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Halloum N, Kloeckner R, Pitton M, Düber C, Treede H, El Beyrouti H. Minimal invasive aortic arch repair with suture-mediated closure system. J Vasc Surg Cases Innov Tech 2023; 9:101337. [PMID: 37965116 PMCID: PMC10641674 DOI: 10.1016/j.jvscit.2023.101337] [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: 05/26/2023] [Accepted: 09/18/2023] [Indexed: 11/16/2023] Open
Abstract
Port implantation can be associated with an array of serious vascular complications, typically involving the subclavian artery. We report a case in which implantation of a port resulted in iatrogenic perforation of the aortic arch at the level of the left subclavian artery, which was sealed off using a percutaneous vascular closure device.
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Affiliation(s)
- Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
- Institute of Interventional Radiology, University Hospital Lübeck, Lübeck, Germany
| | - Michael Pitton
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
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2
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Kloeckner R, Pitton M, Mähringer-Kunz A, Düber C, Schmidtmann I, Koch S, Galle P, Weinmann A. Validierung des Vorhersagemodells SNACOR nach transarterieller Chemoembolisation von hepatozellulären Karzinomen. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- R Kloeckner
- Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - M Pitton
- Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - A Mähringer-Kunz
- Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - C Düber
- Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - I Schmidtmann
- Johannes Gutenberg-Universität Mainz, Institut für Medizinische Statistik, Biometrie, Epidemiologie und Informatik, Mainz
| | - S Koch
- Johannes Gutenberg-Universität Mainz, Clinical Registry Unit (CRU), Mainz
| | - P Galle
- Johannes Gutenberg-Universität Mainz, Innere Medizin, Mainz
| | - A Weinmann
- Johannes Gutenberg-Universität Mainz, Innere Medizin, Mainz
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Maehringer-Kunz A, Kloeckner R, Pitton M, Düber C, Schmidtmann I, Galle P, Koch S, Weinmann A. Validierung der Vorhersagemodelle STATE und START in der TACE-Therapie bei Patienten mit hepatozellulärem Karzinom. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Maehringer-Kunz
- Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - R Kloeckner
- Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - M Pitton
- Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - C Düber
- Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - I Schmidtmann
- Johannes Gutenberg-Universität Mainz, Institut für Medizinische Statistik, Biometrie, Epidemiologie und Informatik, Mainz
| | - P Galle
- Johannes Gutenberg-Universität Mainz, Innere Medizin, Mainz
| | - S Koch
- Johannes Gutenberg-Universität Mainz, Clinical Registry Unit (CRU, Mainz
| | - A Weinmann
- Johannes Gutenberg-Universität Mainz, Innere Medizin, Mainz
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Schotten S, Düber C, Pitton M. Der radiale Zugang bei interventionsradiologischen Prozeduren. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Schotten
- Universitätsmedizin Mainz, Klinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - C Düber
- Universitätsmedizin Mainz, Klinik für Diagnostische und Interventionelle Radiologie, Mainz
| | - M Pitton
- Universitätsmedizin Mainz, Diagnostische und Interventionelle Radiologie, Mainz
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Kloeckner R, Pitton M, Düber C, Schmidtmann I, Galle P, Wörns M, Weinmann A. Validierung der Scoring Systeme ART und ABCR nach Transarterieller Chemoembolisation von Hepatozellulären Karzinomen. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pitton M. Alles über Gefäßstents. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Pitton M. PRG – Perkutane Radiologische Gastrostomie – Indikation, Technik, Ergebnisse. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kloeckner R, Pitton M, Dueber C, Wörns M, Galle P, Weinmann A. Validation of clinical scoring systems ART and ABCR after transarterial chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Foltys D, Zimmermann T, Kaths M, Strempel M, Heise M, Hoppe-Lotichius M, Weiler N, Scheuermann U, Ruckes C, Hansen T, Pitton M, Otto G. Hepatocellular carcinoma in Child's A cirrhosis: a retrospective analysis of matched pairs following liver transplantation vs. liver resection according to the intention-to-treat principle. Clin Transplant 2013; 28:37-46. [DOI: 10.1111/ctr.12273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 01/19/2023]
Affiliation(s)
- Daniel Foltys
- Department of Transplantation and Hepatobiliary Surgery; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Tim Zimmermann
- Department of Internal Medicine I; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Moritz Kaths
- Department of Transplantation and Hepatobiliary Surgery; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Mari Strempel
- Department of Transplantation and Hepatobiliary Surgery; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Michael Heise
- Department of Transplantation and Hepatobiliary Surgery; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Maria Hoppe-Lotichius
- Department of Transplantation and Hepatobiliary Surgery; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Nina Weiler
- Department of Transplantation and Hepatobiliary Surgery; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Uwe Scheuermann
- Department of Transplantation and Hepatobiliary Surgery; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Christian Ruckes
- Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center; Johannes Gutenberg University; Mainz Germany
| | - Torsten Hansen
- Department of Pathology; University Medical Center; Johannes Gutenberg University; Mainz Germany
| | - Michael Pitton
- Department of Radiology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Gerd Otto
- Department of Transplantation and Hepatobiliary Surgery; University Medical Center; Johannes Gutenberg-University; Mainz Germany
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Ghilardi G, Rubino FM, Pitton M, Massetto N, Bissi M, Bianciardi P, Samaja M, Carelli S. Glutathionyl-hemoglobin levels in carotid endarterectomy: a pilot study on 12 cases clinically uneventful. J Cardiovasc Surg (Torino) 2013; 58:65-71. [PMID: 23594507 DOI: 10.23736/s0021-9509.16.06803-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aim: Carotid endarterectomy is a widely accepted procedure for stroke prevention, and carotid clamping is a necessary surgical step. Glutathionylated haemoglobin (HbSSG) has been recently employed as a biomarker of oxidative stress, its level being increased under several conditions, including hypoxia. This study aims to evaluating whether HbSSG level in peripheral and/or jugular blood is affected during carotid surgery under normal routine operative conditions. Methods: This study enrolled 13 consecutive patients undergoing elective carotid endarterectomy under general anesthesia. At different times during surgery, blood was taken simultaneously from both a peripheral vein and the jugular vein ipsilateral to the clamped carotid. HbSSG was measured in RBC hemolysates by MALDI-ToF mass spectrometry in each sample. Results: Three patients showed a complex pattern of rise and fall of HbSSG levels in different time periods before, during and after surgery. They also showed statistically significant differences between peripheral and jugular blood, with mean HbSSG levels in jugular blood higher by approx. 30% than those of peripheral blood at the end of the period of carotid clamping. In all three patients HbSSG levels fell to pre-clamping values within 2 min from removal of carotid artery clamp. Conclusion: Although effective routine drug management allowed brain safety during carotid clamping time, a number of patients showed a fast modification over time of the HbSSG levels in jugular blood, suggesting that "resident" cerebral biochemical protection mechanisms could play some role to compensate clinically silent brain oxidative stress.
