共查询到20条相似文献，搜索用时 31 毫秒
1.
Joseph D. Morrison Nasya Mendoza-Elias Andrew J. Lipnik R. Peter Lokken James T. Bui Charles E. Ray Ron C. Gaba 《Journal of vascular and interventional radiology : JVIR》2018,29(5):636-641
Purpose
To quantify and compare portosystemic pressure gradients (PSGs) between bleeding esophageal varices (EV) and gastric varices (GV).Materials and Methods
In a single-center, retrospective study, 149 patients with variceal bleeding (90 men, 59 women, mean age 52 y) with EV (n = 69; 46%) or GV (n = 80; 54%) were selected from 320 consecutive patients who underwent successful transjugular intrahepatic portosystemic shunt (TIPS) creation from 1998 to 2016. GV were subcategorized using the Sarin classification as gastroesophageal varices (GEV) (n = 57) or isolated gastric varices (IGV) (n = 23). PSG before TIPS was measured from the main portal vein to the right atrium. PSGs were compared across EV, GEV, and IGV groups using 1-way analysis of variance.Results
Overall mean baseline PSG was 21 mm Hg ± 6. PSG was significantly higher in patients with EV versus GV (23 mm Hg vs 19 mm Hg; P < .001). Mean PSG was highest among EV (23 mm Hg) with lower PSGs identified for GEV (20 mm Hg) and IGV (16 mm Hg); this difference was statistically significant (P < .001). Among 95 acute bleeding cases, a similar pattern was evident (EV 23 mm Hg vs GEV mm Hg 20 vs IGV 17 mm Hg; P < .001). At baseline PSG < 12 mm Hg, 13% (3/23) of IGV bled versus 9% (5/57) of GEV and 3% (2/69) of EVs (P = .169). Mean final PSG after TIPS was 8 mm Hg (IGV 6 mm Hg vs EV and GEV 8 mm Hg; P = .005).Conclusions
GV bleed at lower PSGs than EV. EV, GEV, and IGV bleeding is associated with successively lower PSGs. These findings highlight distinct physiology, anatomy, and behavior of GV compared with EV. 相似文献2.
Rany Jawhari Olivier Chevallier Nicolas Falvo Philippe d’Athis Sophie Gehin Pierre-Emmanuel Charles Marco Midulla Romaric Loffroy 《Journal of vascular and interventional radiology : JVIR》2018,29(2):210-217
Purpose
To assess the efficacy and safety of n-butyl cyanoacrylate methacryloxy sulfolane (NBCA-MS) transcatheter arterial embolization for anticoagulation-related soft-tissue bleeding and to evaluate predictive factors of clinical success and 30-day mortality.Materials and Methods
A retrospective review of 50 anticoagulated patients (25 male; mean age, 71.7 y ± 14.2; range, 19–87 y) who underwent emergent Glubran 2 NBCA-MS embolization for iliopsoas hematomas (IPHs; n = 38), rectus sheath hematomas (n = 11), or both (n = 1) between 2011 and 2016 was performed. Inclusion criteria were active bleeding on computed tomography (CT) and anticoagulation. The mean number of red blood cell (RBC) units transfused was 4.8 ± 3.2 (range, 0–14), median hemoglobin level before embolization was 9.7 g/dL (range, 6.2–18 g/dL), and median “mean blood pressure” (MBP) was 62.5 mm Hg (range, 58.3–75 mm Hg). Mean International Normalized Ratio before intervention was 2.5 ± 1.5 (range, 1.0–6.9). Angiograms revealed extravasation in 44 of 50 patients (88%). Mean hematoma volume was 1,119.2 cm3 ± 863.5 (range, 134.0–3,589.0 cm3).Results
Technical success was achieved in 100% of patients, and 30-day clinical success was achieved in 66% of patients. Recurrent bleeding and mortality rates within 30 days of embolization were 34% and 44%, respectively. No complications related to the embolization procedure occurred. Lower MBP (P = .003), greater number of RBC units transfused (P = .003), greater volume of hematoma (P = .04), and IPH location (P = .02) were associated with decreased clinical success. Clinical failure (P = .00002), lower MBP (P = .004), greater number of RBC units transfused (P = .002), and IPH location (P = .01) were significantly associated with higher 30-day mortality rates.Conclusions
Transcatheter arterial embolization with NBCA-MS is safe and effective in treating refractory soft-tissue bleeding in anticoagulated patients despite the high mortality rates associated with this patient population. 相似文献3.
