共查询到20条相似文献，搜索用时 31 毫秒
1.
Edwin A. Takahashi Chad J. Fleming James C. Andrews 《Journal of vascular and interventional radiology : JVIR》2019,30(3):435-439
Purpose
To determine if there is a correlation between intrahepatic tumor volume and future liver remnant (FLR) hypertrophy after portal vein embolization (PVE).Materials and Methods
Forty-four consecutive patients with hepatocellular carcinoma or metastatic colorectal cancer who underwent PVE from 2009 to 2017 and who had complete imaging follow-up were retrospectively reviewed. To maximize the accuracy of tumor volume measurements, 11 patients were excluded for having more than 5 intrahepatic tumors. Volumetric analyses of the patient livers before and after PVE, as well as pre-embolization intrahepatic tumor burden, were performed.Results
A significant inverse correlation was observed between tumor volume and FLR hypertrophy after PVE (Spearman ρ = -0.53, P = .002). Initial FLR volume was also inversely correlated with subsequent hypertrophy (P = .01). Fourteen patients received neoadjuvant chemotherapy 1 month prior to intervention. The number of chemotherapy cycles did not affect hypertrophy (P = .57). Patients with cirrhosis experienced less FLR hypertrophy than patients without cirrhosis (P = .02).Conclusions
Patients with large intrahepatic tumor burden may experience limited FLR hypertrophy. 相似文献2.
Simon Sin-man Wong Brian Tsz-yau Yuen Ryan Ka-lok Lee Chris Siu-chun Tsai Yue Sun Cheung Kit Fai Lee Simon Chun Ho Yu 《Journal of vascular and interventional radiology : JVIR》2019,30(3):440-444
Purpose
Portal vein (PV) embolization (PVE) is traditionally performed via a PV sheath with selective embolization of PV branches. Here, the efficacy and safety of PVE with the use of only an 18-gauge needle is reported.Materials and Methods
Consecutive patients who underwent PVE from 2009 through 2017 were retrospectively reviewed. Forty-five patients (mean age, 60 y ± 7.6; 38 men) underwent 45 PVE procedures. Hepatocellular carcinoma, cholangiocarcinoma, and metastases accounted for 26 (58%), 13 (29%), and 6 (13%) patients, respectively. PVE was performed by puncturing a branch of right PV with an 18-gauge needle under US guidance. Via the same needle, direct portography was performed, followed by PVE with an N-butyl cyanoacrylate/Lipiodol mixture. Percentage increase of future liver remnant (FLR) volume and increase in ratio of FLR to total liver volume were estimated as measures of efficacy. Complications were reported according to Society of Interventional Radiology classification. Fluoroscopy time, procedure time, and dose–area product (DAP) were recorded.Results
Technical success rate was 100%. The median DAP, fluoroscopy time, and procedure time were 74,387 mGy·cm2 (IQR, 90,349 mGy·cm2), 3.5 min (IQR, 2.10 min), and 24 min (IQR, 10.5 min). Among the 23 patients with complete CT volumetry data, mean increase in the ratio of FLR to total liver volume and percentage increase of FLR volume were 12.5% ± 7.7 and 50% ± 33, respectively. There were 3 minor complications (asymptomatic nonocclusive emboli in FLR) and 3 major complications (1 hepatic vein emboli, 1 subphrenic collection, and 1 hepatic infarct).Conclusions
PVE via a sheathless 18-gauge needle approach is feasible, with satisfactory FLR hypertrophy. 相似文献3.
