Percutaneous transluminal angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child after liver transplantation

International Nuclear Information System (INIS)

Yussim, Ethan; Belenky, Alexander; Atar, Eli; Shapiro, Rivka; Mor, Eytan

2005-01-01

Percutaneous transluminal angioplasty is increasingly used in children. We present a case of successful balloon angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child who underwent liver transplantation because of biliary atresia. Percutaneous reopening of the shunt is a relatively safe procedure that may spare patients of surgical intervention. (orig.)

Effect of sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit.

Science.gov (United States)

Ryu, Min-Jung; Park, Jeong Sook; Park, Heeok

2012-03-01

The study compared the effect of earplug-delivered sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit. Diverse types of music have been claimed to improve sleeping elsewhere, but relatively little is known in South Korea. Most studies investigating the effect of sleep-inducing music on sleep have involved persons with insomnia, even though many persons with cardiovascular disease in the intensive care unit suffer from sleeping problems. There is a need to investigate the effect of sleep-inducing music on sleep disorders in persons with percutaneous transluminal coronary angiography in the cardiac care unit. An experimental research design was used. Data collection was conducted in the cardiac care unit of K University Hospital in D city, from 3 September-4 October 2010. Fifty-eight subjects participated and were randomly assigned to the experimental group (earplug-delivered sleep-inducing music for 52 min beginning at 10:00 pm, while wearing an eyeshield, n = 29) and the control group (no music, but earplugs and eyeshield worn, n = 29). The quantity and quality of sleep were measured using questionnaires at 7 am the next morning for each group. Participants in the experimental group reported that the sleeping quantity and quality were significantly higher than control group (t = 3·181, p = 0·002, t = 5·269, p music significantly improved sleep in patients with percutaneous transluminal coronary angiography at a cardiac care unit. Offering earplugs and playing sleep-inducing music may be a meaningful and easily enacted nursing intervention to improve sleep for intensive care unit patients. Nurses working at cardiac care unit can use music to improve sleeping in clients with percutaneous transluminal coronary angiography. © 2011 Blackwell Publishing Ltd.

Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries especially the internal carotid artery

Energy Technology Data Exchange (ETDEWEB)

Kachel, R.; Basche, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Radiologische Klinik); Heerklotz, I.; Grossmann, K. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Innere Medizin); Endler, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Neurologie und Psychiatrie)

1991-06-01

We present our experience with 105 patients in whom percutaneous transluminal angioplasty was performed in 112 stenosed or occluded supra-aortic arteries. Symtoms of cerebrovascular and/or vertebrobasilar insufficiency were present in 104 of the 105 patients. The angioplasty was successful in 35 stenoses of the internal carotid artery, 2 stenoses of the common carotid artery, 1 stenosis of the external carotid artery, 15 stenoses of the vertebral artery, 3 stenoses of the innominate artery and 44 stenoses of the subclavian artery. There were only 4 minor-complications (2 haematomas, 1 transient ischemic attack, 1 small thrombus of the internal carotid artery which was detected by 111-indium platelet scintigraphy and treated by thrombendarterectomy before the appearance of neurological symptoms). All patients were symptom free after angioplasty. During the observations period of 3 to 109 months (average 58 months) there were only two cases with re-stenosis after subclavian angioplasty. The results of more than 700 personal and international published percutaneous transluminal angioplasties of supra-aortic arteries are presented. The results suggest that angioplasty of supra-aortic arteries is an effective method. On strict definition of the indications, the complication rate for angioplasty of the supra-aortic arteries is not likely to be higher than that for operative treatment. (orig.).

Short-, medium-, and long-term follow-up after percutaneous transluminal coronary angioplasty for stable and unstable angina pectoris

NARCIS (Netherlands)

O. Kamp (Otto); K.J. Beatt (Kevin); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); H. Suryapranata (Harry); H.E. Luijten; P.W.J.C. Serruys (Patrick)

1989-01-01

textabstractThe first 840 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) performed in the same institution were retrospectively assessed at an average follow-up period of 25 months after the initial procedure. The study population consisted of 506 patients

Percutaneous transluminal angioplasty and stent placement for iliofemoral arterial atherosclerotic occlusive disease

International Nuclear Information System (INIS)

Zheng Yanbo; Jiang Wenjin; Liu Sheng; Song Xuepeng; Sheng Qirui

2006-01-01

Objectives: To assess the safety and efficacy of percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of iliofemoral arterial atherosclerotic occlusive diseases. Methods From April 1999 to August 2004, 13 cases of iliofemoral arterial occlusions were recanalized with contact thrombolytic therapy combined with guide wire mechanical recanalization method, followed by angioplasty and stent placement. A total of 25 self-expanding Wallstents were deployed. All patients were followed up by means of duplex ultrasound, angiography, or both. Results: All 13 cases were successfully recanalized, with technical successful rate of 100%. Available follow-up for all patients from 8 months-5 years (mean 26.2 months) included one patient undergoing again with successful contact thrombolysis because of early thrombosis; another patient with recurrent symptoms at 19 month after operation undertaking surgical bypass because of later reocclusion; all of the rest stents showing patency by the end of the study. Conclusions: Contact thrombolysis combined with guide wire mechanical recanalization for iliofemoral arterial occlusion is safe and effective, whereas PTA and stent placement would have the nearly same efficacy for the disease with mild injury and low restenosis. (authors)

A Systematic Review of Outcomes Following Percutaneous Transluminal Angioplasty and Stenting in the Treatment of Transplant Renal Artery Stenosis

NARCIS (Netherlands)

Ngo, A. T.; Markar, S. R.; de Lijster, M. S.; Duncan, N.; Taube, D.; Hamady, M. S.

2015-01-01

To evaluate outcomes following treatment of transplant renal artery stenosis by percutaneous transluminal angioplasty and stent insertion. A literature search was performed using Pubmed, MEDLINE, Embase, Wiley Interscience and the Cochrane Library databases. Outcome measures were glomerular

A perspective of percutaneous transluminal angioplasty.

Science.gov (United States)

Stanson, A W

1983-01-01

PTA is a relatively new procedure which is still evolving. More technical improvements are needed. Stiffer balloon plastics and devices to measure arterial wall compliance during balloon inflation are predicted to lead to better long-term success rates. Increasing case numbers provide greater expertise and subsequent refinements in performance and case selection. These factors will lead to improved statistics. Other features of overall patient care must be considered also. The procedure is easy for patients to tolerate, and they can return to activities and work in three or four days. The overall cost is much cheaper than surgery, even at a conservative success rate of 65 percent. There is minimal risk and morbidity, and virtually no mortality. PTA can be repeated if the lesion recurs. Severe complications are rare and almost always surgically treatable. If PTA fails to achieve success, a traditional surgical procedure can be performed. Percutaneous transluminal angioplasty is an important therapeutic alternative to traditional medical and surgical treatment for occlusive arterial disease. It can save legs, veins, time, and money. We need to refine and accurately record the use of this procedure. Total cooperation among clinicians, surgeons, and radiologists is essential for proper utilization of PTA.

Percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease using a transluminal endatherectomy catheter (TEC): Initial results and angiographic follow-up

International Nuclear Information System (INIS)

Rilinger, Norbert; Goerich, Johannes; Scharrer-Pamler, Reinhard; Vogel, Jochen; Tomczak, Reinhard; Merkle, Elmar; Sokiranski, Roman; Brambs, Hans-Juergen

1997-01-01

Purpose. To evaluate the clinical results of percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease. Methods. Rotational atherectomy was performed in 39 patients aged 39-87 years (mean 66.6 years). A total of 71 lesions (43 stenoses and 28 occlusions) were treated in 40 limbs. Additional balloon angioplasty was required in 54% of lesions. Fifteen patients (37.5%) presented in Fontaine stage II, 10 patients (25%) in Fontaine stage III and 15 patients (37.5%) in Fontaine stage IV. Rotational atherectomy at 750 rpm was carried out over a 0.014-inch guidewire with continuous aspiration into a vacuum, bottle. Follow-up angiography and color flow Doppler examinations were performed in 22 patients (23 limbs) after a mean period of 6 months (range 2-14 months). Results. There was one primary technical failure. In 36 of 40 lesions there was a good angiographic result with residual stenoses in less than 30%. In 70 lesions treated by rotational atherectomy, however, 54% showed residual stenoses of 30%-50% and these cases required additional balloon angioplasty. The mean ankle-brachial index improved significantly (p<0.001), from 0.49 before the procedure to 1.01 after the procedure. A single distal embolus, related to primary recanalization, occurred and there were two large inguinal hematomas. Cumulative clinical patency after 6 months was 83.8% and cumulative angiographic patency after 6 months was 79.1%. Conclusion. Percutaneous rotational atherectomy is a promising approach for the treatment of chronic peripheral vascular disease. Further prospective, randomized studies are necessary to compare percutaneous transluminal angioplasty with this new technical approach

Efficacy of 24-Hour Blood Pressure Monitoring in Evaluating Response to Percutaneous Transluminal Renal Angioplasty.

Science.gov (United States)

Jujo, Kentaro; Saito, Katsumi; Ishida, Issei; Furuki, Yuho; Ouchi, Taisuke; Kim, Ahsung; Suzuki, Yuki; Sekiguchi, Haruki; Yamaguchi, Junichi; Ogawa, Hiroshi; Hagiwara, Nobuhisa

2016-08-25

Percutaneous transluminal renal angioplasty (PTRA) improves patency in atherosclerotic renal artery stenosis (ARAS), but improvement in clinic blood pressure (BP) is seen in only 20-40% of patients who undergo PTRA. This study investigated the effects of PTRA on BP lowering, assessed on 24-h ambulatory BP monitoring (ABPM), and identified preoperative features predictive of satisfactory BP improvement after PTRA. Of 1,753 consecutive patients undergoing coronary angiography, 31 patients with angiographically significant ARAS and translesional pressure gradient (TLPG) >20 mmHg underwent PTRA. ABPM was performed before, at 1 month and at 1 year after PTRA; patients with average systolic ABPM-BP decrease >10 mmHg at 1 month from baseline were categorized as responders. There was no obvious relationship between clinic BP and ABPM-BP at baseline. ABPM-BP was significantly higher in responders at baseline (SBP: 148 vs. 126 mmHg, PABPM-BP achieved a larger decrease in ABPM-BP, but the severity of stenosis reflected by TLPG; renal duplex findings; and neurohumoral parameters other than baseline renal function, did not differ between the groups. Clinic BP does not represent daily hemodynamic status, whereas high ABPM-BP is a potent predictor of satisfactory BP response to PTRA. (Circ J 2016; 80: 1922-1930).

[Effect of nattokinase on restenosis after percutaneous transluminal angioplasty of the abdominal artery in rabbits].

Science.gov (United States)

Gong, Min; Lin, Huan-bing; Wang, Qian; Xu, Jiang-ping

2008-08-01

To investigate the effect of nattokinase on intimal hyperplasia in rabbit abdominal artery after balloon injury and explore a novel strategy for the preventing restenosis after percutaneous transluminal angioplasty. Fifty-six New Zealand rabbits were randomly divided into 7 groups, namely the solvent control group, model group, natto extract lavage group, refined nattokinse lavage group, intravenous refined nattokinse injection group, clopidogrel group and clopidogrel-aspirin group. Balloon injury was induced by inserting the catheter through the femoral artery into the thoracic aorta of the rabbits. The platelet counts were notad and platelet aggregation was observed, and the abdominal artery was taken for pathological analysis. The expressions of MMP-2 and -9 in the abdominal artery were detected immunohistochemically. There was no significant difference in the platelet counts, platelet aggregation rate or MMP-2 and -9 expression between the model group and the nattokinse-treated groups (P>0.05). The stenosis index in each nattokinse-treated group was significantly greater and the neointimal proliferation index smaller than that of the model group (P<0.01 or 0.05). Nattokinse can inhibit restenosis of rabbit abdominal artery after percutaneous transluminal angioplasty, which is independent of its actions on the platelet or MMP-2 and -9 expressions.

Percutaneous transluminal angioplasty combining intraarterial drug perfusion for the treatment of chronic lower limb ischemia

International Nuclear Information System (INIS)

Liu Yuan; He Chunshui; Liao Huaqiang; Zeng Wei; Zhang Hongwei; Liu Yang; Mu Yan; Liao Huaqiang; Guan Yongsong

2008-01-01

Objective: To evaluate the clinical effects of balloon angioplasty in combination with intraarterial perfusion of vasoactive drugs in the treatment of chronic lower limb ischemia. Methods: A total of 21 patients were treated with percutaneous transfemoral or transaxillary approach of balloon dilatation of the occlusive arterial segments, and then followed by perfusion of urokinase, Lipo prostaglandin E 1 and ginkgo leaf injection, respectively, into the responsible arteries via the catheter. Postoperatively, some of the patients with tibioperoneal arteries occlusion were perfused with the same drugs into their diseased arterial segments, one time per day altogether 5-7 times, through the ipsilateral femoral arterial sheath reserved temporarily, and then followed by observation for improvement of ischemia, superficial ulceration and gangrenous change. Results: Of the 21 patients, 20 were successfully treated with percutaneous transluminal balloon dilation and arterial perfusion with a technical successful rate of 95.2% (20/21). Five of the total 20 were additionally treated with the same drugs perfusion 5-7 days through the retained sheath, showing well patency. No serious complications occurred and ischemic symptoms of limbs improved, such as rest pain, claudication and dermo temperature. During 2-7 months follow-up, healing of skin ulcer occurred in 4 patients and breakoff of necrotic digits in 2 with the surface wound healed. Necrotic toes in all patients were dehydrated with stopping of necrosis and without any amputation. Conclusions: Percutaneous transluminal angioplasty combining intraarterial drug perfusion is safe and effective for promoting blood circulation with healing of ulceration and ceasing the development of lesions; with furthermore of maintaining the arterial patency through the retained vascular sheath for sustaining the drug plerfusion. (authors)

[The usefullness of percutaneous transluminal balloon angioplasty in the management of budd-Chiari syndrome].

Science.gov (United States)

Kim, Se Hwan; Yu, Kyung Sool; Baek, Seung Min; Lee, Seung Yup; Kim, Hyun Su; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo

2002-06-01

Membranous obstruction is the most common cause of Budd-Chiari syndrome in Orientals. Recently, percutaneous transluminal balloon angioplasty (PTBA) has been successfully applied as a treatment of membranous obstruction. We evaluated etiologies and clinical manifestations in our cases and the usefulness of PTBA. Twelve cases of Budd-Chiari syndrome were analyzed. 50.3 years was the average age of the cases (ranging from 37 to 67 years). Major symptoms or signs were superficial collateral vessels on the chest or the abdomen in 6 cases, ascites in 3, abdominal pain in 4, hepatomegaly in 4, splenomegaly in 3, melena or hematemesis in 2, and leg edema in 2. Upper gastrointestinal endoscopy showed esophageal varices in 6 cases and two of these 6 cases had gastric varices. Of 8 cases with liver cirrhosis, 4 were classified as Child-Pugh class A and 4 as B. Four patients with cirrhosis had concurrent hepatocellular carcinoma including 1 patient who was HBs Ag positive. Etiologies were membranous obstruction in 11 cases and protein C deficiency in 1 case. The main site of obstruction was IVC in 8 and hepatic vein in 4. PTBA was successfully performed in 8 cases of membranous obstruction. During the mean follow-up period of 27.6 months (12-40 months), there were no reobstructions except in 2 cases. The most common cause of Budd-Chiari syndrome in our cases was membranous obstruction of IVC. Percutaneous transluminal balloon angioplasty is a very useful treatment method.

Complications in percutaneous transluminal stenting for carotid artery stenosis

International Nuclear Information System (INIS)

Li Shenmao; Miao Zhongrong; Zhu Fengshui; Ji Xunming; Jiao Liqun; Qi Jianshu; Ling Feng

2007-01-01

Objective: To discuss the complications of endovascular stenting for carotid artery stenosis. Methods: Cerebral vascular angiography and cervical Doppler sonography were performed in 648 patients with carotid artery stenosis. Emboli-protected device was used in 365 patients and none in 283 patients. Results: All 648 patients were technically successful (100%). Symptoms disappeared or improved in 78.7% patients. Slow heart rate during operation existed in 26.4% patients. Embolism caused by dislodgment of emboli occurred in 5 patients, 3 of them recovered after treatment and 2 had unilateral dyskinesias. Intracranial hemorrhage occurred in 3 patients. Stroke or death within 30 days after operation occurred in 6 patients(1.24%). 322 patients (77.8%)were followed up. Restenosis occurred in 17 patients(3.3%). Conclusion: Percutaneous transluminal stenting is a safe option for carotid artery stenosis. Correct evaluation of clinical and angiographic data before operation, together with normative manipulation and nursing during and after operation are the key points to avoid complications. (authors)

Femoral artery recanalisation with percutaneous angioplasty and segmentally enclosed plasminogen activator

DEFF Research Database (Denmark)

Jørgensen, B; Tønnesen, K H; Bülow, J

1989-01-01

To establish whether re-occlusion of the femoral artery could be prevented, in 6 consecutive patients undergoing percutaneous transluminal angioplasty (PTA) for superficial femoral artery occlusion the recanalised segment was isolated, with a 7-French double-balloon catheter. 5 mg recombined huma...

Long-Term Follow-up of the PADI Trial : Percutaneous Transluminal Angioplasty Versus Drug-Eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia

NARCIS (Netherlands)

Spreen, Marlon I; Martens, Jasper M; Knippenberg, Bob; van Dijk, Lukas C; De Vries, Jean-Paul P. M.; Vos, Jan Albert; de Borst, Gert Jan; Vonken, Evert-Jan P A; Bijlstra, Okker D; Wever, Jan J; Statius van Eps, Randolph G; Mali, Willem P Th M; van Overhagen, Hendrik

2017-01-01

BACKGROUND: Clinical outcomes reported after treatment of infrapopliteal lesions with drug-eluting stents (DESs) have been more favorable compared with percutaneous transluminal angioplasty with a bailout bare metal stent (PTA-BMS) through midterm follow-up in patients with critical limb ischemia.

The exposure of radiologists and patients to radiation during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA)

International Nuclear Information System (INIS)

Karppinen, J.; Parviainen, T.

1993-03-01

The exposure of radiologists and patients to radiation during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) in Finland was studied using phantom measurements. Additional tests were made concerning the performance of TV fluoroscopy systems, cine fluorographic units and film processing. These tests include sensitometric quality control of film processing, automatic exposure control in fluoroscopy and cinefluorography, and contrast and resolution in a cine frame and TV image

Comparison of the effect of stem cell therapy and percutaneous transluminal angioplasty on diabetic foot disease in patients with critical limb ischemia

Czech Academy of Sciences Publication Activity Database

Dubský, M.; Jirkovská, A.; Bém, R.; Fejfarová, V.; Pagacová, L.; Němcová, A.; Sixta, B.; Chlupáč, J.; Peregrin, J. H.; Syková, Eva; Jude, E. B.

2014-01-01

Roč. 16, č. 12 (2014), s. 1733-1738 ISSN 1465-3249 Grant - others:GA MZd(CZ) 00023001IKEM Institutional support: RVO:68378041 Keywords : critical limb ischemia * stem cell therapy * percutaneous transluminal angioplasty Subject RIV: FH - Neurology Impact factor: 3.293, year: 2014

Is the Watanabe heritable hyperlipidemic rabbit a suitable experimental model for percutaneous transluminal coronary angioplasty in humans? A light microscopic, immunohistochemical and ultrastructural study

NARCIS (Netherlands)

Wanibuchi, H.; Dingemans, K. P.; Becker, A. E.; Ueda, M.; Naruko, T.; Tanizawa, S.; Nakamura, K.

1993-01-01

This study was designed to assess an experimental model for the study of mechanisms that underlie restenosis after percutaneous transluminal coronary angioplasty. The Watanabe heritable hyperlipidemic (WHHL) rabbit lacks the receptor for low density lipoproteins, produces atherosclerotic lesions

Flow motion waves with high and low frequency in severe ischaemia before and after percutaneous transluminal angioplasty

OpenAIRE

Hoffmann, Ulrich; Schneider, Ernst; Bollinger, Alfred

2017-01-01

Study of objective - The aim was to evaluate skin flux and prevalence of low and high frequency flow motion waves in patients with severe ischaemia due to peripheral arterial occlusive disease before and after percutaneous transluminal angioplasty (PTA) with and without local thrombolysis. Design - Flow motion was recorded by the laser Doppler technique at the dorsum of the foot before, one day, and one month after PTA. The results were separately analysed in patients with successful and unsu...

Percutaneous transluminal angioplasty of renal artery: therapeutic experience of 31 patients

International Nuclear Information System (INIS)

Kim, Seung Cheol; Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Kim, Hong Dae; Jeong, Yoong Ki; Kim, Seung Hoon; Yeon, Kyung Mo

1995-01-01

The purpose of this study is to introduce the experience of 31 patients who had renovascular hypertension and underwent percutaneous transluminal angioplasty of renal artery (PTA). The subjects were 31 patients with hypertension and stenotic renal artery or arteries on angiography. The criteria of stenosis is more than 50% narrowing of the artery. The technical results were considered to be successful if residual stenosis is less than 50%. The clinical results were classified as cure, improvement and fail. And clinical results were analyzed according to the follow-up duration, short term (≤6 mo) and long term (> 6 mo). Technical success rate was 90.2% (37/41) and clinical success rate were 82.8% (24/29) on short term follow-up and 84.2% (16/19) on long term follow-up. Recurred cases were 7 cases. PTA is a safe and effective therapeutic modality on renovascular hypertension

Patients' feelings and experiences during and after peripheral percutaneous transluminal angioplasty

International Nuclear Information System (INIS)

Lundén, Maud; Lundgren, Solveig M.; Persson, Lars-Olof; Lepp, Margret

2015-01-01

Background: Peripheral Arterial Disease (PAD) often caused by atherosclerosis is a major health care issue worldwide. Percutaneous Transluminal Angioplasty (PTA) on the lower limb is a common procedure used to enhance peripheral circulation. With an increasing number of individuals acquiring peripheral PTA treatment and with an increased focus on patient centred care, there is a need to find out more about patients' feelings and thoughts of undergoing PTA. Aim: The aim was to identify patients who are predominantly anxious or calm during and after peripheral PTA and to explore reasons for these feelings. Method: The study includes 51 patients who received PTA treatment in western Sweden. Findings: Seventy-eight percent of the patients rated themselves as calm after the PTA. The analysed interviews resulted in two themes: reasons for feelings of calmness and reasons for feelings of anxiety. Conclusion: In order to feel calm during and after the PTA, information given prior to the PTA needs to be comprehensive and consistent with the actual situation at the angiography suite. The dialogue with the physician and the radiographers was considered valuable, as was the ability to follow the procedure on the image screen. It is concluded that a thorough dialogue with the physician in a calm setting after the PTA is important for the patients' ability to foresee and plan for the future. Moreover, there is a need to find ways to improve analgesic routines regarding assessment and evaluation in connection with PTA treatment as pain is shown to increase anxiety

The Use of Below-Knee Percutaneous Transluminal Angioplasty in Arterial Occlusive Disease Causing Chronic Critical Limb Ischemia

International Nuclear Information System (INIS)

Loefberg, Ann-Marie; Loerelius, Lars-Erik; Karacagil, Sadettin; Westman, Bo; Almgren, Bo; Berqgvist, David

1996-01-01

Purpose: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). Methods: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n= 39) or in combination with PTA of the superficial and/or popliteal artery (n= 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs.Results: A technically successful PTA with at least one crural level was achieved in 88% of cases (n= 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. Conclusion: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions

Percutaneous Transluminal Angioplasty for Complete Membranous Obstruction of Suprahepatic Inferior Vena Cava: Long-Term Results

Energy Technology Data Exchange (ETDEWEB)

Kucukay, Fahrettin, E-mail: fkucukay@hotmail.com [Turkiye Yuksek Ihtisas Hospital, Department of Interventional Radiology (Turkey); Akdogan, Meral, E-mail: akdmeral@yahoo.com [Turkiye Yuksek Ihtisas Hospital, Department of Gastroenterology (Turkey); Bostanci, Erdal Birol, E-mail: ebbostanci@yahoo.com [Turkiye Yuksek Ihtisas Hospital, Department of Gastrointestinal Surgery (Turkey); Ulus, Ahmet Tulga, E-mail: uluss@yahoo.com [Hacettepe University, Department of Cardiovascular Surgery (Turkey); Kucukay, Murat Bulent, E-mail: dr-mbk@hotmail.com [Lokman Hekim Hospital, Department of Internal Medicine (Turkey)

2016-10-15

PurposeTo determine the long-term results of percutaneous transluminal angioplasty (PTA) for a complete membranous obstruction of the suprahepatic inferior vena cava.MethodsPatients (n = 65) who were referred to the interventional unit for PTA for a complete membranous obstruction of the suprahepatic inferior vena cava between January 2006 and October 2014 were included in the study. Thirty-two patients (18 males, 14 females, mean age 35 ± 10.7, range 20–42 years) were treated. The patients presented with symptoms of ascites (88 %), pleural effusion (53 %), varicose veins (94 %), hepatomegaly (97 %), abdominal pain (84 %), and splenomegaly (40 %). Transjugular liver access set and re-entry catheter were used to puncture and traverse the obstruction from the jugular side. PTA balloon dilations were performed. The mean follow-up period was 65.6 ± 24.5 months. The objective was to evaluate technical success, complications, primary patency, and clinical improvement in the symptoms of the patients.ResultsThe technical success rate was 94 %. In two patients, obstruction could not be traversed. These patients underwent cavoatrial graft bypass surgery. There were no procedure-related complications. Clinical improvements were achieved in all patients within 3 months. The primary patency rate at 4 years was 90 %. There was no primary assisted patency. There was no need for metallic stent deployment in the cohort. The secondary patency rate at 4 years was 100 %.ConclusionsPercutaneous transluminal angioplasty for a complete membranous obstruction of the suprahepatic inferior vena cava is safe and effective, and the long-term results are excellent.

Assessment of percutaneous transluminal coronary angioplasty with 123IODO-heptadecanoic acid

International Nuclear Information System (INIS)

Stoddart, P.G.P.; Wilde, P.; Papouchado, M.; Jones, J.V.

1987-01-01

Ten patients underwent myocardial scintigraphy with 123 I-iodo-heptadecanoic acid (HDA), which was injected in the last minute of maximal exercise testing. Six of the patients were rescanned following percutaneous transluminal coronary angioplasty. All ten patients underwent full coronary angiography. There were visible perfusion defects on the static images in 74% of the myocardial areas which were supplied by an artery with a stenosis greater than 75%. The mean half life recorded from areas distal to an arterial stenosis of at least 90% (35.69 min±41.25 min), was longer than the expected normal mean (18.85 min±3.35 min). However, the difference was not statistically significant. The static images changed in some patients following angioplasty, however there was no consistent alteration in the half-lives. It was concluded that HDA is a suitable agent for investigating myocardial perfusion, but that the half life cannot be measured adequately for clinical purposes with a planar imaging sytsem. (orig.)

Percutaneous Transluminal Angioplasty and Enclosed Thrombolysis Versus Percutaneous Transluminal Angioplasty in the Treatment of Femoropopliteal Occlusions: Results of a Prospective Randomized Trial

International Nuclear Information System (INIS)

Nicholson, Tony

1998-01-01

Purpose: To determine whether percutaneous transluminal angioplasty (PTA) and enclosed thrombolysis (ET) is superior to PTA alone in the treatment of femoropopliteal occlusions. Methods: Twenty-five patients with 5-15-cm-long occlusions in the femoropopliteal segments, with otherwise normal run-in arteries and at least one normal tibioperoneal artery to the foot, were randomized to ET/PTA or PTA alone. Ankle brachial systolic index (ABI) was measured before the procedure and at 24 hr and 12 months after the procedure, when a duplex scan was also carried out. End points in the study were patency at, or repeat intervention before, 12 months. Results: Procedures were successful in 23 of 25 patients. There was one immediate occlusion of tibioperoneal arteries, and one early reocclusion of a reopened segment in the ET/PTA group. There was one early reocclusion in the PTA group. At 12 months patency was 70% and 69.2% in the ET/PTA and PTA groups respectively. Covariant analysis showed no significant difference in ABI between the two groups at any of the three measurement times. Conclusion: This trial demonstrated no difference between ET/PTA and PTA alone in femoropopliteal occlusions associated with normal proximal arteries and at least one normal tibioperoneal artery

Percutaneous transluminal angioplasty in the region of the renal artery: indications, technique and results

Energy Technology Data Exchange (ETDEWEB)

Olbert, F; Ogris, E; Muzika, N; Schlegl, A; Vacariu, O; Diez, W

1985-01-01

The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes. (Author).

Percutaneous transluminal angioplasty in the region of the renal artery: indications, technique and results

International Nuclear Information System (INIS)

Olbert, F.; Ogris, E.; Muzika, N.; Schlegl, A.; Vacariu, O.; Diez, W.

1985-01-01

The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes. (Author)

Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

International Nuclear Information System (INIS)

Smeenk, Robert M.; Kock, Mark C. J. M.; Elgersma, Otto E. H.; Schnater, Marco J.

2011-01-01

This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA.

Clinical application of Inoue-balloon in percutaneous transluminal angioplasty for Budd-Chiari syndrome

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Mei Jian; Qu Jian; Zhu Yaoqing; Wang Lei; Liu Cheng

2007-01-01

Objective: To investigate the feasibility and effect of recanalization of inferior vena cava with percutaneous transluminal angioplasty(PTA)by Inoue-balloon. Methods: Eighty-nine patients with Budd-chiari syndrome (BCS )were treated with PTA by Inoue-balloon. Results: After PTA, the median (interquartile range)diameter of hepatic segment inferior vena cava increased from 0.00 (0.20-0.00) cm to 1.90 (2.00 1.47)cm; (P < 0.001), and the mean pressure of inferior vena cava reduced from (20.63 ± 7.22) mmHg to (12.13 ± 5.60) mmHg; (P < 0.001); with only less serious complications as rupture in two cases and without need of prior minor diameter balloon dilation in Inoue-balloon PTA. Conclusion: The advantages of Inoue- balloon PTA for BCS are more reliable and facile than those of polyethylene balloon, and may take the place in the foreseen future. (authors)

Aggressive nonsurgical management of acute coronary artery occlusions developing immediately after percutaneous transluminal coronary angioplasty (PTCA)

International Nuclear Information System (INIS)

Levin, D.C.; Meyerovitz, M.; Boxt, L.; Taus, R.; Ganz, P.; Friedman, P.; Selwyn, A.

1986-01-01

In 368 consecutive percutaneous transluminal coronary angiography (PTCA) procedures, acute occlusion of the dilated artery developed within the first hour after the procedure in 24 cases (6.5%). Four patients underwent emergency bypass surgery. In 17 of the remaining 20 patients, repeat balloon dilation was immediately attempted, and was successful in 11 instances (65%). Five of the six cases in which repeat balloon dilation was not successful responded well to surgical or medical therapy. The author conclude that acute occlusions of dilated coronary arteries shortly after PTCA do not automatically necessitate emergency bypass. Approximately two thirds of such cases can be managed by repeat dilation, converting a potential complication into a successful outcome

Exercise electrocardiography and myocardial scintigraphy in the serial evaluation of the results of percutaneous transluminal coronary angioplasty

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Schall, J.M.; Chaitman, B.R.; David, P.R.; Dupras, G.; Brevers, G; Val, P.G.; Crepeau, J.; Lesperance, J.; Bourassa, M.G.

1982-01-01

The diagnostic value of exercise electrocardiography using 14 leads and thallium-201 scintigraphy were evaluated in 54 of 70 patients who underwent percutaneous transluminal coronary angioplasty (PTCA), both in the initial assessment and serial follow-up of patients after PTCA. Of the 45 patients who had successful PTCA, 36 had complete noninvasive studies performed before and 1 month after PTCA. The use of clinical symptoms in conjunction with the physiologic data, ECG and myocardial scintigram acquired during exercise provide important short-term data on the angiographic evolution of PTCA results. The noninvasive tests may be useful in determining guidelines for repeat angiography in patients who have had PTCA

Close to Transplant Renal Artery Stenosis and Percutaneous Transluminal Treatment

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Leonardou Polytimi

2011-01-01

Full Text Available Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS. Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS, whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS. 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery. Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure. Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension.

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

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Chiba, Emiko; Hamamoto, Kohei; Nagashima, Michio; Matsuura, Katsuhiko; Okochi, Tomohisa; Tanno, Keisuke; Tanaka, Osamu

2016-01-01

PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

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Chiba, Emiko, E-mail: chibaemi23@comet.ocn.ne.jp; Hamamoto, Kohei, E-mail: hkouhei917@gmail.com [Jichi Medical University, Department of Radiology, Saitama Medical Center (Japan); Nagashima, Michio, E-mail: nagamic00@gmail.com [Asahikawa Medical University, Department of Emergency Medicine (Japan); Matsuura, Katsuhiko, E-mail: kmatsur@gmail.com; Okochi, Tomohisa, E-mail: t-shachi@dj8.so-net.ne.jp; Tanno, Keisuke, E-mail: tankichi1974@gmail.com; Tanaka, Osamu, E-mail: otanaka@omiya.jichi.ac.jp [Jichi Medical University, Department of Radiology, Saitama Medical Center (Japan)

2016-10-15

PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).

Radiation dose to patients from the coronary angiography and percutaneous transluminal coronary angioplasty in interventional radiology procedures

International Nuclear Information System (INIS)

Zheng, Jun-Zheng; Bai, Mei; Liu, Bin

2008-01-01

Full text: Objective: To survey and assess radiation dose to patients from coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) in Beijing Xuanwu Hospital of Capital University of Medical Sciences. Methods: The dose-area product (DAP) values to the patient and cumulative dose (CD) were recorded from 84 coronary angiographies and 51 percutaneous transluminal coronary angioplasty. A Monte-Carlo based program PCXMC was used to calculate the effective dose from DAP values for each patient. Organ doses were also measured by thermoluminescent dosimeters (TLD) using a human-shaped phantom to compare the calculated organ dose from DAP. Results: The difference between the organ doses measured by TLDs and those from PCXMC software (P>0.05) were tolerable. The DAP value ranged from 7611∼60538 mGy·cm 2 for CA and 16423∼161973 mGy·cm 2 for PTCA. The effective dose for all procedures was determined to be in the range of 1.1∼6.9 mSv for CA and 2.3∼20.1 mSv for PTCA. CD ranged from 120.0 to 1016.0 mGy for CA and 287 to 2883 mGy for PTCA. Conversion factors between effective dose and DAP were 0.114∼0.139 mSv·Gy - 1·cm -2 for CA and 0.124∼0.142 mSv·Gy -1 ·cm -2 for PTCA; Conversion factors between organ dose and CD were derived for CA and PTCA, respectively. Conclusions: DAP and CD can be used as the dose indicator to calculate the organ dose and effective dose of patient based on Monte Carlo simulation. Using this method can provide important information of patient absorbed dose and enhance the radiation protection of patient in interventional radiology procedures. (author)

Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

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Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Lee, Keun Bae [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

2011-09-15

To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

International Nuclear Information System (INIS)

Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Keun Bae

2011-01-01

To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

Percutaneous transluminal mitral commissurotomy for rheumatic mitral stenosis in a 5-year-old child.

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Ullah, Maad; Sultan, Mehboob; Akbar, Hajira; Sadiq, Nadeem

2012-06-01

We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm(2) without significant change in mitral regurgitation. At 1- and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm(2), a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.

Percutaneous transluminal forceps biopsy in patients suspected of having malignant biliary obstruction: factors influencing the outcomes of 271 patients

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Park, Jung Gu; Jung, Gyoo-Sik; Yun, Jong Hyouk [Kosin University College of Medicine, Department of Radiology, Seo-gu, Busan (Korea, Republic of); Yun, Byung Chul; Lee, Sang Uk; Han, Byung Hoon [Kosin University College of Medicine, Department of Internal Medicine, Busan (Korea, Republic of); Ko, Ji Ho [Busan Medical Center, Department of Radiology, Busan (Korea, Republic of)

2017-10-15

To evaluate predictive factors for false-negative diagnosis of percutaneous forceps biopsies in patients suspected of having a malignant biliary obstruction Two hundred seventy one consecutive patients with obstructive jaundice underwent percutaneous forceps biopsy. In each patient, three to five specimens (mean, 3.5 specimens) were collected from the lesion. The final diagnosis for each patient was confirmed with pathologic findings at surgery, additional histocytologic data, or clinical and radiologic follow-up. Univariate and multivariate logistic regression analysis was used to identify risk factors associated with false-negative diagnosis. One hundred ninety four of 271 biopsies resulted in correct diagnoses of malignancy, while 20 biopsy diagnoses were proved to be true-negative. There were 57 false-negative diagnoses and no false-positive diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstructions was as follows: sensitivity, 77.2%; specificity, 100%; and accuracy, 78.9%; positive predictive value, 100%, negative predictive value; 25.9%. Periampullary segment of common bile duct, intrahepatic bile duct and metastatic disease were the significant risk factors of false-negative diagnosis. Percutaneous forceps biopsy provides relatively high accuracy in the diagnosis of malignant biliary obstructions. The predictive factors of false-negative biopsy were determined to be biopsy site and origin of primary tumour. (orig.)

The Timing and Frequency of Complications After Peripheral Percutaneous Transluminal Angioplasty and Iliac Stenting: Is a Change from Inpatient to Outpatient Therapy Feasible?

International Nuclear Information System (INIS)

Burns, Briony J.; Phillips, Andrea J.; Fox, Anthony; Boardman, Phillip; Phillips-Hughes, Jane

2000-01-01

Purpose: A prospective study was performed to assess the frequency and timing of complications after transluminal angioplasty and stent placement with a view to changing our practice and performing these procedures on an outpatient basis.Method: A total of 266 angioplasties and 51 stent deployments were attempted on 240 consecutive patients. Immediate complications were documented by the radiologists. The timing and nature of any complications during and beyond the first 24 hr were reported by the vascular surgeons.Results: There were 14 complications in 240 patients, giving a complication rate of 4.8% per vessel segment dilated. There were five major and nine minor complications. Eighty-six percent of complications were evident before the patient had left the angiography suite. All complications were evident within 4.5 hr of the procedure.Conclusion: The timing of complications suggests it would be reasonable to perform percutaneous transluminal angioplasties and iliac stenting on an outpatient basis in suitable patients

Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease.

Science.gov (United States)

Krasznai, A G; Sigterman, T A; Welten, R J; Heijboer, R; Sikkink, C J J M; van de Akker, L H J M; Bouwman, L H

2013-11-01

Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Usefulness of percutaneous transluminal coronary angioplasty in silent myocardial ischemia

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Hou, Mami

1996-01-01

The usefulness of percutaneous transluminal coronary angioplasty (PTCA) was assessed in patients with exercise-induced asymptomatic myocardial ischemia (silent ischemia) and compared with exercise-induced symptomatic myocardial ischemia (symptomatic ischemia). Patients with single vessel coronary artery disease (51 with angina pectoris, 40 with old myocardial infarction) and evidence of stress-induced ischemia on thallium-201 single photon emission computed tomography (SPECT) underwent successful PTCA. Thirty-seven percent of angina patients and 60% of infarction patients showed asymptomatic exercise-induced ischemia. There was no significant difference in population characteristics between silent and symptomatic patients. Patients with silent angina had significantly higher percentage thallium uptake and washout rate than symptomatic patients. After PTCA, both percentage diameter stenosis and percentage thallium uptake were improved in all patients with angina irrespective of the presence or absence of symptoms. There were no significant differences in percentage thallium uptake and washout rate between patients with silent and symptomatic infarction. After PTCA, percentage diameter stenosis, percentage thallium uptake, and washout rate improved in all infarction patients irrespective of the symptoms. Zero percent of silent angina patients, 12% of symptomatic angina patients, 12% of silent infarction patients, 19% of symptomatic infarction patients had cardiac events during about 4.5 years after PTCA. The incidence of cardiac events did not significantly differ in any patient group. PTCA improved myocardial perfusion in all patients, and the incidence of cardiac events did not differ between the silent and symptomatic groups. Revascularization with PTCA is suitable for patients with silent as well as symptomatic ischemia. (author)

Randomized trial of Legflow® paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): Study protocol for a randomized controlled trial

NARCIS (Netherlands)

A. Karimi; S.W. de Boer (Sanne W.); D.A.F. Van Den Heuvel; B. Fioole (Bram); D. Vroegindeweij (Dammis); J.M.M. Heyligers (Jan); P.N.M. Lohle (Paul N.M.); O.E. Elgersma (Otto E.); R.P.T. Nolthenius (Rudolf ); J.A. Vos (Jan Albert); J.-P.P.M. de Vries (Jean-Paul)

2013-01-01

textabstractBackground: Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the

Randomized trial of Legflow((R)) paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): study protocol for a randomized controlled trial

NARCIS (Netherlands)

Karimi, A.; Boer, S.W. de; Heuvel, D.A. Van Den; Fioole, B.; Vroegindeweij, D.; Heyligers, J.M.M; Lohle, P.N.; Elgersma, O.; Nolthenius, R.P.T.; Vos, J.A.; Vries, J.P. de

2013-01-01

BACKGROUND: Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the Legflow((R))

Angiographic Characteristics of Symptomatic Recurrent Disease After Infrainguinal Percutaneous Transluminal Angioplasty

International Nuclear Information System (INIS)

Soeder, Heini K.; Manninen, Hannu I.; Matsi, Pekka J.

1999-01-01

Purpose: To evaluate the angiographic patterns of clinically manifest recurrent disease after infrainguinal percutaneous transluminal angioplasty (PTA) of stenoses and total occlusions. Methods: Among 326 infrainguinal PTAs on 263 consecutive patients, selective angiography was performed on 61 limbs of 52 patients 1-60 months after the primary intervention because of clinically suspected recurrent disease. Lesion-specific and patient-related factors were analyzed for 75 angiographically confirmed recurrent lesions in 57 limbs of 48 patients. Results: Recurrent disease was more frequently a stenosis when the original target lesion was a stenosis (92%, 44/48) than when the original lesion was a total occlusion (59%, 16/27; p < 0.001). When the original target lesion was a stenosis, the total length of the recurrent disease was longer than that of the original lesion [3.9 ± 3.9 cm (mean ± standard deviation) vs 2.8 ± 2.7 cm; p= 0.03], while in the subgroup of original total occlusions the length of the recurrent lesion was shorter than that of the original occlusion (7.1 ± 5.0 cm vs 9.9 ± 6.9 cm; p0.02). Half the restenoses (22/44) extended beyond one or both ends of the original stenosis and 38% (6/16) of the reocclusions extended beyond the distal end of the original occlusion. Conclusions: The type of recurrent disease depends on the original lesion type and the restenotic lesion frequently extends beyond one or both ends of the original target lesion

[Synchronized anterograde perfusion during percutaneous transluminal coronary angioplasty: preliminary clinical study].

Science.gov (United States)

Farcot, J C; Berland, J; Derumeaux, G; Letac, B; Bourdarias, J P

1995-03-01

A new circulatory system, "physiologic anteroperfusion system", has been developed and tested in 6 patients with significant proximal coronary artery stenosis. Prolonged and safe balloon inflation was possible without any ischemic signs. The system consists of an electronic cardiac synchroperfusor which, by activating a pulsatile unit, permits increased diastolic anteroperfusion of autologous blood under physiologic pressure through low-profile standard angioplasty catheters. This study reports the results obtained in 6 patients during proximal prolonged percutaneous transluminal coronary angioplasty. Four men and two women suffering from severe exertional angina pectoris, with normal resting left ventricular function, no collaterals and excellent apical two-dimensional four-chamber echocardiographic views were studied. After a 90 +/- 10 seconds of control occlusion under continuous monitoring of hemodynamics, electrocardiograms (3 to 4 leads), two-dimensional echo and chest pain grading, a second balloon inflation protected by the physiologic anteroperfusion system at a flow rate of 44 +/- 12 ml/min was performed for fifteen minutes. The ischemic signs present in the myocardium depending on the occluded artery were totally abolished during prolonged inflation protected by physiologic anteroperfusion system. All the patients were successfully dilated and were discharged from hospital the following morning without cardiac enzyme elevation or signs of central or peripheral hemolysis. Conclusion, in 6 patients with severe proximal coronary artery stenosis, safe prolonged proximal angioplasty without signs of ischemia was performed using a new simple physiologic anteroperfusion system, which allows active diastolic flow-pressure controlled autologous arterial blood perfusion, through standard low profile catheters.

Selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty with duplex scanning

International Nuclear Information System (INIS)

Bostroem Ardin, A.; Hellberg, A.; Ljungman, C.; Logason, K.; Karacagil, S.; Loefberg, A.M.; Andren, B.

2002-01-01

Aim: To evaluate the role of duplex scanning in the selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty (PTA). Material and Methods: From January 1995 through May 2000, 702 patients (952 limbs), with chronic lower extremity ischemia due to infrainguinal atherosclerotic disease diagnosed by duplex scanning, were retrospectively studied. Diagnostic angiography (130 limbs) or infrainguinal PTA (108 limbs) was performed in 238 limbs. Two investigators retrospectively analyzed the duplex examinations and angiographies in a blinded manner and used similar criteria for the interpretation of lesions suitable or not suitable for PTA. Results: The superficial femoral, popliteal and crural artery lesions were correctly selected for PTA in 85%, 66% and 32%, respectively. The accuracy, sensitivity, specificity, negative predictive value and positive predictive value of duplex scanning to appropriately categorize femoropopliteal lesions as suitable or unsuitable for PTA were 89%, 83%, 92%, 94% and 78%, respectively. The accuracy of duplex scanning for predicting the performance of infrainguinal PTA was 83%. Conclusion: Duplex scanning has an important impact on the selection of treatment modalities in limbs with infrainguinal arterial occlusive disease. Femoropopliteal lesions can be reliably selected to PTA according to duplex scan findings

Percutaneous transluminal angioplasty with stenting for treatment of superior vena cava obstructive syndrome

International Nuclear Information System (INIS)

Chen Shiwei; Qiao Delin

2004-01-01

Objective: To evaluate the clinical value of percutaneous transluminal angioplasty with stenting (PTAS) for the treatment of superior vana cava obstructive syndrome (SVCOS). Methods: 15 cases of SVCOS including 10 cases of lung cancer with mediastinal lymphatic metastasis, 3 cases as malignant lymphoma and 2 cases of esophageal cancer with mediastinal lymphadenopathy, were undergone right subclavian vein or elbow vein catheterization for pressure measurement and DSA imaging of SVC with displaying the obstructive characteristics. A self-expanding stent was then implanted through right femoral vein catheterization. Results: 15 cases were all successfully under-taken angioplasty and stenting, except 1 case with a long stricture over 10 cm requiring 2 stents. After successful stent placement, DSA revealed smooth flow of contrast with almost normal diameter of SVC lumen, together with disappearance or relief of SVCOS. The SVC pressure decreased from 30.5±2.3 cmH 2 O down to 8.8 ± 1.5 cmH 2 O after recanalization, with a significant difference in statistics (P<0.01). All the patients were followed up for 6 months and obstructive symptom did not reappear except one case complicated with thrombosis which was treated by regional thrombolysis and balloon dilation leading to obviously improved symptom. Conclusion: PTAS for the treatment of SVCOS is effective, safe, simple and of less complications. (authors)

Transcutaneous oximetry compared to ankle-brachial-index measurement in the evaluation of percutaneous transluminal angioplasty

International Nuclear Information System (INIS)

Wildgruber, Moritz; Wolf, Oliver; Weiss, Wolfgang; Berger, Hermann; Lutzenberger, Werner; Eckstein, Hans-Henning; Heider, Peter

2007-01-01

Objective: To investigate transcutaneous oximetry as parameter of the microcirculation is correlated to ankle-brachial-index as parameter of the macrocirculation after peripheral angioplasty procedures. Design: Prospective study. Materials and methods: 60 patients suffering from intermittent claudication were scheduled for angioplasty treatment. 45 patients were considered as eligible for angioplasty after angiographic evaluation, 15 patients underwent angiography only. Transcutaneous oximetry measurements were performed before the procedure, at the end of intervention, 24 h as well as 2 and 4 weeks after percutaneous transluminal angioplasty. Ankle-brachial-indices were obtained before intervention, 24 h as well as 2 and 4 weeks later. Results: Ankle-brachial-indices increased significantly at 24 h after angioplasty in patients being treated with angioplasty. Transcutaneous oximetry values dropped significantly at the end of the procedure and returned close to the baseline levels at 2 and 4 weeks after angioplasty. Ankle-brachial-indices and transcutaneous oximetry were positively correlated before (r = 0.3833, p = 0.009) as well as 4 weeks after angioplasty (r = 0.4596, p = 0.001). Immediately after radiological interventions, ankle-brachial-indices and transcutaneous oximetry are not positively correlated. In patients undergoing angiography only, transcutaneous oximetry levels drop significantly immediately after angiography and remain at decreased levels even at 4 weeks after intervention. Conclusion: Transcutaneous oximetry as parameter of the microcirculation is positively correlated with ankle-brachial-index as parameter of the macrocirculation before and at 4 weeks after angioplasty. Intraarterial angiography leads to a sudden decrease in skin microcirculation without affecting macrocirculation. As indicated by a lack of recovery in transcutaneous oximetry levels after 4 weeks, angiography alone results in a prolonged impaired microcirculation which may

Treatment of renovascular hypertension by transluminal angioplasty

DEFF Research Database (Denmark)

Øvrehus, Kristian A; Andersen, Poul E; Jacobsen, Ib A

2007-01-01

: with improved control of blood pressure; group III: unchanged blood pressure control. Grouping was performed immediately after treatment, at 1 month, 6 months and at the latest follow-up. One hundred-and-twenty-two patients (124 atherosclerotic and 12 fibromuscular lesions) were treated during 13 years......OBJECTIVE: The study is a follow-up on treatment of renovascular hypertension (RVH) with percutaneous transluminal renal angioplasty (PTRA). METHODS: Patients were screened on the basis of clinical criteria of increased probability of RVH with renography and in selected cases with renal vein renin...

Prevalence of unrecognized diabetes, prediabetes and metabolic syndrome in patients undergoing elective percutaneous coronary intervention.

Science.gov (United States)

Balakrishnan, Revathi; Berger, Jeffrey S; Tully, Lisa; Vani, Anish; Shah, Binita; Burdowski, Joseph; Fisher, Edward; Schwartzbard, Arthur; Sedlis, Steven; Weintraub, Howard; Underberg, James A; Danoff, Ann; Slater, James A; Gianos, Eugenia

2015-09-01

Diabetes mellitus (DM) and metabolic syndrome are important targets for secondary prevention in cardiovascular disease. However, the prevalence in patients undergoing elective percutaneous coronary intervention is not well defined. We aimed to analyse the prevalence and characteristics of patients undergoing percutaneous coronary intervention with previously unrecognized prediabetes, diabetes and metabolic syndrome. Data were collected from 740 patients undergoing elective percutaneous coronary intervention between November 2010 and March 2013 at a tertiary referral center. Prevalence of DM and prediabetes was evaluated using Haemoglobin A1c (A1c ≥ 6.5% for DM, A1c 5.7-6.4% for prediabetes). A modified definition was used for metabolic syndrome [three or more of the following criteria: body mass index ≥30 kg/m2; triglycerides ≥ 150 mg/dL; high density lipoprotein prediabetes at time of percutaneous coronary intervention. Overall, 54.9% met criteria for metabolic syndrome (69.2% of patients with DM and 45.8% of patients without DM). Among patients undergoing elective percutaneous coronary intervention, a substantial number were identified with a new DM, prediabetes, and/or metabolic syndrome. Routine screening for an abnormal glucometabolic state at the time of revascularization may be useful for identifying patients who may benefit from additional targeting of modifiable risk factors. Copyright © 2015 John Wiley & Sons, Ltd.

[Meta-analysis of percutaneous transluminal atherectomy in the treatment for in-stent restenosis of lower extremity peripheral artery disease].

Science.gov (United States)

Li, Weihao; Zhang, Tao; Liu, Yunfeng; Zhang, Yongbao; Li, Qingle; Zhang, Xiaoming; Shen, Chenyang

2015-11-24

To evaluate the clinical safety and efficacy of percutaneous transluminal atherectomy for in-stent restenosis (ISR) in patients with low extremity peripheral arterial diseases (PAD). PubMed, Elsevier, EBSCO, Spring databases and Cochrane Library were searched for relevant articles. Based on the different mechanisms of atherectomy, the patients were divided into mechanic atherectomy group and laser atherectomy group. The safety end points included the rate of distal embolism and severe arterial wall injuries. And the efficacy end points included primary patency rate and freedom from target vessel revascularization (TVR-free) 6 months and 12 months after surgery. A total of 9 studies and 620 patients (published between 2006 and 2014) were accepted. The rate of distal embolism was 4.2% (95% confidence interval (CI): 1.7%-6.7%), while that of severe arterial wall injuries was 1.9% (95%CI: 0.9%-3.0%), respectively. Laser atherectomy was responsible for more distal embolism (6.8%) compared to mechanic atherectomy (2.0%), which was significantly different (Q=21.66, P=0.010). At 6-month follow-up, primary patency rate and rate of TVR-free were 63.0% (95% CI: 55.5%-70.6%) and 80.4% (95% CI: 70.5%-90.3%), while at 12-month follow-up were 43.5% (95%CI: 32.2%-54.9%) and 58.0% (95% CI: 52.1%-63.9%), respectively. The free-TVR rate at 6 months follow-up in mechanical atherectomy group was 77.9%, and was inferior to that in laser atherectomy group (80.8%, Q=13.49, P=0.009). Published bias was discovered at the analysis of 12-month TVR-free rate by means of Begg Test (P=0.039). Meta analysis concerned about the 3 randomized controlled trials demonstrated that there was no significant improvement using atherectomy for ISR comparing to standard balloon at 6-month TVR-free rate (OR=1.34, 95% CI: 0.86-2.07, P=0.196). To treat ISR lesion in lower extremities, laser atherectomy has a lower free-TVR rate in the middle term follow-up.A higher rate of distal embolism is noted though. On

Effect of percutaneous transluminal angioplasty on the stenosis of autogenous radiocephalic ateriovenous fistula for hemodialysis

Energy Technology Data Exchange (ETDEWEB)

Jeong, Sun Min; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin MMo; Choi, Sang Tae; Kim, Jong Woo; Kim, Hyung Sik; Choi, Hye Young [Gachon University Gil Medical Center, Incheon (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Seonam University College of Medicine, Myongji Hospital, Goyang (Korea, Republic of)

2016-02-15

The purpose of this study was to evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) on stenosis of autogenous radiocephalic arteriovenous fistula (RCF) for hemodialysis and to determine the factors influencing patency. This retrospective study included 136 patients referred for PTA of RCF stenosis between March 2005 and July 2014. The technical success rate, complications, and patency rate were evaluated. The following factors were analyzed as they might influence patency: age, gender, site and duration of arteriovenous fistula, underlying disease, body mass index, hypercholesterolemia, smoking, peripheral artery or coronary artery occlusive disease, stenosis length/grade, cutting balloon, and balloon size. The initial technical success rate was 91.9% (125/136). Complications included vessel rupture (n = 2) and vessel dissection (n = 2). The patency rates at 6, 12, 24, and 48 months after PTA were 81.9, 67.1, 52.7, and 42.3%, respectively. The patency rate was higher in cases with longer (> 3 cm) stenosis (p = 0.04). Use of cutting balloon and larger size of balloon catheter made the patency longer, but this difference was not statistically significant (p = 0.637, 0.258). PTA is a safe and effective way to manage stenosis in RCF. The length of stenosis was the only factor which affected the patency rate in this study.

High-Flow Nasal Cannula Therapy in a Patient with Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty

Directory of Open Access Journals (Sweden)

Kiyoshi Moriyama

2014-01-01

Full Text Available A 62-year-old woman with Wolff-Parkinson-White syndrome was with recent worsening of dyspnea to New York Heart Association functional status Class III. The patient was diagnosed as having central type chronic thromboembolic pulmonary hypertension. By cardiac catheterization, her mean pulmonary artery pressure was 53 mmHg with total pulmonary resistance 2238 dynes·sec·cm−5. After medical therapies with tadalafil, furosemide, ambrisentan, beraprost, and warfarin were initiated, percutaneous transluminal pulmonary angioplasty (PTPA was performed. Following PTPA, life-threating hypoxemia resulting from postoperative reperfusion pulmonary edema developed. High-flow nasal cannula therapy (HFNC was applied, and 100% oxygen at 50 L/min of flow was required to keep oxygenation. HFNC was continued for 3 days, and the patient was discharged on 8th postoperative day with SpO2 of 97% on 3 L/min of oxygen inhalation. Because of the simplicity of the technique, the lower cost of equipment, and remarkable patient tolerance to the treatment, we speculate that HFNC can take over the post of noninvasive ventilation as first-line therapy for patients with acute respiratory failure.

Clinical application of hepatic vein percutaneous transluminal angioplasty and stent after stent placement in inferior vena cava

International Nuclear Information System (INIS)

Xu Hao; Zu Maoheng; Gu Yuming; Li Guojun; Zhang Qingqiao; Wei Ning; Xu Wei; Liu Hongtao

2005-01-01

Objective: To investigate the feasibility and effect of recanalization of hepatic vein with percutaneous transluminal angioplasty (PTA) and stent after stent placement in inferior vena cava (IVC). Methods: Eleven patients with Budd-Chiari syndrome (BCS)were once performed metal stent placement in IVC at other hospital, but ascites was not subsided in 9 patients after the stent placement and occurred again in 2 patients in 3 months after the procedure. PTA and metal stent placement were used to treat the occlusion of the hepatic vein (HV) via stent in IVC. Results: Recanalization of occlusive HV was successful in all 11 patients, and symptoms disappeared or were obviously improved. The mean blood pressure in HV dropped from pre-operation (45.12 ± 1.57) cm H 2 O (1 cm H 2 O=0.098 kPa) to post-operation (17.53 ± 0.68) cm H 2 O (P<0.01). In a period of 4-30 months (mean: 13.6 months) following-up, no patient reoccurred symptoms. Conclusion: Recanalization of HV via stent in IVC is a feasible and effective method for occlusive HV, but it is difficult. (authors)

Obstructive jaundice: a comparative study of forceps and brush biopsy under percutaneous transhepatic cholangiography

International Nuclear Information System (INIS)

Li Yongdong; Han Xinwei; Wu Gang; Ma Bo; Xing Gusheng

2004-01-01

Objective: To compare the sensitivity between forceps biopsy and brushing, and to explore a feasible approach to pathological diagnosis of the obstructive jaundice. Methods: 92 consecutive patients with obstructive jaundice underwent transluminal forceps biopsy and brushing during percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage. The technique was performed through a preexisting percutaneous transhepatic tract with multiple specimens obtained after passing the forceps biopsy or brush into a 8-French sheath. Finally the specimens were fixed with formalin for pathologic or cytologic diagnosis. Results: The histopathologic diagnosis was acquired in 81 out of 92 patients with forceps biopsy reaching the successful rate of 97.83%. Sensitivity of forceps biopsy in 92 patients was higher than that of brush in 84 patients (88.04% vs 76.19% χ 2 =4.251, P= <0.05). Conclusions: Percutaneous transhepatic cholangiobiopsy is a simple technique with minimal invasion, high sensitivity and worthy to be used spread extensively. Percutaneous transluminal brush cytology is also an useful method for establishing a diagnosis of cholangiocarcinoma. (authors)

Prevalence of chronic kidney disease among patients undergoing transradial percutaneous coronary interventions.

Science.gov (United States)

Hossain, Mohammad A; Quinlan, Amy; Heck-Kanellidis, Jennifer; Calderon, Dawn; Patel, Tejas; Gandhi, Bhavika; Patel, Shrinil; Hetavi, Mahida; Costanzo, Eric J; Cosentino, James; Patel, Chirag; Dewan, Asa; Kuo, Yen-Hong; Salman, Loay; Vachharajani, Tushar J

2018-03-01

While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival. In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery. Stage of chronic kidney disease was based on estimated glomerular filtration rate and National Kidney Foundation - Kidney Disease Outcomes Quality Initiative guidelines. A total of 497 patients undergoing transradial percutaneous coronary interventions were included. Over 70.4% (350/497) of the patients had chronic kidney disease. Stage II chronic kidney disease was observed in 243 (69%) patients (estimated glomerular filtration rate = 76.0 ± 8.4 mL/min). Stage III was observed in 93 (27%) patients (estimated glomerular filtration rate = 49 ± 7.5 mL/min). Stage IV chronic kidney disease was observed in 5 (1%) patients (estimated glomerular filtration rate = 25.6 ± 4.3 mL/min) and Stage V chronic kidney disease was observed in 9 (3%) patients (estimated glomerular filtration rate = 9.3 ± 3.5 mL/min). Overall, 107 of 350 patients (30%) had advanced chronic kidney disease, that is, stage III-V chronic kidney disease. Importantly, 14 of the 107 (13%) patients had either stage IV or V chronic kidney disease. This study finds that nearly one-third of the patients undergoing transradial percutaneous coronary interventions have advanced chronic kidney disease. Because many of these patients may require dialysis, the use of radial artery to conduct percutaneous coronary interventions must be carefully considered in chronic kidney disease population.

The role of percutaneous transluminal coronary angioplasty in heart transplant recipients.

Science.gov (United States)

Schnetzler, B; Drobinski, G; Dorent, R; Camproux, A C; Ghossoub, J; Thomas, D; Gandjbakhch, I

2000-06-01

Review the acute and late results of percutaneous transluminal coronary angioplasty (PTCA) in heart transplant recipients and examine the factors predictive of restenosis. Coronary graft disease (CGD) is the main factor responsible for late graft loss. Medical treatment, surgical revascularization, or retransplantation gives only suboptimal results in this regard. Therefore, PTCA has been attempted in this situation. More than 332 heart transplantations in our institution have been performed since 1992, the date of the first PTCA in our patients. We are currently in charge of 450 patients. All the characteristics, procedure-related information, and clinical outcome of patients needing PTCA were assessed by review of each patient's clinical records. All coronary angiograms were reviewed by an independent cardiologist. Since 1992, 53 coronary sites have been dilated in the course of 39 procedures in 29 patients. Indication for PTCA was asymptomatic angiographic coronary graft disease in 35 sites (64.8%), angina in 9 (16.6%), silent ischemia in 2 (3.7%), acute myocardial infarction in 1 (1.8%), and CHF in 7 (12.9%). Primary success ( 50%) was 32.5% (14/43). Mean follow-up was 1.27 year +/- 1.2 (SD). Five deaths (17. 2%) occurred in follow-up and were all in relation to coronary graft disease. Mean time separating PTCA from death was 0.9 year +/- 1.3 (SD). We also sought to look at factors predictive of restenosis. By multivariate analysis, a positive recipient's serology for cytomegalovirus (CMV) before the graft was the only factor found protective against restenosis (odds ratio 22.4; confidence interval 1.1 to 443.4). PTCA in heart transplant recipients allows a high level of primary success with a low periprocedural-complication rate. Restenosis rate seems equivalent to restenosis rate in native coronary arteries. Mortality during follow-up is increased in this population and is the consequence of a high level of coronary events. Recipient positivity for CMV before

The usefulness of percutaneous transluminal angioplasty of the middle cerebral artery stenosis in patients with transient ischemic attack

Energy Technology Data Exchange (ETDEWEB)

Lee, Young Chul; Lim, Hyo Soon; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam National Univ. Medical School, Kwangju (Korea, Republic of)

2001-06-01

To determine the effectiveness of percutaneous transluminal angioplasty(PTA) of atherosclerotic middle cerebral artery(MCA) stenosis in patients with transient ischemic attack (TIA). Ten patients with TIA who had undergone PTA were retrospectively investigated. In all ten, angiography revealed stenosis of the MCA. Mechanical dilatation was performed at the stenotic portion, and the angiographic findings after PTA, as well as peri/post-angioplastic complications, were evaluated. Four to 64 (mean, 23.5) months later, neurologic symptoms and the nature and timing of recurrent attacks were also assessed. The degree of stenosis before PTA was 50-75% in six patients and greater than 75% in four. Complete or partial angiographic recanalization of the stenotic segment occurred in nine patients (90%). During follow-up, seven patients recovered without recurrent TIA or cerebral stroke; one reported a tingling sensation and one experienced vertebrobasilar insufficiency. Motor aphasia developed in one patient after PTA, but after systemic heparinization, improved within 24 hours. One patient who suffered intracranial hemorrhage due to vascular rupture during PTA did three days later. PTA for atherosclerotic MCA stenosis in patients with TIA is an effective therapeutic method.

