Letter to the Editor Regarding “PulseRider-Assisted Coil Embolization for Treatment of Intracranial Bifurcation Aneurysms: A Single-Center Case Series with 24-Month Follow-up”

Abstract Background Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment. Methods This retrospective case series evaluates a single center experience of percutaneous stent graft (SG) angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. We also conducted a systematic review of the literature reporting on endovascular UAF management. Results We identified 17 UAF in 16 patients (12 male, 4 female, mean age 69.8 ± 11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 (29.4%) presented with flank pain, in 7 (41.2%) cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all fistulas, major pelvic surgery in 13 cases (76.5%). In 6 cases (35.3%) SG were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). SG placement without previous coil embolization was performed in 10 fistulas (58.8%). In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1–3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases (82.4%). Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment. A total of 152 UAF cases were additionally analyzed from our systematic literature review: SG placement with or without embolization was performed in 140 cases (92.1%) while embolization alone was done in 12 cases (7.9%). Complications included UAF recurrence (18/152, 11.8%), SG thrombosis (7/140, 5%), and SG infections (5/140, 3.6%) with an overall complications rate of 13.8%. Five patients died due to UAF (3.3%). Conclusion Endovascular therapy offers high technical success rates and rapid bleeding control of UAF. Severe complications like SG occlusions or SG infections are rare but significant. Antibiotic treatment and single anti-platelet therapy improve SG durability as well as close and long follow-up to timely perform repeated endovascular or surgical treatment if necessary. Evidence-based medicine Level 4, case series.

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Results of Endovascular Therapy of Ureteroarterial Fistulas: A Single Center Experience

10.21203/rs.3.rs-266941/v1 ◽

2021 ◽

Author(s):

Bjoern Simon ◽

Jakob Neubauer ◽

Martin Schoenthaler ◽

Simon Hein ◽

Fabian Bamberg ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Therapy ◽

Iliac Artery ◽

Coil Embolization ◽

Clinical Success ◽

Hypovolemic Shock ◽

Case Series ◽

Single Center ◽

Single Center Experience

Abstract Background Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment.Methods This retrospective case series evaluates a single center experience of percutaneous stent graft angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. Results We identified 17 UAF in 16 consecutive patients (12 male, 4 female, mean age 69.8 ±11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 presented with flank pain, in 7 of 17 cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all ﬁstulas, pelvic exstirpatory surgery in 13 cases. In 6 cases stent grafts were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). Stent graft placement without previous coil embolization was performed in 10 fistulas. In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1 – 3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases. Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment.Conclusion Endovascular therapy proves to be a safe and efficient method in UAF treatment.Evidence-based medicineLevel 4, case series.

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Highly selective diversion with proactive leakage management after low anterior resection for rectal cancer

British Journal of Surgery ◽

10.1093/bjs/znab018 ◽

2021 ◽

Author(s):

K Talboom ◽

I Vogel ◽

R D Blok ◽

S X Roodbeen ◽

C Y Ponsioen ◽

...

Keyword(s):

Low Anterior Resection ◽

Case Series ◽

Fecal Diversion ◽

Single Center ◽

Single Centre ◽

Diverting Stoma ◽

Faecal Diversion ◽

One Year ◽

Diversion Rate

Abstract In this single center case series with nine percent primary diversion, 86 of 94 patients alive and with complete follow-up at one year had a functioning anastomosis. Seventy-five of the initial 99 patients never had a stoma. Meaning: Highly selective fecal diversion in combination with proactive leakage management, low anastomoses can be preserved safely, and the majority of patients will be spared all disadvantages of a diverting stoma. In this single-centre case series, with a primary diversion rate of 9 per cent, 86 of 94 patients who were alive and had complete follow-up at 1 year had a functioning anastomosis. Seventy-five of the initial 99 patients never had a stoma. The results indicate that, with highly selective faecal diversion in combination with proactive leakage management, low anastomoses can be preserved safely, and the majority of patients will be spared the disadvantages of a diverting stoma.