Juan José Ciampi-Dopazo Juan María Romeu-Prieto Marcelino Sánchez-Casado Beatriz Romerosa Alfonso Canabal María Luisa Rodríguez-Blanco Carlos Lanciego 《Journal of vascular and interventional radiology : JVIR》2018,29(1):101-106
Purpose
To evaluate the feasibility of aspiration thrombectomy in patients with acute massive or submassive pulmonary embolism (PE).Materials and Methods
This prospective study analyzed patient demographic data, procedural details, and outcomes in 18 consecutive patients (8 men and 10 women; mean age, 60.1 y; range, 36–80 y), 10 with acute submassive PE and 8 with massive PE, treated with an Indigo Continuous Aspiration Mechanical Thrombectomy Catheter between January 2016 and February 2017. Three patients underwent concomitant systemic fibrinolytic treatment with 100 mg tissue plasminogen activator. Technical success was defined as successful placement of devices and initiation of aspiration thrombectomy. Clinical success was defined as stabilization of hemodynamic parameters; improvement in pulmonary hypertension, right heart strain, or both; and survival to hospital discharge. Complications were also analyzed.Results
The procedure was considered a technical success in 17 patients (94.4%) and a clinical success in 15 (83.3%). Echocardiography showed significant improvements in right ventricle size (46.36 mm ± 2.2 before treatment vs 41.79 mm ± 7.4 after; P = .041), tricuspid annular plane systolic excursion (16 ± 3 before treatment vs 18.57 ± 3.9 after; P = .011), and systolic wave (10 ± 2.1 before treatment vs 13.1 ± 3.8 after; P = .020). Two patients died of massive PE, and 1 died of submassive PE. Two patients who received systemic fibrinolytic agents experienced intracranial bleeding, and abdominal bleeding developed in 1.Conclusions
Aspiration thrombectomy is a feasible option for the treatment of acute massive or submassive PE in patients with hemodynamic compromise or right ventricular dysfunction. 相似文献4.
Qian Li Xueying Lin Xi Zhang Anthony E. Samir Ronald S. Arellano 《Journal of vascular and interventional radiology : JVIR》2019,30(1):87-94
Purpose
To evaluate imaging-related hemorrhagic risk factors for ultrasound (US)-guided native kidney biopsy.Materials and Methods
A retrospective review was conducted of adult patients who underwent US-guided native kidney biopsy at a single center between January 2006 and March 2016 and identified 37 of 551 patients (6.72%) with postbiopsy bleeding complications, including 11 major complications (2.00%; n = 11) and 26 minor complications (4.72%; n = 26). Ten patients with major complications and 20 with minor complications were matched with 20 control subjects each by propensity score matching based on age, needle size, number of cores, blood pressure, partial thromboplastin time, prothrombin time, platelet count, and estimated glomerular filtration rate.Results
Biopsy needle passing through the renal sinus was identified in the patients with major (6 of 10; 60%) and minor complications (8 of 20; 40.0%) but not in the control groups. For patients with major complications, the needle–sinus distance was significantly shorter (5.11 mm ± 7.32 vs 11.14 mm ± 3.54; P = .023) and the needle–capsule distance was significantly longer (17.52 mm ± 8.04 vs 9.28 mm ± 3.29; P = .0004) than in control subjects. The bimodal distribution of cortical tangential angles (< 30° or ≥ 60°) in minor complication cases (17 of 20; 85.0%) was significantly greater than in the control group (8 of 20; 40.0%; odds ratio = 8.50; P = .004).Conclusions
This study identifies imaging risk factors in US-guided native kidney biopsy and recommends an algorithm to manage them, including appropriate needle path position between the renal capsule and sinus and proper needle cortical tangential angle. 相似文献5.
