1
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Blackburn AF, Landinez GP, Kerlan RK, Lokken RP. Malposition of a Femoral Tunneled Dialysis Catheter through a Patent Foramen Ovale. Semin Intervent Radiol 2023; 40:304-307. [PMID: 37484443 PMCID: PMC10359127 DOI: 10.1055/s-0043-1769745] [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] [Indexed: 07/25/2023]
Abstract
Patent foramen ovale (PFO) is a common congenital abnormality of high prevalence in adults. Its clinical significance is magnified in a right-to-left shunt, where paradoxical embolism can have catastrophic outcomes involving the brain, heart, mesenteric circulation, or extremities. Right-to-left shunting through a PFO is caused by increased right atrial pressure, as seen in the setting of pulmonary artery hypertension or pulmonary embolism. This case highlights the relevance of central venous catheter placement in the setting of a PFO. While the patient did not experience clinical sequelae from line placement, she was at high risk for paradoxical embolus. Recognizing the possibility of a PFO during central venous catheter placement, especially in the setting of increased right pressures, should be a consideration of all interventional radiologists.
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Affiliation(s)
- Anthony Finnay Blackburn
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Gina P. Landinez
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Robert K. Kerlan
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - R. Peter Lokken
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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2
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Lee AY, Lehrman ED, Perito ER, Kerlan RK, Kohi MP, Kolli KP, Taylor AG, Ostroff JW, Kang SM, Roberts JP, Rhee S, Rosenthal P, Fidelman N. Non-operative management of biliary complications after Liver Transplantation in pediatric patients: A 30-year experience. Pediatr Transplant 2021; 25:e14028. [PMID: 33951255 DOI: 10.1111/petr.14028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/15/2020] [Revised: 01/05/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate the efficacy of percutaneous and endoscopic therapeutic interventions for biliary strictures and leaks following LT in children. METHODS Retrospective analysis of 49 consecutive pediatric liver transplant recipients (27 girls, 22 boys, mean age at transplant 3.9 years) treated at our institution from 1989 to 2019 for biliary leak and/or biliary stricture was performed. Minimally invasive approach was considered clinically successful if it resulted in patency of the narrowed biliary segment and/or correction of the biliary leak. RESULTS Forty-two patients had a stricture at the biliary anastomosis; seven had a biliary leak. After an average 13.8 years of follow-up, long-term clinical success with minimally invasive treatment (no surgery or re-transplant) was achieved for 24 children (57%) with biliary stricture and 4 (57%) with biliary leaks. Eight patients required re-transplant; however, only one was due to failure of both percutaneous and surgical management. For biliary strictures, failure of non-surgical management was associated with younger age at stricture diagnosis (p < .02). CONCLUSIONS Percutaneous and endoscopic management of biliary strictures and leaks after LT in children is associated with a durable result in >50% of children.
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Affiliation(s)
- Andrew Y Lee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Evan D Lehrman
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Emily R Perito
- Department of Pediatrics, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Robert K Kerlan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Kanti P Kolli
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Andrew G Taylor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - James W Ostroff
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Sang-Mo Kang
- Department of Surgery, Division of Transplant Surgery, University of California San Francisco, San Francisco, CA, USA
| | - John P Roberts
- Department of Surgery, Division of Transplant Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sue Rhee
- Department of Pediatrics, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Philip Rosenthal
- Department of Pediatrics, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Nicholas Fidelman
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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3
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Abstract
Hepatobiliary and pancreatic cancers can cause malignant biliary constriction of the bile ducts, a lethal complication that leads to obstruction of the bile ducts, cholangitis, sepsis, and death. Patients may present with symptoms such as painless jaundice, dark or amber urine, light colored stools, and weight loss. These patients often have locally advanced disease at presentation, and surgical intervention is often not possible. Biliary stents or percutaneous transhepatic drains are often the treatment intervention to relieve biliary obstruction. This is a perspective educational paper providing an in-depth discussion on management strategies, care of the patient by oncology health providers, and important education for the patient and family.
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Affiliation(s)
| | - Robert K Kerlan
- Department of Radiology and Biomedical Imaging, University of California (San Francisco), San Francisco, California, USA
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Losey AD, Lokken RP, Kolli KP, Kerlan RK, Taylor AG, Kohi MP. Embolization of Arterial-Portal Fistula to Treat Associated Hemobilia after Transjugular Liver Biopsy. Semin Intervent Radiol 2020; 37:430-433. [PMID: 33041491 DOI: 10.1055/s-0040-1715870] [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: 10/23/2022]
Affiliation(s)
- Aaron D Losey
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - R Peter Lokken
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - K Pallav Kolli
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Robert K Kerlan
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Andrew G Taylor
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Maureen P Kohi
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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Koethe Y, Lokken RP, Lehrman ED, Kerlan RK, Roberts JP, Rhee SJ, Kohi MP, Kolli KP. Overdilation of a 6-mm Self-Expanding Stent with a 10-mm Balloon-Expandable Stent Graft Preserves Failing Meso-Rex Bypass. J Vasc Interv Radiol 2020; 31:521-523. [PMID: 32007411 DOI: 10.1016/j.jvir.2019.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yilun Koethe
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - R Peter Lokken
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - Evan D Lehrman
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - Robert K Kerlan
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - John P Roberts
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - Sue J Rhee
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
| | - K Pallav Kolli
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143
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6
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Fidelman N, Johanson C, Kohi MP, Kolli KP, Kohlbrenner RM, Lehrman ED, Taylor AG, Kelley RK, Yao FY, Roberts JP, Kerlan RK. Prospective Phase II trial of drug-eluting bead chemoembolization for liver transplant candidates with hepatocellular carcinoma and marginal hepatic reserve. J Hepatocell Carcinoma 2019; 6:93-103. [PMID: 31355158 PMCID: PMC6588798 DOI: 10.2147/jhc.s206979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose: To determine whether chemoembolization using drug-eluting beads (DEB-TACE) is safe and effective for liver transplantation candidates with liver-limited hepatocellular carcinoma (HCC) without vascular invasion and baseline hepatic dysfunction. Materials and methods: Seventeen adult liver transplantation candidates (median age 66 years, range 58–73 years; 13 men) with HCC were treated with DEB-TACE as a part of Stage 1 of a prospective single-institution Phase II trial. All patients had marginal hepatic reserve based on at least one of the following criteria: ascites (n=14), bilirubin between 3 and 6 mg/dL (n=5), AST 5–10 times upper normal limit (n=1), INR between 1.6 and 2.5 (n=4), portal vein thrombosis (n=2), and/or portosystemic shunt (n=2). Primary study objectives were safety and best observed radiographic response. Results: Thirty-seven DEB-TACE procedures were performed. Objective response rate and disease control rate were 63% and 88%, respectively. HCC progression was observed in 12 patients. Median time to progression was 5.6 months (range 0.9–13.6 months). Within 1 month following DEB-TACE, 13 patients (76%) developed grade 3 or 4 AE attributable to the procedure. Four patients (all within Milan Criteria) were transplanted (2.7–6.9 months after DEB-TACE), and 12 patients died (1.8–32 months after DEB-TACE). All deaths were due to liver failure that was either unrelated to HCC (n=5), in the setting of metastatic HCC (n=5), or in the setting of locally advanced HCC (n=2). Mortality rate at 1 month was 0%. Conclusions: DEB-TACE achieves tumor responses but carries a high risk of hepatotoxicity for liver transplant candidates with HCC and marginal hepatic reserve.
