Chemical Ablation for Treating Anal Fistulas without Surgical Intervention: Long-Term Results

Purposes. This study aimed to evaluate long-term outcomes after the application of a corrosive chemical agent for ablation of epithelial tissue as a non-surgical treatment of anal fistulas. Methods. Adult patients with symptomatic perianal fistula were prospectively included in the study. The fistula tract was irrigated with a 5% silver nitrate solution. The primary outcome measured in this study was the rate of clinical healing after long-term follow-up. Factors that may affect healing were also analysed. Results. A total of 186 patients with anal fistula were analysed. After irrigation with silver nitrate, 82 (44%) patients had complete clinical healing during a median follow-up time of 50 (7–64) months. Patients with intermittent discharge had a significantly higher rate of complete clinical healing than those with continuous discharge ( P < .04). Fistulas without abscesses or secondary tracts had a significantly higher rate of complete clinical healing than the other types ( P = .007). Conclusion. Chemical ablation of the epithelium of the anal fistula yields promising long-term outcomes in the management of anal fistulas without surgical intervention.

Efficacy and safety of ethanol infusion into the vein of Marshall for mitral isthmus ablation

Introduction: Chemical ablation by retrograde infusion of ethanol into the vein of Marshall (VOM-EI) can facilitate achievement of mitral isthmus block. This study sought to describe efficacy and safety of this technique. Methods and Results: Twenty-two consecutive patients (14 male, median age 71 years) with attempted VOM-EI for mitral isthmus ablation were included in the study. VOM-EI was successfully performed with a median of 4 ml of 96% ethanol in 19 patients (86%) and mitral isthmus was successfully blocked in all (100%). Touch up endocardial and/or epicardial ablation after VOM-EI was necessary in 12 patients (63%). Perimitral flutter was present in 12 patients (63%) during VOM-EI and terminated or slowed by VOM-EI in four and three patients, respectively. Low-voltage area of the mitral isthmus region increased from 3.1 cm2 (IQR 0-7.9) before to 13.2 cm2 (IQR 8.2-15.0) after VOM-EI and correlated significantly with the volume of ethanol injected (P = 0.03). Median high-sensitive cardiac troponin-T increased significantly from 330 ng/L (IQR 221-516) the evening of the procedure to 598 ng/L (IQR 382-769; P=0.02) the following morning. A small pericardial effusion occurred in three patients (16%), mild pericarditis in one (5%) and uneventful VOM dissection in two (11%). After a median follow-up of 3.5 months (IQR 3.0-11.0), 10 of 18 patients (56%) with VOM-EI and available follow-up had arrhythmia recurrence. Repeat ablation was performed in five patients (50%) and peri-mitral flutter diagnosed in three (60%). Conclusion: VOM-EI is feasible, safe and effective to achieve acute mitral isthmus block

Two-Year Follow-Up after Endovenous Closure with Short-Chain Cyanoacrylate versus Laser Ablation in Venous Insufficiency

Background: The current treatment of venous disease is focused on the minimally invasive exclusion of the affected vein. Besides widely used thermal ablation, chemical ablation with cyanoacrylate, reported as safe and highly effective, has been gaining increasing interest. Patients and methods: In the current report, we present data from a two-year observation in 89 patients (61 female/28 male, mean age 44.3 ± 13.5) suffering from venous insufficiency (C2–C4), treated either using short-chain cyanoacrylate, the VenaBlock system (n = 43) or laser thermoablation with ELVeS 1470 (n = 46). The assessment comprised the occurrence of venous disease-related symptoms and the ultrasound examination of the leg venous system. Results: The frequency of recanalization after 2 years from the VenaBlock procedure was significantly higher than after laser treatment (37.2 vs. 8.7%). Apart from recanalization, in some individuals from both groups, the symptoms of recurrence and/or disease progression, including the development of insufficiency in other veins of treated or contralateral legs (9.3 vs. 15.2% and 9.3 vs. 17.4%, respectively), were observed. Unexpectedly, the general prevalence of the disease progression did not differ significantly between the VenaBlock and ELVeS groups (44.2 vs. 34.8%, respectively). Conclusions: Despite the higher recanalization rate of VenaBlock compared to ELVeS, the overall effectiveness of cyanoacrylate and laser thermoablation after two years was similar. Therefore, both methods similarly failed to prevent recurrence and disease progression, which seem to be method-independent.

Effect of heat treatment on the microstructure and ablation performance of C/C–SiC composites containing ZrSi2–Si

C/C–SiC composites containing ZrSi2–Si were prepared using low-temperature reactive melt infiltration (LRMI) at 1400 °C, and the thermal chemical ablation of the composites was examined.

THE PERCUTANEOUS CHEMICAL ABLATION APPLICATION IN THE TREATMENT OF PATIENTS WITH HEPATOCELLULAR CARCINOMA

In the world, the incidence of HCC constantly increases each year. In the period from 1990 to 2015, the rate of newly diagnosed cases of HCC increased by 75%. In Ukraine in 2018, only 18.0% of primary patients were gotten special treatment: 4.9% only by surgery, 2.0% by combined and complex treatment. Unsatisfactory results of special treatment coverage are associated with the peculiarities of the etiopathogenesis of HCC, asymptomatic course, and improper screening system of patients at risk, which leads to difficulty in diagnosis of HCC in the early stages. The choice of HCC treatment tactics, associated with viral hepatitis and liver cirrhosis, remains a difficult clinical challenge. The radical treatment at an early stage HCC is a cornerstone for improving overall survival. Percutaneous ablation (PA) was developed for inoperable patients with HCC in the early stages and liver cirrhosis. There are radiofrequency ablation, chemical ablation, cryoablation, microwave ablation, etc. The main indications for the local ablation application are very early and early-stage (according to BCLC - stage 0 and A), compensated or subcompensated liver function in cirrhosis (Child-Pugh class A and B), ECOG 0-1, the diameter of the tumor lesion up to 5.0 cm (most optimally up to 3.0 cm), focal nodal lesion, solitary or multiple lesion. Percutaneous ablation is used as a bridge therapy to local tumor control in patients who undergo the Milan and the UCSFC criteria and are on the waiting list for transplantation. These methods have also shown their effectiveness as neoadjuvant "downstaging" therapy in patients who are not candidates for liver transplantation and/or with initially unresectable lesions. For many decades, percutaneous chemical ablation has been the “gold” standard for minimally invasive treatment of HCC. This method is easy to perform, does not require special equipment, is well tolerated by patients, safe, and cost-effective. The main chemical agents are ethanol and acetic acid. The percutaneous chemical ablation procedure involves intratumoral administration of a chemical agent a real-time under the control of imaging (ultrasound or CT). Chemical ablation is a second-line method and is used only in cases where there are contraindications to radiofrequency ablation. This method is not accompanied by severe specific complications and mortality. The effectiveness of its clinical application directly depends on the size of the tumor. The optimal size of the tumor is not more than 3.0 cm. Intratumoral administration of ethano promotes necrosis of 90% -100% of HCC with a diameter of ≤ 2.0 cm and 70% for tumors with 2.0 - 3.0 cm