Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery

Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7–1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.

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Stent patency and outcome of TIPS through the left versus the right portal branches

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00305-z ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Mohamed S. Alwarraky ◽

Hasan A. Elzohary ◽

Mohamed A. Melegy ◽

Anwar Mohamed

Keyword(s):

Portal Hypertension ◽

Clinical Outcome ◽

Portal Vein ◽

Variceal Bleeding ◽

Patency Rate ◽

Hospital Admissions ◽

Stent Patency ◽

Left Branch ◽

The Right

Abstract Background Our purpose is to compare the stent patency and clinical outcome of trans-jugular intra-hepatic porto-systemic shunt (TIPS) through the left branch portal vein (TIPS-LPV) to the standard TIPS through the right branch (TIPS-RPV). We retrospectively reviewed all patients (n = 54) with refractory portal hypertension who were subjected to TIPS-LPV at our institute (TIPS-LPV) between 2016 and 2018. These patients were matched with 56 control patients treated with the standard TIPS-RPV (TIPS-RPV). The 2 groups were compared regarding the stent patency rate, encephalopathy, and re-interventions for 1 year after the procedure. Results TIPS-LPV group showed 12 months higher patency rate (90.7% compared to 73.2%) (P < 0.005). The number of the encephalopathy attacks in the TIPS-LPV group was significantly lower than that of the TIPS-RPV group at 6 and 12 months of follow-up [P = 0.012 and 0.036, respectively]. Re-bleeding and improvement of ascites were the same in the two groups [P > 0.05]. Patients underwent TIPS-LPV needed less re-interventions and required less hospitalizations than those with TIPS-RPV [P = 0.039 and P = 0.03, respectively]. Conclusion The new TIPS approach is to extend the stent to LPV. This new TIPS-LPV approach showed the same clinical efficiency as the standard TIPS-RPV in treating variceal bleeding and ascites. However, it proved a better stent patency with lower rates of re-interventions, encephalopathy, and hospital admissions than TIPS through the right branch.

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Safety and outcomes of endoscopic ultrasound-guided drainage for malignant biliary obstruction using cautery-enabled lumen-apposing metal stent

Endoscopy International Open ◽

10.1055/a-1236-3217 ◽

2020 ◽

Vol 08 (11) ◽

pp. E1633-E1638

Author(s):

Jerry Yung-Lun Chin ◽

Samir Seleq ◽

Frank Weilert

Keyword(s):

Clinical Success ◽

Clinical Success Rate ◽

Metal Stents ◽

Metal Stent ◽

Endoscopic Retrograde ◽

Stent Patency ◽

Stent Occlusion ◽

Secondary Endpoints ◽

Mean Time

Abstract Background and study aims There is increasing evidence to suggest that EUS-guided biliary drainage (EUS-BD) is a safe and effective treatment alternative for patients with malignant biliary obstructions (MBOs) after failed endoscopic retrograde cholangiopancreatography. Patients and methods We performed a retrospective analysis of data prospectively collected from patients with MBO who underwent choledochoduodenostomy (CDS) or gallbladder drainage (GBD) between August 2016 and June 2020 using the electrocautery-enabled lumen-apposing metal stents (ECE-LAMS). The primary endpoint was technical and clinical success. Secondary endpoints were adverse events (AEs) and reinterventions. Results A total of 60 patients were included in the study, with 56 CDS and 4 GBD. Median age was 76 years with 57 % male (34/60). The most common indication for EUS-BD was pancreatic cancer (78 %). Technical success was achieved in 100 % of cases, with a clinical success rate of 91.7 %. Mean total bilirubin pre-procedure was 202 umol/L (normal < 20 umol/L) and 63.8 umol/L post procedure (P < .001). Twenty-one patients had bilirubin recorded at 2 weeks post EUS-BD with 20 of 21 patients demonstrating > 50 % reduction in bilirubin (mean bilirubin reduction 75 %). AEs occurred in 12 of 60 patients (20 %), all of which were mild. The reintervention rate was 11.7 % (7/60). Stent occlusion occurred in 10 of 60 patients (16.7 %) with a mean time to stent occlusion of 46.2 days (3–133). Stent patency of 83.3 % was observed with a mean follow up of 7.9 months. Conclusion EUS-CDS and GBD using ECE-LAMS are effective EUS-based techniques for managing patients with MBO. AEs are usually mild and resolved by reintervention.

