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1.
OBJECTIVE: We report on our experience with percutaneous interventional techniques for retrieval of intravascular foreign bodies or repositioning of misplaced endovascular prostheses. MATERIALS AND METHODS: Over a period of 6 years, we attempted percutaneous treatment of intravascular foreign bodies in 45 patients. The 45 foreign objects consisted of 12 endovascular stents, 14 catheter fragments, 11 embolization coils, four guidewire fragments, three vena cava filters, and one cardiac valve fragment. Percutaneous extraction was performed using a combination of multipurpose catheters and nitinol snare loop or grasping forceps. Depending on their composition, misplaced or dislodged intravascular stents were either repositioned or percutaneously removed. RESULTS: Percutaneous intervention was successful in 41 (91.1%) of 45 patients. Of 38 patients on whom we performed percutaneous removal, the procedure was successful in 34 patients (89.5%), including 13 of the 14 patients with catheter fragments, all four of the patients with guidewire fragments, 10 of the 11 patients with misplaced or dislodged embolization coils, four of the five patients with misplaced or dislodged endovascular stents, and all three of the patients with misplaced or dislodged vena cava filters. The procedure was not successful in the one patient with a cardiac valve fragment. All seven of the percutaneous repositioning procedures we performed resulted in the endovascular stent being successfully repositioned in a stable intravascular position. Most of the retrieval procedures (77.7%) were performed using the nitinol snare as the primary instrument. No late complications were registered during the follow-up period, which ranged from 9 to 68 months (mean, 42.4 months overall). CONCLUSION: Percutaneous techniques for the extraction of intravascular foreign objects or for repositioning of dislocated endovascular stents are highly effective with a low rate of complications and should always be the primary method of choice. 相似文献
2.
Nina Ni Hamid Mojibian Jeffrey Pollak Michael Tal 《Cardiovascular and interventional radiology》2011,34(1):114-119
To compare the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath
with percutaneous transluminal angioplasty balloons and those who underwent over-the-wire catheter exchange. This study is
a retrospective review of 209 percutaneous transluminal angioplasty balloon disruption and 1304 over-the-wire catheter exchange
procedures performed in 753 patients. Approval from the Human Investigations Committee was obtained for this study. Up to
10-year follow-up was performed. A χ2 test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A t-test was used to compare time to central venous stenosis development. Of the 753 patients in the study, 127 patients underwent
balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18 (14.2%) of 127
patients subsequently developed central venous stenosis, compared with 44 (7.0%) of 626 in the catheter exchange group (P < 0.01, χ2 test). Time to central venous stenosis development was approximately 3 years in both groups and not significantly different
(1371 and 1010 days, P = 0.20). A total of 25.2% of patients in the balloon disruption group had four or more subsequent catheter exchanges, versus
12.6% in the catheter exchange group (P < 0.01, χ2 test). In conclusions, there is a possible association between percutaneous transluminal angioplasty balloon disruption of
fibrin sheath and late-onset central venous stenosis. Because venography was not routinely performed in catheter exchange
patients, future randomized studies are necessary to confirm these findings. 相似文献
3.
Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils? 总被引:8,自引:0,他引:8
Boris Lubicz Carine Neugroschl Laurent Collignon Olivier François Danielle Balériaux 《Neuroradiology》2008,50(10):841-848
Introduction Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation.
The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography
(DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up.
Materials and methods From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n = 9) or without (n = 58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if
a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers
1 and 2) and two other reviewed DSA images.
Results Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in
one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation
in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity
of CE-MRA to detect aneurysm recanalisation was 95.5%.
Conclusion CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention
imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences
may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up. 相似文献
4.