Saebeom Hur Hwan Jun Jae Hyukjoon Lee Myungsu Lee Hyo-Cheol Kim Jin Wook Chung 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1673-1680
Purpose
To evaluate 30-day safety and efficacy of superselective embolization for arterial upper gastrointestinal bleeding (UGIB) using N-butyl cyanoacrylate (NBCA).Materials and Methods
This single-center retrospective 10-year study included 152 consecutive patients with UGIB (gastric, n = 74; duodenal, n = 78) who underwent embolization with NBCA for angiographically positive arterial bleeding. The primary endpoint was clinical success rate defined as achievement of hemostasis without rebleeding or UGIB-related mortality within 30 days after embolization. Mean systolic blood pressure and heart rate were 121.2 mm Hg ± 27.4 and 97.9 beats/minute ± 22.5; 31.1% of patients needed intravenous inotropes, and 36.6% had coagulopathy. The etiology of bleeding was ulcer (80.3%) or iatrogenic injury (19.7%). Statistical analysis was performed to identify predictive factors for outcomes.Results
Technical success rate was 100%. Clinical success, 1-month mortality, and major complication rates were 70.4%, 22.4%, and 0.7%. There were significant differences in the clinical success rates between gastric and duodenal bleeding (79.4% vs 62.2%; P = .025). The need for intravenous inotropes at the time of embolization was a significant negative predictive factor in both gastric (odds ratio [OR] = 0.091, P = .004) and duodenal (OR = 0.156, P = .002) bleeding. The use of a microcatheter with a smaller tip (2 F) was associated with better outcomes in duodenal bleeding (OR = 7.389, P = .005).Conclusions
Superselective embolization using NBCA is safe and effective for angiographically positive arterial UGIB. 相似文献6.
Eliel Ben-David Moran Shochat Ido Roth Isaac Nissenbaum Jacob Sosna S. Nahum Goldberg 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1440-1446
Purpose
To assess overall targeting accuracy for CT-guided needle insertion using prototype robotic system for common target sites.Materials and Methods
Using CT guidance, metallic (2 × 1 mm) targets were embedded in retroperitoneum (n = 8), kidneys (n = 8), and liver (n = 14) of 8 Yorkshire pigs (55–65 kg). Bronchial bifurcations were targeted in the lung (n = 13). CT datasets were obtained for planning and controlled needle placement of commercially available 17- to 19-gauge needles (length 15–20 cm) using a small, patient-mounted, CT-guided robotic system with 5° of motion. Mean distance to target was 92.9 mm ± 19.7 (range, 64–146 mm). Planning included selection of target, skin entry point, and 4.6 ± 1.3 predetermined checkpoints (range, 2–9) where additional CT imaging was performed to permit stepwise correction of needle trajectory path as needed. Scanning and needle advancement were coordinated with breath motion using respiratory gating. Accuracy was assessed as distance from needle tip to predefined target.Results
Of 45 needle insertions performed, 2 were unsuccessful owing to technical issues. Accuracy of targeting was 1.2–1.4 mm ± 0.6 for kidney, retroperitoneum, and lung (P = .51), with 2.9 mm ± 1.9 accuracy for liver (P = .0003). This was achieved in 39 cases (91%) using a single insertion. Intraprocedural target movement was detected (3.5 mm ± 2.1 in retroperitoneum and 6.4 mm ± 3.9 in liver); the system compensated for 52.9% ± 30.3 of this movement. One pneumothorax was the only complication (8%).Conclusions
Accurate needle insertion (< 3 mm error) can be achieved in common target sites when using a CT-guided robotic system. Stepwise checks with corrective angulation can potentially overcome issues of target movement during a procedure from organ deformity and other causes. 相似文献7.
Geert Maleux Tom Matton Annouschka Laenen Lawrence Bonne Sandra Cornelissen Lieven Dupont 《Journal of vascular and interventional radiology : JVIR》2018,29(4):502-509
Purpose
To assess safety, efficacy, and long-term outcome of repeat bronchial artery embolization (BAE) for recurrent hemoptysis.Materials and Methods
This was a retrospective study of patients referred for repeat BAE to manage recurrent hemoptysis after initial successful embolization. BAE was performed in 223 patients; 36 (16.1%) of these patients underwent 59 repeat BAE procedures because of recurring symptoms. The most frequent underlying lung diseases were bronchiectasis (n = 8; 22%), cystic fibrosis (n = 7; 19%), and idiopathic hemoptysis (n = 7; 19%).Results
Most patients (64%) underwent 2 embolization procedures owing to vessel recanalization (71%) as the most frequent pathophysiologic mechanism of recurrent hemoptysis. No serious adverse events requiring prolonged hospital stay were noted. Risk for relapse of hemoptysis was significantly lower for bronchiectasis compared with other chronic infections (P = .0022) and cystic fibrosis (P = .0004). Overall survival after 3-year and 5-year follow-up was 92% and 84%, respectively.Conclusions
Repeat BAE for recurrent hemoptysis after initial successful BAE is safe and efficacious, especially in patients with bronchiectasis as the underlying lung disease. 相似文献8.