Christophe Cassinotto Anthony Dohan Benoît Gallix Eve Simoneau Louis-Martin Boucher Peter Metrakos Tatiana Cabrera Carlos Torres Karl Muchantef David A. Valenti 《Journal of vascular and interventional radiology : JVIR》2017,28(7):963-970
Purpose
To assess frequency of adverse events, efficacy, and clinical outcomes of percutaneous portal vein embolization (PVE) in patients with bilobar colorectal liver metastases undergoing staged hepatectomy with preservation of segment IV ± I only.Materials and Methods
Retrospective analysis was performed of 40 consecutive patients who underwent right PVE after successful left lobectomy between 2005 and 2013. Rates of adverse events, future liver remnant (FLR) > 30% compared with baseline liver volume, clinical success (completion of staged hepatectomy with clearance of liver metastases), and overall survival were analyzed.Results
PVE was performed using polyvinyl alcohol particles (n = 7; 17.5%), particles plus coils (n = 23; 57.5%), and N-butyl cyanoacrylate glue plus ethiodized oil (n = 10; 25%). Technical success was 100%. After PVE, 20% (n = 8) of patients exhibited portal venous thrombosis, ranging from isolated intrahepatic portal branch thrombosis to massive thrombosis of the main portal vein (n = 3) and responsible for periportal cavernoma and portal hypertension in 5 patients. Of patients, 23 (57.5%) had FLR ≥ 30%, and 21 (52.5%) had clinical success. Six patients had significant stenosis or occlusion of the left portal vein or biliary system after original left lobectomy, which was independently associated with FLR < 30% (R2 = 0.24). Clinical success was the only independent variable associated with survival (R2 = 0.25).Conclusions
PVE for staged hepatectomy with preservation of segment IV ± I only is technically feasible, leading to adequate hypertrophy and clinical success rates in these patients with poor oncologic prognosis. Portal venous thrombosis is greater after the procedure than in the setting of standard PVE. 相似文献4.
Surinder K. Dhaliwal Ganesan Annamalai Nelofer Gafoor Robyn Pugash Chris Dey Elizabeth Nishani David 《Journal l'Association canadienne des radiologistes》2018,69(3):316-321
Purpose
The purpose of this study was to compare the effectiveness of portal vein embolization (PVE) with different embolic agents used at our centre. Specifically, the effectiveness of N-butyl cyanoacrylate (NBCA) glue is compared with that of polyvinyl alcohol (PVA) particles.Methods
We performed a retrospective chart review of all patients (N = 77) who underwent PVE at our institution over a 5-year period. Pre- and postprocedural computed tomography or magnetic resonance imaging, when available, were used to measure the volume of total liver volume and future liver remnant (FLR). The absolute values obtained were used to calculate percentage of FLR. The growth in FLR was determined 4–6 weeks after PVE. Technical details of the procedure including the type and amount of embolic agent used were obtained from the chart reviews, electronic patient records, and radiology reports. Statistical analysis was performed using Kruskal-Wallis test, Wilcoxon rank sum test, and the Spearman correlation coefficient with post hoc analysis. Results are expressed as mean ± SD (P < .05 considered statistically significant).Results
NBCA (n = 29) produced a mean change in FLR of 14.8% compared with 9.3% for PVA particles (n = 24; P = .007). Mean change in FLR was 10.1% in the group where a combination of NBCA and PVA particles was used (n = 24). The effect of glue volume and glue-to-lipiodol ratio on the outcome was not found to be statistically significant (P = .5 and .7, respectively).Conclusions
We conclude that NBCA glue is a better embolic agent than PVA particles in inducing liver hypertrophy. 相似文献5.
Jaehyun Yim Dongho Hyun Sung Ki Cho Kwang Bo Park Hong Suk Park Sung Wook Shin Dong Wook Choi Seonwoo Kim Sung-Young Baek Sang Yub Lee 《Journal of vascular and interventional radiology : JVIR》2019,30(1):31-37
Purpose
To retrospectively investigate the impact of hyperbilirubinemia on future liver remnant (FLR) volume after percutaneous transhepatic portal vein embolization (PVE) and incidence of post-hepatectomy liver failure in primary biliary malignancy.Materials and Methods
Eighty-seven patients (62 men, overall mean age 66.9 y) who underwent PVE, using Gelfoam and coils before major hepatectomy between January 2004 and June 2016, were included in this study and divided into a hyperbilirubinemia (serum total bilirubin level at PVE 5.80 ± 2.44 mg/dL; n = 41) group and a control group (1.09 ± 0.73 mg/dL; n = 46). Liver volume was measured from computerized tomographic data before and 18.5 days, on average, after PVE. Correlation between FLR hypertrophy (degree of hypertrophy and percentage increase in future liver remnant [%FLR]) and total bilirubin were analyzed. FLR hypertrophy and incidence of post-hepatectomy liver failure were compared. Simple and multiple regressions were used for univariable and multivariable analyses, respectively.Results
Mean FLR volumes before and after PVE were 529.1 cm3 and 640.5 cm3, respectively. Degree of hypertrophy and %FLR were 7.64 ± 4.22 and 21.77 ± 13.34, respectively. There was no significant correlation between FLR hypertrophy and total bilirubin (P > .5). FLR hypertrophy was not significantly different between the 2 groups. Planned major hepatectomy was performed in 73 patients (83.9%). Grade 3 post-hepatectomy liver failure occurred in 6 patients (8.2%; 2 in the hyperbilirubinemia group and 4 in the control group), and its incidence was not significantly different between the groups (P = .354).Conclusions
Hyperbilirubinemia at the time of PVE seems to have no effect on FLR hypertrophy. The incidence of grade 3 post-hepatectomy liver failure is not likely to be influenced, either. 相似文献6.