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Affiliation(s)
| | | | | | | | | | | | | | - R Kate Kelley
- Department of Medicine - Division of Gastrointestinal Oncology
| | | | - John P Roberts
- Department of Surgery - Division of Transplant Surgery, University of California San Francisco, San Francisco, CA, USA
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Kohi MP, Poder L, Thiet MP, Kerlan RK. Uterine Artery Embolization prior to Gravid Hysterectomy in the Setting of Invasive Placenta. J Vasc Interv Radiol 2018; 28:1295-1297. [PMID: 28841941 DOI: 10.1016/j.jvir.2017.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/08/2017] [Accepted: 03/20/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-361, San Francisco, CA 94143
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-361, San Francisco, CA 94143
| | - Mari-Paule Thiet
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 505 Parnassus Ave., M-361, San Francisco, CA 94143
| | - Robert K Kerlan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-361, San Francisco, CA 94143
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Devulapalli KK, Fidelman N, Soulen MC, Miller M, Johnson MS, Addo E, El-Haddad G, Nutting C, Morrison J, Farsad K, Lokken RP, Gaba RC, Fleming J, Brown DB, Kwan SW, Rose SC, Pennycooke KA, Liu DM, White SB, Gandhi R, Lazar AA, Kerlan RK. 90Y Radioembolization for Hepatic Malignancy in Patients with Previous Biliary Intervention: Multicenter Analysis of Hepatobiliary Infections. Radiology 2018; 288:774-781. [DOI: 10.1148/radiol.2018170962] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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9
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Kohlbrenner R, Kolli KP, Taylor AG, Kohi MP, Lehrman ED, Fidelman N, Conrad M, LaBerge JM, Kerlan RK, Gould R. Radiation Dose Reduction during Uterine Fibroid Embolization Using an Optimized Imaging Platform. J Vasc Interv Radiol 2017; 28:1129-1135.e1. [PMID: 28457758 DOI: 10.1016/j.jvir.2017.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To assess radiation dose reduction during uterine fibroid embolization (UFE) using an optimized angiographic processing and acquisition platform. MATERIALS AND METHODS Radiation dose data for 70 women (mean age, 46 y; range, 34-67 y) who underwent UFE were retrospectively analyzed. Twenty-one patients underwent UFE using the baseline fluoroscopic and angiographic image acquisition platform, and 49 underwent UFE after implementing an optimized imaging platform in otherwise identical angiography suites. Cumulative kerma-area product (CKAP), cumulative air kerma (CAK), total fluoroscopy time, and image exposure number were collected for each procedure. Image quality was assessed by 3 interventional radiologists blinded to the platform used for image acquisition and processing. RESULTS Patients undergoing UFE using the new x-ray fluoroscopy platform had significantly lower CKAP and CAK indicators than patients for whom baseline settings were used. Mean CKAP decreased by 60% from 438.5 Gy · cm2 (range, 180.3-1,081.1 Gy · cm2) to 175.2 Gy · cm2 (range, 47.1-757.0 Gy · cm2; P < .0001). Mean CAK decreased by 45% from 2,034.2 mGy (range, 699.3-5,056.0 mGy) to 1,109.8 mGy (range, 256.6-4,513.6 mGy; P = .001). No degradation of image quality was identified through qualitative evaluation. CONCLUSIONS Significant reduction in patient radiation dose indicators can be achieved with use of an optimized image acquisition and processing platform.
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Affiliation(s)
- Ryan Kohlbrenner
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143.
| | - K Pallav Kolli
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Andrew G Taylor
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Maureen P Kohi
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Evan D Lehrman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Nicholas Fidelman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Miles Conrad
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Jeanne M LaBerge
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Robert K Kerlan
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Robert Gould
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
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10
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Fidelman N, Kerlan RK, Hawkins RA, Pampaloni M, Taylor AG, Kohi MP, Kolli KP, Atreya CE, Bergsland EK, Kelley RK, Ko AH, Korn WM, Van Loon K, McWhirter RM, Luan J, Johanson C, Venook AP. Radioembolization with 90Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study. J Gastrointest Oncol 2016; 7:860-874. [PMID: 28078110 DOI: 10.21037/jgo.2016.08.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This prospective pilot single-institution study was undertaken to document the feasibility, safety, and efficacy of radioembolization of liver-dominant metastatic gastrointestinal cancer using 90Y glass microspheres. METHODS Between June 2010 and October 2013, 42 adult patients (26 men, 16 women; median age 60 years) with metastatic chemotherapy-refractory unresectable colorectal (n=21), neuroendocrine (n=11), intrahepatic bile duct (n=7), pancreas (n=2), and esophageal (n=1) carcinomas underwent 60 lobar or segmental administrations of 90Y glass microspheres. Data regarding clinical and laboratory adverse events (AE) were collected prospectively for up to 5.5 years after radioembolization. Radiographic responses were evaluated using Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1. Time to maximum response, response duration, progression-free survival (PFS) (hepatic and extrahepatic), and overall survival (OS) were measured. RESULTS Median target dose and activity were 109.4 Gy and 2.6 GBq per treatment session, respectively. Majority of clinical AE were grade 1 or 2 in severity. Patients with colorectal cancer had hepatic objective response rate (ORR) of 25% and a hepatic disease control rate (DCR) of 80%. Median PFS and OS were 1.0 and 4.4 months, respectively. Patients with neuroendocrine tumors (NET) had hepatic ORR and DCR of 73% and 100%, respectively. Median PFS was 8.9 months for this cohort. DCR and median PFS and OS for patients with cholangiocarcinoma were 86%, 1.1 months, and 6.7 months, respectively. CONCLUSIONS 90Y glass microspheres device has a favorable safety profile, and achieved prolonged disease control of hepatic tumor burden in a subset of patients, including all patients enrolled in the neuroendocrine cohort.
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Affiliation(s)
- Nicholas Fidelman
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Robert K Kerlan
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Randall A Hawkins
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Miguel Pampaloni
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Andrew G Taylor
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Maureen P Kohi
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - K Pallav Kolli
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Chloe E Atreya
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Emily K Bergsland
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - R Kate Kelley
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Andrew H Ko
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - W Michael Korn
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Katherine Van Loon
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ryan M McWhirter
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Luan
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Curt Johanson
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Alan P Venook
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Lokken RP, Fidelman N, Kolli KP, Kerlan RK. Safety and Efficacy of Doxorubicin Drug-Eluting Embolic Chemoembolization of Hepatocellular Carcinoma Supplied by Extrahepatic Collateral Arteries. J Vasc Interv Radiol 2016; 27:1698-1704. [DOI: 10.1016/j.jvir.2016.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 11/25/2022] Open
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Conrad MB, Ishaque BM, Surman AM, Kerlan RK, Hope MD, Dickey MA, Hetts SW, Wilson MW. Intraprocedural Safety and Technical Success of the MVP Micro Vascular Plug for Embolization of Pulmonary Arteriovenous Malformations. J Vasc Interv Radiol 2016; 26:1735-9. [PMID: 26505940 DOI: 10.1016/j.jvir.2015.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/30/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022] Open
Abstract
This case series describes early experience, intraprocedural safety, and technical success of the MVP Micro Vascular Plug (MVP; Covidien, Irvine, California) for embolization of 20 pulmonary arteriovenous malformations (PAVMs) using 23 plugs in seven patients with hereditary hemorrhagic telangiectasia. There was no device migration, and all devices were successfully detached electrolytically. Immediate cessation of flow through the feeding artery was achieved in 21 of 23 (91%) deployments. There was one minor complication. This series demonstrates the MVP to be safe and technically successful in the treatment of PAVMs.
