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1.
Toshinori Hirai Yukunori Korogi Ken Ono Kousei Maruoka Kazunori Harada Satoshi Aridomi Mutsumasa Takahashi 《Cardiovascular and interventional radiology》2001,24(3):176-179
Purpose: To evaluate the utility of an interventional CT system for intraarterial chemotherapy or chemoembolization for locally advanced
and/or recurrent hepatic tumors.
Methods: Thirty-eight patients with locally advanced or recurrent hepatic tumors underwent 73 intraarterial contrast-enhanced CT (IA-CECT)
examinations immediately before chemotherapy or chemoembolization. The degree of tumor vascularity on angiography and enhancement
on IA-CECT was classified into three grades: no, mild, or marked vascularity. The IA-CECT grades were compared with the angiographic
grades.
Results: Twenty-nine (69%) of 42 examinations that were interpreted as having no or mild vascularity on angiography were classified
as marked enhancement on IA-CECT. Based on IA-CECT findings, the position of the catheter was changed in 14 (19%) of 73 CT
examinations. The reasons for the reposition were as follows: weak or no enhancement of the tumor (n = 11) or strong enhancement of the gallbladder wall (n = 3). The treatment strategy was changed in three patients (8%). No major complications relating to the interventional procedures
were observed.
Conclusions: IA-CECT is a reliable method when evaluating the perfusion of the tumor and adjacent normal tissues. The interventional CT
system is useful for performing safe and effective intraarterial chemotherapy or chemoembolization in patients with locally
advanced and/or recurrent hepatic tumors. 相似文献
2.
Purpose: To quantitatively evaluate the usefulness of lipiodol-CDDP suspension (LCS) chemotherapy in hepatocellular carcinoma (HCC).
Methods: CDDP (cis-diamminedichloroplatinum) powder was prepared by removing the water and NaCl from aqueous CDDP. Two quantities
of prepared CDDP powder, 10 mg and 20 mg, were mixed with 1 ml each of iopamidol 300 mgI/ml (IP300) and lipiodol (LPD) using
a high pressure pumping method, thus producing LCS. Thirty-two patients with HCC, who had good renal function [creatinine
clearance (Ccr) 50 ml/min or more], received additional intraarterial infusion chemotherapy with LCS or LCS alone.
Results: The most frequently observed CDDP powder sizes were 5.95–10.90 μm (average: 11.59 μm). The LCS obtained demonstrated a suspension
of 2–12 μm (average 3.69 μm) immediately after mixing, and no significant changes were observed in LCS particle sizes 3 hr
after mixing. Moreover, the sustained release with LCS was observed for up to 3 hr. Meanwhile, the peripheral free platinum
concentration between intraarterial infusion chemotherapy with LCS and intraarterial infusion with the aqueous solution of
CDDP, with respect to variance residence time (VRT), showed a significant difference, with a p value of 0.0382. The survival rate was 89.84% at 1 year, 73.78% at 2 years, and 68.51% at 3 years. Furthermore, the platinum
concentration in the tumor was 25–95 times the concentration in the surrounding liver parenchyma.
Conclusion: Good clinical results can be expected by applying LCS to HCC. 相似文献
3.
Ernst-Peter K. Strecker Wladimir Ostheim-Dzerowycz Irene B.L. Boos 《Cardiovascular and interventional radiology》1998,21(2):109-115
Purpose: To present the initial results of a new percutaneously implantable catheter port system (PIPS) used for long-term intraarterial
infusion therapy in patients with severe ischemic limb disease.
Methods: Ten patients with deep, extended ischemic ulcerations (all 10) and osteomyelitis (6/10) of the foot received intraarterial
infusions of prostaglandine E1 and antibiotics, if indicated, via a new port catheter system with the port placed subcutaneously above the groin after percutaneous
introduction and the catheter tip placed into the superficial or deep femoral artery.
