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Jørgensen HS, Borghs H, Heye S, Smout D, Claes K, Evenepoel P. Vascular calcification of the abdominal aorta has minimal impact on lumbar spine bone density in patients with chronic kidney disease. Bone 2022; 162:116482. [PMID: 35787485 DOI: 10.1016/j.bone.2022.116482] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Hanne Skou Jørgensen
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Herman Borghs
- Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sam Heye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Dieter Smout
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Claes
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Evenepoel
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.
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Cornelissen SA, Heye S, Maleux G, Daenens K, van Loon J, De Vleeschouwer S. Treatment of ruptured subclavian steal flow-related vertebrobasilar junction aneurysms: Case report on surgical and endovascular considerations from two cases. Int J Surg Case Rep 2022; 90:106744. [PMID: 34991048 PMCID: PMC8741505 DOI: 10.1016/j.ijscr.2021.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Subclavian steal phenomenon causes retrograde flow through the vertebral artery, ipsilateral to the affected subclavian artery, which rarely leads to flow-related vertebrobasilar junction (VBJ) aneurysms. Case descriptions We describe two cases of subarachnoid hemorrhage from such ruptured aneurysms in which the retrograde flow direction in the vertebral artery complicated surgical and endovascular treatment. Discussion Reversed flow in the vertebral artery, ipsilateral to the stenotic subclavian artery leads to a lack of proximal control in surgical clipping of these VBJ aneurysms and jeopardizes stability of coil and stent placement in endovascular aneurysm treatments in this setting. Conclusion: From these 2 experiences over 7 years, treatment considerations emerged for future cases. Subclavian steal phenomenon can be associated with flow-related cerebral aneurysms. These aneurysms are located at the vertebrobasilar junction. If ruptured, treatment of these aneurysms is challenging. Reversed vertebral artery flow complicates any type of aneurysm repair. Recanalization of stenotic subclavian artery contributes sustainable solutions.
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Gruyters I, Stessel B, Yilmaz A, Vekemans K, Heye S, Timmermans P, Vandenbrande J. Surgical adrenalectomy during rescue Extracorporeal Life Support for pheochromocytoma induced cardiogenic shock: a case report. Acta Anaest Belg 2021. [DOI: 10.56126/72.4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction : Pheochromocytoma, a rare catecholamine-producing tumor, has been described to provoke stress-induced Takotsubo-like cardiomyopathy and even severe refractory cardiogenic shock. In this case report, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used for hemodynamic stabilization and was continued during the resection of a large neuroendocrine tumor.
Description : A 69-year old male, recently diagnosed with a pheochromocytoma, was referred to our center because of severe cardiogenic shock after induction of anesthesia for resection of the mass. Despite adequate alpha-and beta-adrenergic blockade for one month, he developed malignant hypertension with subsequently hemodynamic collapse. After successful cardiopulmonary resusci-tation he developed pulmonary oedema with severe hypoxemia and persistent hemodynamic lability. On arrival in our hospital, echocardiography revealed significant left ventricular impairment. Decision was made to commence him on VA-ECMO for a refractory cardiogenic shock with severe pulmonary oedema. Because of persistent blood pressure swings despite VA-ECMO and beta-adrenergic blockade, we decided to remove the tumor on mechanical circulatory support by an open surgical approach the next day. After clamping of the adrenal circulation, the patient experienced profound hypotension requiring high doses of epinephrine and a methylene blue infusion. Surgical resection was successful but complicated by a postoperative bleeding for which the patient underwent an emergent endovascular embolization of an adrenal artery. Over the next days, there was progressive cardiac recovery and the patient was weaned off VA-ECMO on the fourth postoperative day. The patient was discharged from the intensive care 27 days after admission and left the hospital on day 30.
Discussion: VA-ECMO seems to be a feasible last resort therapy in refractory cardiogenic shock induced by pheochromocytoma crisis as suggested by a high survival rate in literature. Despite its support benefit during this type of shock, surgical removal of the tumor is rarely done with mechanical circulatory support and heparinization.
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De Beule T, Boulanger T, Heye S, van Rooij WJ, van Zwam W, Stockx L. The Woven EndoBridge for unruptured intracranial aneurysms: Results in 95 aneurysms from a single center. Interv Neuroradiol 2021; 27:594-601. [PMID: 33745363 PMCID: PMC8493345 DOI: 10.1177/15910199211003428] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) is an intrasaccular flowdisruptor that is increasingly used for the treatment of (wide-necked) aneurysms. We present our experience with the WEB for unruptured aneurysms. MATERIALS AND METHODS Between April 2014 and August 2019, 93 patients with 95 unruptured aneurysms were primarily treated with the WEB. There were 69 women and 24 men, mean age 61 years (median 58, range 37-80). RESULTS Of 95 aneurysms, 86 had been discovered incidentally, 3 were symptomatic and 6 were additional to another ruptured aneurysm. Location was anterior communicating artery 33, middle cerebral artery 29, basilar tip 19, carotid tip 8, posterior communicating artery 4, posterior inferior cerebellar artery 1, superior cerebellar artery 1. Mean aneurysm size was 6 mm (median 6, range 3-13 mm).In one aneurysm additional coils were used and in another, a stent was placed. There was one procedural rupture without clinical sequelae. There were two thrombo-embolic complications leading to permanent deficit in one patient (mRS 2). Morbidity rate was 1.0% (1 of 93, 95%CI 0.01-6.5%) and mortality was 0% (0 of 93, 95%CI 0.0-4.8%). Angiographic follow-up at six months was available in 85 patients with 87 aneurysms (91%). Of 87 aneurysms, 68 (78%) were completely occluded, 14 (16%) had a neck remnant and 5 were incompletely occluded. Four aneurysms were retreated. Retreatment rate was 4.5% (4 of 87, 95%CI 1.7-13.6%). CONCLUSION WEB treatment of unruptured aneurysms is safe and effective. Additional devices are needed only rarely and retreatment at follow-up is infrequent.
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Affiliation(s)
- Tom De Beule
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Sam Heye
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Wim van Zwam
- Department of Radiology, Maastricht Universiteit Medisch Centrum, Maastricht, the Netherlands
| | - Luc Stockx
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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5
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Gallieni M, Hollenbeck M, Inston N, Kumwenda M, Powell S, Tordoir J, Al Shakarchi J, Berger P, Bolignano D, Cassidy D, Chan TY, Dhondt A, Drechsler C, Ecder T, Finocchiaro P, Haller M, Hanko J, Heye S, Ibeas J, Jemcov T, Kershaw S, Khawaja A, Labriola L, Lomonte C, Malovrh M, Marti I Monros A, Matthew S, McGrogan D, Meyer T, Mikros S, Nistor I, Planken N, Roca-Tey R, Ross R, Troxler M, van der Veer S, Vanholder R, Vermassen F, Welander G, Wilmink T, Koobasi M, Fox J, Van Biesen W, Nagler E. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2020; 35:2203. [PMID: 32365363 DOI: 10.1093/ndt/gfaa106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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De Beule T, Boulanger T, Heye S, van Rooij WJ, van Zwam WH, Stockx L. p64 flow diverter: Results in 108 patients from a single center. Interv Neuroradiol 2020; 27:51-59. [PMID: 32506988 DOI: 10.1177/1591019920932048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Flow diverters are increasingly used to treat intracranial aneurysms. We report the safety and efficacy of the p64 flow diverter, a resheathable and detachable device for intracranial aneurysms. MATERIALS AND METHODS We retrospectively reviewed 108 patients with 109 aneurysms treated with the p64 between March 2014 and July 2019. There were 87 women and 21 men, mean age 57 years. Of 109 aneurysms, 74 were discovered incidentally, 12 were symptomatic, 18 were previously treated, and five were ruptured dissection aneurysms. A total of 10 aneurysms were located in the posterior circulation. The mean aneurysm or remnant size was 8.1 mm. RESULTS Hemorrhage by perforation with the distal guidewire occurred in two patients with permanent neurological deficits in one. In one patient, acute in-stent occlusion caused infarction with a permanent deficit. Permanent morbidity was 1.9% (2 of 108, 95%CI 0.1-6.9%); there was no mortality. During follow-up, three in-stent occlusions occurred, all asymptomatic. There were no delayed hemorrhagic complications. At six months, 77 of 96 aneurysms (80.2%) were completely occluded, and at last follow-up, this increased to 93 of 96 aneurysms (96.9%). In-stent stenosis at any degree occurred in 11 patients, progressing to asymptomatic complete occlusion in one. In the other patients, stenosis resolved or improved at further follow-up. CONCLUSION The p64 offers an effective and safe treatment option. Aneurysm occlusion rate was 97% at last follow-up, mostly achieved with a single device. There were no delayed hemorrhagic complications. Delayed in-stent stenosis infrequently progresses to occlusion but remains a matter of concern.
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Affiliation(s)
- Tom De Beule
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - T Boulanger
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - S Heye
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - W J van Rooij
- Department of Radiology, 70515Algemeen Ziekenhuis Turnhout, Rubensstraat, Turnhout, Belgium
| | - W H van Zwam
- Department of Radiology, Maastricht Universiteit, Medisch Centrum, Maastricht, the Netherlands
| | - L Stockx
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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Janssen H, Nannoni S, Francois O, Dewaele T, De Blauwe S, Vanhooren G, Ghekiere J, Kager J, Peeters A, Goffette P, Hammer F, Duprez T, Demeestere J, Lemmens R, Cornelissen S, Heye S, Yperzeele L, Baar I, Voormolen M, Van der Zijden T, Mondelaers A, Andersson T, Pottel H, Odier C, Karkri F, Michel P, Vanacker P. Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians. J Stroke Cerebrovasc Dis 2020; 29:104817. [PMID: 32689620 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/04/2020] [Accepted: 03/14/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly. METHODS Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality. RESULTS Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%. Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days. CONCLUSIONS Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.
