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Müllhaupt G, Hechelhammer L, Graf N, Mordasini L, Schmid HP, Engeler DS, Abt D. Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Obstruction: 5-year Outcomes of a Randomised, Open-label, Noninferiority Trial. Eur Urol Focus 2024:S2405-4569(24)00045-2. [PMID: 38531756 DOI: 10.1016/j.euf.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Prostatic artery embolisation (PAE) and transurethral resection of the prostate (TURP) are two of the surgical options for treatment of lower urinary tract symptoms/benign prostatic obstruction (LUTS/BPO). Our aim was to compare the efficacy and safety of PAE and TURP for LUTS/BPO treatment at long-term follow-up. METHODS We conducted a randomised, open-label, single-centre trial at a Swiss tertiary care centre. The main outcome was the change in International Prostate Symptom Score (IPSS) after PAE versus TURP. Secondary outcomes included patient-reported outcomes, functional measures, and adverse events assessed at baseline and at 3, 6, 12, 24, and 60 mo. Between-group differences in the change from baseline to 5 yr were tested using two-sided Mann-Whitney and t tests. KEY FINDINGS AND LIMITATIONS Of the 103 patients with refractory LUTS/BPO who were randomised between 2014 and 2017, 18/48 who underwent PAE and 38/51 who underwent TURP reached the 60-mo follow-up visit. The mean reduction in IPSS from baseline to 5 yr was -7.78 points after PAE and -11.57 points after TURP (difference 3.79 points, 95% confidence interval [CI] -0.66 to 8.24; p = 0.092). TURP was superior for most patient-reported secondary outcomes except for erectile function. At 5 yr, PAE was less effective than TURP regarding objective parameters, such as the improvement in maximum urinary flow rate (3.59 vs 9.30 ml/s, difference -5.71, 95% CI -10.72 to -0.70; p = 0. 027) and reduction in postvoid residual volume (27.81 vs 219.97 ml; difference 192.15, 95% CI 83.79-300.51; p = 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS The improvement in LUTS/BPO at 5 yr after PAE was inferior to that achieved with TURP. The limitations of PAE should be considered during patient selection and counselling. PATIENT SUMMARY In this study, we show the long-term results of prostate artery embolisation (PAE) in comparison to transurethral resection of the prostate (TURP) for the treatment of benign prostate enlargement causing urinary symptoms. PAE shows good long-term results in properly selected patients, although the improvements are less pronounced than with TURP. This trial is registered on ClinicalTrials.gov as NCT02054013.
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Department of Urology, Spital Thun, Thun, Switzerland.
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Nicole Graf
- Biostatistics Department, Clinical Trials Unit, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Uroviva Practice Sursee, Uroviva Group, Sursee, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Department of Urology, Spitalzentrum Biel, Biel, Switzerland
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Burkhardt O, Abt D, Hechelhammer L, Kim O, Omlin A, Schmid HP, Engeler D, Zumstein V, Müllhaupt G. Prostatic Artery Embolization in Patients with Advanced Prostate Cancer: A Prospective Single Center Pilot Study. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03679-z. [PMID: 38416176 DOI: 10.1007/s00270-024-03679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/27/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE To assess efficacy and safety of prostatic artery embolization (PAE) in patients with advanced prostate cancer (PCa). MATERIALS AND METHODS In this prospective single-center, single-arm, pilot study, 9 men with advanced PCa underwent PAE. PAE was performed with the use of 250-400 µm Embozene microspheres (Boston Scientific, Natick, Massachusetts, USA). International Prostate Symptoms Score (IPSS), urinary peak flow (Qmax) and post-void residual urine volume (PVR) was assessed at 12 weeks and up to 12 months. Changes in total prostate volume (TPV) and tumor responses by PSA, changes in tumor volume and evaluation of tumor regression by multiparametric magnetic resonance imaging were assessed at 12 weeks after PAE. RESULTS IPSS reduction in median 6 points (0-19) and a significant decrease in PVR from median 70 (20-600) mL to 10 (0-280) mL could be achieved within 12 weeks after PAE. Median TPV and tumor volumes (TV) increased slightly from 19.7 (6.4-110.8) mL to 23.4 (2.4-66.3) mL and 6.4 (4.6-18.3) mL to 8.1 (2.4-25.6) mL at a median of 12 weeks after the procedure. Significant tumor necrosis (≥ 50%) was found in one patient. Eight patients showed > 50% of viable tumor on post-PAE MRI according to MRI. Only one Clavien-Dindo Grade 1 adverse event related to PAE occurred. CONCLUSIONS PAE with the use of 250-400 µm microspheres is feasible, safe and effective in some patients with advanced PCa regarding functional outcomes. A cytoreductive effect might be achieved in individual patients but must be further assessed. TRIALS REGISTRATION NCT03457805.
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Affiliation(s)
- Orlando Burkhardt
- Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Dominik Abt
- Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Department of Urology, Spitalzentrum Biel/Centre Hospitalier Bienne, Biel/Bienne, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Olaf Kim
- Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Aurelius Omlin
- Onkozentrum Zürich und Uroonkologisches Zentrum, Hirslanden Zürich, Seestrasse 259, 8038, Zurich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Daniel Engeler
- Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Urologiezug, Zug, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Department of Urology, Spital Thun, Thun, Switzerland
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Leu S, Ardila-Jurado E, Mordasini P, Hechelhammer L. Treatment of an Acute Common Carotid Artery Occlusion Using a Large-Bore Aspiration Thrombectomy Device. J Vasc Interv Radiol 2023; 34:1638-1639. [PMID: 37620059 DOI: 10.1016/j.jvir.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 08/26/2023] Open
Affiliation(s)
- Svenja Leu
- Department of Radiology and Nuclear Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
| | - Elena Ardila-Jurado
- Department of Neurology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Pasquale Mordasini
- Department of Radiology and Nuclear Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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Schmid HP, Hechelhammer L, Müllhaupt G. Re: Early Results of Unilateral Prostatic Artery Embolization as a Focal Therapy in Patients with Prostate Cancer Under Active Surveillance: Cancer Prostate Embolisation, a Pilot Study. Eur Urol 2021; 81:121-122. [PMID: 34772549 DOI: 10.1016/j.eururo.2021.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland.
