MR-Angiographie peripherer Gefäße mit automatischer Verschiebetisch-Technik bei 1.0 T im Vergleich zur i. a. DSA

PURPOSE Contrast-enhanced (CE) 3D-MR angiography of peripheral arteries was performed in 8 patients with peripheral arterial occlusive disease by applying a new tracking technique on a 1.0 T system (Magnetom Harmony, Siemens). The studies were compared with intra-arterial digital angiography as gold standard. MATERIALS AND METHODS Imaging of the distal aorta, pelvis, upper and lower limb arteries was accomplished with a Flash-3D-sequence (TR/TE = 6.2/3.2 ms) within 26 s acquisition time of each region after a single bolus of 30 ml contrast agent. Individual circulation time was determined by a test bolus before each examination. RESULTS 112 vessel segments were evaluated. MR angiography ach…

Intérêt des fistules artérioveineuses pour les pontages distaux à haut-risque d’échec précoce

Les resultats des fistules arterioveineuses adjuvantes (FAV) dans la chirurgie de pontage en cas de mauvaise artere receveuse, de flux peroperatoire severement altere, ou de revision pour defaillance precoce et restauration du flux ont ete analyses dans une etude retrospective. De janvier 1998 a decembre 2006, 24 FAV adjuvantes ont ete construites sur la veine autologue ou des pontages distaux composites ayant un mauvais debit peroperatoire, une mauvaise artere pedieuse, ou en cas de reprise precoce de pontage reussie pour empecher un echec de pontage. Toutes les revascularisations sous-inguinales etaient enregistrees dans une base de donnees automatisee prospective. Les pontages distaux av…

Immunonutritive Scoring in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Prognostic Nutritional Index or Controlling Nutritional Status Score?

ObjectivesThe Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score are immunonutritive scoring systems with proven predictive ability in various cancer entities, including hepatocellular carcinoma (HCC). We performed the first evaluation of the CONUT score for patients undergoing transarterial chemoembolization (TACE) and compared CONUT and PNI in the ability to predict median overall survival (OS).MethodsBetween 2010 and 2020, we retrospectively identified 237 treatment-naïve patients with HCC who underwent initial TACE at our institution. Both scores include the albumin level and total lymphocyte count. The CONUT additionally includes the cholesterol level. …

The addition of TACE to palliative chemotherapy is associated with extended survival in unresectable intrahepatic cholangiocarcinoma

Endovascular treatment of acute bleeding complications in traumatic aortic rupture and aortobronchial fistula.

Objective: Herein we report our experience in placement of endovascular stentgrafts in the descending aorta in patients with acute bleeding complications due to traumatic rupture or aortobronchial fistula. Methods: Six patients (one woman, five men, mean age 47 ^ 19 years) were treated from September 1995 to February 2000 by implantation of endovascular stentgrafts in the descending aorta. Indications included traumatic ruptures of the aortic isthmus (na 3) and aortobronchial fistulas (na 3). All procedures were performed under general anaesthesia. The implants were introduced under fluoroscopic guidance via the aorta (na 1), the iliac (na 4) or femoral (na 2) artery, respectively. Results:…

Radiation exposure in vascular angiographic procedures.

Abstract Purpose To evaluate dose reduction in vascular angiographic procedures by using fluoroscopy capture instead of digital subtraction angiography frames for documentation. Materials and Methods A total of 764 consecutive vascular interventional procedures performed over a period of 1 year were retrospectively analyzed with respect to the fluoroscopy time and the resulting dose–area product (DAP), the DAP of the radiographic frames, and the overall DAP. Results A total of 70% of the total DAP was a result of the acquisition of radiographic frames, leaving only 30% being applied by fluoroscopy. Conclusions Fluoroscopy capture should be used for documentation whenever possible. A registr…

Klassifikation und Therapie von Endolecks nach endovaskulärer Behandlung von abdominellen Aortenaneurysmen

This article describes the classification of endoleaks after endovascular treatment of abdominal aortic aneurysms, thereby summarizing the most important problems of this endovascular technique. The correct classification of endoleaks is a prerequisite for interdisciplinary discussion. It is indispensable for professional reporting of the pathological findings and for the decision making as to the adequate treatment of endoleaks. Irrespective of the types of stent graft and property of the material, five endoleak types are defined in the literature: leakage at the anchor sites (type I); leakage due to collateral arteries (type II); defective stent grafts (type III); leakage due to porosity …

Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma.

Criteria to select patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) are based on tumor size and number of nodules rather than on tumor biology. The present study was undertaken to assess the role of transarterial chemoembolization (TACE) in selecting patients with tumors suitable for LT. Ninety-six consecutive patients with HCC were treated by repeatedly performed TACE, 62 of them exceeding the Milan criteria. Patients meeting the Milan criteria were immediately listed, and patients beyond the listing criteria were listed upon downstaging of the tumor following successful TACE. Fifty patients were finally transplanted. Of these 50 patients, 34 exceeded the Milan c…

The Addition of Transarterial Chemoembolization to Palliative Chemotherapy Extends Survival in Intrahepatic Cholangiocarcinoma

Incidence and mortality of intrahepatic cholangiocarcinoma (iCCA) have been increasing continuously. Recent studies suggest that the combination of palliative chemotherapy (pCTX) and transarterial chemoembolization (TACE) improves overall survival (OS). This study aimed to evaluate the outcome of patients treated with TACE and pCTX in unresectable iCCA at our tertiary care center. A group of 14 patients was treated with both pCTX and TACE. The non-randomized control group of 59 patients received pCTX alone. Patients received a median of two pCTX lines in both groups. Those treated with TACE underwent a median number of 3.5 sessions. Median OS from the time of unresectability was 26.2 months…

