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Biomedical subjects

A C Venbrux

Publications and source records attributed to A C Venbrux.

At least 19 recordsLinked to original sources
PubMed2001

Percutaneous management of benign biliary strictures.

The interventional radiologist plays an increasing role in the management of patients with benign biliary disease. This article summarizes the percutaneous management of patients with benign biliary strictures and includes a discussion of currently available techniques. The techniques of percutaneous transhepatic cholangiography and biliary drainage will be reviewed. This includes anatomic and technical considerations of the right midaxillary and left subxyphoid percutaneous approaches, a review of percutaneous dilation of biliary strictures and the management of patients with chronic indwelling biliary drainage catheters. (ie, periodic catheter exchanges, catheter flushing, etc). The article concludes with a discussion of biliary drainage catheters and the clinical and physiologic parameters used in making a decision to remove the tube.

Catheterization↗
PubMed2001

Advanced percutaneous transhepatic biliary access.

Percutaneous transhepatic cholangiography and percutaneous biliary drainage are generally routine procedures in the majority of patients. However, when difficult clinical situations arise, advanced techniques for achieving biliary access may be required. Several advanced techniques for drainage are discussed.

Biliary Tract Diseases↗
PubMed2001

Percutaneous endoscopy for biliary radiologic interventions.

Biliary endoscopy is an adjunct to percutaneous biliary interventions. Although there are technical and cost considerations, the interventional radiologist may apply this useful tool to patients with a wide range of biliary diseases (eg, patients with retained intrahepatic stones, patients with suspected lesions requiring biopsy, etc). Discussed in this article are advantages, disadvantages, patient preparation, technical advice, complications, and a review of the literature. Percutaneous biliary endoscopy, applied through a transhepatic tube tract or a mature T tube tract, reduces radiation exposure to the patient and health care personnel in the room. The procedure is generally performed on an outpatient basis under conscious sedation. Given access to a choledochofiberscope and familiarity with its use, percutaneous endoscopy for biliary radiologic interventions is a valuable technique and may be used to manage patients with complex biliary disease.

Biliary Tract Diseases↗
PubMed2001

Complications of percutaneous transhepatic biliary interventions.

Complications of percutaneous transhepatic biliary drainage procedures range from skin discomfort to life-threatening arterial hemobilia. A thorough understanding of biliary anatomy and postprocedure care is essential if such procedures are to be performed. This article summarizes the anatomic, technical, and clinical issues related to biliary interventions and assists the interventional radiologist in the management of complications encountered in patients undergoing biliary interventions.

Biliary Tract Diseases↗
PubMed2001

Budd-Chiari syndrome: current management options.

OBJECTIVE: To assess the outcomes of current treatment strategies for Budd-Chiari syndrome. SUMMARY BACKGROUND DATA: Budd-Chiari syndrome, occlusion or obstruction of hepatic venous outflow, is a disease traditionally managed by portal or mesenteric-systemic shunting. The development of other treatment options, such as catheter-directed thrombolysis, transjugular portosystemic shunting (TIPS), and liver transplantation, has expanded the therapeutic algorithm. METHODS: The authors reviewed the medical records of all patients diagnosed with Budd-Chiari syndrome at the Johns Hopkins Hospital during the past 20 years. RESULTS: A total of 54 patients were identified: 13 (24%) male patients and 41 (76%) female patients, ranging in age from 2 to 76 years (median 33 years). Twenty-one (39%) had polycythemia vera, 3 (5.6%) used estrogens, 11 (20%) had a myeloproliferative or coagulation disorder, and in 7 (13%) the cause remained unknown. Forty-three patients were treated with surgical shunting, 24 mesocaval and 19 mesoatrial. Actuarial survival rates at 1, 3, and 5 years after shunting were 83%, 78%, and 75%, respectively. Of 33 patients surviving more than 4 years, 28 (85%) had relief of clinical symptoms. Five patients required shunt revision and eight had radiologic procedures to maintain shunt patency. Primary and secondary shunt patency rates were 46% and 69% respectively for mesoatrial shunts and 70% and 85% respectively for mesocaval shunts. Clot lysis was successful as primary treatment in seven patients. TIPS was performed in three patients, one after a failed mesocaval shunt. During an average of 4 years of follow-up, these patients required multiple procedures to maintain TIPS patency. Six patients underwent liver transplantation. Of these, three had previous shunt procedures. Five of the transplant recipients are alive with follow-up of 2 to 9 years (median 6). CONCLUSIONS: Both shunting and transplantation can result in a 5-year survival rate of at least 75%, and other treatment modalities may be appropriate for highly selected patients. Optimal management requires that treatment be directed by the predominant clinical symptom (liver failure or portal hypertension) and anatomical considerations and be tempered by careful assessment of surgical risk.

