Radiology guided antegrade GASTROSTOMY deployment of mushroom (pull type) catheters with classical and modified methods in patients with oropharyngeal, laryngeal carcinoma, and anesthesia risk

Objective: The aim of study is to evaluate the results of deployment of Percutaneous Radiological Gastrostomy (PRG), which is a good alternative to Surgical Gastrostomy (SG), with transoral approach in cases where Percutaneous Endoscopic Gastrostomy (PEG) is contraindicated, difficult or unsuccessful, in patients with high risk of American Society of Anesthesiologists with four scores. In addition, we aimed to demonstrate the advantages of mushroom pull type catheters over push type gastrostomy catheters. Methods: This retrospective study included a total of 40 patients (18 females and 22 males) aged 21–92 years who underwent PRG with the antegrade transoral approach. PRG was performed by retrograde passing through the esophagus or snaring the guidewire from the stomach and taking out of the anterior abdominal wall. Patients’ demographic data, indications for PRG, procedural outcomes and complications were screened and recorded. Results: PRG was performed in 39 of 40 patients included in the study. Technical success rate was 97.5%. Procedure-dependent major complications such as death, aspiration, colon perforation, and deep abscess were not observed. Aspiration occurred in the first patient during the first feeding on the day after the procedure. Major complication rate was 2.5%. The total minor complication rate was 17.5% in 7 patients; parastomal leakage in 2 patients (5%), skin rash and infection in 3 (7.5%) patients, minor bleeding in 2 (5%) patients with oropharynx cancer, minimal bleeding from the gastrostomy catheter 1 week after the procedure in 1 (2.5%) patient. None of the cases had buried buffer. Tube functionality was preserved in all patients without any damage. Conclusion: Mushroom tip (pull type) gastrostomy catheter is a safe treatment method for patients requiring prolonged feeding because of wide diameter, endurance, long staying opening duration, less excessive dilatation and parastomal leakage, and no need for gastropexy. Lower cost and easier access are advantageous for mushroom tip pull type catheters compared to push type gastrostomy catheters in our country. The less invasive PRG is an alternative option in patients who are difficult to administer PEG, are at high anesthesia risk and cannot be sedated. Advances in knowledge: This article is valuable in terms of its contribution to develop an alternative radiological method for the deployment of gastrostomy tubes in medical difficult patients. This method has shortened the duration of the procedure and increased the success rate in patients with difficulty in transition from the stomach to the esophagus or with difficulty in the upper gastrointestinal tract. Mushroom tip catheters can be placed successfully by radiological methods.

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Use of microspheres in embolization for unruptured renal angiomyolipomas

Open Medicine ◽

10.1515/med-2021-0280 ◽

2021 ◽

Vol 16 (1) ◽

pp. 655-659

Author(s):

Masashi Shimohira ◽

Keiichi Nagai ◽

Kengo Ohta ◽

Yusuke Sawada ◽

Taku Naiki ◽

...

Keyword(s):

Success Rate ◽

Complication Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Major Complication ◽

Shrinkage Rate ◽

Technical Success ◽

Technical Success Rate ◽

Major Complication Rate

Abstract Purpose To describe our initial experience with use of microspheres in transcatheter arterial embolization (TAE) for unruptured sporadic renal angiomyolipomas (AMLs). Materials and methods Seven consecutive patients with seven unruptured sporadic renal AMLs, 6 females and 1 male, with a median age of 45 years (range, 30–69 years), underwent TAE using microspheres between November 2016 and February 2020. We evaluated the technical success rate, complications related to the procedure, clinical success rate, and the shrinkage rate of renal AML. Technical success was defined as the completion of TAE. Clinical success was defined as presence of shrinkage of the renal AML after TAE. Results In all patients, TAE using microspheres was accomplished and technical success rate was 100% (7/7). Three patients exhibited slight pain, but it improved with only observation, and the minor complication rate was 43% (3/7) and major complication rate was 0% (0/7). After the TAE, shrinkage of renal AML was confirmed in 6 of 7 patients, and clinical success rate was 86% (6/7). The median of shrinkage rate was 47% (range, 26–83%) with a median follow-up period of 19 months (range, 4–30 months). Conclusion TAE using microspheres appears to be effective and safe for unruptured sporadic renal AMLs.