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Affiliation(s)
- Miles B Conrad
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143.
| | - Brandon M Ishaque
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Andrew M Surman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Robert K Kerlan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Melissa A Dickey
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143
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13
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Kluijfhout WP, Pasternak JD, Duh QY, Suh I, Kerlan RK. Treatment of a Chylous Fistula in the Neck with Thoracic Duct Embolization. VideoEndocrinology 2016. [DOI: 10.1089/ve.2016.0068] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, California
| | - Insoo Suh
- Department of Surgery, University of California, San Francisco, California
| | - Robert K. Kerlan
- Department of Radiology, University of California, San Francisco, California
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14
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Rafiei P, Walser EM, Duncan JR, Rana H, Ross JR, Kerlan RK, Gross KA, Balter S, Bartal G, Abi-Jaoudeh N, Stecker MS, Cohen AM, Dixon RG, Thornton RH, Nikolic B. Society of Interventional Radiology IR Pre-Procedure Patient Safety Checklist by the Safety and Health Committee. J Vasc Interv Radiol 2016; 27:695-9. [DOI: 10.1016/j.jvir.2016.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/26/2022] Open
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Abstract
Transjugular intrahepatic portosystemic shunts (TIPS) effectively lower portal pressure and are commonly used to manage selected patients with variceal bleeding. Unfortunately, significant consequences are not infrequently encountered as a result of this diversion of portal venous flow. These consequences include disabling hepatic encephalopathy as well as hepatic decompensation. To manage these complications, therapeutic options include TIPS reduction and TIPS occlusion. TIPS reduction is the favored technique because of the potential for venous thrombosis and recurrent variceal hemorrhage after acute TIPS occlusion. Techniques and indications for TIPS reduction and TIPS occlusion are reviewed.
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Affiliation(s)
- Andrew G Taylor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA.
| | - Kanti P Kolli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Robert K Kerlan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
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16
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Pasternak JD, Epelboym I, Seiser N, Wingo M, Herman M, Cowan V, Gosnell JE, Shen WT, Kerlan RK, Lee JA, Duh QY, Suh I. Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein. Surgery 2016; 159:267-73. [DOI: 10.1016/j.surg.2015.06.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/03/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
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Olorunsola OG, Kohi MP, Behr SC, Kolli PK, Taylor AG, Tong RT, LaBerge JM, Kerlan RK, Fidelman N. Imaging Predictors of Elevated Lung Shunt Fraction in Patients Being Considered for Yttrium-90 Radioembolization. J Vasc Interv Radiol 2015; 26:1472-8. [DOI: 10.1016/j.jvir.2015.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 02/08/2023] Open
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18
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Kohlbrenner R, Kolli KP, Taylor AG, Kohi MP, Fidelman N, LaBerge JM, Kerlan RK, Agarwal VK, Lehrman ED, Nanavati S, Avrin DE, Gould R. Patient Radiation Dose Reduction during Transarterial Chemoembolization Using a Novel X-Ray Imaging Platform. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2015.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kohi MP, Taylor AG, Kolli KP, Fidelman N, Kerlan RK. Crossed legs: an unexpected occurrence during an ALN filter placement. Clin Imaging 2015; 39:1128-9. [PMID: 26253773 DOI: 10.1016/j.clinimag.2015.07.017] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/28/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
Inferior vena cava (IVC) filter placement is indicated for patients with pulmonary embolism and/or deep venous thrombosis when anticoagulation therapy is contraindicated. IVC filter placement, however, is not without complications. In this case, we noted crossing of the filter struts immediately after deployment of the ALN IVC filter (ALN Implants Chirurgicaux Ghisonaccia, France). The filter was then successfully removed.
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Affiliation(s)
- Maureen P Kohi
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-361, San Francisco, CA, 94143.
| | - Andrew G Taylor
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-361, San Francisco, CA, 94143.
| | - K Pallav Kolli
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-361, San Francisco, CA, 94143.
| | - Nicholas Fidelman
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-361, San Francisco, CA, 94143.
| | - Robert K Kerlan
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, M-361, San Francisco, CA, 94143.
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20
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Yao FY, Mehta N, Flemming J, Dodge J, Hameed B, Fix O, Hirose R, Fidelman N, Kerlan RK, Roberts JP. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology 2015; 61:1968-77. [PMID: 25689978 PMCID: PMC4809192 DOI: 10.1002/hep.27752] [Citation(s) in RCA: 318] [Impact Index Per Article: 35.3] [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: 04/12/2014] [Accepted: 02/13/2015] [Indexed: 12/07/2022]
Abstract
UNLABELLED We report on the long-term intention-to-treat (ITT) outcome of 118 patients with hepatocellular carcinoma (HCC) undergoing downstaging to within Milan/United Network for Organ Sharing T2 criteria before liver transplantation (LT) since 2002 and compare the results with 488 patients listed for LT with HCC meeting T2 criteria at listing in the same period. The downstaging subgroups include 1 lesion >5 and ≤8 cm (n = 43), 2 or 3 lesions at least one >3 and ≤5 cm with total tumor diameter ≤8 cm (n = 61), or 4-5 lesions each ≤3 cm with total tumor diameter ≤8 cm (n = 14). In the downstaging group, 64 patients (54.2%) had received LT and 5 (7.5%) developed HCC recurrence. Two of the five patients with HCC recurrence had 4-5 tumors at presentation. The 1- and 2-year cumulative probabilities for dropout (competing risk) were 24.1% and 34.2% in the downstaging group versus 20.3% and 25.6% in the T2 group (P = 0.04). Kaplan-Meier's 5-year post-transplant survival and recurrence-free probabilities were 77.8% and 90.8%, respectively, in the downstaging group versus 81% and 88%, respectively, in the T2 group (P = 0.69 and P = 0.66, respectively). The 5-year ITT survival was 56.1% in the downstaging group versus 63.3% in the T2 group (P = 0.29). Factors predicting dropout in the downstaging group included pretreatment alpha-fetoprotein ≥1,000 ng/mL (multivariate hazard ratio [HR]: 2.42; P = 0.02) and Child's B versus Child's A cirrhosis (multivariate HR: 2.19; P = 0.04). CONCLUSION Successful downstaging of HCC to within T2 criteria was associated with a low rate of HCC recurrence and excellent post-transplant survival, comparable to those meeting T2 criteria without downstaging. Owing to the small number of patients with 4-5 tumors, further investigations are needed to confirm the efficacy of downstaging in this subgroup.