Membranous obstruction of inferior vena cava(MOIVC): treatment with percutaneous transluminal angioplasty(PTA) and self expandable metallic stent

Energy Technology Data Exchange (ETDEWEB)

Lee, Ki Yeol; Kim, Baek Hyun; Cha, In Ho; Lee, Nam Joon; Kim, Yun Hwan; Kim, Jung Hyuk [College of Medicine, Korea University, Seoul (Korea, Republic of)

1994-03-15

Percutaneous transluminal angioplasty(PTA) with a balloon catheter is a standard method of treatment for membranous obstruction of inferior vena cava(MOIVC). But, correct therapeutic approach has not been established for MOIVC patients whose lesion is associated with extensive thrombotic IVC occlusion. We tried to treat MOIVC associated with or without thrombus. We treated 13 cases of MOIVC(associated with thrombus in 7 cases, no thrombus in 6 cases) with PTA, thrombolysis and self-expandable metallic stents. PTA was successful in 8 cases, but failed in 5 cases. The recurred cases were retreated with PTA, but follow-up study revealed recoiling restenosis in 4 cases and intimal hyperplasia in 1 case at previous PTA site which could be overcome with a self-expandable metallic stent. The complication were occurred in 3 cases which were hemothorax, hemopericardium, and hemoperitoneum respectively. However, those were resolved by conservative treatment only. Recanalization and dilatation could be done in MOIVC patients with or without thrombosis for improvement of patient's symptom. Gianturco self-expandable metallic stent is useful in treatment of recurred MOIVC after balloon dilatation and preventing reocclusion of the IVC after PTA.

The usefulness of percutaneous transluminal angioplasty of the middle cerebral artery stenosis in patients with transient ischemic attack

International Nuclear Information System (INIS)

Lee, Young Chul; Lim, Hyo Soon; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun

2001-01-01

To determine the effectiveness of percutaneous transluminal angioplasty(PTA) of atherosclerotic middle cerebral artery(MCA) stenosis in patients with transient ischemic attack (TIA). Ten patients with TIA who had undergone PTA were retrospectively investigated. In all ten, angiography revealed stenosis of the MCA. Mechanical dilatation was performed at the stenotic portion, and the angiographic findings after PTA, as well as peri/post-angioplastic complications, were evaluated. Four to 64 (mean, 23.5) months later, neurologic symptoms and the nature and timing of recurrent attacks were also assessed. The degree of stenosis before PTA was 50-75% in six patients and greater than 75% in four. Complete or partial angiographic recanalization of the stenotic segment occurred in nine patients (90%). During follow-up, seven patients recovered without recurrent TIA or cerebral stroke; one reported a tingling sensation and one experienced vertebrobasilar insufficiency. Motor aphasia developed in one patient after PTA, but after systemic heparinization, improved within 24 hours. One patient who suffered intracranial hemorrhage due to vascular rupture during PTA did three days later. PTA for atherosclerotic MCA stenosis in patients with TIA is an effective therapeutic method

Quantitative exercise thallium-201 scintigraphy for predicting angina recurrence after percutaneous transluminal coronary angioplasty

International Nuclear Information System (INIS)

Stuckey, T.D.; Burwell, L.R.; Nygaard, T.W.; Gibson, R.S.; Watson, D.D.; Beller, G.A.

1989-01-01

The aim of this prospective study was to determine the value of quantitative exercise thallium-201 scintigraphy for predicting short-term outcome in patients after percutaneous transluminal coronary angioplasty (PTCA). Quantitative exercise thallium-201 scintigraphy was performed 2.2 +/- 1.2 weeks after successful PTCA in 68 asymptomatic patients, 64 (94%) of whom had class III or IV angina before the procedure. Clinical follow-up was obtained in all patients at a mean of 10 +/- 2 months and all were followed for at least 6 months; 45 patients (66%) remained asymptomatic during follow-up and 23 (34%) developed recurrent class III or IV angina at a mean of 2.6 +/- 1.2 months. Multivariate analysis of 22 clinical, angiographic and exercise test variables revealed that thallium-201 redistribution, any thallium scan abnormality, presence of a distal stenosis and treadmill time were the only significant predictors of recurrent angina after PTCA. Using a stepwise discriminant function model, thallium-201 redistribution was the only significant independent predictor. Despite its prognostic value relative to other variables as a predictor, thallium redistribution at 2 weeks after PTCA was only detected in 9 of the 23 patients (39%) who subsequently developed recurrent angina, although only 2 of the 45 patients (9%) who remained asymptomatic during follow-up demonstrated thallium-201 redistribution at the time of early testing. After repeat angiography was performed in 17 of the 23 patients with recurrent angina, 14 (82%) demonstrated restenosis and 3 (18%) had worse narrowing distal to or remote from the site of dilatation

Diabetes insipidus-like state complicating percutaneous transluminal renal stenting for transplant renal artery stenosis.

Science.gov (United States)

Tian, Lu; He, Yangyan; Zhang, Hongkun; Wu, Ziheng; Li, Donglin; Chen, Shanwen

2014-07-01

To report the incidence, etiology, and treatments of diabetes insipidus-like state that complicate percutaneous transluminal renal stenting (PTRS) for transplant renal artery stenosis (TRAS). Data from 7 patients on whom PTRS for TRAS was performed between October 2008 and March 2012 were reviewed retrospectively. The parameters investigated included blood flow velocity, blood pressure, and creatinine levels before and after the intervention. The procedural success rate was 100%. Three cases developed a diabetes insipidus-like state in the immediate postprocedural period. Urine output returned to normal within 2 weeks after treatment. The median blood flow velocity was significantly reduced from 4.51 m/sec (4.31-4.61 m/sec) at the time of TRAS diagnosis to 1.33 m/sec (1.31-1.51 m/sec) at the most recent follow-up of the group with a diabetes insipidus-like state. The ratio of median blood flow velocity before and after stenting in the group with a diabetes insipidus-like state was significantly higher than that in the group without a diabetes insipidus-like state (3.39 vs. 1.93). Diabetes insipidus-like state that complicates PTRS for TRAS is not an uncommon event, but appears to be underreported in the medical literature. A high ratio of pre- and poststenting median blood flow velocity may be a predictor for a postprocedural diabetes insipidus-like state. The most probable cause may be the marked increase in renal arterial flow. Early recognition of the condition is essential to avoid dehydration and electrolyte imbalance. Copyright © 2014 Elsevier Inc. All rights reserved.

Percutaneous transluminal angioplasty of malfunctioning Brescia-Cimino arteriovenous fistula: analysis of factors adversely affecting long-term patency

International Nuclear Information System (INIS)

Sugimoto, Koji; Hirota, Shozo; Sugimura, Kazuro; Higashino, Takanori; Kuwata, Yoichiro; Imanaka, Kazufumi

2003-01-01

Our objective was to identify the factors adversely affecting long-term patency after percutaneous transluminal angioplasty (PTA) for hemodialysis Brescia-Cimino arteriovenous fistulas. Between November 1995 and March 2000, 91 PTA procedures were performed on 50 patients with 57 Brescia-Cimino fistulas. A retrospective study based on the chart review was performed. The initial technical success rate for all procedures and the primary and secondary patency rates for all fistulas were calculated. Regarding fistulas successfully maintained by the primary PTA, the primary and secondary patency rates were compared using the Kaplan-Meier method between two patient groups. They were classified on the basis of several factors, including age (older, over 70 years, and younger group), age of the fistulas (older, over 6 months, and younger group), with or without diabetes mellitus (DM), solitary or multiple lesions, long or short segment lesion, stenosis or occlusion, and with or without arterial and/or anastomotic lesions. Initial technical success rates for all procedures and fistulas were 91.2 and 89.5%, respectively. Cumulative primary and secondary patency rates at 1 year were 47.3 and 67.3%, respectively. In the comparative study, the secondary patency rate for the older group was lower than that of the younger group with statistical significance (p =0.029). The higher age is the only factor that reduces the long-term patency rate after PTA. (orig.)

Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution Thallium scintigraphy

NARCIS (Netherlands)

W. Wijns (William); P.W.J.C. Serruys (Patrick); J.H.C. Reiber (Johan); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); M.L. Simoons (Maarten); P.G. Hugenholtz (Paul)

1985-01-01

textabstractThe value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and

The Use of Color-Coded Duplex Scanning in the Selection of Patients with Lower Extremity Arterial Disease for Percutaneous Transluminal Angioplasty: A Prospective Study

International Nuclear Information System (INIS)

Elsman, Bernard H.P.; Legemate, Dink A.; Heyden, Frank W.H.M. van der; Vos, Henk de; Mali, Willem P.T.M.; Eikelboom, Bert C.

1996-01-01

Purpose: To exploit the potential benefits of percutaneous transluminal angioplasty (PTA) in patients with short obstructive lesions in the lower extremity, it is preferable to select patients suitable for PTA before proceeding to hospital admission and angiography. The aim of this prospective study was to evaluate the role of color-coded duplex scanning in the correct selection of patients for PTA and its influence on planning the approach to the lesion. Methods: On the basis of clinical history, physical examination, pressure indices, and ultrasound duplex scanning, 109 patients were scheduled for PTA. Results: The indication for PTA was correct in 103 patients (94%), while the procedure was performed successfully in 98 patients (90%). The approach to the lesion was planned successfully in the majority of patients. Conclusion: This study shows that it is justifiable to plan PTA on the basis of information obtained by duplex scanning. Results of the duplex scan may guide the catheterization route

The predictive value of angiographic results for the outcome of percutaneous transluminal angioplasty in stenosed femoral bypass grafts

International Nuclear Information System (INIS)

Spijkerboer, Anje M.; Beek, Frederik J. A.; Graaf, Yolanda van der; Eikelboom, Bert C.; Mali, Willem P. T. M.

1997-01-01

Purpose. To assess the predictive value of immediate angiographic results after percutaneous transluminal angioplasty (PTA) for stenoses in femoral bypass grafts using duplex ultrasound (DUS) criteria. Methods. A 1-year follow-up with DUS was performed in 38 patients with 50 stenoses in 41 grafts, treated with PTA for a graft stenosis. The indication for PTA according to DUS criteria was a severe stenosis in 43 lesions, and a moderate stenosis in 7 lesions. In the moderate stenosis group 3 patients showed claudication and 1 patient had a nonhealing ulcer. For the purposes of statistical evaluation, primary patency was considered present if the graft was not occluded. The graft was considered to have failed when it was found to be occluded on DUS, or when secondary interventions (surgery, repeat PTA) were performed. Results. After 1 year the cumulative primary patency rate was 44$ [95% confidence interval (CI) 27.8-59.8]. Stenoses with initially good angiographic results after PTA (<30% residual stenosis) were 2.9 times more likely to be patent at 1 year than stenoses with initially poor or moderate angiographic results (hazard ratio 2.9, 95% CI 1.3-6.4,p=0.007). Conclusion. A poor or moderate angiographic result immediately following PTA was prognostic for poor long-term results and may indicate a requirement for earlier surgical intervention

Antithrombotic strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome

Directory of Open Access Journals (Sweden)

Son V Pham

2010-09-01

Full Text Available Son V Pham1, Phuong-Chi T Pham2, Phuong-Mai T Pham3, Jeffrey M Miller4, Phuong-Thu T Pham5, Phuong-Anh T Pham61Bay Pines VA Medical Center, Department of Cardiology, Bay Pines, FL, USA; 2Department of Medicine, Nephrology Division, UCLA-Olive View Medical Center, 3Department of Medicine, Greater Los Angeles VA Medical Center, 4Department of Medicine, Hematology-Oncology Division, UCLA-Olive View Medical Center, 5Department of Medicine, Nephrology Division, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 6Mercy General Hospital, Heart and Vascular Institute, Department of Cardiology, Sacramento, CA, USAAbstract: In patients undergoing percutaneous coronary intervention (PCI for acute coronary syndrome (ACS, both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings. While clopidogrel may be of little beneficial effect if administered immediately prior to PCI and may even increase major bleeding risk if coronary artery bypass grafting is anticipated, early discontinuation of the drug may result in insufficient antiplatelet coverage with thrombotic complications. Optimal and rapid inhibition of platelet activity to suppress ischemic and thrombotic events while minimizing bleeding complications is an important therapeutic goal in the management of patients undergoing percutaneous coronary intervention. In this article we present an overview of the literature on clinical trials evaluating the different aspects of antithrombotic therapy in patients

Pressure-wire-guided percutaneous transluminal pulmonary angioplasty: a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension.

Science.gov (United States)

Inami, Takumi; Kataoka, Masaharu; Shimura, Nobuhiko; Ishiguro, Haruhisa; Yanagisawa, Ryoji; Fukuda, Keiichi; Yoshino, Hideaki; Satoh, Toru

2014-11-01

This study sought to prove the safety and effectiveness of pressure-wire-guided percutaneous transluminal pulmonary angioplasty (PTPA). PTPA has been demonstrated to be effective for treatment of chronic thromboembolic pulmonary hypertension. However, a major and occasionally fatal complication after PTPA is reperfusion pulmonary edema. To avoid this, we developed the PEPSI (Pulmonary Edema Predictive Scoring Index). The pressure wire has been used to detect insufficiency of flow in a vessel. We included 350 consecutive PTPA sessions in 103 patients with chronic thromboembolic pulmonary hypertension from January 1, 2009 to December 31, 2013. During these 5 years, 140 PTPA sessions were performed without guidance, 65 with guidance of PEPSI alone, and 145 with both PEPSI and pressure-wire guidance. Each PTPA session was finished after achieving PEPSI scores of PEPSI guidance and each target lesion achieving distal mean pulmonary arterial pressure PEPSI (0% and 6.9%, respectively). Furthermore, the group guided by pressure wire and PEPSI accomplished the same hemodynamic improvements with fewer numbers of target lesions treated and sessions performed. The combined approach using pressure wire and PEPSI produced more efficient clinical results and greatly reduced reperfusion pulmonary edema and vessel complications. This is further evidence that PTPA is an alternative strategy for treating chronic thromboembolic pulmonary hypertension. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Transluminal Angioplasty of Peroneal Artery Branches in Diabetics: Initial Technical Experience

International Nuclear Information System (INIS)

Graziani, Lanfroi; Silvestro, Antonio; Monge, Luca; Boffano, Gian Mario; Kokaly, Francesco; Casadidio, Ilaria; Giannini, Francesco

2008-01-01

The present study aimed to report the technical feasibility of percutaneous transluminal angioplasty (PTA) of obstructed or insufficient collateral branches (anterior and posterior perforating branches) from distal peroneal to foot arteries in diabetic patients with chronic critical limb ischemia (CLI) and chronic noncrossable occlusion of the anterior and posterior tibial arteries. Twenty-four diabetic CLI patients (age, 67 ± 8 years; 87% males) undergoing collateral PTA were included. Baseline clinical angiographic and follow-up data were retrospectively reviewed. Collateral PTA was associated with a concomitant PTA of other sites in 21 (83%) cases. In 15 cases the treated collateral linked the peroneal with the plantaris communis; in 9 cases, the peroneal with the dorsalis pedis. Angiographic results of collateral PTA were good in 13 cases (<30% residual stenosis), whereas the result was considered moderate (30%-49% residual stenosis) in the remaining cases. Neither perforation nor acute occlusion of the treated collaterals or other relevant complications were observed. Mean follow-up was 32 ± 17 months. Major amputation was necessary for two (8.3%) patients. Cumulative limb salvage rates at 2 and 4 years were 96% and 87%, respectively. In conclusion, this initial experience shows that PTA of the collateral branches from distal peroneal to foot arteries is a feasible technique. Future studies are required to define the clinical role of this novel approach

Relationship between the total length of the stents and patients' quality of life after percutaneous coronary intervention.

Science.gov (United States)

Liu, Wei; Yang, Xuming; Dong, Pingshuan; Li, Zhijuan

2015-01-01

The aim of this study was to examine the relationship between the total length of the stents and the postoperative life quality of patients with multi-vessel coronary artery disease who undergo percutaneous coronary intervention (PCI). Using the short-form health survey (SF-36) items, we analyzed the data on the postoperative life quality of 166 patients with multi-vessel coronary artery disease who underwent percutaneous transluminal coronary intervention in the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology from September 2011 to September 2013. Follow-up was performed 6 months later. All of the dimensionalities, except general health and mental health, showed significantly higher scores after PCI. No significant relationships were observed between the total length of the stents and the postoperative life quality of patients with multi-vessel coronary artery disease who underwent PCI. PCI can effectively improve the postoperative life quality of patients; however, there was no significant relationship between the total length of the stents and postoperative life quality of patients.

Successful intestinal ischemia treatment by percutaneus transluminal angioplasty of visceral arteries in a patient with abdominal angina

Directory of Open Access Journals (Sweden)

Nenezić Dragoslav

2011-01-01

Full Text Available Introduction. Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. Case Outline. A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. Conclusion. High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.

Comparative effectiveness and safety of a catheterization laboratory-only eptifibatide dosing strategy in patients undergoing percutaneous coronary intervention.

Science.gov (United States)

Gurm, Hitinder S; Hosman, Carrie; Bates, Eric R; Share, David; Hansen, Ben B

2015-02-01

Eptifibatide, a small-molecule glycoprotein IIb/IIIa inhibitor, is conventionally administered as a bolus plus infusion. A growing number of clinicians are using a strategy of catheterization laboratory-only eptifibatide (an off-label use) as procedural pharmacotherapy for patients undergoing percutaneous coronary intervention although the comparative effectiveness of this approach is unknown. We compared the in-hospital outcome of patients undergoing percutaneous coronary intervention across 47 hospitals and treated with eptifibatide bolus plus infusion with those treated with a catheterization laboratory-only regimen. We used optimal matching to link the use of catheterization laboratory-only eptifibatide with clinical outcomes, including mortality, myocardial infarction, bleeding, and need for transfusion. Of the 84 678 percutaneous coronary interventions performed during 2010 to 2011, and meeting our inclusion criteria, eptifibatide was administered to 21 296 patients. Of these, a catheterization laboratory-only regimen was used in 4511 patients, whereas 16 785 patients were treated with bolus plus infusion. In the optimally matched analysis, compared with bolus plus infusion, a catheterization laboratory-only regimen was associated with a reduction in bleeding (optimally matched adjusted odds ratio, 0.74; 95% confidence interval, 0.58-0.93; P=0.014) and need for transfusion (optimally matched adjusted odds ratio, 0.70; 95% confidence interval, 0.52-0.92; P=0.012), with no difference in mortality or myocardial infarction. A catheterization laboratory-only eptifibatide regimen is commonly used in clinical practice and is associated with a significant reduction in bleeding complications in patients undergoing contemporary percutaneous coronary intervention. © 2015 American Heart Association, Inc.

The Role of Duplex Scanning in the Selection of Patients with Critical Lower-Limb Ischemia for Infrainguinal Percutaneous Transluminal Angioplasty

International Nuclear Information System (INIS)

Loefberg, Anne-Marie; Karacagil, Sadettin; Hellberg, Anders; Bostroem, Annika; Ljungman, Christer; Ostholm, Goerel

2001-01-01

Purpose: To investigate the role of duplex scanning in the selection of patients with critical lower-limb ischemia (CLI) for infrainguinal percutaneous transluminal angioplasty (PTA).Methods: One hundred and sixty-two limbs with CLI (150 patients) that underwent duplex scanning within 3 months prior to conventional diagnostic angiography (n = 88) or infrainguinal PTA (n = 74) were retrospectively studied. The findings obtained from duplex scanning and angiography were analyzed in a masked fashion by two different investigators.Results: The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning in the selection of patients for infrainguinal PTA were 86%, 84%, 89%, 86%, and 87% respectively. Forty-two procedures (57%) were performed at multiple arterial segments. The accuracy of duplex scanning in the selection of femoropopliteal and crural lesions for PTA was over 85%. However, the sensitivity of duplex scanning in the selection of popliteal and crural lesions for PTA was 49% and 38% respectively, compared with 80% for superior femoral artery lesions. In 39% of patients who were correctly selected for PTA, duplex scanning misdiagnosed one of the multiple lesions treated by PTA.Conclusion: Duplex scanning can safely be used for the selection of patients for infrainguinal PTA. The sensitivity of duplex scanning in the selection of lesions for PTA was less satisfactory in the popliteal and crural arteries compared with the femoropopliteal arteries

Neointimal Hyperplasia after Silverhawk Atherectomy versus Percutaneous Transluminal Angioplasty (PTA) in Femoropopliteal Stent Reobstructions: A Controlled, Randomized Pilot Trial

International Nuclear Information System (INIS)

Brodmann, Marianne; Rief, Peter; Froehlich, Harald; Dorr, Andreas; Gary, Thomas; Eller, Philipp; Hafner, Franz; Deutschmann, Hannes; Seinost, Gerald; Pilger, Ernst

2013-01-01

Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate. We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia. In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178 mm vs. IMT PTA 0.1 mm, p = 0.001) with a spike at month 5 (max IMT SH 0.206 mm vs. IMT PTA 0.145 mm, p = 0.003) and a decline once again at month 6 (max IMT SH 0.177 mm vs. IMT PTA 0.121 mm, p = 0.02). The values for mean IMT performed the same way. Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.

Neointimal Hyperplasia after Silverhawk Atherectomy versus Percutaneous Transluminal Angioplasty (PTA) in Femoropopliteal Stent Reobstructions: A Controlled, Randomized Pilot Trial

Energy Technology Data Exchange (ETDEWEB)

Brodmann, Marianne, E-mail: marianne.brodmann@medunigraz.at; Rief, Peter; Froehlich, Harald; Dorr, Andreas; Gary, Thomas; Eller, Philipp; Hafner, Franz [Medical University of Graz, Division of Angiology (Austria); Deutschmann, Hannes [Medical University Graz, Division of Interventional Radiology (Austria); Seinost, Gerald; Pilger, Ernst [Medical University of Graz, Division of Angiology (Austria)

2013-02-15

Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate. We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia. In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178 mm vs. IMT PTA 0.1 mm, p = 0.001) with a spike at month 5 (max IMT SH 0.206 mm vs. IMT PTA 0.145 mm, p = 0.003) and a decline once again at month 6 (max IMT SH 0.177 mm vs. IMT PTA 0.121 mm, p = 0.02). The values for mean IMT performed the same way. Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.

Indirect evidence for a role of a subpopulation of activated neutrophils in the remodelling process after percutaneous coronary intervention

NARCIS (Netherlands)

Costa, MA; de Wit, LEA; de Valk, V.; Serrano, P; Wardeh, AJ; Serruys, PW; Sluiter, W

Aim Leukocytes have been implicated in restenosis following percutaneous transluminal coronary angioplasty. We investigated the link between the activated status of circulating neutrophils and restenosis after angioplasty. Methods and Results The population of 108 patients with single, de novo

Evaluation and percutaneous management of atherosclerotic peripheral vascular disease

International Nuclear Information System (INIS)

Widlus, D.M.; Osterman, F.A. Jr.

1989-01-01

Atherosclerotic peripheral vascular disease (PVD) of the lower extremities deprives a person of the ability to exercise to their satisfaction, later of the ability to perform the activities of their daily life, and finally of their legs themselves. Peripheral vascular disease has long been managed by the vascular surgeon utilizing endarterectomy and peripheral arterial bypass. Patient acceptance of nonsurgical, percutaneous procedures such as percutaneous transluminal balloon angioplasty (PTA) is high. Increased utilization of these procedures has led to improved techniques and adjuncts to therapy, as well as more critical review of long-term results. This article will review the evaluation and nonoperative management of PVD, with an emphasis on the newer modalities of management presently being investigated

Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

International Nuclear Information System (INIS)

Ahmed, Ahmed T.; Mohammed, Khaled; Chehab, Monzer; Brinjikji, Waleed; Hassan Murad, M.; Cloft, Harry; Bjarnason, Haraldur

2016-01-01

Background and PurposeSubclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD.Materials and MethodsWe searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model.ResultsA total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death.ConclusionStent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

Energy Technology Data Exchange (ETDEWEB)

Ahmed, Ahmed T., E-mail: Ahmed.Ahmed1@mayo.edu; Mohammed, Khaled, E-mail: Mohammed.Khaled@mayo.edu [Mayo Clinic, Evidence-Based Practice Research Program (United States); Chehab, Monzer, E-mail: moe.chehab@beumont.edu [Oakland University William Beaumont School of Medicine, Department of Diagnostic Radiology and Molecular Imaging (United States); Brinjikji, Waleed, E-mail: Brinjikji.Waleed@mayo.edu [Mayo Clinic, Department of Radiology (United States); Hassan Murad, M., E-mail: Murad.Mohammad@mayo.edu [Mayo Clinic, Evidence-Based Practice Research Program (United States); Cloft, Harry, E-mail: Cloft.Harry@mayo.edu; Bjarnason, Haraldur, E-mail: Bjarnason.Haraldur@mayo.edu [Mayo Clinic, Department of Radiology (United States)

2016-05-15

Background and PurposeSubclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD.Materials and MethodsWe searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model.ResultsA total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death.ConclusionStent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

DEFF Research Database (Denmark)

Giustino, Gennaro; Mastoris, Ioannis; Baber, Usman

2016-01-01

OBJECTIVES: The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES). BACKGROUND: The clinical correlates and the prognostic significance of CAC...

Efficacy of percutaneous transluminal renal angioplasty with stent in elderly male patients with atherosclerotic renal artery stenosis

Directory of Open Access Journals (Sweden)

Zhao J

2012-10-01

Full Text Available Jiahui Zhao, Qingli Cheng, Xiaoying Zhang, Meihua Li, Sheng Liu, Xiaodan WangDepartment of Geriatric Nephrology, Chinese PLA General Hospital, Beijing, ChinaObjectives: Percutaneous transluminal renal angioplasty with stent implantation (PTRAS has become the treatment of choice for atherosclerotic renal artery stenosis (ARAS. This study evaluates the long-term effects of PTRAS on hypertension and renal function in elderly patients with ARAS.Methods: We conducted a retrospective cohort study of all patients who underwent PTRAS in the geriatric division of a tertiary medical center during the period 2003–2010. The clinical data were extracted from the medical records of each patient. Changes in blood pressure, antihypertensive treatment, and estimated glomerular filtration rate were analyzed before and after PTRAS.Results: Eighty-six stents in 81 elderly patients were placed successfully. The average age of the patients was 76.2 years (65–89 years. Mean follow-up was 31.3 months (range 12 –49 months. There was a significant decrease in both systolic and diastolic blood pressure at the third day after the PTRAS procedure and the reduction in blood pressure was constant throughout the follow-up period until 36 months after PTRAS. However, there was no marked benefit to renal function outcome during the follow-up period. The incidence of contrast-induced nephropathy was 9.9% in this study group. The rate of renal artery restenosis was 14.8%. The survival rate was 96.3% for 4 years after the procedure.Conclusion: It is beneficial to control blood pressure in elderly patients with ARAS up to 36 months after a PTRAS procedure. However, their renal function improvement is limited.Keywords: angioplasty, hypertension, renal function, elderly, renal artery stenosis

Flow motion waves with high and low frequency in severe ischaemia before and after percutaneous transluminal angioplasty.

Science.gov (United States)

Hoffmann, U; Schneider, E; Bollinger, A

1990-09-01

STUDY OF OBJECTIVE: The aim was to evaluate skin flux and prevalence of low and high frequency flow motion waves in patients with severe ischaemia due to peripheral arterial occlusive disease before and after percutaneous transluminal angioplasty (PTA) with and without local thrombolysis. Flow motion was recorded by the laser Doppler technique at the dorsum of the foot before, one day, and one month after PTA. The results were separately analysed in patients with successful and unsuccessful treatment. 18 patients with rest pain or incipient gangrene were included. Mean pretreatment systolic ankle pressure was 55.8(SD 25.5) mm Hg, and mean transcutaneous PO2 at 43 degrees C was 5.2(9.4) mm Hg. Arteriography revealed relevant stenoses or occlusions of the femoropopliteal and calf arteries. Before treatment two patterns of flow motion with characteristic frequency ranges were observed at the foot dorsum and at a probe temperature of 32 degrees C: low frequency (LF) waves with a mean frequency of 2.2(0.5) cycles.min-1 and a mean amplitude of 0.73(0.42) arbitrary units (AU) and high frequency (HF) waves with a mean frequency of 22.6(4.2) cycles.min-1 and a mean amplitude of 0.39(0.33) AU. PTA was successful in 11 of the 18 patients. After successful treatment, prevalence of HF waves decreased from 10/11 to 4/11 cases (p less than 0.001), but remained nearly unchanged after failed procedure. Prevalence of LF waves before and after PTA did not differ significantly. Our data support the hypothesis that HF waves represent a reaction of skin microcirculation to severe ischaemia. With reference to animal studies it is proposed that HF waves originate from terminal arterioles. They may function as a compensatory mechanism of flow regulation involved in pathophysiology of ischaemia.

Low Body Mass Index, Serum Creatinine, and Cause of Death in Patients Undergoing Percutaneous Coronary Intervention.

Science.gov (United States)

Goel, Kashish; Gulati, Rajiv; Reeder, Guy S; Lennon, Ryan J; Lewis, Bradley R; Behfar, Atta; Sandhu, Gurpreet S; Rihal, Charanjit S; Singh, Mandeep

2016-10-31

Low body mass index (BMI) and serum creatinine are surrogate markers of frailty and sarcopenia. Their relationship with cause-specific mortality in elderly patients undergoing percutaneous coronary intervention is not well studied. We determined long-term cardiovascular and noncardiovascular mortality in 9394 consecutive patients aged ≥65 years who underwent percutaneous coronary intervention from 2000 to 2011. BMI and serum creatinine were divided into 4 categories. During a median follow-up of 4.2 years (interquartile range 1.8-7.3 years), 3243 patients (33.4%) died. In the multivariable model, compared with patients with normal BMI, patients with low BMI had significantly increased all-cause mortality (hazard ratio [HR] 1.4, 95% CI 1.1-1.7), which was related to both cardiovascular causes (HR 1.4, 95% CI 1.0-1.8) and noncardiovascular causes (HR 1.4, 95% CI 1.06-1.9). Compared with normal BMI, significant reduction was noted in patients who were overweight and obese in terms of cardiovascular mortality (overweight: HR 0.77, 95% CI 0.67-0.88; obese: HR 0.80, 95% CI 0.70-0.93) and noncardiovascular mortality (overweight: HR 0.85, 95% CI 0.74-0.97; obese: HR 0.82, 95% CI 0.72-0.95). In a multivariable model, in patients with normal BMI, low creatinine (≤0.70 mg/dL) was significantly associated with increased all-cause mortality (HR 1.8, 95% CI 1.3-2.5) and cardiovascular mortality (HR 2.3, 95% CI 1.4-3.8) compared with patients with normal creatinine (0.71-1.0 mg/dL); however, this was not observed in other BMI categories. We identified a new subgroup of patients with low serum creatinine and normal BMI that was associated with increased all-cause mortality and cardiovascular mortality in elderly patients undergoing percutaneous coronary intervention. Low BMI was associated with increased cardiovascular and noncardiovascular mortality. Nutritional support, resistance training, and weight-gain strategies may have potential roles for these patients undergoing

Stability of multilead ST-segment "fingerprints" over time after percutaneous transluminal coronary angioplasty and its usefulness in detecting reocclusion.

Science.gov (United States)

Krucoff, M W; Parente, A R; Bottner, R K; Renzi, R H; Stark, K S; Shugoll, R A; Ahmed, S W; DeMichele, J; Stroming, S L; Green, C E

1988-06-01

Multilead ST-segment recordings taken during percutaneous transluminal coronary angioplasty (PTCA) could function as an individualized noninvasive template or "fingerprint," useful in evaluating transient ischemic episodes after leaving the catheterization laboratory. To evaluate the reproducibility of such ST-segment patterns over time, these changes were analyzed in patients grouped according to the time between occlusion and reocclusion. For the patients in group 1, the study required comparing their "fingerprints" in repeat balloon inflation during PTCA (reocclusion in less than 1 hour), for those in group 2, comparing ST "fingerprints" during PTCA with ST changes during spontaneous early myocardial infarction (reocclusion in 24 hours) and in group 3, comparing ST "fingerprints" with ST changes during repeat PTCA for restenosis greater than 1 month after the initial PTCA. The ST "fingerprints" among the 20 patients in group 1 were identical in 14 cases (70%) and clearly related in another 4 (20%). Of the 23 patients in group 2, 12 (52%) had the same and 8 (35%) had related patterns. Of 19 patients in group 3, 8 (42% had the same pattern and 8 (42%) had related patterns. Thus, ST fingerprints were the same or clearly related with reocclusion in the same patient from less than 1 hour to greater than 1 month after initial occlusion in 87% of patients overall, in 90% in less than 1 hour, in 87% in less than 24 hours and in 84% greater than 1 month later. Multilead pattern ST-segment "fingerprints" may serve as a noninvasive marker for detecting site-specific reocclusion.

Neointimal hyperplasia after silverhawk atherectomy versus percutaneous transluminal angioplasty (PTA) in femoropopliteal stent reobstructions: a controlled, randomized pilot trial.

Science.gov (United States)

Brodmann, Marianne; Rief, Peter; Froehlich, Harald; Dorr, Andreas; Gary, Thomas; Eller, Philipp; Hafner, Franz; Deutschmann, Hannes; Seinost, Gerald; Pilger, Ernst

2013-02-01

Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate. We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia. In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178 mm vs. IMT PTA 0.1 mm, p = 0.001) with a spike at month 5 (max IMT SH 0.206 mm vs. IMT PTA 0.145 mm, p = 0.003) and a decline once again at month 6 (max IMT SH 0.177 mm vs. IMT PTA 0.121 mm, p = 0.02). The values for mean IMT performed the same way. Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.

Percutaneous angioscopy

International Nuclear Information System (INIS)

Beck, A.

1987-01-01

In dogs and 11 patients a new endoscopic method for arteries has been developed. The approach is transfemoral, and endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), and local lysis. An ultrathin endoscope with a diameter of 2.4 mm is used, which also provides a working channel with a diameter of 0.4 mm. Guide wires, contrast media, and drugs for local lysis can be inserted through this channel. Under fluoroscopic control, the endoscope is placed in the region of interest, followed by a special method for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. No complications have occurred. In all patients, it was possible to demonstrate the results of dilatation, recanalization, or local lysis before and after the interventional procedure. (orig.) [de

Safety and efficacy of recombinant hirudin (CGP 39 393) versus heparin in patients with stable angina undergoing coronary angioplasty

NARCIS (Netherlands)

van den Bos, A. A.; Deckers, J. W.; Heyndrickx, G. R.; Laarman, G. J.; Suryapranata, H.; Zijlstra, F.; Close, P.; Rijnierse, J. J.; Buller, H. R.; Serruys, P. W.

1993-01-01

Enhanced thrombin activity has been associated with acute and long-term complications following balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA). We evaluated, in a 2-to-1 randomized, double-blind trial, the effects of recombinant hirudin, CGP 39 393, relative to

Safety and efficacy of recombinant Hirudin (CGP 39 393) versus Heparin in patients with stable angina undergoing coronary angioplasty

NARCIS (Netherlands)

A.A. van den Bos (Arjan); G.R. Heyndrickx (Guy); G-J. Laarman (GertJan); H. Suryapranata (Harry); F. Zijlstra (Felix); P. Close (Philip); J.J.M.M. Rijnierse (Joep); H.R. Büller (Harry); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

1993-01-01

textabstractBACKGROUND. Enhanced thrombin activity has been associated with acute and long-term complications following balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA). We evaluated, in a 2-to-1 randomized, double-blind trial, the effects of recombinant hirudin, CGP 39

Review of the Latest Percutaneous Devices in Critical Limb Ischemia

Directory of Open Access Journals (Sweden)

Leila Haghighat

2018-04-01

Full Text Available Critical limb ischemia (CLI is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within the past decade. This review summarizes the types of percutaneous devices and the techniques that are available for the management of CLI and the data supporting their use. These include devices that establish and maintain vessel patency, including percutaneous transluminal angioplasty, drug-coated balloons, bare metal stents, drug-eluting stents, bioresorbable vascular scaffolds, and atherectomy; devices that provide protection from embolization; and, cell-based therapies. Additionally, ongoing trials with important implications for the field are discussed.

Review of the Latest Percutaneous Devices in Critical Limb Ischemia.

Science.gov (United States)

Haghighat, Leila; Altin, Sophia Elissa; Attaran, Robert R; Mena-Hurtado, Carlos; Regan, Christopher J

2018-04-14

Critical limb ischemia (CLI) is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within the past decade. This review summarizes the types of percutaneous devices and the techniques that are available for the management of CLI and the data supporting their use. These include devices that establish and maintain vessel patency, including percutaneous transluminal angioplasty, drug-coated balloons, bare metal stents, drug-eluting stents, bioresorbable vascular scaffolds, and atherectomy; devices that provide protection from embolization; and, cell-based therapies. Additionally, ongoing trials with important implications for the field are discussed.

Increased Plasma Cathepsin S at the Time of Percutaneous Transluminal Angioplasty is Associated with 6-Months’ Restenosis of the Femoropopliteal Artery

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Mijovski Mojca Bozic

2018-01-01

Full Text Available Background: We tested the hypothesis that increased levels of cathepsin S and decreased levels of cystatin C in plasma at the time of percutaneous transluminal angioplasty (PTA are associated with the occurrence of 6-months’ restenosis of the femoropopliteal artery (FPA. Methods: 20 patients with restenosis and 24 matched patients with patent FPA after a 6-months follow-up were in - cluded in this study. They all exhibited disabling claudication or critical limb ischemia and had undergone technically successful PTA. They were all receiving statins and ACE in hi - bitors (or angiotensin II receptor antagonist before the PTA and the therapy did not change throughout the observational period. Plasma concentrations of C-reactive protein were < 10 mg/L and of creatinine within the reference range at the time of the PTA. Plasma concentration and activity of cathepsin S, together with its potent inhibitor cystatin C, were measured the day before and the day after the PTA. Results: The increased plasma concentration and activity of cathepsin S at the time of PTA was associated with the occurrence of 6-months’ restenosis of FPA, independently of established risk factors (lesion complexity, infrapopliteal run-off vessels, type of PTA, age, gender, smoking, diabetes, lipids and of cystatin C. Plasma cystatin C concentration was not associated with restenosis and did not correlate with cathepsin S activity and concentration in the plasma. Conclusion: Increased level of plasma cathepsin S at the time of PTA is associated with 6-months’ restenosis of PTA, independently of established risk factors.

Post-marketing surveillance in the published medical and grey literature for percutaneous transluminal coronary angioplasty catheters: a systematic review.

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Polisena, Julie; Forster, Alan J; Cimon, Karen; Rabb, Danielle

2013-10-10

Post-marketing surveillance (PMS) may identify rare serious incidents or adverse events due to the long-term use of a medical device, which was not captured in the pre-market process. Percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that uses a balloon-tipped catheter to enlarge a narrowed artery. In 2011, 1,942 adverse event reports related to the use of PTCA catheters were submitted to the FDA by the manufacturers, an increase from the 883 reported in 2008. The primary research objective is to conduct a systematic review of the published and grey literature published between 2007 and 2012 for the frequency of incidents, adverse events and malfunctions associated with the use of PTCA catheters in patients with coronary artery disease (CAD). Grey literature has not been commercially published. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and PubMed for medical literature on PMS for PTCA catheters in patients with CAD published between January 2007 and July 2012. We also searched the grey literature. This review included 11 studies. The in-hospital adverse events reported were individual cases of myocardial infarction and hematoma. In studies of patients with coronary perforation, more patients with balloon angioplasty were identified compared with patients who required stenting. Our systematic review illustrates that the volume and quality of PMS studies associated with the use of PTCA catheters in patients with CAD are low in the published and grey literature, and may not be useful sources of information for decisions on safety. In most studies, the objectives were not to monitor the long-term safety of the use of PTCA catheters in clinical practice. Future studies can explore the strengths and limitations of PMS databases administered by regulatory authorities.

Impact of Triple Therapy in Elderly Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.

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Antonia Sambola

Full Text Available Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplatelet therapy: aspirin plus clopidogrel in patients ≥75 years of age with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI.A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT was analyzed. All outcomes were evaluated at 1-year of follow-up.Five hundred and eighty-five patients, 289 (49% of whom were ≥75 years of age (79.6±3.4 years; 33% women were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA2DS2VASc score: 4.23±1.51 vs 3.76±1.40, p = 0.007 and a higher bleeding risk (HAS-BLED ≥3: 88.6% vs 79.2%, p = 0.02 than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01-0.70, p = 0.004. Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53-17.57, p = 0.008. The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38; however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12-0.86, p = 0.02.In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding.

Preprocedural High-Sensitivity Cardiac Troponin T and Clinical Outcomes in Patients With Stable Coronary Artery Disease Undergoing Elective Percutaneous Coronary Intervention.

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Zanchin, Thomas; Räber, Lorenz; Koskinas, Konstantinos C; Piccolo, Raffaele; Jüni, Peter; Pilgrim, Thomas; Stortecky, Stefan; Khattab, Ahmed A; Wenaweser, Peter; Bloechlinger, Stefan; Moschovitis, Aris; Frenk, Andre; Moro, Christina; Meier, Bernhard; Fiedler, Georg M; Heg, Dik; Windecker, Stephan

2016-06-01

Cardiac troponin detected by new-generation, highly sensitive assays predicts clinical outcomes among patients with stable coronary artery disease (SCAD) treated medically. The prognostic value of baseline high-sensitivity cardiac troponin T (hs-cTnT) elevation in SCAD patients undergoing elective percutaneous coronary interventions is not well established. This study assessed the association of preprocedural levels of hs-cTnT with 1-year clinical outcomes among SCAD patients undergoing percutaneous coronary intervention. Between 2010 and 2014, 6974 consecutive patients were prospectively enrolled in the Bern Percutaneous Coronary Interventions Registry. Among patients with SCAD (n=2029), 527 (26%) had elevated preprocedural hs-cTnT above the upper reference limit of 14 ng/L. The primary end point, mortality within 1 year, occurred in 20 patients (1.4%) with normal hs-cTnT versus 39 patients (7.7%) with elevated baseline hs-cTnT (P<0.001). Patients with elevated hs-cTnT had increased risks of all-cause (hazard ratio 5.73; 95% confidence intervals 3.34-9.83; P<0.001) and cardiac mortality (hazard ratio 4.68; 95% confidence interval 2.12-10.31; P<0.001). Preprocedural hs-TnT elevation remained an independent predictor of 1-year mortality after adjustment for relevant risk factors, including age, sex, and renal failure (adjusted hazard ratio 2.08; 95% confidence interval 1.10-3.92; P=0.024). A graded mortality risk was observed across higher tertiles of elevated preprocedural hs-cTnT, but not among patients with hs-cTnT below the upper reference limit. Preprocedural elevation of hs-cTnT is observed in one fourth of SCAD patients undergoing elective percutaneous coronary intervention. Increased levels of preprocedural hs-cTnT are proportionally related to the risk of death and emerged as independent predictors of all-cause mortality within 1 year. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02241291. © 2016 American Heart Association, Inc.

Feasibility study of natural orifice transluminal endoscopic surgery inguinal hernia repair.

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Sherwinter, Danny A; Eckstein, Jeremy G

2009-07-01

A potentially less-invasive technique, transluminal surgery, may reduce or eliminate pain and decrease time to full return of activities after abdominal operations. Inguinal hernia repair is perfectly suited to the transgastric endoscopic approach and has not been previously reported. Our purpose was to evaluate the feasibility of transgastric bilateral inguinal herniorrhaphy (BIH). Feasibility study with a nonsurvival canine model. Under general anesthesia, male mongrel dogs weighing 20 to 30 kg had a dual-channel endoscope introduced into the peritoneal cavity over a percutaneously placed guidewire. An overtube with an insufflation channel was used. Peritoneoscopy was performed, and bilateral deep and superficial inguinal rings were identified. The endoscope was removed, premounted with a 4 x 6 cm acellular human dermal implant and then readvanced intraperitoneally through the overtube. The implant was then deployed across the entire myopectineal orifice and draped over the cord structures. Bioglue was then applied endoscopically, and the implant was attached to the peritoneum. After completion of bilateral repairs, the animals were killed and necropsy performed. Five dogs underwent pure natural orifice transluminal endoscopic surgery (NOTES) intraperitoneal onlay mesh (IPOM) BIH. Accurate placement and adequate myopectineal coverage was accomplished in all subjects. At necropsy no injuries to the major structures were noted but Bioglue misapplication with contamination of unintended sites did occur. Our study involved only a small number of subjects in nonsurvival experiments, and no gastric closure was used. Many of the characteristics of inguinal hernia repair are especially well suited to the transgastric approach. The repair is in line with the transgastric endoscope vector, bilateral defects are adjacent, and the IPOM technique does not require significant manipulation or novel instrumentation.

Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with acute coronary syndromes undergoing left main percutaneous coronary intervention

OpenAIRE

Jaberg, L; Toggweiler, S; Puck, M; Frank, M; Rufibach, K; Lüscher, T F; Corti, R

2011-01-01

BACKGROUND: Patients undergoing acute left main (LM) coronary artery revascularization have a high mortality and natriuretic peptides such as N-terminal pro-B-type (NT-proBNP) have been shown to have prognostic value in patients with acute coronary syndromes. The present study looked at the prognostic value of NT-proBNP in these patients. METHODS AND RESULTS: We studied all consecutive patients undergoing acute LM coronary artery percutaneous coronary intervention between January 2005 and Dec...

Evaluation of the restenosis of coronary artery after percutaneous transluminal coronary angioplasty by three-dimensional coronary magnetic resonance angiography

International Nuclear Information System (INIS)

Arisaka, Hiraku

2000-01-01

Coronary magnetic resonance angiography (MRA) has been recently brought into clinical use, however, there has not been reports on the comparison with MRA and conventional contrast coronary angiography (CAG) in the detection of the localization and characteristics of coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA). To assess the restenosis of coronary artery after PTCA, this study compared three-dimensional (3D) coronary MRA and CAG. One hundred three patients (76 males and 27 females, average age of 64.6±9.3 years old) were performed coronary MRA at 3-6 months after PTCA. The right coronary artery (RCA) group consist of 21 patients, the left anterior descending branch (LAD) 63 patients and the left circumflex branch (LCX) 19 patients. Coronary MRA was performed with the patients in supine position on a 1.5 T whole body scanner (MAGNETOM VISION, Siemens AG, Germany) using body array coil. The imaging technique used a 3-D gradient echo sequence with respiratory gating and fat suppression. The slice thickness was 2 mm, slab thickness 32 mm, a field of view of 300 mm and a matrix of 128 x 256. Other parameters were an echo time of 2.7 ms and a repetition time of 600 to 1100 msec. The measurement time of 1 imaging slab took 15 to 20 minutes depending on the patient's heart rate. The coronary arteries were reconstructed from the 3-D data set using a multiplanar reconstruction (MPR) technique. According to previous coronary MRA studies, a significant stenosis with a luminal reduction of ≥50% was assumed if a marked signal reduction or signal loss of a vessel segment was visible. In CAG, 57 of 103 patients showed restenosis. In coronary MRA, 37 of 103 patients demonstrated restenosis. The sensitivity, specificity, positive and negative predictive values were 64.9%, 100%, 100% and 69.6%, respectively. Predictive accuracy was 79.6%. Three-dimensional coronary MRA is useful in a noninvasive diagnostic method to evaluate the coronary

Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention

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Zhang, Ming; Sara, Jaskanwal D.S.; Matsuzawa, Yasushi; Gharib, Hossein; Bell, Malcolm R.; Gulati, Rajiv; Lerman, Lilach O.

2016-01-01

Abstract Aims The aim of this study was to investigate the association between hypothyroidism and major adverse cardiovascular and cerebral events (MACCE) in patients undergoing percutaneous coronary intervention (PCI). Methods and results Two thousand four hundred and thirty patients who underwent PCI were included. Subjects were divided into two groups: hypothyroidism ( n = 686) defined either as a history of hypothyroidism or thyroid-stimulating hormone (TSH) ≥5.0 mU/mL, and euthyroidism ( n = 1744) defined as no history of hypothyroidism and/or 0.3 mU/mL ≤ TSH hypothyroidism were further categorized as untreated ( n = 193), or those taking thyroid replacement therapy (TRT) with adequate replacement (0.3 mU/mL ≤ TSH hypothyroidism compared with those with euthyroidism (MACCE: HR: 1.28, P = 0.0001; myocardial infarction (MI): HR: 1.25, P = 0.037; heart failure: HR: 1.46, P = 0.004; revascularization: HR: 1.26, P = 0.0008; stroke: HR: 1.62, P = 0.04). Compared with untreated patients or those with inadequate replacement, adequately treated hypothyroid patients had a lower risk of MACCE (HR: 0.69, P = 0.005; HR: 0.78, P = 0.045), cardiac death (HR: 0.43, P = 0.008), MI (HR: 0.50, P = 0.0004; HR: 0.60, P = 0.02), and heart failure (HR: 0.50, P = 0.02; HR: 0.52, P = 0.017). Conclusion Hypothyroidism is associated with a higher incidence of MACCE compared with euthyroidism in patients undergoing PCI. Maintaining adequate control on TRT is beneficial in preventing MACCE. PMID:26757789

The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome

DEFF Research Database (Denmark)

Fuller, Andrew; Razvi, Hassan; Denstedt, John D

2012-01-01

In addition to more commonly forming stones, obese patients present a number of challenges when undergoing percutaneous nephrolithotomy. We evaluated percutaneous nephrolithotomy outcomes in 3,709 patients stratified by body mass index.......In addition to more commonly forming stones, obese patients present a number of challenges when undergoing percutaneous nephrolithotomy. We evaluated percutaneous nephrolithotomy outcomes in 3,709 patients stratified by body mass index....

Pulmonary edema predictive scoring index (PEPSI), a new index to predict risk of reperfusion pulmonary edema and improvement of hemodynamics in percutaneous transluminal pulmonary angioplasty.

Science.gov (United States)

Inami, Takumi; Kataoka, Masaharu; Shimura, Nobuhiko; Ishiguro, Haruhisa; Yanagisawa, Ryoji; Taguchi, Hiroki; Fukuda, Keiichi; Yoshino, Hideaki; Satoh, Toru

2013-07-01

This study sought to identify useful predictors for hemodynamic improvement and risk of reperfusion pulmonary edema (RPE), a major complication of this procedure. Percutaneous transluminal pulmonary angioplasty (PTPA) has been reported to be effective for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). PTPA has not been widespread because RPE has not been well predicted. We included 140 consecutive procedures in 54 patients with CTEPH. The flow appearance of the target vessels was graded into 4 groups (Pulmonary Flow Grade), and we proposed PEPSI (Pulmonary Edema Predictive Scoring Index) = (sum total change of Pulmonary Flow Grade scores) × (baseline pulmonary vascular resistance). Correlations between occurrence of RPE and 11 variables, including hemodynamic parameters, number of target vessels, and PEPSI, were analyzed. Hemodynamic parameters significantly improved after median observation period of 6.4 months, and the sum total changes in Pulmonary Flow Grade scores were significantly correlated with the improvement in hemodynamics. Multivariate analysis revealed that PEPSI was the strongest factor correlated with the occurrence of RPE (p PEPSI to be a useful marker of the risk of RPE (cutoff value 35.4, negative predictive value 92.3%). Pulmonary Flow Grade score is useful in determining therapeutic efficacy, and PEPSI is highly supportive to reduce the risk of RPE after PTPA. Using these 2 indexes, PTPA could become a safe and common therapeutic strategy for CTEPH. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

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Sana Shoukat

2010-01-01

Full Text Available Contrast Induced Nephropathy (CIN is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI. Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

Percutaneous treatment of transplant renal artery stenosis in children.

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Repetto, Horacio A; Rodríguez-Rilo, Laila; Mendaro, Esteban; Basso, Laura; Galvez, Hugo; Morrone, Gabriela; Vazquez, Luis A

2004-12-01

Percutaneous treatment of renal artery stenosis (RAS) is an accepted procedure and numerous reports have been published. However, experience with its use in RAS in the transplanted kidney in children is scarce. Since 1994 we have diagnosed RAS in seven children with the use of Doppler ultrasonography (US), confirming it with percutaneous angiography (PAG). In six of the seven patients percutaneous transluminal angioplasty (PTA) was performed. In one patient a metallic stent was placed due to the extension of the arterial lesion, and a second stent was placed in another child when a re-stenosis was diagnosed 1 month after the PTA. All patients presented with hypertension (de novo or 30% increase over previous values). After ruling out acute rejection, calcineurin inhibitor toxicity, and urinary obstruction, US was performed and, when an increase in arterial flux velocity was registered, PAG was also performed. Six children showed an increase in serum creatinine (Cr) and proteinuria. Blood pressure decreased after the procedure and Cr returned to previous levels in all children. One of the grafts was lost due to chronic transplant rejection 7 years later. The other children have a functioning kidney. Although this is a small group of patients, the consistently good results and the lack of reported experience prompted us to communicate our preliminary observation.

Comparison of pain and postoperative stress in dogs undergoing natural orifice transluminal endoscopic surgery, laparoscopic, and open oophorectomy.

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Freeman, Lynetta J; Rahmani, Emad Y; Al-Haddad, Mohammad; Sherman, Stuart; Chiorean, Michael V; Selzer, Don J; Snyder, Paul W; Constable, Peter D

2010-08-01

Few studies are available to compare the potential benefits of natural orifice transluminal endoscopic surgery (NOTES) approaches to traditional surgery. To compare complications, surgical stress, and postoperative pain. Prospective study in dogs. Research laboratory. Thirty dogs. Oophorectomy procedures were performed via NOTES and laparoscopic and traditional open surgery. Operative time, pain scores, systemic stress parameters (cortisol, glucose), surgical stress markers (interleukin 6, C-reactive protein), 3-day observation. Median operative times were 76, 44, and 35 minutes for the NOTES, laparoscopic, and open procedures, respectively, with the NOTES procedure being significantly longer than the other 2 procedures. All ovaries were completely excised, and all the animals survived without complications. The NOTES animals had greater increases in serum cortisol concentrations at 2 hours but no statistically significant differences in glucose concentrations compared with the other groups. Serum interleukin 6 and C-reactive protein concentrations were significantly increased at specific times compared with baseline in the NOTES group, but not in the open or laparoscopic surgery groups. Based on the cumulative pain score and nociceptive thresholds, the animals in the NOTES group demonstrated less evidence of pain. Small sample size, limited follow-up. Although the NOTES oophorectomy procedures took approximately twice as long and there may be more evidence of tissue damage as judged by increases in serum cortisol and interleukin 6 concentrations, the dogs in the NOTES group had lower pain scores, especially when compared with animals undergoing open surgery. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Clinical effectiveness of percutaneous angioplasty for acute and chronic mesenteric ischemia: a six case series.

Science.gov (United States)

Jung, Yu Min; Jo, Yun Ju; Ahn, Sang Bong; Son, Byoung Kwan; Kim, Seong Hwan; Park, Young Sook; Bae, June Ho; Cho, Young Kwon

2011-04-01

Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.

77 FR 11120 - Scientific Information Request on Treatment Strategies for Patients With Peripheral Artery...

Science.gov (United States)

2012-02-24

... transluminal angioplasty, atherectomy, or stents), and/or surgical revascularization (endarterectomy, bypass... endovascular intervention (percutaneous transluminal angioplasty, atherectomy, or stents) and surgical...

Incidence of vascular complications in patients submitted to percutaneous transluminal coronary angioplasty by transradial and transfemoral arterial approach Incidencia de complicaciones vasculares en pacientes sometidos a angioplastía coronaria transluminal percutánea por vía arterial transradial y transfemoral Incidência de complicações vasculares em pacientes submetidos a angioplastia coronariana transluminal percutânea por via arterial transradial e transfemoral

Directory of Open Access Journals (Sweden)

Marinez Kellermann Armendaris

2008-03-01

Full Text Available OBJECTIVE: To describe the vascular complications of transradial and transfemoral artery punctures in patients submitted to percutaneous transluminal coronary angioplasty (PTCA. METHODS: Prospective cohort study including patients submitted to PTCA. An interview was performed and an instrument applied to collect risk factors/predictors of complications. After the procedure, a physical examination was performed, vital signs were measured and the puncture site was assessed. RESULTS: 199 patients were included, age 64±10 years. Complications found for the radial and femoral approach were respectively: ecchymosis (18.29%, (17.14%; bruising (17.66%, (14.27%; urinary retention (2.43%, (25.71%; loss of vessel permeability (8.53%, (0%. CONCLUSION: The complications found were considered minor or secondary, depending on the classification found in literature. A higher rate of vascular complications related to transradial artery punctures compared to the interventions performed by transfemoral approach.OBJETIVO: Describir complicaciones vasculares relacionadas a punciones arteriales transradial y transfemoral en pacientes sometidos a angioplastía coronaria transluminal percutánea (ACTP. MÉTODOS: Se trata de un estudio de cohorte prospectivo realizado con pacientes sometidos a ACTP. Se llevó a cabo una entrevista y aplicó un instrumento para obtener factores de riesgo/predictores. Fue realizado un examen físico, medición de signos vitales y se evaluó el lugar de punción. RESULTADOS: Fueron incluidos 199 pacientes, edad 64±10 años. Las complicaciones encontradas para vía radial y femoral respectivamente, fueron: esquimosis (18,29%, (17,14%; hematoma (17,66%, (14,27%; retención urinaria (2,43%, (25,71%; pérdida de permeabilidad de vaso (8,53%, (0%. CONCLUSIÓN: Las complicaciones fueron consideradas menores o secundarias conforme clasificación literaria. Existe una mayor incidencia de complicaciones vasculares relacionadas a punciones

Improved left ventricular function and perfusion at rest after successful transluminal coronary angioplasty

International Nuclear Information System (INIS)

Klepzig, H.; Kaltenbach, M.; Standke, R.; Maul, F.D.; Hoer, G.

1991-01-01

The purpose of this study was to evaluate left ventricular function and perfusion at rest before and after percutaneous transluminal coronary angioplasty. In consecutive 69 patients in whom coronary stenoses were dilated, the radionuclide left ventricular ejection fraction at rest increased significantly. In 26 of these patients, the ejection fraction increased by at least 4%. In these patients, exercise-induced ischemic ST depression had been more pronounced than in the others. 36 other patients underwent 201 Tl myocardial scintigraphy before and after angioplasty. Twelve patients in whom pre-PTCA images had revealed regions with irreversible 201 Tl uptake defects, showed normal 201 Tl distribution patterns on post-PTCA scintigrams. Post-exercise 201 Tl uptake (representing myocardial perfusion and metabolic activity) during pre-PTCA exercise stress tests was significantly lower in these cases. It is concluded that PTCA can improve left ventricular function and perfusion at rest. This improvement is most obvious in patients with pronounced exercise-induced myocardial ischemia as diagnosed by typical ST segment depression and reduced thallium uptake. (orig.) [de

Interventional treatment of renal artery stenosis: a mid-term evaluation of clinical efficacy

International Nuclear Information System (INIS)

Liu Jing; Zhang Xitong

2009-01-01

Objective: To assess the clinical efficacy of interventional management for the treatment of renal artery stenosis. Methods: Percutaneous transluminal balloon renal angioplasty and / or percutaneous transluminal renal artery stenting were performed in 47 patients with renal artery stenosis (55 stenosed arteries in total). A follow-up study on the blood pressure and renal function was conducted and the results were statistically analyzed. Results: Fifty-four stenosed renal arteries were successfully reopened, of which only percutaneous transluminal balloon angioplasty was adopted in 17 and percutaneous transluminal renal artery stenting in 37. One patient died during the procedure. A follow-up for a mean period of (2.5 ± 0.6) years was carried out. The blood pressure determined at one (n = 46), 6 (n = 46), 12 (n = 33) and 24 (n = 29) months after the treatment was significantly decreased when compared to that determined before the treatment (P < 0.01). The clinical effective rate was 89.13% (41 / 46), 72.73% (24 / 33) and 62.07% (18 / 29), respectively. After the therapy,the renal function was improved in 5, remained unchanged in 33 and became worse in 3 patients. The comparison of the post-operative renograms (obtained within 2 months) with the pre-operative ones showed that in eight patients there was an increase in renal blood flow with an improvement in renal function impairment, which took a turn from severe degree to mild or moderate degree. Nevertheless, severe impairment in renal blood flow remained in 3 patients. Conclusion: Percutaneous transluminal balloon renal angioplasty and percutaneous transluminal renal artery stenting are safe and effective treatments for the renal artery stenosis, which also has a beneficial effect on the related renal hypertension and renal insufficiency. (authors)

Survival and sudden cardiac death after septal ablation for hypertrophic obstructive cardiomyopathy

DEFF Research Database (Denmark)

Jensen, Morten Kvistholm; Havndrup, Ole; Hassager, Christian

2011-01-01

Reports of long-term survival and the risk of sudden cardiac death (SCD) after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are sparse.......Reports of long-term survival and the risk of sudden cardiac death (SCD) after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are sparse....

Natural orifice transluminal endoscopic surgery for patients with perforated peptic ulcer.

Science.gov (United States)

Bonin, Eduardo A; Moran, Erica; Gostout, Christopher J; McConico, Andrea L; Zielinski, Martin; Bingener, Juliane

2012-06-01

Perforation accounts for 70% of deaths attributed to peptic ulcers. Laparoscopic repair is effective but infrequently used. Our aim was to assess how many patients with perforated peptic ulcer could be candidates for a transluminal endoscopic omental patch closure. This retrospective study reviewed patients with perforated peptic ulcer from 2005 to 2010. Demographics, ulcer characteristics, operative procedure, and outcomes were recorded. Candidates for endoscopic transluminal repair were defined as those having undergone omental patch closure of an ulcer of appropriate size and no contraindications to laparoscopy or endoscopy. In the retrospective review, a total of 104 patients were identified; 62% female, mean age = 68 years, mean ASA of 3, and 63% medication-related ulcers. Fifty-nine (63%) had an omental patch (80% open), and 35 (37%) had other procedures. Ten patients had nonoperative management. Thirty-day mortality was 14% and 1 year mortality was 35%. Forty-nine patients (52%) were considered potential candidates for transluminal repair. Sixty-three percent of our patients sustained a medication-related perforation with 1 year mortality of 35%. The majority of patients were treated using open omental patch repair. Transluminal endoscopic repair may provide an additional situation for a minimally invasive approach for a number of these patients.

Elevated admission microalbuminuria predicts poor myocardial blood flow and 6-month mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Science.gov (United States)

Chen, Jia Wei; Wang, Yong Liang; Li, Hong Wei

2012-04-01

Microalbuminuria (MA) is considered a major risk factor predisposing to cardiovascular morbidity and mortality. Outcomes after percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) complicated by MA have been well described. However, data regarding admission MA and coronary and myocardial flow are scant. The aims of this study were to evaluate the effects of admission MA on coronary blood flow and prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. Did elevated admission microalbuminuria predict poor myocardial blood flow and 6-month mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention? A total of 247 patients undergoing primary PCI for STEMI within 12 hours after symptom onset were studied. Patients were divided into 2 groups according to admission urinary albumin extraction rate (UAER): (1) an MA group (UAER 20-200 µg/min), and (2) a normoalbuminuria (NA) group (UAER < 20 µg/min). Microalbuminuria was observed in 108 patients. Univariate analyses showed statistical differences between the NA and MA groups in serum creatine level, plasma glucose level, and peak creatine kinase level on presentation. Thrombolysis In Myocardial Infarction (TIMI) flow grades (TFGs) 0-2 in the MA group were more frequent (9.4% vs 21.2%, P < 0.05) than in the NA group, and corrected TIMI frame count was higher (23.9 ± 18.5 vs 29.8 ± 23.5, P < 0.05). Admission MA was an independent predictor of poor myocardial perfusion (adjusted relative risk: 3.14, 95% confidence interval: 0.99-6.78) and a higher rate of 6-month mortality in STEMI patients undergoing primary PCI (adjusted relative risk: 1.58, 95% confidence interval: 0.74-3.39). Admission MA levels are associated with impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI. © 2012 Wiley Periodicals, Inc.

[Natural Orifice Transluminal Endoscopic Surgery (NOTES)].

Science.gov (United States)

Kim, Yong Sik; Kim, Chul Young; Chun, Hoon Jai

2008-03-01

Recently, the field of gastrointestinal endoscopy is developing rapidly. Once limited to the gastroinstestinal lumen, the endoscopic technology is now breaking the barriers and extending its boundary to peritoneal and pleural space. In 2004, Dr. Kalloo, a gastroenterologist, observed intraperitoneal organs of a pig using a conventional endoscope through the stomach wall. Since then, new endoscopic technique of intraperitoneal intervention with transluminal approach named the Natural Orifice Transluminal Endoscopic Surgery or NOTES has been introduced. NOTES reaches the target organ by inserting the endoscope through a natural orifice (e.g. mouth, anus, vagina, urethra) and entering the peritoneal lumen by means of making an incision on the luminal wall. After a series of successful experiences in animal studies, NOTES are now being tried on human subjects. There are still many obstacles to overcome, but bright future for this new technology is expected because of its proposed advantages of less pain, lower complication rate, short recovery time, and scarless access. In this review, we plan to learn about NOTES.