Results: Port implantation and repeated port access were uncomplicated. During the follow-up period (mean 11 months, range 1 week–50
months), port migration, leakage, or infection was not observed. Three catheters thrombosed and were opened by fibrinolysis
with recombinant tissue plasminogen activator instilled via the port. Treatment success was achieved in 8 patients: relief
from rest pain (8 patients), reduction of ulcer size (4/8), and complete healing (4/8). Limb savage rate was 80%. In 2 patients
amputation could not be avoided.
Conclusion: Selective long-term arterial infusion therapy presents a valuable therapeutic regimen for limb salvage. With the new catheter
port system, repeated local intraarterial infusion is safe and simple. 相似文献
4.
Toshinori Hirai Yukunori Korogi Satoshi Hamatake Ryuichi Nishimura Yuji Baba Mutsumasa Takahashi Yasuyoshi Uji Akira Taen 《Cardiovascular and interventional radiology》1999,22(3):201-205
Purpose: This study was designed to assess the 3-year experience with superselective intraarterial chemotherapy prior to definitive
treatment for stages III and IV squamous cell carcinomas of the mouth.
Methods: Twenty-two patients prospectively received superselective intraarterial chemotherapy using relatively low-dose cisplatin
via a transfemoral approach. The locations of the tumors were the tongue (n= 12), gingiva (n= 5), buccal mucosa (n= 2), hard palate (n= 1), floor of the mouth (n= 1), and lip (n= 1). After intraarterial chemotherapy, 21 patients underwent surgery (n= 14), radiation therapy (n= 6), or both (n= 1). The survival rate of 25 patients who underwent surgery with/without radiation therapy until 1992 at Kumamoto University
Hospital was also evaluated as a historical control. The survival curve was calculated with the Kaplan-Meier method, and the
statistical difference between survival curves was determined with the generalized Wilcoxon test.
Results: The overall response rate was 95% [complete response (tumor completely resolved), 24%; partial response (tumor reduction
≥50%), 71%]. Fifty-two intraarterial infusions were performed without any catheter-related complications. Mild and transient
local toxicity such as edema or mucositis of the infused area was relatively common. One patient died of renal failure from
cisplatin. After a median follow-up of 20 months (range 2–41 months), the estimated 3-year survival rate for patients who
underwent intraarterial chemotherapy plus surgery was 91%. The survival of the patients who underwent intraarterial chemotherapy
plus surgery tended to be longer than that of the historical control.
Conclusions: Early tumor reduction without delay of subsequent treatments can be obtained by intraarterial chemotherapy while minimizing
complications and possibly improving survival. Further investigations of long-term survival with larger series need to be
performed. 相似文献
5.
PURPOSE: Patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) commonly have significant post-procedural abdominal pain necessitating narcotic administration. It is known that intraarterial administration of lidocaine is effective in controlling the pain during the procedure. However, optimum timing of the lidocaine administration is not precisely known. The purpose of this study was to assess the efficacy of intraarterial lidocaine administration for control of pain resulting from TACE and to evaluate the optimal timing of administration. METHODS: In a prospective trial, 113 consecutive patients with HCC who underwent TACE were classified into three groups: those who received a lidocaine bolus intraarterially immediately prior to TACE (group A, n = 30), those who received lidocaine immediately after TACE (group B, n = 46), and those who did not received lidocaine (group C, n = 37). Incidence and degree of post-procedural pain was assessed using a subjective method (visual analogue scales scored from 0 to 10) and an objective method (amount of post-procedural analgesics). RESULTS: The incidence of post-procedural pain in group A (16.7%) was significantly lower than that of group B (38.3%; p = 0.005). The mean pain score was 3.0 in group A and 4.8 and 3.1 in groups B and C, respectively. The mean dose of analgesic used after the procedure in group A (25.0 mg) was significantly lower than those in group B (52.9 mg) and group C (41.0 mg; p = 0.002). CONCLUSIONS: Pre-TACE intraarterial administration of lidocaine is much more effective than post-TACE administration in reducing the incidence and the severity of post-procedural pain. Furthermore, in order to reduce the incidence of post-procedural pain and dose of post-procedural analgesics, we recommend routine pre-TACE administration of lidocaine because post-procedural pain might developed even in patients who did not feel any pain during the TACE. 相似文献
6.
