Percutaneous Catheter Research Articles

Imaging and Interventions for Lymphatic and Lymphatic-related Disorders.

The lymphatic system is critical in fluid balance homeostasis. Yet, until recently, lymphatic imaging has been outside of mainstream medicine due to a lack of robust imaging and interventional options. However, during the last 20 years, both clinical lymphatic imaging and interventions have shown dramatic advancement. The key to imaging advancement has been the interstitial delivery of contrast agents through lymphatic-rich tissues. These techniques include intranodal lymphangiography and dynamic contrast-enhanced MR lymphangiography. These methods provide the ability to image and recognize lymphatic anatomy and pathologic conditions. Percutaneous thoracic duct catheterization and embolization became the first widely accepted interventional technique for the management of chyle leaks. Advances in interstitial lymphatic embolization, as well as liver and mesenteric lymphatic interventions, have broadened the scope of possible lymphatic interventions. Also, recent techniques of lymphatic decompression allow for the treatment of a variety of lymphatic disorders. Finally, immunologic studies of central lymphatic fluid reveal the potential of lymphatic interventions on immunity. These advances herald an exciting new chapter for lymphatic imaging and interventions in the coming years.

A novel mini-invasive step-up approach for the treatment of severe acute pancreatitis with extensive infected necrosis: A single center case series study.

Complete removal of necrosis is critical for treating patients with severe acute pancreatitis (SAP) presenting infection of pancreatic necrosis (IPN). Frequently used mini-invasive methods include the surgical step-up approach suitable for necrosis extending laterally, whereas the endoscopic step-up approach is suitable for medial necrosis. However, in patients with extensive IPN, either approach alone usually has limited treatment effects. We describe a case series of combined mini-invasive step-up approach for treating extensive IPN. Patients were diagnosed with SAP and had extensive IPN. Seven patients with SAP and extensive IPN were enrolled. All patients underwent a combined step-up approach comprising 4 steps: percutaneous catheter drainage, continuous negative pressure irrigation (CNPI), percutaneous endoscopic necrosectomy (PEN), and transgastric necrosectomy (TN). The median interval from symptom onset to percutaneous catheter drainage and CNPI was 11 days (range, 6-14) and 18 days (range, 14-26), and the median CNPI duration was 84 days (range, 54-116). The median interval from the onset of symptoms to PEN and TN was 36 days (range, 23-42) and 41 days (range, 34-48), respectively, and the median number of procedures was 2 (range, 1-2) for PEN and 3 (range, 2-4) for TN. Only a minor case of abdominal bleeding and a pancreatic-cutaneous fistula were reported, both resolved after conservative treatment. The median length of stay in the intensive care unit was 111 days (range, 73-133); all patients survived. This mini-invasive step-up approach shows promising clinical effects and is relatively safe in critically ill patients with extensive IPN and high-risk surgical intervention.

Different modalities of management of liver abscess

Background: Liver abscess is an acute suppurative infectious disease of liver parenchyma which may be pyogenic, amoebic or tubercular. It can occur due to direct blood spread through enterohepatic circulation or due to ascending infection occurring through biliary tree. Aim was to evaluate effectiveness of various management strategies in the management of liver abscess. Methods: It is a prospective study carried out in 100 patients of age 12-80 years between 1st December 2021 to 31st May 2022 who presented to general surgery department and diagnosed with liver abscess. Results: 10% cases were treated conservatively with antibiotics only, 59% cases were treated with percutaneous needle aspiration, 21% patients were treated with percutaneous pigtail catheter drainage, 10% cases were treated with open surgical drainage. Conclusions: Liver abscess with size less than 5 cm or 50 cc can be managed conservatively but liver abscess with size >5 cm need intervention.

Using a Catheter for Hemodialysis Placed in the Inferior Vena Cava for the First Time in N. Macedonia - Translumbar Approach.

Maintenance of vascular access for hemodialysis remains a challenge for every doctor. Exhausted conventional vascular access is the cause for the placement of the central venous catheter in unconventional sites such as enlarged collateral vessels, hepatic veins, hemiazygos, azygos, renal veins, and the inferior vena cava. The percutaneous translumbar catheter for hemodialysis in the inferior vena cava was described over 20 years ago. In this article, we report on the procedure and complications arising from the percutaneous translumbar approach of a hemodialysis catheter. This was done for the first time in N. Macedonia. This approach is a potential option in adults and children when conventional approaches are limited.