The Relationship Between Neutrophil–Lymphocyte Ratio and Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Arteriovenous Fistula Stenosis When Using Conventional and Drug-Eluting Balloons

Energy Technology Data Exchange (ETDEWEB)

Çildağ, Mehmet Burak, E-mail: mbcildag@yahoo.com [Adnan Menderes University, Department of Diagnostic and Interventional Radiology (Turkey); Çildağ, Songül, E-mail: songulcildag@yahoo.com [Adnan Menderes University, Department of Immunology and Allergy (Turkey); Köseoğlu, Ömer Faruk Kutsi, E-mail: kutsikoseoglu@yahoo.com [Adnan Menderes University, Department of Diagnostic and Interventional Radiology (Turkey)

2016-12-15

ObjectiveThe aim of this study is to investigate the potential association of neutrophil–lymphocyte ratio (NLR) between primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula stenosis and type (Conventional and Drug-Eluting) of balloons used in PTA.Material-MethodThis retrospective study consists of 78 patients with significant arteriovenous fistulas stenosis who were treated with PTA by using Drug-Eluting Balloon (DEB) (n = 29) or Conventional Balloon (CB) (n = 49). NLR was calculated from preinterventional blood samples. All patients were classified into two groups. Group A; primary patency <12 months (43/78), Group B; primary patency ≥12 months (35/78). Cox regression analysis and Kaplan–Meier method were used to determine respectively independent factors affecting the primary patency and to compare the primary patency for the two balloon types.ResultsNLR ratio and balloon type of the two groups were significantly different (p = 0.002, p = 0.010). The cut-off value of NLR was 3.18 for determination of primary patency, with sensitivity of 81.4 % and specificity of 51.4 %. Primary patency rates between PTA with DEB and CB displayed statistically significant differences (p < 0.05). The cut-off value was 3.28 for determination of 12-month primary patency with the conventional balloon group; sensitivity was 81.8 % and specificity was 81.3 %. There was no statistical relation between NLR levels and the drug-eluting balloon group in 12-month primary patency (p = 0.927).ConclusionIncreased level of NLR may be a risk factor in the development of early AVF restenosis after successful PTA. Preferring Drug-Eluting Balloon at an increased level of NLR can be beneficial to prolong patency.

Percutaneous transhepatic cholangiographic forceps biopsy in pathologic diagnosis for obstructive jaundice

International Nuclear Information System (INIS)

Han Xinwei; Li Yongdong; Ma Bo; Xing Gusheng; Wu Gang; Gao Xuemei; Ma Nan

2004-01-01

Objective: To evaluate the technical feasibility and sensitivity of percutaneous transhepatic cholangiographic forceps biopsy in bile duct diseases. Methods: Between April 2001 and March 2003, 65 consecutive patients (36 men and 29 women; age range 33-88 years, mean 54 years) with obstructive jaundice underwent transluminal forceps biopsy or/and brush during percutaneous transhepatic cholangiography, percutaneous transhepatic cholangiography and drainage, or placement of stents. The technique was performed through an existing percutaneous transhepatic tract. Multiple specimens were obtained after passing the biopsy forceps or brush into a long 8-French sheath, and the specimens were fixed with formalin for pathologic or cytologic diagnosis. Statistical analysis was performed with the χ 2 test or Fisher exact probability, and P 2 =5.919, P=0.015). The cyctologic diagnosis was acquired in 43 of 58 patients with brush biopsy. Pathologic reports included cholangioadenocarcinoma (n=36), cholangiosquam-ocarcinoma (n=1), pancreatic adenocarcinoma (n=1), hepatocellular carcinoma (n=2), metastatic carcinoma (n=2), zoogloea aggregation (n=1), and negative results (n=15). The sensitivity rate of brush biopsy was 74.14%. Sensitivity of brush in the 45 patients with cholangiocarcinoma was higher than in the 11 patients with malignant tumors other than cholangiocarcinoma (82.22% vs 45.45%, χ 2 =4.563, P=0.033). Sensitivity of forceps biopsy in the 65 patients was higher than that of brush in the 58 patients (χ 2 =4.754, P=0.029). Conclusion: Percutaneous transhepatic cholangiobiopsy is a safe and minimal invasive procedure with no pain and low complication that is easy to perform with no addition trauma through a transhepatic biliary drainage tract. It is an effective, economic, accurate, and reliable new approach, which is safe and easy to perform in acquiring the pathologic diagnosis worthy to spread extensively. (authors)

Percutaneous treatment of critical lower limb ischemia in patients with obstruction of the crural arteries

International Nuclear Information System (INIS)

Falkowski, A.; Rutkowski, D.; Poncyliusz, W.; Sienko, J.

2006-01-01

This article describes the application of percutaneous transluminal angioplasty (PTA) in the treatment of crural artery obstruction in patients with critical lower limb ischemia. In 17 patients, 24 PTAs of crural artery obstructions were performed. The clinical material consisted of 9 men and 8 women, whose mean age was 72 years (range 54-85 years). 11 patients were classified in clinical stage Fontaine IV, and 6 in stage III. The obstructions were from 3 to 21 cm (mean 6 cm). In 8 cases, PTA of the femoropopliteal segment was also carried out. The risk factors and comorbidities included diabetes 10 cases (58.8%), hypertension 9 cases (56%), ischemic heart disease 8 cases (50%), hyperlipidaemia 7 cases (43.8%), cerebrovascular diseases 3 cases (18.8%), and cigarette smoking 6 cases (37.5%). Technical success was defined as restoration of the artery along its whole length to the foot. Pain relief at rest and healing of trophic lesions at 30-day follow-up were recognized as a good outcome. Technical success was achieved in 12 patients (70.6%). In 2 cases the patency was only restored in the proximal part of the artery (12.5%). In 3 cases (17.6%) the procedure failed. In one case acute occlusion of the artery occurred. In 2 cases the obstruction was not successfully passed with a guidewire. In 4 cases hematoma was found at the puncture site, without clinical consequences. In 13 patients (76.4%) clinical success was achieved. Percutaneous transluminal angioplasty is an effective and relatively safe method of treatment of patients with critical limb ischemia caused by obstruction of the crural arteries. (author)

Balloon angioplasty in acute and chronic coronary artery disease

International Nuclear Information System (INIS)

Holmes, D.R. Jr.; Vlietstra, R.E.

1989-01-01

Percutaneous transluminal coronary angioplasty has grown exponentially since its introduction. Currently, selection criteria include single-vessel and multivessel disease, stable and unstable angina, and acute infarction. The outcome depends on specific patient and antiographic characteristics. In ideal lesions, success rates should be greater than 90%, with low morbidity and mortality. With more severe and diffuse multivessel disease, success rates are lower and complication rates are higher. In these cases, percutaneous transluminal coronary angioplasty still offers a reasonable option, provided complete revascularization can be achieved or the angina-producing lesion dilated. Numerous issues remain unresolved, including (1) the role of percutaneous transluminal coronary angioplasty vs coronary surgery (currently being tested), (2) restenosis, which occurs in approximately 30% of treated lesions, and (3) organizational adjustments such as training and certification to maintain high standards of care

Angioplasty: MedlinePlus Health Topic

Science.gov (United States)

... segment (Medical Encyclopedia) Also in Spanish Directional coronary atherectomy (DCA) (Medical Encyclopedia) Also in Spanish Percutaneous transluminal ... segment Coronary artery balloon angioplasty - slideshow Directional coronary atherectomy ... transluminal coronary angioplasty (PTCA) Stent Related ...

The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention

DEFF Research Database (Denmark)

Hvelplund, Anders; Jeger, Raban; Osterwalder, Remo

2011-01-01

To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device.......To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device....

Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary percutaneous coronary intervention

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Stone, Gregg W; Mehran, Roxana; Goldstein, Patrick

2015-01-01

BACKGROUND: In the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial, 3,602 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) treated with bivalirudin had lower......, given the evolution in primary PCI. METHODS: Databases from HORIZONS-AMI and EUROMAX were pooled for patient-level analysis. The Breslow-Day test evaluated heterogeneity between trials. RESULTS: A total of 5,800 patients were randomized to bivalirudin (n = 2,889) or heparin ± GPI (n = 2,911). The radial....... Bivalirudin resulted in increased acute (events were lower with bivalirudin (8.8% vs. 11.9%; RR: 0.74; 95% CI: 0...

Trabectome-Initiated Gonioscopy-Assisted Transluminal Trabeculotomy.

Science.gov (United States)

Smith, Brett L; Ellyson, Austin C; Kim, Won I

2018-03-01

To introduce a trabectome-initiated gonioscopy-assisted transluminal trabeculotomy (TIGATT) procedure and to report preliminary results. A preliminary case series of eight patients who have undergone the newly proposed TIGATT procedure is presented. TIGATT is a new concept that modifies established techniques by replacing the initial goniotomy incision of gonioscopy-assisted transluminal trabeculotomy (GATT) with an ab interno trabeculectomy ablation utilizing the trabectome. All surgeries were performed by a single surgeon (W.I.K.) between November 2014 and October 2015 in adults with primary open-angle glaucoma. Recorded outcome measures were intraocular pressure (IOP), number of medications, and complications. Eight patients with an age range of 63-93 yr underwent TIGATT with at least 3 mo of follow-up. Five of the eight initial patients had follow-up to 2 yr. The mean pre-operative IOP was 25 mmHg (standard deviation [SD] 7.0) on four medications (SD 1.1). The mean post-operative IOP at 3 mo was 14 mmHg (SD 1.8) on two medications (SD 1.3). The average decrease in IOP was 9.9 mmHg (SD 7.5) with an average decrease in medications of two (SD 1.4) at 3 mo. At 2 yr, the mean post-operative IOP was 14 mmHg (SD 3.2) on one medication (SD 1.1). The average decrease in IOP was 7.8 mmHg (SD 3.1) with an average decrease in medications of two (SD 1.8). There were two treatment failures that required further glaucoma surgery and one patient was lost to follow-up. The preliminary results and safety profile for TIGATT are promising and appear at least comparable with previously published results for both GATT and trabectome. Initiating the transluminal trabeculotomy with trabectome clearly exposes Schlemm's canal and facilitates threading the microcatheter into the canal. Additionally, if the 360-degree trabeculotomy cannot be completed because of an incompletely patent Schlemm's canal, the patient will at least have a trabectome ablation that can serve as their glaucoma

Transluminal laser angioplasty

Science.gov (United States)

Otto, Wlodzimierz

1996-03-01

Twenty seven patients with femoral artery occlusion were treated by transluminal Nd:YAG laser angioplasty, in 16 patients the procedure was combined with intraarterial infusion of rTPA (actilyse-Boehringer Ing). In 5 out of 11 patients from the initial group recanalization was not successful. In 16 patients from the rTPA group satisfactory immediate results were achieved in all cases. In long time observations ranging from 9 to 24 months all patients remained free from symptoms, although in 4 of them angiography and Doppler ultrasound examination reveal no flow in the femoral artery. In the remaining 12 patients (75%), the previously occluded artery is patent. No complications of laser angioplasty nor intraarterial infusion of rTPA were noted in this series.

Effects of baseline and early acquired thrombocytopaenia on long-term mortality in patients undergoing percutaneous coronary intervention with bivalirudin.

Science.gov (United States)

Ali, Ziad A; Qureshi, Yasir H; Karimi Galougahi, Keyvan; Poludasu, Shyam; Roye, Swathi; Krishnan, Prakash; Zalewski, Adrian; Shah, Zainab Z; Bhatti, Navdeep; Kalapatapu, Kumar; Mehran, Roxana; Dangas, George; Kini, Annapoorna S; Sharma, Samin K

2016-04-08

Bivalirudin use as a procedural anticoagulant in patients undergoing percutaneous coronary intervention (PCI) is associated with a lower incidence of thrombocytopaenia compared to other antithrombotic agents. We aimed to evaluate the prognostic impact of baseline thrombocytopaenia and early changes in platelet counts among patients undergoing PCI with exclusive use of bivalirudin. We evaluated 7,505 patients who underwent PCI over a period of eight years. Patients who received unfractionated heparin and glycoprotein IIb/IIIa receptor inhibitors were specifically excluded. Eight hundred and fifty-eight (11.4%) patients had baseline thrombocytopaenia and 451 (6.0%) developed acquired thrombocytopaenia. After adjustment for potential covariates, moderate to severe acquired thrombocytopaenia was the strongest independent predictor (HR 4.34, 95% CI: 2.13-8.84; pevents, which included major adverse cardiac events and major bleeding complications. Age, male gender, baseline platelet count and intra-aortic balloon pump (IABP) insertion were independent predictors of in-hospital acquired thrombocytopaenia. After a mean follow-up of 2.6±1.7 years, moderate to severe baseline thrombocytopaenia (HR 2.42, 95% CI: 1.79-3.29; p67 k) were significant predictors of mortality. In patients undergoing PCI with bivalirudin, moderate to severe baseline and acquired thrombocytopaenia along with severe changes in platelet count are associated with higher long-term mortality.

Pioneers of invasive cardiovascular medicine - Charles Theodore dotter and colleagues: Short historical review

Directory of Open Access Journals (Sweden)

Kostić Jelena

2014-01-01

Full Text Available Within modern medicine at the beginning of 21st century, we are witnessing a revolutionary development of the invasive diagnostics and therapy of cardiovascular system diseases. With the discovery of X-rays at the end of 19th century by Wilhelm Roentgen, it is appropriate to reflect on the gifted individuals whose efforts drastically altered radiology and cardiology. The early techniques used in peripheral percutaneous transluminal angioplasty form the basis for subsequent percutaneous intervention both in the peripheral and coronary arteries and are largely the contribution of Charles Dotter. The main goal of his work was the use of catheters for diagnosis and treatment in an attempt to replace the scalpel. He was 20 years ahead of his time, especially with percutaneous transluminal angioplasty. The first percutaneous transluminal angioplasty marked a new era in the treatment of peripheral atherosclerotic lesions. This practical genius dedicated his considerable energy to the belief that there is always a better way to treat disease. His personal contributions to clinical medicine, research, and teaching have saved millions of limbs and lives all over the world. European physicians, who were more open to unproven techniques, almost immediately embraced percutaneous transluminal angioplasty. Without the contribution and help of his colleagues, Forssmann, Sones and Gruntzig, all of them pioneers, nothing would be done. They were all ahead of there time and opened completely new chapter in medicine.

Percutaneous angioplasty of carotid artery stenoses

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Freitag, G.; Freitag, J.; Koch, R.D.; Wagemann, W.

1986-03-01

Percutaneous transluminal angioplasty (PTA) is a well-established method to remedy stenoses and short occlusions in the femoro-popliteal region and has also proved worthwhile in dilating stenoses of pelvic, renal and coronary arteries. Following successful experiments in animals, Mathias et al. employed angioplasty to treat carotid artery stenoses in the same way. To date, successful treatment of carotid artery stenoses has been described only in isolated recent reports. For fear of embolism, angioplasty has not yet become standard practice in this region. Because of the limited number of carotid artery stenoses treated so far, the risk involved cannot be reliably assessed. It is remarkable that no embolism has been reported for the greater number of dilated stenoses of the subclavian artery. Moreover, the report by Mathias et al. indicated that for 350 angioplasties of pelvifemoral arteries 1.1% embolisms occured after artery occlusions only, while no embolism was observed after stenoses. Having gained experience of applying PTA to the treatment of vascular obstructions of extremities, we have adopted this technique in the carotid area as well.

Gender differences in risk profile and outcome of Middle Eastern patients undergoing percutaneous coronary intervention.

Science.gov (United States)

Jarrah, Mohamad I; Hammoudeh, Ayman J; Al-Natour, Dalal B; Khader, Yousef S; Tabbalat, Ramzi A; Alhaddad, Imad A; Kullab, Susan M

2017-02-01

To determine the gender differences in cardiovascular risk profile and outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods: In a prospective multicenter study of consecutive Middle Eastern patients managed with PCI from January 2013 to February 2014 in 12 tertiary care centers in Amman and Irbid, Jordan. Clinical and coronary angiographic features, and major cardiovascular events were assessed for both genders from hospital stay to 1 year. Results: Women comprised 20.6% of 2426 enrolled patients, were older (mean age 62.9 years versus 57.2 years), had higher prevalence of hypertension (81% versus 57%), diabetes (66% versus 44%), dyslipidemia (58% versus 46%), and obesity (44% versus 25%) compared with men, p less than 0.001. The PCI for ST-segment elevation myocardial infarction was indicated for fewer women than men (23% versus 33%; p=0.001). Prevalence of single or multi-vessel coronary artery disease was similar in women and men. More women than men had major bleeding during hospitalization (2.2% versus 0.6%; p=0.003) and at one year (2.5% versus 0.9%; p=0.007). There were no significant differences between women and men in mortality (3.1% versus 1.7%) or stent thrombosis (2.1% versus 1.8%) at 1 year. Conclusion: Middle Eastern women undergoing PCI had worse baseline risk profile compared with men.Except for major bleeding, no gender differences in the incidence of major adverse cardiovascular events were demonstrated.

Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

Energy Technology Data Exchange (ETDEWEB)

Patel, Prashant, E-mail: p.patel@bham.ac.uk [University of Birmingham, School of Cancer Sciences, Vincent Drive (United Kingdom); Rangarajan, Balaji; Mangat, Kamarjit, E-mail: kamarjit.mangat@uhb.nhs.uk, E-mail: kamarjit.mangat@nhs.net [University Hospital Birmingham NHS Trust, Department of Radiology (United Kingdom)

2015-08-15

PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.

Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

International Nuclear Information System (INIS)

Patel, Prashant; Rangarajan, Balaji; Mangat, Kamarjit

2015-01-01

PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree

Percutaneous reconstruction of the innominate bifurcation using the retrograde 'kissing stents' technique

International Nuclear Information System (INIS)

Nagata, Shun-ichi; Kazekawa, Kiyoshi; Matsubara, Shuko; Sugata, Sei

2006-01-01

Obstructions of the supraaortic vessels are an important cause of morbidity associated with a variety of symptoms. Percutaneous transluminal angioplasty has evolved as an effective and safe treatment modality for occlusive lesions of the supraaortic vessels. However, the endovascular management of an innominate bifurcation has not previously been reported. A 53-year-old female with a history of systematic hypertension, diabetes mellitus and hypercholesterolemia presented with left hemiparesis and dysarthria. Angiography of the innominate artery showed a stenosis of the innominate bifurcation. The lesion was successfully treated using the retrograde kissing stent technique via a brachial approach and an exposed direct carotid approach. The retrograde kissing stent technique for the treatment of a stenosis of the innominate bifurcation was found to be a safe and effective alternative to conventional surgery. (orig.)

Association of elevated radiation dose with mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention

Energy Technology Data Exchange (ETDEWEB)

Parikh, Puja B.; Prakash, Sheena; Tahir, Usman; Kort, Smadar; Gruberg, Luis; Jeremias, Allen, E-mail: allen.jeremias@stonybrook.edu

2014-09-15

Objectives: This study sought to identify clinical and procedural predictors of elevated radiation dose received by patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) and to determine if elevated radiation dose was predictive of mortality in this population. Background: Little data exist regarding the impact of excessive radiation burden on clinical outcomes in patients undergoing PCI. Methods: The study population included 1,039 patients who underwent PCI for an AMI between January 1, 2007 and December 31, 2008 at an academic tertiary care teaching hospital. Cumulative skin dose (measured in milligray [mGy]) was selected as a measurement of patient radiation burden. Clinical and procedural variables were analyzed in multiple logistic and linear regression models to determine predictors of higher skin dose, and its impact was evaluated on all-cause intermediate-term mortality at two years. Results: Median skin dose was 2120 mGy (IQR 1379–3190 mGy) in the overall population, of which 153 (20.8%) patients received an elevated skin dose (defined as a skin dose > 4,000 mGy). Independent predictors of elevated skin dose included male gender, obesity, multivessel intervention, and presentation with a non-ST-elevation MI (NSTEMI) versus an ST-elevation MI (STEMI). Increased skin dose was not predictive of intermediate-term mortality by multivariate analysis in the overall population or in either subgroup of STEMI and NSTEMI. Conclusions: In this contemporary observational study examining patients with AMI undergoing PCI, male gender, obesity, multivessel intervention, and presentation with a NSTEMI were associated with increased radiation exposure.

Contrast enhanced ultrasound in the evaluation and percutaneous treatment of hepatic and renal tumors

International Nuclear Information System (INIS)

Meloni, Maria Franca; Smolock, Amanda; Cantisani, Vito; Bezzi, Mario; D'Ambrosio, Ferdinando; Proiti, Maria; Lee, Fred; Aiani, Luca; Calliada, Fabrizio; Ferraioli, Giovanna

2015-01-01

Highlights: • Image-guided percutaneous ablation techniques are increasingly being used for the treatment of malignant tumors of the liver and kidney when surgery is not indicated. • Percutaneous ablation relies on imaging at every step of the process in order to detect, guide, and confirm complete tumor coagulation. • CEUS is a real-time dynamic imaging technique that plays an important role in the management of patients treated with ablation for malignant tumors. • This review focuses on the role of CEUS in the evaluation of patients undergoing percutaneous treatments for hepatic and renal tumors. - Abstract: Image-guided percutaneous ablation techniques are increasingly being used for the treatment of malignant tumors of the liver and kidney. Contrast enhanced ultrasound (CEUS) is a real-time dynamic imaging technique that plays an important role in the pre-, intra-, and post-procedural management of these patients. This review will focus on the role of CEUS in the evaluation of patients undergoing treatment with percutaneous ablation for hepatic or renal tumors

Type D Personality, Social Support, and Depression Among Ethnic Chinese Coronary Artery Disease Patients Undergoing a Percutaneous Coronary Intervention: An Exploratory Study.

Science.gov (United States)

Su, Shu-Fen; He, Chung-Ping

2018-01-01

This study investigated the relationships between Type D personality, depression, and social support among ethnic Chinese coronary artery disease (CAD) patients undergoing percutaneous coronary interventions. Type D personality is associated with CAD, and may increase patients' depression and mortality rate. However, very few studies have explored the relationships between depression and social support among ethnic Chinese Type D CAD patients. A longitudinal, repeated-measures design was used; 105 Taiwanese CAD patients undergoing a percutaneous coronary intervention were recruited between January and December 2015. A demographic questionnaire, Type D Scale, ENRICHD Social Support Inventory, and Patient Health Questionnaire-9 were completed by 102 participants (mean age = 64.42, SD = 13.67 years) at hospitalization, and at the second week and third month after discharge. Data were analyzed using t tests and a generalized estimating equation. Results indicated that 46.7% of participants who had Type D personality had lower social support and higher depression than did the remaining (non-Type D) participants. At two weeks after discharge, the improvement in social support was higher among Type D patients than non-Type D participants; the same was true for depression at two weeks and three months after discharge each. Type D Taiwanese CAD patients showed lower perceived social support and higher depression during hospitalization than did non-Type D participants. Furthermore, the more social support patients received at home, the lower was their depression. Health-care providers should provide continuous mental health care, conduct early screening of mental health issues, and ensure that patients receive sufficient social support to reduce depression.

Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery

DEFF Research Database (Denmark)

Graham, Michelle M; Sessler, Daniel I; Parlow, Joel L

2018-01-01

Background: Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. Objective: To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. Design: Nonprespecified subgroup analysis of a mul...

Cirugía endoscópica transluminal por orificios naturales: NOTES Natural orifice transluminal endoscopic surgery: NOTES

Directory of Open Access Journals (Sweden)

M. J. Varas Lorenzo

2009-04-01

Full Text Available Se presenta una revisión actual, puesta al día, y punto de vista de los autores sobre un tema sumamente novedoso y atractivo, como es la Cirugía Endoscópica Transluminal por Orificios Naturales (NOTES: Natural Orifice Translumenal Endoscopic Surgery. La mayoría de los trabajos revisados se han realizado en animales de experimentación, pero la publicación de la colecistectomía por vía transvaginal, y la aparición de editoriales y artículos de revisión sobre el tema, nos llevan a realizar una serie de preguntas no resueltas actualmente sobre este tipo de cirugía, que representa un avance potencial para conseguir "una cirugía endoscópica sin cicatrices, sin infecciones, con mínimos requerimientos de anestesia y una inmediata recuperación".A current review and update of an exceedingly novel and appealing topic, namely natural orifice transluminal endoscopic surgery (NOTES, is discussed, as well as the authors' viewpoint thereon. Most reviewed studies were performed in laboratory animals, but reports on transvaginal cholecystectomy and the emergence of editorials and review articles on this topic pose a number of as yet unanswered questions on this type of surgery, which represents a potential advance towards "endoscopic surgery with no scars, no infection, minimal anesthesia requirements, and immediate recovery".

Cardiovascular risk factors in Middle Eastern patients undergoing percutaneous coronary intervention: Results from the first Jordanian percutaneous coronary intervention study.

Science.gov (United States)

Hammoudeh, Ayman J; Alhaddad, Imad A; Khader, Yousef; Tabbalat, Ramzi; Al-Mousa, Eyas; Saleh, Akram; Jarrah, Mohamad; Nammas, Assem; Izraiq, Mahmoud

2017-07-01

Background and aims: Cardiovascular disease (CVD) is the leading cause of death in the Middle East. We sought to study the prevalence and coexistence of 6 cardiovascular risk factors (RFs) among patients who underwent percutaneous coronary intervention (PCI), and to evaluate the impact of age and gender on the presence of multiple RFs. In this prospective, multicenter study, 2426 consecutive patients were enrolled. Mean age was 59.0 ± 10.1 years and 500 (20.6%) were women. Acute coronary syndrome and stable coronary disease were the indications for PCI in 77.1% and 22.9%, respectively. Hypertension was present in 62.3%, diabetes in 53.8%, hypercholesterolemia in 48.8%, smoking in 43.5%, family history of premature CVD 39.4% and obesity in 28.8%. Only 3.8% did not have any of these RFs. Presence of ⩾3 and ⩾4 RFS was observed in 57.4% and 29.5% of patients, respectively. Presence of ⩾3 RFs was more common in women than men (69.0% vs. 54.5%, p  Eastern population undergoing PCI. More than half and more than one-fourth of the patients had at least 3 or 4 RFs; respectively. More women than men and more middle aged patients than older or younger patients had significantly higher rates of presence of multiple RFs.

The Impact of Prediabetes on Two-Year Clinical Outcomes in Patients Undergoing Elective Percutaneous Coronary Intervention.

Science.gov (United States)

Choi, Woong Gil; Rha, Seung Woon; Choi, Byoung Geol; Choi, Se Yeon; Byun, Jae Kyeong; Mashaly, Ahmed; Park, Yoonjee; Jang, Won Young; Kim, Woohyeun; Choi, Jah Yeon; Park, Eun Jin; Na, Jin Oh; Choi, Cheol Ung; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog

2018-06-01

Prediabetes is an independent risk factor for cardiovascular disease. However, data on the long term adverse clinical outcomes of prediabetic patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) are scarce. The study population comprised 674 consecutive non-diabetic patients who underwent elective PCI between April 2007 and November 2010. Prediabetes was defined as hemoglobin A1c (HbA1c) of 5.7% to 6.4%. Two-year cumulative clinical outcomes of prediabetic patients (HbA1c of 5.7% to 6.4%, n=242) were compared with those of a normoglycemic group (prediabetes group. There was no significant difference between the two groups in coronary angiographic parameters, except for a higher incidence of diffuse long lesion in the prediabetes group. For prediabetic patients, trends toward higher incidences of binary restenosis (15.6% vs. 9.8 %, p=0.066) and late loss (0.71±0.70 mm vs. 0.59±0.62 mm, p=0.076) were noted. During the 24 months of follow up, the incidence of mortality in prediabetic patients was higher than that in normoglycemic patients (5.5% vs. 1.5%, p=0.007). In our study, a higher death rate and a trend toward a higher incidence of restenosis in patients with prediabetes up to 2 years, compared to those in normoglycemic patients, undergoing elective PCI with contemporary DESs. © Copyright: Yonsei University College of Medicine 2018.

Impact of time to treatment on the effects of bivalirudin vs. glycoprotein IIb/IIIa inhibitors and heparin in patients undergoing primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Schoos, Mikkel; De Luca, Giuseppe; Dangas, George D

2016-01-01

AIMS: In the HORIZONS-AMI trial, bivalirudin compared to unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) improved net clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) at the cost of an increased rate of acute stent thrombosis. We...... sought to examine whether these effects are dependent on time to treatment. METHODS AND RESULTS: The interaction between anticoagulation regimen and symptom onset to first balloon inflation time (SBT) on the 30-day and three-year rates of major adverse cardiac events (MACE) was examined in 3...

Temporal changes in outcomes of women and men undergoing percutaneous coronary intervention for chronic total occlusion: 2005-2013.

Science.gov (United States)

Toma, Aurel; Stähli, Barbara E; Gick, Michael; Ferenc, Miroslaw; Mashayekhi, Kambis; Buettner, Heinz Joachim; Neumann, Franz-Josef; Gebhard, Catherine

2018-06-01

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has undergone impressive progress during the last decade, both in strategies and equipment. It is unknown whether technical refinement has translated into improved outcomes in women undergoing CTO-PCI. A total of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) undergoing PCI of at least one CTO lesion at our center between 01/2005 and 12/2013 were evaluated. The incidence of adverse events was compared between two time series (2005-2009 and 2010-2013). A significant increase in adverse lesion characteristics over time was noted in both, women and men (p men but not in women (p trend  men and p trend =0.9 in women). The incidence of procedural complications was significantly higher in women as compared to men and increased over the study period in women (p men. Accordingly, multivariate logistic regression analysis identified female sex as a strong predictor of PCI-related complications in recent years, while this was not the case in earlier years (adjusted HR 2.03, 95% CI 0.62-6.6, p = 0.2 and adjusted HR 4.7, 95% CI 1.8-12.3, p = 0.002, respectively, p men (log rank = 0.046), while no changes were observed in women. While higher success rates and a reduced rate of MACE have been achieved in men, the incidence of procedural complications in women undergoing CTO-PCI has increased over time.

A pilot randomized trial of pentoxifylline for the reduction of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention.

Science.gov (United States)

Aslanabadi, Naser; Shirzadi, Hamid Reza; Asghari-Soufi, Hossein; Dousti, Samaneh; Ghaffari, Samad; Sohrabi, Bahram; Mashayekhi, Simin Ozar; Hamishehkar, Hadi; Entezari-Maleki, Taher

2015-02-01

Periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) has received great attention due to its significant association with mortality and morbidity. Accordingly, cardioprotection during PCI is one of the important therapeutic concerns. Regarding the potential cardiovascular benefits of pentoxifylline this study was performed to evaluate whether the pretreatment pentoxifylline could reduce PMI in patients who are undergoing elective PCI. A randomized clinical trial on 85 patients undergoing elective PCI was performed. The intervention group (n = 41) received 1200 mg pentoxifylline in divided doses plus the standard treatment before PCI, while the control group (n = 44) received the standard treatment. For assessing myocardial damage during PCI, the levels of CK-MB and troponin-I were measured at baseline, 8, and 24 h after the procedure. Then, patients were followed up for a 1-month period regarding the major adverse cardiac effect. Comparing with the control group, no significant change of CK-MB at 8 (p = 0.315) and 24 h (p = 0.896) after PCI was documented in pentoxifylline group. Similarly, no significant change was found in troponin-I at 8 (p = 0.141) and 24 h (p = 0.256) after PCI. This study could not support the pretreatment with pentoxifylline in the prevention of PMI in patients undergoing elective PCI. However, the trend was toward the potential benefit of pentoxifylline.

Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Science.gov (United States)

Karrowni, Wassef; Vora, Amit Navin; Dai, David; Wojdyla, Daniel; Dakik, Habib; Rao, Sunil V

2016-09-01

Acute kidney injury (AKI) complicating percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes. To date, no studies have evaluated the association of blood transfusion with AKI in patients undergoing PCI. We used a retrospective cohort study of all patients with acute coronary syndrome undergoing PCI from CathPCI Registry (n=1 756 864). The primary outcome was AKI defined as the rise in serum creatinine post procedure ≥0.5 mg/dL or ≥25% above baseline values. AKI developed in 9.0% of study sample. Patients with AKI were older, more often women, and had high prevalence of comorbidities, including diabetes mellitus, hypertension, and advanced stages of chronic kidney disease at baseline. Blood transfusion was utilized in 2.2% of patients. In the overall sample, AKI developed in 35.1% of patients who received transfusion versus 8.4% of patients without transfusion (adjusted odds ratio, 4.87 [4.71-5.04]). In the subgroup of patients who sustained bleeding event and received transfusion, the rate of AKI was significantly increased across all preprocedure hemoglobin levels versus no blood transfusion. Similar findings were seen in the subgroup of patients with no bleeding event. Blood transfusion is strongly associated with AKI in patients with acute coronary syndrome undergoing PCI. Further investigation is needed to determine whether a restrictive blood transfusion strategy might improve PCI outcomes by reducing the risk of AKI. © 2016 American Heart Association, Inc.

EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos).

Science.gov (United States)

Khashab, Mouen A; Valeshabad, Ali Kord; Modayil, Rani; Widmer, Jessica; Saxena, Payal; Idrees, Mehak; Iqbal, Shahzad; Kalloo, Anthony N; Stavropoulos, Stavros N

2013-11-01

EUS-guided biliary drainage (EGBD) can be performed via direct transluminal or rendezvous techniques. It is unknown how both techniques compare in terms of efficacy and adverse events. To describe outcomes of EGBD performed by using a standardized approach and compare outcomes of rendezvous and transluminal techniques. Retrospective analysis of prospectively collected data. Two tertiary-care centers. Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EGBD after failed ERCP between July 2006 and December 2012 were included. EGBD by using a standardized algorithm. Technical success, clinical success, and adverse events. During the study period, 35 patients underwent EGBD (rendezvous n = 13, transluminal n = 20). Technical success was achieved in 33 patients (94%), and clinical success was attained in 32 of 33 patients (97.0%). The mean postprocedure bilirubin level was 1.38 mg/dL in the rendezvous group and 1.33 mg/dL in the transluminal group (P = .88). Similarly, length of hospital stay was not different between groups (P = .23). There was no significant difference in adverse event rate between rendezvous and transluminal groups (15.4% vs 10%; P = .64). Long-term outcomes were comparable between groups, with 1 stent migration in the rendezvous group at 62 days and 1 stent occlusion in the transluminal group at 42 days after EGBD. Retrospective analysis, small number of patients, and selection bias. EGBD is safe and effective when the described standardized approach is used. Stent occlusion is not common during long-term follow-up. Both rendezvous and direct transluminal techniques seem to be equally effective and safe. The latter approach is a reasonable alternative to rendezvous EGBD. Copyright © 2013. Published by Mosby, Inc.

Percutaneous reconstruction of the innominate bifurcation using the retrograde 'kissing stents' technique

Energy Technology Data Exchange (ETDEWEB)

Nagata, Shun-ichi; Kazekawa, Kiyoshi; Matsubara, Shuko [Fukuoka University Chikushi Hospital, Department of Neurosurgery, Chikushino, Fukuoka (Japan); Sugata, Sei [Bironoki Neurosurgical Hospital, Shibushi, Kagoshima (Japan)

2006-08-15

Obstructions of the supraaortic vessels are an important cause of morbidity associated with a variety of symptoms. Percutaneous transluminal angioplasty has evolved as an effective and safe treatment modality for occlusive lesions of the supraaortic vessels. However, the endovascular management of an innominate bifurcation has not previously been reported. A 53-year-old female with a history of systematic hypertension, diabetes mellitus and hypercholesterolemia presented with left hemiparesis and dysarthria. Angiography of the innominate artery showed a stenosis of the innominate bifurcation. The lesion was successfully treated using the retrograde kissing stent technique via a brachial approach and an exposed direct carotid approach. The retrograde kissing stent technique for the treatment of a stenosis of the innominate bifurcation was found to be a safe and effective alternative to conventional surgery. (orig.)

The effect of TIcagrelor administered through a nasogastric tube to COMAtose patients undergoing acute percutaneous coronary intervention

DEFF Research Database (Denmark)

Ratcovich, Hanna; Sadjadieh, Golnaz; Andersson, Hedvig B

2017-01-01

resuscitated after an out of hospital cardiac arrest (OHCA) and undergoing primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS: Blood samples were drawn at baseline and at two, four, six, eight, 12, and 24 hours and then daily for up to five days after administration of a 180 mg ticagrelor...... loading dose (LD), followed by 90 mg twice daily in 44 patients. The primary endpoint was the occurrence of high platelet reactivity (HPR) 12 hours after the LD. Assessment by VerifyNow (VFN) showed 96 (15.25-140.5) platelet reactivity units (PRU), and five (12%) patients exhibited HPR. Multiplate...... analysis showed 19 (12-29) units (U) at twelve hours, and three patients (7%) had HPR. Ticagrelor and its main metabolite AR-C124910XX concentrations were 85.2 (37.2-178.5) and 18.3 (6.4-52.4) ng/mL. Median times to sufficient platelet inhibition below the HPR limit were 3 (2-6) hours (VFN) and 4 (2...

Aspirin desensitization in patients undergoing percutaneous coronary intervention: a survey of current practice.

Science.gov (United States)

Chapman, Andrew R; Rushworth, Gordon F; Leslie, Stephen J

2013-01-01

Aspirin remains the mainstay of anti-platelet therapy in cardiac patients. However, if a patient is allergic to aspirin and dual anti-platelet therapy is indicated - such as with percutaneous coronary intervention (PCI), then there is no clear guidance. One possibility is aspirin desensitization. A variety of protocols exist for the rapid desensitization of patients with aspirin allergy. The aim of this survey was to assess current knowledge and practice regarding aspirin desensitization in the UK. We conducted a UK wide survey of all UK 116 PCI centers and obtained complete responses from 40 (35.4%) centers. Of these, just 7 (17.5%) centers had previously desensitised patients; 29 (87.9%) centers suggested a lack of a local protocol prevented them from desensitizing, with 10 (30.3%) unsure of how to conduct desensitization. Only 5 (12.5%) centers had a local policy for aspirin desensitization although 25 (64.1%) units had a clinical strategy for dealing with aspirin allergy; the majority (72%) giving higher doses of thienopyridine class drugs. In the UK, there appears to be no consistent approach to patients with aspirin allergy. Patients undergoing PCI benefit from dual anti-platelet therapy (including aspirin), and aspirin desensitization in those with known allergy may facilitate this. Sustained effort should be placed on encouraging UK centers to use desensitization as a treatment modality prior to PCI rather than avoiding aspirin altogether.

Kronisk tarmiskæmi hos en yngre patient

DEFF Research Database (Denmark)

Hansen, Lars Koch; Kammerlander, Heidi; Cecere, Stefano

2012-01-01

A 46 year-old woman presented with classic symptoms. Computed tomography-angiography and duplex ultrasonography showed stenosis of the aa. mesenteria superior et inferior. The patient was moved to a university hospital and a percutaneous transluminal angioplasty with insertion of stents was perfo......A 46 year-old woman presented with classic symptoms. Computed tomography-angiography and duplex ultrasonography showed stenosis of the aa. mesenteria superior et inferior. The patient was moved to a university hospital and a percutaneous transluminal angioplasty with insertion of stents...... was performed. She was discharged shortly after feeling well....

Patient and physician perception of natural orifice transluminal endoscopic appendectomy

Czech Academy of Sciences Publication Activity Database

Hucl, T.; Saglová, A.; Beneš, M.; Kocík, M.; Oliverius, M.; Valenta, Zdeněk; Špičák, J.

2012-01-01

Roč. 18, č. 15 (2012), s. 1800-1805 ISSN 1007-9327 Institutional research plan: CEZ:AV0Z10300504 Keywords : natural orifice transluminal endoscopic surgery * patient perception * physician perception * appendectomy * laparoscopy Subject RIV: FJ - Surgery incl. Transplants Impact factor: 2.547, year: 2012

Cath lab costs in patients undergoing percutaneous coronary angioplasty - detailed analysis of consecutive procedures.

Science.gov (United States)

Dziki, Beata; Miechowicz, Izabela; Iwachów, Piotr; Kuzemczak, Michał; Kałmucki, Piotr; Szyszka, Andrzej; Baszko, Artur; Siminiak, Tomasz

2017-01-01

Costs of percutaneous coronary interventions (PCI) have an important impact on health care expenditures. Despite the present stress upon the cost-effectiveness issues in medicine, few comprehensive data exist on costs and resource use in different clinical settings. To assess catheterisation laboratory costs related to use of drugs and single-use devices in patients undergoing PCI due to coronary artery disease. Retrospective analysis of 1500 consecutive PCIs (radial approach, n = 1103; femoral approach, n = 397) performed due to ST segment elevation myocardial infarction (STEMI; n = 345) and non ST-segment elevation myocardial infarction (NSTEMI; n = 426) as well as unstable angina (UA; n = 489) and stable angina (SA; n = 241) was undertaken. Comparative cost analysis was performed and shown in local currency units (PLN). The cath lab costs were higher in STEMI (4295.01 ± 2384.54PLN, p costs were positively correlated with X-ray dose, fluoroscopy, and total procedure times. Patients' age negatively correlated with cath lab costs in STEMI/NSTEMI patients. Cath lab costs were higher in STEMI patients compared to other groups. In STEMI/NSTEMI they were lower in older patients. In all analysed groups costs were related to the level of procedural difficulty. In female patients, the costs of PCI performed via radial approach were higher compared to femoral approach. Despite younger age, male patients underwent more expensive procedures.

Pooled Analysis Comparing the Efficacy of Intracoronary Versus Intravenous Abciximab in Smokers Versus Nonsmokers Undergoing Primary Percutaneous Coronary Revascularization for Acute ST-Elevation Myocardial Infarction

DEFF Research Database (Denmark)

Piccolo, Raffaele; Galasso, Gennaro; Eitel, Ingo

2016-01-01

Cigarette smokers with ST-segment elevation myocardial infarction (STEMI) may present different response to potent antithrombotic therapy compared to nonsmokers. We assessed the impact of smoking status and intracoronary abciximab in patients with STEMI undergoing primary percutaneous coronary...... intervention (PCI). We pooled data from 5 randomized trials comparing intracoronary versus intravenous abciximab bolus in patients undergoing primary PCI. The primary end point was the composite of death or reinfarction at a mean follow-up of 292 ± 138 days. Of 3,158 participants, 1,369 (43.3%) were smokers......, and they had a lower risk of the primary end point in crude, but not in adjusted analyses (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.63 to 1.21, p = 0.405). Intracoronary versus intravenous abciximab was associated with a significant reduction in the risk of primary end point among smokers (3...

Milrinone infusion: A therapeutic option in coronary vasospasm after primary percutaneous transluminal coronary angioplasty

Directory of Open Access Journals (Sweden)

Singh Amarpal

2009-01-01

Full Text Available A 42-year-old male presented to the emergency department with acute chest pain. The electrocardiogram revealed inferior wall myocardial infarction. Emergency coronary angiography revealed total occlusion of the distal right coronary artery with thrombus. Patient was taken up for primary percutaneous coronary angioplasty with stenting of distal right coronary artery. Six hours following the procedure, the patient developed re-elevation of ST-segment in inferior leads of electrocardiogram and subsequent haemodynamic instability. Repeat coronary angiography revealed patent stent and coronary artery spasm in proximal part, which was relieved by intracoronary injection of nitroglycerine. After an hour, the patient re-developed symptoms of chest pain along with bradycardia, hypotension and ST segment elevation. Intravenous infusion of nitroglycerine did not improve the condition but produced persistent hypotension. Infusion of milrinone was then started. Over time, normalisation of electrocardiogram occurred. The patient was discharged in stable condition. This case suggests that milrinone may be effective in alleviating coronary artery spasm when the use of other agents fails

Percutaneous endoscopic gastrostomy.

Science.gov (United States)

Gay, F; el Nawar, A; Van Gossum, A

1992-01-01

From March 87 to March 92, fifty eight patients were referred to our department for percutaneous endoscopic gastrostomy (PEG). The modality of the feeding tube insertion is described. The most common indications for placement were neurologic disorders in 62% of the cases (n = 36) and malignant diseases in 32% (n = 19). The success rate of the technique was 98.3% (n = 57). No procedure-related mortality was observed. A low rate of major complication (1.7%) and minor complication (10.5%) was noted. Feeding tubes were removed in 21% of patients (n = 12); none of them with malignant disease. Survival curve analysis demonstrated that 50% of patients died within 3 months of PEG placement. Such results raise questions about the selection of patients undergoing PEG. Our experience of patients undergoing PEG. Our experience suggests that PEG is easy and safe, even in debilitated patients, having an acceptable life expectancy.

Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with acute coronary syndromes undergoing left main percutaneous coronary intervention.

Science.gov (United States)

Jaberg, Laurenz; Toggweiler, Stefan; Puck, Marietta; Frank, Michelle; Rufibach, Kaspar; Lüscher, Thomas F; Corti, Roberto

2011-01-01

Patients undergoing acute left main (LM) coronary artery revascularization have a high mortality and natriuretic peptides such as N-terminal pro-B-type (NT-proBNP) have been shown to have prognostic value in patients with acute coronary syndromes. The present study looked at the prognostic value of NT-proBNP in these patients. We studied all consecutive patients undergoing acute LM coronary artery percutaneous coronary intervention between January 2005 and December 2008 in whom NT-proBNP was measured (n=71). We analyzed the clinical characteristics and the short- and long-term outcomes in relation to NT-proBNP level at admission. Median NT-proBNP was 1,364 ng/L, ranging from 46 to 70,000 ng/L. NT-proBNP was elevated in 63 (89%) patients and was ≥1,000ng/L in 42 (59%). Log NT-proBNP (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.55-7.97, P=0.003) and left ventricular ejection fraction (HR 0.95, 95%CI 0.91-0.99, P=0.007) were predictors for all-cause mortality. Log NT-proBNP was the only independent significant predictor of cardiovascular mortality. In-hospital mortality was 0% for patients with NT-proBNP value for NT-proBNP in patients undergoing acute LM coronary artery intervention.

Medline Plus

Full Text Available ... breast Macular degeneration Nerve conduction Osteoarthritis Osteoporosis Ovulation Parkinson disease Percutaneous transluminal coronary angioplasty (PTCA) Peristalsis Phagocytosis ...

Outcomes of Middle Eastern Patients Undergoing Percutaneous Coronary Intervention: The Primary Analysis of the First Jordanian PCI Registry.

Science.gov (United States)

Alhaddad, Imad A; Tabbalat, Ramzi; Khader, Yousef; Al-Mousa, Eyas; Izraiq, Mahmoud; Nammas, Assem; Jarrah, Mohammad; Saleh, Akram; Hammoudeh, Ayman

2017-01-01

This is a prospective multicenter registry designed to evaluate the incidence of adverse cardiovascular events in Middle Eastern patients undergoing percutaneous coronary interventions (PCI). The registry was also designed to determine the predictors of poor outcomes in such patients. We enrolled 2426 consecutive patients who underwent PCI at 12 tertiary care centers in Jordan between January 2013 and February 2014. A case report form was used to record data prospectively at hospital admission, discharge, and 12 months of follow-up. Mean age was 56 ± 11 years, females comprised 21% of the study patients, 62% had hypertension, 53% were diabetics, and 57% were cigarette smokers. Most patients (77%) underwent PCI for acute coronary syndrome. In-hospital and 1-year mortality rates were 0.78% and 1.94%, respectively. Definite or probable stent thrombosis occurred in 9 patients (0.37%) during hospitalization and in 47 (1.94%) at 1 year. Rates of target vessel repeat PCI and coronary artery bypass graft surgery at 1 year were 3.4% and 0.6%, respectively. The multivariate analysis revealed that cardiogenic shock, congestive heart failure, ST-segment deviation, diabetes, and major bleeding were significantly associated with higher risk of 1-year mortality. In this first large Jordanian registry of Middle Eastern patients undergoing PCI, patients treated were relatively young age population with low in-hospital and 1-year adverse cardiovascular events. Certain clinical features were associated with worse outcomes and may warrant aggressive therapeutic strategies.

Percutaneous implantation of endoprostheses in the carotid arteries

Directory of Open Access Journals (Sweden)

Costa Jr. José Ribamar

2003-01-01

Full Text Available OBJECTIVE: To assess the in-hospital evolution of patients undergoing percutaneous stent placement in the carotid arteries. METHODS: From August 1996 to April 2001, we studied 86 patients with carotid arterial obliterative lesions > 70% who were treated with percutaneous stent placement in the carotid arteries. We assessed the rate of success of the implantation and of the procedure, the types of stents used, mortality rate, and neurological complications. RESULTS: Successful implantation was obtained in 98.9% of the cases, and the procedure was successful in 91.8%. The Wallstent was the most frequently used stent (73 patients - 77%. Cerebral strokes occurred as follows: 3 (3.2% transient ischemic attacks, 1 (1.1% minor stroke, and 3 (3.1% major strokes. One (1.1% patient died during hospitalization. CONCLUSION: The high rate of success of stent implantation (98.9% in addition to the low rate of cerebral stroke/death (4.2% showed the efficiency and safety of percutaneous stent placement in carotid arteries.

Medline Plus

Full Text Available ... breast Macular degeneration Nerve conduction Osteoarthritis Osteoporosis Ovulation Parkinson disease Percutaneous transluminal coronary angioplasty (PTCA) Peristalsis Phagocytosis Pituitary ...

Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

NARCIS (Netherlands)

Drenth, Derk Jan

2005-01-01

This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

Natural orifice transluminal endoscopic surgery vs laparoscopic ovariectomy: Complications and inflammatory response

Czech Academy of Sciences Publication Activity Database

Martínek, J.; Ryska, O.; Filípková, T.; Doležel, R.; Juhás, Štefan; Motlík, Jan; Holubová, Monika; Nosek, V.; Rotnáglová, B.; Zavoral, M.; Ryska, M.

2012-01-01

Roč. 18, č. 27 (2012), s. 3558-3564 ISSN 1007-9327 Institutional research plan: CEZ:AV0Z50450515 Keywords : Natural orifice transluminal endoscopic surgery * Laparoscopy * Ovariectomy Subject RIV: FP - Other Medical Disciplines Impact factor: 2.547, year: 2012

Temporal Trends in the Risk Profile of Patients Undergoing Outpatient Percutaneous Coronary Intervention: A Report from the National Cardiovascular Data Registry's CathPCI Registry.

Science.gov (United States)

Vora, Amit N; Dai, Dadi; Gurm, Hitinder; Amin, Amit P; Messenger, John C; Mahmud, Ehtisham; Mauri, Laura; Wang, Tracy Y; Roe, Matthew T; Curtis, Jeptha; Patel, Manesh R; Dauerman, Harold L; Peterson, Eric D; Rao, Sunil V

2016-03-01

Because of recent changes in criteria for coverage for inpatient hospital stays, most nonacute percutaneous coronary intervention (PCI) procedures are reimbursed on an outpatient basis regardless of underlying patient risk. Downstream effects of these changes on the risk profile of patients undergoing outpatient PCI have not been evaluated. Using the American College of Cardiology National Cardiovascular Data Registry's CathPCI Registry, we assessed temporal trends in risk profiles and rates of hospital admission among 999 279 patients undergoing PCI qualifying for outpatient reimbursement. We estimated mortality and bleeding risk using validated models from the registry. From 2009 to 2014, the proportion of outpatients not admitted to a hospital after PCI increased from 32.8% to 66.3% (Prisk for predicted mortality increased significantly from 17.0% to 19.8% during the study period (Prisk for mortality. Among patients undergoing PCI procedures that qualify for outpatient reimbursement, there has been a temporal decrease in postprocedure hospital admission. Concomitantly, the proportion of these outpatients at high risk for mortality has significantly increased over time. These data suggest that current reimbursement classification could be improved by incorporating patient risk to appropriately match the necessary resources to the needed level of care. © 2016 American Heart Association, Inc.

Is segmental epidural anaesthesia an optimal technique for patients undergoing percutaneous nephrolithotomy?

Directory of Open Access Journals (Sweden)

Devangi A Parikh

2017-01-01

Full Text Available Background and Aims: Neuraxial anaesthesia has recently become popular for percutaneous nephrolithotomy (PCNL. We conducted a study comparing general anaesthesia (GA with segmental (T6–T12 epidural anaesthesia (SEA for PCNL with respect to anaesthesia and surgical characteristics. Methods: Ninety American Society of Anesthesiologists Physical Status-I and II patients undergoing PCNL randomly received either GA or SEA. Overall patient satisfaction was the primary end point. Intraoperative haemodynamics, epidural block characteristics, post-operative pain, time to rescue analgesic, total analgesic consumption, discharge times from post-anaesthesia care unit, surgeon satisfaction scores and stone clearance were secondary end points. Parametric data were analysed by Student's t-test while non-parametric data were compared with Mann–Whitney U-test. Results: Group SEA reported better patient satisfaction (P = 0.005. Patients in group GA had significantly higher heart rates (P = 0.0001 and comparable mean arterial pressures (P = 0.24. Postoperatively, time to first rescue analgesic and total tramadol consumption was higher in Group GA (P = 0.001. Group SEA had lower pain scores (P = 0.001. Time to reach Aldrete's score of 9 was shorter in group SEA (P = 0.0001. The incidence of nausea was higher in group GA (P = 0.001; vomiting rates were comparable (P = 0.15. One patient in group SEA developed bradycardia which was successfully treated. Eight patients (18% had hypertensive episodes in group GA versus none in group SEA (P = 0.0001. One patient in GA group had pleural injury and was managed with intercostal drain. Stone clearance and post-operative haemoglobin levels were comparable in both groups. Conclusion: PCNL under SEA has a role in selected patients, for short duration surgery and in expert hands.

Effectiveness of selective intracoronary thrombolysis in acute myocardial infarction

Energy Technology Data Exchange (ETDEWEB)

Yamaguchi, Hiroshi; Nosaka, Hideyuki; Saitoh, Taroh

1984-10-01

Protective effects of percutaneous transluminal coronary recanalization (PTCR) on the myocardium were investigated by creatine phosphokinase levels, regional left ventricular wall motion in chronic stage and /sup 201/Tl myocardial single photon emission computed tomography. Recanalization of the occlusive coronary artery at the early stage of myocardial infarction was effective for the protection of the myocardium and heart functions. This effect depended largely on the degree of occlusion at the time of the first imaging, the final degree of occlusion after recanalization, and the time required for the recanalization. Cases in which percutaneous transluminal coronary angiography was performed following PTCR are also presented and examined. (Namekawa, K.).

Effectiveness of selective intracoronary thrombolysis in acute myocardial infarction

International Nuclear Information System (INIS)

Yamaguchi, Hiroshi; Nosaka, Hideyuki; Saitoh, Taroh

1984-01-01

Protective effects of percutaneous transluminal coronary recanalization (PTCR) on the myocardium were investigated by creatine phospho kinase levels, regional left ventricular wall motion in chronic stage and 201 Tl myocardial single photon emission computed tomography. Recanalization of the occlusive coronary artery at the early stage of myocardial infarction was effective for the protection of the myocardium and heart functions. This effect depended largely on the degree of occlusion at the time of the first imaging, the final degree of occlusion after recanalization, and the time required for the recanalization. Cases in which percutaneous transluminal coronary angiography was performed following PTCR are also presented and examined. (Namekawa, K.)

Spinopelvic Dissociation: Comparison of Outcomes of Percutaneous versus Open Fixation Strategies

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Jeffrey M. Pearson

2018-01-01

Full Text Available Introduction. Spinopelvic dissociation injuries are historically treated with open reduction with or without decompressive laminectomy. Recent technological advances have allowed for percutaneous fixation with indirect reduction. Herein, we evaluate outcomes and complications between patients treated with open reduction versus percutaneous spinopelvic fixation. Methods. Retrospective review of patients undergoing spinopelvic fixation from a single, level one trauma center from 2012 to 2017. Patient information regarding demographics, associated injuries, and treatment outcome measures was recorded and analyzed. All fractures were classified via the AO Spine classification system. Results. Thirty-one spinopelvic dissociations were identified: 15 treated with open and 16 with percutaneous techniques. The two treatment groups had similar preoperative characteristics including spinopelvic parameters (pelvic incidence and lumbar lordosis. Compared to open reduction internal fixation, percutaneous fixation of spinopelvic dissociation resulted in statistically significantly lower blood loss (171 cc versus 538 cc; p=0.0013. There were no significant differences in surgical site infections (p=0.48 or operating room time (p=0.66. Conclusion. Percutaneous fixation of spinopelvic dissociation is associated with significantly less blood loss. Treatment outcomes in terms of infection, length of stay, operative cost, and final alignment between the open and percutaneous group were similar.

Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG tube insertion under antiplatelet therapy: a systematic review with a meta-analysis

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Alfredo J. Lucendo

2015-03-01

Full Text Available Background and aim: Patients undergoing percutaneous endoscopic gastrostomy (PEG tube placement often are under antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. This systematic review aims to assess if maintaining aspirin and/or clopidogrel treatment increases the risk of bleeding following PEG placement. Methods: A systematic search of the MEDLINE, EMBASE, and SCOPUS databases was developed for studies investigating the risk of bleeding in patients on antiplatelet therapy undergoing PEG tube insertion. Summary estimates, including 95 % confidence intervals (CI, were calculated. A fixed or random effects model was used depending on heterogeneity (I². Publication bias risks were assessed by means of funnel plot analysis. Results: Eleven studies with a total of 6,233 patients (among whom 3,665 were undergoing antiplatelet treatment, met the inclusion criteria and were included in the quantitative summary. Any PEG tube placement-related bleeding was found in 2.67 % (95 % CI 1.66 %, 3.91 % of the entire population and in 2.7 % (95 % CI 1.5 %, 4.1 % of patients not receiving antiplatelet therapy. Pooled relative risk (RR for bleeding in patients under aspirin, when compared to controls, was 1.43 (95 % CI 0.89, 2.29; I² = 0 %; pooled RR for clopidogrel was 1.21 (95 % CI 0.48, 3.04; I² = 0 % and for dual antiplatelet therapy, 2.13; (95 % CI 0.77, 5.91; I² = 47 %. No significant publication bias was evident for the different medications analyzed. Conclusion: Antiplatelet therapy was safe among patients undergoing PEG tube insertion. Future prospective and randomized studies with larger sample sizes are required to confirm the results of this study.

Gender-based outcomes of bivalirudin versus heparin in patients undergoing percutaneous coronary interventions: Meta-analysis of randomized controlled trials.

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Mina, George S; Firouzbakht, Tina; Modi, Kalgi; Dominic, Paari

2017-11-01

We aimed to perform a gender-based meta-analysis of the outcome of bivalirudin versus heparin in patients undergoing percutaneous coronary interventions (PCI). Bivalirudin has been shown to decrease major bleeding when compared to heparin ± glycoprotein IIb/IIIa inhibitors (GPI) in patients undergoing PCI. It is unclear, however, if those differences in outcomes are the same for men and women. We included randomized controlled trials (RCTs) that compared bivalirudin to heparin with or without GPI in patients undergoing PCI and reported outcome data that were stratified by gender. Random effect model was used to pool odds ratio (OR) and 95% confidence intervals (CI). We included 9 trials with 33,224 patients. Bivalirudin decreased major bleeding when compared to heparin plus routine GPI in both men (OR: 0.51, P < 0.001) and women (OR: 0.55, P < 0.001). However, when GPI were used selectively with heparin, the bleeding lowering effect of bivalirudin was statistically significant in men (OR: 0.69, P = 0.02) but not in women (OR: 0.71, P = 0.21). When compared to heparin ± GPI, there was a nonstatistically significant trend toward lower all-cause mortality with bivalirudin in both men (OR: 0.76, P = 0.055) and women (OR: 0.79, P = 0.21). There were no significant differences in major adverse cardiovascular events between heparin and bivalirudin in both men and women. Bivalirudin decreases major bleeding in both men and women when compared to heparin plus routine GPI. However, when compared to heparin alone, the bleeding lowering benefit of bivalirudin is less evident in women. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Relation between the Change in Mean Platelet Volume and Clopidogrel Resistance in Patients Undergoing Percutaneous Coronary Intervention.

Science.gov (United States)

Koh, Young-Youp; Kim, Hyung Ho; Choi, Dong-Hyun; Lee, Young-Min; Ki, Young-Jae; Kang, Seong-Ho; Park, Geon; Chung, Joong-Wha; Chang, Kyong-Sig; Hong, Soon-Pyo

2015-01-01

We aimed to determine the association between the change in mean platelet volume (MPV) over time and aspirin/ clopidogrel resistance in patients undergoing percutaneous coronary intervention (PCI). The MPV and platelet function were analysed in 302 patients who underwent PCI. MPV changes were associated with increased aspirin reaction units (ARU, r = 0.114; P = 0.047), increased P2Y12 reaction units (PRU, r = 0.193; P = 0.001), and decreased P2Y12% inhibition (PI%, r = - 0.273; P resistant group (≥235 PRU or ≤15% of PI%) showed a significantly higher positive change in MPV (ΔMPV) values than the clopidogrel responder group (0.53 ± 0.78 vs. 0.13 ± 0.69 fL, P resistant and responder groups were 72.6% and 59.3%, respectively. After adjusting for traditional risk factors, the odds ratio in the clopidogrel resistant group with ΔMPV ≥0.2 fL was 4.10 (95% confidence interval; 1.84-9.17). In conclusion, ΔMPV was associated with PRU and PI%; a positive ΔMPV was an independent predictive marker for clopidogrel resistance after PCI.

Safety and efficacy of abciximab as an adjunct to percutaneous coronary intervention

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Jennifer Vergara-Jimenez

2010-03-01

Full Text Available Jennifer Vergara-Jimenez, Pierluigi TricociDepartment of Medicine-Cardiology, Duke Clinical Research Institute, Durham, North Carolina, USAAbstract: Abciximab is a widely studied glycoprotein IIb/IIIa inhibitor, specifically in the setting of patients undergoing percutaneous coronary intervention (PCI. The populations studied have included patients with non-ST-segment acute coronary syndromes, ST-segment elevation myocardial infarction, and elective PCI. This large amount of information provides a clear efficacy and safety profile of the drug, although a few questions on the use of abciximab still exist, particularly on its use and preference in the setting of newer antiplatelet and antithrombotic medications. In this article we review the most relevant data from randomized clinical trials with abciximab in patients undergoing PCI and discuss the recent guideline recommendation on use during PCI.Keywords: abciximab, percutaneous coronary intervention, glycoprotein inhibitor

Fractional flow reserve versus angiography for guiding percutaneous coronary intervention

DEFF Research Database (Denmark)

Tonino, Pim A L; De Bruyne, Bernard; Pijls, Nico H J

2009-01-01

of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes. METHODS: In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug......BACKGROUND: In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio...

Midregional-proAtrial Natriuretic Peptide and High Sensitive Troponin T Strongly Predict Adverse Outcome in Patients Undergoing Percutaneous Repair of Mitral Valve Regurgitation.

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Jochen Wöhrle

Full Text Available It is not known whether biomarkers of hemodynamic stress, myocardial necrosis, and renal function might predict adverse outcome in patients undergoing percutaneous repair of severe mitral valve insufficiency. Thus, we aimed to assess the predictive value of various established and emerging biomarkers for major adverse cardiovascular events (MACE in these patients.Thirty-four patients with symptomatic severe mitral valve insufficiency with a mean STS-Score for mortality of 12.6% and a mean logistic EuroSCORE of 19.7% undergoing MitraClip therapy were prospectively included in this study. Plasma concentrations of mid regional-proatrial natriuretic peptide (MR-proANP, Cystatin C, high-sensitive C-reactive protein (hsCRP, high-sensitive troponin T (hsTnT, N-terminal B-type natriuretic peptide (NT-proBNP, galectin-3, and soluble ST-2 (interleukin 1 receptor-like 1 were measured directly before procedure. MACE was defined as cardiovascular death and hospitalization for heart failure (HF.During a median follow-up of 211 days (interquartile range 133 to 333 days, 9 patients (26.5% experienced MACE (death: 7 patients, rehospitalization for HF: 2 patients. Thirty day MACE-rate was 5.9% (death: 2 patients, no rehospitalization for HF. Baseline concentrations of hsTnT (Median 92.6 vs 25.2 ng/L, NT-proBNP (Median 11251 vs 1974 pg/mL and MR-proANP (Median 755.6 vs 318.3 pmol/L, all p<0.001 were clearly higher in those experiencing an event vs event-free patients, while other clinical variables including STS-Score and logistic EuroSCORE did not differ significantly. In Kaplan-Meier analyses, NT-proBNP and in particular hsTnT and MR-proANP above the median discriminated between those experiencing an event vs event-free patients. This was further corroborated by C-statistics where areas under the ROC curve for prediction of MACE using the respective median values were 0.960 for MR-proANP, 0.907 for NT-proBNP, and 0.822 for hsTnT.MR-proANP and hsTnT strongly

Comparison of children versus adults undergoing mini-percutaneous nephrolithotomy: large-scale analysis of a single institution.

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Guohua Zeng

Full Text Available OBJECTIVE: As almost any version of percutaneous nephrolithotomy (PCNL was safely and efficiently applied for adults as well as children without age being a limiting risk factor, the aim of the study was to compare the different characteristics as well as the efficacy, outcome, and safety of the pediatric and adult patients who had undergone mini-PCNL (MPCNL in a single institution. METHODS: We retrospective reviewed 331 renal units in children and 8537 renal units in adults that had undergone MPCNL for upper urinary tract stones between the years of 2000-2012. The safety, efficacy, and outcome were analyzed and compared. RESULTS: The children had a smaller stone size (2.3 vs. 3.1 cm but had smilar stone distribution (number and locations. The children required fewer percutaneous accesses, smaller nephrostomy tract, shorter operative time and less hemoglobin drop. The children also had higher initial stone free rate (SFR (80.4% vs. 78.6% after single session of MPCNL (p0.05. Both groups had low rate of high grade Clavien complications. There was no grade III, IV, V complications and no angiographic embolization required in pediatric group. One important caveat, children who required multiple percutaneous nephrostomy tracts had significant higher transfusion rate than in adults (18.8% vs. 4.5%, p = 0.007. CONCLUSIONS: This contemporary largest-scale analysis confirms that the stone-free rate in pediatric patients is at least as good as in adults without an increase of complication rates. However, multiple percutaneous nephrostomy tracts should be practiced with caution in children.

Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention

DEFF Research Database (Denmark)

Bonde, Lisbeth; Sorensen, Rikke; Fosbøl, Emil Loldrup

2010-01-01

with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan-Meier method and Cox regression analyses. RESULTS: We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n = 5,050) and a mean follow......OBJECTIVES: We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). BACKGROUND: Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel...... is associated with absolute mortality reduction in AMI patients. METHODS: All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score...

Percutaneous common femoral artery interventions using angioplasty, atherectomy, and stenting.

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Mehta, Manish; Zhou, Yi; Paty, Philip S K; Teymouri, Medhi; Jafree, Kamran; Bakhtawar, Humayun; Hnath, Jeffrey; Feustel, Paul

2016-08-01

This study evaluated the feasibility, safety, and effectiveness of endovascular interventions for common femoral artery (CFA) occlusive disease. Using a prospectively maintained multicenter database, we analyzed outcomes in 167 consecutive patients who underwent percutaneous CFA interventions for Rutherford class 3 to class 6 (R3-R6) disease. The standardized treatment approach included primary percutaneous transluminal angioplasty (PTA) only, atherectomy + PTA, and provisional stenting. Outcomes included technical failure rate, recurrence, complications, and major or minor amputation rate. Data were analyzed using multivariate regression analysis. During a 7-year period, 167 patients with R3 (n = 91 [54.5%]) and R4 to R6 (n = 76 [45.5%]) disease underwent CFA interventions that included PTA only (n = 114 [68.2%]), atherectomy ± PTA (n = 38 [22.8%]), and provisional stenting (n = 15 [9.0%]) for failed atherectomy ± PTA. Procedure-related complications included pseudoaneurysm (n = 1 [0.6%]), thrombosis (n = 1 [0.6%]), distal embolization (n = 1 [0.6%]), and death (R6, n = 1 [0.06%]). CFA restenosis was observed in 34 (20.4%) patents; these underwent further percutaneous (n = 18 [10.8%]) or surgical (n = 17 [10.2%]) revascularization that included CFA endarterectomy ± femoral distal bypass. Major or minor amputations were observed in none of the R3 patients and in only three (3.9%) and five (6.5%) of the R4 to R6 patients, respectively. Compared with the atherectomy + PTA group, patients in the PTA-only group had a significantly lower patency. Furthermore, during long-term mean follow-up of 42.5 months, the CFA provisional stent group had a 100% primary patency, which was significantly better than the primary patency in the CFA nonstent groups combined (77.0%; P = .0424). Data from this study to date would suggest that percutaneous CFA interventions in select patients are relatively safe and effective. In the long term, CFA stenting has

Performance of a New Blunt-Tip Coaxial Needle for Percutaneous Biopsy and Drainage of "Hard-To-Reach" Targets.

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Cazzato, Roberto Luigi; Garnon, Julien; Shaygi, Behnam; Caudrelier, Jean; Bauones, Salem; Tsoumakidou, Georgia; Koch, Guillaume; Gangi, Afshin

2017-09-01

To present a new blunt-tip coaxial needle (SoftGuard) applied to access "hard-to-reach" targets undergoing percutaneous image-guided biopsy or drainage. All consecutive patients presenting between August and December 2016 with "hard-to-reach" (blunt-tip needle is a safe and effective tool when applied as a coaxial working cannula for percutaneous biopsy or drainage of "hard-to-reach" targets.

[Thomas' shunt for hemodialysis: dysfunction and its percutaneous treatment].

Science.gov (United States)

Gallego, J J; Santos, E; Méndez, J V; Coronel, F; Torrente, J; Holguín, A; Moreno, R

2003-01-01

To assess the usefulness of percutaneous treatment of abnormalities of the venous tree in extending the survival of external Thomas shunts (TS). Twelve cases of TS were included in a hemodialysis access fistula dysfunction monitoring program and were followed for up to 48 months. The abnormalities found were treated by percutaneous transluminal angioplasty (PTA) or thrombolysis and PTA. Survival curves and the Kaplan-Meier method were used to calculate the likelihood of primary patency (P1), secondary patency (P2), and overall patency (OP). A total of 61 interventions were performed during the period of follow-up. On 12 occasions the fistula was thrombosed; in the rest, increased venous pressure to 150 mmHg or higher was detected during dialysis. Fistulography was performed after washing the thrombosed fistulas with urokinase, and revealed one or more of the following angiographic signs: 1) a short reduction of more than 50% in lumen caliber in the femoral vein adjacent to the anastomosis, present in 52% of the cases (fig. 1); 2) imaging a "jet" of contrast material at the site of entry of the shunt into the femoral vein (fig. 2), present in 22% of the cases; and 3) a filling defect or "flap" at the same site, owing to hyperplastic tissue or piece of thrombus adhering to the intima, present in 34% of the cases (figs. 3-5). This last-mentioned finding ordinarily gave rise to a "valve" effect, whereby injection into the venous branch was feasible but aspiration from the venous branch was difficult or impossible. PTA was carried out and attained anatomical and functional success in 100% of cases. PI was 58%, 33%, 8%, and 0% at 6, 12, 24, and 36 months, respectively; P2 was 100%, 75%, 58%, and 25%; respectively, at those same times. The comparison of the PI and P2 curves was statistically significant; p < 0.001 (table 1). OP was 83%, 66%, 50% and 41% at 12, 24, 36 and 48 months. The comparison of the PI surgical and OP curves was statistically significant; p < 0

Endoscopic treatment of multilocular walled-off pancreatic necrosis with the multiple transluminal gateway technique.

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Jagielski, Mateusz; Smoczyński, Marian; Adrych, Krystian

2017-06-01

The development of minimally invasive techniques allowed access to the necrotic cavity through transperitoneal, retroperitoneal, transmural and transpapillary routes. The choice of access to walled-off pancreatic necrosis (WOPN) should depend not only on the spread of necrosis, but also on the experience of the clinical center. Herein we describe treatment of a patient with multilocular symptomatic walled-off pancreatic necrosis using minimally invasive techniques. The single transmural access (single transluminal gateway technique - SGT) to the necrotic collection of the patient was ineffective. The second gastrocystostomy was performed using the same minimally invasive technique as an extra way of access to the necrosis (multiple transluminal gateway technique - MTGT). In the described case the performance of the new technique consisting in endoscopic multiplexing transmural access (MTGT) was effective enough and led to complete recovery of the patient.

Renoprotective effect of remote ischemic postconditioning in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

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Cao B

2018-02-01

Full Text Available Bangming Cao,* Chi Zhang,* Haipeng Wang, Ming Xia, Xiangjun Yang Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China *These authors contributed equally to this work Background: Whether upper arm remote ischemic postconditioning (RIPostC exerts protection to kidney in patients with ST-elevation myocardial infarction (STEMI undergoing primary percutaneous coronary intervention (PPCI remains unknown. Methods: Sixty-four patients with STEMI were randomized to PPCI + RIPostC (n=29 and PPCI (n=35 groups. RIPostC consisting of 4 cycles of 5 minutes occlusion/reperfusion by cuff inflation/deflation of the upper arm was started within 1 minute after the first balloon dilatation. Peripheral venous blood samples were collected before PPCI and at 0.5, 8, 24, 48, and 72 hours after PPCI to detect serum creatinine (SCr and creatine kinase-MB (CK-MB. Acute kidney injury (AKI rate and estimated glomerular filtration rate (eGFR were calculated. The transthoracic echocardiography was performed 7 days after PPCI to assess left ventricular ejection fraction (LVEF. Results: The patients in the PPCI + RIPostC group had a lower AKI rate compared with those in the PPCI group (P=0.04. The eGFR after PPCI increased in the PPCI + RIPostC group compared to the PPCI group (P<0.01. The peak of CK-MB concentration in the PPCI + RIPostC group was significantly lower than that in the PPCI group (P<0.01. The area under the curve of CK-MB decreased in the PPCI + RIPostC group compared with that in the PPCI group. LVEF in the PPCI + RIPostC group was significantly higher than that in the PPCI group (P=0.04. Conclusion: Upper arm RIPostC exerts renal and cardiac protection following cardiac ischemia–reperfusion in patients with STEMI. Keywords: myocardial ischemia reperfusion, ST-segmental elevation myocardial infarction, primary percutaneous coronary intervention, remote ischemic postconditioning

Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes.

LENUS (Irish Health Repository)

Keeling, Aoife N

2011-03-01

To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI).

Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

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Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer [GATA Medical Faculty, Ankara (Turkmenistan)

2008-08-15

We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 +- 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

Outcome and safety of same-day-discharge percutaneous coronary interventions with femoral access

DEFF Research Database (Denmark)

Antonsen, Lisbeth; Jensen, Lisette Okkels; Thayssen, Per

2013-01-01

Ongoing development in percutaneous coronary intervention (PCI) techniques and closing devices facilitates same-day-discharge in patients undergoing uncomplicated PCI procedures. We examined the safety and outcome in low-risk patients discharged the same day as PCI with femoral access was performed....

Acute occlusion of the coronary artery after transluminal balloon coronary angioplasty

International Nuclear Information System (INIS)

Savchenko, A.P.; Matchin, Yu.G.; Lyakishev, A.A.

1995-01-01

The research was aimed at elucidation of the relationship of the clinical and angiographic factors, on the one hand, and development of acute occlusion following transluminal balloon coronary angioplasty TBCA, on the other. TBCA was carried out in 162 patients. Eight (4.9 %) patients developed acute occlusion of the coronary artery, which was complicated by acute myocardial infarction in 50 % cases. 35 refs.; 4 tabs

Hybrid natural orifice transluminal endoscopic cholecystectomy: prospective human series.

Science.gov (United States)

Cuadrado-Garcia, Angel; Noguera, Jose F; Olea-Martinez, Jose M; Morales, Rafael; Dolz, Carlos; Lozano, Luis; Vicens, Jose-Carlos; Pujol, Juan José

2011-01-01

Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. Currently, it is not possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids fusing minilaparoscopy and transluminal endoscopic surgery. This report presents a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis. The study comprised a clinical series of 25 consecutive nonrandomized women who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis: one 5-mm umbilical trocar and one 3-mm trocar in the upper left quadrant. The study had no control group. The scheduled surgical intervention was performed for all 25 women. No intraoperative complications occurred. One patient had mild hematuria that resolved in less than 12 h, but no other complications occurred during an average follow-up period of 140 days. Of the 25 women, 20 were discharged in 24 h, and 5 were discharged less than 12 h after the procedure. Hybrid transvaginal cholecystectomy, combining NOTES and minilaparoscopy, is a good surgical model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly using the instruments normally used for endoscopy and laparoscopic surgery. Due to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.

Evaluation of patients skin dose undergoing interventional cardiology procedure using radiochromic films

International Nuclear Information System (INIS)

Silva, Mauro W. Oliveira da; Canevaro, Lucia V.; Rodrigues, Barbara B. Dias

2011-01-01

In interventional cardiology (IC), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures are the most frequent ones. Since the 1990s, the number of IC procedures has increased rapidly. It is also known that these procedures are associated with high radiation doses due to long fluoroscopy time (FT) and large number of cine-frames (CF) acquired to document the procedure. Mapping skin doses in IC is useful to find the probability of skin injuries, to detect areas of overlapping field, and to get a permanent record of the most exposed areas of skin. The purpose of this study was to estimate the maximum skin dose (MSD) in patients undergoing CA and PTCA, and to compare these values with the reference levels proposed in the literature. Patients' dose measurements were carried out on a sample of 38 patients at the hemodynamic department, in four local hospitals in Rio de Janeiro, Brazil, using Gafchromic XR-RV2 films. In PTCA procedures, the median and third quartile values of MSD were estimated at 2.5 and 5.3 Gy, respectively. For the CA procedures, the median and third quartile values of MSD were estimated at 0.5 and 0.7 Gy, respectively. In this paper, we used the Pearson's correlation coefficient (r), and we found a fairly strong correlation between FT and MSD (r=0.8334, p<0.0001), for CA procedures. The 1 Gy threshold for deterministic effects was exceeded in nine patients. The use of Gafchromic XR-RV2 films was shown to be an effective method to measure MSD and the dose distribution map. The method is effective to identify the distribution of radiation fields, thus allowing the follow-up of the patient to investigate the appearance of skin injuries. (author)

Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting

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Tae Hee Hong

2015-06-01

Full Text Available Venoarterial extracorporeal membrane oxygenation (VA ECMO is widely used in patients with cardiogenic shock. Insufficient decompression of the left ventricle (LV is considered a major factor preventing adequate LV recovery. A 40-year-old male was diagnosed with acute myocardial infarction, and revascularization was performed using percutaneous stenting. However, cardiogenic shock occurred, and VA ECMO was initiated. Severe LV failure developed, and percutaneous transaortic catheter venting (TACV was incorporated into the venous circuit of VA ECMO under transthoracic echocardiography guidance. The patient was successfully weaned from VA ECMO. Percutaneous TACV is an effective, relatively noninvasive, and rapid method of LV decompression in patients undergoing VA ECMO.

Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

International Nuclear Information System (INIS)

Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer

2008-01-01

We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 ± 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

CIRUGÍA ENDOSCÓPICA TRANSLUMINAL: ¡ES POSIBLE!

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Arecio Peñaloza-Ramírez

2015-03-01

Full Text Available Introducción: La cirugía endoscópica transluminal es una técnica de ingreso a través de orificios naturales a la cavidad peritoneal y a los órganos allí contenidos, que busca disminuir los efectos adversos y las complicaciones de los procedimientos abiertos, acorde con la tendencia mundial de obtener resultados iguales a través de abordajes menos invasivos. Objetivo: Determinar las complicaciones de la cirugía endoscópica transluminal para la revisión de la cavidad peritoneal y la toma de biopsia hepática en cerdos. Metodología: Estudio experimental en 12 cerdos. Se tomó biopsia hepática transgástrica y se hizo un seguimiento durante 30 días, evaluando complicaciones y mortalidad. Al final se realizó autopsia al animal. Resultados: No se encontró mortalidad intraoperatoria. La mediana de tiempo quirúrgico fue de 84,5 minutos (RIQ 76-99. Se utilizaron para el cierre de la gastrotomía en promedio 7,8 clips (DE 3.5. En la peritoneoscopia se observó el intestino delgado, bazo, hígado y colon en la mayoría de los casos. La calidad de la biopsia hepática fue buena en 10 especímenes. La cicatrización gástrica fue adecuada en el 81.8%. Se encontraron cultivos de líquido peritoneal positivos en 9 casos. Conclusiones: La técnica requiere destreza y la peritoneoscopia es difícil por la falta de apoyo del equipo al maniobrar en retroflexión. El potencial de la técnica y el enorme beneficio para los pacientes son razones suficientes para continuar avanzando en este tipo de abordajes

[A clinical observation of percutaneous balloon dilation and maintenance percutaneous transhepatic cholangial catheter drainage for treatment of 21 patients with benign biliary strictures and difficult endoscopy].

Science.gov (United States)

Pan, Jie; Shi, Hai-feng; Li, Xiao-guang; Zhang, Xiao-bo; Liu, Wei; Jin, Zheng-yu; Hong, Tao; Yang, Ai-ming; Yang, Ning

2012-06-01

To investigate the value of percutaneous balloon dilation and percutaneous transhepatic cholangial drainage (PTCD) catheter maintenance in the treatment of benign biliary strictures. The clinical data of 21 patients with benign biliary strictures at Peking Union Medical College Hospital from June 2005 to June 2011 were retrospectively studied, in which 12 patients in severe stricture (stenosis > 70%) were treated with percutaneous balloon dilation and PTCD catheter placed across the stricture, while another 9 patients in median stricture (stenosis stenosis was seen in 2 patients. A severe complication with biliary artery branch rupture and massive hemobilia was seen in 1 patient during balloon dilation. Of the 9 patients only treated with 1 - 12 months (median: 6 months) of PTCD catheter placement, 7 patients had the catheter successfully removed. In the follow-up of 5 - 18 months (median: 8 months), patency of bile duct was preserved in 5 of 7 patients, and recurrent stenosis was seen in 2 patients. No severe complication occurred. When endoscopy therapy is failed or the patient can't undergo endoscopy therapy, the percutaneous balloon dilation and PTCD catheter maintenance method is an effective alternative therapeutic approach in the treatment of benign biliary strictures. The moderate benign biliary stricture may be effectively treated only by the PTCD catheter maintenance method.

Percutaneous transluminal angioplasty of supraaortic vessel

International Nuclear Information System (INIS)

Belli, L.; Puricelli, G.; Cerasano, A.; Cornalba, P.; Rota, L.; Facchinetti, P.

1988-01-01

Sixteen cases are reported of dilatation of supra-aortic vessels; in 14/16 patients the vessel involved was either the subclavian artery or the brachio-cephalich trunk. Special attention is paid to the choice of patients - the ideal one presenting with a single uncalcified lesion, with stenosis more than 50% of diameter; the symptoms have recently appeared, with a significant difference (more than 20 mmHg) in the pressure of the two arms. The technical aspects of the angioplastic procedure are discussed, especially in order to preserve the intracriminal circulation and to limit possible complications. The presence of reversed blood flow in the vertebral artery is extremely important to preserve intracranial circulation from possible embolism; normal flow obtained at the end of the procedure is therefore an useful proof of successful dilatation. The advantages are stressed of dilatation over the surgical technique used in the past. Finally, the importance is emphasized of a correct follow-up and doppler control of supra-aortic circulation

Transluminal endovascular stent-graft for the treatment of aortic aneurysms

Energy Technology Data Exchange (ETDEWEB)

Lee, Do Yun; Chang, Byung Chul; Shim, Won Heum; Cho, Seung Yun; Chung, Nam Sik; Kwon, Hyuk Moon; Lee, Young Joon; Lee, Jong Tae [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1995-09-15

The standard treatment for aortic aneurysms is surgical replacement with a prosthetic graft. Currently there is great interest in endoluminal intervention for treatment of aortic aneurysm. The purpose of this study was to evaluate the safety and effectiveness of endoluminally placed Stent-graft for the treatment of aortic aneurysms. Transluminal endovascular Stent-graft placements were attempted in 9 patients with infra-renal aortic aneurysms(n 6), thoracic aortic aneurysm(n = 1), and aortic dissection(n = 2). The endovascular Stent-grafts were custom-designed for each patient and were constructed of self-expandable modified Gianturco Stents covered with polytetrafluroethylene. The Stent-grafts were introduced through a 16-18 French sheath and expanded to 17-30 mm in diameter. The endovascular therapy was performed using a common femoral artery cutdown with local anesthesia. The endovascular Stent-graft deployment was achieved in 7 of 9 patients. Two cases failed deployment of the Stent-graft due to iliac artery stenosis and tortousity. There were complete thrombosis of the thoracic and infra-renal aortic aneurysm surround the Stent-graft in 3 patients, and persistent leak with partial thrombosis in 2. Two patients with aortic dissection were successfully treated by obliteration of entry tears. There were no major complication associated with Stent-graft placement. These preliminary results show that transluminal endovascular Stent-grafts offer great promise and good results. Further investigation is needed to establish its long-term safety and efficacy.

Transluminal endovascular stent-graft for the treatment of aortic aneurysms

International Nuclear Information System (INIS)

Lee, Do Yun; Chang, Byung Chul; Shim, Won Heum; Cho, Seung Yun; Chung, Nam Sik; Kwon, Hyuk Moon; Lee, Young Joon; Lee, Jong Tae

1995-01-01

The standard treatment for aortic aneurysms is surgical replacement with a prosthetic graft. Currently there is great interest in endoluminal intervention for treatment of aortic aneurysm. The purpose of this study was to evaluate the safety and effectiveness of endoluminally placed Stent-graft for the treatment of aortic aneurysms. Transluminal endovascular Stent-graft placements were attempted in 9 patients with infra-renal aortic aneurysms(n 6), thoracic aortic aneurysm(n = 1), and aortic dissection(n = 2). The endovascular Stent-grafts were custom-designed for each patient and were constructed of self-expandable modified Gianturco Stents covered with polytetrafluroethylene. The Stent-grafts were introduced through a 16-18 French sheath and expanded to 17-30 mm in diameter. The endovascular therapy was performed using a common femoral artery cutdown with local anesthesia. The endovascular Stent-graft deployment was achieved in 7 of 9 patients. Two cases failed deployment of the Stent-graft due to iliac artery stenosis and tortousity. There were complete thrombosis of the thoracic and infra-renal aortic aneurysm surround the Stent-graft in 3 patients, and persistent leak with partial thrombosis in 2. Two patients with aortic dissection were successfully treated by obliteration of entry tears. There were no major complication associated with Stent-graft placement. These preliminary results show that transluminal endovascular Stent-grafts offer great promise and good results. Further investigation is needed to establish its long-term safety and efficacy

Percutaneous intervention in the menagement of insufficient native arteriovenous hemodialysis fistulae

International Nuclear Information System (INIS)

Kim, Hye Jung; Seong, Chang Kyu; Kwon, Jae Hyun; Kim, Young Hwan; Park, Noh Hyuck; Kim, Tae Hun; Kim, Yong Joo; Kang, Duck Sik; Shin, Tae Beom

2002-01-01

To determine the effectiveness and patency of percutaneous intervention in insufficient native arteriovenous hemodialysis fistulae (AVFs). Between March 1997 and September 2001, 67 cases of insufficient native AVFs resulted from central vein lesion, PTA was performed in 48 cases, and thrombolytic therapy with or without PTA in 11. In eight of the cases, in which central vein stenosis had led to the insufficency, percutaneous transluminal angioplasty (PTA) was performed, and in three of the eight, a stent was inserted. Angiography findings and complications, as well as success and patency rates in the non-thrombosis and thrombosis group, were evaluated; the central vein lesion group was analysed separately. Among 84 lesions observed at angiography, three were 54 cases of stenosis, 17 of occlusion, and 13 of combined thrombosis. The lesions were located in a proximal vein (n=51), distal vein (n=14), artery (n=6), and at the site of anastomosis (n=13). In the central vein lesion group (n=8), seven cases of stenosis and one of occlusion were noted. The overall procedural success rate was 79.1% (53/67). That is, in patients with no central vein lesion, the procedural success rate of PTA of native AVFs was 85.4% (41/48) and the patency rates of this were 83.1% at 6 months and 67.4% at 12 months. In cases of thrombolysis with/without PTA, the procedural success rate was 54.5% (6/11) and the patency rates were 83.3% at 6 months and 62.5% at 12 months. Finally, in patients with a central vein lesion, the procedural success rate was 75% (6/8) and the patency rates were 80% at 6 months and 30% at 12 months. There was one case of pseudoaneurysm formation at the puncture site of the brachial artery, which was used as the access route for intervention; one embolism in the brachial artery; and three cases of vascular spasm and two of hematoma which did not require active treatment. Percutaneous intervention offers effective and safe management of insufficient AVFs. The procedural

A Segmental Hypoplastic Anterior Tibial Artery Coexisting with a Hypertrophied Perforating Fibular Artery a Case Report and Clinical Implications

OpenAIRE

Ariyo, Olutayo

2015-01-01

Vascular injuries of the lower limb, especially from penetrating gunshot wounds, and peripheral arterial diseases are on the increase and management of these and many other lower limb injuries involve increasing usage of vascular interventions like by-pass surgery, per-cutaneous transluminal angioplasty, arterial cannulation, arterial bypass graft or minimally invasive measures like percutaneous trans-arterial catheterization, among others. A thorough knowledge of infrapopliteal branching mos...

Transluminal color-coded three-dimensional magnetic resonance angiography for visualization of signal Intensity distribution pattern within an unruptured cerebral aneurysm: preliminarily assessment with anterior communicating artery aneurysms

International Nuclear Information System (INIS)

Satoh, T.; Ekino, C.; Ohsako, C.

2004-01-01

The natural history of unruptured cerebral aneurysm is not known; also unknown is the potential growth and rupture in any individual aneurysm. The authors have developed transluminal color-coded three-dimensional magnetic resonance angiography (MRA) obtained by a time-of-flight sequence to investigate the interaction between the intra-aneurysmal signal intensity distribution patterns and configuration of unruptured cerebral aneurysms. Transluminal color-coded images were reconstructed from volume data of source magnetic resonance angiography by using a parallel volume-rendering algorithm with transluminal imaging technique. By selecting a numerical threshold range from a signal intensity opacity chart of the three-dimensional volume-rendering dataset several areas of signal intensity were depicted, assigned different colors, and visualized transparently through the walls of parent arteries and an aneurysm. Patterns of signal intensity distribution were analyzed with three operated cases of an unruptured anterior communicating artery aneurysm and compared with the actual configurations observed at microneurosurgery. A little difference in marginal features of an aneurysm was observed; however, transluminal color-coded images visualized the complex signal intensity distribution within an aneurysm in conjunction with aneurysmal geometry. Transluminal color-coded three-dimensional magnetic resonance angiography can thus provide numerical analysis of the interaction between spatial signal intensity distribution patterns and aneurysmal configurations and may offer an alternative and practical method to investigate the patient-specific natural history of individual unruptured cerebral aneurysms. (orig.)

Atypical Presentation of Acute Coronary Syndrome-Not ST Elevation: A Case Report

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Nicola Vitulano

2012-01-01

Full Text Available We describe the unexpected case of a 70-year-old man, with medical history of ischemic heart disease and surgery for aneurysm of abdominal aorta, who comes to the emergency department complaining of low-back pain without other symptoms or signs of organic failure. After a few hours we see a deterioration of physical conditions with pulmonary oedema, increase of blood pressure, changing in the ECG pattern, and worsening of left ventricular function with progressive increase of biomarkers for myocardial necrosis. So this pain has revealed the premature symptom of an acute coronary syndrome (ACS. After a short time a subsequent cardiac arrest complicates the clinical situation. After resuscitation, the patient undergoes successfully to coronary angiography and performed a percutaneous transluminal coronary angioplasty (PTCA.

Uses of ionizing radiation and medical-care-related problems

International Nuclear Information System (INIS)

Smathers, J.B.

1988-01-01

The uses of ionizing radiation in medicine are currently undergoing changes due to at least four major influences: (1) the constantly changing public perception of the hazards of radiation, (2) continuing technical innovation and development in equipment, (3) the imposition of diagnosis-related group funding by government health-care funding agencies, and (4) an increase in the average age of the U.S. population. The combined effect of these influences will probably result in a major increase in biplanar fluoroscopic examinations to support nonsurgical approaches such as percutaneous transluminal coronary angioplasty, percutaneous transluminal neuroembolism, and lithotripsy (the fracturing of kidney stones). As some of these examinations can result in 1.5 h of fluoroscopy, major doses to the patient and to the clinical staff can be expected. In addition, improved diagnostic techniques, such as using positron emission tomography (a combination of biochemistry and positron-emitting isotopes), can be expected to increase the number of small cyclotrons installed in medical centers. Counteracting these increases in radiation exposure is the development of digital radiography, which generally results in a lowering of the dose per diagnostic procedure. In the realm of therapeutic uses, one can expect higher-energy treatment accelerators, more patients being released from the hospital on therapeutic doses of isotopes, and a potential acceptance of neutron therapy as a cancer treatment modality. The latter treatment may take the form of boron capture therapy, 252Cf implant therapy, or external beam therapy using high-energy cyclotrons and the p,Be or the d,Be reaction to create the neutrons

Outcome of Diabetic and Non-Diabetic Patients Undergoing Successful Percutaneous Coronary Intervention of Chronic Total Occlusion

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Bahram Sohrabi

2011-05-01

Full Text Available Introduction: Diabetes mellitus is associated with an increased risk of adverse clinical outcomes after percutaneous coronary intervention (PCI. The prognosis of patients with diabetes mellitus and chronic total occlusion (CTO treated with PCI is poorly investigated. Current study evaluates outcome of successful PCI on CTO in patients with and without diabetes. Methods: One hundred and sixty three patients treated with successful PCI on CTO between January 2009 and March 2011 were prospectively identified from the PCI registry at the Madani Heart Center, Tabriz, Iran. Patients were followed for 15±3 months, were evaluated for the occurrence of major adverse cardiac events (MACE comprising death, acute myocardial infarction, and need for repeat revascularization.Results: No differences were found in baseline clinical and procedural variables between patients with (n=34 and without diabetes (n=129, unless for hypertension (p=0.03. Hospitalization period after PCI in diabetics (3.26±0.61 days and non-diabetics (2.86±0.52 days was similar. In-hospital MACE occurred in 8 (23.5% individuals of diabetics and 10 (7.8% individuals of non-diabetics (p=0.02, among them revascularization was significantly higher in diabetics (20.6% vs. 7%, p=0.04. Follow-up events in diabetic and non-diabetic groups were 12 (35.3% and 37 (28.5%, respectively (p was not significant. Conclusion: In patients undergoing successful PCI on CTO, diabetes is associated with higher in-hospital adverse events; however diabetes does not affect long term outcomes in these patients.

A random forest based risk model for reliable and accurate prediction of receipt of transfusion in patients undergoing percutaneous coronary intervention.

Directory of Open Access Journals (Sweden)

Hitinder S Gurm

Full Text Available BACKGROUND: Transfusion is a common complication of Percutaneous Coronary Intervention (PCI and is associated with adverse short and long term outcomes. There is no risk model for identifying patients most likely to receive transfusion after PCI. The objective of our study was to develop and validate a tool for predicting receipt of blood transfusion in patients undergoing contemporary PCI. METHODS: Random forest models were developed utilizing 45 pre-procedural clinical and laboratory variables to estimate the receipt of transfusion in patients undergoing PCI. The most influential variables were selected for inclusion in an abbreviated model. Model performance estimating transfusion was evaluated in an independent validation dataset using area under the ROC curve (AUC, with net reclassification improvement (NRI used to compare full and reduced model prediction after grouping in low, intermediate, and high risk categories. The impact of procedural anticoagulation on observed versus predicted transfusion rates were assessed for the different risk categories. RESULTS: Our study cohort was comprised of 103,294 PCI procedures performed at 46 hospitals between July 2009 through December 2012 in Michigan of which 72,328 (70% were randomly selected for training the models, and 30,966 (30% for validation. The models demonstrated excellent calibration and discrimination (AUC: full model  = 0.888 (95% CI 0.877-0.899, reduced model AUC = 0.880 (95% CI, 0.868-0.892, p for difference 0.003, NRI = 2.77%, p = 0.007. Procedural anticoagulation and radial access significantly influenced transfusion rates in the intermediate and high risk patients but no clinically relevant impact was noted in low risk patients, who made up 70% of the total cohort. CONCLUSIONS: The risk of transfusion among patients undergoing PCI can be reliably calculated using a novel easy to use computational tool (https://bmc2.org/calculators/transfusion. This risk prediction

Economic Outcomes of Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention: 1-Year Results From the ABSORB III Trial.

Science.gov (United States)

Baron, Suzanne J; Lei, Yang; Chinnakondepalli, Khaja; Vilain, Katherine; Magnuson, Elizabeth A; Kereiakes, Dean J; Ellis, Stephen G; Stone, Gregg W; Cohen, David J

2017-04-24

The purpose of this study was to evaluate the economic impact of the Absorb bioresorbable vascular scaffold compared with the Xience everolimus-eluting stent in patients undergoing percutaneous coronary intervention. The ABSORB III trial (Everolimus-Eluting Bioresorbable Scaffolds for Coronary Artery Disease) demonstrated that the Absorb scaffold was noninferior to the Xience stent with respect to target lesion failure at 1 year. Whether health care costs differ between the Absorb scaffold and the Xience stent is unknown. We performed a prospective health economic study alongside the ABSORB III trial, in which patients undergoing percutaneous coronary intervention for stable or unstable angina were randomized to receive the Absorb scaffold (n = 1,322) or Xience stent (n = 686). Resource use data were collected through 1 year of follow-up. Costs were assessed using resource-based accounting (for procedures), MedPAR data (for other index hospitalization costs), and Medicare reimbursements (for follow-up costs and physician fees). Initial procedural costs were higher with the Absorb scaffold than the Xience stent ($6,316 ± 1,892 vs. $6,103 ± 1,895; p = 0.02), driven mainly by greater balloon catheter use and the higher cost of the scaffold in the Absorb group. Nonetheless, index hospitalization costs ($15,035 ± 2,992 for Absorb vs. $14,903 ± 3,449 for Xience; p = 0.37) and total 1-year costs ($17,848 ± 6,110 for Absorb vs. $17,498 ± 7,411 for Xience; p = 0.29) were similar between the 2 groups. Although initial procedural costs were higher with the Absorb scaffold, there were no differences in total 1-year health care costs between the 2 cohorts. Longer term follow-up is needed to determine whether meaningful cost savings emerge after scaffold resorption. (A Clinical Evaluation of Absorb™ BVS, the Everolimus-Eluting Bioresorbable Vascular Scaffold in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT01751906). Copyright © 2017

Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Science.gov (United States)

Mandurino-Mirizzi, Alessandro; Crimi, Gabriele; Raineri, Claudia; Pica, Silvia; Ruffinazzi, Marta; Gianni, Umberto; Repetto, Alessandra; Ferlini, Marco; Marinoni, Barbara; Leonardi, Sergio; De Servi, Stefano; Oltrona Visconti, Luigi; De Ferrari, Gaetano M; Ferrario, Maurizio

2018-05-01

Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3 ± 22 vs. 29.1 ± 15 ml, P = 0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P = 0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3 ± 22.4 vs. 29.9 ± 15.4 ml, P = 0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2-weighted edema (53.8 vs. 41.2 ml, P = 0.031) and less favorable MBG (MBG < 2: 44.4 vs. 13.6%, P = 0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, all-cause mortality was higher in the eSUA group (18.8 vs. 2.4%, P = 0.028). eSUA may affect myocardial

Assessing transgastric Natural Orifice Transluminal Endoscopic Surgery prior to clinical implementation

DEFF Research Database (Denmark)

Donatsky, Anders Meller

2014-01-01

The objective was to investigate whether transgastric Natural Orifice Transluminal Endoscopic Surgery (NOTES) could be implemented safely in clinical practice. The experimental studies proved ultrasonography guided access through the stomach to be feasible and safe without iatrogenic complications......-abdominal abscess formation as a result of contamination from the access route was still present. To reduce this contamination, mouthwash with chlorhexidine was effective in a human randomised study. The same study also found significant higher bacterial load in the stomach of patients using proton pump inhibitor...

Collagen turnover in arterial disease

NARCIS (Netherlands)

Sluijter, J.P.G.

2004-01-01

Increased atherosclerotic plaque formation can lead to lumen reduction and finally to lumen obstruction. Percutaneous transluminal angioplasty (PTA) or balloon angioplasty (dilation) are approaches generally used to treat coronary, but also peripheral atherosclerotic disease. Their goal is to

Postconditioning during primary percutaneous coronary intervention: a review and meta-analysis

DEFF Research Database (Denmark)

Hansen, Peter Riis; Thibault, Helene; Abdulla, Jawdat

2010-01-01

Myocardial postconditioning (POC), defined as intermittent interruptions of blood flow at the onset of reperfusion after sustained ischemia, may attenuate reperfusion injury. In order to weigh the current evidence linking POC to reduction of myocardial infarct size in patients with ST-segment ele......-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), we performed a systematic review and meta-analysis of the available data from small randomised trials....

Meta-analysis comparing efficacy and safety of first generation drug-eluting stents to bare-metal stents in patients with diabetes mellitus undergoing primary percutaneous coronary intervention

DEFF Research Database (Denmark)

De Luca, Giuseppe; Dirksen, Maurits T; Spaulding, Christian

2013-01-01

revascularization (hazard ratio 0.42, 95% confidence interval 0.29 to 0.59, p 1 year) with DES. In conclusion, this meta-analysis, based on individual patients' data from 11 randomized trials, showed that among patients with diabetes with STEMIs who undergo primary percutaneous coronary intervention, sirolimus...... with high rates of target vessel revascularization after bare-metal stent (BMS) implantation but also higher rates of ST after DES implantation. Therefore, the aim of this study was to perform a meta-analysis of individual patients' data to evaluate the long-term safety and effectiveness of DES compared......Several concerns have emerged regarding the higher risk for stent thrombosis (ST) after drug-eluting stent (DES) implantation, especially in the setting of ST-segment elevation myocardial infarction (STEMI). Few data have been reported so far in patients with diabetes mellitus, which is associated...

Case report: renovascular hypertension following radiotherapy and chemotherapy treated by transluminal angioplasty

International Nuclear Information System (INIS)

Minton, M.J.; McIvor, J.; Cappuccio, F.P.; MacGregor, G.A.; Newlands, E.S.

1986-01-01

A man aged 33 with poorly controlled hypertension who had been treated with radiotherapy and combination chemotherapy for testicular teratoma 8 years earlier was found on arteriography to have 75% stenosis of the left renal artery and occlusion of the right renal artery. The stenosis was dilated by transluminal angioplasty and the hypertension adequately controlled. Patients who develop high blood pressure after abdominal radiotherapy with or without chemotherapy should be investigated for renal artery stenosis. (author)

Intraarterial 192Ir high-dose-rate brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty: the prospective randomized Vienna-2-trial radiotherapy parameters and risk factors analysis

International Nuclear Information System (INIS)

Pokrajac, Boris; Poetter, Richard; Maca, Thomas; Fellner, Claudia; Mittlboeck, Martina; Ahmadi, Ramazanali; Seitz, Wolfgang; Minar, Erich

2000-01-01

Purpose: The aim of the Vienna-2-trial was to compare the restenosis rate of femoropopliteal arteries after percutaneous transluminal angioplasty (PTA) with or without intraarterial high-dose-rate (HDR) brachytherapy (BT) using an 192 Ir source. Materials and Methods: A prospective, randomized trial was conducted from 11/96 to 8/98. A total of 113 patients (63 men, 50 women), with a mean age of 71 years (range, 43-89 years) were included. Inclusion criteria were (1) claudication or critical limb ischemia, (2) de-novo stenosis of 5 cm or more, (3) restenosis after former PTA of any length, and (4) no stent implantation. Patients were randomized after successful PTA for BT vs. no further treatment. A well-balanced patient distribution was achieved for the criteria used for stratification, as there were 'de-novo stenosis vs. restenosis after former PTA', 'stenosis vs. occlusion', 'claudication vs. critical limb ischemia' and above these for 'diabetes vs. nondiabetes'. PTA length was not well balanced between the treatment arms: a PTA length of 4-10 cm was seen in 19 patients in the PTA alone group and in 11 patients in the PTA+BT group, whereas a PTA length of greater than10 cm was seen in 35 patients and 42 patients, respectively. A dose of 12 Gy was prescribed in 3-mm distance from the source axis. According to AAPM recommendations, the dose was 6.8 Gy in 5-mm distance (vessel radius + 2 mm). Primary endpoint of the study was femoropopliteal patency after 6 months. Results: PTA and additional BT were feasible and well tolerated by all 57 pts in this treatment arm. No acute, subacute, and late adverse side effects related to BT were seen after a mean follow up of 12 months (6-24 months) in 107 patients (PTA n = 54; PTA+ BT n = 53). Crude restenosis rate at 6 months was in the PTA arm 54% vs. 28% in the PTA + BT arm (χ 2 test; p 10 cm) showed significant decrease of the restenosis rate, if BT was added. Significant reduction was not achieved in diabetes patients

[Astronauts, asteroids and the universe of antithrombotic therapies in primary percutaneous coronary intervention].

Science.gov (United States)

De Luca, Leonardo; Granatelli, Antonino

2017-06-01

A sensation of self-awareness on the relativity of our certainties comes over looking to the huge amount of data on antithrombotic therapies assessed in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This sensation can be compared to the so-called "overview effect", a cognitive shift in awareness reported by some astronauts during spaceflight, often while viewing the Earth from orbit. In this review we will mention drugs floated like meteors in the Universe of STEMI treatment and we will discuss the body of evidence on oral and intravenous antithrombotic therapies for patients undergoing pPCI.

Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review

NARCIS (Netherlands)

van Brussel, Peter M.; van de Hoef, Tim P.; de Winter, Robbert J.; Vogt, Liffert; van den Born, Bert-Jan

2017-01-01

Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional

Revascularização miocárdica de urgência após complicação de angioplastia transluminal coronária: abordagem cirúrgica atual Emergency myocardial revascularization after complicated percutaneous transluminal coronary angioplasty: actual surgical approach

Directory of Open Access Journals (Sweden)

Luís Alberto Dallan

1990-04-01

Full Text Available Entre julho de 1981 e fevereiro de 1990, foram realizados no INCOR 3016 angioplastias transluminais coronárias (ATC, em 2431 pacientes portadores de insuficiência coronária em suas diferentes manifestações. A cirurgia de revascularizaçâo do miocárdio de urgência foi necessária em 79 (3,2% desses pacientes, dos quais 32 (40,5% infartaram e 12 (15,2% faleceram. Dos 1530 pacientes submetidos estivamente a ATC por angina estável, 11,9% (7/59 faleceram no intra ou no pós-operatório. Dentre os 112 pacientes em que a ATC foi realizada de urgência devido a angina instável, 18,2% (2/11 evoluíram para óbito operatório. Nos 789 já infartados previamente à ATC, a mortalidade cirúrgica foi de 33,3% (3/9. A análise estatística demonstrou mortalidade mais elevada em pacientes idosos, em pacientes com dissecção do tronco da artéria coronária esquerda ou trombose coronária tardia e, especialmente, naqueles com instabilidade hemodinâmica após a ATC. O tempo decorrido entre a complicação da ATC e a revascularizaçâo do miocárdio também constitui fator agravante no prognóstico. O número de cirurgias de urgência após ATC diminuiu significativamente nos últimos dois anos (10/1351, a despeito do grau progressivo de complexidade das lesões dilatadas. O emprego de balões com extremidade atraumática e, especialmente, de cateter de reperíusão (Stack, que mantém o fluxo coronário mesmo diante do desprendimento da placa ateromatosa, contribuiu, decisivamente, para esses resultados. As modificações introduzidas na sistematização operatória, principalmente o uso de cardioplegia sangüínea com indução normotérmica e administrada por vias anterógrada e retrógrada, também propiciaram melhores resultados cirúrgicos. A associação desses procedimentos vem se mostrando benéfica, não tendo sido observados óbitos nos últimos 14 meses.Between July 1981 and February 1990, 2431 patients underwent attempted percutaneous

[Temporal evolution of antithrombotic therapy use in patients with acute coronary syndromes undergoing percutaneous coronary intervention in Italy: comparison between the EYESHOT and SCOPE registries].

Science.gov (United States)

De Luca, Leonardo; Pennacchi, Mauro; Musumeci, Giuseppe; D'Ascenzo, Fabrizio; Gallo, Pamela; Rigattieri, Stefano; Granatelli, Antonino; Berti, Sergio; Gulizia, Michele Massimo; De Servi, Stefano; Bolognese, Leonardo

2018-02-01

Few data exist on temporal evolution of antithrombotic agent use in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) in Italy. We sought to compare data from the most recent prospective, multicenter, nationwide registries conducted in Italy, namely EYESHOT and SCOPE. EYESHOT enrolled 2585 consecutive ACS patients, both ST-segment elevation myocardial infarction (STEMI) and non-ST elevation ACS (NSTE-ACS), admitted to 203 Italian coronary care units over a 3-week period (2-22 Dec 2013 and 27 Jan-16 Feb 2014). Among patients enrolled in EYESHOT, 1755 (67.9%) underwent PCI (52.6% with STEMI and 47.4% with NSTE-ACS). In the SCOPE registry, a total of 1363 patients undergoing PCI were enrolled over 3 months (15 Feb-15 Apr 2016) in 39 Italian cath lab centers at medium to high PCI volume: 331 (24.3%) with a diagnosis of STEMI and 1032 (75.7%) with a diagnosis of NSTE-ACS. Over 2 years, the use of clopidogrel in the cath lab significantly decreased (from 11% to 8% in STEMI; p=0.06 and from 9% to 5% in NSTE-ACS; p=0.0002), while the administration of ticagrelor dramatically increased (from 14% to 37%; pSCOPE registries, a significant increase in the use of novel P2Y12 receptor inhibitors was observed, both at the time of PCI and at discharge.

Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia

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Prologo, J.D.; Williams, Roger [Emory University Hospital, Department of Radiology and Imaging Sciences Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA (United States); Lin, Roger C. [University Hospitals Case Medical Center, Department of Radiology, Cleveland, OH (United States); Corn, David [Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH (United States)

2015-05-01

To evaluate the safety and efficacy of percutaneous CT-guided cryoablation of the pudendal nerve for the treatment of refractory pudendal neuralgia. Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. Brief Pain Inventory questionnaires were administered prior to the procedure, during the immediate 24 h post procedure, and 45 days and 6 months following the procedure. Prior to treatment, the average level of pain on a scale from 0 (no pain) to 10 (worst pain imaginable) was 7.6, with pain described as ''burning'' (80%), ''pulling'' (37.5%), ''crushing'' (50%), ''pressure'' (84.5%), ''throbbing'' (50%), ''knife-life'' (52%), and ''other'' (60%). At 24 h, 45 days, and 6 months post-treatment, pain intensity dropped to 2.6, 3.5, and 3.1, respectively (p < 0.005). There were no procedure-related complications. CT-guided percutaneous cryoablation may represent a safe and efficacious option for selected patients with refractory pudendal neuralgia. (orig.)

First report on a human percutaneous transluminal implantation of a self-expanding valve prosthesis for interventional treatment of aortic valve stenosis.

Science.gov (United States)

Grube, Eberhard; Laborde, Jean C; Zickmann, Bernfried; Gerckens, Ulrich; Felderhoff, Thomas; Sauren, Barthel; Bootsveld, Andreas; Buellesfeld, Lutz; Iversen, Stein

2005-12-01

Percutaneous aortic valve replacement is a new technology for the treatment of patients with significant aortic valve stenosis. We present the first report on a human implantation of a self-expanding aortic valve prosthesis, which is composed of three bovine pericardial leaflets inserted within a self-expanding nitinol stent. The 73-year-old woman presented with severe symptomatic aortic valve stenosis (mean transvalvular gradient of 45 mmHg; valve area of 0.7 cm2). Surgical valve replacement had been declined for the patient because of comorbidities, including previous bypass surgery. A retrograde approach via the common iliac artery was used for valve deployment. The contralateral femoral vessels were used for a temporary extracorporal circulation, unloading the left ventricle during the actual stent expansion. Clinical, hemodynamic, and echocardiographic outcomes were assessed serially during the procedure. Clinical and echocardiographic follow-up at day 1, 2, and 14 post procedure was performed to evaluate the short-term outcome. The prosthesis was successfully deployed within the native aortic valve, with accurate and stable positioning and with no impairment of the coronary artery or vein graft blood flow. 2D and doppler echo immediately after device deployment showed a significant reduction in transaortic mean pressure gradient (from 45 to 8 mmHg) without evidence of aortic or mitral valve insufficiency. The clinical status has then significantly improved. These results remained unchanged up to the day 14 follow-up. This case report demonstrates a successful percutaneous implantation of a self-expanding aortic valve prosthesis with remarkable functional and clinical improvements in the acute and short-term outcome. Copyright (c) 2005 Wiley-Liss, Inc.

Reality of obesity paradox: Results of percutaneous coronary intervention in Middle Eastern patients.

Science.gov (United States)

Jarrah, Mohamad; Hammoudeh, Ayman J; Khader, Yousef; Tabbalat, Ramzi; Al-Mousa, Eyas; Okkeh, Osama; Alhaddad, Imad A; Tawalbeh, Loai Issa; Hweidi, Issa M

2018-04-01

Objective The aim of this study was to assess the baseline clinical characteristics, coronary angiographic features, and adverse cardiovascular events during hospitalization and at 1 year of follow-up in obese patients compared with overweight and normal/underweight patients. Methods A prospective, multicenter study of consecutive patients undergoing percutaneous coronary intervention was performed. Results Of 2425 enrolled patients, 699 (28.8%) were obese, 1178 (48.6%) were overweight, and 548 (22.6%) were normal/underweight. Obese patients were more likely to be female and to have a higher prevalence of diabetes, hypertension, hypercholesterolemia, or previous percutaneous coronary intervention. Acute coronary syndrome was the indication for percutaneous coronary intervention in 77.0% of obese, 76.4% of overweight, and 77.4% of normal/underweight patients. No significant differences in the prevalence of multi-vessel coronary artery disease or multi-vessel percutaneous coronary intervention were found among the three groups. Additionally, no significant differences were found in stent thrombosis, readmission bleeding rates, or cardiac mortality among the three groups during hospitalization, at 1 month, and at 1 year. Conclusion The major adverse cardiovascular event rate was the same among the three groups throughout the study period. Accordingly, body mass index is considered a weak risk factor for cardiovascular comorbidities in Arab Jordanian patients.

Asian-Chinese patient perceptions of natural orifice transluminal endoscopic surgery cholecystectomy.

Science.gov (United States)

Teoh, Anthony Yuen Bun; Ng, Enders Kwok Wai; Chock, Alana; Swanstrom, Lee; Varadarajulu, Shyam; Chiu, Philip Wai Yan

2014-05-01

Patient and physician perceptions of natural orifice transluminal endoscopic surgery (NOTES) have been reported for the Western population. However, whether Asian-Chinese patients share the same perspectives as compared to the Western population is unknown. This was a cross-sectional survey carried out in the surgical outpatient's clinic at the Prince of Wales Hospital between June and September 2011. Patients were provided with an information leaflet and asked to complete a questionnaire regarding their perceptions of and preferences for NOTES cholecystectomy. Female patients attending the clinic were given an additional questionnaire regarding attitudes towards transvaginal surgery. Two hundred patients were recruited to complete the questionnaire(s) and the male to female ratio was 1:1. One hundred and fourteen patients (57%) preferred to undergo NOTES cholecystectomy for cosmetic reasons (P=0.009). Oral and anal routes were both acceptable for NOTES accesses in males and females. Forty-one percent of the female patients would consider transvaginal NOTES. Of these patients, significantly more patients indicated that the reason for choosing transvaginal NOTES was to minimize the risk of hernia (P=0.016) and to reduce pain associated with the procedure (P=0.017). The risk of complications (84.5%) and the cost of the procedure (58%) were considered the most important aspects when choosing a surgical approach by Asian-Chinese patients. Asian-Chinese preferred NOTES mainly for cosmetic reasons. However, the transvaginal route was less acceptable to females. Significant differences in patient perception on NOTES were observed between Asian-Chinese and Western patients. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

Triggers of blood transfusion in percutaneous nephrolithotomy

International Nuclear Information System (INIS)

Zehri, A.K.; Biyabani, S.R.; Siddiqui, K.M.; Memon, A.

2011-01-01

To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL). The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quantity of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis. A total of 326 procedures were performed in 316 patients. Two hundred and thirty two procedures were included in the study. There were 167 males and 65 females. The mean age was 41+14 years. The mean haemoglobin drop was 1.68 +1.3 gm/dL. The overall blood transfusion rate was 14.2%. Stepwise multivariate regression analysis showed that female gender (p = 0.003), staghorn stone (p = 0.023), stone fragmentation with ultrasound (p = 0.054) and chronic renal failure (p = 0.001) were significantly predictive of the need for blood transfusion. Chronic renal failure, female gender, presence of staghorn calculi and stone fragmentation using ultrasonic device were predictive of blood transfusion in this cohort of patients. (author)

Transluminal coronary angioplasty (TCA) techniques, indications and results

International Nuclear Information System (INIS)

Kober, G.; Lang, H.; Vallbracht, C.; Bussmann, W.D.; Hopf, R.; Kunkel, B.; Kaltenbach, M.

1985-01-01

Transluminal coronary angioplasty (TCA) was introduced in 1977 for dilatation of coronary stenoses. From October 1977 to December 1984 1087 procedures have been performed in Frankfurt. The mean success rate was 77% with an increase from 58% to 84% since 1977. Recurrences were seen within the first year in 15% of the patients, which could be treated successfully in a high percentage with a second TCA. Emergency bypass operations were necessary in 5.2%. Four patients (fatality rate 0.37%) died as the consequence of the intervention. Within few years TCA has become an established procedure for myocardial revascularisation, with a high success rate. Major progress has been possible in the last few years due to technical developments, which are still going on. They may lead to further improvement of the results and enlargement of the indication for TCA. (orig.) [de

Renal sympathetic denervation: MDCT evaluation of the renal arteries.

LENUS (Irish Health Repository)

Hutchinson, Barry D

2013-08-01

Percutaneous transluminal renal sympathetic denervation is a new treatment of refractory systemic hypertension. The purpose of this study was to assess the clinical utility of MDCT to evaluate the anatomic configuration of the renal arteries in the context of renal sympathetic denervation.

Routine Urine Culture at the Time of Percutaneous Urinary Drainage: Does Every Patient Need One?

International Nuclear Information System (INIS)

Brody, L.A.; Brown, K.T.; Covey, A.M.; Brown, A.E.; Getrajdman, G.I.

2006-01-01

Purpose. To determine the clinical variables associated with bacteriuria in patients undergoing primary percutaneous antegrade urinary drainage procedures in order to predict the utility of routinely obtaining urine cultures at the time of the procedure. Methods. Between October 1995 and March 1998 urine cultures were prospectively obtained in all patients undergoing a primary percutaneous antegrade urinary drainage procedure. One hundred and eighty-seven patients underwent 264 procedures. Results were available in 252 cases. Culture results were correlated with clinical, laboratory, and demographic variables. Anaerobic cultures were not uniformly performed. Results. Urine cultures were positive in 24 of 252 (9.5%) cases. An indwelling or recently removed ipsilateral device (catheter or stent) and a history of previous cystectomy with urinary diversion were significant predictors of a positive culture. Patients without either of these predictors, and without clinical or laboratory evidence of infection, were rarely found to have positive cultures. Conclusion. The likelihood of a positive urine culture can be predicted on the basis of the aforementioned clinical variables. In the absence of these clinical indicators routine urine cultures are neither useful nor cost-effective

The Factors That Effects Hemorrhage in Percutaneous Nephrolitotomy

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Fatih Duz

2014-03-01

Full Text Available Aim: Today, PNL has become primary treatment alternative in multiple or large kidney stones where ESWL treatment has failed. In our study, we have analyzed the facts that affect hemorrhage in PNL surgeries. Material and Method: Between March 2008 and December 2009, 204 patient%u2019s histories who had undergone percutaneous nephrolithotomy surgery in Izmir Bozyaka Training & Research Hospital, Urology Department were analyzed retrospectively. The patients were assembled under four groups according to the effect of some factors related to stone (size and localization, operation (number and localization of the entrances and the effects of PNL hemorrhage between these groups was investigated. Results: Of the 204 patients undergoing percutaneous nephrolithotomy, 76 were female, 128 were male, with an average age of 46.9±14.2 (18-80. The preoperation and postoperation Hb differences of the 176 patients whose stone load was less than 1000 mm2 and 28 patients whose stone load was over 1000 m2 were compared, yielding no statistically significant difference (p=0.942. Also no statistically significant difference was observed with regard to stone type, number of entries and percutaneous entry location. Discussion: In our study, it has been observed the size and localization of the stone is not an independent factor that affects the hemorrage itself. And also it has been observed that number and localization of entrances are not an independent factor that affecting haemorrhage.

Percutaneous nephrolithotomy in hypertensive patients with different sizes of instruments.

Science.gov (United States)

Resorlu, B; Kara, C; Ozyuvali, E; Unsal, A

2011-01-01

The risk of major complications, especially hemorrhage, is significantly elevated during surgery in hypertensive patients. To determine whether percutaneous nephrolithotomy (PCNL) can be safely performed in the hypertensive patients using different sized instruments. We reviewed the records of 602 patients undergoing PCNL at our institution and identified 53 who were on antihypertensive therapy at the time of surgery. Patients were categorized into three groups according to size of devices used in surgery : those 24 F percutaneous tract with 22 F nephroscope (Group 1, n = 12 [22.7%]; 26 F percutaneous tract with 24 F nephroscope (Group 2, n = 19 [35.8%]) and 30 F percutaneous tract with 26 F nephroscope (Group 3, n = 22 [41.5%]). We compared the groups with regard to baseline characteristics, intraoperative parameters, stone-free and complication rates, and the length of hospitalization. There were no differences between the three groups in age, gender, weight and stone laterality. Fluoroscopy time, access to the collecting system and mean operative time for per cm2 stone did not differ between the groups. Hemoglobin decrease, postoperative hospital stay and blood transfusion rate was higher in group 3. Stones were completely cleared in 83.3%, 84.2% and 81.3% of patients, which increased to 91.6%, 89.5%, and 90.1% with adjunctive therapy in the group 1,2 and 3, respectively. PCNL with smaller devices is a safe and effective method in hypertensive patients. It has significantly a shorter hospital stay and less bleeding rates compared to classical PCNL.

Percutaneous drainage of colonic diverticular abscess: is colon resection necessary?

Science.gov (United States)

Gaertner, Wolfgang B; Willis, David J; Madoff, Robert D; Rothenberger, David A; Kwaan, Mary R; Belzer, George E; Melton, Genevieve B

2013-05-01

Recurrent diverticulitis has been reported in up to 30% to 40% of patients who recover from an episode of colonic diverticular abscess, so elective interval resection is traditionally recommended. The aim of this study was to review the outcomes of patients who underwent percutaneous drainage of colonic diverticular abscess without subsequent operative intervention. This was an observational study. This investigation was conducted at a tertiary care academic medical center and a single-hospital health system. Patients treated for symptomatic colonic diverticular abscess from 2002 through 2007 were included. The primary outcomes measured were complications, recurrence, and colectomy-free survival. Two hundred eighteen patients underwent percutaneous drainage of colonic diverticular abscesses. Thirty-two patients (15%) did not undergo subsequent colonic resection. Abscess location was pelvic (n = 9) and paracolic (n = 23), the mean abscess size was 4.2 cm, and the median duration of percutaneous drainage was 20 days. The comorbidities of this group of patients included severe cardiac disease (n = 16), immunodeficiency (n = 7), and severe pulmonary disease (n = 6). Freedom from recurrence at 7.4 years was 0.58 (95% CI 0.42-0.73). All recurrences were managed nonoperatively. Recurrence was significantly associated with an abscess size larger than 5 cm. Colectomy-free survival at 7.4 years was 0.17 (95% CI 0.13-0.21). This study was limited by its retrospective, nonexperimental design and short follow-up. In selected patients, observation after percutaneous drainage of colonic diverticular abscess appears to be a safe and low-risk management option.

Long-term outcomes of percutaneous lumbar facet synovial cyst rupture

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Huang, Ambrose J.; Bos, Stijn A.; Torriani, Martin; Simeone, F.J.; Chang, Connie Y.; Pomerantz, Stuart R.; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States)

2017-01-15

To evaluate the therapeutic value, safety, and long-term clinical outcomes of percutaneous lumbar facet synovial cyst (LFSC) rupture. Our study was institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant. The study group comprised 71 patients (44 women, mean age: 65 ± 17 years) who underwent CT- or fluoroscopy-guided percutaneous LFSC rupture. The technical success of LFSC rupture, the long-term clinical outcome, including repeat procedures or surgery, and imaging findings on MRI and CT were recorded. Seventy-nine LFSC ruptures were performed in 71 patients. CT guidance was used in 57 cases and fluoroscopy guidance in 22 cases. LFSC rupture was technically successful in 58 out of 79 cases (73 %). Mean injection volume for cyst rupture was 3.6 ± 2.2 mL and a combination of steroid and anesthetic was injected in all cases. Over a mean follow-up time of 44 months, 12 % of patients underwent repeat cyst rupture, and 46 % eventually underwent surgery, whereas the majority of patients (55 %) experienced symptomatic relief and did not undergo surgery. There was no significant association between a successful outcome and age, sex, level, or size of LFSC (p > 0.1). LFSCs with T2 hypointensity were more likely to require surgery (p = 0.02). There was one complication, a bacterial skin infection that completely resolved following antibiotic therapy. Percutaneous LFSC rupture is an effective and safe nonsurgical treatment option for LFSC. More than half of treated patients were able to avoid subsequent surgery. Therefore, percutaneous LFSC rupture should be considered before surgical intervention. (orig.)

Long-Term Outcomes After Percutaneous Lower Extremity Arterial Interventions With Atherectomy vs. Balloon Angioplasty　- Propensity Score-Matched Registry.

Science.gov (United States)

Janas, Adam; Buszman, Piotr P; Milewski, Krzysztof P; Wiernek, Szymon; Janas, Ksenia; Pruski, Maciej; Wojakowski, Wojciech; Błachut, Aleksandra; Picheta, Wojciech; Buszman, Pawel; Kiesz, Stefan

2017-02-24

The impact of endovascular revascularization of the lower extremity arteries with atherectomy (AT) compared with percutaneous transluminal angioplasty (PTA) is still unclear. Therefore, the aim of the study was to compare long-term outcomes after percutaneous PTA and AT in patients requiring endovascular revascularization.Methods and Results:This was a single-center, retrospective registry of obstructive and symptomatic PAD patients who underwent endovascular revascularization. PTA was performed in 215 patients, and AT in 204 (Silver Hawk, EV3, n=125; CSI 360°, n=66; Pathway Medical Technologies, n=13). There were no significant between-group differences in baseline characteristics except for increased CAD, dialysis and CLI prevalence in the PTA group. Following propensity score analysis 131 well-matched pairs were included in analysis. Bail-out stenting was more frequent in the reference group (PTA, 6.1% vs. AT, 0%; P=0.004). At 6- and 12-month follow-up there were no differences in TLR between the groups (PTA, 8.3% vs. AT, 5.3%; P=0.47; and PTA, 16.7% vs. AT, 13.7%; P=0.73, respectively). The difference was in favor of AT at 24-month follow-up (PTA, 29.0% vs. AT, 16.7%; P=0.05). No difference was observed in amputation rate (PTA, 0.7% vs AT, 1.5%; P=0.62). On Kaplan-Meier analysis there were no significant differences between groups in time to TLR, amputation or death. AT was associated with lower risk of TLR, and this should be confirmed in randomized controlled trials.

Pure natural orifice transluminal endoscopic surgery (NOTES) with ultrasonography-guided transgastric access and over-the-scope-clip closure

DEFF Research Database (Denmark)

Donatsky, Anders Meller; Andersen, Luise; Nielsen, Ole Lerberg

2012-01-01

Most natural orifice transluminal endoscopic surgery (NOTES) procedures to date rely on the hybrid technique with simultaneous laparoscopic access to protect against access-related complications and to achieve adequate triangulation for dissection. This is done at the cost of the potential benefi...

Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

NARCIS (Netherlands)

Amoroso, G; Van Boven, AJ; Crijns, HJGM

Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

Quantitative angiographic follow-up of the coronary wallstent in native vessels and bypass grafts (European experience - March 1986 to March 1990)

NARCIS (Netherlands)

B.H. Strauss (Bradley); P.W.J.C. Serruys (Patrick); M.E. Bertrand (Michel); J. Puel (Jacques); B. Meier (Bernard); J-J. Goy (Jean-Jacques); L. Kappenberger (Lukas); A.F. Rickards (Anthony); U. Sigwart (Ulrich); M-A.M. Morel (Marie-Angèle); E.W.J. Montauban van Swijndregt (Eline)

1992-01-01

textabstractThe coronary stent has been investigated as an adjunct to percutaneous transluminal coronary angioplasty to obviate the problems of early occlusion and late restenosis. From March 1986 to March 1990, 265 patients (308 lesions) were implanted with the coronary Wallstent in 6 European

Coronary stenting as an adjunct to balloon angioplasty

NARCIS (Netherlands)

B.H. Strauss (Bradley)

1991-01-01

textabstractAndreas Gruentzig initiated the era of interventional cardiology in 19n with the introduction of percutaneous transluminal coronary angioplasty (PTCA) (1). The acceptance of coronary angioplasty is obvious by the widespread use of the procedure (>300,000 cases in the United States in

Laserassisteret ballonangioplastik af okklusioner i det femoropopliteale segment

DEFF Research Database (Denmark)

Eiberg, J P; Rasmussen, John Bøje Grønvall; Schroeder, T V

1995-01-01

of collateral vessels. In this series, laser angioplasty carried a high risk of perforation. The initial and long-term results were no better than could be expected of percutaneous transluminal angioplasty, suggesting that laser-assisted balloon angioplasty has no place in the vascular surgical armamentarium....

Percutaneous Management of Occlusive Arterial Disease Associated with Vasculitis: A Single Center Experience

International Nuclear Information System (INIS)

Both, M.; Jahnke, T.; Reinhold-Keller, E.; Reuter, M.; Grimm, J.; Biederer, J.; Brossmann, J.; Gross, W.L.; Heller, M.; Mueller-Huelsbeck, S.

