scholarly journals 697 An Evaluation of Patient Outcomes Following Percutaneous Cholecystostomy (PC) For Acute Cholecystitis (AC) At Our Health Board Between 2011-2020

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Maharaj ◽  
S A Haider ◽  
K G De Silva
Keyword(s):  
Patient Outcomes ◽  
Health Board ◽  
Percutaneous Cholecystostomy ◽  
Success Rates ◽  
Gram Negative ◽  
Abdominal Wall Abscess ◽  
Risk Patients ◽  
Procedural Success ◽  
Radiological Intervention

Abstract Introduction PC is a radiological intervention used in the management of high-risk patients with AC. Method A retrospective study of outcomes following PC, including success rates, complications, AC resolution, readmissions, and subsequent cholecystectomy. Results Our database identified 28 patients (14M:14F), median age 73 (range 40-93). 82% were ASA III/IV. Median follow-up was 2 (range 0-8) years. Imaging suggested AC in 61% and empyema in 39%. 86% were calculous. All procedures were USS-guided with 100% success. AC resolution occurred in 89.3%. Of three unresolved, there was 1 death day-1 post-PC (non-procedure related), 1 index cholecystectomy, 1 chronic complicated cholecystitis. 28.6% developed complications, 2 major (1 late biliary peritonitis and 1 cholecystocutaneous fistula with abdominal wall abscess), 17.9% dislodged drain, 10.7% other. 20 patients had bile cultures (70% positive, mainly gram-negative). 17.9% patients were readmitted with AC, 1 had repeat PC. 21.4% had subsequent ERCP. 32.1% underwent subsequent cholecystectomy, 1 laparoscopic cholecystectomy(LC) index, 4 elective (3 LC, 1 open), 4 emergency (2 LC, 1 LC subtotal, 1 failed open with drain insertion). Conclusions PC is both safe and effective with significant procedural success rates and resolution rates. There are few major complications but significant morbidities, mainly dislodged drains. One-third of patients have subsequent cholecystectomy.

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.

scholarly journals A mitralis elégtelenség sebészi kezelésének új megközelítése: transapicalis ínhúrpótlás dobogó szíven

2016 ◽  
Vol 157 (18) ◽  
pp. 700-705
Author(s):  
Tamás Ruttkay ◽  
Gábor Jancsó ◽  
Károly Gombocz ◽  
Balázs Gasz
Keyword(s):  
Mitral Regurgitation ◽  
Surgical Intervention ◽  
Transoesophageal Echocardiography ◽  
Invasive Technique ◽  
Success Rates ◽  
Special Instrument ◽  
Improved Outcomes ◽  
Procedural Success ◽  
Early Surgical Intervention

Severe mitral regurgitation due to prolapse of the valve demands early surgical intervention. Recently artificial chord implantation is the prefered solution, which requires cardioplegia and application of cardiopulmonary bypass using the left atrial approach. Transoesophageal echocardiography guided transapical neochord implantation is an emerging new technique for the treatment of mitral regurgitation. It enables the operation through left minithoracotomy on beating heart using a special instrument introduced into the left ventricle. Acute procedural success rates in different centres vary between 86 and 100%. According to reports, 92% of the patients do not require additional intervention at the 3-month follow-up. Continuous integration of data resulting improved outcomes supports the hope that this novel, less-invasive technique will be applied widely for the treatment of mitral regurgitation. Orv. Hetil., 2016, 157(18), 700–705.

Hepaticojejunostomy for Benign Disease: Long-Term Stricture Rate and Management

2019 ◽  
Vol 85 (12) ◽  
pp. 1350-1353 ◽  
Author(s):  
Shannon M. Zielsdorf ◽  
John J. Klein ◽  
Vidya A. Fleetwood ◽  
Martin Hertl ◽  
Edie Y. Chan
Keyword(s):  
Success Rate ◽  
Benign Disease ◽  
Success Rates ◽  
Transplant Patients ◽  
Stricture Rate ◽  
Anastomotic Strictures ◽  
The Mean ◽  
Radiological Intervention