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Kohi MP, Agarwal VK, Naeger DM, Taylor AG, Kolli KP, Fidelman N, LaBerge JM, Kerlan RK. The inferior emissary vein: a reliable landmark for right adrenal vein sampling. Acta Radiol 2015; 56:454-7. [PMID: 24682403 DOI: 10.1177/0284185114529107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/15/2022]
Abstract
BACKGROUND Right adrenal vein (RAV) catheterization can be a very challenging step in adrenal venous sampling (AVS). Visualization of the inferior emissary vein (IEV) may be an indication of successful RAV catheterization. PURPOSE To compare the rate of successful RAV sampling in the presence of the IEV. MATERIAL AND METHODS Retrospective review of all consecutive patients with PA who underwent AVS between April 2009 and April 2012 was performed. A total of 30 patients were identified. Procedural images, cortisol, and aldosterone values obtained from sampling of the RAV and inferior vena cava (IVC) were reviewed. Cortisol measurements obtained from RAV samples were divided by measurements from the infra-renal IVC blood samples in order to calculate the selectivity index (SI). An SI >3 was considered indicative of technically successful RAV sampling. RESULTS RAV sampling was considered technically successful in 29 out of 30 cases (97%). In cases of successful RAV sampling (29 patients), the IEV was identified in 25 patients (86%). The IEV was visualized in isolation in 16 patients (64%), and in conjunction with visualization of the RAV or right adrenal gland stain in nine patients (36%). The IEV was not visualized in the one case of unsuccessful RAV sampling. Visualizing the IEV had a sensitivity of 86.2% for successful RAV sampling. CONCLUSION The IEV may serve as a reliable landmark for the RAV during RAV sampling.
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Affiliation(s)
- Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Vishal K Agarwal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - David M Naeger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Andrew G Taylor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - K Pallav Kolli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Nicholas Fidelman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jeanne M LaBerge
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Robert K Kerlan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Young K, Fidelman N, Yao FY, Hills NK, Kohi MP, Kolli KP, Taylor AG, Kerlan RK. Implications of discordant findings between hepatic angiography and cross-sectional imaging in transplant candidates with hepatocellular carcinoma. Liver Transpl 2015; 21:454-67. [PMID: 25678220 PMCID: PMC4807728 DOI: 10.1002/lt.24090] [Citation(s) in RCA: 2] [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: 08/18/2014] [Revised: 12/05/2014] [Accepted: 01/10/2015] [Indexed: 02/06/2023]
Abstract
The goal of this study was to determine whether the detection of discordant numbers of hypervascular foci at hepatic angiography versus contrast-enhanced (CE) cross-sectional imaging [computed tomography (CT) or magnetic resonance imaging (MRI)] is associated with adverse clinical outcomes in patients with hepatocellular carcinoma (HCC) who are listed for liver transplantation. We retrospectively reviewed the records of 218 consecutive patients with HCC who were listed for a liver transplant and who underwent transarterial chemoembolization at our institution between January 1, 2006 and December 31, 2010. Patients were grouped into 3 categories: (1) the number of nodules at CT/MRI was concordant with the number of hypervascular foci detected at angiography (n=136), (2) the number of nodules at CT/MRI was greater than the number of hypervascular foci at angiography (n=45), and (3) the number of nodules at CT/MRI was fewer than the number of hypervascular foci at angiography (n=37). The study outcomes were liver transplantation and tumor recurrence after transplantation. The detection of at least 3 more hypervascular foci at angiography versus the number of HCC nodules on CT/MRI was associated with a significantly lower rate of transplantation [multivariate subhazard ratio (SHR), 0.39; 95% confidence interval (CI), 0.17-0.92]. The detection of fewer hypervascular foci at angiography versus the number of HCC nodules on CT/MRI was associated with a significantly higher rate of tumor recurrence after transplantation (multivariate SHR, 3.49; 95% CI, 1.27-9.56). In conclusion, liver transplant candidates with HCC who demonstrate discordant findings between angiography and CE CT or MRI may be at a higher risk for dropout from the transplant list and for tumor recurrence after transplantation.
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Bartolome B, Kohi MP, Fidelman N, Taylor AG, Kolli KP, LaBerge JM, Kerlan RK. Hemothorax Resulting from Injury to the Right Inferior Phrenic Artery following Transhepatic Procedures. J Vasc Interv Radiol 2015; 26:600-1. [DOI: 10.1016/j.jvir.2014.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 10/23/2022] Open
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Kohi MP, Naeger DM, Lorenson MJ, Taylor AG, Kolli KP, Fidelman N, Kerlan RK. Hook, Line, and Sinker: Hook Wire Localization of a Retained Suture Needle in the Perineum. J Vasc Interv Radiol 2014; 25:1479-80. [DOI: 10.1016/j.jvir.2014.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/15/2014] [Accepted: 02/16/2014] [Indexed: 11/26/2022] Open
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25
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Kohi MP, Fidelman N, Kerlan RK. Reply to Re: Hepatotoxicity after transarterial chemoembolization and transjugular intrahepatic portosystemic shunt: do two rights make a wrong? J Vasc Interv Radiol 2014; 24:1076. [PMID: 23796101 DOI: 10.1016/j.jvir.2013.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 11/28/2022] Open
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26
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Veal DR, Lee AY, Kerlan RK, Gordon RL, Fidelman N. Outcomes of metallic biliary stent insertion in patients with malignant bilobar obstruction. J Vasc Interv Radiol 2014; 24:1003-10. [PMID: 23796087 DOI: 10.1016/j.jvir.2013.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 03/14/2013] [Accepted: 03/15/2013] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To assess clinical outcomes of metal stent insertion in patients with bilobar bile duct obstruction by malignant tumors. MATERIALS AND METHODS Records of 120 consecutive patients who underwent placement of metallic stents for palliation of malignant bilobar biliary obstruction between 1995 and 2010 were retrospectively reviewed. Single-duct stent insertion was performed in 44 patients with one liver lobe that accounted for more than 70% of total liver volume or only one patent lobar portal vein (group 1). Bilobar stent insertion was performed in 60 patients with approximately equal lobe sizes, patent lobar portal veins, or cholangitis at presentation (group 2). In 16 patients with discontiguous right anterior and posterior segmental ducts (group 3), three stents were deployed in the left lobar and right anterior and posterior segmental ducts. Overall survival, primary patency, and patient morbidity rates following stent insertion were assessed. RESULTS No significant differences in mean overall survival (group 1, 7.3 mo; group 2, 10.3 mo; group 3, 6.5 mo; P = .21) or mean primary stent patency (group 1, 4.2 mo; group 2, 5.9 mo; group 3, 3.5 mo; P = .17) were demonstrated. However, patients in group 3 were significantly more likely to require hospitalizations for cholangitis and additional invasive procedures for recurrent biliary obstruction than patients in groups 1 and 2. CONCLUSIONS Unilobar and bilobar metal stent insertion led to similar outcomes when treatment decision was based on relative liver lobe volumes, lobar portal vein patency, and presence of cholangitis on presentation.
