Percutaneous Evacuation Research Articles

Mirror syndrome associated with fetal cardiomyopathy

Mirror syndrome is a rare condition of generalized maternal oedema caused by fetal hydrops. A 37-year-old patient was admitted to our hospital because of suspected mirror syndrome caused by fetal cardiomyopathy. At 26th week of gestation patient developed bilateral pulmonary oedema as her condition rapidly deteriorated. Consequently, preterm labor was induced, percutaneous evacuation of fetal ascites was performed, and the patient finally vaginally delivered stillborn fetus. Although the initial postpartum period was severely complicated by hemorrhage, the condition of the patient significantly improved later, and she was discharged seven days after delivery. We believe this case is worth presenting due to its rarity and significant perinatal and obstetric challenges in treatment of those patients. Furthermore, preimplantation genetic testing could be performed to prevent at least some of the cases.

Sonoguided Percutaneous Endoscopic Evacuation and Drainage (SPEED) Technique: Report of a Novel Surgery for Hydatid Cyst of the Liver

The spectrum of treatment for hydatid cyst varies from medical therapy, surgery, radiology-guided intervention to laparoscopy. Initially surgery was considered the gold standard. However, in the last few decades, percutaneous interventional therapy has been proved to be an effective and safe alternative to open surgery. Despite being the last entrant, laparoscopy has set significant standards in the care of hydatid disease. We describe a novel technique for the treatment of hydatid cyst of the liver. The technique is called Sonoguided Percutaneous Endoscopic Evacuation and Drainage (SPEED) ( https://youtu.be/ietvpAuxzDo ). This is based on the PAIR technique of sonography-guided puncture followed by introduction of rigid scope into the cyst. The technique was successful in the patient in terms of cyst evacuation and successful short-term outcome. The advantage of this procedure is that though minimally invasive, the procedure is very aggressive in terms of complete cyst evacuation. Thus, it can be a suitable replacement for the PAIR procedure, thereby increasing the chances of cure. The validation of the process is in progress.

Minimally Invasive Surgical Approach for Treatment of Chronic Subdural Hematoma, Outcome in 1079 Patients.

To present the authors' experience in treatment of chronic subdural hematoma (CSDH) by a minimally surgical percutaneous approach. We relate our experience of mini-invasive evacuation of chronic subdural hematoma. Between May 2006 and December 2017, 1079 patients have been operated for percutaneous evacuation of chronic subdural hematoma. Prior to operation, the volume of hematoma was measured quantitatively by using a software for CT scan. From May 2006 to December 2017, 1079 patients underwent mini-invasive percutaneous evacuation (MIPE). Of the 1079 patients, 994 (92.12%) became asymptomatic or improved clinically. Six weeks later, the scan revealed the hematoma had wholly disappeared in 699 (64.78%) of the cases. We had one postoperative abscess. Treatment of CSDH using our MIPE technique is a safe method with satisfactory outcome and a good therapeutic alternative to the craniostomy.

Ultrasound Diagnosis and Minimally Invasive Treatment of Posttraumatic Hematomas of the Spleen

The work presents the analysis of ultrasound diagnostic of traumatic hematomas of the spleen in 12 patients after blunt abdominal trauma. Traumatic injuries of large (4 patients) and giant (5 patients) sizes prevailed. Only 3 patients had medium sized traumatic lesion. Ultrasound examination was performed for all patients as a primary procedure and for dynamic observation. We tracked evolution of traumatic spleen injuries and identified four stages of pathological process in case of aseptic development: the stage of “fresh hemorrhage”, the stage of “formed clot”, the stage of “aseptic lysis of the clot”, the stage of “connective tissue organization”. We determined the evidence of pyogenesis of spleen hematomas, identified the stage “bacterial lysis of the clot” and stage of “forming capsules”. We determined the indications and contraindications for the minimally invasive treatment of spleen hematoma. Percutaneous evacuation of the spleen hematoma was performed in all patients. In four cases of minimally invasive treatment was puncture. In one patient the treatment was completed with a single puncture, in 3 patients – with a double one. Drainage of spleen hematomas was performed in 8 patients. We analyzed the results of minimally invasive treatment of traumatic injuries of the spleen under ultrasound control. Minimally invasive treatment was successful in 11 patients. Only 1 patient was operated for post-traumatic aneurysm of the splenic artery due to the continuing bleeding into hematoma.