Noriaki Sakamoto Yasuaki Arai Yoshito Takeuchi Masahide Takahashi Masakatsu Tsurusaki Kazuro Sugimura 《Cardiovascular and interventional radiology》2010,33(5):989-994
The purpose of this study was to assess the technical success rate and adverse events (AEs) associated with ultrasound (US)-guided
radiological placement (RP) of a central venous port (CVP) via the subclavian vein (SCV). Between April 2006 and May 2007,
a total of 500 US-guided RPs of a CVP via the SCV were scheduled in 486 cancer patients (mean age ± SD, 54.1 ± 18.1 years)
at our institute. Referring to the interventional radiology report database and patients’ records, technical success rate
and AEs relevant to CVP placement were evaluated retrospectively. The technical success rate was 98.6% (493/500). AEs occurred
in 26 cases (5.2%) during follow-up (range, 1–1080 days; mean ± SD, 304.0 ± 292.1 days). AEs within 24 h postprocedure occurred
in five patients: pneumothorax (n = 2), arterial puncture (n = 1), hematoma formation at the pocket site (n = 2), and catheter tip migration into the internal mammary vein (n = 1). There were seven early AEs: hematoma formation at the pocket site (n = 2), fibrin sheath formation around the indwelling catheter (n = 2), and catheter-related infections (n = 3). There were 13 delayed AEs: catheter-related infections (n = 7), catheter detachments (n = 3), catheter occlusion (n = 1), symptomatic thrombus in the SCV (n = 1), and catheter migration (n = 1). No major AEs, such as procedure-related death, air embolism, or events requiring surgical intervention, were observed.
In conclusion, US-guided RP of a CVP via the SCV is highly appropriate, based on its high technical success rate and the limited
number of AEs. 相似文献
5.
Claude Haller Sébastien Déglise Francois Saucy Claudine Mathieu Erik Haesler Francesco Doenz Jean Marc Corpataux Salah Dine Qanadli 《Cardiovascular and interventional radiology》2009,32(4):695-702
A method for hemodialysis catheter placement in patients with central thoracic venous stenosis or occlusion is described and
initial results are analyzed. Twelve patients, with a mean age of 63.2 years (42–80 years), with central venous stenosis or
occlusion, and who required a hemodialysis catheter were reviewed. All lesions were confirmed by helical CT or phlebography.
Five patients had stenosis while seven patients were diagnosed with an occlusion of thoracic central veins. All patients were
asymptomatic, without sign of superior vena cava syndrome. After percutaneous transstenotic catheterization or guidewire-based
recannalization in occlusions, a balloon dilatation was performed and a stent was placed, when necessary, prior to catheter
placement. Technical success was 92%. Three patients had angioplasty alone and nine patients had angioplasty with stent placement.
Dialysis catheters were successfully inserted through all recannalized accesses. No immediate complication occurred, nor did
any patient develop superior vena cava syndrome after the procedure. The mean follow-up was 21.8 months (range, 8–48 months).
Three patients developed a catheter dysfunction with fibrin sheath formation (at 7, 11, and 12 months after catheter placement,
respectively). Two were successfully managed by percutaneous endovascular approach and one catheter was removed. In conclusion,
for patients with central venous stenosis or occlusion and those who need a hemodialysis catheter, catheter insertion can
be reliably achieved immediately after endovascular recannalization with acceptable technical and long-term success rates.
This technique should be considered as an alternative procedure for placing a new hemodialysis catheter through a patent vein. 相似文献
6.
Radeleff B Sommer CM Heye T Lopez-Benitez R Sauer P Schmidt J Kauczor HU Richter GM 《Cardiovascular and interventional radiology》2009,32(1):32-37
The purpose of this study was to investigate alterations of hepatic arterial flow during transjugular intrahepatic portosystemic
stent shunt (TIPS) applying intravascular Doppler sonography. This prospective monocenter study included 25 patients with
liver cirrhosis (alcohol induced [n = 19], chronic hepatitis associated [n = 3], primary biliary cirrhosis associated [n = 1], and cryptogenic [n = 2]) successfully treated with TIPS. All patients underwent intravascular hepatic arterial flow measurements during TIPS
using an endoluminal flow sensor. The average arterial peak velocity (APV) and the maximum arterial peak velocity (MPV) were
registered. Twenty-two patients (88%) showed increased APV, one patient (4%) showed unaffected APV, and two patients (8%)
showed decreased APV after TIPS. The average portosystemic pressure gradient decreased significantly, from 22.0 ± 5.1 mmHg
before TIPS to 11.0 ± 4.1 mmHg after TIPS (−50.0%; p < 0.0001). The average APV increased significantly, from 41.9 ± 17.8 cm/s before TIPS to 60.7 ± 19.0 cm/s after TIPS (+44.9%; p < 0.0001). The average MPV increased significantly, from 90.8 ± 31.7 cm/s before TIPS to 112.6 ± 34.9 cm/s after TIPS (+24.0%; p = 0.0002). These changes in perfusion set in within seconds after TIPS tract formation in all the patients with increased
APV. We conclude that TIPS-induced portosystemic decompression leads to a significant increase in hepatic arterial flow. The
changes occurred within seconds, suggesting a reflex-like mechanism. 相似文献
7.
