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1.
Kichang Han Man-Deuk Kim Joon Ho Kwon Yong Seek Kim Gyoung Min Kim Junhyung Lee Woosun Choi Jong Yun Won Do Yun Lee 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1702-1707
Purpose
To prospectively compare 2 different types of percutaneous fluoroscopic gastrostomy procedures (pigtail-retained gastrostomy [PG] vs mushroom-retained gastrostomy [MG]).Materials and Methods
Between March 2014 and February 2016, 100 patients were randomly assigned to receive 14-F PG or 20-F MG. Block randomization (block size 4) was performed, and sample size was calculated to assess the difference in minor complications. One patient withdrew from the study after allocation. Baseline characteristics were not significantly different between groups (P > .05). Technical success, defined as successful placement of gastrostomy tube, and procedural complications were evaluated. Procedural complications were divided into major and minor complications according to the Society of Interventional Radiology criteria.Results
Technical success rate was 100%. In the PG group, the major complication rate was 2% (1 of 50); 1 patient had a misplaced PG in the peritoneal cavity between the gastric and abdominal walls and developed peritonitis that had to be surgically treated. The minor complication rate was 34% (17 of 50) in the PG group. In the MG group, the major complication rate was 0%, and the minor complication rate was 12.2% (6 of 49). The most common minor complication was tube occlusion. Minor complication rate was significantly higher in the PG group (P = .016). Mean fluoroscopy time was significantly longer in the MG group (P = .013).Conclusions
Both PG and MG demonstrated high technical success rates in all indications. MG had lower complication rates than PG at the cost of an increase in fluoroscopy times. 相似文献2.
Brent Burbridge Chris Plewes Grant Stoneham Peter Szkup Rob Otani Paul Babyn Rhonda Bryce 《Journal of vascular and interventional radiology : JVIR》2018,29(5):648-656.e3
Purpose
To evaluate the hypothesis that power-injectable (PI) totally implanted venous access devices (TIVADs) situated in the arm are associated with more frequent complications and complication-related removal than non-power–injectable (NPI) arm TIVADs among adult cancer patients.Materials and Methods
In this single-center trial, 211 adult chemotherapy patients were randomized to receive either a PI or a NPI arm TIVAD. Follow-up involved a standardized telephone interview 1 week after insertion, followed by a chest X-ray, arm X-ray, and Doppler ultrasound at 3 months and 12 months. Online complication reporting was also provided by patients and care providers for a minimum of 1 year. The primary end point was removal for port-related complications; the secondary end point was the occurrence of any port-related complication.Results
Forty-two complications occurred (19.9% of patients), precipitating the removal of 6 PI ports and 7 standard ports. Time-to-removal did not differ between TIVAD types (hazard ratio 0.75, 95% confidence interval [CI] 0.25–2.24; P = .61). Complications were related to thrombosis, infection, or mechanical issues, with no statistical difference between groups for overall occurrence (23.1% vs 17.0%, odds ratio 1.47, 95% CI 0.74–2.92; P = .27); however, by type of complication, thrombosis occurred more frequently among PI TIVAD patients (15.2% vs 6.1%, odds ratio 2.79, 95% CI 1.04–7.44; P = .03).Conclusions
There was no difference in port-related complication occurrence or complication-related removal when using the arm PI port compared with the NPI port among cancer patients. 相似文献3.
