (IVC) filters is associated with various complications. We aimed to elucidate the clinical course and predictive factors for complications of IVC filters, especially IVC penetration METHODS: A retrospective observational study was performed in 45 adult patients with retrievable IVC filters and follow-up computed tomography (CT) between January 2003 and December 2012. Primary outcomes were the prevalence and predictive factors of IVC penetration. Secondary outcome was other complications of IVC filters. RESULTS: IVC penetration following filter placement occurred in 87.6% of patients, and 57.8% of those involved significant penetration. Embedding of filter tips, suggestive of lateral tilting, was observed in 51.1%. Both Vertebral body erosions and aortic penetrations were seen in 4.4%, but they were asymptomatic. Longer indwelling duration of the IVC filter was significantly associated with a higher grade of IVC penetration, and the risk of significant IVC penetration increased in patients with the filter indwelling time of more than 20 days and an IVC diameter of less than 24.2mm. CONCLUSIONS: In patients with a retrievable IVC filter, IVC penetration on CT was common, and significant IVC penetration was associated with a longer indwelling time of the IVC filter and a lesser IVC diameter.


Assuntos
Embolia Pulmonar/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/lesões , Tromboembolia Venosa/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
15.
J Clin Gastroenterol ; 48(1): 66-72, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23751848

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) is an efficient and safe treatment modality for early-stage hepatocellular carcinoma (HCC). However, its application is sometimes limited by several topographical factors. Whether topographical characteristics are risk factors for local recurrence after RFA is still under debate. GOALS: The aims of this study were to identify topographical risk factors for the local recurrence of solitary HCC after RFA and to evaluate their impact on long-term treatment outcomes. METHODS: The clinical and radiologic findings of patients with solitary hepatitis B virus (HBV)-related HCC<4.0 cm undergoing RFA were retrospectively reviewed. The Cox regression model was used to identify risk factors that predicted local recurrence. RESULTS: A total of 300 patients with solitary, HBV-related HCC were included in this retrospective cohort study. Seventy patients (23.3%) experienced local recurrence after RFA during the median follow-up duration of 43.0 months (range, 3.0 to 69.0 mo). Multivariate analysis showed that tumor size ≥2.0 cm [hazard ratio (HR), 1.716; P=0.047], proximity to a large vessel (HR, 2.609; P=0.024), and proximity to the diaphragm (HR, 3.128; P=0.004) were independent predictors of the local recurrence of solitary HCC. Moreover, the cumulative risk of local recurrence after RFA increased with the number of risk factors. CONCLUSIONS: Proximity of HCC to a large vessel or the diaphragm as well as large tumor size may increase the risk of local recurrence after RFA. Therefore, the topographical factors of HCC should be considered to tailor therapeutic decisions for solitary, HBV-related HCC.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Hepatite B/complicações , Neoplasias Hepáticas/cirurgia , Idoso , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia , Modelos de Riscos Proporcionais , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco
16.
Tuberc Respir Dis (Seoul) ; 75(3): 120-4, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24101937

RESUMO

Herein, we report a case of multiple systemic arteries to pulmonary artery fistulas without any underlying causes, presenting recurrent hemoptysis. Transcatheter embolization was successfully performed several times on multiple systemic feeding arteries. Multiple systemic arteries to pulmonary fistulas can be a source of uncontrolled bleeding, and embolization may be a reasonable therapeutic option to control the bleeding.

17.
J Korean Med Sci ; 27(10): 1170-6, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23091313

RESUMO

We investigated tissue responses to endoskeleton stent grafts for saccular abdominal aortic aneurysms (AAAs) in canines. Saccular AAAs were made with Dacron patch in 8 dogs, and were excluded by endoskeleton stent grafts composed of nitinol stent and expanded polytetrafluoroethylene graft. Animals were sacrificed at 2 months (Group 1; n = 3) or 6 months (Group 2; n = 5) after the placement, respectively. The aortas embedding stent grafts were excised en bloc for gross inspection and sliced at 5 to 8 mm intervals for histopathologic evaluation. Stent grafts were patent in all except a dog showing a thrombotic occlusion in Group 2. In the 7 dogs with patent lumen, the graft overhanging the saccular aneurysm was covered by thick or thin thrombi with no endothelial layer, and the graft over the aortic wall was completely covered by neointima with an endothelial layer. Transgraft cell migration was less active at an aneurysm than at adjacent normal aorta. In conclusion, endoskeleton stent grafts over saccular aneurysms show no endothelial coverage and poor transgraft cell migration in a canine model.


