RESUMO
PURPOSE: This study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA). METHODS: We retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5-7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure. RESULTS: In all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy. CONCLUSIONS: The ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %).
Assuntos
Artéria Femoral/diagnóstico por imagem , Hemostasia/fisiologia , Dispositivos de Oclusão Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Radiografia Intervencionista , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Ultrassonografia de IntervençãoRESUMO
PURPOSE: To report our approach for treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). PATIENTS AND METHODS: Twenty-two symptomatic patients (11 men and 11 women, age range 51 to 88 years) with intrahepatic or common bile duct calculi underwent PTBL. Nine patients had undergone previous gastrectomy and small-bowel anastomosis, thus precluding endoscopic retrograde cholangiopancreatography. In the other 13 patients, stone removal attempts by ERCP failed due to failed access or very large calculi. We used a 7.5F flexible ureteroscope and a 200-µm holmium laser fiber by way of a percutaneous transhepatic tract, with graded fluoroscopy, to fragment the calculi with direct vision. Balloon dilatation was added when a stricture was seen. The procedure was performed with the patient under general anaesthesia. A biliary drainage tube was left at the end of the procedure. RESULTS: All stones were completely fragmented and flushed into the small bowel under direct vision except for one patient in whom the procedure was aborted. In 18 patients, 1 session sufficed, and in 3 patients, 2 sessions were needed. In 7 patients, balloon dilatation was performed for benign stricture after Whipple operation (n = 3), for choledochalenteric anastomosis (n = 3), and for recurrent cholangitis (n = 1). Adjunctive "balloon push" (n = 4) and "rendezvous" (n = 1) procedures were needed to completely clean the biliary tree. None of these patients needed surgery. CONCLUSION: Complicated or large biliary calculi can be treated successfully using PTBL. We suggest that this approach should become the first choice of treatment before laparoscopic or open surgery is considered.
Assuntos
Colelitíase/terapia , Endoscopia/métodos , Litotripsia a Laser/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Tecnologia de Fibra Óptica , Fluoroscopia , Hólmio , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Resultado do TratamentoRESUMO
The purpose of this study was to assess the indwelling time and retrievability of the Optease IVC filter. Between 2002 and 2009, a total of 811 Optease filters were inserted: 382 for prophylaxis in multitrauma patients and 429 for patients with venous thromboembolic (VTE) disease. In 139 patients [97 men and 42 women; mean age, 36 (range, 17-82) years], filter retrieval was attempted. They were divided into two groups to compare change in retrieval policy during the years: group A, 60 patients with filter retrievals performed before December 31 2006; and group B, 79 patients with filter retrievals from January 2007 to October 2009. A total of 128 filters were successfully removed (57 in group A, and 71 in group B). The mean filter indwelling time in the study group was 25 (range, 3-122) days. In group A the mean indwelling time was 18 (range, 7-55) days and in group B 31 days (range, 8-122). There were 11 retrieval failures: 4 for inability to engage the filter hook and 7 for inability to sheathe the filter due to intimal overgrowth. The mean indwelling time of group A retrieval failures was 16 (range, 15-18) days and in group B 54 (range, 17-122) days. Mean fluoroscopy time for successful retrieval was 3.5 (range, 1-16.6) min and for retrieval failures 25.2 (range, 7.2-62) min. Attempts to retrieve the Optease filter can be performed up to 60 days, but more failures will be encountered with this approach.
Assuntos
Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Remoção de Dispositivo , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Desenho de Prótese , Doses de Radiação , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior , Tromboembolia Venosa/complicaçõesRESUMO
The purpose of this paper is to report on the histology of tissues found on retrieved filters with regard to indwelling time. Between February 2006 and January 2007, 28 Optease inferior vena cava filters (Cordis Europa, Roden, The Netherlands) were retrieved from 27 patients. Twenty-two filters were inserted prophylactically for trauma patients and six for patients with venous thromboembolism. Cavography was performed both before and after filter removal to evaluate the presence of thrombi or wall damage. Filters were retrieved with the snare and sheath method. All material adherents to the filters were examined histologically.The mean indwelling time of the filters was 24.9 days (range, 6-69 days). Red tissue fragments were seen on all the filters, consistent microscopically with clots and fibrin. On five filters (18%; mean indwelling time, 45.4 days) white tissue consistent with vascular intima was found. All postprocedure cavographies were normal. We conclude that most material adherent to the retrieved filters is thrombi, while vascular intima can be found in the minority of filters with a longer indwelling time.
Assuntos
Tromboembolia/patologia , Túnica Íntima/patologia , Filtros de Veia Cava , Adolescente , Adulto , Distribuição de Qui-Quadrado , Remoção de Dispositivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
BACKGROUND: The treatment for and long-term outcome of renal angiomyolipoma (AML) at high-risk for bleeding has not been determined. OBJECTIVE: To evaluate the complication rates and the long-term outcomes among patients treated by selective arterial embolization (SAE) for a large or symptomatic renal AML. DESIGN, SETTING, AND PARTICIPANTS: Forty-one patients with 48 kidneys containing AML were treated by SAE at a single tertiary academic center. INTERVENTION: All patients were treated by SAE and followed in a single center. MEASUREMENTS: SAE was performed with a mixture of 96% ethanol and polyvinyl alcohol particles. The variables used for the analysis included age, gender, presence of tuberous sclerosis (TS), and maximal tumor size prior to SAE. The study end points were recurrence of symptoms or bleeding, the need for re-embolization or surgery, and disease-specific survival. The mean follow-up period for the entire group was 4.8 yr. RESULTS AND LIMITATIONS: Mean patient age was 51 yr (range: 24-82), and the mean initial tumor size was 10.3 cm. Successful SAE was achieved in 40 patients (91%) with a minor complication rate of 11%. Avoidance of surgery was achieved in 96% of the kidneys. No retroperitoneal hemorrhage was noted during follow-up, and 98% of the kidneys were preserved during the follow-up period. No significant changes in creatinine levels were noted following SAE (P=0.27). The freedom from surgical treatment at 5 yr following SAE was 94% (95% CI, 89-99%). Disease-specific survival of the entire cohort was 100%. The study is a retrospective, and treatment was not given according to prospective protocol, and therefore sample bias may be present. CONCLUSIONS: SAE of renal AML has long-term efficacy in preventing hemorrhagic complications of renal AML, and preservation of the involved kidneys is amenable in both TS and sporadic cases.