MR-tomographische Funktionsanalyse des linken Ventrikels

The following contribution presents a continuous MRT analysis of the contraction and relaxation processes of healthy left ventricles giving reference values for contraction and relaxation velocities. For the total ventricle we have Vsyst. r. total = 342 +/- 47% LVEDV/sec and Vdiast. r. total = 303 +/- 59% LVEDV/sec. In relation to the end-diastolic (tomographic) volume (EDSV) significantly greater changes in volume per unit of time were measured apically compared to basal (systolic: 411 +/- 89% EDSV/sec apical vs 261 +/- 35% EDSV/sec basal; diastolic: 810 +/- 145% EDSV/sec apical vs 245 +/- 70% EDSV/sec basal). Occurrence of the end-systolic minimal volumes of apical tomographic layers was …

Endovaskuläres Simulator-Training: ein Mittel, um die Begeisterung von Medizin-Studenten für die interventionelle Radiologie zu steigern.

Prognostic factors and outcomes of patients with hepatocellular carcinoma in non-cirrhotic liver

To report the outcome of patients with hepatocellular carcinoma (HCC) in non-cirrhotic liver depending on the mode of primary treatment and to define clinicopathological factors influencing patients' prognosis.A retrospective analysis of an unselected cohort of 105 patients was performed. Overall survival (OS) was estimated by the Kaplan-Meier method and potentially prognostic factors were analyzed in Cox regression models.OS of the whole cohort at 1, 3, and 5 years was 66%, 47%, and 29%, respectively. Tobacco consumption, ECOG0, macroscopic vascular invasion, continuous tumor diameter, and treatment other than resection were predictors of decreased OS in the whole cohort. Resection was per…

CT angiography versus intraarterial digital subtraction angiography for assessment of aortoiliac occlusive disease.

The purpose of this study was to evaluate the accuracy of CT angiography (CTA) with a single helical acquisition for assessment of stenoses and occlusions of the iliac arteries.In our prospective study, intraarterial digital subtraction angiography and IV CTA were performed from the suprarenal aorta to below the femoral bifurcation in 30 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were also obtained. The accuracy of CTA with and without analysis of axial images was determined.Sensitivity and specificity of CTA were 100% for iliac artery occlusions with a confidence interval 85-100% and 97-100%, respectively. When axial scans were interpret…

Hemodynamic Effects of Nonionic Contrast Bolus Injection and Oxygen Inhalation During Pulmonary Angiography in Patients With Chronic Major-Vessel Thromboembolic Pulmonary Hypertension

Background Pulmonary angiography is the gold standard for the diagnosis of chronic thromboembolic pulmonary hypertension; however, major complications have been reported. This study evaluates the hemodynamic effects of direct pulmonary nonionic contrast bolus injection and oxygen inhalation in patients with chronic thromboembolic pulmonary hypertension. Methods and Results In 33 patients, hemodynamic parameters were measured after oxygen inhalation and during bolus injection of nonionic contrast medium in a control group (group 1, n=11), in a group of patients with moderately severe pulmonary hypertension (group 2, n=9), and in a group with severe pulmonary hypertension (group 3, n=13). Ox…

Immunonutritive Scoring for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Evaluation of the CALLY Index

The novel CRP–albumin–lymphocyte (CALLY) index is an improved immunonutritive scoring system, based on serum C-reactive protein (CRP), serum albumin, and the lymphocyte count. It has shown promise as a prognostic index for patients with hepatocellular carcinoma (HCC) undergoing resections. This study evaluated the prognostic ability of the CALLY index for patients with HCC undergoing transarterial chemoembolization (TACE). We retrospectively identified 280 treatment-naïve patients with HCC that underwent an initial TACE at our institution, between 2010 and 2020. We compared the CALLY index to established risk factors in univariate and multivariate regression analyses for associations with m…

Comparison of resection and transarterial chemoembolisation in the treatment of advanced intrahepatic cholangiocarcinoma--a single-center experience.

Abstract Aims The aim of this study is to evaluate factors associated with the outcome after surgical resection and to compare the efficacy of surgery to transarterial chemoembolisation (TACE) in patients with advanced intrahepatic cholangiocarcinoma (IHC). Materials and methods 273 patients with IHC treated in our department between 1997 and 2012 were included in our study. Patients were divided according to therapy into surgical ( n  = 130), TACE ( n  = 32), and systemic chemotherapy/best supportive care ( n  = 111) groups. Clinicopathological characteristics and survival were reviewed retrospectively. Results The 1-, 3-, and 5-year survival rates in patients after surgical resection were…

Kontrastverstärkte MR-Angiographie abdomineller Gefäßean einem 1.0 T-System*

Purpose To evaluate the efficacy of breath-hold, three-dimensional, contrast-enhanced magnetic resonance angiography with a 1.0 T system for imaging the abdominal vessels in comparison to conventional arteriography (CA). Methods The abdominal aorta and visceral arteries were studied in 54 patients (60 examinations) on a 1.0 T scanner using an ultrafast gadolinium-enhanced gradient-echo sequence with the following parameters: TR/TE = 3.8/1.4 ms, flip angel 25 degrees, matrix 198 x 256, field 380-420 mm, pixel size 1.9 x 1.48 mm2, slice thickness 1.5-2.5 mm, acquisition time 22-26 sec. Individual circulation times were determined by a test bolus before each MR angiography. Conventional arteri…