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
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Abt D, Müllhaupt G, Hechelhammer L, Markart S, Güsewell S, Schmid HP, Engeler D. Prostatic Artery Embolisation (PAE) versus Transurethral Resection of the Prostate (TURP) for benign prostatic hyperplasia: Two-year outcomes of a randomised, open-label, single-centre trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00449-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abt D, Müllhaupt G, Hechelhammer L, Markart S, Güsewell S, Schmid HP, Mordasini L, Engeler DS. Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: 2-yr Outcomes of a Randomised, Open-label, Single-centre Trial. Eur Urol 2021; 80:34-42. [PMID: 33612376 DOI: 10.1016/j.eururo.2021.02.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Prostatic artery embolisation (PAE) for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) still remains under investigation. OBJECTIVE To compare the efficacy and safety of PAE and transurethral resection of the prostate (TURP) in the treatment of LUTS/BPO at 2 yr of follow-up. DESIGN, SETTING, AND PARTICIPANTS A randomised, open-label trial was conducted. There were 103 participants aged ≥40 yr with refractory LUTS/BPO. INTERVENTION PAE versus TURP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS International Prostate Symptoms Score (IPSS) and other questionnaires, functional measures, prostate volume, and adverse events were evaluated. Changes from baseline to 2 yr were tested for differences between the two interventions with standard two-sided tests. RESULTS AND LIMITATIONS The mean reduction in IPSS after 2 yr was 9.21 points after PAE and 12.09 points after TURP (difference of 2.88 [95% confidence interval 0.04-5.72]; p = 0.047). Superiority of TURP was also found for most other patient-reported outcomes except for erectile function. PAE was less effective than TURP regarding the improvement of maximum urinary flow rate (3.9 vs 10.23 ml/s, difference of -6.33 [-10.12 to -2.54]; p < 0.001), reduction of postvoid residual urine (62.1 vs 204.0 ml; 141.91 [43.31-240.51]; p = 0.005), and reduction of prostate volume (10.66 vs 30.20 ml; 19.54 [7.70-31.38]; p = 0.005). Adverse events were less frequent after PAE than after TURP (total occurrence n = 43 vs 78, p = 0.005), but the distribution among severity classes was similar. Ten patients (21%) who initially underwent PAE required TURP within 2 yr due to unsatisfying clinical outcomes, which prevented further assessment of their outcomes and, therefore, represents a limitation of the study. CONCLUSIONS Inferior improvements in LUTS/BPO and a relevant re-treatment rate are found 2 yr after PAE compared with TURP. PAE is associated with fewer complications than TURP. The disadvantages of PAE regarding functional outcomes should be considered for patient selection and counselling. PATIENT SUMMARY Prostatic artery embolisation is safe and effective. However, compared with transurethral resection of the prostate, its disadvantages regarding subjective and objective outcomes should be considered for individual treatment choices.
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Affiliation(s)
- Dominik Abt
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland.
| | - Gautier Müllhaupt
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Sabine Güsewell
- Biostatistics, Clinical Trials Unit, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
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Abt D, Zumstein V, Hechelhammer L. Commentary on the Article "Systematic Review and Meta-Analysis Comparing Prostatic Artery Embolisation to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia". Cardiovasc Intervent Radiol 2020; 44:194-195. [PMID: 33205291 DOI: 10.1007/s00270-020-02706-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dominik Abt
- Department of Urology, School of Medicine, University of St. Gallen, St. Callen, 9007, Switzerland.
| | - Valentin Zumstein
- Department of Urology, School of Medicine, University of St. Gallen, St. Callen, 9007, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, School of Medicine, University of St. Gallen, St. Callen, Switzerland
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Zumstein V, Binder J, Güsewell S, Betschart P, Pratsinis M, Müllhaupt G, Hechelhammer L, Schmid HP, Abt D. Radiation Exposure During Prostatic Artery Embolisation: A Systematic Review and Calculation of Associated Risks. Eur Urol Focus 2020; 7:608-611. [PMID: 32418877 DOI: 10.1016/j.euf.2020.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
Although evidence supporting the efficacy and safety of prostatic artery embolisation (PAE) is increasing, potential associated risks of ionising radiation in this context remain largely unknown. We systematically reviewed reports on radiation exposure (RE) during PAE in the literature and estimated the risk RE poses using a Monte Carlo dose calculation algorithm. Of 842 studies screened, 22 were included. The overall mean dose area product (DAP) was 181.6 Gy∙cm2 (95% confidence interval 125.7-262.4). The risk model for the effects of RE in a 66-yr-old patient exposed to DAP of 200 Gy∙cm2 showed that the probability of cancer death from the intervention was 0.117%. The highest specific lifetime risk was expected for leukaemia (0.061%). Wide DAP variation between individual studies (medians ranging from 33.2 to 863.4 Gy∙cm2) indicate large potential to reduce RE during PAE at some study centres. RE must be included in patient counselling on PAE, especially for younger patients. PATIENT SUMMARY: We systematically assessed radiation exposure during prostatic artery embolisation (PAE) in the literature and simulated the associated risks in a computer model. PAE exposes patients to very low but not negligible risks, which are most relevant for younger men. This should be discussed with patients before PAE.
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Affiliation(s)
- Valentin Zumstein
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jörg Binder
- Radiation Protection Unit, Kantonsspital Aarau, Aarau, Switzerland
| | - Sabine Güsewell
- Biostatistics, Clinical Trials Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Manolis Pratsinis
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
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Müllhaupt G, Hechelhammer L, Diener PA, Engeler DS, Güsewell S, Schmid HP, Mordasini L, Abt D. Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials. World J Urol 2019; 38:2595-2599. [PMID: 31813028 PMCID: PMC7508929 DOI: 10.1007/s00345-019-03036-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/21/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aims to specify and explain the previous findings of unexpectedly high rates of ejaculatory disorders, i.e. 56%, found after prostatic artery embolization (PAE) in a randomized controlled trial comparing safety and efficacy of PAE and transurethral resection of the prostate (TURP). Patients and methods Case report forms of the randomized controlled trial were analyzed to specify the grade of postoperative ejaculatory dysfunction 3 months postoperatively. In addition, study participants with assessable ejaculation were asked to complete the four-item Male Sexual Health Questionnaire-Ejaculation Dysfunction Short Form (MSHQ-EjD) referring to their ejaculatory function at present, as well as before treatment and 3 months after. Potential explanations for ejaculatory disorders after PAE were derived from histological examination of five radical prostatectomy specimens of patients that underwent PAE 6 weeks before radical prostatectomy within a proof-of-concept trial at the study site, St. Gallen Cantonal Hospital. An experienced uropathologist systematically examined the whole-gland embedded tissue with focus on structures that are involved into ejaculation. Results While patients after TURP predominantly suffered from anejaculation (52%), diminished ejaculation was found more often after PAE (40%). Significantly higher MSHQ-EjD scores were found 3 months after PAE and at a median follow-up of 31 months. Histological examination showed marked changes of structures involved into ejaculation (e.g., prostatic glands, seminal vesicles, ejaculatory ducts) after PAE. Conclusion Although anejaculation occurs less frequently after PAE (16%) compared to TURP (52%), patients have to be informed about the relevant risk of ejaculatory disorders, especially diminished ejaculation.