Haibo Shao Colin McCarthy Eric Wehrenberg-Klee Ashraf Thabet Raul Uppot Steven Dawson Ronald S. Arellano 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1429-1436
Purpose
To assess the technical success rate, diagnostic yield, and clinical value of computed tomography (CT)–guided percutaneous needle biopsy (PNB) for retroperitoneal and pelvic lymphadenopathy.Materials and Methods
This retrospective study included 344 patients evaluated for safety and technique and 334 patients evaluated for diagnostic yield and clinical analyses. PNBs were performed with fine-needle aspiration (FNA) in 315 patients and with core biopsy in 333 patients. Follow-up analyses, including repeat biopsy, open surgery, imaging, and clinical indicators, were conducted for 94 patients who had nonspecific malignant or benign results. Diagnostic yields were calculated based on biopsy and follow-up results. Factors associated with final diagnoses were compared and modeled by multivariate analysis.Results
Technical success rate was 99.7%. Thirty-nine patients (11.3%) had minor complications. From biopsy results and follow-up analyses, final malignant diagnoses were determined for 281 patients (84.1%). Overall sensitivity, specificity, and accuracy rates of PNB were 91.5%, 100%, and 92.8%, respectively. For patients with a history of malignancy, the likelihood of nodal involvement was 84.6% and that of a new, different malignancy was 3.7%. Older age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00–1.05), history of malignancy (OR, 3.44; 95% CI, 1.71–6.92), multiple lymph nodes (LNs; OR, 2.65; 95% CI, 1.38–5.09), and new or enlarging LNs (OR, 2.62; 95% CI, 1.25–5.48) were independent risk factors for malignancy diagnosis.Conclusions
CT-guided PNB is a safe, effective procedure that can achieve high diagnostic yields for patients with retroperitoneal and pelvic lymphadenopathy. 相似文献4.
Dimitri Dorcaratto Niamh M. Hogan Elena Muñoz Marina Garcés Paolo Limongelli Luis Sabater Joaquin Ortega 《Journal of vascular and interventional radiology : JVIR》2018,29(5):676-687
Purpose
To compare postoperative complications in patients who underwent pancreatoduodenectomy after either endoscopic or percutaneous biliary drain (BD).Material and Methods
Data from studies comparing the rate of postoperative complications in patients who underwent endoscopic BD or percutaneous BD before pancreatoduodenectomy were extracted independently by 2 investigators. The primary outcome compared in the meta-analysis was the risk of postoperative complications. Secondary outcomes were the risks of procedure-related complications, postoperative mortality, postoperative pancreatic fistula, severe complications, and wound infection. For dichotomous variables, the odds ratio (OR) with 95% confidence interval (CI) was calculated.Results
Thirteen studies, including 2334 patients (501 in the percutaneous BD group and 1833 in the endoscopic group), met the inclusion criteria. Postoperative and procedure-related complication rates were significantly lower in the percutaneous BD group (OR = .7, 95% CI = .52–.94, P = .02 and OR = .44, 95% CI = .23–.84, P = .01, respectively). No significant differences were observed when severe postoperative complications, postoperative mortality, postoperative pancreatic fistula, and wound infection rates were compared.Conclusions
In patients awaiting pancreatoduodenectomy, preoperative percutaneous BD is associated with fewer procedure-related or postoperative complications than endoscopic drain. 相似文献5.
Andrew J. Kesselman Nam Sao Hoang Alexander Y. Sheu William T. Kuo 《Journal of vascular and interventional radiology : JVIR》2018,29(6):758-764
Purpose
To evaluate the safety and efficacy of attempted percutaneous filter fragment removal during retrieval of fractured inferior vena cava (IVC) filters and to report outcomes associated with retained filter fragments.Materials and Methods
Over a 5-year period, 82 consecutive patients presenting with a fractured IVC filter were prospectively enrolled into an institutional review board–approved registry. There were 27 men and 55 women (mean, 47 y; range, 19–85 y). After main filter removal, percutaneous removal of fragments was attempted if they were deemed intravascular and accessible on preprocedural computed tomography (CT), cone-beam CT, and/or intravascular ultrasound; distal pulmonary artery (PA) fragments were left alone. A total of 185 fragments were identified (81 IVC, 33 PA, 16 cardiac, 2 hepatic vein, 1 renal vein, 1 aorta, 51 retroperitoneal). Mean filter dwell time was 2,183 days (range, 59–9,936 d). Eighty-seven of 185 fragments (47%) were deemed amenable to attempted removal: 65 IVC, 11 PA, 8 cardiac, 2 hepatic, and 1 aortic. Primary safety outcomes were major procedure-related complications.Results
Fragment removal was successful in 78 of 87 cases (89.7%; 95% confidence interval [CI], 81.3–95.2). There were 6 minor complications with no consequence (6.9%; 95% CI, 2.6–14.4) involving intraprocedural fragment embolization and 1 major complication (1.1%; 95% CI, 0.0–6.2), a cardiac tamponade that was successfully treated. The complication rate from attempted cardiac fragment removal was 12.5% (1 of 8; 95% CI, 0.3–52.7). Among patients with retained cardiopulmonary fragments (n = 19), 81% remained asymptomatic during long-term clinical follow-up of 845 days (range, 386–2,071 d).Conclusions
Percutaneous removal of filter fragments from the IVC and proximal PAs is safe and effective overall, but attempted intracardiac fragment removal carries a higher risk of complication. Most residual filter fragments not amenable to percutaneous removal remain asymptomatic and may be monitored clinically. 相似文献6.