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Endoscopic deployment of multiple (≥ 3) metal stents for unresectable malignant hilar biliary strictures

Endoscopy International Open ◽

10.1055/a-0849-9334 ◽

2019 ◽

Vol 07 (05) ◽

pp. E672-E677

Author(s):

Tatsuya Koshitani ◽

Shuji Nakagawa ◽

Yoshitomo Konaka ◽

Keimei Nakano ◽

Shuichi Fuki ◽

...

Keyword(s):

Obstructive Jaundice ◽

Clinical Success ◽

Guide Wire ◽

Metal Stents ◽

High Grade ◽

Success Rates ◽

Biliary Strictures ◽

Stent Patency ◽

Stent Occlusion

Abstract Background and study aims Endoscopic deployment of multiple (≥ 3) self-expandable metal stents (SEMS) for high-grade unresectable malignant hilar biliary strictures (UMHBS) is technically challenging. Eleven consecutive patients with high-grade UMHBS (mean age: 76 years, male/female: 5/6, Bismuth-Corlette classification IIIa/IV: 7/4) underwent endoscopic deployment of multiple SEMS using a combination of side-by-side (SBS) and stent-in-stent (SIS) methods. Technical and clinical success rates were 11/11. More than three SEMS were successfully deployed, and obstructive jaundice was fully improved in all cases. Stent occlusion was recognized in four of 11 patients (mean: 134 days, range: 28 – 232). Reinterventions for both liver lobes were feasible by passing the guide wire inside the previously placed stents in three of four patients. Median stent patency was 150 days during a mean follow-up period of 184 days (range: 37 – 558). Three patients developed self-limiting cholangitis without definite stent occlusion as late (> 30 days) adverse events. Employing the combination of SBS and SIS methods may facilitate endoscopic deployment of multiple SEMS to treat high-grade UMHBS.

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Fully covered self-expandable esophageal metallic stents in patients with inoperable malignant disease who survived for more than 6 months after stent placement

British Journal of Radiology ◽

10.1259/bjr.20190321 ◽

2019 ◽

Vol 92 (1100) ◽

pp. 20190321

Author(s):

Nader Bakheet ◽

Jung-Hoon Park ◽

Hong-Tao Hu ◽

Sung Hwan Yoon ◽

Kun Yung Kim ◽

...

Keyword(s):

Stent Placement ◽

Malignant Disease ◽

Clinical Success ◽

Success Rates ◽

Esophageal Obstruction ◽

Stent Patency ◽

Oncological Treatment ◽

Dysphagia Score ◽

Effective Option

Objectives: To investigate the clinical outcomes of fully covered self-expanding metal stent (FCSEMS) placement in patients with malignant esophageal obstruction who survived longer than 6 months. Methods: From January 2002 to January 2018, 88 FCSEMS were placed in 64 patients (mean age 62.9 ± 11.6 years; 58 males) with inoperable malignant esophageal obstruction with or without esophago-respiratory fistula. Only patients who survived more than 6 months with FCSEMS in place were included. Data regarding technical and clinical success, complications, reinterventions, stent patency, and patient survival were obtained from a prospectively maintained hospital database. Results: The technical and clinical success rates were 100 % (64/64). During follow-up, the median dysphagia score significantly improved (3.09 ± 0.68 to 1.05 ± 0.60, p < 0.001). The complication rate was 48.8 %. Multivariate analysis revealed that only longer stenting duration was associated with complications [hazard ratio = 1.220, 95 % confidence interval (CI) (1.074–2.760), p = 0.039]. The median follow-up duration was 257 days (range, 181–969). The median stent patency duration was 289 days [95% CI (209.9–368.1)]. The median survival was 254 days [95% CI (219.7–288.3)]. Conclusions: Our data suggest that esophageal FCSEMS placement is an effective option for patients with malignant dysphagia when survival longer than 6 months is expected. The rate of complications increases with time, and SEMS development is needed to keep up with the advancement in oncological treatment. Advances in knowledge: Fully covered esophageal self-expandable stent placement is effective in patients surviving more than 6 months, however, the rate of complications also increases. SEMS development is needed to cope with the advancement in oncological treatment.

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Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽

10.1024/0301-1526/a000571 ◽

2016 ◽

Vol 45 (6) ◽

pp. 497-504 ◽

Cited By ~ 11

Author(s):

Tom De Beule ◽

Jan Vranckx ◽

Peter Verhamme ◽

Veerle Labarque ◽

Marie-Anne Morren ◽

...