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Affiliation(s)
- Helena Janssen
- Ghent University, Department of neurology, Gent, Belgium.
| | | | | | | | | | | | | | | | - André Peeters
- Cliniques Universitaires Saint-Luc, Brussel, Belgium
| | | | - Frank Hammer
- Cliniques Universitaires Saint-Luc, Brussel, Belgium
| | | | | | | | | | - Sam Heye
- University Hospital Leuven, Leuven, Belgium
| | | | - Ingrid Baar
- Antwerp University Hospital, Edegem, Belgium
| | | | | | | | - Tommy Andersson
- Ghent University, Department of neurology, Gent, Belgium; AZ Groeninge Kortrijk and Karolinska Sweden
| | - Hans Pottel
- University of Leuven campus Kortrijk, Kortrijk, Belgium
| | - Céline Odier
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Fatine Karkri
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Patrik Michel
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Peter Vanacker
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Antwerp University Hospital, Edegem, Belgium; AZ Groeninge Kortrijk, Antwerp University Hospital and University Antwerp, Antwerpen, Belgium
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Demeestere J, Scheldeman L, Cornelissen SA, Heye S, Wouters A, Dupont P, Christensen S, Mlynash M, Albers GW, Lansberg M, Lemmens R. Alberta Stroke Program Early CT Score Versus Computed Tomographic Perfusion to Predict Functional Outcome After Successful Reperfusion in Acute Ischemic Stroke. Stroke 2019; 49:2361-2367. [PMID: 30355098 DOI: 10.1161/strokeaha.118.021961] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 11/16/2022]
Abstract
Background and Purpose- We aimed to compare the ability of conventional Alberta Stroke Program Early CT Score (ASPECTS), automated ASPECTS, and ischemic core volume on computed tomographic perfusion to predict clinical outcome in ischemic stroke because of large vessel occlusion ≤18 hours after symptom onset. Methods- We selected patients with acute ischemic stroke from the CRISP study (Computed Tomographic Perfusion to Predict Response to Recanalization in Ischemic Stroke Project) with successful reperfusion (modified treatment in cerebral ischemia score 2b or 3). We used e-ASPECTS software to calculate automated ASPECTS and RAPID software to estimate ischemic core volumes. We studied associations between these imaging characteristics and good outcome (modified Rankin Scale score, 0-2) or poor outcome (modified Rankin Scale score, 4-6) in univariable and multivariable analysis, after adjustment for relevant clinical confounders. Results- We included 156 patients. Conventional and automated ASPECTS was not associated with good or poor outcome in univariable analysis ( P=nonsignificant for all). Automated ASPECTS was associated with good outcome in multivariable analysis ( P=0.02) but not with poor outcome. Ischemic core volume was associated with good ( P<0.01) and poor outcome ( P=0.04) in univariable and multivariable analysis ( P=0.03 and P=0.02, respectively). Computed tomographic perfusion predicted good outcome with an area under the curve of 0.62 (95% CI, 0.53-0.71) and optimal cutoff core volume of 15 mL. Conclusions- Ischemic core volume assessed on computed tomographic perfusion is a predictor of clinical outcome among patients in whom endovascular reperfusion is achieved ≤18 hours after symptom onset. In this population, conventional or automated ASPECTS did not predict outcome.
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Affiliation(s)
- Jelle Demeestere
- From the Division of Experimental Neurology, Department of Neurosciences (J.D., A.W., R.L.), Catholic University (KU) Leuven-University of Leuven, Belgium.,Flemish Institute for Biotechnology (VIB), Center for Brain and Disease Research, Laboratory of Neurobiology, Leuven, Belgium (J.D., A.W., R.L.).,Department of Neurology (J.D., L.S., A.W., R.L.), University Hospitals Leuven, Belgium
| | - Lauranne Scheldeman
- Department of Neurology (J.D., L.S., A.W., R.L.), University Hospitals Leuven, Belgium
| | | | - Sam Heye
- Department of Radiology, Jessa Hospital, Hasselt, Belgium (S.H.)
| | - Anke Wouters
- From the Division of Experimental Neurology, Department of Neurosciences (J.D., A.W., R.L.), Catholic University (KU) Leuven-University of Leuven, Belgium.,Flemish Institute for Biotechnology (VIB), Center for Brain and Disease Research, Laboratory of Neurobiology, Leuven, Belgium (J.D., A.W., R.L.).,Department of Neurology (J.D., L.S., A.W., R.L.), University Hospitals Leuven, Belgium
| | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology (P.D.), Catholic University (KU) Leuven-University of Leuven, Belgium
| | - Sören Christensen
- Stanford University and Stanford Stroke Center, Palo Alto, CA (S.C., M.M., G.W.A., M.L.)
| | - Michael Mlynash
- Stanford University and Stanford Stroke Center, Palo Alto, CA (S.C., M.M., G.W.A., M.L.)
| | - Gregory W Albers
- Stanford University and Stanford Stroke Center, Palo Alto, CA (S.C., M.M., G.W.A., M.L.)
| | - Maarten Lansberg
- Stanford University and Stanford Stroke Center, Palo Alto, CA (S.C., M.M., G.W.A., M.L.)
| | - Robin Lemmens
- From the Division of Experimental Neurology, Department of Neurosciences (J.D., A.W., R.L.), Catholic University (KU) Leuven-University of Leuven, Belgium.,Flemish Institute for Biotechnology (VIB), Center for Brain and Disease Research, Laboratory of Neurobiology, Leuven, Belgium (J.D., A.W., R.L.).,Department of Neurology (J.D., L.S., A.W., R.L.), University Hospitals Leuven, Belgium
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Gallieni M, Hollenbeck M, Inston N, Kumwenda M, Powell S, Tordoir J, Al Shakarchi J, Berger P, Bolignano D, Cassidy D, Chan TY, Dhondt A, Drechsler C, Ecder T, Finocchiaro P, Haller M, Hanko J, Heye S, Ibeas J, Jemcov T, Kershaw S, Khawaja A, Labriola L, Lomonte C, Malovrh M, Marti I Monros A, Matthew S, McGrogan D, Meyer T, Mikros S, Nistor I, Planken N, Roca-Tey R, Ross R, Troxler M, van der Veer S, Vanholder R, Vermassen F, Welander G, Wilmink T, Koobasi M, Fox J, Van Biesen W, Nagler E. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 35:1824. [PMID: 31325303 DOI: 10.1093/ndt/gfz153] [Citation(s) in RCA: 1] [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] [Indexed: 11/13/2022] Open
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Gallieni M, Hollenbeck M, Inston N, Kumwenda M, Powell S, Tordoir J, Al Shakarchi J, Berger P, Bolignano D, Cassidy D, Chan TY, Dhondt A, Drechsler C, Ecder T, Finocchiaro P, Haller M, Hanko J, Heye S, Ibeas J, Jemcov T, Kershaw S, Khawaja A, Labriola L, Lomonte C, Malovrh M, Marti I Monros A, Matthew S, McGrogan D, Meyer T, Mikros S, Nistor I, Planken N, Roca-Tey R, Ross R, Troxler M, van der Veer S, Vanholder R, Vermassen F, Welander G, Wilmink T, Koobasi M, Fox J, Van Biesen W, Nagler E. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 34:ii1-ii42. [PMID: 31192372 DOI: 10.1093/ndt/gfz072] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | | | | | - Jan Tordoir
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Davide Bolignano
- Institute of Clinical Physiology of the Italian National Council of Research, Reggio Calabria, Italy.,ERBP, guideline development body of ERA-EDTA, London, UK
| | | | | | | | - Christiane Drechsler
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Würzburg, Würzburg, Germany
| | - Tevfik Ecder
- Istanbul Bilim University School of Medicine, Istanbul, Turkey
| | | | - Maria Haller
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | - Sam Heye
- Jessa Hospital, Hasselt, Belgium
| | - Jose Ibeas
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Aurangzaib Khawaja
- Queen Elisabeth Hospital, University Hospitals Birmingham, West Midlands Deanery, Birmingham, UK
| | | | - Carlo Lomonte
- Miulli General Hospital, Acquaviva delle Fonti, Italy
| | | | | | | | | | | | | | - Ionut Nistor
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Medicine and Pharmacy, Iasi, Romania
| | - Nils Planken
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ramon Roca-Tey
- Hospital de Mollet, Fundació Sanitària Mollet, Barcelona, Spain
| | - Rose Ross
- Ninewells Hospital Scotland, Dundee, UK
| | | | | | | | | | | | - Teun Wilmink
- Heart of England NHS foundation Trust, Birmingham, UK
| | - Muguet Koobasi
- ERBP, guideline development body of ERA-EDTA, London, UK
| | - Jonathan Fox
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Glasgow, UK
| | - Wim Van Biesen
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ghent University Hospital, Ghent, Belgium
| | - Evi Nagler
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ghent University Hospital, Ghent, Belgium
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Niknejad HR, van der Zwan A, Heye S, Van Calenbergh F, Van Loon J. The Value of the Middle Meningeal Artery in Cerebrovascular Bypass Surgery: An Anatomic Feasibility Study. Oper Neurosurg (Hagerstown) 2017; 15:89-96. [DOI: 10.1093/ons/opx200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Over the past decade, there has been a revival and a renewed interest for cerebrovascular bypass procedures. The superficial temporal artery (STA) has its value as a reliable donor vessel; however, a possible role for the middle meningeal artery (MMA) as a donor artery is still unclear.
OBJECTIVE
To assess the feasibility of using the MMA as a donor vessel in cerebrovascular surgery.
METHODS
We performed cadaveric dissections on 12 fresh specimens (23 sides) after bilateral silicone injection into the internal and external carotid arteries. We compared the size, diameter, and possibility to perform a bypass to the middle cerebral artery for both the MMA and the STA. Measurements were done using an electrical caliper. Additional measurements of the MMA and STA were performed on 20 random angiograms.
RESULTS
There was no statistically significant difference in diameter of the MMA at its ostium being 2.4 mm, compared to 2.7 mm for the STA ostium (t-test; P = .21). The MMA could be mobilized over 4.1 cm, whereas the STA over 8.3 cm. Finally, the mean diameter of the donor vessel at the site of the anastomosis was 1.6 mm versus 1.9 mm for MMA and STA, respectively (P = .0026). We were able to perform an MMA and middle cerebral artery anastomosis on 17 sides.
CONCLUSION
These results suggest that the MMA is a potentially valuable donor vessel to be used in selected cases. The availability of a suitable MMA branch should be assessed preoperatively on the angiogram.