Questionable Value of Adjuvant Arteriovenous Fistula in Pedal Bypass at High Risk for Early Failure

Results of an adjuvant arteriovenous fistula (AVF) in pedal bypass surgery in the presence of poor status of the recipient artery, severely impaired intraoperative runoff, or revision for early failure and flow restitution were analyzed in a retrospective study. From January 1998 to December 2006, 24 adjuvant AVFs were constructed in autologous vein or composite pedal bypasses with low intraoperative bypass flow, poor status of the pedal artery, or during successful early bypass revision to prevent graft failure. All infrainguinal bypass operations were registered in a computerized database and prospectively followed. Pedal bypasses with adjunctive AVF were reviewed for fistula function, gr…

Transarterielle Chemoembolisation (TACE) des Hepatozellulären Karzinoms (HCC) bei Patienten mit Pfortaderthrombose - Erfahrungen

PURPOSE: Comparative analysis of the course of disease in patients with initial diagnosis of portal vein thrombosis in HCC treated with sequential TACE. Evaluation of the efficacy and safety of the method in a selected patient cohort. PATIENTS AND METHODS: The study included 22 patients with HCC that were palliatively treated at least 3 times with TACE. All patients presented a portal vein thrombosis in the initial CT investigation. The TACE-procedure was carried out in regular intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10-20 ml Lipiodol. Follow-up investigations were carried out with contrast enhanced Multislice-CT before and after TACE and control…

Validation of clinical scoring systems ART and ABCR after transarterial chemoembolization of hepatocellular carcinoma

Bone Mineral Density and Vitamin D Status in Female and Male Patients with Osteoarthritis of the Knee or Hip

<i>Objective:</i> Osteoporosis (OP), osteoarthritis (OA) and vitamin D deficiency are age-related disorders. We investigated the association between bone mineral density (BMD), vitamin D and OA in patients undergoing total hip or knee replacements. <i>Method:</i> In total, 82 women and 35 men with mean ages of 70 and 68 years, respectively, were recruited for the study. The BMD of the lumbar spine and the proximal femur were measured by dual-energy X-ray absorptiometry. The vitamin D status was assessed by 25(OH)D levels, with a cut-off of ≤30 ng·ml<sup>–1</sup>. <i>Results:</i> In total, 84.7% of the patients had a vitamin D deficiency; 20% o…

Druckentlastung im Aneurysmasack nach endovaskulärer Therapie von Aortenaneurysmen*

PURPOSE Stent grafting of aortic aneurysms should result in relief of pressure within the excluded aneurysmal sac, however confirming data are not available. This study evaluates the intra-extraluminal pressure translation and translation of maximum pressure increase (dp/dtmax) into the excluded aneurysmal sac after endovascular treatment of experimental aortic aneurysms. MATERIALS AND METHODS Experimental autologous aneurysms were created surgically using a patch from the sheath of the rectus abdominis muscle in 12 mongrel dogs. After 12 weeks reconvalescence, endovascular treatment was performed viafemoral access using dacron-covered nitinol stents. Spiral CT and angiography were performe…

CT-Angiographie versus intraarterielle DSA bei Bauchaortenaneurysmen

PURPOSE To evaluate if CT angiography is able to image all features necessary for the preoperative planning of abdominal aortic aneurysms (accessory renal arteries, stenoses or occlusions of renal and iliac arteries, patency of inferior mesenteric artery). METHODS CT angiography and DSA were performed on 27 patients with abdominal aortic aneurysms. CT angiography was performed using a protocol that covered the abdominal aorta and the pelvic arteries with a single spiral acquisition (contrast dose: 150 ml, collimation: 5 mm, table feed: 7.5 mm/s, increment of reconstruction: 2 mm). Maximum intensity projections (MIP) and axial scans were compared with the results of intraarterial DSA. RESULT…

MRI versus 64-row MDCT for diagnosis of hepatocellularcarcinoma

To compare the diagnostic capability of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the detection of hepatocellular carcinoma (HCC) tumour nodules and their effect on patient management.A total of 28 patients (25 male, 3 female, mean age 67 +/- 10.8 years) with biopsy-proven HCC were investigated with 64-row MDCT (slice 3 mm native, arterial and portal-venous phase, 120 mL Iomeprol, 4 mL/s, delay by bolus trigger) and MRI (T1fs fl2d TE/TR 2.72/129 ms, T2tse TE/TR 102/4000 ms, 5-phase dynamic contrast-enhanced T1fs fl3d TE/TR 1.56/4.6, Gadolinium-DTPA, slice 4 mm). Consensus reading of both modalities was used as reference. Tumour nodules were analyzed w…

Evaluation eines neuen Softwareassistenten zur automatischen Volumenbestimmung von intrahepatischen Tumoren

Purpose: Computed tomography has become the preferred method in detecting liver carcinomas. The introduction of spiral CT added volumetric assessment of intrahepatic tumors, which was unattainable in the clinical routine with incremental CT due to complex planimetric revisions and excessive computing time. In an ongoing clinical study, a new software tool was tested for the automatic detection of tumor volume and the time needed for this procedure. Materials and Methods: We analyzed patients suffering from hepatocellular carcinoma (HCC). All patients underwent treatment with repeated transcatheter chemoembolization of the hepatic arteria. The volumes of the HCC lesions detected in CT were m…

