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Sun SL, Sarofim M, Morris DL. Transhepatic Bromelain and Acetylcysteine for Treatment of Posterior Gastric Pseudomyxoma Peritonei: A Case Report. Anticancer Res 2024; 44:2239-2241. [PMID: 38677761 DOI: 10.21873/anticanres.17031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND/AIM Pseudomyxoma peritonei (PMP) is a rare condition characterized by diffuse spread of mucinous tumors within the peritoneal cavity. Traditional treatment modalities, such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are challenging in cases of recurrent disease, owing to anatomical complexities and increasing morbidity and mortality risk. BromAc® has emerged as a novel, targeted therapy for PMP with evidence for intra-tumoral administration to break down mucin deposits. CASE REPORT We present a 70-year-old female with confirmed diagnosis of symptomatic appendiceal PMP situated behind the stomach, refractory to prior CRS and HIPEC. Transhepatic intra-tumor injection of BromAc® was performed, guided by imaging, with catheter placement into the posterior gastric mucinous tumor. The procedure was well-tolerated, and post-treatment imaging revealed a significant 40% reduction in tumor burden. The patient had fever on cycle days two and three, which self-resolved and septic screen performed was negative. Following BromAc® administration, the patient demonstrated improvement in symptoms and quality of life. CONCLUSION This case highlights the potential efficacy and safety of transhepatic administration of BromAc® for the treatment of recurrent PMP behind the stomach. The targeted delivery of BromAc® directly into a mucinous tumor via the transhepatic route offers a minimally invasive alternative for cases where traditional surgical interventions pose challenges. However, further research and clinical trials are warranted to validate the broader applicability of this novel approach, assess long-term outcomes, and optimize procedural parameters for enhanced therapeutic outcomes in PMP treatment.
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Affiliation(s)
- Si Louise Sun
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, NSW, Australia
| | - Mina Sarofim
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, NSW, Australia
| | - David L Morris
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, NSW, Australia
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2
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Arkoudis NA, Reppas L, Spiliopoulos S. Image-guided percutaneous cholecystostomy: challenging the norms. Abdom Radiol (NY) 2024; 49:939-941. [PMID: 38294540 DOI: 10.1007/s00261-023-04173-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
Image-guided percutaneous cholecystostomy (IGPC) is a widely recognized and regularly employed procedure in numerous institutions, serving as an indispensable cornerstone in the management of patients with acute cholecystitis. The most up-to-date literature has found that the transperitoneal route is at least as safe as the transhepatic route and that both the trocar and Seldinger techniques are equally safe and effective. The above novel insights may offer reassurance and alleviate concerns among operators performing IGPC by dispelling the fixation on previously established beliefs and thus providing flexibility, which lightens the load on the operator. Future studies could further investigate these findings and shed light on potential disparities in the safety and efficacy profiles associated with the subcostal and intercostal approaches, different drainage catheter sizes, and/or the impact of operator experience on complication rates.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Lazaros Reppas
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
- 2nd Department of Radiology, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
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3
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Salah DM, Fadel FI, Abdel Mawla MA, Mooty HNA, Ghobashy ME, Salem AM, Fathallah MG, Abd Alazem EA. Vascular access challenges in hemodialysis children. Ital J Pediatr 2024; 50:11. [PMID: 38254126 PMCID: PMC10804700 DOI: 10.1186/s13052-024-01590-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Hemodialysis (HD) success is dependent mainly on vascular access (VA). The aim of this study is to share the experience of Pediatric Nephrology Unit (PNU), Cairo University Children's Hospital (CUCH), with VA-related obstacles in end stage kidney disease (ESKD) HD children. METHODS This is a retrospective analysis of VA related data of 187 ESKD children received regular HD over 3 year duration (2019-2021). Kaplan-Meier curves were used to present arteriovenous fistula (AVF) and cuffed catheters survivals. RESULTS Uncuffed central venous catheter (CVC) was the primary VA for HD in up to 97.3% with 2.7% of patients had AVF performed and attained maturation before initiation of regular HD. Fifty-six (29.9%) patients have inserted 120 tunneled CVCs. AVFs & AV grafts (AVF) were performed in 79 (42.2%) and 6 (3.2%) patients respectively. There were 112 uncuffed CVCs implanted beneath the screen in Rt internal jugular vein (IJV) (44%) Lt IJV (17%), right internal mammary vein (2.7%) while Trans hepatic (TH) technique was used to place 39 uncuffed CVCs (34%) in the inferior vena cava (IVC). Catheter-related bacteremia (CRB) was the most frequent complication in uncuffed and cuffed CVCs (2.58 / 100 catheters day and 10.1 /1000 catheter days respectively). AVFs achieved a high success rate (83%) after 757.71 ± 512.3 functioning days. CONCLUSION Native AVF is the preferred VA for pediatric HD but its creation is limited by the small sized vessels where non-cuffed CVC could be a reasonable relatively long-term alternative. Challenging situations (occluded central veins) could benefit from TH technique of CVC insertion in IVC.
