Percutaneous Therapeutic Procedures Research Articles

Methodological notes on physical parameters of low-level laser irradiation. Part 2. Light dosage at laser therapeutic sessions

Purpose. The general goal of this methodological article, consisting of two parts, is to provide a unifying theoretical approach to the still debated problem on determining the depth of laser light penetration into biotissues and the dosage of laser therapeutic effect from the standpoint of modern medical physics. The purpose of the second part of the article is to demonstrate that calculation of the absorbed dosage at laser therapy sessions is similar to the calculation of classical doses in radiobiology and radiation therapy.Materials and methods. The authors reviewed current state of terms and definitions related to the calculation of doses in ionizing and non-ionizing radiation. The Monte Carlo method was used to simulate the soft tissue volume in which 95 % of radiation energy is absorbed. A classical absorbed dose measured in Grays was estimated. Numerical simulation of absorbed doses for various typical laser therapy procedures was performed.Results. It has been shown that the effective irradiated volume of tissues, despite of small variations in soft tissue density between patients, allows to calculate the absorbed radiation dose in Grays, similar to radiobiological doses. Comparative findings on a single local absorbed dose for various percutaneous therapeutic procedures do not contradict the known clinical data, and even more, make the relationship of different doses for different therapeutic purposes more clear. As it has been found, typical doses range from 0.7 Gy for intravascular blood irradiation to 106 Gy for destructive photodynamic therapy and UV therapy procedures in dermatology.Conclusion. The proposed methodological approach proposes a new look at both the problem of the depth of laser light penetration into biotissues and the problem of laser light doses during therapeutic and diagnostic procedures from a unified medical and physical standpoint.

Trends in cardiovascular care in the National Health System in Spain. Data from the RECALCAR project 2011-2020

Introduction and objectivesThe RECALCAR project (Resources and Quality in Cardiology), an initiative of the Spanish Society of Cardiology, aims to standardize information to generate evidence on cardiovascular health outcomes. The objective of this study was to analyze trends in the resources and activity of cardiology units and/or services and to identify the results of cardiovascular care during the last decade in Spain. MethodsThe study was based on the 2 annual data sources of the RECALCAR project: a survey on resources and activity of cardiology units and/or services (2011-2020) and the minimum data set of the National Health System (2011-2019), referring to heart failure (HF), STEMI, and non-STEMI. ResultsThe survey included 70% of cardiology units and/or services in Spain. The number of hospital beds and length of stay decreased, while there was a notable increase in the number of cardiac imaging studies and percutaneous therapeutic procedures performed. Age- and sex-adjusted admissions for HF tended to decrease, despite an increase in mortality and the percentage of readmissions. In contrast, the trend in mortality and readmissions was highly favorable in STEMI; in non-STEMI, although positive, the trend was less marked. ConclusionsThe information provided by the RECALCAR project shows a favorable trend in the last decade in resources, activity and results of certain cardiovascular processes and constitutes an essential source for future improvements and decision-making in health policy.

Evolución de la asistencia cardiovascular en el Sistema Nacional de Salud de España. Datos del proyecto RECALCAR 2011-2020

Introduction and objectivesThe RECALCAR project (Resources and Quality in Cardiology), an initiative of the Spanish Society of Cardiology, aims to standardize information to generate evidence on cardiovascular health outcomes. The objective of this study was to analyze trends in the resources and activity of cardiology units and/or services and to identify the results of cardiovascular care during the last decade in Spain. MethodsThe study was based on the 2 annual data sources of the RECALCAR project: a survey on resources and activity of cardiology units and/or services (2011-2020) and the minimum data set of the National Health System (2011-2019), referring to heart failure (HF), STEMI, and non-STEMI. ResultsThe survey included 70% of cardiology units and/or services in Spain. The number of hospital beds and length of stay decreased, while there was a notable increase in the number of cardiac imaging studies and percutaneous therapeutic procedures performed. Age- and sex-adjusted admissions for HF tended to decrease, despite an increase in mortality and the percentage of readmissions. In contrast, the trend in mortality and readmissions was highly favorable in STEMI; in non-STEMI, although positive, the trend was less marked. ConclusionsThe information provided by the RECALCAR project shows a favorable trend in the last decade in resources, activity and results of certain cardiovascular processes and constitutes an essential source for future improvements and decision-making in health policy.Full English text available from:www.revespcardiol.org/en

Incidence of contrast induced nephropathy among patients undergoing coronary interventions