Kontrastmittelgestützte 3D-MR-Angiographie der Becken- und Beinarterien mit automatischer Tischverschiebung bei 1,0 Tesla

PURPOSE Assessment of the value of contrast-enhanced MR angiography (ceMRA) using an automatic tracking technique at 1.0 Tesla in comparison with digital subtraction angiography (DSA) of the pelvic and lower limb arteries. MATERIALS AND METHODS In 15 patients with peripheral arterial occlusive disease a ceMRA (3D FLASH, TR/TE = 6.2/2.3 ms, Flip angle alpha = 30 degrees, Matrix 170 x 256) using a new automatic tracking technique was accomplished. The reference method was DSA. Twenty-one vessel segments of each patient were graded as normal, stenosed (> 50%) or occluded. Image material was evaluated independently by two radiologists. RESULTS In comparison, the interobserver agreement showed a…

Utilidad cuestionable de la fístula arteriovenosa auxiliar en el bypass distal de riesgo

En un estudio retrospectivo se analizaron los resultados de la colocacion de una fistula arteriovenosa (FAV) auxiliar en la cirugia de bypass distal en presencia de una arteria receptora de mala calidad o con severa alteracion de la circulacion colateral. Desde enero de 1998 hasta diciembre de 2006, se crearon 24 FAV auxiliares en venas autologas o en bypass distales mixtos que presentaban un flujo intraoperatorio bajo, arteria distal de mala calidad, o durante la revision inicial de un bypass para prevenir su fracaso. Todas las cirugias de bypass infrainguinal se registraron en una base de datos informatizada y se realizo su seguimiento de forma prospectiva. En los bypass distales con FAV …

Transarterial Chemoembolization in Patients Not Eligible for Liver Transplantation: Single-Center Results

OBJECTIVE. The purpose of this study was to evaluate the effectiveness of transarterial chemoembolization in the care of patients not eligible for liver transplantation.CONCLUSIONS. Prognosis depends on local response, Okuda score, α-fetoprotein level, and tumor size and is independent of the presence of portal venous thrombosis.

Strategies for endovascular aortic repair in aortobronchial and aortoesophageal fistulas.

Objective To report our experience of thoracic endovascular aortic repair (TEVAR) for acute bleeding originating from the thoracic aorta in patients with aortobronchial fistula (ABF) or aortoesophageal fistula (AEF). Patients and Methods A total of nine patients (three woman) were treated from September 1995 to March 2012 by TEVAR for ABF (n = 5) and AEF (n = 4). The implants (N = 14) were introduced with fluoroscopic guidance via the aorta (n = 1), the iliac (n = 2), or femoral (n = 11) artery, respectively. Results All aortic lesions could be sealed successfully. Perioperative morbidity was 0% in the ABF group and 50% (2 of 4) in the AEF group and no procedure-related morbidity was noted …

Endovaskuläre Behandlung akuter Erkrankungender thorakalen Aorta

Purpose To investigate the safety and efficacy of emergency treatment of acute aortic diseases with endovascular stent grafts. Methods In 11 patients (median age 55 years, range 18 - 85) with acute complications of descending aortic diseases endovascular emergency treatment was performed: traumatic aortic rupture (n = 4), penetrating ulcer with aortobronchial fistula or hematothorax (n = 4), acute type B dissection (n = 2, one with penetration, one with subacute mesenteric ischemia), and symptomatic aneurysm of the thoracic aorta (n = 1) with pain and diameter progression. 15 stent grafts were implanted (Talent n = 11, Vanguard/Stentor n = 4). Stent extension was necessary in 4 cases. In 2 …

Refining Prognosis in Chemoembolization for Hepatocellular Carcinoma: Immunonutrition and Liver Function

A combination of albumin-bilirubin (ALBI) grading and the Prognostic Nutritional Index (PNI) was identified recently as a highly predictive tool for patients with hepatocellular carcinoma (HCC) undergoing tumor ablation. The present study evaluated this combination in patients undergoing transarterial chemoembolization (TACE). Between 2010 and 2020, 280 treatment-naïve patients were retrospectively identified. The influence of ALBI grade, PNI and the novel ALBI-PNI on the median overall survival (OS) was assessed. In the next step, the prognostic ability of the combined approach was compared to established scoring systems. Both ALBI grade 2−3 and a low PNI were highly predictive for median …

Kontrastmittelverstärkte dreidimensionale MR-Angiographie der Lungenarterien bei Patienten mit chronisch-rezidivierender Lungenembolie - Vergleich mit der selektiven intraarteriellen DSA∗ *

Purpose: This study compares contrast-enhanced 3D-MR angiography (MRA) of the pulmonary arteries with selective intraarterial DSA in patients with chronic thromboembolic pulmonary hypertension. Materials and Methods: 20 patients preoperatively underwent a contrast-enhanced 3D-MRA of the pulmonary arteries at 1.5T using the phased-array body coil. For MRA, we used a 3D-Flash-sequence after bolus timing. 2 radiologists analyzed the acquired image material in consensus with respect to the detection of central thromboembolic material and the visualization of the pulmonary arterial tree. Finally, the MR angiograms were compared with selective DSA images using surgical findings as the definitive …

