Plug-Assisted Retrograde Transvenous Obliteration

2017 ◽  
Vol 01 (04) ◽  
pp. 293-301
Author(s):  
Eung Kim ◽  
Dong Gwon
Keyword(s):  
Hepatic Encephalopathy ◽  
Clinical Success ◽  
Treatment Options ◽  
Clinical Effectiveness ◽  
Gastric Varices ◽  
Gelatin Sponge ◽  
Success Rates ◽  
Endoscopic Injection ◽  
Balloon Catheters ◽  
Portosystemic Shunts

AbstractGastric fundal varices and portosystemic hepatic encephalopathy are major complications of portal hypertension in patients with liver cirrhosis. Many treatment options have been used for gastric varices, including endoscopic injection and transjugular intrahepatic portosystemic shunts (TIPS), but the clinical effectiveness of these treatments remains contentious. Today, balloon-occluded retrograde transvenous obliteration (BRTO) has become the treatment of choice because of its excellent clinical effectiveness and outcomes; however, the associated use of sclerosants and temporary indwelling balloon catheters can cause specific complications. Vascular plugs are another option that has been shown to be safe, feasible, and effective when used as an embolic material in vascular disease. Recently, a technique has been developed that uses such vascular plugs with a gelatin sponge to embolize gastrorenal shunts. This technique is known as plug-assisted retrograde transvenous obliteration (PARTO), and it is also associated with high technical and clinical success rates. Moreover, it appears to be a much safer and more feasible procedure than BRTO. In this review, we introduce PARTO and outline its strengths and potential for use as the treatment of choice in gastric varices and hepatic encephalopathy.

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 Silicon Nitride (Si3N4) Implants: The Future of Dental Implantology?

2017 ◽  
Vol 43 (3) ◽  
pp. 240-244 ◽  
Author(s):  
Zahi Badran ◽  
Xavier Struillou ◽  
Francis J Hughes ◽  
Assem Soueidan ◽  
Alain Hoornaert ◽  
...  
Keyword(s):  
Silicon Nitride ◽  
Dental Implants ◽  
Dental Implant ◽  
Clinical Success ◽  
Treatment Options ◽  
Antibacterial Properties ◽  
Antimicrobial Properties ◽  
Future Research ◽  
Success Rates ◽  
Biological Performance

For decades titanium has been the preferred material for dental implant fabrication, with mechanical and biological performance resulting in high clinical success rates. These have been further enhanced by incremental development of surface modifications aimed at improving speed and degree of osseointegration and resulting in enhanced clinical treatment options and outcomes. However, increasing demand for metal-free dental restorations has also led to the development of ceramic-based dental implants, such as zirconia. In orthopedics, alternative biomaterials, such as polyetheretherketone or silicon nitride, have been used for implant applications. The latter is potentially of particular interest for oral use as it has been shown to have antibacterial properties. In this article we aim to shed light on this particular biomaterial as a future promising candidate for dental implantology applications, addressing basic specifications required for any dental implant material. In view of available preclinical data, silicon nitride seems to have the essential characteristics to be a candidate for dental implants material. This novel ceramic has a surface with potentially antimicrobial properties, and if this is confirmed in future research, it could be of great interest for oral use.

Transarterial embolisation for gastroduodenal bleeding following endoscopic resection

2021 ◽  
pp. 20210062
Author(s):  
Suyoung Park ◽  
Boryeong Jeong ◽  
Ji Hoon Shin ◽  
Eun Ho Jang ◽  
Jung Han Hwang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Clinical Success ◽  
Vital Signs ◽  
Left Gastric Artery ◽  
Gelatin Sponge ◽  
Success Rates ◽  
Gastric Artery ◽  
Delayed Bleeding ◽  
Transcatheter Arterial Embolisation ◽  
Angiographic Findings

Objectives: Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. Methods: Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. Results: Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1–30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. Conclusions: TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. Advances in knowledge: This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.

scholarly journals The Role of Endoscopic Ultrasound (EUS) in the Management of Gastric Varices

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Sushrut Sujan Thiruvengadam ◽  
Alireza Sedarat
Keyword(s):  
Endoscopic Ultrasound ◽  
Conventional Therapy ◽  
Primary Prophylaxis ◽  
Gastric Varices ◽  
Secondary Prophylaxis ◽  
Review Literature ◽  
Gelatin Sponge ◽  
Current Recommendation ◽  
Endoscopic Injection

