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Aoki R. Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients With Exsanguinating Hemorrhage. JAMA 2024; 331:979. [PMID: 38502081 DOI: 10.1001/jama.2024.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Ryo Aoki
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
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Jansen JO, MacLennan GS, Campbell MK. Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients With Exsanguinating Hemorrhage-Reply. JAMA 2024; 331:981-982. [PMID: 38502076 DOI: 10.1001/jama.2024.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Jan O Jansen
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Graeme S MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Marion K Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
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Kamijo K, Matsumura Y. Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients With Exsanguinating Hemorrhage. JAMA 2024; 331:978-979. [PMID: 38502080 DOI: 10.1001/jama.2024.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Kyosuke Kamijo
- Department of Gynecology, Nagano Municipal Hospital, Nagano, Japan
| | - Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency and Psychiatry Medical Center, Chiba, Japan
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Tingerides C, Walker P. Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients With Exsanguinating Hemorrhage. JAMA 2024; 331:979-980. [PMID: 38502079 DOI: 10.1001/jama.2024.0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
| | - Paul Walker
- Vascular and Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, England
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Kessel B, Tal H, de Oliveira Góes AM. Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients With Exsanguinating Hemorrhage. JAMA 2024; 331:980. [PMID: 38502078 DOI: 10.1001/jama.2024.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Boris Kessel
- Hillel Yaffe Medical Center, Rappaport Medical School, Haifa, Israel
| | - Horer Tal
- Department of Cardiothoracic and Vascular Surgery, Örebro University, Örebro, Sweden
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Chin B, Patel H, Elkbuli A. Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients With Exsanguinating Hemorrhage. JAMA 2024; 331:980-981. [PMID: 38502077 DOI: 10.1001/jama.2024.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Brian Chin
- John A. Burns School of Medicine, University of Hawai'i, Honolulu
| | - Heli Patel
- Kiran Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida
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Deprest JA, Benachi A, Gratacos E, Nicolaides KH, Berg C, Persico N, Belfort M, Gardener GJ, Ville Y, Johnson A, Morini F, Wielgoś M, Van Calster B, DeKoninck PLJ. Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia. N Engl J Med 2021; 385:119-129. [PMID: 34106555 PMCID: PMC7613454 DOI: 10.1056/nejmoa2026983] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fetoscopic endoluminal tracheal occlusion (FETO) has been associated with increased postnatal survival among infants with severe pulmonary hypoplasia due to isolated congenital diaphragmatic hernia on the left side, but data are lacking to inform its effects in infants with moderate disease. METHODS In this open-label trial conducted at many centers with experience in FETO and other types of prenatal surgery, we randomly assigned, in a 1:1 ratio, women carrying singleton fetuses with a moderate isolated congenital diaphragmatic hernia on the left side to FETO at 30 to 32 weeks of gestation or expectant care. Both treatments were followed by standardized postnatal care. The primary outcomes were infant survival to discharge from a neonatal intensive care unit (NICU) and survival without oxygen supplementation at 6 months of age. RESULTS In an intention-to-treat analysis involving 196 women, 62 of 98 infants in the FETO group (63%) and 49 of 98 infants in the expectant care group (50%) survived to discharge (relative risk , 1.27; 95% confidence interval [CI], 0.99 to 1.63; two-sided P = 0.06). At 6 months of age, 53 of 98 infants (54%) in the FETO group and 43 of 98 infants (44%) in the expectant care group were alive without oxygen supplementation (relative risk, 1.23; 95% CI, 0.93 to 1.65). The incidence of preterm, prelabor rupture of membranes was higher among women in the FETO group than among those in the expectant care group (44% vs. 12%; relative risk, 3.79; 95% CI, 2.13 to 6.91), as was the incidence of preterm birth (64% vs. 22%, respectively; relative risk, 2.86; 95% CI, 1.94 to 4.34), but FETO was not associated with any other serious maternal complications. There were two spontaneous fetal deaths (one in each group) without obvious cause and one neonatal death that was associated with balloon removal. CONCLUSIONS This trial involving fetuses with moderate congenital diaphragmatic hernia on the left side did not show a significant benefit of FETO performed at 30 to 32 weeks of gestation over expectant care with respect to survival to discharge or the need for oxygen supplementation at 6 months. FETO increased the risks of preterm, prelabor rupture of membranes and preterm birth. (Funded by the European Commission and others; TOTAL ClinicalTrials.gov number, NCT00763737.).
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Affiliation(s)
- Jan A Deprest
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Alexandra Benachi
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Eduard Gratacos
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Kypros H Nicolaides
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Christoph Berg
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Nicola Persico
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Michael Belfort
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Glenn J Gardener
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Yves Ville
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Anthony Johnson
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Francesco Morini
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Mirosław Wielgoś
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Ben Van Calster
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
| | - Philip L J DeKoninck
- From the Department of Obstetrics and Gynecology, University Hospitals KU Leuven (J.A.D., P.L.J.D.) and Academic Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium (J.A.D., B.V.C., P.L.J.D.); Hospital Antoine-Béclère, Université Paris-Saclay, Clamart (A.B.), and Necker-Enfants Malades Hospital, Paris (Y.V.) - both in France; Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Institute for Women's Health, University College London Hospital (J.A.D.) and King's College Hospital(K.H.N.) - both in London; the University Hospital Bonn, Bonn, Germany (C.B.); Hospital Maggiore Policlinico, Milan (N.P.), and Bambino Gesù Children's Hospital, Rome (F.M.) - both in Italy; Baylor College of Medicine and Texas Children's Hospital (M.B.) and Children's Memorial Hermann Hospital (A.J.) - all in Houston; Mater Mothers' Hospital, Brisbane, QLD, Australia (G.J.G.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (P.L.J.D.)
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Deprest JA, Nicolaides KH, Benachi A, Gratacos E, Ryan G, Persico N, Sago H, Johnson A, Wielgoś M, Berg C, Van Calster B, Russo FM. Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia. N Engl J Med 2021; 385:107-118. [PMID: 34106556 PMCID: PMC7613453 DOI: 10.1056/nejmoa2027030] [Citation(s) in RCA: 143] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Observational studies have shown that fetoscopic endoluminal tracheal occlusion (FETO) has been associated with increased survival among infants with severe pulmonary hypoplasia due to isolated congenital diaphragmatic hernia on the left side, but data from randomized trials are lacking. METHODS In this open-label trial conducted at centers with experience in FETO and other types of prenatal surgery, we randomly assigned, in a 1:1 ratio, women carrying singleton fetuses with severe isolated congenital diaphragmatic hernia on the left side to FETO at 27 to 29 weeks of gestation or expectant care. Both treatments were followed by standardized postnatal care. The primary outcome was infant survival to discharge from the neonatal intensive care unit. We used a group-sequential design with five prespecified interim analyses for superiority, with a maximum sample size of 116 women. RESULTS The trial was stopped early for efficacy after the third interim analysis. In an intention-to-treat analysis that included 80 women, 40% of infants (16 of 40) in the FETO group survived to discharge, as compared with 15% (6 of 40) in the expectant care group (relative risk, 2.67; 95% confidence interval [CI], 1.22 to 6.11; two-sided P = 0.009). Survival to 6 months of age was identical to the survival to discharge (relative risk, 2.67; 95% CI, 1.22 to 6.11). The incidence of preterm, prelabor rupture of membranes was higher among women in the FETO group than among those in the expectant care group (47% vs. 11%; relative risk, 4.51; 95% CI, 1.83 to 11.9), as was the incidence of preterm birth (75% vs. 29%; relative risk, 2.59; 95% CI, 1.59 to 4.52). One neonatal death occurred after emergency delivery for placental laceration from fetoscopic balloon removal, and one neonatal death occurred because of failed balloon removal. In an analysis that included 11 additional participants with data that were available after the trial was stopped, survival to discharge was 36% among infants in the FETO group and 14% among those in the expectant care group (relative risk, 2.65; 95% CI, 1.21 to 6.09). CONCLUSIONS In fetuses with isolated severe congenital diaphragmatic hernia on the left side, FETO performed at 27 to 29 weeks of gestation resulted in a significant benefit over expectant care with respect to survival to discharge, and this benefit was sustained to 6 months of age. FETO increased the risks of preterm, prelabor rupture of membranes and preterm birth. (Funded by the European Commission and others; TOTAL ClinicalTrials.gov number, NCT01240057.).
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Affiliation(s)
- Jan A Deprest
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Kypros H Nicolaides
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Alexandra Benachi
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Eduard Gratacos
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Greg Ryan
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Nicola Persico
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Haruhiko Sago
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Anthony Johnson
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Mirosław Wielgoś
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Christoph Berg
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Ben Van Calster
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
| | - Francesca M Russo
- From the Department of Obstetrics and Gynecology, KU Leuven (J.A.D., F.M.R.) and Academic Department of Development and Regeneration, Biomedical Sciences, University Hospitals KU Leuven, Leuven, Belgium (J.A.D., B.V.C., F.M.R.); King's College Hospital (K.H.N.) and the Institute for Women's Health, University College London Hospital (J.A.D.) - both in London; Hospital Antoine-Béclère, Université Paris-Saclay, Clamart, France (A.B.); Hospital Clinic and Sant Joan de Déu, Barcelona (E.G.); Mount Sinai Hospital, Toronto (G.R.); Hospital Maggiore Policlinico, Milan (N.P.); the National Center for Child Health and Development, Tokyo (H.S.); Children's Memorial Hermann Hospital, Houston (A.J.); the Medical University of Warsaw, Warsaw, Poland (M.W.); and University Hospital Bonn, Bonn, Germany (C.B.)