Bartley Thornburg Kush Desai Ryan Hickey Elias Hohlastos Laura Kulik Daniel Ganger Talia Baker Michael Abecassis Juan C. Caicedo Daniela Ladner Jonathan Fryer Ahsun Riaz Robert J. Lewandowski Riad Salem 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1714-1721.e2
Purpose
To report the final analysis of the safety and efficacy of portal vein (PV) recanalization (PVR) and transjugular intrahepatic portosystemic shunt (TIPS) creation (PVR-TIPS) in patients with PV thrombosis (PVT) in need of liver transplantation.Materials and Methods
Sixty-one patients with cirrhosis and PVT underwent PVR-TIPS to improve transplantation candidacy. Median patient age was 58 years (range, 22–75 y), and median pre-TIPS Model for End-Stage Liver Disease score was 14 (range, 7–42). The most common etiologies of cirrhosis were nonalcoholic fatty liver disease in 18 patients (30%) and hepatitis C in 13 patients (21%). Twenty-seven patients (44%) had partial PVT, and 34 patients (56%) had complete thrombosis. Forty-nine patients (80%) had Yerdel grade 2 PVT, and 12 (20%) had Yerdel grade 3 PVT. Twenty-nine patients (48%) had cavernous transformation of the PV.Results
PVR-TIPS was technically successful in 60 of 61 patients (98%). PV/TIPS patency was maintained in 55 patients (92%) at a median follow-up of 19.2 months (range, 0–105.9 mo). Recurrent PV/TIPS thrombosis occurred in 5 patients (8%), all of whom initially presented with complete PVT. The most common adverse events were TIPS stenosis in 13 patients (22%) and transient encephalopathy in 11 patients (18%). Twenty-four patients (39%) underwent transplantation, 23 of whom (96%) received an end-to-end anastomosis. There were no cases of recurrent PVT following transplantation, with a median imaging follow-up of 32.5 months (range, 0.4–75.4 mo). Five-year overall survival rate was 82%.Conclusions
PVR-TIPS is a safe, effective, and durable treatment option for patients with chronic PVT who need liver transplantation. 相似文献7.
Jian Lu Jin-He Guo Hai-Dong Zhu Guang-Yu Zhu Li Chen Gao-Jun Teng 《Journal of vascular and interventional radiology : JVIR》2017,28(6):786-794.e3
Purpose
To assess feasibility, safety, and preliminary efficacy of an irradiation portal vein stent for portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC).Materials and Methods
Between October 2012 and September 2015, 25 of 40 patients (mean age of 55.5 y) with PVTT caused by HCC were recruited for treatment with an irradiation portal vein stent (self-expandable stent loaded with iodine-125 seeds) at a single hospital. Liver function was classified as Child-Pugh class A in 15 patients (60%) and class B in 10 patients (40%). The Eastern Cooperative Oncology Group performance status score was 0 in 3 patients (12%), 1 in 13 patients (52%), and 2 in 9 patients (36%). Transarterial chemoembolization was performed after stent placement. Outcomes were measured in terms of technical success, complications, stent patency, and overall survival.Results
The technical success rate was 92.0% (23/25). No complications grade 3 or higher according to Common Terminology Criteria for Adverse Events were observed. Median stent patency period was 8.0 months (range, 0.6–30.0 months). Between 7 and 955 days after stent placement, 65 cycles of transarterial chemoembolization were performed with a mean of 2.8 cycles per patient. Median survival was 12.5 months (range, 0.6–35.7 months).Conclusions
Placement of an irradiation portal vein stent appears feasible and safe and may prolong the patency of the portal vein. It is a promising technique for combining recanalization of an occluded portal vein and brachytherapy. 相似文献8.