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MO291RITUXIMAB IS EFFECTIVE AND SAFE IN ADULTS WITH STEROID-DEPENDENT NEPHROTIC SYNDROME: A LONG-TERM, SINGLE-CENTER EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab104.0049 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Gemma Patella ◽

Alessandro Comi ◽

Giuseppe Coppolino ◽

Nicolino Comi ◽

Giorgio Fuiano ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Case Series ◽

Adult Patients ◽

Single Center ◽

Single Center Experience ◽

Steroid Dependent ◽

The Mean ◽

Steroid Dependent Nephrotic Syndrome

Abstract Background and Aims Steroid-dependent nephrotic syndrome (SDNS) may require a prolonged multi-drug therapy with risk of drug toxicity and renal failure. Rituximab (RTX) treatment has been found to be helpful in reducing the steroid dosage and the need for immunosuppressants (ISs), but little data are currently available regarding very long-term outcomes in adults. We herein describe a long-term, single-center experience of RTX use in a large series of adults with SDNS. Method We studied 23 adult patients with SDNS (mean age 54.2±17.1 y; 65% male; BMI 28.5±4.7), mostly consequent to membranous (47.8%) or focal glomerulonephritis (30.2 %) who were eligible to start a RTX regimen. Before entering the RTX protocol, proteinuria and eGFR were 7.06±3.87 g/24h and 65.9±28.2 ml/min/1.73 m2, respectively; albumin and CD19/CD20 ratio were 2.9±0.9 g/L and 0.99±0.01 respectively; the mean number of ISs was 2.39±0.89 and the mean annual rate of relapses was 2.2±0.9. Results Patients were followed over a mean follow-up of 64 months (range: 12-144). After RTX (mean dose: 1202.1±372.4 mg) the rate of relapses was virtually nullified (p<0.001). eGFR remained roughly stable (62.1±19.8 ml/min/1.73 m2, p=NS), while proteinuria, albumin, CD19/CD20 and BMI all significantly improved (p ranging from 0.01 to 0.001). The mean number of additional ISs was also reduced (0.44±0.12; p<0.001) and RTX enabled discontinuation of steroids in 13/23 (56.5%) patients. No major adverse events related to therapy were recorded. Conclusion Findings from this large case-series with a remarkable very long follow-up reinforce the role of RTX as an efficient and safe weapon to improve outcomes in adult patients suffering from SDNS.

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Case Series Regarding Parastomal Variceal Bleeding: Presentation and Management

Annals of Hepatology ◽

10.5604/01.3001.0012.2228 ◽

2018 ◽

Vol 17 (5) ◽

pp. 0-10

Author(s):

John Romano ◽

Charles V. Welden ◽

Jordan Orr ◽

Brendan McGuire ◽

Mohamed Shoreibah

Keyword(s):

Portal Hypertension ◽

High Risk ◽

Literature Review ◽

Variceal Bleeding ◽

Coil Embolization ◽

Case Series ◽

Treatment Modalities ◽

Post Procedure ◽

Lost To Follow Up

Parastomal variceal bleeding (PVB) is a serious complication occurring in up to 27% of patients with an ostomy and concurrent cirrhosis and portal hypertension. The management of PVB is difficult and there are no clear guidelines on this matter. TIPS, sclerotherapy, and /or coil embolization are all therapies that have been shown to successful manage PVB. We present a case series with five different patients who had a PVB at our institution. The aim of this case series is to report our experience on the management of this infrequently reported but serious condition. We also conducted a systemic literature review focusing on the treatment modalities of 163 patients with parastomal variceal bleeds. In our series, patient 1 had embolization and sclerotherapy without control of bleed and expired on the day of intervention due to hemorrhagic shock. Patient 2 had TIPS in conjunction with embolization and sclerotherapy and had no instance of rebleed 441 days after therapy. Patient 3 did not undergo any intervention due to high risk for morbidity and mortality, the bleed self-resolved and there was no further rebleed, this same patient died of sepsis 73 days later. Patient 4 had embolization and sclerotherapy and had no instance of rebleed 290 days after therapy. Patient 5 had TIPS procedure and was discharged five days post procedure without rebleed, patient has since been lost to follow-up.

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DELAYED VISUAL DEFICITS AND MONOCULAR BLINDNESS AFTER ENDOVASCULAR TREATMENT OF LARGE AND GIANT PARAOPHTHALMIC ANEURYSMS

Neurosurgery ◽

10.1227/01.neu.0000324730.37144.4b ◽

2008 ◽

Vol 63 (3) ◽

pp. 469-475 ◽

Cited By ~ 45

Author(s):

Raymond D. Turner ◽

James V. Byrne ◽

Michael E. Kelly ◽

Aristotelis P. Mitsos ◽

Vivek Gonugunta ◽

...