Levofloxacin impregnation and extended release: Concentration model for insulin catheters

Increasing the lifetime of percutaneous insulin delivery catheters to minimize painful needle sticks increases the risk of infection. To combat surface-adherent bacteria and potential biofilm formation, we developed a method to impregnate levofloxacin antibiotic into the outer polymer of the catheter so that it can leach into the external medium. Complementarily, we developed a method to quantify the concentration of antibiotic to ensure the minimum inhibitory concentration (MIC) is maintained throughout the duration of catheter use. Additionally, we have investigated the extent of antibiotic resistance after a zwitterionic nonfouling coating treatment to ensure suitable release after further surface modification. Levofloxacin was incorporated into the catheter through the swelling of the outer polyurethane of the bilayer catheter and subsequent solvent evaporation. The zone of inhibition was measured over time with S. epidermidis on LB agar plates. The release of levofloxacin was measured using optical absorbance spectroscopy in water and quantified against a linear standard curve at 292 nm. We developed a model using Fick's second law of diffusion to calculate the concentration around the catheter. Visible inhibition of bacterial growth and biofilm formation was shown for up to 38 days. A total of 8–45 µg of antibiotic was released over 26 days and a concentration of 820,000 µg/mL in the 0.17 µL control volume was reached at day 26 for the minimally-loaded samples, an amount many orders of magnitude greater than the MIC. After the nonfouling treatment, the lowest concentration reached was 16 µg/mL after 26 days. In conclusion, we have demonstrated a suitable method to induce antibacterial activity for insulin catheters, maintain the MIC, and sustain antibacterial character following further surface coatings.

Percutaneous catheter drainage versus needle aspiration for liver abscess management: an updated systematic review, meta-analysis, and meta-regression of randomized controlled trials.

Liver abscess is a life-threatening condition. Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) are both minimally invasive techniques used to manage liver abscess. We aim to compare both techniques' efficacy and safety. We performed a systematic review and meta-analysis involving randomized controlled trials (RCTs) from PubMed, Embase, Scopus, WOS, Cochrane, and Google scholar until July 22nd, 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol with ID: CRD42022348755. We included 15 RCTs with 1,626 patients. Pooled RR favored PCD (RR: 1.21 with 95% CI: 1.11, 1.31, P<0.00001) in success rate and recurrence after six months (RR: 0.41 with 95% CI: 0.22, 0.79, P=0.007). We found no difference in adverse events (RR: 2.2 with 95% CI: 0.51, 9.54, P=0.29). Pooled MD favored PCD in time to clinical improvement (MD: -1.78 with 95% CI: -2.50, -1.06, P<0.00001), time to achieve 50% reduction (MD: -2.83 with 95% CI: -3.36, -2.30], P<0.00001) and duration of antibiotic needed (MD: -2.13 with 95% CI: -3.84, -0.42, P=0.01). We found no difference in the duration of hospitalization (MD: -0.72 with 95% CI: -1.48, 0.03, P=0.06). The results were heterogeneous for all the continuous outcomes which were all measured in days. Our updated meta-analysis concluded that PCD is more effective than PNA in liver abscess drainage. However, evidence is still uncertain, and more high-quality trials are still required to confirm our results.

The mystery of post-cholecystectomy persistent bile leak: a case report.

Laparoscopic cholecystectomy (LC) is commonly performed for benign gallbladder diseases. Biliary leak is the most common complication of bile duct injury following this surgery. We report a case of persistent bile leak following the procedure despite endoscopic and radiological management. A female patient presented to the hepatopancreatobiliary unit of the Bahria International Hospital (Orchard), Lahore, with complaint of persistent bile leakage after laparoscopic cholecystectomy performed elsewhere. She had been investigated in various hospitals but the cause of the persistent bile leak remained a mystery and she was offered surgery. After real time fluoroscopic contrast enhanced imaging, further confirmed by a Computerised Tomography (CT) Scan of the abdomen, it was revealed that the persistent bile leak in the drain was due to iatrogenic injury of the duodenum secondary to percutaneous catheter insertion. The patient was managed non-surgically. She remained stable. This is a rare complication of one of the most common surgical procedures performed in the world.