Savage C Ozkan OS Walser EM Wang D Zwischenberger JB 《Cardiovascular and interventional radiology》2003,26(5):440-442
To evaluate the feasibility of intravascular retrieval of chronic foreign bodies, we retrospectively reviewed an 8 year experience (1993–2001) of percutaneous retrieval of chronically retained intravascular foreign bodies (n = 6). In 6 of 6 cases (4 catheter fragments, 2 guidewires), 5–90 days elapsed before retrieval via the femoral or internal jugular vein. Under fluoroscopy, we determined the foreign bodys course, position and size. A guidewire was advanced through a multipurpose catheter to the foreign body. The multipurpose catheter was replaced with a gooseneck snare catheter and the snare advanced to grasp and remove the foreign body.
Percutaneous retrieval was successful in all 6 cases. One patient experienced mild hemoptysis, which resolved within 24 hr of observation. No patient experienced long-term sequelae.
Given the potential life-threatening complications from intravascular foreign bodies and the low complication rate from percutaneous retrieval, we recommend extraction of the foreign body even if it is asymptomatic in the chronic setting (> 24 hr). 相似文献
8.
Tobias Struffert Martin Köhrmann Tobias Engelhorn Tim Nowe Gregor Richter Peter D. Schellinger Stefan Schwab Arnd Doerfler 《European radiology》2009,19(9):2286-2293
The Penumbra Stroke System (PSS) was cleared for use in patients with ischemic stroke by the FDA in January 2008. We describe
our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive
patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial
standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial
median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion
presented with coma. Median symptom to procedure start time was 151 min. In the anterior circulation, 9 of the 12 target vessels
were recanalised successfully (TIMI 2 and 3). The rate of patients with independent clinical outcome (mRS ≤ 2) was 42%. One
patient died 5 days after unsuccessful treatment, one after 28 days and one after 85 days owing to heart attack. Basilar artery
occlusions could be recanalised in all cases to TIMI 3. The clinical result after 90 days was mRS 4 in two cases and mRS 5
in one case. Symptomatic haemorrhage did not occur. The PSS can safely be used for recanalisation in patients with acute ischemic
stroke due to large vessel occlusion, who have already received thrombolysis treatment. The recanalisation rate was 80%. Symptomatic
haemorrhage did not occur. Randomized trials may demonstrate that endovascular mechanical thrombectomy improves patient outcome. 相似文献
9.
Michele Miragoli Matteo Goldoni Pierluigi Demola Arianna Paterlini Mauro Li Calzi Margherita Ilaria Gioia Francesco Visioli Stefano Rossi Giovanna Pel 《Scandinavian journal of medicine & science in sports》2019,29(11):1727-1735
Some forms of early ECG repolarization QRS pattern (ERp) with J‐point elevation of 0.1 mV in two contiguous inferior and/or lateral leads with or without ST‐elevation are potentially associated with a higher arrhythmic risk in adults. We assessed the prevalence of ERp among non‐professional adolescent athletes and correlated it with age, sex, ethnicity, and structural and electric cardiac parameters. We retrospectively analyzed 414 ECGs obtained from young athletes referred to our center from 2006 to 2017. We found ERp in 22% of cases. In the ERp group, we found a greater percentage of black athletes, a higher systolic blood pressure, and lower heart rate (HR) compared with the group without ERp. This pattern was less frequent in female athletes. In athletes with ERp, the occurrence of ventricular ectopic beats was less frequent and QRS‐duration was shorter. They also exhibited greater (a) ECG‐based left ventricular hypertrophy (LVH), (b) left ventricular mass, and (c) relative wall thickness (RWT), suggesting a tendency to concentric geometry. At logistic regression analysis, we found that HR (OR 0.98 [0.96‐0.99] P = .013), QRS‐duration (OR 0.96 [0.94‐0.99], P = .003), LVH (OR 1.09 [1.05‐1.12], P < .001), and RWT (OR 1.08 [1.01‐1.16] P = .032) were significant predictors of ERp incidence. ERp is quite common in adolescent athletes and correlates with concentric LV remodeling. Specific clinical and ECG‐findings related to training such as lower HR, LVH, and QRS‐duration are also predictors of ERp. In adolescent non‐professional athletes, ERp is a benign finding associated with some structural and electric cardiac modifications induced by training. 相似文献
10.
