Role Of Interventional Therapy Research Articles

PULMONARY HYPERTENSION – A MINIREVIEW

Pulmonary hypertension (PH) is a rare disease characterized by considerable morbidity and mortality. Significant progress has been recently achieved in enhancing the identification, diagnosis, and treatment of the disease, as evidenced by the latest guideline. Several additional medical conditions can complicate the overall understanding of the patient's condition, making the diagnosis even more difficult. Genetic and molecular factors, certain toxic drugs (such as methamphetamines, desatinib, or anorexigens), systemic disorders, or other predisposing conditions lead to the remodeling of distal pulmonary arterioles, resulting in pulmonary hypertension. Non-invasive investigations are initially undertaken in suspected cases based on cardiac biomarkers, lung function, and echocardiograms. Nowadays, the definition of pulmonary hypertension (PH) has recently changed, now including patients with mean pulmonary artery pressure >20 mmHg, and hemodynamic evaluation with right heart catheterization remains the diagnostic gold standard. Beyond new medically targeted therapies, there is a greater appreciation for the importance of supervised training in stable PH and the possible role of interventional therapies in select cases. The landscape of PH is in constant change, characterized by progress, innovation, and new medical opportunities.

New trends in pulmonary hypertension.

Pulmonary hypertension (PH) is a prevalent disease of the pulmonary vasculature that is characterised by considerable morbidity and mortality. Substantial efforts have been made in recent years to improve disease recognition, diagnosis and management, and this is reflected in current guidelines. The haemodynamic definition of PH has been revised and a definition for exercise PH has been provided. Risk stratification has been refined and the importance of comorbidities and phenotyping have been highlighted. These changes provide an opportunity to potentially identify pulmonary vascular disease at an earlier stage and to enhance patient-centred, goal-orientated treatment decisions. A promising fourth treatment pathway for pulmonary arterial hypertension and potential targeted therapies for group 3 PH are on the horizon, concepts which seemed inconceivable only a few years ago. Beyond medication, there is a greater appreciation for the importance of supervised training in stable PH and the possible role of interventional therapies in select cases. The landscape of PH is changing and it is characterised by progress, innovation and opportunities. In this article, we highlight some of the new trends in PH, with a specific focus on the revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and management of PH.

Vascular Complications of Pancreatitis: Role of Interventional Therapy

Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.

The Role of Interventional Therapies in Cancer Pain Management

Cancer pain is complex and multifactorial. Most cancer pain can be effectively controlled using analgesics in accordance to the WHO analgesic ladder. However, in a small but significant percentage of cancer patients, systemic analgesics fail to provide adequate control of cancer pain. These cancer patients can also suffer from intolerable adverse effects of drug therapy or intractable cancer pain in advance disease. Though the prognosis of these cancer patients is often very limited, the pain relief, reduced medical costs and improvement in function and quality of life from a wide variety of available interventional procedures is extremely invaluable. These interventions can be used as sole agents or as useful adjuncts to supplement analgesics. This review will discuss interventional procedures such as epidural and intrathecal drug infusions, intrathecal neurolysis, sympathetic nervous system blockade, nerve blocks, vertebroplasty and the more invasive neurosurgical procedures. Intrathecal medications including opioids, local anaesthetics, clonidine, and ziconotide will also be discussed.

Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture. Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases. Diffuse intra- and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases. Progressive, non-anastomosis, and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

Role of interventional therapy in patients with coronary heart disease and life-threatening ventricular tachyarrhythmias.

This study includes 357 patients with coronary heart disease and life-threatening ventricular tachyarrhythmias. Thirty-three patients (10%) underwent direct current (DC) catheter ablation (group 1), 121 (34%) mapping-guided surgery (group 2) and 203 (56%) received an implantable cardioverter defibrillator (ICD) (group 3). The mean follow-up was 35 +/- 25 months in group 1, 41 +/- 37 months in group 2 and 22 +/- 22 months in group 3. During follow-up, 6 patients (18%) died in group 1, 45 (37%) in group 2 and 46 (23%) in group 3. Sudden death occurred in two patients (6%) in group 1, 10 patients (8%) in group 2 and eight patients (4%) in group 3. Non-fatal recurrences group were observed in 19 patients (57%) in group 1 and in 16 patients (14%) in group 2. ICD discharges occurred in 175/203 patients (86%) in group 3 with a mean number of 18 +/- 28 ICD shocks per patient. Our data show that catheter ablation has a low incidence of sudden death but a high incidence of non-fatal recurrences. Mapping-guided surgery yields low rates of sudden death or recurrence. Patients with an ICD have a low sudden death rate. A treatment algorithm is necessary to evaluate patients at high risk for sudden death and to choose the right patient for the right treatment.

Effort thrombosis: Role of interventional therapy

Effort thrombosis, a form of axillary-subclavian vein occlusion in young people, was identified in patients referred over a 5-year period. Eleven of 120 patients (9%) with venous occlusion from many causes had effort thrombosis. They were treated acutely with heparin and then by thrombolysis, angioplasty, surgical bypass, or a combination. Five of the 10 patients with thrombolysis or surgery had patent veins on follow-up venography, but 9 of these later developed axillary-subclavian reocclusion. By later follow-up, however, all patients were asymptomatic at the time of collateral vein formation. We conclude that effort thrombosis leads to recurrent occlusion of the axillary-subclavian vein, short-term (12-month) recurrence of symptoms with exercise, and progressive compensatory collateral vein development. Radiographic documentation of reestablished venous flow is important, and can be used to guide the completion of treatment.