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Linnemann B, Blank W, Doenst T, Erbel C, Isfort P, Janssens U, Kalka C, Klamroth R, Kotzerke J, Ley S, Meyer J, Mühlberg K, Müller OJ, Noppeney T, Opitz C, Riess H, Solomayer EF, Volk T, Beyer-Westendorf J. Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism. The revised AWMF S2k Guideline. VASA 2023; 52:1-146. [PMID: 37904504 DOI: 10.1024/0301-1526/a001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
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Pedersoli F, Van den Bosch V, Keil S, Schulze-Hagen M, Isfort P, Kuhl KC, Bruners P. Stentgraftimplantation für die Behandlung von Pseudoaneurysmen der Arteria hepatica: Effektivität und Durchgängigkeit in Follow-up. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749834] [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] [Indexed: 11/06/2022]
Affiliation(s)
- F Pedersoli
- Uniklinik RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - V Van den Bosch
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - S Keil
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - M Schulze-Hagen
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - P Isfort
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - K C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
| | - P Bruners
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik RWTH Aachen, Aachen
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Pedersoli F, Van den Bosch V, Sieben P, Barzakova E, Schulze-Hagen M, Isfort P, Keil S, Wiltberger G, Kuhl CK, Bruners P. Stent Graft Placement by Pseudoaneurysm of the Hepatic Arteries: Efficacy and Patency Rate in Follow-up. Cardiovasc Intervent Radiol 2021; 45:21-28. [PMID: 34734334 PMCID: PMC8716354 DOI: 10.1007/s00270-021-02993-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/14/2021] [Indexed: 12/27/2022]
Abstract
Purpose To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm. Materials and Methods A retrospective analysis of patients who had undergone endovascular treatment of hepatic artery pseudoaneurysms between 2011 and 2020 was performed. Medical records were examined to obtain patients’ surgical histories and to screen for active bleeding. Angiographic data on vascular access, target vessel, material used and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, were collected. Vessel patency at follow-up CT was analyzed and classified as short-term (< 6 weeks), mid-term (between 6 weeks and 1 year), and long-term patency (> 1 year). In case of stent occlusion, collateralization and signs of hepatic hypoperfusion were examined. Results In total, 30 patients were included and of these, 25 and 5 had undergone stent graft implantation and coiling, respectively. In patients with implanted stent grafts, technical success was achieved in 23/25 patients (92%). Follow-up CT scans were available in 16 patients, showing stent graft patency in 9/16 patients (56%). Short-term, mid-term, and long-term short-term stent patency was found in 81% (13/16), 40% (4/10), and 50% (2/4). In patients with stent graft occlusion, 86% (6/7) exhibited maintenance of arterial liver perfusion via collaterals and 14% (1/7) exhibited liver abscess during follow-up. Conclusion Stent graft provides an effective treatment for hepatic artery pseudoaneurysms. Even though patency rates decreased as a function of time, stent occlusion was mainly asymptomatic due to sufficient collateralization.