Levent Onat Ali Kursat Ganiyusufoglu Ayhan Mutlu Mustafa Sirvanci Cihan Duran Onur Levent Ulusoy Azmi Hamzaoglu 《Cardiovascular and interventional radiology》2009,32(5):992-997
We aimed to evaluate the efficacy and safety of the OptEase and TrapEase (both from Cordis, Roden, Netherlands) vena cava
filters in the prevention of pulmonary embolism (PE). Between May 2004 and December 2008, OptEase (permanent/retrievable;
n = 228) or TrapEase (permanent; n = 30) vena cava filters were placed in 258 patients (160 female and 98 male; mean age 62 years [range 22 to 97]). Indications
were as follows: prophylaxis for PE (n = 239), contraindication for anticoagulation in the presence of PE or DVT (n = 10), and development of PE or DVT despite anticoagulation (n = 9). Medical records were retrospectively reviewed for indications, clinical results, and procedure-related complications
during placement and retrieval. Clinical PE did not develop in any of the patients. However, radiologic signs of segmental
PE were seen in 6 of 66 patients with follow-up imaging data. Migration or fracture of the filter or cava perforation was
not seen in any of the patients. Except for a single case of asymptomatic total cava thrombosis, no thrombotic occlusion was
observed. One hundred forty-one patients were scheduled to undergo filter removal; however, 17 of them were not suitable for
such based on venography evaluation. Removal was attempted in 124 patients and was successful in 115 of these (mean duration
of retention 11 days [range 4 to 23]). Nine filters could not be removed. Permanent/retrievable vena cava filters are safe
and effective devices for PE prophylaxis and for the management of venous thromboembolism by providing the option to be left
in place. 相似文献
11.
Young Chul Kim Jong Yun Won Sun Young Choi Heung-kyu Ko Kwang-Hun Lee Do Yun Lee Byung-Chul Kang Seung-Jung Kim 《Cardiovascular and interventional radiology》2009,32(2):271-278
The purpose of this study was to evaluate the long-term outcomes of endovascular treatment of central venous stenosis in patients
with arteriovenous fistulas (AVFs) for hemodialysis. Five hundred sixty-three patients with AVFs who were referred for a fistulogram
were enrolled in this study. Among them, 44 patients showed stenosis (n = 35) or occlusions (n = 9) in the central vein. For the initial treatment, 26 patients underwent percutaneous transluminal angioplasty (PTA) and
15 patients underwent stent placements. Periods between AVF formation and first intervention ranged from 3 to 144 months.
Each patient was followed for 14 to 60 months. Procedures were successful in 41 of 44 patients (93.2%). Primary patency rates
for PTA at 12 and 36 months were 52.1% and 20.0%, and assisted primary patency rates were 77.8% and 33.3%, respectively. Primary
patency rates for stent at 12 and 36 months were 46.7% and 6.7%, and assisted primary patency rates were 60.0% and 20.0%,
respectively. Fifteen of 26 patients with PTAs underwent repeated interventions because of restenosis. Fourteen of 15 patients
with a stent underwent repeated interventions because of restenosis and combined migration (n = 1) and shortening (n = 6) of the first stent. There was no significant difference in patency between PTAs and stent placement (p > 0.05). Average AVF patency duration was 61.8 months and average number of endovascular treatments was 2.12. In conclusion,
endovascular treatments of central venous stenosis could lengthen the available period of AVFs. There was no significant difference
in patency between PTAs and stent placement. 相似文献
12.
