ABSTRACT
Pancreas transplantation exposes to high rates of complications, either vascular (thrombosis, stenosis, pseudoaneurysm, arteriovenous fistula) or nonvascular (fluid collection, graft rejection). With advances in percutaneous and endovascular techniques, interventional radiologists are increasingly involved in the management of these complications. In this article, we review the anatomical considerations relevant to pancreas transplantation, the techniques used for image-guided interventions for vascular and nonvascular complications, and the expected outcomes of these interventions.
Subject(s)
Aneurysm, False , Endovascular Procedures , Pancreas Transplantation , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/therapy , Humans , Pancreas Transplantation/adverse effects , Postoperative Complications/diagnostic imaging , Radiography, Interventional , Radiology, InterventionalSubject(s)
Hemangioma, Cavernous , Hypertension, Portal , Portasystemic Shunt, Transjugular Intrahepatic , Hemangioma, Cavernous/diagnostic imaging , Hemangioma, Cavernous/surgery , Humans , Hypertension, Portal/surgery , Laparotomy , Portal Vein/diagnostic imaging , Portal Vein/surgery , Treatment OutcomeABSTRACT
PURPOSE: The purpose of our study was to retrospectively assess the safety and efficacy of percutaneous real-time ultrasound guidance for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Between January 2011 and November 2018, procedure details and outcome were retrospectively analyzed for 224 patients who underwent TIPS placement using real-time ultrasound guidance for portal vein puncture. There were 175 men and 49 women with a mean age of 52.7±10.6 (SD) years (range: 22-82 years). For each procedure, technical success, primary ultrasound guidance success, portosystemic pressure gradient, duration of the intervention, procedural complications, radiation exposure, mortality and morbidity rates at day 30 post-procedure were recorded for data analysis. RESULTS: Technical success rate was 100.0% with a success rate of the primary ultrasound guidance of 97.8% (219/224; 95% CI: 95.8-99.7). Mean duration of the procedure was 86.2±41.7 (SD) min (range: 22.0-267.0min). Mean dose-area product was 62.0±50.2 (SD) Gy.cm2 (range: 3.7-306.5Gy.cm2). Twelve complications (12/224; 5.4%) occurred in ten patients during TIPS procedures including 8 arterial punctures (3.6%) and 4 biliary punctures (1.8%). Four complications (4/224; 1.8%) were clinically significant. Mortality rate at day 30 after the procedure was 9.8% (22/224), without any patient dying from technical complications. CONCLUSION: Real-time ultrasound guidance is a safe technique to assist in the creation of TIPS and may allow for lower radiation exposure.
Subject(s)
Portal Vein/diagnostic imaging , Portasystemic Shunt, Transjugular Intrahepatic/methods , Punctures , Ultrasonography, Interventional , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultSubject(s)
Aneurysm, False/diagnostic imaging , Aneurysm, False/therapy , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/therapy , Embolization, Therapeutic/methods , Enbucrilate , Pulmonary Artery , Tomography, X-Ray Computed , Enbucrilate/administration & dosage , Humans , Male , Middle AgedABSTRACT
Francisella tularensis, the agent of tularemia, is a Gram-negative coccobacillus primarily pathogen for animals and occasionally for humans. The clinical manifestations of tularemia include pneumonia, ulceroglandular, oropharyngeal, or typhoidal disease. Rare manifestations are also described, but to our knowledge, we describe here the first case of F. tularensis aortitis in a human. Diagnosis was confirmed by the presence of F. tularensis in blood culture, by the presence of F. tularensis DNA in the aortic biopsy and by specific IgG and IgM responses against the bacteria. The outcome was favorable after surgery and specific antimicrobial therapy.