Keyword(s):

Clinical Outcomes ◽

Clinical Improvement ◽

Arteriovenous Malformations ◽

Clinical Success ◽

Transarterial Embolization ◽

Recurrent Bleeding ◽

Complete Disappearance ◽

Ethylene Vinyl Alcohol ◽

Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

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A Prospective Multicenter Study of “Inside Stents” for Biliary Stricture: Multicenter Evolving Inside Stent Registry (MEISteR)

Journal of Clinical Medicine ◽

10.3390/jcm10132936 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2936

Author(s):

Hirofumi Kogure ◽

Hironari Kato ◽

Kazumichi Kawakubo ◽

Hirotoshi Ishiwatari ◽

Akio Katanuma ◽

...

Keyword(s):

Multicenter Study ◽

Stent Placement ◽

Controlled Trial ◽

Adverse Event Rate ◽

Success Rates ◽

Technical Success ◽

Biliary Strictures ◽

Prospective Multicenter Study ◽

Stent Occlusion ◽

Benign Biliary Strictures

Background: Endoscopic biliary stent placement is the standard of care for biliary strictures, but stents across the papilla are prone to duodenobiliary reflux, which can cause stent occlusion. Preliminary studies of “inside stents” placed above the papilla showed encouraging outcomes, but prospective data with a large cohort were not reported. Methods: This was a prospective multicenter registry of commercially available inside stents for benign and malignant biliary strictures. Primary endpoint was recurrent biliary obstruction (RBO). Secondary endpoints were technical success of stent placement and removal, adverse events, and stricture resolution. Results: A total of 209 inside stents were placed in 132 (51 benign and 81 malignant) cases with biliary strictures in 10 Japanese centers. During the follow-up period of 8.4 months, RBO was observed in 19% of benign strictures. The RBO rate was 49% in malignant strictures, with the median time to RBO of 4.7 months. Technical success rates of stent placement and removal were both 100%. The adverse event rate was 8%. Conclusion: This prospective multicenter study demonstrated that inside stents above the papilla were feasible in malignant and benign biliary strictures, but a randomized controlled trial is warranted to confirm its superiority to conventional stents across the papilla.

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Abstract 1787: Vertebral Artery Stent Placement for Symptomatic Patients: One-Year Follow-up

Circulation ◽

10.1161/circ.116.suppl_16.ii_379-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Samir N Patel ◽

J. Stephen Jenkins ◽

Christopher J White ◽

Paul McMullan ◽

J.P. Reilly ◽

...

Keyword(s):

Vertebral Artery ◽

Stent Placement ◽

Clinical Success ◽

High Morbidity ◽

Symptom Resolution ◽

Non Invasive ◽

Procedural Success ◽

Repeat Angiography ◽

One Year

Background : Symptomatic vertebral artery stenosis (VAS) has a five-year stroke risk of 30%–35%. Mortality associated with posterior circulation (PC) strokes is high, ranging from 20%–30%. Surgical revascularization is rarely performed due to high morbidity and mortality. Endovascular revascularization with stents offers a potential treatment option for these patients. Methods : One hundred nine patients (116 arteries, 70% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995–2006. Symptoms included vertigo (63%), visual changes (31%), syncope (11%), ataxia (7%), and drop attack (5%). Four patients had asymptomatic critical stenosis. Sixty-one patients (56%) had bilateral VAS, 74 patients (69%) had concomitant carotid disease, and 43 patients (39%) had a prior stroke. Procedural success was defined as residual stenosis of ≤ 20% without peri-procedural stroke or death. Clinical success was defined as procedural success with symptom resolution. Restenosis was defined as angiographic narrowing within the stent of ≥ 70% or > 50% with recurrent symptoms, or evidence of severe stenosis on non-invasive imaging (ultrasound, CT, or MR). Results : Procedural and clinical success was achieved in 108 (99.1%) and 95 (94.3%) patients, respectively. At one year, follow-up was obtained in 91 patients (83.5%), 6 patients (5.5%) had died, 5 patients (5.3%) experienced a PC stroke, and 47 patients (43.1%) underwent repeat angiography and/or non-invasive imaging. Eighty-seven of the 91 patients were initially symptomatic, 69 (79.3%) of which were symptom-free at one year. Three of those that had recurrent symptoms never achieved clinical success, 9 had developed restenosis, and 7 underwent successful re-intervention. At median follow-up of 31 months (lower and upper quartiles of 13.0 and 51.8 months), 72.5% were alive and 71.6% remained symptom-free. Conclusion : Our data demonstrates that stenting for VAS can be successfully performed in 99% of patients without peri-procedural stroke or death and is associated with durable symptom resolution in approximately 80% of patients at one year. In these high-risk patients, endovascular therapy for symptomatic VAS appears to be safe and effective at relieving symptoms.