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Affiliation(s)
- F Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - V Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Sieben
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - E Barzakova
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - S Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - G Wiltberger
- Department of General, Visceral, and Transplantation Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Schulze-Hagen M, Truhn D, Duong F, Keil S, Pedersoli F, Kuhl CK, Lurje G, Neumann U, Isfort P, Bruners P, Zimmermann M. Correlation Between Sarcopenia and Growth Rate of the Future Liver Remnant After Portal Vein Embolization in Patients with Colorectal Liver Metastases. Cardiovasc Intervent Radiol 2020; 43:875-881. [PMID: 31974746 PMCID: PMC7225189 DOI: 10.1007/s00270-020-02416-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate whether sarcopenia and myosteatosis correlate with the degree of hypertrophy (DH) and kinetic growth rate (KiGR) of the future liver remnant (FLR) in patients with colorectal liver metastases undergoing portal vein embolization (PVE) in preparation for right hepatectomy. MATERIALS AND METHODS Forty-two patients were included. Total liver volume and FLR volume were measured before and 2-4 weeks after PVE. KiGR of the FLR was calculated. Sarcopenia was assessed using the total psoas muscle volume (PMV), the psoas muscle cross-sectional area (PMCS) and the total skeletal muscle index (L3SMI) at the level of 3rd lumbar vertebra. Degree of myosteatosis was assessed by mean muscle attenuation at L3 (L3MA). Correlations between muscle indices and DH and KiGR were assessed using simple linear regression analyses. RESULTS Mean DH was 8.9 ± 5.7%, and mean KiGR was 3.6 ± 2.3. Mean PMV was 55.56 ± 14.19 cm3/m3, mean PMCS was 8.76 ± 2.3 cm2/m2, mean L3SMI was 45.6 ± 9.89 cm2/m2, and mean L3MA was 27.9 ± 18.6 HU. There was a strong positive correlation between PMV and DH (R = 0.503, p = 0.001) and PMV and KiGR (R = 0.545, p < 0.001). Furthermore, there was a moderate correlation between PMCS and KiGR (R = 0.389, p = 0.014). L3SMI and L3MA were neither associated with DH (p = 0.390 and p = 0.768, respectively) nor with KiGR (p = 0.188 and p = 0.929, respectively). CONCLUSION We identified a positive correlation between PMV and PMCS, as markers for sarcopenia, and the KiGR of the FLR after PVE. PMV and PMCS might therefore aid to identify patients who are poor candidates for FLR augmentation using PVE alone.
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Affiliation(s)
- M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany.
| | - D Truhn
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, DE, Germany
| | - F Duong
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, DE, Germany
| | - S Keil
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - F Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - G Lurje
- Department of Surgery and Transplantation, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - U Neumann
- Department of Surgery and Transplantation, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
| | - M Zimmermann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, DE, Germany
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Thüring J, Zimmermann M, Bruners P, Pedersoli F, Schulze-Hagen M, Barzakova E, Kuhl CK, Isfort P. Short-Term Oral Sorafenib for Therapy of Intratumoral Shunts of Hepatocellular Carcinoma to Enable Intraarterial Treatment. Cardiovasc Intervent Radiol 2019; 42:1494-1499. [PMID: 31363899 PMCID: PMC6715807 DOI: 10.1007/s00270-019-02294-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Significant intratumoral shunts between tumor-supplying arteries and portal or liver veins are a contraindication for transarterial therapy of HCC because interventional treatment of these shunts is frequently insufficient. Sorafenib has anti-angiogenic effects and is indicated for palliative treatment of patients with HCC. Here, we report our experience with the use of sorafenib for the closure of intratumoral shunts in patients scheduled for transarterial therapy of HCC. MATERIALS AND METHODS Three patients with HCC, aged 65, 82 and 79 years, exhibited a significant intratumoral shunting from tumor artery to portal (n = 1) or liver veins (n = 2). In all cases, intratumoral shunting had already been suspected based on pre-interventional CT angiography, and DSA confirmed the shunt. Oral sorafenib (800 mg/day) was administered for at least four weeks, only and specifically to occlude the shunt. Hereafter, patients were re-evaluated by CT and DSA. RESULTS All patients tolerated the full prescribed dose for at least 4 weeks. In one case, therapy was prolonged with an adapted dose (400 mg/day) due to sorafenib-related hand-foot syndrome. After sorafenib treatment, CT and DSA confirmed a complete closure of intratumoral shunts for all patients. No tumor progression was observed. All three patients hereafter underwent successful transarterial treatment by TACE (n = 2) or TARE (n = 1) without complications. Progression-free survival according to mRECIST was 501, 397 and 599 days, respectively. CONCLUSION Even short-term oral sorafenib seems to effectively close intratumoral shunts in patients with HCC and thus might enable transarterial treatment of these patients.