Jung-Hoon Park Woo Seok Kang Kun Yung Kim Byung-Chul Kang Jun Woo Park Min Tae Kim Nadar G. Bekheet Seung Jun Hwang Joonmyeong Choi Kyu-Jin Cho Hong Ju Park Ho-Young Song 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1187-1193
Purpose
To investigate the technical feasibility of stent placement in the cartilaginous portion of the Eustachian tube (ET).Materials and Methods
Twelve ETs of 6 cadavers were used. Two different-sized stents were placed on either the right (2.5 mm in diameter) or left (3.5 mm in diameter) side of the ET. The procedural feasibility was assessed by subtraction Eustachian tubography, computed tomography before and after the procedure, and fluoroscopic and endoscopic images. The stent location, inner luminal diameter of the stented ET, radiation dose, procedural time, and fluoroscopy time were analyzed.Results
Stent placement was successful in 11 of 12 cadaveric specimens without procedure-related complications. In the 1 specimen, the balloon catheter with crimped stent was passed into the bony canal of the ET without any resistance. The distal end of the stent was located in the middle ear cavity. Stents were located within the cartilaginous portion of the ET (n = 1), the proximal tip bridging the nasopharyngeal orifice of the ET (n = 5), or the proximal end of the stent protruded from the tubal orifice (n = 5). The mean luminal diameter in the outer segment was significantly smaller than in the middle (P < .001) and inner (P < .001) segments. The mean procedure time was 128 ± 37 seconds. The mean radiation dose and fluoroscopy time of each cadaver were 3235.4 ± 864.8 cGy/cm2 and 139 ± 49 seconds, respectively.Conclusions
Stent placement of the ET under endoscopic and fluoroscopic guidance is technically feasible in a human cadaver model. 相似文献9.
Hui Gu Yang Gao Haiping Wang Zhennan Li Liang Xu Bo Xu Ximing Wang Bin Lu 《Journal of Cardiovascular Computed Tomography》2017,11(2):105-110
Background
To compare the difference of coronary diameter stenosis by quantitative analysis of CT angiography (QCT) in the systolic (QCT-S) and diastolic phase (QCT-D) of the cardiac cycle, with invasive catheter angiography (QCA) as reference standard.Methods
A total of 109 patients (57.5 ± 10.6 years, 78.9% male) with suspected coronary artery disease (CAD) who underwent both CT angiography and invasive catheter angiography were retrospectively included in this study. Coronary diameter stenoses in systolic and diastolic coronary CTA reconstructions were compared with QCA.Results
Mean time interval between CT angiography and invasive angiography was 17.4 ± 4.4 days. QCT-D overestimated coronary diameter stenosis by 5.7%–8.5% while QCT-S overestimated coronary diameter stenosis by 9.4%–11.9% (p < 0.05). In calcified lesions, QCT-D overestimated coronary diameter stenosis by 13.2 ± 4.3%, while QCT-S overestimated by stenosis by 16.6 ± 4.3% (p < 0.05).Conclusions
Coronary diameter stenosis was overestimated by QCT-D as well as QCT-S, respectively, when compared with QCA. Overestimation was more pronounced in calcified lesions. 相似文献10.
Geert Maleux Ward Vander Mijnsbrugge Denis Henroteaux Annouschka Laenen Sandra Cornelissen Kathleen Claes Inge Fourneau Nicolas Verbeeck 《Journal of vascular and interventional radiology : JVIR》2018,29(4):470-475.e3
Purpose
To investigate the potential added value of paclitaxel-coated balloon (PCB) angioplasty to reduce fistula dysfunction related to recurrent stenoses in patients undergoing hemodialysis.Materials and Methods
A prospective, randomized study was conducted in 3 dialysis referral centers. From January 2013 to October 2015, 64 patients (22 female, 42 male) with dysfunctional autologous dialysis fistulae were randomized to undergo conventional percutaneous balloon angioplasty (n = 31) or PCB angioplasty (n = 33). Procedural and postprocedural data were assessed. Primary patency of the fistula was evaluated at 3, 6, and 12 months following the procedure. Statistical analysis was based on the Fisher exact test and independent t test.Results
There were no procedural or postprocedural complications. After 3, 6, and 12 months of follow-up, primary patency rates after PCB angioplasty and percutaneous transluminal angioplasty (PTA) were 88% and 80% (P = .43), 67% and 65% (P = .76), and 42% and 39% (P = .95), respectively.Conclusions
Although primary patency rates after PCB angioplasty in autologous dialysis fistulae at 3, 6, and 12 months of follow-up are slightly better than those after PTA, the difference is not statistically significant. 相似文献11.