Femoral Neuropathy Following Spontaneous Retroperitoneal Hemorrhage After Cardiac Surgery

A woman underwent ascending aortic aneurysm repair, aortic root and valve replacement, and coronary artery bypass grafting. Her postoperative course was complicated by stroke and status epilepticus. With supportive care and antiepileptics, her neurologic status improved. Intravenous heparin and aspirin were initiated. On postoperative day 13, she developed a large retroperitoneal hematoma with femoral neuropathy. Because her hematoma was not amenable to percutaneous drainage or surgical evacuation, and considering her comorbidities, a conservative approach was elected. Anticoagulation was held but not reversed, and she was transfused. Her impairment resolved fully after 3 days, and anticoagulation was restarted in staggered fashion.

Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report

BackgroundLife-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery.Case presentationA 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient’s blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient’s arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was hemodynamically stable. She was weaned off mechanical ventilation 2 days later and made an uneventful recovery. She was discharged to a local hospital on day 13 without neurological disability.ConclusionsAlthough rare, bleeding caused by liver injury due to chest compressions can be life-threatening after successful cardiopulmonary resuscitation. Reported mortality is high after surgical intervention, and patients may benefit from less invasive treatment strategies such as those presented in this case report.

Cardiac Perforation Caused by Cement Embolus After Total Hip Replacement

A 77-year-old woman was transferred to our hospital with persistent chest pain. She had no previous history of coronary heart disease. Two months earlier, she had undergone a complication-free hip replacement surgery with a cemented prosthesis. On admission, she was nearly asymptomatic, but because of elevated cardiac troponin and ST-segment elevation in the inferior and lateral leads, a coronary angiography was performed, which showed normal coronary arteries. However, fluoroscopy revealed a thin, opaque structure apparently overlying the heart. After 2 hours of observation, signs and symptoms of pericarditis were noted, and shortly thereafter, worsening ensued with progression to cardiac tamponade. After percutaneous evacuation of 250 mL blood from the pericardial cavity, her clinical condition normalized. A computed tomography scan was performed …

Albendazolesulphoxide concentrations in plasma and hydatid cyst and prediction of parasitological and clinical outcomes in patients with liver hydatidosis caused by Echinococcus granulosus.

AimTo investigate the relationship between plasma and cyst concentrations of albendazolesulphoxide (ASO) and their effects on parasitological findings and disease recurrence in patients with liver hydatidosis.MethodsThe study was conducted at the University Hospital for Infectious Diseases “Dr. Fran Mihaljević,” Zagreb, Croatia, between August 2006 and January 2011. Consecutive patients (N = 48, age 6-77 years) were treated with albendazole (3 × 5 mg/kg/d) over 28 days before surgical cyst removal (n = 34) or percutaneous evacuation (PAIR) (n = 14). Plasma ASO was determined on days 10 and 28 of treatment and cyst concentrations at surgery/PAIR.ResultsDisease recurred in 3 surgically treated patients. Variability of ASO concentrations was substantial. Plasma concentrations on day 10 were higher than on day 28 (geometric means ratio [GMR] 2.00; 95%CI 1.38-2.91, P < 0.001) and higher than cyst concentrations at the time of treatment (GMR = 1.58, 1.01-2.34, P = 0.045). Higher cyst (but not plasma) concentrations were independently associated with lower odds of protoscolex motility (OR = 0.23, 0.01-0.70, P < 0.001) and higher odds of protoscolex destruction (OR = 1.17, 1.04-1.46, P < 0.001). With adjustment for age and protoscolex motility, higher day 10 plasma concentrations (but not cyst concentrations) were associated with lower odds of disease recurrence (OR = 0.49, 0.09-0.97, P = 0.035). Plasma concentrations did not predict cyst concentrations.ConclusionViability of protoscolices progressively decreased with increasing ASO concentrations in the cyst. Data strongly suggested that higher plasma concentrations reduced the risk of disease recurrence.

Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

IntroductionPulmonary interstitial emphysema is a serious complication of mechanical ventilation and can become life-threatening if progression occurs. Therapeutic lung puncture is a treatment option for severe pulmonary interstitial emphysema but has a limited use in babies with extremely low birth weight. We present a case of pulmonary interstitial emphysema in a Japanese baby (1-day-old) boy with extremely low birth weight. The emphysema was successfully decompressed by therapeutic lung puncture performed with a trocar catheter.Case presentationThe baby was born with a weight of 420g, which, to the best of our knowledge, is the lowest reported birth weight among babies with pulmonary interstitial emphysema. A chest X-ray on postnatal day 2 revealed pulmonary interstitial emphysema, which gradually progressed to diffuse pseudocystic changes. His condition became life-threatening despite the use of high-frequency oscillatory ventilation and lateral decubitus positioning. We evacuated the pulmonary interstitial emphysema by lung puncture with a trocar catheter to avoid respiratory and cardiovascular collapse. This resulted in adequate evacuation of the emphysema and a dramatic improvement in his clinical condition.ConclusionsTherapeutic lung puncture performed with a trocar catheter is beneficial in babies with extremely low birth weight and diffuse pulmonary interstitial emphysema. This treatment option may be broadly applicable, especially in an emergency situation.

Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients.

Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. There in a high variance in the treatment in literature. We report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients. From January 2007 to July 2009, 28 patients underwent percutaneous evacuation. 27 of the 28 patients (96.4%) became asymptomatic or improved clinically. Six weeks later, the scan showed the hematoma had completely disappeared in 18 of the cases. We did not have any postoperative infection. Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy.

Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients

Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients

Simple renal cysts and arterial hypertension: does their evacuation decrease the blood pressure?

To evaluate the relationships between simple renal cysts and arterial hypertension and whether their evacuation decreases the blood pressure (BP). In a cross-sectional design, we analyzed 184 study participants with cysts and compared hypertensive and nonhypertensive among them. Outcomes were the number, the size and the location of a cyst. In a cross-over design, we first evaluated the change in absolute value of SBP, DBP and mean BP in 62 hypertensive patients who underwent percutaneous evacuation of a cyst and then the decrease of BP as a categorical variable that comprised all study participants. There were 55% giant renal cysts among hypertensive and 24% among nonhypertensive patients (P = 0.0001). The prevalence rates of multiple and peripheral cysts in hypertensive and nonhypertensive patients were similar to those of single and perihilar cysts, respectively. Significant differences in SBP, DBP and mean BP were found between pretreatment readings and 3 days, 1 month, 3 months and 6 months after cyst evacuation (P < 0001). The differences were significant in all hypertensive patients (P < 0.001). There were less hypertensive patients 3 days after treatment than before treatment (P < 0.0001). An apparent association between the size of a simple renal cyst and hypertension was found, and aspiration of cysts resulted in a reduction of BP. Location and number of cysts were not related to BP.

Cystic echinococcosis in immigrant from Peru: First case treated with percutaneous treatment in Japan

We report a case of cystic echinococcosis (CE) caused by Echinococcus granulosus, for which a modified percutaneous evacuation (PEVAC) treatment was applied. The patient had immigrated from Peru to Japan and had 2 hydatid cystic masses, 1 located in segment (S)5 of the liver and the other in S3 (5.3 and 3.5 cm in diameter, respectively), both of which were visualized as pseudotumors by ultrasound (US) examinations. Albendazole treatment showed no effects and surgical treatment was refused. After punctuation of the S5 cyst under US guidance and S3 with CT guidance, 10- and 12-French gauge catheters, respectively, with multiple side holes were inserted. About 60 ml of the cyst contents was drawn out from the S5 lesion and 2 ml from the S3 lesion. Using repetitive manual injections and aspiration of small amounts of hypertonic saline, the remaining cyst content was removed as much as possible, after which 20 and 10 ml of 98% ethanol was injected into the S5 and S3 lesions, respectively. A short-term evaluation during the 4 month-period following the procedure using US revealed nearly complete evacuation of the S5 lesion, whereas that at S3 remained as a pseudo-solid mass. We consider that percutaneous treatment is a safe therapeutic modality for hydatid cysts. This is the first case report of CE treated percutaneously in Japan.