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Transbrachial angiography: an effective and safe approach

VASA ◽

10.1024/0301-1526.33.4.231 ◽

2004 ◽

Vol 33 (4) ◽

pp. 231-234 ◽

Cited By ~ 13

Author(s):

Basche ◽

Eger ◽

Aschenbach

Keyword(s):

Image Quality ◽

Success Rate ◽

Complication Rate ◽

Low Risk ◽

Retrospective Evaluation ◽

Technical Success ◽

Technical Success Rate ◽

Transbrachial Approach ◽

Safe Approach

Background: Description of the technique of the transbrachial catheter diagnostics, retrospective evaluation of the technical success rate and the complications. Patients and methods: In a period of 8 years the transbrachial approach was used in 2555 patients, 1734 men and 821 women with an average age of 62.9 years. The investigation was done with outpatients in approximately 90% of the cases. Usually, the preferred arm was not punctured. For the diagnostics F4 and F5-catheter sheaths and selective catheter and/or plain catheters were used. Results: 12 times (0.47%) the investigation did not succeed technically. The image quality of the vascular representations was diagnostically sufficient. The total complication rate amounted to 0.47%. The following complications appeared: four dissections in the site of puncture, one embolism into arteries at the forearm, three transitory ischemic attacks, four haematoma at the site of puncture. Conclusions: The transbrachial catheter diagnostics is a little invasive, efficient and low-risk method, which is practicable in out-patients.

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TRIACCESS study: randomized comparison between radial, femoral and transpedal access for for percutanous supertfitial femoral artery angioplasty

European Heart Journal ◽

10.1093/ehjci/ehaa946.2380 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Z Ruzsa ◽

A Csavajda ◽

M Deak ◽

P Sotonyi ◽

O.F Bertrand ◽

...

Keyword(s):

Success Rate ◽

Femoral Artery ◽

Complication Rate ◽

Randomized Study ◽

Technical Success ◽

Access Site ◽

Femoral Access ◽

X Ray ◽

Technical Success Rate ◽

Access Site Complication

Abstract Background Traditional access for the treatment of femoral artery lesions is the femoral artery (FA) approach, but radial (RA) and pedal access (PA) is an alternative access site. The aim of the study was to compare the success rate, complication rate of different access sites for the treatment of superfitial artery stenosis in a randomized study Methods 180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral stenosis, via RA, FA and PA. Primary endpoint: technical success, rate of major and minor access site complications. Secondary endpoints: major adverse events (MAE), procedural factors, cross-over rate, and duration of hospitalization. Results Technical success was achieved in 96.6%, 100% and 100% patients in RA, FA and PA group (p=ns). Secondary access site was used in 30%, 3.3% and 30% in the RA, FA and PA access group (p<0.01). Stent implantation was done in the femoral artery in 26.6%, 58.3% and 71.6% cases in RA, FA and PA group (p<0.01). CTO recanalization was performed in 34/36 (100%), 30/30 (100%) and 45/45 (100%) cases successfully in RA, FA and PA group (p=ns). Contrast consumption, fluoroscopy and procedure time was not statistically different, but the X Ray dose was significantly lower in PA than in the RA and FA access group (63.1 vs 162 vs 153 Dyn). The cumulative rate of access site complications in the RA, FA and PA group was 3.3% (0% major and 3.3% minor), 15% (3.3% major and 11.6% minor) and 3.3% (0% major and 3.3% minor) (p<0.01), respectively. The cumulative incidence of MAE's at 6 months in the RA, FA and PA group was 8.3% vs 13.3% and 18.3%. (p<0.05) Conclusion Femoral artery intervention can be safely and effectively performed using radial, femoral and pedal access, but radial and pedal access is associated with less access site complication rate. Pedal access is associated with less X Ray dose than radial and femoral access. Funding Acknowledgement Type of funding source: None

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Safety, Efficacy, and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10112298 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2298

Author(s):

Olivier Chevallier ◽

Kévin Guillen ◽

Pierre-Olivier Comby ◽

Thomas Mouillot ◽

Nicolas Falvo ◽

...