Fluoroscopy-guided Hepaticoneojejunostomy in Recurrent Anastomotic Stricture after Repeated Surgical Hepaticojejunostomy

Meßfehlerschätzung bei der MR-tomographischen Volumetrie des linken Ventrikels mit Mehrschicht-Technik

A multi-slice technique for MRT measurements of the left ventricular volume is much faster than the use of single-slice methods and is therefore better tolerated, leaving time for additional measurements. The end-diastolic left ventricular volume can be reliably measured by this method (123.3 +/- 13.5 ml vs. 124.1 +/- ml). The end-systolic volume is consistently overestimated by 23.7 +/- 18.3% compared with the reference value obtained by single slice measurements (47.9 +/- 8.9 ml vs 39.1 +/- 7.9 ml). Correspondingly, stroke volume and ejection fraction is underestimated on average by 10.6 +/- 9.7% and 10.6 +/- 7.6% respectively).

Sequential Femorodistal Composite Bypass with Second Generation Glutaraldehyde Stabilized Human Umbilical Vein (HUV)

Abstract Objective To evaluate the performance of sequential composite bypasses with second generation glutaraldehyde stabilized human umbilical vein (HUV) and autologous vein. Design Retrospective study of consecutive patients, in a single centre. Patients From January 1998 to December 2003, 54 femoro-distal HUV-autologous vein sequential composite bypasses were constructed in 52 patients with critical leg ischemia and absence of sufficient length of autologous vein. Methods All infra-inguinal bypass operations were registered in a computerized database and prospectively followed. Bypasses using sequential HUV-composite technique were reviewed for graft patency, limb salvage and patient su…

Sequentielle transarterielle Chemoembolisation (TACE) des hepatozellulären Karzinoms (HCC) - Erfahrungsbericht eines einzelnen Zentrums über 5 Jahre

PURPOSE: To analyze the course of disease of patients treated with sequential TACE and to evaluate the dependent and independent prognostic factors for patient survival using the Cox Proportional Hazard Model. MATERIALS AND METHODS: 94 patients palliatively treated with TACE. Patients were selected if they had been treated at least 3 times. The TACE procedure was carried out at 8-week intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10 ml Lipiodol. Follow-up investigations included contrast-enhanced multislice CT before and after TACE and assessment of the laboratory test results (i. e., blood count, liver enzymes, and coagulation). RESULTS: In 66.7 % of …

Alpha-fetoprotein and modified response evaluation criteria in Solid Tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation

Locoregional therapy (LRT) is being increasingly used for the management of hepatocellular cancer (HCC) in patients listed for liver transplantation (LT). Although several selection criteria have been developed, stratifications of survival according to the pathology of explanted livers and pre-LT LRT are lacking. Radiological progression according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and alpha-fetoprotein (AFP) behavior was reviewed for 306 patients within the Milan criteria (MC-IN) and 116 patients outside the Milan criteria (MC-OUT) who underwent LRT and LT between January 1999 and March 2010. A prospectively collected database originating from 6 collabor…

Kontrastverstärkte dreidimensionale MR-Angiographie der A. carotis bei 1,0 Tesla im Vergleich zuri.a. DSA - ist die Methode für die Diagnostik von Karotisstenosen geeignet?

Artery Disease? Purpose: To evaluate the efficacy of three-dimensional, contrast-enhanced magnetic resonance angiography (CE-MRA) of the carotid artery with a 1.0 system in comparison to intra-arterial conventional angiography (i.a.CA) for the assessment of carotid artery disease. Method: 55 patients with suspected stenosis of the carotid artery were examined with a 3D-CE gradient-echo sequence on a 1.0 T scanner (TR/TE = 6.2/2.2 ms) and a selective DSA i.a. angiography. Image quality was evaluated by estimating the arterial contrast and venous enhancement. Morphological pathologies were registered for all arteries, stenoses of the internal carotid artery were graded by applying the NASCET …

Therapie thrombembolischer Verschlüsse der Unterschenkelarterien: Klinische Erfahrungen mit dem Angiojet®-Thrombektomiekatheter

UNLABELLED To investigate the clinical impact of a new hydrodynamic thrombectomy catheter in thromboembolic occlusion of tibial arteries. METHOD 10 patients with thromboembolic occlusion of all tibial arteries were treated with the Angiojet thrombectomy device in order to reestablish blood flow. Depending on angiographic and clinical results of thrombectomy, additional thrombolysis, PTA, recanalization, or surgical bypass grafting was performed. RESULTS Antegrade blood flow in at least one tibial artery was reestablished in 6 cases with the thrombectomy device. However, additional treatment modalities were used in order to improve the outcome and to resolve adherent thrombi or to treat vess…

Pulmonary balloon angioplasty of chronic thromboembolic pulmonary hypertension (CTEPH) in surgically inaccessible cases.

Abstract The clinical course of patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) depends on the distribution pattern of the thromboembolic material. In patients with thromboembolic findings in the central pulmonary segments pulmonary thrombendarterectomy (PTE) has excellent results and acceptable operative risk. This paper presents two surgically inaccessible cases that were successfully treated with balloon pulmonary angioplasty. Balloon angioplasty improved parenchymal perfusion, increased cardiac index (Delta CI +19.2 % [Case 1], and +15.4 % [2]), reduced pulmonary vascular resistance during follow-up (Delta PVRI -25.0 % [1] and -15.9 % [2]), and is discussed…

Hepatocellular carcinoma in Child's A cirrhosis: a retrospective analysis of matched pairs following liver transplantation vs. liver resection according to the intention-to-treat principle.