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Case Series ◽

Mass Effect ◽

Endovascular Coiling ◽

Visual Deterioration ◽

Paraclinoid Aneurysms ◽

Bare Platinum Coils ◽

Platinum Coils

ABSTRACT OBJECTIVE Paraophthalmic aneurysms may exert mass effect on the optic apparatus. Although surgical clipping and endovascular coiling of these aneurysms can be complicated by immediate postoperative visual deterioration, endovascular coil embolization has the unique risk of visual complications later (>24 h) in the perioperative period. METHODS Six patients with a delayed onset of vision loss after technically successful coil embolization of paraophthalmic region aneurysms were identified. All available clinical, angiographic, and cross sectional imaging for these patients, in addition to histopathological data, were reviewed. RESULTS Six patients who underwent endovascular treatment of paraclinoid aneurysms at our institutions developed delayed postoperative visual decline. Four were treated with combination hydrogel-coated and bare platinum coils, one with hydrogel-coated coils, and one with bare platinum coils. Three patients presented with some degree of visual impairment caused by their aneurysms. Catheter angiography performed after the visual decline revealed no etiology in any of the cases. Magnetic resonance imaging was performed in all patients and was unremarkable in two. At follow-up, two had improved, three remained unchanged, and one patient died before any follow-up assessment of her vision. CONCLUSION Both acute and delayed visual disturbances can present after the endovascular treatment of carotid artery paraophthalmic aneurysms. Delayed visual deterioration can be observed up to 35 days after embolization. Although the cause is still undefined, it is likely that the more delayed visual deterioration can be attributed to progression of mass effect and/or perianeurysmal inflammatory change. Our case series raises the possibility that this phenomenon may be more likely with HydroCoil (HydroCoil Embolic System; MicroVention, Aliso Viejo, CA). This possibility should be taken into account by neurointerventionists when selecting a coil type to treat large paraophthalmic aneurysms.

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554. Do we know everything about the effective multidisciplinary diagnostic and follow up procedures performed in patients with rare synchronous double cancers? An single-center case series analysis and review

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.06.312 ◽

2016 ◽

Vol 42 (9) ◽

pp. S176-S177

Author(s):

B. Zegarska ◽

M. Nowacki ◽

K. Pietkun ◽

W. Zegarski

Keyword(s):

Case Series ◽

Single Center ◽

Series Analysis ◽

Double Cancers

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Five-Year Clinical Outcomes of Trabectome Surgery at a Single Glaucoma Center

10.20944/preprints201804.0248.v1 ◽

2018 ◽

Author(s):

Hamed Esfandiari ◽

Priyal Shah ◽

Pooya Torkian ◽

Ian P. Conner ◽

Joel S. Schuman ◽

...

Keyword(s):

Risk Factors ◽

Success Rate ◽

Retention Rate ◽

Case Series ◽

Series Data ◽

Cumulative Probability ◽

Single Center ◽

Trabectome Surgery ◽

Ab Interno

Purpose: To analyze the five-year results of Trabectome ab interno trabeculectomy of a single glaucoma center. Method: In this retrospective interventional single-center case series, data of 93 patients undergoing ab interno trabeculotomy between September 2010, and December 2012 were included. Kaplan-Meier analysis was performed using success criteria defined as postoperative intraocular pressure (IOP) ≤21 mm Hg, or >20% reduction from preoperative IOP, and no need for further glaucoma surgery. Risk factors for failure were identified using Cox proportional hazards ratio (HR). Results: The retention rate for five years follow-up was 66%. The cumulative probability of success at 1, 2, 3, 4 and 5 years was 82.6%, 76.7%, 73.9%, 72.3%, and 67.5%. Risk factors for failure were lower baseline IOP (HR=0.27, P=0.001), younger age (HR=0.25, P=0.02), and higher central corneal thickness (HR=0.18, P= 0.01). Pseudoexfoliation was associated with a higher success rate (HR= 0.39, P=0.02). IOP was decreased significantly from 20.0±5.6 mmHg at baseline to 15.6±4.6 mmHg at 5-year follow-up (P=0.001). The baseline number of glaucoma medications was 1.8±1.2, which decreased to 1.0±1.2 medications at 5 years. Conclusion: Trabectome surgery was associated with a good long-term efficacy and safety profile in this single-center case series with a high retention rate. A higher baseline IOP, older age, thinner cornea, and pseudoexfoliation glaucoma were associated with a higher success rate.

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