Keyword(s):

Systematic Review ◽

Gastrointestinal Bleeding ◽

Success Rate ◽

Meta Analysis ◽

Major Complication ◽

Technical Success ◽

Cyanoacrylate Glue ◽

Technical Success Rate ◽

Major Complications ◽

Number Of Patients

We performed a systematic review and meta-analysis of published studies to assess the efficacy, safety, and outcomes of N-butyl cyanoacrylate (NBCA) injection for the treatment of variceal gastrointestinal bleeding (GIB). The MEDLINE/PubMed, EMBASE, and SCOPUS databases were searched for English-language studies published from January 1980 to December 2019 and including patients who had injection of NBCA for variceal GIB. Two independent reviewers extracted and evaluated the data from eligible studies. Exclusion criteria were sample size <5, article reporting the use of NBCA with other embolic agents, no extractable data, and duplicate reports. NBCA was injected during endoscopy in 42 studies and through a direct percutaneous approach for stomal varices in 1 study. The study’s endpoints were: Technical success, 30-day rebleeding, and 30-day overall and major complications. The estimated overall rates were computed with 95% confidence intervals, based on each study rate, weighted by the number of patients involved in each study. In total, 43 studies with 3484 patients were included. The technical success rate was 94.1% (95% CI: 91.6–96.1%), the 30-day rebleeding rate was 24.2% (18.9–29.9%), and 30-day overall and major complications occurred in 15.9% (11.2–21.3%) and 5.3% (3.3–7.8%) of patients, respectively. For treating variceal GIB, NBCA injection is a safe and effective method that demonstrates high technical success rate and very low major complication rate.

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Safety of Transcatheter Arterial Embolization for Visceral Artery Pseudoaneurysms: Incidence of Intraprocedural Rupture

Vascular and Endovascular Surgery ◽

10.1177/1538574421992938 ◽

2021 ◽

Vol 55 (4) ◽

pp. 361-366

Author(s):

Masashi Shimohira ◽

Keiichi Nagai ◽

Kengo Ohta ◽

Yusuke Sawada ◽

Keita Nakayama ◽

...

Keyword(s):

Success Rate ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Major Complication ◽

Visceral Artery ◽

Technical Success ◽

Advanced Level ◽

Technical Success Rate ◽

A Minor

Introduction: Transcatheter arterial embolization is the first-line treatment for visceral artery pseudoaneurysms (VAPAs); however, the intraprocedural rupture of pseudoaneurysms is an important complication. The present study was performed to evaluate the safety of embolization for VAPAs, including the incidence of intraprocedural rupture. Methods: Among 56 consecutive patients with 57 VAPAs who underwent treatment between April 2009 and October 2020, 46 patients with 47 VAPAs underwent embolization. Complications related to embolization including intraprocedural rupture, the technical success rate, and clinical outcomes were evaluated. Complications that required extended hospitalization, an advanced level of care, or resulted in permanent adverse sequelae or death were classified as major complications, while the remainder were considered to be minor. Technical success was defined as the completion of embolization. Results: The intraprocedural rupture of pseudoaneurysms occurred in 3 out of 47 VAPAs treated with embolization (6%) and resulted in minor complications. One liver abscess requiring drainage was regarded as a major complication (2%). Focal infarction after embolization was observed as a minor complication in 20 cases. Complications occurred in 24 out of 47 cases (51%), comprising one major complication (2%) and 23 minor complications (48%). The technical success rate was 100% (47/47). Fifty-three out of 56 patients (95%) were alive in a median follow-up period of 18 months (range: 2 days-137 months). Conclusions: Embolization is safe and useful for the treatment of VAPAs; however, the intraprocedural rupture of pseudoaneurysms may occur, and, thus, care is needed during this procedure.

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Safety and Efficacy of Totally Percutaneous Access Compared With Open Femoral Exposure for Endovascular Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/1526602816689679 ◽

2017 ◽

Vol 24 (2) ◽

pp. 246-253 ◽

Cited By ~ 15

Author(s):

Zhanjiang Cao ◽

Weiwei Wu ◽

Keqiang Zhao ◽

Junlai Zhao ◽

Yu Yang ◽

...