The objective of the study was to determine the long-term stricture rate of hepaticojejunostiomy (HJ) performed for benign disease, to compare stricture rates for transplant patients and non-transplant patients, and to compare the success rates of procedural and surgical treatment options. Hospital charts of 135 consecutive patients undergoing HJ between 1998 and 2016 were analyzed retrospectively. The primary outcome was stricture formation. Secondary outcomes were time to stricture diagnosis and success rates of various interventions. The anastomotic stricture rate was 13.3 per cent (18). The mean follow-up period was 4.3 years. The mean time to stricture diagnosis was 2.3 years. Stricture rates were similar between the transplant (19.2%) and nontransplant, non-Whipple group (13%). Strictures were treated with radiological intervention with a 44.4 per cent success rate; each required multiple interventions. Mortality from liver disease after failure of nonoperative management of HJ strictures reached 30 per cent (3). Five of ten patients who failed radiological intervention underwent HJ revision; the success rate was 80 per cent. Anastomotic strictures of HJ performed for benign disease occur in 13 per cent of patients and typically develop within 2.5 years postoperatively. Yet, given the dangerous sequelae of chronic biliary obstruction and potential delay in presentation, a follow-up is recommended for up to 10 years. When strictures occur, HJ revision should be considered early, after two failed radiological interventions.

scholarly journals Factors Influencing Failure to Undergo Interval Cholecystectomy After Percutaneous Cholecystostomy Among Patients With Acute Cholecystitis: a Retrospective Study

2021 ◽  
Author(s):  
Yao Peng ◽  
Zhihui Chang ◽  
Zhaoyu Liu
Keyword(s):  
Acute Cholecystitis ◽  
Acalculous Cholecystitis ◽  
Albumin Level ◽  
Percutaneous Cholecystostomy ◽  
Factors Influencing ◽  
Effective Treatment Modality ◽  
Risk Patients ◽  
History Of ◽  
Grade Iii

Abstract Background: Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy.Methods: Data from patients with acute cholecystitis who had undergone PC from January 1, 2017, to December 31, 2019, in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy.Results: In total, 205 participants were identified, and 67 (32.7%) patients did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that Tokyo guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27–11.49; p=0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59–12.50; p=0.005), albumin level <28 g/L (OR: 4.15; 95% CI: 1.09–15.81; p=0.037), and history of malignancy (OR: 4.65; 95% CI: 1.62–13.37; p=0.004) were independent risk factors for a patient’s failure to undergo interval cholecystectomy. Among them, history of malignancy showed the highest predictor point on the nomogram for predicting non-interval cholecystectomy.Conclusions: TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and history of malignancy are the factors influencing failure to undergo cholecystectomy after PC in patients with acute cholecystitis.

scholarly journals Factors influencing failure to undergo interval cholecystectomy after percutaneous cholecystostomy among patients with acute cholecystitis: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Peng Yao ◽  
Zhihui Chang ◽  
Zhaoyu Liu
Keyword(s):  
Acute Cholecystitis ◽  
Acalculous Cholecystitis ◽  
Albumin Level ◽  
Percutaneous Cholecystostomy ◽  
Factors Influencing ◽  
Effective Treatment Modality ◽  
Risk Patients ◽  
History Of ◽  
Grade Iii

Abstract Background Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy. Methods Data from patients with acute cholecystitis who had undergone PC from January 1, 2017 to December 31, 2019 in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy. Results Overall, 205 participants were identified, and 67 (32.7%) did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that having a Tokyo Guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27–11.49; p = 0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59–12.50; p = 0.005), an albumin level < 28 g/L (OR: 4.15; 95% CI: 1.09–15.81; p = 0.037), and a history of malignancy (OR: 4.65; 95% CI: 1.62–13.37; p = 0.004) were independent risk factors for a patient’s failure to undergo interval cholecystectomy. Among them, the presence of a history of malignancy exhibited the highest influence in the nomogram for predicting non-interval cholecystectomy. Conclusions Having a TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and a history of malignancy influence the failure to undergo cholecystectomy after PC in patients with acute cholecystitis.

