Y90 Radioembolization of Liver Tumors via Radial approach – Correlation Between Common Femoral artery and Radial Artery Size

Abstract PurposeTypically, before Y90 radioembolization procedure undergoes, a CT is completed and the Barbeau test followed by radial artery ultrasound is used to determine if the artery is sufficiently large for vascular access [1-4]. 2.5 mm is the average radial artery diameter, and a vessel measurement of 2.0 mm is the recommended minimum diameter for safe vessel access, but a diameter of 1.5–2.0 mm can be accessed [4-9]. Our study explores using common femoral artery measurements from the pre-procedure CT abdomen/pelvis to assess in a binary manner if the vessel is sufficiently large to use for radial artery access. Materials and MethodsAll computed tomography scans of yttrium-90(Y90) radioembolization of the liver tumor procedures from January 1, 2015 - December 31, 2019 were retrospectively reviewed. Medical records were used from 47 procedures to gather patients' age, gender, Avastin use, femoral artery size (mm), administer Y90 (%), history of diabetes, and smoking status were recorded. ResultsThe minimum femoral artery size in patients who underwent transradial artery Y90 liver tumor radioembolization was 6 mm, with a mean femoral artery size of 10 mm. A comparative analysis of Y90 liver tumor uptake revealed no significant difference in radioembolization tumor uptake based on the initial site of procedure, transfemoral or transradial artery, (p > 0.81229). ConclusionThe study suggests that femoral arteries can predict radial artery diameter and that a femoral artery diameter of 10 mm should yield high confidence that the patient will be a candidate for transradial approach.

Download Full-text

Determinants of Success and Early Complications in Common Femoral Artery Endarterectomy: A Retrospective Study

Surgeries ◽

10.3390/surgeries2020019 ◽

2021 ◽

Vol 2 (2) ◽

pp. 180-189

Author(s):

Marcel Libertus Johannes Quax ◽

Daniël Eefting ◽

Herman Joseph Smeets

Keyword(s):

Retrospective Study ◽

Femoral Artery ◽

Clinical Success ◽

Ankle Brachial Index ◽

Emergency Operation ◽

Common Femoral Artery ◽

Walking Distance ◽

Safe Procedure ◽

Hybrid Procedures ◽

Significant Difference

Introduction: Common femoral artery endarterectomy (CFE) is considered a relatively simple, successful and safe procedure in the literature, but major complications can occur. This retrospective study was performed in order to define characteristics contributing to success or failure after common femoral artery endarterectomy, either performed as a single or hybrid procedure. Methods: A total of 298 patients who underwent CFE in our hospital between 1 January 2011 and 1 January 2017 were included. After exclusion, 227 patients were analyzed. Patient characteristics and outcomes were derived from the patient records. Follow-up was 30 days postoperatively. Outcomes were analyzed by the chi-square test and regression analysis. Clinical success was defined as a combination of technical success, improvement in the ankle-brachial index, increased walking distance and “no complications.” Results: The procedure was clinically successful in 74.4% of the patients, and in 25.6%, a complication occurred. The Rutherford class improved in 65.1% of the patients with 1.6 (SD 1.3) class points. The ankle-brachial index improved in 44.8% of the cases, with an average of 116.6%. The most contributing factors for complications such as death, unplanned amputation, surgical site infection, thrombosis and longer hospital admission were emergency operation and a higher ASA classification. Significantly more complications also occurred in patients with renal failure, congestive heart disease, a high Rutherford classification and previous groin incision. A higher Rutherford class was the only factor correlating with an increase in the ankle-brachial index. When single CFE (48.9% of cases) and hybrid procedures (51.1%) were compared, no significant difference in success or failure was found. Conclusion: Limb ischemia requiring emergency operation and preoperative comorbidity were identified as the most important factors predictive for complications following femoral artery endarterectomy. Combining femoral endarterectomy with an endovascular intervention does not seem to increase the risk of a postoperative complication.

Download Full-text

Comparison of mid-term graft patency in common femoral versus superficial femoral artery inflow for infra-geniculate bypass in the vascular quality initiative

Vascular ◽

10.1177/1708538120924908 ◽

2020 ◽

Vol 28 (6) ◽

pp. 722-730

Author(s):

Kenneth Tran ◽

Vy T Ho ◽

Nathan K Itoga ◽

Jordan R Stern

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Life Table ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Bypass Graft ◽