Background: Contrast media (CM) used during diagnostic and therapeutic percutaneous procedures is eliminated by the kidneys. A study has been planned to find the adverse effects of contrast agents on renal system. Methods: This was a hospital based cross sectional study, conducted in the department of general medicine, GSL Medical College. Individuals >25 age, both gender with heamoglobin concentration of > 10mg/dl were included. Exclusion criteria was also followed. Iodixanol or iohexol was used, administered at the rate of 80 – 100 ml per participants. Blood samples were collected standard techniques before the procedure and 48 hours after the procedure for serum creatinine levels. Renal function was assessed by estimating creatinine clearance using the Cockcroft-gault formulae. As per national kidney foundation participants were divided in to 4 categories normal, mildly impaired, moderately impaired and severely impaired renal function; p<0.05 was considered as statistically significant. Results: Out of 80 study subjects, CIN was increased with age, identified in 37.9% diabetics, 48.3% smokers, 41.4% alcoholics; statistically there was no significant difference. In the normal category 34.5%, 41.4% in mild category, 24.1% in moderate renal dysfunction category developed CIN, association was statistically significant. Conclusions: With these findings we conclude that overall increase in the incidence of CIN with age and no influence of gender as well as conditions like diabetes and hypertension.

Hepatocellular carcinoma and liver metastases: clinical data on a new dual-lumen catheter kit for surgical sealant infusion to prevent perihepatic bleeding and dissemination of cancer cells following biopsy and loco-regional treatments.

BackgroundRFA is a safe and effective procedure for treating unresectable primary or secondary liver malignancies, but it is not without complications. The most common reported complications include abdominal hemorrhage, bile leakage, biloma formation, hepatic abscesses, and neoplastic seeding.The aim of this study is to evaluate the feasibility of percutaneous use of surgical sealant with a new coaxial bilumen catheter, to prevent the perihepatic bleeding and dissemination of cancer cells through the needle-electrode (neoplastic seeding) or along the needle track.MethodsWe designed a novel dual-lumen catheter to facilitate the optimal application of fibrin sealant after diagnostic and therapeutic percutaneous procedures. Percutaneous RFA has been performed using mask ventilation or neuroleptanalgesia. The main aims of this study, after the ablation procedure, in the treatment of unresectable liver cancer were to prevent major adverse events: a) the perihepatic bleeding; b) dissemination of cancer cells through the needle-electrode and or needle track.ResultsA total of 181 patients were evaluated for this study at National Cancer Institute of Naples from January 2012 to January 2014. The association of blood loss (≤1 g/dl; ≥1 g/dl) with age, gender, histological diagnosis were analyzed. No statistical significance was observed between bleeding and age (p = 0.840), gender (p = 0.607) and histological diagnosis (p = 0,571), respectively.ConclusionsThis study demonstrated that fibrin sealant or other surgical sealant injection, after any locoregional procedure such as biopsy or ablation, could make adverse events even more rare.

Echocardiographic guidance for diagnostic and therapeutic percutaneous procedures.

Echocardiographic guidance has an important role in percutaneous cardiovascular procedures and vascular access. The advantages include real time imaging, portability, and availability, which make it an effective imaging modality. This article will review the role of echocardiographic guidance for diagnostic and therapeutic percutaneous procedures, specifically, transvenous and transarterial access, pericardiocentesis, endomyocardial biopsy, transcatheter pulmonary valve replacement, pulmonary valve repair, transcatheter aortic valve implantation, and percutaneous mitral valve repair. We will address the ways in which echocardiographic guidance provides these procedures with detailed information on anatomy, adjacent structures, and intraprocedural instrument position, thus resulting in improvement in procedural efficacy, safety and patient outcomes.

Common Congenital Heart Disorders in Adults: Percutaneous Therapeutic Procedures

The population of adults with unrepaired, palliated, and repaired congenital heart disease is growing. Surgical intervention, once the mainstay of palliative and corrective therapy, has been supplanted in many instances by less invasive trans-catheter techniques. Hybrid procedures involving the symbiotic use of surgical and trans-catheter techniques are increasingly utilized in patients with complex lesions. This article summarizes some of the currently applied trans-catheter interventional techniques for pulmonary stenosis, ASD, VSD, and coarctation of the aorta.