2003-01-01

The purpose of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty for occlusive arterial disease associated with vasculitis. Eleven patients(10 women, 1 man; ages 35-82 years) with the diagnosis of vasculitis of the large vessels underwent interventional treatment during intraarterial angiography. The causes included giant cell arteritis(n = 8) and Takayasu arteritis (n = 3).Thirty-three occlusive lesions (including brachiocephalic and renalarteries, and arteries of upper and lower extremities) were treated with balloon angioplasty and/or stent placement. Follow-up included clinical examination, angiography, and color duplex ultrasound.Technical success was 100% (25/25) for stenoses and 50% (4/8) for occlusive lesions, representing all lesions combined from different anatomic locations. Dissection (n = 3) and arterial rupture with retroperitoneal hematoma (n = 1) was found in three patients. During follow-up (mean 12 months), restenoses(n = 8) and re-restenoses (n = 1)occurred in 8 vascular areas. Three of these lesions were treated with repeated PTA (n = 4). The cumulative primary clinical success rate was 67.6%, cumulative secondary success rate 74.4%, and cumulative tertiary success rate 75.9%. Interventional therapy in systemic vasculitis provides promising results in technical success rates and followup. Angioplasty may result in arterial injury, but the rate of complications is low

A prospective study of percutaneous vertebroplasty in patients with myeloma and spinal metastases

International Nuclear Information System (INIS)

Chew, C.; Ritchie, M.; O’Dwyer, P.J.; Edwards, R.

2011-01-01

Aim: To assess patient outcome in a consecutive series of patients with myeloma and spinal metastases who underwent percutaneous vertebroplasty. Materials and methods: Data were gathered prospectively on all patients undergoing percutaneous vertebroplasty between June 2001 and June 2010. Outcome measures included visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ) in patients treated since 2005 as well as complications and long-term outcome in all patients. Results: One hundred and twenty-eight patients underwent percutaneous vertebroplasty for myeloma (n = 41) or spinal metastases (n = 87) over a 9 year period. VAS scores fell from 7.75 ± 1.88 pre-vertebroplasty to 4.77 ± 2.69 post-vertebroplasty (p = 0.001). RDQ scores improved from 18.55 ± 4.79 to 13.5 ± 6.96 (p = 0.001). Complications were recorded in three patients: cement extension to vena cava (n = 1), local haematoma (n = 1), and loss of sensation over T1 dermatome (n = 1). The Kaplan–Meier estimate of 5 year survival post-vertebroplasty was 40% for patients with myeloma and 25% for those with metastases. Conclusion: This large prospective study demonstrates percutaneous vertebroplasty reduces pain and improves disability in patients from intractable pain from myeloma or spinal metastases and now forms an important part of the multimodality treatment for these patients.

Impact of anticoagulation strategy with bivalirudin or heparin on nonaccess site bleeding in percutaneous coronary interventions: A meta-analysis of randomized trials

NARCIS (Netherlands)

Verdoia, M.; Barbieri, L.; Parodi, G.; Bellandi, B.; Schaffer, A.; Suryapranata, H.; Luca, G. De

2017-01-01

BACKGROUND: Transradial approach has significantly decreased the rate of access site bleeding in patients undergoing percutaneous coronary interventions (PCI), therefore potentially mitigating the benefits offered by bivalirudin in lowering major bleeding complications as compared to heparin.

Technical skill set training in natural orifice transluminal endoscopic surgery: how should we approach it?

LENUS (Irish Health Repository)

Nugent, Emmeline

2011-03-01

The boundaries in minimally invasive techniques are continually being pushed further. Recent years have brought new and exciting changes with the advent of natural orifice transluminal endoscopic surgery. With the evolution of this field of surgery come challenges in the development of new instruments and the actual steps of the procedure. Included in these challenges is the idea of developing a proficiency-based curriculum for training.

Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts

Energy Technology Data Exchange (ETDEWEB)

Sane, S.S.; Towbin, A.; Bergey, E.A.; Kaye, R.D.; Fitz, C.R.; Albright, L.; Towbin, R.B. [Department of Radiology, Children`s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213 (United States)

1998-07-01

Objective. The purpose of this study is to determine the risk of CNS and/or peritoneal infection in children with ventriculoperitoneal shunts in whom a percutaneous gastrostomy tube is placed. Materials and methods. We placed 205 gastrostomy or gastrojejunostomy tubes from January of 1991 to December 1996. Twenty-three patients (10 boys, 13 girls) had ventriculoperitoneal shunts at the time of placement. All shunts were placed at least 1 month prior to placement of the gastrostomy tube. The patients ranged in age from 8 months to 16 years with a mean age of 6 years, 9 months. Patient weight ranged from 2 kg to 60 kg. All 23 children required long-term nutritional support due to severe neurologic impairment. No prophylactic antibiotics were given prior to the procedure. Of the patients, 21/23 had a 14-F Sacks-Vine gastrostomy tube with a fixed terminal retention device inserted, using percutaneous fluoroscopic antegrade technique. Two of the 23 patients had a Ross 14-F Flexi-flo gastrostomy tube which required a retrograde technique due to a small caliber esophagus in these children. Results. All 23 children had technically successful placements of percutaneous gastrostomy (7) or gastrojejunostomy (16) tubes. Of the children, 21/23 (91 %) had no complications from the procedure. Two of 23 (9 %) patients demonstrated signs of peritonitis after placement of their gastrostomy tubes and subsequently had shunt infections. In both, children CSF culture grew gram-positive cocci. The antegrade technique was used in both children who developed peritonitis. Conclusion. Our study indicates children with ventriculoperitoneal shunts who undergo percutaneous gastrostomy are at greater risk for infection and subsequent shunt malfunction. Therefore, we recommend prophylactic antibiotic therapy to cover for skin and oral flora. (orig.) With 1 fig., 7 refs.

Second generation drug-eluting stents versus bare-metal stents for percutaneous coronary intervention of the proximal left anterior descending artery

DEFF Research Database (Denmark)

Mangione, Fernanda Marinho; Biering-Sørensen, Tor; Nochioka, Kotaro

2017-01-01

OBJECTIVES: To compare mid-term outcomes between patients undergoing proximal left anterior descending artery (LAD) percutaneous coronary intervention (PCI) with second generation drug-eluting stent (DES) or bare-metal stent (BMS). BACKGROUND: PCI with BMS and first-generation DES have shown to b...

Percutaneous coronary intervention and antiplatelet therapy in patients with atrial fibrillation receiving apixaban or warfarin: Insights from the ARISTOTLE trial

NARCIS (Netherlands)

Kopin, D.; Jones, W.S.; Sherwood, M.W.; Wojdyla, D.M.; Wallentin, L.; Lewis, B.S.; Verheugt, F.W.A.; Vinereanu, D.; Bahit, M.C.; Halvorsen, S.; Huber, K.; Parkhomenko, A.; Granger, C.B.; Lopes, R.D.; Alexander, J.H.

2018-01-01

BACKGROUND: We assessed antiplatelet therapy use and outcomes in patients undergoing percutaneous coronary intervention (PCI) during the ARISTOTLE trial. METHODS: Patients were categorized based on the occurrence of PCI during follow-up (median 1.8 years); PCI details and outcomes post-PCI are

Percutaneous Ureteral stent insertion

Energy Technology Data Exchange (ETDEWEB)

Yoon, Yup; Sung, Dong Wook; Choi, Woo Suk; Lee, Dong Ho; Ko, Young Tae; Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1990-10-15

Percutaneous ureteral stent insertion is a treatment of permanent or temporary urinary diversion to maintain continuity and function of the obstructed and injured ureter. We performed 31 cases of percutaneous double pig tall ureteral stent insertion in 21 patients, included 13 patients with malignant ureteral obstruction and eight patients with injured ureter as well as benign inflammatory stricture. Satisfactory resulted was obtained in all patients but one, who need percutaneous nephrostomy on week later for urinary diversion. No significant complication was encountered. The authors concluded that percutaneous ureteral stent insertion, an interventional procedure alternative to urologic retrograde method, is an effective method for urinary diversion.

Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST segment elevation myocardial infarction from the western denmark heart registry

DEFF Research Database (Denmark)

Antonsen, Lisbeth; Jensen, Lisette Okkels; Terkelsen, Christian Juhl

2012-01-01

BACKGROUND: Elderly patients with ST-segment elevation myocardial infarction (STEMI) constitute a particular risk group in relation to primary percutaneous coronary intervention (PPCI). OBJECTIVE: We examined the proportion of octogenarians and nonagenarians undergoing PPCI in Western Denmark...

Cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

DEFF Research Database (Denmark)

Sloth, Astrid D; Schmidt, Michael R; Munk, Kim

2016-01-01

AIMS: Remote ischaemic conditioning seems to improve long-term clinical outcomes in patients undergoing primary percutaneous coronary intervention. Remote ischaemic conditioning can be applied with cycles of alternating inflation and deflation of a blood-pressure cuff. We evaluated the cost...

Nuclear medical control of the efficiency of transluminal coronary angioplasty (TCA)

International Nuclear Information System (INIS)

Klepzig, H. Jr.; Scherer, D.; Kober, G.; Maul, F.D.; Kanemoto, N.; Standke, R.; Hoer, G.; Kaltenbach, M.; Frankfurt Univ.

1982-01-01

To assess the results of transluminal coronary angioplasty 48 patients with coronary heart disease were investigated at rest and during exercise with the ECG (46 patients), thallium-201 myocardial scintigraphy (26 patients), and equilibrium radionuclide ventriculography (38 patients). Exercise stress test was quantified by means of an ischemia score, myocardial scintigraphy by an vitality index and by corresponding redistribution factors, and radionuclide ventriculography by ejection fraction and maximum systolic volume change as a fraction of enddiastolic volume. This, the results show, that in selected cases, TCA can achieve improved left ventricular function and perfusion comparable to that of aortocoronary bypass surgery. (orig./MG) [de

Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

International Nuclear Information System (INIS)

Kaskarelis, Ioannis S.; Papadaki, Marina G.; Malliaraki, Niki E.; Robotis, Epaminondas D.; Malagari, Katerina S.; Piperopoulos, Ploutarchos N.

2001-01-01

Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures

A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial.

Science.gov (United States)

Rao, Sunil V; Hess, Connie N; Barham, Britt; Aberle, Laura H; Anstrom, Kevin J; Patel, Tejan B; Jorgensen, Jesse P; Mazzaferri, Ernest L; Jolly, Sanjit S; Jacobs, Alice; Newby, L Kristin; Gibson, C Michael; Kong, David F; Mehran, Roxana; Waksman, Ron; Gilchrist, Ian C; McCourt, Brian J; Messenger, John C; Peterson, Eric D; Harrington, Robert A; Krucoff, Mitchell W

2014-08-01

This study sought to determine the effect of radial access on outcomes in women undergoing percutaneous coronary intervention (PCI) using a registry-based randomized trial. Women are at increased risk of bleeding and vascular complications after PCI. The role of radial access in women is unclear. Women undergoing cardiac catheterization or PCI were randomized to radial or femoral arterial access. Data from the CathPCI Registry and trial-specific data were merged into a final study database. The primary efficacy endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding or vascular complications requiring intervention. The primary feasibility endpoint was access site crossover. The primary analysis cohort was the subgroup undergoing PCI; sensitivity analyses were conducted in the total randomized population. The trial was stopped early for a lower than expected event rate. A total of 1,787 women (691 undergoing PCI) were randomized at 60 sites. There was no significant difference in the primary efficacy endpoint between radial or femoral access among women undergoing PCI (radial 1.2% vs. 2.9% femoral, odds ratio [OR]: 0.39; 95% confidence interval [CI]: 0.12 to 1.27); among women undergoing cardiac catheterization or PCI, radial access significantly reduced bleeding and vascular complications (0.6% vs. 1.7%; OR: 0.32; 95% CI: 0.12 to 0.90). Access site crossover was significantly higher among women assigned to radial access (PCI cohort: 6.1% vs. 1.7%; OR: 3.65; 95% CI: 1.45 to 9.17); total randomized cohort: (6.7% vs. 1.9%; OR: 3.70; 95% CI: 2.14 to 6.40). More women preferred radial access. In this pragmatic trial, which was terminated early, the radial approach did not significantly reduce bleeding or vascular complications in women undergoing PCI. Access site crossover occurred more often in women assigned to radial access. (SAFE-PCI for Women; NCT01406236). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc

Pleural space infections after image-guided percutaneous drainage of infected intraabdominal fluid collections: a retrospective single institution analysis.

Science.gov (United States)

Avella, Diego M; Toth, Jennifer W; Reed, Michael F; Gusani, Niraj J; Kimchi, Eric T; Mahraj, Rickeshvar P; Staveley-O'Carroll, Kevin F; Kaifi, Jussuf T

2015-04-11

Percutaneous drainage of infected intraabdominal fluid collections is preferred over surgical drainage due to lower morbidity and costs. However, it can be a challenging procedure and catheter insertion carries the potential to contaminate the pleural space from the abdomen. This retrospective analysis demonstrates the clinical and radiographic correlation between percutaneous drainage of infected intraabdominal collections and the development of iatrogenic pleural space infections. A retrospective single institution analysis of 550 consecutive percutaneous drainage procedures for intraabdominal fluid collections was performed over 24 months. Patient charts and imaging were reviewed with regard to pleural space infections that were attributed to percutaneous drain placements. Institutional review board approval was obtained for conduct of the study. 6/550 (1.1%) patients developed iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections. All 6 patients presented with respiratory symptoms and required pleural space drainage (either by needle aspiration or chest tube placement), 2 received intrapleural fibrinolytic therapy and 1 patient had to undergo surgical drainage. Pleural effusion cultures revealed same bacteria in both intraabdominal and pleural fluid in 3 (50%) cases. A video with a dynamic radiographic sequence demonstrating the contamination of the pleural space from percutaneous drainage of an infected intraabdominal collection is included. Iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections occur at a low incidence, but the pleural empyema can be progressive requiring prompt chest tube drainage, intrapleural fibrinolytic therapy or even surgery. Expertise in intraabdominal drain placements, awareness and early recognition of this complication is critical to minimize incidence, morbidity and mortality in these patients.

Pneumoperitoneum Caused by Air Leakage Through the Percutaneous Puncture Tract as a Complication of Rendezvous Technique: A Case Report

Directory of Open Access Journals (Sweden)

Chiao-Hsiung Chuang

2008-11-01

Full Text Available The rendezvous technique, combining percutaneous and endoscopic procedures, is a safe and effective method to achieve biliary cannulation if an endoscopic approach fails. The two procedures in this technique can be carried out simultaneously or in stages. A simultaneous approach is reported to be associated with fewer complications, and patients undergoing this approach can recover and be discharged more rapidly. Here, we report a complication of pneumoperitoneum in a patient who underwent percutaneous and endoscopic procedures simultaneously for the removal of a common bile duct stone. It was supposed that prolonged air insufflation during endoscopy forced intestinal air to track into the peritoneal cavity through the bile ducts and the puncture tract. Accordingly, a short wait before removing the percutaneous catheter to deflate the intestinal air will be helpful to avoid such a complication.

Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention

OpenAIRE

Baschet, Louise; Bourguignon, Sandrine; Marque, S?bastien; Durand-Zaleski, Isabelle; Teiger, Emmanuel; Wilquin, Fanny; Levesque, Karine

2016-01-01

Objective To determine the cost-effectiveness of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients requiring a percutaneous coronary intervention in France, using a recent meta-analysis including second-generation DES. Methods A cost-effectiveness analysis was performed in the French National Health Insurance setting. Effectiveness settings were taken from a meta-analysis of 117?762 patient-years with 76 randomised trials. The main effectiveness criterion was major c...

Prevention of Contrast-Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

DEFF Research Database (Denmark)

Busch, Sarah Victoria Ekeløf; Jensen, Svend Eggert; Rosenberg, Jacob

2012-01-01

-acetylcysteine, one study of early and late hydration regimens, one study of recombinant human brain natriuretic peptide and one study comparing a low-osmolar contrast agent with an iso-osmolar contrast agent. Results: Recombinant human brain natriuretic peptide and the regimens of hydration significantly reduced...... the incidence of CIN and administration of N-acetylcysteine in one of the six studies significantly reduced the occurrence of CIN. The iso-osmolar contrast agent was not proven to be superior to the low-osmolar contrast agent in terms of preventing CIN. Conclusion: Preliminary studies are promising but further......Objective: To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac...

Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study

DEFF Research Database (Denmark)

Bonde, Lisbeth; Sorensen, Rikke; Fosbøl, Emil Loldrup

2010-01-01

We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI).......We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI)....

Contemporary Antithrombotic Treatment in Patients with Non-valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Rationale and Design of the Greek AntiPlatElet Atrial Fibrillation (GRAPE-AF) Registry.

Science.gov (United States)

Xanthopoulou, Ioanna; Dragona, Vasiliki-Maria; Davlouros, Periklis; Tsioufis, Costas; Iliodromitis, Efstathios; Alexopoulos, Dimitrios

2018-04-20

Approximately 5 to 7% of patients undergoing percutaneous coronary intervention (PCI) for the treatment of coronary artery disease require chronic oral anticoagulation (OAC) on top of aspirin and a P2Y 12 receptor antagonist, mainly due to non-valvular atrial fibrillation (AF). The advent of non-vitamin K antagonist oral anticoagulants (NOACs) increased treatment options, while there is cumulative evidence that dual combination of a NOAC and a P2Y 12 receptor antagonist attenuates risk of bleeding, compared to traditional triple therapy, consisting of a vitamin K antagonist (VKA), aspirin, and a P2Y 12 receptor antagonist, without significantly compromising efficacy. Greek AntiPlatElet Atrial Fibrillation (GRAPE-AF, NCT 03362788) is an observational, nationwide study of non-valvular AF patients undergoing PCI, planning to enroll over 1-year period > 500 participants in 25 tertiary and non-tertiary PCI centers in Greece. Key data to be collected pre-discharge include demographics, detailed past medical history, and antithrombotic and concomitant treatment. Patients will be followed up at 1, 6, and 12 months post hospital discharge. Αt each follow-up visit, data on antithrombotic treatment, ischemic, bleeding, and adverse events will be collected. Study's primary endpoint is clinically significant bleeding (Bleeding Academic Research Consortium, BARC ≥ 2) at 12 months, between VKAs and NOACs-treated patients, analyzed using Cox proportional hazards models, by an intention-to-treat principle. An independent endpoint committee will adjudicate all clinical events. This study aims at providing "real-world" information on current antithrombotic treatment patterns and clinical outcome of patients with non-valvular AF undergoing PCI.

Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

Energy Technology Data Exchange (ETDEWEB)

Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

2003-02-01

AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

International Nuclear Information System (INIS)

Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C.

2003-01-01

AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127

Early Stent Thrombosis and Mortality After Primary Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction

DEFF Research Database (Denmark)

Dangas, George D; Schoos, Mikkel M.; Steg, Philippe Gabriel

2016-01-01

BACKGROUND: Early stent thrombosis (ST) within 30 days after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction is a serious event. We sought to determine the predictors of and risk of mortality after early ST according to procedural antithrombotic therapy...... with bivalirudin compared with heparin±GPI because of increased ST within 4 hours after primary percutaneous coronary intervention. However, the mortality attributable to early ST was significantly lower after bivalirudin than after heparin±GPI. CLINICAL TRIAL REGISTRATION: URL: http....... METHODS AND RESULTS: In a patient-level pooled analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trials, we examined 30-day outcomes in 4935 patients undergoing primary...

Interest of Electrostimulation of Peripheral Motor Nerves during Percutaneous Thermal Ablation

International Nuclear Information System (INIS)

Tsoumakidou, Georgia; Garnon, Julien; Ramamurthy, Nitin; Buy, Xavier; Gangi, Afshin

2013-01-01

Purpose: We present our experience of utilizing peripheral nerve electrostimulation as a complementary monitoring technique during percutaneous thermal ablation procedures; and we highlight its utility and feasibility in the prevention of iatrogenic neurologic thermal injury. Methods: Peripheral motor nerve electrostimulation was performed in 12 patients undergoing percutaneous image-guided thermal ablations of spinal/pelvic lesions in close proximity to the spinal cord and nerve roots. Electrostimulation was used in addition to existing insulation (active warming/cooling with hydrodissection, passive insulation with CO 2 insufflation) and temperature monitoring (thermocouples) techniques. Impending neurologic deficit was defined as a visual reduction of muscle response or need for a stronger electric current to evoke muscle contraction, compared with baseline. Results: Significant reduction of the muscle response to electrostimulation was observed in three patients during the ablation, necessitating temporary interruption, followed by injection of warm/cool saline. This resulted in complete recovery of the muscle response in two cases, while for the third patient the response did not improve and the procedure was terminated. No patient experienced postoperative motor deficit. Conclusion: Peripheral motor nerve electrostimulation is a simple, easily accessible technique allowing early detection of impending neurologic injury during percutaneous image-guided thermal ablation. It complements existing monitoring techniques and provides a functional assessment along the whole length of the nerve

Interest of Electrostimulation of Peripheral Motor Nerves during Percutaneous Thermal Ablation

Energy Technology Data Exchange (ETDEWEB)

Tsoumakidou, Georgia, E-mail: gtsoumakidou@yahoo.com; Garnon, Julien, E-mail: juliengarnon@gmail.com; Ramamurthy, Nitin, E-mail: nitin_ramamurthy@hotmail.com; Buy, Xavier, E-mail: xbuy@ymail.com; Gangi, Afshin, E-mail: gangi@unistra.fr [University Hospital of Strasbourg (France)

2013-12-15

Purpose: We present our experience of utilizing peripheral nerve electrostimulation as a complementary monitoring technique during percutaneous thermal ablation procedures; and we highlight its utility and feasibility in the prevention of iatrogenic neurologic thermal injury. Methods: Peripheral motor nerve electrostimulation was performed in 12 patients undergoing percutaneous image-guided thermal ablations of spinal/pelvic lesions in close proximity to the spinal cord and nerve roots. Electrostimulation was used in addition to existing insulation (active warming/cooling with hydrodissection, passive insulation with CO{sub 2} insufflation) and temperature monitoring (thermocouples) techniques. Impending neurologic deficit was defined as a visual reduction of muscle response or need for a stronger electric current to evoke muscle contraction, compared with baseline. Results: Significant reduction of the muscle response to electrostimulation was observed in three patients during the ablation, necessitating temporary interruption, followed by injection of warm/cool saline. This resulted in complete recovery of the muscle response in two cases, while for the third patient the response did not improve and the procedure was terminated. No patient experienced postoperative motor deficit. Conclusion: Peripheral motor nerve electrostimulation is a simple, easily accessible technique allowing early detection of impending neurologic injury during percutaneous image-guided thermal ablation. It complements existing monitoring techniques and provides a functional assessment along the whole length of the nerve.

Impact of triple antithrombotic therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention in real-world practice

NARCIS (Netherlands)

Yan, Yan; Wang, Xiao; Fan, Jing-Yao; Nie, Shao-Ping; Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Henriques, Jose P. Simao; D'Ascenzo, Fabrizio; Saucedo, Jorge; González-Juanatey, José R.; Wilton, Stephen B.; Kikkert, Wouter J.; Nuñez-Gil, Iván; Ariza-Sole, Albert; Song, Xian-Tao; Alexopoulos, Dimitrios; Liebetrau, Christoph; Kawaji, Tetsuma; Moretti, Claudio; Huczek, Zenon; Fujii, Toshiharu; Correia, Luis Cl; Kawashiri, Masa-Aki; Kedev, Sasko

2017-01-01

The optimal antithrombotic regimen for patients on oral anticoagulation (OAC) after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI) remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world

Temporal changes in the outcomes of patients with diabetes mellitus undergoing percutaneous coronary intervention in the National Heart, Lung, and Blood Institute dynamic registry.

Science.gov (United States)

Holper, Elizabeth M; Abbott, J Dawn; Mulukutla, Suresh; Vlachos, Helen; Selzer, Faith; McGuire, Darren; Faxon, David P; Laskey, Warren; Srinivas, Vankeepuram S; Marroquin, Oscar C; Jacobs, Alice K

2011-02-01

Patients with diabetes mellitus (DM) are at higher risk for adverse outcomes following percutaneous coronary intervention (PCI). To determine whether outcomes have improved over time, we analyzed data from 2,838 consecutive patients with medically treated DM, including 1,066 patients (37.6%) treated with insulin, in the National Heart, Lung, and Blood Institute Dynamic Registry undergoing PCI registered in waves 1 (1997-1998), 2 (1999), 3 (2001-2002), 4 (2004), and 5 (2006). We compared baseline demographics and 1-year outcomes in the overall cohort and in analyses stratified by recruitment wave and insulin use. Crude mortality rates by chronological wave were 9.5%, 12.5%, 8.9%, 11.6%, and 6.6% (P value(trend) = .33) among those treated with insulin and, respectively, 9.7%, 6.5%, 4.1%, 5.4%, and 4.7% (P value(trend) = .006) among patients treated with oral agents,. The adjusted hazard ratios of death, myocardial infarction (MI), and overall major adverse cardiovascular events (death, MI, revascularization) in insulin-treated patients with DM in waves 2 to 5 as compared with wave 1 were either higher or the same. In contrast, the similar adjusted hazard ratios for oral agent-treated patients with DM were either similar or lower. Significant improvements over time in adverse events by 1 year were detected in patients with DM treated with oral agents. In insulin-treated diabetic patients, despite lower rates of repeat revascularization over time, death and MI following PCI have not significantly improved. These findings underscore the need for continued efforts at optimizing outcomes among patients with DM undergoing PCI, especially those requiring insulin treatment. Copyright © 2011 Mosby, Inc. All rights reserved.

QRS Score at Presentation Electrocardiogram Is Correlated With Infarct Size and Mortality in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

Science.gov (United States)

Shiomi, Hiroki; Kosuge, Masami; Morimoto, Takeshi; Watanabe, Hiroki; Taniguchi, Tomohiko; Nakatsuma, Kenji; Toyota, Toshiaki; Yamamoto, Erika; Shizuta, Satoshi; Tada, Tomohisa; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Kimura, Kazuo; Kimura, Takeshi

2017-07-25

In ST-segment elevation myocardial infarction (STEMI), QRS score at presentation ECG may reflect the progression of infarction and facilitate prediction of the degree of myocardial salvage achieved by reperfusion therapy.Methods and Results:Admission electrocardiogram (ECG) was studied in 2,607 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptom onset. Patients were classified into 3 groups according to QRS score: low (0-3, n=1,227), intermediate (4-7, n=810), and high (≥8, n=570). An increase of infarct size estimated by median peak creatine phosphokinase was observed as QRS score increased (low score, 1,836 IU/L; inter-quartile range (IQR), 979-3,190 IU/L; intermediate score, 2,488 IU/L; IQR, 1,126-4,640 IU/L; high score, 3,454 IU/L; IQR, 1,759-5,639 IU/L; P<0.001). Higher QRS score was associated with higher long-term mortality (low, intermediate, and high score, 15.6%, 19.7%, and 23.7% at 5 years, respectively; log-rank P<0.001). The positive relationship of QRS score with mortality was consistently seen when stratified by infarct location. The association of high QRS score with increased mortality was most remarkably seen in patients with early (≤2 h) presentation (low, intermediate, and high score: 16.7%, 16.6%, and 28.1% at 5 years, respectively; log-rank P<0.001). Higher QRS score at presentation ECG was associated with larger infarct size, and higher long-term mortality in patients with STEMI undergoing primary PCI. QRS score appears to be important in the early risk stratification for STEMI.

Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation

Energy Technology Data Exchange (ETDEWEB)

Uflacker, A., E-mail: andreuflacker@gmail.com; Sheeran, D., E-mail: dsheeran9@gmail.com; Khaja, M., E-mail: mkhaja@mac.com [University of Virginia/Interventional Radiology (United States); Patrie, J., E-mail: jp4h@virginia.edu [UVA Health System/Radiology (United States); Elias, G., E-mail: gae2y@virginia.edu [VCU Medical Center/Radiology (United States); Saad, W., E-mail: wspikes@yahoo.com [University of Michigan Health System (United States)

2015-06-15

PurposeThis study was designed o evaluate outcomes of percutaneous management of anastomotic ureteral strictures in renal transplants using nephroureteral stents with or without balloon dilatation.MethodsA retrospective audit of 1,029 consecutive renal transplants was performed. Anastomotic ureteral strictures were divided into two groups: nephroureteral stent only (NUS) and NUS+PTA (nephroureteral stent plus percutaneous transluminal angioplasty), with each cohort subdivided into early versus late presentation (obstructive uropathy occurring <90 day or >90 days from transplant, respectively). Overall and 6-month technical success were defined as removal of NUS any time with <30 % residual stenosis (any time lapse less or more than 6 months) and at >6 months, respectively. Patency was evaluated from NUS removal to last follow-up for both groups and compared.ResultsSixty-seven transplant patients with 70 ureteric anastomotic strictures (6.8 %, n = 70/1,029) underwent 72 percutaneous treatments. 34 % were late (>90 days, n = 24/70), and 66 % were early (<90 days, n = 46/70). Overall technical success was 82 % (n = 59/72) and 6-month success was 58 % (n = 42/72). Major and minor complications were 2.8 % (n = 2/72), and 12.5 % (n = 9/72). NUS+PTA did not improve graft survival (p = 0.354) or patency (p = 0.9) compared with NUS alone. There was no difference in graft survival between treated and nontreated groups (p = 0.74).ConclusionsThere is no advantage to PTA in addition to placement of NUS, although PTA did not negatively impact graft survival or long-term patency and both interventions were safe and effective. Neither the late or early groups benefited from PTA in addition to NUS. Earlier obstructions showed greater improvement in serum creatinine than later obstructions.

[Acetylsalicylic acid desensitization in the new era of percutaneous coronary intervention].

Science.gov (United States)

Fuertes Ferre, Georgina; Ferrer Gracia, Maria Cruz; Calvo Cebollero, Isabel

2015-09-21

Dual antiplatelet therapy is essential in patients undergoing percutaneous coronary intervention with stent implantation. Hypersensitivity to acetylsalicylic acid (ASA) limits treatment options. Desensitization to ASA has classically been studied in patients with respiratory tract disease. Over the last years, many protocols have been described about ASA desensitization in patients with ischemic heart disease, including acute coronary syndrome and the need for coronary stent implantation. It is important to know the efficacy and safety of ASA desensitization in these patients. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Preoperative percutaneous cranial nerve mapping in head and neck surgery.

Science.gov (United States)

Park, Jung I

2003-01-01

To identify and map the course of the peripheral branches of the cranial nerve preoperatively and percutaneously. Prospective study. Preoperative percutaneous nerve mapping performed prior to the operation under deep sedation or general anesthesia without muscle paralysis. Private office surgery suite, freestanding surgery center, and regional medical centers. A total of 142 patients undergoing head and neck surgery and facial plastic surgery between August 1994 and July 1999. Monopolar probe was used for nerve stimulation. Electromyographic reading was done through intramuscular bipolar recording electrodes. The equipment used was a nerve monitor. The mandibular divisions were tested in 142 cases, the frontal division in 60 cases, the accessory nerve in 12 cases, and the hypoglossal nerve in 3 cases. Satisfactory mappings were obtained in 115 cases of the mandibular division, 49 cases of the frontal division, 8 cases of the accessory division, and 1 case of the hypoglossal nerve. Preoperative percutaneous nerve mapping is a new method of identifying the location of the peripheral branches of the cranial nerves. Identifying and mapping the course of peripheral branches of the cranial nerves safely assists the head and neck surgeon in the placement of incisions in a favorable location and in the dissection of the area involving the nerves. Mapping alerts the surgeon to an area containing a nerve and allows the surgeon to avoid just the specific area where a nerve is present, preventing large-scale abandonment of unmapped areas for fear of potential nerve damage.

Balloon Angioplasty - The Legacy of Andreas Grüntzig, M.D. (1939-1985).

Science.gov (United States)

Barton, Matthias; Grüntzig, Johannes; Husmann, Marc; Rösch, Josef

2014-01-01

In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939-1985) for the first time applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure, which he initially called "percutaneous transluminal dilatation". Balloon angioplasty as a therapy of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920-1985) received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the twentieth century. Known today as percutaneous transluminal angioplasty (PTA) in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40(th) anniversary of balloon angioplasty, we summarize Grüntzig's life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter's first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, António Egas Moniz and Reynaldo dos Santos in Portugal, Sven-Ivar Seldinger in Sweden, and Barney Brooks, Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes by Grüntzig and excerpts from his unfinished autobiography, statements of Grüntzig's former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials. This year, on June 25, 2014, Andreas Grüntzig would have celebrated his 75(th

Balloon Angioplasty – The Legacy of Andreas Grüntzig, M.D. (1939–1985)

Science.gov (United States)

Barton, Matthias; Grüntzig, Johannes; Husmann, Marc; Rösch, Josef

2014-01-01

In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939–1985) for the first time applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure, which he initially called “percutaneous transluminal dilatation”. Balloon angioplasty as a therapy of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920–1985) received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the twentieth century. Known today as percutaneous transluminal angioplasty (PTA) in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40th anniversary of balloon angioplasty, we summarize Grüntzig’s life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter’s first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, António Egas Moniz and Reynaldo dos Santos in Portugal, Sven-Ivar Seldinger in Sweden, and Barney Brooks, Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes by Grüntzig and excerpts from his unfinished autobiography, statements of Grüntzig’s former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials. This year, on June 25, 2014, Andreas Grüntzig would have celebrated

Percutaneous intervention in obstructive

International Nuclear Information System (INIS)

Souftas, V.

2012-01-01

Percutaneous intervention procedures in obstructive uropathy include percutaneous nephrostomy tube placements, nephroureteral stents, percutaneous nephrostomy combined with ureteral embolization, percutaneous management of stone disease, suprapubic tube placements into the bladder, and perinephric/retroperitoneal urinomas/abscesses drainages. Percutaneous nephrostomy is performed to relieve urinary obstruction or divert the urinary stream away from the ureter or bladder. Patients are given preprocedure antibiotics. Percutaneous nephrostomies can be emergent cases because of risk of pyuria and sepsis from a stagnant urine collection. The procedure is performed using both ultrasound and fluoroscopy (or fluoroscopy alone using anatomic landmarks, or an internal radiopaque calculus, or delayed phase excretion of the contrast into the renal collecting system) under local anesthesia or conscious sedation. Ureteral stents are placed to bypass an obstructing stone or to stent across of an area of stricture or ureteral laceration. Stents may be placed by the urologist via a transurethral approach or by the interventional radiologist via a percutaneous approach. The decision as to method of stent placement is based upon the location and accessibility of the ureteral pathology. Ureteral embolization is performed in patients with unresectable tumors of the pelvis with long-standing nephrostomy tubes and distal urine leaks refractory to other treatments. Coils, gelfoam and liquid embolic materials can be used. Ureteral embolization for ureteral fistulas and incontinence is technically successful in 100% of the patients. Complications include bleeding, infection, ureteral or renal injury, and deployment (or movement) of the coils within the renal pelvis. Percutaneous management of stone disease, including renal, ureteral, and bladder stones requires close cooperation between the urologist and interventional radiologist, because of availability of sonographic lithotripsy

Transluminal recanalization of chronic total occlusion of radial artery using rendezvous technique: a case report and literature review.

Science.gov (United States)

Arabi, Mohammad; Ahmed, Ishtiaq; Qattan, Nabeel

2014-01-01

Although endovascular management of lower extremity peripheral arterial disease (PAD) is well studied, little information exists regarding endovascular treatment of critical upper limb ischemia. We report a case of transluminal recanalization of right radial artery chronic total occlusion (CTO) using rendezvous technique in a patient with critical hand ischemia and dry gangrene of the right index finger.

The novel echo-guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation.

Science.gov (United States)

Honda, Yohsuke; Araki, Motoharu; Yamawaki, Masahiro; Tokuda, Takahiro; Tsutumi, Masakazu; Mori, Shinsuke; Sakamoto, Yasunari; Kobayashi, Norihiro; Hirano, Keisuke; Ito, Yoshiaki

2018-04-01

The aim of this study was to assess clinical benefit of the Echo-guided ProGlide technique in patients undergoing percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI). The efficacy of the Echo-guided ProGlide technique during percutaneous TF-TAVI was not previously clarified. A total of 121 consecutive patients who underwent percutaneous TF-TAVI at our institution between February 2014 and July 2017 were enrolled in this study. According to the introduction of this novel technique in March 2016, patients were divided into two groups (echo-guided group who underwent TAVI from March 2016 to July 2017, n = 63; not echo-guided group who underwent TAVI from February 2014 to February 2016, n = 58). The incidence of major vascular complications, defined per the Valve Academic Research Consortium-2 criteria, and ProGlide complications including acute femoral artery stenosis or occlusion and bleeding requiring any intervention. The incidence of major vascular complication and ProGlide complication were significantly lower in the echo-guided group than in not echo-guided group (1.6% vs 17.2%, P guided ProGlide technique was independently associated with prevention of ProGlide complications (odds ratio, 0.11; 95% confidential interval, 0.01-0.76; P = 0.03). This novel Echo-guided ProGlide technique was associated with a lower rate of major vascular complications, particularly ProGlide complications during percutaneous TF-TAVI. © 2017, Wiley Periodicals, Inc.

Impact of abciximab in elderly patients with high-risk acute coronary syndrome undergoing percutaneous coronary intervention: an observational registry study

DEFF Research Database (Denmark)

Iversen, Allan Z; Galatius, Soeren; Haahr-Pedersen, Sune Ammentorp

2011-01-01

BACKGROUND: An increasing proportion of patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI) are classified as elderly (aged =70 years). The glycoprotein IIb/IIIa inhibitor abciximab is known to reduce adverse outcomes in patients aged

1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention

DEFF Research Database (Denmark)

Piccolo, Raffaele; Eitel, Ingo; Galasso, Gennaro

2016-01-01

BACKGROUND: Diabetic patients are at increased risk for future cardiovascular events after ST-segment elevation myocardial infarction (STEMI). Administration of an intracoronary abciximab bolus during primary percutaneous coronary intervention (PCI) may be beneficial in this high-risk subgroup.......68 to 1.33; p = 0.77), resulting in a significant interaction (p = 0.034). Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs. 11.2%; HR: 0.51; 95% CI: 0.26 to 0.98; p = 0.043) and definite/probable stent thrombosis...

Percutaneous transhepatic biliary drainage

International Nuclear Information System (INIS)

Park, Jae Hyung; Hong, Seong Mo; Han, Man Chung

1982-01-01

Percutaneous transhepatic biliary drainage was successfully made 20 times on 17 patients of obstructive jaundice for recent 1 year since June 1981 at Department of Radiology in Seoul National University Hospital. The causes of obstructive jaundice was CBD Ca in 13 cases, metastasis in 2 cases, pancreatic cancer in 1 case and CBD stone in 1 case. Percutaneous transhepatic biliary drainage is a relatively ease, safe and effective method which can be done after PTC by radiologist. It is expected that percutaneous transhepatic biliary drainage should be done as an essential procedure for transient permanent palliation of obstructive jaundice

Design and Rationale for the Endothelin-1 Receptor Antagonism in the Prevention of Microvascular Injury in Patients with non-ST Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention (ENDORA-PCI) Trial.

Science.gov (United States)

Liou, Kevin; Jepson, Nigel; Buckley, Nicolas; Chen, Vivien; Thomas, Shane; Russell, Elizabeth Anne; Ooi, Sze-Yuan

2016-04-01

Peri-procedural myocardial infarction (PMI) occurs in a small but significant portion of patients undergoing percutaneous intervention (PCI). The underlying mechanisms are complex and may include neurohormonal activation and release of vasoactive substances resulting in disruption of the coronary microcirculation. Endothelin in particular has been found in abundance in atherosclerotic plaques and in systemic circulation following PCI, and may be a potential culprit for PMI through its action on microvascular vasoconstriction, and platelet and neutrophil activation. In this study we aim to characterize the behavior of the coronary microcirculation during a PCI with the index of microvascular resistance (IMR) and the effect of peri-procedural endothelin antagonism. The ENDORA-PCI trial is a randomized, double-blind, placebo-controlled, single-center clinical trial designed to evaluate the efficacy of endothelin antagonism in attenuating the peri-procedural rise in IMR as a surrogate marker for PMI. The patients of interest are those with non-ST elevation acute coronary syndrome (NSTEACS) undergoing PCI, and we aim to recruit 52 patients overall to give the study a power of 80 % at an α level of 5 %. Patients will be randomized in a 1:1 fashion to either Ambrisentan, an endothelin antagonist, or placebo, prior to their PCI. IMR will be measured before and after PCI. The primary endpoint is the difference in peri-procedural changes in patients' IMR between the two groups. The ENDORA-PCI study will investigate whether endothelin antagonism with Ambrisentan attenuates the peri-procedural rise in IMR in patients with NSTEACS undergoing PCI, and thus potentially the risk of PMI.

Effect of Supine vs Prone Position on Outcomes of Percutaneous Nephrolithotomy in Staghorn Calculi: Results From the Clinical Research Office of the Endourology Society Study

DEFF Research Database (Denmark)

Astroza, Gaston; Lipkin, Michael; Neisius, Andreas

2013-01-01

To analyze the effect of patient positioning on outcomes of percutaneous nephrolithotomy (PNL) among patients with staghorn stones. The choice of optimal position for these patients undergoing PNL remains challenging. No previous studies exclusively addressing this point have been performed....

Relationship between blood viscosity and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Science.gov (United States)

Cecchi, Emanuele; Liotta, Agatina Alessandriello; Gori, Anna Maria; Valente, Serafina; Giglioli, Cristina; Lazzeri, Chiara; Sofi, Francesco; Gensini, Gian Franco; Abbate, Rosanna; Mannini, Lucia

2009-05-15

Previous studies explored the association between hemorheological alterations and acute myocardial infarction, pointing out the role of hematological components on microvascular flow. The aim of this study was to evaluate the association between blood viscosity and infarct size, estimated by creatine kinase (CK) peak activity and cardiac Troponin I (cTnI) peak concentration in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI). The study population included 197 patients with diagnosis of STEMI undergoing PCI. Hemorheological studies were performed by assessing whole blood viscosity (measured at shear rates of 0.512 s(-1) and 94.5 s(-1)) and plasma viscosity using the Rotational Viscosimeter LS 30 and erythrocyte deformability index by Myrenne filtrometer. Significant correlations between CK peak activity, cTnI peak concentration, left ventricular ejection fraction and hemorheological variables were observed. At linear regression analysis (adjusted for age, gender, traditional cardiovascular risk factors, renal dysfunction, timeliness of reperfusion, pre-PCI TIMI flow, infarct location, multivessel disease and previous coronary artery disease) leukocytes and whole blood viscosity at 0.512 s(-1) and 94.5 s(-1) were independently and positively associated with infarct size. These results demonstrate a significant and independent association between hemorheology and infarct size in STEMI patients after PCI suggesting that blood viscosity, in a condition of low flow, might worsen myocardial perfusion leading to an increased infarct size. The measurement of whole blood viscosity in STEMI patients could help to identify those who may benefit from new therapeutic strategies.

Transluminal Recanalization of Chronic Total Occlusion of Radial Artery Using Rendezvous Technique: A Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Mohammad Arabi

2014-01-01

Full Text Available Although endovascular management of lower extremity peripheral arterial disease (PAD is well studied, little information exists regarding endovascular treatment of critical upper limb ischemia. We report a case of transluminal recanalization of right radial artery chronic total occlusion (CTO using rendezvous technique in a patient with critical hand ischemia and dry gangrene of the right index finger.

Central venous obstruction in hemodialysis patients: the usefulness of percutaneous treatment

International Nuclear Information System (INIS)

Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul

2002-01-01

To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. In 100 patients, 107 central venous strictures (56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23,stenosis:28)) were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion was also determined. We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2-and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required

Percutaneous anterior C1/2 transarticular screw fixation: salvage of failed percutaneous odontoid screw fixation for odontoid fracture

OpenAIRE

Wu, Ai-Min; Jin, Hai-Ming; Lin, Zhong-Ke; Chi, Yong-Long; Wang, Xiang-Yang

2017-01-01

Background The objective of this study is to investigate the outcomes and safety of using percutaneous anterior C1/2 transarticular screw fixation as a salvage technique for odontoid fracture if percutaneous odontoid screw fixation fails. Methods Fifteen in 108 odontoid fracture patients (planned to be treated by percutaneous anterior odontoid screw fixation) were failed to introduce satisfactory odontoid screw trajectory. To salvage this problem, we chose the percutaneous anterior C1/2 trans...

The Effect of Peritubal Infiltration with Bupivacaine and Morphine on Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

Directory of Open Access Journals (Sweden)

Isra Karaduman

2017-01-01

Full Text Available Objective. We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption in patients who underwent percutaneous nephrolithotomy. Material and Methods. Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL, in Group P (n=66, infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue, and skin under fluoroscopy. In Group C (n=64, none of the patients received a peritubal injection. In the first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands, and postoperative complications were compared between groups. Results. The mean VAS score at postoperative 8, 12, and 24 h and dynamic VAS score at postoperative 4, 8, 12, and 24 h were significantly lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand was significantly longer in Group P. Conclusion. Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption.

An Intestinal Occlusion Device for Prevention of Small Bowel Distention During Transgastric Natural Orifice Transluminal Endoscopic Surgery

OpenAIRE

Tomasko, Jonathan M.; Mathew, Abraham; Moyer, Matthew T.; Haluck, Randy S.; Pauli, Eric M.

2013-01-01

Background and Objectives: Bowel distention from luminal gas insufflation reduces the peritoneal operative domain during natural orifice transluminal endoscopic surgery (NOTES) procedures, increases the risk for iatrogenic injury, and leads to postoperative patient discomfort. Methods: A prototype duodenal occlusion device was placed in the duodenum before NOTES in 28 female pigs. The occlusion balloon was inflated and left in place during the procedure, and small bowel distension was subject...

A review on the status of natural orifice transluminal endoscopic surgery (NOTES cholecystectomy: techniques and challenges

Directory of Open Access Journals (Sweden)

Michael C Meadows

2010-09-01

Full Text Available Michael C Meadows1,3, Ronald S Chamberlain1,2,31Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA; 3Saint George’s University, School of Medicine, West Indies, GrenadaIntroduction: The evolution of techniques for the performance of a cholecystectomy over the last 25 years has been swift. The laparoscopic approach is now the gold standard for removal of the gall bladder and is the most frequently performed minimally invasive procedure globally. Currently in its infancy stage, natural orifice transluminal endoscopy surgery, or NOTES, is purported to be the next leap forward in minimally invasive approaches. The safety, feasibility, and effectiveness of this procedure, as well as the significance of potential benefits to patients beyond current surgical approaches are yet undetermined.Methods: A comprehensive literature search was conducted using PubMed, a search engine ­created by the National Library of Medicine. Keywords used in the search included “natural orifice transluminal endoscopic surgery”, “NOTES”, “cholecystectomy”, “transcolonic”, “transvaginal”, and “transgastric”. The accumulated literature was critically analyzed and reviewed.Results: One-hundred and eighty-six cases of NOTES cholecystectomies have been published to date. Of these, 174 have been performed through a transvaginal approach. The remainder of the procedures were performed transgastrically. There are no published reports of ­transcolonic cholecystectomies performed in humans. Four of 186 cases (2.15% were converted to traditional laparoscopy due to intraoperative complications. No significant complications or mortalities have been reported.Conclusion: NOTES cholecystectomy appears to be a feasible procedure. However, technical, safety, and ethical issues remain relatively unresolved. Besides improved cosmesis, whether additional

Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

NARCIS (Netherlands)

Muinck, Ebo Derk de

1994-01-01

In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

Preoperative endoscopic versus percutaneous transhepatic biliary drainage in potentially resectable perihilar cholangiocarcinoma (DRAINAGE trial): design and rationale of a randomized controlled trial.

Science.gov (United States)

Wiggers, Jimme K; Coelen, Robert J S; Rauws, Erik A J; van Delden, Otto M; van Eijck, Casper H J; de Jonge, Jeroen; Porte, Robert J; Buis, Carlijn I; Dejong, Cornelis H C; Molenaar, I Quintus; Besselink, Marc G H; Busch, Olivier R C; Dijkgraaf, Marcel G W; van Gulik, Thomas M

2015-02-14

Liver surgery in perihilar cholangiocarcinoma (PHC) is associated with high postoperative morbidity because the tumor typically causes biliary obstruction. Preoperative biliary drainage is used to create a safer environment prior to liver surgery, but biliary drainage may be harmful when severe drainage-related complications deteriorate the patients' condition or increase the risk of postoperative morbidity. Biliary drainage can cause cholangitis/cholecystitis, pancreatitis, hemorrhage, portal vein thrombosis, bowel wall perforation, or dehydration. Two methods of preoperative biliary drainage are mostly applied: endoscopic biliary drainage, which is currently used in most regional centers before referring patients for surgical treatment, and percutaneous transhepatic biliary drainage. Both methods are associated with severe drainage-related complications, but two small retrospective series found a lower incidence in the number of preoperative complications after percutaneous drainage compared to endoscopic drainage (18-25% versus 38-60%, respectively). The present study randomizes patients with potentially resectable PHC and biliary obstruction between preoperative endoscopic or percutaneous transhepatic biliary drainage. The study is a multi-center trial with an "all-comers" design, randomizing patients between endoscopic or percutaneous transhepatic biliary drainage. All patients selected to potentially undergo a major liver resection for presumed PHC are eligible for inclusion in the study provided that the biliary system in the future liver remnant is obstructed (even if they underwent previous inadequate endoscopic drainage). Primary outcome measure is the total number of severe preoperative complications between randomization and exploratory laparotomy. The study is designed to detect superiority of percutaneous drainage: a provisional sample size of 106 patients is required to detect a relative decrease of 50% in the number of severe preoperative

Percutaneous transhepatic sphincterotomy

International Nuclear Information System (INIS)

Gandin, G.; Zanon, E.; Righi, D.; Fonio, P.; Ferrari, A.; Recchia, S.

1990-01-01

The authors describe the techique employed for percutaneous trans-hepatic sphincterotomy as performed on 3 patients with common bile duct (CBD) stones. In all patients, previous endoscopic attempt had failed for anatomical reasons (Billroth II gastric resection or partial gastric resection with brown anastomosis), and the ampulla could not be correctly incannulated with the sphincterotome. In all aptients endoscopy was useful to check the position of the diethermic loop inserted percutaneously. Conplete and immediate success was obtained in all 3 cases. No major complications occurred during transhepatic treatment. To date, 1 recurrence has been observed, and the patient has been retreated with bilioplasty. All patients were followed after 5-6 months with US, plain X-rays of the abdomen and blood tests (γGt, alkaline phosphatase, and bilirubinemia). The authors suggest that percutaneous transhepatic sphincterotomy be employed electively in patients with biliary tree diseases in case the endoscopic approach failes

Comparison of usefulness of N-terminal pro-brain natriuretic peptide as an independent predictor of cardiac function among admission cardiac serum biomarkers in patients with anterior wall versus nonanterior wall ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Science.gov (United States)

Haeck, Joost D E; Verouden, Niels J W; Kuijt, Wichert J; Koch, Karel T; Van Straalen, Jan P; Fischer, Johan; Groenink, Maarten; Bilodeau, Luc; Tijssen, Jan G P; Krucoff, Mitchell W; De Winter, Robbert J

2010-04-15

The purpose of the present study was to determine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), among other serum biomarkers, on cardiac magnetic resonance (CMR) imaging parameters of cardiac function and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We measured NT-pro-BNP, cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and creatinine on the patients' arrival at the catheterization laboratory in 206 patients with ST-segment elevation myocardial infarction. The NT-pro-BNP levels were divided into quartiles and correlated with left ventricular function and infarct size measured by CMR imaging at 4 to 6 months. Compared to the lower quartiles, patients with nonanterior wall myocardial infarction in the highest quartile of NT-pro-BNP (> or = 260 pg/ml) more often had a greater left ventricular end-systolic volume (68 vs 39 ml/m(2), p pro-BNP level of > or = 260 pg/ml was the strongest independent predictor of left ventricular ejection fraction in patients with nonanterior wall myocardial infarction compared to the other serum biomarkers (beta = -5.8; p = 0.019). In conclusion, in patients with nonanterior wall myocardial infarction undergoing primary percutaneous coronary intervention, an admission NT-pro-BNP level of > or = 260 pg/ml was a strong, independent predictor of left ventricular function assessed by CMR imaging at follow-up. Our findings suggest that NT-pro-BNP, a widely available biomarker, might be helpful in the early risk stratification of patients with nonanterior wall myocardial infarction. Copyright 2010 Elsevier Inc. All rights reserved.

Percutaneous management of tumoral biliary obstruction in children

Energy Technology Data Exchange (ETDEWEB)

Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe School of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Ekinci, Saniye [Hacettepe School of Medicine, Department of Paediatric Surgery, Sihhiye, Ankara (Turkey); Akcoren, Zuhal [Hacettepe School of Medicine, Department of Paediatric Pathology, Sihhiye, Ankara (Turkey); Kutluk, Tezer [Hacettepe School of Medicine, Department of Paediatric Oncology, Sihhiye, Ankara (Turkey)

2007-10-15

There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

Percutaneous management of tumoral biliary obstruction in children

International Nuclear Information System (INIS)

Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan; Ekinci, Saniye; Akcoren, Zuhal; Kutluk, Tezer

2007-01-01

There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

DEFF Research Database (Denmark)

Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe

2015-01-01

The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11......,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST......-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p clinical...

Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

Energy Technology Data Exchange (ETDEWEB)

Manenti, Guglielmo; Perretta, Tommaso; Gaspari, Eleonora; Pistolese, Chiara A.; Scarano, Lia; Cossu, Elsa; Simonetti, Giovanni; Masala, Salvatore [University Hospital ' ' Tor Vergata' ' , Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Rome (Italy); Bonanno, Elena [University Hospital ' ' Tor Vergata' ' , Department of Biopathology, Rome (Italy); Buonomo, Oreste C.; Petrella, Giuseppe [University Hospital ' ' Tor Vergata' ' , Department of General Surgery Division, Rome (Italy)

2011-11-15

To assess the ablative effectiveness, the oncological and cosmetic efficacy of image-guided percutaneous cryoablation in the treatment of single breast nodules with subclinical dimensions after identification with ultrasonography (US), mammography, magnetic resonance (MRI) and characterization by vacuum assisted biopsy. Fifteen women with a mean age of 73 {+-} 5 years (range 64-82 years) and lesion diameter of 8 {+-} 4 mm were undergoing cryotherapy technology with a single probe under US-guidance associated with intra-procedural lymph-node mapping and excision of the sentinel node. All the patients underwent surgical resection (lumpectomy) from 30 to 45 days after the percutaneous ablation. The iceball size generated by the cryoprobe during the procedure at minus 40 C was 16 x 41 mm. In 14 of the 15 patients was observed a complete necrosis of the cryo-ablated lesion both in post-procedural MRI follow-up and anatomo-pathological evaluation after surgical resection. In one case there was a residual disease in post-procedural MRI and postoperative histological examination, probably justified by an incorrect positioning of the probe. The percutaneous cryoablation as a ''minimally invasive'' technique can provide excellent oncological and cosmetic results on selected cases handled by experienced operators by using the tested devices. (orig.)

Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

International Nuclear Information System (INIS)

Manenti, Guglielmo; Perretta, Tommaso; Gaspari, Eleonora; Pistolese, Chiara A.; Scarano, Lia; Cossu, Elsa; Simonetti, Giovanni; Masala, Salvatore; Bonanno, Elena; Buonomo, Oreste C.; Petrella, Giuseppe

2011-01-01

To assess the ablative effectiveness, the oncological and cosmetic efficacy of image-guided percutaneous cryoablation in the treatment of single breast nodules with subclinical dimensions after identification with ultrasonography (US), mammography, magnetic resonance (MRI) and characterization by vacuum assisted biopsy. Fifteen women with a mean age of 73 ± 5 years (range 64-82 years) and lesion diameter of 8 ± 4 mm were undergoing cryotherapy technology with a single probe under US-guidance associated with intra-procedural lymph-node mapping and excision of the sentinel node. All the patients underwent surgical resection (lumpectomy) from 30 to 45 days after the percutaneous ablation. The iceball size generated by the cryoprobe during the procedure at minus 40 C was 16 x 41 mm. In 14 of the 15 patients was observed a complete necrosis of the cryo-ablated lesion both in post-procedural MRI follow-up and anatomo-pathological evaluation after surgical resection. In one case there was a residual disease in post-procedural MRI and postoperative histological examination, probably justified by an incorrect positioning of the probe. The percutaneous cryoablation as a ''minimally invasive'' technique can provide excellent oncological and cosmetic results on selected cases handled by experienced operators by using the tested devices. (orig.)

Safety and efficacy of everolimus-eluting stents compared with first-generation drug-eluting stents in patients undergoing primary percutaneous coronary intervention

Energy Technology Data Exchange (ETDEWEB)

Escárcega, Ricardo O.; Baker, Nevin C.; Magalhaes, Marco A.; Lipinski, Michael J.; Minha, Sa’ar; Torguson, Rebecca; Satler, Lowell F.; Pichard, Augusto D.; Suddath, William O.; Waksman, Ron, E-mail: ron.waksman@medstar.net

2014-09-15

Objective: To assess the safety and efficacy everolimus-eluting stents (EES) compared with first-generation drug-eluting stents (DES) in patients with acute myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI). Background: EES have been associated with improved clinical outcomes compared to paclitaxel-eluting stents (PES) and with similar outcomes compared to sirolimus-eluting stents (SES). Methods: A total of 520 patients who presented with ST-elevation myocardial infarction (STEMI) from 2003 to 2013, who underwent primary PCI with DES, were retrospectively analyzed. Of these, 247 received SES, 136 PES, and 137 EES. Patients were followed up to 2 years for major adverse cardiac events (MACE). Univariate and multivariate models detected correlates to outcome. Results: EES implantation, compared with PES and SES, resulted in comparable rates of MACE (8.8% vs. 16.2%, p = 0.06 and 8.8% vs. 12.6%, respectively, p = 0.26), stent thrombosis, MI, and target lesion revascularization. Patients who received EES had lower rates of all-cause mortality (3.7% vs. 12.6% vs. 9.4%, p = 0.03) at 1-year follow up. However, in the univariate and multivariate analyses, stent type was not independently associated with the primary outcome or with all-cause mortality. Diabetes mellitus and number of stents implanted were independently associated with the primary outcome. Conclusion: While EES seem to be associated with better outcome when compared to PES, the main correlates of STEMI patients are the presence of diabetes and number of stents implanted, and not the type of stent used for intervention.

Transluminal radio-frequency thermal ablation using a stent-type electrode: an experimental study

Energy Technology Data Exchange (ETDEWEB)

Kim, Young Sun; Rhim, Hyun Chul [Hanyang University College of Medicine, Seoul (Korea, Republic of); Song, Ho Young [Asan Medical Center, Seoul (Korea, Republic of)] [and others

2003-06-01

To assess the feasibility of transluminal radiofrequency thermal ablation using a stent-type electrode and to determine, by means of in-vivo and in-vivo animal studies, the appropriate parameters. In-vivo: the radiofrequency electrode used was a self-expandable nitinol stent with 1cm insulated ends. A stent was placed in the portal vein of bovine liver, and ablations at target temperatures of 70, 80, 90, and 100 .deg. C were performed. Ablated sizes were measured longitudinally. In vivo: four mongrel dogs were anesthetized, and a stent was inserted in the common bile duct under fluoroscopic guidance through an ultrasound-guided gall bladder puncture site. The ablation temperature was set at 80 .deg. C, and each dog underwent proximal and distal esophageal ablations lasting 12 minutes. They were sacrificed immediately. In-vivo: ablated sizes showed significant correlation with target temperatures (r>0.04; p<0.05). Although most lesions were fusiform, dumbbell-shaped lesions with central thinning were found in two cases in the 70 .deg. C group. In all cases in the 70 .deg. C and 80 .deg. C group, the length of the insulated segment was less than 1cm. In-vivo: at microscopy, tissues at the center of the biliary stent showed more prominent pathological change than those at the periphery while those remote from the stent showed minimal or no change. In esophageal ablations, the mean highest temperature was 48.6 .deg. C. Microscopy demonstrated the destruction and shedding of mucosa, edema, and coagulation necrosis of submucosa, but in muscle layers no abnormalities were apparent. Transluminal radio-frequency thermal ablation using a stent-type electrode may be useful for elongating patency. The appropriate target temperature for biliary ablation is 80 .deg. C.

Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)-Results of the FERARI study.

Science.gov (United States)

Becher, Tobias; Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula; Mashayekhi, Kambis; Borggrefe, Martin; Akin, Ibrahim

2016-12-01

Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose-area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8min, p=0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p=0.826), procedural duration (46.0 vs. 45.0min, p=0.363) and contrast agent use (185.5 vs. 199.5ml, p=0.742) were also similar in radial and femoral PCI. There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

Transluminal angioplasty of a stenotic surgical splenorenal shunt

International Nuclear Information System (INIS)

Beers, B. van; Roche, A.; Cauquil, P.

1988-01-01

A stenosis of a side-to-side splenorenal shunt was treated by percutaneous angioplasty two years after the performance of the shunt. After dilatation, there was a fall of the splenorenal pressure gradient from 28 to 17 cm H 2 O and good transanastomotic flow was re-estabilshed. As in other arterial and venous territories, angioplasty may be an interesting alternative to surgery. (orig.)

Predictive Value of Plasma Glucose Level on Admission for Short and Long Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

NARCIS (Netherlands)

Hoebers, Loes P.; Damman, Peter; Claessen, Bimmer E.; Vis, Marije M.; Baan, Jan; van Straalen, Jan P.; Fischer, Johan; Koch, Karel T.; Tijssen, Jan G. P.; de Winter, Robbert J.; Piek, Jan J.; Henriques, Jose P. S.

2012-01-01

Published reports describe a strong association between plasma glucose levels on admission and mortality in patients who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. The aim of this study was to assess the predictive value of admission glucose

Pheripheral Simpson atherectomy

International Nuclear Information System (INIS)

Kueffer, G.

1990-01-01

A report is given on the experience acquired to date with a new catheter method (Simpson atherectomy, S-AE) for reducing arteriosclerotic stenoses in the pelvic and leg arteries of 47 patients. If the correct instrument size is selected, one can regularly perform complete atherectomies in femoropopliteal vessels. The result of recanalization is not affected by the form of the stenosis, but eccentric, calcified or ulcerated lesions are ideal indications. Percutaneous transluminal angioplasty and atherectomy can be used as complementary methods to optimize, percutaneous peripheral vascular recanalization. The histological findings, methodological limitations, and clinical results are discussed. (orig.) [de

The use of nitrates in the prevention of contrast-induced nephropathy in patients hospitalized after undergoing percutaneous coronary intervention.

Science.gov (United States)

Peguero, Julio G; Cornielle, Vertilio; Gomez, Sabas I; Issa, Omar M; Heimowitz, Todd B; Santana, Orlando; Goldszer, Robert C; Lamas, Gervasio A

2014-05-01

Contrast-induced nephropathy (CIN) is a significant cause of morbidity and mortality and effective strategies for its prevention are greatly needed. The purpose of this retrospective, single-center study was to investigate whether nitrate use during percutaneous coronary artery intervention reduces the incidence of CIN. Chart review of all individuals who underwent percutaneous coronary intervention (PCI) from April 2010 to March 2011 was done. Included in the study were patients who were admitted to the hospital after percutaneous coronary artery intervention and had baseline and follow-up creatinine measured. Patients with end-stage renal disease requiring dialysis and those patients with insufficient information to calculate Mehran score were excluded. There were 199 patients who met the eligibility criteria for inclusion in this study. In the identified population, postprocedure renal function was compared between 112 patients who received nitrates prior to coronary intervention and 87 who did not. Baseline characteristics were similar between the 2 groups. Contrast-induced nephropathy was defined as either a 25% or a 0.5 mg/dL, or greater, increase in serum creatinine during the first 48 to 72 hours after contrast exposure. Overall, 43 (21.6%) patients developed CIN post-PCI. Of the patients who received nitrates, 15.2% developed renal impairment when compared to 29.9% in those who did not (odds ratio [OR] = 0.42, 95% confidence interval [CI] 0.21-0.84, P = .014). Multivariate logistic regression analysis demonstrated that nitrate use was independently correlated with a reduction in the development of contrast nephropathy (OR = 0.334, 95% CI 0.157-0.709, P = .004). Additionally, of the various methods of nitrate administration, intravenous infusion was shown to be the most efficacious route in preventing renal impairment (OR = 0.42, 95% CI 0.20-0.90, P = .03). In conclusion, the use of nitrates prior to PCI, particularly intravenous nitroglycerin infusion, may

Palliative Percutaneous Jejunal Stent for Patients with Short Bowel Syndrome

Directory of Open Access Journals (Sweden)

Satoru Takayama

2009-04-01

Full Text Available Gastrointestinal obstruction is a common preterminal event in patients with gastric and pancreatic cancer who often undergo palliative bypass surgery. Although endoscopic palliation with self-expandable metallic stents has emerged as a safe and effective alternative to surgery, experience with this technique remains limited. In particular, a proximal jejunal obstruction requires more technical expertise than a duodenal obstruction. Palliative treatment modalities include both surgical and nonsurgical approaches. In this report, we describe the successful placement of self-expandable metallic stents at the proximal jejunum using a combination of percutaneous endoscopic, intraoperative, and transstomal stenting. Usually endoscopy is not indicated in cases of proximal jejunal obstruction, but some cases may require palliative endoscopy instead of bypass operation.