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9
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Benham DA, Calvo RY, Carr MJ, Wessels LE, Schrader AJ, Lee JJ, Krzyzaniak MJ, Martin MJ. Is cerebral perfusion maintained during full and partial resuscitative endovascular balloon occlusion of the aorta in hemorrhagic shock conditions? J Trauma Acute Care Surg 2021; 91:40-46. [PMID: 33605703 DOI: 10.1097/ta.0000000000003124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/24/2023]
Abstract
BACKGROUND Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is a technology that occludes aortic flow and allows for controlled deflation and restoration of varying distal perfusion. Carotid flow rates (CFRs) during partial deflation are unknown. Our aim was to measure CFR with the different pREBOA balloon volumes and correlate those to the proximal mean arterial pressure (PMAP) and a handheld pressure monitoring device (COMPASS; Mirador Biomedical, Seattle, WA). METHODS Ten swine underwent a hemorrhagic injury model with carotid and iliac arterial pressures monitored via arterial lines. Carotid and aortic flow rates were monitored with Doppler flow probes. A COMPASS was placed to monitor proximal pressure. The pREBOA was inflated for 15 minutes then partially deflated for an aortic flow rate of 0.7 L/min for 45 minutes. It was then completely deflated. Proximal mean arterial pressures and CFR were measured, and correlation was evaluated. Correlation between CRF and COMPASS measurements was evaluated. RESULTS Carotid flow rate increased 240% with full inflation. Carotid flow rate was maintained at 100% to 150% of baseline across a wide range of partial deflation. After full deflation, CFR transiently decreased to 45% to 95% of baseline. There was strong positive correlation (r > 0.85) between CFR and PMAP after full inflation, and positive correlation with partial inflation (r > 0.7). Carotid flow rate had strong correlation with the COMPASS with full REBOA (r > 0.85) and positive correlation with pREBOA (r > 0.65). CONCLUSION Carotid flow rate is increased in a hemorrhagic model during full and partial inflation of the pREBOA and correlates well with PMAP. Carotid perfusion appears maintained across a wide range of pREBOA deflation and could be readily monitored with a handheld portable COMPASS device instead of a standard arterial line setup.
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Affiliation(s)
- Derek A Benham
- From the Department of Surgery (D.A.B., M.J.C., L.E.W., A.J.S., J.J.L., M.J.K.), Naval Medical Center San Diego; and Trauma Service, Department of Surgery (R.Y.C., M.J.M.), Scripps Mercy Hospital, San Diego, California
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10
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Arya AK, Hu K, Subedi L, Li T, Hu B. Focal intra-colon cooling reduces organ injury and systemic inflammation after REBOA management of lethal hemorrhage in rats. Sci Rep 2021; 11:13696. [PMID: 34211011 PMCID: PMC8249469 DOI: 10.1038/s41598-021-93064-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/14/2021] [Indexed: 12/04/2022] Open
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving maneuver for the management of lethal torso hemorrhage. However, its prolonged use leads to distal organ ischemia-reperfusion injury (IRI) and systemic inflammatory response syndrome (SIRS). The objective of this study is to investigate the blood-based biomarkers of IRI and SIRS and the efficacy of direct intestinal cooling in the prevention of IRI and SIRS. A rat lethal hemorrhage model was produced by bleeding 50% of the total blood volume. A balloon catheter was inserted into the aorta for the implementation of REBOA. A novel TransRectal Intra-Colon (TRIC) device was placed in the descending colon and activated from 10 min after the bleeding to maintain the intra-colon temperature at 37 °C (TRIC37°C group) or 12 °C (TRIC12°C group) for 270 min. The upper body temperature was maintained at as close to 37 °C as possible in both groups. Blood samples were collected before hemorrhage and after REBOA. The organ injury biomarkers and inflammatory cytokines were evaluated by ELISA method. Blood based organ injury biomarkers (endotoxin, creatinine, AST, FABP1/L-FABP, cardiac troponin I, and FABP2/I-FABP) were all drastically increased in TRIC37°C group after REBOA. TRIC12°C significantly downregulated these increased organ injury biomarkers. Plasma levels of pro-inflammatory cytokines TNF-α, IL-1b, and IL-17F were also drastically increased in TRIC37°C group after REBOA. TRIC12°C significantly downregulated the pro-inflammatory cytokines. In contrast, TRIC12°C significantly upregulated the levels of anti-inflammatory cytokines IL-4 and IL-10 after REBOA. Amazingly, the mortality rate was 100% in TRIC37°C group whereas 0% in TRIC12°C group after REBOA. Directly cooling the intestine offered exceptional protection of the abdominal organs from IRI and SIRS, switched from a harmful pro-inflammatory to a reparative anti-inflammatory response, and mitigated mortality in the rat model of REBOA management of lethal hemorrhage.
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Affiliation(s)
- Awadhesh K Arya
- Departments of Anesthesiology, Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kurt Hu
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lalita Subedi
- Departments of Anesthesiology, Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tieluo Li
- Departments of Anesthesiology, Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bingren Hu
- Departments of Anesthesiology, Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA.
- Veterans Affairs Maryland Health Center System, 10 North Greene Street, Baltimore, MD, USA.
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11
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McCracken BM, Tiba MH, Colmenero CI, Leander DC, Greer NL, Plott JS, Shih AJ, Ward KR. Novel intraperitoneal hemostasis device prolongs survival in a swine model of noncompressible abdominal hemorrhage. J Trauma Acute Care Surg 2021; 90:838-844. [PMID: 33496551 DOI: 10.1097/ta.0000000000003091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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
BACKGROUND Noncompressible torso hemorrhage (NCTH) of the abdomen is a challenge to rapidly control and treat in the prehospital and emergency department settings. In this pilot study, we developed a novel intraperitoneal hemostasis device (IPHD) prototype and evaluated its ability for slowing NCTH and prolonging survival in a porcine model of lethal abdominal multiorgan hemorrhage. METHODS Yorkshire male swine (N = 8) were instrumented under general anesthesia for monitoring of hemodynamics and blood sampling. Animals were subjected to a 30% controlled arterial hemorrhage followed by lacerating combinations of the liver, spleen, and kidney. The abdomen was closed and after 2 minutes of NCTH, and the IPHD was inserted into the peritoneal cavity via an introducer (n = 5). The balloon was inflated and maintained for 60 minutes. At 60 minutes postdeployment, the balloon was deflated and removed, and blood resuscitation was initiated followed by gauze packing for hemostasis. The remaining animals (n = 3) were used as controls and subjected to the same injury without intervention. RESULTS All animals managed with IPHD intervention (5 of 5 swine) survived the duration of the intervention period (60 minutes), while all control animals (3 of 3 swine) died at a time range of 15 to 43 minutes following organ injury (p = 0.0042). Animals receiving IPHD remained hemodynamically stable with a mean arterial pressure range of 44.86 to 55.10 mm Hg and experienced increased cardiac output and decreased shock index after treatment. Controls experienced hemodynamic decline in all parameters until endpoints were met. Upon IPHD deflation and removal, all treated animals began to hemorrhage again and expired within 2 to 132 minutes despite packing. CONCLUSION Our data show that the IPHD concept is capable of prolonging survival by temporarily stanching lethal NCTH of the abdomen. This device may be an effective temporary countermeasure to NCTH of the abdomen that could be deployed in the prehospital environment or as a bridge to more advanced therapy.
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Affiliation(s)
- Brendan M McCracken
- From the Department of Emergency Medicine (B.M.M., M.H.T., C.I.C., D.C.L., N.L.G., K.R.W.), Michigan Center for Integrative Research in Critical Care (B.M.M., M.H.T., C.I.C., D.C.L., N.L.G., J.S.P., A.J.S., K.R.W.), Biomedical Engineering (J.S.P., A.J.S., K.R.W.), and Mechanical Engineering (J.S.P., A.J.S.), University of Michigan, Ann Arbor, Michigan
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12
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Kemp MT, Wakam GK, Williams AM, Biesterveld BE, O'Connell RL, Vercruysse CA, Chtraklin K, Russo RM, Alam HB. A novel partial resuscitative endovascular balloon aortic occlusion device that can be deployed in zone 1 for more than 2 hours with minimal provider titration. J Trauma Acute Care Surg 2021; 90:426-433. [PMID: 33492106 DOI: 10.1097/ta.0000000000003042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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
BACKGROUND Hemorrhage is a leading cause of mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) can control hemorrhage, but distal ischemia, subsequent reperfusion injury, and the need for frequent balloon titration remain problems. Improved device design can allow for partial REBOA (pREBOA) that may provide hemorrhage control while also perfusing distally without need for significant provider titration. METHODS Female Yorkshire swine (N = 10) were subjected to 40% hemorrhagic shock for 1 hour (mean arterial pressure [MAP], 28-32 mm Hg). Animals were then randomized to either complete aortic occlusion (ER-REBOA) or partial occlusion (novel pREBOA-PRO) without frequent provider titration or distal MAP targets. Detection of a trace distal waveform determined partial occlusion in the pREBOA-PRO arm. After 2 hours of zone 1 occlusion, the hemorrhaged whole blood was returned. After 50% autotransfusion, the balloon was deflated over a 10-minute period. Following transfusion, the animals were survived for 2 hours while receiving resuscitation based on objective targets: lactated Ringer's fluid boluses (goal central venous pressure, ≥ 6 mm Hg), a norepinephrine infusion (goal MAP, 55-60 mm Hg), and acid-base correction (goal pH, >7.2). Hemodynamic variables, arterial lactate, lactate dehydrogenase, aspartate aminotransferase, and creatinine levels were measured. RESULTS All animals survived throughout the experiment, with similar increase in proximal MAPs in both groups. Animals that underwent partial occlusion had slightly higher distal MAPs. At the end of the experiment, the partial occlusion group had lower end levels of serum lactate (p = 0.006), lactate dehydrogenase (p = 0.0004) and aspartate aminotransferase (p = 0.004). Animals that underwent partial occlusion required less norepinephrine (p = 0.002), less bicarbonate administration (p = 0.006), and less fluid resuscitation (p = 0.042). CONCLUSION Improved design for pREBOA can decrease the degree of distal ischemia and reperfusion injury compared with complete aortic occlusion, while providing a similar increase in proximal MAPs. This can allow pREBOA zone-1 deployment for longer periods without the need for significant balloon titration.
