Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis

BACKGROUND

Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone.

METHODS

A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase.

RESULTS

Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients).

CONCLUSION

Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.

Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy

STUDY PURPOSE

The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases.

METHODS

The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection.

RESULTS

Not applicable.

CONCLUSION

DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).

Spiral 2D T2-Weighted TSE Brain MR Imaging: Initial Clinical Experience

BACKGROUND AND PURPOSE

Spiral MR imaging may enable improved image quality and higher scan speeds than Cartesian trajectories. We sought to compare a novel spiral 2D T2-weighted TSE sequence with a conventional Cartesian and an artifact-robust, non-Cartesian sequence named MultiVane for routine clinical brain MR imaging.

MATERIALS AND METHODS

Thirty-one patients were scanned with all 3 sequences (Cartesian, 4 minutes 14 seconds; MultiVane, 2 minutes 49 seconds; spiral, 2 minutes 12 seconds) on a standard clinical 1.5T MR scanner. Three readers described the presence and location of abnormalities and lesions and graded images qualitatively in terms of overall image quality, the presence of motion and pulsation artifacts, gray-white matter differentiation, lesion conspicuity, and subjective preference. Image quality was objectivized by measuring the SNR and the coefficients of variation for CSF, GM, and WM.

RESULTS

Spiral achieved a scan time reduction of 51.9% and 21.9% compared with Cartesian and MultiVane, respectively. The number and location of lesions were identical among all sequences. As for the qualitative analysis, interreader agreement was high (Krippendorff α > .75). Spiral and MultiVane both outperformed the Cartesian sequence in terms of overall image quality, the presence of motion artifacts, and subjective preference (P < .001). In terms of the presence of pulsation artifacts, gray-white matter differentiation, and lesion conspicuity, all 3 sequences performed similarly well (P > .15). Spiral and MultiVane outperformed the Cartesian sequence in coefficient of variation WM and SNR (P < .01).

CONCLUSIONS

Spiral 2D T2WI TSE is feasible for routine structural brain MR imaging and offers high-quality, artifact-robust brain imaging in short scan times.

[Unusual course of a planned lumbar microdiscectomy]

We report the case of a 30-year-old female patient who underwent unilateral transverse sinus stenosis stenting due to a newly diagnosed idiopathic intracranial hypertension (Pseudotumor cerebri) with symptoms of papilledema, decreased visual acuity and headache. Resolution of the symptoms and improvement of magnetic resonance and ophthalmiologic findings could be documented.

Endovascular stent treatment for symptomatic benign iliofemoral venous occlusive disease: long-term results 1987-2009

Venous stenting has been shown to effectively treat iliofemoral venous obstruction with good short- and mid-term results. The aim of this study was to investigate long-term clinical outcome and stent patency. Twenty patients were treated with venous stenting for benign disease at our institution between 1987 and 2005. Fifteen of 20 patients (15 female, mean age at time of stent implantation 38 years [range 18-66]) returned for a clinical visit, a plain X-ray of the stent, and a Duplex ultrasound. Four patients were lost to follow-up, and one patient died 277 months after stent placement although a good clinical result was documented 267 months after stent placement. Mean follow-up after stent placement was 167.8 months (13.9 years) (range 71 (6 years) to 267 months [22 years]). No patient needed an additional venous intervention after stent implantation. No significant difference between the circumference of the thigh on the stented side (mean 55.1 cm [range 47.0-70.0]) compared with the contralateral thigh (mean 54.9 cm [range 47.0-70.0]) (p=0.684) was seen. There was a nonsignificant trend toward higher flow velocities within the stent (mean 30.8 cm/s [range 10.0-48.0]) and the corresponding vein segment on the contralateral side (mean 25.2 cm/s [range 12.0-47.0]) (p=0.065). Stent integrity was confirmed in 14 of 15 cases. Only one stent showed a fracture, as documented on x-ray, without any impairment of flow. Venous stenting using Wallstents showed excellent long-term clinical outcome and primary patency rate.

