Interventional Treatment Group Research Articles

Chest tube insertion versus Oxygen therapy treatment in spontaneous pneumothorax; systemic review

Abstract Background: conservative management including oxygen therapy and analgesia may safely and effectively manage patients with spontaneous pneumothorax without hemodynamic compromise. The primary objective of this systematic review was to evaluate the safety and efficacy of conservative versus interventional care in the management of spontaneous pneumothorax. Method: We conducted a comprehensive search of the Cochrane Library, PubMed, and EMBASE databases till 2023 to find cohort studies and randomized controlled trials that compared interventional therapy with conservative care as the first line of treatment for patients experiencing spontaneous pneumothorax. Success and recurrence rates were the main objectives. The rates of complications were the secondary focus. Each reviewer carried out data extraction and quality evaluation individually from papers that qualified. Results: after filtration of duplicated and ineligible articles we included 7 relevant research in the final systematic review. There were two randomized clinical trials, one prospective cohort research, four retrospective cohort studies, and a total of 1071 participants in the seven included investigations. Overall, success rates for 619 patients were reported in 5 included studies. The success rates of the interventional management group and the conservative management group did not differ statistically significantly. Difference in complication rates between the conservative and interventional therapy groups was not statistically significant, the conservative therapy group experienced fewer complications than the interventional treatment group. Conclusion: In contrast to interventional care, conservative therapy provides a secure and efficient first line of treatment for individuals with spontaneous pneumothorax.

Gender differences in the antihypertensive effect after radiofrequency denervation of the renal arteries in resistant arterial hypertension

Objective: evaluation of gender differences in the antihypertensive effect after denervation of the renal arteries based on the results of office and daily measurements of blood pressure in resistant arterial hypertension in a 3-year follow-up.Materials and methods: the study involved 80 patients with resistant arterial hypertension (RAH); Patients were divided by stratification randomization into the interventional treatment group, who continue to receive antihypertensive therapy (AHT) (RDN group) and the MT group (patients on drug therapy only. The study groups were comparable in terms of gender, age, duration of hypertension, the number of antihypertensive drugs taken, the presence of For 12 months, a comparative study was conducted between groups, further analysis of the effectiveness of surgical treatment of RDN PA was carried out at control points of 24 and 36 months, in which laboratory and instrumental examinations were performed.Results: according to the office measurement of blood pressure within the RDN and MT study groups, both in men and women, it turned out to be similar. After 12 months of observation between the comparison groups, the women of the group showed a statistically significant negative dynamics of the office SBP (p<0.01) and office DBP (p<0.05) parameters. According to the analysis of average daily, average daily, average night SBP indicators, after 12 months in the RDN group, a decrease was observed in all main parameters (p<0.001). It is worth paying attention to the fact that in the MT group, among the average daily, average daily, average night ABPM indicators after 12 months, no statistically significant changes were detected. When conducting a gender analysis of ABPM indicators using the Friedman test and correcting the p value for multiple comparisons at visits of 24 and 36 months, a statistically significant decrease in the main average daily indicators in women was demonstrated, while in men such changes were not established.Conclusions: the data obtained indicate a more pronounced antihypertensive effect after radiofrequency denervation of the renal arteries in resistant arterial hypertension in women.

Do treatment methods for deep vein thrombosis have different effects on post-thrombotic syndrome and the quality of life?

This study aimed to compare the effects of interventional methods and medical therapy in patients with acute proximal deep vein thrombosis (DVT) on the risk of development of post-thrombotic syndrome (PTS) and the quality of life during the follow-up period. Clinical statuses of the patients who were treated medical therapy alone or medical therapy and endovascular treatment for acute proximal (iliofemoral-popliteal) DVT between 1st January 2014 and 1st November 2022 were reviewed retrospectively. The study included 128 patients who received interventional treatment (Group I) and 120 patients who received medical therapy alone (Group M). The mean age of the patients was 52.98 ± 12.45years in Group I and 55.60 ± 16.15years in Group M. Patients were classified as provoked or unprovoked and by LET scale (lower extremity thrombosis level scale). Patients were followed-up for 1year using Villalta scores and VEINES-QoL/Sym questionnaire. LET scale was evaluated based on the results of lower extremity venous Doppler ultrasound (DUS). No early acute phase mortality was observed. LET classification showed that there is higher proximal involvement in Group I (Table 1[Table: see text]). Recurrence rate was 6.25% (8 patients) in Group I and 21.66% (26 patients) in Group M (p < .001). Pulmonary embolism was not observed in either group. At 12-month follow-up, the number of patients with a Villalta score of ≥5 was 8 (6.25%) in Group I and 81 (67.5%) in Group M (p < .001), while the mean VEINES-QoL/Sym scale score was found to be 72.5 ± 6.35 in Group I and 40.2 ± 9.31 in Group M (p < .001). The rates of anticoagulant-associated bleeding were 3.12% (4 patients) in Group I and 6.66% (8 patients) in Group M. The mean complete recanalization rates calculated using DUS at year 1 was found to be 63.28% (81 patients) in Group I and 9.16% (11 patients) in Group M (p < .001). When deep vein thrombosis is treated using interventional methods, lower Villalta scores are detected after 1year of follow-up. Development of post-thrombotic syndrome is reduced substantially. According to VEINES-QoL/Sym quality of life (QoL) scale, QoL is higher in patients who underwent interventional procedures. Interventional treatment provides persistent benefit in the short and medium terms especially in DVT with proximal involvement.