Adult↗
PubMed2000

How much guidewire is too much? Direct measurement of the distance from subclavian and internal jugular vein access sites to the superior vena cava-atrial junction during central venous catheter placement.

OBJECTIVE: The introduction of excessive lengths of guidewire during placement of central venous catheters from the internal jugular vein (IJV) or the subclavian vein (SCV) can result in rare but significant complications. To identify a "safe" guidewire insertion length, the authors performed direct intravascular measurement of the distance from these venous access sites to the superior vena cava-atrial junction (CAJ), and evaluated these distances relative to the patients' height, weight, sex, and chest radiographs. DESIGN: Prospective, nonrandomized observation. SETTING: The Interventional Radiology Department of a tertiary care referral hospital. PATIENTS: 100 adults (45 women, 55 men) evaluated during fluoroscopically directed central venous catheter placement. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The distance from the IJV or SCV access site was directly measured using fluoroscopy and an intravascular guidewire. 40 right IJVs, 31 right SCVs, 16 left SCVs, and 13 left IJVs were studied. Comparative measurements from the postprocedure radiograph were made in 20 of these cases. All measurements were correlated with patient sex, height, and weight. The mean distance from all access sites to the superior vena cava-atrial junction was 18.0 cm. The right IJV distance was the shortest, averaging 16 cm. The left SCV distance was the longest, averaging 21.2 cm. Right SCV and left IJV distances were 18.4 and 19.1 cm, respectively, but this difference was not statistically significant. Weight and radiographic measurements did not correlate with the measured vascular distance, although there was a trend toward longer distances in taller patients and males. CONCLUSIONS: Patient height, weight, and measurements from previous chest radiographs are less reliable in predicting a safe wire length than is the access site selected. In most cases, 18 cm should be considered the upper limit of guidewire introduced during central catheter placement in adults. The guidewires supplied in catheter kits should have lengths correlated to those of the catheters, and should have distance markings printed upon them.

Catheterization, Central Venous↗
PubMed1999

Placement of a flexible endovascular stent across the femoral joint: an in vivo study in the swine model.

PURPOSE: To investigate the effects of joint motion on the structural integrity of periarticular stents and on the development of neointimal hyperplasia within these devices. MATERIALS AND METHODS: In four juvenile farm swine, Wall-stents were implanted in the common femoral arteries and contralateral common femoral veins, centered at the point of maximal conformational change during passive hip flexion. Control stents were placed in the aortae and iliac veins. Angiography and transcatheter blood pressure measurements were obtained across each stent, with periarticular stents studied in flexion and extension. Two animals underwent repeated evaluation after 1 month, the others after 3 months. Findings were correlated with gross and histopathologic findings in the harvested stents. RESULTS: No stent fractures occurred. One femoral vein was injured during stent placement and was occluded 1 month later at follow-up. Hemodynamically significant stenoses were identified in one arterial stent and one venous stent at 3 months. The amount of neointimal hyperplasia was greater in periarticular stents than in controls and greater in animals studied at 1 month than in those studied at 3 months. The pattern of neointimal hyperplasia within mobile arteries was circumferentially asymmetric and thicker at the distal ends of the stents. Venous neointimal hyperplasia was thicker and markedly different in character than that seen in arterial stents from the same animals. CONCLUSIONS: Periarticular Wallstents and the underlying vascular anatomy remained structurally intact despite the stresses of repetitive motion during a 3-month period. Stents deployed across joints or in venous locations may be at greater risk for neointimal hyperplasia development and eventual occlusion than those deployed in immobile vessels and arteries. Neointimal hyperplasia may decrease in thickness after an initial period of exuberant development. Additional studies are necessary to determine long-term outcomes.

Analysis of Variance↗
PubMed1999

Embolization of the ovarian veins as a treatment for patients with chronic pelvic pain caused by pelvic venous incompetence (pelvic congestion syndrome).

Ovarian and pelvic (internal iliac) varices have long been recognized as a source of chronic pelvic pain in women. The technique of transcatheter embolotherapy for ovarian and pelvic varices requires selective catheterization of the ovarian and internal iliac veins, followed by contrast venography and embolization. The long-term effects of treatment are the subject of ongoing investigation. This article provides a concise background on ovarian and pelvic varices and reviews the recently published literature on their embolization for the treatment of pelvic venous incompetence (also known as pelvic congestion syndrome).

Chronic Disease↗
PubMed1998

Primary sclerosing cholangitis: resect, dilate, or transplant?