Compression of the inferior vena cava by the right iliac artery: a rare variant of May-Thurner syndrome

May-Thurner syndrome is known as compression of the left common iliac vein by the right common iliac artery. We describe a case of an atypical compression of the inferior vena cava by the right common iliac artery secondary to a high aortic bifurcation. Despite an extensive collateral network, there was a significant venous gradient between the iliac veins and the inferior vena cava above the compression. After stenting the venous pressure gradient disappeared. Follow-up 4 months later revealed a good clinical response with a patent stent.

Patient's assessment of discomfort during MR arthrography of the shoulder

PURPOSE

To assess patient discomfort during (a) intraarticular contrast material injection (arthrography) and (b) magnetic resonance (MR) imaging in patients referred for MR arthrography of the shoulder and to compare the relative discomfort associated with each part of the examination.

MATERIALS AND METHODS

With use of a visual analogue scale (VAS) and relative ratings, 202 consecutive patients referred for MR arthrography of the shoulder rated the expected discomfort and that actually experienced during both arthrography and MR imaging. The Student t test was used for statistical analysis.

RESULTS

The average VAS score (0 = "did not feel anything," 100 = "unbearable") was 16.1 +/- 16.4 (SD) for arthrography and 20.2 +/- 25.0 for MR imaging. This difference was statistically significant (P =.036, paired t test). The discomfort experienced during arthrography was as expected in 90 (44.6%) patients, less than expected in 110 (54.4%), and worse than expected in two (1.0%). MR imaging-related discomfort was as expected in 114 (56.4%) patients, less than expected in 66 (32.7%), and worse in 22 (10.9%). Arthrography was rated worse than MR imaging by 53 (26.2%) patients, equal to MR imaging by 69 (34.2%), and less uncomfortable than MR imaging by 80 (39.6%).

CONCLUSION

Arthrography-related discomfort was well tolerated, often less severe than anticipated, and rated less severe than MR imaging-related discomfort.

Can MR measurement of renal artery flow and renal volume predict the outcome of percutaneous transluminal renal angioplasty?

PURPOSE

Predicting therapeutic benefit from percutaneous transluminal renal angioplasty (PTRA) in patients with renal artery stenosis (RAS) remains difficult. This study investigates whether magnetic resonance (MR)-based renal artery flow measurements relative to renal parenchymal volume can predict clinical outcome following PTRA.

METHODS

The data on 23 patients (13 men, 10 women; age range 47-82 years, mean age 64 years) were analyzed. The indication for treatment was hypertension (n = 18) or renal insufficiency (n = 5). Thirty-four cases of RAS were identified: bilateral disease was manifest in 11 and unilateral disease in 12 patients. The MR imaging protocol included a breath-hold, cardiac-gated cine phase-contrast sequence for renal flow measurement and a fast multiplanar spoiled gradient-echo sequence for renal volume measurement. MR measurements were performed on the day prior to and the day following PTRA. Clinical success was defined as (a) a reduction in diastolic blood pressure > 15% or (b) a reduction in serum creatinine > 20%. Kidneys were categorized as normal volume or low volume. A renal flow index (RFI) was calculated by dividing the renal flow (ml/min) by the renal volume (cm3).

RESULTS

Clinical success was observed in patients. Twelve patients did not benefit from angioplasty. Normal kidney volume was seen in 10 of 11 responders and in 8 of 12 nonresponders, resulting in a sensitivity of 91%, specificity of 33%, a positive predictive value (PPV) of 56% and a negative predictive value (NPV) of 80%. A RFI below a threshold of 1.5 ml/min/cm3 predicted successful outcome with 100% sensitivity, 33% specificity, 58% PPV, and 100% NPV. The combination of normal renal volume and a RFI below 1.5 ml/min/cm3 identified PTRA responders with a sensitivity of 91%, a specificity of 67%, a PPV of 71%, and a NPV of 89%. PTRA resulted in a greater increase in renal flow in responders compared with nonresponders (p < 0.001).

CONCLUSION

A combination of cine phase-contrast MR renal flow and parenchymal volume measurements enables identification of patients benefiting from PTRA with a high sensitivity and NPV, but only moderate specificity and PPV.

Utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals in patients undergoing uterine artery embolization for fibroids

PURPOSE

To review the incidence of ovarian collateral supply to uterine fibroids as demonstrated by nonselective abdominal aortography before uterine artery embolization (UAE) and to evaluate the effect of such visualization on interventional management.

MATERIALS AND METHODS

The aortograms of 51 consecutive patients (mean age, 42.4 y; range, 30--53 y) undergoing UAE for symptomatic uterine fibroids were reviewed retrospectively for the visualization of ovarian arteries extending into the pelvis. If ovarian arteries were visualized, their size relative to the ipsilateral external iliac artery was measured. Arteries believed large enough to represent a significant blood supply to the uterine fibroids were further evaluated after UAE to determine whether flow persisted.

RESULTS

In 13 of 51 patients (25%), a total of 18 ovarian arteries were identified. They were bilateral in five patients and unilateral in eight. Their sizes relative to the ipsilateral external iliac artery ranged from 8% to 57% (mean, 26%). Eight ovarian arteries with a relative size > or = 25% were further evaluated. Five of the eight (62.5%) were not visible after UAE. Of the three persistent ovarian collateral arteries, two were successfully embolized. The patient with the untreated collateral artery experienced persistent menorrhagia.

CONCLUSION

Preembolization aortography with the catheter tip at level of the renal arteries demonstrated ovarian collateral arteries in 25% of patients with uterine fibroids. However, their detection influenced treatment in only 6% of the reported cases.

MR arthrography of the glenohumeral joint: two concentrations of gadoteridol versus Ringer solution as the intraarticular contrast material

PURPOSE

To compare two concentrations of gadoteridol with Ringer solution as the contrast material for magnetic resonance (MR) arthrography of the glenohumeral joint.

MATERIALS AND METHODS

One hundred fifty-six consecutive MR arthrograms were randomly obtained with either 2 mmol/L gadoteridol (n = 52), 4 mmol/L gadoteridol (n = 52), or Ringer solution (n = 52). MR arthrograms were assessed quantitatively (for contrast-to-noise ratio [CNR]) and qualitatively (for overall image quality, image contrast, degree of joint distention, and motion artifacts). MR diagnoses were compared with arthroscopic or surgical reports in 88 patients.

RESULTS

The mean CNR at imaging was 40.4 with 2 mmol/L gadoteridol, 45.6 with 4 mmol/L gadoteridol, and 48.7 with Ringer solution. The CNR with 2 mmol/L gadoteridol was significantly lower than that with 4 mmol/L gadoteridol (P =.025) and Ringer solution (P =.012). Qualitative differences between the two gadoteridol concentrations were not significant. Ringer solution was significantly worse with regard to overall quality, motion artifacts, image contrast, and joint distention compared with both gadoteridol concentrations. Ringer solution was slightly more sensitive and less specific than the gadoteridol solutions in the detection of supraspinatus tears and less sensitive and more specific in enabling diagnosis of superior labrum anteroposterior lesions.

CONCLUSION

MR arthrograms of the shoulder obtained with gadoteridol and those obtained with Ringer solution provided equivalent diagnostic accuracy. The authors, however, preferred the image quality of the gadoteridol-enhanced arthrograms.

MR morphology of alar ligaments and occipitoatlantoaxial joints: study in 50 asymptomatic subjects

PURPOSE

To assess the magnetic resonance (MR) imaging appearance of the alar ligaments and joints in the upper cervical spine to determine the prevalence of structural alterations in asymptomatic individuals.

MATERIALS AND METHODS

Fifty healthy individuals (31 men, 19 women) with a mean age of 30 years (range, 19-47 years) underwent coronal T1- and T2-weighted and transverse T1-weighted MR imaging. MR findings were analyzed independently by two musculoskeletal radiologists, with disagreements resolved in conference.