Management of traumatic peripheral artery pseudoaneurysm: A 10-year experience at a single center

PurposeThis study aimed to report our 10-year experience with the management of iatrogenic (penetrating trauma) and traumatic (blunt or penetrating trauma) peripheral artery pseudoaneurysms, based on data from a tertiary referral center. MethodsFrom January 2012 to December 2021, the medical records of consecutive patients with iatrogenic and traumatic peripheral artery pseudoaneurysms were retrospectively reviewed. Patient demographics, clinical features, imaging data, treatment details, and follow-up results were analyzed. ResultsSixty-one consecutive patients were included in this study; 48 (79%) were men and 13 (21%) women, with a mean age of 49.4 ​± ​13.4 years (range 24–73 years). There were 42 patients (69%) who underwent open surgery, 18 (29%) undergoing endovascular embolization or stent implantation, and one (2%) undergoing ultrasound-guided thrombin injection. All patients successfully underwent open or interventional treatment. The median follow-up was 46.8 months (2.5–117.9 months), and the overall reintervention rate was 10%. Of these, one (5%) patient in the interventional treatment group and five (12%) patients in the open surgery group underwent reintervention. The overall complication rate was 8%, with complications occurring only in the open surgery group. No deaths occurred in the peri-operative period. No late complications, such as thrombosis or pseudoaneurysm recurrence, were observed. ConclusionPeripheral artery pseudoaneurysms arising from iatrogenic or traumatic causes can be effectively treated by both open surgery and interventional procedures in selected patients with acceptable mid- and long-term outcomes.

A Proposed Personalized Spine Care Protocol (SpineScreen) to Treat Visualized Pain Generators: An Illustrative Study Comparing Clinical Outcomes and Postoperative Reoperations between Targeted Endoscopic Lumbar Decompression Surgery, Minimally Invasive TLIF and Open Laminectomy.

Background: Endoscopically visualized spine surgery has become an essential tool that aids in identifying and treating anatomical spine pathologies that are not well demonstrated by traditional advanced imaging, including MRI. These pathologies may be visualized during endoscopic lumbar decompression (ELD) and categorized into primary pain generators (PPG). Identifying these PPGs provides crucial information for a successful outcome with ELD and forms the basis for our proposed personalized spine care protocol (SpineScreen). Methods: a prospective study of 412 patients from 7 endoscopic practices consisting of 207 (50.2%) males and 205 (49.8%) females with an average age of 63.67 years and an average follow-up of 69.27 months was performed to compare the durability of targeted ELD based on validated primary pain generators versus image-based open lumbar laminectomy, and minimally invasive lumbar transforaminal interbody fusion (TLIF) using Kaplan-Meier median survival calculations. The serial time was determined as the interval between index surgery and when patients were censored for additional interventional and surgical treatments for low back-related symptoms. A control group was recruited from patients referred for a surgical consultation but declined interventional and surgical treatment and continued on medical care. Control group patients were censored when they crossed over into any surgical or interventional treatment group. Results: of the 412 study patients, 206 underwent ELD (50.0%), 61 laminectomy (14.8%), and 78 (18.9%) TLIF. There were 67 patients in the control group (16.3% of 412 patients). The most common surgical levels were L4/5 (41.3%), L5/S1 (25.0%), and L4-S1 (16.3%). At two-year f/u, excellent and good Macnab outcomes were reported by 346 of the 412 study patients (84.0%). The VAS leg pain score reduction was 4.250 ± 1.691 (p < 0.001). No other treatment during the available follow-up was required in 60.7% (125/206) of the ELD, 39.9% (31/78) of the TLIF, and 19.7% (12/61 of the laminectomy patients. In control patients, only 15 of the 67 (22.4%) control patients continued with conservative care until final follow-up, all of which had fair and poor functional Macnab outcomes. In patients with Excellent Macnab outcomes, the median durability was 62 months in ELD, 43 in TLIF, and 31 months in laminectomy patients (p < 0.001). The overall survival time in control patients was eight months with a standard error of 0.942, a lower boundary of 6.154, and an upper boundary of 9.846 months. In patients with excellent Macnab outcomes, the median durability was 62 months in ELD, 43 in TLIF, and 31 months in laminectomy patients versus control patients at seven months (p < 0.001). The most common new-onset symptom for censoring was dysesthesia ELD (9.4%; 20/206), axial back pain in TLIF (25.6%;20/78), and recurrent pain in laminectomy (65.6%; 40/61) patients (p < 0.001). Transforaminal epidural steroid injections were tried in 11.7% (24/206) of ELD, 23.1% (18/78) of TLIF, and 36.1% (22/61) of the laminectomy patients. The secondary fusion rate among ELD patients was 8.8% (18/206). Among TLIF patients, the most common additional treatments were revision fusion (19.2%; 15/78) and multilevel rhizotomy (10.3%; 8/78). Common follow-up procedures in laminectomy patients included revision laminectomy (16.4%; 10/61), revision ELD (11.5%; 7/61), and multilevel rhizotomy (11.5%; 7/61). Control patients crossed over into ELD (13.4%), TLIF (13.4%), laminectomy (10.4%) and interventional treatment (40.3%) arms at high rates. Most control patients treated with spinal injections (55.5%) had excellent and good functional outcomes versus 40.7% with fair and poor (3.7%), respectively. The control patients (93.3%) who remained in medical management without surgery or interventional care (14/67) had the worst functional outcomes and were rated as fair and poor. Conclusions: clinical outcomes were more favorable with lumbar surgeries than with non-surgical control groups. Of the control patients, the crossover rate into interventional and surgical care was 40.3% and 37.2%, respectively. There are longer symptom-free intervals after targeted ELD than with TLIF or laminectomy. Additional intervention and surgical treatments are more often needed to manage new-onset postoperative symptoms in TLIF- and laminectomy compared to ELD patients. Few ELD patients will require fusion in the future. Considering the rising cost of surgical spine care, we offer SpineScreen as a simplified and less costly alternative to traditional image-based care models by focusing on primary pain generators rather than image-based criteria derived from the preoperative lumbar MRI scan.