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Pierre-André Diener
- Department of Pathology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
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Hechelhammer L, Müllhaupt G, Mordasini L, Markart S, Güsewell S, Betschart P, Schmid HP, Engeler DS, Abt D. Predictability and Inducibility of Detachment of Prostatic Central Gland Tissue after Prostatic Artery Embolization: Post Hoc Analysis of a Randomized Controlled Trial. J Vasc Interv Radiol 2019; 30:217-224. [DOI: 10.1016/j.jvir.2018.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/19/2018] [Accepted: 09/21/2018] [Indexed: 01/14/2023] Open
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Müllhaupt G, Hechelhammer L, Engeler DS, Güsewell S, Betschart P, Zumstein V, Kessler TM, Schmid HP, Mordasini L, Abt D. In-hospital cost analysis of prostatic artery embolization compared with transurethral resection of the prostate: post hoc analysis of a randomized controlled trial. BJU Int 2019; 123:1055-1060. [PMID: 30578705 PMCID: PMC6850481 DOI: 10.1111/bju.14660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To perform a post hoc analysis of in-hospital costs incurred in a randomized controlled trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS In-hospital costs arising from PAE and TURP were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs, including those arising from surgical and interventional procedures, consumables, personnel and accommodation, were analysed for all of the study participants and compared between PAE and TURP using descriptive analysis and two-sided t-tests, adjusted for unequal variance within groups (Welch t-test). RESULTS The mean total costs per patient (±sd) were higher for TURP, at €9137 ± 3301, than for PAE, at €8185 ± 1630. The mean difference of €952 was not statistically significant (P = 0.07). While the mean procedural costs were significantly higher for PAE (mean difference €623 [P = 0.009]), costs apart from the procedure were significantly lower for PAE, with a mean difference of €1627 (P < 0.001). Procedural costs of €1433 ± 552 for TURP were mainly incurred by anaesthesia, whereas €2590 ± 628 for medical supplies were the main cost factor for PAE. CONCLUSIONS Since in-hospital costs are similar but PAE and TURP have different efficacy and safety profiles, the patient's clinical condition and expectations - rather than finances - should be taken into account when deciding between PAE and TURP.
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, St. Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
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Abt D, Müllhaupt G, Mordasini L, Güsewell S, Markart S, Zumstein V, Kessler TM, Schmid HP, Engeler DS, Hechelhammer L. Outcome prediction of prostatic artery embolization: post hoc analysis of a randomized, open-label, non-inferiority trial. BJU Int 2018; 124:134-144. [PMID: 30499637 DOI: 10.1111/bju.14632] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify predictors for different treatment outcomes after prostatic artery embolization (PAE) in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. PATIENTS AND METHODS A post hoc analysis of data derived from the 48 patients undergoing PAE in a randomized, open-label, non-inferiority trial was performed. Relative changes in the International Prostate Symptoms Score (IPSS), absolute changes in maximum urinary flow rate (Qmax ), and relative changes in magnetic resonance imaging-assessed prostate volume from baseline to 12 weeks were defined as the outcomes measures of interest. Their association with various baseline characteristics and measures, technical details of PAE, and early postoperative measures were analysed using Spearman rank correlations and Wilcoxon rank-sum tests. The most promising predictors were further evaluated in receiver-operating characteristic (ROC) curve analyses. RESULTS Higher total prostate and central gland (i.e. central plus transitional zone) volumes were associated with more pronounced improvements in the IPSS (Spearman rank correlation [rs]: -0.35 and -0.34; P = 0.01 and P = 0.02, respectively) and the Qmax (rs: 0.31 and 0.39; P = 0.05 and P = 0.01, respectively). ROC curve analyses suggested that volumes of 39 and 38 mL for total prostate and central gland volume, respectively, would be the optimal thresholds with which to predict PAE success as measured by the IPSS. Other anatomical characteristics of the prostate, such as the central gland index, also showed an even more distinct correlation to the improvement in Qmax (rs: 0.46, P = 0.003). The relative changes in prostate volume were clearly dependent on the technical performance of PAE. Occurrence of postoperative pain and blood levels of prostate-specific antigen and C-reactive protein emerged as potential early-stage outcome predictors after PAE. CONCLUSION Baseline and peri-operative findings might help to guide patient selection and outcome prediction for PAE. Patients with larger prostates have a higher chance of success with PAE. Larger-scale clinical trials including a longer follow-up are warranted to further elucidate the most suitable patients for PAE.
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Affiliation(s)
- Dominik Abt
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St Gallen, Switzerland
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Zumstein V, Betschart P, Vetterlein MW, Kluth LA, Hechelhammer L, Mordasini L, Engeler DS, Kessler TM, Schmid HP, Abt D. Prostatic Artery Embolization versus Standard Surgical Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis. Eur Urol Focus 2018; 5:1091-1100. [PMID: 30292422 DOI: 10.1016/j.euf.2018.09.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 09/10/2018] [Indexed: 01/28/2023]
Abstract
CONTEXT Prostatic artery embolization (PAE) has been introduced into clinical practice for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS) despite a lack of high-level evidence. OBJECTIVE To perform a systematic review and meta-analysis of clinical trials comparing efficacy and safety of PAE versus established surgical therapies. EVIDENCE ACQUISITION Medline, Embase, and York CRD were searched up to June 23, 2018. Only comparative studies were included. The risk of bias was assessed by the Cochrane Collaboration tool. Meta-analyses were performed using RevMan 5.3. EVIDENCE SYNTHESIS Five studies including 708 patients met the selection criteria. Risk of bias was rated high for most of the studies. Mean reduction in the International Prostate Symptom Score was lower after PAE compared with standard surgical therapies (mean difference 3.80 points [95% confidence interval: 2.77-4.83]; p<0.001). PAE was less efficient regarding improvements in all functional parameters assessed including maximum urinary flow, post void residual, and reduction of prostate volume. In contrast, patient-reported erectile function (International Index of Erectile Function 5) was better after PAE and significantly fewer adverse events occurred after PAE. CONCLUSIONS Moderately strong evidence confirms efficacy and safety of PAE in the treatment of BPH-LUTS in the short term. Significant advantages regarding safety and sexual function, but clear disadvantages regarding all other patient-reported and functional outcomes were found for PAE. Large-scale randomized controlled trials including longer follow-up periods are mandatory before PAE can be considered as a standard therapy and to define the ideal indication for PAE in the management of BPH-LUTS. PATIENT SUMMARY We reviewed the role of prostatic artery embolization (PAE) in the treatment of symptoms associated with benign overgrowth of the prostate. The results suggest that PAE is not as effective as established surgical therapies but has fewer side effects. Further research is required to determine whether PAE is the best treatment for certain types of patients. PAE should, therefore, not yet be considered a standard treatment.
