Coil-Assisted Retrograde Transvenous Obliteration: A Valid Treatment for Gastric Variceal Hemorrhage and Hepatic Encephalopathy

2017 ◽  
Vol 01 (04) ◽  
pp. 302-305 ◽  
Author(s):  
Andrew Marsala ◽  
Edward Lee
Keyword(s):  
Hepatic Encephalopathy ◽  
Clinical Success ◽  
Portosystemic Shunt ◽  
Comparable Efficacy ◽  
Variceal Hemorrhage ◽  
Success Rates ◽  
Small Series ◽  
Shunt Occlusion ◽  
Gastric Variceal Hemorrhage

AbstractCoil-assisted retrograde transvenous obliteration (CARTO) has evolved as a simpler and perhaps safer alternative to balloon-occluded retrograde transvenous obliteration (BRTO). The efficacy of BRTO has been established, and early data supports the use of CARTO in similar situations. In a small series of patients with gastric variceal hemorrhage treated with CARTO, complete portosystemic shunt occlusion, complete variceal obliteration, and no rebleeding during the follow-up period were observed in all patients. In a larger, unpublished study, an improvement in hepatic encephalopathy was observed in over 80% of patients treated with CARTO. In addition, overall liver function was markedly improved in 1 month. As for complications, new or worsened ascites and esophageal varices were observed in 24% and 30%, respectively. Overall, CARTO is an effective treatment of gastric variceal hemorrhage and hepatic encephalopathy with high technical and clinical success rates. Compared with plug-assisted retrograde transvenous obliteration (PARTO), CARTO can be used to safely close larger shunts with a comparable efficacy and complication profiles.

scholarly journals One-year outcomes of microhook trabeculotomy versus suture trabeculotomy ab interno

2021 ◽  
Author(s):  
Hiroshi Yokoyama ◽  
Masashi Takata ◽  
Fumi Gomi
Keyword(s):  
Survival Analysis ◽  
Clinical Success ◽  
Treatment Success ◽  
Medication Use ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Kaplan Meier ◽  
One Year ◽  
Ab Interno

Abstract Purpose To compare clinical success rates and reductions in intraocular pressure (IOP) and IOP-lowering medication use following suture trabeculotomy ab interno (S group) or microhook trabeculotomy (μ group). Methods This retrospective review collected data from S (n = 104, 122 eyes) and μ (n = 42, 47 eyes) groups who underwent treatment between June 1, 2016, and October 31, 2019, and had 12-month follow-up data including IOP, glaucoma medications, complications, and additional IOP-lowering procedures. The Kaplan–Meier survival analysis was used to evaluate treatment success rates defined as normal IOP (> 5 to ≤ 18 mm Hg), ≥ 20% reduction of IOP from baseline at two consecutive visits, and no further glaucoma surgery. Results Schlemm’s canal opening was longer in the S group than in the μ group (P < 0.0001). The Kaplan–Meier survival analysis of all eyes showed cumulative clinical success rates in S and µ groups were 71.1% and 61.7% (P = 0.230). The Kaplan–Meier survival analysis of eyes with preoperative IOP ≥ 21 mmHg showed cumulative clinical success rates in S and μ groups were 80.4% and 60.0% (P = 0.0192). There were no significant differences in postoperative IOP at 1, 3, and 6 months (S group, 14.9 ± 5.6, 14.6 ± 4.5, 14.6 ± 3.9 mmHg; μ group, 15.8 ± 5.9, 15.2 ± 4.4, 14.7 ± 3.7 mmHg; P = 0.364, 0.443, 0.823), but postoperative IOP was significantly lower in the S group at 12 months (S group, 14.1 ± 3.1 mmHg; μ group, 15.6 ± 4.1 mmHg; P = 0.0361). There were no significant differences in postoperative numbers of glaucoma medications at 1, 3, 6, and 12 months (S group, 1.8 ± 1.6, 1.8 ± 1.5, 2.0 ± 1.6, 1.8 ± 1.5; μ group, 2.0 ± 1.6, 2.0 ± 1.6, 2.1 ± 1.6, 2.2 ± 1.7; P = 0.699, 0.420, 0.737, 0.198). Conclusion S and µ group eyes achieved IOP reduction, but μ group eyes had lower clinical success rates among patients with high preoperative IOP at 12 months.