Jason Chiang Kwang Nickel Randall J. Kimple Christopher L. Brace 《Journal of vascular and interventional radiology : JVIR》2017,28(7):1053-1058
Purpose
To evaluate potential biologic and thermal mechanisms of the observed differences in thrombosis rates between hepatic vessels during microwave (MW) ablation procedures.Materials and Methods
MW ablation antennae were placed in single liver lobes of 2 in vivo porcine liver models (n = 3 in each animal; N = 6 total) in the proximity of a large (> 5 mm) portal vein (PV) and hepatic veins (HVs). Each ablation was performed with 100 W for 5 minutes. Conventional ultrasound imaging and intravascular temperature probes were used to evaluate vessel patency and temperature changes during the ablation procedure. Vascular endothelium was harvested 1 hour after ablation and used to characterize genes and proteins associated with thrombosis in PVs and HVs.Results
Targeted PVs within the MW ablation zone exhibited thrombosis at a significantly higher rate than HVs (54.5% vs 0.0%; P = .0046). There was a negligible change in intravascular temperature in PVs and HVs during the ablation procedure (0.2°C ± 0.4 vs 0.6°C ± 0.9; P = .46). PVs exhibited significantly higher gene expression than HVs in terms of fold differences in thrombomodulin (2.9 ± 2.0; P = .0001), von Willebrand factor (vWF; 7.6 ± 1.5; P = .0001), endothelial protein C receptor (3.50 ± 0.49; P = .0011), and plasminogen activator inhibitor (1.46 ± 0.05; P = .0014). Western blot analysis showed significantly higher expression of vWF (2.32 ± 0.92; P = .031) in PVs compared with HVs.Conclusions
Large PVs exhibit thrombosis more frequently than HVs during MW ablation procedures. Biologic differences in thrombogenicity, rather than heat transfer, between PVs and HVs may contribute to their different rates of thrombosis. 相似文献9.
Siddharth A. Padia Guy E. Johnson Kathryn J. Horton Christopher R. Ingraham Matthew J. Kogut Sharon Kwan Sandeep Vaidya Wayne L. Monsky James O. Park Renuka Bhattacharya Daniel S. Hippe William P. Harris 《Journal of vascular and interventional radiology : JVIR》2017,28(6):777-785.e1
Purpose
To compare segmental radioembolization with segmental chemoembolization for localized, unresectable hepatocellular carcinoma (HCC) not amenable to ablation.Materials and Methods
In a single-center, retrospective study (2010–2015), 101 patients with 132 tumors underwent segmental radioembolization, and 77 patients with 103 tumors underwent segmental doxorubicin-based drug-eluting embolic or conventional chemoembolization. Patients receiving chemoembolization had worse performance status (Eastern Cooperative Oncology Group 0, 76% vs 56%; P = .003) and Child-Pugh class (class A, 65% vs 52%; P = .053); patients receiving radioembolization had larger tumors (32 mm vs 26 mm; P < .001), more infiltrative tumors (23% vs 9%; P = .01), and more vascular invasion (18% vs 1%; P < .001). Toxicity, tumor response, tumor progression, and survival were compared. Analyses were weighted using a propensity score (PS).Results
Toxicity rates were low, without significant differences. Index and overall complete response rates were 92% and 84% for radioembolization and 74% and 58% for chemoembolization (P = .001 and P < .001). Index tumor progression at 1 and 2 years was 8% and 15% in the radioembolization group and 30% and 42% in the chemoembolization group (P < .001). Median progression-free and overall survival were 564 days and 1,198 days in the radioembolization group and 271 days and 1,043 days in the chemoembolization group (PS-adjusted P = .002 and P = .35; censored by transplant PS-adjusted P < .001 and P = .064).Conclusions
Segmental radioembolization demonstrates higher complete response rates and local tumor control compared with segmental chemoembolization for HCC, with similar toxicity profiles. Superior progression-free survival was achieved. 相似文献10.