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Affiliation(s)
| | - Albert van der Zwan
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sam Heye
- Department of interventional neuroradiology, University Hospitals Leuven, Belgium
| | | | - Johannes Van Loon
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Vander Mijnsbrugge W, Laleman W, Van Steenbergen W, Heye S, Verslype C, Maleux G. Long-term clinical and radiological outcome of endovascular embolization of pancreatitis-related pseudoaneurysms. Acta Radiol 2017; 58:316-322. [PMID: 27178033 DOI: 10.1177/0284185116648502] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 12/17/2022]
Abstract
Background Long-term outcome after embolization of pancreatitis-induced pseudoaneurysm is not yet determined. Purpose To assess the long-term efficacy and patients' overall survival after embolization of pancreatitis-induced pseudoaneurysm. Material and Methods Patients referred for endovascular treatment of a pancreatitis-induced pseudoaneurysm between January 1998 and January 2014 were analyzed. Embolization procedures were performed by transcatheter techniques using different types of embolic agents. Demographic, technical-radiological, and clinical data were collected. Results Thirty-four patients were identified with a pancreatitis-induced pseudoaneurysm; the underlying disease was acute (n = 13; 38%) or chronic (n = 21; 62%) pancreatitis; seven patients (20.6%) had active bleeding when embolized, while in the remaining 27 patients (79.4%) the pseudoaneurysm was not bleeding. In all 34 patients, successful endovascular exclusion of the pseudoaneurysm was obtained after the first attempt. Minor complications occurred in 11 patients (30%); no major complications were noted. A new pseudoaneurysm on a different vessel was identified during follow-up in three patients (9%). In another patient (3%), the excluded pseudoaneurysm reopened during follow-up. All four recurrences occurred within the first 5 months after embolization. Long-term follow-up (mean, 6.6 years; range, 4 months-16 years) revealed estimated survival rates of 94%, 89%, and 75% after 2, 5, and 10 years respectively, without pseudoaneurysm-related death. Conclusion Catheter-directed embolization of pancreatitis-induced pseudoaneurysms is relatively safe and effective. Recurrence or new pseudoaneurysm formation was low and occurred within the first 6 months after embolization. Overall survival is high, with no pseudoaneurysm-related deaths.
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Affiliation(s)
| | - Wim Laleman
- Department of Hepatology, University Hospitals Leuven, Belgium
| | | | - Sam Heye
- Department of Radiology, University Hospitals Leuven, Belgium
| | - Chris Verslype
- Department of Hepatology, University Hospitals Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium
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13
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De Keyzer B, Nevens F, Laenen A, Heye S, Laleman W, Verslype C, van der Merwe S, Maleux G. Percutaneous shunt reduction for the management of TIPS-induced acute liver decompensation: A follow-up study. Ann Hepatol 2016; 15:911-917. [PMID: 27740526 DOI: 10.5604/16652681.1222110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Background and rationale for the study. The purpose of this study was to assess the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) reduction for the management of TIPS-induced acute liver decompensation. Between August 2000 and November 2013, 347 patients underwent a TIPS procedure in the authors' institution; 21/347 (6%) developed post-TIPS acute liver decompensation which was managed using a percutaneous shunt reduction technique. Patient demographics, laboratory tests before and after initial TIPS and TIPS reduction, procedural data and clinical follow-up data were analysed. RESULTS Twenty-one patients (mean age 63 years) who underwent an initial TIPS procedure for variceal bleeding (n = 7; 33%) or refractory ascites (n = 14; 67%) successfully underwent shunt reduction ten days (3-34 days) after the initial TIPS procedure. The portosystemic pressure gradient (PSPG) increased from 8 (3-17) mmHg before reduction to 12 (7-23) mmHg after shunt reduction. Survival at one and six months follow-up was 15 (71%) and 11 patients (52%), respectively. The international normalised ratio (INR) (1.7 vs. 1.5; p = 0.044) was significantly different after TIPS reduction in the non-survival group compared to the survival group. In conclusion, TIPS reduction for the management of TIPS-induced acute liver decompensation is technically feasible and is associated with a one and six-month mortality rate of 29% and 48%, respectively. Higher post-TIPS-reduction INR values may be associated with higher risk of early mortality.
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Affiliation(s)
- Bart De Keyzer
- Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven and Hasselt University, Belgium
| | - Sam Heye
- Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium
| | - Chris Verslype
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium
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14
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De Beule T, Van Deun W, Vranckx J, de Dobbelaere B, Maleux G, Heye S. Anatomical variations and pre-operative imaging technique concerning the anterolateral thigh flap: guiding the surgeon. Br J Radiol 2016; 89:20150920. [PMID: 27150071 DOI: 10.1259/bjr.20150920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The anterolateral thigh (ALT) flap has widespread use throughout the body because of the many engineering options. The ALT has a complex local vasculature, which can be of importance for the surgical approach. In general, the flap receives its perfusion from branches of the lateral circumflex femoral artery (LCFA). The LCFA, however, has a large anatomic variance. CT angiography can guide the surgeon in the selection of the most suitable site and aid in the surgical approach.
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Affiliation(s)
- Tom De Beule
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Van Deun
- 2 Department of Reconstructive and Plastic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Vranckx
- 2 Department of Reconstructive and Plastic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart de Dobbelaere
- 3 Medical Imaging Research Centre (Louvre/MiRC), University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sam Heye
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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15
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Maleux G, Vertenten B, Laenen A, De Wever L, Heye S, Clement P, Oyen R. Palliative endovascular treatment of cancer-related iliocaval obstructive disease: technical and clinical outcomes. Acta Radiol 2016; 57:451-6. [PMID: 25907119 DOI: 10.1177/0284185115582059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/21/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cancer-related obstruction of large abdominal and pelvic veins might become symptomatic with clinical signs of lower limb venous congestion. Technical and clinical outcome after interventional treatment is not well studied yet. PURPOSE To retrospectively assess the technical and clinical outcome of endovascular management of symptomatic cancer-related iliocaval venous obstructive disease. MATERIAL AND METHODS From 1998 to 2013, 19 patients (15 men, 4 women; mean age, 63.6 years) referred for interventional treatment of cancer-related iliocaval obstructive disease were identified. Patients' symptoms included unilateral (n = 16; 84%) or bilateral (n = 3; 16%) painful swelling of the lower limbs. Patients' demographics as well as interventional and clinical outcome data were collected. RESULTS All 19 patients underwent, under local anesthesia, stenting of the iliac vein (n = 16; 84%) or inferior vena cava (n = 3; 16%). Immediate technical success (n = 19) was 100%; immediate clinical success (n = 18) was 94.7%. During follow-up, seven patients (36.8%) presented with recurrent symptoms of painful limb swelling. Estimated survival after 3 and 6 months was 68.4% (95% confidence interval [CI], 47.8-82.3%) and 19.8% (95% CI, 11.9-29.2%), respectively. CONCLUSION Endovascular stenting of cancer-related iliocaval venous obstructive disease is safe and results in immediate relief of symptoms. However, recurrent venous obstruction is common. At 3 months follow-up, the majority of patients with iliac vein stenting were still alive.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
| | - Bart Vertenten
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and Universiteit Hasselt, Leuven, Belgium
| | - Liesbeth De Wever
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
| | - Sam Heye
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
| | - Paul Clement
- Department of General Oncology, University Hospitals Leuven, Belgium
| | - Raymond Oyen
- Department of Radiology, University Hospitals Leuven – Department of Imaging and Pathology, KU Leuven, Belgium
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16
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Viaene L, Behets GJ, Heye S, Claes K, Monbaliu D, Pirenne J, D'Haese PC, Evenepoel P. Inflammation and the bone-vascular axis in end-stage renal disease. Osteoporos Int 2016; 27:489-97. [PMID: 26294291 DOI: 10.1007/s00198-015-3233-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Bone loss and vascular calcification coincide in patients with end-stage renal disease, similar as to what is observed in the general population. In the present bone biopsy study, we provide further evidence that (micro-)inflammation may represent a common soil for both diseases. INTRODUCTION Vascular calcification is a common complication of end-stage renal disease (ESRD) and is predictive of subsequent cardiovascular disease and mortality. Mounting evidence linking bone disorders with vascular calcification has contributed to the development of the concept of the bone-vascular axis. Inflammation is involved in the pathogenesis of both disorders. The aim of the present study was to evaluate the relationship between aortic calcification, inflammation, and bone histomorphometry in patients with ESRD. METHODS Parameters of inflammation and mineral metabolism were assessed in 81 ESRD patients (55 ± 13 year, 68 % male) referred for renal transplantation. Static bone histomorphometry parameters were determined on transiliac bone biopsies performed during the transplant procedure. Aortic calcification was quantified on lateral lumbar X-rays using the Kauppila method. RESULTS Aortic calcification, low bone turnover, and low bone area were observed in 53, 37, and 21 % of patients respectively. Inflammatory markers were found to be independently associated with aortic calcification (hsIL-6) and low bone area (TNF-α). Low bone area associated with aortic calcification, independent of age, diabetes, and inflammation. CONCLUSIONS Low bone area and inflammation associates with aortic calcification, independent of each other and traditional risk factors. Our data emphasize the role of (micro-)inflammation in the bone-vascular axis in CKD.
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Affiliation(s)
- L Viaene
- Department of Nephrology, Catholic University Leuven, KU Leuven, Belgium
| | - G J Behets
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
| | - S Heye
- Department of Radiology, University Hospitals Leuven, KU Leuven, Belgium
| | - K Claes
- Department of Nephrology, Catholic University Leuven, KU Leuven, Belgium
| | - D Monbaliu
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Belgium
| | - J Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Belgium
| | - P C D'Haese
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
| | - P Evenepoel
- Department of Nephrology, Catholic University Leuven, KU Leuven, Belgium.