A Record based Analysis of Percutaneous aspiration Versus Pigtail catheter drainage in the management of Liver abscess at a tertiary care centre in Mandya

A Record based Analysis of Percutaneous aspiration Versus Pigtail catheter drainage in the management of Liver abscess at a tertiary care centre in Mandya

ROLE OF 128 SLICE MDCT IN PANCREATIC TRAUMA DIAGNOSIS AND MANAGEMENT

Aims and Objectives:This study aimed to detail how multi-detector computed tomography (MDCT) can be utilised to the study diagnosis of pancreatic trauma and its management. Material and Methods:This Hospital-based prospective study was carried out over 10 months from December 2020 to SEP 2021 at the Department of Radiodiagnosis, Narayana medical college, Nellore. 30 patients with pancreatic injury were included in study. All patients underwent Contrast enhanced computed tomography abdomen on128 slice CT(GE OPTIMA 660).Grading of pancreatic injury done using American Association for the surgery of trauma organ injury scale .One patient underwent MRI abdomen and MRCP. 20 patients are treated conservatively. 10 out of 30 patients underwentsurgery.Intraoperative findings noted. Results: 1. According to American Association for the surgery of trauma organ injury scale 19/30 patients are of grade I &amp;grade II injury. 6/30 in grade III and 5/30 were grade IV injuries. 2. Grade I &amp;II patients were managed conservatively and improved remarkably on followup. 3. Grade III&amp;IV patients underwent surgery and CT findings are confirmed intraoperatively. 4. 6 patients with grade III injury undergone Distal pancreatectomy + Splenectomy and 4 patients undergone Spleen preserving Distal Pancreatectomy. 5. Grade IV patients initially managed conservatively in which 4 patients developed pseudocyst they were treated with cystogastrostomy and one patient developed fistula .This fistula was initially controlled with Percutaneous catheter drainage followed by roux -en- y fistulojejunostomy. Conclusion: 1. CT represents an accurate tool for diagnosing pancreatic trauma, it provides useful information to plan therapeutic approach .

Abstract No. 56 Comparing Outcomes of Percutaneous Biliary Drainage Catheters in Right versus Left Hepatic Approaches

Determine if there is a difference in complications associated with right or left hepatic percutaneous biliary drain placement in patients with benign or malignant biliary etiology. This retrospective study included patients with benign or malignant biliary stricture and treated with percutaneous biliary drainage at a single institution from 7/28/2004 to 3/30/2021. Three hundred fifty-seven patients met inclusion criteria, seventy-seven on the left and two hundred and eighty on the right, with a mean age of 65.1 years. Complications associated with the initial drain placement or during subsequent intervention were collected and categorized. Perioperative complications included surgery, infection, hemorrhage, and drain failure. Complications during treatment with a percutaneous biliary drain included death, chills, catheter displacement, cholangitis, biliary stones, drain malfunction, fever resolving without treatment, and pericatheter leakage. Complications were also grouped as major or minor. Statistical analyses were performed using logistic regression analysis and P values less than 0.05 were considered significant. Major interventional and treatment complication rates showed no statistical significance between left and right drains. The rate of minor interventional and treatment complications also showed no statistical significance between right and left drains. However, when cholangitis was analyzed individually, right sided hepatobiliary drains demonstrated a statistically significant increase in complication rates. Current literature describes safety of right biliary drain placement when compared with left, despite current equivocal study analyses. This large group analysis describes no statistically significant difference in complications between right and left hepatobiliary drains aside from slightly higher incidence of cholangitis for right sided drains.

The mystery of post-cholecystectomy persistent bile leak: a case report

Laparoscopic cholecystectomy (LC) is commonly performed for benign gallbladder diseases. Biliary leak is the most common complication of bile duct injury following this surgery. We report a case of persistent bile leak following the procedure despite endoscopic and radiological management. A female patient presented to the hepatopancreatobiliary unit of the Bahria International Hospital (Orchard), Lahore, with complaint of persistent bile leakage after laparoscopic cholecystectomy performed elsewhere. She had been investigated in various hospitals but the cause of the persistent bile leak remained a mystery and she was offered surgery. After real time fluoroscopic contrast enhanced imaging, further confirmed by a Computerised Tomography (CT) Scan of the abdomen, it was revealed that the persistent bile leak in the drain was due to iatrogenic injury of the duodenum secondary to percutaneous catheter insertion. The patient was managed non-surgically. ---Continue

Discussion on operation: To compare the curative effect of PMT and CDT in the treatment of middle and high risk stratified APE and the clinical application value of serum BNP, TnI and plasma DFR levelse.