Assuntos
Aneurisma da Aorta Abdominal/patologia , Stents , Ligas/química , Angiografia , Animais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Movimento Celular , Modelos Animais de Doenças , Cães , Células Endoteliais/citologia , Neointima/etiologia , Politetrafluoretileno/química , Trombose/etiologia , Tomografia Computadorizada por Raios X , Ultrassonografia
18.
Korean J Radiol ; 13(1): 73-81, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22247639

RESUMO

OBJECTIVE: The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. MATERIALS AND METHODS: We reviewed the records of 10 patients (3%; M:F = 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. RESULTS: Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; ± 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. CONCLUSION: Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.


Assuntos
Doenças Biliares/cirurgia , Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Esfinterotomia Endoscópica , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Doenças Biliares/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
19.
J Comput Assist Tomogr ; 35(5): 544-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21926846

RESUMO

OBJECTIVE: The objective of the study was to analyze computed tomography (CT) appearance and clinical features of adjacent-organ injuries related to expanded polytetrafluoroethylene (ePTFE) grafts after living-donor liver transplantation (LDLT). METHODS: We evaluated follow-up CT images of 204 patients who underwent venoplasty with ePTFE during LDLT and encountered 4 patients (1.96%) with adjacent-organ injuries related to ePTFE. Clinical imaging records were reviewed in terms of imaging findings and possible risk factors. RESULTS: In 3 patients, ePTFE graft perforated gastric antrum or duodenal bulb; in another patient, the common bile duct was injured. The mean interval between transplantation and identification of injury was 30 months. In patients with adjacent-organ injuries, biliary or perihepatic interventional treatments, adhesion of bowel and early occlusion of ePTFE grafts were commonly observed. CONCLUSIONS: Adjacent-organ injuries by ePTFE graft after LDLT were rare but present. Interventional procedures, adhesion of the bowel wall and early occlusion of the grafts were possible risk factors.


Assuntos
Prótese Vascular/efeitos adversos , Ducto Colédoco/lesões , Duodeno/lesões , Veias Hepáticas/cirurgia , Transplante de Fígado , Politetrafluoretileno/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Estômago/lesões , Tomografia Computadorizada por Raios X/métodos , Idoso , Ducto Colédoco/diagnóstico por imagem , Duodeno/diagnóstico por imagem , Seguimentos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estômago/diagnóstico por imagem , Aderências Teciduais/diagnóstico por imagem
20.
Acad Radiol ; 18(4): 471-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21237678

RESUMO

RATIONALE AND OBJECTIVES: In spite of various therapies developed, hepatocellular carcinoma still shows poor prognosis. In this study, we introduced ethylbromopyruvate (EBrP), a hydrophobic derivative of 3-bromopyruvate, as an agent for intraarterial therapy of hepatocellular carcinoma. MATERIALS AND METHODS: In in vitro study, we evaluated whether EBrP induced apoptotic cell death in Huh-BAT cells. Chemical degradation products of EBrP were identified by performing proton nuclear magnetic resonance spectroscopy and thin layer chromatography. VX2 carcinoma was implanted and grown in the liver of 25 rabbits for in vivo study. By transfemoral intraarterial approach, 0.4 mL of 10 mM and 40 mM EBrP dissolved in an iodized oil (Lipiodol) was infused into the proper hepatic artery in 8 and 10 rabbits, respectively. In the remaining seven rabbits, 0.4 mL of Lipiodol alone was intraarterially injected as a control. One week later, tumor necrosis rate was calculated with histopathologic examination and hepatotoxicity was evaluated with biochemical analysis. RESULTS: EBrP induced apoptosis in human HCC cells via mitochondrial apoptotic signaling cascades. EBrP dissociated into 3-bromopyruvate and ethanol in the aqueous environment. In VX2 liver tumor models, the group of intraarterial delivery of 40 mM EBrP/Lipiodol solution showed higher tumor necrosis rates (96.1% ± 3.8) than the other groups (38.9% ± 15.9 of a control, 90.5% ± 2.9 in 10 mM) (P < .05). There was transient elevation of AST and ALT enzyme levels without any mortality. CONCLUSIONS: Intraarterial infusion of EBrP/Lipiodol solution is a feasible intraarterial therapy for liver tumors with potent antitumor effects and transient hepatotoxicity.


Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Óleo Iodado/química , Neoplasias Hepáticas/terapia , Piruvatos/química , Piruvatos/uso terapêutico , Animais , Linhagem Celular Tumoral , Portadores de Fármacos/química , Hemostáticos/química , Hemostáticos/uso terapêutico , Humanos , Injeções Intra-Arteriais , Coelhos , Resultado do Tratamento
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