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Affiliation(s)
- David R Veal
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA
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27
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Price AJ, Fidelman N, Wilson MW, Kerlan RK. Percutaneous interventions in failing "necklace" hemodialysis grafts: long-term outcomes. J Vasc Interv Radiol 2013; 25:199-205. [PMID: 24290096 DOI: 10.1016/j.jvir.2013.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/24/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine primary and secondary patency after percutaneous interventions for malfunctioning anterior chest wall ("necklace") arteriovenous grafts (AVGs) for hemodialysis. MATERIALS AND METHODS Records of six consecutive patients with subclavian artery-to-contralateral subclavian vein necklace AVGs were reviewed. Patients underwent 34 procedures, including 28 balloon angioplasties, 24 pharmacomechanical thrombolyses, and six stent placements. Patency intervals after graft placement and after first intervention were calculated. RESULTS After 3 months, primary and secondary patency rates were 33% (two of six grafts) and 67% (four of six grafts), respectively. At 12 months, primary and secondary patency rates were 17% (one of six grafts) and 50% (three of six grafts), respectively. Median and mean primary patency times were 49 and 374 days, and median and mean secondary patency times were 293 and 575 days, respectively. The anatomic success rate of percutaneous interventions in malfunctioning AVGs was 97% (33 of 34 cases). At 3 years after implantation, the graft patency rate was 57% (four of seven grafts). CONCLUSIONS Percutaneous interventions were effective at maintaining patency in failing necklace AVGs. However, their primary and secondary patency were inferior to those cited in extremity AVG guidelines set forth by the Society of Interventional Radiology.
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Affiliation(s)
- Adi J Price
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143
| | - Nicholas Fidelman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143.
| | - Mark W Wilson
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143
| | - Robert K Kerlan
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143
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28
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Tong RT, Kohi M, Fidelman N, Kuo YC, Foster R, Peled A, Kolli KP, Taylor AG, LaBerge JM, Kerlan RK. Clinical outcomes of percutaneous drainage of breast fluid collections after mastectomy with expander-based breast reconstruction. J Vasc Interv Radiol 2013; 24:1369-74. [PMID: 23810309 PMCID: PMC4393952 DOI: 10.1016/j.jvir.2013.04.036] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/29/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To determine clinical outcomes of patients who underwent imaging-guided percutaneous drainage of breast fluid collections after mastectomy and breast reconstruction. MATERIALS AND METHODS A retrospective review was performed including all consecutive patients who underwent percutaneous drainage of fluid collections after mastectomy with tissue expander-based reconstruction between January 2007 and September 2012. During this period, 879 mastectomies (563 patients) with expander-based breast reconstruction were performed. Fluid collections developed in 28 patients (5%), which led to 30 imaging-guided percutaneous drainage procedures. The median follow-up time was 533 days. Patient characteristics, surgical technique, microbiology analysis, and clinical outcomes were reviewed. RESULTS The mean age of patients was 51.5 years (range, 30.9-69.4 y), and the median time between breast reconstruction and drainage was 35 days (range, 4-235 d). Erythema and swelling were the most common presenting symptoms. The median volume of fluid evacuated at the time of drain placement was 70 mL. Drains were left in place for a median 14 days (range, 6-34 d). Microorganisms were detected in the fluid in 12 of 30 drainage procedures, with Staphylococcus aureus being the most common microorganism. No further intervention was needed in 21 of 30 drainage procedures (70%). However, surgical intervention (removal of expanders) was needed after 6 (20%) drainage procedures, and additional percutaneous drainage procedures were performed after 3 (10%) drainage procedures. CONCLUSIONS Percutaneous drainage is an effective means of treating postoperative fluid collections after expander-based breast reconstruction and can obviate the need for repeat surgery in most cases.
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Affiliation(s)
- Ricky T Tong
- Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, USA.
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29
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Burke C, Taylor AG, Ring EJ, Kerlan RK. Creation of a percutaneous mesocaval shunt to control variceal bleeding in a child. Pediatr Radiol 2013; 43:1218-20. [PMID: 23447003 DOI: 10.1007/s00247-013-2643-z] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/12/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
Although transjugular intrahepatic portosystemic shunt (TIPS) placement is the standard procedure for the treatment of portal hypertension, it is often impossible to perform in patients with extrahepatic portal vein occlusion. In these patients, options for decompressing the liver are few. In this report, we present a novel solution for managing gastro-esophageal hemorrhage in a child with portal hypertension and extrahepatic portal vein occlusion, through the creation of a percutaneous mesocaval shunt.
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Affiliation(s)
- Colin Burke
- University of Miami Miller School of Medicine, Miami, FL, USA
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30
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Kuo YC, Kohi MP, Naeger DM, Tong RT, Kolli KP, Taylor AG, Laberge JM, Kerlan RK, Fidelman N. Efficacy of TACE in TIPS patients: comparison of treatment response to chemoembolization for hepatocellular carcinoma in patients with and without a transjugular intrahepatic portosystemic shunt. Cardiovasc Intervent Radiol 2013; 36:1336-43. [PMID: 23864021 DOI: 10.1007/s00270-013-0698-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 05/15/2013] [Accepted: 06/19/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare treatment response after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS A retrospective review of patients who underwent conventional TACE for HCC between January 2005 and December 2009 identified 10 patients with patent TIPS. From the same time period, 23 patients without TIPS were selected to control for comparable Model for End-Stage Liver Disease and Child-Pugh-Turcotte scores. The two groups showed similar distribution of Barcelona Clinic Liver Cancer and United Network of Organ Sharing stages. Target HCC lesions were evaluated according to the modified response evaluation criteria in solid tumors (mRECIST) guidelines. Transplantation rate, time to tumor progression, and overall survival (OS) were documented. RESULTS After TACE, the rate of complete response was significantly greater in non-TIPS patients compared with TIPS patients (74 vs. 30 %, p = 0.03). Objective response rate (complete and partial response) trended greater in the non-TIPS group (83 vs. 50 %, p = 0.09). The liver transplantation rate was 80 and 74 % in the TIPS and non-TIPS groups, respectively (p = 1.0). Time to tumor progression was similar (p = 0.47) between the two groups. OS favored the non-TIPS group (p = 0.01) when censored for liver transplantation. CONCLUSION TACE is less effective in achieving complete or partial response using mRECIST criteria in TIPS patients compared with those without a TIPS. Nevertheless, similar clinical outcomes may be achieved, particularly in TIPS patients who are liver-transplantation candidates.
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Affiliation(s)
- Yuo-Chen Kuo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA, 94143, USA,
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31
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Johnson DT, Durack JC, Fidelman N, Kerlan RK, LaBerge JM. Distribution of Reported StarClose SE Vascular Closure Device Complications in the Manufacturer and User Facility Device Experience Database. J Vasc Interv Radiol 2013; 24:1051-6. [DOI: 10.1016/j.jvir.2013.03.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/23/2013] [Accepted: 03/25/2013] [Indexed: 11/28/2022] Open
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Olorunsola OG, Kohi MP, Fidelman N, LaBerge JM, Kerlan RK. Failure of filter reexpansion during unsuccessful retrieval of Option inferior vena cava filter. J Vasc Interv Radiol 2013; 24:1065-7. [PMID: 23796095 DOI: 10.1016/j.jvir.2013.03.026] [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] [Received: 01/11/2013] [Revised: 03/17/2013] [Accepted: 03/20/2013] [Indexed: 11/27/2022] Open
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33
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Marshall D, Laberge JM, Firetag B, Miller T, Kerlan RK. The changing face of percutaneous image-guided biopsy: molecular profiling and genomic analysis in current practice. J Vasc Interv Radiol 2013; 24:1094-103. [PMID: 23806383 DOI: 10.1016/j.jvir.2013.04.027] [Citation(s) in RCA: 33] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 04/25/2013] [Accepted: 04/25/2013] [Indexed: 12/19/2022] Open
Abstract
Oncology is undergoing a revolutionary change. Image-guided biopsy is expected to play an increasingly important role in this radical transformation. Current concepts of disease and treatment are based on an established set of physical signs and symptoms and laboratory tests broken down by organ system. However, soon diseases will be categorized and treated based on much more specific and detailed molecular and genetic information. This transformation in how disease is categorized and treated will depend on the ability to harvest tissue from tumors and analyze it appropriately.