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Affiliation(s)
- Valentin Zumstein
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Patrick Betschart
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luis A Kluth
- Department of Urology, University Medical Center Frankfurt, Frankfurt (Main), Germany
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Daniel S Engeler
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
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Abt D, Hechelhammer L, Müllhaupt G, Markart S, Güsewell S, Kessler TM, Schmid HP, Engeler DS, Mordasini L. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ 2018; 361:k2338. [PMID: 29921613 PMCID: PMC6006990 DOI: 10.1136/bmj.k2338] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare prostatic artery embolisation (PAE) with transurethral resection of the prostate (TURP) in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia in terms of patient reported and functional outcomes. DESIGN Randomised, open label, non-inferiority trial. SETTING Urology and radiology departments of a Swiss tertiary care centre. PARTICIPANTS 103 patients aged ≥40 years with refractory lower urinary tract symptoms secondary to benign prostatic hyperplasia were randomised between 11 February 2014 and 24 May 2017; 48 and 51 patients reached the primary endpoint 12 weeks after PAE and TURP, respectively. INTERVENTIONS PAE performed with 250-400 μm microspheres under local anaesthesia versus monopolar TURP performed under spinal or general anaesthesia. MAIN OUTCOMES AND MEASURES Primary outcome was change in international prostate symptoms score (IPSS) from baseline to 12 weeks after surgery; a difference of less than 3 points between treatments was defined as non-inferiority for PAE and tested with a one sided t test. Secondary outcomes included further questionnaires, functional measures, magnetic resonance imaging findings, and adverse events; changes from baseline to 12 weeks were compared between treatments with two sided tests for superiority. RESULTS Mean reduction in IPSS from baseline to 12 weeks was -9.23 points after PAE and -10.77 points after TURP. Although the difference was less than 3 points (1.54 points in favour of TURP (95% confidence interval -1.45 to 4.52)), non-inferiority of PAE could not be shown (P=0.17). None of the patient reported secondary outcomes differed significantly between treatments when tested for superiority; IPSS also did not differ significantly (P=0.31). At 12 weeks, PAE was less effective than TURP regarding changes in maximum rate of urinary flow (5.19 v 15.34 mL/s; difference 10.15 (95% confidence interval -14.67 to -5.63); P<0.001), postvoid residual urine (-86.36 v -199.98 mL; 113.62 (39.25 to 187.98); P=0.003), prostate volume (-12.17 v -30.27 mL; 18.11 (10.11 to 26.10); P<0.001), and desobstructive effectiveness according to pressure flow studies (56% v 93% shift towards less obstructive category; P=0.003). Fewer adverse events occurred after PAE than after TURP (36 v 70 events; P=0.003). CONCLUSIONS The improvement in lower urinary tract symptoms secondary to benign prostatic hyperplasia seen 12 weeks after PAE is close to that after TURP. PAE is associated with fewer complications than TURP but has disadvantages regarding functional outcomes, which should be considered when selecting patients. Further comparative study findings, including longer follow-up, should be evaluated before PAE can be considered as a routine treatment. TRIAL REGISTRATION Clinicaltrials.gov NCT02054013.
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Affiliation(s)
- Dominik Abt
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
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Messerli M, Hechelhammer L, Leschka S, Warschkow R, Wildermuth S, Bauer RW. Coronary risk assessment at X-ray dose equivalent ungated chest CT: Results of a multi-reader study. Clin Imaging 2018; 49:73-79. [DOI: 10.1016/j.clinimag.2017.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022]
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Messerli M, Giannopoulos AA, Leschka S, Warschkow R, Wildermuth S, Hechelhammer L, Bauer RW. Diagnostic accuracy of chest X-ray dose-equivalent CT for assessing calcified atherosclerotic burden of the thoracic aorta. Br J Radiol 2017; 90:20170469. [PMID: 28972810 DOI: 10.1259/bjr.20170469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To determine the value of ultralow-dose chest CT for estimating the calcified atherosclerotic burden of the thoracic aorta using tin-filter CT and compare its diagnostic accuracy with chest direct radiography. METHODS A total of 106 patients from a prospective, IRB-approved single-centre study were included and underwent standard dose chest CT (1.7 ± 0.7 mSv) by clinical indication followed by ultralow-dose CT with 100 kV and spectral shaping by a tin filter (0.13 ± 0.01 mSv) to achieve chest X-ray equivalent dose in the same session. Two independent radiologists reviewed the CT images, rated image quality and estimated presence and extent of calcification of aortic valve, ascending aorta and aortic arch. Conventional radiographs were also reviewed for presence of aortic calcifications. RESULTS The sensitivity of ultralow-dose CT for the detection of calcifications of the aortic valve, ascending aorta and aortic arch was 93.5, 96.2 and 96.2%, respectively, compared with standard dose CT. The sensitivity for the detection of thoracic aortic calcification was significantly lower on chest X-ray (52.3%) compared with ultralow-dose CT (p < 0.001). CONCLUSION A reliable estimation of calcified atherosclerotic burden of the thoracic aorta can be achieved with modern tin-filter CT at dose values comparable to chest direct radiography. Advances in knowledge: Our findings suggest that ultralow-dose CT is an excellent tool for assessing the calcified atherosclerotic burden of the thoracic aorta with higher diagnostic accuracy than conventional chest radiography and importantly without the additional cost of increased radiation dose.