scholarly journals SpyGlass DS-guided lithotripsy for pancreatic duct stones in symptomatic treatment-refractory chronic calcifying pancreatitis

2019 ◽  
Vol 07 (02) ◽  
pp. E99-E103 ◽  
Author(s):  
Christian Gerges ◽  
David Pullmann ◽  
Farzan Bahin ◽  
Markus Schneider ◽  
Peter Siersema ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Clinical Success ◽  
Symptomatic Treatment ◽  
Complication Rates ◽  
Success Rates ◽  
Technical Success Rate ◽  
Extracorporeal Shock Wave ◽  
Small Series ◽  
Chronic Calcifying Pancreatitis ◽  
Calcifying Pancreatitis

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) and/or extracorporeal shock wave lithotripsy are first-line therapies for draining an obstructed pancreatic duct (PD) in painful chronic calcifying pancreatitis (CCP). Pancreaticoscopy has shown promising success rates in small series. Materials and methods This study was a retrospective analysis of a clinical database. Included were all digital single-operator digital video (SOV) pancreaticoscopy-guided interventions (n = 23) on CCP patients (n = 20) between 2015 and 2017. Success and complication rates were collected from the database. Clinical success was determined by assessing pain level score (NRS) and quality of life (QoL) using standardized questionnaires. Results Overall technical success rate (successful SOV-pancreaticoscopy and PD drainage) was 95 %. Adverse events occurred in 7 of 23 procedures (30 %) and included extravasation from the PD (n = 1), self-limiting post-sphincterotomy bleeding (n = 1) and post-ERCP pancreatitis (PEP) (n = 6). At 3- to 6-month follow-up, 95 % of patients reported improvement in symptoms and reduction in intake of analgesics. Mean NRS decreased from 5.4 (±1.6) to 2.8 (± 1.8) (P < 0.01). Clinical success was achieved in 95 % of patients. Conclusions Digital SOV-guided lithotripsy was found to be safe and effective in this highly selected population of CCP patients. PD decompression had a beneficial effect on pain reduction and QoL.

scholarly journals Rheolytic Thrombectomy Using AngioJet ZelanteDVT Catheter or Solent Omni Catheter for Treatment of Patients with Proximal Vein Thrombosis

2021 ◽  
Author(s):  
Maofeng Gong ◽  
Guanqi Fu ◽  
Zhengli Liu ◽  
Yangyi Zhou ◽  
Jie Kong ◽  
...  
Keyword(s):  
Clinical Success ◽  
Successful Outcome ◽  
Success Rates ◽  
Technical Success ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
Rheolytic Thrombectomy ◽  
Deep Vein ◽  
Clinical Characteristic

Abstract Purpose The present study aimed to investigate the preliminary safety and efficacy of rheolytic thrombectomy (RT) using AngioJet ZelanteDVT catheter or Solent Omni catheter for acute proximal deep vein thrombosis (DVT).Material and Methods We conducted a retrospective review of 40 patients who treated by AngioJet RT divided into ZelanteDVT group (n=17) and Solent group (n=23) from January 2019 to January 2021. Data of demographics, clinical characteristic, technical success, clinical success, complications, and early follow-up were analysed.Results No significant differences regarding demographics were detected (all p >.05). The technical success rates were both 100%. ZelanteDVT group had a shorter duration time of RT and a higher primary RT success than those of Solent group (all p <.05), and percentage of adjunctive CDT was 29.4% in ZelanteDVT group, significantly lower than that was 79.3% in Solent group (p =.010). The successful outcome for ZelanteDVT group and Solent group were 100% (17/17) and 95.7% (22/23), both high in the two groups (p >.05). Except for transient macroscopic hemoglobinuria occurred in all patients at the first 24 hours post-RT, none suffered other procedure-related adverse events or major complications in both groups. Minor complications presented as bleeding events occurred in 21.7% (5/23) patients of Solent group, and one (5.9%) patient in Zelante DVT group (p >.05). At 6-month, the frequency of PTS was 5.9% (1/17) in ZelanteDVT group compared with 17.4% (4/ 23) in Solent group (p >.05).Conclusion Both catheters are safe and effective for the management of patients with proximal DVT, leading to improved clinical outcomes with low complication. Zelante-DVT catheter offered more powerful thrombectomy over Solent catheter, allowing for faster extraction of the DVT with shorter run time and lower adjunctive CDT.

Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

2019 ◽  
Vol 53 (4) ◽  
pp. 284-291
Author(s):  
Hirokazu Onishi ◽  
Toru Naganuma ◽  
Koji Hozawa ◽  
Tomohiko Sato ◽  
Hisaaki Ishiguro ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Stent Implantation ◽  
De Novo ◽  
Clinical Success ◽  
Primary Patency ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Procedural Success

Introduction: The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. Material and Methods: We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. Results: There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Conclusion: Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

Adjustable Small-Diameter TIPS

2018 ◽  
Author(s):  
Zubin Irani ◽  
Sara Zhao
Keyword(s):  
Hepatic Encephalopathy ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Small Diameter ◽  
Portosystemic Shunt ◽  
Shunt Revision ◽  
Metal Stents ◽  
Ptfe Graft ◽  
Variceal Hemorrhage ◽  
Graft Material ◽  
Intrahepatic Portosystemic Shunt

Transjugular intrahepatic portosystemic shunt (TIPS) was first described by Rosch et al. in 1969, and in 1982, Colopinto et al. described its first clinical application in a patient with cirrhosis and variceal hemorrhage. It was not until 1988 that the first metal-lined shunt was created, and in 1997 the first polytetrafluoroethylene (PTFE)-lined stent was used in humans for shunt revision after stenosis, created by pinning the Gore PTFE graft material between two metal stents. Introduced in 2000, the Viatorr stent graft is now the most commonly used device for TIPS. One of the major side effects of TIPS creation is hepatic encephalopathy (HE). This chapter discusses the adjustable small-diameter transjugular intrahepatic portosystemic shunt.

scholarly journals Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

2020 ◽  
Vol 13 ◽  
pp. 175628482096128 ◽  
Author(s):  
Judit Vidal-González ◽  
Sergi Quiroga ◽  
Macarena Simón-Talero ◽  
Joan Genescà
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Portosystemic Shunt ◽  
Venous System ◽  
Variceal Hemorrhage ◽  
Portal Venous System ◽  
Portal Flow ◽  
Portosystemic Shunts ◽  
Intrahepatic Portosystemic Shunt

Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as well as the complications derived from its formation and its management. The role of SPSS embolization is specifically discussed, as SPSSs have been assessed as a therapeutic target, mainly for patients with recurrent/persistent hepatic encephalopathy and preserved liver function. Furthermore, different aspects of the role of SPSS in liver transplantation, as well as in candidates for transjugular intrahepatic portosystemic shunt are reviewed. In these settings, SPSS occlusion has been proposed to minimize possible deleterious effects, but results are so far inconclusive.

scholarly journals Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism

2021 ◽  
Vol 12 ◽  
Author(s):  
Wenjing Ni ◽  
Yue Yuan ◽  
Xiaoqiu Chu ◽  
Guofang Chen ◽  
Xue Han ◽  
...  
Keyword(s):  
Renal Function ◽  
Bone Turnover ◽  
Clinical Success ◽  
Lesion Volume ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Parathyroid Lesions ◽  
Serum Pth ◽  
Bone Turnover Biomarkers