Indications for percutaneous nephrostomy in patients with obstructive uropathy due to malignant urogenital neoplasias

Directory of Open Access Journals (Sweden)

Frederico R. Romero

2005-04-01

Full Text Available INTRODUCTION: Urogenital neoplasias frequently progress with obstructive uropathy due to local spreading or pelvic metastases. The urinary obstruction must be immediately relieved in order to avoid deterioration in these patients. The percutaneous nephrostomy is a safe and effective method for relief the obstruction; however the indications of such procedures have been questioned in patients with poor prognosis. MATERIAL AND METHODS: A retrospective study was performed with 43 patients (29 female and 14 male with urogenital neoplasias who were undergoing percutaneous nephrostomy during a 54-month period. The median age was 52 years. The primary tumoral site was the uterine cervix in 53.5% of patients, the bladder in 23.3%, the prostate in 11.6% and other sites in 11.6%. RESULTS: Postoperative complications occurred in 42.3% of the patients. There was no procedure-related mortality. Thirty-nine per cent of the patients died during the hospitalization period due to advanced neoplasia. The mortality rate was higher in patients with prostate cancer (p = 0.006, in patients over 52 years of age (p = 0.03 and in those who required hemodialysis before the procedure (p = 0.02. Thirty-two per cent of the patients survived long enough to undergo some form of treatment focused on the primary tumor. The survival rate was 40% at 6 months and 24.2% at 12 months. The percentage of the lifetime spent in hospitalization was 17.7%. The survival rate was higher in patients with neoplasia of the uterine cervix (p = 0.007 and in patients with 52 years of age or less (p = 0.008. CONCLUSION: Morbidity was high in this patient group; however, the majority of patients could be discharged from hospital and followed at home. Patients under 52 years of age and patients with neoplasia of the uterine cervix benefited most from the percutaneous nephrostomy when compared to patients with hormone therapy-refractory prostate cancer, bladder cancer or over 52 years of age.

Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized, controlled trial examining renal function.

Science.gov (United States)

Smith, R C; Pooley, M; George, C R; Faithful, G R

1985-06-01

Thirty patients with obstructive jaundice with plasma bilirubin values greater than 200 mumol/L were randomized at the time of percutaneous transhepatic Cholangiography to undergo immediate or delayed surgery. The patients who had preoperative percutaneous transhepatic biliary drainage (PTBD) for 13.8 +/- 5.8 days had fewer surgical complications than did patients who underwent immediate surgery (p less than 0.02), although when the complications of PTBD were included this advantage was diminished. Immediate surgery caused greater deterioration of renal function as measured by plasma urea, plasma B 2-microglobulin, phosphate clearance, uric acid clearance, and maximal concentrating ability than occurred after PTBD or delayed surgery. The improvement in phosphate clearance that followed PTBD was sustained through delayed surgical treatment, indicating better tubular function in these patients. This article supports the concept that preoperative PTBD will reduce surgical morbidity and will result in less renal impairment than will immediate surgery. However, the morbidity rates of the PTBD procedure will preclude its wide use.

A retrospective matched cohort study evaluating the effects of percutaneous endoscopic gastrostomy feeding tubes on nutritional status and survival in patients with advanced gastroesophageal malignancies undergoing systemic anti-cancer therapy.

Science.gov (United States)

Mitchell, Scott; Williams, John P; Bhatti, Harsimrandeep; Kachaamy, Toufic; Weber, Jeffrey; Weiss, Glen J

2017-01-01

Many patients with cancer or other systemic illnesses can experience malnutrition. One way to mitigate malnutrition is by insertion of a percutaneous endoscopic gastrostomy feeding tube (PEG tube). The goal of this retrospective matched cohort study is to evaluate if PEG tube placement improved nutritional status and overall survival (OS) in advanced gastroesophageal (GE) cancer patients who are undergoing anti-neoplastic therapy. GE cancer patients who were treated and evaluated by a nutritionist and had at least 2 nutritionist follow-up visits were identified. Patients with PEG tube were matched to patients that did not undergo PEG placement (non-PEG). Clinical characteristics, GE symptoms reported at nutrition follow-up visits, and OS were recorded. 20 PEG and 18 non-PEG cases met criteria for further analyses. After correction for multiple testing, there were no OS differences between PEG and non-PEG, treatment naive and previously treated. However, PEG esophageal carcinoma has statistically significant inferior OS compared with non-PEG esophageal carcinoma. PEG placement did not significantly reduce the proportion of patients with weight loss between the initial nutrition assessment and 12-week follow-up. In this small study, PEG placement had inferior OS outcome for GE esophageal carcinoma, no improvement in OS for other evaluated groups, and did not reduce weight loss between baseline and 12-week follow-up. Unless there is prospective randomized trial that can show superiority of PEG placement in this population, PEG placement in this group cannot be endorsed.

Safe percutaneous suprapubic catheterisation.

Science.gov (United States)

Goyal, N K; Goel, A; Sankhwar, S N

2012-11-01

We describe our technique of percutaneous suprapubic catheter insertion with special reference to steps that help to avoid common complications of haematuria and catheter misplacement. The procedure is performed using a stainless steel reusable trocar under local infiltrative anaesthesia, usually at the bedside. After clinical confirmation of a full bladder, the trocar is advanced into the bladder through a skin incision. Once the bladder is entered, the obturator is removed and the assistant inserts a Foley catheter followed by rapid balloon inflation. Slight traction is applied to the catheter for about five minutes. Patients with previous lower abdominal surgery, an inadequately distended bladder or acute pelvic trauma do not undergo suprapubic catheterisation using this method. The procedure was performed in 72 men (mean age: 42.4 years, range: 18-78 years) with urinary retention with a palpable bladder. The average duration of the procedure was less than five minutes. No complications were noted in any of the patients. Trocar suprapubic catheter insertion is a safe and effective bedside procedure for emergency bladder drainage and can be performed by resident surgeons. The common complications associated with the procedure can be avoided with a few careful steps.

Anthropometric Renal Anatomic Alterations Between Supine and Prone Positions in Percutaneous Renal Ablation for Renal Cortical Neoplasms.

Science.gov (United States)

Lusch, Achim; Fujimoto, Scott; Findeiss, Laura K; Okhunov, Zhamshid; McDougall, Elspeth M; Landman, Jaime

2016-02-01

To establish patterns of anatomic changes relevant to the kidney and colon during positional change between the supine and prone positions as noted on CT scans performed during percutaneous cryoablation for renal cortical neoplasms (RCN). Nineteen patients undergoing percutaneous cryoablation for RCN with abdominal CT scan in both the supine and prone positions were included in the study. We documented the anterior/posterior, medial/lateral, and cranial/caudal anatomic changes of the kidney, kidney rotation, and the proportion of the kidney whose access was limited by the liver, spleen, and lung. We also calculated the length of the percutaneous access tract and the distance between the colon and kidney in hilar position as well as the anterior/posterior location of the colon relative to the kidney. In the prone position, the kidney lies significantly more anteriorly on both sides: 4.7 cm vs 4.3 cm (L) and 4.4 cm vs 4.1 cm (R) (p = 0.02 and p = 0.03, respectively). On prone CT images, both kidneys are more cranial when compared with the supine position: 80.4 mm vs 60.8 mm (L) and 87.2 mm vs 57.4 mm (R) (p = 0.002 and p anatomic alterations between supine and prone CT imaging. The changes associated with the prone position modify percutaneous access, particularly for right upper pole tumors. Prone imaging before surgery may be helpful in selected cases.

Clinical utility of new bleeding criteria: a prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention.

Science.gov (United States)

Choi, Jae-Hyuk; Seo, Jeong-Min; Lee, Dong Hyun; Park, Kyungil; Kim, Young-Dae

2015-04-01

The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI). The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of multiple trials and registries. All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians. A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type ≥2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type ≥2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (pdefinition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Effectiveness of prophylactic percutaneous endoscopic gastrostomy for oropharyngeal cancer patients undergoing concurrent chemoradiotherapy

International Nuclear Information System (INIS)

Teshima, Masanori; Tanimoto, Hitoshi; Saito, Miki; Otsuki, Naoki; Sasaki, Ryohei; Kiyota, Naomi; Okuno, Shinya; Nibu, Ken-ichi

2009-01-01

Patients with head and neck carcinoma are often provided concurrent chemoradiotherapy (CCRT), but they experience severe mucositis and dysphagia. These side effects can lead to decreased oral intake, resulting in interruption of treatment. In our hospital, from September 2007, all patients with oropharyngeal cancer who were to receive CCRT, were principally offered percutaneous endoscopic gastrostomy (PEG) before the start of treatment, and tube feeding was started when swallowing became impaired, to accomplish the treatment as planned. To evaluate the effect of prophylactic PEG, outcome measures in this study included the frequency of unplanned break from CCRT, nutritional deterioration and required analgesic during CCRT, complication of PEG, and patient satisfaction between 15 patients with PEG and 11 patients without PEG as a control group. Although no significant weight loss occurred in either group, there were fewer patients with a Body Mass Index <18.5 in the PEG group after CCRT than in the control group. Regarding the treatment, most patients were satisfied with their PEG and considered that prophylactic PEG was necessary and helpful in completing the CCRT. This study suggests that prophylactic PEG helps patients to complete CCRT both mentally and nutritionally. (author)

Percutaneous penetration studies for risk assessment

DEFF Research Database (Denmark)

Sartorelli, Vittorio; Andersen, Helle Raun; Angerer, Jürgen

2000-01-01

. In order to predict the systemic risk of dermally absorbed chemicals and to enable agencies to set safety standards, data is needed on the rates of percutaneous penetration of important chemicals. Standardization of in vitro tests and comparison of their results with the in vivo data could produce...... internationally accepted penetration rates and/or absorption percentages very useful for regulatory toxicology. The work of the Percutaneous Penetration Subgroup of EC Dermal Exposure Network has been focussed on the standardization and validation of in vitro experiments, necessary to obtain internationally...... accepted penetration rates for regulatory purposes. The members of the Subgroup analyzed the guidelines on percutaneous penetration in vitro studies presented by various organizations and suggested a standardization of in vitro models for percutaneous penetration taking into account their individual...

Behandling af renovaskulær hypertension med transluminal angioplastik--13 års erfaring--sekundærpublikation

DEFF Research Database (Denmark)

Øvrehus, Kristian Altern; Andersen, Poul Erik; Jacobsen, Ib Abildgaard

2008-01-01

angioplasty. A total of 124 patients were treated; 31% were normotensive immediately after angioplasty, 59% had improved blood pressure control and 10% had unchanged hypertension. The corresponding figures after six months and at the latest follow-up were 13, 72 and 15%. Udgivelsesdato: 2008-Jan-21......The result of treatment of renovascular hypertension by renal angioplasty over a period of 13 years was analysed. Patients with a positive diagnostic work-up with renography or renal vein renin measurement had renal angiography performed and in cases of renal artery stenosis, transluminal...

抚触对缓解椎间盘激光汽化术中患者疼痛的作用%Effects of therapeutic touch on the intraoperative pain in patients undergoing percutaneous laser disk decompression

Institute of Scientific and Technical Information of China (English)

徐素华; 孙业安; 吴汉玉

2009-01-01

Objective To evaluate the effects of therapeutic touch on the pain in patients being undergoing percutaneous laser disk decompression. Methods Ninety-one patients undergoing pereutaneous laser disk decompression were randomly as-signed to therapeutic touch group and routine care group. The intraoperative pain was assessed at the end of operation. Result There was significant difference in the level of pain between the two groups(P<0.05). Conclusion Therapeutie touch can alleviate intraoperative pain in patients undergoing percutuneous laser disk decompression.%目的 探讨抚触对缓解椎间盘激光汽化术中患者疼痛的作用.方法 将91例接受椎间盘激光汽化术的患者随机分为观察组和对照组,对照组接受常规护理,观察组术中接受护士实施的抚触,手术结束时评估两组患者术中疼痛程度.结果 观察组患者与对照组相比,术中疼痛程度降低,差异有统计学意义(P<0.05).结论 抚触能缓解患者椎间盘激光汽化术中疼痛程度,有利于手术顺利进行.

Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention

Directory of Open Access Journals (Sweden)

Xiangfei Wang

2014-01-01

Full Text Available Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.

The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

OpenAIRE

Gulmez, Oyku; Atar, Ilyas; Ozin, B?lent; Korkmaz, Mehmet Emin; Atar, Asli; Aydinalp, Alp; Yildirir, Aylin; Muderrisoglu, Haldun

2008-01-01

Background: Use of intracoronary calcium channel blockers (CCBs) during percutaneous coronary intervention (PCI) has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB) levels in patients undergoing elective PCI. Methods: A total of 570 patients who underwent PCI were evaluated for CK-MB elevation. Patients who were on CCB therapy when admitted to the hospital constituted the CCB group. ...

Percutaneous vertebroplasty (pv): indications, contraindications, and technique

International Nuclear Information System (INIS)

Hoffmann, R.T.; Jakobs, T.F.; Wallnoefer, A.; Reiser, M.F.; Helmberger, T.K.

2003-01-01

Percutaneous vertebroplasty (pv) is a worldwide increasingly performed interventional therapeutic procedure. This article addresses indications, patient preparation, technical requirements and approach as well as possible complications of percutaneous vertebroplasty. Percutaneous vertebroplasty is a technique consisting in an injection of bone cement into a vertebral body under imaging guidance. This procedure is performed to relief pain and support the mechanical stability in partially collapsed vertebral bodies. In the management of spinal compression fractures secondary to osteoporosis, myeloma, osteolytic metastases and aggressive hemangiomas, percutaneous vertebroplasty yields analgesic effect, and provides additional fortification in weakened segments of the vertebral column. Contraindications include major bleeding disorders, radicular pain and pain caused by compression of the myelon. Percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, using correct technique, pv is a safe and effective procedure for treating pain, caused either by osteoporotic or malignant vertebral compression fractures. (orig.) [de

[Developments in percutaneous coronary intervention and coronary stents].

Science.gov (United States)

Simsek, C; Daemen, J; Zijlstra, F

2014-01-01

In The Netherlands, more than 30.000 patients undergo a percutaneous coronary intervention every year, during which a coronary stent implantation will be performed in 90% of the cases. It is estimated that more than 5 million coronary stent implantations will be performed worldwide this year. While these numbers are impressive, however, coronary stents still have as a limitation the possibility of stent thrombosis. This has been and is an important stimulus for the development of both coronary stents, from a bare metal stent via a drug eluting stent to the present-day development of bio-absorbable stents, and anti-platelet drugs,from acenocoumarol to thieropyridines. The possibility of shortening the period of use of this powerful medication by developing new kinds of non-thrombogenic stents would, for example, make it possible to achieve significant reductions in subsequent bleeding during (dental) procedures.

Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review.

Science.gov (United States)

van Brussel, Peter M; van de Hoef, Tim P; de Winter, Robbert J; Vogt, Liffert; van den Born, Bert-Jan

2017-05-22

Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional coronary lesions, hyperemic measurements have earned a place in daily practice for clinical decision making, allowing discrimination between solitary coronary lesions and diffuse microvascular disease. Next to differences in clinical characteristics, the selection of renal arteries suitable for intervention is currently on the basis of anatomic grading of the stenosis by angiography rather than functional assessment under hyperemia. It is conceivable that, like the coronary circulation, functional measurements may better predict therapeutic efficacy of percutaneous transluminal renal angioplasty with stent placement. In this systematic review, the authors evaluate the available clinical evidence on the optimal hyperemic agents to induce intrarenal hyperemia, their association with anatomic grading, and their predictive value for treatment effects. In addition, the potential value of combined pressure and flow measurements to discriminate macrovascular from microvascular disease is discussed. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The Erasme Study: A Multicenter Study on the Safety and Technical Results of the Palmaz Stent Used for the Treatment of Atherosclerotic Ostial Renal Artery Stenosis

International Nuclear Information System (INIS)

Bakker, Jeannette; Goffette, Pierre P.; Henry, Michel; Mali, Willem P.T.M.; Melki, Jean-Pierre; Moss, Jon G.; Rabbia, Claudio; Therasse, Eric; Thomson, Kenneth R.; Thurnher, Siegfried; Vignali, Claudio

1999-01-01

Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis. Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up. Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5-18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated. Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up

Percutaneous treatment of liver hydatid cysts

Energy Technology Data Exchange (ETDEWEB)

Akhan, Okan; Oezmen, Mustafa N

1999-10-01

Hydatic disease caused by Echinococcus granulosus is an endemic disease and an important public health problem in some countries of the world. The results of surgical treatment are associated with a high rate of mortality, morbidity, postoperative recurrence and a long period of hospital stay and the medical treatment results are still controversial. Although the percutaneous aspiration and treatment of liver hydatid cysts were considered to be contraindicated due to risks of anaphylactic shock and dissemination of clear-crystal fluid into the abdomen, several reports of successful percutaneous treatment of liver hydatid cysts have been published in the literature. Today, percutaneous treatment of liver hydatid cysts is the most effective and reliable treatment procedure in the selected cases. In this review, indications, contraindications, method and techniques, healing criteria, complications, results and importance of the percutaneous treatment of liver hydatid cysts are discussed.

Percutaneous treatment of liver hydatid cysts

International Nuclear Information System (INIS)

Akhan, Okan; Oezmen, Mustafa N.

1999-01-01

Hydatic disease caused by Echinococcus granulosus is an endemic disease and an important public health problem in some countries of the world. The results of surgical treatment are associated with a high rate of mortality, morbidity, postoperative recurrence and a long period of hospital stay and the medical treatment results are still controversial. Although the percutaneous aspiration and treatment of liver hydatid cysts were considered to be contraindicated due to risks of anaphylactic shock and dissemination of clear-crystal fluid into the abdomen, several reports of successful percutaneous treatment of liver hydatid cysts have been published in the literature. Today, percutaneous treatment of liver hydatid cysts is the most effective and reliable treatment procedure in the selected cases. In this review, indications, contraindications, method and techniques, healing criteria, complications, results and importance of the percutaneous treatment of liver hydatid cysts are discussed

A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia.

Science.gov (United States)

Singh, Vishwajeet; Sinha, Rahul Janak; Sankhwar, S N; Malik, Anita

2011-01-01

A prospective randomized study was executed to compare the surgical parameters and stone clearance in patients who underwent percutaneous nephrolithotomy (PNL) under combined spinal-epidural anesthesia (CSEA) versus those who underwent PNL under general anesthesia (GA). Between January 2008 to December 2009, 64 patients with renal calculi were randomized into 2 groups and evaluated for the purpose of this study. Group 1 consisted of patients who underwent PNL under CSEA and Group 2 consisted of patients who underwent PNL under GA. The operative time, stone clearance rate, visual pain analog score, mean analgesic dose and mean hospital stay were compared amongst other parameters. The difference between visual pain analog score after the operation and the dose of analgesic requirement was significant on statistical analysis between both groups. PNL under CSEA is as effective and safe as PNL under GA. Patients who undergo PNL under CESA require lesser analgesic dose and have a shorter hospital stay. Copyright © 2011 S. Karger AG, Basel.

Correlation of Admission Heart Rate With Angiographic and Clinical Outcomes in Patients With Right Coronary Artery ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: HORIZONS-AMI (The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial.

Science.gov (United States)

Kosmidou, Ioanna; McAndrew, Thomas; Redfors, Björn; Embacher, Monica; Dizon, José M; Mehran, Roxana; Ben-Yehuda, Ori; Mintz, Gary S; Stone, Gregg W

2017-07-19

Bradycardia on presentation is frequently observed in patients with right coronary artery ST-segment elevation myocardial infarction, but it is largely unknown whether it predicts poor angiographic or clinical outcomes in that patient population. We sought to determine the prognostic implications of admission heart rate (AHR) in patients with ST-segment elevation myocardial infarction and a right coronary artery culprit lesion. We analyzed 1460 patients with ST-segment elevation myocardial infarction and a right coronary artery culprit lesion enrolled in the randomized HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial who underwent primary percutaneous coronary intervention. Patients presenting with high-grade atrioventricular block were excluded. Outcomes were examined according to AHR range (AHR 100 beats per minute). Angiographic analysis showed no significant association between AHR and lesion location or complexity. On multivariate analysis, admission bradycardia (AHR ST-segment elevation myocardial infarction and a right coronary artery culprit lesion undergoing primary percutaneous coronary intervention, admission bradycardia was not associated with increased mortality or major adverse cardiac events at 1 year. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00433966. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Duodenal perforation during percutaneous nephrolithotomy (PCNL ...

African Journals Online (AJOL)

A. Bansal

2016-06-03

Jun 3, 2016 ... Calculus;. Duodenum;. Injury;. Paediatric;. Percutaneous nephrolithotomy. Abstract. Introduction: Colonic perforations are known complications of percutaneous nephrolithotomy (PCNL). However, to the best of our knowledge, small bowel perforation has rarely been reported.. Observation: We report the ...

The New York State risk score for predicting in-hospital/30-day mortality following percutaneous coronary intervention.

Science.gov (United States)

Hannan, Edward L; Farrell, Louise Szypulski; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Stamato, Nicholas J; Sharma, Samin; King, Spencer B

2013-06-01

This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality. Risk scores are simplified linear scores that provide clinicians with quick estimates of patients' short-term mortality rates for informed consent and to determine the appropriate intervention. Earlier PCI risk scores were based on in-hospital mortality. However, for PCI, a substantial percentage of patients die within 30 days of the procedure after discharge. New York's Percutaneous Coronary Interventions Reporting System was used to develop an in-hospital/30-day logistic regression model for patients undergoing PCI in 2010, and this model was converted into a simple linear risk score that estimates mortality rates. The score was validated by applying it to 2009 New York PCI data. Subsequent analyses evaluated the ability of the score to predict complications and length of stay. A total of 54,223 patients were used to develop the risk score. There are 11 risk factors that make up the score, with risk factor scores ranging from 1 to 9, and the highest total score is 34. The score was validated based on patients undergoing PCI in the previous year, and accurately predicted mortality for all patients as well as patients who recently suffered a myocardial infarction (MI). The PCI risk score developed here enables clinicians to estimate in-hospital/30-day mortality very quickly and quite accurately. It accurately predicts mortality for patients undergoing PCI in the previous year and for MI patients, and is also moderately related to perioperative complications and length of stay. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Observational Study of Platelet Reactivity in Patients Presenting With ST-Segment Elevation Myocardial Infarction Due to Coronary Stent Thrombosis Undergoing Primary Percutaneous Coronary Intervention: Results From the European PREvention of Stent Thrombosis by an Interdisciplinary Global European Effort Registry.

Science.gov (United States)

Godschalk, Thea C; Byrne, Robert A; Adriaenssens, Tom; Malik, Nikesh; Feldman, Laurent J; Guagliumi, Giulio; Alfonso, Fernando; Neumann, Franz-Josef; Trenk, Dietmar; Joner, Michael; Schulz, Christian; Steg, Philippe G; Goodall, Alison H; Wojdyla, Roman; Dudek, Dariusz; Wykrzykowska, Joanna J; Hlinomaz, Ota; Zaman, Azfar G; Curzen, Nick; Dens, Jo; Sinnaeve, Peter; Desmet, Walter; Gershlick, Anthony H; Kastrati, Adnan; Massberg, Steffen; Ten Berg, Jurriën M

2017-12-26

High platelet reactivity (HPR) was studied in patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) undergoing immediate percutaneous coronary intervention (PCI). HPR on P2Y 12 inhibitors (HPR-ADP) is frequently observed in stable patients who have experienced ST. The HPR rates in patients presenting with ST for immediate PCI are unknown. Consecutive patients presenting with definite ST were included in a multicenter ST registry. Platelet reactivity was measured before immediate PCI with the VerifyNow P2Y 12 or Aspirin assay. Platelet reactivity was measured in 129 ST patients presenting with STEMI undergoing immediate PCI. HPR-ADP was observed in 76% of the patients, and HPR on aspirin (HPR-AA) was observed in 13% of the patients. HPR rates were similar in patients who were on maintenance P2Y 12 inhibitor or aspirin since stent placement versus those without these medications. In addition, HPR-ADP was similar in patients loaded with a P2Y 12 inhibitor shortly before immediate PCI versus those who were not. In contrast, HPR-AA trended to be lower in patients loaded with aspirin as compared with those not loaded. Approximately 3 out of 4 ST patients with STEMI undergoing immediate PCI had HPR-ADP, and 13% had HPR-AA. Whether patients were on maintenance antiplatelet therapy while developing ST or loaded with P2Y 12 inhibitors shortly before undergoing immediate PCI had no influence on the HPR rates. This raises concerns that the majority of patients with ST have suboptimal platelet inhibition undergoing immediate PCI. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

A first-in-man study of the Reitan catheter pump for circulatory support in patients undergoing high-risk percutaneous coronary intervention.

Science.gov (United States)

Smith, Elliot J; Reitan, Oyvind; Keeble, Thomas; Dixon, Kerry; Rothman, Martin T

2009-06-01

To investigate the safety of a novel percutaneous circulatory support device during high-risk percutaneous coronary intervention (PCI). The Reitan catheter pump (RCP) consists of a catheter-mounted pump-head with a foldable propeller and surrounding cage. Positioned in the descending aorta the pump creates a pressure gradient, reducing afterload and enhancing organ perfusion. Ten consecutive patients requiring circulatory support underwent PCI; mean age 71 +/- 9; LVEF 34% +/- 11%; jeopardy score 8 +/- 2.3. The RCP was inserted via the femoral artery. Hemostasis was achieved using Perclose sutures. PCI was performed via the radial artery. Outcomes included in-hospital death, MI, stroke, and vascular injury. Hemoglobin (Hb), free plasma Hb (fHb), platelets, and creatinine (cre) were measured pre PCI and post RCP removal. The pump was inserted and operated successfully in 9/10 cases (median 79 min). Propeller rotation at 10,444 +/- 1,424 rpm maintained an aortic gradient of 9.8 +/- 2 mm Hg. Although fHb increased, there was no significant hemolysis (4.7 +/- 2.4 mg/dl pre vs. 11.9 +/- 10.5 post, P = 0.04, reference 20 mg/dl). Platelets were unchanged (pre 257 +/- 74 x 10(9) vs. 245 +/- 63, P = NS). Renal function improved (cre pre 110 +/- 27 micromol/l vs. 99 +/- 28, P = 0.004). The RCP was not used in one patient following femoral introducer sheath related aortic dissection. All PCI procedures were successful with no deaths or strokes, one MI, and no vascular complications following pump removal. The RCP can be used safely in high-risk PCI patients. This device may be an alternative to other percutaneous systems when substantial cardiac support is needed. (c) 2009 Wiley-Liss, Inc.

The role of atherectomy in the treatment of lower extremity peripheral artery disease

Science.gov (United States)

2012-01-01

Background The incidence of lower extremity peripheral artery disease (LE-PAD) continues to increase and associated morbidity remains high. Despite the significant development of percutaneous revascularization strategies, over the past decade, LE-PAD still represents a unique challenge for interventional cardiologists and vascular surgeons. Method Typical features of atherosclerosis that affects peripheral vascular bed (diffuse nature, poor distal runoff, critical limb ischemia, chronic total occlusion) contribute to the disappointing results of traditional percutaneous transluminal angioplasty (PTA). New technologies have been developed in attempt to improve the safety and effectiveness of percutaneous revascularization. Among these, atherectomy, debulking and removing atherosclerotic plaque, offers the potential advantage of eliminating stretch on arterial walls and reducing rates of restenosis. Conclusions This review summarizes the features and the current applications of new debulking devices. PMID:23173800

Intrarenal punctate bleedings after PTA of a poorly perfused kidney: a rare complication

International Nuclear Information System (INIS)

Mali, W.P.T.M.; Straalen, A. van; Puijlaert, C.B.A.J.; Klinge, J.; Geyskes, C.G.; Feldberg, M.A.M.; Kooiker, C.J.

1987-01-01

A 52-year-old male was treated with percutaneous transluminal renal angioplasty (PTA) for hypertension due to renal artery stenosis. After successful dilatation, a CT scan showed extravasation of material with a high CT number thought to be blood. An emergency nephrectomy, however, revealed contrast containing urine. Pathologic examination of the kidney showed numerous punctate bleedings possibly caused by high blood pressure. 7 refs.; 3 figs

Recurrence of hepatocellular carcinoma after liver transplantation presenting as anastomotic biliary stricture Presentación del carcinoma hepatocelular recurrente tras el trasplante de hígado en forma de estenosis biliar anastomótica

OpenAIRE

S. Y. Chen; C. H. Lin; J. C. Yu; C. Y. Yu; C. B. Hsieh

2008-01-01

A 52-year-old man visited our hospital complaining of anorexia and fatigue two months after receiving orthotopic liver transplantation for hepatocellular carcinoma. A laboratory investigation demonstrated a clinical picture of obstructive jaundice. T-tube cholangiography showed biliary stricture over the anastomotic site. Percutaneous transluminal balloon dilatation and stenting was attempted but failed. Magnetic resonance cholangiography showed possible tumor recurrence over the site of the ...

PTMC in post-MV repair status

Directory of Open Access Journals (Sweden)

Lachikarathman Devegowda

2016-09-01

Full Text Available MV repair in the rheumatic population is feasible with acceptable long-term results.1 Incidence of mitral stenosis (MS following mitral valve (MV repair for severe rheumatic mitral regurgitation (MR and usefulness of percutaneous transluminal mitral valvuloplasty (PTMC in these patients is not described in literature. We report a case of successful PTMC in severe MS following MV repair for severe rheumatic MR.

Independent Predictors of Bleeding Complications in Patients Undergoing PCI With Concomitant Treatment With Bivalirudin in Clinical Practice Results From the Improver Registry

DEFF Research Database (Denmark)

Koeth, Oliver; Gulba, Dietrich; Huber, Kurt

2013-01-01

Bleeding complications are associated with an adverse outcome after a percutaneous coronary intervention (PCI) is performed. Traditional risk factors for bleeding complications are age, gender, underweight, hypertension, and renal impairment. The aim of our study was to identify the independent...... predictors of bleeding complications in patients undergoing a PCI with concomitant treatment with bivalirudin....

Robotics in percutaneous cardiovascular interventions.

Science.gov (United States)

Pourdjabbar, Ali; Ang, Lawrence; Behnamfar, Omid; Patel, Mitul P; Reeves, Ryan R; Campbell, Paul T; Madder, Ryan D; Mahmud, Ehtisham

2017-11-01

The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.

Treatment of calculus of upper urinary tract with mini-percutaneous nephrolithotomy under ultrasound guidance

International Nuclear Information System (INIS)

Gao Feng; Ye Chunhua; Wang Kanger; Sun Yan

2009-01-01

Objective: To evaluate the feasibility and availability of minimally invasive percutaneous nephrolithotomy (MPCNL) under ultrasound guidance for treatment of calculus of upper urinary tract. Methods: The clinical data of 48 cases with calculus of upper urinary tract undergoing MPCNL were reviewed. Results: In 48 cases, cutaneous-nephric passages were successfully constructed by ultrasound guidance, stone-free rate was 90%. The average operation time was 90 minutes, the average hospitalization was 8 days. No major complications were noted. Conclusion: Under ultrasound guidance, MPCNL with holmium laser is a simply, safe and effective method for treating calculus of upper urinary tract. (authors)

Percutaneous nephrostomy

Energy Technology Data Exchange (ETDEWEB)

Ryu, In Hoon; Ryu, Kook Hyun; Kim, Jae Kyu; Park, Jin Gyoon; Kang, Heoung Keun; Chung, Hyeon De [Chonnam National University College of Medicine, Chonju (Korea, Republic of)

1990-12-15

Percutaneous nephrostomy was performed in 82 patients under the fluoroscopic guidance for recent 3 years. The cause of hydronephrosis were as follows: unknown origin of stricture (N=37), stone (N=20), tumor (N=14), tuberculosis (N=8), postoperative ureteral injury (N=1), postoperative anastomotic stricture(N=1)and renal transplantation complication (N=1). Successful nephrostomy was achieved in 79 patients (96%). Causes if failure were minimal dilatation of pelvocaliceal system (N=2) and staghorn calculi (N=1). Follow up laboratory test shows high BUN and creatinine level returned to normal limit within 1 or 3 weeks in 73 patient. Major complication was not found, but temporary hematuria (N=4) or fever (N=1) was noted. In conclusion, percutaneous nephrostomy is the safe and effective method for the temporary and permanent relief of urinary obstruction and maintenance of ureteral patency.

Percutaneous nephrostomy

International Nuclear Information System (INIS)

Ryu, In Hoon; Ryu, Kook Hyun; Kim, Jae Kyu; Park, Jin Gyoon; Kang, Heoung Keun; Chung, Hyeon De

1990-01-01

Percutaneous nephrostomy was performed in 82 patients under the fluoroscopic guidance for recent 3 years. The cause of hydronephrosis were as follows: unknown origin of stricture (N=37), stone (N=20), tumor (N=14), tuberculosis (N=8), postoperative ureteral injury (N=1), postoperative anastomotic stricture(N=1)and renal transplantation complication (N=1). Successful nephrostomy was achieved in 79 patients (96%). Causes if failure were minimal dilatation of pelvocaliceal system (N=2) and staghorn calculi (N=1). Follow up laboratory test shows high BUN and creatinine level returned to normal limit within 1 or 3 weeks in 73 patient. Major complication was not found, but temporary hematuria (N=4) or fever (N=1) was noted. In conclusion, percutaneous nephrostomy is the safe and effective method for the temporary and permanent relief of urinary obstruction and maintenance of ureteral patency

Percutaneous management of urolithiasis during pregnancy.

Science.gov (United States)

Kavoussi, L R; Albala, D M; Basler, J W; Apte, S; Clayman, R V

1992-09-01

A total of 6 pregnant women with obstructing urinary calculi was managed by percutaneous nephrostomy drainage placed under ultrasound guidance with the patient under local anesthesia. All patients initially had relief of acute obstruction. However, occlusion of the percutaneous nephrostomy tubes with debris necessitated tube changes in 5 of 6 patients. In 2 patients recurrent nephrostomy tube obstruction, fever and pain led to percutaneous stone removal during pregnancy. In the remaining 4 patients the nephrostomy tubes were left indwelling through delivery. During the postpartum period 3 patients successfully underwent ureteroscopic stone extraction and 1 passed the stone spontaneously. Bacteriuria developed in each patient despite the use of preventive antibiotics. All 6 women had uncomplicated vaginal deliveries of healthy newborns and are currently asymptomatic with no evidence of obstruction. Percutaneous drainage of an acutely obstructed kidney in a pregnant woman is an effective temporizing alternative to ureteral stent placement until definitive treatment can be performed.

Advances in percutaneous stone surgery

OpenAIRE

Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

2015-01-01

Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, ...

The value of percutaneous transhepatic treatment of biliary strictures following pediatric liver transplantation

Directory of Open Access Journals (Sweden)

Leandro Cardarelli-Leite

Full Text Available Abstract Objective: To evaluate the percutaneous transhepatic approach to the treatment of biliary strictures in pediatric patients undergoing liver transplantation. Materials and Methods: This was a retrospective study of data obtained from the medical records, laboratory reports, and imaging examination reports of pediatric liver transplant recipients who underwent percutaneous transhepatic cholangiography, because of clinical suspicion of biliary strictures, between 1st September 2012 and 31 May 2015. Data were collected for 12 patients, 7 of whom were found to have biliary strictures. Results: In the 7 patients with biliary strictures, a total of 21 procedures were carried out: 2 patients (28.6% underwent the procedure twice; 3 (42.8% underwent the procedure three times; and 2 (28.6% underwent the procedure four times. Therefore, the mean number of procedures per patient was 3 (range, 2–4, and the average interval between them was 2.9 months (range, 0.8–9.1 months. The drainage tube remained in place for a mean of 5.8 months (range, 3.1–12.6 months. One patient presented with a major complication, hemobilia, which was treated with endovascular embolization. Clinical success was achieved in all 7 patients, and the mean follow-up after drain removal was 15.4 months (range, 5.3–26.7 months. Conclusion: The percutaneous transhepatic approach to treating biliary strictures in pediatric liver transplant recipients proved safe, with high rates of technical and clinical success, as well as a low rate of complications.

A method for estimating DMSA SPECT renal function for assessing the effect of percutaneous nephrolithotripsy on the treated pole

International Nuclear Information System (INIS)

AGUIAR, Pablo; RUIBAL, Álvaro; CORTÉS, Julia; PÉREZ-FENTES, Daniel; GARCÍA, Camilo; GARRIDO, Miguel

2016-01-01

The aim of this study was to develop a method for estimating DMSA SPECT renal function on each renal pole in order to evaluate the effect of percutaneous nephrolithotripsy by focusing the measurements on the region through which the percutaneous approach is performed. Twenty patients undergoing percutaneous nephrolithotripsy between November 2010 and June 2012 were included in this study. Both Planar and SPECT-DMSA studies were carried out before and after nephrolithotripsy. The effect of percutaneous nephrolithotripsy was evaluated by estimating the total renal function and the regional renal function of each renal pole. Despite PCNL has been previously reported as a minimally invasive technique, our results showed regional renal function decreases in the treated pole in most patients, affecting the total renal function in a few of them. A quantification method was used for estimating the SPECT DMSA renal function of the upper, inter polar and lower renal poles. Our results confirmed that total renal function was preserved after nephrolithotripsy. Nevertheless, the proposed method showed that the regional renal function of the treated pole decreased in most patients (15 of 20 patients), allowing us to find differences in patients who had not shown changes in the total renal function obtained from conventional quantification methods. In conclusion, a method for estimating the SPECT DMSA renal function focused on the treated pole enabled us to show for the first time that nephrolithotripsy can lead to a renal parenchymal damage restricted to the treated pole.

Minimizing radiation exposure during percutaneous nephrolithotomy.

Science.gov (United States)

Chen, T T; Preminger, G M; Lipkin, M E

2015-12-01

Given the recent trends in growing per capita radiation dose from medical sources, there have been increasing concerns over patient radiation exposure. Patients with kidney stones undergoing percutaneous nephrolithotomy (PNL) are at particular risk for high radiation exposure. There exist several risk factors for increased radiation exposure during PNL which include high Body Mass Index, multiple access tracts, and increased stone burden. We herein review recent trends in radiation exposure, radiation exposure during PNL to both patients and urologists, and various approaches to reduce radiation exposure. We discuss incorporating the principles of As Low As reasonably Achievable (ALARA) into clinical practice and review imaging techniques such as ultrasound and air contrast to guide PNL access. Alternative surgical techniques and approaches to reducing radiation exposure, including retrograde intra-renal surgery, retrograde nephrostomy, endoscopic-guided PNL, and minimally invasive PNL, are also highlighted. It is important for urologists to be aware of these concepts and techniques when treating stone patients with PNL. The discussions outlined will assist urologists in providing patient counseling and high quality of care.

Analysis of complications of percutaneous X-Ray endoscopic surgical operations of patients with urolithiasis and nephrolithiasis with a single functioning kidney

Directory of Open Access Journals (Sweden)

S. S. Zenkov

2015-01-01

Full Text Available The presented article focuses on the important matters of development of intraoperative and postoperative complications in patients with urolithiasis undergoing percutaneous operative treatment for coral calculus of a solitary or sole functioning kidney. Complications of percutaneous X-ray-endoscopic operations in these patients always require careful medical and diagnostic approach, as they can lead to oppression of an already impaired solitary kidney function and, as a consequence, can have life-threatening nature. They are divided into two groups: intraoperative and postoperative complications. Intraoperative complications include: bleeding, damage of the renal pelvis in the course of creating of puncture access, perforation of internal organs, loss of stroke. Postoperative complications include: development of acute inflammation in a single kidney, bleeding, urinoma or hematoma development, progression of renal failure, leave of residual concretions, organ loss. There is a sufficient amount of data on the development of complications after percutaneous endoscopic surgeries in the literature, but very few works are devoted to a solitary kidney matter. The object of this study was the group of patients with urolithiasis, coral nephrolithiasis by a solitary or a single functioning kidney, who were on treatment in the urology department of the N.I. Pirogov City Clinical Hospital No. 1 from January 2007 to July 2014. All patients underwent percutaneous operative treatment for the removal of coral calculi. 

Ultrasound guided percutaneous fine needle aspiration biopsy ...

African Journals Online (AJOL)

)-guided percutaneous fine needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is efficacious in diagnosis, is helpful in treatment choice, to evaluate whether various other investigations ...

A Renal Perforating Artery Mistaken for Arterial Bleeding after Percutaneous Renal Biopsy: A Case Report

International Nuclear Information System (INIS)

Kim, Ye Lim; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min

2009-01-01

Perirenal hematoma after a renal biopsy is a common complication that usually resolves spontaneously, but this rarely requires transfusions or surgical/radiological intervention. We report here on a case of a renal perforating artery that was mistaken for renal arterial bleeding in a 53-year-old woman who was complicated with perirenal hematoma after undergoing a percutaneous renal biopsy. On the color and pulsed wave Doppler ultrasonography, linear blood flow was seen in the perirenal hematoma, which extended perpendicularly from the renal parenchyma into the perirenal space, and this linear blood flow exhibited an arterial pulse wave. On CT angiography, the renal perforating artery was demonstrated as a curvilinear vessel coursing tangentially to the renal margin and we decided that it was a pseudolesion caused by the renal perforating artery. A renal perforating artery may be mistaken for renal arterial bleeding after a percutaneous renal biopsy. A renal perforating artery and arterial bleeding can be differentiated by the location and shape seen on a color Doppler examination and the pulse waves characteristics

A Renal Perforating Artery Mistaken for Arterial Bleeding after Percutaneous Renal Biopsy: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Kim, Ye Lim; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min [Korea University College of Medicine, Seoul (Korea, Republic of)

2009-12-15

Perirenal hematoma after a renal biopsy is a common complication that usually resolves spontaneously, but this rarely requires transfusions or surgical/radiological intervention. We report here on a case of a renal perforating artery that was mistaken for renal arterial bleeding in a 53-year-old woman who was complicated with perirenal hematoma after undergoing a percutaneous renal biopsy. On the color and pulsed wave Doppler ultrasonography, linear blood flow was seen in the perirenal hematoma, which extended perpendicularly from the renal parenchyma into the perirenal space, and this linear blood flow exhibited an arterial pulse wave. On CT angiography, the renal perforating artery was demonstrated as a curvilinear vessel coursing tangentially to the renal margin and we decided that it was a pseudolesion caused by the renal perforating artery. A renal perforating artery may be mistaken for renal arterial bleeding after a percutaneous renal biopsy. A renal perforating artery and arterial bleeding can be differentiated by the location and shape seen on a color Doppler examination and the pulse waves characteristics

Italian Percutaneous EVAR (IPER) Registry: outcomes of 2381 percutaneous femoral access sites' closure for aortic stent-graft.

Science.gov (United States)

Pratesi, G; Barbante, M; Pulli, R; Fargion, A; Dorigo, W; Bisceglie, R; Ippoliti, A; Pratesi, C

2015-12-01

The aim of this paper was to report outcomes of endovascular aneurysm repair with percutaneous femoral access (pEVAR) using Prostar XL and Proglide closure systems (Abbot Vascular, Santa Clara, CA, USA), from the multicenter Italian Percutaneous EVAR (IPER) registry. Consecutive patients affected by aortic pathology treated by EVAR with percutaneous access (pEVAR) between January 2010 and December 2014 at seven Italian centers were enrolled in this multicenter registry. All the operators had an experience of at least 50 percutaneous femoral access procedures. Data were prospectively collected into a dedicated online database including patient's demographics, anatomical features, intra- and postoperative outcomes. A retrospective analysis was carried out to report intraoperative and 30-day technical success and access-related complication rate. Uni- and multivariate analyses were performed to identify factors potentially associated with an increased risk of percutaneous pEVAR failure. A total of 2381 accesses were collected in 1322 patients, 1249 (94.4%) male with a mean age of 73.5±8.3 years (range 45-97). The overall technical success rate was 96.8% (2305/2381). Major intraoperative access-related complications requiring conversion to surgical cut-down were observed in 3.2% of the cases (76/2381). One-month pEVAR failure-rate was 0.25% (6/2381). Presence of femoral artery calcifications resulted to be a significant predictor of technical failure (OR: 1.69; 95% CI: 1.03-2.77; P=0.036) at multivariate analysis. No significant association was observed with sex (P=0.28), obesity (P=0.64), CFA diameter (P=0.32), level of CFA bifurcation (P=0.94) and sheath size >18 F (P=0.24). The use of Proglide was associated with a lower failure rate compared to Prostar XL (2.5% vs. 3.3%) despite not statistically significant (P=0.33). The results of the IPER registry confirm the high technical success rate of percutaneous EVAR when performed by experienced operators, even in

Percutaneous Endovascular Radiofrequency Ablation for Malignant Portal Obstruction: An Initial Clinical Experience

International Nuclear Information System (INIS)

Wu, Tian-Tian; Li, Hu-Cheng; Zheng, Fang; Ao, Guo-Kun; Lin, Hu; Li, Wei-Min

2016-01-01

PurposeThe Habib™ VesOpen Catheter is a new endovascular radiofrequency ablation (RFA) device used to treat malignant portal obstruction. The purpose of this study was to evaluate the clinical feasibility and safety of RFA with this device.MethodsWe collected the clinical records and follow-up data of patients with malignant portal obstruction treated with percutaneous endovascular portal RFA using the Habib™ VesOpen Catheter. Procedure-related complications, improvement of symptoms, portal patency, survival, and postoperative biochemical tests were investigated.ResultsThe 31 patients enrolled in the study underwent 41 successful endovascular portal RFA procedures. Patients were divided into a portal-stenting (PS) group (n = 13), which underwent subsequent portal stenting with self-expandable metallic stents, and a non-stenting (NS) group (n = 18), which did not undergo stenting. No procedure-related abdominal hemorrhage or portal rupture occurred. Postablation complications included abdominal pain (n = 26), fever (n = 13), and pleural effusion (n = 15). Improvements in clinical manifestations were observed in 27 of the 31 patients. Of the 17 patients experiencing portal restenosis, 10 underwent successful repeat RFA. The rate of successful repeat RFA was significantly higher in the NS group than in the PS group. Median portal patency was shorter in the PS group than in the NS group. No mortality occurred during the 4 weeks after percutaneous endovascular portal RFA.ConclusionsPercutaneous endovascular portal RFA is a feasible and safe therapeutic option for malignant portal obstruction. Prospective investigations should be performed to evaluate clinical efficacy, in particular, the need to evaluate the necessity for subsequent portal stenting.

Percutaneous Endovascular Radiofrequency Ablation for Malignant Portal Obstruction: An Initial Clinical Experience

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Wu, Tian-Tian, E-mail: matthewwu1979@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China); Li, Hu-Cheng, E-mail: hucheng-li-surgery@126.com [The 307th Hospital of PLA, General Surgery Department (China); Zheng, Fang, E-mail: fang-zheng-surgery@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China); Ao, Guo-Kun, E-mail: guokun-ao-radiology@126.com; Lin, Hu, E-mail: hu-lin-radiology@126.com [The 309th Hospital of PLA, Radiology Department (China); Li, Wei-Min, E-mail: weimin-li-surgery@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China)

2016-07-15

PurposeThe Habib™ VesOpen Catheter is a new endovascular radiofrequency ablation (RFA) device used to treat malignant portal obstruction. The purpose of this study was to evaluate the clinical feasibility and safety of RFA with this device.MethodsWe collected the clinical records and follow-up data of patients with malignant portal obstruction treated with percutaneous endovascular portal RFA using the Habib™ VesOpen Catheter. Procedure-related complications, improvement of symptoms, portal patency, survival, and postoperative biochemical tests were investigated.ResultsThe 31 patients enrolled in the study underwent 41 successful endovascular portal RFA procedures. Patients were divided into a portal-stenting (PS) group (n = 13), which underwent subsequent portal stenting with self-expandable metallic stents, and a non-stenting (NS) group (n = 18), which did not undergo stenting. No procedure-related abdominal hemorrhage or portal rupture occurred. Postablation complications included abdominal pain (n = 26), fever (n = 13), and pleural effusion (n = 15). Improvements in clinical manifestations were observed in 27 of the 31 patients. Of the 17 patients experiencing portal restenosis, 10 underwent successful repeat RFA. The rate of successful repeat RFA was significantly higher in the NS group than in the PS group. Median portal patency was shorter in the PS group than in the NS group. No mortality occurred during the 4 weeks after percutaneous endovascular portal RFA.ConclusionsPercutaneous endovascular portal RFA is a feasible and safe therapeutic option for malignant portal obstruction. Prospective investigations should be performed to evaluate clinical efficacy, in particular, the need to evaluate the necessity for subsequent portal stenting.

Prognostic impact of alkaline phosphatase measured at time of presentation in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

Directory of Open Access Journals (Sweden)

Pyung Chun Oh

Full Text Available Serum alkaline phosphatase (ALP has been shown to be a prognostic factor in several subgroups of patients due to its promotion of vascular calcification. However, the prognostic impact of serum ALP level in ST-segment elevation myocardial infarction (STEMI patients with a relatively low calcification burden has not been determined. We aimed to investigate the association of ALP level measured at time of presentation on clinical outcomes in patients with STEMI requiring primary percutaneous coronary intervention (PCI.A total of 1178 patients with STEMI undergoing primary PCI between 2007 and 2014 were retrospectively enrolled from the INTERSTELLAR registry and classified into tertiles by ALP level (83 IU/L. The primary study outcome was a major adverse cardiac or cerebrovascular event (MACCE, defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization.Median follow-up duration was 25 months (interquartile range, 10-39 months. The incidence of MACCE significantly increased as ALP level increased, that is, for the 83 IU/L tertiles incidences were 8.7%, 11.7%, and 15.7%, respectively; p for trend = 0.003. After adjustment for potential confounders, the adjusted hazard ratios for MACCE in the middle and highest tertiles were 1.69 (95% CI 1.01-2.81 and 2.46 (95% CI 1.48-4.09, respectively, as compared with the lowest ALP tertile.Elevated ALP level at presentation, but within the higher limit of normal, was found to be independently associated with higher risk of MACCE after primary PCI in patients with STEMI.

Clinical-pathological-angiographic correlations following transluminal atherectomy

International Nuclear Information System (INIS)

Althaus, S.J.; Maynar, M.; Reyes, R.; Pulido-Duque, J.M.; Casal, G.; Hunter, D.W.; Castaneda-Zuniga, W.R.; Amplatz, K.

1989-01-01

Following percutaneous atherectomy, arterial and catheter diameter relationships were correlated with angiographic and ankle-arm index results. There was a greater amount of tissue removed, improved luminal reconstitution, and ankle-arm index in lesions where the catheter and arterial diameters were equal or within 0.5 mm. Excluding lesions requiring angioplasty, 77% of our lesions had less than 30% residual stenosis; including lesions requiring concomitant angioplasty, the initial overall patency was 93%, with a 1-year patency rate of 92.5%. This study indicates that adequate matching of the atherectomy catheter diameter to the arterial diameter is necessary to optimize tissue removal and clinical results

Percutaneous transcatheter sclerotherapy of oophoritic cysts

International Nuclear Information System (INIS)

Huang Youhua; Xu Qiang; Sun Jun; Shen Tao; Shi Hongjian; Tang Qingfang; Chen Qiying; Zhou Mingxia; Li Hongyao

2005-01-01

Objective: To evaluate the clinical value of percutaneous transcatheter sclerotherapy in oophoritic cysts. Methods: Seventy six oophoritic cysts incluoling 48 simple and 28 chocolate cysts of 64 patients were treated with percutaneous transcatheter sclerotherapy under CT guidance. 4F multisideholes pigtail catheter was introduced into cyst using absolute alcohol as sclerosing agents. Results: The successful rate of percutaneous oophoritc cyst puncture was 100% in all 64 patients. Among them 58 were cured (90.6%), 6 improved significantly (9.4%). The total effective rate reached 100% with no serious complications. Conclusions: Catheterization sclerotherapy for oophoritic cyst is a simple, complete, safe and effective method. (authors)

Interventional uroradiology

International Nuclear Information System (INIS)

Lang, E.K.

1987-01-01

All extensions of percutaneous nephropyelostomy are addressed, including nephropyelostomy as an adjunct modality in the management of infections. The concepts, techniques, and caveats for placing ureteral stents in the management of traumatic, neoplastic, and inflammatory conditions of the ureter are examined. Particular emphasis is placed on the long-term management with indwelling stents, of patients with ureters compromised by neoplastic disease. Different stent materials and the time factors necessitating replacement of stents are analyzed. Percutaneous ureteroneocystostomies (re-entry procedures) or percutaneous ureteropyelostomies in allograft kidneys are reviewed, along with their indications, techniques, and possible complications. The discussion continues with the management of ureteral strictures by transluminal dilation via antegrade and retrograde approaches as well as under dual control. The advantages of combining antegrade and retrograde techniques to gain access to and maintain control of devices in marginally accessible regions are illustrated with pertinent examples. Percutaneous stone extraction via antegrade and retrograde techniques and adjunctive procedures for dealing with complications of extracorporeal shock wave lithotripsy are discussed

Unexplained occurrence of multiple de novo pseudoaneurysms in patients with chronic kidney disease undergoing angioembolization for bleeding following percutaneous renal intervention: Are we dealing with infection or vasculitis?

Directory of Open Access Journals (Sweden)

Debansu Sarkar

2013-01-01

Full Text Available Background and Objectives: Patients with chronic kidney disease (CKD are more prone for bleeding following percutaneous renal intervention, as compared to those with normal renal function. Causes are multi-factorial. Finding multiple aneurysms away from the site of renal intervention following initial angioembolization for hemorrhage is very unusual in these patients. Materials and Methods: Clinical and radiological findings of all the patients who underwent renal angiography for post-intervention bleed for a period of 5 years were reviewed and analyzed. Results: A total of 29 patients required angiography for post-intervention hemorrhage. Six patients had recurrence of hemorrhage for which they underwent repeat angiography. Four of these patients had appearance of multiple new aneurysms away from the site of percutaneous nephrostomy (PCN/percutaneous nephrolithotomy (PNL puncture and the site of previous bleeding. All the patients had CKD (creatinine >2.5 mg/dl. They were on prolonged preoperative urinary diversion and had polymicrobial urinary infection. Three patients had candiduria. None of these patients had re-bleeding after repeat embolization and treatment with antibacterial and antifungal agents. Conclusions: Development of multiple aneurysms away from the sites of punctures in patients with CKD following percutaneous intervention is very unusual. Its causation including infection with bacteria and fungus, reaction of embolizing material, and angiopathy needs to be explored.

Long-Term Follow-Up of Percutaneous Balloon Angioplasty in Adult Aortic Coarctation

International Nuclear Information System (INIS)

Paddon, Alex J.; Nicholson, Anthony A.; Ettles, Duncan F.; Travis, Simon J.; Dyet, John F.

2000-01-01

Purpose: To assess long-term outcomes following percutaneous transluminal angioplasty (PTA) of congenital aortic coarctation in adults.Methods: Seventeen patients underwent PTA for symptomatic adult coarctation of the aorta. Sixteen patients, with a mean age of 28 years (range 15-60 years), were reviewed at a mean interval after angioplasty of 7.3 years (range 1.5-11 years). Assessment included magnetic resonance imaging (MRI), Doppler echocardiography, and clinical examination. Current clinical measurements were compared with pre- and immediate post-angioplasty measurements.Results: At follow-up 16 patients were alive and well. The patient not included in follow-up had undergone surgical repair and excision of the coarctation segment following PTA. Mean brachial systolic blood pressure for the group decreased from 174 mmHg before angioplasty to 130 mmHg at follow-up (p 0.0001). The mean gradient had fallen significantly from 50.9 to 17.8 at follow-up (p = 0.001). The average number of antihypertensive drugs required per patient decreased from 0.56 to 0.31 (p = 0.234). No significant residual stenoses or restenoses were seen at MRI. Small but clinically insignificant residual pressure gradients were recorded in all patients using Doppler echocardiography. Complications included one transient ischemic attack at 5 days, one external iliac dissection requiring stent insertion, and a further patient who developed a false aneurysm close to the coarctation site at 12 months which subsequently required surgical excision.Conclusion: PTA of adult coarctation is safe and effective in the long term. Although primary stenting has recently been advocated in the treatment of this condition, our results suggest that PTA remains the treatment of choice

Gonioscopy-assisted Transluminal Trabeculotomy (GATT): Thermal Suture Modification With a Dye-stained Rounded Tip.

Science.gov (United States)

Grover, Davinder S; Fellman, Ronald L

2016-06-01

To describe a novel technique for thermally marking the tip of a suture, in preparation for a gonioscopy-assisted transluminal trabeculotomy. One patient was used as an example for this technique. Technique report. The authors introduce a modification of a novel surgical procedure (GATT) in which a suture is marked and thermally blunted allowing a proper visualization while performing an ab interno, minimally invasive, circumferential 360-degree suture trabeculotomy. The authors have previously reported on the GATT surgery with the use of an illuminated microcatheter, which allowed for visualization of the tip of the catheter as it circumnavigated Schlemm canal. This modification allows for similar visualization of the tip of the suture, however, is much more cost-effective while still maintaining similar safety.

Extended indications for percutaneous tracheostomy.

Science.gov (United States)

Ben Nun, Alon; Altman, Eduard; Best, Lael Anson

2005-10-01

In recent years, percutaneous tracheostomy has become a routine practice in many hospitals. In the early publications, most authors considered adverse conditions such as short, fat neck or obesity as relative contraindications whereas cervical injury, coagulopathy, and emergency were regarded as absolute contraindications. More recently, several reports demonstrated the feasibility of percutaneous tracheostomy in patients with some of these contraindications. The aim of this study is to determine the safety and efficacy of percutaneous tracheostomy in conditions commonly referred to as contraindications. Between June 2000 and July 2001, 157 consecutive percutaneous tracheostomy procedures were performed on 154 critically ill adult patients in the general intensive care unit of a major tertiary care facility. The Griggs technique and Portex set were used at the bedside. All procedures were performed by staff thoracic surgeons and anesthesiologists experienced with the technique. Anatomical conditions, presence of coagulopathy and anti-coagulation therapy, demographics, and complication rates were recorded. Five of 157 procedures (154 patients owing to three repeat tracheostomies) had complications. In patients with normal anatomical conditions and coagulation profiles, there was one case of bleeding (50 cc to 120 cc) and one case of mild cellulitis around the stoma. In patients with adverse conditions, there was one case of bleeding (50 cc to 120 cc) and two cases of minor bleeding (< 50 cc). Patients with adverse conditions had a low complication rate similar to patients with normal conditions. For this reason, we believe that percutaneous tracheostomy is indicated in patients with short, fat neck; inability to perform neck extension; enlarged isthmus of thyroid; previous tracheostomy; or coagulopathy and anti-coagulation therapy.

Non-O blood groups can be a prognostic marker of in-hospital and long-term major adverse cardiovascular events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Science.gov (United States)

Cetin, Mehmet Serkan; Ozcan Cetin, Elif Hande; Aras, Dursun; Topaloglu, Serkan; Temizhan, Ahmet; Kisacik, Halil Lutfi; Aydogdu, Sinan

2015-09-01

Recent studies have suggested ABO blood type locus as an inherited predictor of thrombosis, cardiovascular risk factors, myocardial infarction. However, data is scarce about the impact of non-O blood groups on prognosis in patients with ST-elevation myocardial infarction (STEMI). Therefore, we aimed to evaluate the prognostic importance of non-O blood groups in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) METHODS: 1835 consecutive patients who were admitted with acute STEMI between 2010 and 2015 were included and followed-up for a median of 35.6months. The prevalence of hyperlipidemia, total cholesterol, LDL, peak CKMB and no-reflow as well as hospitalization duration were higher in patients with non-O blood groups. Gensini score did not differ between groups. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, non-fatal MI, and mortality were higher in non-O blood groups. In multivariate logistic regression analysis, non-0 blood groups were demonstrated to be independent predictors of in-hospital (OR:2.085 %CI: 1.328-3.274 p=0.001) and long term MACE (OR:2.257 %CI: 1.325-3.759 pblood group compared with O blood group (pblood groups were determined to be significant prognostic indicators of short- and long-term cardiovascular adverse events and mortality in patients with STEMI undergoing pPCI. In conjunction with other prognostic factors, evaluation of this parameter may improve the risk categorization and tailoring the individual therapy and follow-up in STEMI patient population. Copyright © 2015 Elsevier Ltd. All rights reserved.

Long-term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis in the pediatric population.

Science.gov (United States)

Merino-Ingelmo, Raquel; Santos-de Soto, José; Coserria-Sánchez, Félix; Descalzo-Señoran, Alfonso; Valverde-Pérez, Israel

2014-05-01

Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population. The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up. Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients. Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Percutaneous catheter drainage of intrapulmonary fluid collection

International Nuclear Information System (INIS)

Park, E. D.; Kim, H. J.; Choi, P. Y.; Jung, S. H.

1994-01-01

With the success of percutaneous abdominal abscess drainage, attention is now being focused on the use of similar techniques in the thorax. We studied to evaluate the effect of percutaneous drainage in parenchymal fluid collections in the lungs. We performed percutaneous drainage of abscesses and other parenchymal fluid collections of the lungs in 15 patients. All of the procedures were performed under the fluoroscopic guidance with an 18-gauge Seldinger needle and coaxial technique with a 8-10F drainage catheter. Among 10 patients with lung abscess, 8 patients improved by percutaneous catheter drainage. In one patient, drainage was failed by the accidental withdrawal of the catheter before complete drainage. One patient died of sepsis 5 hours after the procedure. Among three patients with complicated bulla, successful drainage was done in two patients, but in the remaining patient, the procedure was failed. In one patient with intrapulmonary bronchogenic cyst, the drainage was not successful due to the thick internal contents. In one patient with traumatic hematoma, after the drainage of old blood clots, the signs of infection disappeared. Overally, of 14 patients excluding one who died, 11 patients improved with percutaneous catheter drainage and three patients did not. There were no major complications during and after the procedure. We conclude that percutaneous catheter drainage is effective and safe procedure for the treatment of parenchymal fluid collections of the lung in patients unresponsive to the medical treatment

Percutaneous catheter drainage of intrapulmonary fluid collection

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Park, E. D.; Kim, H. J.; Choi, P. Y.; Jung, S. H. [Gyeongsang National University Hospital, Chinju (Korea, Republic of)

1994-01-15

With the success of percutaneous abdominal abscess drainage, attention is now being focused on the use of similar techniques in the thorax. We studied to evaluate the effect of percutaneous drainage in parenchymal fluid collections in the lungs. We performed percutaneous drainage of abscesses and other parenchymal fluid collections of the lungs in 15 patients. All of the procedures were performed under the fluoroscopic guidance with an 18-gauge Seldinger needle and coaxial technique with a 8-10F drainage catheter. Among 10 patients with lung abscess, 8 patients improved by percutaneous catheter drainage. In one patient, drainage was failed by the accidental withdrawal of the catheter before complete drainage. One patient died of sepsis 5 hours after the procedure. Among three patients with complicated bulla, successful drainage was done in two patients, but in the remaining patient, the procedure was failed. In one patient with intrapulmonary bronchogenic cyst, the drainage was not successful due to the thick internal contents. In one patient with traumatic hematoma, after the drainage of old blood clots, the signs of infection disappeared. Overally, of 14 patients excluding one who died, 11 patients improved with percutaneous catheter drainage and three patients did not. There were no major complications during and after the procedure. We conclude that percutaneous catheter drainage is effective and safe procedure for the treatment of parenchymal fluid collections of the lung in patients unresponsive to the medical treatment.

Does the nephrostomy tract length impact the outcomes of percutaneous nephrolithotomy (PNL)?

Science.gov (United States)

Astroza, Gaston M; Neisius, Andreas; Tsivian, Matvey; Wang, Agnes J; Preminger, Glenn M; Lipkin, Michael E

2014-12-01

Different factors can determine the outcomes of percutaneous nephrolithotomy (PNL). We analyzed the effect of tract length (TL) on outcomes after PNL. We performed a retrospective review of patients undergoing PNL between 2006 and 2011. Patients with preoperative computed tomography (CT), one percutaneous access tract and follow-up imaging within 3 months were included. TL was defined as distance between the skin to the calyx of puncture as measured on preoperative CT. Measurements were independently performed by two urologists and the average was used for analysis. Stone-free rate (SFR) was defined as zero fragments on follow-up imaging. Factors independently associated with the likelihood of being stone-free after PNL were determined using multivariable analysis adjusted for TL, location of access, the presence of incomplete or complete staghorn calculi and type of follow-up imaging. Complications (Clavien score) were independently assessed. A total of 222 patients were included. Median stone burden and body mass index (BMI) was 239.4 mm(2) and 30.5 [interquartile range (IQR): 25.7-36.2]. The median TL was 85.0 mm (IQR: 70.3-100.0) and highly correlated with BMI (ρ = 0.66, p PNL. PNL is a safe and effective treatment for stones in patients with differing body habitus.

