Technique Of Stent Placement Research Articles

The safety and efficacy of through-and-through wire technique for ureteral Double-J stent placement.

To evaluate the efficacy and safety of the through-and-through wire (TTW) technique for antegrade ureteral Double-J stent placement after failure of either antegrade or retrograde ureteral stent placement. This retrospective study analyzed the medical records of consecutive patients who underwent Double-J stent placement with the TTW technique at Asan Medical Center and Gil Medical Center between January 2016 and February 2023. Patient histories, reasons for employing the TTW technique, TTW pathways, and complications were reviewed. Eight patients were included in the study. The reasons for using the TTW technique were failure to advance a larger-diameter catheter, balloon catheter, or Double-J stent passing over the guidewire beyond the stricture (6/8, 75.0%); failure to negotiate the stricture with a guidewire (1/8, 12.5%); and guidewire passing through a ureteropelvic junction defect (1/8, 12.5%). TTW was applied either between a percutaneous nephrostomy (PCN) and the urethral orifice (n=4), between a PCN and an ileostomy pouch (n=3), or between a left and right PCN (n = 1). Urologic assistance was required for retrograde ureteral cannulation in one male patient (12.5%). Subsequently, balloon dilation and/or Double-J stent placement were performed in all eight patients, resulting in 100% technical success. No major or minor complications occurred. The TTW technique was safe and effective in the undertaking of PCN and antegrade Double-J stent placement in patients for whom either antegrade or retrograde access had failed.

Novel Technique of Stent Placement via Gateway Balloon in Intracranial Atherosclerosis-associated Large Vessel Occlusion (P3-5.019)

Novel Technique of Stent Placement via Gateway Balloon in Intracranial Atherosclerosis-associated Large Vessel Occlusion (P3-5.019)

Novel technique of additional anchor plastic stent placement during endoscopic ultrasound-guided gallbladder drainage.

Novel technique of additional anchor plastic stent placement during endoscopic ultrasound-guided gallbladder drainage.

How I do it: novel use of a modified nasopharyngeal airway in laryngotracheal stenosis as a temporary stent.

This paper reports the innovative use of a modified nasopharyngeal airway device as a temporary stent in patients with laryngotracheal stenosis. It also discusses the technique of endoscopic stent placement, and our experience in terms of the indications and suitability. The nasopharyngeal airway device was modified to use as an airway stent by trimming it to the desired length. Next, the stent was inserted endoscopically and anchored using a novel approach. The surgery was performed successfully without complications. The patients had full use of their voice while the stent was in situ. No significant granulation tissue was observed. This paper demonstrates the feasibility of using a nasopharyngeal airway device as a temporary stent to prevent restenosis in cases where the patients have a strong demand for phonation. The modified nasopharyngeal airway device is potentially very promising, but cases must be selected carefully to avoid compromising efficacy and safety.

Novel technique of stent placement via gateway balloon in intracranial atherosclerosis-associated large vessel occlusion.

Neuroform Atlas stent can be deployed directly via gateway balloon for angioplasty and stent placement without the need for exchange maneuver required for Wingspan stent use. We present our initial experience of this strategy in intracranial atherosclerosis-associated large vessel occlusions. Patients were identified through mechanical thrombectomy (MT) database from January 2020 to June 2022 at our institutions. Due to reocclusion or impending occlusion, rescue angioplasty with stent placement was performed after initial standard MT. Primary outcomes were good angiographic recanalization with modified thrombolysis in cerebral infarction (mTICI) score of 2b-3, rate of intracranial hemorrhage (ICH), and favorable functional outcome at 3months, that is, modified Rankin Scale (mRS) score of 0-3. We identified 22 patients treated using this technique. Among those, 11 were females with their average age at 66years (range: 52-85). Initial median National Institute of Health Stroke Scale score was 11 (range: 5-30) and all patients received loading doses of aspirin and P2Y₁₂ inhibitor. After performing submaximal angioplasty and Neuroform Atlas stent deployment through the gateway balloon, we achieved final mTICI of 2b-3 in 20 (90%) patients. One patient had ICH post-op that was asymptomatic. Eight (36%) patients had mRS of 0-3 at 90days. Our preliminary experience suggests possible safety and feasibility of deploying Neuroform Atlas stent through a compatible Gateway balloon microcatheter without the need for ICH-associated microcatheter exchange. Further studies with long-term clinical and angiographic follow-up are warranted to corroborate our initial findings.