OBJECTIVE: The current study examines the results of extrahepatic biliary resection, nonoperative endoscopic biliary dilation with or without percutaneous stenting, and liver transplantation in the management of patients with primary sclerosing cholangitis (PSC). SUMMARY BACKGROUND DATA: Primary sclerosing cholangitis is a progressive inflammatory disease leading to secondary biliary cirrhosis. The most effective management of sclerosing cholangitis before the onset of cirrhosis remains unclear. METHODS: From 1980 to 1994, 146 patients with PSC were managed with either resection of the extrahepatic bile ducts and long-term transhepatic stenting (50 patients), nonoperative endoscopic biliary dilation with or without percutaneous stenting (54 patients), medical therapy (28 patients), and/or liver transplantation (21 patients). RESULTS: Procedure-related morbidity and mortality rates were similar between surgically resected and nonoperatively managed patients. In noncirrhotic patients, the serum bilirubin level was significantly (p < 0.05) reduced from preoperative levels (8.3+/-1.5 mg/dL) 1 (1.7+/-0.4 mg/dL) and 3 (2.7+/-0.9 mg/ dL) years after resection, but not after endoscopic or percutaneous management. For noncirrhotic PSC patients, overall 5-year survival (85% vs. 59%) and survival until death or transplantation (82% vs. 46%) were significantly longer (p < 0.05) after resection than after nonoperative dilation with or without stenting. For cirrhotic patients, survival after liver transplantation was longer than after resection or nonoperative dilation with or without stenting. Five patients developed cholangiocarcinoma, including three (6%) of the nonoperatively managed patients but none of the resected patients. CONCLUSIONS: In carefully selected noncirrhotic patients with PSC, resection and long-term stenting remains a good option. Patients with cirrhosis should undergo liver transplantation.

Adolescent↗
PubMed1998

Portal venous system thrombosis: helical CT angiography before transjugular intrahepatic portosystemic shunt creation.

PURPOSE: To evaluate the utility of helical computed tomographic (CT) angiography for depiction of thrombi in the portal venous system in patients under consideration for transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: Contrast material-enhanced helical CT was performed before TIPS creation in 25 patients. Axial, multiplanar, and three-dimensional images were evaluated to determine whether thrombus was present in the portal system and whether TIPS creation was contraindicated. CT findings were confirmed at visceral angiography (n = 3), direct portography (n = 20), or duplex ultrasonography (n = 2). RESULTS: Ten (40%) of 25 patients, including 10 (56%) of 18 patients with refractory variceal hemorrhage, had thrombus in the portal venous system. Helical CT scans depicted thrombus in nine (90%) of 10 patients (95% confidence interval = 0.71, 1.00) and in 16 (94%) of 17 vessels (95% confidence interval = 0.83, 1.00), including the portal vein (eight of eight patients), splenic vein (three of four patients), and superior mesenteric vein (five of five patients). TIPS creation was canceled in four (16%) patients on the basis of CT findings. CONCLUSION: Thrombi in the portal venous system are common in patients with refractory variceal hemorrhage. Helical CT angiography is sensitive and specific for portal venous system thrombosis and can provide information that alters treatment in these patients.

Contraindications↗
PubMed1998

Real-time bronchoscope tip localization enables three-dimensional CT image guidance for transbronchial needle aspiration in swine.

STUDY OBJECTIVE: To determine the feasibility of using real-time bronchoscope position technology coupled with previously acquired three-dimensional CT data to enhance transbronchial needle aspiration (TBNA). DESIGN: Eight swine were given percutaneously created target lesions for TBNA. A miniature position sensor was placed at the tip of a bronchoscope, and real-time position information during bronchoscopy was presented on a monitor simultaneously displaying previously acquired three-dimensional CT data. INTERVENTIONS: TBNA of target lesions and submucosal ink-spot injection of computer-generated targets. MEASUREMENTS AND RESULTS: TBNA specimens revealed successful aspiration of target material. Distances between ink marks made at computer-generated tracheal targets varied, on average (+/- SD), 4.2 mm +/- 2.6 mm from predetermined computer-distance coordinates. CONCLUSION: Real-time bronchoscope position technology coupled with previously acquired CT images may aid with TBNA of nonvisible extrabronchial lesions.

Animals↗
PubMed1997

Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster.