RESULTS

Alar ligaments were detected in 42 (84%) (left side) and 38 (76%) (right side) of 50 individuals. The majority of ligaments (88%) and joints (58%) of the craniocervical junction (CCJ) were asymmetric. Asymmetry of the joint between C1 and C2 was less frequent (46%). Small amounts of fluid were detected in 8% of CCJ joints and 56% of C1-C2 joints in asymptomatic individuals.

CONCLUSION

Asymmetry of alar ligaments, CCJ and C1-C2 facet joints, and joint effusions are common in asymptomatic individuals. The clinical relevance of these MR findings is therefore limited in the identification of the source of neck pain in symptomatic patients.

Equilibrium-phase MR angiography of the aortoiliac and renal arteries using a blood pool contrast agent

OBJECTIVE

The purpose of this study was to determine the diagnostic usefulness of a new blood pool contrast agent, NC100150, for assessing the aortoiliac and renal arteries.

SUBJECTS AND METHODS

Twenty patients with hemodynamically significant stenosis (> or =50% of luminal diameter) of the iliac or renal arteries or an aortic aneurysm documented by digital subtraction angiography underwent MR angiography at 1.5 T after administration of NC100150. Three-dimensional MR angiographic data sets were collected ill the equilibrium phase. In a prospective analysis, each vascular segment (16 segments per arterial tree) was evaluated.

RESULTS

All patients tolerated the NC100150 administration well. Mean contrast-to-noise ratios of the vascular data collected in the equilibrium phase of NC100150 was 3.3+/-15.9. Compared with digital subtraction angiography, the sensitivity and specificity of MR angiography for the renal arteries were 82% and 98%, respectively; for the common iliac arteries, 86% and 97%, respectively; for the external iliac arteries, 80% and 100%, respectively; and for the internal iliac arteries, 71% and 977, respectively. All 83 aneurysmal changes revealed by digital subtraction angiograpy of the aortoiliac arteries were well displayed on the MR angiographic data sets.

CONCLUSION

Equilibrium-phase NC 00150-enhanced three-dimensional MR angiography shows high specificity when evaluating the abdominal and pelvic vascular systems, but the attendant venous overlap can limit the assessment of stenosis in renal and pelvic arterial segments.

Functional MR imaging of the craniocervical junction. Correlation with alar ligaments and occipito-atlantoaxial joint morphology: a study in 50 asymptomatic subjects

PURPOSE

Whiplash injuries are frequent in industrialized countries. The acute and chronic symptoms following such injuries are incompletely understood and objective clinical or imaging findings are rare. Several authors have suspected that rear end collisions occurring when the head is rotated may result in tears of the alar ligaments. There has been experimental proof that a torn alar ligament increases the rotation of the C0/C1 and C1/C2 segments to the contralateral side. Functional cross sectional imaging has therefore been proposed to diagnose injuries of the alar ligaments. So far, published data on normal ranges of rotation in an asymptomatic population have been sparse. The aim of this study was to determine by MR imaging the normal range of rotation in the first three cervical segments and their relation to the morphology of the alar ligaments and the occipito-atlantoaxial joints.

MATERIAL AND METHODS

Functional MR imaging of the craniocervical junction in maximum active left and right head rotation was performed in 50 healthy volunteers with a mean age of 29.8 years (31 men, 19 women, range 19-47 years). Measurements were independently performed by two musculoskeletal radiologists to assess interobserver error. The results were correlated with gender and age, with morphological findings in the occipito-atlantoaxial joints (i.e. joint symmetry, joint effusions, dens position), and with the form, course and symmetry of the alar ligaments.

RESULTS

The mean range of rotation for the C0/C1 joint was 2.7 degrees (standard deviation [SD] 3.3 degrees)/3.3 degrees (SD 3.6 degrees) (right/left) and at the C1/C2 level 38 degrees (SD 6.5 degrees)/37.8 degrees (SD 6.4 degrees). The mean differences in left/right rotation were: C0/C1 3.5 degrees (SD 2.8 degrees) and C1/C2 6.3 degrees (SD 4.4 degrees). No correlation was found between segmental rotation and morphological characteristics of the craniocervical joints or ligament structures.