Sphoorti Shellikeri Robert Daulton Madeleine Sertic Bairbre Connolly Mark Hogan Francis Marshalleck Anne Marie Cahill 《Journal of vascular and interventional radiology : JVIR》2018,29(3):328-334
Purpose
To analyze technique, outcomes, and complications of a large series of pediatric percutaneous nephrostomy (PCN) procedures performed at 4 tertiary pediatric centers.Materials and Methods
Retrospective multicenter study of PCNs performed during an 11-year period. Six hundred seventy-five PCNs were performed on 441 patients (median age: 4 y, range: 1 d–18 y, median weight: 17 kg, range: 0.7–112 kg); 31% were younger than 1 year. The most frequent indications for PCN procedures included hydronephrosis (57%), calculus (14%), and infection (12%). Forty-five percent of patients had severe and 32% had moderate hydronephrosis.Results
Technical success was 99% (n = 668); 7 failures occurred from lost access, during tract dilatation (n = 5) and during staghorn calculi without dilatation (n = 2). General anesthesia was used in 73% of procedures. Combined ultrasound and fluoroscopy was used in 98% of procedures. Of the 668 procedures, 561 (84%) were primary nephrostomy insertions, and 107 (16%) were a variety of exchanges (secondary catheter insertions). Twenty-four of 675 (4%) were transplanted kidneys. Access sites included lower (47%), mid (28%), and upper (12%) poles and pelvis (11%). Catheters were predominantly 7-8 French (n = 352). The mean catheter dwell time was 25 days (0–220 d). Total primary catheter days were 14,482, with an additional 2,241 days after secondary procedures. Follow-up in 653/668 (98%) procedures documented elective removal (79%) and salvage procedures (21%), which included wire exchange (8.7%), nephroureteral stent/catheter conversion (8.8%), and tube upsizing (3.5%). Periprocedural complications occurred in 30/668 (4.5%) procedures: 1 major (0.1%) self-limiting hematuria requiring transfusion and 29 (4.4%) minor complications.Conclusions
PCN is safe and successful in children of all ages, with few major complications. PCN in children is associated with specific technical challenges and requires ongoing management tailored to the very young to achieve good outcomes. 相似文献7.
Daniel L. Kirkpatrick Hasnain Hasham Zachary Collins Philip Johnson Steven Lemons Hassan Shahzada Suzanne L. Hunt Carissa Walter Jacqueline Hill Thomas Fahrbach 《Journal of vascular and interventional radiology : JVIR》2018,29(5):688-694
Purpose
To determine whether treating benign biliary strictures via a stricture protocol reduced the probability of developing symptomatic recurrence and requiring surgical revision compared to nonprotocol treatment.Materials and Methods
A stricture protocol was designed to include serial upsizing of internal/external biliary drainage catheters to a target maximum dilation of 18-French, optional cholangioplasty at each upsizing, and maintenance of the largest catheter for at least 6 months. Patients were included in this retrospective analysis if they underwent biliary ductal dilation at a single institution from 2005 to 2016. Forty-two patients were included, 25 women and 17 men, with an average age of 51.9 years (standard deviation ± 14.6). Logistic regression models were used to determine the probability of symptomatic recurrence and surgical revision by stricture treatment type.Results
Twenty-two patients received nonprotocol treatment, while 20 received treatment on a stricture protocol. After treatment, 7 (32%) patients in the nonprotocol group experienced clinical or laboratory recurrence of a benign stricture, whereas only 1 patient in the stricture protocol group experienced symptom recurrence. Patients in the protocol group were 8.9 times (95% confidence interval [CI] = 1.4–175.3) more likely to remain symptom free than patients in the nonprotocol group. Moreover, patients in the protocol group had an estimated 89% reduction in the probability of undergoing surgical revision compared to patients receiving nonprotocol treatment (odds ratio = .11, 95% CI = .01–.73).Conclusions
Establishing a stricture protocol may decrease the risk of stricture recurrence and the need for surgical revision when compared to a nonprotocol treatment approach. 相似文献8.