Enxin Wang Lei Liu Dongdong Xia Wenjun Wang Wei Bai Qiuhe Wang Jie Yuan Xiaomei Li Lei Zhang Jing Niu Zhanxin Yin Jielai Xia Hongwei Cai Daiming Fan Guohong Han 《Journal of vascular and interventional radiology : JVIR》2017,28(7):956-962
Purpose
To investigate treatment outcome, prognostic factors for overall survival, and appropriate candidates for transarterial chemoembolization among patients with hepatocellular carcinoma (HCC) and extrahepatic spread (EHS).Materials and Methods
From January 2010 to June 2014, 111 consecutive patients with HCC and EHS treated by transarterial chemoembolization alone were evaluated. Factors associated with overall survival were evaluated using Cox regression analysis, and a scoring equation was established to subgroup patients with EHS.Results
Median follow-up was 3.8 months, and median overall survival was 3.8 months (95% confidence interval [CI], 2.9–4.7 months). Multivariate analysis demonstrated maximum tumor size ≥ 10 cm (hazard ratio [HR] 1.58; 95% CI, 1.02–2.46; P = .041), multifocal intrahepatic tumors (HR 1.55; 95% CI, 1.03–2.33; P = .037), and portal vein tumor thrombosis (PVTT) (HR 1.81; 95% CI, 1.12–2.91; P = .015) as significant predictors of overall survival. Based on these factors, a scoring equation was developed to predict treatment outcome of transarterial chemoembolization, with an area under the receiver operating characteristic curve of 0.76 in predicting 6-month survival. Using a cutoff score of 5.5, patients with HCC and EHS were divided into 2 groups with significantly different overall survival (8.1 months for EHS1 and 2.4 months for EHS2; P < .001). The described method of subgrouping remained discriminatory regardless of baseline characteristics.Conclusions
Maximum tumor size, intrahepatic tumor distribution, and presence of PVTT were significant determinants of overall survival for patients with HCC and EHS. Transarterial chemoembolization may be appropriate for patients with EHS but lower intrahepatic tumor burden. 相似文献11.
Josep Marti Massimo Giacca Kutaiba Alshebeeb Sumeet Bahl Charles Hua Jeremy C. Horn Jad BouAyache Rahul Patel Marcelo Facciuto Myron Schwartz Sander Florman Edward Kim Ganesh Gunasekaran 《Journal of vascular and interventional radiology : JVIR》2018,29(7):920-926
Purpose
To analyze outcomes of patients with hepatocellular carcinoma (HCC) undergoing preoperative portal vein embolization (PVE).Materials and Methods
A retrospective analysis of survival, recurrence, and complications was performed in 82 patients with HCC undergoing preoperative PVE and surgical treatment with curative intention from June 2006 to December 2014.Results
Rate of major adverse events after PVE was 11% with no mortality. Twenty-eight (34.1%) patients showed radiologic progression of HCC after PVE; 72 patients (87.8%) eventually were accepted as surgical candidates. Median interval between PVE and surgery was 37 days, and 69 patients (84.1%) ultimately underwent surgical resection. At 1 and 3 years, disease-free survival rates were 81.3% and 53.1%, respectively, and overall patient survival rates were 77.5% and 63.1%. Compared with patients accepted as surgical candidates, patients who did not undergo surgery had a higher median number of HCC tumors (1 [range, 1–5] vs 2 [range, 1–4], P = .031). At 1 and 3 years, patients with disease progression after PVE but who still underwent surgical resection showed similar recurrence-free (90% vs 79.6% and 75% vs 48.6%) and overall (72.2% vs 78.4% and 57.8% vs 64%) survival rates as the rest of the patients who underwent resection.Conclusions
PVE is a safe technique with good outcomes that potentially increases the number of patients with initially unresectable HCC who can be offered resection. Radiologic progression after PVE should not be seen as a contraindication to offer resection if it is still deemed possible. 相似文献12.
13.
