1
|
Stahl R, Seidensticker M, Arbogast H, Kuppinger D, Greif V, Crispin A, D’Anastasi M, Pedersen V, Forbrig R, Liebig T, Rutetzki T, Trumm CG. Technical and Clinical Outcome of Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement in Abdominal Fluid Collections after Liver Transplantation: A 16-Year Retrospective Analysis of 50 Consecutive Patients. Diagnostics (Basel) 2024; 14:353. [PMID: 38396392 PMCID: PMC10887879 DOI: 10.3390/diagnostics14040353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE Evaluation of the effectiveness of CT-guided drainage (CTD) placement in managing symptomatic postoperative fluid collections in liver transplant patients. The assessment included technical success, clinical outcomes, and the occurrence of complications during the peri-interventional period. METHODS Analysis spanned the years 2005 to 2020 and involved 91 drain placement sessions in 50 patients using percutaneous transabdominal or transhepatic access. Criteria for technical success (TS) included (a) achieving adequate drainage of the fluid collection and (b) the absence of peri-interventional complications necessitating minor or prolonged hospitalization. Clinical success (CS) was characterized by (a) a reduction or normalization of inflammatory blood parameters within 30 days after CTD placement and (b) the absence of a need for surgical revision within 60 days after the intervention. Inflammatory markers in terms of C-reactive protein (CRP), leukocyte count and interleukin-6, were evaluated. The dose length product (DLP) for various intervention steps was calculated. RESULTS The TS rate was 93.4%. CS rates were 64.3% for CRP, 77.8% for leukocytes, and 54.5% for interleukin-6. Median time until successful decrease was 5.0 days for CRP and 3.0 days for leukocytes and interleukin-6. Surgical revision was not necessary in 94.0% of the cases. During the second half of the observation period, there was a trend (p = 0.328) towards a lower DLP for the entire intervention procedure (median: years 2013 to 2020: 623.0 mGy·cm vs. years 2005 to 2012: 811.5 mGy·cm). DLP for the CT fluoroscopy component was significantly (p = 0.001) lower in the later period (median: years 2013 to 2020: 31.0 mGy·cm vs. years 2005 to 2012: 80.5 mGy·cm). CONCLUSIONS The TS rate of CT-guided drainage (CTD) placement was notably high. The CS rate ranged from fair to good. The reduction in radiation exposure over time can be attributed to advancements in CT technology and the growing expertise of interventional radiologists.
Collapse
Affiliation(s)
- Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Max Seidensticker
- Department of Radiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.S.); (V.G.)
| | - Helmut Arbogast
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (H.A.); (D.K.)
| | - David Kuppinger
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (H.A.); (D.K.)
| | - Veronika Greif
- Department of Radiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.S.); (V.G.)
| | - Alexander Crispin
- IBE—Institute for Medical Information Processing, Biometry and Epidemiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Melvin D’Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta;
| | - Vera Pedersen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Tim Rutetzki
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.F.); (T.L.); (T.R.); (C.G.T.)
| |
Collapse
|
2
|
Kim JS, Hansen JJ, Taon MC. Percutaneous Blunt Dissection Using a Stiffened Balloon Catheter to Access a Windowless Abscess. J Vasc Interv Radiol 2023; 34:2249-2251. [PMID: 37625666 DOI: 10.1016/j.jvir.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Affiliation(s)
- Jason S Kim
- Interventional Radiology Service, Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78219.
