We describe our preliminary experience with percutaneous renal denervation in end-stage renal disease patients with resistant hypertension and challenging anatomy, in terms of the feasibility, safety, and efficacy of this procedure. Four patients with end-stage renal disease patients with resistant hypertension (mean hemodialysis time, 2.3 years) who had been taking at least four antihypertensive medications underwent percutaneous renal denervation. Renal artery eligibility included the absence of prior renal artery interventions, vessel stenosis <70%, or extended calcifications (more than 30% of the vessel circumference). No cut off values of vessel diameter were used. All patients were successfully treated with no intra- or postprocedural complications, and all showed 24-hour ambulatory blood pressure reduction at the 12-month follow-up. Percutaneous renal denervation is a feasible approach for end-stage renal disease patients with resistant hypertension with encouraging short-term preliminary results in terms of procedural efficacy and safety.
Vascular calcification (VC), particularly medial (Mönckeberg s medial sclerosis) arterial calcification, is common in patients with diabetes mellitus and chronic kidney disease and is associated with increased cardiovascular morbidity and mortality. Although, the underlying pathophysiological mechanisms and genetic pathways of VC are not fully known, hypocalcemia, hyperphosphatemia, and the suppression of parathyroid hormone activity are central to the development of vessel mineralization and, consequently, bone demineralization. In addition to preventive measures, such as the modification of atherosclerotic cardiovascular risk factors, current treatment strategies include the use of calcium-free phosphate binders, vitamin D analogs, and calcium mimetics that have shown promising results, albeit in small patient cohorts. The impact of intimal and medial VC on the safety and effectiveness of endovascular devices to treat symptomatic peripheral arterial disease (PAD) remains poorly defined. The absence of a generally accepted, validated vascular calcium grading scale hampers clinical progress in assessing the safety and utility of various endovascular devices (e.g., atherectomy) in treating calcified vessels. Accordingly, we propose the peripheral arterial calcium scoring system (PACSS) and a method for its clinical validation. A better understanding of the pathogenesis of vascular calcification and the development of optimal medical and endovascular treatment strategies are crucial as the population ages and presents with more chronic comorbidities. © 2014 Wiley Periodicals, Inc.
We report the case of a 57-year-old man who was diagnosed with a large unresectable cholangiocarcinoma associated with 2 satellite nodules and without clear margins with the right hepatic vein. Despite 4 cycles of GEMOX (stopped due to a hypertransaminasemia believed to be due to gemcitabine) and 4 cycles of FOLFIRINOX, the tumor remained stable and continued to be considered unresectable. Radioembolization (resin microspheres, SIRS-spheres®) targeting the left liver (474 MBq) and segment IV (440 MBq) was performed. This injection was very well tolerated, and 4 more cycles of FOLFIRINOX were given while waiting for radioembolization efficacy. On computed tomography scan, a partial response was observed; the tumor was far less hypervascularized, and a margin was observed between the tumor and the right hepatic vein. A left hepatectomy enlarged to segment VIII was performed. On pathological exam, most of the tumor was acellular, with dense fibrosis around visible microspheres. Viable cells were observed only at a distance from beads. Radioembolization can be useful in the treatment of cholangiocarcinoma, allowing in some cases a secondary resection.
AIM: To evaluate the success rates, procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS).
Pelvic congestion syndrome is associated with pelvic varicosities that result in chronic pelvic pain, especially in the setting of prolonged standing, coitus, menstruation, and pregnancy. Although the underlying pathophysiology of pelvic congestion syndrome is unclear, it probably results from a combination of dysfunctional venous valves, retrograde blood flow, venous hypertension, and dilatation. Asymptomatic women may also have pelvic varicosities, making pelvic congestion syndrome difficult to diagnose. This article explores the etiologies of pain, use of imaging techniques, and clinical management of pelvic congestion syndrome. Possible explanations for the spectrum of pain among women with pelvic varicosities are also discussed.