Acetic acid as a sclerosing agent for renal cysts: Comparison with ethanol in follow-up results 总被引:1,自引:0,他引:1
Seo TS Oh JH Yoon Y Lim JW Park SJ Chang SG Jeon YH 《Cardiovascular and interventional radiology》2000,23(3):177-181
Purpose: To compare follow-up results of sclerotherapy for renal cyst using 50% acetic acid with those using 99% ethanol as sclerosing
agents.
Methods: Eighty-one patients underwent sclerotherapy and 58 patients, 23 males, 35 females, aged 6–76 years, having a total of 60
cysts, were included in this study; the others were lost to follow-up. The renal cysts were diagnosed by sonography, computed
tomography (CT), or magnetic resonance imaging (MRI). Sclerotherapy was performed using 50% acetic acid for 32 cysts in 31
patients and 99% ethanol for 28 cysts in 27 patients. Under fluoroscopic guidance, cystic fluid was aspirated as completely
as possible. After instillation of a sclerosing agent corresponding to 11.7%–25% (4–100 ml) of the aspirated volume, the patient
changed position for 20 min and then the agent was removed. Patients were followed up by sonography for a period of 1–49 months.
The volume of the renal cyst after sclerotherapy was compared with that of the renal cyst calculated before sclerotherapy.
Medical records were reviewed to analyze complications.
Results: The mean volume after sclerotherapy of the 17 cysts followed for 3–4 months in the acetic acid group was 5.1% of the initial
volume, and for the 14 cysts in the ethanol group it was 10.2%. Complete regression during follow-up was shown in 21 cysts
(66%) in the acetic acid group; the mean volume of these cysts before the procedure was 245 ml. The mean volume of the nine
(32%) completely regressed cysts in the ethanol group was 184 ml. Mild flank pain, which occurred in three patients in each
group, was the only complication and resolved the next day.
Conclusion: Acetic acid was an effective and safe sclerosing agent for renal cysts, tending to induce faster and more complete regression
than ethanol. 相似文献
7.
《Cardiovascular and interventional radiology》1998,22(2):114-118
Purpose: To assess the efficacy of intrapleural urokinase instillation through small-caliber catheters for the treatment of loculate
and/or septate effusions.
Methods: We inserted small-caliber catheters (8.2 Fr) in 102 patients with septate and/or loculate pleural effusions using ultrasonographic
guidance. Urokinase (100,000 IU/2 hr, 3 times a day) was instilled through the catheter until the effusion resolved and D-dimer
levels were <500 ng/ml. Patients were enrolled regardless of the etiology of the pleural effusion provided there were no contraindications
for the use of urokinase. D-dimer levels were determined before and after treatment. Follow-up was performed by chest radiograph
and sonography at 1 day, 7 days, and every 30 days thereafter for 6 months.
Results: Successful catheter placement was achieved in all cases. The mean time catheters stayed in place was 5.7 days and the mean
dose of drug instilled was 690,000 IU. Pleural effusion drainage was complete at the first assessment in all patients. Failure
of the treatment, with recurrent effusion at 30 days, occurred in six patients (5.8%). Complete resolution without sequelae
was observed in 19 patients (19.6%). In 75 cases (73.5%) resolution was partial, with pleural thickening (>2 mm). Two patients
died from unrelated causes within 30 days after catheter placement. Complications were seen in 13 patients (12.74%): hydropneumothorax,
nine cases (8.82%); infection of the puncture point, three cases (2.94%); and adverse reaction, one case (0.98%). No further
treatment was required.
Conclusion: The use of intrapleural fibrinolytic agents delivered through small-caliber catheters for the treatment of loculate and/or
septate pleural effusion is a simple, effective, minimally invasive and inexpensive procedure that can prevent sequelae and
shorten drainage time. 相似文献
8.