The Local Intraarterial Administration of Nimodipine Might Positively Affect Clinical Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage and Delayed Cerebral Ischemia.

The effect of the intraarterial administration of nimodipine as a rescue measure to treat delayed vasospasm after aSAH remains understudied; therefore, we evaluated its effect on short- and long-term functional and neuropsychological outcomes after aSAH. In this prospective observational study, a total of 107 consecutive patients treated for aSAH of WFNS grades I–V were recruited. At follow-up visits 3-, 12- and 24-months after the hemorrhage, functional outcome was assessed using the Extended Glasgow Outcome (GOSE) and modified Rankin (mRS) scales, while neurocognitive function was evaluated using the screening module of the Neuropsychological Assessment Battery (NAB-S). The outcome of patients, who had received rescue therapy according to the local standard treatment protocol (interventional group, n = 37), and those, who had been treated conservatively (conservative group, n = 70), were compared. Even though significantly more patients in the interventional treatment group suffered from high-grade aSAH (WFNS Grades IV and V, 54.1% vs. 31.4%, p = 0.04) and required continuous drainage of cerebrospinal fluid at discharge (67.7% vs. 37.7%, p = 0.02) compared to the control group, significant differences in functional outcome were present only at discharge and three months after the bleeding (GOSE > 4 in 8.1% vs. 41.4% and 28.6% vs. 72.7%, p < 0.001 and p = 0.01 for the interventional and control group, respectively). Thereafter, group differences were no longer significant. While significantly more patients in the intervention group had severe neuropsychological deficits (76.3% vs. 36.0% and 66.7% vs. 29.2%, p = 0.04 and 0.05, respectively) and were unable to work (5.9% vs. 38.1%, p = 0.03 at twelve months) at three and twelve months after the hemorrhage, no significant differences between the two groups could be detected at long-term follow-up. The presence of moderate neuropsychological impairments did not significantly differ between the groups at any timepoint. In conclusion, despite initially being significantly more impaired, patients treated with intraarterial administration of nimodipine reached the same functional and neuropsychological outcomes at medium- and long-term follow-up as conservatively treated patients suggesting a potential beneficial effect of intraarterial nimodipine treatment for delayed vasospasm after aSAH.

Comparison of efficiency and safety of conservative versus interventional management for primary spontaneous pneumothorax: A meta-analysis.