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Affiliation(s)
- Michael T Kemp
- From the Department of Surgery (M.T.K., G.K.W., A.M.W., B.E.B., R.L.O., C.A.V., K.C., H.B.A.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (R.M.R.), UC Davis Medical Center, Sacramento; US Air Force Medical Corps, 60th Medical Group (R.M.R.), Travis AFB, Fairfield, California; and Department of Surgery (H.B.A.), Northwestern University, Chicago, Illinois
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13
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Forte DM, Do WS, Weiss JB, Sheldon RR, Kuckelman JP, Cook BA, Levine TC, Eckert MJ, Martin MJ. Validation of a novel partial resuscitative endovascular balloon occlusion of the aorta device in a swine hemorrhagic shock model: Fine tuning flow to optimize bleeding control and reperfusion injury. J Trauma Acute Care Surg 2020; 89:58-67. [PMID: 32569103 DOI: 10.1097/ta.0000000000002718] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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
OBJECTIVES Partial restoration of aortic flow during resuscitative endovascular balloon occlusion of the aorta (REBOA) is advocated by some to mitigate distal ischemia. Our laboratory has validated the mechanics and optimal partial REBOA (pREBOA) flow rates using a prototype device. We hypothesize that pREBOA will increase survival when compared with full REBOA (fREBOA) in prolonged nonoperative management of hemorrhagic shock. METHODS Twenty swine underwent placement of aortic flow probes, zone 1 REBOA placement, and 20% blood volume hemorrhage. They were randomized to either solid organ or abdominal vascular injury. The pREBOA arm (10 swine) underwent full inflation for 10 minutes and then deflation to a flow rate of 0.5 L/min for 2 hours. The fREBOA arm (10 swine) underwent full inflation for 60 minutes, followed by deflation/resuscitation. The primary outcome is survival, and secondary outcomes are serologic/pathologic signs of ischemia-reperfusion injury and quantity of hemorrhage. RESULTS Two of 10 swine survived in the fREBOA group (2/5 solid organ injury; 0/5 abdominal vascular injury), whereas 7 of 10 swine survived in the pREBOA group (3/5 solid organ injury, 4/5 abdominal vascular injury). Survival was increased (p = 0.03) and hemorrhage was higher in the pREBOA group (solid organ injury, 1.36 ± 0.25 kg vs. 0.70 ± 0.33 kg, p = 0.007; 0.86 ± 0.22 kg vs. 0.71 ± 0.28 kg, not significant). Serum evidence of ischemia was greater with fREBOA, but this was not significant (e.g., lactate, 16.91 ± 3.87 mg/dL vs. 12.96 ± 2.48 mg/dL at 120 minutes, not significant). Swine treated with pREBOA that survived demonstrated trends toward lower alanine aminotransferase, lower potassium, and higher calcium. The potassium was significantly lower in survivors at 60 minutes and 90 minutes time points (5.97 ± 0.60 vs. 7.53 ± 0.90, p = 0.011; 6.67 ± 0.66 vs. 8.15 ± 0.78, p = 0.029). Calcium was significantly higher at 30 minutes, 60 minutes, and 90 minutes (8.56 ± 0.66 vs. 7.50 ± 0.40, p = 0.034; 8.63 ± 0.62 vs. 7.15 ± 0.49, p = 0.019; 8.96 ± 0.64 vs. 7.00, p = 0.028). CONCLUSION Prolonged pREBOA at a moderate distal flow rate provided adequate hemorrhage control, improved survival, and had evidence of decreased ischemic injury versus fREBOA. Prophylactic aggressive calcium supplementation may have utility before and during the reperfusion phase.
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Affiliation(s)
- Dominic M Forte
- From the Department of Surgery (D.M.F., W.S.D., J.B.W., R.R.S., J.P.K., M.J.E.) and Department of Pathology (B.A.C., T.C.L.), Madigan Army Medical Center, Tacoma, Washington; and Trauma and Emergency Surgery Service, Scripps Mercy Medical Center (M.J.M.), San Diego, California
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14
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Gerard J, Skertich NJ, Wiegmann A, Bokhari F. REBOA Catheter Balloon Rupture during CPR. Am Surg 2020; 86:e196-e197. [PMID: 32391777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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15
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Pandav V, Dandapat S, Bohnstedt BN. Penumbra Occlusion Device for neurovascular vessel sacrifice: Feasibility and application. J Clin Neurosci 2018; 61:84-87. [PMID: 30459013 DOI: 10.1016/j.jocn.2018.10.139] [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: 06/08/2018] [Accepted: 10/27/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study is to describe the use of the Penumbra Occlusion Device (POD), which is a coil with an enhanced anchor segment, along with standard coils for carotid and vertebral artery sacrifice, and to assess its feasibility, safety, and efficacy. METHODS This is a retrospective chart review of patients with vessel sacrifices who were treated using POD. For the procedure, a balloon test occlusion was performed prior to permanent arterial sacrifice. Following this, a POD was deployed followed by subsequent angiography to confirm occlusion. Secondary PODs or standard coils were deployed as necessary. RESULTS A total of 5 internal carotid arteries and 5 vertebral arteries were treated in 10 patients. The mean vessel diameter of the vessel sacrificed was 4 mm (range 2.9-7.7 mm). The total mean number of coils required for vessel sacrifice was 7 (range 3-17). The mean number of PODs used for vessel sacrifice was 2.4 (range, 1-6). The mean number of additional standard coils used was 4.1 (range, 0-13). 9/10 (90%) parent arteries were successfully occluded. One patient had slow flow distal to the occluded segment. One (10%) of the patients had a delayed ischemic event. There were no immediate periprocedural complications including coil migrations or vessel dissections. 6/10 patients had follow-up imaging and no patients developed recanalization during the follow-up period. CONCLUSION Parent vessel sacrifice using a combination of PODs and standard coils appear to be a feasible, safe and effective alternative to the traditional vessel sacrifice techniques.
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Affiliation(s)
- Vijay Pandav
- Department of Neurology, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
| | - Sudeepta Dandapat
- Department of Neurology, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Bradley N Bohnstedt
- Department of Neurosurgery, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
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McCarthy C, Kanterman I, Trauzettel F, Jaeger HA, Goetz AA, Colvard B, Swanstrom L, Cantillon-Murphy P. Automated Balloon Control in Resuscitative Endovascular Balloon Occlusion of the Aorta. IEEE Trans Biomed Eng 2018; 66:1723-1729. [PMID: 30387716 DOI: 10.1109/tbme.2018.2878642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal of this study was to demonstrate the technical feasibility of automated balloon pressure management during resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-clinical setting. METHODS This paper presents an intelligent balloon management device which automates the balloon inflation process, preventing the possibility of balloon over or under inflation, optimizes inflation pressure, and if indicated, deflates automating partial REBOA to allow the distal organ perfusion. Edwards TruWave pressure transducers are used to monitor the blood pressure proximal and distal to the balloon, as well as the internal balloon pressure. A faux PID controller, implemented on an Arduino platform, is used in a feedback control loop to allow a user-defined mean arterial pressure setpoint to be reached, via a syringe driver which allows intelligent inflation and deflation of the catheter balloon. RESULTS Ex vivo testing on a vascular perfusion simulator provided the characteristic behavior of a fully occluded aorta, namely the decrease of distal pressure to zero. In vivo testing on live porcine models indicated that automated partial REBOA is achievable and by enabling partial occlusion may offer improved medical outcomes compared to the manual control. CONCLUSION Automated balloon pressure management of endovascular occlusion is feasible and can be successfully implemented without changes on current clinical workflows. SIGNIFICANCE With further development, automated balloon management may significantly improve clinical outcomes in REBOA.