V06-09 ROBOT-ASSISTED NEPHRON-SPARING MANAGEMENT OF URETERAL TUMORS: PATIENT-TAILORED APPROACH WITH DEMONSTRATION OF FOUR DIFFERENT TECHNIQUES

You have accessJournal of UrologyCME1 Apr 2023V06-09 ROBOT-ASSISTED NEPHRON-SPARING MANAGEMENT OF URETERAL TUMORS: PATIENT-TAILORED APPROACH WITH DEMONSTRATION OF FOUR DIFFERENT TECHNIQUES Sumit Saini, Timothy O'Rourke, and Ashok Hemal Sumit SainiSumit Saini More articles by this author , Timothy O'RourkeTimothy O'Rourke More articles by this author , and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Need for renal function preservation may influence the decision to take a nephron sparing approach of segmental ureterectomy for localized ureteral tumors, as an alternative to radical nephroureterectomy. In this video we demonstrate four different individualized surgical techniques tailored according to patient’s disease. METHODS: All the surgeries were performed by single surgeon (AKH) using da Vinci (Si/Xi) robotic surgical system. For distal ureteral tumors, distal ureterectomy with bladder cuff excision/partial cystectomy with pelvic lymph node dissection (PLND) and uretero-neo-cystostomy was performed in 11 patients. Proximal ureteral tumors were addressed with segmental ureterectomy and uretero-ureterostomy in 5 patients and another patient underwent augmented anastomotic ureteroplasty using free circumferential ileal patch. Regardless of the surgical approach adopted, complete preoperative evaluation was carried out with cross sectional imaging and other investigations (renogram, retrograde pyelogram & nephrostogram) as indicated. These procedures were considered in carefully selected patients with unifocal disease associated with medical co-morbidities, advancing age, and compromised renal function. Intraoperative fluoroscopy guided navigation and/or molecular imaging using indocyanine green (intraluminal or intravascular) are also helpful. RESULTS: In this video, we have demonstrated four such techniques, including our novel approach of augmented anastomotic ureteroplasty with free circumferential ileal patch to bridge a significant defect following segmental ureterectomy. We have also highlighted our novel technique of intra-corporeal JJ stent placement. No intra or post operative complications were noted, and all the surgical margins were negative. JJ Stents was removed in about 4 weeks post-operatively. CONCLUSIONS: Robot-assisted patient-tailored approach for ureteral tumors may be effectively employed in appropriately selected patients of ureteral tumors with excision and end to end anastomosis, augmented anastomosis or uretero-neo-cystotomy with psoas hitch as an alternative to radical nephroureterectomy to salvage the ipsilateral kidney. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e511 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumit Saini More articles by this author Timothy O'Rourke More articles by this author Ashok Hemal More articles by this author Expand All Advertisement PDF downloadLoading ...