High-Resolution Ultrasound in Research of Mouse Orthotopic Glioma and Ultrasound-Guided Cell Implant

The purpose is to evaluate the feasibility of imaging mouse brain with high resolution ultrasound (HiRes US), and generation of mouse brain tumor (glioma) model under HiRes US guided implantation of glioma cells. Normal mouse brain was imaged with 30 MHz HiRes US in six pups and ten adult nude mice. Glioma model was developed by injecting human glioma cells (5 × 105), U-87MG-luc, under HiRes US guidance, in three pups and five adult mice. Bioluminescence imaging, magnetic resonance imaging, and HiRes US were used for in vivo tumor imaging. In addition, brain imaging ex vivo with HiRes US were also performed in three tumor bearing and five normal brains. The brain parenchyma was seen as a homogeneous low echo on HiRes US without locoregional echo differences. An inverted U shaped linear echo structure (fissure) differentiated the telencephalon from the diencephalon. Bilaterally budding structure at the base of the skull represented the trigeminal nerve. The inserted needle, used to implant the glioma cells, was seen as a high linear echogenic reflection. Brain tumor on ex vivo HiRes US was well demarcated, homogeneous and hyperechoic compared to the surrounding healthy brain. In conclusion, imaging the brain with HiRes US in small animal model like mouse is possible and convenient. Real-time guiding is possible to perform any intervention from tumor implantation to percutaneous therapeutic procedures. Ex vivo, HiRes US is extremely useful to study the detailed anatomical features.

Tratamento percutâneo de pseudoaneurismas por injeção de trombina guiada por Ultrassom

INTRODUÇÃO: Pseudoaneurisma iatrogênico ocorre em 0,5% a 2% dos procedimentos percutâneos diagnósticos e em até 7% a 8% dos procedimentos percutâneos terapêuticos. A oclusão do pseudoaneurisma pela injeção de trombina guiada por ultrassom diretamente no interior do saco aneurismático é técnica pouco invasiva, de execução rápida e segura, e com alto índice de sucesso. A proposta deste trabalho é relatar nossa experiência no tratamento do pseudoaneurisma iatrogênico por injeção de trombina guiada por ultrassom MÉTODO: Entre setembro de 2006 e fevereiro de 2010 realizamos 1.811 procedimentos cardíacos percutâneos com ocorrência de 15 pseudoaneurismas (0,8%), dos quais 13 foram tratados com injeção de trombina guiada por ultrassom de forma consecutiva. Características clínicas, tipo de procedimento, medicações coadjuvantes, tamanho e morfologia dos pseudoaneurismas, dose de trombina utilizada, resultado da terapia e ocorrência de complicações foram documentados e armazenados prospectivamente em banco de dados e, então, analisados retrospectivamente RESULTADOS: A taxa de sucesso primário foi de 100%, com apenas uma recidiva sete dias após a abordagem inicial, tratada com sucesso pela mesma técnica. Não foi observada ocorrência de complicações relacionadas à injeção de trombina guiada por ultrassom e todos os pacientes apresentavam-se assintomáticos aos 30 dias de acompanhamento CONCLUSÃO: A injeção de trombina guiada por ultrassom realizada por profissionais com experiência em ultrassom vascular e em punções transparietais de cistos e coleções é uma opção terapêutica viável, prática e segura no tratamento do pseudoaneurisma iatrogênico.

Imaging of Tendons

Both magnetic resonance imaging (MRI) and sonography are well suited to tendon imaging. A normal tendon on MRI demonstrates low signal intensity and on sonography, an echogenic fibrillar pattern. MRI is considered the imaging gold standard, providing an anatomic overview and excellent soft tissue contrast. Sonography is a more rapidly performed examination; it has greater resolution than that of MRI; it allows dynamic evaluation of tendons and muscles; and it can guide percutaneous therapeutic procedures. Moreover, the advent of sonographic extended-field-of-view imaging allows the demonstration of the entire length of a tendon, matching MRI’s ability to display a large anatomic region. Sonography should best be considered a focused examination, concentrating on the area of pain and clinical suspicion of pathology, whereas MRI can provide a global assessment of the region of concern. Both modalities demonstrate high accuracy for abnormalities of various tendons. This article reviews normal tendon anatomy and its imaging appearance, as well as the imaging appearances of tendon degeneration and tear.

Needle track seeding following percutaneous procedures for hepatocellular carcinoma

Neoplastic seeding may arise after diagnostic or therapeutic percutaneous procedures for hepatocellular carcinoma. The true incidence of seeding with hepatocellular carcinoma is difficult to assess precisely, but a significant risk of seeding exists and is greater when performing diagnostic biopsy as compared to therapeutic percutaneous procedures [radiofrequency ablation, radiofrequency ablation (RFA); percutaneous ethanol injection, Percutaneous ethanol injection (PEI)]. Whenever liver transplantation is feasible, diagnostic needle biopsies should be avoided, but RFA and PEI are often needed as "bridge" treatments. The role of adjuvant treatments in reducing the incidence of seeding following RFA or PEI requires further evaluation.

