Clinical impact of the Sherlock 3CG® Tip Confirmation System for peripherally inserted central catheters

Objective This study was performed to evaluate the technical success rate and catheter tip malposition rate of peripherally inserted central catheter (PICC) placement using the Sherlock 3CG® Tip Confirmation System (TCS). Methods In total, 114 patients who underwent PICC insertion via the Sherlock 3CG® TCS from October 2017 to February 2018 were retrospectively evaluated. The primary endpoints were the technical success rate, malposition rate, and mean procedure time. The secondary endpoints were the sex-related difference in the malposition rate, radiologist’s experience level, and side of insertion. Technical success was defined as procedure completion using only the Sherlock 3CG® TCS without a guidewire or fluoroscopy guidance. In accordance with the North American guidelines, an adequate position was defined as the lower third of the superior vena cava and the cavoatrial junction. Results The technical success rate was 97% (111/114). The malposition rate was 16% (18/111), and four catheters were repositioned. There were no significant differences in the malposition rate between the sexes, radiologist’s level of experience, or side of insertion. Conclusions PICC placement using the Sherlock 3CG® TCS yielded a high technical success rate and low catheter tip malposition rate regardless of the radiologist’s level of experience or side of insertion.

Download Full-text

One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device: Cohort study from East Asia

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520973488 ◽

2020 ◽

pp. 026835552097348

Author(s):

Chang-Ming Wang ◽

Shi-Lu Zhao ◽

Qi-Chen Feng ◽

Shuo Gai ◽

Xuan Li

Keyword(s):

Cohort Study ◽

Radiofrequency Ablation ◽

Success Rate ◽

Technical Success ◽

Technical Success Rate ◽

Sonographic Evaluation ◽

Primary Endpoints ◽

Secondary Endpoints ◽

One Year

Objectives The present study was designed to assess outcomes of patients undergone radiofrequency ablation (RFA) for their incompetent perforator veins (IPVs) with ClosureFast stylets. Methods Data of 165 IPVs in 138 limbs of 117 consecutive patients between July 2017 to Nov. 2019 were retrospectively reviewed. Primary endpoints (technical success rate, complications) and secondary endpoints (VCSS) were analyzed. Results The immediate technical success rate was 100%. There were no major complications. The rate of ecchymosis and induration was 5.8%. 129/165 IPVs in 79.5% (93/117) patients had achieved sonographic evaluation at 1 year followed-up, in which 3 perforators were recanalized. VCSS scores at pre-operation and 1-year follow-up were 5.77 ± 1.88 and 2.70 ± 1.39, respectively ( t= 29.644, P= .000). Conclusions In conclusion, RFA is safe and effective for the treatment of IPVs. At the 1-year follow-up, the RFA of IPVs showed a low recanalization rate and had a satisfactory improvement on VCSS.

Download Full-text

One-Year Results of ZBIS Iliac Branch Device With an Off-Label Connection Limb

Journal of Endovascular Therapy ◽

10.1177/15266028211054760 ◽

2021 ◽

pp. 152660282110547

Author(s):

Jose Torrealba ◽

Giuseppe Panuccio ◽

Fiona Rohlffs ◽

Thomas Gandet ◽

Catharina Gronert ◽

...

Keyword(s):

Primary Patency ◽

Main Body ◽

Secondary Patency ◽

Technical Success ◽

Technical Success Rate ◽

Off Label ◽

Primary Endpoints ◽

Secondary Endpoints ◽

One Year

Purpose: The purpose of this article is to study 1-year results of Zenith branch iliac endovascular graft (ZBIS) with the off-label use of a 13 mm spiral Z limb to connect to the aortic main body. Materials and Methods: A retrospective review from 2015 to 2019 of all iliac branch devices (IBDs) was performed at 1 institution that were connected to an aortic main body with a 13 mm spiral Z limb and had at least 1-year follow-up with computed tomography (CT). Primary endpoints are freedom from ZBIS separation from the connection limb, endoleak (EL), or reintervention at 1 year. Secondary endpoints are primary and secondary ZBIS patency, presence of any EL, and aortic reinterventions. Results: Of 149 IBDs implanted in this period, 45 ZBIS in 35 patients were connected with a 13 mm limb and had a 1-year CT; 97% of patients had common iliac artery (CIA) aneurysms, 7% of patients had hypogastric artery (HA) aneurysms, and 30% of patients had bilateral ZBIS implantation. Technical success was 98%. In 84% of cases, the Advanta V12 was used as the HA mating stent; 56% of patients had an EL, mostly type II, which resolved spontaneously in 70% at 1 year, and 9% of ZBIS required reinterventions at 1 year (2 for thrombosis, 2 for type Ic EL from HA mating stent). One-year ZBIS primary patency and secondary patency were 96% and 100%, respectively. No EL was noted to be related to the 13 mm connection limb. No migration or separation of the devices occurred. Conclusions: The use of 13 mm spiral Z limb to connect a ZBIS with the main body in our series yields a high technical success rate and good 12-month outcomes without device separation or migration.