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Affiliation(s)
- J Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany.
| | - M Zimmermann
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - F Pedersoli
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - E Barzakova
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstreet 30, 52072, Aachen, Germany
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Barabasch A, von Stillfried S, Kuhl CK, Heinzel A, Sander A, Isfort P. Toward Transpulmonary Chemoembolization with Degradable Starch Microspheres: Systematic Analysis of Local and Systemic Effects in a Porcine Model. Cardiovasc Intervent Radiol 2019; 42:1475-1482. [PMID: 31119355 DOI: 10.1007/s00270-019-02246-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate local and systemic effects of transpulmonary chemoembolization (TPCE) with degradable starch microspheres (DSM) and doxorubicin. The long-term goal is to establish DSM-TPCE as a treatment option for pulmonary malignancies. MATERIALS AND METHODS Nine pigs underwent TPCE of either the right or left lower lobe pulmonary artery (LLPA) and bland embolization (TPE) of the contralateral LLPA. Before the procedures, macroaggregated albumin (MAA) particles were injected into both LLPAs, to exclude systemic shunting. Pulmonary arterial pressure, heart rate and oxygenation were recorded immediately before and at 1, 3, 5 and 10 min after treatment. To investigate possible nontarget embolization, animals underwent cerebral MRI (cMRI). We killed the animals after a contrast-enhanced chest computed tomography (CT) and performed a pathologic examination at 12 h (3), 24 h (3) and 72 h (3) after treatment. RESULTS All experiments were technically successful. Mean injected DSM dose until stasis was similar in TPCE and TPE (4.3 ± 1.4 vs. 4.0 ± 1.4 mL). Pulmonary arterial pressure increased significantly 3 min after treatment (TPE: 17 ± 5 vs. 27 ± 7 mmHg; TPCE: 22 ± 6 vs. 36 ± 8 mmHg). No significant changes in heart rate or peripheral oxygenation levels occurred. We observed no evidence of structural lung damage or permanent perfusion disruption on CT. MAA test injection and cMRI revealed no shunting or nontarget embolization. The pathologic assessment revealed nonspecific local inflammation of the lung parenchyma. CONCLUSION In this large-animal model, TPCE and TPE appear feasible and safe. We observed a mild increase in pulmonary arterial pressure. Nontarget embolization did not occur. TPCE, as well as TPE, did not cause structural damage to the normal lung parenchyma.
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Affiliation(s)
- A Barabasch
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - S von Stillfried
- Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Heinzel
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Sander
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Isfort P, Pedersoli F, Liebl M, Zimmermann M, Schulze-Hagen M, Scheck J, Kuhl C, Bruners P. Bildmorphologische Unterschiede nach irreversibler Elektroporation und Radiofrequenzablation im Follow-up mittels Mehrphasen-CT. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600278] [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] [Indexed: 10/19/2022]
Affiliation(s)
- P Isfort
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - F Pedersoli
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - M Liebl
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - M Zimmermann
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - M Schulze-Hagen
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - J Scheck
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - C Kuhl
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - P Bruners
- Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
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Reinartz S, Imhoff M, Tolba R, Fischer F, Fischer E, Teschner E, Koch S, Gärber I, Isfort P, Gremse F. Elektrische Impedanz Tomografie (EIT) überwacht valide und robust globale und regionale Ventilation in physiologischen und pathologischen Beatmungszuständen im Schweinemodell. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600200] [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] [Indexed: 10/19/2022]
Affiliation(s)
- S Reinartz
- Universitätsklinikum Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | | | | | | | | | | | | | | | - P Isfort