- Dienst nefrologie, Universitair Ziekenhuis Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
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17
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Maleux G, Deroose C, Laenen A, Verslype C, Heye S, Haustermans K, De Hertogh G, Sagaert X, Topal B, Aerts R, Prenen H, Vanbeckevoort D, Vandecaveye V, Van Cutsem E. Yttrium-90 radioembolization for the treatment of chemorefractory colorectal liver metastases: Technical results, clinical outcome and factors potentially influencing survival. Acta Oncol 2015; 55:486-95. [PMID: 26625262 DOI: 10.3109/0284186x.2015.1101151] [Citation(s) in RCA: 21] [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: 12/31/2022]
Abstract
BACKGROUND The purpose of this study was to retrospectively assess the technical and clinical outcomes, overall survival and prognostic factors for prolonged survival after yttrium-90 ((90)Y) radioembolization as a salvage therapy for patients with chemorefractory liver-only or liver-dominant colorectal metastases. MATERIAL AND METHODS From January 2005 to January 2014, all the patients selected for (90)Y radioembolization to treat chemorefractory colorectal liver metastases were identified. Demographic, laboratory, imaging and dosimetry data were collected. Post-treatment technical and clinical outcomes were analyzed as well as overall survival; finally several factors potentially influencing survival were analyzed. RESULTS In total 88 patients were selected for angiographic workup; 71 patients (81%) finally underwent catheter-directed (90)Y microsphere infusion into the hepatic artery 25 days (standard deviation 13 days) after angiographic workup. Median infused activity was 1809 MBq; 30-day toxicity included: fatigue (n = 39; 55%), abdominal discomfort (n = 33; 47%), nausea (n = 5; 7%), fever (n = 14; 20%), diarrhea (n = 6; 9%), liver function abnormalities and elevated bilirubin (transient) (n = 3; 4%). Gastric ulcer was found in five patients (7%). A late complication was radioembolization-induced portal hypertension (REIPH) in three patients (4%). Median time to progression in the liver was 4.4 months. Estimated survival at six and 12 months was 65% and 30%, respectively, with a 50% estimated survival after 8.0 months in this group of chemorefractory patients. Prognostic factors for worse survival were high preprocedural bilirubin, alkaline phosphatase and tumor volume levels. CONCLUSION (90)Y microsphere radioembolization for chemorefractory colorectal liver metastases has an acceptable safety profile with a 50% estimated survival after 8.0 months. Pretreatment high bilirubin, alkaline phosphatase and tumor volume levels were associated with early death.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium
| | | | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven and University Hasselt, Belgium
| | - Chris Verslype
- Department of Gastroenterology, University Hospitals Leuven, Belgium
| | - Sam Heye
- Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Belgium
| | - Xavier Sagaert
- Department of Pathology, University Hospitals Leuven, Belgium
| | - Baki Topal
- Department of Abdominal Surgery, University Hospitals Leuven, Belgium
| | - Raymond Aerts
- Department of Abdominal Surgery, University Hospitals Leuven, Belgium
| | - Hans Prenen
- Department of Gastroenterology, University Hospitals Leuven, Belgium
| | - Dirk Vanbeckevoort
- Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium
| | - Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium
| | - Eric Van Cutsem
- Department of Gastroenterology, University Hospitals Leuven, Belgium
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18
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Ceulemans LJ, Jochmans I, Monbaliu D, Verhaegen M, Laleman W, Nevens F, Heye S, Maleux G, Pirenne J. Preoperative arterial embolization facilitates multivisceral transplantation for portomesenteric thrombosis. Am J Transplant 2015; 15:2963-9. [PMID: 26015088 DOI: 10.1111/ajt.13336] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/02/2015] [Accepted: 03/25/2015] [Indexed: 01/25/2023]
Abstract
Multivisceral transplantation (MvTx) for diffuse venous portomesenteric thrombosis is a surgically and anesthesiologically challenging procedure, partly because of the risk of massive bleeding during visceral exenteration. Preoperative visceral artery embolization might reduce this risk. In three consecutive MvTx, the celiac trunk (CT) and superior mesenteric artery (SMA) were embolized immediately pretransplant. We analyzed demographics, serum D-lactate, pH, base excess, hemoglobin, blood pressure, transfused packed cell (PC) units, intervention time and outcome. Results are reported as median (range). All recipients were male (43, 22, 47 years old). Portomesenteric thrombosis followed antiphospholipid syndrome, neuroendocrine tumor and liver cirrhosis. A peritransplant D-lactate peak of 6.1 (5.1-7.6) mmol/L, lowest pH of 7.24 (7.18-7.36) and lowest base excess level of -9.5 (-7.6 to -11.5) were observed. Values normalized within 3 h posttransplant. Embolization and exenteration times were 80 (70-90) min and 140 (130-165) min, respectively, during which blood pressure remained stable, lowest hemoglobin was 6.1 (6.1-7.6) g/dL and three (2-4) PC were administered. All procedures were uneventful. Follow-up was 7 (4-9) months. The first patient died 4 months post-MvTx after an intracranial bleeding; the other patients are doing well. Our experience suggests that preoperative embolization of CT and SMA facilitates native organ resection in MvTx.
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Affiliation(s)
- L J Ceulemans
- Abdominal Transplant Surgery, University Hospitals Leuven, & Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - I Jochmans
- Abdominal Transplant Surgery, University Hospitals Leuven, & Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - D Monbaliu
- Abdominal Transplant Surgery, University Hospitals Leuven, & Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - M Verhaegen
- Anaesthesiology, University Hospitals Leuven, & Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - W Laleman
- Hepatology, University Hospitals Leuven, & Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - F Nevens
- Hepatology, University Hospitals Leuven, & Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - S Heye
- Radiology, University Hospitals Leuven, & Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - G Maleux
- Radiology, University Hospitals Leuven, & Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - J Pirenne
- Abdominal Transplant Surgery, University Hospitals Leuven, & Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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19
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Heylen L, Naesens M, Jochmans I, Monbaliu D, Lerut E, Claes K, Heye S, Verhamme P, Coosemans W, Bammens B, Evenepoel P, Meijers B, Kuypers D, Sprangers B, Pirenne J. The effect of anastomosis time on outcome in recipients of kidneys donated after brain death: a cohort study. Am J Transplant 2015; 15:2900-7. [PMID: 26484837 DOI: 10.1111/ajt.13397] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 01/30/2015] [Revised: 05/19/2015] [Accepted: 05/23/2015] [Indexed: 01/25/2023]
Abstract
Whether warm ischemia during the time to complete the vascular anastomoses determines renal allograft function has not been investigated systematically. We investigated the effect of anastomosis time on allograft outcome in 669 first, single kidney transplantations from brain-dead donors. Anastomosis time independently increased the risk of delayed graft function (odds ratio per minute [OR] 1.05, 95% confidence interval [CI] 1.02-1.07, p < 0.001) and independently impaired allograft function after transplantation (p = 0.009, mixed-models repeated-measures analysis). In a subgroup of transplant recipients, protocol-specified biopsies at 3 months (n = 186), 1 year (n = 189), and 2 years (n = 153) were blindly reviewed. Prolonged anastomosis time independently increased the risk of interstitial fibrosis and tubular atrophy on these protocol-specified biopsies posttransplant (p < 0.001, generalized linear models). In conclusion, prolonged anastomosis time is not only detrimental for renal allograft outcome immediately after transplantation, also longer-term allograft function and histology are affected by the duration of this warm ischemia.
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Affiliation(s)
- L Heylen
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - M Naesens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - I Jochmans
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - D Monbaliu
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - E Lerut
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - K Claes
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - S Heye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - P Verhamme
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - W Coosemans
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - B Bammens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - P Evenepoel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - B Meijers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - D Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - B Sprangers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - J Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium
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20
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Swinnen B, Schreurs A, Heye S, Lemmens R. Limb-shaking TIA during balloon test occlusion of the internal carotid artery. Acta Neurol Belg 2015; 115:449-51. [PMID: 25283769 DOI: 10.1007/s13760-014-0366-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/18/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Bart Swinnen
- Department of Neurology, University Hospitals Leuven, University of Leuven and VIB, Herestraat 49, 3000, Leuven, Belgium
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21
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Terry C, Yazar O, Heye S, Fourneau I. TEVAR for Ruptured type B Aortic Dissection in a Patient with Turner Syndrome. Acta Chir Belg 2015; 115:314-6. [PMID: 26324036 DOI: 10.1080/00015458.2015.11681119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
TEVAR has replaced open surgical repair as preferred treatment for complicated acute type B aortic dissection. But the literature on thoracic endovascular aortic repair (TEVAR) for ruptured type B dissection is scarce. Patients with Turner syndrome are at risk for aortic dissection and rupture at a young age with an immediate mortality rate of 63%. Only a few cases have been described and the best treatment is not yet established. We present a case of a 49 year-old woman with Turner syndrome who suffered from a ruptured aortic dissection Stanford type B. A TEVAR procedure was performed, but the life of the patient could not be saved. In this case report we discuss the lessons we learned as well as some unsolved questions about TEVAR for ruptured type B aortic dissection.
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22
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Martens P, Maleux GA, Devos T, Monbaliu D, Heye S, Verslype C, Laleman W, Cassiman D, Van der Merwe SW, Van Steenbergen W, Jochmans I, Aerts R, Pirenne J, Nevens F. Budd-Chiari syndrome: reassessment of a step-wise treatment strategy. Acta Gastroenterol Belg 2015; 78:299-305. [PMID: 26448411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND STUDY AIMS The Budd-Chiari syndrome is a rare disorder characterized by hepatic venous outflow obstruction. A step-wise management was recently proposed. The aim of this study is to reassess our treatment approach and long-term outcome. PATIENTS AND METHODS The data of 37 Budd-Chiari patients, seen in our unit, were critically analyzed and compared with the ENVIE (European Network For Vascular Disorders of the Liver) data. RESULTS Most patients had multiple prothrombotic conditions (41%), of which an underlying myeloproliferative neoplasm was the most frequent (59%). The JAK2V617F mutation was associated with more complete occlusion of all hepatic veins (JAK2 mutation +: 70% vs JAK2 mutation -: 23% and a higher severity score. The step-wise treatment algorithm used in our unit, in function of the severity of the liver impairment and the number and the extension of hepatic veins occluded, resulted in the following treatments: only anticoagulation (n = 7.21%), recanalization procedure (n = 4.21%), portosystemic shunts (n = 9.26%) and liver transplantation (n = 14.44%). This resulted in a 10 year survival rate of 90%. Treatment of the underlying hemostatic disorder offered a low recurrence rate. None of the 21 patients with a myeloproliferative neoplasm died in relation to the hematologic disorder. CONCLUSIONS An individualized treatment regimen consisting of anticoagulation and interventional radiology and/or transplantation when necessary and strict follow-up of the underlying hematologic disorder, provided an excellent long-term survival, which confirm the data of the ENVIE study.