Ulku Cenk Turba Bulent Arslan Michael Meuse Saher Sabri Barbara Gail Macik Klaus D. Hagspiel Alan H. Matsumoto John F. Angle 《Cardiovascular and interventional radiology》2010,33(4):732-738
We report our experience with Günter Tulip filter placement indications, retrievals, and procedural problems, with emphasis
on alternative retrieval techniques. We have identified 92 consecutive patients in whom a Günter Tulip filter was placed and
filter removal attempted. We recorded patient demographic information, filter placement and retrieval indications, procedures,
standard and nonstandard filter retrieval techniques, complications, and clinical outcomes. The mean time to retrieval for
those who experienced filter strut penetration was statistically significant [F(1,90) = 8.55, p = 0.004]. Filter strut(s) IVC penetration and successful retrieval were found to be statistically significant (p = 0.043). The filter hook-IVC relationship correlated with successful retrieval. A modified guidewire loop technique was
applied in 8 of 10 cases where the hook appeared to penetrate the IVC wall and could not be engaged with a loop snare catheter,
providing additional technical success in 6 of 8 (75%). Therefore, the total filter retrieval success increased from 88 to
95%. In conclusion, the Günter Tulip filter has high successful retrieval rates with low rates of complication. Additional
maneuvers such as a guidewire loop method can be used to improve retrieval success rates when the filter hook is endothelialized. 相似文献
13.
A transfemoral venous approach is the current standard for accessing malpositioned and fractured central venous catheters
(CVCs). The purpose of this study was (1) to describe a transbrachial approach for correction and (2) to assess the success
and failure of this method in a pediatric population. A 12-year retrospective review of all patients referred for correction
of malpositioned, retained, and fractured CVCs was conducted. Based on the performing interventionalist’s preference, transbrachial
or transfemoral venous sheaths where placed under ultrasonographic guidance. Diagnostic angiographic catheters and snares
were used to manipulate the catheters. Patients who underwent the transfemoral approach received postprocedural monitoring
for 4 hours, whereas patients who underwent the transbrachial approach were allowed unrestricted activity immediately after
hemostasis was obtained. Technical success of malpositioned lines was defined (1) by final position in the superior vena cava
or at the cavoatrial junction on postprocedural imaging or (2) by successful removal of retained catheter fragments, if present.
Transbrachial approach was used for access in 11 patients. Problematic lines included malpositioned (n = 10) and retained (n = 1) lines. The ipsilateral arm was used for transbrachial entry in 7 patients. Initial use of angiographic catheters was
attempted in 7 cases, of which 4 were successful. All 3 unsuccessful cases had tips positioned in the contralateral brachiocephalic
vein, and these were successfully repositioned using snares. A combination of snares and angiographic catheters was used in
2 cases. Snares were used for all other cases. Technical success by way of the transbrachial approach was observed in all
cases. Periprocedural follow-up demonstrated no immediate complications. We conclude that the transbrachial approach is a
suitable alternative to the transfemoral approach for catheter tip position correction. Tip malposition in the contralateral
brachiocephalic vein suggests higher rate of conversion to use of snare devices. 相似文献
14.
Carlo Ferro Umberto G. Rossi Giulio Bovio Francesco Petrocelli Sara Seitun 《Cardiovascular and interventional radiology》2010,33(4):844-848
The purpose of this communication is to describe our preliminary experience with the AMPLATZER Vascular Plug 4 (AVP 4) in
peripheral vascular embolization. The AVP 4 was used for peripheral vascular embolization in five patients with renal pseudoaneurysm
(n = 2), postsurgical peritoneal bleeding (n = 1), posttraumatic gluteal hemorrhage (n = 1), and intercostal pseudoaneurysm (n = 1). Occlusion time was recorded. Patients were followed up clinically and by imaging for 1 month after the procedure. All
treated vessels or vascular abnormalities were successfully occluded within 3 min for low-flow circulation and over 8 min
for high-flow circulation. At 1-month follow-up, all patients were symptom-free. All deployed devices remained in the original
locations and desirable configurations. In conclusion, the AVP 4 seems to be safe and effective for occluding peripheral vessels
and vascular abnormalities. Because of its compatibility with 0.038–in. catheters, it can be deployed through a diagnostic
catheter following angiography without exchanging a sheath or guiding catheter. Compared with the previous generation of vascular
plugs, the AVP 4 allows for faster procedure times and decreased exposure to radiation. 相似文献
15.