There is growing opinion that primary spontaneous pneumothorax (PSP) patients without hemodynamic compromise could be safely and successfully managed with observation alone. The aims of this meta-analysis were to estimate the safety and effectiveness of conservative treatment compared with that of interventional management as the initial treatment option for patients with PSP. The PubMed, Embase and Cochrane library databases were systematically searched for randomized controlled trials (RCTs) and cohort studies (prospective or retrospective) until April 25, 2020, that compared conservative treatment and interventional treatment as the initial treatment for patients with PSP. The primary outcomes were success rates and recurrence rates. The secondary outcome was complication rates. Data extraction and quality assessment from eligible studies were independently conducted by two reviewers. 8 trials with a total of 1342 patients were identified. The success rates of conservative management were similar with interventional treatment, with a risk ratio 1.05 (95% confidence interval 0.94 to 1.17, I2 = 69.1%). There was no significant difference of recurrence rates between these two type managements. (RR, 1.43, 95% confidence interval 0.45 to 4.55, I2 = 86.7%). Complication rates were lower in conservative treatment group (13 of 215 [6.05%]) than in interventional treatment group (57 of 212, [26.89%]), although the difference did not reach statistical significance (RR, 0.15, 95% CI, 0.02 to 1.13, I2 = 56.7%). Results of the meta-analysis suggest that conservative treatment offers a safe and effective alternative as compared with interventional management as the initial treatment approach for patients with PSP. However, more randomized clinical trials are need to provide more strong evidence to confirm our results.

A prospective, multicentre study in acute non-cirrhotic, non-malignant portal vein thrombosis: comparison of medical and interventional treatment.

To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non-cirrhotic, non-malignant portal vein thrombosis (PVT). This prospective, observational study enrolled 65 patients with acute (<28days since begin of symptoms, no cavernoma) PVT in nine centres. Thirty patients received medical treatment and 35 patients received interventional treatment. PVT was graded into grade 1: short thrombosis and incomplete occlusion of the vessel lumen and grade 2: extended thrombosis or complete occlusion. Treatment response was classified as partial or complete, if thrombosis was reduced by one grade or to <25% of the vessel diameter respectively. Partial and complete response rates were 7% and 30% in the medical compared to 17% and 54% (P<0.001) in the interventional treatment group. In the multivariate analysis, interventional treatment showed a strong positive (OR 4.32, P<0.016) and a myeloproliferative aetiology a negative (OR 0.09, P=0.006) prediction of complete response. Complications were rare in the medical group and consisted of septicaemia and upper gastrointestinal bleeding of unknown origin in one patient each. Interventional treatment was accompanied by mild and self-limiting bleeding complications in nine patients, moderate intra-abdominal bleeding requiring transfusions (2 units) in one patient and peritoneal bleeding requiring surgical rescue in one patient. Four patients in each group developed intestinal gangrene requiring surgery. One patient died 52days after unsuccessful interventional treatment. Compared to medical treatment alone, interventional treatment doubled response rates at the cost of increased bleeding complications.

STADE-HF (sST2 As a help for management of HF): a pilot study.

AimsBiomarkers are not recommended until now to guide the management of patients with heart failure (HF). Soluble suppression of tumorigenicity 2 (sST2) appears as a promising biomarker. The current study considered pre‐discharged sST2 values as a guide for medical management in patients admitted for acute HF decompensation, in an attempt to reduce hospital readmission.Methods and resultsSTADE‐HF was a blinded prospective randomized controlled trial and included 123 patients admitted for acute HF. They were randomized into the usual treatment group (unknown sST2 level) or the interventional treatment group, for whom sST2 level was known and used on Day 4 of hospitalization to guide the treatment. The primary endpoint was the readmission rate for any cause at 1 month. It occurred in 10 patients (19%) in the usual group and 18 (32%) in the sST2 group without statistical difference (P = 0.11). Post hoc analysis in the whole group shows that the mean duration of hospitalization was lower in patients with low sST2 (<37 ng/mL) at admission vs. high sST2 (8.5 ± 9.5 vs. 14.8 ± 14.9 days, respectively, P = 0.003). In addition, a decrease in sST2 greater than 18% is significantly associated with a lower readmission rate.ConclusionsSoluble suppression of tumorigenicity 2‐guided therapy over a short period of time does not reduce readmissions. However, sST2 was clearly associated with duration of hospitalization, and the decrease in sST2 was associated with decreased rehospitalizations. Long‐term outcome using sST2‐guided therapy deserves further investigations.

STADE-HF: A Titration based on sST2 is safe but failed to decrease readmissions in patients admitted for acute heart failure

Heart failure is a leading cause of hospitalization, morbidity and mortality. Treatments are not up-titrated for all patients because of adverse effects. Strategies to better discriminate patients who may benefit most from titration are needed to improve the benefit-risk balance. Soluble suppression of tumorigenicity-2 (sST2) is a new prognostic biomarker of heart failure. Patients with a high baseline sST2 levels could benefit the most from cardioprotective treatments. The current study considered sST2 value as a guide for medical management in patients admitted for acute HF decompensation, in an attempt to minimize hospital readmission. STADE-HF (sST2 As a help for management of Diagnosis, Evaluation and management of HF) was a blinded prospective randomized controlled trial and included 123 patients admitted for heart failure between January 2017 and August 2018 for acute HF. There were randomized into 2 groups: Usual treatment group, in which patient's sST2 level was unknown, and interventional treatment group, for whom sST2 level was known and used on day 4 of hospitalization for guide the treatment. The main clinical endpoint was the readmission rate for any cause at 1 month. The primary endpoint of readmission during the first month follow-up was observed in 28 patients (25%); 10 patients (19%) in the usual group, and 18 (32%) in the sST2 group without statistical difference ( P = 0.11). The mean duration of hospitalization was lower in patients with low sST2 (< 37 ng/mL) at admission (8.5 ± 9.5 days vs. 14.8 ± 14.9 days when sST2 > 37 ng/mL, P = 0.003). The STADE-HF study failed to decrease readmissions for patients admitted for acute HF. A long-term follow-up is conducted to evaluate the effect on cardiovascular hospitalization and mortality at one year after index hospitalization.