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Affiliation(s)
- G Ghilardi
- Department of Medicine Surgery and Dentistry, University of Milan, Milan, Italy -
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11
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Abstract
INTRODUCTION Right-sided hepatectomy including segment 1 and right trisectionectomy are typical approaches to surgical treatment of hilar cholangiocarcinoma. In this study we have compared the oncological capacity of this approach to left-sided hepatectomy. PATIENTS AND PROCEDURES: In 223 patients referred to our institution 150 hepatic resections were performed: 14 hilar resections, 68 right and 68 left hepatectomies. RESULTS Survival after curative (R0) and palliative surgery was significantly superior to that in patient with exploration or no surgery at all (p < 0.0001). 5- and 10-year survival after right versus left hepatectomy was 29 and 22 % versus 21 and 7 % (p = 0.204). If hospital mortality was eliminated, survival after right hepatectomy was marginally significantly superior to that after left-sided hepatectomy (p = 0.041). Hospital mortality was 13 % after right compared to 4 % after left hepatectomy (p = 0.069). The R situation was of prognostic importance following right and the N situation after left hepatectomy (p = 0.038 and 0.01, respectively). Vascular resection - in right-sided procedures performed as "hilar en bloc resection" - did not influence the outcome. CONCLUSIONS Low perioperative mortality after left-sided resection and, obviously, inferior oncological radicality are features of left hepatectomy. These features do not detract from the importance of left hepatectomy which is an indispensable approach to surgically treated patients with hilar cholangiocarcinoma.
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Affiliation(s)
- G Otto
- Abteilung für Transplantation und Hepatopankreobiliäre Chirurgie, Universitätsmedizin Mainz, Deutschland.
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Dorweiler B, Weigang E, Duenschede F, Pitton M, Düber C, Vahl CF. TEVAR in aortic erosion – Results of endovascular treatment of aortobronchial and aortoesophageal fistulas and mycotic aneurysm. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Mrema E, Turci R, Rubino F, Fugnoli L, Pitton M, Mandic-Rajcevic S, Colosio C, Minoia C. Serum levels of polychlorinated biphenyls (PCBs) and organochorinated pesticides (OCPs) among individuals of general population in three Italian geographic regions. Toxicol Lett 2011. [DOI: 10.1016/j.toxlet.2011.05.472] [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: 11/24/2022]
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Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, Pitton M, Sergent G, Pfammatter T, Terraz S, Benhamou Y, Avajon Y, Gruenberger T, Pomoni M, Langenberger H, Schuchmann M, Dumortier J, Mueller C, Chevallier P, Lencioni R. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2009; 33:41-52. [PMID: 19908093 PMCID: PMC2816794 DOI: 10.1007/s00270-009-9711-7] [Citation(s) in RCA: 1115] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/21/2009] [Indexed: 11/27/2022]
Abstract
Transcatheter arterial chemoembolization (TACE) offers a survival benefit to patients with intermediate hepatocellular carcinoma (HCC). A widely accepted TACE regimen includes administration of doxorubicin-oil emulsion followed by gelatine sponge-conventional TACE. Recently, a drug-eluting bead (DC Bead) has been developed to enhance tumor drug delivery and reduce systemic availability. This randomized trial compares conventional TACE (cTACE) with TACE with DC Bead for the treatment of cirrhotic patients with HCC. Two hundred twelve patients with Child-Pugh A/B cirrhosis and large and/or multinodular, unresectable, N0, M0 HCCs were randomized to receive TACE with DC Bead loaded with doxorubicin or cTACE with doxorubicin. Randomization was stratified according to Child-Pugh status (A/B), performance status (ECOG 0/1), bilobar disease (yes/no), and prior curative treatment (yes/no). The primary endpoint was tumor response (EASL) at 6 months following independent, blinded review of MRI studies. The drug-eluting bead group showed higher rates of complete response, objective response, and disease control compared with the cTACE group (27% vs. 22%, 52% vs. 44%, and 63% vs. 52%, respectively). The hypothesis of superiority was not met (one-sided P = 0.11). However, patients with Child-Pugh B, ECOG 1, bilobar disease, and recurrent disease showed a significant increase in objective response (P = 0.038) compared to cTACE. DC Bead was associated with improved tolerability, with a significant reduction in serious liver toxicity (P < 0.001) and a significantly lower rate of doxorubicin-related side effects (P = 0.0001). TACE with DC Bead and doxorubicin is safe and effective in the treatment of HCC and offers a benefit to patients with more advanced disease.
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Affiliation(s)
- Johannes Lammer
- Cardiovascular and Interventional Radiology, Medical University Vienna, Vienna, Austria.
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15
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Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, Pitton M, Sergent G, Pfammatter T, Terraz S, Benhamou Y, Avajon Y, Gruenberger T, Pomoni M, Langenberger H, Schuchmann M, Dumortier J, Mueller C, Chevallier P, Lencioni R. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2009. [PMID: 19908093 DOI: 10.1007/s00270-099-9711-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Transcatheter arterial chemoembolization (TACE) offers a survival benefit to patients with intermediate hepatocellular carcinoma (HCC). A widely accepted TACE regimen includes administration of doxorubicin-oil emulsion followed by gelatine sponge-conventional TACE. Recently, a drug-eluting bead (DC Bead) has been developed to enhance tumor drug delivery and reduce systemic availability. This randomized trial compares conventional TACE (cTACE) with TACE with DC Bead for the treatment of cirrhotic patients with HCC. Two hundred twelve patients with Child-Pugh A/B cirrhosis and large and/or multinodular, unresectable, N0, M0 HCCs were randomized to receive TACE with DC Bead loaded with doxorubicin or cTACE with doxorubicin. Randomization was stratified according to Child-Pugh status (A/B), performance status (ECOG 0/1), bilobar disease (yes/no), and prior curative treatment (yes/no). The primary endpoint was tumor response (EASL) at 6 months following independent, blinded review of MRI studies. The drug-eluting bead group showed higher rates of complete response, objective response, and disease control compared with the cTACE group (27% vs. 22%, 52% vs. 44%, and 63% vs. 52%, respectively). The hypothesis of superiority was not met (one-sided P = 0.11). However, patients with Child-Pugh B, ECOG 1, bilobar disease, and recurrent disease showed a significant increase in objective response (P = 0.038) compared to cTACE. DC Bead was associated with improved tolerability, with a significant reduction in serious liver toxicity (P < 0.001) and a significantly lower rate of doxorubicin-related side effects (P = 0.0001). TACE with DC Bead and doxorubicin is safe and effective in the treatment of HCC and offers a benefit to patients with more advanced disease.
