Value of the portal venous phase in evaluation of treated hepatocellular carcinoma following transcatheter arterial chemoembolisation.

AIM: To evaluate the utility of the portal venous phase on multiphasic computed tomography (CT) after treatment of hepatocellular carcinoma (HCC) with trans-arterial chemoembolisation (TACE). MATERIALS AND METHODS: This was a retrospective review of patients who underwent TACE for HCC between 1 April 2012 and 21 December 2014, with appropriate multiphasic, pre- and post-procedural CT examinations. The maximum non-contrast, arterial phase, and portal venous phase attenuation values of the tumour and tumour bed were evaluated within a region of interest (ROI), with values adjusted against background hepatic parenchyma. Linear regression analyses were performed for both the arterial and venous phases, to assess the level of enhancement and to determine if the venous phase had additional value in this setting. RESULTS: A total of 86 cases from 51 patients were reviewed. All pre-procedural CT examinations of lesions demonstrated arterial phase enhancement with portal venous and delayed phase washout compatible with HCC. The post-procedural CT examinations following TACE revealed expected decreased arterial enhancement. Sixty-five cases (76%) showed persistent non-enhancement on the portal venous phase following embolisation therapy. A total of 21 cases (24%), however, demonstrated progressive portal venous hyper enhancement. Linear regression analysis demonstrated a statistical significance between the difference in maximal arterial and portal venous enhancement in these cases. CONCLUSION: Following TACE, the treated lesion may demonstrate portal venous phase hyper-enhancement within the tumour bed. As such, full attention should be given to these images for comprehensive evaluation of tumour response following treatment.

Single-dose toxicity study of hepatic intra-arterial infusion of doxorubicin coupled to a novel magnetically targeted drug carrier.

The toxicity of a single hepatic intra-arterial administration of doxorubicin (DOX) coupled to a magnetically targeted drug carrier (MTC) was evaluated in a swine model. MTC is a microparticle composite of elemental iron and activated carbon. MTC-DOX is a new formulation of doxorubicin absorbed to the MTC and is designed for site-specific delivery to a solid tumor in the presence of an externally applied magnetic field. The magnetic field induces extravasation of MTCs through the vascular wall, leading to localization and retention in the tissue at the targeted site. Eighteen swine were assigned to 6 treatment groups, including 3 control groups (vehicle control, doxorubicin, MTC), and 3 experimental groups that received the MTC-DOX preparation. Animals were given a single administration of test article, evaluated over 28 days, and then sacrificed. Signs of toxicity were monitored via clinical status, total body weight, gross and microscopic pathology, and serum chemistries. Angiography was used to determine the extent of any embolization present. There were no adverse effects observed in the DOX-alone group. Biologically significant, treatment-related gross and microscopic lesions were limited to the targeted area of the liver only in groups receiving > or =75 mg of MTC (with or without doxorubicin). The severity of liver necrosis correlated to the severity of embolization following treatment. Doxorubicin was not freely circulating in any of the MTC-DOX groups, suggesting successful localization to the targeted site. The no-adverse-effect level (NOAEL) was determined to be the MTC-DOX low-dose group.

CT findings after uterine artery embolization.

Asymptomatic uterine leiomyoma can be detected on routine computed tomography (CT) of the pelvis. Leiomyomas have been described as low attenuation masses that can disrupt the smooth contour of a normal uterus. Four women underwent uterine artery embolization for the treatment of uterine leiomyoma. CT findings include initial retention of contrast in fibroids the day of the procedure and central necrosis of the fibroid with subsequent cavitation as early as 1 month postprocedure.

Hydrodynamic thrombectomy system versus pulse-spray thrombolysis for thrombosed hemodialysis grafts: a multicenter prospective randomized comparison.

PURPOSE: To evaluate the safety and efficacy of a hydrodynamic thrombectomy system in a prospective, multicenter randomized comparison with pulse-spray thrombolysis in hemodialysis grafts. MATERIALS AND METHODS: Nine centers enrolled 120 adult patients with recently (

Retrieval of a Greenfield IVC filter displaced to the right brachiocephalic vein.