| | - Jaron J Hansen
- Interventional Radiology Service, Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78219
| | - Matthew C Taon
- Interventional Radiology Service, Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78219
| |
Collapse
|
3
|
Stahl R, Seidensticker M, de Figueiredo GN, Pedersen V, Crispin A, Forbrig R, Ozpeynirci Y, Liebig T, D’Anastasi M, Hackner D, Trumm CG. Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients. Diagnostics (Basel) 2023; 13:diagnostics13040711. [PMID: 36832199 PMCID: PMC9955776 DOI: 10.3390/diagnostics13040711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To assess the technical (TS) and clinical success (CS) of CT fluoroscopy-guided drainage (CTD) in patients with symptomatic deep pelvic fluid collections following colorectal surgery. METHODS A retrospective analysis (years 2005 to 2020) comprised 43 drain placements in 40 patients undergoing low-dose (10-20 mA tube current) quick-check CTD using a percutaneous transgluteal (n = 39) or transperineal (n = 1) access. TS was defined as sufficient drainage of the fluid collection by ≥50% and the absence of complications according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). CS comprised the marked reduction of elevated laboratory inflammation parameters by ≥50% under minimally invasive combination therapy (i.v. broad-spectrum antibiotics, drainage) within 30 days after intervention and no surgical revision related to the intervention required. RESULTS TS was gained in 93.0%. CS was obtained in 83.3% for C-reactive Protein and in 78.6% for Leukocytes. In five patients (12.5%), a reoperation due to an unfavorable clinical outcome was necessary. Total dose length product (DLP) tended to be lower in the second half of the observation period (median: years 2013 to 2020: 544.0 mGy*cm vs. years 2005 to 2012: 735.5 mGy*cm) and was significantly lower for the CT fluoroscopy part (median: years 2013 to 2020: 47.0 mGy*cm vs. years 2005 to 2012: 85.0 mGy*cm). CONCLUSIONS Given a minor proportion of patients requiring surgical revision due to anastomotic leakage, the CTD of deep pelvic fluid collections is safe and provides an excellent technical and clinical outcome. The reduction of radiation exposition over time can be achieved by both the ongoing development of CT technology and the increased level of interventional radiology (IR) expertise.
Collapse
Affiliation(s)
- Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-74629
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Giovanna Negrão de Figueiredo
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland
| | - Vera Pedersen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Alexander Crispin
- IBE—Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Yigit Ozpeynirci
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas Liebig
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Melvin D’Anastasi
- Department of Radiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta
| | - Danilo Hackner
- Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377 Munich, Germany
| |
Collapse
|
4
|
D’Anastasi M, Ebenberger S, Alghamdi A, Helck A, Herlemann A, Stief C, Khoder W, Trumm CG, Stahl R. Technical Outcome, Clinical Success, and Complications of Low-Milliampere Computed Tomography Fluoroscopy-Guided Drainage of Lymphoceles Following Radical Prostatectomy with Pelvic Lymph Node Dissection. Diagnostics (Basel) 2022; 12:diagnostics12102394. [PMID: 36292083 PMCID: PMC9600916 DOI: 10.3390/diagnostics12102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
To evaluate the technical outcome, clinical success, and safety of low-milliampere CT fluoroscopy (CTF)-guided percutaneous drain (PD) placement in patients with lymphoceles following radical prostatectomy (RP) with pelvic lymph node dissection (LND). This retrospective analysis comprised 65 patients with PD placement in lymphoceles following RP under low-milliampere CTF guidance. Technical and clinical success were evaluated. Complications within a 30-day time interval associated with CTF-guided PD placement were classified according to SIR. Patient radiation exposure was quantified using dose-length products (DLP) of the pre-interventional planning CT scan (DLPpre), of the sum of intra-interventional CT fluoroscopic acquisitions (DLPintra) and of the post-interventional control CT scan (DLPpost). Eighty-nine lymphoceles were detected. Seventy-seven CT-guided interventions were performed, with a total of 92 inserted drains. CTF-guided lymphocele drainage was technically successful in 100% of cases. For all symptomatic patients, improvement in symptoms was reported within 48 h after intervention. Time course of C-reactive protein and Leucocytes within 30 days revealed a statistically significant (p < 0.0001) decrease. Median DLPpre, DLPintra and DLPpost were 431 mGy*cm, 45 mGy*cm and 303 mGy*cm, respectively. Only one minor complication (self-resolving haematoma over the bladder dome; SIR Grade 2) was observed. Low-milliampere CTF-guided drainage is a safe treatment option in patients with lymphoceles following RP with pelvic LND characterized by high technical and good clinical success rates, which provides rapid symptom relief and serves as definite treatment or as a bridging therapy prior to laparoscopic marsupialisation.