This is the first matched pair analysis on the puzzling clinical problem of whether to perform liver transplantation (LT) or liver resection (LR) for Child's A hepatocellular carcinoma (HCC) patients. A total of 201 patients diagnosed with HCC and Child's A liver cirrhosis were treated with LT transarterial chemoembolization (TACE) or LR between 1998 and 2012. To achieve the most accurate study design, two groups of 57 patients were matched retrospectively according to their tumor characteristics detected by the initial computerized tomography (CT) scan. Sixteen of 57 LT candidates were not transplanted due to tumor progress during pre-treatment (TACE). Nevertheless, the retrospective analy…

Chronische thromboembolische pulmonale Hypertonie: Diagnostische Wertigkeit von Mehrschicht-CT und selektiver Pulmonalis-DSA

Purpose To evaluate the diagnostic impact of multislice-CT and selective pulmonary DSA in chronic thromboembolic pulmonary hypertension (CTEPH). Methods 994 vessel segments of 14 consecutive patients with CTEPH were investigated with multislice-CT (slice thickness 3 mm, collimation 2.5 mm, reconstruction intervall 2 mm) and selective pulmonary DSA (posterior-anterior, 45 degrees oblique, and lateral projection. Analysis was performed by 2 investigators independently for CT and DSA. Diagnostic criteria were occlusions and non-occlusive changes like webs and bands, irregularities of the vessel wall, diameter reduction and thromboembolic depositions at different levels from central pulmonary a…

Multidisciplinary approach to the complex treatment for non-cirrhotic portal hypertension - case-report-based discussion.

Non-cirrhotic portal vein thrombosis (PVT) in patients with antiphospholipid syndrome (APS) is a rare complication, and the management has to be determined individually based on the extent and severity of the presentation. We report on a 37-year-old male patient with non-cirrhotic chronic PVT related to a severe thrombophilia, comprising APS, antithrombin-, factor V- and factor X-deficiency. Three years after the initial diagnosis of non-cirrhotic PVT, the patient presented with severe hemorrhagic shock related to acute bleeding from esophageal varices, requiring an emergency transjugular intrahepatic portosystemic stent shunt (TIPSS). TIPSS was revised after a recurrent bleeding episode du…

Validation of clinical scoring systems ART and ABCR after transarterial chemoembolization of hepatocellular carcinoma.

Abstract Purpose To perform an external validation of the Assessment for Retreatment with Transarterial Chemoembolization (ART) and α-fetoprotein (AFP), Barcelona Clinic Liver Cancer (BCLC), Child–Pugh, and response (ABCR) scores and to compare them in terms of prognostic power. Materials and Methods From 2000 to 2015, 871 patients with hepatocellular carcinoma underwent transarterial chemoembolization at a tertiary referral hospital, and 176 met all inclusion and exclusion criteria for both scores and were analyzed. Nineteen percent (n = 34) had BCLC stage A disease and 81% had stage B disease. Thirty-nine patients (22%) presented with elevated AFP levels. Overall survival was calculated. …

Endovaskuläre Aneurysmatherapie - Langzeitergebnisse nach 7 Jahren

Hintergrund: Seit der Entwicklung von Stentprothesen und deren kommerzieller Verfugbarkeit 1994 gibt es eine neue, sich zunehmend verbreitende endovaskulare Methode der Aneurysmatherapie.

Noninvasive assessment of pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension by high temporal resolution phase-contrast MRI: correlation with simultaneous invasive pressure recordings.

Background— Right heart catheterization is the gold standard for assessment of pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension. To date, MRI has not been able to produce precise measurements of mean pulmonary arterial pressure (mPAP). The purpose of the study was to create a model for estimating mPAP and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension by high temporal resolution phase-contrast MRI (PC-MRI) and to correlate the results with simultaneously acquired, invasive catheter-based measurements (simultaneously measured mPAP) and with right heart catheterization measurements. Methods and Results— A tota…

Auswirkungen der Sauerstoffinhalation auf die Hämodynamik bei chronischer thromboembolischer pulmonaler Hypertonie

PURPOSE This study evaluates the haemodynamic effects of oxygen inhalation on pulmonary artery pressure and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. METHOD In 47 patients with chronic thromboembolic pulmonary hypertension haemodynamic parameters were measured before and after oxygen inhalation. RESULTS In moderately severe and severe pulmonary hypertension oxygen inhalation significantly reduced mean pulmonary artery pressure by about 11.1% and 4.6%, respectively. However, pulmonary vascular resistance was not significantly affected. Oxygen saturation improved and heart rate was reduced. Cardiac index decreased in severe pulmonary hyperte…

Krurale und pedale Bypasschirurgie bei kritischer Isch�mie und nicht heilenden Fu�l�sionen

Die Ischamie ist der haufigste Grund fur nicht heilende Lasionen an den Fusen. Mit der weltweiten Zunahme vaskularer Erkrankungen und insbesondere des diabetischen Fussyndroms steigt auch die Zahl der Patienten, die durch eine Revaskularisation geheilt werden konnen, momentan aber uberwiegend (25.000/Jahr in Deutschland) amputiert werden. In den letzten Jahrzehnten sind in der Gefaschirurgie subtile Methoden entwickelt worden, die auch eine Revaskularisation und Bypassoperationen bei Patienten mit einem distalen Verschlusstyp, der immer haufiger und gerade beim Diabetiker angetroffenen wird, zulassen. Eine besondere Rolle spielt hier der Venenbypass aus V. saphena magna oder alternativen Ve…