EFFECT OF THE 'DOUBLE J STENT PLACEMENT TECHNIQUE' ON EARLY AND LATE STENT-RELATED COMPLICATIONS

Amaç
 Double J stent takımında evrensel olarak kabul görmüş
 bir metot yoktur. Kliniğimizde uyguladığımız metodun
 başarı ve komplikasyon oranlarını ortaya koyarak
 bizim ile aynı teknik alt yapı ve imkanlara sahip
 klinikler için bir öngörü ortaya koymaktır.
 Gereç ve Yöntem
 Kliniğimizde Ocak 2019 ile Ocak 2022 tarihleri arasında
 double J stent takılan 774 hastanın verileri geriye
 dönük olarak tarandı. Stente bağlı komplikasyon
 oranları ve stent migrasyonuna etkili olabilecek bağımsız
 risk faktörleri analiz edildi.
 Bulgular
 774 hastaya 907 adet double J stent takıldı. Hastaların
 yaş ortalaması 54,3±20,1 (20-90) idi. Hastalara
 double J stent takılma nedenleri: üreter taşı (%46,5),
 böbrek taşı (%19,1) ve üreter darlığı (%34,4) idi. Tüm
 hastaların 91 (%11,8) adedinde ek müdahaleyi gerektiren
 ciddi stent migrasyon vardı.
 Sonuç
 Bizim çalışmamız litertürdeki double J stent takma
 tekniği ile stent migrasyonu arasındaki ilişkiyi araştıran
 ilk çalışma olma özelliğini taşımaktadır. Double
 J stent migrasyon oranımız (%11,8) hemen hemen
 güncel literatürde stent boyu çeşitli formülasyonlar ile
 hesaplanarak bulunan ve skopi altında takılan stentlerde
 görülen migrasyon oranına yakındır.

A Novel Suction-Irrigation Cannula-Guided Hydrophilic Tip Guidewire Technique of Intraoperative Ureteral Stent Placement During Robot-Assisted Radical Prostatectomy

Background: Patients with large median lobe, history of pelvic radiotherapy, or transurethral resection of the prostate are on the verge of ureteral orifice (UO) injury during robot-assisted radical prostatectomy (RARP). Not all aforementioned patients require ureteral stent placement. Intraoperative findings justify whether to proceed with ureteral stent placement or not. Previously described techniques of intraoperative stent placement involve use of transurethral cystoscopy or suprapubic skin incision, which makes procedure further difficult especially with robotic arms in place.1 Herein, we describe a simple and efficacious method Suction-Irrigation cannula-Guided Hydrophilic Tip guidewire (SIGHT) technique for intraoperative ureteral stent placement. Technique: The case shown here is a 64-year-old gentleman with Gleason 8 prostate cancer and opted for RARP. After division of bladder neck, the interior of the bladder was routinely inspected and the UOs were found too close to the bladder margins. The decision was made to proceed with bilateral ureteral stents placement. To facilitate stent placement, bladder margin is held up using 4th arm of the robot. The bedside assistant inserted laparoscopic suction irrigation cannula from 5 mm assistant trocar. Cannula tip was held a couple of centimeters away from respective UO. A 0.038 Inch diameter, 150 cm long hydrophilic straight tip guidewire is fed into the abdomen through shaft of the cannula. The surgeon on console (A.T.) places the wire into UO and feeds it proximally until the resistance is met. The bedside assistant (R.B.) then feeds the stent over the wire into the abdomen, and the surgeon threads the stent over the wire. The assistance held back-tension on the wire. A pusher is then guided over the wire in similar manner and stent is advanced until distal end of the stent is seen. The wire is pulled out by the bedside assistant, and the distal end of the stent is confirmed with use of robot and secure inside the bladder. Surgery proceeded as usual. Stent placement was verified postoperatively by plain kidney, ureter and bladder radiograph. Patient was discharged next day. Catheter removal was done at postoperative day 7. Ureteral stents were removed under local anesthesia in the office at 4 weeks postoperative visit without complication. Conclusions: Our SIGHT technique is safe, effective, and easily adaptable method for intraoperative ureteral stent placement during robotic procedures. It avoids intraoperative cystoscopy or suprapubic skin incision or use of additional guidewires thereby saving time during which patient is under anesthesia during surgery. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Music Source:www.epidemicsound.com Copyright: Author owns copyright/license for the music used in the video. A.T. has served as a site-PI on pharma/industry-sponsored clinical trials from Kite Pharma, Lumicell Inc., Dendreon, and Oncovir Inc. He has received research funding (grants) to his institution from Department of Defence, National Institute of Health, Axogen, Intuitive Surgical, Arthur M. Blank Family Foundation, and other philanthropy. A.T. has served as an unpaid consultant to Roivant Biosciences and advisor to Promaxo. He owns equity in Promaxo. Rest of the authors do not have conflict of interests. Runtime of video: 3 mins 21 secs