Percutaneous treatment in patients presenting with malignant cardiac tamponade

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Marcy, P.Y. [Antoine Lacassagne Center, Interventional Radiology Department, Nice (France); Bondiau, P.Y. [Antoine Lacassagne Center, Radiation Therapy Department, Nice (France); Brunner, P. [Centre Hospitalier Princesse, Grace (Monaco). Interventional Radiology Department

2005-09-01

The percutaneous treatment of pericardial effusion resulting in cardiac tamponade has undergone an evolution in recent years with the use of less invasive drainage techniques in selected cases. To determine optimal therapy modalities for oncology patients with malignant pericardial tamponade (MPT), the authors review their institutional experience with percutaneous needle puncture routes, means of imaging-guided drainage and percutaneous management of the pericardial fluid effusion (pericardial sclerosis and balloon pericardiotomy). Advantages and limits of the percutaneous techniques will be compared to the surgical treatment. (orig.)

Advances in percutaneous stone surgery.

Science.gov (United States)

Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

2015-01-01

Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.

Angioplasty of symptomatic high-grade internal carotid artery stenosis with intraluminal thrombus: therapeutic approach

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Gonzalez, A.; Mayol, A. [Seccion de Neurorradiologia Intervencionista, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Gil-Peralta, A.; Gonzalez-Marcos, J.R. [Servicio de Neurologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Boza, F. [Servicio de Neurofisiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Ruano, J. [Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain)

2004-04-01

Intraluminal thrombus in the internal carotid artery (ICA) is usually found in patients with severe atheromatous stenosis. Having reviewed 300 carotid angioplasties for symptomatic >70% ICA stenosis, we found three patients (1%) with intraluminal thrombus. Conservative treatment with anticoagulants and double antiplatelet coverage can result in lysis of the thrombus without severe risks. Percutaneous transluminal angioplasty and stenting, preferably with distal protection, can be an excellent alternative to carotid endarterectomy. (orig.)

Reperfusion hemorrhage following superior mesenteric artery stenting.

LENUS (Irish Health Repository)

Moore, Michael

2012-02-03

Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250).

Science.gov (United States)

Noguera, José F; Cuadrado, Angel; Dolz, Carlos; Olea, José M; García, Juan C

2012-12-01

Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.

Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis

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Hoffer, F.A. [Dept. of Diagnostic Imaging, St. Jude Children' s Research Hospital, Memphis, TN (United States); Gow, K.; Davidoff, A. [Dept. of Surgery, St. Jude Children' s Research Hospital, Memphis, TN (United States); Flynn, P.M. [Dept. of Infectious Diseases, St. Jude Children' s Research Hospital, Memphis, TN (United States)

2001-03-01

Background. Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection. Objective. We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis. Materials and methods. We retrospectively reviewed 28 imaging-guided percutaneous biopsies of the lungs of 24 children with suspected pulmonary aspergillosis. Twenty-two were being treated for malignancy and two for congenital immunodeficiency; 15 had received bone-marrow transplants. The accuracy of the percutaneous lung biopsy was determined by subsequent surgical resection, autopsy, or clinical course. Results. Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in culture. The remaining 18 biopsies revealed no fungi. No patient had progressive aspergillosis after negative biopsy. Invasive pulmonary mold was detected by percutaneous biopsy with 100 % (10/10) sensitivity and 100 % (18/18) specificity. Percutaneous biopsy results influenced the surgical decision in 86 % (24 of 28) of the cases. Bleeding complicated the biopsy in 46 % (13/28) and hastened one death. Conclusion. Percutaneous biopsy of the lung is an accurate technique for the diagnosis of invasive pulmonary aspergillosis and correctly determines which immunosuppressed pediatric patients would benefit from therapeutic pulmonary resection. (orig.)

Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis

International Nuclear Information System (INIS)

Hoffer, F.A.; Gow, K.; Davidoff, A.; Flynn, P.M.

2001-01-01

Background. Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection. Objective. We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis. Materials and methods. We retrospectively reviewed 28 imaging-guided percutaneous biopsies of the lungs of 24 children with suspected pulmonary aspergillosis. Twenty-two were being treated for malignancy and two for congenital immunodeficiency; 15 had received bone-marrow transplants. The accuracy of the percutaneous lung biopsy was determined by subsequent surgical resection, autopsy, or clinical course. Results. Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in culture. The remaining 18 biopsies revealed no fungi. No patient had progressive aspergillosis after negative biopsy. Invasive pulmonary mold was detected by percutaneous biopsy with 100 % (10/10) sensitivity and 100 % (18/18) specificity. Percutaneous biopsy results influenced the surgical decision in 86 % (24 of 28) of the cases. Bleeding complicated the biopsy in 46 % (13/28) and hastened one death. Conclusion. Percutaneous biopsy of the lung is an accurate technique for the diagnosis of invasive pulmonary aspergillosis and correctly determines which immunosuppressed pediatric patients would benefit from therapeutic pulmonary resection. (orig.)

Prognostic value of elevated mean platelet volume in patients undergoing primary angioplasty for ST-elevation myocardial infarction.

Science.gov (United States)

Akgul, Ozgur; Uyarel, Huseyin; Pusuroglu, Hamdi; Gul, Mehmet; Isiksacan, Nilgun; Turen, Selahattin; Erturk, Mehmet; Surgit, Ozgur; Cetin, Mustafa; Bulut, Umit; Baycan, Omer Faruk; Uslu, Nevzat

2013-06-01

The aim of this study was to evaluate the prognostic value of mean platelet volume (MPV) in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We prospectively enrolled 495 consecutive STEMI patients.The study population was divided into tertiles based on admission MPV values. The high MPV group (n= 148) was defined as a value in the third tertile (> 8.9), and the low MPV group (n = 347) included those patients with a value in the lower two tertiles ( 8.9) was found to be a powerful independent predictor of six-month all-cause mortality. These results suggest that a high admission MPV level was associated with increased six-month all-cause mortality in patients with STEMI undergoing primary PCI.

Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial

NARCIS (Netherlands)

Dewilde, Willem J. M.; Oirbans, Tom; Verheugt, Freek W. A.; Kelder, Johannes C.; de Smet, Bart J. G. L.; Herrman, Jean-Paul; Adriaenssens, Tom; Vrolix, Mathias; Heestermans, Antonius A. C. M.; Vis, Marije M.; Tijsen, Jan G. P.; van 't Hof, Arnoud W.; ten Berg, Jurriën M.; Schölzel, B. E.; van den Branden, B. J.; Plokker, H. W. M.; Bosschaert, M. A.; Slagboom, T.; Vos, J.; Brueren, B. R. G.; Breet, N. J.; Sheikjoesoef, K.; Aarnoudse, W.; Rasoul, S.; van Mieghem, C.; Vandendriessche, T.; Cornelis, K.

2013-01-01

If percutaneous coronary intervention (PCI) is required in patients taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. We investigated the safety and efficacy of clopidogrel alone compared with

High Residual Collagen-Induced Platelet Reactivity Predicts Development of Restenosis in the Superficial Femoral Artery After Percutaneous Transluminal Angioplasty in Claudicant Patients

Energy Technology Data Exchange (ETDEWEB)

Gary, Thomas, E-mail: thomas.gary@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Prüller, Florian, E-mail: florian.prueller@klinikum-graz.at; Raggam, Reinhard, E-mail: reinhard.raggam@klinikum-graz.at [Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics (Austria); Mahla, Elisabeth, E-mail: elisabeth.mahla@medunigraz.at [Medical University of Graz, Department of Anesthesiology and Intensive Care Medicine (Austria); Eller, Philipp, E-mail: philipp.eller@medunigraz.at; Hafner, Franz, E-mail: franz.hafner@klinikum-graz.at; Brodmann, Marianne, E-mail: marianne.brodmann@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria)

2016-02-15

PurposeAlthough platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets.Materials and MethodsA prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated.ResultsEight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04].ConclusionsHigh residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.

Percutaneous placement of self-expandable metallic stents in patients with obstructive janudice secondary to metastalic gastric cancer after gastrectomy

Energy Technology Data Exchange (ETDEWEB)

Hong, Hyun Pyo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Seo, In Ho; Yu, Jung Rim; Mok, Young Jae; Oh, Joo Hyeong [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kwon, Se Hwan [Dept. of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Kim, Sam Soo [Dept. of Radiology, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Kim, Seung Kwon [Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

2013-10-15

To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

Image guided percutaneous splenic interventions

International Nuclear Information System (INIS)

Kang, Mandeep; Kalra, Naveen; Gulati, Madhu; Lal, Anupam; Kochhar, Rohit; Rajwanshi, Arvind

2007-01-01

Aim: The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. Materials and methods: We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n = 93) or CT (n = 2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n = 78) and aspiration (n = 10) or percutaneous catheter drainage of a splenic abscess (n = 7). Results: Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. Conclusions: Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery

Biomechanical study of percutaneous lumbar diskectomy

International Nuclear Information System (INIS)

Li Yuan; Huang Xianglong; Shen Tianzhen; Hu Zhou; Hong Shuizong; Mei Haiying

2003-01-01

Objective: To investigate the stiffness of lumbar spine after the injury caused by percutaneous diskectomy and evaluate the efficiency of percutaneous lumbar diskectomy by biomechanical study. Methods: Four fresh lumbar specimens were used to analyse load-displacement curves in the intact lumbar spine and vertical disc-injured lumbar spine. The concepts of average flexibility coefficient (f) and standardized average flexibility coefficient (fs) were also introduced. Results: The load-displacement curves showed a good stabilization effect of the intact lumbar spine and disc-injured lumbar spine in flexion, extension, right and left bending. The decrease of anti-rotation also can be detected (P<0.05). Conclusion: In biomechanical study, percutaneous lumbar diskectomy is one of the efficiency methods to treat lumbar diac hernia

Improved early risk stratification of patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention using a combination of serum soluble ST2 and NT-proBNP.

Directory of Open Access Journals (Sweden)

Jongwook Yu

Full Text Available Although soluble suppression of tumorigenicity 2 (sST2 in serum is known to be associated with ischemic heart disease and heart failure, data regarding its prognostic impact in ST-segment elevation myocardial infarction (STEMI is limited. We evaluated the prognostic impacts of serum sST2 and other serum biomarkers in STEMI patients undergoing primary percutaneous coronary intervention (PCI.Consecutive all 323 patients with STEMI that underwent primary PCI were enrolled. Blood tests and samples were obtained in an emergency room. The primary endpoint was 1-year major adverse cardiovascular and cerebrovascular events (MACCEs, defined as a composite of cardiovascular death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization.Mean age was 59.1±13.1 years (men 84%. MACCE (20 cardiovascular deaths, 7 non-fatal MI, 4 non-fatal stroke, 7 ischemia-driven revascularizations occurred in 38 patients (12%. After adjusting for confounding factors, Cox regression analysis revealed that high serum sST2 (>75.8 ng/mL mean value, adjusted hazard ratio 2.098, 95% CI 1.008-4.367, p = 0.048 and high serum NT-proBNP level (>400 pg/mL, adjusted hazard ratio 2.606, 95% CI 1.086-6.257, p = 0.032 at the time of presentation independently predicted MACCE within a year of primary PCI. Furthermore, when high serum sST2 level was combined with high serum NT-proBNP level, the hazard ratio of MACCE was highest (adjusted hazard ratio 7.93, 95% CI 2.97-20.38, p<0.001.Elevated serum levels of sST2 or NT-proBNP at the time of presentation were found to predict 1-year MACCE independently and elevated serum levels of sST2 plus NT-proBNP were associated with even poorer prognosis in patients with STEMI undergoing primary PCI.

Percutaneous lumbar discectomy

International Nuclear Information System (INIS)

Xiao Chengjiang; Su Huanbin; Xu Sui; He Xiaofeng; Li Yanhao

2004-01-01

Objective: To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods: To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpiform nacleus forceps, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results: The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions: PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation. (authors)

First magnetic resonance imaging-guided aortic stenting and cava filter placement using a polyetheretherketone-based magnetic resonance imaging-compatible guidewire in swine: proof of concept.

Science.gov (United States)

Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M; Borm, Paul J A; Jacob, Augustinus L; Bilecen, Deniz

2009-05-01

The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.

First Magnetic Resonance Imaging-Guided Aortic Stenting and Cava Filter Placement Using a Polyetheretherketone-Based Magnetic Resonance Imaging-Compatible Guidewire in Swine: Proof of Concept

International Nuclear Information System (INIS)

Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H.; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M.; Borm, Paul J. A.; Jacob, Augustinus L.; Bilecen, Deniz

2009-01-01

The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.

Use of clopidogrel in the reduction of myocardial damage during percutaneous coronary intervention

Directory of Open Access Journals (Sweden)

Arijit Dasgupta

2009-03-01

Full Text Available Arijit Dasgupta, Debabrata MukherjeeGill Heart Institute, University of Kentucky, Lexington, KY, USAAbstract: It is estimated that approximately a quarter of patients undergoing coronary intervention may have significant post-procedural creatinine (CK/creatinine kinase myocardial band (CK-MB elevations and approximately half may have post-procedural troponin elevations. Current data suggest that periprocedural infarction is associated with short-, intermediate-, and long-term adverse outcomes, most notably mortality. This review examines the role of clopidogrel in decreasing periprocedural myonecrosis following percutaneous coronary intervention (PCI. Clopidogrel is an important pharmacologic agent used to reduce myocardial infarction post-coronary intervention as assessed directly by the evaluation of cardiac biomarkers and indirectly by the evaluation of short-term ischemic events. The optimal dose of clopidogrel is considered to be at least 300 mg given 6 to 15 hours prior to PCI but there is considerable evidence to suggest that a loading dose of 600 mg given 2 to 6 hours prior to PCI may be more efficacious in limiting post-coronary intervention events. The benefit obtained from clopidogrel appears independent of and incremental to that of other antiplatelet and antithrombotic agents used during and after coronary intervention.Keywords: percutaneous coronary intervention, myonecrosis, clopidogrel, antiplatelet agents, myocardial infarction 

Age-related percutaneous penetration part 1: skin factors.

Science.gov (United States)

Konda, S; Meier-Davis, S R; Cayme, B; Shudo, J; Maibach, H I

2012-05-01

Changes in the skin that occur in the elderly may put them at increased risk for altered percutaneous penetration from pharmacotherapy along with potential adverse effects. Skin factors that may have a role in age-related percutaneous penetration include blood flow, pH, skin thickness, hair and pore density, and the content and structure of proteins, glycosaminoglycans (GAGs), water, and lipids. Each factor is examined as a function of increasing age along with its potential impact on percutaneous penetration. Additionally, topical drugs that successfully overcome the barrier function of the skin can still fall victim to cutaneous metabolism, thereby producing metabolites that may have increased or decreased activity. This overview discusses the current data and highlights the importance of further studies to evaluate the impact of skin factors in age-related percutaneous penetration.

False coronary dissection with the new Monorail angioplasty balloon catheter.

Science.gov (United States)

Esplugas, E; Cequier, A R; Sabaté, X; Jara, F

1990-01-01

During percutaneous transluminal coronary angioplasty, the appearance of persistent staining in the vessel by contrast media suggests coronary dissection. We report seven patients in whom a false image of severe coronary dissection was observed during angioplasty performed with the new Monorail balloon catheter. This image emerges at the moment of balloon inflation, is distally located to the balloon, and disappears with balloon catheter deflation. No complications were associated with the appearance of this image.

High-Dose Statin Pretreatment Decreases Periprocedural Myocardial Infarction and Cardiovascular Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of Twenty-Four Randomized Controlled Trials

Science.gov (United States)

Wang, Le; Peng, Pingan; Zhang, Ou; Xu, Xiaohan; Yang, Shiwei; Zhao, Yingxin; Zhou, Yujie

2014-01-01

Background Evidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this meta-analysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention. Methods We searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment. Results Twenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34–0.49; Pstatin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50–0.95; P = 0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI: 0.12–0.65; P = 0.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34–0.79; P = 0.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45–1.10; P = 0.12). Long-term effects on survival were less obvious. Conclusions High-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of high-dose statin pretreatment on PMI and MACE is significant for statin-naïve patients and patients with prior treatment. The positive effect of high-dose statin pretreatment on MACE is significant for

Usefulness of proteinuria as a prognostic marker of mortality and cardiovascular events among patients undergoing percutaneous coronary intervention (data from the Evaluation of Oral Xemilofiban in Controlling Thrombotic Events [EXCITE] trial).

Science.gov (United States)

Mercado, Nestor; Brugts, Jasper J; Ix, Joachim H; Shlipak, Michael G; Dixon, Simon R; Gersh, Bernard J; Lemos, Pedro A; Guarneri, Mimi; Teirstein, Paul S; Wijns, William; Serruys, Patrick W; Boersma, Eric; O'Neill, William W

2008-11-01

Proteinuria was associated with cardiovascular events and mortality in community-based cohorts. The association of proteinuria with mortality and cardiovascular events in patients undergoing percutaneous coronary intervention (PCI) was unknown. The association of urinary dipstick proteinuria with mortality and cardiovascular events (composite of death, myocardial infarction, or nonhemorrhagic stroke) in 5,835 subjects of the EXCITE trial was evaluated. Dipstick urinalysis was performed before PCI, and proteinuria was defined as trace or greater. Subjects were followed up for 210 days/7 months after enrollment for the occurrence of events. Multivariate Cox regression analysis evaluated the independent association of proteinuria with each outcome. Mean age was 59 years, 21% were women, 18% had diabetes mellitus, and mean estimated glomerular filtration rate was 90 ml/min/1.73 m(2). Proteinuria was present in 750 patients (13%). During follow-up, 22 subjects (2.9%) with proteinuria and 54 subjects (1.1%) without proteinuria died (adjusted hazard ratio 2.83, 95% confidence interval [CI] 1.65 to 4.84, p use tool as urinary dipstick may be useful to identify and treat patients at high risk of mortality at the time of PCI.

Pulmonary Cement Embolism following Percutaneous Vertebroplasty

Directory of Open Access Journals (Sweden)

Ümran Toru

2014-01-01

Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

Peritonitis following percutaneous gastrostomy tube insertions in children

Energy Technology Data Exchange (ETDEWEB)

Dookhoo, Leema [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada); University of Toronto, Faculty of Medicine, Toronto, ON (Canada); Mahant, Sanjay [The Hospital for Sick Children, Department of Pediatrics, Toronto, ON (Canada); Parra, Dimitri A.; John, Philip R.; Amaral, Joao G.; Connolly, Bairbre L. [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

2016-09-15

Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

Peritonitis following percutaneous gastrostomy tube insertions in children

International Nuclear Information System (INIS)

Dookhoo, Leema; Mahant, Sanjay; Parra, Dimitri A.; John, Philip R.; Amaral, Joao G.; Connolly, Bairbre L.

2016-01-01

Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

Peritonitis following percutaneous gastrostomy tube insertions in children.

Science.gov (United States)

Dookhoo, Leema; Mahant, Sanjay; Parra, Dimitri A; John, Philip R; Amaral, Joao G; Connolly, Bairbre L

2016-09-01

Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

Nuclear medical quality control of transluminal coronary angioplastic (TCA)

International Nuclear Information System (INIS)

Klepzig, H. Jr.; Scherer, D.; Kober, G.; Kaltenbach, M.; Maul, F.D.; Standke, R.; Hoer, G.; Kanemoto, N.

1984-01-01

To assess the results of transluminal coronary angioplasty 48 patients with coronary heart disease were investigated at rest and during exercise with the ECG (46 patients), thallium-201 myocardial scintigraphy (26 patients), and equilibrium radionuclide ventriculography (38 patients). Exercise stress test was quantified by means of an ischemia score, myocardial scintigraphy by an vitality index and by corresponding redistribution factors, and radionuclide ventriculography by ejection fraction and maximum systolic volume change as a fraction of enddiastolic volume. The patients were divided into three groups: 36 patients had successful TCA (group 1); 6 patients underwent aortocoronary bypass operation (ACB, group 2); in 6 patients TCA was unsuccessful, they served as control (group 3). On average TCA yielded a reduction of coronary artery stenosis from 83% to 44%. Functional improvement was comparable in group 1 and 2: Ischemia score was reduced significantly. Perfusion index increased, the corresponding redistribution factors decreased. Left ventricular ejection fraction increased at rest and during exercise. Maximum systolic volume change increased correspondingly. Only slight changes were noted in group 3. Three months later 2 of 16 reinvestigated patients showed a restenosis and one a new narrowing distal to the successfully dilated stenosis. Functional deterioration could be demonstrated in these, whilst maintainance of the good functional results was documented in the others. (orig./MG) [de

Long-term outcome of endovascular treatment versus medical care for carotid artery stenosis in patients not suitable for surgery and randomised in the Carotid and Vertebral Artery Transluminal Angioplasty study (CAVATAS).

LENUS (Irish Health Repository)

Ederle, Jörg

2009-01-01

Optimal treatment of carotid stenosis in patients not suitable for surgery is unclear. The Carotid and Vertebral Artery Transluminal Angioplasty study contained a trial comparing medical and endovascular treatment in patients not suitable for surgery.

Case Report Percutaneous Dilational Tracheostomy A bed side ...

African Journals Online (AJOL)

Introduction: Tracheostomy is one of the most commonly performed procedures in critically ill patients. Percutaneous dilatational tracheostomy (PDT), according to ciaglias technique described in 1985, has become the most popular technique for percutaneous tracheostomy and is demonstrably as safe as surgical.

Percutaneous gastrostomy and jejunostomy: Technique, results, and complications in 55 cases

International Nuclear Information System (INIS)

Mueller, P.R.; Brown, A.; Saini, S.; Hahn, P.F.; Steiner, E.; Ferrucci, J.T.; Forman, B.H.; Silverman, S.G.

1987-01-01

Percutaneous radiologic gastrostomy is a well-described method that has not been widely adopted by radiologists. The authors reviewed their experience to highlight technical points and clinical results. Direct percutaneous gastrostomy was performed in 51 patients and percutaneous jejunostomy in four. Indications for gastrostomy procedures were the need for general nutrition (n = 31), complications of use of a nasogastric feeding tube (n = 7), gastric or small bowel decompression (n = 4) and endoscopic failure (n = 5). The major indication for percutaneous jejunostomy was decompression of small bowel obstruction. Key technical aspects include the use of a novel needle device that tacks the abdominal wall to the stomach, thus assuring a seal between the two structures. In the percutaneous gastrostomies, 18-F Foley catheters were introduced through the tacked portion of the stomach with a Seldinger technique and dilators. For percutaneous jejunostomy, 18-F feeding tubes were placed. All procedures were performed under local anesthesia. The authors conclude that a radiologic percutaneous gastrostomy is a safe and effective procedure and should be pursued aggressively by interventional radiologists

Percutaneous aspiration of hydatid cysts

International Nuclear Information System (INIS)

Hernandez, G.; Serrano, R.

1996-01-01

A perspective study was carried out to assess the efficacy of a combination of percutaneous aspiration plus oral albendazole to assess its efficacy as an alternative to surgery in the treatment of hydatid cyst. We performed percutaneous aspiration followed by injection of 20% hypertonic saline solution into 16 hydatid cysts in 13 patients. All the patients received oral albendazole (400 mg/12 hours) starting 2 days before and lasting until there weeks after the procedure. There were no anaphylactic reactions during or after the procedure. Follow-up included monthly ultrasound over a period ranging between 10 and 36 months. Three cysts disappeared completely; in 10 cases, the cysts cavity was replaced by a complex ultrasonographic findings, with strong signals similar to those of a pseudotumor. In another case, the aspirate was sterile and its morphology remained unchanged. In two cases, infection of the cyst ensued, requiring surgical treatment. We consider that percutaneous aspiration in combination with albendazole may prove to be a good alternative to surgery for the management of hepatic hydatid disease. (Author) 15 refs

Evaluation of efficacy of amikacin for attenuation of catheter-related bladder discomfort in patients undergoing percutaneous nephrolithotomy: A prospective, randomized, placebo-controlled, double-blind study.

Science.gov (United States)

Verma, Ruchi; Agarwal, Anil; Singh, Prabhat Kumar; Gupta, Devendra; Shamim, Rafat

2016-01-01

Catheter-related bladder discomfort (CRBD) is the most distressing symptom in patients due to intraoperative urinary catheterization. Amikacin significantly inhibits detrusor contraction evoked by prejunctional stimulation. The aim of this study is to evaluate the efficacy of amikacin in prevention of CRBD in patients undergoing percutaneous nephrolithotomy. Study areas were operation theater and postanesthesia care unit of the Department of Anesthesiology, SGPGIMS, Lucknow. One hundred adult patients of either sex were randomly assigned into two groups of fifty each. Patients in control group received normal saline whereas patients in amikacin group received amikacin 10 mg/kg just before induction. Grading of CRBD was done as none, mild, moderate, and severe by a blinded observer at 0, 1, 6, 12, and 24 h after surgery. Data were analyzed using Student's t -test and Chi-square test among groups. Incidence of CRBD was compared with Chi-square test whereas severity was analyzed by the test of proportions (Z-test). Visual analog score was compared using Mann-Whitney U-test for surgical site pain. Incidence of CRBD in control group was 66% as compared to 44% observed in amikacin group ( P < 0.05). During intergroup comparison at different time points, incidence of CRBD was reduced at 1 and 6 h in the amikacin group ( P < 0.05). Significant reduction in the severity of CRBD (moderate) was also observed at 1 h in the amikacin group ( P < 0.05). At rest of the time points, there was no significant difference. Amikacin can significantly reduce the incidence and severity of CRBD in the first few hours after surgery.

Prevention and treatment of complications following percutaneous nephrolithotomy

NARCIS (Netherlands)

Skolarikos, Andreas; de la Rosette, Jean

2008-01-01

PURPOSE OF REVIEW: The aim of this article is to identify classification and grading systems of percutaneous nephrolithotomy-related complications and evidence for the prevention and treatment of these complications. RECENT FINDINGS: A total complication rate of up to 83% following percutaneous

Short-Term Safety and Efficacy of Femoral Vascular Closure after Percutaneous Coronary Intervention with Combination of the Boomerang(TM) Device and Intravenous Protamine Sulfate.

Science.gov (United States)

Chen, Ching-Pei; Huang, Huang-Kai; Hsia, Chien-Hsun; Chang, Yung-Ming; Lin, Lee-Shin; Lee, Cheng-Liang

2013-11-01

The Cardiva Boomerang(TM) is a device used to perform femoral vascular closure. It facilitates passive hemostasis at the arteriotomy site, leaving no residual foreign body. We performed a controlled, randomized study of 60 patients undergoing percutaneous coronary intervention. Patients were randomized into two groups (30 per group) to undergo vascular closure with the Boomerang(TM) or the Perclose(TM) suture-based device after the intravenous administration of protamine sulfate. We compared overall success rates, patient-reported pain, length of time to achieve hemostasis and mobilization of the patient, and the frequency of complications in the two groups. Overall success rates using the Boomerang(TM) and Perclose(TM) devices were similarly high, at 93% and 97%, respectively. The Boomerang(TM) was significantly quicker to deploy than the PercloseTM, device deployment time, median (Q1-Q3), [2.00 (1.33-2.75) vs. 3.84 (2.75-4.38) mins, p Boomerang(TM) group (1.1 ± 1.7 vs. 6.4 ± 2.9, p Boomerang(TM) (p Boomerang(TM) device is as safe and effective as the Perclose(TM) device for femoral vascular closure, but quicker to deploy and less painful to patients. Boomerang; Percutaneous intervention; Vascular closure device.

Percutaneous brachial artery catheterization for coronary angiography and percutaneous coronary interventions (pci): an encouraging experience of 100 cases

International Nuclear Information System (INIS)

Islam, Z.U.; Maken, G.R.; Saif, M.; Khattak, Z.A.

2013-01-01

Objective: To evaluate the practicability and safety of the percutaneous transbrachial approach (TBA) for diagnostic coronary angiography and therapeutic percutaneous coronary interventions. Study Design: Quasi experimental study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) from March 2009 to May 2011. Patients and Methods: We collected data of 100 consecutive patients who underwent coronary catheterization by the percutaneous transbrachial approach. Transbrachial catheterization was performed only if the radial access failed or radial pulse was feeble. Study endpoints included successful brachial artery catheterization, vascular and neurological complications at access site and procedure success rate. Results: Mean age of the patients was 54 years (range 33-79 yrs) and 65(65%) were males and 35 (35%) were females. The right brachial artery was used in all of the cases. Procedural success was achieved in 100% of the patients. Coronary angiography was performed in 70 patients and percutaneous coronary interventions were done in 30 cases. Out of these 30 cases, PCI to left coronary arteries (LAD and LCX) were performed in 19 patients while 11 patients had PCI to right coronary artery (RCA). No case of vascular complications such as major access site bleeding, vascular perforation, brachial artery occlusion causing forearm ischemia, compartment syndrome, vascular spasm or failure to catheterize coronary arteries requiring alternate vascular access were observed. Conclusion: Brachial artery is a safe and easily accessible approach for coronary angiography and percutaneous coronary interventions. (author)

Safety of Prasugrel Loading Doses in Patients Pre-Loaded With Clopidogrel in the Setting of Primary Percutaneous Coronary Intervention

DEFF Research Database (Denmark)

Räber, Lorenz; Klingenberg, Roland; Heg, Dik

2015-01-01

OBJECTIVES: The aim of this study was to assess the safety of the concurrent administration of a clopidogrel and prasugrel loading dose in patients undergoing primary percutaneous coronary intervention. BACKGROUND: Prasugrel is one of the preferred P2Y12 platelet receptor antagonists for ST-segment.......62, p = 0.36). CONCLUSIONS: This observational, nonrandomized study of ST-segment elevation myocardial infarction patients suggests that the administration of a loading dose of prasugrel in patients pre-treated with a loading dose of clopidogrel is not associated with an excess of major bleeding events...

Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

DEFF Research Database (Denmark)

Jensen, Lisette Okkels; Thayssen, Per; Lassen, Jens Flensted

2007-01-01

AIMS: Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis...... in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment. METHODS AND RESULTS: In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure.......02-1.12, P = 0.016). CONCLUSION: Recruitable collateral blood flow measured during balloon inflation predicts angiographic instent restenosis in PCI patients treated with bare metal stents. Udgivelsesdato: 2007-Aug...

Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)—Results of the FERARI study

Energy Technology Data Exchange (ETDEWEB)

Becher, Tobias, E-mail: Tobias.Becher@umm.de [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Mashayekhi, Kambis [Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen (Germany); Borggrefe, Martin; Akin, Ibrahim [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany)

2016-12-15

Summary: Background: Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. Methods: The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose–area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Results: Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8 min, p = 0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p = 0.826), procedural duration (46.0 vs. 45.0 min, p = 0.363) and contrast agent use (185.5 vs. 199.5 ml, p = 0.742) were also similar in radial and femoral PCI. Conclusion: There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. - Highlights: • Data comparing radiation exposure in radial versus femoral PCI remain controversial. • 400 enrolled in the FERARI study were prospectively evaluated. • There was no difference regarding radiation exposure in radial versus femoral access. • Furthermore, there was no significant difference regarding contrast agent use.

Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)—Results of the FERARI study

International Nuclear Information System (INIS)

Becher, Tobias; Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula; Mashayekhi, Kambis; Borggrefe, Martin; Akin, Ibrahim

2016-01-01

Summary: Background: Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. Methods: The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose–area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Results: Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8 min, p = 0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p = 0.826), procedural duration (46.0 vs. 45.0 min, p = 0.363) and contrast agent use (185.5 vs. 199.5 ml, p = 0.742) were also similar in radial and femoral PCI. Conclusion: There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. - Highlights: • Data comparing radiation exposure in radial versus femoral PCI remain controversial. • 400 enrolled in the FERARI study were prospectively evaluated. • There was no difference regarding radiation exposure in radial versus femoral access. • Furthermore, there was no significant difference regarding contrast agent use

Percutaneous management of staghorn renal calculi

International Nuclear Information System (INIS)

Lee, Won Jay

1989-01-01

During a four year period, ending May 1987, 154 cases of symptomatic staghorn calculi have been treated by percutaneous nephrolithotomy. Of these patients,86% were discharged completely stone free with the remainder having fragments less than 5 mm in greatest diameter. More than one operative procedure during the same hospitalizations was required in 24% of patients and multiple percutaneous tracts were established in excess of 73% of them. Significant complications occurred in 16% of patients and there was one death. Most complications can be generally by minimized by careful approach and manageable by interventional radiological means. The management of patients with staghorn calculi requires a comprehensive understanding of the renal anatomy, selection of appropriate percutaneous nephrostomy tract sites, and radiologic-urologic expertise needed to remove the large stone mass. The advent of extracorporeal shock wave lithotripsy will not abolish the need for nephrolithotomy, particularly complex stones such as staghorn calculi

Lung abscess; Percutaneous catheter therapy

Energy Technology Data Exchange (ETDEWEB)

Ha, H.K. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Kang, M.W. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Park, J.M. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Yang, W.J. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Shinn, K.S. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of)); Bahk, Y.W. (Depts. of Radiology and Internal Medicine, Catholic Univ. Medical Coll., Seoul (Korea, Republic of))

1993-07-01

Lung abscess was successfully treated with percutaneous drainage in 5 of 6 patients. Complete abscess resolution occurred in 4 patients, partial resolution in one, and no response in one. The duration of drainage ranged from 7 to 18 days (mean 15.5 days) in successful cases. The failure of drainage in one neurologicall impaired patient was attributed to persistent aspiration. In 2 patients, concurrent pleural empyema was also cured. CT provided the anatomic details necessary for choosing the puncture site and avoiding puncture of the lung parenchyma. Percutaneous catheter drainage is a safe and effective method for treating lung abscess. (orig.).

Total Percutaneous Aortic Repair: Midterm Outcomes

International Nuclear Information System (INIS)

Bent, Clare L.; Fotiadis, Nikolas; Renfrew, Ian; Walsh, Michael; Brohi, Karim; Kyriakides, Constantinos; Matson, Matthew

2009-01-01

The purpose of this study was to examine the immediate and midterm outcomes of percutaneous endovascular repair of thoracic and abdominal aortic pathology. Between December 2003 and June 2005, 21 patients (mean age: 60.4 ± 17.1 years; 15 males, 6 females) underwent endovascular stent-graft insertion for thoracic (n = 13) or abdominal aortic (n = 8) pathology. Preprocedural computed tomographic angiography (CTA) was performed to assess the suitability of aorto-iliac and common femoral artery (CFA) anatomy, including the degree of CFA calcification, for total percutaneous aortic stent-graft repair. Percutaneous access was used for the introduction of 18- to 26-Fr delivery devices. A 'preclose' closure technique using two Perclose suture devices (Perclose A-T; Abbott Vascular) was used in all cases. Data were prospectively collected. Each CFA puncture site was assessed via clinical examination and CTA at 1, 6, and 12 months, followed by annual review thereafter. Minimum follow-up was 36 months. Outcome measures evaluated were rates of technical success, conversion to open surgical repair, complications, and late incidence of arterial stenosis at the site of Perclose suture deployment. A total of 58 Perclose devices were used to close 29 femoral arteriotomies. Outer diameters of stent-graft delivery devices used were 18 Fr (n = 5), 20 Fr (n = 3), 22 Fr (n = 4), 24 Fr (n = 15), and 26 Fr (n = 2). Percutaneous closure was successful in 96.6% (28/29) of arteriotomies. Conversion to surgical repair was required at one access site (3.4%). Mean follow-up was 50 ± 8 months. No late complications were observed. By CT criteria, no patient developed a >50% reduction in CFA caliber at the site of Perclose deployment during the study period. In conclusion, percutaneous aortic stent-graft insertion can be safely performed, with a low risk of both immediate and midterm access-related complications.

Percutaneous fiducial marker placement prior to stereotactic body radiotherapy for malignant liver tumors: an initial experience

International Nuclear Information System (INIS)

Ohta, Kengo; Shimohira, Masashi; Murai, Taro; Nishimura, Junichi; Iwata, Hiromitsu; Ogino, Hiroyuki; Hashizume, Takuya; Shibamoto, Yuta

2016-01-01

The aim of this study was to describe our initial experience with a gold flexible linear fiducial marker and to evaluate the safety and technical and clinical efficacy of stereotactic body radiotherapy using this marker for malignant liver tumors. Between July 2012 and February 2015, 18 patients underwent percutaneous fiducial marker placement before stereotactic body radiotherapy for malignant liver tumors. We evaluated the technical and clinical success rates of the procedure and the associated complications. Technical success was defined as successful placement of the fiducial marker at the target site, and clinical success was defined as the completion of stereotactic body radiotherapy without the marker dropping out of position. All 18 fiducial markers were placed successfully, so the technical success rate was 100% (18/18). All 18 patients were able to undergo stereotactic body radiotherapy without marker migration. Thus, the clinical success rate was 100% (18/18). Slight pneumothorax occurred as a minor complication in one case. No major complications such as coil migration or bleeding were observed. The examined percutaneous fiducial marker was safely placed in the liver and appeared to be useful for stereotactic body radiotherapy for malignant liver tumors

Outcomes in elderly and young patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with bivalirudin versus heparin: Pooled analysis from the EUROMAX and HORIZONS-AMI trials.

Science.gov (United States)

Qaderdan, Khalid; Vos, Gerrit-Jan A; McAndrew, Thomas; Steg, Philippe Gabriel; Hamm, Christian W; Van't Hof, Arnoud; Mehran, Roxana; Deliargyris, Efthymios N; Bernstein, Debra; Stone, Gregg W; Ten Berg, Jurriën M

2017-12-01

Since older age is a strong predictor of not only bleeding but also of ischemic events, understanding the risk:benefit profile of bivalirudin in the elderly undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation (STEMI) is important. For this, we aim to compare elderly with young patients, who all underwent pPCI for STEMI and randomly received either bivalirudin or heparin. We performed a patient-level pooled analysis (n=5800) of two large randomized trials. A total of 2149 (37.1%) elderly patients (>65 years of age) with STEMI were enrolled and randomly assigned to either bivalirudin or heparin with or without a GPI (control group) before pPCI. Clinical outcomes at 30 days were analyzed. In elderly patients, bivalirudin significantly reduced non-CABG major bleeding (7.1% vs 10.4%; PST (0.4% vs 1.5%; PST, or all-cause death, when compared with heparin with or without GPI. In a large group of elderly patients enrolled in the EUROMAX and HORIZONS-AMI trials, bivalirudin was associated with lower 30-day rates of non-CABG major bleeding, subacute ST and NACE, with similar 30-day rates of acute ST and mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

Does Imaging Modality Used For Percutaneous Renal Access Make a Difference?

DEFF Research Database (Denmark)

Andonian, Sero; Scoffone, Cesare; Louie, Michael K

2013-01-01

OBJECTIVE To assess peri-operative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. METHODS A prospectively collected international CROES database containing 5806 patients treated with PCNL was used for the study. Patients were...... divided into two groups based on the methods of percutaneous access: ultrasound vs. fluoroscopy. Patient characteristics, operative data and post-operative outcomes were compared. RESULTS Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only...

Effect of X-ray contrast agents on hemostasis and its role in the genesis of adverse reactions

International Nuclear Information System (INIS)

Sviridov, N.K.; Napolov, Yu.K.

2001-01-01

Based on available data, the effect of X-ray contrast agents (XCA) on homeostasis and its role in side reactions genesis are discussed. It is shown that the contrast agent type used can essentially affect the thrombocytes. Nonionic XCA are able to increase the thrombocytes degranulation in case of coronarography and percutaneous transluminal coronary angioplastics with release of procoagulants in vessel gap. This effect can to lead to acute thromboses and be the start of restenosis [ru

Successful angioplasty of tripolar renal arteries in a single setting: a case report.

Science.gov (United States)

Sharma, Gyarsi Lal; Morice, Marie-Claude; Catineau, Patrick

2002-08-01

Renal artery stenosis (RAS) is one of the important causes of correctable hypertension. There are various modes of therapy for RAS, including percutaneous transluminal renal angioplasty (PTRA) and surgery. PTRA has emerged as the treatment of choice in cases of renal artery stenosis. PTRA combined with stenting is associated with good immediate and long-term results. This case report describes successful angioplasty of bilateral multiple renal arteries in a single setting with good immediate and follow-up results.

Percutaneous Management of Abscess and Fistula Following Pancreaticoduodenectomy

International Nuclear Information System (INIS)

AAssar, O. Sami; LaBerge, Jeanne M.; Gordon, Roy L.; Wilson, Mark W.; Mulvihill, Sean J.; Way, Lawrence W.; Kerlan, Robert K.

1999-01-01

Purpose: To evaluate the efficacy of percutaneous drainage of fluid collections following pancreaticoduodenectomy (Whipple's procedure). Methods: We performed a retrospective review of 19 patients referred to our service with fluid collections following pancreaticoduodenectomy. The presence of associated enteric or biliary fistulas, the route(s) of access for image-guided drainage, the incidence of positive bacterial cultures, and the duration and success of percutaneous management were recorded. Results: Fistulous communication to the jejunum in the region of the pancreatico-jejunal anastomosis was demonstrable in all 19 patients by gentle contrast injection into drainage tubes. Three patients had concurrent biliary fistulas. In 18 of 19 patients, fluid samples yielded positive bacterial cultures. Successful percutaneous evacuation of fluid was achieved in 17 of 19 patients (89%). The mean duration of drainage was 31 days. Conclusion: Percutaneous drainage of abscess following pancreaticoduodenectomy is effective in virtually all patients despite the coexistence of enteric and biliary fistulas

A novel technique of percutaneous stone extraction in choledocholithiasis after cholecystostomy.

Science.gov (United States)

Lim, Kyoung Hoon; Kim, Yong Joo

2013-05-01

To evaluate the technical feasibility and clinical efficacy of percutaneous common bile duct stone extraction via cystic duct after percutaneous cholecystostomy. Twenty-five consecutive patients with choledocholithiasis underwent percutaneous stone extraction under conscious sedation. The stones were extracted through the 12-Fr sheath using Wittich nitinol stone basket under fluoroscopic guidance via cystic duct after percutaneous trnas-hepatic cholecystostomy. Common bile duct stones were successfully removed in 22 of the 25 patients (88%) by this new technique. The causes of failure in three patients were bile leakage, hematoma of the gallbladder and failure of cystic duct cannulation. Cystic duct injury during this procedure did not occur and there was no post-procedure mortality. The mean period of indwelling catheter was 8.7±4.6 days and the mean duration of hospitalization was 13.4±5.9 days. Percutaneous commmon bile duct stone extraction via the cystic duct through percutaneous cholecystostomy route is effective and feasible for treating choledocholithiasis.

Ectopic ACTH syndrome complicated by multiple opportunistic infections treated with percutaneous ablation of the adrenal glands.

Science.gov (United States)

Chan, Chrystal; Roberts, James Mark

2017-11-14

Ectopic adrenocorticotropic hormone (ACTH)-related Cushing's syndrome can lead to multiple complications including severe immunosuppression. If the ACTH-secreting tumour cannot be found, definitive treatment is surgical adrenalectomy, typically followed by glucocorticoid replacement. Here, we present a case of fulminant respiratory failure secondary to coinfection with Pneumocystis jirovecii and cytomegalovirus in a patient with ectopic ACTH-dependent Cushing's syndrome with occult primary. Due to significant deconditioning, she was unable to undergo definitive adrenalectomy and instead underwent percutaneous microwave ablation of the adrenal glands. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effect of sex difference in clinical presentation (stable coronary artery disease vs unstable angina pectoris or non-ST-elevation myocardial infarction vs ST-elevation myocardial infarction) on 2-year outcomes in patients undergoing percutaneous coronary intervention.

Science.gov (United States)

Tang, Xiao-Fang; Song, Ying; Xu, Jing-Jing; Ma, Yuan-Liang; Zhang, Jia-Hui; Yao, Yi; He, Chen; Wang, Huan-Huan; Jiang, Ping; Jiang, Lin; Liu, Ru; Gao, Zhan; Zhao, Xue-Yan; Qiao, Shu-Bin; Xu, Bo; Yang, Yue-Jin; Gao, Run-Lin; Yuan, Jin-Qing

2018-02-01

To determine whether there is a difference in 2-year prognosis among patients across the spectrum of coronary artery disease undergoing percutaneous coronary intervention (PCI). We analyzed all consecutive patients undergoing PCI at a single center from 1/1-12/31/2013. Clinical presentations were compared between sexes according to baseline clinical, angiographic, and procedural characteristics and 2-year (mean 730 ± 30-day) outcomes. We grouped 10 724 consecutive patients based on sex and clinical presentation. Among patients with ST-elevation myocardial infarction (STEMI), rates of all-cause death (6.7% vs 1.4%) and cardiac death (3.8% vs 1.1%) were significantly higher in women than in men (P presenting with ACS. After multivariable adjustment, female sex was not an independent predictor of outcomes in STEMI (hazard ratio [HR] for all-cause death: 1.33, 95% confidence interval [CI]:0.52-3.38; P = 0.55; HR for cardiac death: 0.69, 95%CI: 0.23-2.09, P = 0.51], but was still an independent predictor of bleeding in STEMI (HR: 3.53, 95%CI: 1.26-9.91, P = 0.017). Among STEMI patients, women had worse 2-year mortality after PCI therapy, but female sex was not an independent predictor of mortality after adjustment for baseline characteristics. In STEMI patients, women were at higher bleeding risk than men after PCI, even after multivariable adjustment. © 2017, Wiley Periodicals, Inc.

ASSOCIATION OF HIGH LIPOPROTEIN(a LEVELS WITH CORONARY ARTERY PATENCY DURING THE FIRST YEAR AFTER PERCUTANEOUS CORONARY INTERVENTIONS

Directory of Open Access Journals (Sweden)

M. V. Ezhov

2011-01-01

Full Text Available Objective: to study an association of high lipoprotein(a [Lp(a] levels with the development of restenosis and the progression of coronaryatherosclerosis after percutaneous coronary interventions (PCI in patients with chronic coronary heart disease (CHD.Subjects and methods. From 502 enrolled patients (mean age 54.7 ± 8.9 years, 92 underwent routine percutaneous transluminal coronary angioplasty (PTCA, 270 had PTCA with the bare metal stent (BMS being implantation, 140 had PTCA using drug-eluting stents (DES. Functionalclasses III and IV angina have been registered in 337 (67 % patients; history of one myocardial infarction (MI was noted in 234 (47 % cases, 171 (34 % had experienced 2 or more MIs. Blood samples for lipid and Lp(a measurements were taken in all the patients. Restenosis was defined as at least 50 % lumen narrowing of the coronary artery segment after angioplasty. Coronary atherosclerosis progression was established in cases of the new occlusion occurring, as well as identifying a 10 % decrease in lumen diameter in comparison with baseline angiograms.Results. Repeated coronary angiography revealed the signs of restenosis in 103 of 243 patients. Dividing patients into 3 groups according to the type of intervention demonstrated that the level of Lp(a (median 25–75 % quartiles was significantly higher in the restenosis group after implantation of BMS (33; 11–62 and 16; 6–39 mg/dl, respectively; p = 0.014 versus those who had undergone DES implantation (23; 10–30 and 20; 6–60 mg/dl; p = 0.7 or balloon angioplasty (17; 4–48 and 9; 4–36 mg/dl; p = 0.3. Patients with progression of coronary atherosclerosis had difference only in Lp(a levels compared to the group without progression (36; 13–62 versus 12; 4–26 mg/dl, p < 0,001.Conclusion. During the first year after elective PCI Lp(a concentration determined the severity of coronary atherosclerosis in non-culprit lesionsand associated with the risk of in

ASSOCIATION OF HIGH LIPOPROTEIN(a LEVELS WITH CORONARY ARTERY PATENCY DURING THE FIRST YEAR AFTER PERCUTANEOUS CORONARY INTERVENTIONS

Directory of Open Access Journals (Sweden)

M. V. Ezhov

2014-07-01

Full Text Available Objective: to study an association of high lipoprotein(a [Lp(a] levels with the development of restenosis and the progression of coronaryatherosclerosis after percutaneous coronary interventions (PCI in patients with chronic coronary heart disease (CHD.Subjects and methods. From 502 enrolled patients (mean age 54.7 ± 8.9 years, 92 underwent routine percutaneous transluminal coronary angioplasty (PTCA, 270 had PTCA with the bare metal stent (BMS being implantation, 140 had PTCA using drug-eluting stents (DES. Functionalclasses III and IV angina have been registered in 337 (67 % patients; history of one myocardial infarction (MI was noted in 234 (47 % cases, 171 (34 % had experienced 2 or more MIs. Blood samples for lipid and Lp(a measurements were taken in all the patients. Restenosis was defined as at least 50 % lumen narrowing of the coronary artery segment after angioplasty. Coronary atherosclerosis progression was established in cases of the new occlusion occurring, as well as identifying a 10 % decrease in lumen diameter in comparison with baseline angiograms.Results. Repeated coronary angiography revealed the signs of restenosis in 103 of 243 patients. Dividing patients into 3 groups according to the type of intervention demonstrated that the level of Lp(a (median 25–75 % quartiles was significantly higher in the restenosis group after implantation of BMS (33; 11–62 and 16; 6–39 mg/dl, respectively; p = 0.014 versus those who had undergone DES implantation (23; 10–30 and 20; 6–60 mg/dl; p = 0.7 or balloon angioplasty (17; 4–48 and 9; 4–36 mg/dl; p = 0.3. Patients with progression of coronary atherosclerosis had difference only in Lp(a levels compared to the group without progression (36; 13–62 versus 12; 4–26 mg/dl, p < 0,001.Conclusion. During the first year after elective PCI Lp(a concentration determined the severity of coronary atherosclerosis in non-culprit lesionsand associated with the risk of in

Natural-orifice transluminal endoscopic surgery (NOTES) in Europe: summary of the working group reports of the Euro-NOTES meeting 2010

DEFF Research Database (Denmark)

Meining, A; Feussner, H; Swain, P

2011-01-01

The fourth Euro-NOTES workshop took place in September 2010 and focused on enabling intensive scientific dialogue and interaction between participants to discuss the state of the practice and development of natural-orifice transluminal endoscopic surgery (NOTES) in Europe. Five working groups were...... collaboration and indications, robotics and platforms, and matters related to training and education. This review summarizes consensus statements of the working groups to give an overview of what has been achieved so far and what might be relevant for research related to NOTES in the near future....

The effect of volatility on percutaneous absorption.

Science.gov (United States)

Rouse, Nicole C; Maibach, Howard I

2016-01-01

Topically applied chemicals may volatilize, or evaporate, from skin leaving behind a chemical residue with new percutaneous absorptive capabilities. Understanding volatilization of topical medications, such as sunscreens, fragrances, insect repellants, cosmetics and other commonly applied topicals may have implications for their safety and efficacy. A systematic review of English language articles from 1979 to 2014 was performed using key search terms. Articles were evaluated to assess the relationship between volatility and percutaneous absorption. A total of 12 articles were selected and reviewed. Key findings were that absorption is enhanced when coupled with a volatile substance, occlusion prevents evaporation and increases absorption, high ventilation increases volatilization and reduces absorption, and pH of skin has an affect on a chemical's volatility. The articles also brought to light that different methods may have an affect on volatility: different body regions; in vivo vs. in vitro; human vs. Data suggest that volatility is crucial for determining safety and efficacy of cutaneous exposures and therapies. Few articles have been documented reporting evaporation in the context of percutaneous absorption, and of those published, great variability exists in methods. Further investigation of volatility is needed to properly evaluate its role in percutaneous absorption.

Laparoscopic-assisted percutaneous internal ring ligation in children

African Journals Online (AJOL)

Annals of Pediatric Surgery ... Patients and methods Laparoscopic percutaneous ligation of internal inguinal ring has been ... The mean operative time in our series was 15 (± 3) and 20 (± 5) min for bilateral cases, without anesthesia time. ... Conclusion Laparoscopic percutaneous ligation of internal inguinal ring repair of ...

Percutaneous tracheostomy--special considerations.

Science.gov (United States)

Ernst, Armin; Critchlow, Jonathan

2003-09-01

Percutaneous tracheostomy is safe and highly effective in well-trained hands in establishing a long-term artificial airway. Most alleged contraindications and some suggestions on how the procedures should be performed likely stem from early trials when only "perfect candidates" were chosen. Most of those contraindications should not be viewed as prohibitions, but as suggestions related to the skill level and training of the operator. We have used this technique in many situations where the small incision and tamponading effect of the tracheostomy tube has been quite beneficial, in selected patients with coagulapathies and severe venous congestion from superior cava syndromes as well as thyroid cancers, and in whom operative approaches would have been difficult. Knowing one's level of expertise and comfort in choosing and rejecting patients and procedures accordingly is the key to keeping PT a procedure with an excellent safety record. As the experience with PT grows, more and more perceived contraindications will disappear. Studies will address the role of PT in children and as a means of establishing emergent airway access. Also, the exact coagulation limits will need to be established. Few contraindications will most likely remain absolute, such as active infections over the proposed entry site, uncontrollable bleeding disorders and excessive ventilatory and oxygenation requirements. In our institution, taking into account these absolute contraindications, fewer than 5% of patients in need of a tracheostomy in the intensive care unit will undergo a primary open procedure.

An unusual complication of combined gonioscopy-assisted transluminal trabeculotomy and phacoemulsification: vision loss due to intracapsular hematoma.

Science.gov (United States)

Yalinbas, Duygu; Aktas, Zeynep; Hepsen, İbrahim; Dilekmen, Nilay

2017-09-23

To report two cases with an acute vision loss due to intracapsular hemorrhage (hematoma) after an uncomplicated gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification surgery. Case report. Seventy-six-year-old male and 75-year-old female patients with cataract and pseudoexfoliative glaucoma (XFG) uncontrolled with maximum medical therapy both underwent GATT combined with phacoemulsification. Shortly after the surgery, intracapsular hematoma behind the intraocular lens (IOL) were noted in both patients. Hematoma cleared in both of them via IOL extraction-anterior vitrectomy and YAG-laser capsulotomy, respectively. Hematoma cleared in both patients without any surgical complications. Vision loss due to unclearing intracapsular hematoma might be an early complication of combined GATT and phacoemulsification surgery.

Nephron-sparing percutaneous ablation of a 5 cm renal cell carcinoma by superselective embolization and percutaneous RF-ablation

International Nuclear Information System (INIS)

Tacke, J.; Mahnken, A.; Buecker, A.; Guenther, R.W.; Rohde, D.

2001-01-01

Purpose: To report on the nephron-sparing, percutaneous ablation of a large renal cell carcinoma by combined superselective embolization and percutaneous radiofrequency ablation. Materials and Methods: A 5 cm renal cell carcinoma of a 43-year-old drug abusing male with serologically proven HIV, hepatitis B and C infection, who refused surgery, was superselectively embolized using microspheres (size: 500 - 700 μm) and a platinum coil under local anesthesia. Percutaneous radiofrequency ablation using a 7F LeVeen probe (size of expanded probe tip: 40 mm) and a 200 Watt generator was performed one day after transcatheter embolization under general anesthesia. Results: The combined treatment resulted in complete destruction of the tumor without relevant damage of the surrounding healthy renal tissue. The patient was discharged 24 hours after RF ablation. No complications like urinary leaks or fistulas were observed and follow up CT one day and 4 weeks after the radiofrequency intervention revealed no signs of residual tumor growth. Conclusion: The combined transcatheter embolization and percutaneous radiofrequency ablation of renal cell carcinoma has proved technically feasible, effective, and safe in this patient. It may be offered as an alternative treatment to partial or radical nephrectomy under certain circumstances. Abbreviations: RF = radiofrequency ablation; CT = computed tomography; HIV = human immunodeficiency virus. (orig.) [de

Percutaneous dilatation of biliary benign strictures

Energy Technology Data Exchange (ETDEWEB)

Park, Jae Hyung; Choi, Byung Ihn; Sung, Kyu Bo; Han, Man Chung; Park, Yong Hyun; Yoon, Yong Bum [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1986-06-15

Percutaneous biliary dilation was done in 3 patients with benign strictures. The first case was 50-year-old male who had multiple intrahepatic stones with biliary stricture. The second 46-year-old female and the third 25-year-old male suffered from recurrent cholangitis with benign stricture of anastomotic site after choledocho-jejunostomy. In the first case, a 6mm diameter Grunzing dilatation balloon catheter was introduced through the T-tube tract. In the second case, the stricture was dilated with two balloons of 5mm and 8mm in each diameter sequentially through the U-loop tract formed by surgically made jejunostomy and percutaneous transhepatic puncture. In the third case, the dilatation catheter was introduced through the percutaneous transhepatic tract. Dilatation was made with a pressure of 5 to 10 atmospheres for 1 to 3 minutes duration for 3 times. In all 3 cases, the strictures were successfully dilated and in second and third cases internal stent was left across the lesion for prevention of restenosis.

Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis

International Nuclear Information System (INIS)

Sehn, Jennifer K.; Gilula, Louis A.

2012-01-01

Background: Biopsy with demonstration of the infectious organism is the gold standard for diagnosing spondylodiscitis. The purpose of this study is to evaluate the positive culture rate of image-guided percutaneous biopsy in cases of radiologically suspected and unsuspected spinal osteomyelitis and to assess the role of pathology in diagnosis. Methods: With IRB approval and in compliance with HIPAA regulations, the charts of patients undergoing 323 consecutive image-guided percutaneous spinal biopsies performed by one musculoskeletal radiology department between January 2001 and March 2007 were reviewed. Image guidance was via fluoroscopy or computed tomography. Radiological and clinical suspicion, cultures, and pathology were assessed and compared to previously published reports. Results: In 92 cases radiographically and clinically consistent with infection (high probability of infection), 28 specimens yielded positive cultures (30.4%). Positive cultures resulted from 5 of 31 cases (16.1%) radiographically indeterminate for infection (intermediate probability of infection versus tumor). When radiographically not suggestive of infection (low probability of infection, i.e. suspicious for tumor), 10 of 200 cultures were positive (5.0%). From 113 cases sent to pathology with an intermediate or high suspicion for infection, 63 were histopathologically diagnosed as such (55.8%). Cultures were positive in 19 of those 63 cases (30.2%). Culture and/or pathology was positive in 73 (64.6%) of the 113 cases. There were no significant differences in rates of positive culture or pathology by vertebral region (p = 0.51, p = 0.81). The most frequently identified organisms were Staphylococcus aureus (13) and coagulase negative staphylococci (13). Conclusions: Our results suggest that the positive culture rate of percutaneous spinal biopsy specimens is 30.4% with radiographically high probability for infection, which is lower than previously published. Infection may also be present

Percutaneous transluminal angioplasty of stenoses of the proximal subclavian artery

International Nuclear Information System (INIS)

Grote, R.; Freyschmidt, J.; Walterbusch, G.; Medizinische Hochschule Hannover

1983-01-01

Between August 1980 and June 1982, 12 left-sided proximal subclavian stenoses were dilated with balloon catheters. The dilatation was successful in all patients. Differences in blood pressure in the arm could be demonstrated subsequently. Recurrences occurred in two patients after seven and eleven months. Follow-up of nine patients up to 24 months showed them to be symptom-free. (orig.)

Percutaneous transluminal angioplasty in renal artery stenosis by takayasu's arteritis

International Nuclear Information System (INIS)

Zeon, Seok Kil; Kim, Ok Bae; Kim, Hyun Chul

1984-01-01

Authors want to report that PTA was an out-standing therapeutic method in treatment of renovascular hypertension by renal artery stenosis due to Takayasu's arteritis in an 18-years-old Korean female. Abdominal aortogram and bilateral renal arteriogram showed mild smooth narrowing of the mid abdominal aorta of 4cm length from origin of renal arteries, complete occlusion of left renal artery from it's origin with a few small collateral arteries and severe stenosis of proximal right renal artery. PTA of right renal artery was performed with Gruntzig Balloon dilatation catheter, and the patient's blood pressure was down to 120/80 from 220/130, stable for 8 months follow-up examination. Takayasu's arteritis is one of the most important cause of renovascular hypertension in Orientals. Multiple treatment modalities, such as steroid administration or variable surgical intervention, were attempted and limited response was presented. But PTA is a simple, cost-effective, repeated, and relatively complication-free method in treatment of renovascular hypertension due to Takayasu's arteritis, with an outstanding result, as authors case

Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis

Energy Technology Data Exchange (ETDEWEB)

Bruennler, T.; Langgartner, J.; Lang, S.; Salzberger, B.; Schoelmerich, J. [University Hospital of Regensburg, Department of Internal Medicine 1, Regensburg (Germany); Zorger, N.; Herold, T.; Feuerbach, S.; Hamer, O.W. [University Hospital of Regensburg, Department of Radiology, Regensburg (Germany)

2008-08-15

The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery. (orig.)

Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis

International Nuclear Information System (INIS)

Bruennler, T.; Langgartner, J.; Lang, S.; Salzberger, B.; Schoelmerich, J.; Zorger, N.; Herold, T.; Feuerbach, S.; Hamer, O.W.

2008-01-01

The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery. (orig.)

Percutaneous biopsy of malignant hepatic tumor in patients with bleeding tendency : usefulness of gelfoam plugging up the biopsy track

International Nuclear Information System (INIS)

Yoon, Hye Ran; Kwak, Byung Kook; Choi, Chi Hoon; Park, Yong Ok; Yang, Keun Myeong; Seo, Ja Young; Lee, Shin Hyung; Lee, Chang Joon; Shim, Hyung Jin

1998-01-01

To plug the biopsy site in eight patients with coagulopathy who had undergone percutaneous liver biopsy. To this end, gelfoam cartridge was used as a sealant. Materials and Methods: Using an 18G Tru-Cut-type disposable automated biopsy gun(Soo Ho Medi-tech, Seoul, Korea) and under US guidance, eight patients underwent percutaneous liver biopsy. After the gun had fired, the biopsy specimen in the inner stylet was retrieved while the outer cannula was held in place ; the cannula was then used to plug the biopsy tracks with gelfoam, using two or three cartridges. If bleeding occurred, this was controlled by the use of more gelfoam cartridges. Results:Diagnostic target tissue was obtained in seven of the eight patients(87.5%). Hepatocellular carcinoma was diagnosed in five cases and metastatic cancer in two. Profuse bleeding was observed in one patient(12.5%) and resolved by gelfoam plugging. Conclusion: We believe that in patients with coagulopathy who are required to undergo liver biopsy plugging the liver biopsy track with gelfoam cartridge is a simple, safe and useful method

Percutaneous drainage of lung abscess

Energy Technology Data Exchange (ETDEWEB)

Ri, Jong Min; Kim, Yong Joo; Kang, Duk Sik [Kyung-Pook National University Hospital, Daegu (Korea, Republic of)

1992-05-15

Medical treatment using antibiotics and postural drainage has been widely adopted as a treatment method of pulmonary abscess, accompanied by surgical methods in cases intractable to drug therapy. However long-term therapy may be required, and the tolerance of organisms to antibiotics or other complications are apt to be encountered, during medical treatment. To shorten the convalescent period or to decrease the risk of invasive procedures, rather simple and relatively easy interventional techniques such as transbronchial or percutaneous catheter drainage have been successfully tried. We have performed 12 cases of percutaneous drainages of lung abscesses under fluoroscope guidance. This report is on the results of this procedure.

Percutaneous drainage of lung abscess

International Nuclear Information System (INIS)

Ri, Jong Min; Kim, Yong Joo; Kang, Duk Sik

1992-01-01

Medical treatment using antibiotics and postural drainage has been widely adopted as a treatment method of pulmonary abscess, accompanied by surgical methods in cases intractable to drug therapy. However long-term therapy may be required, and the tolerance of organisms to antibiotics or other complications are apt to be encountered, during medical treatment. To shorten the convalescent period or to decrease the risk of invasive procedures, rather simple and relatively easy interventional techniques such as transbronchial or percutaneous catheter drainage have been successfully tried. We have performed 12 cases of percutaneous drainages of lung abscesses under fluoroscope guidance. This report is on the results of this procedure

Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation

International Nuclear Information System (INIS)

Miraglia, Roberto; Maruzzelli, Luigi; Caruso, Settimo; Riva, Silvia; Spada, Marco; Luca, Angelo; Gridelli, Bruno

2008-01-01

We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.

Percutaneous catheter drainage of pancreatic pseudocysts

International Nuclear Information System (INIS)

Karnel, F.; Gebauer, A.; Jantsch, H.; Prayer, L.; Schurawitzki, H.; Feil, W.

1991-01-01

The results of CT/US-guided percutaneous drainage in 35 patients with pancreatic pseudocysts are reported. 27 patients recovered without surgery and no further treatment was required. 8 patients required a subsequent surgery due to recurrence. The role of CT/US-guided percutaneous drainage in pancreatic pseudocysts as well as an analysis of the technical aspects associated with a successful procedure are discussed. Although US may be used, we believe CT is safer and allows more precise localisation and guidance in the treatment of pseudocysts. (orig.) [de

The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

DEFF Research Database (Denmark)

Haarmark, Christian; Hansen, Peter R; Vedel-Larsen, Esben

2011-01-01

INTRODUCTION: The Tpeak-Tend interval (TpTe) has been linked to increased arrhythmic risk. TpTe was investigated before and after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHOD: Patients with first-time STEMI treated...... with pPCI were included (n = 101; mean age 62 years; range 39-89 years; 74% men). Digital electrocardiograms were taken pre- and post-PCI, respectively. Tpeak-Tend interval was measured in leads with limited ST-segment deviation. The primary end point was all-cause mortality during 22 +/- 7 months (mean...