Gegenwärtiger Stellenwert der perkutanentranshepatischen Cholangiodrainage

Percutaneous transhepatic biliary drainage (PTBD) is a well established method in the treatment of obstructive jaundice. Major indications are malignant diseases. PTBD may be necessary preoperatively in cases with severe jaundice or cholangitis or as part of palliative treatment concepts. In the past, it has been proposed that a period of preoperative PTBD may improve the morbidity rates of surgery. Various studies could not prove this theory. The significance of preoperative PTBD has changed, as observed during a 15 years period in our own institution, the indications for preoperative PTBD have decreased by half. At present, the majority of treatments with PTBD are palliative (almost 70 % …

Endovaskuläre Therapie aortaler Aneurysmen: erste klinische Ergebnisse

PURPOSE A clinical study aiming at examining the implantation technique and the clinical results of a new vascular prosthesis in endovascular therapy of aneurysms of the aorta. MATERIAL AND METHODS In 21 patients (20 men of 55 to 87 years of age, average age 70 years) with aneurysms of the infrarenal abdominal aorta (AAA n = 19) and the thoracic aorta (n = 2), a self-expanding nitinol stent with outer Dacron sheath (tubular prosthesis n = 4; bifurcation prosthesis n = 17) was implanted by means of an F-18 introductory set after surgical opening of the inguinal artery. RESULTS By means of the 4 tubular prostheses and 13 of the 17 bifurcation prostheses the aneurysm was bypassed completely. I…

Radiofrequency ablation as first-line treatment in patients with early colorectal liver metastases amenable to surgery.

Aiming at avoidance of futile surgery, we have tested whether radiofrequency ablation (RFA) may be used as first-line treatment in patients with colorectal metastases (CRLM) occurring within the first year after colorectal surgery.Surgical resection is the standard treatment in patients with CRLM. Major retrospective analyses have identified the interval between colorectal surgery and the occurrence of CRLM to be of prognostic importance. So far, it is unknown whether survival of the respective patients is hampered if RFA is used as first-line treatment.According to a clinical pathway, we have treated patients with CRLM detected within the first year after colorectal surgery preferentially …

Radiation exposure in CT-guided interventions.

To investigate radiation exposure in computed tomography (CT)-guided interventions, to establish reference levels for exposure, and to discuss strategies for dose reduction.We analyzed 1576 consecutive CT-guided procedures in 1284 patients performed over 4.5 years, including drainage placements; biopsies of different organs; radiofrequency and microwave ablations (RFA/MWA) of liver, bone, and lung tumors; pain blockages, and vertebroplasties. Data were analyzed with respect to scanner settings, overall radiation doses, and individual doses of planning CT series, CT intervention, and control CT series.Eighty-five percent of the total radiation dose was applied during the pre- and post-interv…

Chronische thromboembolische pulmonale Hypertonie: Hämodynamische Auswirkungen der selektiven Pulmonalis-DSA mit nicht-ionischem Kontrastmittel

PURPOSE This study evaluates the effects of pulmonary bolus injection of nonionic contrast medium on pulmonary artery pressure and resistance in patients with chronic thromboembolic pulmonary hypertension. METHODS In 39 patients (age 52 +/- 15) haemodynamic measurements were performed during bolus injection of nonionic contrast medium in a control group (I), in moderately severe (II) and severe pulmonary hypertension (III). RESULTS Initial inspiratory arrest caused significant pressure increase in all groups prior to bolus injection (delta PAsyst: 7.1 +/- 6.7 [I], 6.8 +/- 3.9 [II] und 7.2 +/- 7.9 mmHg p < 0.05). However, contrast bolus injection (25.1 +/- 2.3 ml iopamidol, 13.0 ml/s) caused…

Long-term results after thromboendarterectomy for chronic pulmonary embolism1

Objective: In patients with chronic thromboembolic pulmonary hypertension, pulmonary vascular resistance (PVR) can be reduced by pulmonary thromboendarterectomy (PTE). In this study, long-term symptomatic and hemodynamic effects were investigated. Methods: Twenty-two patients (12 female, 10 male, mean age 40 years, preoperative NYHA functional class II/III/IV: n = 1/12/9) were re-evaluated 48‐72 months (mean 60 months) after surgery. In addition to clinical assessment, radiologic, hemodynamic and echocardiographic investigations were performed. Results: All patients reported a marked improvement of their clinical condition. At follow-up, 11 patients were identified as NYHA class I, 10 as NY…

Einfluss von Typ-II-Endoleaks auf die Größenänderung und Hämodynamik experimenteller Aortenaneurysmen nach endovaskulärer Therapie

PURPOSE To evaluate the aneurysm volume and the intra-aneurysmatic pressure and maximal pressure pulse (dp/dtmax) in completely excluded aneurysms and cases with endoleaks. MATERIALS AND METHODS In 36 mongrel dogs, experimental autologous aneurysms were treated with stent-grafts. All aortic side branches were ligated in 18 cases (group I) but were preserved in group II (n = 18). Aneurysm volumes were calculated from CT scans before and after intervention, and from follow-up CT scans at 1 week, 6 weeks and 6 months. Finally, for hemodynamic measurements, manometer-tipped catheters were introduced into the excluded aneurysm sac (group I and II), selectively in endoleaks (group II), and intral…