OBJECTIVE: This study was designed to evaluate the total costs associated with repair of laparoscopic cholecystectomy (LC)-related bile duct injuries. SUMMARY BACKGROUND DATA: The popularity of LC with both patients and surgeons is such that this procedure now exceeds open cholecystectomy by a ratio of approximately 4 to 10:1. However, costs associated with LC-related injuries, particularly regarding treatment patterns, have up to now not been explored fully. METHODS: The complete hospital and interventional radiology (IR) billing records for 49 patients who have completed treatment for laparoscopic cholecystectomy-related bile duct injuries were divided into 8 categories. These records were totaled for comparison of costs between patient groups that experienced different injuries and treatment patterns. RESULTS: Patients with LC-related bile duct injuries were billed a mean of $51,411 for all care related to repair of their bile duct injury. Patients incurred an average of 32 days of inpatient hospitalization and 10 outpatient care days. Postoperative treatment included long-term chronic biliary intubation averaging 378 days. Two patients (4%) died as a result of their LC-related complications. Patients with bile duct injuries that were recognized immediately at the time of the initial surgery ultimately experienced a total cost for their repair and hospitalization of 43% to 83% less than for patients in whom recognition of the injury was delayed (p < 0.019 to 0.070). In addition, the total hospitalization and outpatient care days was reduced by as much as 76% with early recognition of an iatrogenic injury. CONCLUSIONS: Repair of cholecystectomy-related bile duct injuries can run 4.5 to 26.0 times the cost of the uncomplicated procedure and carries a significant mortality rate. Intraoperative recognition of such an injury with immediate conversion to an open procedure for definitive repair can result in significant cost savings and relates directly to a decreased morbidity, mortality, length of hospitalization, and number of outpatient care days.

Adult↗
PubMed1997

Major bile duct injuries during laparoscopic cholecystectomy. Follow-up after combined surgical and radiologic management.

OBJECTIVE: The authors provide the results of follow-up evaluation after combined surgical and radiologic management of 89 patients with major bile duct injuries during laparoscopic cholecystectomy. SUMMARY BACKGROUND DATA: The incidence and mechanism of injury of major bile duct injuries during laparoscopic cholecystectomy has been clearly defined. Furthermore, a number of series have described the management of these injuries by surgical, endoscopic, and radiologic techniques with excellent short-term results. Long-term follow-up data, however, are lacking in the management of these injuries. METHODS: Data were collected prospectively on 89 patients treated at a single institution with major bile duct injuries after laparoscopic cholecystectomy managed between July 1, 1990, and July 1, 1996. Patients referred with injuries underwent early percutaneous transhepatic cholangiography and biliary drainage. Based on the cholangiographic appearance and clinical situation, patients were managed by either percutaneous balloon dilatation or surgical reconstruction with a Roux-en-Y hepaticojejunostomy with transanastomotic stenting. Follow-up was obtained by personal interview during October 1996. RESULTS: Two patients died without an attempt at definitive therapy. Both deaths were caused by sepsis and multisystem organ failure present at the time of transfer to the authors' institution. The remaining 87 patients were managed initially by either balloon dilatation (N = 28) or surgical reconstruction (N = 59). Ten patients have not completed treatment and still have biliary stents in place. Evaluation of 25 patients completing treatment after balloon dilatation (mean follow-up, 27.8 months) showed a success rate of 64%. Evaluation of 52 patients completing treatment after surgical reconstruction (mean follow-up, 33.4 months) showed a success rate of 92%. All failures were managed successfully by either surgical reconstruction or balloon dilatation. CONCLUSIONS: Major bile duct injuries can be managed successfully by combined surgical and radiologic techniques. This series provides, for the first time, significant follow-up on a large number of patients with overall success rates of 64% after balloon dilatation and 92% after surgical reconstruction. The combination of surgery and balloon dilatation resulted in a successful outcome in 100% of patients treated.

Adult↗
PubMed1997

Cholangiocarcinoma: a review.

Cholangiocarcinoma is associated with several etiological factors including cystic dilation of the bile duct, clonorchiasis, hepatolithiasis, and sclerosing cholangitis. Jaundice is the presenting symptom in over 90% of patients who present with cholangiocarcinoma. The disease is suspected on the basis of an abnormal ultrasound or computed tomography (CT). Tumor markers are often normal, but a significant elevation of carcinoembryonic antigen or CA 19-9 should alert the clinician of a possible diagnosis of cholangiocarcinoma. Cholangiogram is essential to dileneate the bile duct anatomy in hilar or distal cholangiocarcinoma. A tissue diagnosis can be obtained in 60 to 70% of patients using bile cytology, brush cytology, or percutaneous fine-needle aspiration. A multidisciplinary approach is essential for optimal management. Management is based on a number of factors, including age of the patient, performance status, other comorbid conditions, location of the tumor, and tumor resectability. Complete surgical resection offers the only chance for cure in patients with cholangiocarcinoma. Tumor resectability can be accomplished using a combination of CT or magnetic resonance imaging, cholangiography, and visceral angiography. The 5-year survival rate after a potentially curative resection for hilar cholangiocarcinoma ranges from 0 to 22% (mean 14%). By comparison, the 5-year survival rate for distal cholangiocarcinoma ranges from 0 to 39% (mean 25%). Symptomatic patients who are unsuitable for curative resection can have pallitive decompression performed using either percutaneously or endoscopically placed drainage catheters.

Bile Duct Neoplasms↗