Download Full-text

Evaluation of percutaneous transcatheter embolization for pulmonary arteriovenous malformations

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01448-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

ZhengZhong Wu ◽

JunQing Lin ◽

WeiZhu Yang ◽

Na Jiang ◽

Ning Huang ◽

...

Keyword(s):

New York ◽

Success Rate ◽

Arteriovenous Malformations ◽

Heart Association ◽

Transcatheter Embolization ◽

Pulmonary Arteriovenous Malformations ◽

Technical Success ◽

Arterial Blood Gas ◽

Technical Success Rate ◽

Arterial Blood

Abstract Background The purpose of this study was to assess the safety and efficacy of percutaneous transcatheter embolization (TCE) for the treatment of pulmonary arteriovenous malformations (PAVMs). Methods Forty-three consecutive patients (n = 17 males; n = 26 females) with 72 untreated PAVMs underwent coil and/or plug embolization between January 2010 and February 2018. The mean patient age was 42 ± 14 years (range 19–71 years). The median size of the feeding artery was 7.9 ± 2.9 mm (range 3.5–14.0 mm). The arterial blood gas level and cardiac function of all patients were analysed. The technical success rate, recanalization rate, and complications were evaluated. Computed tomography angiography (CTA) examinations were scheduled for 12 months after treatment and every 2–4 years thereafter. Results Twenty-five PAVMs were treated with coils alone, twenty-one were treated with plugs alone, and twenty-six were treated with both coils and plugs. The technical success rate was 100%. There were no complications during operation. However, one patient (2.3%) had pulmonary thrombosis and embolism post-operation. The patients’ pre-operative and post-operative PaO2 and SaO2 levels were significantly different (p < 0.01). A comparison of the New York Heart Association (NYHA) grade before and after embolization in all patients showed a significant decrease in the post-operative grade (p < 0.01). The 72 PAVMs were divided into three groups (coils only group [n = 25], plugs only group [n = 21], and coils/plugs combined group [n = 26]). After 12 months of follow-up, there were seven reperfusion PAVMs in the coil group, seven reperfusion PAVMs in the plug group, and 1 reperfusion PAVM in the combined group. There were significant differences between the two groups and the combined group. Conclusion Percutaneous TCE is safe and effective for the treatment of PAVMs. A combination of coils and vascular plugs may be useful for preventing recanalization after the embolization of PAVMs.

Download Full-text

Modified percutaneous radiologic gastrostomy technique without endoscopic or nasogastric access

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0086-8 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Reda Tabashy ◽

Amira Darwish ◽

Ashraf Ibrahim ◽

Mohamed Gad El-Mola

Keyword(s):

Esophageal Cancer ◽

Success Rate ◽

Nasogastric Tube ◽

Conventional Technique ◽

Fluoroscopic Guidance ◽

Efficacy And Safety ◽

Technical Success ◽

Technical Success Rate ◽

Major Complications ◽

Percutaneous Radiologic Gastrostomy

Abstract Background The aim of this study is to evaluate the efficacy and safety of a modified percutaneous radiologic gastrostomy (MPRG) technique under ultrasound and fluoroscopic guidance without endoscopic or nasogastric access. Results The study included 24 patients: 10 males and 14 females whose ages ranged from 44 to 80 years old. Ten patients had esophageal cancer and 14 patients had neck cancer. Technical success was achieved in 23 out of the 25 procedures (92%). Two procedures failed (8%) and were converted to the conventional technique by using the nasogastric tube. No major complications were reported. Minor complications were observed in 5 patients (20%): intraperitoneal air and contrast leakage in 4 patients and focal mucosal dissection by the contrast in 1 patient. Conclusion The MPRG has high technical success rate, is safe with no major complications, and is most feasible when endoscopic or nasogastric access cannot be performed.