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Affiliation(s)
- Michael Messerli
- 1 Department of Nuclear Medicine, University Hospital Zurich, University Zurich , Zürich , Switzerland.,2 Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen , St. Gallen , Switzerland
| | - Andreas A Giannopoulos
- 1 Department of Nuclear Medicine, University Hospital Zurich, University Zurich , Zürich , Switzerland
| | - Sebastian Leschka
- 2 Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen , St. Gallen , Switzerland.,3 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich , Zurich , Switzerland
| | - René Warschkow
- 4 Department of Surgery, Cantonal Hospital St. Gallen , St. Gallen , Switzerland
| | - Simon Wildermuth
- 2 Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen , St. Gallen , Switzerland
| | - Lukas Hechelhammer
- 2 Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen , St. Gallen , Switzerland.,3 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich , Zurich , Switzerland
| | - Ralf W Bauer
- 2 Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen , St. Gallen , Switzerland
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Abt D, Hechelhammer L, Müllhaupt G, Kessler T, Schmid HP, Engeler D, Mordasini L. 1080 Prostatic artery embolization vs conventional TUR-P in the treatment of benign prostatic hyperplasia: First results of a prospective, randomized non-inferiority trial. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1569-9056(16)61081-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Erschbamer M, Den Hollander J, Sauter D, Erhardt J, Hechelhammer L, Külling F. Endovascular embolisation is a successful and safe treatment for post-operative arterial complications after total hip arthroplasty and revision surgery. Int Orthop 2015; 40:1577-1582. [PMID: 26614108 DOI: 10.1007/s00264-015-3058-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Arterial complications are rare but clinically critical during or following total hip arthroplasty (THA) surgery. They usually require secondary interventions, either through open or endovascular approaches. In a retrospective study, we analysed indications for, as well as success and safety of, endovascular embolisation for arterial complications after THA. METHODS We reviewed all arterial complications that had occurred through THA surgery and been treated by endovascular embolisation. We analysed angiographic findings, endovascular treatment, location in relation to the surgical approach and success of the interventions. RESULTS Between 1997 and 2013 we performed 3,891 THAs at our hospital. We identified 14 patients with acute arterial complications treated by minimally invasive endovascular embolisation. Clinical findings included swelling of the ipsilateral leg, pain, prolonged wound bleeding, decreased haemoglobin and/or haemodynamic instability. Angiography revealed pseudoaneurysm in 11 patients, arteriovenous fistulas in two and extravasation of contrast media in one. Two patients showed no signs of acute bleeding. Twelve patients were treated, each with a single session of endovascular embolisation; in two additional patients, the haematoma was evacuated. No complications from the endovascular treatment were observed in this series. CONCLUSION Endovascular embolisation is a safe and successful minimally-invasive method to treat arterial injuries occurring through THA. Therefore, it should be considered as a first-line option of treatment for those injuries.
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Affiliation(s)
- Matthias Erschbamer
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Jürgen Den Hollander
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Daniel Sauter
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Johannes Erhardt
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Fabrice Külling
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
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Sawatzki M, Hechelhammer L, Meyenberger C, Schoenenberger U, Stoeckli SJ. Nanopowder spray for temporary hemostasis in a patient presenting with esophago-carotid fistula after radiation and surgery for a head and neck cancer. Endoscopy 2015; 46 Suppl 1 UCTN:E644-5. [PMID: 25526405 DOI: 10.1055/s-0034-1390850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mikael Sawatzki
- Division of Gastroenterology and Hepatology, Kantonsspital, St. Gallen, Switzerland
| | | | - Christa Meyenberger
- Division of Gastroenterology and Hepatology, Kantonsspital, St. Gallen, Switzerland
| | - Ursula Schoenenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland
| | - Sandro J Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland
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Abt D, Mordasini L, Hechelhammer L, Kessler TM, Schmid HP, Engeler DS. Prostatic artery embolization versus conventional TUR-P in the treatment of benign prostatic hyperplasia: protocol for a prospective randomized non-inferiority trial. BMC Urol 2014; 14:94. [PMID: 25425136 PMCID: PMC4258033 DOI: 10.1186/1471-2490-14-94] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/13/2014] [Indexed: 12/27/2022] Open
Abstract
Background Benign prostatic hyperplasia (BPH) is a prevalent entity in elderly men and transurethral resection of the prostate (TURP) still represents the gold standard of surgical treatment despite its considerable perioperative morbidity. Recently, prostatic artery embolization (PAE) was described as a novel effective and less invasive treatment alternative. Despite promising first results, PAE still has to be considered experimental due to a lack of good quality studies. Prospective randomized controlled trials comparing PAE with TUR-P are highly warranted. Methods/design This is a single-centre, prospective, randomized, non-inferiority trial comparing treatment effects and adverse events of PAE and TURP in a tertiary referral centre. One hundred patients who are electable for both treatment options are randomized to either PAE or TURP. Changes of the International Prostate Symptom Score (IPSS) after 3 months are defined as primary endpoint. Changes in bladder diaries, laboratory analyses, urodynamic investigations and standardised questionnaires are assessed as secondary outcome measures. In addition contrast-enhanced magnetic resonance imaging of the pelvis before and after the interventions will provide crucial information regarding morphological changes and vascularisation of the prostate. Adverse events will be assessed on every follow-up visit in both treatment arms according to the National Cancer Institute Common Terminology Criteria for Adverse events and the Clavien classification. Discussion The aim of this study is to assess whether PAE represents a valid treatment alternative to TURP in patients suffering from BPH in terms of efficacy and safety. Trial registration ClinicalTrials.gov NCT02054013.
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Affiliation(s)
- Dominik Abt
- Department of Urology, Cantonal Hospital St, Gallen, Rorschacherstrasse 95, St, Gallen 9007, Switzerland.
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Behme D, Kowoll A, Mpotsaris A, Hader C, Hechelhammer L, Weber J, Weber W. Multicenter clinical experience in over 125 patients with the Penumbra Separator 3D for mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg 2014; 8:8-12. [DOI: 10.1136/neurintsurg-2014-011446] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/13/2014] [Indexed: 11/03/2022]
Abstract
BackgroundThe aim of this study was to assess reperfusion and clinical outcome of treatment with the self-expanding retrievable Separator 3D in revascularization of acute ischemic stroke. The three-dimensional (3D) device secures thrombus with direct aspiration and supports debulking of the clot.MethodsAt two centers, 129 consecutive stroke patients with National Institutes of Health Stroke Scale (NIHSS) scores ≥5 were treated with mechanical thrombectomy using the Separator 3D as a component of the Penumbra System within 8 h of symptom onset; modified Treatment in Cerebral Infarction (mTICI) revascularization scores, NIHSS score on admission and discharge, mortality rates, and modified Rankin Scale (mRS) outcomes at 90 days were evaluated.ResultsA total of 129 vessels in 129 patients were treated. Occlusions were located in the middle cerebral artery (MCA, 48%), internal carotid artery (ICA, 33%), cervical ICA–MCA (3%), and vertebrobasilar arteries (16%). Intravenous thrombolytic therapy with recombinant tissue plasminogen activator was given to 78% of patients. Median NIHSS was 15 prior to treatment. Reperfusion to mTICI 2b or 3 was successful in 96/129 (74%) target arterial lesions, with more than half of cases (51%) achieving mTICI 3. The mean time from arterial puncture to revascularization was 65 min. At 90 days, the symptomatic intracranial hemorrhage rate was 4%, all cause mortality was 32%, and 43/99 patients (43%) achieved functional independence with an mRS score of ≤2.ConclusionsThe results suggest that the Separator 3D enables safe and effective revascularization of occluded large arteries in acute stroke intervention, leading to a high rate of functional independence at 90 days.