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Affiliation(s)
- Johannes Lammer
- Cardiovascular and Interventional Radiology, Medical University Vienna, Vienna, Austria.
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Pitton M, Lüderitz B. Fall 1632. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0029-1235634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Freo U, Pitton M, Carron M, Ori C. Anesthesia for urgent sequential ventriculoperitoneal shunt revision and cesarean delivery. Int J Obstet Anesth 2009; 18:284-7. [DOI: 10.1016/j.ijoa.2009.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2009] [Indexed: 11/25/2022]
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Wirth G, Weber S, Kunz P, Pitton M, Meyer E, Düber C, Kreitner KF. Bestimmung des mittleren pulmonalarteriellen Drucks (mPAP) bei Patienten mit chronisch thromboembolischer pulmonaler Hypertonie (CTEPH) mittels hochaufgelöster Phasenkontrast-MRT. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1208340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hallenbeck J, Koutsimpelas D, Pitton M, Külkens C, Lippert BM, Mann WJ. Endovascular Carotid Reconstruction in Palliative Head and Neck Cancer Patients with Threatened Carotid Blowout Presents a Beneficial Supportive Care Measure. J Palliat Med 2008; 11:784-9. [DOI: 10.1089/jpm.2008.9901] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Michael Pitton
- Department of Radiology, University Hospital of Mainz, Mainz, Germany
| | - Christoph Külkens
- Department of Otorhinolaryngology, University Hospital of Mainz, Mainz, Germany
| | - Burkard M. Lippert
- Department of Otorhinolaryngology, University Hospital of Mainz, Mainz, Germany
| | - Wolf J. Mann
- Department of Otorhinolaryngology, University Hospital of Mainz, Mainz, Germany
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Neufang A, Espinola-Klein C, Dorweiler B, Pitton M, Savvidis S, Schmiedt W, Vahl C. Questionable Value of Adjuvant Arteriovenous Fistula in Pedal Bypass at High Risk for Early Failure. Ann Vasc Surg 2008; 22:379-87. [DOI: 10.1016/j.avsg.2007.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 08/13/2007] [Accepted: 09/14/2007] [Indexed: 11/24/2022]
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Herber S, Pitton M, Mönch C, Schneider J, Manzl N, Kummer I, Kanzler S, Schuchmann M, Junginger T, Düber C, Otto G. Transarterielle Chemoembolisation (TACE) des Hepatozellulären Karzinoms (HCC) bei Patienten mit Pfortaderthrombose - Erfahrungen. Zentralbl Chir 2007; 132:306-15. [PMID: 17724633 DOI: 10.1055/s-2007-981207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Comparative analysis of the course of disease in patients with initial diagnosis of portal vein thrombosis in HCC treated with sequential TACE. Evaluation of the efficacy and safety of the method in a selected patient cohort. PATIENTS AND METHODS The study included 22 patients with HCC that were palliatively treated at least 3 times with TACE. All patients presented a portal vein thrombosis in the initial CT investigation. The TACE-procedure was carried out in regular intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10-20 ml Lipiodol. Follow-up investigations were carried out with contrast enhanced Multislice-CT before and after TACE and control of the laboratory panel (i. e. blood count, liver enzymes and coagulation). RESULTS Mean survival was 15.7 months (95%-CI 11.6-19.8) with a mean follow-up after last TACE of 6.1 +/- 4.8 months. The mean number of TACE procedures was 5.5 +/- 2.7. During the investigation period 17 / 22 (77.3%) patients died. In 23.5% retrospective analysis revealed a liver decompensation as the cause of death and in 58.8% patients died from the tumor disease. The cumulative 1-, 2- and 3-year survival was 55.0, 21.0 and 0%. The mean tumor size was 7.2 +/- 3.4 cm. Unifocal tumors were found in 18.2% of the cases whereas multifocal tumors were found in 81.8%. In 59.1% of the patients tumor extended to both liver lobes. In case of tumor infiltration of the portal vein survival was significantly worse compared to patients with no evidence of a tumor thrombosis (p = 0.01; cumulative 1- and 2-year survival 46% and 8% vs. 77% and 46%). CONCLUSION The palliative treatment of the HCC with TACE shows an improvement of survival. There was no increase of death due to liver decompensation in our cohort. Patients with a tumor infiltration of the portal vein showed a significantly worsened survival. The presence of a portal vein thrombosis at the initial diagnosis of the HCC is not an absolute contraindication for TACE treatment but patients have to be elected carefully with critical regard to their liver function.
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Affiliation(s)
- S Herber
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Johannes-Gutenberg-Universität, Mainz.
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Herber S, Otto G, Schneider J, Manzl N, Kummer I, Kanzler S, Schuchmann A, Thies J, Düber C, Pitton M. Transarterial chemoembolization (TACE) for inoperable intrahepatic cholangiocarcinoma. Cardiovasc Intervent Radiol 2007; 30:1156-65. [PMID: 17508242 DOI: 10.1007/s00270-007-9032-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 03/27/2007] [Accepted: 03/28/2007] [Indexed: 12/17/2022]
Abstract
The aim of this retrospective study was to determine the safety and efficacy of chemoembolization (TACE) as palliative treatment for patients with unresectable intrahepatic cholangiocarcinoma (CCA) and to compare the results with those in the literature. Fifteen patients with histology-proven CCA (5 men, 10 women) had received palliative treatment with TACE over a 6-year period. The treatment protocol comprised repeated TACE at a minimum of 8-week intervals. TACE was performed with a mixture of 10 ml Lipiodol and 10 mg mitomycin C injected into the tumor-supplying vessels. Follow-up investigations after 8-10 weeks comprised contrast-enhanced multislice spiral CT and laboratory control. Statistical evaluation included survival analysis using the Kaplan-Meier method. During the investigation period 58 TACEs (3.9 +/- 3.8; 1-15) were performed in 15 patients. Mean tumor size was 10.8 +/- 4.6 cm (range, 2.0-18.0 cm). Unifocal tumor disease was diagnosed in eight patients, and multifocal disease in seven. Mean survival was 21.1 months (95% CI, 9.4-32.5 months). At the end of the investigation period 3 patients are still alive, and 12 patients have died. The 1-, 2-, and 3-year survival rate was 51.3%, 27.5%, and 27.5% respectively. According to RECIST criteria interim best response to therapy was stable disease in 9 of 15 patients, a partial response in 1 of 15 patients, and tumor progression in 4 of 15 patients. No deaths and no acute liver failure occurred under TACE therapy. Major complications were observed in two patients, comprising anaphylactic shock owing to contrast medium administration in one and gastric ulceration due to lipiodol displacement in the second patient. These results demonstrate that TACE is a safe procedure with a moderate number of complications for patients suffering from inoperable CCA. According to recently published data on i.v. chemotherapy we suggest that TACE might be able to prolong survival in selected patients who would succumb under other palliative treatment modalities.