Alexandre A. Cochet Luc Lorgis Alain Lalande Marianne Zeller Jean-Claude Beer Paul M. Walker Claude Touzery Jean-Eric Wolf François Brunotte Yves Cottin 《European radiology》2009,19(9):2117-2126
The aim of this study was to compare the prognostic significance of microvascular obstruction (MO) and persistent microvascular
obstruction (PMO) as assessed by cardiac magnetic resonance (CMR) in patients with acute myocardial infarction (AMI). CMR
was performed in 184 patients within the week following successfully reperfused first AMI. First-pass images were performed
to evaluate extent of MO and late gadolinium-enhanced images to assess PMO and infarct size (IS). Major adverse cardiac events
(MACE) were collected at 1-year follow-up. MO and PMO were found in 127 (69%) and 87 (47%) patients, respectively. By using
univariate logistic regression analysis, high Global Registry of Acute Coronary Events (GRACE) risk score (odds ratio [OR]
95% confidence interval [CI]: 3.6 [1.8–7.4], p < 0.001), IS greater than 10% (OR [95% CI]: 2.7 [1.1–6.9], p = 0.036), left ventricular ejection fraction less than 40% (OR [95% CI]: 2.4 [1.1–5.2], p = 0.027), presence of MO (OR [95% CI]: 3.1 [1.3–7.3], p = 0.004) and presence of PMO (OR [95% CI]:10 [4.1–23.9], p < 0.001) were shown to be significantly associated with the outcome. By using multivariate analysis, presence of MO (OR [95%
CI]: 2.5 [1.0–6.2], p = 0.045) or of PMO (OR [95% CI]: 8.7 [3.6–21.1], p < 0.001), associated with GRACE score, were predictors of MACE. Presence of microvascular obstruction and persistent microvascular
obstruction is very common in AMI patients even after successful reperfusion and is associated with a dramatically higher
risk of subsequent cardiovascular events, beyond established prognostic markers. Moreover, our data suggest that the prognostic
impact of PMO might be superior to MO. 相似文献
16.
《Journal of vascular and interventional radiology : JVIR》2022,33(8):919-925.e2
PurposeTo determine risk factors (RFs) for hemorrhagic adverse events (AEs) associated with percutaneous transhepatic biliary drainage (PTBD) and to develop a risk assessment model.Materials and MethodsThis was a multicenter, prospective, case control study between 2015 and 2020. Adults with an indication for PTBD were included. Patients who had undergone recent previous drainage procedures were excluded. Multiple variables were controlled. The exposure variables were the number of capsular punctures and passes (using the same puncture). A multivariate analysis was performed (logistic regression analysis).ResultsA total of 304 patients (mean age, 63 years ± 14 [range, 23–87 years]; female, 53.5%) were included. Hemorrhagic AEs occurred in 13.5% (n = 41) of the patients, and 3.0% (n = 9) of the cases were severe. Univariate analysis showed that the following variables were not associated with hemorrhagic AEs: age, sex, bilirubin and hemoglobin levels, type of pathology, portal hypertension, location of vascular punctures, ascites, nondilated bile duct, intrahepatic tumors, catheter features, blood pressure, antiplatelet drug use, and tract embolization. Multivariate analysis showed that number of punctures (odds ratio [OR], 2.5; P = .055), vascular punctures (OR, 4.1; P = .007), fatty liver or cirrhosis (OR, 3.7; P = .021), and intrahepatic tumor obstruction (Bismuth ≥ 2; OR, 2.4; P = .064) were associated with hemorrhagic AEs. Patients with corrected coagulopathies had fewer hemorrhagic AEs (OR, ?5.5; P = .026). The predictability was 88.2%. The area under the curve was 0.56 (95% confidence interval, 0.50–0.61).ConclusionsPreprocedural and intraprocedural RFs were identified in relation to hemorrhage with PTBD. AE risk assessment information may be valuable for prediction and management of hemorrhagic AEs. 相似文献
17.