Shunqing Zhang Katsuhiro Kobayashi Masoud Faridnia Philip Skummer Dianbo Zhang Mitchel I. Karmel 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1148-1155
Purpose
To identify clinical predictors of port infections in adult patients with hematologic malignancies.Materials and Methods
A retrospective chart review identified 223 adult patients (age ≥ 18 y) with hematologic malignancies, including lymphoma (n = 163), leukemia (n = 49), and others (n = 11), who had a port placed from 2012 to 2015. Early (< 30 d after port placement) and overall port infections (bloodstream and site infections) were recorded. To elucidate clinical predictors for early and overall port infections, proportional subdistribution hazard regression (PSHREG) analyses were conducted with variables including patients’ demographics, medications used, laboratory data, and port characteristics.Results
Total duration of follow-up was 83,722 catheter-days (median per patient, 274 catheter-days). Early and overall port infections were identified in 8 (3.6%) and 26 (11.7%) patients, respectively. Early and overall infection rates were 1.2 and 0.3 infections/1,000 catheter-days, respectively. Backward stepwise multivariate PSHREG analyses identified hypoalbuminemia (< 3.5 mg/dL) at the time of port placement (hazard ratio = 5.03; 95% confidence interval, 1.14–22.16; P = .03) and steroid use (> 30 d cumulatively during follow-up period) (hazard ratio = 3.41; 95% confidence interval, 1.55–7.47; P = .002) as independent risk factors for early and overall port infections, respectively.Conclusions
In adult patients with hematologic malignancies, hypoalbuminemia at the time of port placement was a clinical predictor for early port infections, whereas steroid use was a clinical predictor for overall port infections. 相似文献12.
Zi-Han Zhang Wen Zhang Jun-Ying Gu Qing-Xin Liu Jing-Qin Ma Ling-Xiao Liu Jian-Hua Wang Jian-Jun Luo Zhi-Ping Yan 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1085-1093
Purpose
To evaluate the safety and efficacy of iodine-125 (125I) seed strand implantation in combination with transarterial chemoembolization for the treatment of hepatitis B–related unresectable hepatocellular carcinoma (HCC) with portal vein invasion.Materials and Methods
From January 2013 to June 2016, 76 HCC patients with type II tumor thrombus were included in this single-center retrospective study. Twenty patients underwent 125I seed strand implantation combined with transarterial chemoembolization (group A; n = 20), while 56 patients underwent transarterial chemoembolization alone (group B; n = 56). The procedure-related and radiation complications were assessed. Overall survivals were compared by propensity-score analysis.Results
The technique was successfully performed in all patients. The mean intended dose (r = 10 mm; z = 0; 240 days) was 62.6 ± 1.8 Gy. No grade 3 or 4 adverse events related to the procedure occurred in either group. After propensity-score-matching analysis, 19 patients were selected into each group, respectively. In the propensity-matching cohort, the median overall survival time was significantly longer in group A than in the group B (19 pairs; 28.0 ± 2.4 vs 8.7 ± 0.4 mo; P = .001). Treatment strategy, arterioportal shunt, and number of transarterial chemoembolization sessions were significant predictors of favorable overall survival time.Conclusions
125I seed strand implantation combined with transarterial chemoembolization is a safe and effective treatment for HCC patients with portal vein invasion. 相似文献13.