During insertion of a central venous sheath an inferior vena cava stainless steel Greenfield filter was dislodged to the right brachiocephalic vein without a free end. Successful retrieval was achieved by using a combination of a guidewire and a snare. Percutaneous retrieval of this vena cava filter is feasible with minimal risk using this method.

Percutaneous delivery of a heparin-impregnated collagen stent-graft in a porcine model of atherosclerotic disease.

RATIONALE AND OBJECTIVES: To develop collagen stent-grafts impregnated with heparin to improve the biocompatibility of endovascular stents and to design a percutaneous delivery system for graft deployment in a swine model. METHODS: Heparin-impregnated collagen stent-grafts were deployed, and follow-up angiograms were obtained every 15 minutes for 90 minutes to assess acute thromboses and again at 2 and 4 weeks afterward to assess patency. If stenosis or occlusion was detected at the 2-week evaluation, guidewire passage across the lesion was attempted and angioplasty was performed. If stenosis or occlusion was present at the 4-week evaluation, only guidewire passage was attempted; thereafter, the animals were killed and the stent-grafts were harvested and reviewed by a vascular pathologist. RESULTS: Group A represents a feasibility study to optimize the deployment method applied in groups B and C. Fifteen of 17 stent-grafts were successfully deployed using this method. In group B, 89% of grafts were successfully deployed; 12% were patent at 2 weeks and none at 4 weeks. In group C, a 10-minute inflation time was added to the deployment procedure; 88% of grafts were successfully deployed and 28% were patent at 2 weeks and 14% at 4 weeks. Extensive luminal thrombosis and myointimal hyperplasia were present in every case. CONCLUSIONS: A method was developed for percutaneous implantation of collagen stent-grafts into peripheral vessels. The heparin-impregnated grafts did not prevent vessel restenosis. Modification of the graft-processing technique may improve patency.

Uterine artery embolization: a minimally invasive technique for the treatment of uterine fibroids.

Uterine artery embolization (UAE) as a primary therapy for symptomatic fibroids was first used in France in 1991. Currently, there are at least 250 centers in the United States, as well as centers in Canada and England, with experience in this technique. Initial published results worldwide indicate that after UAE, uterine fibroids shrink at least 50% in volume on average and symptoms of refractory vaginal bleeding and chronic pelvic pain are controlled in approximately 85% of patients. Major complications are rare. Overall, this technique is minimally invasive, preserves the uterus, and requires a shorter hospitalization than hysterectomy or myomectomy.

An agenda for research into uterine artery embolization: results of an expert panel conference.

PURPOSE: To develop a research agenda for uterine artery embolization (UAE) for the treatment of symptomatic leiomyomata. MATERIALS AND METHODS: An expert panel was convened to examine data and develop a consensus for UAE research. Panelists reviewed data from articles about UAE and data on hysterectomy and myomectomy, which were abstracted into evidence tables. A modified Delphi process was used to rate the importance of measuring specific outcomes and a nominal group process was used to develop ideas for study designs. RESULTS: Panelists agreed that UAE studies would have to examine certain key measures. Outcomes identified as either "important to measure" or "essential to measure" were death, reoperation, operative injury, menorrhagia, premature menopause, recurrence of myomata, and satisfaction. The panel proposed four areas for research: randomized trial, prospective registry, disease-specific quality-of-life instrument, and cost analysis. CONCLUSIONS: Symptomatic uterine leiomyomata are a major health concern for women. New techniques that promise to provide symptom relief deserve careful consideration. Traditionally, surgical procedures have been poorly studied until after they have been widely used. If the process described in this article can guide the acquisition of knowledge in this field, it may serve as a model for evaluating other new technologies before they become widely adopted.

Uterine artery embolization for the treatment of uterine leiomyomata midterm results.