Isolated superior mesenteric artery dissection: CTA features and clinical relevance.

To determine the detailed computed tomography angiography (CTA) features of isolated superior mesenteric artery dissection (ISMAD), aiming to improve the current understanding of ISMAD. We retrospectively analyzed 57 patients with confirmed diagnoses of ISMAD with CTA from June 2011 to June 2018 in our hospital. The superior mesenteric artery (SMA) angle, entry site of dissection, and features of both false and true lumen were analyzed individually. In general, middle-aged men with atherosclerosis (42.1%), hypertension (35.3%), or long-term smoking (33.3%) were the main populations. 80.7% of patients can be discharged successfully after conservative treatment. 87% of patients had a right (or almost right) SMA angle, and the entry site of dissection in 90% of patients occurred in the curved segment of the SMA. As a polymorphic disease, we can use the coded CTA features to delineate individual cases, including cases beyond the presenting classification systems. The diameter of the true lumen is the only different CTA feature between the conservative treatment group and the interventional treatment group (p = 0.000). The re-entry site (p = 0.501), thrombosis in the false lumen (p = 0.135), the distance between the entry site of dissection and SMA root (p = 0.133), and SMA branch involvement (p = 0.322) had no difference between the 2 groups. Based on CTA analysis, the bending area, especially in the SMA with right or nearly right SMA angle, is the most vulnerable anatomical region for the occurrence of ISMAD. The diameter of true lumen is the determined CTA feature for the decision of treatment. CTA should be recommended as a standardized diagnostic and classification tool for ISMAD.

The Relationship Between Renal Artery Involvement in Stanford B-Type Aortic Dissection and the Short-Term Prognosis: A Single-Centre Retrospective Cohort Study

Renal artery involvement has not received sufficient attention despite the fact that aortic computed tomography angiography (CTA) examinations of Stanford B-type aortic dissection patients usually show renal artery involvement [3]. To study the influence of renal artery involvement on aortic dissection, we performed a retrospective study on acute Stanford B-type aortic dissection patients with or without renal artery involvement to investigate its effect on the prognosis of aortic dissection. A total of 221 patients with acute Stanford-B type aortic dissection between January 2012 and January 2014 were enrolled. The patients were divided into a renal artery involvement group and a non-renal artery involvement group based on aortic computed tomography angiography (CTA) results. The clinical data of the two groups were compared. Univariate analyses and multiple logistic regression analyses were performed to determine risk factors related to in-hospital mortality. The effect of renal artery involvement on the prognosis of Stanford B-type aortic dissection patients was analysed. Among the 221 patients with acute Stanford type-B aortic dissection, 100 patients (45.2%) exhibited renal artery involvement. The percentage of patients with a past history of hypertension in the renal artery involvement group was significantly higher than that in the non-renal artery involvement group (84.0% vs. 74.8%, p=0.025). The estimated glomerular filtration rate (eGFR), creatinine level, and urea nitrogen level at admission were not significantly different between the renal artery involvement group and the non-renal artery involvement group. The in-hospital mortality rate in the renal artery involvement group was higher than that in the non-renal artery involvement group; the difference in the percentage of in-hospital mortality between these two groups was statistically significant (12.0% vs. 4.1%, p<0.05). The results of multiple logistic regression analysis showed that renal artery involvement was a risk factor for in-hospital mortality in acute Stanford B-type aortic dissection patients (odds ratio (OR)=3.536 (1.127∼11.095)). In the renal artery involvement group, the in-hospital mortality rate in the conservative treatment group was significantly higher than that in the interventional treatment group (30.8% vs. 5.4%, p=0.001). Although renal artery involvement was not associated with short-term renal function damage, it was a risk factor for in-hospital mortality after acute Stanford B-type aortic dissection.

Residual Cardiovascular Risk—Is Inflammation the Primary Cause?

