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Li X, D'Amico G, Quintini C, Uso TD, Gadani S, Romero-Marrero C, Martin C, Partovi S. Intravascular ultrasound in the diagnosis and treatment of central venous diseases. VASA 2020; 50:2-10. [PMID: 33138741 DOI: 10.1024/0301-1526/a000914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Intravascular ultrasound (IVUS) has been used extensively in coronary applications. Its use in venous applications has increased as endovascular therapy has increasingly become the mainstay therapy for central venous diseases. IVUS has been used for both diagnostic and therapeutic purposes in managing venous stenotic disease, venous occlusive disease, and IVC filter placement and removal. IVUS has been proven to be effective in providing detailed measurement of the venous anatomy, which aid in determining the appropriate size and the approach for venous stent placement. In IVC filter placement, IVUS can provide detailed measurement and guide IVC filter placement in emergent and critical care settings. It also has certain utility in filter removal. At any rate, to date there are only a few studies examining its impact on patient outcomes. Prospective randomized controlled trials are warranted in the future.
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Affiliation(s)
- Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Giuseppe D'Amico
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Cristiano Quintini
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Teresa Diago Uso
- Department of Transplant Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Carlos Romero-Marrero
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Martin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
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Bisceglia M, Minenna E, Altobella A, Sanguedolce F, Panniello G, Bisceglia S, Ben-Dor DJ. Anaplastic Kaposi's Sarcoma of the Adrenal in an HIV-negative Patient With Literature Review. Adv Anat Pathol 2019; 26:133-149. [PMID: 30212382 DOI: 10.1097/pap.0000000000000213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Kaposi's sarcoma (KS) is a peculiar tumor of viral etiology, with the HHV8 rhadinovirus playing a fundamental role in its development. Several epidemiological categories of KS have been identified, of which the sporadic, endemic, iatrogenic, and the epidemic are the main ones. Several histologic disease morphologies have been described, such as inflammatory, angiomatous, spindle cell, mixed, and the anaplastic (sarcomatous) subtypes. The skin of the limbs is most commonly affected, but any other organ or site may be involved. Microscopically KS may enter the differential diagnosis with several different entities, and for this purpose the immunohistochemical detection of the viral latent nuclear antigen-1 (LNA-1) may be crucial. Sporadic KS is usually benign, but rarely it may be aggressive. Anaplastic histology heralds an ominous course in any clinical context. We report a case of anaplastic retroperitoneal KS, occurring in an HIV-negative adult man. This patient presented with a huge left suprarenal mass, which was totally resected, and initially diagnosed as inflammatory leiomyosarcoma, because of the monomorphic spindle cell tumor morphology. After 12 years the tumor recurred locally as an unresectable mass, which was biopsied and examined. At the time of recurrence, the histologic slides of the primary tumor were reviewed, and the previous diagnosis was changed to that of atypical KS. Histologically the recurrent tumor showed both spindle cell and epithelioid appearances. Strongly diffuse HHV8/LAN-1 immunopositivity was documented in both tumors. The final diagnosis for the entire case was anaplastic KS. Then, the patient died in a few months.
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Affiliation(s)
- Michele Bisceglia
- Department of Anatomic Pathology, School of Biomedical Sciences, Etromapmax Pole, Lesina (FG)
| | - Elena Minenna
- Department of Medical and Surgical Sciences, School of Allergology and Clinical Immunology, University of Foggia
| | | | | | | | - Stefano Bisceglia
- Department of Emergency Medicine, Polyclinic of Modena, Modena, Italy
| | - David J Ben-Dor
- Department of Pathology, The Barzilai Medical Center, Ashkelon, Israel
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3
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Ierardi AM, Jannone ML, Petrillo M, Brambillasca PM, Fumarola EM, Angileri SA, Crippa M, Carrafiello G. Treatment of venous stenosis in oncologic patients. Future Oncol 2018; 14:2933-2943. [DOI: 10.2217/fon-2017-0737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Symptomatic obstruction related to malignant involvement of large veins may occur in central veins both in the thoracic and pelvic regions, and in the abdominal region of the body. Both cases represent a therapeutic challenge, and endovascular revascularization, consisting of angioplasty and stent placement, is safe and effective. Superior vena cava stenting has become widespread in the management of occlusive venous disease. The percutaneous placement of large expandable metal stents allows rapid restoration of normal blood flow in the majority of patients, thus improving symptoms. Published data on the diagnosis and treatment of symptomatic cancer-related iliocaval obstructions are limited and mainly consist of case reports and small case series. The present review reports the current state of endovascular treatment for both superior vena cava occlusion and iliac compression syndrome in cancer patients.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic & Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Maria Laura Jannone