To compare the efficacy of Percutaneous mechanical thrombectomy (PMT) and Catheter directed thrombolysis (CDT) in the treatment of patients with moderate and high-risk ape and explore the clinical application value of biomarkers in the treatment of moderate and high-risk ape. A total of 84 patients with ape were selected from the Department of vascular surgery of the Second Affiliated Hospital of Shandong First Medical University and the Department of vascular surgery of Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine. According to the relevant guidelines, they were divided into high-risk and medium-risk groups, including PMT groups (35 cases) and CDT groups (49 cases). To detect the changes of serum B-type brain natriuretic peptide (BNP),Troponin I (TnI) and plasma D-dimer/fibrinogen ratio (DFR) levels in different risk stratification before and after PMT and CDT, the correlation and diagnostic value of each index, and compare the thrombus clearance rate, pulmonary artery pressure, average dosage of urokinase, effective thrombolytic time, average hospitalization time and complications of PMT and CDT. Under different treatment methods and risk stratification, there was no statistically significant difference in the clinical data of patients at general baseline;The preoperative BNP, TnI and DFR levels of PMT and CDT in the middle and high risk stratification were significantly lower than those in the other groups (P < 0.005),Compared with the CDT group, PMT has significantly better therapeutic effect on ape than the CDT group in terms of thrombus clearance rate, pulmonary artery pressure, average dosage of urokinase, effective thrombolytic time and average hospitalization time (P < 0.05),meanwhile,there was no significant difference in postoperative complications between the two groups (P < 0.05). After half a year of follow-up, the levels of BNP, TnI and DFR in the cured group were significantly lower than those in the effective group and the ineffective group. The areas under the curve of serum BNP, TnI and plasma DFR were 0.91, 0.87 and 0.93 and the area under the curve DFR has higher diagnostic efficiency than BNP and TnI, while the sensitivity and specificity of TnI are significantly higher than BNP and DFR. Serum BNP, TnI and plasma DFR levels can reflect the risk stratification and better clinical diagnostic value of ape,PMT and CDT are used to treat high-risk ape. For hospitals with medical conditions, PMT is more worthy of clinical recommendation.

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

ObjectiveAssessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management...

COMPARISON OF THE MODIFIED CT SEVERITY INDEX WITH THE CT SEVERITY INDEX FOR THE ASSESSMENT OF ACUTE PANCREATITIS SEVERITY

Introduction: Acute pancreatitis (AP) is a frequent, mild, self-limiting condition with only minor or temporary systemic symptoms. In the evaluation of AP, imaging by CT or MRI is helpful for diagnosis as well as for identifying regional pancreatic problems and directing interventional therapies. A retrospective analysis of a prospectively collected database Material and methods: was performed. The demographic, clinical, and laboratory data of the 40 cases of acute pancreatitis in patients were reviewed for this study. 40 patients underwent CECT or MRI within 1 week of onset of symptoms. A single radiologist performed imaging studies and recorded all pancreatic, peripancreatic, and extrapancreatic ndings and complications. According to CTSI, the number of patients with mild moderate and Results: severe disease were 19, 14 and 7 respectively; According to MCTSI, the number of patients with mild, moderate and severe disease were 7, 18, 15 respectively. Mean length of hospital stay and ICU stay was 4.48±2.03 and 1.7±2.11 respectively. Both the scoring systems more accurately correlated with the length of ICU stay, organ failure and necrosectomy and accurately correlated with infection and percutaneous catheter drainage. MCTSI showed superior and better Conclusion: correlation with disease severity than CTSI. There was statistical signicant association noted with CTSI and MCTSI each with the severity parameters and outcome assessed.

Embolização percutânea de fístulas arteriovenosas pulmonares

Pulmonary arteriovenous malformation is an abnormal communication between an artery and a vein, causing clinical manifestations, such as chronic hypoxemia and embolic events. Arteriovenous malformations were treated surgically, with a significant rate of complications. In the 1970 ́s, the first percutaneous catheter embolization was performed with coils. We describe three cases in which percutaneous embolization techniques were effective to prevent embolic, hemorrhagic, and hypoxemic events in the follow-up of patients.

Cinematic Rendering of Acute Myocardial Infarction.