Fetal Surgery: Coming to a Center Near You?

consent process that accompanies these procedures. Maternal–fetal surgery when properly performed by trained individuals in well-structured centers typically proceeds without the mother requiring admission to an intensive care unit. Nevertheless, familiarity with critical care considerations for the obstetric patient is helpful. Even in the best centers, significant maternal complications may arise at subsequent pregnancies, especially following open fetal surgery. On the other hand, the fetus is at risk for procedurerelated complications, preterm delivery, and the morbidity associated with the underlying anomaly. These and other factors should be discussed in a nondirected manner during the informed consent process. This is an area in which the intensivist should actively participate. Newborns who have undergone fetal surgery have had the natural history of their anomalies altered. The physiologic consequences of these alterations may or may not be predictable, challenges for which the neonatologist should be prepared. Fetuses that undergo procedures, especially shortly before birth, may manifest physiologic changes not typical of the average newborn. For example, drainage of large intrathoracic, cervical, or sacrococcygeal cystic lesions just before delivery may result in significant fluid shifts that need to be accounted for during the early newborn period. Expanding fetal surgical indications and a wide variety of interventions present new challenges for the neonatologist and other practitioners in the intensive care setting. A larger number of centers perform percutaneous procedures in utero. Although the vast majority of these are diagnostic and do not typically affect the well-being of the mother or fetus, increasing numbers of percutaneous therapeutic procedures are also being performed at many centers. Fetoscopic procedures require a higher skill set and special The intrigue and mystique of fetal surgery have moved from the realm of science fiction to medical reality. Since the initial attempts at fetal surgery in the 1960s, extensive preclinical studies coupled with advances in imaging technology and surgical instrumentation have resulted in a rapidly growing field. No longer is the womb a barrier to addressing some anomalies that plague newborn infants. Initially developed by perinatologists using needle-based interventions, fetal surgery has expanded to involve fetal/pediatric surgeons performing operations through a partially opened uterus. Minimal access surgery has also found its way into the fetal realm with fetoscopic interventions, which permit endoscopic visualization of the fetus and placenta. With markedly improved optics in recent years, fetoscopy has undergone a resurgence, especially for placenta-based procedures. However, limitations in instrumentation haverestricted its use for correction of structural anomalies (at least for now). Fetal surgical procedures affect the mother and fetus. The mother is typically an innocent bystander who assumes a significant amount of risk with minimal or no direct medical benefit. Many mothers would be willing to do whatever they can for the benefit of their fetus or baby, even putting themselves at undue risk. Understanding the expected benefit of the fetal intervention and the possible risks to the mother is therefore a critical part of the informed

Seeding risk following percutaneous approach to hepatocellular carcinoma

Tumour biopsy is usually considered mandatory for patient management by oncologists. Currently percutaneous ablation is used therapeutically for cirrhotic patients with small hepatocellular carcinoma (HCC), not suitable for resection or waiting for liver transplantation. However malignant seeding is a recognized complication of both diagnostic and therapeutic procedures in patients with HCC. Although percutaneous therapy whether with or without biopsy of a suspected HCC nodule may minimize the risk of seeding, this has not been confirmed. To evaluate the risk of seeding, defined as new neoplastic disease occurring outside the liver capsule, either in the subcutaneous tissue or peritoneal cavity following needle biopsy and/or local ablation therapy (LAT). A literature search resulted in 179 events in 99 articles between January 1983 and February 2007: 66 seedings followed liver biopsy, 26 percutaneous ethanol injection (PEI), 1 microwave, 22 radiofrequency ablation (RFA), and 64 after combined biopsy and percutaneous treatment (5 microwave; 33 PEI; 26 RFA). In 41 papers specifying the total number of patients biopsied and/or treated, the median risk of seeding was 2.29% (range 0-11%) for biopsy group; 1.4% (1.15-1.85%) for PEI when used with biopsy and 0.61% (0-5.56%) for RFA without biopsy, 0.95% (0-12.5%) for RFA with biopsy and 0.72% (0-10%) for liver nodules (including non-HCC nodules) biopsied and ablated. Risk of seeding with HCC is substantial and appears greater with using diagnostic biopsy alone compared to therapeutic percutaneous procedures. This risk is particularly relevant for patients being considered for liver transplantation.