《Cardiovascular and interventional radiology》1998,22(2):96-102
Purpose: To determine the efficacy of percutaneous endoluminal stents and stent-grafts for the treatment of isolated femoropopliteal
aneurysms.
Methods: Seven men (age 51–69 years) with femoropopliteal occlusions (n= 6) related to aneurysms and a patent femoropopliteal aneurysm (n= 1) were treated percutaneously. In two patients uncovered Wallstents and in five patients polyester-covered nitinol stents
were implanted. Assessment was performed with Doppler ultrasound and duplex ultrasonography 24 hr, 1, 3, 6, 12, and 24 months
after the intervention. Additionally, intraarterial angiography was performed at 6 months.
Results: Stent placement succeeded in all cases. No immediate adjunctive surgical treatment was necessary. Ankle-brachial index (ABI)
improved from 0.29 ± 0.29 (SD) before to 0.78 ± 0.23 (SD) 24 hr after the intervention. One patient was lost to follow-up.
Stent-graft occlusion occurred in four patients: after 2 days (n= 1), 1 month (n= 2), and 3 months (n= 1). One of the patients, whose stent occluded at 1 month, underwent successful recanalization with local fibrinolysis therapy.
Three of the seven, all with three-vessel run-off, demonstrated patency of the stent, which was assessed by duplex ultrasonography
at 29, 31, and 34 months. Breaking of the stent struts or significant stent migration was not observed.
Conclusions: These results in a small number of patients warrant further investigation to evaluate the role of percutaneous stents in
femoropopliteal aneurysms. Until further data of clinical studies are available, this method cannot be recommended, and it
cannot replace surgical treatment. 相似文献
9.
Effect of preoperative radiological treatment of hepatocellular carcinoma before liver transplantation: A retrospective study 总被引:13,自引:0,他引:13
Andrea Veltri Maurizio Grosso Maria C. Martina Alessia Ciancio Ezio David Mauro Salizzoni Umberto Soldano Joseph Galli Cesare Fava 《Cardiovascular and interventional radiology》1998,21(5):393-398
Purpose: To assess the results of radiological treatment of patients with hepatocellular carcinoma (HCC) performed before orthotopic
liver transplantation (OLT).
Methods: Sixty-two transplanted patients with a total of 89 HCC nodules were studied; 50 lesions in 38 patients had been treated prior
to OLT with transcatheter arterial chemoembolization (TACE; n= 29), percutaneous ethanol injection (PEI; n= 10), or combined therapy (TACE + PEI; n= 11). The induced necrosis was pathologically evaluated. The recurrence rate after OLT in the treated group of patients (n= 38) was compared with that in the non-treated group (n= 24).
Results: After TACE, necrosis was complete in 7 of 29 lesions (24.1%), partial in 11 of 29 (37.9%), and absent in 11 of 29 (37.9%).
After PEI, necrosis was complete in 8 of 10 lesions (80%), and partial in 2 of 10 (20%). Using combined therapy, necrosis
was complete in 11 of 11 lesions (100%). Four of 24 untreated and 4 of 38 treated patients did not survive OLT from causes
not related to the HCC; 3 of 20 non-treated patients (15%) and 4 of 34 treated patients (11.8%) had post-OLT recurrence (these
last four patients had undergone only TACE and did not have tumor necrosis at pathological examination).
Conclusion: TACE of HCC prior to OLT had no influence on the recurrence rate. PEI and combined therapy (TACE + PEI) may be recommended
in patients awaiting OLT. 相似文献
10.
CT-guided epidural/perineural injections in painful disorders of the lumbar spine: Short- and extended-term results 总被引:1,自引:0,他引:1
Gebhard Schmid M.D. Sylvia Vetter Dieter Göttmann Ernst-Peter Strecker 《Cardiovascular and interventional radiology》1999,22(6):493-498
Purpose: Evaluation of short- and extended-term results of repeated epidural/perineural injections (EDT/PRT) of corticoids in painful
afflictions of the lumbar spine.