Common Femoral Artery ◽

Secondary Patency ◽

Significant Difference

Objectives The superficial femoral artery can be used as inflow for infra-geniculate bypass, but progressive proximal occlusive disease may affect graft durability. We sought to evaluate the effect of superficial femoral artery versus common femoral artery inflow on infra-geniculate bypass patency within a large contemporary multicenter registry. Methods The vascular quality initiative was queried from 2013 to 2019 to identify patients with >30-day patency follow-up, Rutherford chronic limb ischemia stage 1–6, and an infra-geniculate bypass, excluding those with prior ipsilateral bypass. The cohort was stratified by inflow vessel, with primary, primary-assisted, and secondary patency serving as the primary outcome variables. Multivariate Cox-proportional hazard models and radius-based propensity-score matching were performed to reduce treatment-selection bias due to clinical covariates. Results A total of 11,190 bypass procedures were performed (8378 common femoral artery inflow, 2812 superficial femoral artery) on 10,110 patients, with a mean follow-up of 12.8 months (range 1–98). Patients receiving superficial femoral artery inflow bypasses were more commonly male ( p = 0.002), obese ( p < 0.0001) and had chronic, limb threatening ischemia ( p < 0.0001), whereas those with common femoral artery inflow were older ( p < 0.0004), and had higher baseline comorbidities including smoking ( p < 0.0001), coronary disease ( p < 0.0001), and pulmonary disease ( p < 0.0001). On life-table analysis, there was no significant difference in three year estimated primary (32.1 vs 30.1%, p = 0.928), primary assisted (60.5 vs 65.8%, p = 0.191), or secondary patency (62.5 vs 66.7%, p = 0.139) between superficial femoral artery and common femoral artery inflow groups, respectively. A multivariate Cox model found no significant association between inflow vessel and primary patency (0.96 [0.88–1.04], HR [95%CI]), primary-assisted (1.07 [0.95–1.20], HR [95%CI]), or secondary patency (1.08 [0.96–1.22]). In a propensity-matched cohort ( n = 11,151), there were small but statistically significant differences in primary, primary-assisted, and secondary patency at latest follow-up (non-time-to-event data) between groups. The largest difference was observed when evaluating secondary patency, with common femoral artery inflow having a marginally higher secondary patency of 88.1% compared to 85.6% for those with superficial femoral artery inflow at latest follow-up ( p = 0.009). Conclusions Within the vascular quality initiative, there is no significant difference in life-table determined three-year primary, primary-assisted, and secondary patency between infra-geniculate bypasses using common femoral artery inflow compared to superficial femoral artery inflow. Small, statistically significant differences exist in primary, primary-assisted, and secondary patency favoring common femoral artery inflow after propensity score matching. Long-term follow-up data are required in the vascular quality initiative to better evaluate bypass graft durability as this study was limited by a mean follow-up of one year.

Download Full-text

The Effects of Diagnosis-Related Group Payment on Diagnostic Cerebral Angiograms through a Transradial and Transfemoral Approach: A Comparative Observational Study

Journal of Healthcare Engineering ◽

10.1155/2022/9670757 ◽

2022 ◽

Vol 2022 ◽

pp. 1-8

Author(s):

Wei Chen ◽

Xi-Fang Song ◽

Min Wan ◽

Li Liu ◽

Wei-Hua Jia

Keyword(s):

Success Rate ◽

Radial Artery ◽

Femoral Artery ◽

Cerebral Angiography ◽

Diagnosis Related Group ◽

X Ray ◽

Significant Difference ◽

Related Group ◽

Medical Process

Background. Cerebral angiography is an X-ray examination technique widely used in hospitals. At present, it is mainly divided into two kinds of angiography examination: transfemoral artery and transradial artery puncture. The diagnosis-related group (DRG) system is a new type of payment standard recognized internationally, but its impact on medical care and health outcomes is currently controversial. Aim. In this study, we conducted a comparative study on two invasive approaches, transradial artery and transfemoral artery puncture and observed whether DRG had an impact on the quality of the medical process. Methods. We compared and analyzed patients undergoing cerebral angiography via the femoral artery and radial artery puncture by recording the relevant parameters and comfort scale scores (GCQ) during the operation, as well as postoperative complications. At the same time, we observed the proportion of different puncture routes and the success rate of cerebral angiography before and after the implementation of a DRG payment simulation. Results. The results of the comparative analysis of patients’ transradial artery and transfemoral artery puncture angiography showed that the puncture success rate (99.1% vs. 97.2%, P > 0.05 ), angiography success rate (97.3% vs. 95.1%, P > 0.05 ), and X-ray radiation time (4.82 vs. 5.15 min, P > 0.05 ) demonstrated no significant difference. The ambulation time (1.52 vs. 12.06 h, P < 0.05 ), puncture time (22.42 vs. 31.02 min, P < 0.05 ), and complications (3.57% vs. 9.03%, P < 0.05 ) of the radial artery group were significantly lower than those of the femoral artery group. In contrast, the GCQ score of the radial artery group at each stage after angiography was significantly higher than that of the femoral artery group ( P < 0.05 ). Compared with before the DRG simulation, the proportion of cerebral angiography with transradial artery puncture increased significantly after its implementation. Conclusion. Compared with transfemoral cerebrovascular angiography, transradial cerebrovascular angiography has many advantages, such as less local damage, less pain, less postoperative bed-rest time, significantly lower incidence of total complications, and a lower cost. Following the implementation of the DRG payment method, the quality of the angiography medical process improved.