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Affiliation(s)
- Dustyn Marshall
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143-0628, USA.
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Arrayeh E, Fidelman N, Gordon RL, LaBerge JM, Kerlan RK, Klimov A, Bloom AI. Transcatheter arterial embolization for upper gastrointestinal nonvariceal hemorrhage: is empiric embolization warranted? Cardiovasc Intervent Radiol 2013; 35:1346-54. [PMID: 22302348 DOI: 10.1007/s00270-012-0351-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 07/07/2011] [Accepted: 01/06/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. METHODS Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared. RESULTS For patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). CONCLUSION Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.
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Affiliation(s)
- Elnasif Arrayeh
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA 94134, USA
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35
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Kohi MP, Naeger DM, Kukreja J, Fidelman N, Laberge JM, Gordon RL, Kerlan RK. Preoperative CT-Guided percutaneous wire localization of ground glass pulmonary nodules with a modified Kopans wire. J Thorac Dis 2013; 5:E31-4. [PMID: 23585953 DOI: 10.3978/j.issn.2072-1439.2012.07.05] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 07/01/2012] [Indexed: 11/14/2022]
Abstract
PURPOSE To report a technique of using a modified Kopans wire to localize ground glass pulmonary nodules prior to resection. METHODS CT-guided preoperative localization of ground glass nodules was performed using the modified Kopans wire. RESULTS In both cases, the wire successfully localized the ground glass nodule and the surgeon was able to remove the nodule during video-assisted thoracoscopic wedge resection. CONCLUSIONS Preoperative CT-guided insertion of the modified Kopans wire can result in successful wedge resection of ground glass nodules. The reinforced segment of the modified Kopans wire serves as an excellent source of palpation and localization for the surgeon.
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Affiliation(s)
- Maureen P Kohi
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628, USA
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Olorunsola OG, Kohi MP, Fidelman N, Westphalen AC, Kolli PK, Taylor AG, Gordon RL, LaBerge JM, Kerlan RK. Caval Penetration by Retrievable Inferior Vena Cava Filters: A Retrospective Comparison of Option and Günther Tulip Filters. J Vasc Interv Radiol 2013; 24:566-71. [DOI: 10.1016/j.jvir.2012.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/06/2012] [Accepted: 12/30/2012] [Indexed: 10/27/2022] Open
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Garwood ER, Fidelman N, Hoch SE, Kerlan RK, Yao FY. Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction. Liver Transpl 2013; 19:164-73. [PMID: 23008091 DOI: 10.1002/lt.23552] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [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: 05/14/2012] [Accepted: 08/29/2012] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine the rate and risk factors for the development of irreversible hepatotoxicity after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and synthetic hepatic dysfunction. Two hundred fifty-one consecutive patients with HCC and hepatic dysfunction who underwent 443 TACE procedures from 2005 to 2010 were retrospectively reviewed. The included patients met one of the following criteria: a pre-TACE bilirubin level ≥ 2 mg/dL, an international normalized ratio (INR) > 1.5, a creatinine level > 1.2 mg/dL, a platelet count ≤ 60,000/mL, a Model for End-Stage Liver Disease (MELD) score > 15, Child-Turcotte-Pugh class B or C, ascites, or portal vein thrombosis. Hepatotoxicity was defined as new or worsening ascites, encephalopathy, or grade 3 or 4 toxicity (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, or INR) according to the National Cancer Institute Common Terminology Criteria for Adverse Events. The rate and risk factors for death or urgent liver transplantation within 6 weeks of TACE and irreversible hepatotoxicity were determined with a generalized estimating equation analysis. Reversible hepatotoxicity developed after 90 procedures (20%) in 78 patients (31%). Irreversible hepatotoxicity developed after 41 procedures (9%) in 37 patients (15%). Six patients (2%) underwent urgent liver transplantation, and 11 (4%) died within 6 weeks of TACE. Patients at increased risk for procedure-related mortality or urgent liver transplantation within 6 weeks of TACE had a baseline serum bilirubin level ≥ 4.0 mg/dL (P = 0.01), an elevated INR (P < 0.001), hypoalbuminemia with an albumin level < 2.0 g/L (P = 0.01), a serum creatinine level > 2.0 mg/dL (P = 0.02), large ascites (P = 0.002), encephalopathy (P = 0.005), or a MELD score ≥ 20 (P < 0.001). In conclusion, TACE can be performed safely in patients with baseline hepatic dysfunction. However, a poor hepatic reserve increases the risk of irreversible hepatotoxicity, which may lead to death or the need for urgent liver transplantation.
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Affiliation(s)
- Elisabeth R Garwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco 94143, CA
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Kohi MP, Fidelman N, Naeger DM, LaBerge JM, Gordon RL, Kerlan RK. Hepatotoxicity after transarterial chemoembolization and transjugular intrahepatic portosystemic shunt: do two rights make a wrong? J Vasc Interv Radiol 2012. [PMID: 23176968 DOI: 10.1016/j.jvir.2012.08.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare the rates of hepatotoxicity after transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS) who were stratified into comparable risk groups. MATERIALS AND METHODS A retrospective review of patients with HCC who were treated with transarterial chemoembolization between January 2005 and December 2009 was performed. Of 158 patients with comparable model for end-stage liver disease (MELD) scores, 10 had a patent TIPS. Hepatobiliary severe adverse events (SAEs) occurring after transarterial chemoembolization were documented. In addition, 1-year survival and liver transplantation rate after transarterial chemoembolization were calculated in each group. RESULTS The incidence of hepatobiliary SAEs after transarterial chemoembolization was nearly two times higher in patients with a TIPS (70%) than in patients without a TIPS (36%; P=.046). The liver transplantation rate 1 year after transarterial chemoembolization was 2.5 times higher in patients with a TIPS (80%) than in patients without a TIPS (32%; P=.004). There was no significant difference in 1-year survival between the two groups after transarterial chemoembolization. CONCLUSIONS Patients with HCC and a patent TIPS are more likely to develop significant hepatotoxicity after transarterial chemoembolization than comparable patients without a TIPS in place.
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Affiliation(s)
- Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, USA.