INTRODUCTION: The authors review their midterm experience with uterine artery embolization for the treatment of uterine fibroids. MATERIALS AND METHODS: Sixty patients were referred for permanent polyvinyl alcohol (PVA) foam particle uterine artery embolization during an 18-month period. Detailed clinical follow-up and ultrasound follow-up were obtained. RESULTS: Bleeding was a presenting symptom in 56 patients and pain was a presenting symptom in 47 patients. All patients underwent a technically successful embolization. One of the patients underwent unilateral embolization. Fifty-nine patients underwent bilateral embolization. Of all patients undergoing bilateral embolization, at last follow-up (mean, 16.3 months), 81% had their uterus and had moderate or better improvement in their symptoms. Ninety-two percent of these patients also had reductions in uterine and dominant fibroid volumes. Overall, the mean uterine and dominant fibroid volume reduction were 42.8% and 48.8%, respectively (mean follow-up, 10.2 months). One infectious complication that necessitated hysterectomy occurred. CONCLUSION: Uterine artery embolization for the treatment of uterine fibroids is a minimally invasive technique with low complication rates and very good clinical efficacy.

Technique for reduction of bile peritonitis after T-tube removal in liver transplant patients.

PURPOSE: The purpose of this work was to evaluate the incidence of bile peritonitis following T-tube removal in liver transplant patients as a function of the method of T-tube removal. Removal at the bedside was compared to removal in the interventional radiology department with subsequent placement of a temporary drainage catheter. MATERIALS AND METHODS: From June 1987 through July 1993, 1,105 patients underwent orthotopic liver transplantation at the UCLA Medical Center. Three hundred patients were randomly selected from this group and their charts were reviewed. Two hundred sixty-three patients who had choledocho-choledochostomies over a T tube, and adequate documentation of the method of T-tube removal and subsequent clinical course were included in the study. Forty-one patients had their drainage catheter removed at the bedside, and 222 patients had their T-tube removed over a wire in the interventional radiology department with subsequent placement of a temporary drainage catheter. RESULTS: Among all patients included in this study, 10.3% had bile peritonitis. Of the patients who had their T-tube removed at the bedside, 19.5% had bile peritonitis, whereas only 8.6% of the patients who had their T-tube removed in the interventional radiology department had bile peritonitis. This result is statistically significant (P < .05). CONCLUSION: Placing a temporary drain at the time of T-tube removal in the interventional radiology department results in a significant reduction in the incidence of bile peritonitis in liver transplant patients. The procedure is relatively simple, quickly mastered, and well tolerated by patients.

Uterine artery embolization for the treatment of uterine fibroids.

The first reported cases of uterine artery embolization in obstetric and gynaecological practice were carried out in the late 1970s. Recently, bilateral uterine artery embolization was used as a primary treatment for fibroids. Meticulous preoperative assessment is essential. The technique of uterine artery embolization involves the catheterization of both uterine arteries and the installation of tiny micro particles of polyvinyl alcohol. Following the procedure, post-procedural pain occurs within the first 24 h and most patients are advised to rest for 1 week. In the UCLA and RSCH series, three infective complications occurred leading to hysterectomy and some patients developed amenorrhoea. Average shrinkage of fibroids in the UCLA, RSCH and French series were 40%, 64% and 70%, respectively, with most patients losing their symptoms and being satisfied with the procedure. Meticulous pre-operative assessment is essential. At UCLA, 140 patients, and at RSCH, 96 patients have been embolized. To date in the UK, US and French series, fibroid growth has been arrested and new fibroids have not formed. However, long-term follow-up on a larger number of cases will be required before the role of uterine artery embolization in the gynaecologic therapeutic armamentarium can be fully defined.

Dialysis access graft thrombolysis: randomized study of pulse-spray versus continuous urokinase infusion.

PURPOSE: To compare pulse-spray to continuous-infusion thrombolysis with high-dose urokinase in thrombosed dialysis access grafts. METHODS: A prospective randomized controlled trial was performed. From August 1992 to September 1993, 30 thrombosed polytetrafluoroethylene (PTFE) grafts in 24 patients were included, 15 grafts in each group. The success of thrombolysis, mean time to thrombolysis, mean urokinase dose, and 60-day patency rate were evaluated. RESULTS: In the pulse-spray group, the mean time to thrombolysis was 72 min with a mean urokinase dose of 560,000 U. The 60-day patency rate was 71%. In the continuous-infusion group, the mean infusion time to thrombolysis was 55 min with a mean dose of 479,000 U. The 60-day patency rate was 73%. CONCLUSION: No statistically significant difference was found between the two techniques in the mean time to thrombolysis, the mean urokinase dose used, or the 60-day patency rate.