Female-only Ureteral Stent Placement and Replacement Technique Using Pig-tail Straightener

Female-only Ureteral Stent Placement and Replacement Technique Using Pig-tail Straightener

Radiological stent placement of post sleeve gastrectomy leak: efficacy, imaging features and post-procedure complications

Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric procedure. The primary and insidious early post-SG complication is the gastric leak (GL). In literature, there are many studies describing the endoscopic stent placement as treatment of GL and few studies about stent placement performed by interventional radiology under fluoroscopic guide. Our aims were to describe the radiological stent placement technique, to compare endoscopic and radiological stent placement, to illustrate normal diagnostic features and summarise the incidence of complications after stent placement, removal, and their imaging features. This was a single centre retrospective study of 595 patients who underwent SG between 2011 and 2019. Inclusion criteria: patients who developed GL after SG and treated with gastro-oesophageal stent placement by endoscopy or interventional radiology; availability of medical history and imaging studies; follow-up time after stent removal (1 year). The rates of technical success, clinical success and complications after stent placement and removal were collected and compared between the two methods of stent positioning. A total of 17/595 (2.8%) patients developed a radiologically diagnosed GL after SG. The type II-III GLs (15/17) were treated with endoscopic or radiological stent placement. 9/15 (60%/Group A) patients underwent gastro-oesophageal stenting by interventional radiology and 6/15 (40%/Group B) were treated with endoscopic stent placement. The technical and clinical success rate was 100% for both groups. Stent migration occurred in 22% and 27% for Group A and B respectively. Post-extraction stenosis was the main late complication, occurring in 22% in Group A and 0% in Group B. Gastro-esophageal stent placement performed by interventional radiologists is a valid “mini-invasive” treatment for GL. This procedure is not inferior to endoscopic positioning regarding efficacy, periprocedural and postprocedural complication rate. It's necessary to be familiar with radiological findings after stent placement and removal. Computed tomography (CT) scan is the main radiological technique to identify stent placement complications. Upper gastrointestinal (UGI) series are the first radiological procedures used to detect late complications after stent removal.

Real-time intravascular ultrasound guidance: A novel technique for accurate placement of ostial stents.

To describe a novel technique for ostial stent placement using real-time IVUS guidance. Accurate placement of coronary stents at ostial locations is challenging with the true ostium frequently being missed increasing the risk of adverse events. We have developed a novel technique for ostial stent placement and report our benchtop testing and initial clinical experience. Benchtop testing was performed to validate the appearance of the stent and delivery system on IVUS. Benchtop testing of real-time IVUS guided ostial stent positioning was carried out in a left main bifurcation phantom. Real-time IVUS guidance of stent placement in aorto-ostial, ostial left anterior descending (LAD), or ostial circumflex lesions was assessed in a prospective registry. Bench model IVUS demonstrated clear differences between the appearances of the stent and other components of the delivery system. Positioning of 10 consecutive stents into the ostial LAD using real-time IVUS guidance was assessed in a left main bifurcation model. Median distance from proximal stent edge to LAD ostium was 0.39 mm (interquartile range 0.31 to 0.73). Real-time IVUS guidance of ostial stent placement was performed in 50 patients (51 lesions). Angiographic success was 100%. IVUS post-stenting demonstrated median distance from the proximal stent edge to the ostium was 0.2 mm (interquartile range 0.1 to 0.5 mm). There was one periprocedural myocardial infarction but no other major adverse cardiac events at 30-days. We have developed a novel technique using real-time IVUS guidance allowing accurate ostial stent placement.