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Affiliation(s)
- Doaa M Salah
- Department of Pediatrics, Pediatric Nephrology and Transplantation Unit, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Fatina I Fadel
- Department of Pediatrics, Pediatric Nephrology and Transplantation Unit, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Hesham NAbdel Mooty
- Department of Vascular Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El Ghobashy
- Department of Radiodiagnosis, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr M Salem
- Department of Pediatrics, Pediatric Nephrology and Transplantation Unit, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Gamal Fathallah
- Department of Pediatrics, Pediatric Nephrology and Transplantation Unit, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Abobakr Abd Alazem
- Department of Pediatrics, Pediatric Nephrology and Transplantation Unit, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
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Magnus PC, Chodosh A, Salis A, Wicks C. Percutaneous Transhepatic Venous Access for Left Atrial Appendage Closure in a Patient with Left Sided Inferior Vena Cava with Hemiazygos Continuation. Cardiovasc Revasc Med 2023; 53S:S184-S187. [PMID: 35641363 DOI: 10.1016/j.carrev.2022.05.027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022]
Abstract
The transfemoral venous approach is the standard for Left Atrial Appendage Closure (LAAC) using the WATCHMAN device. However in patients without a patent inferior vena cava, an alternate access site can be utilized. We present a case of a patient with left sided inferior vena cava with hemiazygos continuation who had clinical indication for LAAC and in whom a transhepatic approach was successfully utilized.
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Affiliation(s)
- Patrick C Magnus
- Concord Hospital Cardiovascular Institute, Concord Hospital, 250 Pleasant Street, Concord, NH 03301, United States of America.
| | - Adam Chodosh
- Concord Hospital Cardiovascular Institute, Concord Hospital, 250 Pleasant Street, Concord, NH 03301, United States of America
| | - Ari Salis
- Concord Hospital Cardiovascular Institute, Concord Hospital, 250 Pleasant Street, Concord, NH 03301, United States of America
| | - Charles Wicks
- Concord Hospital Cardiovascular Institute, Concord Hospital, 250 Pleasant Street, Concord, NH 03301, United States of America
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Sanfilippo F, La Via L, Dezio V, Amelio P, Genoese G, Franchi F, Messina A, Robba C, Noto A. Inferior vena cava distensibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on mechanically ventilated patients. Intensive Care Med Exp 2023; 11:40. [PMID: 37423948 DOI: 10.1186/s40635-023-00529-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/03/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Variation of inferior vena cava (IVC) is used to predict fluid-responsiveness, but the IVC visualization with standard sagittal approach (SC, subcostal) cannot be always achieved. In such cases, coronal trans-hepatic (TH) window may offer an alternative, but the interchangeability of IVC measurements in SC and TH is not fully established. Furthermore, artificial intelligence (AI) with automated border detection may be of clinical value but it needs validation. METHODS Prospective observational validation study in mechanically ventilated patients with pressure-controlled mode. Primary outcome was the IVC distensibility (IVC-DI) in SC and TH imaging, with measurements taken both in M-Mode or with AI software. We calculated mean bias, limits of agreement (LoA), and intra-class correlation (ICC) coefficient. RESULTS Thirty-three patients were included. Feasibility rate was 87.9% and 81.8% for SC and TH visualization, respectively. Comparing imaging from the same anatomical site acquired with different modalities (M-Mode vs AI), we found the following IVC-DI differences: (1) SC: mean bias - 3.1%, LoA [- 20.1; 13.9], ICC = 0.65; (2) TH: mean bias - 2.0%, LoA [- 19.3; 15.4], ICC = 0.65. When comparing the results obtained from the same modality but from different sites (SC vs TH), IVC-DI differences were: (3) M-Mode: mean bias 1.1%, LoA [- 6.9; 9.1], ICC = 0.54; (4) AI: mean bias 2.0%, LoA [- 25.7; 29.7], ICC = 0.32. CONCLUSIONS In patients mechanically ventilated, AI software shows good accuracy (modest overestimation) and moderate correlation as compared to M-mode assessment of IVC-DI, both for SC and TH windows. However, precision seems suboptimal with wide LoA. The comparison of M-Mode or AI between different sites yields similar results but with weaker correlation. Trial registration Reference protocol: 53/2022/PO, approved on 21/03/2022.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy.