Download Full-text

Feasibility and Techniques of Securing 3D-Safety Margin in Superselective Transarterial Chemoembolization to Improve Local Tumor Control for Small Hepatocellular Carcinoma: An Intend-to-Treat Analysis

Liver Cancer ◽

10.1159/000512337 ◽

2021 ◽

Vol 10 (1) ◽

pp. 63-71

Author(s):

Ching Charoenvisal ◽

Toshihiro Tanaka ◽

Hideyuki Nishiofuku ◽

Hiroshi Anai ◽

Takeshi Sato ◽

...

Keyword(s):

Success Rate ◽

Tumor Recurrence ◽

Safety Margin ◽

Small Hepatocellular Carcinoma ◽

Technical Success ◽

Local Tumor ◽

Local Tumor Recurrence ◽

3D Images ◽

Technical Success Rate ◽

Treat Analysis

Introduction: The aim of this study was to investigate the technical success rate of obtaining 3D-safety margin in superselective conventional transarterial chemoembolization (cTACE) using 3D images for small hepatocellular carcinoma (HCC). Methods: Consecutive 48 HCC nodules (diameter, 1–3 cm) in 44 patients were intentionally treated by superselective cTACE in an attempt to achieve 3D-safety margin. Superselective CT during hepatic arteriography (CTHA) was obtained before cTACE. When negative 3D-safety margin was found, branches supplied into the margin area were detected by using a 3D workstation. The technical success rate to obtain 3D-safety margin was investigated by intend-to-treat analysis. Local tumor recurrence rate and adverse events were also evaluated. Result: Nine of 48 tumors (18.8%) had 3D-safety margin in the initial superselective CTHA. After pulling back of the catheter and/or selection of another branch based on 3D images, 3D-safety margin was finally achieved in 45 (93.8%). There were 8 of 46 tumors (17.4%) with local recurrence after 5-year follow-up. Grade 3–4 of aspartate aminotransferase, alanine aminotransferase, and total bilirubin were found in 38.6, 36.4, and 2.3%, respectively. One portal vein thrombus and 3 biliary dilation or biloma were developed. Conclusion: Superselective cTACE obtaining 3D-safety margin in small HCC was feasible with a high success rate by using 3D images, which could be tolerable and prevent local tumor recurrence.

Download Full-text

Packing Technique with or without Remodeling for Endovascular Coil Embolization of Renal Artery Aneurysms: Safety, Efficacy and Mid-Term Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm10020326 ◽

2021 ◽

Vol 10 (2) ◽

pp. 326

Author(s):

Grégory Secco ◽

Olivier Chevallier ◽

Nicolas Falvo ◽

Kévin Guillen ◽

Pierre-Olivier Comby ◽

...

Keyword(s):

Renal Artery ◽

Success Rate ◽

Coil Embolization ◽

Preventive Treatment ◽

Parent Artery ◽

Technical Success ◽

Technical Success Rate ◽

Endovascular Coil Embolization ◽

Lower Morbidity

The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010–2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs.

Download Full-text

Endoscopic Stricturotomy Is an Efficacious Option for Management of Strictures in Patients With Inflammatory Bowel Disease

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa069 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Nabeeha Mohy-ud-din ◽

Gursimran S Kochhar

Keyword(s):

Inflammatory Bowel Disease ◽

Success Rate ◽

Bowel Disease ◽

Chart Review ◽

Common Complication ◽

Technical Success ◽

Technical Success Rate ◽

Safe Technique ◽

Inflammatory Bowel ◽

The Mean

Abstract Background Strictures are a common complication for patients with inflammatory bowel disease. Endoscopic stricturotomy (ESt) is a novel procedure for treatment of these strictures. Methods A chart review was performed for patients with strictures who underwent ESt. Results Eleven patients were included in the study and the total number of strictures treated was 12. The mean length of the strictures was 10.25 ± 4.36 mm. Technical success was achieved in 92% (n = 11) of the procedures. Postprocedural bleeding occurred in 9% (n = 1) of patients, and none of the patients had complications of infection or perforation. Conclusions ESt is a safe technique with high technical success rate.

Download Full-text

Benefits of early intervention with catheter ablation in patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0363 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Mohanty ◽

C Trivedi ◽

D G Della Rocca ◽

C Gianni ◽

B MacDonald ◽

...