CONCLUSION

There is wide variation of segmental motion in the upper cervical spine. Differences in right-to-left rotation are frequently encountered in an asymptomatic population. Therefore, these measurements are unsuitable for indirect diagnosis of soft tissue lesions after whiplash injury and should not be used as a basis for treatment guidelines.

Spinal cord vascular disease: characterization with fast three-dimensional contrast-enhanced MR angiography

BACKGROUND AND PURPOSE

Noninvasive characterization of spinal vascular lesions is essential for guiding clinical management, and several MR angiographic techniques have been applied in the past with variable results. The purpose of our study was to assess the potential of a dynamic 3D contrast-enhanced MR angiographic sequence to characterize spinal vascular lesions and to identify their arterial feeders and venous drainage.

METHODS

A contrast-enhanced gradient-echo 3D pulse sequence providing angiographic information within 24 seconds was applied prospectively in 12 consecutive patients with a presumed spinal vascular lesion. The images were evaluated for visibility of the arterial feeder, and the results were compared with those of conventional angiography performed the next day.

RESULTS

The MR angiographic findings proved that the lesions were correctly characterized as spinal arteriovenous malformations (AVMs) (n = 6), spinal dural arteriovenous fistulas (AVFs) (n = 3), a hemangioblastoma (n = 1), a teratoma (n = 1), and a vertebral hemangioma (n = 1). The arterial feeder was visible in all six AVMs and in the hemangioblastoma, corresponding to conventional angiographic findings. In two of three spinal dural AVFs, an enlarged draining medullary vein was seen within the neural foramen, providing correct localization. The third fistula could not be seen owing to reduced image quality from motion artifacts.

CONCLUSION

Fast 3D contrast-enhanced MR angiography is a noninvasive technique with high accuracy in the characterization of spinal vascular disease. Visibility of the arterial pedicles corresponds well with that of digital subtraction angiography, facilitating the management of these patients.

Characterization of renal artery stenoses based on magnetic resonance renal flow and volume measurements

BACKGROUND

The benefits of percutaneous angioplasty of renal artery stenosis is not known. In an attempt to better define the patient subgroup most likely to benefit from a revascularization procedure, the relationship between renal arterial morphology, blood flow volume, and renal volume was investigated using magnetic resonance (MR) techniques.

METHODS

Analysis was based on arterial flow volume and renal volume measurements of 130 kidneys in 65 patients with clinically suspected renal vascular disease. Significant renal arterial stenosis (RAS), documented by contrast-enhanced three-dimensional MR angiography, compromised blood supply to 31 kidneys. Renal volume measurements were related to the body mass index to derive the renal volume index (RVI). The RVI of 72 kidneys in 36 patients without evidence of RAS or severe renal insufficiency was used as a standard of reference to differentiate normal-volume from reduced-volume kidneys.

RESULTS

Eighteen out of 31 RAS kidneys were significantly reduced in volume (3.08 +/- 0.75); the volume of the remaining 13 kidneys was within one standard deviation of the normal reference value. Flow volumes in kidneys with RAS were significantly reduced compared with kidneys without RAS (91.56 vs. 279.15 ml/min). Based on the RFI values (RFI = flow volume/renal volume), there was only minimal overlap between normal volume kidneys with RAS (0.73 +/- 0.34) and kidneys without RAS (2.02 +/- 0.59). RFI values of small volume kidneys with RAS (1.55 +/- 0.47), on the other hand, overlapped with both groups.

CONCLUSIONS

Normal volume kidneys with impaired arterial flow caused by RAS can be differentiated from those without based on a flow index (RFI). These data suggest the existence of a critical cut-off value (flow index <1.2 ml/min per cm3 of renal tissue) beyond which the renal parenchyma starts shrinking.