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy.
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Veronica Dezio
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Paolo Amelio
- School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Giulio Genoese
- Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Federico Franchi
- Anesthesia and Intensive Care Unit, University Hospital of Siena, University of Siena, Siena, Italy
| | - Antonio Messina
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Chiara Robba
- Department of Surgical Science and Diagnostic Integrated, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy
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6
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Sanfilippo F, La Via L, Dezio V, Santonocito C, Amelio P, Genoese G, Astuto M, Noto A. Assessment of the inferior vena cava collapsibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on healthy volunteers. Intensive Care Med Exp 2023; 11:15. [PMID: 37009935 PMCID: PMC10068684 DOI: 10.1186/s40635-023-00505-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/22/2023] [Indexed: 04/04/2023] Open
Abstract
PURPOSE Assessment of the inferior vena cava (IVC) respiratory variation may be clinically useful for the estimation of fluid-responsiveness and venous congestion; however, imaging from subcostal (SC, sagittal) region is not always feasible. It is unclear if coronal trans-hepatic (TH) IVC imaging provides interchangeable results. The use of artificial intelligence (AI) with automated border tracking may be helpful as part of point-of-care ultrasound but it needs validation. METHODS Prospective observational study conducted in spontaneously breathing healthy volunteers with assessment of IVC collapsibility (IVCc) in SC and TH imaging, with measures taken in M-mode or with AI software. We calculated mean bias and limits of agreement (LoA), and the intra-class correlation (ICC) coefficient with their 95% confidence intervals. RESULTS Sixty volunteers were included; IVC was not visualized in five of them (n = 2, both SC and TH windows, 3.3%; n = 3 in TH approach, 5%). Compared with M-mode, AI showed good accuracy both for SC (IVCc: bias - 0.7%, LoA [- 24.9; 23.6]) and TH approach (IVCc: bias 3.7%, LoA [- 14.9; 22.3]). The ICC coefficients showed moderate reliability: 0.57 [0.36; 0.73] in SC, and 0.72 [0.55; 0.83] in TH. Comparing anatomical sites (SC vs TH), results produced by M-mode were not interchangeable (IVCc: bias 13.9%, LoA [- 18.1; 45.8]). When this evaluation was performed with AI, such difference became smaller: IVCc bias 7.7%, LoA [- 19.2; 34.6]. The correlation between SC and TH assessments was poor for M-mode (ICC = 0.08 [- 0.18; 0.34]) while moderate for AI (ICC = 0.69 [0.52; 0.81]). CONCLUSIONS The use of AI shows good accuracy when compared with the traditional M-mode IVC assessment, both for SC and TH imaging. Although AI reduces differences between sagittal and coronal IVC measurements, results from these sites are not interchangeable.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy.
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy.