Andrew J. Miller Edwin A. Takahashi William S. Harmsen Kristin C. Mara Sanjay Misra 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1681-1686
Purpose
To determine the predictors of restenosis, major adverse limb events (MALEs), postoperative death (POD), and all-cause mortality after repeat endovascular treatment of superficial femoral artery (SFA) restenosis.Materials and Methods
This was a retrospective review of 440 patients with 518 SFA lesions who were treated between January 2002 and October 2011. Ninety-six limbs were treated for restenosis with bare metal stents (BMSs) or percutaneous transluminal angioplasty (PTA), of which 28 limbs developed another restenosis requiring a third procedure. The interaction measured in this study was between the second and third intervention. Predictors of SFA patency, MALEs, POD, and all-cause mortality after SFA restenosis treatment were identified.Results
Patients who were treated with BMSs (n = 51) had similar rates of restenosis compared with patients who were treated with PTA (n = 45) (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.68–2.90; P = .37). Patients in the BMS group who took statins had a significantly lower risk of restenosis than patients who did not take statins (HR 0.13; 95% CI 0.04–0.41; P < .001). Stage 4–5 chronic kidney disease (CKD) (n = 12) was associated with a significantly higher risk of MALE + POD (HR 6.17; 95% CI 1.45–26.18; P = .014) and all-cause mortality (HR 2.83; 95% CI 1.27–6.33; P = .01). Clopidogrel was protective against all-cause mortality (HR 0.41; 95% CI 0.20–0.80; P = .01).Conclusions
Patients in the BMS group who took statins at the time of intervention had a significantly lower risk of developing restenosis. Stage 4–5 CKD was a risk factor for MALE + POD and all-cause mortality, while clopidogrel decreased all-cause mortality risk. 相似文献9.
Shahnawaz Bashir Amar Mukund Ruzina Firdose Syed Suman Lata Nayak Archana Rastogi Shiv K. Sarin 《Journal of vascular and interventional radiology : JVIR》2018,29(5):696-703
Purpose
To evaluate the safety and diagnostic yield of combined fluoroscopy and ultrasound-guided transjugular kidney biopsy (TJKB) in cirrhotic patients with suspected renal parenchymal disease.Materials and Methods
A retrospective review was made of 27 patients (21 men; overall mean age 44.7 y) who underwent TJKB from June 2013 to June 2016; 21 patients had coagulopathy and/or thrombocytopenia, 4 underwent simultaneous TJKB with transjugular liver biopsy, and 1 patient each had severe obesity and gross ascites. All procedures were performed with the use of fluoroscopy and simultaneous transabdominal ultrasound guidance. The data were analyzed for number of passes taken, number of glomeruli in the tissue cores, adequacy of tissue core for histopathologic diagnosis, and incidence and severity of complications.Results
The average number of passes per case was 3.6 (range 2–6). The total length of tissue cores ranged from 0.4 cm to 2.5 cm. The mean numbers of glomeruli per procedure on light microscopy were 6.7 (range 0–17). Diagnostic biopsy specimens were obtained in 23 out of 27 patients (85%). Eleven patients had minor complications. One patient had major complication in the form of hemoglobin drop of 2.1 mg/dL which required embolization and blood transfusion.Conclusions
Combined use of fluoroscopy and ultrasound guidance for TJKB yielded adequate tissue samples with fewer passes and a low rate of complications in high-risk patients with cirrhosis. 相似文献10.