- Diagnostic & Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Mario Petrillo
- Diagnostic & Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Pietro Maria Brambillasca
- Diagnostic & Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic & Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Salvatore Alessio Angileri
- Diagnostic & Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Matteo Crippa
- Surgery Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic & Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
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Devcic Z, Techasith T, Banerjee A, Rosenberg JK, Sze DY. Technical and Anatomic Factors Influencing the Success of Inferior Vena Caval Stent Placement for Malignant Obstruction. J Vasc Interv Radiol 2016; 27:1350-1360.e1. [PMID: 27117949 DOI: 10.1016/j.jvir.2016.02.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To evaluate the outcomes of inferior vena cava (IVC) stent placement for malignant obstruction and to identify anatomic and procedural factors influencing technical and clinical success. MATERIALS AND METHODS A total of 57 patients (37 male, 20 female; age range, 22-86 y) underwent 62 IVC stent placement procedures using 97 stents (47 Wallstents, 15 S.M.A.R.T. stents, 18 Wallflex stents, 17 others) from 2005 to 2016 for malignant IVC obstruction caused by hepatic metastases (n = 22; 39%), primary hepatic malignancy (n = 16; 28%), retroperitoneal metastases (n = 16; 28%), or other primary malignancy (n = 5; 9%). Presenting symptoms included lower-extremity edema (n = 54; 95%), ascites (n = 28; 50%), and perineal edema (n = 14; 25%). Sixteen percent (n = 10) and 10% (n = 6) of the procedures involved tumor and bland thrombus, respectively. RESULTS Stent placements resulted in 100% venographic patency and significantly decreased pressure gradients (P < .0001). Lower-extremity swelling, perineal swelling, and abdominal distension improved within 7 days in 83% (35 of 42), 100% (9 of 9), and 40% (6 of 15) of patients, respectively, and at 30 days after the procedure in 86% (25 of 29), 89% (8 of 9), and 80% (4 of 5) of patients, respectively. Increased pre- and post-stent placement pressure gradients were associated with worse outcomes. A 4% stent misplacement rate (4 of 97) was related to the use of Wallstents with caudal stent tapering, asymmetric deployment superior to the obstruction, suprahepatic IVC involvement, and decreased stent adherence to the IVC wall as a result of local mechanical factors. CONCLUSIONS Stent placement is reliable, rapid, and durable in improving malignant IVC syndrome. Understanding of technical and anatomic factors can improve accuracy and avoid complications of stent misplacement.
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Affiliation(s)
- Zlatko Devcic
- Division of Interventional Radiology, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305
| | - Tust Techasith
- Division of Interventional Radiology, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305
| | - Arjun Banerjee
- Division of Interventional Radiology, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305
| | - Jarrett K Rosenberg
- Radiology Sciences Laboratory, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305
| | - Daniel Y Sze
- Division of Interventional Radiology, Stanford University School of Medicine, H-3646, 300 Pasteur Dr., Stanford, CA 94305.
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Maleux G, Vertenten B, Laenen A, De Wever L, Heye S, Clement P, Oyen R. Palliative endovascular treatment of cancer-related iliocaval obstructive disease: technical and clinical outcomes. Acta Radiol 2016; 57:451-6. [PMID: 25907119 DOI: 10.1177/0284185115582059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/21/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cancer-related obstruction of large abdominal and pelvic veins might become symptomatic with clinical signs of lower limb venous congestion. Technical and clinical outcome after interventional treatment is not well studied yet. PURPOSE To retrospectively assess the technical and clinical outcome of endovascular management of symptomatic cancer-related iliocaval venous obstructive disease. MATERIAL AND METHODS From 1998 to 2013, 19 patients (15 men, 4 women; mean age, 63.6 years) referred for interventional treatment of cancer-related iliocaval obstructive disease were identified. Patients' symptoms included unilateral (n = 16; 84%) or bilateral (n = 3; 16%) painful swelling of the lower limbs. Patients' demographics as well as interventional and clinical outcome data were collected. RESULTS All 19 patients underwent, under local anesthesia, stenting of the iliac vein (n = 16; 84%) or inferior vena cava (n = 3; 16%). Immediate technical success (n = 19) was 100%; immediate clinical success (n = 18) was 94.7%. During follow-up, seven patients (36.8%) presented with recurrent symptoms of painful limb swelling. Estimated survival after 3 and 6 months was 68.4% (95% confidence interval [CI], 47.8-82.3%) and 19.8% (95% CI, 11.9-29.2%), respectively. CONCLUSION Endovascular stenting of cancer-related iliocaval venous obstructive disease is safe and results in immediate relief of symptoms. However, recurrent venous obstruction is common. At 3 months follow-up, the majority of patients with iliac vein stenting were still alive.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