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Iwashita Y, Uchida H, Takayama H, Ichimanda M, Taniguchi K, Kiguchi H, Sakaguchi T, Fujishima H, Saga K, Tada K, Hara T, Watanabe K, Hirashita T, Endo Y, Ohta M, Inomata M. Control of inferior vena cava injury during laparoscopic surgery using a double balloon-equipped central venous catheter: proof of concept in a live porcine model. Surg Endosc 2018; 32:2397-2401. [PMID: 29101571 PMCID: PMC5897466 DOI: 10.1007/s00464-017-5938-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/17/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Iatrogenic inferior vena cava (IVC) injury is a rare but potentially life-threatening complication during laparoscopic surgery. This experimental study aimed to assess the hemostatic ability of a new device, double balloon-equipped central venous (DB-CV) catheter, for IVC injury. METHODS The DB-CV catheter comprises a triple-lumen sphincterotome combined with two dilating balloons having a diameter of 25 mm. The experimental procedures were performed in five pigs. The DB-CV catheter was inserted via the right femoral vein. For the IVC occlusion test, correct placement of the balloons was confirmed by indocyanine green fluorescence imaging, and hemodynamic data were recorded. For the IVC injury test, a 3- to 4-mm circumferential incision was created in IVC, and hemostasis was initiated using balloon inflation 5 s after the injury. RESULTS Hemodynamic changes were minimal, with a 20 mmHg reduction in the mean arterial pressure because of IVC occlusion. All bleeding from IVC injuries was successfully temporarily stopped by direct balloon compression, with a mean time to hemostasis of 69 s and mean blood loss of 32 ml. Subsequently, the positioning of IVC injuries between two balloons made it possible to suture the injured IVC. CONCLUSIONS Balloon occlusion using the DB-CV catheter provides a rapid temporal hemostatic effect and can overcome the serious condition of massive hemorrhage from IVC injuries.
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Affiliation(s)
- Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Hiroki Uchida
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Hiroomi Takayama
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Michihiro Ichimanda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | | | | | | | - Hajime Fujishima
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Kunihiro Saga
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Kazuhiro Tada
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Takao Hara
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Kiminori Watanabe
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
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de Martinis L, Groppelli G, Corti R, Moramarco LP, Quaretti P, De Cata P, Rotondi M, Chiovato L. Disabling portosystemic encephalopathy in a non-cirrhotic patient: Successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein. World J Gastroenterol 2017; 23:8426-8431. [PMID: 29308002 PMCID: PMC5743513 DOI: 10.3748/wjg.v23.i47.8426] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/20/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/dL (reference range < 75 mg/dL) while hepatitis viral markers were negative. The patient was started on lactulose, rifaximin and low-protein diet. On the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments.
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Affiliation(s)
- Luca de Martinis
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
| | - Gloria Groppelli
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
| | - Riccardo Corti
- Unit of Interventional Radiology, Radiology Department, IRCCS Fondazione Policlinico San Matteo, Pavia 27100, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology, Radiology Department, IRCCS Fondazione Policlinico San Matteo, Pavia 27100, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology, Radiology Department, IRCCS Fondazione Policlinico San Matteo, Pavia 27100, Italy
| | - Pasquale De Cata
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
| | - Mario Rotondi
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
| | - Luca Chiovato
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
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Fernández López AJ, Tamayo Rodríguez ME, González Valverde FM, Albarracín Marín-Blázquez A. Esophageal perforation by a Sengstaken balloon. Rev Esp Enferm Dig 2017; 109:371. [PMID: 28480724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Iatrogenic esophageal perforations are rare but associated with a high morbidity and mortality. Secondary to placing a Sengstaken ballon are even more extraordinary because of the infrequency which this measure is used to control upper gastrointestinal bleeding. Therefore, we think it is of interest to communicate this complication, to remember the need to check the correct placement of the Sengstaken ballon before insufflation, since it would help further decrease this complication.
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de Vaal MH, Gee MW, Stock UA, Wall WA. Computational evaluation of aortic occlusion and the proposal of a novel, improved occluder: Constrained endo-aortic balloon occlusion. Int J Numer Method Biomed Eng 2016; 32:e02773. [PMID: 26846598 DOI: 10.1002/cnm.2773] [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] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 12/25/2015] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
Because aortic occlusion is arguably one of the most dangerous aortic manipulation maneuvers during cardiac surgery in terms of perioperative ischemic neurological injury, the purpose of this investigation is to assess the structural mechanical impact resulting from the use of existing and newly proposed occluders. Existing (clinically used) occluders considered include different cross-clamps (CCs) and endo-aortic balloon occlusion (EABO). A novel occluder is also introduced, namely, constrained EABO (CEABO), which consists of applying a constrainer externally around the aorta when performing EABO. Computational solid mechanics are employed to investigate each occluder according to a comprehensive list of functional requirements. The potential of a state of occlusion is also considered for the first time. Three different constrainer designs are evaluated for CEABO. Although the CCs were responsible for the highest strains, largest deformation, and most inefficient increase of the occlusion potential, it remains the most stable, simplest, and cheapest occluder. The different CC hinge geometries resulted in poorer performance of CC used for minimally invasive procedures than conventional ones. CEABO with a profiled constrainer successfully addresses the EABO shortcomings of safety, stability, and positioning accuracy, while maintaining its complexities of operation (disadvantage) and yielding additional functionalities (advantage). Moreover, CEABO is able to achieve the previously unattainable potential to provide a clinically determinable state of occlusion. CEABO offers an attractive alternative to the shortcomings of existing occluders, with its design rooted in achieving the highest patient safety. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- M H de Vaal
- Institute for Computational Mechanics, Technische Universität München, Garching bei München, Germany
| | - M W Gee
- Mechanics & High Performance Computing Group, Technische Universität München, Garching bei München, Germany
| | - U A Stock
- Department of Cardiac and Vascular Surgery, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - W A Wall
- Institute for Computational Mechanics, Technische Universität München, Garching bei München, Germany
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Lv X, Chen X, Ge H, He H, Jiang C, Li Y. Adjunct to Embolize the High-Flow Fistula Part of Arteriovenous Malformation Using a Double-Lumen Balloon Catheter. World Neurosurg 2016; 96:370-374. [PMID: 27633716 DOI: 10.1016/j.wneu.2016.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/26/2016] [Accepted: 09/01/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study is to report our initial experience of Onyx embolization of the high-flow fistula part of arteriovenous malformation (AVM) using a double-lumen balloon catheter. METHODS A Scepter C balloon catheter was used in 2 patients with AVMs associated with high-flow fistulas. The fistulas were located in the anterior cerebral artery and the middle cerebral artery. RESULTS Onyx embolization was successful in 2 cases, resulting in elimination of the high-flow fistula part of the AVM. There were no treatment-related events. CONCLUSIONS The double-lumen Scepter balloon appears to be a safe and convenient device for Onyx embolization of high-flow fistulas.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiheng Chen
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huijian Ge
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongwei He
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chuhan Jiang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Youxiang Li
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
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Cai K, Zhang Y, Shen L, Ni Y, Ji Q. Comparison of Stent-Assisted Coiling and Balloon-Assisted Coiling in the Treatment of Ruptured Wide-Necked Intracranial Aneurysms in the Acute Period. World Neurosurg 2016; 96:316-321. [PMID: 27647035 DOI: 10.1016/j.wneu.2016.09.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 05/20/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy, stability, and safety of stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) in the treatment of ruptured wide-necked aneurysms in the acute period. METHODS Consecutive patients including 65 cases treated with SAC and 32 with BAC were reviewed at the authors' institution between November 2011 and December 2014. The efficacy of these 2 approaches and the incidence of periprocedural complications were retrospectively evaluated. RESULTS Morphologic analysis showed a lower fundus/neck ratio (1.2 vs. 1.6) in the aneurysms treated with SAC versus BAC (P < 0.001). The mean neck width of aneurysms was 4.0 mm in the patients treated with SAC versus 3.4 mm in those treated with BAC (P < 0.04). Coil protrusion into the parent vessels during embolization was an independent risk factor for cerebral ischemic events (odds ratio [OR], 4.08; 95% confidence interval [CI], 1.03-16.2). Neck width (OR, 0.65; 95% CI, 0.44-0.97) and aneurysm perforation during procedure (OR, 6.24; 95% CI, 1.21-32.3) were independent predictors of complete occlusion (Raymond 1) by immediate postembolization angiography. There was no statistical difference between the 2 techniques regarding the rate of aneurysm occlusion at the end of procedure, periprocedural complications, and favorable outcome at discharge and follow-up. CONCLUSIONS These findings suggested that SAC was more appropriate than BAC for ruptured wide-necked aneurysms with lower fundus/neck ratio or wider neck size. However, periprocedural complications, occlusion rates, and favorable outcomes did not differ between the 2 techniques.
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Affiliation(s)
- Kefu Cai
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China
| | - Yunfeng Zhang
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China
| | - Lihua Shen
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China
| | - Yaohui Ni
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China
| | - Qiuhong Ji
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China.
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23
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Biebl M, Hakaim AG, Oldenburg WA, Klocker J, McKinney JM, Paz-Fumagalli R. Management of a Large Intraoperative Type IIIb Endoleak in a Bifurcated Endograft. Vasc Endovascular Surg 2016; 39:267-71. [PMID: 15920656 DOI: 10.1177/153857440503900308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this paper is to describe the intraoperative management of a type IIIb endoleak after deployment of a bifurcated endograft in a patient with narrow iliac access vessels. A 62-year-old man underwent elective endovascular repair (EVAR) of a 53 mm abdominal aortic aneurysm. After device deployment, a large IIIb endoleak, arising from the main body of the device, was visualized. Narrow iliac vessels precluded deployment of a second bifurcated graft, and the endoleak was successfully excluded with an aortomonoiliac device, followed by contralateral iliac occlusion and subsequent creation of a femorofemoral bypass. At 1-year follow-up, the aneurysm remains excluded and is decreasing in size. Type III endoleaks are a known complication of EVAR, requiring immediate treatment through their association with aneurysm enlargement and rupture. If an additional bifurcated graft cannot be used, aortomonoiliac conversion represents a feasible endovascular alternative treatment for type III endoleaks, other than conversion to open surgical repair. Therefore, aortomonoiliac converters with appropriate occluder devices should be readily available during deployment of bifurcated devices.