Every cardiovascular clinical trial that has examined the beneficial effects of lowering LDL cholesterol to prevent cardiovascular events has demonstrated residual cardiovascular risk in the interventional treatment group. Residual risk is the term applied to the cardiovascular events (e.g., myocardial infarction, stroke, and cardiovascular death) that occur in spite of being on “optimal” medical therapy. This term is usually applied to secondary intervention studies, i.e., lipid lowering treatments in subjects who have already had at least one cardiovascular event. Studies that described residual risk have attributed it, at least in part, to the fact that the LDLc has not been lowered sufficiently to stop atherosclerotic plaque formation and rupture into the arterial lumen. However, a recent cardiovascular intervention clinical trial which achieved a very low group median LDLc of 30 mg/dl still demonstrated significant residual risk. Of more importance to reducing residual risk may be addressing the ongoing inflammation in the coronary arteries that results in cellular liberation of cytokines and proteases that attack the atherosclerotic plaque’s fibrous cap. Recent studies have shown that inflammation may act independently of LDL to cause cardiovascular events. This article provides evidence that inflammation is the primary cause of residual risk and will need to be treated as aggressively as LDL lowering if CVD events in the post treatment period are to be significantly reduced. Addressing major risk factors including obesity, diabetes, smoking, hypertension and hyperlipidemia are critical to reducing inflammation. Statins and aspirin are the mainstay medications to reduce ongoing inflammation. However, newer pharmaceuticals may also be required to reduce inflammation to undetectable levels. Targeting inflammation to eradicate residual cardiovascular risk will be the next therapeutic challenge facing primary care physicians.

Use of Percutaneous Aspiration Thrombectomy vs. Anticoagulation Therapy to Treat Acute Iliofemoral Venous Thrombosis: 1-year Follow-up Results of a Randomised, Clinical Trial

The purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy (PAT) followed by standard anticoagulant therapy, with anticoagulation therapy alone, for the treatment of acute proximal lower extremity deep vein thrombosis. In this randomised, prospective study, 42 patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination, were separated into an interventional treatment group (16 males, 5 females, average age 51years) and a medical treatment group (13 males, 8 females, average age 59years). In the interventional group, PAT with large-lumen 9-F diameter catheterisation was applied, after initiation of standard anticoagulant therapy. Balloon angioplasty (n 19) and stent implementation (n: 14) were used to treat patients with residual stenosis (>50%) after PAT. Prophylactic IVC filters were placed in two patients. The thrombus clearance status of the venous system was evaluated by venography. In both the medical and interventional groups, venous patency rates and clinical symptom scores were evaluated at months 1, 3, and 12 after treatment. Deep venous systems became totally cleared of thrombi in 12 patients treated with PAT. The venous patency rates in month 12 were 57.1 and 4.76% in the interventional and medical treatment groups, respectively. A statistically significant improvement was observed in clinical symptom scores of the interventional group (PAT) with or without stenting (4.23±0.51 before treatment; 0.81±0.92 at month 12) compared with the medical treatment group (4.00±0.63 before treatment; 2.43±0.67 at month 12). During follow-up, four patients in the medical treatment and one in the interventional group developed pulmonary embolisms. For treatment of acute deep vein thrombosis, PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. PAT is a safe, inexpensive, and easily performed method of endovascular treatment with a low rate of major complications. Our present findings and literature data suggest that PAT can be used as first-line treatment in proximal deep vein thrombosis patients, especially when thrombolytic treatment is contraindicated.

In Reply

We thank Dr. Harper for his comments and interest on our recent study published in Anesthesiology.1We fully agree with the author that complete compliance with the enhanced recovery after surgery recommendations would have involved absence of mechanical bowel preparation (MBP) in left-sided colonic surgery. Nevertheless, the largest systematic review on the role of MBP in colonic surgery (including approximately 5,000 patients) failed to demonstrate harmful effects of MBP in terms of anastomotic leakage.2 In addition, two large-scale randomized controlled trials3,4 suggested more deep intraabdominal abscesses in the absence of MBP and a significant benefit in patients who had MBP. It has also been shown that preoperative MBP is useful when intraoperative colonoscopy is required to precisely locate small tumors. Finally, although MBP has adverse physiologic effects attributed to dehydration, omission of preoperative fasting and use of individualized goal-directed fluid administration may easily and effectively compensate for this.We respectfully disagree with the author when stated that midline incision may not represent current daily for colorectal surgery. To the best of knowledge, current recommendations do not advocate use of transverse or oblique incisions for open colorectal surgery. Since the publication of the Cochrane review, the Postsurgical Pain Outcome of Vertical and Transverse Abdominal Incision randomized controlled trial5 has shown no relevant difference in pain scores and postoperative morbidity between incision types after major abdominal procedures, whereas more wound infections were seen after transverse incisions. Although problematic, these concerns are not the most important ones. Indeed, as a possible clinical benefit of wound catheters placement in oblique and/or transverse incisions has never been explored during colorectal surgery, any comparison between continuous wound analgesia, as an interventional treatment group in this setting, and epidural analgesia would have been only speculative.Until more thorough studies addressing the question have been carried out, our opinion is that there is no sufficient evidence to shift from epidural analgesia to continuous wound infiltration of local anesthetics in elective open colorectal surgery. We are convinced that the soon-to-be-published Dr. Harper’s study will help provide answers to the many remaining questions regarding the optimal analgesic regimen in open colorectal surgery.