| | - Bart Vertenten
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and Universiteit Hasselt, Leuven, Belgium
| | - Liesbeth De Wever
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
| | - Sam Heye
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
| | - Paul Clement
- Department of General Oncology, University Hospitals Leuven, Belgium
| | - Raymond Oyen
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
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Busken CJ, Grimsley BR, Shutze WP. Iliac Artery Stenosis Complicating Iliac Vein Stenting in a Patient with a History of Radiation and Cancer: Case Report and Literature Review. Ann Vasc Surg 2015; 29:843.e7-15. [DOI: 10.1016/j.avsg.2014.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 11/24/2022]
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Tseng YC, Wu ST, Chao TK, Wu CJ, Chau T, Yang SS. A giant non-functional adrenocortical carcinoma presenting with acute kidney injury. Int Urol Nephrol 2013; 46:1101-5. [PMID: 24375435 DOI: 10.1007/s11255-013-0629-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/10/2013] [Indexed: 01/24/2023]
Abstract
Hormonally inactive adrenocortical carcinoma (ACC) is a rare disease where abdominal discomfort and back pain are common presenting symptoms due to mass effect from a large tumor. Acute kidney injury (AKI) from retroperitoneal tumors has rarely been reported. The most common etiologies include venous thrombosis, ureteral compression, or both. Here, we described a man who presented with AKI from a large retroperitoneal tumor, which was finally diagnosed as a non-functional ACC. The inferior vena cava (IVC) was nearly completely compressed by the large retroperitoneal tumor leading to venous outflow obstruction and AKI. After surgical resection, his urine output increased and renal function recovered. Unfortunately, AKI recurred 2 months later due to recurrence of the tumor. Treatment with a tyrosine kinase inhibitor stabilized his tumor size, and hemodialysis was started. IVC-compression-associated AKI can be the presenting scenario for ACC, a rare but prognostically important aggressive neoplasm.
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Affiliation(s)
- Yu-Chen Tseng
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec2, Cheng-gong Rd., Neihu District, Taipei, 114, Taiwan, ROC
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Abstract
Kaposi's sarcoma (KS), a low-grade malignancy that is associated with human herpesvirus-8 (HHV-8), is a multifocal tumor that most commonly affects mucocutaneous sites. It might also involve lymph nodes and visceral organs, in particular of the respiratory and gastrointestinal tract, but it can affect every organ system. Four forms of the disease have been recognized: the classic, the endemic, the transplant-associated, and the epidemic form. The endemic form, or African KS, currently accounts for 10%-50% of all cancers in adults and up to 25% of cancers in children in certain parts of Africa. The epidemic form or acquired immune deficiency syndrome (AIDS)-associated KS is a frequent neoplasm in bisexual and homosexual men with AIDS in the United States. Even though in North America and Europe the incidence of KS in men with AIDS has decreased significantly after the introduction of highly active antiretroviral therapy (HAART), in some developing countries, the incidence of KS keeps growing. The pathophysiology, clinical manifestations, imaging findings, and more relevant differential diagnoses are reviewed.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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Zacharatos H, Hassan AE, Qureshi AI. Intravascular ultrasound: principles and cerebrovascular applications. AJNR Am J Neuroradiol 2010; 31:586-97. [PMID: 20133387 DOI: 10.3174/ajnr.a1810] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intravascular sonography is a valuable tool for the morphologic assessment of coronary atherosclerosis and the effect of pharmacologic and nonpharmacologic interventions on the progression or stabilization of atherosclerosis. An analysis of the different modes, applications, and limitations is provided on the basis of review of existing data from multiple clinical case studies, trials, and mechanistic studies. Intravascular sonography has been used to assess the outcomes of different percutaneous interventions, including angioplasty and stent implantation, and to provide detailed characterization of atherosclerotic lesions, aneurysms, and dissections within the cerebrovascular circulation. Evolution of intravascular sonographic technology has led to the development of more sophisticated diagnostic tools such as color-flow, virtual histology, and integrated backscatter intravascular sonography. The technologic advancement in intravascular sonography has the potential of providing more accurate information prior, during, and after a medical or endovascular intervention. Continued assessment of this diagnostic technique in both the intracranial and extracranial circulation will lead to increased use in clinical practice with the intent to improve outcomes.
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Affiliation(s)
- H Zacharatos
- Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, 55455, USA
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