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Affiliation(s)
- Matthias Biebl
- Section of Vascular Surgery, Mayo Clinic Jacksonville, FL 32224, USA
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24
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Leung BHK, Poon CCY, Zhang R, Zheng Y, Chan CKW, Chiu PWY, Lau JYW, Sung JJY. A Therapeutic Wireless Capsule for Treatment of Gastrointestinal Haemorrhage by Balloon Tamponade Effect. IEEE Trans Biomed Eng 2016; 64:1106-1114. [PMID: 27416587 DOI: 10.1109/tbme.2016.2591060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Wireless capsule endoscope (WCE) is a revolutionary approach to diagnose small bowel pathologies. Currently available WCEs are mostly passive devices with image capturing function only, while on-going efforts have been placed on robotizing WCEs or to enhance them with therapeutic functions. In this paper, the authors present a novel inflatable WCE for haemostasis in the gastrointestinal (GI) tracts by balloon tamponade effect. METHODS The proposed wireless capsule consists of a balloon that can be inflated using the endothermic reaction of acid and base. When the balloon reached a precalculated pressure level, it is able to stop at a bleeding site in the bowel, and achieve haemostasis by tamponade effect. The prototype is 14 mm in diameter, with three sections of 13, 35, and 12 mm in length, respectively. The three sections are linked together with flexible joints and enclosed in a silicone balloon. The prototypes were tested in ex vivo porcine intestine models. RESULTS In the ten ex vivo trials conducted, the inflatable wireless capsule achieved average balloon pressure of 46.0 mmHg and withstood average maximum longitudinal pulling force at 1.46 N. An in vivo study was carried out as a proof-of-concept for treating bleeding in a porcine model. The proposed inflatable WCE succeeded in the animal test by controlling haemostasis within 5 min. No rebleeding was observed in the next 20 min. CONCLUSION The results suggested that the inflatable capsule with a real-time bleeding detection algorithm can be implemented. Moreover, the proposed inflatable WCE prototype can achieve haemorrhage control in the lower GI. SIGNIFICANCE To our best knowledge, this is the first study that demonstrated the potential to treat GI haemorrhage by an inflatable WCE. The proposed capsule enables the development of a closed-loop system based on a body sensor network to provide early treatment of GI bleeding for p-medicine.
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Rajasinghe HA, Pigott JP, Kritpracha B, Corbey MJ, Beebe HG. Internal Iliac Artery Occlusion Using a Stent-Graft Tunnel during Endovascular Aneurysm Repair: A New Alternative to Coil Embolization. J Endovasc Ther 2016; 10:1082-6. [PMID: 14723566 DOI: 10.1177/152660280301000609] [Citation(s) in RCA: 9] [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] [Indexed: 11/17/2022]
Abstract
Purpose: To report a new endovascular technique for internal iliac artery (IIA) occlusion during stent-graft treatment in patients with aortoiliac aneurysm. Technique: Stent-grafts measuring 20 to 28 mm in diameter and 37.5 mm long were deployed at the iliac bifurcation to occlude the IIA at its origin. Subsequent deployment of an aortic bifurcation endograft with ipsilateral extension into the external iliac artery was through this iliac stent-graft tunnel. This approach has been used in 5 patients with abdominal aortic aneurysm and common iliac artery aneurysm (n = 4) or isolated iliac artery aneurysm. Proximal IIA occlusion was achieved in all cases with no distal type I endoleak. IIA patency on the side opposite to the tunnel procedure was preserved in each case. No patient described new onset of pelvic ischemic symptoms. Over a mean 10-month follow-up (range 1–12), there was no secondary procedure required for type I endoleak. Three patients had a CIA aneurysm diameter change of −1, −4, and 0 mm at 1 year. Conclusions: This new method for IIA occlusion at its origin without coil embolization may prove to be a useful adjunct to endovascular aortoiliac aneurysm repair. The technique is simple, rapid, and may minimize the risk of pelvic ischemia.
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Chuter TAM, Pak LK, Gordon RL, Reilly LM, Messina LM. Heparin-Induced Thrombocytopenia and Graft Thrombosis following Endovascular Aneurysm Repair. J Endovasc Ther 2016; 10:1087-90. [PMID: 14723565 DOI: 10.1177/152660280301000610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Abstract
Purpose: To report a case of heparin-induced thrombocytopenia (HIT) complicated by stent-graft thrombosis. Case Report: An 82-year-old woman underwent endovascular aortic aneurysm repair using a Zenith stent-graft. She returned 2 weeks later with an occluded graft limb, large quantities of thrombus lining the remainder of the stent-graft, thrombocytopenia, and antiplatelet antibodies. There were no signs of kinking or compression of the graft, nor was there any thrombosis of the native arteries downstream from the occluded graft limb. Thrombolysis restored graft patency. Anticoagulation was induced using hirudin and warfarin. The graft remains patent at 6-month follow-up. Conclusion: HIT is a rare cause of postoperative endograft thrombosis. In this case, the presumed source of the inciting heparin dosage was the stent-graft itself, which had been soaked in a concentrated heparin solution prior to insertion.
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Affiliation(s)
- Timothy A M Chuter
- Division of Vascular Surgery, University of California, San Francisco, California 94143, USA.
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Celebi A, Yucel IK, Balli S, Kucuk M. Two Cases of Transcatheter Closure of Central Aortopulmonary Shunts: One with an Amplatzer Duct Occluder II and One with an Amplatzer Vascular Plug I. Tex Heart Inst J 2016; 43:241-5. [PMID: 27303241 DOI: 10.14503/thij-15-5080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
When total correction is not possible in infants who have a cyanotic congenital heart disease, creation of a palliative aortopulmonary shunt is essential. A central aortopulmonary shunt is preferable, because of its technical and hemodynamic advantages. Overcirculation, thrombosis, and stenosis of the shunt are the main postoperative sequelae that necessitate urgent reintervention. Percutaneous transcatheter closure of aortopulmonary shunts can eliminate the need for reoperation and substantially decrease postoperative morbidity and mortality rates. We report our successful transcatheter closures of central aortopulmonary shunts in a 3-month-old infant and a 15-year-old girl, with use of an Amplatzer Duct Occluder II and an Amplatzer Vascular Plug I, respectively. To our knowledge, this is the first report of the transcatheter closure of central aortopulmonary shunts with these 2 devices.
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Bechan RS, Majoie CB, Sprengers ME, Peluso JP, Sluzewski M, van Rooij WJ. Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients. AJNR Am J Neuroradiol 2016; 37:125-9. [PMID: 26294643 DOI: 10.3174/ajnr.a4487] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 05/05/2015] [Accepted: 06/08/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE At our institution, patients with large or giant ICA aneurysms are preferably treated with endovascular ICA balloon occlusion. Alternative treatment or conservative treatment is offered only for patients who cannot tolerate permanent ICA occlusion. In this observational study, we report the clinical and imaging results of ICA occlusion for aneurysms in a large single-center patient cohort. MATERIALS AND METHODS Between January 1995 and January 2015, occlusion of the ICA was considered in 146 patients with large or giant ICA aneurysms. Ninety-six patients (66%) passed the angiographic test occlusion, and, in 88 of these 96 patients (92%), the ICA was permanently occluded. In 11 of 88 patients with angiographic tolerance, ICA occlusion was performed with the patient under general anesthesia without clinical testing. RESULTS There was 1 hypoperfusion infarction after hypovolemic shock from a large retroperitoneal hematoma (complication rate 1.1% [95% CI, 1%-6.8%]). The mean imaging and clinical follow-up was 35 months (median 18 months; range, 3-180 months). On the latest MR imaging, 87 of 88 aneurysms (99%) were completely occluded and 61 of 80 aneurysms (76%) were decreased in size or completely obliterated. Of 62 patients who presented with cranial nerve dysfunction by mass effect of the aneurysm, 30 (48%) were cured, 25 (40%) improved, 6 (10%) were unchanged, and 1 patient (2%) was hemiplegic after a complication. CONCLUSIONS ICA occlusion for large and giant aneurysms after angiographic test occlusion was safe and effective. Two-thirds of eligible patients passed the angiographic test. Most aneurysms shrunk, and most cranial nerve dysfunctions were cured or improved.
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Affiliation(s)
- R S Bechan
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - C B Majoie
- Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands
| | - M E Sprengers
- Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands
| | - J P Peluso
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - M Sluzewski
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - W J van Rooij
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
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Vallone N, Pizzo MC, Massaroni C, Saccomandi P, Silvestri S, Carassiti M, Mattei A, Schena E. Design and characterization of a measurement system for monitoring pressure exerted by bronchial blockers: In vitro trials. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:1691-1694. [PMID: 26736602 DOI: 10.1109/embc.2015.7318702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Bronchial blockers (BBs) allow occluding the bronchial duct and collapsing the "dependent" lung in a number of thoracic surgery. The occlusion is obtained through a cuff that, inflated with a proper air volume, exerts a pressure, Pe, on the inner wall of the mainstem bronchus. In this work a measurement chain, based on two piezorestistive force sensors, was developed and calibrated to measure Pe exerted by six BBs, as a function of inflated volume on in vitro models (two latex ducts with diameters similar to the ones of the adult mainstem bronchi: 12 mm and 15 mm). Pe showed wide changes considering different BBs, and significantly increases with the decrease of the model's diameter, at the same inflated volume. Lastly, the minimum occlusive volume (MOV) to sail the two models was estimated for each BB. These experiments were performed by applying a pressure difference across the cuff of 25 cmH2O, in order to simulate the worst condition in a clinical scenario. Results show that MOV depends on both the type of BB and the duct diameter. The knowledge of this volume allows estimating the minimum value of Pe exerted by BBs to avoid air leakage.
