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  • 1
    Online-Ressource
    Online-Ressource
    Anatomic variants of arteries often coil-occluded prior to hepatic radioembolization
    SAGE Publications ; 2015
    In:  Acta Radiologica Vol. 56, No. 2 ( 2015-02), p. 159-165
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 56, No. 2 ( 2015-02), p. 159-165
    Kurzfassung: Prior to radioembolization (RE) treatment of malignant liver lesions, many interventionalists occlude the right gastric artery (RGA), the cystic artery (CA), and the gastroduodenal artery (GDA) to prevent radioactive microspheres from entering non-target vessels. Purpose: To systematically analyze anatomic variants of arteries that are important to know for the interventional radiologist performing RE of the liver. Material and Methods: The computed tomography (CT) angiographies and conventional angiographies of 166 patients evaluated for RE were retrospectively analyzed for the presence of anatomic variants of the RGA, GDA, and CA. Results: The RGA was found to arise from the left hepatic artery in 42% of cases, from the proper hepatic artery in 40%, from the GDA in 10%, from the right hepatic artery in 4%, and from the common hepatic artery in 3% of cases. The GDA originated in the common hepatic artery in 97% of cases, in the left hepatic artery in 2%, and in the celiac trunk in 1% of cases. The CA arose from the right hepatic artery in 96% of cases and from the GDA in 2% of cases; in 2% of our study population, the gallbladder was supplied by small branches from the liver parenchyma. Conclusion: Variant anatomy of the RGA is common, while it is quite rare for the GDA and CA. Knowledge of the variations of liver supplying arteries helps the interventionalist to embolize necessary vessels prior to RE.
    Materialart: Online-Ressource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185114522148
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2015
    ZDB Id: 2024579-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 2
    Online-Ressource
    Online-Ressource
    Uterine artery embolization in single symptomatic leiomyoma: do anatomical imaging criteria predict clinical presentation and long-term outcome?
    SAGE Publications ; 2014
    In:  Acta Radiologica Vol. 55, No. 4 ( 2014-05), p. 441-449
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 55, No. 4 ( 2014-05), p. 441-449
    Kurzfassung: Uterine artery embolization (UAE) has proven to be an effective treatment alternative for women suffering from symptomatic uterine leiomyomas. However, long-term clinical evaluation reveals treatment failure in approximately 25% of patients. To cope with the great variability in the extent of leiomyoma disease former studies are based on the simplifying assumption that the largest leiomyoma mainly causes the symptoms. Purpose To evaluate whether anatomical characteristics in women with a single symptomatic leiomyoma influence clinical presentation and outcome after UAE. Material and Methods Ninety-one patients with a single leiomyoma underwent UAE. Age, uterine and fibroid volume, fibroid location, and clinical symptoms (bleeding- and/or bulk-related symptoms) were documented. The need for reinterventions (i.e. repeat UAE, hysterectomy, myomectomy) and unchanged or worsened symptoms after UAE were classified as treatment failure (TF). Contrast-enhanced magnetic resonance imaging (MRI) 48–72 h after UAE was available in 38 women. The rate of fibroid infarction was determined and patients were assigned to one of three groups: complete (100%), almost complete (90–99%), or partial infarction ( 〈 90%). Cox regression analysis (CRA) was used to determine the influence of morphological and clinical parameters on outcome. Results Follow-up was available in 79/91 (87%) women (median age, 42 years; range, 33–56 years) at a median of 5 years (range, 3.1–9.2 years) after UAE. Anatomical leiomyoma criteria neither connected to specific clinical presentation nor influenced clinical outcome. Younger women showed a higher risk for TF with every year older lowering the risk by the factor of 0.86 ( P = 0.024). Subgroup analysis showed predictive value of fibroid infarction with a cumulative survival free from TF of 91% for complete vs. 0% for partial infarction ( P  〈  0.001). Conclusion Even in women with single leiomyomas, anatomical criteria do not specify clinical presentation or predict clinical outcome. Younger patient age and incomplete fibroid infarction relate to higher rates of TF.