Hyukjoon Lee Chang Jin Yoon Nak Jong Seong Chang Ho Jeon Ho Il Yoon Joongseok Go 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1161-1166
Purpose
To describe angiographic findings and assess safety and effectiveness of bronchial artery embolization (BAE) with N-butyl cyanoacrylate (NBCA) in patients with cryptogenic hemoptysis (CH).Materials and Methods
Between May 2003 and March 2014, 26 patients who underwent BAE for CH were enrolled. A retrospective review was conducted for angiographic findings and clinical outcomes of BAE, including technical and clinical success, complications, and recurrent hemoptysis.Results
Selective arteriograms were abnormal in 22 patients (85%), showing hypertrophied bronchial arteries (n = 19), parenchymal hypervascularity (n = 18), and bronchial-to-pulmonary shunting (n = 8). All abnormal bronchial and nonbronchial collateral arteries (n = 36) were successfully embolized with NBCA. Hemoptysis ceased within 24 hours in all patients. There were no procedure-related complications. During 11–117 months of follow-up (median, 60.2 mo), 1 patient (4%) experienced recurrent hemoptysis at 5 months after initial BAE, which was treated with repeat BAE. The 5-year hemoptysis-free survival rate was 96%.Conclusions
Bronchial arteries were angiographically abnormal in most patients with CH (85%). BAE is a safe and effective treatment with excellent short- and long-term results in patients with CH. NBCA appears to be a useful embolic material for this application. 相似文献14.
Hyo-Cheol Kim Yoon Jun Kim Jin Chul Paeng Jin Wook Chung 《Journal of vascular and interventional radiology : JVIR》2018,29(4):556-563
Purpose
To address the feasibility of infusion of yttrium-90 (90Y) glass microspheres directly through the right inferior phrenic artery (RIPA).Materials and Methods
From November 2015 to May 2017, 20 patients underwent 90Y radioembolization through the RIPA. When the systemic-to-pulmonary shunt was demonstrated on C-arm computed tomography (CT) of the RIPA, prophylactic embolization by polyvinyl alcohol (PVA) particles was performed prior to infusion of 90Y glass microspheres. Follow-up CT scans were retrospectively reviewed for pulmonary complications. Tumor response was determined by the modified Response Evaluation Criteria in Solid Tumors.Results
Nine (45%) patients had systemic-to-pulmonary shunts on C-arm CT images of the RIPA. The feeder of the systemic-to-pulmonary shunt was the azygoesophageal branch (n = 7) and the anterior branch (n = 2). The mean activity of 90Y glass microspheres infused into the RIPA was 0.49 GBq (range, 0.19–1.55 GBq). No patient had symptomatic radiation pneumonitis or cutaneous complications during follow-up. Seven patients had focal atelectasis (n = 5), focal ground-glass opacity (n = 2), and/or a small amount of pleural effusion (n = 2) on follow-up image. Best tumor response fed by the RIPA was complete response (n = 4), partial response (n = 9), stable disease (n = 2), progressive disease (n = 4), and unevaluable (n = 1).Conclusion
The administration of 90Y glass microspheres through the RIPA may be safe after embolization of a systemic-to-pulmonary shunt identified on C-arm CT. 相似文献15.
Jiaywei Tsauo He Zhao Xiaowu Zhang Huaiyuan Ma Mingshan Jiang Ningna Weng Xiao Li 《Journal of vascular and interventional radiology : JVIR》2019,30(2):170-177
Purpose
To evaluate effect of transjugular intrahepatic portosystemic shunt (TIPS) creation on pulmonary gas exchange in patients with hepatopulmonary syndrome (HPS).Materials and Methods
All patients with cirrhosis or Budd-Chiari syndrome undergoing elective TIPS creation at a single institution between June 2014 and June 2015 were eligible for inclusion. Twenty-three patients with HPS (age 55.0 y ± 14.4; 11 men; Model for End-Stage Liver Disease score 10.2 ± 2.7) who achieved technical success were included in the analysis. Diagnosis of HPS was established by contrast-enhanced echocardiography demonstrating intrapulmonary vascular dilatation and arterial blood gas analysis demonstrating arterial oxygenation defects.Results
Mean portosystemic gradient was reduced from 21.7 mm Hg ± 8.3 before TIPS creation to 10.8 mm Hg ± 5.1 after TIPS creation. Among the 5 (21.7%) patients who experienced dyspnea, 4 (80.0%) reported improvement after TIPS creation. This improvement was not maintained at 3 months after TIPS creation in 2 (50.0%) patients. Compared with before TIPS creation, mean change in alveolar-arterial oxygen gradient for patients with HPS was statistically significant at 1 month (?9.2 mm Hg ± 8.0; P < .001) after TIPS creation, but not at 2–3 days (?0.9 mm Hg ± 10.5; P = .678) or 3 months (?3.4 mm Hg ± 11.8; P = .179) after TIPS creation.Conclusions
TIPS creation can transiently improve pulmonary gas exchange in patients with HPS. 相似文献16.