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Zhang D, Shi R, Yao J, Zhang R, Xu Z, Wang L. Treatment of massive esophageal variceal bleeding by Sengstaken-Blackmore tube compression and intensive endoscopic detachable mini- loop ligation: a retrospective study in 83 patients. Hepatogastroenterology 2015; 62:77-81. [PMID: 25911872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS To evaluate the effectiveness of improved sengstaken-blackmore tube combined with intensive endoscopic detachable mini-loop ligation for the treatment of massive esophageal variceal bleeding (EVB). METHODOLOGY Eighty-three patients diagnosed with massive EVB and admitted from January 2005 to July 2011 were retrospectively evaluated. Upon admission, all patients received 12 h balloon tamponade with sengstaken-blackmore tube in addition to conventional therapy (blood volume resuscitation, prophylactic antibiotics and somatostatin). Within 24 h after admission, all patients further received endoscopic variceal ligation (EVL) with intensive endoscopic detachable nylon ring (mini-loop). RESULTS No severe complications were observed after the patients received the 12 h consistent compression with sengstaken-blackmore tube. Eighty-two patients (98.8%) showed effective hemostasis, among which seventy-eight showed complete hemostasis. After receiving the subsequent EVL therapy with intensive endoscopic detachable mini-loop in 24 h after admission, patients did not show active bleeding in 24 h after EVL. Rehaemorrhagia appeared only in one patient within the 7 days of observation period, which was controlled by a second EVL. Each patient was ligated with 10 to 15 loops. CONCLUSIONS EVB can be effectively treated with improved sengstaken-blackmore tube followed by EVL therapy with intensive endoscopic detachable mini-loop.
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Sato W, Kamada K, Goto T, Ohshima S, Miura K, Shibuya T, Dohmen T, Kanata R, Sakai T, Chiba M, Sugimoto Y, Minami S, Ishiyama K, Hashimoto M, Ohnishi H. Efficacy of combined balloon-occluded retrograde transvenous obliteration and simultaneous endoscopic injection sclerotherapy. Intern Med 2015; 54:261-5. [PMID: 25748733 DOI: 10.2169/internalmedicine.54.3465] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We evaluated the efficacy and safety of balloon-occluded retrograde transvenous obliteration (B-RTO) performed using absolute ethanol with iodized oil (ET+LPD) and simultaneous endoscopic injection sclerotherapy (EIS) with cyanoacrylate (CA) for gastric varices (GVs). METHODS A total of 16 patients with endoscopically proven high-risk GVs treated using combined B-RTO with ET+LPD and EIS with CA between January 2007 and July 2012 were enrolled. RESULTS Twelve cases included GVs involving both the cardia and fundus, two cases included fundal varices and two cases included cardiac varices. In terms of the form of GVs, 10 cases involved F2 lesions and six cases involved F3 lesions. The flow vein was the left gastric vein in 13 cases and the posterior gastric vein in three cases. The drainage route was a splenorenal shunt in all cases. The average dose of ET+LPD was 12.0 mL, while that of CA was 2.45 mL. All complications were transient, and no major complications occurred after the procedures. None of the patients experienced bleeding or recurrence of gastric varices after the combined B-RTO and EIS procedures during an average follow-up period of 38.3 months. CONCLUSION Combined B-RTO with ET+LPD and simultaneous EIS with CA is considered to be an effective and safe procedure for treating GVs.
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Affiliation(s)
- Wataru Sato
- Department of Gastroenterology, Akita University Graduate School of Medicine, Japan
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Narin N, Baykan A, Argun M, Ozyurt A, Pamukcu O, Bayram A, Uzum K. New modified balloon-assisted technique to provide appropriate deployment in the closure of large secundum atrial septal defect using amplatzer septal occluder in children. J Invasive Cardiol 2014; 26:597-602. [PMID: 25364001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Transcatheter closure of secundum atrial septal defect (ASD) is accepted as a safe alternative method to surgery. However, the deployment of the device across the septum using the conventional method presents difficulties in large ASDs. METHODS In the modified balloon-assisted technique (modified BAT), a Tyshak balloon (Numed, Inc) is placed in one of the left pulmonary veins and a long sheath is placed in the right upper pulmonary vein. Through this sheath, the Amplatzer septal occluder is deployed to its proper position with the help of the Tyshak balloon, which prevents the left atrial disc from prolapsing into the right atrium. This method was implemented in the treatment of patients with a large secundum ASD. In this study, defects that measured ≥15 mm by transesophageal echocardiography (TEE) were considered to be large secundum ASDs. Between June 2011 and September 2013, the modified BAT was used in the closure procedure of 30 patients (18 females/12 males) with large ASDs (group I). Between September 2003 and September 2013, 78 patients (47 females/31 males) with large ASDs were treated with conventional methods (group II). The results of both groups were compared. RESULTS In the comparison of the results between group I and group II, there were no significant differences between mean maximal ASD sizes by transthoracic echocardiography, mean maximal ASD size by TEE, Qp/Qs ratio, mean device diameter, failure rate, embolization incidences, residual shunt, and fluoroscopy time. However, there were significant differences in the mean ages, mean body weights, and mean PAPs between group I and group II. After adjusting for age and body weight, in terms of process failure, the conventional method was found 5.6 times more risky compared to modified BAT. CONCLUSION Large secundum ASDs in children, transcatheter closure with Amplatzer septal occluder using the modified BAT is a simple, quite useful method. In addition, this method seems to reduce the procedure failure rate.
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Affiliation(s)
- Nazmi Narin
- Erciyes University Medical Faculty, Department of Pediatric Cardiology, Kayseri Turkey.
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Park S, Hwang SM, Lim OK, Hwang C, Lee DH. Compliant neurovascular balloon catheters may not be compatible with liquid embolic materials: intraprocedural rupture of the protecting balloon during tumor embolization using n-butyl cyanoacrylate and lipiodol mixture. J Neurointerv Surg 2014; 7:740-3. [PMID: 25165384 DOI: 10.1136/neurintsurg-2014-011331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 08/04/2014] [Indexed: 11/03/2022]
Affiliation(s)
- Soonchan Park
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ok Kyun Lim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Changmo Hwang
- Biomedical R&D Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Chung EJ, Shin YS, Lee CH, Song JH, Park JE. Comparison of clinical and radiologic outcomes among stent-assisted, double-catheter, and balloon-assisted coil embolization of wide neck aneurysms. Acta Neurochir (Wien) 2014; 156:1289-95. [PMID: 24806533 DOI: 10.1007/s00701-014-2104-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 02/19/2014] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endovascular treatment of intracranial aneurysms can be technically challenging in cases of wide necks or unfavorable dome-to-neck ratio. Coils deployed without supporting devices may herniate from the aneurysm sac into the parent artery, causing thromboembolic complications or vessel occlusion. Therefore, alternative strategies for managing wide-necked aneurysms have been introduced such as stent-assisted coil embolization (SAC), balloon-assisted coil embolization (BAC), and double-catheter coil embolization (DCC). METHODS SAC, BAC, or DCC were used to treat 201 patients with 207 wide-neck aneurysms between 2008 and 2013. Initial occlusion rates, recanalization rates, and periprocedural complications were retrospectively evaluated. The mean follow-up periods for SAC, BAC, and DCC were 16.2 months, 11.6 months, and 14.3 months, respectively. RESULTS Clinical and anatomical analyses were conducted in 201 patients with 207 anuerysms. Complete occlusion rates of SAC, DCC, and BAC were 63.8 %, 46.7 %, and 63.2 %, respectively, and incomplete occlusion rates were 13.4 %, 15.5 %, 10.5 %, respectively (p value = 0.798). No rebleeding or hemorrhage occurred after coil embolization. Recanalization rates did not differ among the SAC, DCC, and BAC groups (7.1 % vs. 11.1 % vs. 7.9 %, p value = 0.696). Statistically insignificant results were observed in the rate of periprocedural complications among SAC, DCC, and BAC (11.0 % vs. 13.3 % vs. 15.8 %, p value = 0.578). CONCLUSIONS There were no significant differences in the recurrence rate and periprocedural complication rate, and no rebleeding or aneurysmal rupture after treatment. Sufficient occlusion rates were achieved with SAC, DCC, and BAC. Notably, DCC does not require the use of antiplatelet agents and achieves coil stability without compromising the parent artery or major branch. Thus, we believe that the double-catheter technique was found to be a feasible and safe treatment modality for branching wide-neck aneurysms.