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Affiliation(s)
- S Herber
- Department of Diagnostic and Interventional Radiology, University of Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
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Otto G, Heise M, Moench C, Herber S, Bittinger F, Schuchmann M, Hoppe-Lotichius M, Pitton M. Transarterial Chemoembolization Before Liver Transplantation in 60 Patients With Hepatocellular Carcinoma. Transplant Proc 2007; 39:537-9. [PMID: 17362776 DOI: 10.1016/j.transproceed.2006.12.007] [Citation(s) in RCA: 22] [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] [Indexed: 12/31/2022]
Abstract
Tumor recurrence is a major problem after orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC). In 60 patients OLT was performed for HCC after pretreatment by repeated transarterial chemoembolization (TACE). Forty-four recipients exceeded the Milan criteria. Recurrence-free 5-year survival was 65.2% and 5-year freedom from recurrence was 73.2%. During the waiting time, 14 patients experienced minimal change, which did not fulfill the definition of tumor progression according to official oncological criteria. Five-year freedom from recurrence among patients with stable compared with progressive disease was 93.3% versus 28.1%, respectively (P = .0001). A strict TACE pretreatment protocol may select patients with obviously biologically less aggressive tumors, who are suitable for OLT even if the HCC exceeds the commonly accepted listing criteria.
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Affiliation(s)
- G Otto
- Department of Transplantation and Hepatobiliary Surgery, Mainz, Germany.
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Dorweiler B, Schmiedt W, Neufang A, Pitton M, Duber C, Vahl CF. Long-term results of endovascular treatment of acute thoracic aortic lesions. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Waldner M, Schimanski C, Klaas W, Bittinger F, Pitton M, Korenkov M, Kiesslich R, Neurath M, Galle P, Kanzler S. [Massive hemorrhage in a 28-year-old male patient with intestinal Behçet's disease]. Z Gastroenterol 2006; 44:1047-51. [PMID: 17063434 DOI: 10.1055/s-2006-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A 28-year-old man was admitted to the emergency room of our hospital after syncope and acute gastrointestinal bleeding. On the basis of numerous oral and genital ulcerations as well as uveitis anterior and erythema nodosum, the diagnosis of Behçet's disease had been confirmed previously. The bleeding focus could not be detected by endoscopy. During the next days recurrent massive hemorrhages occurred in spite of immunosuppressive therapy with steroids. Angiography revealed a circumscribed bleeding source in the colon transversum near the left colonic flexure, which was treated by superselective coil embolization. A massive hemorrhage reoccurred and required a surgical approach with a Hartmann procedure. Histology depicted bleeding into the submucosa and mucosa and an ulcer in this area as well as lymphatic infiltration of the mucosa. Immunosuppressive therapy was intensified with azathioprine and resulted in a dramatic improvement of the oral and genital ulcers. In addition, no further gastrointestinal hemorrhage occurred. Due to its higher prevalence in patients from eastern Asia, Behçet's disease poses an important differential diagnosis of intestinal hemorrhage in patients of this descent.
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Affiliation(s)
- M Waldner
- I. Medizinische Klinik, Johannes-Gutenberg-Universität, Mainz
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Otto G, Herber S, Heise M, Lohse AW, Mönch C, Bittinger F, Hoppe-Lotichius M, Schuchmann M, Victor A, Pitton M. Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma. Liver Transpl 2006; 12:1260-7. [PMID: 16826556 DOI: 10.1002/lt.20837] [Citation(s) in RCA: 304] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Criteria to select patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) are based on tumor size and number of nodules rather than on tumor biology. The present study was undertaken to assess the role of transarterial chemoembolization (TACE) in selecting patients with tumors suitable for LT. Ninety-six consecutive patients with HCC were treated by repeatedly performed TACE, 62 of them exceeding the Milan criteria. Patients meeting the Milan criteria were immediately listed, and patients beyond the listing criteria were listed upon downstaging of the tumor following successful TACE. Fifty patients were finally transplanted. Of these 50 patients, 34 exceeded the Milan criteria. In these 96 patients, overall 5-year survival was 51.9%. However, it was 80.9% for patients undergoing LT and 0% for patients without transplantation (P < 0.0001). Tumor recurrence was primarily influenced by the control of the disease through continued TACE during the waiting time. Freedom from recurrence after 5 years was 94.5% in patients (n = 39) with progress-free TACE during the waiting time. Tumor recurrence was significantly higher in patients (n = 11) who after initial response to TACE progressed again before LT (freedom from recurrence 35.4%; P = 0.0017). Progress-free course of TACE during the waiting time (P = 0.006; risk ratio, 8.95), and a limited number of tumor nodules as assessed in the surgical specimen (P = 0.025; risk ratio, 0.116) proved to be significant predictors for freedom from recurrence in the multivariate analysis. Milan criteria were without impact on recurrence. Our data suggest that sustained response to TACE is a better selection criterion for LT than the initial assessment of tumor size or number.
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Affiliation(s)
- Gerd Otto
- Department of Transplantation and Hepatobiliopancreatic Surgery, Johannes Gutenberg University, Mainz, Germany.
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Neufang A, Espinola-Klein C, Dorweiler B, Reinstadler J, Pitton M, Savvidis S, Fischer R, Vahl C, Schmiedt W. Sequential Femorodistal Composite Bypass with Second Generation Glutaraldehyde Stabilized Human Umbilical Vein (HUV). Eur J Vasc Endovasc Surg 2005; 30:176-83. [PMID: 15950502 DOI: 10.1016/j.ejvs.2005.04.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 11/02/2004] [Accepted: 04/19/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the performance of sequential composite bypasses with second generation glutaraldehyde stabilized human umbilical vein (HUV) and autologous vein. DESIGN Retrospective study of consecutive patients, in a single centre. PATIENTS From January 1998 to December 2003, 54 femoro-distal HUV-autologous vein sequential composite bypasses were constructed in 52 patients with critical leg ischemia and absence of sufficient length of autologous vein. METHODS All infra-inguinal bypass operations were registered in a computerized database and prospectively followed. Bypasses using sequential HUV-composite technique were reviewed for graft patency, limb salvage and patient survival. RESULTS Primary patency and secondary patency rates at 1, 2, 3 and 4 years were 71, 61, 53 and 53% and 89, 80, 73 and 67%, respectively. Corresponding limb salvage rates were 96, 92, 88 and 88%. Patient survival was 56% at 4 years. After 30 days additional procedures to maintain graft patency were necessary in six bypasses. Asymptomatic occlusion of one sequential anastomosis was found in five patients. CONCLUSION Graft patency and limb salvage rate support the use of the sequential composite technique with second generation HUV in femorodistal bypass surgery, when autologous vein of sufficient length is not available.