Abstract Purpose of Review Gastric varices (GV) are an important complication of portal hypertension, and the current recommendation for management is beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt (TIPS) for active bleeding or secondary prophylaxis. Direct endoscopic injection of cyanoacrylate (CYA) glue has been investigated but has drawbacks including limited endoscopic characterization of GV and possible distal glue embolism. To this end, endoscopic ultrasound (EUS) has been pursued to help in characterization of GV, visualization of treatment in real time, and confirmation of obliteration with Doppler. Recent Findings In this paper, we review treatments for GV involving EUS, including EUS-guided injection of CYA and coils, either alone or in combination. We also discuss less common methods, including EUS-guided injection of thrombin and absorbable gelatin sponge. We then review literature comparing EUS-guided methods with direct endoscopic therapy and comparing individual EUS-guided methods with one another. We conclude by highlighting drawbacks of EUS in this field, including the unproven benefit over conventional therapy, lack of a standardized approach, and limited availability of expertise and necessary materials. Summary Novel EUS-based methods offer a unique opportunity to directly visualize and access gastric varices for treatment and obliteration. This may provide key advantages over current endoscopic or angiographic treatments. Comparative studies investigating the benefit of EUS over conventional therapy are needed.

Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial

Endoscopy ◽  
2020 ◽  
Vol 52 (04) ◽  
pp. 268-275 ◽  
Author(s):  
Carlos Robles-Medranda ◽  
Roberto Oleas ◽  
Manuel Valero ◽  
Miguel Puga-Tejada ◽  
Jorge Baquerizo-Burgos ◽  
...  
Keyword(s):  
Endoscopic Ultrasonography ◽  
Coil Embolization ◽  
Clinical Success ◽  
Controlled Trial ◽  
Combined Treatment ◽  
Gastric Varices ◽  
Success Rates ◽  
Multicenter Studies ◽  
End Points ◽  
Technical Success Rate

Abstract Background Gastric variceal bleeding is a life-threating condition with challenging management. We aimed to compare the efficacy and safety of endoscopic ultrasonography (EUS)-guided coil embolization and cyanoacrylate injection versus EUS-guided coil embolization alone in the management of gastric varices. Methods A single-center, parallel-randomized controlled trial involving 60 participants with gastric varices (GOV II and IGV I) who were randomly allocated to EUS-guided coil embolization and cyanoacrylate injection (n = 30) or EUS-guided coil embolization alone (n = 30). The primary end points were the technical and clinical success rates of both procedures. The secondary end points were the reappearance of gastric varices during follow-up, along with rebleeding, the need for reintervention, and complication and survival rates. Results The technical success rate was 100 % in both groups. Immediate disappearance of varices was observed in 86.7 % of patients treated with coils and cyanoacrylate, versus 13.3 % of patients treated with coils alone (P < 0.001). Median survival time was 16.4 months with coils and cyanoacrylate versus 14.2 months with coils alone (P = 0.90). Rebleeding occurred in 3.3 % of patients treated with combined treatment and 20 % of those treated with coils alone (P = 0.04). With combined treatment, 83.3 % of patients were free from reintervention versus 60 % with coils alone (hazard ratio 0.27; 95 % confidence interval 0.095 – 0.797; P = 0.01). Conclusions EUS-guided coil embolization with cyanoacrylate injection achieved excellent clinical success, with lower rates of rebleeding and reintervention than coil treatment alone. Multicenter studies are required to define the most appropriate technique for gastric variceal obliteration.

scholarly journals Insights into the role of endoscopic ultrasound–guided vascular therapy

2019 ◽  
Vol 12 ◽  
pp. 263177451987828
Author(s):  
Roberto Oleas ◽  
Carlos Robles-Medranda
Keyword(s):  
Gastrointestinal Bleeding ◽  
Endoscopic Ultrasound ◽  
Endovascular Therapy ◽  
Combined Therapy ◽  
Treatment Options ◽  
Gastric Varices ◽  
Ultrasound Guided ◽  
Endoscopic Injection ◽  
Life Threatening

Gastroesophageal variceal bleeding is a life-threatening complication in patients with liver cirrhosis and portal hypertension. The endoscopic injection of cyanoacrylate is considered as the first-line alternative for gastric varices treatment; however, the incidence of adverse events supports the endoscopic ultrasound–guided approach. Endoscopic ultrasound–guided interventions are a safe and feasible technique for the injection of sclerosants, cyanoacrylate, thrombin, and the deployment of coils into targeted vessels. This review article aims to offer an overview of the role of endoscopic ultrasound–guided vascular therapy and present the available data regarding endoscopic ultrasound–guided management of gastrointestinal bleeding and other vascular therapies. The available data have shown the superiority of endoscopic ultrasound–guided endovascular therapy over the endoscopic technique, which supports the implementation of endoscopic ultrasound–guided therapy in therapeutical algorithms and guidelines. Regarding whether injecting cyanoacrylate, the deployment of coils, or combined therapy, we recommend the endoscopic ultrasound–guided combined therapy in patients with gastric varices due to the high eradication rate with lower rebleeding and reintervention rates. Multicenter worldwide studies are required to confirm the actual clinical applicability of endoscopic ultrasound–guided endovascular therapy and establish treatment algorithms. Endoscopic ultrasound offered a safe and effective alternative in the management of variceal and nonvariceal gastrointestinal bleeding, with the implementation of new diagnostic and treatment options for various gastrointestinal conditions, representing a new territory for research and development.