Keyword(s):

Success Rate ◽

Complication Rate ◽

Meta Analysis ◽

Endovascular Aneurysm Repair ◽

Procedure Time ◽

Technical Success ◽

Safety And Efficacy ◽

Technical Success Rate ◽

Percutaneous Access ◽

Aneurysm Repair

Purpose: To compare the safety and efficacy of percutaneous (PEVAR) vs open femoral access (OFA) techniques for endovascular aneurysm repair (EVAR). Methods: A systematic review of English-language articles (Medline, EMBASE, and Cochrane databases) between January 1999 and August 2016 returned 11 studies including 1650 patients with 2500 groin accesses eligible for the meta-analysis. Data extracted from each study were synthesized to evaluate technical success rates, procedure time, and complications for the 2 access approaches. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The quality of individual studies was evaluated based on the Newcastle-Ottawa scale. Results: The mean technical success rate in the PEVAR group was 94.5% (785/831). The overall OR was 0.38 (95% CI 0.12 to 1.18, p=0.09), indicating no significant difference between the methods. The procedure time in PEVAR was shorter than OFA (mean difference −24.52, 95% CI −46.45 to −22.60, p<0.001). Overall, the total complication rate was 15.3% in the OFA group vs 7.8% in the PEVAR group (OR 0.52, 95% CI 0.37 to 0.73, p<0.001). The meta-analysis identified significant differences between groups for all complications (p<0.001) and the following individual adverse events: wound infection (OR 0.28, 95% CI 0.10 to 0.81, p=0.02), pseudoaneurysm (OR 8.07, 95% CI 1.54 to 42.32, p=0.01), seroma (OR 0.10, 95% CI 0.02 to 0.55, p=0.008), and lymphocele or lymph leak (OR 0.19, 95% CI 0.04 to 0.92, p=0.04). Conclusion: PEVAR had a similar technical success rate, shorter procedure time, and lower complication rate compared with OFA. Thus, percutaneous access appears to be the preferential approach for EVAR. However, larger and randomized studies are needed to draw definitive conclusions.

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Endovascular recanalization for symptomatic non-acute middle cerebral artery occlusion: proposal of a new angiographic classification

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016692 ◽

2020 ◽

pp. neurintsurg-2020-016692

Author(s):

Feng Gao ◽

Xu Guo ◽

Ju Han ◽

Xuan Sun ◽

Zhenhua Zhou ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Success Rate ◽

Complication Rate ◽

Type I ◽

Technical Success ◽

Technical Success Rate ◽

Endovascular Recanalization ◽

Mca Occlusion ◽

Perioperative Complication

BackgroundEndovascular recanalization for medically refractory non-acute middle cerebral artery (MCA) occlusion remains a clinical dilemma, and limited data are available. We report the multicenter clinical results of endovascular recanalization for symptomatic non-acute MCA occlusion and propose a new angiographic classification to explore which subgroups of patients are most suitable for this treatment.MethodsFrom January 2015 to December 2019, 50 consecutive patients who underwent endovascular recanalization for recurrent symptomatic non-acute MCA occlusion were analyzed retrospectively. All patients were divided into three types according to the angiographic classification. The technical success rate, periprocedural complications, rate of stroke or death within 30 days, and follow-up results were evaluated.ResultsThe overall technical success rate was 84.0% (42/50). The perioperative complication rate was 14.0% (7/50), and the rate of stroke or death within 30 days was 12.0% (6/50). The revascularization success rate was higher in patients with type I occlusion than in those with type II or type III occlusion (95.5%, 83.3%, and 60%, respectively; p=0.014), and the opposite was true for the perioperative complication rate (4.5%, 11.1%, and 40.0%, respectively; p=0.013). The median clinical follow-up period was 13.4 months (IQR 12.5–15.6), and the rate of stroke or death beyond 30 days was 8.3%.ConclusionsEndovascular recanalization for non-acute MCA occlusion is technically feasible in reasonably selected patients, especially type I patients, and has potential as an alternative option for patients with recurrent stroke or transient ischemic attack in the short term despite optimal medical therapy.