Keyword(s):

Atrial Fibrillation ◽

Early Intervention ◽

Catheter Ablation ◽

Success Rate ◽

Therapeutic Option ◽

Superior Vena ◽

Vena Cava ◽

Posterior Wall ◽

Early Group ◽

Late Group

Abstract Background Radiofrequency catheter ablation, a widely recognized therapeutic option for atrial fibrillation (AF) has limited success rate as it is influenced by several factors including duration of AF. Purpose We evaluated the ablation success in AF patients intervened early versus late in the disease course. Methods Consecutive AF patients undergoing their first catheter ablation in 2015–16 at our center were included in the analysis. Patients were classified into two groups based on the time to ablation after AF diagnosis; 1) early: ≤12 months and 2) late: >12 months. All received PV isolation plus isolation of posterior wall and superior vena cava. Additionally, in non-paroxysmal AF cases, non-PV triggers were identified with isoproterenol-challenge and ablated. Patients were prospectively followed up for 3 years with regular rhythm monitoring. Results A total of 752 and 1248 patients were included in the “early” and “late” group respectively. Baseline characteristics of the study population is provided in Table 1 A. At 4 years of follow-up, overall success rate off-antiarrhythmic drugs was significantly higher in the “early” group (65.4% vs 57%, p<0.001). After stratification by AF type, “early” group was still associated with significantly higher success rate compared to the “late” group (Table 1B). Conclusion In this large series with standardized ablation strategy, early intervention with catheter ablation was associated with higher success rate in all AF types. FUNDunding Acknowledgement Type of funding sources: None. Table 1

Download Full-text

Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

PLoS ONE ◽

10.1371/journal.pone.0260223 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260223

Author(s):

Bálint Kokas ◽

Attila Szijártó ◽

Nelli Farkas ◽

Miklós Ujváry ◽

Szabolcs Móri ◽

...

Keyword(s):

Success Rate ◽

Extrahepatic Bile Duct ◽

Treatment Algorithm ◽

Success Rates ◽

Technical Success ◽

Tertiary Referral Center ◽

Technical Success Rate ◽

Percutaneous Transhepatic Drainage ◽

First Choice ◽

Transhepatic Drainage

Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

Download Full-text

Transvenous Treatment of Carotid Cavernous and Dural Arteriovenous Fistulae: Results for 31 Patients and Review of the Literature

Neurosurgery ◽

10.1227/01.neu.0000083551.26295.ab ◽

2003 ◽

Vol 53 (4) ◽

pp. 836-857 ◽

Cited By ~ 150

Author(s):

Joachim Klisch ◽

Hans Juergen Huppertz ◽

Uwe Spetzger ◽

Andreas Hetzel ◽

Wolfgang Seeger ◽

...

Keyword(s):

Success Rate ◽

Clinical Symptoms ◽

Sigmoid Sinus ◽

High Rate ◽

Technical Success ◽

Arteriovenous Fistulae ◽

Time Resolved ◽

Complete Occlusion ◽

Technical Success Rate ◽

Age Range

Abstract OBJECTIVE To evaluate findings for patients with carotid cavernous fistulae or dural arteriovenous fistulae (AVFs) who underwent transvenous embolization via different transvenous approaches. METHODS Retrospective analysis of data for 31 patients (age range, 17–81 yr; mean age, 59.3 yr) with carotid cavernous fistulae (n = 6) or dural AVFs (cavernous sinus [CS], n = 11; transverse/sigmoid sinus, n = 14) was performed. The AVFs were treated with coils via different transvenous approaches, in 56 procedures. Doppler ultrasonography and time-resolved, two-dimensional, magnetic resonance projection angiography were performed to confirm the treatment. The mean clinical follow-up period was 32.5 months. RESULTS A total of 34 transvenous procedures were performed for 17 AVFs of the CS. Eleven patients with AVFs of the CS (63%) were cured with respect to clinical symptoms, and six patients experienced improvement (37%). The approach via the internal jugular vein and inferior petrosal sinus (n = 15) was possible in 60% of cases, with complete occlusion of the fistula in 78% of cases. With the approach via the facial vein (n = 8), there was a 50% success rate. The superior ophthalmic vein approach (n = 5) was associated with a high rate of technical success (100%), with a rate of complete fistula occlusion of 80%. We encountered complications, with transient morbidity, in four cases (23.5%). For 14 dural AVFs of the transverse/sigmoid sinus, 22 transvenous procedures were performed; 12 patients were cured (85.7%) and 2 experienced improvement (14.3%). The technical success rate was 86%, with complete occlusion in 42% of cases. Minor complications occurred in six cases (42.9%) but did not lead to permanent morbidity. CONCLUSION Transvenous treatment of CS and transverse/sigmoid sinus AVFs can be effective if all transvenous approaches, including combined surgical/endovascular approaches, are considered.

Download Full-text