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Veronica Dezio
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Cristina Santonocito
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
| | - Paolo Amelio
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Giulio Genoese
- Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy
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Abrishami A, Alborzi Avanaki M, Khalili N, Taher M, Ghanaati H. Multi-organ infarction following percutaneous transhepatic esophageal variceal obliteration with glue injection: a case report. Radiol Case Rep 2021; 16:1828-1832. [PMID: 34025894 PMCID: PMC8134026 DOI: 10.1016/j.radcr.2021.04.032] [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: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous transhepatic variceal obliteration (PTVO) is currently one of the best treatment options for controlling acute recurrent bleeding in cirrhotic patients. Nevertheless, this procedure is associated with major and minor complications such as fever, pain, fatal intraperitoneal hemorrhage, and rarely, embolization of embolic agents to the systemic circulation. Only one study has reported systemic emboli following the use of glue-lipiodal mixture for percutaneous transhepatic embolization of esophageal varices and here we report another case of this complication. Here, we report a 44-year-old man presenting with multi-organ infarction following PTVO with glue-Lipiodol mixture. He was a known case of liver cirrhosis who was admitted for recurrent bleeding from esophageal varices. The patient became a candidate for transjugular intrahepatic portosystemic shunt surgery; however, he did not provide consent for this procedure. the patient eventually decided to undergo PTVO as an alternative option. Twelve hours after the procedure, the patient developed neurological symptoms such as left side weakness, dysarthria, and fecal incontinence. Further investigation showed glue particles in brain, liver, spleen and both lungs. Contrast echocardiography and splenoportography did not show any evidence of right-to-left shunt. Thus, conservative management was initiated for the patient, which resulted in the gradual improvement after three weeks. Prior evaluation with splenoportography and contrast echocardiography before performing PTVO may help in the early detection of any connection with systemic circulation. Also, based on the desired procedure, the most appropriate glue/Lipiodol ratio and injection technique should be selected to minimize the risk of adverse events.
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Affiliation(s)
- Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Alborzi Avanaki
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Taher
- Division gastroenterology & hepatology, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran.,Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Nas OF, Candan S, Oztepe MF, Kandemirli SG, Bilgin C, Inecikli MF, Ozkaya G, Gokalp G, Ongen G, Erdogan C. Right- Versus Left-Sided Approach for Transhepatic Tunneled Catheter Placement: Is There a Difference? Cardiovasc Intervent Radiol 2021; 44:1039-1047. [PMID: 33928408 DOI: 10.1007/s00270-021-02843-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to compare the technical difficulties, complications, long-term efficacy, and risks between right- and left-sided approach transhepatic tunneled catheterization. METHODS We retrospectively evaluated transhepatic tunneled catheter placement cases in our institution between May 2012 and November 2019. Demographic and procedural parameters were recorded. Statistical tests were used to compare the complication rates of right- and left-sided approach. Furthermore, Cox regression analyses were used to investigate the relationship between functional catheter days and included parameters. RESULTS A total of 83 procedures were performed in 46 patients, with a female to male ratio of 1.88 and a mean age of 55.5 ± 18.2 years. Indication for catheter placement was chronic renal insufficiency and loss of central venous access through traditional routes in all cases. Median functional catheter durations were 28 days (1-382) and 55.5 days (1-780) for right-sided and left-sided access, respectively. Complication rates were similar for both sides. There was no difference between primary and revision procedures in terms of safety and efficacy outcomes. In univariate Cox regression analysis, gender was the only variable which was found to be statistically significant (HR = 2.014 (1.004-4.038)) for functional catheter days. In multivariate Cox regression model, gender and access side were included which failed to reach statistical significance. CONCLUSIONS In our study, both right- and left-sided approaches provided similar safety and efficacy outcomes, suggesting that both techniques can be employed based on physician's preference.
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Affiliation(s)
- Omer F Nas
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey.