Collapse
Affiliation(s)
- Melvin D’Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, MSD 2090 Msida, Malta
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Correspondence: ; Tel.: +356-2545-6783
| | - Simone Ebenberger
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Abdulmajeed Alghamdi
- Department of Urology, Albaha University, Albaha 65779-7738, Saudi Arabia
- Department of Urology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Andreas Helck
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Radiology and Neuroradiology, Hirslanden Klinik Im Park, Seestrasse 220, 8027 Zürich, Switzerland
| | - Annika Herlemann
- Department of Urology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Wael Khoder
- Department of Urology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Department of Urology, Helios-Amper Klinikum Dachau, Krankenhausstraße 15, 85221 Dachau, Germany
| | - Christoph G. Trumm
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| |
Collapse
|
5
|
Planz V, Galgano SJ. Percutaneous biopsy and drainage of the pancreas. Abdom Radiol (NY) 2022; 47:2584-2603. [PMID: 34410433 PMCID: PMC8375282 DOI: 10.1007/s00261-021-03244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 01/18/2023]
Abstract
Percutaneous pancreatic interventions performed by abdominal radiologists play important diagnostic and therapeutic roles in the management of a wide range of pancreatic pathology. While often performed with endoscopy, pancreatic mass biopsy obtained via a percutaneous approach may serve as the only feasible option for diagnosis in patients with post-surgical anatomy, severe cardiopulmonary conditions, or prior non-diagnostic endoscopic attempts. Biopsy of pancreatic transplants are commonly performed percutaneously due to inaccessible location of the allograft by endoscopy, usually in the right lower quadrant or pelvis. Percutaneous drainage of collections in acute pancreatitis is primarily indicated for infection with clinical deterioration and may be performed alone or in combination with endoscopic drainage. Post-surgical pancreatic collections related to pancreatic duct fistula or leak also often warrant therapeutic percutaneous drainage. Knowledge of appropriate indications, strategies of approach, technique, and complications associated with these procedures is critical for a successful clinical practice.
Collapse
Affiliation(s)
- Virginia Planz
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Samuel J. Galgano
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT J779, Birmingham, AL 35249 USA
| |
Collapse
|
6
|
Trumm CG, Burgard C, Deger C, Stahl R, Forbrig R, D'Anastasi M. Intermittent quick-check CT fluoroscopy-guided percutaneous drainage placement in patients with infected renal and perirenal fluid collections: 11-year experience. ACTA ACUST UNITED AC 2021; 27:378-385. [PMID: 34003125 DOI: 10.5152/dir.2021.20068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to evaluate technical and clinical success and safety of computed tomography fluoroscopy (CTF)-guided percutaneous pigtail drainage (PPD) placement in patients with infected renal and perirenal fluid collections. METHODS This retrospective analysis comprised 44 patients (52.27% men; age, 57.1±18.5 years) undergoing low-milliampere (10-20 mA) CTF-guided PPD placement in 61 sessions under local anesthesia from August 2005 to November 2016. Infected fluid collections (n=71) included infected renal cysts (12.68%), renal and perirenal abscesses due to comorbidities (23.94%), or fluid collections after renal surgery or urological intervention (63.38%). Technical success was defined as PPD placement with consecutive fluid aspiration, clinical success as normalization or marked improvement of clinical symptoms (e.g., flank pain, fever) and inflammatory parameters (leukocyte count, C-reactive protein) after minimally invasive combination therapy (intravenous broad-spectrum antibiotics and drainage). Complications were classified according to the CIRSE classification. RESULTS Overall, 73 single lumen PPD (7.5-12 F) were utilized (1 PPD per session, 69.86%; 2 PPD per session, 15.07%). In 4 cases, PPD could not be inserted into the fluid collection (4.11%) or could not be aspirated (1.37%), yielding overall 94.5% primary technical success. Mean duration of functioning PPD before removal was 10.9 days. Adverse events within 30 days comprised PPD failure (2.27%) or secondary dislocation (Grade 3, 11.36%) and one death (Grade 6, unrelated to intervention, 2.27%). Additional invasive measures after primary CTF-guided PPD were required in 5 patients (nephrectomy 6.82%, partial nephrectomy 2.27%, surgical drainage 2.27%). Thus, clinical success using only minimally invasive measures was achieved in 39 of 44 patients (88.64%). CONCLUSION Given a minor proportion of patients requiring surgical revision, combined antibiotics and CTF-guided PPD of infected renal and perirenal fluid collections provides an excellent technical and clinical outcome.
Collapse
Affiliation(s)
- Christoph G Trumm
- Institute for Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Caroline Burgard
- Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Constanze Deger
- Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, Triq tal-Qroqq, Msida, Malta
| |
Collapse
|