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Meyer A, Stöckli S, Hechelhammer L. [Percutaneous transabdominal thoracic duct embolisation for a chylous fistula after neck dissection]. Laryngorhinootologie 2014; 93:620-1. [PMID: 25152973 DOI: 10.1055/s-0034-1384527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gertsch T, Pfammatter T, Braun M, Hechelhammer L, Meyenberger C, Semela D, Sawatzki M. [Liver failure in a 27 years old female patient]. Praxis (Bern 1994) 2012; 101:1051-1055. [PMID: 22878949 DOI: 10.1024/1661-8157/a001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report about a 27-years old female patient with acute liver failure due to an acute Budd Chiari Syndrom (thrombosis of all three liver veins an vena cava inferior) with caval web, birth control pills and after long distance flight. After successfull aspiration of the caval thrombus and dilatation of caval web liver transplantation could be bypassed. Two weeks after intervention the patient was in a good healthy condition with normal laboratory values, normal liver size, normal perfusion of the V. cava inferior and signs of reperfusion of the middle liver vein.
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Affiliation(s)
- T Gertsch
- Departement Innere Medizin, Kantonsspital St. Gallen.
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Pecoraro F, Pfammatter T, Mayer D, Frauenfelder T, Papadimitriou D, Hechelhammer L, Veith FJ, Lachat M, Rancic Z. Multiple Periscope and Chimney Grafts to Treat Ruptured Thoracoabdominal and Pararenal Aortic Aneurysms. J Endovasc Ther 2011; 18:642-9. [DOI: 10.1583/11-3556.1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Cazejust J, De Baère T, Auperin A, Deschamps F, Hechelhammer L, Abdel-Rehim M, Schlumberger M, Leboulleux S, Baudin E. Transcatheter arterial chemoembolization for liver metastases in patients with adrenocortical carcinoma. J Vasc Interv Radiol 2011; 21:1527-32. [PMID: 20801688 DOI: 10.1016/j.jvir.2010.05.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 05/18/2010] [Accepted: 05/25/2010] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To retrospectively evaluate the effectiveness, tolerance, and predictors of response to transcatheter arterial chemoembolization for treatment of liver metastases from adrenocortical carcinoma. MATERIALS AND METHODS Twenty-nine patients with progressive liver metastases from adrenocortical carcinoma were treated with transcatheter arterial chemoembolization. Rate and duration of tumor response were defined according to Response Evaluation Criteria In Solid Tumors. The size of liver metastases, percentage of liver involvement, and Lipiodol uptake were studied as potential predictive factors of response. Time to liver and metastatic lesion progression were considered as endpoints. RESULTS Three months after transcatheter arterial chemoembolization, a liver morphologic response was observed in six of 29 patients (21%), stabilization in 18 (62%), and progression in five (17%). According to per-lesion analysis (n = 103), a morphologic response was observed in 23 lesions (22%), stabilization in 67 (65%), and progression in 13 (13%). Higher response rates were observed in cases in which the diameter of the target metastasis was 3 cm or smaller (P = .002) and in cases of high Lipiodol uptake (> 50%; P < .0001). On per-patient and per-lesion bases, progression rates were 32% and 55% at 6 months and 23% and 38% at 12 months. The median time to progression was 9 months and median survival was 11 months after the first procedure. CONCLUSIONS Transcatheter arterial chemoembolization should be considered as part of the therapeutic arsenal to treat liver metastases from adrenocortical carcinoma. The size of liver metastases and the percentage of Lipiodol uptake may help identify patients likely to benefit most from transcatheter arterial chemoembolization.
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Affiliation(s)
- Julien Cazejust
- Department of Interventional Radiology, Institut Gustave Roussy, 39 Rue Camille Desmoulins, Villejuif 94805, France
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Hechelhammer L, Rancic Z, Pfiffner R, Mayer D, Meier T, Lachat M, Pfammatter T. Midterm outcome of endovascular repair of ruptured isolated iliac artery aneurysms. J Vasc Surg 2010; 52:1159-63. [DOI: 10.1016/j.jvs.2010.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 06/01/2010] [Accepted: 06/03/2010] [Indexed: 11/26/2022]
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Mayer DO, Lachat M, Pfammatter T, Hechelhammer L, Veith FJ, Rancic Z. Long-term Survival After Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysms. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mayer D, Veith FJ, Lachat M, Pfammatter T, Hechelhammer L, Rancic Z. Abdominal compartment syndrome. MINERVA CHIR 2010; 65:329-346. [PMID: 20668421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are frequently encountered in critically ill patients and carry a high morbidity and mortality risk. Despite these facts, IAH/ACS are still overlooked by many physicians and therefore timely diagnosis is not made and treatment is often inadequate. All clinicians should be aware of the risk factors predicting IAH/ACS, the profound implications and derangements on all organ systems, the clinical presentation, the appropriate measurement of intra-abdominal pressure to detect IAH/ACS and the current treatment options for these detrimental syndromes. This comprehensive review provides knowledge about known facts, unresolved issues and future directions for research to improve patient survival and long-term outcome.
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Affiliation(s)
- D Mayer
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
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Magnetti F, Thalhammer C, Hechelhammer L, Husmann M, Pfammatter T, Amann-Vesti B. Spontaneous pseudoaneurysm of a femoro-popliteal Omniflow II graft treated with a stentgraft. VASA 2010; 39:196-8. [PMID: 20464678 DOI: 10.1024/0301-1526/a000028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the case of a symptomatic spontaneous leak of a biosynthetic graft (Omniflow (II) treated endovascularly with a stentgraft. Potential degeneration of biosynthetic grafts with aneurysm formation is a well known problem with a reported incidence of up to 7 %. Implantation of a stentgraft for treatment of a pseudoaneurysm is a valuable treatment option in native arteries; however its use in Omniflow II bypass grafts has not been reported so far. Surveillance of peripheral bypass grafts with duplex ultrasound may be helpful to detect morphological alterations of the graft.
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Affiliation(s)
- F Magnetti
- Clinic for Angiology, University Hospital Zürich, Switzerland
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Rancic Z, Pfammatter T, Lachat M, Hechelhammer L, Frauenfelder T, Veith FJ, Criado FJ, Mayer D. Periscope graft to extend distal landing zone in ruptured thoracoabdominal aneurysms with short distal necks. J Vasc Surg 2010; 51:1293-6. [DOI: 10.1016/j.jvs.2009.11.076] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 11/11/2009] [Accepted: 11/15/2009] [Indexed: 10/19/2022]
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Mayer D, Rancic Z, Pfammatter T, Hechelhammer L, Veith FJ, Donas K, Lachat M. Logistic Considerations for a Successful Institutional Approach to the Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. Vascular 2010; 18:64-70. [DOI: 10.2310/6670.2010.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.