Retrograde Open Mesenteric Stenting for Acute and Chronic Mesenteric Ischaemia: Results from an Intestinal Stroke Centre

To report the intra-operative adverse events (IOAEs) and the initial and one year outcomes of retrograde open mesenteric stenting (ROMS) using balloon expandable covered stents for acute and chronic mesenteric ischaemia. Clinical data and outcomes of all consecutive patients treated with ROMS for acute and chronic mesenteric ischaemia at an intestinal stroke centre between November 2012 and September 2019 were reviewed. ROMS was performed using balloon expandable covered stents. Endpoints included IOAEs, in hospital mortality, post-operative complications, and re-interventions. One year overall survival, freedom from re-intervention, primary patency and assisted primary patency rates were analysed using the Kaplan-Meier time to event method. During the study period, 379 patients were referred to the centre for acute or chronic mesenteric ischaemia. Thirty-seven patients who underwent the ROMS procedure were included. All the patients had severe atherosclerotic mesenteric lesions. The ROMS technical success rate was 89% in this cohort. The rate of IOAEs was 19% and included four cases of retrograde recanalisation failure. All ROMS failures occurred in patients presenting with flush superior mesenteric artery occlusion and they were treated by mesenteric bypass. Ten patients (27%) underwent bowel resection, four of which resulted in a short bowel syndrome (11%). The in hospital mortality rate was 27%. Post-operative complications and re-intervention rates were 67% (n= 25) and 32% (n= 12), respectively. The median follow up was 20.2 months (interquartile range 29). The estimated one year overall survival for the cohort was 70.1% (95% confidence interval [CI] 52.5% - 82.2%). The estimated freedom from re-intervention at one year was 61.1% (95% CI 42.3 - 75.4). The one year primary patency and assisted primary patency rates were 84.54% (95% CI 63.34 - 94) and 92.4% (95% CI 72.8 - 98), respectively. ROMS procedures offer acceptable one year outcomes for mesenteric ischaemia but are associated with frequent stent related complications. Precise pre-operative planning, high quality imaging, and meticulous stent placement techniques may limit the occurrence of such events.

Endoscopic Management of Bowel Obstruction.

The traditional morbidity and mortality associated with traditional management has stimulated exploration of endoscopic approaches. Success depends on patient selection, the location and etiology of obstruction, patient status, and the capability of the endoscopist. This article discusses techniques of intralumenal dilation and stent placement and results from systematic reviews.

Efficacy of Monitoring for Multiple Antiplatelet Therapy during Intracranial Stent Placement: A Preliminary Study.