- Universitätsklinikum Aachen, Klinik für Diagnostische und Interventionelle Radiologie, Aachen
| | - F Gremse
- ExMI-Experimental Molecular Imaging, Aachen
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Liebl M, Zimmermann M, Schulze-Hagen M, Isfort P, Bruners P, Kuhl C. Der Einfluss von OP-Clips auf die Mikrowellenablation in der Leber – eine systematische in-vitro Untersuchung. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600285] [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] [Indexed: 10/19/2022]
Affiliation(s)
- M Liebl
- Uniklinikum Aachen, Radiologie, Aachen
| | | | | | | | | | - C Kuhl
- Uniklinik Aachen, Radiologie
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Pedersoli F, Isfort P, Keil S, Goerg F, Zimmermann M, Liebl M, Schulze-Hagen M, Schmeding M, Kuhl CK, Bruners P. Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm. Cardiovasc Intervent Radiol 2016; 39:575-81. [PMID: 26797022 DOI: 10.1007/s00270-015-1274-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 04/07/2015] [Accepted: 11/29/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Hepatic artery pseudoaneurysms are a rare but potentially life-threatening complication of major pancreaticobiliary surgery. We evaluated the safety and efficacy of endovascular stentgraft implantation for the management of such vascular lesions. MATERIALS AND METHODS Between May 2013 and October 2015, ten patients with postoperative hepatic artery pseudoaneurysm, of which eight presented with active hemorrhage, were treated with endovascular stentgraft implantation. All patients had undergone major pancreatic or hepatic surgery before (pylorus-preserving pancreaticoduodenectomy, pancreatectomy, hemihepatectomy, extended hemihepatectomy). The pseudoaneurysms were diagnosed 13-202 days after surgery and were associated with postsurgical complications (e.g., leakage of pancreaticojejunal anastomosis). RESULTS In 9/10 patients, the pseudoaneurysm was completely excluded via stentgraft implantation. In 1/10 patient, the pseudoaneurysm ruptured during the procedure and was successfully treated by immediate open surgery. In 1/10 patient, a second intervention was performed after 6 days because of rebleeding; this was successfully treated by implantation of a second overlapping stentgraft. Mean follow-up time is 51 days. None of the patients died due to stentgraft- or aneurysm-related complications. Further episodes of hemorrhage were not observed. In one patient, clinically asymptomatic complete occlusion of the stentgraft was discovered at follow-up imaging. CONCLUSION Stentgraft implantation is a safe and effective technique to treat hepatic artery pseudoaneurysms related to major pancreatic or hepatic surgery, especially in the setting of acute hemorrhage.
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Affiliation(s)
- F Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - S Keil
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - F Goerg
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Zimmermann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Liebl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Schmeding
- Clinic for General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
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Schulze-Hagen M, Pfeffer J, Zimmermann M, Na H, Freifrau von Stillfried S, Kuhl C, Isfort P, Bruners P. Entwicklung und in-vitro Untersuchung einer steuerbaren Nadel für die Biopsie von Läsionen, die nicht mittels geradem Punktionsweg erreichbar sind. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551044] [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: 10/23/2022]
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Pedersoli F, Pedersoli F, Isfort P, Zimmermann M, Liebl M, Schulze-Hagen M, Goerg F, Neumann U, Kuhl C, Bruners P. Sicherheit und Effektivität der Stentgraftimplantation für die Behandlung von iatrogener Aneurysmen der Arteria hepatica. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551094] [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: 10/23/2022]
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Zimmermann M, Pfeffer J, Na H, Schulze-Hagen M, Liebl M, Kuhl C, Bruners P, Isfort P. Vollständig endovaskuläre Anlage eines extraanatomischen arterio-arteriellen Bypass – In vitro-Machbarkeitsstudie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551110] [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: 10/23/2022]