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Candy-Plug Generation II for False Lumen Occlusion in Chronic Aortic Dissection: Feasibility and Early Results

Journal of Endovascular Therapy ◽

10.1177/1526602819871613 ◽

2019 ◽

Vol 26 (6) ◽

pp. 782-786 ◽

Cited By ~ 7

Author(s):

Ahmed Eleshra ◽

Tilo Kölbel ◽

Nikolaos Tsilimparis ◽

Giuseppe Panuccio ◽

Martin Scheerbaum ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Success ◽

False Lumen ◽

The Other ◽

Type I ◽

Technical Success ◽

Chronic Aortic Dissection ◽

Early Results ◽

Aortic Remodeling

Purpose: To present the early results of false lumen (FL) occlusion in chronic aortic dissection using the Candy-Plug generation II (CP II), which has a self-closing fabric channel that obviates the need for separate occlusion of its center. Materials and Methods: Fourteen consecutive patients (mean age 60±11 years; 10 men) with persistent FL backflow and aneurysm formation at the thoracic segment in chronic aortic dissection underwent thoracic endovascular aortic repair (TEVAR) with FL occlusion using the refined CP II. Primary endpoints were technical success (successful deployment) and clinical success (no FL backflow at the CP II level). Secondary endpoints included 30-day mortality and morbidity and aortic remodeling during follow-up. Results: Technical success was 100%. One patient required additional intraprocedural FL embolization at the CP II level due to persistent FL backflow on final angiography (clinical success 93%), though there was no flow through the CP II center. There were no intraprocedural complications. Immediate complete FL occlusion was achieved in 12 patients; the other 2 required reintervention. One had contrast enhancement in the distal FL proximal to the CP II and was treated with coil embolization. The other patient had persistent type I endoleak at the level of the left subclavian artery (LSA) and underwent left carotid–LSA bypass and proximal stent-graft extension. One patient died due to retrograde type A aortic dissection that was not related to CP II placement. Over a mean 8-month follow-up (range 3–12), 9 patients had computed tomography angiography; 8 patients had evidence of aortic remodeling, while 1 aneurysm sac was stable. Conclusion: The CP II reduces the number of procedural steps and offers good seal, with minimal morbidity and mortality and a high rate of aortic remodeling.

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Angiographic features and transarterial embolization of retained placenta with abnormal vaginal bleeding

CVIR Endovascular ◽

10.1186/s42155-021-00265-z ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Ryo Takaji ◽

Hiro Kiyosue ◽

Miyuki Maruno ◽

Norio Hongo ◽

Ryuichi Shimada ◽

...

Keyword(s):

Vaginal Bleeding ◽

Transarterial Embolization ◽

Recurrent Bleeding ◽

Study Cohort ◽

Technical Success ◽

Retained Placenta ◽

Vascular Channel ◽

Abnormal Bleeding ◽

Abnormal Vaginal Bleeding

Abstract Objectives To clarify characteristic angiographic features and clinical efficacy of selective transarterial embolization (TAE) of retained placenta with abnormal vaginal bleeding. Methods The study cohort comprised 22 patients (mean age, 33.5 years; range, 22–24 years) who underwent selective TAE for retained placenta with abnormal bleeding between January 2018 and December 2020 at our institution. Angiographic images were reviewed by two certified radiologists with consensus. Medical records were reviewed to evaluate the efficacy of TAE. Angiographic features of retained placenta, technical success (disappearance of abnormal findings on angiography), complications, clinical outcomes (hemostatic effects and recurrent bleeding) were evaluated. Results Pelvic angiography showed a dilated vascular channel mimicking arteriovenous fistulas or an aneurysm contiguous with dilated uterine arteries in the mid-arterial–capillary phase in 20 patients; it showed contrast brush in the remaining two patients. TAE technical success was achieved in all patients. No major complications were observed in any patients. Fifteen patients were followed up with expectant management after TAE; all but one patient showed no re-bleeding during the follow-up period (mean follow-up interval, 3.4 months; range, 1–17 months). One patient showed minor rebleeding, which resolved spontaneously. Seven patients underwent scheduled hysteroscopic resection within 1 week after TAE, and no excessive bleeding was observed during or after the surgical procedure in all seven patients. Conclusions The characteristic angiographic feature of retained placenta is “dilated vascular channel that mimic low flow AVM.” TAE is a safe and effective treatment to manage retained placenta with abnormal bleeding.

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

10.21203/rs.3.rs-1073588/v1 ◽

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.

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