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Maleux G, Van Camp L, Houthoofd S, Heye S, Fourneau I. Endurant endograft limb occlusion associated with a floating thrombus: a word of caution. J Vasc Interv Radiol 2015; 26:918-20. [PMID: 26003460 DOI: 10.1016/j.jvir.2015.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Geert Maleux
- Departments of RadiologyUniversity Hospitals Leuven, Herestraat 49, B-3000 Leuven; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Laurent Van Camp
- Departments of RadiologyUniversity Hospitals Leuven, Herestraat 49, B-3000 Leuven; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Departments of RadiologyUniversity Hospitals Leuven, Herestraat 49, B-3000 Leuven; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Sam Heye
- Vascular Surgery University Hospitals Leuven, Herestraat 49, B-3000 Leuven
| | - Inge Fourneau
- Vascular Surgery University Hospitals Leuven, Herestraat 49, B-3000 Leuven
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Peeters K, Heye S, Dewever L, Claes K, Fourneau I. Hemodialysis access-induced ischemia is not related to configuration and access flow rates of upper arm arteriovenous fistulas at the elbow. Ann Vasc Surg 2015; 29:682-9. [PMID: 25656688 DOI: 10.1016/j.avsg.2014.11.012] [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] [Received: 07/04/2014] [Revised: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of the study was to find a relationship between the configuration of autogenous upper arm arteriovenous fistulas (AVFs) at the elbow and high access flow rates. METHODS Forty-seven patients with well-functioning autogenous upper arm AVFs at the elbow were included. The configuration of the AVF and access flow rate was determined by duplex scanning. RESULTS Hemodialysis access-induced distal ischemia scores and access flow rates were comparable in AVFs with 1 or 2 efferent veins (1829.9 ± 1121.3 mL/min, range [400-5000] vs. 1988.5 ± 1324.5 mL/min, range [130-5000]; P = 0.61). The basilic vein had statistically significant larger diameters than the cephalic vein (8.1 ± 2.7 mm, range [2.7-11.0] vs. 5.8 ± 2.5 mm, range [3.8-13.0]; P = 0.02), but no statistically significant difference in flow rates were observed (1884.5 ± 889.0 mL/min, range [824-3600] vs. 1130.0 ± 1258.4 mL/min, range [400-5000]; P = 0.53). Access flow rates were higher in AVFs with the brachial artery as afferent artery than when the radial artery was used (1909.5 ± 1273.2 mL/min, range [550-5000] vs. 1188.6 ± 642.7 mL/min, range [130-2800]; P = 0.02). CONCLUSIONS There is no difference in access flow rates in autogenous AVFs at the elbow with 1 or 2 efferent veins. Autogenous AVFs at the elbow on the radial artery have lower access flow rates than AVFs on the brachial artery.
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Affiliation(s)
- Karen Peeters
- Department of Vascular Surgery, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Sam Heye
- Department of Radiology, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth Dewever
- Department of Radiology, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Claes
- Department of Nephrology, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium.
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Maleux G, De Coster B, Laenen A, Vaninbroukx J, Meijers B, Claes K, Fourneau I, Heye S. Percutaneous Rheolytic Thrombectomy of Thrombosed Autogenous Dialysis Fistulas. J Endovasc Ther 2015; 22:80-6. [DOI: 10.1177/1526602814566378] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To retrospectively analyze the technical and clinical outcome of percutaneous rheolytic thrombectomy with the use of the AngioJet device in thrombosed autogenous arteriovenous dialysis fistulas. Methods: A cohort of 38 consecutive patients (24 men; mean age 70.7±13.8 years) presenting with 59 thrombotic events in 39 autogenous dialysis fistulas were retrospectively analyzed. The AngioJet rheolytic thrombectomy device was used in all cases. Adjunctive therapies, as well as procedure-related complications, were noted. Primary, assisted primary, and secondary patency of the autogenous fistulas was assessed along with factors potentially influencing patency. Results: Initial technical success to recanalize the efferent vein was 100% (n=59), and a successful postprocedure dialysis session was possible in 97% (n=57) of cases. Adjunctive procedures included percutaneous thromboaspiration (n=4, 7%), balloon angioplasty (n=59, 100%), and stent placement (n=16, 27%). Complications related to thrombectomy occurred in 3 (5%) procedures (distal arterial embolus). Primary, assisted primary, and secondary patency rates at 12 months were 56.1% (95% CI 42.8% to 75.2%), 61.6% (95% CI 48.6% to 74.7%), and 86.2% (95% CI 74.9% to 97.5%), respectively. Risk factors for early fistula occlusion were greater patient age (p=0.045), the age of the fistula (p=0.045), previous stent insertion (p=0.019), and an upper arm fistula (p=0.047). Conclusion: Percutaneous rheolytic thrombectomy of autogenous dialysis fistulas is effective in restoring patency and allowing subsequent hemodialysis. The complication rate is acceptably low, and the large majority of the fistulas are still used for hemodialysis at 1-year follow-up. Older fistulas and upper arm fistulas are at higher risk for early rethrombosis.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven / Department of Imaging & Pathology, KU Leuven, Belgium
| | - Bruno De Coster
- Department of Radiology, University Hospitals Leuven / Department of Imaging & Pathology, KU Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and Universiteit Hasselt, Belgium
| | - Johan Vaninbroukx
- Department of Radiology, University Hospitals Leuven / Department of Imaging & Pathology, KU Leuven, Belgium
| | - Björn Meijers
- Department of Nephrology, University Hospitals, Leuven, Belgium
| | - Kathleen Claes
- Department of Nephrology, University Hospitals, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals, Leuven, Belgium
| | - Sam Heye
- Department of Radiology, University Hospitals Leuven / Department of Imaging & Pathology, KU Leuven, Belgium
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Heye S, Stracke CP, Nordmeyer H, Heddier M, Stauder M, Chapot R. Retrograde access to the posterior inferior cerebellar artery in balloon-assisted coiling of posterior inferior cerebellar artery aneurysms. J Neurointerv Surg 2014; 7:824-8. [PMID: 25261442 DOI: 10.1136/neurintsurg-2014-011417] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/11/2014] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Balloon-assisted coil embolization of proximal posterior inferior cerebellar artery (PICA) aneurysms may be limited by the inferiorly oriented, acutely angulated origin of the PICA from the vertebral artery. The aim of this study is to evaluate retrograde access to the PICA via the contralateral vertebral artery or the posterior communicating artery. METHODS Twenty-nine proximal PICA aneurysms treated by balloon remodeling with navigation of the balloon in the PICA via the contralateral vertebral artery or posterior communicating artery were found in our database between January 2007 and December 2013 and were reviewed. RESULTS Access to the PICA was made via the contralateral vertebral artery in 26 patients (90%), six of them (23%) with a hypoplastic V4 segment. In three patients (10%) the retrograde approach was made via the posterior communicating artery. After balloon remodeling, additional stenting was performed in 16 patients (55%). The complication rate was 3% (1 acute stent thrombosis). Grade 0 or 1 occlusion was obtained in all patients at completion angiography. No recurrence was found during follow-up. CONCLUSIONS Retrograde access to the PICA to perform balloon-assisted coil embolization of proximal PICA aneurysms with or without additional stenting after coiling is safe and effective. Hypoplastic V4 segment of the contralateral vertebral artery is not a contraindication.
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Affiliation(s)
- Sam Heye
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany Department of Radiology, UZ Leuven, Leuven, Belgium Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Christian Paul Stracke
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany
| | - Hannes Nordmeyer
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany
| | - Markus Heddier
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany
| | - Michael Stauder
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany
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Maleux G, Bielen J, Laenen A, Heye S, Vaninbroukx J, Laleman W, Verhamme P, Wilmer A, Van Steenbergen W. Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome. Eur Radiol 2014; 24:2779-86. [PMID: 25063394 DOI: 10.1007/s00330-014-3332-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/25/2014] [Accepted: 07/08/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE To retrospectively analyse the technical and clinical outcomes of embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy, and in addition, to analyse factors potentially influencing 30-day mortality. MATERIALS AND METHODS From November 1998 to November 2012, 34 patients underwent percutaneous embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic treatment. Demographic, laboratory, angiographic, and clinical follow-up data were collected. RESULTS Indication for initial endoscopic sphincterotomy was benign (n = 28) or malignant (n = 6) disease. A precut sphincterotomy followed by sphincterotomy was performed in 13 patients (38 %), whereas the remaining 21 patients (62 %), underwent only sphincterotomy. Seven patients (20.6 %) were still on antithrombotic medication at the time of sphincterotomy. Angiographic evaluation revealed contrast extravasation (n = 31), pseudoaneurysm (n = 2), or a combination of both (n = 1). Embolization was successful in 33 of 34 patients (97 %). Recurrent bleeding occurred in three patients (9 %), and 30-day mortality was 20.6 % (n = 7). Factors significantly influencing 30-day mortality were INR (P = 0.008) and aPTT (P = 0.012). CONCLUSION Angiographic embolization is very effective in stopping post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy. The rate of rebleeding is acceptably low, but 30-day mortality remains significant. Haemostatic disorders appear to significantly influence 30-day survival. KEY POINTS • Transcatheter embolization is very effective in stopping major post-biliary sphincterotomy bleeding • The rate of rebleeding is acceptably low • Haemostatic disorders appear to significantly influence 30-day survival.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium,
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Maleux G, Michielsen K, Timmerman D, Poppe W, Heye S, Vaninbroukx J, Bosmans H. 2D versus 3D roadmap for uterine artery catheterization: impact on several angiographic parameters. Acta Radiol 2014; 55:62-70. [PMID: 23873889 DOI: 10.1177/0284185113492457] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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 Three-dimensional (3D) roadmap is a recently developed imaging technique used to guide diagnostic and interventional catheter-directed procedures and mainly evaluated for neurovascular procedures. Few data with regard to efficacy and radiation dose are currently available in literature. PURPOSE To evaluate the use of 3D roadmap technique as compared with the conventional two-dimensional (2D) roadmap for uterine artery catheterization and embolization during uterine fibroid embolization and assess the potential impact on radiation dose, contrast load, and total procedure time. MATERIAL AND METHODS In this prospective study, 40 patients were randomly assigned to the 2D or 3D roadmap technique for uterine artery catheterization. Demographic data, specifically the patient's age, weight, height, pelvic circumference, and total uterine and fibroid volume were recorded. Exposure parameters, contrast load, and procedure time were recorded and organ doses for ovaries and uterus were calculated. RESULTS Demographic data did not differ between the groups. Catheterization and embolization of both uterine arteries were feasible in all patients, although in one patient in the 3D group, a focal dissection of the proximal uterine artery occurred. No significant difference in estimated ovarian dose was found in the 3D versus 2D group (P = 0.07). Total procedure time was shorter in the 2D group (P = 0.01) and no difference in total contrast load was seen (P = 0.17). CONCLUSION Both roadmap techniques are effective imaging-guided tools for uterine artery catheterization, without difference in terms of radiation exposure or contrast load. The total procedure time is shorter in the 2D group.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, section of Interventional Radiology, University Hospitals Leuven, Belgium
| | - Koen Michielsen
- Department of Radiology, section of Medical Physics, University Hospitals Leuven, Belgium
| | - Dirk Timmerman
- Department of Gynaecology, University Hospitals Leuven, Belgium
| | - Willy Poppe
- Department of Gynaecology, University Hospitals Leuven, Belgium
| | - Sam Heye
- Department of Radiology, section of Interventional Radiology, University Hospitals Leuven, Belgium
| | - Johan Vaninbroukx
- Department of Radiology, section of Interventional Radiology, University Hospitals Leuven, Belgium
| | - Hilde Bosmans
- Department of Radiology, section of Medical Physics, University Hospitals Leuven, Belgium
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Dekervel J, van Malenstein H, Vandecaveye V, Nevens F, van Pelt J, Heye S, Laleman W, Van Steenbergen W, Vaninbroukx J, Verslype C, Maleux G. Transcatheter arterial chemoembolization with doxorubicin-eluting superabsorbent polymer microspheres in the treatment of hepatocellular carcinoma: midterm follow-up. J Vasc Interv Radiol 2013; 25:248-55.e1. [PMID: 24295569 DOI: 10.1016/j.jvir.2013.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/11/2013] [Accepted: 10/12/2013] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate prospectively the safety, tolerability, and efficacy of transarterial chemoembolization using superabsorbent polymer (SAP) microspheres loaded with doxorubicin for the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS During the years 2006-2011, 64 patients underwent 144 transarterial chemoembolization with SAP microspheres procedures. Most of the patients were staged as Barcelona Clinic Liver Cancer class B (65%). The most frequent underlying liver diseases were hepatitis C (35%) and alcoholic liver disease (28%) resulting in Child-Pugh A (73.4%) or Child-Pugh B (17%) liver cirrhosis. Tumor response was assessed using modified Response Evaluation Criteria in Solid Tumors with magnetic resonance (MR) imaging performed 4-6 weeks after each procedure. RESULTS Serious adverse events (n = 9) were ischemic or infectious in nature. Transarterial chemoembolization with SAP microspheres resulted in objective response rates of 67.5%, 44.5%, and 25% after first, second, and third sessions. There were 16 patients (25%) who underwent orthotopic liver transplantation after transarterial chemoembolization with SAP microspheres, of whom 2 experienced recurrent disease. During a median follow-up time of 14 months (range, 2-55 mo), 26 patients (40.5%) died. Median overall and transplant-free survivals were 20.5 months (95% confidence interval, 13.2-27.7) and 18 months (95% confidence interval, 14.2-21.8), respectively. CONCLUSIONS Transarterial chemoembolization with SAP microspheres has an excellent safety profile in cirrhotic patients, even in the presence of advanced liver disease (Child-Pugh B) or advanced stages of HCC. This treatment produced meaningful tumor response rates as assessed by MR imaging.