Download Full-text

Bile Leakage After Hepatectomy for Liver Tumors

International Surgery ◽

10.9738/intsurg-d-16-00023.1 ◽

2016 ◽

Vol 101 (7-8) ◽

pp. 338-346 ◽

Cited By ~ 2

Author(s):

Takaaki Osawa ◽

Tsuyoshi Sano ◽

Yoshiki Senda ◽

Seiji Natsume ◽

Yasuhiro Shimizu

Keyword(s):

Portal Vein ◽

Preoperative Chemotherapy ◽

Predictive Factors ◽

Liver Tumor ◽

Portal Vein Embolization ◽

Liver Tumors ◽

Operation Time ◽

Bile Leakage ◽

Prolonged Operation ◽

Significant Difference

This study aimed to clarify the predictive factors for bile leakage after hepatectomy for liver tumor in terms of the International Study Group of Liver Surgery (ISGLS) definition. Between August 2006 and July 2012, 242 patients with a diagnosis of liver tumor underwent hepatectomy in our department, and the total bilirubin level of peritoneal drainage fluid prior to removal of the abdominal drains was examined. The data on all of the patients were analyzed retrospectively to identify the factors that might significantly affect the postoperative bile leakage. There was no grade C bile leakage, and grade A was documented in 65 patients (26.9%) and grade B in 7 patients (2.9%) in terms of the ISGLS definition. Although there was no significant difference in postoperative hospital stay between grade A bile leakage only and those without bile leakage (P = 0.933), a significant difference was noted between grades A and B (median, 11.0 versus 21.0 days; P < 0.001). Multivariate analysis revealed 4 independent significant predictive factors: prolonged operation time (P = 0.040), cholecystectomy (P = 0.048), non–portal vein embolization (P = 0.010), and preoperative chemotherapy (P = 0.021). The ISGLS definition of bile leakage is clinically useful. Prolonged operation time, cholecystectomy, non–portal vein embolization, and preoperative chemotherapy were significant independent risk factors of bile leakage in this study.

Download Full-text

SEGMENTATION OF LIVER TUMOR USING FAST GREEDY SNAKE ALGORITHM

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237219500133 ◽

2019 ◽

Vol 31 (02) ◽

pp. 1950013 ◽

Cited By ~ 2

Author(s):

T. Rajalakshmi ◽

U. Snekhalatha ◽

Jisha Baby

Keyword(s):

Neural Network ◽

Standard Deviation ◽

Liver Tumor ◽

Liver Tumors ◽

Ct Images ◽

Neural Network Classifier ◽

Statistical Features ◽

Automated Method ◽

Significant Difference ◽

Liver Image

Back Ground: Liver tumors are a type of growth found in the liver which can be categorized as malignant or benign. It is also called as hepatic tumors. Early stage detection of tumor could be treated at a faster phase; if it is left undiagnosed it may lead to several complications. Traditional method adopted for diagnosis can be time consuming, error-prone and also requires an experts study. Hence a non invasive diagnostic method is required which overcomes the flaws of conventional method. Liver segmentation from CT images in post processing techniques not only is an essential prerequisite, but, by playing an important role in confirming liver function, pathological, and anatomical studies, is also a key technique for diagnosis of liver disease. Hence in the proposed study Fast greedy snakes algorithm in abdominal CT images were used for segmenting tumor portion. Aim & Objectives: The aim and objectives of study is: (i) to segment tumor region in the liver image using Fast Greedy Snakes Algorithm (FGSA); (ii) to extract the GLCM features from the segmented region; (iii) to classify the normal and abnormal liver image using neural network classifier. Methodology: The study involved a total of 30 normal and 30 abnormal Images from database. In the proposed study automated segmentation was performed using Fast Greedy Snakes (FGS) Algorithm and the features were extracted using GLCM method. Classification of normal and abnormal images was carried out using Back propagation Neural Network classifier. Result: The proposed FGS algorithm provides accurate segmentation in liver images. Statistical features like mean, kurtosis, correlation and Entropy showed a higher value for the normal image than liver tumor image. On the other hand, features like Skewness, Homogeneity, contrast, Energy and standard deviation showed a comparatively higher value for a liver tumor image than the normal. Statistical features such as Mean, Contrast, Homogeneity and standard deviation are statistically significant at [Formula: see text]. Features like correlation, entropy and energy exhibits significance at [Formula: see text]. The feature extracted values provided significant difference between the normal and abnormal liver images. The neural network classifier yields the sensitivity of 95.8%, sensitivity of 81.4% and achieved the overall accuracy of 92%. Conclusion: A most accurate, reliable and fast automated method was implemented to segment the liver tumor image using Fast Greedy snakes algorithm. Hence the proposed algorithm resulted in effective segmentation and the classifier could classify the normal and abnormal images with greater accuracy.

Download Full-text