Methods: Thirty-two patients who had persistent radicular or low back pain for more than 6 weeks were treated with CT-guided injection
therapy. By EDT/PRT, 40 mg of triamcinolonacetonid was injected either periradicularly or by a direct intraspinal epidural
method at intervals of 3 weeks. Altogether, 140 EDT/PRT were performed in 32 patients (mean 4.4, range 2–8). In nine patients
partial facet joint denervation with 1–2 ml of 50% alcohol solution was combined with EDT/PRT to reduce low back pain. Before
and after treatment and at follow-up (mean 9.6 months), treatment success was evaluated on a visual analog scale and by physical
examination (good = >50% improvement, moderate = 20%–50%, no improvement = <20%).
Results: Short-term (end of therapy) good or moderate improvement was achieved in 91% of patients, extended-term (mean 9.6 months)
in 56%. Regarding certain subgroups, those with disc herniations of the lumbar spine showed a better outcome with good or
moderate improvement in 95% short-term and 69% extended-term than those with spinal stenosis who had 72% short-term and 28%
long-term.
Conclusion: Results indicate that CT-guided EDT/PRT in combination with partial facet joint denervation is a safe and effective outpatient
treatment. 相似文献
11.
Therapeutic Consequences of Variation in Intraarterial Pressure Measurements After Iliac Angioplasty
Eric Tetteroo Cees Haaring Andries D. van Engelen Yolanda van der Graaf Willem P.T.M. Mali 《Cardiovascular and interventional radiology》1997,20(6):426-430
Purpose: To assess the accuracy of intraarterial measurement of transstenotic pressure gradients for the detection of hemodynamically
suboptimal iliac angioplasty.
Methods: In 14 patients, referred for diagnostic angiography, mean pressure gradients in the aorta and iliac artery were obtained
twice, using a double-sensor pressure catheter. Additional iliac measurements were performed during pharmacologically induced
flow augmentation. Repeatability was assessed by calculation of the mean difference plus standard deviation (MD ± SD) and
repeatability coefficient (2 × SD). These results were extrapolated to 137 iliac angioplasty procedures with secondary stenting
where there was a residual pressure gradient > 10 mmHg.
Results: MD ± SD for repeated measurements at rest and during flow augmentation were 0 ± 2 mmHg and 1 ± 3 mmHg, respectively. Repeatability
coefficients were 3 and 6 mmHg. Mean pressure gradients after hemodynamically insufficient angioplasty were 8 ± 7 mmHg at
rest and 17 ± 5 mmHg following vasodilatation. Inaccurate pressure recordings may have led to inappropriate stent placement
in less than 2.5%, and inappropriate denial of stent placement in less than 5% of the lesions.
Conclusion: Variability of intraarterial pressure measurements has little consequence in the detection of hemodynamically significant
stenosis after angioplasty.
Received: 0/00/00/Accepted: 0/00/00 相似文献
12.
Gary P. Siskin Brian F. Stainken Valerie S. Mandell R. Clement Darling Kyran Dowling Allen Herr 《Cardiovascular and interventional radiology》1999,22(5):375-380
Purpose: To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts.
Methods: Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for
treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n= 3), rest pain (n= 9), and minor or major tissue loss (n= 3). Lesions were at the proximal anastomosis (n= 6), the distal anastomosis (n= 3), or within the graft (n= 6).
Results: Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated
with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency
was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary
patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous
runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement
(at a mean of 10.8 months). Three late deaths occurred during follow-up.
Conclusion: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent
placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts.
Further evaluation is warranted to compare intragraft stent placement with surgical graft revision. 相似文献
13.
Beregi JP Mounier-Vehier C Devos P Gautier C Libersa C McFadden EP Carré A 《Cardiovascular and interventional radiology》2000,23(5):340-346
Purpose: To study the vasomotor responses of the renal microcirculation in patients with essential hypertension.
Methods: We studied the reactivity of the renal microcirculation to papaverine, with intraarterial Doppler and quantitative arteriography,
in 34 renal arteries of 19 hypertensive patients without significant renal artery stenosis. Isosorbide dinitrate was given
to maximally dilate proximal renal arteries. APV (average peak blood flow velocity) was used as an index of renal blood flow.