PURPOSE : A magnetic resonance imaging-ultrasonography (MRI-US) fusion-guided prostate biopsy increases detection rates compared to an extended sextant biopsy. The imaging characteristics and pathology outcomes of subsequent biopsies in patients with initially negative MRI-US fusion biopsies are described in this study.
PURPOSE: We aimed to examine the efficacy and safety of Tempofilter II (B. Braun, Melsungen, Germany) implantation to prevent pulmonary embolism in patients with lower-extremity fractures and proximal deep vein thrombosis (DVT).
The AMPLATZER™ vascular plugs (AVPs) (St. Jude Medical, Inc., St. Paul, MN) are a family of well-established embolization devices with multiple models, including the AVP, AVP II, and AVP 4 (Figure 1). Most recently, the AVP 4 was cleared by the US Food and Drug Administration and offers a variety of clinical applications. In this article, we discuss the characteristics of the newest vascular plug, as well as its clinical applications and selection criteria.
For the past several years, one of the hottest topics at congresses has been the potential for sympathetic denervation in treating patients with resistant hypertension. These patients have long presented a quandary for primary care physicians and specialists alike, with resistances including nonresponsiveness as well as noncompliance for a variety of reasons.
Objectives This study investigated the feasibility of noninvasive renal sympathetic denervation (RSD) by using the novel approach of extracorporeal high-intensity focused ultrasound (HIFU).
The shortage of deceased donor liver grafts led to the use of living donor liver transplant (LDLT). Patients who undergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation (LT). Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplant. The aim of this paper is to review indications, diagnostic modalities, technical considerations, achievements and potential complications of interventional radiology procedures after LDLT.
Stent restenosis secondary to tissue hyperplasia is a major problem in nonvascular organs such as the esophagus and the urethra (1–3). Tissue hyperplasia is caused by excessive fibrosis and is comparable to other benign proliferative lesions such as keloids (4). Proliferation of granulation tissue involves multiple cytokines and growth factors. Of these, transforming growth factor (TGF)-β has been identified as a key player in fibrosis proliferation. As a major TGF-β receptor, activin receptor–like kinase (ALK)-5 contributes substantially to tissue hyperplasia by propagating TGF-β signals. Kim et al (5) have investigated the potential of the ALK-5 inhibitor 3-((4-(6-methylpyridin-2-yl)-5-(quinolin-6-yl)-1H-imidazol-2-yl) methyl) benzamide (IN-1233) to prevent tissue hyperplasia. Intraperitoneal injection of IN-1233 after bare stent placement in the rat urethra or common iliac artery prevented tissue hyperplasia (6,7). However, intraperitoneal administration of IN-1233 was limited because of the large dose of IN-1233 required and systemic adverse effects, including inguinal or abdominal herniation of the small bowel.
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related morbidity and mortality. HCC is a cancer with rapid progression and the hepatitis B virus (HBV) is associated with 70% of all HCC cases worldwide (1). Despite surveillance programs conducted in high-risk populations, most HCCs are diagnosed at an advanced stage (2), and as a result, only 10%–20% of patients are eligible for curative surgery (3). Therefore, the remaining 80% with an unresectable tumor should be considered for local-regional therapies including transarterial chemoembolization (TACE) (4).
The management of classic type B double-barreled aortic dissection (AD) consists of medical therapy in patients without complications. The therapeutic strategy and risk factors for AD-related events and deaths are well established for patients with double-barreled AD, which is characterized by a true and a single false lumen (1–6). In some cases, type B AD is multibarreled, showing multiple false lumens at initial presentation or during the follow-up period. This entity is not widely recognized and has been considered a relatively rare condition (7–11). To the best of our knowledge, the imaging findings of the dissected aorta in multibarreled AD, complications, causes of death, and long-term clinical outcomes have not been previously evaluated.
OBJECTIVE. The purpose of this article is to evaluate whether antiplatelet therapy increases the occurrence and severity of percutaneous transthoracic needle biopsy (PTNB)–related hemoptysis.
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