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Isfort P, Na H, Penzkofer T, Wilkmann C, Osterhues S, Besting A, Hänisch C, Bisplinghoff S, Jansing J, von Werder S, Gooding J, de la Fuente M, Mahnken A, Disselhorst-Klug C, Schmitz-Rode T, Kuhl C, Bruners P. Electromagnetically navigated TIPS procedure: phantom and in vivo evaluation. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.331] [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: 11/27/2022] Open
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Na HS, Bruners P, Isfort P, Besting A, Jansing J, Osterhues S, Disselhorst-Klug C, Schmitz-Rode T, Mahnken AH, Kuhl CK, Penzkofer T. Elektromagnetisch navigierte, antegrade in-situ Fenestrierung von Aortenprothesen im Phantom- und Tiermodell. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346503] [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: 10/26/2022]
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Bruners P, Isfort P, Ritter A, Baumann M, Penzkofer T, Schmitz-Rode T, Kuhl CK, Mahnken AH. Entwicklung und erste ex-vivo Versuche eines Prototypen zur interstitiellen Elektrochemotherapie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346313] [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: 10/26/2022]
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Penzkofer T, Apitzsch J, Alparslan Y, Isfort P, Bruners P, Westphal S, Knüchel-Clarke R, Kuhl CK, Mahnken AH. Dosisskalierung im kontrastmittelangehobenen Kadavermodell zur Evaluation von iterativen Rekonstruktionsverfahren in der Computertomografie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346461] [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: 10/26/2022]
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Na HS, Penzkofer T, Isfort P, Wilkmann C, Mahnken AH, Kuhl CK, Osterhues S, Besting A, Hänisch C, Bisplinghoff S, Jansing J, Werder SV, de la Fuente M, Disselhorst-Klug C, Schmitz-Rode T, Bruners P. Elektromagnetische navigierte in-situ Fenestrierung von Aortenprothesen. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1329784] [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: 10/27/2022]
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Isfort P, Witte H, Slabu O, Penzkofer T, Baumann M, Bruners P, Kuhl CK, Schmitz-Rode T, Mahnken AH. Effektivität von superparamegnetischen Eisenoxid-Nanopartikeln bei der Behandlung von Osteoidosteomen in einem ex-vivo Modell verglichen mit Radiofrequenzablation und Mikrowellenablation. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1329770] [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: 10/27/2022]
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Abstract
CLINICAL ISSUE Primary and secondary liver tumors often limit patient outcome and only a minority of patients are eligible for potential curative surgery. Minimally invasive treatments, such as radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation are alternative treatment options in a curative and palliative setting. One major limitation of RFA and MWA is the limited size of tumor ablation. Furthermore during the procedure the ablation size can only be roughly estimated using RFA and MWA. STANDARD TREATMENT RFA is the standard modality of minimally invasive tumor therapy. In comparison cryoablation is rarely used despite its advantages. TREATMENT INNOVATIONS Argon-helium-based cryoablation systems of the newest generation combine the advantage of small diameter applicators comparable with those of RFA and MWA systems with intrinsic advantages. ACHIEVEMENTS Cryoablation is a minimally invasive treatment option with advantages, such as virtually unlimited ablation size, real-time visualization using computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound and intrinsic analgesic effects. On the other hand it is not very time-efficient in comparison to MWA. Especially in liver metastases RFA is the preferred treatment option. PRACTICAL RECOMMENDATIONS Cryoablation is a fascinating treatment option in minimally invasive tumor treatment. It demonstrates good results in hepatocellular carcinoma within the Milan criteria and T1a renal cell carcinoma. Furthermore it is a well-established treatment modality for palliative pain management in bone tumors.