Bruno C. Odisio Suguru Yamashita Steven Y. Huang Scott E. Kopetz Kamran Ahrar Takashi Mizuno Claudius Conrad Thomas A. Aloia Yun Shin Chun Sanjay Gupta Jean-Nicolas Vauthey 《Journal of vascular and interventional radiology : JVIR》2018,29(3):395-403.e1
Purpose
To test the hypothesis that, given the current resection eligibility criteria for colorectal liver metastasis (CLM), prior hepatectomy would be associated with improved local tumor control and survival after percutaneous ablation of CLMs.Materials and Methods
This single-institution retrospective study included 82 consecutive patients with 97 CLMs treated with ablation (radiofrequency ablation, microwave ablation, or cryoablation) from January 2005 to December 2014. Local tumor progression-free survival (LTPFS), recurrence-free survival (RFS) at any organ, and overall survival (OS) were calculated using the Kaplan-Meier method from the time of ablation and compared between patients with (n = 49) and without (n = 33) prior hepatectomy. Cox regression models were used to identify LTPFS predictors.Results
Median overall follow-up period was 28 months (range, 4.5–132 months). Three-year actuarial LTPFS (patient level: 73% vs 34%, P < .001) was significantly higher in patients with than without prior hepatectomy, respectively. Similarly, 3-year RFS (23% vs 9.1%, P = .026) and OS (78% vs 48%, P = .003) were improved in patients with prior hepatectomy. At multivariate analysis, predictors of worse LTPFS were: no prior hepatectomy (hazard ratio [HR] 2.35, 95% confidence interval [CI] 1.02–5.45; P = .045), minimal ablation margin < 5 mm (HR 2.4, 95% CI 1.18–4.87; P = .016), and RAS-mutant tumor (HR 2.65, 95% CI 1.18–5.94; P = .019).Conclusions
Prior hepatectomy for CLMs is associated with improved local tumor control after percutaneous ablation of post-resection-developed CLMs. 相似文献11.
Andrew J. Erie Jonathan M. Morris Brian T. Welch A. Nicholas Kurup Adam J. Weisbrod Thomas D. Atwell Grant D. Schmit Eugene D. Kwon Matthew R. Callstrom 《Journal of vascular and interventional radiology : JVIR》2017,28(7):987-992
Purpose
To retrospectively review and report the efficacy and safety of percutaneous image-guided ablation (cryoablation or radiofrequency ablation) in the treatment of oligometastatic prostate cancer.Materials and Methods
An institutional registry was retrospectively reviewed and revealed 16 patients with oligometastatic prostate cancer (median age, 67 y; range, 50–86 y) who underwent percutaneous image-guided ablation to treat 18 metastatic sites. A subgroup of 7 patients with 8 metastases were androgen-deprivation therapy (ADT)–naïve and underwent ablation to delay initiation of ADT. Local tumor control, progression-free survival (PFS), ADT-free survival, and procedural complications were analyzed.Results
Local tumor control was achieved in 15 of 18 metastases (83%) at a median follow-up of 27 months (range, 5–56 mo). Local tumor recurrence was found in 3 of 18 metastases (17%), with a median time to local recurrence of 3.5 months (range, 3–38 mo). Estimated PFS rates at 12 and 24 months were 56% (95% confidence interval [CI], 30%–76%) and 43% (95% CI, 19%–65%), respectively. In the 7 ADT-naïve patients, local tumor control was achieved in all metastases, and the median ADT-free survival period was 29 months. There were no major procedural complications.Conclusions
In this cohort of patients with oligometastatic prostate cancer, percutaneous image-guided ablation was feasible and well tolerated and achieved acceptable local tumor control rates. Percutaneous ablation may be of particular utility in patients who wish to delay initiation of ADT. 相似文献12.