Giant simple renal cyst complicated with hypertension

Solitary renal cysts are a common and usually asymptomatic occurrence in older patients. They may be associated with hypertension or abdominal disturbances, as they can be responsible for compression of surrounding tissues and distortion of renal vessels. This report presents an interesting case of a hypertensive patient with a solitary renal cyst of a marked size. Owing to the high risk of performing a surgical procedure in such a patient, a distinct therapeutic solution was opted for. Successful management of this case was achieved by a combination of percutaneous fluid aspiration and injection of alcohol and Vibramycin inside the cystic cavity. Percutaneous fluid evacuation combined with the administration of a sclerosing agent is suggested as a safe and effective alternative for cyst decompression and blood pressure normalisation.

Diagnosis and treatment of Hepatic echinococcosis: an overview

Background: Surgery has long been considered the first-choice treatment in patients with echinococcosis of the liver. The poorly predictable outcome of older studies using mebendazole or albendazole confirmed this belief. Since the introduction of a percutaneous technique (PAIR; puncture, aspiration, injection, reaspiration) treatment policy is changing. The actual question is which treatment is preferred in which patients. Methods: Review of recent literature. Results: Laparoscopic treatment of anteriorly located hepatic cysts is a new surgical technique with high success rates (77%-100%) and low complication (0%-17%) and recurrence rates (0%-9%). Albendazole is superior to mebendazole treatment. Degenerative changes were found in 82% of patients treated with albendazole and in 56% of those treated with mebendazole. The main problem is the high relapse rate: 25% mostly within 2 years. PAIR proved to be superior to albendazole treatment (88% versus 18%) and equally effective as surgery (86% versus 76%). A combined injection of alcohol with polidocanol is a simple alternative to PAIR. Percutaneous evacuation of cyst content (PEVAC) made percutaneous treatment accessible to patients with complicated cysts. Conclusions: Albendazole is the first-choice treatment in patients with univesicular cysts. PAIR or combined injection of alcohol with polidocanol is indicated when pain is intractable or albendazole fails. In patients with multivesicular cysts, PEVAC is a better choice. Surgery is the first-choice treatment only when the expertise of percutaneous treatment is not available or when percutaneous treatment fails.

Robotically Assisted Minimally Invasive Surgery in a Pediatric Population: Initial Experience, Technical Considerations, and Description of the da Vinci® Surgical System

Introduction: Reports of robotically assisted minimal access surgery (RMAS) in the adult patient population have increased over the last several years. Few reports have addressed RMAS in pediatric patients. We present our initial RMAS experience with the da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, California), and discuss technical considerations, advantages, and disadvantages. Methods: From July 2002 to April 2003, the da Vinci surgical system was used in 20 pediatric patients (9 female, 11 male) with a mean age of 8.4 years (range, 4 months to 16 years). The mean weight of our patients was 38.7 kg (range, 6.8-82 kg). Procedures performed were: Nissen fundoplication (10, including 3 with gastrostomy tube placement and 1 with pyloroplasty), cholecystectomy (3), splenectomy (2), urachus resection (1), unilateral iliac and retroperitoneal lymphadenectomy (1), incisional biopsy retroperitoneal presacral mass (1), incisional biopsy hepatic mass (1), Gortex patch repair of a Morgagni diaphragmatic hernia (1), biopsy of a benign infracarinal mediastinal mass (1). Operating times, technical considerations, complications, length of stay, and patient outcomes were recorded. Results: Mean operating room (OR) setup time was 45 minutes (range, 29-80 minutes). Mean patient positioning and preparation time was 17 minutes (range, 5-45 minutes). Mean trocar mapping time was 22 minutes (range, 4-55 minutes). Mean surgical cart docking time was 13 minutes (range 5-40 minutes). Mean console operating time was 93 minutes (range, 10-299 minutes). Mean OR turn-over time was 18 minutes (range, 5-54 minutes). An intraoperative complication rate of 15% was recorded, as each splenectomy required conversion to laparotomy to control bleeding, and the Morgagni hernia repair required intraoperative, percutaneous evacuation of a pneumothorax. All other procedures were completed with the da Vinci surgical system. Mean postoperative length of hospitalization for all patients was 2.7 days (range, 1-16 days). Postoperative complications included limited dysphagia in 2 patients and superficial wound infection from gastrostomy tube leak in 1 patient (10%). Conclusion: RMAS with the da Vinci surgical system can be performed safely in children and offers advantages over conventional minimal access surgery (CMAS), including articulating instruments enabling more precise, intracorporeal tissue manipulation and suturing, three-dimensional vision, and intuitive ergonomics. Currently, disadvantages of RAMS include larger trocar incisions, longer total OR time, and limited tactile sensation and maneuverability in smaller patients.