    Materialart: Online-Ressource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185113497943
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2014
    ZDB Id: 2024579-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 3
    Online-Ressource
    Online-Ressource
    Apparent Migration of Implantable Port Devices: Normal Variations in Consideration of BMI
    SAGE Publications ; 2016
    In:  The Journal of Vascular Access Vol. 17, No. 2 ( 2016-03), p. 155-161
    Details
    In: The Journal of Vascular Access, SAGE Publications, Vol. 17, No. 2 ( 2016-03), p. 155-161
    Kurzfassung: To evaluate the extent of normal variation in implantable port devices between supine fluoroscopy and upright chest x-ray in relation to body mass index (BMI) based on three different measurement methods. Methods Retrospectively, 80 patients with implanted central venous access port systems from 2012-01-01 until 2013-12-31 were analyzed. Three parameters (two quantitative and one semi-quantitative) were determined to assess port positions: projection of port capsule to anterior ribs (PCP) and intercostal spaces, ratio of extra- and intravascular catheter portions (EX/IV), normalized distance of catheter tip to carina (nCTCD). Changes were analyzed for males and females and normal-weight and overweight patients using analysis of variance with Bonferroni-corrected pairwise comparison. Results PCP revealed significantly greater changes in chest x-rays in overweight women than in the other groups (p 〈 0.001, F-test). EX/IV showed a significantly higher increase in overweight women than normal-weight women and men and overweight men (p 〈 0.001). nCTCD showed a significantly greater increase in overweight women than overweight men (p = 0.0130). There were no significant differences between the other groups. Inter- and intra-observer reproducibility was high (Cronbach alpha of 0.923-1.0) and best for EX/IV. Conclusions Central venous port systems show wide normal variations in the projection of catheter tip and port capsule. In overweight women apparent catheter migration is significantly greater compared with normal-weight women and with men. The measurement of EX/IV and PCP are straightforward methods, quick to perform, and show higher reproducibility than measurement of catheter tip-to-carina distance.
    Materialart: Online-Ressource
    ISSN: 1129-7298 , 1724-6032
    URL: Article
    DOI: 10.5301/jva.5000502
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2016
    ZDB Id: 2079292-X
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 4
    Online-Ressource
    Online-Ressource
    Hepatopulmonary shunting after surgical, interventional and systemic therapy in patients with liver malignancies scheduled for radioembolization
    SAGE Publications ; 2016
    In:  Acta Radiologica Vol. 57, No. 8 ( 2016-08), p. 908-913
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 57, No. 8 ( 2016-08), p. 908-913
    Kurzfassung: Hepatopulmonary shunts (HPS) lead to radiation exposure of the lungs in patients undergoing radioembolization (RE) of malignant liver tumors. Purpose To retrospectively analyze how HPS is affected by prior systemic or local therapy of the liver. Material and Methods The percentage HPS was calculated from SPECT/CT scans obtained after technetium-99 m macroaggregated albumin administration into hepatic arteries in 316 patients evaluated for RE. Results Patients with partial liver resection ( n = 80) did not differ in HPS from the remaining patient population ( n = 236) (HPS (median [range]) = 10.2 [2.1–48.3] resection % vs. 8.9 [2.3–32.9] no resection %; P = 0.527). In patients undergoing sequential RE, HPS was significantly higher in the liver lobe treated second ( n = 10; HPS = 6.4 [2.1–10.2] firstlobe/session % vs. 12.0 [2.0–24.6] second lobe/session %; P = 0.019). (Chemo-)embolization ( n = 19; HPS = 11.0 [2.8–48.3]%) or transcutaneous ablation ( n = 63; HPS = 8.8 [3.0–32.9] %) had no effect on HPS compared to patients without prior interventions (no (chemo-)embolization: n = 297; HPS = 9.3 [2.1–47.3]%; P = 0.489; no ablation: n = 253; HPS = 9.5 [2.1–48.3] %; P = 0.382). Pretreatment with sorafenib (HPS = 9.5 [2.3–35.9] yes % vs. 10.2 [2.8–42.0] no %; P = 0.777) orbevacizumab (HPS = 10.7 [2.1–30.6] yes % vs. 9.0 [3.9–23.3] no %; P = 0.870) had no effect on HPS. Conclusion Sequential RE results in an increase in the HPS in the contralateral liver lobe at the time of the second RE session. Other investigated therapy do not affect HPS.
    Materialart: Online-Ressource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185115605680
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2016
    ZDB Id: 2024579-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 5
    Online-Ressource
    Online-Ressource
    Two-year follow-up after treatment of an aortic transection in the presence of an aberrant right subclavian artery
    SAGE Publications ; 2022
    In:  Vascular
    Details
    In: Vascular, SAGE Publications
    Kurzfassung: An aberrant right subclavian artery (ARSA) is one of the most common anatomic variants of the aortic arch. The combination of an ARSA and a transection is naturally rare. Methods This case report describes the treatment of a transection in the presence of an ARSA and the follow-up of two years. Results We successfully treated the contained rupture with a stentgraft. Both subclavian arteries had to be covered in the emergency setting. At the two-year follow-up, the patient did not suffer from any neurological impairment. Conclusions In emergency settings, primary cover of both subclavian arteries with a stentgraft can be performed in individual cases after risk assessment. Severe complications such as development of upper limb ischaemia, ASAS or reduced perfusion of the posterior cerebral circulation should be considered in treatment planning.
    Materialart: Online-Ressource
    ISSN: 1708-5381 , 1708-539X
    URL: Article
    DOI: 10.1177/17085381221135704
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2022
    ZDB Id: 2143006-8
    Standort Signatur Einschränkungen Verfügbarkeit
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