Combination chemotherapy of gemcitabine and cisplatin by double way plus implantation of radioactive seed 125I in treating stage III non-small cell lung cancer

Objective To assess the therapeutic effect of combination chemotherapy of gemcitabine and cisplatin by double way plus implantation of radioactive seed 125I implantation in treating stage Ⅲ non-small cell lung cancer. Methods Sixty cases with stage Ⅲ non-small cell lung cancer were randomly divided into two groups with random number table. In group A (in interventional treatment group, n = 30),the gemcitabine 1000 mg/m2 and one third of the cisplatin 100 mg/m2 was given using seldinger technique for transcatheter bronchial arterial infusion chemotherapy on day 1. Two-thirds of the cisplatin 100 mg/m2 was infused in veins on day 2 and 3. The gemcitabine 1000 mg/m2 was infused in veins on day 8, 21 days for a period. In group B (interventional - 125I groups), the method of combination chemotherapy of gemcitabine and cisplatin was the same as in Group A. After ten days of arterial perfusion, 125I seeds were implantated, 21 days for a period. All patients received at least 2 cycles. The imaging evaluation of patients after treatment standards included complete remission (CR), partial remission (PR), stable (SD),progressive disease (PD), effective rate (CR + PR)/30 and clinical benefit rate (CR + PR + SD)/30.Non-parametric rank sum test was used to compare short-term effect of the two groups treatment of two cycles.x2 test was used to compare year survival, Kaplan-Meier method was used to calculate median survival,log-rank test method was used to difference between the groups. Results In group A, there were 17 PR,9SD and 4 PD. The overall response rate was 56. 7% (17/30) and clinical beneficial rate was 86. 7% (26/30). In Group B, there were 2 CR, 21 PR, 7 SD. The overall response rate was 76.7% (23/30) and clinical beneficial rate was 100% (30/30). There was significant difference between the two groups (P =0. 036). In group A, the 1 year survival rate was 46. 7% (14/30) and the 2 year survival rate was 36. 7%(11/30), median survival time (MST) was 10 months . In group B, the 1 year survival rate was 76. 7%(23/30) and the 2 year survival rate was 63. 3% (19/30) , median survival time (MST) was 27 months.There was a significant difference between two group in 1 year survival rate (P = 0. 017), 2 year survival rate (P = 0. 039) and median survival time (P = 0. 006). Conclusion The treatment effects of Ⅲ stage non-small cell lung cancer by gemcitabine and cisplatin combination chemotherapy with double way plus radioactive seed 125I implantation was better than gemcitabine and cisplatin combination chemotherapy with double way. Key words: Carcinoma,non-small-cell lung; Radiology,interventional; Iodine isotopes

Efficacy of Transcatheter Arterial Infusion Alone or Combined with Transcatheter Arterial Chemoembolization on Advanced Hepatocellular Carcinoma

Objective: Interventional therapy for advanced hepatocellular carcinoma (HCC) is still controversial. This retrospective study was to evaluate the efficacy of transcatheter arterial infusion (TAI) alone or combined with transcatheter arterial chemoembolization (TACE) on advanced HCC. Methods: The study population consisted of 132 advanced HCC patients with Child-pugh A/B. Tumor in all patients was involved with main trunk of portal vein and/or inferior vena cava, or local lymph node metastasis, or distant metastasis. TAI alone or combined with TACE were performed in 65 patients with advanced HCC (interventional treatment group), 67 patients were treated with traditional Chinese herbal drug (Chinese herb group). The prime end point was overall survival (OS), and prognostic factors were analysed. Results: The median OS was 205 days [95% confidence interval (CI), 155-255 days] in interventional treatment group and 127 days (95% CI, 70-184 days) in Chinese herb group (P <0.05). The 6-month, 1-year, and 2-year OS rates were 58.9%, 29.1%, 7.7% in interventional treatment group, and 33.3%, 12.3%, 1.8% in Chinese herb group. The portal vein thrombosis, ECOG performance status were independent prognostic factors for OS. Conclusion: Interventional treatment could greatly prolong the OS of advanced HCC patients.