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Affiliation(s)
- Jeroen Dekervel
- Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
| | - Hannah van Malenstein
- Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
| | | | - Frederik Nevens
- Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
| | - Jos van Pelt
- Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
| | - Sam Heye
- Department of Radiology, University Hospitals Leuven, Herestraat 49
| | - Wim Laleman
- Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
| | - Werner Van Steenbergen
- Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
| | | | - Chris Verslype
- Department of Hepatology, University Hospitals Leuven, Herestraat 49; Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49.
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Maleux G, Hoffman I, Heye S, Cassiman D. Focal portal vein stenosis in an adolescent potentially related to complicated umbilical catheter insertion in the neonatal period. Acta Radiol Short Rep 2013; 2:2047981613492723. [PMID: 24198960 PMCID: PMC3805426 DOI: 10.1177/2047981613492723] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/13/2013] [Indexed: 11/25/2022] Open
Abstract
A 14-year-old girl, with no medical history except for a preterm birth at 7 months, presented with clinical and laboratory signs of pancytopenia. Radiological investigation, including abdominal ultrasound and magnetic resonance imaging revealed a focal irregular main portal vein wall and splenomegaly. Endoscopy showed major esophageal and gastric varices. Definitive diagnosis was made by direct, transhepatic portography revealing a focal stenosis associated with a dissection of the main portal vein. Percutaneous treatment including balloon angioplasty and stent placement resulted in complete re-expansion of the portal vein main branch. Clinical and radiological follow-up over 5 years showed complete disappearance of all clinical signs and normalization of laboratory data and splenic volume.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, UZ Leuven/Department of Imaging & Pathology, KU Leuven
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Van Holsbeeck A, Thijs M, Bielen D, Heye S, Maleux G. Sonographic evaluation of transjugular intrahepatic portosystemic shunt. JBR-BTR 2013; 96:275-281. [PMID: 24479286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this article is to review the role of sonography before, during and after transjugular intrahepatic portosystemic shunt placement. A sonographic assessment of the liver and abdomen is recommended before the procedure. We illustrate several important sonographic findings for the echographist, which may alter the procedure approach or even preclude transjugular intrahepatic portosystemic shunt placement. The most challenging step during the procedure is the puncture of the right portal vein. Sonography can be a helpful tool in reducing the number of needle passes, thereby reducing the risk of hemorrhagic complications. Because of its non-invasive and cost-benefit nature, sonography is useful for transjugular intrahepatic portosystemic shunt follow-up. A baseline study at 24 to 48 hours is recommended to discover procedure-related complications. Long-term follow-up is important to detect malfunction of the shunt. Doppler ultrasound is very accurate in detecting shunt thrombosis. However, no consensus exists on the optimal sonographic screening protocol for detecting stenosis. We describe three sonographic parameters to detect transjugular intrahepatic portosystemic shunt stenosis with high sensitivity. Finally, additional sonographic parameters and potential pitfalls are provided in order to improve sensitivity.
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Affiliation(s)
- A Van Holsbeeck
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - M Thijs
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - D Bielen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - S Heye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - G Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Haegeman S, Vaninbroukx J, Heye S, Joniau S, Van Poppel H, Oyen R, Maleux G. Pseudoaneurysm associated with an arteriovesical fistula after bladder substitution surgery definitively treated with a covered stent: a report of 3 cases. Vasc Endovascular Surg 2013; 47:652-5. [PMID: 23970780 DOI: 10.1177/1538574413500724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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
A fistula between the iliac artery and a bladder pouch is a rare but potentially life-threatening condition. In 3 patients presenting with massive hematuria after urinary diversion, an iliac artery pseudoaneurysm was found on imaging studies. These pseudoaneurysms were considered to be associated with a fistula between artery and pouch, causing the hematuria. All patients were successfully treated with a covered stent to exclude the pseudoaneurysm and the arteriovesical fistula. Clinical follow-up of 10 weeks, 16 months, and 27 months, respectively, showed no residual hematuria. In addition, no clinical signs of stent graft infection or thrombosis were identified during follow-up. In conclusion, the placement of a covered stent is a valuable therapeutic treatment option in the management of hematuria due to an arteriovesical fistula after urinary diversion surgery.
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Affiliation(s)
- Steven Haegeman
- 1Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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Abstract
CONTEXT Sclerostin, a Wnt antagonist produced by osteocytes, regulates osteoblast activity and is a well-established key player in bone turnover. Recent data indicate that the Wnt pathway may also be involved in vascular calcification. OBJECTIVE The present study tests the hypothesis that serum sclerostin levels are associated with vascular calcification in patients with chronic kidney disease (CKD) not yet receiving dialysis. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We performed a cross-sectional analysis in 154 patients with CKD. Aortic calcification (AC) was assessed by lumbar X-ray and scored with a maximum score of 24. In addition to traditional and nontraditional cardiovascular (CV) risk factors, serum sclerostin levels were assessed (ELISA). Regression analysis was performed to identify determinants of serum sclerostin and AC. RESULTS AC was present in 59% of patients. Older age (P < .0001), male sex (P = .006), lower estimated glomerular rate (eGFR) (P = .0008), lower bone-specific alkaline phosphatase (P = .03), and the absence of AC (P = .006) were identified as independent determinants of higher serum sclerostin levels. In univariate logistic regression, higher age, diabetes, CV history, higher body mass index, higher serum C-reactive protein and sclerostin levels and lower estimated glomerular rate were all associated with the presence of AC. In multivariate analysis, lower, not higher, sclerostin levels (P = .04, odds ratio [OR] per ng/mL of 0.24), higher age (P < .0001, OR per year of 1.17) and CV history (P = .02, OR for a positive CV history of 3.83) were identified as independent determinants of AC. CONCLUSIONS In this cohort of patients with CKD, we found that patients with aortic calcifications (ACs) had higher sclerostin levels. However, in multivariate analysis, the association became inverse. Additional clinical and experimental studies are urgently required to clarify whether or not sclerostin protects against progression of vascular calcification.
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Affiliation(s)
- Kathleen J Claes
- Department of Nephrology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Claes KJ, Heye S, Bammens B, Kuypers DR, Meijers B, Naesens M, Vanrenterghem Y, Evenepoel P. Aortic calcifications and arterial stiffness as predictors of cardiovascular events in incident renal transplant recipients. Transpl Int 2013; 26:973-81. [PMID: 23870026 DOI: 10.1111/tri.12151] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 11/19/2012] [Revised: 12/02/2012] [Accepted: 06/23/2013] [Indexed: 12/14/2022]
Abstract
Renal transplant recipients have an increased risk of cardiovascular (CV) disease. Arterial stiffness (AS) and aortic calcifications (ACs) are well-known CV risk factors in patients with chronic kidney disease. We aimed to determine the prognostic value of AS and AC in incident renal transplant recipients (RTRs). We conducted a prospective study in 253 single RTR. AC were scored by means of lumbar X-ray. Carotid-femoral pulse wave velocity (PWV) was assessed in a subgroup of 115 patients. AC were present in 61% of patients. After a mean follow-up of 36 months, 32 CV events occurred in the overall group and 13 events in the PWV subgroup. When we accounted for age, gender, and CV history, AC score (HR, hazard ratio 1.09 per 1 unit increase; 95% CI 1.02-1.17) and PWV (HR 1.45 per 1 m/s; 95% CI 1.16-1.8) remained an independent predictor of CV events in Cox-regression analyses. Using receiver operating characteristics, the area under the curve for predicting CV events amounted to 0.80 and 0.72 for sum AC and PWV, respectively. Both AS and AC are strong predictors of future CV events in an incident RTR population. These vascular assessments are readily available and easy to perform, making them ideal tools for further risk stratification. (ClinicalTrials.gov number: NCT00547040).