Abstract 17839: Transcatheter Annuloplasty Ring Multicentre Trial Report

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Karl-Heinz Kuck ◽  
Alec Vahanian ◽  
Georg Nickenig ◽  
Ottavio Alfieri ◽  
Antonio Colombo ◽  
...  
Keyword(s):  
Nyha Class ◽  
Functional Mitral Regurgitation ◽  
Heart Team ◽  
Class Iii ◽  
Annuloplasty Ring ◽  
Device Implantation ◽  
Risk Patients ◽  
Team Evaluation ◽  
Procedural Success

Aim: Cardioband system enables percutaneous implantation of an adjustable “surgical-like” mitral annuloplasty ring using a transseptal approach. The aim of this study was to evaluate the feasibility, safety and up to 12 month outcome of Cardioband in patients with functional mitral regurgitation (FMR) in a multicentre study. Methods and Results: Between February 2013 and March 2015, 40 high-risk patients with significant FMR were enrolled at 6 sites in Europe. After a Heart Team evaluation all patients were screened by echocardiography and cardiac CT to assess feasibility. Echocardiographic data were analysed by an independent core-lab. Mean age was 72±7 years, thirty patients were males (75%). Mean EuroScore II 9.0%±7.02% and median STS score 7.2 % (1.0%-34.0%). At baseline 93% of patients were in NYHA class III-IV with mean EF of 33.3±10% (15%-57%). Device implantation was feasible in all patients (100%). Acute procedural success (device successfully implanted with acute reduction of MR <2+) was achieved in 92% of the patients (37/40. After cinching of the device, an average of 20% reduction of the septo-lateral diameter was observed (from 37±5 mm to 29±5 mm; p<0.01). Thirty-day mortality was 5.0% (adjudicated unrelated to the device). At 6 months follow up (n=20) 80% of patients were in NYHA class I-II with significant improvement in quality of life (MLWHFQ from 38 to 18; p<0.05) and 85% of patients had MR≤2+. At 12 months follow up (n=14), 93% of patients had MR<2+). Conclusions: Transseptal direct annuloplasty with an adjustable “surgical-like” ring is feasible, with a comparable safety profile similar to other transcatheter mitral procedures. Effective reduction in MR severity is observed in most patients related to a significant septo-lateral dimension reduction. MR reduction is stable and consistent up to 12 months, with clinical benefit.

scholarly journals Transcatheter Mitral Valve Repair in Surgical High-Risk Patients: Gender-Specific Acute and Long-Term Outcomes

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Eike Tigges ◽  
Daniel Kalbacher ◽  
Christina Thomas ◽  
Sebastian Appelbaum ◽  
Florian Deuschl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Long Term Outcomes ◽  
Reduced Ejection Fraction ◽  
Cardiovascular Comorbidities ◽  
Risk Patients ◽  
Echocardiographic Parameters ◽  
Artery Disease ◽  
Procedural Success

Background. Analyses emphasizing gender-related differences in acute and long-term outcomes following MitraClip therapy for significant mitral regurgitation (MR) are rare.Methods. 592 consecutive patients (75±8.7years, 362 men, 230 women) underwent clinical and echocardiographic follow-up for a median of 2.13 (0.99–4.02) years.Results.Significantly higher prevalence of cardiovascular comorbidities, renal failure, and adverse echocardiographic parameters in men resulted in longer device time(p=0.007)and higher numbers of implanted clips(p=0.0075), with equal procedural success(p=1.0). Rehospitalization for heart failure did not differ(p[logrank]=0.288)while survival was higher in women(p[logrank]=0.0317). Logarithmic increase of NT-proBNP was a common independent predictor of death. Hypercholesterolemia and peripheral artery disease were predictors of death only in men while ischemic and dilative cardiomyopathy (CM) and age were predictors in women. Independent predictors of rehospitalization for heart failure were severely reduced ejection fraction and success in men while both ischemic and dilative CM, logistic EuroSCORE, and MR severity were predictive in women.Conclusions. Higher numbers of implanted clips and longer device time are likely related to more comorbidities in men. Procedural success and acute and mid-term clinical outcomes were equal. Superior survival for women in long-term analysis is presumably attributable to a comparatively better preprocedural health.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

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