MR-tomographische Messung der diastolischen Relaxation hypertrophierter linker Ventrikel mit Single-slice-multi-phase-Technik

In order to assess diastolic ventricular function in hypertensive patients, a single-slice multiphase sequence was used in order to measure contraction and early diastolic relaxation. There was no difference in the contraction velocity between hypertensives and normals (Vsys. n.r. = 56.1 +/- 13.8% LVDV/s vs. 51.7 +/- 8.6% LVEDV/s, stat, n. sign.). Early diastolic relaxation velocity in hypertensives was reduced as compared with the control group (Vdiast. 1n.r. = 37.9 +/- 13.1% LVEDV/s vs. 47.1 +/- 9.6% LVEDV/s, p < 0.05). There was no linear relation between abnormal relaxation and the extent of myocardial hypertrophy. Hypertensives with myocardial hypertrophy frequently had reduced early d…

Midterm follow-up after DC-BEAD™-TACE of Hepatocellular Carcinoma (HCC)

Abstract Aim To determine local response, its predictors and survival and complication rates after DC-Bead™-TACE in patients with hepatocellular carcinoma (HCC). Materials and methods DC-Beads™ are non-resorbable, polyvinyl-alcoholic hydrophilic microspheres. They release high amounts of chemotherapeutics directly into the tumour. Delivery is sustained over time, tumour feeders are embolised. We used beads from 100–300 to 500–700 μm loaded with Doxorubicin (max. 150 mg/4 ml). Fifty patients (mean age: 68.5 ± 8.8 years) with HCC were analysed. DC-Bead™-TACE was performed once or repeated in two-month intervals. Imaging scans (CT or MRI) were done one-month following each procedure. To evalua…

Systemic pulsatile pressure in type II endoleaks after stent grafting of experimental abdominal aortic aneurysms.

Purpose: To investigate pressure and maximum rate of rise of systolic pressure (peak dP/dt) in completely excluded aneurysms and endoleaks to determine the hemodynamic impact of endoleaks. Methods: In mongrel dogs (n = 36) experimental aneurysms were created by insertion of a patch (portion of rectus abdominis muscle sheath) into the infrarenal aorta. In group I (n = 18), all aortic branches of the aneurysm were ligated and all aneurysms were completely excluded by stent grafts. Group II (n = 18) consisted of aneurysms with patent aortic side branches that represented sources of endoleaks. One week (n = 12), six weeks (n = 12), and six months (n = 12) after stent grafting, hemodynamic measu…

Indirekte MR-Arthrographie zur Verlaufskontrolle nach autologer osteochondraler Transplantation

Purpose: To evaluate the spectrum of findings in indirect MR-arthrography following autologous osteochondral transplantation. Patients and Methods: 10 patients with autogenous osteochondral homografts underwent indirect MR-arthrography at three, 6 and 12 months postoperatively. The MR protocol at 1.5 T comprised unenhanced imagings with PD- and T 2 -weighted TSE-sequences with and without fat-suppression as well as T 1 -weighted fat-suppressed SE-sequences before and after iv. contrast ad ministration and after active joint exercise. Image analysis was done by two radiologists in conference and comprised the evaluation of signal intensity (Sl) and integrity of the osseous plug and the carti…

Endovascular Aneurysm Repair

Background — The purpose of the present study was to systematically analyze the histopathologic organization processes in excluded aneurysms after endovascular stenting and to develop a noninvasive monitoring method for these processes using MRI. Methods and Results — In 36 mongrel dogs, autologous aortic aneurysms were created. Endovascular treatment was performed using covered stents. Follow-up was after 1 week, 6 weeks, and 6 months. MRI was performed with T 2 -weighted turbo-spin-echo sequences and T 1 -weighted spin-echo sequences and was repeated after contrast bolus with gadolinium. Histopathologic findings were correlated to signal intensities (SIs) of MRI images. SIs of distinct a…

Chronic Thromboembolic Pulmonary Hypertension: Pre- and Postoperative Assessment with Breath-hold MR Imaging Techniques

To evaluate the potential of breath-hold magnetic resonance (MR) imaging techniques in morphologic and functional assessment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after surgery.Thirty-four patients with CTEPH were examined before and after pulmonary thromboendarterectomy (PTE). For morphologic assessment, contrast material-enhanced MR angiography was used; for assessment of hemodynamics, velocity-encoded gradient-echo sequences and cine gradient-echo sequences along the short axis of the heart were performed. Contrast-enhanced MR angiography was compared with selective digital subtraction angiography (DSA) for depiction of central thromboembolic m…

Trends in Epidemiology, Treatment, and Survival of Hepatocellular Carcinoma Patients Between 1998 and 2009

The aim of this study was to analyze clinical presentation, course of disease, and management of patients with hepatocellular carcinoma (HCC) in a German referral center between 1998 and 2009.HCC is a rare tumor in Germany, but its incidence has increased over the last 30 years. New therapies such as chemoembolization with drug-eluting beads, selective internal radiotherapy, and sorafenib were introduced recently; however, the impact on clinical management and overall survival (OS) is unclear.In this retrospective analysis, 1066 patients with HCC, separated into two 6-year periods (n=385; 1998 to 2003 and n=681; 2004 to 2009) were evaluated.The number of patients presenting each year (64 vs…