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Durack JC, Hope TA, Seo Y, Saeed M, He J, Wilson MW, Kerlan RK, Ring EJ. Intravenous Vasopressin for the Prevention of Nontarget Gastrointestinal Embolization during Liver-directed Cancer Treatment: Experimental Study in a Porcine Model. J Vasc Interv Radiol 2012; 23:1505-12. [DOI: 10.1016/j.jvir.2012.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/06/2012] [Accepted: 07/10/2012] [Indexed: 11/17/2022] Open
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Lee AY, Gregorius J, Kerlan RK, Gordon RL, Fidelman N. Percutaneous transhepatic balloon dilation of biliary-enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries. PLoS One 2012; 7:e46478. [PMID: 23110053 PMCID: PMC3482176 DOI: 10.1371/journal.pone.0046478] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 08/31/2012] [Indexed: 12/22/2022] Open
Abstract
Purpose To evaluate the efficacy of percutaneous balloon dilation of biliary-enteric anastomotic strictures resulting from surgical repair of laparoscopic cholecystectomy-related bile duct injuries. Material and Methods A total of 61 patients were referred to our institution from 1995 to 2010 for treatment of obstruction at the biliary-enteric anastomosis following surgical repair of laparoscopic cholecystectomy-related bile duct injuries. Of these 61 patients, 27 underwent surgical revision upon stricture diagnosis, and 34 patients were managed using balloon dilation. Of these 34 patients, 2 were lost to follow up, leaving 32 patients for analysis. The primary study objective was to determine the clinical success rate of balloon dilation of biliary-enteric anastomotic strictures. Secondary study objectives included determining anastomosis patency, rates of stricture recurrence following treatment, and morbidity. Results Balloon dilation of biliary-enteric anastomotic strictures was clinically successful in 21 of 32 patients (66%). Anastomotic stricture recurred in one of 21 patients (5%) after an average of 13.1 years of follow-up. Patients who were unsuccessfully managed with balloon dilation required significantly more invasive procedures (6.8 v. 3.4; p = 0.02) and were left with an indwelling biliary catheter for a significantly longer period of time (8.8 v. 2.0 months; p = 0.02) than patients whose strictures could be resolved by balloon dilation. No significant differences in the number of balloon dilations performed (p = 0.17) or in the maximum balloon diameter used (p = 0.99) were demonstrated for patients with successful or unsuccessful balloon dilation outcomes. Conclusion Percutaneous balloon dilation of anastomotic biliary strictures following surgical repair of laparoscopic cholecystectomy-related injuries may result in lasting patency of the biliary-enteric anastomosis.
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Affiliation(s)
| | | | | | | | - Nicholas Fidelman
- Department of Radiology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Park SJ, Freise CE, Hirose R, Kerlan RK, Yao FY, Roberts JP, Vagefi PA. Risk factors for liver transplant waitlist dropout in patients with hepatocellular carcinoma. Clin Transplant 2012; 26:E359-64. [PMID: 22693962 DOI: 10.1111/j.1399-0012.2012.01668.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2012] [Indexed: 12/13/2022]
Abstract
Loco-regional therapy has been developed to reduce waitlist dropout in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation. We evaluated the probability of transplantation and waitlist dropout, and analyzed risk factors for waitlist dropout, in 76 patients with HCC from September 2004 to August 2006. Seventy-three (96.1%) patients received one or more preoperative loco-regional treatments and 55 (72.3%) received an orthotopic liver transplantation with a median wait time of seven months (range, 2-26 months). There were 11 dropouts (14.5%) associated with tumor progression or hepatic decompensation (median waiting time; 5.4 months and range, 0.4-13 months). Cumulative probabilities of transplantation at three, six, nine, 12, 15, and 18 months were 5.4%, 35.4%, 67.5%, 78.8%, 80.7%, and 80.7%, respectively and those of waitlist dropout at three, six, nine, 12, 15, and 18 months were 3.9%, 8.7%, 12.8%, 22.9%, 29.3%, and 29.3%, respectively. A laboratory model for end-stage liver disease (MELD) score >15 or multiple tumors at the time of UNOS listing were significant risk factors for waitlist dropout (p = 0.006 and 0.026, respectively). Patients with HCC being managed with loco-regional therapy who have a laboratory MELD score >15 or multiple tumors should be considered for earlier access to liver transplantation to prevent waitlist dropout.
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Affiliation(s)
- Sang-Jae Park
- Center for Liver Cancer, National Cancer Center, Goyang, South Korea
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Kwan SW, Fidelman N, Ma E, Kerlan RK, Yao FY. Imaging predictors of the response to transarterial chemoembolization in patients with hepatocellular carcinoma: a radiological-pathological correlation. Liver Transpl 2012; 18:727-36. [PMID: 22344899 PMCID: PMC4161220 DOI: 10.1002/lt.23413] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [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] [Indexed: 12/12/2022]
Abstract
Transarterial chemoembolization (TACE) is one of the standard therapies for bridging patients with hepatocellular carcinoma (HCC) to transplantation. This study was designed to determine which features on pre- and post-TACE imaging are associated with tumor necrosis in pathological specimens. Records of 105 patients with 132 HCC lesions who underwent liver transplantation after TACE were retrospectively reviewed. In 70% of the nodules, >90% necrosis was achieved. The development of >90% lesion necrosis upon pathological analysis was associated with avid lesion enhancement (P = 0.03) and the presence of a feeding vessel larger than 0.9 mm in diameter on the pre-TACE visceral angiogram (P = 0.01). Near-complete lesion necrosis was also associated with an extensive accumulation of ethiodized oil within a lesion during TACE administration (P = 0.04). On post-TACE computed tomography imaging, a lack of residual contrast enhancement (P < 0.0001), a decrease in the lesion size (P = 0.04), a high lesion density due to an accumulation of ethiodized oil (P = 0.03), and a diffuse distribution of ethiodized oil throughout the lesion (P = 0.0001) were also correlated with near-complete lesion necrosis upon pathological analysis. In conclusion, this study found multiple pre- and post-TACE imaging characteristics of HCC that were associated with near-complete tumor necrosis upon histopathological analysis after TACE. These findings may help to guide the selection of an optimal treatment strategy for bridging patients with HCC to liver transplantation.