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Affiliation(s)
- Eui Jin Chung
- Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul, 137-701, Korea
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Abstract
Coronary collateral growth (arteriogenesis) is a physiological adaptive response to transient and repetitive occlusion of major coronary arteries in which small arterioles (native collaterals) with minimal to no blood flow remodel into larger conduit arteries capable of supplying adequate perfusion to tissue distal to the site of occlusion. The ability to reliably and reproducibly mimic transient, repetitive coronary artery occlusion (ischemia) in animal models is critical to the development of therapies to restore coronary collateral development in type II diabetes and the metabolic syndrome. Current animal models for repetitive coronary artery occlusion implement a pneumatic occluder (balloon) that is secured onto the surface of the heart with the suture, which is inflated manually, via a catheter connected to syringe, to effect occlusion of the left anterior descending coronary artery (LAD). This method, although effective, presents complications in terms of reproducibility and practicality. To address these limitations, we have designed a device for automated, transient inflation of balloon catheters in coronary artery occlusion models. This device allows repeated, consistent inflation (to either specified pressure or volume) and the capability for implementing very complex, month-long protocols. This system has significantly increased the reproducibility of coronary collateral growth studies in our laboratory, resulting in a significant decrease in the numbers of animals needed to complete each study while relieving laboratory personnel from the burden of extra working hours and enabling us to continue studies over periods when we previously could not. In this paper, we present all details necessary for construction and operation of the inflator. In addition, all of the components for this device are commercially available and economical (Table S1). It is our hope that the adoption of automated balloon catheter inflation protocols will improve the experimental reliability of transient ischemia studies at many research institutions.
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Affiliation(s)
- Silas J. Leavesley
- Chemical and Biomolecular Engineering, University of South Alabama, Mobile, Alabama, United States of America
- Pharmacology, University of South Alabama, Mobile, Alabama, United States of America
- Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States of America
- * E-mail:
| | - Whitley Ledkins
- Chemical and Biomolecular Engineering, University of South Alabama, Mobile, Alabama, United States of America
| | - Petra Rocic
- Pharmacology, New York Medical College, Valhalla, New York, United States of America
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Cakır H, Acar G, Pala S. Fast track occlusion of aorta with atrial septal defect sizing balloon. Catheter Cardiovasc Interv 2014; 83:1182-4. [PMID: 24403245 DOI: 10.1002/ccd.25379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/06/2013] [Accepted: 12/23/2013] [Indexed: 11/07/2022]
Abstract
We describe the case of a 57-year-old woman referred to our emergency service with ruptured abdominal aneurysm. We placed a 34-mm Amplatzer sizing balloon II into the suprarenal level of aorta to immediately control the active massive bleeding and to get the patient out of hemorrhage shock into the stable condition. After the bleeding control, endovascular repair was successfully performed. This is the first case report, to our knowledge, of atrial septal defect (ASD) sizing balloon use for blocking the blood flow through aorta to control the bleeding. ASD sizing balloon has some different properties compared to aortic occlusion balloon catheter (AOBC). Due to availability of sheathless usage, ASD sizing balloon may be preferred over AOBC for some of patient groups with peripheral artery diseases and small femoral artery diameters.
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Affiliation(s)
- Hakan Cakır
- Department of Cardiology, Kosuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
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Abstract
Transcatheter closure of atrial septal defects has evolved significantly over the last 20 years. Transcatheter closure has replaced surgical closure for the treatment of most secundum atrial septal defectsat the current time. A major reason for this is the lower morbidity of transcatheter closure procedures. Several closure devices have come into clinical use. The Amplatzer septal occluder (AGA Medical Co.) currently has the largest reported experience and subsequently the best-established safety and efficacy features. Clinically challenging situations, such as larger atrial septal defects, atrial septal defects with deficient rims and multiple atrial septal defects, are increasingly being addressed using the transcatheter approach, with improved results. The incidence of most complications has significantly reduced over time, and serious side effects are relatively uncommon. In this review, the literature is summarized regarding the current role of transcatheter closure, the evolution of the different available devices for clinical use and the complications that occur with their use. A comparison is also made with surgical closure techniques.
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Affiliation(s)
- Anuja Gupta
- KEM Hospital, 48/49 Hatkesh Society, Road number 7, Juhu Scheme, Mumbai400 049, India.
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Tokur M, Ergin M, Kürkçüoğlu IC, Dündar ZD. A pilot experimental study of a catheter to facilitate treatment for penetrating cardiac injury. Turk J Med Sci 2014; 44:935-940. [PMID: 25552144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND/AIM Penetrating heart injuries result in high mortality. We designed a new catheter to facilitate the treatment of penetrating cardiac injuries and provide more effective initial bleeding control and fluid replacement. MATERIALS AND METHODS The cardiac injury model was applied to 8 female 1-year-old Sus domesticus pigs. Subjects were grouped according to whether a Foley catheter or a newly designed catheter was placed into the heart through cardiac lacerations. Changes in systolic blood pressures, mortality, and problems encountered during surgery and other intraoperative findings were recorded. RESULTS There were higher mean blood pressure measurements in the newly designed catheter group during stages IV to VII. All subjects had tamponade and cardiac activity after completion of the repair of all lacerations in the catheter group, whereas in the other group only one subject did. Intraoperative direct fluid infusion to the heart through the catheters in the diastole was performed in all subjects of both groups. However, regurgitation from the cardiac cavity in the systole was seen only in the Foley catheter group. All of the intraoperative complications were seen in the same group.
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Affiliation(s)
- Mahmut Tokur
- Department of Thoracic Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Trehan VK, Subhendu MSK, Chaturvedi V, Pandit BN, Goyal M. Paravalvular leak closure with two large size devices. Indian Heart J 2013; 66:91-4. [PMID: 24581103 PMCID: PMC3946467 DOI: 10.1016/j.ihj.2013.12.033] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 07/03/2013] [Accepted: 12/05/2013] [Indexed: 11/18/2022] Open
Abstract
Paravalvular leaks (PVL) after valve replacement surgeries are not uncommon. A significant number of these patients need some form of intervention as they commonly present with heart failure or severe hemolysis. Surgical correction is associated with high mortality and morbidity. Device closure of PVLs has been found to have good results. Since there are no devices designed specifically for PVL closure, large PVL closure is difficult. Occasional larger PVLs have been closed with a combination of a device and smaller coils. We present here a case of very large sized mitral PVL, in a patient with high risk for surgery, which was closed with two large size devices.
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Affiliation(s)
- V K Trehan
- Professor of Cardiology, Department of Cardiology, Gobind Ballabh Pant Hospital, New Delhi 110002, India
| | - M S K Subhendu
- Assistant Professor of Cardiology, Department of Cardiology, Gobind Ballabh Pant Hospital, New Delhi 110002, India.
| | - V Chaturvedi
- Assistant Professor of Cardiology, Department of Cardiology, Gobind Ballabh Pant Hospital, New Delhi 110002, India
| | - B N Pandit
- Department of Cardiology, Gobind Ballabh Pant Hospital, New Delhi 110002, India
| | - M Goyal
- Department of Cardiology, Gobind Ballabh Pant Hospital, New Delhi 110002, India
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Bansal NO, Shivapuje SK. Left main artery dissection with bail out stenting during percutaneous coronary intervention. Indian Heart J 2013; 65:707-9. [PMID: 24407544 PMCID: PMC3905257 DOI: 10.1016/j.ihj.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 10/09/2013] [Indexed: 11/15/2022] Open
Affiliation(s)
- N O Bansal
- Prof. & HOD, Dept. of Cardiology, GMC, Mumbai, India; Hon Cardiologist, H. E. Governer of Maharashtra, Secretary, Cardiology Society of India, Mumbai Branch, India; Faculty, TCT, Asia Pacific 2009, South Korea; Interventional Cardiologist, Cumballa Hill Hospital, India
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Andrade G, Ponte De Souza ML, Marques R, Silva JL, Abath C, Azevedo-Filho HRC. Endovascular treatment of traumatic carotid cavernous fistula with balloon-assisted sinus coiling. A technical description and initial results. Interv Neuroradiol 2013; 19:445-54. [PMID: 24355148 PMCID: PMC3902743 DOI: 10.1177/159101991301900407] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 03/11/2013] [Accepted: 05/12/2013] [Indexed: 11/16/2022] Open
Abstract
This study aimed to propose an alternative treatment for carotid cavernous fistula (CCF) using the balloon-assisted sinus coiling (BASC) technique and to describe this procedure in detail. Under general anesthesia, we performed the BASC procedure to treat five patients with traumatic CCF. Percutaneous access was obtained via the right femoral artery, and a 7F sheath was inserted, or alternatively, a bifemoral 6F approach was accomplished. A microcatheter was inserted into the cavernous sinus over a 0.014-inch microwire through the fistulous point; the microcatheter was placed distal from the fistula point, and a "U-turn" maneuver was performed. Through the same carotid access, a compliant balloon was advanced to cross the point of the fistula and cover the whole carotid tear. Large coils were inserted using the microcatheter in the cavernous sinus. Coils filled the adjacent cavernous sinus, respecting the balloon. Immediate complete angiographic resolution was achieved, and an early angiographic control (mean = 2.6 months) indicated complete stability without recanalization. The clinical follow-up has been uneventful without any recurrence (mean = 15.2 months). An endovascular approach is optimal for direct CCF. Because the detachable balloon has been withdrawn from the market, covered stenting requires antiplatelet therapy and its patency is unconfirmed, but cavernous sinus coiling remains an excellent treatment option. Currently, there is no detailed description of the BASC procedure. We provide detailed angiograms with suitable descriptions of the exact fistula point, and venous drainage pathways. Familiarity with these devices makes this technique effective, easy and safe.