Antonio Saviano Roberto Iezzi Felice Giuliante Lucia Salvatore Caterina Mele Alessandro Posa Francesco Ardito Anna Maria De Gaetano Maurizio Pompili 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1512-1519
Purpose
To compare liver resection (LR) with single-step, balloon-occluded radiofrequency (RF) ablation plus drug-eluting embolics transarterial chemoembolization in cirrhotic patients with single hepatocellular carcinoma (HCC) ≥ 3 cm.Materials and Methods
From 2010 to 2014, 25 patients with compensated cirrhosis and single HCC ≥ 3 cm (median size 4.5 cm; range, 3.0–6.8 cm) not suitable for LR or liver transplantation were treated with RF ablation plus transarterial chemoembolization in a prospective observational single-center pilot study; all patients had complete tumor necrosis after treatment. A retrospective control group included 29 patients (median HCC size 4.0 cm; range, 3.0–7.4 cm) who underwent LR. RF ablation plus transarterial chemoembolization group included more patients with severe portal hypertension (65.5% vs 35.0%, P = .017). Primary endpoints were overall survival (OS) and tumor recurrence (TR) rates.Results
One death and 1 major complication (4%) were observed in LR group. No major complications were reported in RF ablation plus transarterial chemoembolization group (P = .463). OS rates at 1 and 3 years were 91.8% and 79.3% in LR group and 89.4% and 48.2% in RF ablation plus transarterial chemoembolization group (P = 0.117). TR rates at 1 and 3 years were 29.5% and 45.0% in LR group and 42.4% and 76.0% in RF ablation plus transarterial chemoembolization group (P = .034). Local tumor progression (LTP) rates at 3 years were significantly lower in LR group (21.8% vs 58.1%, P = .005). Similar results were found in patients with HCC ≤ 5 cm (TR rates 35.4% vs 75.1%, P = .016; LTP 16.0% vs 55.7%, P = .013).Conclusions
LR achieved lower TR and LTP rates than RF ablation plus transarterial chemoembolization, but 3-years OS rates were not statistically different between the 2 groups. RF ablation plus transarterial chemoembolization is an effective treatment option in patients with compensated cirrhosis and solitary HCC ≥ 3 cm unsuitable for LR. 相似文献14.
Orapin Chansanti Younes Jahangiri Yusuke Matsui Akira Adachi Yindee Geeratikun John A. Kaufman Kenneth J. Kolbeck Jeffrey S. Stevens Khashayar Farsad 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1528-1535
Purpose
To evaluate dose-response relationship in yttrium-90 (90Y) resin microsphere radioembolization for neuroendocrine tumor (NET) liver metastases using a tumor-specific dose estimation based on technetium-99m–labeled macroaggregated albumin (99mTc MAA) single photon emission computed tomography (SPECT)-CT.Materials and Methods
Fifty-five tumors (mean size 3.9 cm) in 15 patients (10 women; mean age 57 y) were evaluated. Tumor-specific absorbed dose was estimated using a partition model. Initial (median 2.3 months) follow-up data were available for all tumors; last (median 7.6 months) follow-up data were available for 45 tumors. Tumor response was evaluated using Modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow-up CT. Tumors with complete or partial response were considered responders. Mean tumor absorbed dose was 231.4 Gy ± 184.3, and mean nontumor liver absorbed dose was 39.0 Gy ± 18.0.Results
Thirty-six (65.5%) and 30 (66.7%) tumors showed response at initial and last follow-up, respectively. Mean absorbed doses in responders and nonresponders at initial and last follow-up were 285.8 Gy ± 191.1 and 128.1 Gy ± 117.1 (P = .0004) and 314.3 Gy ± 195.8 and 115.7 Gy ± 117.4 (P = .0001). Cutoff value of ≥ 191.3 Gy for tumor-specific absorbed dose predicted tumor response with 93% specificity, whereas < 72.8 Gy predicted nonresponse with 100% specificity at last follow-up. Estimated mean absorbed tumor dose per patient was significantly higher in responders versus nonresponders over the follow-up period (224.5 Gy ± 90.3 vs 70.0 Gy ± 28.0; P = .007).Conclusions
Tumor-specific absorbed dose, estimated with a partition model, was significantly associated with tumor response in NET liver metastases. An estimated dose ≥ 191.3 Gy predicted treatment response with high sensitivity and specificity. 相似文献15.