During cerebral aneurysm embolization using intracranial stents, platelet aggregation increases owing to increased wall shear stress and a loss of vascular endothelial function at the stent implantation site. Preoperative multiple antiplatelet therapy was introduced to prevent severe thromboembolic complications due to increased platelet aggregation. However, specific guidelines for the administration and pharmacological evaluation of this therapy do not exist currently. We examined the benefits of perioperative platelet aggregation monitoring in a cohort of patients. We had 377 patients with unruptured intracranial aneurysms who underwent stent-assisted embolization at our hospital between December 2012 and November 2019. We ultimately included 181 patients in our final analysis. These patients were continuously administered aspirin (100 mg/day) and clopidogrel (75 mg/day) for more than 5 days before the procedure to the post-procedural period. Of these patients, 30 patients who underwent light transmission aggregometry (LTA) before procedure, post-procedure (3 days after procedure), and at first post-discharge clinic visit were included as the subjects. The following characteristics were studied: age; sex; presence/absence of hypertension, dyslipidemia, and/or diabetes mellitus; location of aneurysm; type/number of stent; technique for stent placement; duration of preoperative multiple antiplatelet therapy; perioperative platelet aggregation test results; and postoperative ischemic or hemorrhagic complications. Among these 30 patients, the median duration of antiplatelet therapy prior to the preoperative platelet aggregation measurements was 7 (interquartile range [IQR]: 6-8) days, and post-discharge measurement of LTA was performed at a median period of 27 (IQR: 22-35.5) days after procedure. The preoperative, postoperative, and first post-discharge clinic visit LTA values for adenosine diphosphate (ADP)-induced platelet aggregation were 50% (IQR: 44-54%), 42.5% (IQR: 36-48%), and 36% (IQR: 32-40%), respectively. These results represented gradual decrease in LTA values and a significant difference between the preoperative and post-discharge values. The LTA values for collagen aggregation showed a significant difference evident between the preoperative and post-discharge values; preoperative 38% (IQR: 27-60%), postoperative 42% (IQR: 30-58%), post-discharge 28% (IQR: 20-42%), respectively. We had one thromboembolic complication and one hemorrhagic complication. The results indicated that appropriate platelet aggregation monitoring during multiple antiplatelet therapy prevents thromboembolic complications such as stent thrombosis. However, we also found that many patients demonstrated increased postoperative platelet aggregation inhibitory effects due to the postoperative continuation of the same multiple antiplatelet therapy that was used preoperatively. This study demonstrates that postoperative, continuous, oral antiplatelet therapy induces increased platelet aggregation inhibition effects, which may lead to hemorrhagic complications. Therefore, continued platelet aggregation monitoring after surgery may be important to allow for any necessary alterations to the therapeutic dose and regimen.

Stent Placement Technique with ERCP to the Patient with Situs Inversus Totalis and Splenosis

Stent Placement Technique with ERCP to the Patient with Situs Inversus Totalis and Splenosis

PD41-06 LONG-TERM OUTCOMES OF LASER INCISION AND KENALOG INJECTION FOR THE MANAGEMENT OF URETEROENTERIC ANASTOMOTIC STRICTURES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-06 LONG-TERM OUTCOMES OF LASER INCISION AND KENALOG INJECTION FOR THE MANAGEMENT OF URETEROENTERIC ANASTOMOTIC STRICTURES Andrew B. Katims*, Beth T. Edelblute, Andrew W. Tam, Anna M. Zampini, Reza Mehrazin, and Mantu Gupta Andrew B. Katims*Andrew B. Katims* More articles by this author , Beth T. EdelbluteBeth T. Edelblute More articles by this author , Andrew W. TamAndrew W. Tam More articles by this author , Anna M. ZampiniAnna M. Zampini More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign ureteroenteric anastomotic stricture (UEAS) is a common postoperative complication after urinary diversion with an incidence of 3-10%. The gold standard of management is ureteral reimplantation, but due to the associated morbidity, endoscopic repair is an attractive management option. Minimally invasive approaches, including balloon dilatation, endoureterotomy, or metal stenting, have been investigated in multiple short-term studies. However, there is a paucity of long-term data in the current literature after endoscopic UEAS treatment. Our objective is to report long-term follow up of our technique for endoscopically managing UEAS after cystectomy. METHODS: Patients with endoscopically managed benign UEAS after cystectomy were included regardless of the type of enteric urinary diversion. The patients were treated between 2012 and 2019. Endoscopic intervention entailed flexible ureteroscopy with biopsy followed by laser incision of the stricture and of periureteral and perileal tissues 1 cm below and 1 cm above the stricture into fat. Kenalog injection was then performed, followed by balloon dilation of the incised area to 24Fr to assure no residual strands, and to ingrain the steroid into the incised area. The procedure was concluded by placement of parallel or solitary stents for 6 weeks. Patients were followed with CT scans at three months and one year after surgery, and renal ultrasound at six and nine months, and then annually. RESULTS: Twenty two patients, and a total of 26 UEAS were treated. Urinary diversion included ileal conduit (n=12), neobladder (n=8), and Indiana pouch (n=2). Twenty patients had no recurrence of stricture, including three who had bilateral disease, yielding an overall success rate of 88.5%. Both patients, one with bilateral disease, with recurrence had evidence of stricture within three months of their endoscopic surgery. Follow-up ranged from two to 96 months, with a median of 33.5 months. CONCLUSIONS: Patients treated endoscopically for UEAS have been shown to have acceptable short-term success with less morbidity when compared to ureteral reimplantation. Our technique of laser incision, Kenalog injection, balloon dilation, and temporary stent placement has a cure rate of nearly 90% and is unique in that long-term data confirms the durability of this endoscopic procedure. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e823-e823 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew B. Katims* More articles by this author Beth T. Edelblute More articles by this author Andrew W. Tam More articles by this author Anna M. Zampini More articles by this author Reza Mehrazin More articles by this author Mantu Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