Gastric Varices and Hepatic Encephalopathy: Treatment with Vascular Plug and Gelatin Sponge–assisted Retrograde Transvenous Obliteration—A Primary Report

Radiology ◽  
2013 ◽  
Vol 268 (1) ◽  
pp. 281-287 ◽  
Author(s):  
Dong Il Gwon ◽  
Gi-Young Ko ◽  
Hyun-Ki Yoon ◽  
Kyu-Bo Sung ◽  
Jin Hyoung Kim ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Gastric Varices ◽  
Gelatin Sponge ◽  
Vascular Plug

scholarly journals Meta-analysis of Clinical Outcomes Using Ceftazidime/Avibactam, Ceftolozane/ Tazobactam, and Meropenem/ Vaborbactam for the Treatment of Multidrug Resistant Gram-Negative Infections

2021 ◽  
Author(s):  
Geneva Wilson ◽  
Margaret Fitzpatrick ◽  
Kyle Walding ◽  
Beverly Gonzalez ◽  
Marin L Schweizer ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Infection Type ◽  
Meta Analysis ◽  
Treatment Options ◽  
Clinical Success Rate ◽  
Multidrug Resistant ◽  
Success Rates ◽  
Beta Lactam ◽  
Review Reports

Abstract Ceftolozane-tazobactam (C/T), Ceftazidime-avibactam (C/A), and Meropenem/vaborbactam (M/V) are new beta-lactam/beta-lactamase combination antibiotics commonly used to treat multi-drug resistant Pseudomonas aeruginosa (MDRPA) and carbapenem-resistant Enterobacteriaceae (CRE) infections. This review reports the clinical success rates for C/T, C/A., and M/V. PubMed and EMBASE were searched from January 1 st, 2012 through September 2 nd, 2020 for publications detailing use of C/T, C/A, and M/V. Meta-analysis determined the pooled effectiveness of C/T, C/A, and M/V. The literature search returned 1,950 publications, 29 publications representing 1,620 patients were retained. Pneumonia was the predominant infection type (49.8%). MDRPA was the major pathogen treated (65.3%). The pooled clinical success rate was 73.3% (95% CI 68.9%-77.5%). C/T, C/A, or M/V resistance was reported in 8.9% of the population. These antibiotics had a high clinical success rate in patients with complicated infections and limited treatment options. Larger studies comparing C/T, C/A, and M/V against other antibiotic regimens are needed.

scholarly journals Comparison of different techniques for the management of venous steno-occlusive lesions during placement of peripherally inserted central catheter

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Woo Jin Yang ◽  
Danbee Kang ◽  
Ji Hoon Shin ◽  
Eun Ho Jang ◽  
Seung Yeon Noh ◽  
...  
Keyword(s):  
Clinical Success ◽  
Alternative Pathway ◽  
Transluminal Angioplasty ◽  
Second Line ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Success Rates ◽  
Initial Attempt ◽  
Technical Success Rate ◽  
Occlusive Lesion

AbstractThe purpose of this study is to investigate strategies for peripherally inserted central catheter (PICC) placement in patients with venous steno-occlusive lesion (VSOL). We performed a retrospective cohort study in adults with central or peripheral VSOL who underwent PICC placement procedures from January 2015 to December 2018. Four different strategies [selecting alternative pathway/over the wire (SAP/OTW), percutaneous transluminal angioplasty (PTA), re-puncture in ipsilateral arm (RIA), and catheter placement in the contralateral arm (CICA)] were analyzed and we compared the clinical outcomes by strategy and compared the strategy between central and peripheral VSOLs. During 4 years, 258 PICC procedures performed in patients with VSOLs, 100 PICC were included in the analysis. The overall technical success rate of initial attempt with SAP/OTW was 32.2%. As a second-line technique, PTA was most frequently used in both central (100%) and peripheral (68.2%) VSOL groups. The clinical success rates within 2 months of SAP/OTW, PTA, RIA, CICA were 55.2%, 43.2%, 14.3%, and 33.3%, respectively (P = 0.24). In conclusion, when the SAP/OTW failed, the PTA can be preferred as a second-line technique for both central and peripheral VSOLs. When guidewire passage fails, the operator could adopt the RIA or CICA technique as an alternative method.

scholarly journals Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years’ experience at a tertiary care centre

2021 ◽  
Author(s):  
Szabolcs Ábrahám ◽  
Illés Tóth ◽  
Ria Benkő ◽  
Mária Matuz ◽  
Gabriella Kovács ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Cholecystitis ◽  
Conversion Rate ◽  
Clinical Success ◽  
Definitive Treatment ◽  
Success Rates ◽  
Female Ratio ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Iii

Abstract Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

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