Pyeong Hwa Kim Kun Yung Kim Ho-Young Song Jiaywei Tsauo Jung Hwan Park Jung-Hoon Park Min Tae Kim 《Journal of vascular and interventional radiology : JVIR》2018,29(3):320-327
Purpose
To identify predictors associated with clinical outcomes (initial clinical failure, stent patency, and survival) after self-expandable metal stent (SEMS) placement for malignant esophagorespiratory fistulas (ERFs).Materials and Methods
Using logistic and Cox regression analyses, this study reviewed 88 patients (mean age 59.4 y ± 8.4; 84 men [95.5%] and 4 women [4.5%]) who underwent fluoroscopic SEMS placement for palliating malignant ERF from January 2000 to December 2016.Results
Technical success was achieved in all patients. Initial clinical success was achieved in 78.4% (69/88; 95% confidence interval [CI], 68.7%–85.7%). Among the 69 patients in whom initial clinical success was achieved, aspiration symptoms recurred in 37.7% (26/69; 95% CI, 27.2%–49.5%). Overall major complication rate was 25.0% (22/88; 95% CI, 17.1%–35.0%). Cumulative stent patency and cumulative survival rates at 1, 3, 6, and 12 months were 72.8%, 38.9%, 32.4%, and 21.6% and 81.4%, 51.9%, 30.5%, and 13.3%, respectively. Stricture of the upper esophagus was an independent predictor of initial clinical failure (odds ratio, 3.760; 95% CI, 1.207–11.811) and shorter stent patency (hazard ratio [HR], 2.036; 95% CI, 1.170–3.544). Initial clinical failure was an independent predictor of shorter survival (HR, 2.902; 95% CI, 1.587–5.305).Conclusions
SEMS placement offers sufficient short-term relief despite considerable major complications. Stricture of the upper esophagus is an independent predictor of initial clinical failure and shorter stent patency. Initial clinical failure is an independent predictor of shorter survival. 相似文献13.
Pierleone Lucatelli Renato Argirò Stefano Ginanni Corradini Luca Saba Carlo Cirelli Fabrizio Fanelli Carmelo Ricci Giovanni Battista Levi Sandri Carlo Catalano Mario Bezzi 《Journal of vascular and interventional radiology : JVIR》2017,28(7):978-986
Purpose
To compare image quality and diagnostic performance of cone-beam computed tomography (CT) and multidetector CT in the detection of hypervascular hepatocellular carcinoma (HCC) in patients with cirrhosis undergoing transarterial chemoembolization with drug-eluting embolic agents.Materials and Methods
Fifty-five consecutive patients referred for chemoembolization of hypervascular HCC were prospectively enrolled. Imaging included preprocedural multidetector CT within 1 month before planned treatment, intraprocedural cone-beam CT, and 1-month follow-up multidetector CT. Analysis of image quality was performed with calculations of lesion-to-liver contrast-to-noise ratio (LLCNR) and lesion-to-liver signal-to-noise-ratio (LLSNR). One-month follow-up multidetector CT was considered the reference standard for the detection of HCC nodules.Results
Median LLCNR values were 3.94 (95% confidence interval [CI], 3.06–5.05) for preprocedural multidetector CT and 6.90 (95% CI, 5.17–7.77) for intraprocedural cone-beam CT (P < .0001). Median LLSNR values were 11.53 (95% CI, 9.51–12.44) for preprocedural multidetector CT and 9.36 (95% CI, 8.12–10.39) for intraprocedural cone-beam CT (P < .0104). Preprocedural multidetector CT detected 115 hypervascular nodules with typical HCC behavior, and cone-beam CT detected 15 additional hypervascular nodules that were also visible on 1-month follow-up multidetector CT.Conclusions
Cone-beam CT has a significantly higher diagnostic performance compared with preprocedural multidetector CT in the detection of HCCs and can influence management of patients with cirrhosis by identifying particularly aggressive tumors. 相似文献14.