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Affiliation(s)
- Dieter Mayer
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Zoran Rancic
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Thomas Pfammatter
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Lukas Hechelhammer
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Frank J. Veith
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Konstantin Donas
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Mario Lachat
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
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de Baere T, Teriitehau C, Deschamps F, Catherine L, Rao P, Hakime A, Auperin A, Goere D, Elias D, Hechelhammer L. Predictive factors for hypertrophy of the future remnant liver after selective portal vein embolization. Ann Surg Oncol 2010; 17:2081-9. [PMID: 20237856 DOI: 10.1245/s10434-010-0979-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND To analyze predictive factors of hypertrophy of the nonembolized future remnant liver (FRL) after transhepatic preoperative portal vein embolization (PVE) of the liver to be resected. MATERIALS AND METHODS Age, gender, indocyanin green clearance test, chemotherapy before PVE, type of chemotherapy, operators, extent of PVE, radiofrequency ablation (RFA) associated with PVE, time delay between PVE and surgery, and platelet count were retrospectively evaluated as predictive factors for hypertrophy of FRL in 107 patients with malignant disease in noncirrhotic liver. PVE targeted the right liver lobe [n = 70] or the right liver lobe and segment IV [n = 37] when FRL/total liver volume ratio was below 25% in healthy liver or 40% in altered liver. RESULTS After PVE, FRL volume significantly increased by 69%, from 344 +/- 156 cm(3) to 543 +/- 192 cm(3) (P < .0001). The degree of hypertrophy was negatively correlated with FRL volume (correlation coefficient = -0.55, P < .0001) and FRL/TFL ratio (correlation coefficient = -0.52, P < .0001) before PVE. Patients, who have undergone chemotherapy with platin agents prior to PVE, demonstrated lower hypertrophy (P = .048). CONCLUSION Hypertrophy after PVE is inversely correlated to initial FRL volume. Hypertrophy of the liver might be influenced by the systemic chemotherapeutic received before PVE.
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Affiliation(s)
- Thierry de Baere
- Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France.
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Rancic Z, Pfammatter T, Lachat M, Hechelhammer L, Oberkofler C, Veith F, Mayer D. Pull-Down Technique to Allow Complete Endovascular Relining of Failed AAA Vanguard Endografts with Excluder Bifurcated Endografts. Eur J Vasc Endovasc Surg 2009; 38:54-60. [DOI: 10.1016/j.ejvs.2008.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 12/05/2008] [Indexed: 10/20/2022]
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de Baere T, Deschamps F, Briggs P, Dromain C, Boige V, Hechelhammer L, Abdel-Rehim M, Aupérin A, Goere D, Elias D. Hepatic Malignancies: Percutaneous Radiofrequency Ablation during Percutaneous Portal or Hepatic Vein Occlusion. Radiology 2008; 248:1056-66. [DOI: 10.1148/radiol.2483070222] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Hechelhammer L, Pfirrmann CWA, Zanetti M, Hodler J, Boos N, Schmid MR. Imaging findings predicting the outcome of cervical facet joint blocks. Eur Radiol 2006; 17:959-64. [PMID: 17180331 DOI: 10.1007/s00330-006-0379-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 06/08/2006] [Accepted: 06/23/2006] [Indexed: 11/30/2022]
Abstract
To determine which cross-sectional imaging findings predict the short-term outcome of cervical facet joint blocks (FJB) and to evaluate the effect of combined intra-/periarticular versus periarticular injection on pain. Fifty facet joints in 37 patients were included in the study. Single, unilateral FJBs in 24 patients, and bilateral single level FJBs in 13 patients were performed, respectively. In all patients, pain relief was assessed using a visual analogue scale. All computed tomography (CT) examinations were blindly reviewed by two radiologists. Osteoarthritis was rated using the Kellgren classification. The presence of combined intra-/periarticular vs. sole periarticular injection of contrast was evaluated. Kellgren Grades 0 (n=23), 1 (n=5), 2 (n=3), 3 (n=9), and 4 (n=10) were found. Mean pain relief after injection was 35% (range: 0-100%). 40% of all injections were combined intra-/periarticular. There was neither a statistically significant difference between pain relief and combined intra-/periarticular versus sole periarticular injection (p=0.64) nor the grade of osteoarthritis (p=0.49). Pain relief after cervical FJBs does not correlate with morphologic alterations seen on CT. Periarticular FJBs are not less successful than combined intra-/periarticular FJBs.
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Affiliation(s)
- Lukas Hechelhammer
- Radiology, University of Zurich, Balgrist Hospital, CH-8008, Zurich, Switzerland
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Hechelhammer L, Lachat ML, Wildermuth S, Bettex D, Mayer D, Pfammatter T. Midterm outcome of endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2005; 41:752-7. [PMID: 15886655 DOI: 10.1016/j.jvs.2005.02.023] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE We sought to analyze the clinical and morphologic outcomes of bifurcated stent grafts in patients with ruptured aortoiliac aneurysms at midterm follow-up. METHODS Thirty-seven patients (4 women; mean age, 73 years; mean abdominal aortic aneurysm [AAA] diameter, 77 mm) underwent endovascular abdominal aneurysm repair between June 1997 and July 2003 for ruptured AAA. Devices inserted were as follows: Vanguard (Boston Scientific, Natick, Mass; n = 7), Excluder (W.L. Gore, Flagstaff, Ariz; n = 25), Talent (Medtronic Vascular, Santa Rosa, Calif; n = 2), and Zenith (Cook Inc, Bloomington, Ind; n = 3). Except for the adjunct postimplantation computed tomographic scanning, the imaging follow-up was the same as for nonruptured AAAs. RESULTS The mean follow-up period was 24 months (range, 1-59) months. Thirty-day mortality was 10.8%. Three patients died during the follow-up of non-AAA-related causes. One patient was converted early for presumed renal overstenting. The late conversion rate was 9% because of stent graft migration (n = 2) or infection (n = 1). Freedom from endoleak was 57% +/- 8.5% and 48.8% +/- 9% at 2 and 4 years, respectively. Seventeen secondary interventions were performed during the follow-up period, 41% of these within 1 month of stent graft placement. Endoleaks, primary or secondary, were responsible for 58.8% of these interventions. The cumulative risk of a secondary intervention was 35.3% +/- 9% at 2 years and 44.6% +/- 11% at 3 years. Aneurysmal sac shrinkage was observed in 30.8% +/- 9.1% and sac enlargement was observed in 15.3% +/- 10.8% at 2 years. CONCLUSION Endoluminal devices are able to convert the acute life-threatening situation of ruptured AAA to a controlled situation that results in good patient survival at midterm follow-up.