Percutaneous Treatment of Varicocele with Microcoil Embolization: Comparison of Treatment Outcome with Laparoscopic Varicocelectomy

Successful treatment of a testicular varicocele, which can result in scrotal pain and swelling as well as male subfertility, can be accomplished via operative ligation of the varicocele or interventional treatment with coil embolization of the testicular vein. This study compared the treatment outcome of percutaneous embolization treatment versus laparoscopic varicocelectomy in patients with symptomatic varicoceles. Patients with varicoceles undergoing either laparoscopic varicocelectomy or percutaneous coil embolization of the testicular vein during a recent 5-year period were analyzed. Treatment outcome and hospital costs of these two minimally invasive treatment modalities were compared. Forty-one patients underwent percutaneous coil embolization of the testicular vein, which were compared with a cohort of 43 patients who underwent laparoscopic varicocelectomy. Technical success in interventional and laparoscopic treatment was 95% and 100%, respectively. The mean operative time or procedural time was 63 +/- 13 minutes and 52 +/- 25 minutes for interventional and laparoscopic cohorts (not significant), respectively. Embolization treatment resulted in two recurrent varicoceles (4.8%) compared to one patient following laparoscopic repair (2.3%, not significant). Embolization treatment was associated with a lower complication rate than laparoscopic repair (9.7% vs 16.3%, p = .03). Regarding cost analysis, no significant difference in hospital cost was noted between the interventional or laparoscopic treatment strategies. Both laparoscopic varicocelectomy and coil embolization are effective treatment modalities for varicoceles. With lower treatment complication rates in the interventional treatment group, coil embolization of the testicular vein offers treatment advantage compared with laparoscopic repair in patients with varicoceles.

Research of β-elemene interventional treatment on VX2 carcinoma transplanted on kidney in rabbits

To investigate the curative effect and mechanism of beta-elemene interventional treatment on VX2 carcinoma transplanted on kidney in rabbits. The rabbits were all transplanted with VX2 carcinoma on kidney. Fifty-five rabbits were randomly divided into 11 groups. Rabbits in these groups were administered interventional treatment of normal saline, iodinated oil, mitomycin, 5-fluorouracil, beta-elemene, cisplatin, carboplatin, adriamycin, thiotepa, cyclophopsphamide, and vincristine, respectively. After corresponding intervention, the tumor volume in each group was measured by ultrasonography and spiral computed tomography, and the tumor growth rate (TGR) was calculated. Nenal and hepatic functions of the rabbits in each group were compared 1 day, 7 and 14 days after the interventional treatment. Morphologic change of the tumor was observed by a light microscopy and a transmission electron microscopy 14 days after interventional treatment. The expressions of Bax and Bcl-2 were measured by immunohistochemical straining. There was statistical significance in the effects of different medicines intervened on VX2 kidney transplanted carcinoma. The VX2 carcinoma of rabbits had high-sensitivity to iodized oil embolism, mitomycin, cisplatin and carboplatin, which showed serious damage to the kidney function, medium-sensitivity to beta-elemene, adriamycin and 5-fluorouracil, in which beta-elemene showed slight damage to the kidney function, and resistance to thiotepa, cyclohosphamide and vincristine. Most tumor cells displayed apoptosis in the beta-elemene interventional treatment group under light microscopy and transmission electron microscopy, and only few tumor cells displayed necrosis. The Bax expression was up-regulated (P<0.05) and the Bcl-2 expression had no significant difference (P>0.05) in the beta-elemene interventional treatment group. Intervention treatment of beta-elemene has significant effect on VX2 kidney transplanted carcinoma and little side effect on the kidney function. Its mechanism is related to enhancing the apoptosis of tumor cells, and Bax gene participates in this action.

Inflammation and Chlamydia pneumoniae Infection Correlate with the Severity of Peripheral Arterial Disease

Background Our aim was to investigate the association of inflammation and Chlamydia pneumoniae infection with the presence and severity of peripheral arterial disease. Methods Twenty-eight patients whose initial claudication distance (ICD) in the traditional constant-load treadmill test was <200 m, underwent femoral endarterectomy as part of their interventional treatment (group A). Group B consisted of 23 patients whose ICD was >200 m and were put on medication and a daily exercise program. The control group consisted of 30 non-vascular patients of the Ophthalmology Department (group C). We measured the levels of C-reactive protein, fibrinogen, vascular cell adhesion molecule-1 and tumor necrosis factor-α, and the titers of IgA and IgG antibodies against C. pneumoniae in the serum of all the patients. Finally, the atheromas and vein segments of group A patients, were immunohistochemically (IHC) examined for the presence of C. pneumoniae. Results Peripheral arterial disease (PAD) patients, had significantly higher CRP (p=0.026) and anti-Cp IgA levels (p=0.001) when compared to control subjects, after a multiple linear regression analysis. The odds ratio for the prevalence of femoral atherosclerosis was 3.16 for IgA seropositive patients (CI 1.15–8.67). When comparing group A and group B patients, CRP (p=0.003) and IgA (p=0.011), were significantly correlated with severe PAD. Group A patients with positive immunohistochemical examination of the plaque, had higher anti-Cp IgA levels (p=0.023) and TNF-α values (p=0.031), compared to the IHC negative patients. C. pneumoniae was detected in 50% of the femoral atheromas, but in only 3.6% of the veins. Conclusion This study supports the hypothesis that inflammation (CRP) and chronic C. pneumoniae infection (IgA seropositivity), have an important role in lower limb atherosclerosis and correlate with the severity of the disease.