Shawna N. Smith Nancy Moureau Valerie M. Vaughn Tanya Boldenow Scott Kaatz Paul J. Grant Steven J. Bernstein Scott A. Flanders Vineet Chopra 《Journal of vascular and interventional radiology : JVIR》2017,28(5):749-756.e2
Purpose
To evaluate patterns and predictors of peripherally inserted central catheter (PICC)–related occlusion.Materials and Methods
Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics.Results
A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72–0.94). Verification of catheter tip position following insertion was associated with reduction in occlusion (OR = 0.75; 95% CI = 0.61–0.92). Although normal saline solution or heparin flushes did not reduce occlusion, PICCs flushed with normal saline solution and “locked” with heparin were less likely to become occluded (OR = 0.54; 95% CI = 0.33–0.88). Compared with single-lumen devices, double- and triple-lumen PICCs were associated with greater incidences of occlusion (double, OR = 3.07; 95% CI = 2.56–3.67; triple, OR = 3.72; 95% CI = 2.92–4.74). Catheter tip malposition was also associated with occlusion (OR = 1.46; 95% CI = 1.14–1.87).Conclusions
Several patient, provider, and device characteristics appear associated with PICC occlusion. Interventions targeting these factors may prove valuable in reducing this complication. 相似文献15.
Hua Zhang Sheng Qian Rong Liu Wei Yuan Jian-Hua Wang 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1116-1122
Purpose
To evaluate short-term and long-term effectiveness of interventional treatment for hepatic artery thrombosis (HAT).Materials and Methods
From March 2003 to October 2015, 34 patients (32 male and 2 female; mean age, 45 y; range 7–64 y) with HAT were identified 0–21d (mean 6.5 d ± 6.0) after liver transplantation and underwent interventional treatments. Technical success, clinical success, complications, hepatic artery patency, and survival time were assessed.Results
All 34 patients underwent urokinase thrombolytic treatment. The mean dosage of urokinase was 1,250,000 U ± 1,000,000 (range, 350,000–9,000,000 U). Thrombolysis treatment required 5–120 h (mean 50 h ± 31) for completion. In 21 patients, stents were also implanted during thrombolytic treatment. In 3 patients with splenic artery steal syndrome, proximal splenic artery embolization was performed during thrombolytic treatment. The technical and clinical success rate was 91% (31/34), with treatment failure in 3 children. Hemorrhage was observed in 11 cases. Local necrotic foci in the transplanted liver were found on CT in 5 patients. Complications associated with the interventional procedures occurred in 2 patients. Patency rates of the hepatic artery at 1 y, 2 y, 3 y, and 5 y were 96%, 93%, 83%, and 83%. Overall survival rate at 1 y, 2 y, 3 y, and 5 y were 82%, 73%, 57%, and 57%.Conclusions
Interventional treatment can achieve satisfactory short-term and long-term effectiveness for adult HAT. 相似文献16.
Robert G. Jones Andrew P. Willis Karen Tullett Peter L. Riley 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1417-1421
Purpose
To determine effectiveness of the VIABAHN (W.L. Gore & Associates, Flagstaff, Arizona) stent graft to treat cephalic arch stenosis in patients with dysfunctional brachiocephalic arteriovenous fistulas after inadequate venoplasty response.Materials and Methods
Between 2012 and 2015, patients with failed venoplasty of symptomatic cephalic arch stenosis received a VIABAHN stent graft. Follow-up venography was performed at approximately 3, 6, and 12 months. Data were retrospectively analyzed with patency estimated using Kaplan-Meier and log-rank methodology. There were 39 patients included.Results
Technical and clinical success was 100%. Primary target lesion patency was 85% (95% confidence interval [CI], 69%–93%), 67% (95% CI, 50%–80%), and 42% (95% CI, 25%–57%) at 3, 6, and 12 months. There was no significant difference in patency with regard to sex or age (P = .8 and P = .6, respectively). Primary assisted patency was 95% (95% CI, 82%–99%) at 3, 6, and 12 months. Access circuit primary patency was 85% (95% CI, 69%–93%), 67% (95% CI, 50%–80%), and 42% (95% CI, 25%–57%) at 3, 6, and 12 months. There was no significant difference in patency between patients with the stent graft as the first treatment episode in the cephalic arch and those that had previous intervention at this site (P = .98). There were 48 repeat venoplasty procedures performed in the cephalic arch to maintain patency, including 7 repeat VIABAHN insertions. No complications were encountered.Conclusions
The VIABAHN stent graft is a safe, effective, and durable device for treating cephalic arch stenosis when venoplasty fails. 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.