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Affiliation(s)
- A Neufang
- Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University School of Medicine, Mainz, Germany.
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Rieker O, Pitton M, Herber S, Vomweg T, Teifke A, Düber C. Die direkte perkutane radiologische Jejunostomie (PRJ) und Duodenostomie: eine retrospektive Auswertung. ROFO-FORTSCHR RONTG 2005; 177:393-8. [PMID: 15719302 DOI: 10.1055/s-2004-813916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To present our experience with direct percutaneous radiologic duodenostomy and jejunostomy (PRJ) for alimentation. MATERIALS AND METHODS A retrospective study identified 24 patients who had undergone percutaneous jejunostomy or duodenostomy guided by CT and fluoroscopy over a period of 9 years. Whenever possible, the jejunum was inflated with a 5 French diagnostic catheter and jejunopexy was performed using Cope anchors (T-fasteners). A 12 to14 French locking pigtail drain was inserted for alimentation. In 8 patients, percutaneous direct jejunostomy was performed using only fluoroscopy. In 9 patients, both CT and fluoroscopy were used to guide the jejunostomy. In all 7 patients who underwent duodenostomy, a combination of CT and fluoroscopy was used. The reports were reviewed for complications and the technical success rate. The technical success rate was determined. RESULTS Percutaneous radiologic jejunostomy was attempted in 17 patients and failed in 5 patients. PRJ was successful in all 8 procedures guided by fluoroscopy and in 4 of 9 procedures guided by CT and fluoroscopy. Direct percutaneous duodenostomy guided by CT and fluoroscopy was successful in all 7 cases. There were no procedure-related laparotomies and no mortality related to the jejunostomy. Minor complications were infection of the abdominal wall (n = 1), lingering pain requiring a new jejunostomy (n = 1) and aspiration because of persistent reflux (n = 1). CONCLUSION PRJ is a safe procedure even in critically ill patients. It is technically difficult and may fail if the jejunum cannot be distended. Percutaneous radiologic duodenostomy and jejunostomy are recommended for prolonged alimentation of malnourished patients following esophageal or gastric surgery.
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Affiliation(s)
- O Rieker
- Klinik und Poliklinik für Radiologie der Johannes-Gutenberg-Universität Mainz.
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Trevisanuto D, Pitton M, Altinier S, Zaninotto M, Plebani M, Zanardo V. Cardiac troponin I, cardiac troponin T and creatine kinase MB concentrations in umbilical cord blood of healthy term neonates. Acta Paediatr 2004; 92:1463-7. [PMID: 14971799 DOI: 10.1080/08035250310006584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
AIMS To measure and compare cardiac troponin I, cardiac troponin T and creatine kinase MB concentrations in the umbilical cord blood of healthy term infants and to investigate the relationship between maternal and neonatal troponin values at birth. METHODS Troponin I, troponin T and creatine kinase MB concentrations were measured from the umbilical cord samples of 85 healthy term neonates and in the blood samples of their respective mothers at birth. RESULTS Median (interquartile range) umbilical cord concentrations were 0 microg/L (0-0) for troponin I, 0 microg/L (0-0.019) for troponin T and 4.90 microg/L (3.90-6.61) for creatine kinase MB. Troponin I and T concentrations were higher than the detection limit for the assay in 2 (2.3%) and 41 (48.2%) neonates, respectively. Two mothers (2.3%) had cTnT levels above the detection limit; none of them had increased levels of cTnI. CONCLUSION Probably owing to differences in expression and assay detection limits, cord blood troponin T concentrations are frequently over the detection limit at birth, while troponin I is mostly undetectable and comparable with that in healthy pregnant women. These cardiac regulatory proteins are of neonatal origin and are not influenced by maternal levels.
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Affiliation(s)
- D Trevisanuto
- Paediatric Department, Medical School, University of Padua, Azienda Ospedaliera di Padova, Padua, Italy.
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Meier S, Schenk A, Mildenberger P, Bourquain H, Pitton M, Thelen M. [Evaluation of a new software tool for the automatic volume calculation of hepatic tumors. First results]. ROFO-FORTSCHR RONTG 2004; 176:234-8. [PMID: 14872378 DOI: 10.1055/s-2004-817633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Computed tomography has become the preferred method in detecting liver carcinomas. The introduction of spiral CT added volumetric assessment of intrahepatic tumors, which was unattainable in the clinical routine with incremental CT due to complex planimetric revisions and excessive computing time. In an ongoing clinical study, a new software tool was tested for the automatic detection of tumor volume and the time needed for this procedure. MATERIALS AND METHODS We analyzed patients suffering from hepatocellular carcinoma (HCC). All patients underwent treatment with repeated transcatheter chemoembolization of the hepatic arteria. The volumes of the HCC lesions detected in CT were measured with the new software tool in HepaVison (MeVis, Germany). The results were compared with manual planimetric calculation of the volume performed by three independent radiologists. RESULTS Our first results in 16 patients show a correlation between the automatically and the manually calculated volumes (up to a difference of 2 ml) of 96.8 %. While the manual method of analyzing the volume of a lesion requires 2.5 minutes on average, the automatic method merely requires about 30 seconds of user interaction time. CONCLUSION These preliminary results show a good correlation between automatic and manual calculations of the tumor volume. The new software tool requires less time for accurate determination of the tumor volume and can be applied in the daily clinical routine.
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Affiliation(s)
- S Meier
- Klinik und Poliklinik für Radiologie, University Mainz, Germany.
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31
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Schmiedt W, Neufang A, Dorweiler B, Reinstadler J, Espinola-Klein C, Savvidis S, Kraus O, Herber S, Gerhards A, Pitton M, Proebstle T. Krurale und pedale Bypasschirurgie bei kritischer Isch�mie und nicht heilenden Fu�l�sionen. Gef�sschirurgie 2003. [DOI: 10.1007/s00772-003-0316-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schmiedt W, Düber C, Pitton M, Neufang A, Dorweiler B, Herber S, Reinstadler J, Kirsch D, Eberle B, Espinola-Klein C, Thelen M, Oelert H. [Endovascular aneurysm therapy--long-term treatment outcomes after 7 years]. Med Klin (Munich) 2002; 97:204-8. [PMID: 11977575 DOI: 10.1007/s00063-002-1151-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stentgrafts for endovascular treatment of abdominal aortic aneurysms (AAA) have been commercially available since 1994, with now large numbers of implantations all over the world. PATIENTS AND METHODS From 1994-2001, 115 patients were treated with Stentor, Vanguard and Talent stentgrafts in our institution. RESULTS Late complications of the first- and second-generation stentgrafts as radiologic or surgical interventions to maintain complete exclusion of the aneurysm amounted to 30% with an additional 22% for observed endoleaks and configuration changes of the stentgraft. Third-generation stentgrafts had a lower complication rate of 12.2% for interventions and 18.3% for late endoleaks and graft changes. CONCLUSION High costs of the devices, a pretty high late complication rate, and the uncertain maintenance of stentgraft function to prevent aneurysm rupture currently limit the widespread application of this new technology, leaving conventional aneurysmectomy the standard for aneurysm treatment and reserving the endovascular method for selected patients.