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Affiliation(s)
- Kathleen J Claes
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, KU Leuven, Belgium
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Abstract
Oesophagal perforation after foreign body ingestion may result in an arterio-oesophageal fistula. We present a case of a man who presented with haematemesis and hypovolemic shock after ingestion of a chicken bone. Imaging revealed an infected fistula between the oesophagus and the left subclavian artery. Haemorrhage stopped after endovascular deployment of a stent graft in the subclavian artery. Aftercare consisted of intravenous antibiotics and parenteral feeding. The patient was discharged after 3 weeks and he encountered no infectious or vascular problems on follow-up. This unique case deals with a patient in whom an infected arterio-oesophageal fistula was successfully treated with a vascular stent-graft, thereby avoiding open surgical repair.
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Affiliation(s)
- Bernard Floré
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Maleux G, Jiang X, Heye S, Mariën I, Nevens F, Grünhagen T. Transjugular intrahepatic portosystemic shunt stent-graft placement: mean optimal portal venous projection view determined by three-dimensional portography. Acta Radiol 2013; 54:516-20. [PMID: 22940860 DOI: 10.1258/ar.2012.120403] [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: 11/18/2022]
Abstract
BACKGROUND Suboptimal stent-graft placement at the lower anastomosis during transjugular intrahepatic portosystemic shunt (TIPS) may result in early shunt stenosis and occlusion owing to incomplete covering of the parenchymal tract by the covered part of the stent-graft. PURPOSE To determine the optimal portal venous projection view for stent-graft placement during TIPS and the potential influence of the portal vein anatomy. MATERIAL AND METHODS On 76 cirrhotic patients (48 men and 28 women) selected for TIPS, rotational, three-dimensional (3D), catheter-directed angiography of the portal vein was performed. The 3D portograms were reviewed by two independent interventional radiologists to determine the optimal angiographic projection views for stent-graft placement. Intra-observer and inter-observer reliabilities were tested and subgroups of patient portal vein anatomy were categorized. RESULTS Among all patients, the optimal portal venous projection views for stent-graft placement during TIPS centered around 27° (±14°) right oblique and 3° (±7°) craniocaudal. Of these, 56% were within the standard deviations. Intra-observer reliabilities were 0.60 and 0.62 for the two radiologists, respectively. Inter-observer reliability was 0.48. Anatomical variations in the patient population were: normal portal vein (67%), trifurcation at main portal vein (16%), right posterior portal vein as the first branch of main portal vein (3%), no right posterior portal vein (1%), and other variations (13%). Anatomical subgroups did not influence the best angiographic projection view significantly (F4,295 = 0.91, P = 0.457). CONCLUSION The mean optimal angiographic projection view for TIPS stent-graft placement was 27° right oblique and 3° craniocaudal. Patient anatomic variations do not play a significant role in determining the optimal angiographic view for TIPS stent-graft placement.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium
| | - X Jiang
- Interventional X-ray, Philips Healthcare, Best, Netherlands
| | - S Heye
- Department of Radiology, University Hospitals Leuven, Belgium
| | - I Mariën
- Department of Radiology, University Hospitals Leuven, Belgium
| | - F Nevens
- Department of Hepatology, University Hospitals Leuven, Belgium
| | - T Grünhagen
- Interventional X-ray, Philips Healthcare, Best, Netherlands
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Monbaliu D, Vandersmissen J, De Hertogh G, Van Assche G, Hoffman I, Knops N, Debbaut C, Heye S, Pirenne J, Maleux G. Portal hypertension after combined liver and intestinal transplantation, a diagnostic and therapeutic challenge? Pediatr Transplant 2012; 16:E301-5. [PMID: 22409328 DOI: 10.1111/j.1399-3046.2012.01670.x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A widely accepted technique to transplant the liver-bowel bloc is first to perform a piggyback anastomosis of the donor suprahepatic vena cava to the recipient vena cava; second to restore the arterial blood supply through an aortic interposition graft; and third to ensure venous drainage of the native foregut. The venous drainage of the native foregut can be restored through an end-to-end portocaval anastomosis between the donor infrahepatic vena cava and the recipient portal vein. Stenosis of this anastomosis can lead to portal hypertension presenting with upper GI congestion, bleeding, and hypersplenism. We report the successful treatment of this complication using an e-PTFE-covered stent inserted following balloon angioplasty.
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Affiliation(s)
- Diethard Monbaliu
- Abdominal Transplant Surgery Department, University Hospitals Leuven, Leuven, Belgium.
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Heye S, Maleux G, Oyen RH, Claes K, Kuypers DRJ. Occupational Radiation Dose:Percutaneous Interventional Procedures on Hemodialysis Arteriovenous Fistulas and Grafts. Radiology 2012; 264:278-84. [DOI: 10.1148/radiol.12110978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Verhamme P, Heye S, Peerlinck K, Cahillane G, Tangelder M, Fourneau I, Daenens K, Belmans A, Pakola S, Verhaeghe R, Maleux G. Catheter-directed thrombolysis with microplasmin for acute peripheral arterial occlusion (PAO): an exploratory study. INT ANGIOL 2012; 31:289-296. [PMID: 22634985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM We performed an open-label, dose-ascending, single-centre, Phase IIa study to explore the safety and efficacy of catheter-directed thrombolysis (CDT) with microplasmin for infrainguinal arterial or bypass occlusions. METHODS Patients who presented with acute occlusions were subsequently treated with an intrathrombus infusion of five ascending doses of microplasmin: 0.3 mg/kg/h for 4 hours; 0.45 mg/kg/h for 4 hours; 0.6 mg/kg/h for 4 hours; 0.9 mg/kg/h for 4 hours or 0.6 mg/kg/h for 6 hours. Repeat angiograms were obtained to assess the degree of clot lysis. The primary outcome was complete thrombolysis defined as >95% thrombus volume reduction at the end of the microplasmin infusion. Safety evaluation included bleedings, adverse events and coagulation biomarkers. RESULTS Complete thrombolysis was obtained in 3 of the 19 treated patients at the end of microplasmin infusion. Thrombus volume reduction between 50% and 95% was achieved with all dosing regimens. Clinically significant distal embolization occurred in 8 patients. One major and two non-major bleedings occurred. Microplasmin depleted α2-anti-plasmin and decreased fibrinogen. CONCLUSION Intrathrombus infusion of microplasmin for 4 or 6 hours resulted in significant clot lysis. Distal embolization appeared the most important limitation.
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Affiliation(s)
- P Verhamme
- Department of Vascular Medicine and Hemostasis, University Hospitals Leuven, Leuven, Belgium.
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Maleux G, Van Sonhoven F, Hofkens PJ, Laenen A, Cappelle S, Vaninbroukx J, Heye S, Verhamme P. Soft tissue bleeding associated with antithrombotic treatment: technical and clinical outcomes after transcatheter embolization. J Vasc Interv Radiol 2012; 23:910-916.e1. [PMID: 22609289 DOI: 10.1016/j.jvir.2012.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 03/30/2012] [Accepted: 04/05/2012] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To assess retrospectively technical and clinical outcomes after transcatheter embolization in patients presenting with soft tissue bleeding associated with antithrombotic therapy and to determine factors potentially affecting the clinical outcomes after embolization. MATERIALS AND METHODS There were 42 patients who underwent embolization for soft tissue bleeding associated with antithrombotic therapy. Principal clinical symptoms were hemodynamic shock (n = 21), abdominal pain (n = 9), back pain (n = 7), and buttock or thigh pain (n = 5). Ultrasound or computed tomography (CT) or both were performed in 40 patients (95%); 2 patients (5%) were immediately referred for angiography. Several laboratory and radiographic factors were analyzed to determine if any influenced the clinical outcome. RESULTS A hematoma was identified in the anterior abdominal wall (n = 18 [43%]), in the retroperitoneum (n = 18 [43%]), or in the thigh or gluteal region (n = 6 [14%]). Embolization was successful in all patients; early recurrent bleeding with a fatal outcome was recorded in one patient (2%). In nine patients (22%), secondary surgical drainage of the hematoma was performed to manage a compartment syndrome. During follow-up (mean, 37.9 months; range, 0.03-85.28 months), 11 patients (26%) died; death was related to the bleeding in 6 patients (14%). Both activated partial thromboplastin time (aPTT) and prothrombin time (PT) were correlated with hematoma size. Prolonged aPTT before embolization was associated with a higher risk of bleeding-related mortality (P = .04). CONCLUSIONS Transcatheter embolization was very effective in stopping soft tissue bleeding associated with antithrombotic therapy. However, there was still considerable morbidity and mortality after successful embolization. aPTT prolongation emerged as a risk factor for bleeding-related deaths.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Maleux G, Van Sonhoven F, Cappelle S, Vaninbroukx J, Heye S, Hofkens P, Verhamme P, Laenen A. Abstract No. 151: Spontaneous, anticoagulation-induced haemorrhage in the soft tissues: mid-term outcome after transcatheter embolotherapy. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.195] [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: 11/30/2022] Open
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Maleux G, Herten PJ, Vaninbroukx J, Thijs M, Nijs S, Fourneau I, Heye S. Value of percutaneous embolotherapy for the management of traumatic vascular limb injury. Acta Radiol 2012; 53:147-52. [PMID: 22287145 DOI: 10.1258/ar.2011.110493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Arterial injuries to the extremities may result in severe hemorrhagic complications. Open surgical repair has been the standard of care for these patients, but endovascular management may be a valuable, less invasive alternative. PURPOSE To evaluate the safety, efficacy and long-term durability of embolotherapy for the management of hemorrhagic, traumatic vascular injuries in upper and lower limbs. MATERIAL AND METHODS Patients with traumatic or iatrogenic hemorrhagic vascular injuries to the extremities and managed with endovascular embolotherapy in the authors' institution between 1998 and 2010 were included in this retrospective study. Embolization was performed with different embolic materials; technical and long-term clinical outcome was assessed by review of the medical records or by telephone interviews of the referring physicians. RESULTS Embolization was performed in 31 patients. In six patients the vascular lesion was traumatic, in the remaining 25 patients the lesion was of iatrogenic origin. Angiographic vascular lesions identified were: contrast extravasation (n = 19, 61%), pseudoaneurysm (n = 8, 26%), and pseudoaneurysm with arteriovenous fistula (n = 3, 10%). Primary and secondary clinical success was obtained in 84% and 97% of cases, respectively. Procedure-related complications occurred in five patients (16%). Most of them were mild. One patient expired 34 days after the procedure due to amputation-stump infection, septicaemia, and multiple organ failure. Long-term outcome showed no recurrent bleeding or other embolization-related complications. CONCLUSION Embolotherapy for the management of hemorrhagic, traumatic vascular injuries in upper and lower limbs is relatively safe, very effective without recurrence or other embolization-related symptoms.
