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   Table of Contents - Current issue
January-June 2018
Volume 2 | Issue 1
Page Nos. 1-40

Online since Tuesday, February 6, 2018

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Transarterial embolization of intermediate hepatocellular carcinoma in elderly patients: Which technique should be first-line? Highly accessed article p. 1
Azzam Khankan, Abdul Rahman Jazieh
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How i do it: Celiac and splanchnic plexus neurolysis p. 4
Aghiad Al-Kutoubi
Celiac block to alleviate pain in the upper abdomen was first described by Kappis in 1914. Since then the role of this procedure has been fairly established in the management of pain related to pancreatic disease and also in pain related to liver, gall bladder and gastric diseases. This article discusses the clinical indications and technical details of celiac and splanchnic neurolysis.
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Endovascular management of arterial injuries related to venous access: A retrospective review of 10-year single-center experience p. 8
Mohammad Arabi, Abdullah Almutairi, Abdulaziz Abdullah Alangari, Mohammad Mari Alamri, Abdulaziz Alharbi, Abdulrahman Alvi, Qazi Shahbaz, Yousof Alzahrani, Omar Bashir, Azzam Khankan, Essam Dulaigan, Refaat Salman, Mohammad Almoaiqel
Purpose: Retrospective review of the pattern and management techniques of arterial injuries related to central venous access with long-term outcomes. Materials and Methods: Between January 2007 and November 2017, a total of 20 patients (13 females) were included with the mean age of 63 (28–89 years) and mean body mass index of 25.75 (13.3–36.5). Venous access procedures included central venous catheter (CVC) placement, dialysis line insertion, or endovascular venous procedures. The study excluded patients who had arterial injuries related to arterial access, such as postarterial line placement, postangiography, or percutaneous coronary interventions. Results: Iatrogenic arterial injuries occurred after attempted venous access procedures involving the common femoral vein (n = 18) and subclavian vein (n = 2). Injuries were related to CVC placement (n = 5), temporary dialysis catheter (n = 14), and inferior vena cava filter insertion (n = 1). Nine patients had transarterial venous catheter insertion complicated by active bleeding from pseudoaneurysm and arteriovenous fistula. Other injuries included isolated fistula (n = 3), isolated pseudoaneurysm (n = 4), isolated branch injury (n = 2), and intra-arterial insertion (n = 2). Endovascular management included stent–graft placement (n = 14), embolization of bleeding vessel (n = 2), and thrombin injection for pseudoaneurysm (n = 2). Conservative management with manual compression achieved hemostasis in two patients. Technical success was achieved in 100%. One patient required repeat angiography and embolization of bleeding branch vessel following stent–graft placement to control bleeding fistula and pseudoaneurysm. Clinical success was achieved in all patients. Procedure-related complications included puncture site hematoma (n = 1) and partially occlusive thrombus/spasm of deep femoral artery after stent–graft placement. Six patients (33%) died within 20 days after the procedure (3–20 days) due to other comorbidities. Three additional patients (16%) died during the same hospital admission at the time of the procedure (38–114 days). There were no reported complaints related to possible stent–graft stenosis or occlusion at mean follow-up time of 5 years (50 days–8.64 years) in all seven patients who survived after stent–graft placement procedure. Conclusion: Despite technically successful endovascular management of arterial injuries related to venous access in critically ill patients, the mortality rate remains high due to other comorbidities. Allowing for the small sample size, stent–graft placement for arterial injuries in this cohort of patients appears to be an effective option with high long-term patency rate.
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Safety and efficacy of cryoablation of renal tumors in a high-risk patient population at a community hospital p. 14
Martin Oselkin, Nathan Cornish, Peter Homel, Shaun Honig, David Silver, Sergei Sobolevsky
Purpose: The purpose of the study was to evaluate the safety and efficacy of percutaneous cryoablation for the treatment of renal masses in a high surgical risk population stratified by Charlson Comorbidity Index treated at a community hospital and to determine parameters associated with higher complication rates. Materials and Methods: A retrospective chart review of patients with renal masses treated with image-guided percutaneous cryoablation between 2007 and 2013 was performed. Results: A total of 121 tumors were ablated in 105 patients. The mean patient age was 70 years old. Comorbidities included morbid obesity, hypertension, diabetes mellitus, coronary artery disease, pulmonary disease, cigarette use, and renal insufficiency. Mean tumor size treated was 3.15 cm in largest diameter, ranging from 1.4 to 6.5 cm. Complications were observed in 16 cases. The most common complication was perinephric and/or pararenal hemorrhage. Procedures with >3.5 probes, hemoglobin >12.5 g/dl, tumor size >3.55 cm, and age >75 years were all associated with greater likelihood of complications. Conclusions: Our experience with percutaneous cryoablation of small renal masses offers similar results in efficacy to published data in patients with significant comorbidities. In addition, the results of our study show that percutaneous cryoablation is relatively safe in patients with renal cancer who are poor surgical candidates but warrants special consideration. Parameters associated with higher rates of complications have been established, which may be used by physicians as a guide.