Results: Kidneys could be divided into two distinct subgroups based on their response to papaverine. An increase in APV of up to 55%
occurred in 21 kidneys, an increase > 55% in 13 kidneys. Within each group the values were normally distributed. Both baseline
APV and the effect of papaverine on mean velocity differed significantly between groups.
Conclusion: There seems to be a subgroup of patients with essential hypertension that has an impaired reactivity to papaverine, consistent
with a functional impairment of the renal microcirculation. Further studies are required to determine whether this abnormality
contributes to or results from elevated blood pressure. 相似文献
14.
Ernst-Peter K. Strecker M.D. Dieter Göttmann Irene B. L. Boos Sylvia Vetter 《Cardiovascular and interventional radiology》1998,21(5):375-379
Purpose: To examine the efficacy of the low-molecular-weight heparin, reviparin, for prevention of femoropopliteal stent restenosis.
Methods: Forty-two patients who had implantation of flexible tantalum stents for the treatment of stenosis (n= 24) or occlusion (n= 18) of the femoral (n= 27) or popliteal (n= 15) arteries were included in this study protocol. An intraarterial bolus of 5000 IU heparin was given before percutaneous
transluminal angioplasty (PTA), and in the case of stent implantation due to unsuccessful PTA, an additional dose of reviparin
(3500 anti-factor Xa IU) was given. Postprocedurally, 10,500 anti-factor Xa IU of reviparin were administered intravenously
over 24 hr, followed by 3500 anti-factor Xa IU subcutaneously twice a day for 23 days. Oral aspirin (100 mg/day) was prescribed
for the long term. Follow-up criteria (maximum follow-up 37 months) were clinical symptoms, Doppler ankle arm indices, color
and duplex sonography, and angiography for suspicion of restenosis.
Results: Early stent thromboses were not observed. Overall primary patency rate (PPR) was 88% ± 6.0% (1 year) and 74% ± 10.1% (2 years).
Major hemorrhagic complications have not occurred.
Conclusion: Reviparin administered in a high dose over a period of 24 days is a safe medication regimen and provides excellent patency
rates after stent implantation. 相似文献
15.
Jeannette Bakker M.D. Pierre P. Goffette Michel Henry Willem P. T. M. Mali Jean-Pierre Melki Jon G. Moss Claudio Rabbia Eric Therasse Kenneth R. Thomson Siegfried Thurnher Claudio Vignali 《Cardiovascular and interventional radiology》1999,22(6):468-474
Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of
atherosclerotic ostial renal artery stenosis.
Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful
percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in
patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical
results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up.
Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic
follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5–18 months). Fifteen stents (16.9%) showed
restenosis (at a mean of 8.5 months), of which 10 were successfully redilated.
Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal
angioplasty, and a low rate of restenosis at 8 months angiographic follow-up. 相似文献
16.
Emanuele Neri Davide Caramella Cristina Bisogni Edoardo Laiolo Francesco Trincavelli Adriano Viviani Claudio Vignali Roberto Cioni Carlo Bartolozzi 《Cardiovascular and interventional radiology》1999,22(1):1-6
Purpose: To evaluate the diagnostic accuracy of virtual vascular endoscopy (VVE) in the detection of accessory renal arteries.
Methods: We retrospectively reviewed the CT angiography data sets of 67 patients (29 male and 38 female; age range 17–72 years, mean
age 53 years) imaged for the study of the renal arteries, and affected by renovascular hypertension. All patients also had
intraarterial digital subtraction angiography (DSA). CT angiography data sets were processed to obtain maximum intensity projection
(MIP) and surface-rendered VVE of the aorta. Axial images, MIP, and VVE were evaluated separately and in combination in the
detection of accessory renal arteries. Their results in terms of sensitivity and specificity were then compared with DSA.