Jarrod M. Ehrie Therese E. Sammarco Jesse L. Chittams Scott O. Trerotola 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1409-1414
Purpose
To determine the frequency of new-onset symptoms of central venous stenosis (CVS) after percutaneous transluminal angioplasty (PTA) of a hemodialysis access–related stenosis in patients with previously asymptomatic CVS and to identify risk factors for this phenomenon.Materials and Methods
Retrospective review was performed of patients treated with PTA for an access-related stenosis (excluding central vein interventions) between 2001 and 2016 who returned within 3 months with symptoms of CVS (ie, “unmasking”): 39 patients met these criteria. A control group of 122 patients who had untreated asymptomatic CVS and did not experience unmasking was selected. Fistulograms were graded for degree of CVS. A total of 51% of the unmasked group was male, with an average age of 65 years; 57% of the control group was male, with an average age of 63 years.Results
The incidence of unmasking among patients with untreated asymptomatic CVS was 4.9%. A total of 90% of the unmasked group (35 of 39) had upper-arm access, compared with 77% of the control group (94 of 122; P = .017). A total of 28% of unmasked-group patients (11 of 39) underwent thrombectomy, vs 4% of controls (5 of 122; P < .0001). A total of 54% of unmasked-group patients (21 of 39) had significant brachiocephalic vein stenosis, vs 26% of controls (32 of 122; P = .001). A total of 8% of unmasked-group patients (3 of 39) had superior vena cava stenosis, vs none of the 122 controls (P = .01). A total of 64% of unmasked-group patients (25 of 39) had extensive collateral vessels, vs 24% of controls (29 of 122; P < .0001).Conclusions
The incidence of unmasking of asymptomatic CVS is low. Prophylactic treatment of asymptomatic CVS therefore remains generally inadvisable. However, patients undergoing declotting with extensive collateral vessels might warrant treatment of asymptomatic CVS. 相似文献16.
Luka Jeraj Mateja Kaja Jezovnik Pavel Poredos 《Journal of vascular and interventional radiology : JVIR》2017,28(7):941-944
Purpose
To investigate the relationship between recanalization rate of occluded veins after deep venous thrombosis (DVT) and development of postthrombotic syndrome (PTS).Materials and Methods
Patients treated for DVT of the lower limbs were evaluated 12–36 months after acute DVT. Of 100 patients, 34 developed PTS, defined as Villalta score of ≥ 5. Symptoms and signs of PTS were assessed, and ultrasound examination of the veins was performed, checking for residual thrombus and presence of reflux.Results
Patients with PTS were older (64.0 y vs 55.5 y; P = .007) and more frequently experienced recurrent DVT (15% vs 3%; P = .030). Patients with PTS had a lower rate of recanalization. Patients with residual thrombus appeared to be at increased risk for PTS development compared with patients with total recanalization (odds ratio 6.0; 95% confidence interval, 1.7–21.9; P = .006). No difference in the presence of reflux was observed.Conclusions
Incomplete or absent recanalization is associated with a higher incidence of PTS, probably as a consequence of deteriorated blood flow and increased venous pressure. This suggests early recanalization could improve the outcome of DVT treatment in selected patients. 相似文献17.
Nobuo Tomizawa Kodai Yamamoto Shinichi Inoh Takeshi Nojo Sunao Nakamura 《Journal of Cardiovascular Computed Tomography》2017,11(2):129-134
Background
Thin-cap fibroatheroma (TCFA) is assumed to cause acute coronary syndromes.Objective
To compare the accuracy of different models for diagnosing TCFA using parameters derived by CT, validated against optical coherence tomography (OCT).Methods
One hundred twenty-nine plaques in 106 patients were analyzed using data acquired by 64-row CT with a reconstruction thickness of 0.67 mm and an increment of 0.33 mm. TCFA was defined by OCT as a plaque with lipid content in ≥2 quadrants and the thinnest part of the fibrous cap measuring ≤65 μm. The following parameters were obtained from CT: remodeling index (RI), proportion of low-attenuation (LA) volume (<60 HU), minimum CT number and napkin-ring sign (NRS). We compared three models to predict TCFA: Model 1, RI > 1.1, minimum CT number <30 HU and NRS; Model 2, RI > 1.1, minimum CT number <30 HU or NRS; Model 3, regression model using RI, proportion of LA volume and NRS.Results
In OCT, 83 plaques fulfilled the criteria of TCFA. The area under the receiver operating characteristics curve significantly (p < 0.01) increased to 0.96 (95% confidence interval (CI), 0.92–1.0) in model 3 as compared to models 1 (0.74, 95% CI, 0.68–0.80) and 2 (0.72, 95% CI, 0.67–0.79). Diagnostic accuracy of model 3 (93%) was significantly higher than that of models 1 (67%, p < 0.001) and 2 (80%, p = 0.001). Sensitivity and specificity of model 3 was 94% and 91%, respectively.Conclusion
Diagnostic performance to identify TCFA by coronary CTA improves when RI and proportion of LA volume are used as continuous values rather than dichotomizing these parameters. 相似文献18.