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Affiliation(s)
| | | | | | | | | | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Belgium
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Maleux G, Willems E, Fieuws S, Heye S, Vaninbroukx J, Laleman W, Cassiman D, Verslype C, Nevens F. Prospective study comparing different indirect methods to measure portal pressure. J Vasc Interv Radiol 2012; 22:1553-8. [PMID: 22024115 DOI: 10.1016/j.jvir.2011.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/26/2011] [Accepted: 08/01/2011] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare the accuracy of wedged hepatic venous pressure (WHVP) measurement with use of an end-hole catheter or an occlusion-balloon catheter versus direct portal pressure (PP) measurement in patients with cirrhosis with sinusoidal portal hypertension and to investigate the factors that affect the results of these indirect measurements. MATERIALS AND METHODS In a cohort of 174 patients with cirrhosis referred for transjugular intrahepatic portosystemic shunt creation, indirect PP was measured with an end-hole catheter and an occlusion-balloon catheter placed in the right hepatic vein. Direct PP was measured by a pigtail catheter in the main branch of the portal vein. RESULTS PP was more accurately estimated by the occlusion-balloon technique: mean WHVP measurements were 25.5 mm Hg ± 7.9 and 30.6 mm Hg ± 13.9, respectively, for the occlusion-balloon and end-hole catheter techniques, and the direct PP measurement was 25.0 mm Hg ± 7.0. The median absolute differences between direct and the indirect methods were 6.0 mm Hg with the end-hole catheter and 2.0 mm Hg with the occlusion-balloon catheter (P < .0001, signed-rank test). Relative to direct PP measurements, the occlusion-balloon technique overestimated pressures in cases of higher Model for End-Stage Liver Disease (MELD) scores (Spearman ρ = -0.24; P = .0005). CONCLUSIONS Compared with direct PP measurements, agreement was clearly higher for indirect WHVP measurement with occlusion-balloon catheters versus end-hole catheters. However, in patients with a high MELD score, there was an overestimation of PP with the occlusion-balloon method.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
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Claes KJ, Heye S, Nuyens D, Bammens B, Kuypers DR, Vanrenterghem Y, Evenepoel P. Impact of vascular calcification on corrected QT interval at the time of renal transplantation. Am J Nephrol 2012; 35:24-30. [PMID: 22143191 DOI: 10.1159/000334597] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/22/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIMS Sudden death is the major cause of cardiac mortality in dialysis patients, accounting for approximately 60% of cardiovascular deaths. A prolonged QT interval and arterial calcification have been associated with increased cardiovascular morbidity and mortality in different patient populations including patients with chronic kidney disease (CKD). In the present study, we aimed to elucidate the association of vascular calcification with corrected QT interval duration in patients with end-stage renal disease. METHODS We performed a single-center cross-sectional study in patients referred for renal transplantation. Patients taking QT-prolonging agents or with conduction abnormalities were excluded. Aortic calcifications were scored by means of lumbar X-rays. RESULTS In the final analysis, 193 patients (118 men, 52 years old) were included. A prolonged QT interval was observed in 26% of the patients. Multivariate analysis showed an independent and direct association between corrected QT duration and the extent of aortic calcifications (p = 0.0004) independent of age, gender, cardiovascular history, electrolytes and parameters of mineral metabolism. CONCLUSIONS A prolonged QT interval is prevalent in patients with CKD stage 5D. Aortic calcification is associated with a prolonged QT duration, independent of traditional determinants.
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Affiliation(s)
- Kathleen J Claes
- Department of Nephrology and Renal Transplantation, University Hospital Gasthuisberg, Leuven, Belgium.
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Heye S, Maleux G, Vaninbroukx J, Claes K, Kuypers D, Oyen R. Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas. Eur J Radiol 2011; 81:2298-303. [PMID: 21955605 DOI: 10.1016/j.ejrad.2011.09.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/02/2011] [Accepted: 09/06/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine predictors of technical success, dysfunction recurrence and patency after percutaneous transluminal angioplasty (PTA) of de novo dysfunctional hemodialysis arteriovenous fistulas (AVFs). METHODS Retrospective analysis of first time PTA of 167 AVF in 162 patients (100 men, 66±13 years). Anatomical (location, length, grade and number of stenoses) and clinical variables (sex, age, prior AVF, diabetes mellitus and AVF age, side and location) were reviewed. RESULTS 217 stenoses or segmental occlusions were treated. Technical success rate (84.4%) was higher in radiocephalic AVF compared to brachial artery-median vein AVF (p=0.030) and was negatively correlated with initial stenosis (p=0.049). Dysfunction recurrence was seen in 52.7% and correlated negatively with technical success (p=0.013) and AVF age (p=0.008). Early dysfunction (within 6 months) was negatively correlated with AVF age (p=0.016) and positively with diabetes (p=0.003). Higher AVF age resulted in higher primary (p=0.005) and secondary patency rates (p=0.037-0.005). CONCLUSIONS Technical success of PTA in hemodialysis AVF is affected by AVF type and initial stenosis and has significant effect on dysfunction recurrence, but not on AVF longevity. Younger AVF has increased risk for (early) recurrent dysfunction and lower patency rates. Patients with diabetes mellitus have higher risk for early dysfunction.
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Affiliation(s)
- Sam Heye
- University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium.
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Abstract
Endovascular aneurysm repair (EVAR) has become an established technique for the treatment of many infrarenal aortic aneurysms. Although EVAR is obviously less invasive than open surgical repair, it is not free of complications. These can potentially result in severe morbidity or even mortality, stressing the need for an early detection and subsequent treatment. In this review article, the pathophysiology, diagnosis, and treatment of the most common complications of EVAR, with the exception of endoleaks, are described.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Maleux G, Heye S, Verhamme P, Vaninbroukx J, Delcroix M. Penetration of a fractured Bird's Nest filter strut into the liver parenchyma: report of two cases. Acta Radiol 2011; 52:643-5. [PMID: 21521727 DOI: 10.1258/ar.2011.100519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This report deals with two rare but similar cases of asymptomatic fracture of a Bird's Nest inferior vena cava (IVC) filter strut, penetrated into the liver parenchyma. Follow-up over 4 and 6 years, respectively, could not reveal any changes in the position of the fragmented strut in the liver parenchyma or any evidence of clinical symptoms owing to the migrated strut fragment.
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Affiliation(s)
| | | | | | | | - M Delcroix
- Department of Pneumology, University Hospitals Leuven, Belgium
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van Malenstein H, Maleux G, Vandecaveye V, Heye S, Laleman W, van Pelt J, Vaninbroukx J, Nevens F, Verslype C. A randomized phase II study of drug-eluting beads versus transarterial chemoembolization for unresectable hepatocellular carcinoma. ACTA ACUST UNITED AC 2011; 34:368-76. [PMID: 21734423 DOI: 10.1159/000329602] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transcatheter arterial chemoembolization (TACE) is the standard treatment in selected patients with unresectable hepatocellular carcinoma (HCC). Drug-eluting particles are developed to reduce side effects and improve efficacy. We present safety data of a prospective randomized phase II study with doxorubicin-eluting superabsorbent polymer (SAP) microspheres. MATERIAL AND METHODS We prospectively included 30 HCC patients with different Barcelona Clinic Liver Cancer (BCLC) stages (A = 3, B = 19, C = 8) and randomly assigned them to receive conventional TACE (n = 14) (control group) or doxorubicin-eluting SAP microspheres (n = 16). The doxorubicin plasma level was assessed at different time points, biochemical analysis was performed, and side effects were reported following the Common Toxicity Criteria. Tumor response was assessed at 6 weeks according to the modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria. RESULTS There was a significantly lower plasma peak concentration (Cmax) of doxorubicin and smaller area under the curve (AUC) with SAP microspheres (mean Cmax 495 ± 293.9 ng/ml, mean AUC 69.7 ± 26.9 ng/ml min) compared to controls (mean Cmax 1,928 ± 560.8 ng/ml, mean AUC 165 ± 32.3 ng/ml/min; both p < 0.001). Furthermore, there were less grade 3 and no grade 4 adverse events in the SAP microsphere group. Tumor response was comparable between the groups. CONCLUSIONS TACE with SAP microspheres leads to low plasma levels of the cytotoxic drug and therefore minimizes toxicity compared to conventional TACE.
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Affiliation(s)
- Hannah van Malenstein
- Department of Hepatology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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Maleux G, Vaninbroukx J, Heye S. Failed surgical ligation of the proximal left subclavian artery during hybrid thoracic endovascular aortic repair successfully managed by percutaneous plug or coil occlusion: a report of 3 cases. J Cardiothorac Surg 2011; 6:45. [PMID: 21477301 PMCID: PMC3090327 DOI: 10.1186/1749-8090-6-45] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 04/08/2011] [Indexed: 11/28/2022] Open
Abstract
Open surgical rerouting and proximal ligation of one or more supra-aortic vessels prior to endovascular stent-graft placement has become an alternative to major open thoracic surgery in the treatment of complex thoracic aortic disease. Complications owing to failed surgical ligation of the left subclavian artery are rare. In this report, 3 cases of failed ligation are presented. Diagnosis was made by CT-scan and treatment was performed by transcatheter coil and plug embolization, avoiding redo neck surgery.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium.
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Maleux G, Rega F, Heye S, Troost E, Budts W. Asymptomatic Migration of a First-generation AMPLATZER Vascular Plug into the Abdominal Aorta: Conservative Management May Be an Option. J Vasc Interv Radiol 2011; 22:569-70. [DOI: 10.1016/j.jvir.2010.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/05/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022] Open
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