Percutaneous drainage in conservative therapy for perforated gastroduodenal ulcers.

Science.gov (United States)

Oida, Takatsugu; Kano, Hisao; Mimatsu, Kenji; Kawasaki, Atsushi; Kuboi, Youichi; Fukino, Nobutada; Kida, Kazutoshi; Amano, Sadao

2012-01-01

The management of peptic ulcers has dramatically changed and the incidence of elective surgery for gastroduodenal peptic ulcers has markedly decreased; hence, the incidence of emergency surgery for perforated peptic ulcers has slightly increased. In select cases, conservative therapy can be used as an alternative for treating perforated gastroduodenal ulcers. In this study, we evaluated the efficacy of percutaneous abdominal drainage for the conservative treatment of perforated gastroduodenal ulcers. We retrospectively studied 51 patients who had undergone conservative therapy for perforated gastroduodenal ulcers. These patients were divided into 2 groups on the basis of the initial treatment with conservative therapy with or without percutaneous drainage: group PD included patients who had undergone percutaneous drainage and group NPD, patients who had undergone non-percutaneous drainage. In the PD group, 14.3% (n=3) of the patients did not respond to conservative therapy, while this value was 43.3% (n=13) in the NPD group. The 2 groups differed significantly with respect to conversion from conservative therapy to surgery (pperforated gastroduodenal ulcers should be performed only in the case of patients meeting the required criteria; its combination with percutaneous intraperitoneal drainage is effective as initial conservative therapy.

Antiplatelet and anticoagulation regimen in patients with mechanical valve undergoing PCI - State-of-the-art review.

Science.gov (United States)

Gajanana, Deepakraj; Rogers, Toby; Iantorno, Micaela; Buchanan, Kyle D; Ben-Dor, Itsik; Pichard, Augusto D; Satler, Lowell F; Torguson, Rebecca; Okubagzi, Petros G; Waksman, Ron

2018-04-02

A common clinical dilemma regarding treatment of patients with a mechanical valve is the need for concomitant antiplatelet therapy for a variety of reasons, referred to as triple therapy. Triple therapy is when a patient is prescribed aspirin, a P2Y12 antagonist, and an oral anticoagulant. Based on the totality of the available evidence, best practice in 2017 for patients with mechanical valves undergoing percutaneous coronary intervention (PCI) is unclear. Furthermore, the optimal duration of dual antiplatelet therapy after PCI is evolving. With better valve designs that are less thrombogenic, the thromboembolic risks can be reduced at a lower international normalized ratio target, thus decreasing the bleeding risk. This review will offer an in-depth survey of current guidelines, current evidence, suggested approach for PCI in this cohort, and future studies regarding mechanical valve patients undergoing PCI. Copyright © 2017 Elsevier B.V. All rights reserved.

Rapid prototyping model for percutaneous nephrolithotomy training.

Science.gov (United States)

Bruyère, Franck; Leroux, Cecile; Brunereau, Laurent; Lermusiaux, Patrick

2008-01-01

Rapid prototyping is a technique used for creating computer images in three dimensions more efficiently than classic techniques. Percutaneous nephrolithotomy (PCNL) is a popular method to remove kidney stones; however, broader use by the urologic community has been hampered by the morbidity associated with needle puncture to gain access to the renal calix (bleeding, pneumothorax, hydrothorax, inadvertent colon injury). A training model to improve technique and understanding of renal anatomy could improve complications related to renal puncture; however, no model currently exists for resident training. We created a training model using the rapid prototyping technique based on abdominal CT images of a patient scheduled to undergo PCNL. This allowed our staff and residents to train on the model before performing the operation. This model allowed anticipation of particular difficulties inherent to the patient's anatomy. After training, the procedure proceeded without complication, and the patient was discharged at postoperative day 1 without problems. We hypothesize that rapid prototyping could be useful for resident education, allowing the creation of numerous models for research and surgical training. In addition, we anticipate that experienced urologists could find this technique helpful in preparation for difficult PCNL operations.

Ameliorative percutaneous lumbar discectomy

International Nuclear Information System (INIS)

Xiao Chengjiang; Su Huanbin; He Xiaofeng; Li Yanhao

2005-01-01

Objective: To ameliorate the percutaneous lumbar discectomy (APLD) for improving the effectiveness and amplifying the indicative range of PLD. Methods: To ameliorate percutaneous punctured route based on classic PLD and discectomy of extracting pulp out of the herniated disc with special pulpforceps. The statistical analysis of the therapeutic results on 750 disc protrusions of 655 cases undergone APLD following up from 6 to 54 months retrospectively. Results: The effective ratios were excellent in 40.2%, good for 46.6% and bad of 13.3%. No occurrance of intervertebral inflammation and paradiscal hematoma, there were only 1 case complicated with injuried cauda equina, and 4 cases with broken appliance within disc. Conclusions: APLD is effective and safe, not only indicative for inclusion disc herniation, but also for noninclusion herniation. (authors)

Covered stents for endovascular repair of iatrogenic injuries of iliac and femoral arteries

Energy Technology Data Exchange (ETDEWEB)

Kufner, Sebastian, E-mail: kufners@dhm.mhn.de [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); Cassese, Salvatore; Groha, Philipp; Byrne, Robert A. [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); Schunkert, Heribert; Kastrati, Adnan [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich (Germany); Ott, Ilka; Fusaro, Massimiliano [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany)

2015-04-15

Background: The growing number of complex endovascular procedures is expected to increase the risk of iatrogenic injuries of peripheral arteries. A strategy of percutaneous transluminal angioplasty (PTA) with covered stent (CS) may represent a valuable alternative to open surgery. However, systematic evaluations of CS in this setting represent a scientific gap. In the present study, we investigate the procedural and clinical outcomes associated with PTA and CS implantation to repair iatrogenic injuries of peripheral arteries. Methods: All patients undergoing PTA with CS for endovascular repair of iatrogenic injuries of peripheral arteries between August 2010 and July 2013 at our Institution were retrospectively analyzed. The primary endpoint was the technical success. Secondary endpoints were in-hospital mortality and cumulative death, target lesion revascularization (TLR), amputation and major stroke at 12-month follow-up. Results: During the period of observation, a total of 30 patients underwent PTA with either self-expandable (43.3%) or balloon-expandable CS (56.7%) for iatrogenic injuries of peripheral arteries. Injuries consisted of perforation/rupture (76.7%), arteriovenous fistula (16.7%) and pseudoaneurysm (6.7%) of iliac–femoral arteries. Technical success was achieved in all cases. Median follow-up was 409 days [210–907]. The incidence of in-hospital mortality was 10.0%. At 12-month follow-up, the incidence of death, TLR, amputation and major stroke was 20.0%, 17.0%, 3.3% and 6.7%, respectively. Conclusion: The use of covered stents for endovascular repair of iatrogenic injuries of peripheral arteries shows a high technical success and may be alternative to surgery. Further studies with larger populations are needed to confirm these preliminary findings. - Highlights: • The growing number of complex endovascular procedures is expected to increase the risk of iatrogenic injuries of peripheral arteries. • Percutaneous transluminal angioplasty with

Anticoagulant and Antiplatelet Prescribing Patterns for Patients with Atrial Fibrillation after Percutaneous Coronary Intervention.

Science.gov (United States)

Woods, Erin A; Ackman, Margaret L; Graham, Michelle M; Koshman, Sheri L; Boswell, Rosaleen M; Barry, Arden R

2016-01-01

Current guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, for patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation. The choice of anticoagulant/antiplatelet therapy in this population is ambiguous and complex, and prescribing patterns are not well documented. To characterize local prescribing patterns for anticoagulant/antiplatelet therapy after percutaneous coronary intervention in patients with nonvalvular atrial fibrillation. A chart review was conducted at a single quaternary cardiology centre. Patients with nonvalvular atrial fibrillation were identified via medical records, and those who underwent percutaneous coronary intervention were identified using a local clinical patient registry. Adult inpatients with nonvalvular atrial fibrillation and a CHADS2 score (based on congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke) of 1 or higher who underwent percutaneous coronary intervention from 2011 to 2013 were included. Patients undergoing cardiovascular surgery or transcatheter aortic valve replacement, those with mechanical devices requiring anticoagulation, and those with an allergy to any component of TAT were excluded. Seventy patients were included. The median age was 75 years, and 52 (74%) were men. At discharge, 30 (43%) were receiving TAT and 27 (39%) were receiving dual antiplatelet therapy (clopidogrel and ASA). No patients received the combination of warfarin and clopidogrel. Among those who received TAT, 90% (19 of 21) who received a bare metal stent had a recommended duration of 1 month, and 75% (6 of 8) who received a drug-eluting stent had a recommended duration of 1 year. Direct-acting oral anticoagulants with 2 antiplatelet drugs were prescribed for 9% (6 of 70) of the patients, and 10% (7 of 70) received ticagrelor and ASA with or without warfarin. Overall, the

Frequency of Cardiac Death and Stent Thrombosis in Patients With Chronic Obstructive Pulmonary Disease Undergoing Percutaneous Coronary Intervention (from the BASKET-PROVE I and II Trials)

DEFF Research Database (Denmark)

Jatene, Tannas; Biering-Sørensen, Tor; Nochioka, Kotaro

2017-01-01

Chronic obstructive pulmonary disease (COPD) is associated with long-term all-cause death after percutaneous coronary intervention with bare-metal stents. Regarding other outcomes, previous studies have shown conflicting results and the impact of drug-eluting stent (DES) in this population is not...

Percutaneous drainage treatment of primary liver abscesses

Energy Technology Data Exchange (ETDEWEB)

Berger, H.; Pratschke, E.; Berr, F.; Fink, U.

1989-02-01

28 primary liver abscesses, including 9 amoebic abscesses, in 24 patients were drained percutaneously. Indication for drainage in amoebic abscesses was imminent rupture and clinical symptoms as pleural effusion, lung atelectasis and pain. 95% of the primary abscesses were cured by percutaneous drainage and systemic antibiotic treatment. There was one recurrence of abscess, which was managed surgically. Reasons for drainage failure were: tumour necrosis and tumour perforation with secondary liver abscess.

Infective endocarditis following percutaneous pulmonary valve replacement

DEFF Research Database (Denmark)

Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj

2013-01-01

Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.......Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult....

Percutaneous biliary drainage and stenting

International Nuclear Information System (INIS)

Totev, M.

2012-01-01

Full text: Percutaneous transhepatic cholangiography (PTC) is an X-ray or US guided procedure that involves the injection of a contrast material directly into the bile ducts inside the liver to produce pictures of them. If a blockage or narrowing is found, additional procedures may be performed: 1. insertion of a catheter to drain excess bile out of the body or both - internal and external; 2. plastic endoprothesis placement; 3. self-expandable metal stents placement to help open bile ducts or to bypass an obstruction and allow fluids to drain. Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) and biliary drainage to manage benign and malignant obstructions. Internal biliary stents are either plastic or metallic, and various types of each kind are available. Internal biliary stents have several advantages. An external tube can be uncomfortable and have a psychological disadvantage. An internal stent prevents the problems related to external catheters, for example, pericatheter leakage of bile and the need for daily flushing. The disadvantages include having to perform endoscopic retrograde cholangiopancreatography (ERCP) or new PTC procedures to obtain access in case of stent obstruction. Better patency rates are reported with metallic than with plastic stents in cases of malignant obstruction, though no effect on survival is noted. Plastic internal stents are the cheapest but reportedly prone to migration. Metallic stents are generally not used in the treatment of benign disease because studies have shown poor long-term patency rates. Limited applications may include the treatment of patients who are poor surgical candidates or of those in whom surgical treatment fails. Most postoperative strictures are treated surgically, though endoscopic and (less commonly) percutaneous placement of nonmetallic stents has increasingly been used in the past few years. Now there are some reports about use of biodegradable biliary

Percutaneous injuries among dental professionals in Washington State

Directory of Open Access Journals (Sweden)

Shah Syed M

2006-10-01

Full Text Available Abstract Background Percutaneous exposure incidents facilitate transmission of bloodborne pathogens such as human immunodeficiency virus (HIV, hepatitis C virus (HCV and hepatitis B virus (HBV. This study was conducted to identify the circumstances and equipment related to percutaneous injuries among dental professionals. Methods We used workers' compensation claims submitted to the Department of Labor and Industries State Fund during a 7-year period (1995 through 2001 in Washington State for this study. We used the statement submitted by the injured worker on the workers' compensation claim form to determine the circumstances surrounding the injury including the type of activity and device involved. Results Of a total of 4,695 accepted State Fund percutaneous injury claims by health care workers (HCWs, 924 (20% were submitted by dental professionals. Out of 924 percutaneous injuries reported by dental professionals 894 (97% were among dental health care workers in non-hospital settings, including dentists (66, 7%, dental hygienists (61, 18% and dental assistants (667, 75%. The majority of those reporting were females (638, 71%. Most (781, 87% of the injuries involved syringes, dental instruments (77, 9%, and suture needles (23%. A large proportion (90% of injuries occurred in offices and clinics of dentists, while remainder occurred in offices of clinics and of doctors of medicine (9%, and a few in specialty outpatient facilities (1%. Of the 894 dental health care workers with percutaneous injuries, there was evidence of HBV in 6 persons, HCV in 30 persons, HIV in 3 persons and both HBV and HVC (n = 2 exposure. Conclusion Out of hospital percutaneous injuries are a substantial risk to dental health professionals in Washington State. Improved work practices and safer devices are needed to address this risk.

Combined Value of Red Blood Cell Distribution Width and Global Registry of Acute Coronary Events Risk Score for Predicting Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Science.gov (United States)

Zhao, Na; Mi, Lan; Liu, Xiaojun; Pan, Shuo; Xu, Jiaojiao; Xia, Dongyu; Liu, Zhongwei; Zhang, Yong; Xiang, Yu; Yuan, Zuyi; Guan, Gongchang; Wang, Junkui

2015-01-01

Global Registry of Acute Coronary Events (GRACE) risk score and red blood cell distribution width (RDW) content can both independently predict major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergoing percutaneous coronary intervention (PCI) for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58%) patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30-12.90, 13.00-13.50, 13.60-16.40). GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were independent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024-1.055; p risk of MACEs increased with increasing RDW content (p value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.

Different postconditioning cycles affect prognosis of aged patients undergoing primary percutaneous coronary intervention.

Science.gov (United States)

Zhang, Jie; Zhang, Xin; Cui, Yuqi; Ferdous, Misbahul; Cui, Lianqun; Zhao, Peng

2017-07-17

Postconditioning can affect the infarct size in acute myocardial infarction (AMI). However, few studies show an effect of different postconditioning cycles on AMI aged patients. This study sought to assess the effect of different postconditioning cycles on prognosis in aged patients with AMI who underwent primary percutaneous coronary intervention (PCI). 74 aged patients were randomly assigned to three groups. Control group; PC-1 group accepted postconditioning 4 cycles of 30 s inflation and 30 s deflation; PC-2 group accepted postconditioning 4 cycles of 60 s. Creatine kinase MB (CK-MB), troponin I (cTnI), high-sensitive C-reactive protein (hs-CRP) and corrected Thrombolysis in Myocardial Infarction (TIMI) frame counts (CTFC) were analyzed before andafter treatment. All patients received an echocardiographic examination for whole heart function, wall motion score index (WMSI) and single-photon emission computed tomography (SPECT) examination at 7 days and 6 months after treatment. S: The peak of CK-MB, postoperative 72 h cTnI and CTFC were significantly attenuated by postconditioning when compared with the control group. The hs-CRP of the postconditioning group was lower than the control group 24 h postoperative. No difference was observed between PC-1 and PC-2 group about the effect described above. At 7 days, heart function in the postconditioning group was improved when compared with the control group. At 6 months, the WMSI and SPECT score significantly reduced in the PC-2 group compared with the control and PC-1 groups, but there was no difference among the three groups about echo data except the left ventricular end-systolic diameter. Postconditioning is significantly beneficial to prognosis in aged patients with AMI. The cardiac protective effect of 4 cycles of 60 s procedure was observed in WMSI and SPECT. It is favorable to implement this procedure in aged patients with AMI in clinic.

Percutaneous Cystgastrostomy as a Single-Step Procedure

International Nuclear Information System (INIS)

Curry, L.; Sookur, P.; Low, D.; Bhattacharya, S.; Fotheringham, T.

2009-01-01

The purpose of this study was to evaluate the success of percutaneous transgastric cystgastrostomy as a single-step procedure. We performed a retrospective analysis of single-step percutaneous transgastric cystgastrostomy carried out in 12 patients (8 male, 4 female; mean age 44 years; range 21-70 years), between 2002 and 2007, with large symptomatic pancreatic pseudocysts for whom up to 1-year follow-up data (mean 10 months) were available. All pseudocysts were drained by single-step percutaneous cystgastrostomy with the placement of either one or two stents. The procedure was completed successfully in all 12 patients. The pseudocysts showed complete resolution on further imaging in 7 of 12 patients with either enteric passage of the stent or stent removal by endoscopy. In 2 of 12 patients, the pseudocysts showed complete resolution on imaging, with the stents still noted in situ. In 2 of 12 patients, the pseudocysts became infected after 1 month and required surgical intervention. In 1 of 12 patients, the pseudocyst showed partial resolution on imaging, but subsequently reaccumulated and later required external drainage. In our experience, percutaneous cystgastrostomy as a single-step procedure has a high success rate and good short-term outcomes over 1-year follow-up and should be considered in the treatment of large symptomatic cysts.

Pleural fluid drainage: Percutaneous catheter drainage versus surgical chest tube drainage

International Nuclear Information System (INIS)

Illescas, F.F.; Reinhold, C.; Atri, M.; Bret, P.M.

1987-01-01

Over the past 4 years, 55 cases (one transudate, 28 exudates, and 26 empymas) were drained. Surgical chest tubes alone were used in 35 drainages, percutaneous catheters alone in five drainages, and both types in 15 drainages. Percutaneous catheter drainage was successful in 12 of 20 drainages (60%). Surgical tube drainage was successful in 18 of 50 drainages (36%). The success rate for the nonempyema group was 45% with both types of drainage. For the empyema group, the success rate for percutaneous catheter drainage was 66% vs 23% for surgical tube drainage. Seven major complications occurred with surgical tube drainage, but only one major complication occurred with percutaneous catheter drainage. Radiologically guided percutaneous catheter drainage should be the procedure of choice for pleural fluid drainage. It has a higher success rate for empyemas and is associated with less complications

NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator.

Science.gov (United States)

Korzeniowski, Przemyslaw; Barrow, Alastair; Sodergren, Mikael H; Hald, Niels; Bello, Fernando

2016-12-01

Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. We developed NOViSE-the first force-feedback-enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom-built, and the behaviour of the virtual flexible endoscope is based on an established theoretical framework-the Cosserat theory of elastic rods. We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES. VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype, and the initial results indicate that it provides promising foundations for further development.

Malfunctioning Plastic Biliary Endoprosthesis: Percutaneous Transhepatic Balloon Pulling Technique

Directory of Open Access Journals (Sweden)

Umberto G. Rossi

2013-01-01

Full Text Available Percutaneous transhepatic removal techniques for malfunctioning plastic biliary endoprosthesis are considered safe and efficient second-line strategies, when endoscopic procedures are not feasible. We describe the percutaneous transhepatic balloon pulling technique in a patient with an unresectable malignant hilar cholangiocarcinoma.

The Association of Peri-Procedural Blood Transfusion with Morbidity and Mortality in Patients Undergoing Percutaneous Lower Extremity Vascular Interventions: Insights from BMC2 VIC.

Science.gov (United States)

Henke, Peter K; Park, Yeo Jung; Hans, Sachinder; Bove, Paul; Cuff, Robert; Kazmers, Andris; Schreiber, Theodore; Gurm, Hitinder S; Grossman, P Michael

2016-01-01

To determine the predictors of periprocedural blood transfusion and the association of transfusion on outcomes in high risk patients undergoing endoluminal percutaneous vascular interventions (PVI) for peripheral arterial disease. Between 2010-2014 at 47 hospitals participating in a statewide quality registry, 4.2% (n = 985) of 23,273 patients received a periprocedural blood transfusion. Transfusion rates varied from 0 to 15% amongst the hospitals in the registry. Using multiple logistic regression, factors associated with increased transfusion included female gender (OR = 1.9; 95% CI: 1.6-2.1), low creatinine clearance (1.3; 1.1-1.6), pre-procedural anemia (4.7; 3.9-5.7), family history of CAD (1.2; 1.1-1.5), CHF (1.4; 1.2-1.6), COPD (1.2; 1.1-1.4), CVD or TIA (1.2; 1.1-1.4), renal failure CRD (1.5; 1.2-1.9), pre-procedural heparin use (1.8; 1.4-2.3), warfarin use (1.2; 1.0-1.5), critical limb ischemia (1.7; 1.5-2.1), aorta-iliac procedure (1.9; 1.5-2.5), below knee procedure (1.3; 1.1-1.5), urgent procedure (1.7; 1.3-2.2), and emergent procedure (8.3; 5.6-12.4). Using inverse weighted propensity matching to adjust for confounders, transfusion was a significant risk factor for death (15.4; 7.5-31), MI (67; 29-150), TIA/stroke (24; 8-73) and ARF (19; 6.2-57). A focused QI program was associated with a 28% decrease in administration of blood transfusion (p = 0.001) over 4 years. In a large statewide PVI registry, post procedure transfusion was highly correlated with a specific set of clinical risk factors, and with in-hospital major morbidity and mortality. However, using a focused QI program, a significant reduction in transfusion is possible.

Multidisciplinary Assessment in Optimising Results of Percutaneous Patent Foramen Ovale Closure.

Science.gov (United States)

Davies, Allan; Ekmejian, Avedis; Collins, Nicholas; Bhagwandeen, Rohan

2017-03-01

Percutaneous patent foramen ovale (PFO) closure is a therapeutic option to prevent recurrent cerebral ischaemia in patients with cryptogenic stroke and transient cerebral ischaemia (TIA). The apparent lack of benefit seen in previous randomised trials has, in part, reflected inclusion of patients with alternate mechanisms of stroke. The role of formal neurology involvement in accurately delineating the likely aetiology of stroke or TIA is crucial in appropriate identification of patients for device closure. Furthermore, as the benefits of device closure may accrue over time, long-term follow-up is essential to define the role of device closure in management of presumed cryptogenic stroke. We retrospectively reviewed our experience with percutaneous PFO device closure since 2005. All subjects who underwent PFO closure at John Hunter and Lake Macquarie Private Hospitals were included in the study. All patients referred for device closure following cryptogenic stroke or TIA had first undergone formal neurology review with appropriate imaging and exclusion of paroxysmal atrial arrhythmia. Patients with a history of transient ischaemic attack (TIA) are frequently referred to a specialised clinic, aimed to identify patients with conditions not referable to cerebral ischaemia, with investigations initiated by the specialist clinic to elucidate an underlying aetiology. Outcome data was derived from the Hunter New England Area Local Health District Cardiac and Stroke Outcomes Unit, in addition to review of the medical record. The Cardiac and Stroke Outcomes Unit prospectively identified all patients presenting with stroke, TIA and atrial fibrillation. One hundred and twelve consecutive patients undergoing percutaneous patent foramen ovale closure between 2005 and 2015 were identified. The average age was 42.7 years and 57 (50.9%) patients were male. Cryptogenic stroke (68.8%) and transient cerebral ischaemia (23.2%) were the most common indications for PFO closure, with the

Percutaneous drainage treatment of primary liver abscesses

International Nuclear Information System (INIS)

Berger, H.; Pratschke, E.; Berr, F.; Fink, U.; Klinikum Grosshadern, Muenchen; Klinikum Grosshadern, Muenchen

1989-01-01

28 primary liver abscesses, including 9 amoebic abscesses, in 24 patients were drained percutaneously. Indication for drainage in amoebic abscesses was imminent rupture and clinical symptoms as pleural effusion, lung atelectasis and pain. 95% of the primary abscesses were cured by percutaneous drainage and systemic antibiotic treatment. There was one recurrence of abscess, which was managed surgically. Reasons for drainage failure were: tumour necrosis and tumour perforation with secondary liver abscess. (orig.) [de

Percutaneous Transhepatic Cholangiography

African Journals Online (AJOL)

1974-03-30

Mar 30, 1974 ... Percutaneous transhepatic cholangiography can play a major role in expediting the early diagnosis of surgically correctable jaundice. The need for this is emphasised by the fact that in a group of 46 patients the delay between the onset of jaundice and diagnosis ranged from 20 to 90 days. Transhepatic ...

Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery.

Science.gov (United States)

Autorino, Riccardo; Stein, Robert J; Lima, Estevão; Damiano, Rocco; Khanna, Rakesh; Haber, Georges-Pascal; White, Michael A; Kaouk, Jihad H

2010-05-01

Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been successfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

Blood flow quantification from 2D phase contrast MRI in renal arteries using an unsupervised data driven approach

Energy Technology Data Exchange (ETDEWEB)

Zoellner, Frank Gerrit [Computer Assisted Clinical Medicine, Faculty of Medicine Mannheim, Univ. of Heidelberg, Mannheim (Germany); Section for Radiology, Dept. of Surgical Sciences, Univ. of Bergen (Norway); Monssen, Jan Ankar [Dept. of Radiology, Haukeland Univ. Hospital, Bergen (Norway); Roervik, Jarie [Section for Radiology, Dept. of Surgical Sciences, Univ. of Bergen (Norway); Dept. of Radiology, Haukeland Univ. Hospital, Bergen (Norway); Lundervold, Arvid [Dept. of Radiology, Haukeland Univ. Hospital, Bergen (Norway); Dept. of Biomedicine, Univ. of Bergen (Norway); Schad, Lothar R. [Computer Assisted Clinical Medicine, Faculty of Medicine Mannheim, Univ. of Heidelberg, Mannheim (Germany)

2009-07-01

We present a clustering approach to segment the renal artery from 2D PC Cine MR images to measure arterial blood velocity and flow. Such information is important in grading renal artery stenosis and to support the decision on surgical interventions like percutaneous transluminal angioplasty. Results from 20 data sets (volunteers, 7 patients) show that the renal arteries could be extracted automatically and the corresponding velocity profiles were close (r = 0.977) to that obtained by manual delineations of the vessel areas. (orig.)

Blood flow quantification from 2D phase contrast MRI in renal arteries using an unsupervised data driven approach

International Nuclear Information System (INIS)

Zoellner, Frank Gerrit; Monssen, Jan Ankar; Roervik, Jarie; Lundervold, Arvid; Schad, Lothar R.

2009-01-01

We present a clustering approach to segment the renal artery from 2D PC Cine MR images to measure arterial blood velocity and flow. Such information is important in grading renal artery stenosis and to support the decision on surgical interventions like percutaneous transluminal angioplasty. Results from 20 data sets (volunteers, 7 patients) show that the renal arteries could be extracted automatically and the corresponding velocity profiles were close (r = 0.977) to that obtained by manual delineations of the vessel areas. (orig.)

Clinical experience with iodine-123-iodophenylpentadecanoic acid.

Science.gov (United States)

Corbett, J

1994-04-01

Initial research in dogs and later research in normal volunteers and patients with coronary artery disease indicated that 123I-iodophenylpentadecanoic acid (IPPA) can provide valuable diagnostic information. This agent compared favorably to 201Tl in detecting stenosed coronary arteries and identified reversible lesions with greater frequency. Testing with both 201Tl and IPPA before and after percutaneous transluminal coronary angioplasty produced similar results, supporting the notion that IPPA deserves inclusion among the diagnostic tools used to evaluate coronary heart disease.

Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty: randomized trial.

Science.gov (United States)

Shammas, Nicolas W; Coiner, Denise; Shammas, Gail A; Dippel, Eric J; Christensen, Lori; Jerin, Michael

2011-09-01

Target lesion revascularization (TLR) with primary percutaneous transluminal angioplasty (PTA) versus SilverHawk atherectomy and adjunctive PTA of de novo infrainguinal disease has not been well defined. This study was conducted to compare the two approaches. In this prospective, two-center randomized trial of PTA versus atherectomy of infrainguinal vessels, the primary endpoint of TLR was evaluated at 1 year. Secondary endpoints included the rate of "bailout" stent placement for suboptimal acute angiographic results and the rate of target vessel revascularization (TVR). Fifty-eight patients were included in the study. Of these, 29 (36 vessels) were randomized to the atherectomy arm and 29 (48 vessels) to the PTA arm. Final acute angiographic success rates were 100% in the PTA arm and 97.2% in the atherectomy arm (P value not significant). There was no statistical difference in TLR (16.7% vs 11.1%) or TVR (21.4% vs 11.1%) between the PTA and atherectomy groups, respectively. Bailout stent placement was performed in 18 of 29 patients (62.1%) in the PTA arm and eight of 29 patients (27.6%) in the atherectomy arm (P = .017). Major adverse events were similar between the PTA and atherectomy arms. Finally, when embolic filter protection was used, distal macroembolization occurred in 11 of 17 patients (64.7%) treated with atherectomy versus none of 10 in the PTA group (P atherectomy and primary PTA. Atherectomy reduced the need for bailout stent placement compared with primary PTA. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

Effect of rosuvastatin dose-loading on serum sLox-1, hs-CRP, and postoperative prognosis in diabetic patients with acute coronary syndromes undergoing selected percutaneous coronary intervention (PCI).

Science.gov (United States)

Jiao, Yungen; Hu, Feng; Zhang, Zhengang; Gong, Kaizheng; Sun, Xiaoning; Li, Aihua; Liu, Naifeng

2015-01-01

To investigate the effect of rosuvastatin dose-loading on serum levels of lectin-like oxidized low-density lipoprotein receptor-1 (Lox-1) and high-sensitivity c-reactive protein (hs-CRP) and postoperative prognosis in patients with diabetes and non-ST segment elevation acute coronary syndromes (NSTEACS) undergoing selected percutaneous coronary intervention (PCI). A total of 72 patients with diabetes and NSTEACS were randomized to either the group treated with 20 mg rosuvastatin 12 hours prior to PCI with a second dose administered just before PCI (n = 33), or a control group treated with standard method according guideline (n = 39). Serum levels of sLox-1, hs-CRP, CK-MB, and cTnI were measured prior to PCI, and at 24 hours and 30 days after PCI. The 30-day incidence of major adverse cardiac events (MACE) was recorded in both groups. Compared to pre-PCI, serum levels of sLox-1 and hs-CRP of the two groups were increased at 24 hours after PCI (P PCI (P PCI, the levels of TC and LDL-C were not changed at 24 hours after PCI (P > 0.05) until 30 days after PCI (P PCI; the 30-day incidence of MACE occurred in 6.06% of patients in the loading-dose rosuvastatin-treated group and in 23.08% of patients in the control-treated group (P PCI, and also reduce the occurrence of MACE 30 days after PCI.

Percutaneous management of bile duct injury after laparoscopic cholecystectomy

International Nuclear Information System (INIS)

Islim, F.; Ors, S.; Salik, A.; Guven, K.; Yanar, F.; Alis, H.

2012-01-01

Full text: Introduction: The risk of bile duct injury after laparoscopic cholecystectomy is higher than open cholecystectomy. Objective: To discuss the importance of minimally invasive treatment options in the management of bile duct injuries after laparoscopic cholecystectomy and to present our approach in the management. Materials and methods: Management of 25 patients with symptomatic bile duct injury after laparoscopic cholecystectomy was retrospectively evaluated. Percutaneous collection drainage, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and percutaneous biliary drainage were performed for the management of the patients. Results: Mean age of the patients (15 women, 10 men) was 55. Either ultrasonography or computed tomography guided percutaneous drainage was performed in 13 patients. 9 of them completely recovered only with percutaneous drainage. In 4 of them ERCP was performed because of high drainage volume. In 9 of the patients with jaundice and high bilirubin levels ERCP was performed as the first option. And 3 patients were reoperated because of acute abdomen signs. ERCP, MRCP and PTC revealed type A in 7, type E2 in 3, type E3 in 3 and type E4 in 1 of the patients according to Strasberg classification. Conclusion: Presenting symptoms of the patients with symptomatic bile duct injury are useful in the determination of the treatment option.

Percutaneous rendezvous technique for the management of a bile duct injury.

Science.gov (United States)

Meek, James; Fletcher, Savannah; Crumley, Kristen; Culp, W C; Meek, Mary

2018-02-01

The rendezvous technique typically involves combined efforts of interventional radiology, endoscopy, and surgery. It can be done solely percutaneously, whereby the interventionalist gains desired access to one point in the body by approaching it from two different access sites. We present the case of a woman who underwent cholecystectomy complicated by a bile duct injury. A percutaneous rendezvous procedure enabled placement of an internal-external drain from the intrahepatic ducts through the biloma and distal common bile duct and into the duodenum. Thus, a percutaneous rendezvous technique is feasible for managing a bile duct injury when endoscopic retrograde cholangio-pancreatography or percutaneous transhepatic cholangiogram alone has been unsuccessful.

Percutaneous rendezvous technique for the management of a bile duct injury

Directory of Open Access Journals (Sweden)

James Meek, DO

2018-02-01

Full Text Available The rendezvous technique typically involves combined efforts of interventional radiology, endoscopy, and surgery. It can be done solely percutaneously, whereby the interventionalist gains desired access to one point in the body by approaching it from two different access sites. We present the case of a woman who underwent cholecystectomy complicated by a bile duct injury. A percutaneous rendezvous procedure enabled placement of an internal-external drain from the intrahepatic ducts through the biloma and distal common bile duct and into the duodenum. Thus, a percutaneous rendezvous technique is feasible for managing a bile duct injury when endoscopic retrograde cholangio-pancreatography or percutaneous transhepatic cholangiogram alone has been unsuccessful.

Percutaneous embolisation of retroperitoneal bleeding from pelvic fractures

International Nuclear Information System (INIS)

Grabenwoeger, F.; Dock, W.; Ittner, G.; Vienna Univ.

1989-01-01

Pelvic fractures may lead to severe retroperitoneal bleeding. Percutaneous catheter embolisation has become an increasingly important therapeutic alternative to surgical intervention. Most studies dealing with this problem have been small and we have attempted to evaluate the method on the basis of our own experience and a review of the literature. The success rate of percutaneous embolisation appears to be about 94%. The use of blood transfusion dropped from an average of 25.7 units before embolisation to an average of 6.5 units after embolisation. In spite of this, mortality in these patients remains high at 43.3% because of the serious additional injuries. The advantages and disadvantages of various embolising materials are discussed and various techniques of percutaneous embolisation are described. (orig.) [de

Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease.

Science.gov (United States)

Rothberg, Michael B; Sivalingam, Senthil K; Kleppel, Reva; Schweiger, Marc; Hu, Bo; Sepucha, Karen R

2015-07-01

Patients with stable coronary disease undergoing percutaneous coronary intervention (PCI) are frequently misinformed about the benefits of PCI. Little is known about the quality of decision making before angiography and possible PCI. To assess the quality of informed decision making and its association with patient decisions. We performed a cross-sectional analysis of recorded conversations between August 1, 2008, and August 31, 2012, among adults with known or suspected stable coronary disease at outpatient cardiology practices. Presence of 7 elements of informed decision making and the decision to undergo angiography and possible PCI. Of 59 conversations conducted by 23 cardiologists, 2 (3%) included all 7 elements of informed decision making; 8 (14%) met a more limited definition of procedure, alternatives, and risks. Specific elements significantly associated with not choosing angiography and possible PCI included discussion of uncertainty (odds ratio [OR], 20.5; 95% CI, 2.3-204.9), patient's role (OR, 5.3; 95% CI, 1.3-21.3), exploration of alternatives (OR, 9.5; 95% CI, 2.5-36.5), and exploration of patient preference (OR, 4.8; 95% CI, 1.2-19.4). Neither the presence of angina nor severity of symptoms was associated with choosing angiography and possible PCI. In a multivariable analysis using the total number of elements as a predictor, better informed patients were less likely to choose angiography and possible PCI (OR per additional element, 3.2; 95% CI, 1.4-7.1; P = .005). In conversations between cardiologists and patients with stable angina, informed decision making is often incomplete. More complete discussions are associated with patients choosing not to undergo angiography and possible PCI.

The optimal definition of contrast-induced acute kidney injury for prediction of inpatient mortality in patients undergoing percutaneous coronary interventions.

Science.gov (United States)

Parsh, Jessica; Seth, Milan; Briguori, Carlo; Grossman, Paul; Solomon, Richard; Gurm, Hitinder S

2016-05-01

It is unknown which definition of contrast-induced acute kidney injury (CI-AKI) in the setting of percutaneous coronary interventions is best associated with inpatient mortality and whether this association is stable across patients with various preprocedural serum creatinine (SCr) values. We applied logistic regression models to multiple CI-AKI definitions used by the Kidney Disease Improving Global Outcomes guidelines and previously published studies to examine the impact of preprocedural SCr on a candidate definition's correlation with the adverse outcome of inpatient mortality. We used likelihood ratio tests to examine candidate definitions and identify those where association with inpatient mortality remained constant regardless of preprocedural SCr. These definitions were assessed for specificity, sensitivity, and positive and negative predictive values to identify an optimal definition. Our study cohort included 119,554 patients who underwent percutaneous coronary intervention in Michigan between 2010 and 2014. Most commonly used definitions were not associated with inpatient mortality in a constant fashion across various preprocedural SCr values. Of the 266 candidate definitions examined, 16 definition's association with inpatient mortality was not significantly altered by preprocedural SCr. Contrast-induced acute kidney injury defined as an absolute increase of SCr ≥0.3 mg/dL and a relative SCr increase ≥50% was selected as the optimal candidate using Perkins and Shisterman decision theoretic optimality criteria and was highly predictive of and specific for inpatient mortality. We identified the optimal definition for CI-AKI to be an absolute increase in SCr ≥0.3 mg/dL and a relative SCr increase ≥50%. Further work is needed to validate this definition in independent studies and to establish its utility for clinical trials and quality improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

International Nuclear Information System (INIS)

Thompson, Scott M.; Callstrom, Matthew R.; McKusick, Michael A.; Woodrum, David A.

2015-01-01

PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA

Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

Energy Technology Data Exchange (ETDEWEB)

Thompson, Scott M., E-mail: Thompson.scott@mayo.edu [Mayo Clinic, Mayo Graduate School, Mayo Medical School and the Mayo Clinic Medical Scientist Training Program, College of Medicine (United States); Callstrom, Matthew R., E-mail: callstrom.matthew@mayo.edu; McKusick, Michael A., E-mail: mckusick.michael@mayo.edu; Woodrum, David A., E-mail: woodrum.david@mayo.edu [Mayo Clinic, Department of Radiology, College of Medicine (United States)

2015-10-15

PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA.

Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention

Science.gov (United States)

Pham, Phuong-Anh; Pham, Phuong-Thu; Pham, Phuong-Chi; Miller, Jeffrey M; Pham, Phuong-Mai; Pham, Son V

2011-01-01

The advent of potent antiplatelet and antithrombotic agents over the past decade has resulted in significant improvement in reducing ischemic events in acute coronary syndrome (ACS). However, the use of antiplatelet and antithrombotic combination therapy, often in the settings of percutaneous coronary intervention (PCI), has led to an increase in the risk of bleeding. In patients with non-ST elevation myocardial infarction treated with antithrombotic agents, bleeding has been reported to occur in 0.4%–10% of patients, whereas in patients undergoing PCI, periprocedural bleeding occurs in 2.2%–14% of cases. Until recently, bleeding was considered an intrinsic risk of antithrombotic therapy, and efforts to reduce bleeding have received little attention. There have been increasing data demonstrating that bleeding is associated with adverse outcomes, including myocardial infarction, stroke, and death. Therefore, it is imperative to optimize patient outcomes by adopting pharmacological and nonpharmacological strategies to minimize bleeding while maximizing treatment efficacy. In this paper, we present a review of the bleeding classifications used in large-scale clinical trials in patients with ACS and those undergoing PCI treated with antiplatelets and antithrombotic agents, adverse outcomes, particularly mortality associated with bleeding complications, and suggested predictive risk factors. Potential mechanisms of the association between bleeding and mortality and strategies to reduce bleeding complications are also discussed. PMID:21915172

Emergency bypass post percutaneous atrial ablation: a case report.

LENUS (Irish Health Repository)

Hargrove, M

2010-11-01

A 34-year-old male undergoing percutaneous atrial ablation procedure for paroxysmal fibrillation required emergency sternotomy for cardiac tamponade. The patient had been anticoagulated and had received plavix and aspirin prior to and during the ablation procedure. Seven units of red cell concentrate had been transfused in the cardiac catherisation laboratory. On arrival in theatre, the patient was hypotensive, but was awake on induction of anaesthesia. No recordable blood pressure with non-invasive monitoring was observed. A sternotomy was immediately performed and, on evacuation of the pericardium, a bleeding site was not visible. The patient was commenced on cardiopulmonary bypass. Bleeding site was identified and the defect closed. The patient was weaned from cardiopulmonary bypass with minimal inotropic support and made an uneventful recovery. Bypass time was 38 minutes. A literature review showed a 1% incidence of post-ablation bleeding(1). The incidence of reverting to bypass for such an event has not been reported previously. During these procedures, it might be wise to have the cardiothoracic team notified while atrial ablation procedures are being performed in the cardiac catheterization laboratory.

CT-guided percutaneous treatment of solitary pyogenic splenic abscesses

Energy Technology Data Exchange (ETDEWEB)

Pombo, F. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Suarez, I. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Marini, M. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Arrojo, L. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Echaniz, A. [Dept. of Internal Medicine, Hospital Juan Canalejo, La Coruna (Spain)

1991-08-01

Six patients with solitary pyogenic splenic abscesses treated by CT-guided percutaneous drainage (by catheter or needle), are presented. There were 3 unilocular, purely intrasplenic abscesses and 3 complex lesions with loculations and perisplenic involvement. Percutaneous drainage and intravenous antibiotics were curative in 4 patients. In the other 2, who had multiloculated abscesses, despite initially successful drainage, splenectomy was performed because of intractable left upper quadrant pain in one case and persistent fever and drainage of pus after 30 days in the other. These patients also developed large, sterile left pleural effusions. Solitary pyogenic splenic abscesses - particularly if uniloculated - can be effectively treated by CT-guided percutaneous drainage. (orig.)

Percutaneous cholecystostomy at the community hospital: value evaluation

International Nuclear Information System (INIS)

Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun; Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul

1997-01-01

To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20

Percutaneous cholecystostomy at the community hospital: value evaluation

Energy Technology Data Exchange (ETDEWEB)

Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun [Namwon Medical Center, Namwon (Korea, Republic of); Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul [Chonbuk National Univ., Chonju (Korea, Republic of)

1997-10-01

To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20.

Percutaneous Cryotherapy of Vascular Malformation: Initial Experience

Energy Technology Data Exchange (ETDEWEB)

Cornelis, F., E-mail: francoiscornelis@hotmail.com [Institut Bergonie, Department of Radiology (France); Neuville, A. [Institut Bergonie, Department of Pathology (France); Labreze, C. [Pellegrin Hospital, Department of Pediatric Dermatology (France); Kind, M. [Institut Bergonie, Department of Radiology (France); Bui, B. [Institut Bergonie, Department of Oncology (France); Midy, D. [Pellegrin Hospital, Department of Vascular Surgery (France); Palussiere, J. [Institut Bergonie, Department of Radiology (France); Grenier, N. [Pellegrin Hospital, Department of Radiology (France)

2013-06-15

The present report describes a case of percutaneous cryotherapy in a 36-year-old woman with a large and painful pectoral venous malformation. Cryoablation was performed in a single session for this 9-cm mass with 24 h hospitalisation. At 2- and 6-month follow-up, the pain had completely disappeared, and magnetic resonance imaging demonstrated a significant decrease in size. Percutaneous cryoablation shows promise as a feasible and apparently safe method for local control in patients with symptomatic venous vascular malformations.

Percutaneous Cryotherapy of Vascular Malformation: Initial Experience

International Nuclear Information System (INIS)

Cornelis, F.; Neuville, A.; Labrèze, C.; Kind, M.; Bui, B.; Midy, D.; Palussière, J.; Grenier, N.

2013-01-01

The present report describes a case of percutaneous cryotherapy in a 36-year-old woman with a large and painful pectoral venous malformation. Cryoablation was performed in a single session for this 9-cm mass with 24 h hospitalisation. At 2- and 6-month follow-up, the pain had completely disappeared, and magnetic resonance imaging demonstrated a significant decrease in size. Percutaneous cryoablation shows promise as a feasible and apparently safe method for local control in patients with symptomatic venous vascular malformations.

Pancreatic cancer seeding of percutaneous needle tract

Directory of Open Access Journals (Sweden)

Qiao Zhou, MD

2017-03-01

Full Text Available A 65-year old African-American female presents with biliary ductal dilatation due to an obstructive pancreatic head mass. Percutaneous transhepatic cholangiogram performed and biliary drainage catheter placement for decompression of the biliary system. The patient had a Whipple procedure performed several months later. On follow up CT imaging, there was interval development and enlargement of a subcutaneous lesion by the right oblique muscles. Biopsy of this lesion revealed pancreatic adenocarcinoma from percutaneous seeding of the transhepatic needle tract.

Percutaneous drainage with ultrasound guidance in the intensive care unit

International Nuclear Information System (INIS)

Kang, Doo Kyung; Won, Je Hwan; Kim, Jai Keun; Lee, Kwang Hun; Kim, Ji Hyung

2004-01-01

To determine the efficacy and safety of bedside percutaneous drainage procedures with ultrasound guidance in critically ill patients in the intensive care unit (ICU). Sixty five percutaneous drainage procedures performed at the bedside, in 39 ICU patients, were evaluated. All of the procedures were performed with ultrasound guidance alone. The procedures consisted of percutaneous drainage of abdominal (n=35) and pleural (n=27) fluids, percutaneous cholecystostomy (n=2) and percutaneous nephrostomy (n=1). The clinical responses were classified as 'complete response', 'partial response', 'failure' or 'undetermined'. The medical records were reviewed retrospectively to evaluate the clinical response. Technical success was achieved in 64 of the 65 procedures (98.5%). The complication rate was 13.8% (9 cases). There was no immediate procedure-related death or worsening of the clinical condition of the patients. The clinical responses after drainage were 'complete response' in 39 cases (60.9%). 'partial response' in 14 (21.9%), 'failure' in 3 (4.7%), and 'undetermined' in 8 (12.5%). Bedside drainage procedures with ultrasound guidance are effective and safe to perform when patients are too critically ill to be moved from the ICU to the angiography room

Recurrence of primary aldosteronism after percutaneous ethanol injection

Directory of Open Access Journals (Sweden)

Fan-Chi Chang

2012-03-01

Full Text Available Adrenalectomy is the definite treatment for aldosterone-producing adenoma (APA. Percutaneous ethanol or acetic acid injection with computed tomography (CT guidance has been described as a safe, noninvasive, and effective alternative treatment modality in patients with high surgical risk. We report on a man who was 49 years of age and presented with treatment-resistant hypertension and was later diagnosed with APA. CT-guided percutaneous ethanol injection (PEI was performed for this high surgical risk patient. He had aldosteronism recurrence 4 years after the ethanol injection, so a second PEI was performed. The tumor size was reduced and his blood pressure was normalized. Therefore, we suggest that clinicians should closely check aldosterone to renin ration and potassium level if percutaneous chemical ablation is considered in functioning adrenal adenomas.

The application of percutaneous endoscopic colostomy to the management of obstructed defecation.

Science.gov (United States)

Heriot, A G; Tilney, H S; Simson, J N L

2002-05-01

We describe the case of a 52-year woman with a 17-year history of obstructed defecation in whom all other standard treatments had failed and the patient had refused a colostomy. Her symptoms were controlled by percutaneous endoscopic colostomy with antegrade colonic irrigation. A percutaneous endoscopic colostomy tube was placed in the sigmoid colon endoscopically using a colonoscope and the patient irrigated two liters of water through the percutaneous endoscopic colostomy twice each day and was able to successfully evacuate her rectum without excess straining or discomfort. Percutaneous endoscopic colostomy is an alternative option to colostomy in the management of obstructed defecation.

Seven-year follow-up of percutaneous closure of patent foramen ovale.

Science.gov (United States)

Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Johansson, Magnus Carl; Furenäs, Eva; Eriksson, Peter; Dellborg, Mikael

2013-12-01

Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical treatment to reduce recurrent stroke while randomized trials fail to demonstrate significant superiority of percutaneous PFO closure. Few long-term studies are available post PFO closure. This study reports long-term clinical outcomes after percutaneous PFO closure. Between 1997 and 2006, 86 consecutive eligible patients with cerebrovascular events, presumably related to PFO, underwent percutaneous PFO closure. All 86 patients were invited to a long-term follow-up, which was carried out during 2011 and 2012. Percutaneous PFO closure was successfully performed in 85 of 86 patients. The follow-up rate was 100%. No cardiovascular or cerebrovascular deaths occurred. Two patients (both women) died from lung cancer during follow-up. Follow-up visits were conducted for 64 patients and the remaining 20 patients were followed up by phone. The mean follow-up time was 7.3 years (5 to 12.4 years). Mean age at PFO closure was 49 years. One patient had a minor stroke one month after PFO closure and a transient ischemic attack (TIA) two years afterwards. One other patient suffered from a TIA six years after closure. No long-term device-related complications were observed. Percutaneous PFO closure was associated with very low risk of recurrent stroke and is suitable in most patients. We observed no mortality and no long-term device-related complications related to PFO closure, indicating that percutaneous PFO closure is a safe and efficient treatment even in the long term.

Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study.

Science.gov (United States)

Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S

2009-08-01

Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

Pediatric interventional radiology: Indications, techniques, and management

International Nuclear Information System (INIS)

Towbin, R.B.; Ball, W.S. Jr.

1987-01-01

This course develops a practical approach to pediatric interventional radiology. Radiologic intervention in the pediatricage group is possible by attending to the care and special needs of the child. The authors also emphasize their approach to patient preparation, sedation and anesthesia, nursing care, monitoring of the patient during the procedure, and follow-up care. The course is divided into nonvascular and vascular sections. The discussion of nonvascular procedures focus on the chest and the GU and GI systems. Biopsy techniques and drainage of effusions and abscesses within the chest are discussed. A variety of GU procedures are presented including insertion of a nephrostomy tube and percutaneous tract dilation for placement of internal stents, percutaneous stone removal, and percutaneous surgery for pyeloplasty. The authors approach to percutaneous pyeloplasty is briefly discussed. Intervention within the GI system includes percutaenous aspiration, drainage, and biopsies. Emphasis is placed on the selection of embolic agents and catheter delivery systems, techniques, and current treatment concepts. The authors describe experience with embolization of vascular malformations, renovascular disease, uncontrollable hemorrhage, and selected neoplastic processes. Comments on the indications for and techniques of transluminal angioplasty and fibrinolytic therapy in children conclude the lecture

Anatomical study of forearm arteries with ultrasound for percutaneous coronary procedures.

Science.gov (United States)

Yan, Zhen-xian; Zhou, Yu-jie; Zhao, Ying-xin; Zhou, Zhi-ming; Yang, Shi-wei; Wang, Zhi-jian

2010-04-01

In recent years, the radial artery (RA) has become an alternative vascular access site for percutaneous coronary procedures, and the ulnar artery (UA) is another possibility. The objective of this study was to investigate the anatomy of the forearm arteries with ultrasound (US) and to evaluate the effect of the anatomy of the right RA (RRA) on the outcomes of transradial coronary procedures. The 638 patients undergoing transradial coronary procedures were examined with US for measurement of the diameters of the forearm arteries and determination of their anatomical abnormalities before the procedures. The next day the incidence of RA occlusion was recorded. The diameters of the radial and ulnar arteries were similar (P>0.05). The procedure time was longer in patients with anatomical abnormalities (Pforearm arteries of Chinese people are similar. The small diameter and anatomical abnormalities of the RRA could result in longer procedure time, more incidence of procedure failure and RA occlusion.

Effect of technique and timing of tracheostomy in patients with acute traumatic spinal cord injury undergoing mechanical ventilation

Science.gov (United States)

Ganuza, Javier Romero; Forcada, Angel Garcia; Gambarrutta, Claudia; De La Lastra Buigues, Elena Diez; Gonzalez, Victoria Eugenia Merlo; Fuentes, Fátima Paz; Luciani, Alejandro A.

2011-01-01

Objective To assess the effect of timing and techniques of tracheostomy on morbidity, mortality, and the burden of resources in patients with acute traumatic spinal cord injuries (SCIs) undergoing mechanical ventilation. Design Review of a prospectively collected database. Setting Intensive and intermediate care units of a monographic hospital for the treatment of SCI. Participants Consecutive patients admitted to the intensive care unit (ICU) during their first inpatient rehabilitation for cervical and thoracic traumatic SCI. A total of 323 patients were included: 297 required mechanical ventilation and 215 underwent tracheostomy. Outcome measures Demographic data, data relevant to the patients’ neurological injuries (level and grade of spinal cord damage), tracheostomy technique and timing, duration of mechanical ventilation, length of stay at ICU, incidence of pneumonia, incidence of perioperative and early postoperative complications, and mortality. Results Early tracheostomy (tracheostomy was performed in 101 patients (47%) and late (≥7 days) in 114 (53%). Surgical tracheostomy was employed in 119 cases (55%) and percutaneous tracheostomy in 96 (45%). There were 61 complications in 53 patients related to all tracheostomy procedures. Two were qualified as serious (tracheoesophageal fistula and mediastinal abscess). Other complications were mild. Bleeding was moderate in one case (late, percutaneous tracheostomy). Postoperative infection rate was low. Mortality of all causes was also low. Conclusion Early tracheostomy may have favorable effects in patients with acute traumatic SC. Both techniques, percutaneous and surgical tracheostomy, can be performed safely in the ICU. PMID:21528630

Effectiveness of prophylactic percutaneous endoscopic gastrostomy on nutritional status and mucositis in oropharyngeal cancer patients undergoing concurrent chemoradiotherapy

International Nuclear Information System (INIS)

Takahashi, Miki; Takemoto, Naoko; Sano, Ayaka

2012-01-01

Recently, concurrent chemoradiotherapy (CCRT) is frequently used for the treatment of oropharyngeal cancer. However, CCRT induces mucositis and dysphagia and causes inadequate oral nutrition intake. Thus, percutaneous endoscopic gastrostomy (PEG) in advance is recently recommended. To evaluate the effectiveness of PEG on nutritional intake, nutritional status, blood test, and grade of mucositis of 29 patients who had CCRT with PEG were investigated retrospectively. The results were statistically compared with those of 13 patients who had CCRT without PEG as a control group. Regarding the total energy, no significant change was observed in the PEG group, while the total energy intake significantly decreased in the control group (P=0.026). A significant correlation was observed between the rate of body weight loss during CCRT and total energy intake (R=0.78). The total energy intake of patients who could maintain body weight was 34.1 kcal/kg/day. Taken together, these results suggested that early nutritional administration using PEG can reduce the weight loss during CCRT. (author)

Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

LENUS (Irish Health Repository)

Ederle, Jörg

2009-10-01

Endovascular treatment (angioplasty with or without stenting) is an alternative to carotid endarterectomy for carotid artery stenosis but there are scarce long-term efficacy data showing that it prevents stroke. We therefore report the long-term results of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS).

Percutaneous catheter drainage of lung abscess

Energy Technology Data Exchange (ETDEWEB)

Kim, Young Shin; Chun, Kyung Ah; Choi, Hyo Sun; Ha, Hyun Kown; Shinn, Kyung Sub [Catholic University Medical college, Seoul (Korea, Republic of)

1993-09-15

From March 1987 to July 1989, six patients (five adults and one child) with lung abscess (size, 5-13 cm in diameter) were treated with percutaneous aspiration and drainage. In each case, the puncture was made where the wall of the abscess was in contact with the pleural surface. An 8 to 10 Fr cartheter was inserted for drainage. Five of 6 had a dynamatic clinical response within 24 hours of the drainage. Percutaneous drainage was successful with complete abscess resolution in four and partial resolution in one patient. No response was seen in the rest one. The duration of drainage ranged from 7 to 18 days(average, 15.5 days) in successful cases. One case of the failure in drainage was due tio persistent aspiration of the neurologically impaired patient. In one patient, the abscess resolved after drainage but recurred after inadvertent removal of the catheter 7 days after insertion. In two patients, concurrent pleural empyema was resolved completely by the drainage. Computed tomography provide anatomic details necessary for choosing the puncture site and avoiding a puncture of the lung parenchyma. Percutaneous catheter drainage is safe and effective method for treating patient with lung abscess.

Percutaneous catheter drainage of lung abscess

International Nuclear Information System (INIS)

Kim, Young Shin; Chun, Kyung Ah; Choi, Hyo Sun; Ha, Hyun Kown; Shinn, Kyung Sub

1993-01-01

From March 1987 to July 1989, six patients (five adults and one child) with lung abscess (size, 5-13 cm in diameter) were treated with percutaneous aspiration and drainage. In each case, the puncture was made where the wall of the abscess was in contact with the pleural surface. An 8 to 10 Fr cartheter was inserted for drainage. Five of 6 had a dynamatic clinical response within 24 hours of the drainage. Percutaneous drainage was successful with complete abscess resolution in four and partial resolution in one patient. No response was seen in the rest one. The duration of drainage ranged from 7 to 18 days(average, 15.5 days) in successful cases. One case of the failure in drainage was due tio persistent aspiration of the neurologically impaired patient. In one patient, the abscess resolved after drainage but recurred after inadvertent removal of the catheter 7 days after insertion. In two patients, concurrent pleural empyema was resolved completely by the drainage. Computed tomography provide anatomic details necessary for choosing the puncture site and avoiding a puncture of the lung parenchyma. Percutaneous catheter drainage is safe and effective method for treating patient with lung abscess

Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization.

Science.gov (United States)

Barbash, Israel M; Gaglia, Michael A; Torguson, Rebecca; Minha, Sa'ar; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

2013-10-01

Marriage confers various health advantages in the general population. However, the added value of marriage among patients who undergo percutaneous coronary intervention (PCI) beyond the standard cardiovascular risk factors is not clear. This study aimed to assess the effects of marital status on outcomes of patients undergoing elective or urgent PCI. Clinical observational analysis of consecutive patients undergoing elective or urgent PCI from 1993 to 2011 was performed. Patients were stratified by marital status, comparing married to unmarried patients. Clinical outcome up to 12 months was obtained by telephone contact or office visit. A total of 11,216 patients were included in the present analysis; 55% were married and 45% unmarried. Significant differences in baseline characteristics were noted, including a lower prevalence of hypertension (86% vs 88%), diabetes (34% vs 38%), and smoking (19% vs 25%) among married vs unmarried patients, respectively (P married patients had a higher prevalence of hypercholesterolemia and family history of coronary artery disease. Early and late major adverse cardiac event rates were significantly lower for married vs unmarried patients up to 1 year (13.3% vs 8.2%, P Married status was independently associated with improved outcome in multivariable analysis (hazard ratio 0.7, 95% CI 0.6-0.9). Married patients who undergo urgent or elective PCI have superior short- and long-term outcomes up to 1 year when compared with unmarried patients. These benefits persist after adjustment for multiple traditional cardiovascular risk factors. © 2013.

Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

Directory of Open Access Journals (Sweden)

S.L. Xia

2015-08-01

Full Text Available The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD=-0.14, 95% confidence interval (CI=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009. There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38. Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001 was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02. We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

Motivation is a crucial factor for adherence to a healthy lifestyle among people with coronary heart disease after percutaneous coronary intervention.

Science.gov (United States)

Kähkönen, Outi; Kankkunen, Päivi; Saaranen, Terhi; Miettinen, Heikki; Kyngäs, Helvi; Lamidi, Marja-Leena

2015-10-01

To test the Theory of Adherence of People with Chronic Disease with regard to adherence to treatment among patients with coronary heart disease after a percutaneous coronary intervention. Increased knowledge of the concept of adherence is needed for the development of nursing interventions and nursing guidelines for patients with coronary heart disease. A cross-sectional, multi-centre study. This study was conducted from February-December 2013 with 416 patients with coronary heart disease 4 months after undergoing a percutaneous coronary intervention. A self-reported questionnaire was used to assess their adherence to treatment. Data were analysed using structural equation modelling. The theory explained 45% of the adherence to a healthy lifestyle and 7% of the adherence to medication. Structural equation modelling confirmed that motivation and results of care had the highest association with adherence to a healthy lifestyle. Responsibility was associated with adherence to medication. Support from next of kin, support from nurses and physicians, and motivation, co-operation, fear of complications and a sense of normality were associated with adherence. Patients who are motivated to perform self-care and consider the results of care to be important were more likely to adhere to a healthy lifestyle. Responsible patients were more likely to adhere to their medication. It is important to account for these elements as a part of secondary prevention strategies among patients with coronary heart disease after a percutaneous coronary intervention. © 2015 John Wiley & Sons Ltd.

History of Retractor Technologies for Percutaneous Pedicle Screw Fixation Systems.

Science.gov (United States)

Mobbs, Ralph J; Phan, Kevin

2016-02-01

Minimally invasive techniques aimed at minimizing surgery-associated risk and morbidity of spinal surgery have increased in popularity in recent years. Their potential advantages include reduced length of hospital stay, blood loss, and requirement for post-operative analgesia and earlier return to work. One such minimally invasive technique is the use of percutaneous pedicle screw fixation, which is paramount for promoting rigid and stable constructs and fusion in the context of trauma, tumors, deformity and degenerative disease. Percutaneous pedicle screw insertion can be an intimidating prospect for surgeons who have only been trained in open techniques. One of the ongoing challenges of this percutaneous system is to provide the surgeon with adequate access to the pedicle entry anatomy and adequate tactile or visual feedback concerning the position and anatomy of the rod and set-screw construct. This review article discusses the history and evolution of percutaneous pedicle screw retractor technologies and outlines the advances over the last decade in the rapidly expanding field of minimal access surgery for posterior pedicle screw based spinal stabilization. As indications for percutaneous pedicle screw techniques expand, the nuances of the minimally invasive surgery techniques and associated technologies will also multiply. It is important that experienced surgeons have access to tools that can improve access with a greater degree of ease, simplicity and safety. We here discuss the technical challenges of percutaneous pedicle screw retractor technologies and a variety of systems with a focus on the pros and cons of various retractor systems. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Percutaneous sonographically assisted endoscopic gastrostomy for difficult cases with interposed organs.

Science.gov (United States)

Moriwaki, Yoshihiro; Otani, Jun; Okuda, Junzo; Zotani, Hitomi; Kasuga, So

2018-03-27

The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound. Twenty-one patients (95.5%) successfully underwent PSEGD. Early complications (more than grade 2 in Clavien-Dindo classification) just after the procedure occurred in one case (active oozing). We did not encounter a case with mispuncture of the intraperitoneal organs and tissues. Delayed complications occurring within 1 mo were pneumonia in five patients, including death in three cases; bleeding from puncture site in two patients; and atrial fibrilation in one patient. PSEGD using the introduction method is a useful procedure for difficult patients in whom intraperitoneal organ or tissue is suspected to be interposed between the abdominal wall and stomach. Copyright © 2018 Elsevier Inc. All rights reserved.

Post-angioplasty far infrared radiation therapy improves 1-year angioplasty-free hemodialysis access patency of recurrent obstructive lesions.

Science.gov (United States)

Lai, C-C; Fang, H-C; Mar, G-Y; Liou, J-C; Tseng, C-J; Liu, C-P

2013-12-01

To explore the role of far infrared (FIR) radiation therapy for hemodialysis (HD) access maintenance after percutaneous transluminal angioplasties (PTA). This was a prospective observational study. Eligible patients were those who received repeated PTA with the last PTA successfully performed within 1 week before the study enrollments. Consecutively enrolled patients undergoing successful HD treatments after PTA were randomly assigned to the FIR-radiated group or control group without radiation. FIR-radiated therapy meaning 40-minute radiation at the major lesion site or anastomosed site three times a week was continued until an end-point defined as dysfunction-driven re-PTA or the study end was reached. Of 216 participants analyzed, including 97 with arteriovenous grafts (AVG) (49 FIR-radiated participants and 48 control participants) and 119 with arteriovenous fistulas (AVF) (69 FIR-radiated participants and 50 control participants), the FIR-radiated therapy compared with free-radiated usual therapy significantly enhanced PTA-unassisted patency at 1 year in the AVG subgroup (16.3% vs. 2.1%; p radiated therapy improves PTA-unassisted patency in patients with AVG who have undergone previous PTA. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

CT-guided percutaneous aspiration and drainage of postoperative abdominal fluid collections

International Nuclear Information System (INIS)

Marano, I.; Mainenti, P.P.; Selva, G.; Cannavale, M.; Sodano, A.

1999-01-01

The authors report the personal techniques and the results of CT-guided percutaneous drainage of postoperative abdominal fluid collections. CT-guided percutaneous drainage offers many advantages over surgery: it is less invasive, can be repeated and requires no anesthesia, there are not surgery-related risks and lower morbidity and mortality rates. Moreover, subsequent hospitalization is shorter and costs are consequently reduced. The authors conclude that CT-guided percutaneous drainage is the method of choice in the treatment of postoperative abdominal fluid collections [it