| | - Selman Candan
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Muhammed F Oztepe
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Sedat G Kandemirli
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa, IA, USA
| | - Cem Bilgin
- Department of Radiology, University of Health Sciences Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Mehmet F Inecikli
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Guven Ozkaya
- Department of Statistics, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Gokhan Gokalp
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Gokhan Ongen
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Cuneyt Erdogan
- Department of Radiology, Bursa Medicana Hospital, Bursa, Turkey
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9
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van Niekerk CJ, Pandey AC, Nelson T, Wang H, Gibson DN. Successful left atrial appendage closure using a percutaneous hepatic venous approach. HeartRhythm Case Rep 2019; 5:545-8. [PMID: 31890570 DOI: 10.1016/j.hrcr.2019.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/14/2022] Open
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10
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Chick JFB, Roush BB, Khaja MS, Prohaska D, Cooper KJ, Saad WE, Srinivasa RN. Transbiliary intravascular ultrasound-guided diagnostic biopsy of an inaccessible pancreatic head mass. Radiol Case Rep 2017; 12:323-326. [PMID: 28491180 PMCID: PMC5417622 DOI: 10.1016/j.radcr.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/02/2017] [Indexed: 12/17/2022] Open
Abstract
Percutaneous image-guided biopsies of pancreatic malignancies may prove challenging and nondiagnostic due to a variety of anatomic considerations. For patients with complex post-surgical anatomy, such as a Roux-en-Y gastric bypass, diagnosis via endoscopic ultrasound with fine-needle aspiration may not be possible because of an inability to reach the proximal duodenum. This report describes the first diagnostic case of transbiliary intravascular ultrasound-guided biopsy of a pancreatic head mass in a patient with prior Roux-en-Y gastric bypass for which a diagnosis could not be achieved via percutaneous and endoscopic approaches. Transbiliary intravascular ultrasound-guided biopsy resulted in a diagnosis of pancreatic adenocarcinoma, allowing the initiation of chemotherapy.
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Affiliation(s)
- Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Benjamin B Roush
- Western Michigan University School of Medicine, Kalamazoo, MI, USA
| | - Minhaj S Khaja
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Dennis Prohaska
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kyle J Cooper
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Wael E Saad
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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11
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Baspinar O, Sahin DA, Yildirim A. Retrieval of an intra-cardiac embolised very long wire via transhepatic access from a war victim child. Cardiol Young 2016; 26:784-6. [PMID: 26358097 DOI: 10.1017/S1047951115001766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the case report of a war victim child with severe burn scars, orthopnoea, and dyspnoea due to diffuse pulmonary thromboembolism. During ICU stay, a central venous catheter's 45-mm wire embolised into the heart. The embolised wire was successfully removed via transhepatic access through the creation of an artificial simple snare.
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Battal B, Celikkanat S, Akgun V, Karaman B. Re: percutaneous retroperitoneal access. Korean J Radiol 2014; 15:179. [PMID: 24497812 PMCID: PMC3909855 DOI: 10.3348/kjr.2014.15.1.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Bilal Battal
- Department of Radiology, Gulhane Military Medical Academy, School of Medicine, Ankara 06018, Turkey
| | - Serhat Celikkanat
- Department of Radiology, Gulhane Military Medical Academy, School of Medicine, Ankara 06018, Turkey
| | - Veysel Akgun
- Department of Radiology, Gulhane Military Medical Academy, School of Medicine, Ankara 06018, Turkey
| | - Bulent Karaman
- Department of Radiology, Gulhane Military Medical Academy, School of Medicine, Ankara 06018, Turkey
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van der Merwe SW, Omoshoro-Jones J, Sanyika C. Endocoil placement after endoscopic ultrasound-guided biliary drainage may prevent a bile leak. World J Gastrointest Endosc 2013; 5:246-50. [PMID: 23678378 PMCID: PMC3653024 DOI: 10.4253/wjge.v5.i5.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 02/12/2013] [Accepted: 02/28/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To further reduce the risk of bleeding or bile leakage.
METHODS: We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography (ERCP) had failed. Biliary access of a dilated segment 2 or 3 duct was achieved from the stomach using a 19G needle. After radiologically confirming access a guide wire was placed, a transhepatic tract created using a 6 Fr cystotome followed by balloon dilation of the stricture and antegrade metallic stent placement across the malignant obstruction. This was followed by placement of an endocoil in the transhepatic tract.
RESULTS: Dilated segmental ducts were observed in all patients with the linear endoscopic ultrasound scope from the proximal stomach. Transgastric biliary access was obtained using a 19G needle in all patients. Biliary drainage was achieved in all patients. Placement of an endocoil was possible in 5/6 patients. All patients responded to biliary drainage and no complications occurred.
CONCLUSION: We show that placing endocoils at the time of endoscopic ultrasound guided biliary stenting is feasible and may reduce the risk of bleeding or bile leakage.
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Affiliation(s)
- Schalk Willem van der Merwe
- Schalk Willem van der Merwe, Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria 0002, South Africa
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