Results: Axial images had a sensitivity of 88% and specificity of 94% for accessory renal artery detection, MIP had a sensitivity
of 88% and specificity of 98%, and VVE had a sensitivity of 63% and a specificity of 88% (p < 0.05 vs DSA), but these increased to 88% and 98% respectively if endoscopic views were integrated with the other display
techniques.
Conclusion: VVE based on surface rendering does not add substantial benefits to CTY angiography; by contrast MIP is the most accurate
display technique for the detection of accessory renal arteries. 相似文献
17.
Fujiwara K Hayakawa K Nagata Y Hiraoka M Nakamura T Shimizu Y Ikada Y 《Cardiovascular and interventional radiology》2000,23(3):218-223
Purpose: We performed a basic investigation using white rabbits of the sustained release and embolizing effects of poly L-lactic acid
microspheres (PLA) to determine their usefulness for chemoembolization.
Methods: Fifteen male Japanese white rabbits were used. Sustained release of an embolizing material, EPI-PLA was accomplished with
1 mg of PLA containing 0.03 mg of epirubicin hydrochloride (EPI). Embolization with 50 mg of PLA (total dose of EPI 1.5 mg)
was performed after the renal artery of the rabbits was selected (Chemo-TAE group). A group in which a bolus of 1.5 mg EPI
alone was injected through the renal artery (TAI group) was established as a control group. Furthermore, a group in which
embolization was performed with 50 mg of PLA alone (TAE group) was also established. These three groups, each consisting of
five rabbits, were compared.
Results: Blood EPI levels were serially measured. The blood EPI level in the TAI group rapidly reached a peak more than 30 min after
injection, then decreased to almost zero 24 hr after injection. In the Chemo-TAE group, the blood EPI level was transiently
increased 30 min after embolization, but remained low thereafter until 24 hr after embolization. EPI levels in kidney tissue
isolated 24 hr after embolization were measured. In the Chemo-TAE group, the tissue EPI level was significantly higher than
that in the TAI group. When isolated kidneys were macroscopically and histologically examined, atrophy of the entire embolized
kidney, as well as infarction and necrosis in the renal cortex, were observed in both the TAE group and the Chemo-TAE group.
However, there were no such findings in the TAI group. The area of the infarction in the renal cortex did not significantly
differ between the Chemo-TAE group and the TAE group; however, there was vascular injury in the Chemo-TAE group and none in
the TAE group.
Conclusion: It was demonstrated that EPI-PLA, a chemoembolizing material, maintained high local concentrations of the anticancer drug,
while maintaining low blood levels of the anticancer drug. 相似文献
18.
Masao Hamuro Kenji Nakamura Yukimasa Sakai Manabu Nakata Hideki Ichikawa Yoshinobu Fukumori Ryusaku Yamada 《Cardiovascular and interventional radiology》1998,22(2):130-134
Purpose: The evaluation of new oily agents for targeting chemoembolization for hepatocellular carcinoma.
Methods: Five types of oily preparation were injected into the hepatic artery of 54 rabbits inoculated with VX2 carcinoma cells in
order to evaluate (1) the safety of these preparations, (2) their histologic distribution and the amount of agents remaining
at tumor sites, and (3) computed tomographic (CT) images obtained. Of these preparations, three were made by mixing non-iodinated
poppy seed oil and a thickener and then adjusted to have a viscosity lower than, equal to, or higher than that of lipiodol.
A fourth preparation was a mixture of lipiodol and a thickener with a higher viscosity than lipiodol alone, and the fifth
preparation was lipiodol alone.
Results: (1) No injury to the hepatic parenchyma was observed hematologically or histologically. (2) With increase in the viscosity,
a significantly larger amount of agent remained at the tumor site. No agent was present at normal sites 14 days after intraarterial
injection, regardless of which preparation was given. (3) On CT scans following intraarterial injection, tumor cells were
visibly deeply stained in the non-iodinated preparation groups, while the lipiodol groups were not evaluable because of excessively
high attenuation.