ObjectiveTo assess the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT), and to investigate whether MWA can improve the bone turnover and renal function.MethodsA total of 20 consecutive PHPT patients with 21 parathyroid lesions treated with MWA in our center from May 2019 to March 2021 were recruited in this study. Serum parathyroid hormone (PTH), calcium and phosphorus levels before MWA and at 20 minutes, 4 hours, 1 day, 3 months, 6 months and 12 months after MWA were measured. Bone turnover biomarkers, renal function and lesion volume with volume reduction rate (VRR) before MWA and at the last follow-up were compared. Any complication related with MWA was evaluated. The technical and clinical success rates of MWA in the treatment of PHPT were calculated. Clinical success was defined as normal serum PTH and calcium without PHPT-associated manifestations at more than 6 months after ablation. Technical success was defined as complete ablation indicated by immediate postoperative contrast-enhanced ultrasound.ResultsThe serum PTH, calcium and phosphorus levels at their respective follow-up time points dropped significantly after MWA (P &lt;0.05). The volume of parathyroid lesions at the final examination was significantly reduced, compared with pre-ablation volume (P &lt;0.001), with a median VRR reaching 89%. The technical and clinical success rates were 100% and 63.6%, respectively. Substantial changes of bone turnover biomarkers were observed before and after MWA (P &lt;0.05), but the differences in renal function were not statistically significant. No major complications were reported in all cases. Pre-MWA serum PTH, lesion volume, maximum diameter of lesion and ablation time were significantly different between patients with successful and failed MWA.ConclusionsPHPT can be effectively and safely treated by ultrasound-guided MWA, as proven by drop in serum PTH and reduction in the volume of parathyroid adenomas. Besides, MWA can impede bone remodeling to suppress hyperparathyroidism in the condition of PHPT.

scholarly journals A Clinical and Radiographic Assessment of Sodium Hypochlorite Versus Formocresol Pulpotomy in Primary Molar Teeth: 12-month Follow-up.

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Zahra Bahrololoomi ◽  
Fatemeh Zarebidoki ◽  
Atefeh Shakib
Keyword(s):  
Root Resorption ◽  
Clinical Success ◽  
Primary Molars ◽  
Pathologic Finding ◽  
Success Rates ◽  
Primary Molar ◽  
Exact Test ◽  
Significant Difference ◽  
Molar Teeth

Objective: The aim of this study was to compare the clinical and radiographic success rates of pulpotomy in primary molars using formocresol versus sodium hypochlorite.Methods:  Twenty-three children aged 4-9 years with at least two primary molars requiring pulpotomy were randomly allocated into two groups. All teeth received stainless steel crown after conventional pulpotomy procedure with either NaOCl or formocresol. Clinical and radiographic signs/symptoms were recorded at six and 12 months. Outcomes were statistically analyzed using Fisher’s exact test and Chi-squaretest.Results: Clinical success rates at 6 and 12-month follow-up in both groups was 100%. At 6-month follow-up, radiographic success rate for NaOCl and formocresol groups was 100%. At 12-month recalls, in NaOCl group, 20 teeth (87%) and in formocresol group, 21 teeth (91.3%) had radiographic success. No significant difference was found in the radiographic success rates at 12 months (P=1.00). Internal root resorption was the most common radiographic pathologic finding in both groups.Conclusion:Clinical and radiographic success rates in NaOCl group was comparable with formocresol group, so NaOCL can be suggested as an alternative for primary teeth pulpotomies. However further clinical studies with long-term follow-ups are needed. 

Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review

2019 ◽  
Vol 48 (3) ◽  
pp. 744-753 ◽  
Author(s):  
Burak Altintas ◽  
Nicole L. Anderson ◽  
Rafael Pitta ◽  
Patrick S. Buckley ◽  
Sanjeev Bhatia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Clinical Success ◽  
Rotator Cuff Tears ◽  
Age Group ◽  
Level Of Evidence ◽  
Imaging Evaluation ◽  
Small Series ◽  
Retear Rate

Background: The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years. Purpose: To systematically review the literature on the outcomes of RCR among patients ≥70 years old. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included. Results: Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs ( P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively. Conclusion: RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.

scholarly journals Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series

2017 ◽  
Vol 05 (11) ◽  
pp. E1111-E1116 ◽  
Author(s):  
Raffaele Manta ◽  
Claudio Zulli ◽  
Angelo Zullo ◽  
Edoardo Forti ◽  
Alberto Tringali ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Symptom Relief ◽  
Case Series ◽  
Metal Stents ◽  
Success Rates ◽  
Gallbladder Drainage ◽  
First Case

Abstract Background and study aim Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges. Patients and methods Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed. Results EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 – 180 days). Conclusions Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.

Sign in / Sign up

Export Citation Format

Share Document