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Abstract WP501: Recanalization of the Occluded Carotid by Endovascular and Hybrid Interventions

Stroke ◽

10.1161/str.51.suppl_1.wp501 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mario Zanaty ◽

Jorge Roa ◽

Edgar Samaniego ◽

David Hasan

Keyword(s):

Success Rate ◽

Complication Rate ◽

Controlled Trial ◽

Major Complication ◽

Type A ◽

Hybrid Surgery ◽

Refractory Hypertension ◽

Type D ◽

Type C ◽

A Minor

Introduction: Patients with medically refractory COICA (chronically occluded internal carotid artery) have an annual stroke risk of 5%-7%, can suffer from cognitive impairment, refractory hypertension, and have decreased quality of life. Methods: We reviewed the literature on interventions for COICA patients to assess the risks/benefits after recanalization via endovascular techniques (ETs) or hybrid surgery [ET plus carotid endarterectomy] (HS). Carotid occlusion was defined as 100% stenosis based on DSA. Chronicity was defined as ≥ 1 month of documented occlusion of the ICA. We used the Hasan et al grading system for COICA classification. Results: The rate of successful recanalization varied from 60-100%, and that of complications from 0-21.75%. Both rates were classification dependent: for type A and B, the successful recanalization rate using ET was 100.00% with a 5.00% complication rate. For type C, the success rate for ET was 44.44% with a complication rate of 44.44%; however, for the HS, developed to treat specifically type C, the success rate was 88.73% with a major complication rate of 5.66% and a minor complication rate of 7.04%. For type D, the success rate was 25% with a 12.5% complication rate. Successful recanalization leads to an improvement in the neurological symptoms with control of the recurrent ischemic symptoms in 88.0%. Failure to recanalize lead to recurrent T.I.As/strokes 30 days post-procedure in 40% of the patients. Successful recanalization leads to a reversal of systolic hypertension, which was maintained at follow-up in 85.71% (23/27) patients. Bradycardia occurred in 62% (36/69) of ET of COICA, and in 0% of HS, and was classification dependent: 90% of type A, 80% of type B, 44% of type C and 44% of type D. Successful recanalization resulted in symmetrical perfusion between the 2 hemispheres, resolution of penumbra, normalization of the MTT and improvement in MoCA score. Conclusion: Type A and B benefited from ET. Type C can benefit from HS. Type D did not benefit from any intervention. A phase 2b randomized controlled trial is needed

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Peritoneal dialysis catheters in pediatric patients: 10 years of experience in a single centre

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2020.221 ◽

2020 ◽

Vol 42 (1) ◽

Author(s):

Mario Lima ◽

Niel Di Salvo ◽

Giovanni Marchi ◽

Vincenzo Davide Catania ◽

Michele Libri ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Complication Rate ◽

Total Population ◽

Demographic Data ◽

Laparoscopic Approach ◽

Major Complication ◽

Catheter Insertion ◽

Advantages And Disadvantages ◽

Major Complication Rate ◽

Group 2

Peritoneal Dialysis (PD) is one of the numerous options for chronic dialysis and in many cases when access for acute dialysis is required early in a hospital course, at any age. PD catheter can be inserted with an open or laparoscopic approach. The complication rate after catheter insertion is still high, as reported in published literature. We present the experience matured at our Centre in the last 10 years on implantation of peritoneal dialysis catheters in children, emphasising surgical complications. We conducted a retrospective study on patients who underwent PD at our Centre in a range period of 10 years. We analysed patients ’demographic data, past and present medical, perioperative and post-operative data, permanence of the catheter, duration of dialysis, the gap between placement and use, outcomes and complications. We compared the data, dividing patients in 2 groups: patients operated with a traditional open technique and patients operated laparoscopically. We retrospectively reviewed 29 children with an average age of 3years and 6 months. Mean age was 42 months (1 month; 8 years) for the VLS group, 18 months (11 days, 4 years) for the OT group. Mean operative time was 106 min for the VLS group; 44 min for the OT group. The Catheter permanence period was 17 days (12h-64 days). Duration of dialysis was between 48 hours and 23 days (average 8 days). In the total population, we registered 8 complications (5 minor, 3 major), the overall complication rate being 33 % (minor complication rate 21%, major complication rate 12,5 %). 6 complications occurred in patients operated laparoscopically (6/14 = 36 %); 2 complications in the OT group (2/10 = 20 %). The complication rate after PD catheter insertion is still high. Advantages and disadvantages of the open and laparoscopic approach must be known. Both minor and major complications, such as bowel perforations and occlusions, must be understood and differentiated.

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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.

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