Conclusion: The non-iodinated oily preparations and highly viscous oily preparations developed in the present study were more useful
than lipiodol for treatment of hepatic tumors. 相似文献
19.
Percutaneous implantation of a catheter with subcutaneous reservoir for intraarterial regional chemotherapy: Technique and preliminary results 总被引:5,自引:0,他引:5
Grosso M Zanon C Mancini A Garruso M Gazzera C Anselmetti GC Veglia S Gandini G 《Cardiovascular and interventional radiology》2000,23(3):202-210
Purpose: We present the technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to
a subcutaneous infusion reservoir for prolonged regional chemotherapy of hepatic and extrahepatic tumors.
Methods: Two hundred patients with primary or secondary hepatic neoplasms, pelvic, pancreatic, renal, lingual, and breast cancer underwent
the procedure. The access was the left axillary artery (188 patients) and the femoral artery (12 patients). The catheter tip
was placed in the hepatic (170 patients), hypogastric (18), splenic (4), internal thoracic (2), gastroduodenal (3), renal
(2) or the external carotid artery (1). The catheter was connected to a subcutaneous reservoir and filled with heparin; chemotherapeutic
infusion was subsequently started.
Results: One hundred percent immediate technical success was obtained. Forty-three of 200 (21.5%) patients had a complication: 29
patients had a catheter dislodgment, nine had arterial thrombosis, three had a pseudoaneurysm of the left axillary artery
and two had a port pocket hematoma. Most complications (37/43, 86%) were treated percutaneously without interruption of chemotherapy.
In only six cases (3% of the total population) was chemotherapy discontinued due to the complication itself. The mean duration
of catheter patency was 7.2 months.
Conclusion: Percutaneous placement of an intraarterial catheter is feasible and causes less discomfort to the patient than the surgical
approach. The technique has an acceptable complication rate (21.5%), similar to that for surgical implantation (17.8%), with
the advantage that in most cases the complications can be resolved percutaneously. This technique represents an alternative
to surgical implantation in the treatment of liver metastases from colorectal cancer and opens new therapeutic possibilities
for the local prolonged treatment of other kinds of tumor, though its clinical efficacy must be assessed in selected trials. 相似文献
20.
Percutaneous implantation of a Port-Catheter System using the left subclavian artery 总被引:1,自引:0,他引:1
Chen Y He X Chen W Lu W Mei Q Zeng Q Li Y 《Cardiovascular and interventional radiology》2000,23(1):22-25
Purpose: To evaluate the safety and feasibility of a percutaneous Port-Catheter System (PCS) implanted via the subclavian artery (SCA)
for regional chemotherapy or chemoembolization of thoracic, abdominal, and pelvic malignant tumors.
Methods: Percutaneous puncture of the SCA was performed in 256 patients with thoracic, abdominal, or pelvic malignant tumors; then
a catheter was inserted into the target artery. After the first transcatheter chemotherapy or chemoembolization with an emulsion
of lipiodol and anticancer agents, an indwelling catheter was introduced with its tip placed in the target artery and its
end subcutaneously connected to a port.
Results: The procedure was successfully completed in all 256 cases (100%). The indwelling catheter tip was satisfactorily placed in
the target arteries in 242 cases (98%). Complications attributable to the procedure occurred in 20 (7.8%) cases, including
pneumothorax (n = 10, 4%), hemothorax (n = 1, 0.4%), infections in the pocket (n = 4, 1.6%), and hematoma at the puncture site (n = 5, 2%). There were no severe sequelae or deaths. The duration of PCS usage was 1–36 months (median 9.5 months). During the course
of treatment, occlusion of the target artery occurred in 20 cases (7.8%). Dislocation of the tip of the indwelling catheter
occurred in 12 cases (4.7%); in 10 of the 12, the tip of the indwelling catheter was repositioned into the target artery.
In all 10 cases no large symptomatic hematomas developed after the PCS was removed.
Conclusion: Percutaneous PCS implantation via the left SCA, a relatively new procedure, is a safe and less invasive treatment approach
than surgical placement for malignancies. 相似文献