Joseph L. McDevitt Stefany Acosta-Torres Ning Zhang Tianshen Hu Ayobami Odu Jijia Wang Yin Xi Daniel Lamus David S. Miller Anil K. Pillai 《Journal of vascular and interventional radiology : JVIR》2017,28(7):1036-1042.e8
Purpose
To estimate the least costly routine exchange frequency for percutaneous nephrostomies (PCNs) placed for malignant urinary obstruction, as measured by annual hospital charges, and to estimate the financial impact of patient compliance.Materials and Methods
Patients with PCNs placed for malignant urinary obstruction were studied from 2011 to 2013. Exchanges were classified as routine or due to 1 of 3 complication types: mechanical (tube dislodgment), obstruction, or infection. Representative cases were identified, and median representative charges were used as inputs for the model. Accelerated failure time and Markov chain Monte Carlo models were used to estimate distribution of exchange types and annual hospital charges under different routine exchange frequency and compliance scenarios.Results
Long-term PCN management was required in 57 patients, with 87 total exchange encounters. Median representative hospital charges for pyelonephritis and obstruction were 11.8 and 9.3 times greater, respectively, than a routine exchange. The projected proportion of routine exchanges increased and the projected proportion of infection-related exchanges decreased when moving from a 90-day exchange with 50% compliance to a 60-day exchange with 75% compliance, and this was associated with a projected reduction in annual charges. Projected cost reductions resulting from increased compliance were generally greater than reductions resulting from changes in exchange frequency.Conclusions
This simulation model suggests that the optimal routine exchange interval for PCN exchange in patients with malignant urinary obstruction is approximately 60 days and that the degree of reduction in charges likely depends more on patient compliance than exact exchange interval. 相似文献19.
Bo Liu Joseph Limback Melissa Kendall Michael Valente Jamil Armaly Vincent Grekoski Alex Pinizzotto Jeremy Burt Thomas J. Ward 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1727-1731
Purpose
To test the hypothesis that computed tomography (CT)-guided bone marrow biopsy in patients with a platelet count between 20,000/uL and 50,000/uL is safe and that preprocedure platelet transfusion is unnecessary.Materials and Methods
This single-center retrospective study included bone marrow biopsies performed between May 2009 and May 2016. The study population included 981 patients—age range, 15–93 years; average age, 57 years; 505 (51.5%) men; and 476 (48.5%) women. One hundred eighty-seven biopsies were performed in patients with a platelet count of 20,000–50,000/μL; 33 were performed in patients with a platelet count of < 20,000/μL. The primary endpoint was hemorrhagic complications, Society of Interventional Radiology (SIR) complication class C or above. The complication rates in thrombocytopenic patients were compared to patients with a platelet count of ≥ 50,000/uL. Ninety-five percent confidence intervals (CIs) for the complication rate in each group were also calculated.Results
There were no SIR class C or above postprocedure bleeding-related complications, including interventions or transfusions. For patients with a platelet count of < 20,000/μL and of 20,000–50,000/μL, hemorrhagic complications rates were 0% (95% CI: 0–9.1%) and 0% (95% CI: 0–1.6%), respectively.Conclusions
CT-guided bone marrow biopsy is safe in thrombocytopenic patients, with a hemorrhagic complication rate below 1.6% for patients with a platelet count of 20,000–50,000/μL. Routine preprocedure platelet transfusion may not be necessary for patients with a platelet count of 20,000–50,000/μL. 相似文献20.
Jiahe Zheng Zubin Irani Donald Lawrence Keith Flaherty Ronald S. Arellano 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1369-1375