Diagnostic and Therapeutic Percutaneous Procedures in the Spine

Diagnostic and Therapeutic Percutaneous Procedures in the Spine

The role of interventional radiology in management of patients with end-stage renal disease

The aim of the paper is to review the role of interventional radiology in the management of hemodialysis vascular access and complications in renal transplantation. The evaluation of patients with hemodialysis vascular access is complex. It includes the radiology/ultrasound (US) evaluation of the peripheral veins of the upper extremities with venous mapping and the evaluation of the central vein prior to the access placement and radiological detection and treatment of the stenosis and thrombosis in misfunctional dialysis fistulas. Preoperative screening enables the identification of a suitable vessel to create a hemodynamically-sound dialysis fistula. Clinical and radiological detection of the hemodynamically significant stenosis or occlusion demands fistulography and endovascular treatment. Endovascular prophylactic dilatation of stenosis greater than 50% with associated clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. The technical success rates are over 90% for dilatation. One-year primary patency rate in forearm fistula is 51%, versus graft 40%. Stents are placed only in selected cases; routinely in central vein after dilatation, in ruptured vein and elastic recoil. Thrombosed fistula and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. The success rate of the technique is 89–90%. Primary patency rate is 8–26% per year and secondary 75% per year. The most frequently radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. US is often the method of choice for the diagnostic evaluation and management of the percutaneous therapeutic procedures in early and late transplantation complications. Computed tomography and magnetic resonance are valuable alternatives when US is inconclusive. Renal and perirenal fluid collection are usually treated successfully with percutaneous drainage. Doppler US, magnetic resonance angiography and digital subtraction angiography have a principle role in the evaluation of vascular complications of renal transplantation and management of the endovascular therapy. Stenosis, the most common vascular complication, occurs in 1–12% of transplanted renal arteries and represents a potentially curable cause of hypertension following transplantation and/or renal dysfunction. Treatment with percutaneous transluminal renal angioplasty (PTRA) or PTRA with stent has been technically successful in 82–92% of the cases, and graft salvage rate has ranged from 80 to 100%. Restenosis occurs in up to 20% of cases, but are usually amenable to repeated PTRA. Complications such as arterial and vein thrombosis are uncommon. Intrarenal A/V fistulas and pseudoaneurysms are occasionally seen after biopsy, the treatment requires superselective embolisation. Urologic complications are relatively uncommon, predominantly they consist of the urinary leaks and urethral obstruction. Interventional treatment consists of percutaneous nephrostomy, balloon dilation, insertion of the double J stents, metallic stent placement and external drainage of the extrarenal collections.

Percutaneous therapeutic procedures in acute aortic dissection: Evidence for benefit is mounting Rossella Fattori, Kim A. Eagle, David Williams, Jeanna Cooper, Eric Isselbacher, Christoph Nienaber. University of Michigan Medical Center, Ann Arbor, MI

Percutaneous therapeutic procedures in acute aortic dissection: Evidence for benefit is mounting Rossella Fattori, Kim A. Eagle, David Williams, Jeanna Cooper, Eric Isselbacher, Christoph Nienaber. University of Michigan Medical Center, Ann Arbor, MI

Interventional therapeutic techniques in Budd-Chiari syndrome

To analyze the results obtained with percutaneous therapeutic procedures in patients with Budd-Chiari syndrome (BCHS). Between August 1991 and April 1993, seven patients with BCHS were treated in our hospital. Three presented with a congenital web; in another three cases the hepatic veins and/or the inferior vena cava (IVC) were compromised after major hepatic surgery; one patient presented with a severe stenosis of the intrahepatic IVC due to hepatomegaly. One of the patients with congenital web has required several new dilatations due to restenosis; one patient required a transjugular intrahepatic portosystemic shunt procedure while awaiting a liver transplantation. The two postsurgical patients with stenosed hepatic veins did not require any new procedure after the placement of metallic endoprostheses. However, the patient with liver transplantation presented IVC restenosis after balloon angioplasty that required the deployment of metallic endoprostheses. In the patient with hepatomegaly a self-expandable prosthesis was placed in the intrahepatic portion of the IVC before (4 months) a liver transplantation. Interventional therapeutic techniques offer a wide variety of possibilities for the treatment of patients with BCHS. For IVC stenoses, the results obtained with balloon angioplasty are at least as good as those obtained with surgery.