Hybrid placement technique for hepatic hilar obstruction using a new uncovered self-expandable metal stent.

Background and study aim Recently, a novel technique combining stent-in-stent (SIS) and side-by-side (SBS) technique (hybrid technique) has been reported. This technique may have application for hepatic hilar obstruction (HBO) because it reduces the number of times the stent mesh has to be passed. However, to the best our knowledge, evaluation of its use in that setting has not been reported. Recently, a new uncovered self-expandable metal stent (UCSEMS) has become available in Japan. The diameter of this stent delivery shaft is only 5.4 Fr, and the discrepancy between the guidewire and top of stent delivery system is strongly reduced. We herein report technical tips for hybrid metal stent deployment for high-grade HBO using this novel UCSEMS. Hybrid metal stent deployment using he novel UCSEMS was attempted in seven patients. Technical success was obtained in all patients. Mean procedure time was 33.3 minutes (range, 27 to 43). Clinical success was obtained in six patients. Median stent patency was 109 days (range, 48 – 160 days).In conclusion, the hybrid metal stent placement technique appears to be useful using the new UCSEMS because of its fine-gauge stent delivery system.

Managing Arrow-Trerotola Percutaneous Thrombolytic Device Complications.

Dialysis access interventions are frequently performed by interventional radiologists. Several commercially available percutaneous thrombolytic devices can help restore patency to thrombosed arteriovenous access circuits. The Arrow-Trerotola Percutaneous Thrombolytic Device is one such device, and has a long track record of safe and effective use. However, like any medical device, complications can occur during its use. This article describes three complications and associated management strategies utilizing fundamental interventional radiology techniques of balloon tamponade, stent placement, and snare mediated foreign body retrieval.

Percutaneous Transluminal Stenting of Infra-Renal Abdominal Aorta Penetrating Atherosclerotic Ulcer

Predominantly found in the descending thoracic aorta, Penetrating Atherosclerotic Ulcer (PAU) is uncommon in the infra-renal abdominal aorta. It is defined as atherosclerotic lesions with ulceration of the aortic intima and media, and rupture of the internal elastic lamina. PAU is considered as a rare serious clinical entity that may induce aortic dissection, aortic rupture, and secular aortic aneurysm typically occurs in elderly hypertensive patients with severe systemic atherosclerosis disease. The treatment of PAU remains a subject of considerable controversy. With the development of percutaneous techniques of stent placement, stenting has emerged as a new option in the treatment of abdominal aorta PAU. We report a 68 years old man with PAU being diagnosed with symptoms of intermittent claudication of both lower limbs; that underwent intraluminal stenting. The technical success rate was 100%. We obtained excellent short and medium term clinical success without finding any complications related. Although open surgical repair is an effective therapeutic option, endovascular treatment of abdominal aortic PAU is a safe attractive alternative to surgery therapy that should be considered as the treatment of choice. Keywords: Claudication penetrating atherosclerotic ulcer; Angioplasty; Palmaz stent; Abdominal aorta

Endoscopic drainage of pancreatic fluid collections by use ofanovel biflanged stent with electrocautery-enhanced deliverysystem.

Endoscopic drainage of pancreatic fluid collections by use ofanovel biflanged stent with electrocautery-enhanced deliverysystem.