Tao Pan Jin-He Guo Long Ling Yue Qian Yong-Hua Dong Hua-Qing Yin Hai-Dong Zhu Gao-Jun Teng 《Journal of vascular and interventional radiology : JVIR》2018,29(5):731-738.e2
Purpose
To evaluate the effects of multi-electrode catheter-based renal denervation (RDN) on insulin sensitivity and glucose metabolism in a type 2 diabetes mellitus (T2DM) canine model.Materials and Methods
Thirty-three dogs were divided equally into 3 groups: bilateral renal denervation (BRDN) group, left renal denervation (LRDN) group, and sham operation (SHAM) group. Body weight and blood biochemistry were measured at baseline, 20 weeks, and 32 weeks, and renal angiography and computerized tomographic (CT) angiography were determined before the procedure and 1 month, 2 months, and 3 months after the procedure. Western blot was used to identify the activities of gluconeogenic enzymes and insulin-signaling proteins.Results
Fasting plasma glucose (9.64 ± 1.57 mmol/L vs 5.12 ± 1.08 mmol/L; P < .0001), fasting insulin (16.19 ± 1.43 mIU/mL vs 5.07 ± 1.13 mIU/mL; P < .0001), and homeostasis-model assessment of insulin resistance (HOMA-IR; 6.95 ± 1.33 vs 1.15 ± 0.33; P < .0001) in the BRDN group had significantly decreased at the 3-month follow-up compared with the SHAM group. Western blot analyses showed that RDN suppressed the gluconeogenetic genes, modulated insulin action, and activated insulin receptors–AKT signaling cascade in the liver. CT angiography and histopathologic analyses did not show any dissection, aneurysm, thrombus, or rupture in any of the renal arteries.Conclusions
These findings identified that multi-electrode catheter-based RDN could effectively decrease gluconeogenesis and glycogenolysis, resulting in improvements in insulin sensitivity and glucose metabolism in a T2DM canine model. 相似文献17.
Hussein D. Aoun Peter J. Littrup Mohamed Jaber Fatima Memon Barbara Adam Mark Krycia Matthew Prus Elisabeth Heath Edson Pontes 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1363-1370
Purpose
To retrospectively assess long-term outcomes of percutaneous renal cryoablation, including factors affecting complications and local recurrence rates.Materials and Methods
A total of 357 computed tomographic (CT) fluoroscopy–guided percutaneous cryoablation procedures were performed for 382 masses in 302 outpatients; 347 were biopsy-proven renal-cell carcinoma (RCC) or Bosniak category > III masses (n = 28). Benign pathologic conditions (n = 18) or metastatic non-RCC disease (n = 17) were included to analyze procedural complication rate, but recurrence rates, tumor staging, and nephrometry score were limited to RCCs. The average tumor diameter was 2.9 cm (range, 1–10.3 cm), and median nephrometry score for RCC was 8 (mean, 7.4). Protection of adjacent vital structures was performed in 34% of procedures (n = 121), and ureteral stent placement was performed for 9.2% (n = 33). All major complications were graded per surgical Clavien–Dindo criteria.Results
The average CT-visible cryoablation zone diameter was 5 cm (range, 2.5–10.5 cm). Grade ≥ 3 complications occurred in 2.8% of procedures (n = 10), and appeared related to only high nephrometry scores (P = .0086) and larger tumors (P = .0034). No significant changes in renal function before and after the procedure were noted (P = .18). At a mean follow-up of 31.8 months, the local tumor recurrence rate was 3.2% (11 of 347) for RCC, and no significant difference was noted between tumors larger or smaller than 3 cm (P = .15). The difference reached significance only among the small number of stage ≥ T2 RCC tumors (P = .0039).Conclusions
Long-term follow-up of percutaneous renal cryoablation demonstrates low recurrence rates with preserved renal function, even for patients with high nephrometry scores and body mass index, assuming thorough cytotoxic technique and protection measures. 相似文献18.