Contrast-enhanced MR angiography of the supra-aortic vessels in 24 seconds: a feasibility study

A contrast-enhanced, gradient-echo 3D pulse sequence providing angiographic information in 24 s was tested in five healthy subjects and used prospectively in 21 patients for the investigation of the cervical arteries. Indications included suspected stenosis of the carotid (in 13), or vertebral arteries (in 1), carotid dissection (3), variants of the branches of the aortic arch (2) and extracranial carotid aneurysms (2). The results in all patients were compared with those of intra-arterial digital subtraction angiography (DSA). In patients with carotid stenosis, they were also compared with high-resolution 3D time-of-flight (TOF) MR angiography (MRA). Good quality MR angiograms of the neck vessels were obtained with the fast 3D sequence in 20 of the 21 patients. One claustrophobic patient was unable to cooperate. The degree of internal carotid artery (ICA) stenosis was graded correctly (compared to DSA) in 21 of 24 cases (87.5%). Two mild stenoses were overestimated as moderate using the fast MR sequence and one high-grade stenosis was misdiagnosed as a complete occlusion. Carotid dissection was confirmed in one case and correctly excluded in two. Four extracranial ICA aneurysms in two patients, arterial variants and stenosis of the origin of the vertebral artery were correctly diagnosed using the contrast-enhanced MR angiogram. Three-dimensional TOF MRA was unsuccessful due to motion artefacts in half of the cases of ICA stenosis.

Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents--a preliminary report

PURPOSE

Evaluation of clinical aspects and cost-effectiveness of use of self-expanding metallic stents in the treatment of acute colonic obstruction as either a preoperative procedure or palliation.

MATERIALS AND METHODS

Thirteen consecutive patients, aged 49-83 years (mean, 67 years), with clinical and radiologic signs of colonic obstruction were treated as a preoperative procedure in 10 patients and as a palliative treatment in three. A total of 16 self-expanding metallic stents (diameter, 16 mm; length fully expanded, 56 mm) were implanted with combined fluoroscopic and endoscopic guidance. The costs (hospitalization, intensive care unit, stent placement, and surgery) were compared with costs for 13 surgically treated patients at the same hospital.

RESULTS

Stent placement was successful in 12 of the 13 patients; all recovered from mechanical obstruction, and single-stage surgery was possible in eight of nine patients treated preoperatively. One very narrow stenosis could not be passed. Dysfunction occurred in two long stenoses after 5 days with reocclusion 2 and 6 weeks, respectively, after stent placement. A cost reduction of 19.7% was observed as a result of shorter hospitalization and a lower complication rate. In patients with colon cancer in the preoperative treatment group, the cost reduction increased to 28.8%.

CONCLUSION

Metallic stent placement in patients with acute colonic obstruction was a minimally invasive and cost-effective preoperative procedure that allowed single-stage surgery in most cases. Stent placement for palliation should be limited to patient with special indications.

Treatment of pelvic venous spur (May-Thurner syndrome) with self-expanding metallic endoprostheses

PURPOSE

The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative to surgery.

METHODS

Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients (seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic leg swelling). Four patients had surgical thrombectomy prior to stent placement.

RESULTS

Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency rate of 100% was observed during an average follow-up of 3 years (range 10-121 months). There were no procedural or stent-related complications.

CONCLUSION

The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur.

Benign and malignant stenoses of the stomach and duodenum: treatment with self-expanding metallic endoprostheses

PURPOSE

To assess palliation of inoperable stenoses of the stomach and the duodenum with self-expanding metallic endoprostheses.

MATERIALS AND METHODS

Under combined endoscopic and fluoroscopic guidance, 13 Wallstents were placed in nine consecutive patients, two with benign and seven with malignant obstruction.

RESULTS

Technical success was achieved in eight patients (89%). One failure was due to stent dislocation during implantation. No major complications occurred; in two patients (22%), additional stents were implanted to improve patency. During the follow-up, which was 1-52 weeks (mean, 17 weeks) or until death there were no signs of stent obstruction. In seven patients (78%), quality of life improved substantially with restoration of oral food intake and relief of vomiting.

CONCLUSION

The placement of Wallstents offers good palliation of inoperable outlet stenoses of the stomach and the duodenum. With a combined radiologic and endoscopic approach, it is an easy and rapid procedure that can be performed without general anesthesia.