Cardiovascular and interventional radiology
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Cardiovasc Intervent Radiol · Sep 2007
ReviewLong-term retrievability of IVC filters: should we abandon permanent devices?
Thromboembolic disease produces a considerable disease burden, with death from pulmonary embolism in the UK alone estimated at 30,000-40,000 per year. Whilst it is unproven whether filters actually improve longevity, the morbidity and mortality associated with thromboembolic disease in the presence of contraindications to anticoagulation is high. Thus complications associated with filter insertion, and whilst they remain in situ, must be balanced against the alternatives. ⋯ Follow-up (preferably prospective) is necessary for all retrievable filters, whether or not they are retrieved. Until these data become available we should restrict ourselves to the present indications of permanent and retrievable filters. If long-term follow-up data on larger numbers of cases confirm the initial data that retrievable filters are as safe and effective as permanent filters, the use of the retrievable filters is likely to expand.
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Cardiovasc Intervent Radiol · Sep 2007
Randomized Controlled TrialUse of 120 kilovolt tube potential for digital subtraction angiography and fluoroscopy in an image-intensifier angiographic system: decrease of skin dose in transarterial chemoembolization therapy for hepatocellular carcinoma.
In an image-intensifier angiographic system, the tube potential is commonly regulated in ranges from 75 to 90 kV for digital subtraction angiography (DSA) and fluoroscopy in transarterial chemoembolization therapy (TACE) for hepatocellular carcinoma. The purpose of this study was to investigate whether or not a 120-kV tube potential could be used for DSA and fluoroscopy in TACE to decrease the skin dose. Forty-three patients administered TACE were randomly allocated into two groups: TACE was performed using standard-kilovoltage (75- to 90-kV) DSA and fluoroscopy modes (group A; n = 20) or using high-kilovoltage (120-kV) modes (group B; n = 23). ⋯ The peak skin dose (mGy) for group A was 383.6 +/- 176.5 and that for group B was 265.1 +/- 145.1. The peak skin dose was decreased by 31% in the 120-kV mode, a statistically significant difference (t-test, p = 0.022). We conclude that the use of 120 kV tube potential for DSA and fluoroscopy may be one option for performing TACE while decreasing the skin dose.
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Cardiovasc Intervent Radiol · Sep 2007
ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease: can tumor ingrowth be prevented?
To determine the application and clinical effectiveness of ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease, and to evaluate the efficiency of stent coverage in preventing tumor ingrowth. ⋯ ePTFE/FEP-covered metallic stents are safe and effective for palliation of malignant biliary disease. The presence of the ePTFE/FEP coating is likely to prevent from tumor ingrowth.
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Cardiovasc Intervent Radiol · Sep 2007
Comparative StudyPreoperative chemoembolization in patients with hepatocellular carcinoma undergoing liver transplantation: influence of emergent versus elective procedures on patient survival and tumor recurrence rate.
Our purpose was to compare the recurrence rate and survival in patients with hepatocellular carcinoma (HCC) who had elective transarterial chemoembolization (TACE), immediate preoperative TACE, or no treatment prior to orthotopic liver transplantation (OLT). A total of 132 patients with HCC had TACE prior to OLT. Eighteen patients had no TACE before OLT and functioned as a control group. ⋯ TACE within 24 h of OLT causes an average of 35% necrosis and elective TACE increases necrosis further to 77%. Despite this difference, the tumor recurrence rate in the three groups is equivalent and no different from that in the group that received no treatment before OLT. The decreased survival in the immediate and no-TACE groups was due to non-cancer-related deaths.
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Cardiovasc Intervent Radiol · Sep 2007
Case ReportsTransjugular intrahepatic portosystemic shunt, mechanical aspiration thrombectomy, and direct thrombolysis in the treatment of acute portal and superior mesenteric vein thrombosis.
A patient was admitted because of severe abdominal pain, anorexia, and intestinal bleeding. Contrast-enhanced multidetector computed tomography demonstrated acute portal and superior mesenteric vein thrombosis (PSMVT). The patient was treated percutaneously with transjugular intrahepatic portosystemic shunt (TIPS), mechanical aspiration thrombectomy, and direct thrombolysis, and 1 week after the procedure, complete patency of the portal and superior mesenteric veins was demonstrated. TIPS, mechanical aspiration thrombectomy, and direct thrombolysis together are promising endovascular techniques for the treatment of symptomatic acute PSMVT.