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Affiliation(s)
- Walther Schmiedt
- Klinik für Herz-, Thorax- und Gefässchirurgie, Johannes Gutenberg-Universität Mainz.
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Oberholzer K, Kreitner KF, Kalden P, Pitton M, Requardt M, Thelen M. Kontrastverstärkte dreidimensionale MR-Angiographie der A. carotis bei 1,0 Tesla im Vergleich zuri.a. DSA - ist die Methode für die Diagnostik von Karotisstenosen geeignet? ROFO-FORTSCHR RONTG 2001; 173:350-5. [PMID: 11367845 DOI: 10.1055/s-2001-12476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the efficacy of three-dimensional, contrast-enhanced magnetic resonance angiography (CE-MRA) of the carotid artery with a 1.0 T system in comparison to intra-arterial conventional angiography (i.a.CA) for the assessment of carotid artery disease. METHOD 55 patients with suspected stenosis of the carotid artery were examined with a 3 D-CE gradient-echo sequence on a 1.0 T scanner (TR/TE = 6.2/2.2 ms) and a selective DSA i.a. angiography. Image quality was evaluated by estimating the arterial contrast and venous enhancement. Morphological pathologies were registered for all arteries, stenoses of the internal carotid artery were graded by applying the NASCET criteria. RESULTS Sensitivity and specificity of MRA in detecting high-grade stenosis (> or = 70%) and occlusion of the extracranial internal carotid artery were 97.7 and 94.0%. Therapeutic relevant misinterpretations were mostly based on overestimating the stenoses. CONCLUSION The applied CE-MRA technique with a 1.0 T system is suitable for the assessment of carotid artery stenoses. In case of a therapeutically relevant stenosis revealed by MRA, however, verification of the diagnosis by i.a. CA is recommended.
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Affiliation(s)
- K Oberholzer
- Klinik für Radiologie, Johannes Gutenberg Universität Mainz.
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Kalden P, Kreitner KF, Oberholzer K, Pitton M, Krummenauer F, Requardt M, Thelen M. [Contrast media-enhanced 3D MR angiography of peripheral arteries using an automatic tracking technique at 1.0 Tesla]. ROFO-FORTSCHR RONTG 2000; 172:978-84. [PMID: 11199441 DOI: 10.1055/s-2000-9224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE Assessment of the value of contrast-enhanced MR angiography (ceMRA) using an automatic tracking technique at 1.0 Tesla in comparison with digital subtraction angiography (DSA) of the pelvic and lower limb arteries. MATERIALS AND METHODS In 15 patients with peripheral arterial occlusive disease a ceMRA (3D FLASH, TR/TE = 6.2/2.3 ms, Flip angle alpha = 30 degrees, Matrix 170 x 256) using a new automatic tracking technique was accomplished. The reference method was DSA. Twenty-one vessel segments of each patient were graded as normal, stenosed (> 50%) or occluded. Image material was evaluated independently by two radiologists. RESULTS In comparison, the interobserver agreement showed a good (Cohen's kappa > 71%) concordance for 38% of the 21 vessel segments, a moderate (Cohen's kappa between 31%-70%) for 21% and a poor (Cohen's kappa < 30%) concordance for 38% of the 21 vessel segments. Regarding the MRA and DSA results, a good concordance was achieved for 62% of the 21 vessel segments, 14% showed a moderate concordance and 24% only a poor concordance. CONCLUSION In patients with peripheral arterial occlusive disease ceMRA using an automatic tracking technique enables a reliable evaluation of pelvis and upper limb arteries at 1.0 Tesla. However, a reliable evaluation of lower limb arteries is not yet possible.
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Affiliation(s)
- P Kalden
- Klinik und Poliklinik für Radiologie, Johannes Gutenberg Universität, Mainz.
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Oberholzer K, Kreitner KF, Kalden P, Pitton M, Requardt M. [Contrast-enhanced MR angiography of abdominal vessels using a 1.0 T system]. ROFO-FORTSCHR RONTG 2000; 172:134-8. [PMID: 10723486 DOI: 10.1055/s-2000-102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the efficacy of breath-hold, three-dimensional, contrast-enhanced magnetic resonance angiography with a 1.0 T system for imaging the abdominal vessels in comparison to conventional arteriography (CA). METHODS The abdominal aorta and visceral arteries were studied in 54 patients (60 examinations) on a 1.0 T scanner using an ultrafast gadolinium-enhanced gradient-echo sequence with the following parameters: TR/TE = 3.8/1.4 ms, flip angel 25 degrees, matrix 198 x 256, field 380-420 mm, pixel size 1.9 x 1.48 mm2, slice thickness 1.5-2.5 mm, acquisition time 22-26 sec. Individual circulation times were determined by a test bolus before each MR angiography. Conventional arteriography was performed in 23 of the 60 cases. RESULTS 172 vessel segments of 23 MR angiographies were compared with CA, sensitivity and specificity were 96.4% and 97.2%. Over-estimations of stenoses or occlusions (n = 4) were caused by the limited resolution of small vessel branches and one stent artifact. CONCLUSION Contrast-enhanced MR angiography of the abdominal vessels may replace invasive digital subtraction angiography in certain cases like perioperative or peri-interventional diagnostics. Imaging of small peripheral vessels remains a problem and limits use of the method.
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Affiliation(s)
- K Oberholzer
- Klinik für Radiologie, Johannes Gutenberg-Universität Mainz.
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Oberholzer K, Kreitner KF, Kalden P, Requardt M, Pitton M, Mildenberger P, Thelen M. [MR angiography of peripheral vessels with automatic tracking table technique at 1.0 in comparison with intra-arterial digital subtraction angiography]. ROFO-FORTSCHR RONTG 1999; 171:240-3. [PMID: 10520335 DOI: 10.1055/s-1999-245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Contrast-enhanced (CE) 3D-MR angiography of peripheral arteries was performed in 8 patients with peripheral arterial occlusive disease by applying a new tracking technique on a 1.0 T system (Magnetom Harmony, Siemens). The studies were compared with intra-arterial digital angiography as gold standard. MATERIALS AND METHODS Imaging of the distal aorta, pelvis, upper and lower limb arteries was accomplished with a Flash-3D-sequence (TR/TE = 6.2/3.2 ms) within 26 s acquisition time of each region after a single bolus of 30 ml contrast agent. Individual circulation time was determined by a test bolus before each examination. RESULTS 112 vessel segments were evaluated. MR angiography achieved a sensitivity of 89% and a specificity of 100% for detecting high grade stenoses and vessel occlusions. CONCLUSIONS Tracking CE 3D-MR angiography with a 1.0 T MR imager proved to be a promising method in evaluating hemodynamically significant stenoses and occlusions of peripheral arteries. However, its definite role in the diagnostic work-up of peripheral arterial occlusive disease has to be evaluated in larger prospective studies.