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Affiliation(s)
- P Isfort
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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Isfort P, Tanaka T, Penzkofer T, Bruners P, Braunschweig T, Kichikawa K, Schmitz-Rode T, Kuhl C, Mahnken AH. Vergleich der Mikrowellenablation und der Radiofrequenzablation in bovinem Eutergewebe. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311341] [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: 10/28/2022]
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Isfort P, Penzkofer T, Tanaka T, Bruners P, Schmitz-Rode T, Kuhl C, Mahnken AH. Effektivität der antegraden Pyeloperfusion mit gekühlter Glukose-Lösung zum Schutz des Nierenbeckens vor thermischen Schäden bei der renalen Mikrowellenablation. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311343] [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: 10/28/2022]
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Isfort P, Penzkofer T, Bruners P, Schmitz-Rode T, Kuhl CK, Mahnken AH. Silicon carbide-enhanced microwave ablation in an ex-vivo bovine liver model - effects on heat distribution and ablation volume. ROFO-FORTSCHR RONTG 2012; 184:542-7. [PMID: 22516963 DOI: 10.1055/s-0031-1299485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Evaluation of the maximum temperatures and ablation volumes in microwave ablation (MWA) after injection of different concentrations of silicon carbide (SiC) particles in an ex-vivo bovine liver model. MATERIALS AND METHODS 15 ml of different concentrations of SiC particles (20 vol% SiC; 50 vol% SiC) mixed with 2 % gelatin were injected into an ex-vivo bovine liver. As a reference group, 2 % gelatin without SiC was injected. MWA was performed using a clinical MWA system with different generator settings (10 - 45 W/10 minutes). The temperature was measured at a distance of 5 mm and 10 mm from the applicator. Afterwards the liver tissue was sliced along the short and long axis, the ablation zones were measured on the x, y and z-axis and the ablation volume was calculated. All experiments were performed 5 times (total: 40 experiments). RESULTS The average maximum temperatures measured at a generator setting of 45 W at a distance of 5 mm from the applicator were 103.4 ± 4.6 °C (20 vol% SiC), 103.3 ± 6.5 °C (50 vol% SiC) and 96.0 ± 4.2 °C in the control group (0 vol% SiC). At 45 W, injection of 20 vol% SIC caused a significantly higher maximum temperature than that achieved in the control group (p = 0.016). No significant temperature increase compared to the control group could be measured using 50 vol% SiC. The mean ablation volumes at 45 W and 20 vol% SiC and 50 vol% SiC were significantly larger (172.7 ± 31.5 ml and 171.0 ± 34.7 ml, respectively) than those achieved in the control group (111.2 ± 23.8 ml) (p = 0.027 and p = 0.045). CONCLUSION In an ex-vivo bovine liver model, the SiC particles demonstrated an enhancing effect of MWA with respect to maximum temperatures and ablation volume. Therefore, SiC is a promising candidate for enhancing MWA in vivo.
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Affiliation(s)
- P Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany.
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Na HS, Penzkofer T, Isfort P, Wilkmann C, Mahnken AH, Kuhl CK, Osterhues S, Besting A, Hänisch C, Bisplinghoff S, Jansing J, Werder SV, Fuente MDL, Disselhorst-Klug C, Schmitz-Rode T, Bruners P. In.nrw Hyther: Electromagnetically navigated in situ fenestration of aortic stent grafts. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cleven NJ, Woitok A, Penzkofer T, Isfort P, Görtz M, Goettsche T, Steinseifer U, Schmitz-Rode T. Results from long-term In-vivo Tests of a Wireless, Intravascular Blood-Pressure Monitoring System for Hypertension Patients. BIOMED ENG-BIOMED TE 2012; 57. [DOI: 10.1515/bmt-2012-4446] [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: 08/30/2023]
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Isfort P, Penzkofer T, Bruners P, Pfaff E, Kuhl C, Mahnken CK. Modifikation der Mikrowellen-induzierten Erhitzungseigenschaften und Ablationseffekte durch Siliziumcarbid-Mikropartikel in einem ex-vivo Rinderlebermodell. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279361] [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: 10/18/2022]
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Penzkofer T, Isfort P, Bruners P, Apitzsch J, Westphal S, Kuhl C, Schmitz-Rode T, Mahnken AH. Iterative Rekonstruktion in der Computertomographie: Kadaverstudie zur systematischen Evaluation der Dosisreduktion. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279465] [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: 10/18/2022]
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Isfort P, Penzkofer T, Pfaff E, Bruners P, Günther RW, Schmitz-Rode T, Mahnken AH. Silicon Carbide as a Heat-enhancing Agent in Microwave Ablation: In Vitro Experiments. Cardiovasc Intervent Radiol 2010; 34:833-8. [DOI: 10.1007/s00270-010-0033-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 10/24/2010] [Indexed: 11/30/2022]