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Affiliation(s)
- Lukas Hechelhammer
- Institute of Diagnostic Radiology, University Hospital of Zurich, CH 8091 Zurich, Switzerland
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Hechelhammer L, Wildermuth S, Lachat ML, Pfammatter T. Endovascular Repair of Inflammatory Abdominal Aneurysm: A Retrospective Analysis of CT Follow-up. J Vasc Interv Radiol 2005; 16:737-41. [PMID: 15872330 DOI: 10.1097/01.rvi.0000156188.28349.23] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Retrospective radiologic and clinical midterm follow-up is reported for 10 patients with inflammatory abdominal aortic aneurysm (IAAA) after endovascular aortic aneurysm repair (EVAR). At a mean follow-up of 33 months, regression of the thickness of the perianeurysmal fibrosis (PAF) and decrease of aneurysmal sac diameter was observed in nine patients. Four EVAR-associated complications were observed: periinterventional dissection of femoral artery (n = 1), blue toe syndrome (n = 1), and stent-graft disconnection (n = 2). EVAR is the less invasive method of aneurysm exclusion in patients with IAAA with a comparable evolution of the PAF as reported after open repair.
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Affiliation(s)
- Lukas Hechelhammer
- Institute of Diagnostic Radiology, University Hospital of Zurich, Switzerland
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Hechelhammer L, Crook DW, Widmer U, Wildermuth S, Pfammatter T. Thrombosis of a Superior Mesenteric Vein Aneurysm: Transarterial Thrombolysis and Transhepatic Aspiration Thrombectomy. Cardiovasc Intervent Radiol 2004; 27:551-5. [PMID: 15383863 DOI: 10.1007/s00270-004-0020-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the case of a 31-year-old woman presenting with abdominal pain due to acute thrombosis of a superior and inferior mesenteric vein aneurysm, which was treated by a combination of arterial thrombolysis and transhepatic thrombus aspiration. At the last follow-up CT, 21 months following this procedure, there was no evidence of rethrombosis, and the patient continues to do well under oral anticoagulation. The literature regarding these uncommon mesenteric vein aneurysms without portal vein involvement, as well as their treatment options, is reviewed.
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Affiliation(s)
- L Hechelhammer
- Institute of Diagnostic Radiology, University Hospital of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
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Abstract
Pneumocystis carinii pneumonia in patients with chronic lymphocytic leukaemia (CLL) who have not been treated with fludarabin are rare, although clinically relevant CD4 T-cell depletion can occur in longstanding CLL without prior treatment with purine analogues. A 52 year old woman is reported who was on long term treatment with chlorambucil and taking a short course of prednisone for familial CLL before she developed progressive dyspnoea, and P carinii pneumonia was diagnosed in bronchoalveolar lavage fluid. Despite treatment with high dose co-trimoxazole the patient died.
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Affiliation(s)
- S R Vavricka
- Department of Medicine, University Hospital of Zurich, Switzerland
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40
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Abstract
A variant application of the renal Quick-Core needle in 3 patients with cavo-atrial tumors is reported. In all 3 patients either a transjugular or transfemoral venous biopsy approach with this device yielded sufficient tissue for histological diagnosis at the first attempt. Bioptic diagnoses were confirmed either by surgery or radiological and clinical response to a specific chemotherapy. There were no procedure-related complications.
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Affiliation(s)
- Lukas Hechelhammer
- Institute of Diagnostic Radiology, University Hospital, Zürich, Switzerland
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Hechelhammer L, Störkel S, Odermatt B, Heitz P, Jochum W. Epidermal growth factor receptor is a marker for syncytiotrophoblastic cells in testicular germ cell tumors. Pathol Res Pract 2004. [DOI: 10.1016/s0344-0338(04)80459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pfammatter T, Mayer D, Pfiffner R, Koehler C, Hechelhammer L, Lachat ML. Repair of abdominal aortic aneurysms with the Excluder bifurcated stent-graft. J Cardiovasc Surg (Torino) 2003; 44:549-52. [PMID: 14627228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The design of the Excluder, which is considered a 3rd generation device for endovascular repair of abdominal aortic aneurysms, is described. Based on a literature search, clinical short- to mid-term results are reviewed. So far, efficacy and safety of the Excluder for elective and emergent aneurysm repair have been demonstrated. In none of the studies perioperative conversion to open surgery or late aneurysm rupture has been reported. The cumulative 30-day-mortality rate was below 1%. Compared to the other commercial devices, aneurysm shrinkage is less marked after repair with the Excluder. Whether this is inconvenient remains to be proven on long-term follow-up.
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Affiliation(s)
- T Pfammatter
- Institute of Diagnostic Radiology, University Hospital of Zurich, Zurich, Switzerland.
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Hechelhammer L, Störkel S, Odermatt B, Heitz PU, Jochum W. Epidermal growth factor receptor is a marker for syncytiotrophoblastic cells in testicular germ cell tumors. Virchows Arch 2003; 443:28-31. [PMID: 12783324 DOI: 10.1007/s00428-003-0835-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 04/28/2003] [Indexed: 10/26/2022]
Abstract
The epidermal growth factor receptor (EGFR) has been implicated in the pathogenesis, therapy and prognosis of various tumor types. The aim of this study was to investigate EGFR expression in a large series of testicular germ cell tumors (TGCTs). A total of 88 TGCTs (37 of pure type and 51 of mixed type) comprising a total of 44 seminoma, 49 embryonal carcinoma, 32 yolk sac tumor, 28 teratoma and 7 choriocarcinoma components were immunostained for EGFR. EGFR reactivity was observed in the stromal cells of embryonal carcinoma (29%) and in epithelial compartments of teratoma (71%). In addition, EGFR staining was consistently detected in syncytiotrophoblastic cells of choriocarcinoma, seminoma, embryonal carcinoma and yolk sac tumor components. EGFR staining, similar to beta-human chorionic gonadotropin (HCG) immunohistochemistry, was efficiently able to identify syncytiotrophoblastic cells in TGCTs. This study shows that EGFR is expressed in a subset of testicular germ cell tumors and suggests that EGFR may be a useful marker for syncytiotrophoblastic cells.
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Affiliation(s)
- Lukas Hechelhammer
- Institute of Clinical Pathology, Department of Pathology, University Hospital, Schmelzbergstrasse 12, 8091, Zürich, Switzerland
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