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Affiliation(s)
- K Oberholzer
- Klinik für Radiologie, Johannes-Gutenberg-Universität, Mainz.
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Kramm T, Mayer E, Dahm M, Guth S, Menzel T, Pitton M, Oelert H. Long-term results after thromboendarterectomy for chronic pulmonary embolism. Eur J Cardiothorac Surg 1999; 15:579-83; discussion 583-4. [PMID: 10386400 DOI: 10.1016/s1010-7940(99)00076-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE In patients with chronic thromboembolic pulmonary hypertension, pulmonary vascular resistance (PVR) can be reduced by pulmonary thromboendarterectomy (PTE). In this study, long-term symptomatic and hemodynamic effects were investigated. METHODS Twenty-two patients (12 female, 10 male, mean age 40 years, preoperative NYHA functional class II/III/IV: n = 1/12/9) were re-evaluated 48-72 months (mean 60 months) after surgery. In addition to clinical assessment, radiologic, hemodynamic and echocardiographic investigations were performed. RESULTS All patients reported a marked improvement of their clinical condition. At follow-up, 11 patients were identified as NYHA class I, 10 as NYHA class II and one patient was in class III. PVR and mean pulmonary artery pressure (mPAP) were significantly reduced (preoperative PVR 800+/-274 dynes/s per cm(-5), follow-up PVR 180+/-28.3 dynes/s per cm(-5); P < 0.001; preoperative mPAP 48.5+/-7.4 mmHg, follow-up mPAP 27.5+/-4.9 mmHg; P < 0.001). There was also a significant increase in arterial blood oxygen tension (preoperative PaO2 59+/-10 mmHg; follow-up PaO2 84+/-12 mmHg; P < 0.001). Chest roentgenograms and echocardiographic examinations revealed significantly decreased right heart dimensions and a recovery of right heart function. CONCLUSION In patients with severe chronic thromboembolic pulmonary hypertension, persistent symptomatic and hemodynamic improvements can be achieved by PTE.
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Affiliation(s)
- T Kramm
- Department of Cardiothoracic- and Vascular Surgery, Johannes Gutenberg University Hospital, Mainz, Germany.
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Schunk K, Pitton M, Düber C, Kersjes W, Schadmand-Fischer S, Thelen M. Dynamic phosphorus-31 magnetic resonance spectroscopy of the quadriceps muscle: effects of age and sex on spectroscopic results. Invest Radiol 1999; 34:116-25. [PMID: 9951791 DOI: 10.1097/00004424-199902000-00004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Phosphorus-31 (31p) magnetic resonance spectroscopy (MRS) is used to assess the influence of sex and age on quadriceps muscle metabolism before and after exercise. METHODS Fifty-four healthy volunteers and 56 patients with an arterial occlusive disease were examined by dynamic 31p MRS. In the magnet, the quadriceps muscle was stressed by an isometric and an isotonic form of exercise until exhaustion. RESULTS Older subjects showed a significantly larger ratio of inorganic phosphate (P(i)) to phosphocreatine (PCr) than younger subjects (r = 0.52, P = 8 x 10(-9)). With subjects' increasing age, the ratio of adenosine triphosphate (beta-ATP) to total phosphate decreased (r = -0.36, P = 5 x 10(-5)). The ratio of phosphomonoester to beta-ATP and phosphodiester (PDE) to beta-ATP showed a strong age dependence (r = 0.71 and 0.69, P = 3 x 10(-17) and 4 x 10(-15), respectively). The pH was the only one of the evaluated spectroscopic parameters that showed a sex dependence. Female subjects had a significantly lower pH (7.03+/-0.02) than male subjects (7.05+/-0.03) (P = 6 x 10(-4)). With increasing age, the maxima of P(i) to PCr were less extreme during both of the exercises (r = -0.51, P = 3 x 10(-16)). Likewise, the exercise-induced acidosis was less severe with increasing age (r = -0.51, P = 7 x 10(-16)). After the exercises ended, the times of half recovery of P(i) to PCr and the pH neither correlated with the subjects' age nor with sex or the cross-sectional area of the quadriceps muscle. CONCLUSIONS The sex and age of volunteers or patients may affect spectroscopic results in a significant way. This influence has to be considered in the interpretation of spectroscopic studies. According to the recovery rates of P(i) to PCr and the pH, an age-related deterioration of muscular metabolism seems to be avoidable by appropriate physical activity.
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Affiliation(s)
- K Schunk
- Department of Radiology, University Hospital Mainz, Federal Republic of Germany
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Rieker O, Düber C, Neufang A, Pitton M, Schweden F, Thelen M. CT angiography versus intraarterial digital subtraction angiography for assessment of aortoiliac occlusive disease. AJR Am J Roentgenol 1997; 169:1133-8. [PMID: 9308477 DOI: 10.2214/ajr.169.4.9308477] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the accuracy of CT angiography (CTA) with a single helical acquisition for assessment of stenoses and occlusions of the iliac arteries. SUBJECTS AND METHODS In our prospective study, intraarterial digital subtraction angiography and IV CTA were performed from the suprarenal aorta to below the femoral bifurcation in 30 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were also obtained. The accuracy of CTA with and without analysis of axial images was determined. RESULTS Sensitivity and specificity of CTA were 100% for iliac artery occlusions with a confidence interval 85-100% and 97-100%, respectively. When axial scans were interpreted, 14 of 15 high-grade (> 75%) stenoses were recognized. Sensitivity and specificity of CTA were 93% (range, 68-100%) and 99% (range, 97-100%), respectively. When maximum intensity projections alone were analyzed, sensitivity for the diagnosis of 15 high-grade stenoses was only 53% (range, 27-79%) because calcified plaques obscured six stenoses. CONCLUSIONS CTA accurately reveals iliac artery occlusions. Observers of CT angiograms may overlook short stenoses in rare instances. Calcified plaques limit the use of maximum-intensity-projection images.