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyCinematic Rendering of Acute Myocardial InfarctionXiaoqing Ding , Zhigang GongXiaoqing Ding , Zhigang GongAuthor AffiliationsFrom the Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No 528, Zhangheng R. Pudong New Area, Shanghai, 201203, China.Address correspondence to X.D. (email: [email protected]).Xiaoqing Ding Zhigang GongPublished Online:Jan 31 2023https://doi.org/10.1148/radiol.221828MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 43-year-old male patient presented to the emergency department with acute chest pain. The patient condition was stable, and an electrocardiography scan was obtained and showed ST segment changes with troponin I levels of 106.251 ng/mL; however, the patient refused percutaneous catheter intervention. To exclude aortic and pulmonary artery disease, dual-source CT angiography (CTA) of the chest was performed. No aortic or pulmonary artery abnormalities were identified; however, CTA demonstrated suspicious occlusion of left anterior descending coronary artery, focal hypodensity of the anterior wall, and interventricular septum, which is further highlighted with use of cinematic rendering reconstruction technique (Figure, Movie).CT angiography of the chest in a 43-year-old man with acute chest pain. Cinematic rendering of (A) four-chamber heart view and (B) anteroposterior view shows a focal area of decreased attenuation in the myocardium (anterior wall and interventricular septum).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: Cinematic rendering of the heart, show a focal area of decreased attenuation in the myocardium.Download Original Video (20.9 MB)With increasing temporal resolution, it becomes possible to observe changes in myocardial density in the setting of acute myocardial infarction with use of conventional CTA of the chest (1). Cinematic rendering reconstruction technique (2) allows CTA to achieve highly realistic, photograph-level, postprocessed images that show the areas of acute myocardial ischemia more intuitively in three dimensions.Disclosures of conflicts of interest: X.D. No relevant relationships. Z.G. No relevant relationships.

Diagnosis and treatment of blunt high-grade pancreatic trauma

The clinical data of 20 patients with blunt high-grade pancreatic trauma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of Changhai Hospital Affiliated to Naval Military Medical University from December 2003 to February 2022 were retrospectively analyzed. There were 15 males and 5 females with a median age of 39 years (range: 14-54 years). The degree of pancreatic injury was graded according to the American Association for the Surgery of Trauma (AAST) scale, including 10 cases of grade Ⅲ (50%), 8 cases of grade Ⅳ (40%), and 2 cases of grade Ⅴ (10%). Then, the strategy of diagnosis and treatment for blunt high-grade pancreatic trauma was summarized. The diagnostic rate of CT was 78.9%. Finally, 17 cases (85%) were cured and 3 cases (15%) died. Among the 10 patients with grade Ⅲ pancreatic injury, 7 cases received distal pancreatectomy and splenectomy, 1 case received distal pancreatectomy with spleen preserved, 1 case received pancreatic duct stent placement under endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous catheter drainage (PCD), and 1 case received only PCD. Among 8 cases of grade Ⅳ, 3 cases underwent Roux-en-Y pancreaticojejunostomy, 1 case received distal pancreatectomy and splenectomy, 1 case underwent distal pancreatectomy with spleen preserved, 2 cases received necrotic tissue removal+external drainage of pancreatic duct+abdominal drainage, and 1 case received exploratory laparotomy and gauze packing hemostasis. For 2 cases of grade Ⅴ, 1 underwent pylorus preserving pancreaticoduodenectomy, and the other case underwent pancreaticoduodenectomy combined with right hemicolectomy and splenectomy. Therefore, the treatment of blunt high-grade pancreatic trauma should follow the individualized treatment strategy, pay attention to the control of bleeding, extensive external drainage, appropriate debridement and resection and rational application of damage control surgery, select appropriate patients for conservative treatment, and ultimately benefit the patient.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

Removal of a broken percutaneous transhepatic biliary drainage catheter by cholangioscopy through a lumen-apposing metal stent used for choledochoduodenostomy.

Removal of a broken percutaneous transhepatic biliary drainage catheter by cholangioscopy through a lumen-apposing metal stent used for choledochoduodenostomy.

A novel technique for the non-surgical management of inadvertent bowel catheterization during percutaneous abscess drainage: a technical note

Percutaneous abscess drainage-related inadvertent bowel catheterization is an undesired complication that requires treatment. In two cases without signs of peritonitis that we examined, it was possible to achieve successful abscess drainage, and to treat abscess-related inadvertent bowel catheterization by using a novel technique without surgery.