Objective
To investigate the clinical presentation of dislodged totally implantable central venous access system (central venous port-catheter) fragments and the efficacy and safety of percutaneous retrieval of them in our hospital.Materials and methods
Ninety-two cancer patients, mean age of 53.8 years old with 51.1% male, were enrolled from January 2005 to March 2007. They were referred to our catheterization laboratory for retrieval of fractured central venous port-catheter in our hospital. All patients were followed in the outpatient department for at least 1 month after surgical insertion. The characteristics of disrupted central venous port-catheter were recorded. The procedure-related clinical condition was evaluated.Results
The most common presentation of central venous port-catheter dislodgement is irrigation resistance to infusion (51/92). The most common location of fractured fragments is between superior vena cava and right atrium (i.e. proximal end remained in superior vena cava and distal end in right atrium) (22/92). The most common fracture site of the catheter is at the anastomosis between injection port and catheter (77/92). The retrieval set used mostly is loop snare. The success rate of the percutaneous retrieval of dislodged fragment was 97.8% and the complication rate was 3.3% only.Conclusion
The faulty connection between catheter and injection port contributes mainly to dislodgement of central venous port-catheter. Percutaneous retrieval of dislodged catheter is a highly successful, safe and efficient method. 相似文献18.
BackgroundThe purpose of this study is to systematically evaluate the application value of fluorescence visualization-assisted technology in the resection of liver cancer.MethodsA systematic search was conducted of the literature on fluorescence visualization-assisted technology in the resection of liver cancer in randomized controlled trials, semi-randomized controlled trials, and observational studies. The retrieval period was up to April 2022. Publications and conference papers in English were manually searched and the references included in the literature were traced. After evaluating the quality of the included studies, the total analysis and subgroup analysis based on pathological types of liver malignant lesions were conducted using the Review Manager 5.1 software.ResultsEight studies were included with a total of 646 patients enrolled. Analysis indicated that the fluorescence visualization could significantly shorten the operative time [mean difference (MD) = -38.33; 95% CI = -71.70 ∼ -4.96; P = 0.02], reduce blood loss [MD = 12.96; 95% CI = 11.98 ∼ 13.95; P < 0.001], shorten the hospital stay [MD = -8.0; 95% CI = -14.29 ∼ -1.72; P = 0.01], reduce postoperative complications [odds ratio (OR) = 0.44, 95% CI = 0.21 ∼ 0.91; P = 0.03], and reduce the recurrence rate [OR = 0.41, 95% CI = 0.21 ∼ 0.77; P = 0.006].ConclusionThis systematic review revealed the superiority of fluorescence visualization-assisted technology for the resection of liver cancer, and offers high practical application value. 相似文献
19.
Olivier Naggara Emmanuel Touzé Rodolpho Marsico Xavier Leclerc Thanh Nguyen Jean-Louis Mas Jean-Pierre Pruvo Jean-François Meder Catherine Oppenheim 《European radiology》2009,19(9):2255-2260
It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial
edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis.
Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection,
searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized
as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory
biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of
infection (OR = 12.5 [95%CI = 1.3–119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [95%CI = 2.2–82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [95%CI = 1.2–32.1], p = 0.0002) or ESR (OR = 8.8 [95%CI = 1.5–50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological
inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD. 相似文献
20.
A total of 20 patients with centrally embolized Port-A catheter fragments underwent the percutaneous retrieval procedures at our hospital. The causes of the dislodgement of these catheters included bad connection between the port and catheter, angulation or distortion at the anastomosis site, severing the catheter during insertion and removal of the catheter, improper catheter position and fatigue of the catheter. Consequently, improper procedure handling by the inexperienced surgeons could be considered as the most frequent cause of embolization. The percutaneous retrieval procedures were successful in all centrally embolized fragments. Of 20 successful retrievals, 16 were performed will loop snare catheters and 4 with Dormia basket retrievers. 相似文献