Wouter G. Wieringa Chris P.H. Lexis Erik Lipsic Hindrik W. van der Werf Johannes G.M. Burgerhof Vincent E. Hagens G. Louis Bartels Alexander Broersen Remco A. Schurer Eng-Shiong Tan Pim van der Harst Ad F.M. van den Heuvel Tineke P. Willems Gabija Pundziute 《Journal of Cardiovascular Computed Tomography》2017,11(2):111-118
Background
In vitro studies have shown the feasibility of coronary lesion grading with computed tomography angiography (CTA), intravascular ultrasound (IVUS) and optical coherence tomography (OCT) as compared to histology, whereas OCT had the highest discriminatory capacity.Objective
We investigated the ability of CTA and IVUS to differentiate between early and advanced coronary lesions in vivo, OCT serving as standard of reference.Methods
Multimodality imaging was prospectively performed in 30 NSTEMI patients. Plaque characteristics were assessed in 1083 cross-sections of 30 culprit lesions, co-registered among modalities. Absence of plaque, fibrous and fibrocalcific plaque on OCT were defined as early plaque, whereas lipid rich-plaque on OCT was defined as advanced plaque. Odds ratios adjusted for clustering were calculated to assess associations between plaque types on CTA and IVUS with early or advanced plaque.Results
Normal findings on CTA as well as on IVUS were associated with early plaque. Non-calcified, calcified plaques and the napkin ring sign on CTA were associated with advanced plaque. On IVUS, fatty and calcified plaques were associated with advanced plaque.Conclusions
In vivo coronary plaque characteristics on CTA and IVUS are associated with plaque characteristics on OCT. Of note, normal findings on CTA and IVUS relate to early lesions on OCT. Nevertheless, multiple plaque features on CTA and IVUS are related to advanced plaques on OCT, which may make it difficult to use qualitative plaque assessment in clinical practice. 相似文献19.
Eric J. Hohenwalter James R. Stone Paul V. O’Moore Steven J. Smith J. Bayne Selby Robert J. Lewandowski Shaun Samuels Paul M. Kiproff David W. Trost David C. Madoff Jeremy Handel Eric J. Gandras Athanasios Vlahos William S. Rilling 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1353-1362
Purpose
To demonstrate rates of successful filter conversion and 6-month major device-related adverse events in subjects with converted caval filters.Materials and Methods
An investigational device exemption multicenter, prospective, single-arm study was performed at 11 sites enrolling 149 patients. The VenaTech Convertible Vena Cava Filter (B. Braun Interventional Systems, Inc, Bethlehem, Pennsylvania) was implanted in 149 patients with venous thromboembolism and contraindication to or failure of anticoagulation (n = 119), with high-risk trauma (n = 14), and for surgical prophylaxis (n = 16). When the patient was no longer at risk for pulmonary embolism as determined by clinical assessment, an attempt at filter conversion was made. Follow-up of converted patients (n = 93) was conducted at 30 days, 3 months, and 6 months after conversion. Patients who did not undergo a conversion attempt (n = 53) had follow-up at 6 months after implant.Results
All implants were successful. One 7-day migration to the right atrium required surgical removal. Technical success rate for filter conversion was 92.7% (89/96). Mean time from placement to conversion was 130.7 days (range, 15–391 d). No major conversion-related events were reported. The mean conversion procedure time was 30.7 minutes (range, 7–135 min). There were 89 converted and 32 unconverted patients who completed 6-month follow-up with no delayed complications.Conclusions
The VenaTech Convertible filter has a high conversion rate and low 6-month device-related adverse event rate. Further studies are necessary to determine long-term safety and efficacy in both converted and unconverted patients. 相似文献20.
Edwin A. Takahashi David F. Kallmes Chad J. Fleming Robert J. McDonald Michael A. McKusick Haraldur Bjarnason William S. Harmsen Sanjay Misra 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1687-1692