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Affiliation(s)
- Gustavo Andrade
- Interventional Neuroradiology, ANGIORAD-IMIP; Recife PE, Brazil - Department of Neurosurgery, Hospital da Restauração; Recife PE, Brazil -
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Ishikawa T, Kubota T, Abe H, Nagashima A, Hirose K, Seki K, Honma T, Yoshida T. Improved method for transjugular liver biopsy using imaging sheaths developed for balloon-occluded retrograde transvenous obliteration. Hepatogastroenterology 2013; 60:1684-1688. [PMID: 24624455 DOI: 10.5754/hge13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND/AIMS Patients with ascites or coagulation abnormalities and requiring a liver biopsy may undergo transjugular liver biopsy (TJLB) rather than percutaneous liver biopsy. Currently, the difficulty in maneuvering the sheath towards the hepatic vein keeps this procedure from being widely used. Therefore, the utility of imaging sheaths, typically used for balloon-occluded retrograde transvenous obliteration, during TJLB was examined. METHODOLOGY TJLB was conducted on 41 patients using conventional, Teflon vascular sheaths (9 Fr, 45 cm) and on 60 patients using S1 sheaths (8 Fr, 50 cm). The duration of TJLB procedures, and their associated complications were compared. RESULTS The mean duration of the procedure was 26.9±7.94 minutes in the group undergoing TJLB with Teflon sheaths, significantly longer (p <0.01) than 20.1±4.52 minutes in the patients using S1 sheaths. However, in two (3.3%) of the S1 sheath patients, the sheaths had to be replaced with Teflon TJLB sheaths. CONCLUSIONS This study demonstrates that liver biopsies can be successfully collected by TJLB using S1 sheaths instead of the Teflon sheaths. This substitution for a more flexible material allows for a shorter invasive intervention time for patients for which percutaneous liver biopsy is not an option.
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Khripun AV, Malevannyĭ MV, Kulikovskikh IV, Fomenko EP. [Internal carotid artery stenting with proximal protection systems in patients with concomitant external carotid artery injury]. Vestn Rentgenol Radiol 2013:5-9. [PMID: 24428062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE to evaluate the possibility, efficiency, and safety of using the proximal protection systems in patients with concomitant injury to the ipsilateral external carotid artery (ECA) during internal carotid artery (ICA) stenting. MATERIAL AND METHODS The results of ICA stenting were analyzed in 39 patients. Their mean age was 66.4 +/- 7.8 years; 29 (74.4%) patients were male. All the patients were symptomatic. The time of ICA blood flow arrest averaged 5.4 +/- 2.1 min. Intolerance to blood flow arrest was noted in 3 (7.7%) patients. The intervention time was 27.6 +/- 8.3 min. The results were assessed from progress in positioning a proximal protection system and ensuring adequate cerebral embolic protection and from the presence of new neurological symptoms, acute coronary events, and fatal outcomes during hospitalization. RESULTS The proximal protection system could be positioned in 100% of cases, which allowed ICA stenting to be successfully accomplished in all the patients with concomitant injury to the ipsilateral ECA. During hospitalization, the patients were found to have no new neurological symptoms. They had no acute coronary events or fatal outcomes either. CONCLUSION The proximal protection systems are technically possible, effective, and safe in patients with concomitant ipsilateral ECA during cervical ICA stenting.
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Fitzmaurice GJ, Coleman DM, Walsh KP, Oslizlok P, Russell JD, McGuinness JG. Extrinsic bronchial compression due to patent ductus arteriosus closure device. Ann Thorac Surg 2013; 95:e143-5. [PMID: 23706465 DOI: 10.1016/j.athoracsur.2012.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 10/30/2012] [Accepted: 11/12/2012] [Indexed: 11/19/2022]
Abstract
Interventional cardiology provides a valuable nonoperative approach for the modern management of patent ductus arteriosus (PDA) in patients with non-complex congenital heart disease. We describe a patient with a right-sided aortic arch who developed severe bronchomalacia after PDA device closure that necessitated extensive surgical repair. Consequently, we advise that in infants with a right-sided aortic arch and PDA inserting into the right pulmonary artery, device closure is challenging due to the potential risk of bronchial compression and subsequent development of bronchomalacia. Consideration should be given to surgical closure or use of a softer duct occlusion device.
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Affiliation(s)
- Gerard J Fitzmaurice
- Department of Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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Abstract
We report two cases of transcatheter-device closure of aortopulmonary windows, a residual defect occurring after previous surgical closure, and a native lesion. The postsurgical defect was closed with an Amplatzer Duct Occluder II (AGA Medical Corporation, MN). The native lesion was not suitable for an Amplatzer Duct Occluder II device; thus, it was closed using an Amplatzer Duct Occluder (AGA Medical Corporation, MN). The Amplatzer Duct Occluder II provides an additional device for aortopulmonary window closure, but anatomy and defect characteristics dictate the most appropriate device.
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Affiliation(s)
- Patrick M E Noonan
- Birmingham Children's Hospital, Steel House Lane, Birmingham, B4 6NH, UK
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Saygılı A, Tokel K, Koçyiğit ÖI, Sarıoğlu T. Double covered stent closure of extracardiac Fontan multiple fenestrations. Anadolu Kardiyol Derg 2012; 12:693-695. [PMID: 22989801 DOI: 10.5152/akd.2012.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Arda Saygılı
- Clinic of Pediatric Cardiology, Acıbadem Hospital, İstanbul-Turkey.
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Gory B, Kessler I, Seizem Nakiri G, Riva R, Al-Khawaldeh M, Mounayer C. Initial experience of intracranial aneurysm embolization using the balloon remodeling technique with Scepter C, a new double-lumen balloon. Interv Neuroradiol 2012; 18:284-7. [PMID: 22958766 PMCID: PMC3442301 DOI: 10.1177/159101991201800306] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 02/22/2012] [Accepted: 04/08/2012] [Indexed: 11/16/2022] Open
Abstract
The balloon remodeling technique (BRT) was designed for endovascular treatment of wide-necked intracranial aneurysms. To date, the balloon catheters available have had a single lumen and suitable guidewires ranging from 0.010 to 0.012 inches. We describe the first case of aneurysm embolization using the BRT with the new double-lumen balloon catheter, Scepter C(®), navigable on a 0.014-inch wire, and discuss the benefit of such a device.
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Affiliation(s)
- B Gory
- Department of Interventional Neuroradiology, CHU Dupuytren, Limoges, France
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Xiong YQ, Song HB, Tu CQ, Xu HW, Zhang L. [Appling the color Doppler in abdominal aortic balloon occlusion for pelvic and sacral surgery]. Sichuan Da Xue Xue Bao Yi Xue Ban 2012; 43:715-719. [PMID: 23230746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To apply the color Doppler in abdominal aortic balloon occlusion for pelvic or sacral surgery, and to evaluate its effectiveness in controlling blood loss. METHODS A Philips 4500 color Doppler was used to place abdominal aortic balloons in 20 patients with pelvic or sacral tumors who underwent surgery. The temporary abdominal aortic balloons were used for controlling blood loss in the surgery. Transesophageal echocardiography was performed to detect the renal blood flow. RESULTS Abdominal aortic balloons were successfully placed to the 20 patients, with a water injection rate of 10-18 (13.8 +/- 2.6) mL and a total of 45-180 min occlusion during the 70-450 (265 +/- 102) min surgery. The intraoperative blood loss ranged from 250 to 4000 (1357 +/- 997) mL. The water injection rate of abdominal aortic-balloons (Y) was correlated with the diameter of abdominal aorta (X): Y = 7.1602X + 2. 9968 (R2 = 0.7371, P < 0.05). Renal blood flow was not affected. The patients stayed in hospital for 7-13 (9.8 +/- 11.9) days after operation. One patient developed complications. The one year recurrence rate of tumors was 10%. CONCLUSION The color Doppler provides a simple and accurate instrument for abdominal aortic-balloon occlusion, with reliable blood loss control.
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Affiliation(s)
- Ya-Qin Xiong
- Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu 610041, China
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de Barros Faria M, Castro RN, Lundquist J, Scrivano E, Ceratto R, Ferrario A, Lylyk P. The role of the pipeline embolization device for the treatment of dissecting intracranial aneurysms. AJNR Am J Neuroradiol 2011; 32:2192-5. [PMID: 21885721 DOI: 10.3174/ajnr.a2671] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracranial dissecting aneurysms constitute rare lesions with complex management and elevated morbidity and mortality. Results of 23 patients harboring such lesions treated with the PED are reported. Standard dual antiplatelet therapy was instituted. Neurologic and angiographic assessments were obtained at 3, 6, and 12 months. Clinical presentation included SAH (52%), symptoms of mass effect (22%), ischemia (4%), and incidental finding (22%). The posterior circulation was affected in 91% of cases. Total occlusion was demonstrated in 69.5% of patients, with an increment to 87.5% considering only patients with at least 3 months of follow-up. Small aneurysms demonstrated higher rates of total occlusion (6/7) compared with large (5/7) and giant (5/9) ones. Good clinical outcome was achieved in 74% of patients. Reconstructive endovascular treatment of intracranial dissecting aneurysms with the PED provided good clinical and angiographic results with acceptable risks, representing an attractive therapeutic option for this complex disease, especially when parent vessel preservation is mandatory.
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Affiliation(s)
- M de Barros Faria
- Department of Neurosurgery and Interventional Neuroradiology, Clínica La Sagrada Família, Buenos Aires, Argentina.
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