Assuntos
Angiolipoma/terapia , Embolização Terapêutica/métodos , Artéria Femoral , Hemorragia/prevenção & controle , Neoplasias Renais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Angiografia/métodos , Angiolipoma/diagnóstico por imagem , Angiolipoma/mortalidade , Angiolipoma/patologia , Biópsia por Agulha , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Seguimentos , Hemorragia/etiologia , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Seleção de Pacientes , Probabilidade , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The purpose of this study was to report the prevalence of thrombus within a retrievable vena cava filter inserted prophylactically in major trauma patients referred for filter extraction. Between November 2002 and August 2005, 80 retrievable inferior vena cava filters (68 Optease and 12 Gunther-Tulip) were inserted into critically injured trauma patients (mean injury severity score 33.5). The filters were inserted within 1 to 6 (mean 2) days of injury. Thirty-seven patients were referred for filter removal (32 with Optease and 5 with Gunther-Tulip). The indwelling time was 7 to 22 (mean 13) days. All patients underwent inferior vena cavography prior to filter removal. There were no insertion-related complications and all filters were successfully deployed. Forty-three (54%) of the 80 patients were not referred for filter removal, as these patients continued to have contraindications to anticoagulation. Thirty-seven patients (46%) were referred for filter removal. In eight of them (22%) a large thrombus was seen within the filters and they were left in place, all with the Optease device. The other 29 filters (36%) were removed uneventfully. We conclude that the relatively high prevalence of intrafilter thrombi with the Optease filter may be explained by either spontaneous thrombus formation or captured emboli.
Assuntos
Remoção de Dispositivo/estatística & dados numéricos , Traumatismo Múltiplo/terapia , Trombose/epidemiologia , Trombose/etiologia , Filtros de Veia Cava/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estado Terminal/terapia , Remoção de Dispositivo/métodos , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Prevalência , Probabilidade , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Trombose/diagnóstico por imagem , Centros de Traumatologia , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
OBJECTIVE: The purpose of this study was to assess the immediate and midterm effects of embolization of the angiogenic component of renal angiomyolipoma in which a mixture of ethanol and polyvinyl alcohol is used as a permanent obliterator. MATERIALS AND METHODS: Seventeen patients with 18 renal angiomyolipomas (size range, 5.5-20 cm; mean size, 10 cm) were treated with transcatheter embolization over an 8-year period. Embolization was performed with a mixture of 96% ethanol and polyvinyl alcohol particles. Follow-up with CT (mean follow-up period, 22.4 months) and one (mean, 14 months) or two (mean, 27 months) angiographic examinations were conducted to evaluate changes in the size of the tumor and to look for recurrence of the angiogenic component. RESULTS: All initial angiograms showed the characteristic tortuous, hypervascular, and aneurysm-forming angiogenic component. Immediate complete obliteration was achieved in 17 tumors (94.4% technical success rate). There was one partial technical failure. Mean tumor size was reduced to 7.6 cm (mean size reduction, 24%). Fourteen patients with 15 tumors underwent one angiographic follow-up examination (mean time after treatment, 14 months), and four patients underwent two angiographic follow-up examinations (mean time after treatment, 27 months). Reduction of the angiogenic component occurred in 10 (66.6%) of the tumors and complete obliteration in five (33.3%) of the tumors. No retroperitoneal hemorrhage or tumor growth was seen during the follow-up period. No complications were encountered. CONCLUSION: We found a mixture of ethanol and polyvinyl alcohol an efficient embolizing agent with a sustained midterm effect in the management of renal angiomyolipoma. Repeated embolization was needed in tumors with a large angiogenic component. Tumor shrinkage after embolization was minimal.
Assuntos
Angiomiolipoma/terapia , Embolização Terapêutica/métodos , Neoplasias Renais/terapia , Adulto , Angiomiolipoma/diagnóstico por imagem , Etanol/administração & dosagem , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica , Álcool de Polivinil/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Complete aneurysm resolution is the hallmark of successful endoluminal stent-graft treatment. We describe 5 patients in whom an abdominal aortic aneurysm (AAA) disappeared completely at mid-term follow-up after endovascular stent-graft placement. We reviewed 45 patients (43 men and 2 women) who underwent AAA repair using an endovascular technique, from April 1997 to December 2001. Mean AAA diameter was 58.3 mm. On 48-month follow-up, 12 aneurysms had not changed in size, 4 had grown, 16 had shrunk, and 5 had resolved completely. We describe these 5 patients in detail. The 5 patients were all men, mean age 68 years: their mean aneurysmal sac diameter was 54 mm. The only common finding in all of them was patency of lumbar and inferior mesenteric arteries at pre-procedure evaluation as well as at follow-up. Mean time to complete resolution was 18 months. No major complications were encountered. AAA may resolve completely after endovascular stent-graft implantation. Patent side branches may perhaps contribute to AAA disappearance by antegrade flow. A larger patient population should be reviewed, however, before any statistical conclusion can be drawn.