Percutaneous Catheter Drainage of Pancreatic Pseudocysts: Five Years Experience

Objective: Pancreatic pseudocysts are common complications of pancreatitis. Pseudocysts can be treated by various drainage procedures such as endoscopic cystenterostomy or transpapillary drainage, percutaneously with image guidance or operatively. We report our experience with image-guided percutaneous evacuation of pancreatic pseudocysts. Materials and Methods: This retrospective study was conducted on 37 consecutive patients who underwent 45 percutaneous catheter placements for the drainage of pseudocysts. The catheters were introduced under ultrasound or computerized tomography guidance. The patients were followed up with a fluoroscopic catheter check for evaluation of size of collection, communication with gastrointestinal tract and the pancreatic duct. The catheter was removed when the patient was asymptomatic and the output from the catheter was less than 10 cm³ in 24 h. Results: Forty-five procedures of percutaneous drainage of pancreatic pseudocysts were performed in 37 consecutive patients. The size of the cysts ranged between 4 and 20 cm. Drainage was performed on cysts larger than 5 cm in diameter. Forty-eight percent of the patients had communication with the pancreatic duct. Percutaneous drainage was successful in 95% of the cases in our study regardless of pseudocyst communication with the main pancreatic duct. The average duration of catheter drainage was 30 days in cases without communication versus 33 days in patients with communication with the pancreatic duct. Conclusion: Percutaneous drainage is a safe and effective alternative to surgery in patients with pancreatic pseudocysts. The duration of catheter drainage in cases with or without communication with the pancreatic duct was nearly the same.

PERCUTANEOUS MANAGEMENT OF INTRAPULMONARY AIR AND FLUID COLLECTIONS

The radiologist's role in the management of intrapulmonary air and fluid collections is becoming more important. Improvements in percutaneous interventional techniques now allow the radiologist to offer patients an alternative treatment option with less morbidity and mortality than surgical resection. The use of CT allows optimal catheter placement and enables safe and effective percutaneous evacuation of intrapulmonary collections. In summary, image-guided percutaneous catheter drainage should (1) be the initial procedure performed to diagnose and treat lung abscesses not responding to conservative therapy; and (2) because of its effectiveness and safety, be considered as a treatment option in the management of symptomatic patients with intrapulmonary mycetomas.

Percutaneous management of abscess and fistula following pancreaticoduodenectomy.

To evaluate the efficacy of percutaneous drainage of fluid collections following pancreaticoduodenectomy (Whipple's procedure). We performed a retrospective review of 19 patients referred to our service with fluid collections following pancreaticoduodenectomy. The presence of associated enteric or biliary fistulas, the route(s) of access for image-guided drainage, the incidence of positive bacterial cultures, and the duration and success of percutaneous management were recorded. Fistulous communication to the jejunum in the region of the pancreatico-jejunal anastomosis was demonstrable in all 19 patients by gentle contrast injection into drainage tubes. Three patients had concurrent biliary fistulas. In 18 of 19 patients, fluid samples yielded positive bacterial cultures. Successful percutaneous evacuation of fluid was achieved in 17 of 19 patients (89%). The mean duration of drainage was 31 days. Percutaneous drainage of abscess following pancreaticoduodenectomy is effective in virtually all patients despite the coexistence of enteric and biliary fistulas.

The discipline of vascular surgery at the inception of The Society for Vascular Surgery: Recollections of the beginning

The discipline of vascular surgery at the inception of The Society for Vascular Surgery: Recollections of the beginning