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Percutaneous endovascular sapheno-femoral bypass for treatment of chronic iliac vein stent occlusion Highly accessed article p. 20
Osman S Ahmed, Roberto Santos Loanzon, Bulent Arslan
We report a case of a 45-year-old female with a history of chronic iliac vein and inferior vena cava (IVC) occlusion, who presented with diffuse bilateral lower limb edema and pain secondary to severe postthrombotic syndrome. Computed tomography and digital subtraction angiography demonstrated reocclusion in the patient's previously placed iliofemoral and IVC stents. Recanalization was achieved with a percutaneous endovascular bypass approach after unsuccessful attempts using standard and other advanced endovascular techniques including sharp needle and radiofrequency wire recanalization.
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Endovascular management of symptomatic hypervascular endometrial polyposis in a virgin patient p. 24
Ibrahim Alrashidi, Fares Garad, Faisal Alahmari, Sultan Alammari, Nayef Alqahtani, Abdulaziz Almathami, Hatim Alobaidi
We report a case of uterine artery embolization (UAE) of endometrial polyposis in a 42-year-old virgin female who had a 10-year history of menorrhagia resulting in with chronic anemia. Endometrial polyps resolved and patient's symptoms improved with no recurrence at 18-month follow-up pelvic magnetic resonance imaging. This case presents UAE as an alternative option for the management of endometrial polyps in patients who decline surgical or hysteroscopic options.
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A hybrid approach to right-sided aortic arch aneurysm using bilateral carotid to subclavian bypass with a customized fenestrated thoracic endovascular aortic repair device p. 26
Victoria A Burrows, Siuchan Sookhoo
We present a hybrid approach to the management of an aortic aneurysm in a right-sided aortic arch with aberrant left subclavian artery and associated Kommerell's diverticulum. The aneurysm extended from the origin of the left common carotid artery to the mid-descending thoracic aorta. A bilateral carotid to subclavian artery bypass was performed followed by endovascular placement of a customized fenestrated thoracic endovascular aortic repair device (TEVAR, Cook Medical, Australia). Endovascular stents (Viabahn, Gore Medical, Arizona) were placed in the carotid arteries bilaterally and Amplatzer II plugs (AGA Medical Corporation) were used to occlude the subclavian arteries. Follow-up imaging at 1 month revealed no evidence of endoleak.
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Extra-anatomic “rendezvous” technique in management of biliary complications following liver surgery: A technical note p. 29
Wafa Boughanmi, Haytham Derbel, Yann Lebaleur, Melanie Chiaradia, Vania Tacher, Hicham Kobeiter
We describe extra-anatomic “rendezvous” technique for the management of bile leak associated with biliary stricture following hepatic surgery in two patients. In the procedure, the endoscopic guidewire was snared from the biloma cavity and pulled through the percutaneous access allowing for a drain to be placed. Both procedures were technically successful.
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Endovascular management in a case of recurrent bleed following transurethral resection of the prostate p. 33
RB Nerli, Vishal Kadeli, Naveen Mulimani, Shridhar C Ghagane
Transurethral resection of prostate (TURP) remains the gold standard surgical therapy for symptomatic benign prostatic enlargement, with reported International Prostate Symptom Score reduction of up to 70%. However, as many as 20% of patients can have significant complications including sexual dysfunction, perioperative bleeding requiring blood transfusion, and incontinence. Intractable hematuria from the prostate can be life-threatening, and its management remains a difficult clinical problem. Prostate artery embolization (PAE) is occasionally indicated in such patients when all other measures have failed. PAE has been used to treat benign prostatic hyperplasia; however, literature related to its use for bleeding following TURP remains limited. We report a case of an elderly male who presented with recurrent episodes of hematuria following TURP and was successfully treated by endovascular management.
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Encapsulating peritoneal sclerosis: A rare complication of peritoneal dialysis p. 36
Ahmed Ali Sumayli, Nasser Dafer Alhendi
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Patent foramen ovale during pulmonary embolism thrombolysis p. 37
Rahaf El-Hussein Salem, Latifah Al-Fahad, Mohammed Al-Shammari
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Wallflex stent targeting for the placement of retrograde jejunostomy in a patient with intrathoracic stomach and organoaxial gastric rotation p. 38
Ravi N Srinivasa, Nishant Patel, James J Shields, Joseph J Gemmete, Jeffrey Forris Beecham Chick
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