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Isfort P, Penzkofer T, Bruners P, Schmitz-Rode T, Mahnken AH. Siliziumcarbid zur Amplifikation der Mikrowellenablation: In-vitro Versuche. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1268299] [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: 10/18/2022]
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Bruners P, Levit E, Penzkofer T, Isfort P, Schmitz-Rode T, Mahnken AH. CT-basiertes, nicht-invasives Temperaturmonitoring während hepatischer Radiofrequenzablation: Eine ex-vivo Machbarkeitsstudie. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1268300] [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: 10/18/2022]
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Penzkofer T, Bruners P, Donker H, Isfort P, Pfeffer J, Düring K, Schmitz-Rode T, Mahnken AH. Evaluation eines neuen multikompositen Führungsdrahts zum Einsatz in der Magnetresonanz- und Angiografieumgebung. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1268335] [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: 10/18/2022]
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Bruners P, Penzkofer T, Pfeffer J, Isfort P, Günther RW, Schmitz-Rode T, Mahnken AH. Entwicklung einer Trucut-Biopsienadel zur bipolaren Koagukation des Punktionstratktes. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252795] [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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Isfort P, Tanaka T, Bruners P, Penzkofer T, Kichikawa K, Schmitz-Rode T, Mahnken AH. Gleichstrommodulierte monopolare Radiofrequenzablation: ex-vivo Experimente. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252781] [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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Penzkofer T, Bruners P, Isfort P, Schoth F, Krombach GA, Günther RW, Schmitz-Rode T, Mahnken AH. CT-basierte elektromagnetisch navigierte Interventionen: Genauigkeit und Effizienz in der klinischen Anwendung. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252783] [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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Isfort P, Penzkofer T, Bruners P, Günther RW, Schmitz-Rode T, Mahnken AH. Temperaturmodulierende Effekte von Siliziumcarbid bei der Mikrowellenablation. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252779] [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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Mahnken AH, Penzkofer T, Grommes J, Isfort P, Langer S, Bruners P, Schmitz-Rode T, Mommertz F. CO2 verstärkte CT-gesteuerte Implantation von Aortenstents: Machbarkeitsstudie im Tiermodell. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252774] [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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Isfort P, Penzkofer T, Bruners P, Günther RW, Schmitz-Rode T, Mahnken AH. Flüssigkeitsmodulierte Mikrowellenablation: in-vitro Experimente. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252780] [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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Isfort P, Bruners P, Penzkofer T, Günther R, Schmitz-Rode T, Mahnken A. In-vitro-Experimente zur flüssigkeitsmodulierten Mikrowellenablation. ROFO-FORTSCHR RONTG 2010; 182:518-24. [DOI: 10.1055/s-0028-1109960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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Lüers JC, Isfort P, Bovenschulte H, Beutner D. [Unilateral tongue atrophy and articulation difficulties]. HNO 2009; 58:68-71. [PMID: 19727629 DOI: 10.1007/s00106-009-1955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 24-year-old female complained of difficulty articulating and chewing of 2 more than weeks' standing. She reported that her tongue felt "heavy and inert". Clinically, right-sided atrophy of the tongue and deflection of the tongue to the right were observed. Tone audiogram demonstrated normal hearing on both sides and tympanometry was also normal. On CT, a bone-destroying process was seen in the area of the right lateral skull base, which reached as far as the internal carotid artery. MRI demonstrated atrophy of the right tongue musculature with fatty degeneration, as well as an oval, smoothly edged lesion which showed marked contrast-medium uptake with a "salt and pepper" configuration in the region of the right jugular foramen. The diagnosis was hypoglossal paresis due to ipsilateral jugular paraganglioma (Fisch classification C1). Following embolization of the feeding vessels of the paraganglioma, the tumor was completely resected, including the hypoglossal nerve which ran through the tumor. Postoperative dysfunction of the vagus and facial nerves became unsymptomatic with time as a result of logopedic therapy.
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Affiliation(s)
- J-C Lüers
- Klinik und Poliklinik für Hals-, Nasen-, Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik Köln, Kerpener Strasse 62, 50924, Köln, Deutschland.
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