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Affiliation(s)
- O Rieker
- Department of Radiology, Klinik für Radiologie, Johannes Gutenberg-Universität Mainz, Germany
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Rieker O, Düber C, Schmiedt W, Neufang A, Pitton M, Schweden F. [CT angiography versus intra-arterial DSA in abdominal aortic aneurysms]. ROFO-FORTSCHR RONTG 1996; 165:17-23. [PMID: 8765358 DOI: 10.1055/s-2007-1015708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate if CT angiography is able to image all features necessary for the preoperative planning of abdominal aortic aneurysms (accessory renal arteries, stenoses or occlusions of renal and iliac arteries, patency of inferior mesenteric artery). METHODS CT angiography and DSA were performed on 27 patients with abdominal aortic aneurysms. CT angiography was performed using a protocol that covered the abdominal aorta and the pelvic arteries with a single spiral acquisition (contrast dose: 150 ml, collimation: 5 mm, table feed: 7.5 mm/s, increment of reconstruction: 2 mm). Maximum intensity projections (MIP) and axial scans were compared with the results of intraarterial DSA. RESULTS Using axial scans and subvolume MIP, CTA accurately defined 7/8 accessory renal arteries, 13/13 occlusions and 9/12 high grade stenoses of renal and pelvic arteries. High-grade stenoses of the iliac arteries were underestimated in two cases and overlooked in one case. CT angiography was superior to DSA in imaging the inferior mesenteric artery. CT angiography precisely diagnosed 33 aneurysms of the iliac, renal and coeliac arteries. CONCLUSION CT angiography using a single administration of intravenous contrast may replace preoperative DSA in most cases of abdominal aortic aneurysm.
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Affiliation(s)
- O Rieker
- Klinik für Radiologie, Johannes-Gutenberg-Universität Mainz
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Mayer E, Dahm M, Hake U, Schmid FX, Pitton M, Kupferwasser I, Iversen S, Oelert H. Mid-term results of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Ann Thorac Surg 1996; 61:1788-92. [PMID: 8651785 DOI: 10.1016/0003-4975(96)00169-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients with chronic thromboembolic pulmonary hypertension, acute and striking decreases of pulmonary artery pressures and vascular resistance can be achieved by pulmonary thromboendarterectomy. In this study, the long-term effects of pulmonary thromboendarterectomy on hemodynamic indices and right ventricular function were investigated. METHODS Sixty-five patients (31 women and 34 men; mean age, 47 +/- 17 years; range, 19 to 69 years; New York Heart Association [NYHA] functional class II, n = 3; class III, n = 38; class IV, n = 24) were reassessed 13 to 48 months (mean, 27 months) after pulmonary thromboendarterectomy. Measurements are reported as mean +/- standard deviation. RESULTS All patients reported a significant improvement of symptoms: 46 patients were in NYHA functional class I, 16 patients in class II, and 3 patients in class III. Mean pulmonary vascular resistance was significantly reduced compared with preoperative and postoperative values (preoperative: 1,015 +/- 454 dynes.s.cm-5; postoperative: 322 +/- 154 dynes.s.cm-5; follow-up: 198 +/- 72 dynes.s.cm-5; p < 0.001 versus preoperative; p < 0.025 versus postoperative). Concomitantly, cardiac index was significantly increased compared with preoperative values (preoperative: 2.0 +/- 0.7 L.min-1.m-2; follow-up: 2.9 +/- 0.5 L.min-1.m-2; p < 0.001). Significant reductions of right ventricular dimensions and recovery of right ventricular function could be demonstrated radiologically and echocardiographically. In 3 patients (preoperative NYHA class IV, NYHA class III at follow-up) with proven coagulation abnormalities, pulmonary vascular resistance was moderately increased at follow-up compared with postoperative measurements. CONCLUSIONS In patients with chronic thromboembolic pulmonary hypertension, a persistent decrease of pulmonary vascular resistance and improvement of right ventricular function and NYHA functional status can be achieved by pulmonary thromboendarterectomy.
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Affiliation(s)
- E Mayer
- Department for Cardiothoracic, Johannes Gutenberg-University Hospital Mainz, Germany
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Düber C, Schmiedt W, Pitton M, Neufang A, Eberle B, Wollmann JC, Oelert H, Thelen M. [Intravascular therapy of aortic aneurysms: initial clinical results]. ROFO-FORTSCHR RONTG 1996; 164:55-61. [PMID: 8630361 DOI: 10.1055/s-2007-1015608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE A clinical study aiming at examining the implantation technique and the clinical results of a new vascular prosthesis in endovascular therapy of aneurysms of the aorta. MATERIAL AND METHODS In 21 patients (20 men of 55 to 87 years of age, average age 70 years) with aneurysms of the infrarenal abdominal aorta (AAA n = 19) and the thoracic aorta (n = 2), a self-expanding nitinol stent with outer Dacron sheath (tubular prosthesis n = 4; bifurcation prosthesis n = 17) was implanted by means of an F-18 introductory set after surgical opening of the inguinal artery. RESULTS By means of the 4 tubular prostheses and 13 of the 17 bifurcation prostheses the aneurysm was bypassed completely. In 4 cases residual perfusion through leaks (n = 3) or collateral blood supply (n = 1) was seen. In 6 patients 7 complications occurred which did not require to be operated on. No patient died in consequence of the surgical intervention or during the hospital stay. Follow-ups up to 8 months after surgery did not reveal any late complications to date. CONCLUSIONS Endovascular implantation of vascular prostheses is a promising new method for interdisciplinary treatment of aneurysms of the aorta.
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Affiliation(s)
- C Düber
- Klinik und Poliklinik für Radiologie, Johannes Gutenberg-Universität, Mainz
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Abstract
Pericardiectomy today is an accepted therapeutic concept in patients with different pericardial disorders. The postoperative outcome of patients is mainly influenced by two factors. First, diagnosis has to be established early to avoid myocardial deterioration and secondary organ failure, especially of liver and kidneys. Second, the whole accessible surface of atria and ventricles has to be freed from diseased and calcified pericardium. To achieve this, we prefer a total median sternotomy for the surgical approach. In selected cases of acute pericardial effusion or as a palliative procedure, a small infrasternal incision or anterolateral thoracotomy is used for pericardiocentesis and creation of a pericardio-pulmonary window. Between January 1969 and March 1990 we treated 187 patients with different pericardial disorders. Mortality was 4.8% overall, and was especially low (2.8%) among the 106 patients with acute and chronic pericardial effusion. Out of 67 patients with constrictive pericarditis, four died during hospital stay (5.9%). The prognosis is still poor for patients with primary or secondary malignant pericardial tumours, in whom surgery is mostly restricted to palliative resection, and a special group with constrictive and mostly calcified epicarditis, for whom no surgical option is available.
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Affiliation(s)
- F W Hehrlein
- Klinik für Herz- und Gefässchirurgie, Zentum Chirurgie der Justus-Liebig-Universität Giessen, F.R.G
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