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Affiliation(s)
- Sharon W. Kwan
- Department of Radiology, University of Washington, Seattle, WA
| | - Nicholas Fidelman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Elizabeth Ma
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Robert K. Kerlan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Francis Y. Yao
- Department of Medicine, University of California, San Francisco, San Francisco, CA
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Kerlan RK, LaBerge JM. Intranodal Lymphangiography: Coming Soon to a Hospital Near You. J Vasc Interv Radiol 2012; 23:617. [DOI: 10.1016/j.jvir.2012.03.003] [Citation(s) in RCA: 14] [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: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 11/16/2022] Open
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Durack JC, Wang JH, Schneider DB, Kerlan RK. Vena Cava Filter Scaffold to Prevent Migration of Embolic Materials in the Treatment of a Massive Renal Arteriovenous Malformation. J Vasc Interv Radiol 2012; 23:413-6. [DOI: 10.1016/j.jvir.2011.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 10/28/2022] Open
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Durack JC, Thor Johnson D, Fidelman N, Kerlan RK, LaBerge JM. Entrapment of the StarClose Vascular Closure System After Attempted Common Femoral Artery Deployment. Cardiovasc Intervent Radiol 2011; 35:942-4. [DOI: 10.1007/s00270-011-0264-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
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Villalta JD, Sorensen MD, Durack JC, Kerlan RK, Stoller ML. Selective arterial embolization of angiomyolipomas: a comparison of smaller and larger embolic agents. J Urol 2011; 186:921-7. [PMID: 21791345 DOI: 10.1016/j.juro.2011.04.082] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE Selective transarterial embolization for renal angiomyolipomas is effective in preventing or limiting hemorrhage and preserving normal parenchyma. Data are insufficient regarding the safety and efficacy of embolic agents. We compared transarterial embolization of angiomyolipomas using embolic agents of different sizes. MATERIALS AND METHODS We performed a retrospective review of all transarterial angiomyolipoma embolizations from 1999 to 2010, and evaluated demographics, procedural data, embolization response and outcomes comparing smaller (less than 150 microns) and larger (more than 150 microns) embolic agents. RESULTS Overall 48 patients underwent 66 embolization procedures for 72 angiomyolipomas. Smaller agents were used more commonly (58%). Age, gender, indications, pre-embolization angiomyolipoma size and prevalence of tuberous sclerosis were similar between the groups. Angiomyolipomas decreased a mean±SD 25%±18% after embolization with no differences between the groups (p=0.24). There were 10 angiomyolipomas that required 14 repeat embolizations (median 14 months). Repeat embolization of the same mass was almost sixfold more likely in those embolized with smaller agents (OR 5.88, 95% CI 1.64-20.8, p=0.002). Complications were similar between the groups, although 2 of 3 patients with acute respiratory distress underwent embolization with smaller agents. Patients with tuberous sclerosis had similar angiomyolipoma size, decrease in angiomyolipoma size, followup, complications and need for repeat embolization. Practice patterns changed regarding embolization agent size during the study period. CONCLUSIONS Angioembolization with larger embolic agents is associated with higher long-term efficacy compared to smaller agents. Due to concerns for serious pulmonary complications, we no longer use agents smaller than 150 microns. Prospective studies are necessary to evaluate the optimal embolization technique to achieve durable outcomes without increasing patient morbidity.
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Affiliation(s)
- Jacqueline D Villalta
- Department of Urology, University of California, San Francisco, San Francisco, California 94143, USA
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Abstract
Antibiotics are among the most common pharmaceutical agents used by the interventional radiologist. This article updates some of the practical aspects of the use of antibiotics in interventional radiological practice and provides some general guidelines with respect to indications for and selection of antibiotics. In particular, the objectives of this article are to review the basic pharmacology of the common antibiotic agents, the interventional radiological procedures in which prophylactic antibiotics are usually administered, the specific antimicrobial agents recommended for prophylaxis before common interventional radiological procedures, the appropriate antibiotics for patients allergic to penicillins, and the indications for antibiotic prophylaxis to prevent bacterial endocarditis.
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Affiliation(s)
- Ali Zarrinpar
- Department of Radiology, University of California, San Francisco
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Kwan SW, Fidelman N, Durack JC, Roberts JP, Kerlan RK. Rex shunt preoperative imaging: diagnostic capability of imaging modalities. PLoS One 2011; 6:e22222. [PMID: 21765956 PMCID: PMC3134475 DOI: 10.1371/journal.pone.0022222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 06/21/2011] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic capability of imaging modalities used for preoperative mesenteric-left portal bypass (“Rex shunt”) planning. Twenty patients with extrahepatic portal vein thrombosis underwent 57 preoperative planning abdominal imaging studies. Two readers retrospectively reviewed these studies for an ability to confidently determine left portal vein (PV) patency, superior mesenteric vein (SMV) patency, and intrahepatic left and right PV contiguity. In this study, computed tomographic arterial portography allowed for confident characterization of left PV patency, SMV patency and left and right PV continuity in 100% of the examinations. Single phase contrast-enhanced CT, multi-phase contrast-enhanced CT, multiphase contrast-enhanced MRI, and transarterial portography answered all key diagnostic questions in 33%, 30%, 0% and 8% of the examinations, respectively. In conclusion, of the variety of imaging modalities that have been employed for Rex shunt preoperative planning, computed tomographic arterial portography most reliably allows for assessment of left PV patency, SMV patency, and left and right PV contiguity in a single study.
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Affiliation(s)
- Sharon W. Kwan
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Nicholas Fidelman
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Jeremy C. Durack
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - John P. Roberts
- Department of Surgery, University of California San Francisco, San Francisco, California, United States of America
| | - Robert K. Kerlan
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
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Tan JH, Fidelman N, Durack JC, Hays SR, Leard LL, LaBerge JM, Kerlan RK, Golden JA, Gordon RL. Management of Recurrent Airway Strictures in Lung Transplant Recipients using AERO Covered Stents. J Vasc Interv Radiol 2010; 21:1900-4. [DOI: 10.1016/j.jvir.2010.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 04/22/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022] Open
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Posselt AM, Bellin MD, Tavakol M, Szot GL, Frassetto LA, Masharani U, Kerlan RK, Fong L, Vincenti FG, Hering BJ, Bluestone JA, Stock PG. Islet transplantation in type 1 diabetics using an immunosuppressive protocol based on the anti-LFA-1 antibody efalizumab. Am J Transplant 2010; 10:1870-80. [PMID: 20659093 PMCID: PMC2911648 DOI: 10.1111/j.1600-6143.2010.03073.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The applicability of islet transplantation as treatment for type 1 diabetes is limited by renal and islet toxicities of currently available immunosuppressants. We describe a novel immunosuppressive regimen using the antileukocyte functional antigen-1 antibody efalizumab which permits long-term islet allograft survival while reducing the need for corticosteroids and calcineurin inhibitors (CNI). Eight patients with type 1 diabetes and hypoglycemic unawareness received intraportal allogeneic islet transplants. Immunosuppression consisted of antithymocyte globulin induction followed by maintenance with efalizumab and sirolimus or mycophenolate. When efalizumab was withdrawn from the market in mid 2009, all patients were transitioned to regimens consisting of mycophenolate and sirolimus or mycophenolate and tacrolimus. All patients achieved insulin independence and four out of eight patients became independent after single-islet transplants. Insulin independent patients had no further hypoglycemic events, hemoglobin A1c levels decreased and renal function remained stable. Efalizumab was well tolerated and no serious adverse events were encountered. Although long-term follow-up is limited by discontinuation of efalizumab and transition to conventional imunnosuppression (including CNI in four cases), these results demonstrate that insulin independence after islet transplantation can be achieved with a CNI and steroid-free regimen. Such an approach may minimize renal and islet toxicity and thus further improve long-term islet allograft survival.
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Affiliation(s)
- Andrew M. Posselt
- Transplant Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Melena D. Bellin
- Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Mehdi Tavakol
- Transplant Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Gregory L. Szot
- Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Lynda A. Frassetto
- Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Umesh Masharani
- Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Robert K. Kerlan
- Interventional Radiology, University of California, San Francisco, San Francisco, CA, United States
| | - Lawrence Fong
- Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Flavio G. Vincenti
- Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Jeffrey A. Bluestone
- Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Peter G. Stock
- Transplant Surgery, University of California, San Francisco, San Francisco, CA, United States
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