Bruno C. Odisio Suguru Yamashita Steven Y. Huang Scott E. Kopetz Kamran Ahrar Takashi Mizuno Claudius Conrad Thomas A. Aloia Yun Shin Chun Sanjay Gupta Jean-Nicolas Vauthey 《Journal of vascular and interventional radiology : JVIR》2018,29(3):395-403.e1
Purpose
To test the hypothesis that, given the current resection eligibility criteria for colorectal liver metastasis (CLM), prior hepatectomy would be associated with improved local tumor control and survival after percutaneous ablation of CLMs.Materials and Methods
This single-institution retrospective study included 82 consecutive patients with 97 CLMs treated with ablation (radiofrequency ablation, microwave ablation, or cryoablation) from January 2005 to December 2014. Local tumor progression-free survival (LTPFS), recurrence-free survival (RFS) at any organ, and overall survival (OS) were calculated using the Kaplan-Meier method from the time of ablation and compared between patients with (n = 49) and without (n = 33) prior hepatectomy. Cox regression models were used to identify LTPFS predictors.Results
Median overall follow-up period was 28 months (range, 4.5–132 months). Three-year actuarial LTPFS (patient level: 73% vs 34%, P < .001) was significantly higher in patients with than without prior hepatectomy, respectively. Similarly, 3-year RFS (23% vs 9.1%, P = .026) and OS (78% vs 48%, P = .003) were improved in patients with prior hepatectomy. At multivariate analysis, predictors of worse LTPFS were: no prior hepatectomy (hazard ratio [HR] 2.35, 95% confidence interval [CI] 1.02–5.45; P = .045), minimal ablation margin < 5 mm (HR 2.4, 95% CI 1.18–4.87; P = .016), and RAS-mutant tumor (HR 2.65, 95% CI 1.18–5.94; P = .019).Conclusions
Prior hepatectomy for CLMs is associated with improved local tumor control after percutaneous ablation of post-resection-developed CLMs. 相似文献19.
Ammar Sarwar Lujia Zhou Nihara Chakrala Olga R. Brook Jeffrey L. Weinstein Max P. Rosen Muneeb Ahmed 《Journal of vascular and interventional radiology : JVIR》2017,28(5):629-636
Purpose
To determine all-cause readmission rates for 12 IR procedures and association of time to readmission with risk-adjusted 90-day mortality.Materials and Methods
Patients discharged after 12 inpatient IR procedures at a tertiary-care hospital between June 2008 and May 2013 (N = 4,163) were categorized as no readmission (n = 1,479; 40.5%) or readmission between 0 and 7 (n = 379; 10.4%), 8 and 30 (n = 650; 17.8%), 31 and 60 (n = 378; 10.3%), 61 and 90 (n = 169; 4.6%), or 91 and 180 days (n = 280; 7.7%). Readmission rate ≥ 15% was considered high based on published national readmission rates for procedures. Risk-adjusted 90-day mortality for each interval was calculated for transjugular intrahepatic portosystemic shunt (TIPS), transjugular and percutaneous liver biopsy (TJLB, PLB), ports, inferior vena cava (IVC) filter, lower extremity angioplasty (LEA), arteriovenous fistulagrams, vascular embolization (VE), percutaneous cholecystostomy (PC), percutaneous transhepatic biliary drainage (PTBD), primary urinary drainage, and feeding tube placement. Covariates included age, sex, race, insurance status, and Charlson Comorbidity Index.Results
All procedures had high 30-day readmission rates (15%–50.5%). Readmissions were highest for ports (50.5%), TJLB (43.4%), PTBD (38.5%), PC (31.9%), and TIPS (31.3%). Readmissions occurred most frequently 8–30 days after discharge for all procedures except VE (31–60 d; 10.6%), PC (31–60 d; 23.4%), and LEA (91–180 d; 15.1%). On multivariate analysis, 30-day readmissions for LEA (AOR 3.19; 95% CI, 1.2–8.2; P = .02), VE (AOR 10.01; 95% CI, 3.1–32.9; P < .001), IVC filter (AOR 2.98; 95% CI, 1.3–6.9; P = .01), PLB (AOR 2.86; 95% CI, 1.71–4.79; P < .001), and PCN (AOR 3.09; 95% CI, 1.29–7.37; P = .01) were associated with 90-day mortality.Conclusions
Inpatient IR procedures have high 30-day all-cause readmission rates, which can be associated with increased 90-day mortality. Further evaluation to determine preventable causes for readmission may impact 90-day mortality. 相似文献20.
Mustafa M. Haddad Grant D. Schmit A. Nicholas Kurup John J. Schmitz Stephen A. Boorjian Jennifer Geske R. Houston Thompson Matthew R. Callstrom Thomas D. Atwell 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1122-1126