Search PubMed⌕ Search

Biomedical subjects

Constantinos T Sofocleous

Publications and source records attributed to Constantinos T Sofocleous.

15 recordsLinked to original sources
PubMed2006

Treatment of metastatic sarcoma to the liver with bland embolization.

BACKGROUND: The authors evaluated the impact of bland particle embolization on survival in patients with metastatic sarcoma to the liver. METHODS: Twenty-four patients with liver-dominant metastases from sarcoma were treated with particle embolization from 1996 to 2002. Primary tumors included 16 gastrointestinal stromal tumors (GISTs), 7 intestinal leiomyosarcomas, and 1 liposarcoma. Thirteen patients had known extrahepatic disease. Embolization was performed by using polyvinyl alcohol or trisacryl microspheres to effect stasis in the target vessel(s). Follow-up images to assess response were obtained 4 weeks after the procedure. Decrease in the size of the target lesion by >25% or development of >50% necrosis on follow-up imaging was considered a treatment response. RESULTS: Nineteen patients had metachronous liver metastases, and the median disease-free interval was 22 months (range 10-156 months) from resection of the primary tumor. Ten patients underwent prior liver resection for metastatic disease. Of 15 evaluable patients, 9 patients (60%) had a radiographic response. The median follow-up for all patients was 21 months. The median follow-up for surviving patients was 59 months. Overall survival from the time of initial embolization was 62% at 1 year, 41% at 2 years, and 29% at 3 years. Patients who had radiographic evidence of response survived significantly longer than patients who did not respond (63 months vs. 19 months; P < .007). Patients with GIST survived significantly longer than patients with visceral leiomyosarcoma (median, 36 months vs. 18 months; P < .03). CONCLUSIONS: Bland embolization was efficacious in some patients with metastatic sarcoma to the liver. Radiographic evidence of response was correlated with improved survival. This regional therapy may enter the treatment algorithm for patients who have unresectable disease or disease that has failed conventional therapies.

Adult↗
PubMed2006

Particle embolization of recurrent hepatocellular carcinoma after hepatectomy.

BACKGROUND: Complete surgical resection is the mainstay of treatment for patients with hepatocellular carcinoma (HCC). Unfortunately, most patients ultimately develop disease recurrence and the median survival from the time of recurrence is <1 year. The purpose of the current study was to review the authors' experience using bland hepatic arterial embolization to treat recurrent HCC after definitive surgical resection. METHODS: The authors reviewed their single-center hepatic embolization database from 1995 through 2004 to identify patients who underwent bland hepatic arterial embolization for disease recurrence. Data analyzed included patient demographics, Okuda stage and Child score, imaging findings, and embolization variables. Recurrence-free survival (from surgery to disease recurrence) and survival time (from recurrence to last follow-up) were calculated using the Kaplan-Meier method. RESULTS: The authors identified 45 patients treated with bland embolization for recurrent HCC after resection. Six patients also underwent ablative therapy after embolization. Of the 45 patients, 42 (93.3%) patients had Okuda Stage 1 disease. The median time to recurrence was 13 months. The median survival after embolization was 46 months, and actuarial survival rates at 1 year, 2 years, and 5 years after recurrence were 86%, 74%, and 47%, respectively, with a median follow-up of 31 months. Patients who developed disease recurrence with a solitary lesion had a significantly improved survival (P = .03) At the time of last follow-up, 3 patients (6.6%) were alive with no evidence of viable disease. CONCLUSIONS: Bland arterial embolization was found to be an effective method of salvage therapy for patients with good liver function with recurrent HCC after prior surgical resection. Patients whose disease recurred with a solitary lesion appear to have a significantly increased survival compared with patients who develop disease recurrence with multiple tumors. A small proportion of patients can be rendered without evidence of viable disease.

Adult↗
PubMed2006

Arterial embolization for salvage of hepatic artery infusion pumps.

PURPOSE: Hepatic artery infusion pumps (HAIPs) ideally provide for homogenous perfusion of the liver with chemotherapeutic agents. Perfusion of extrahepatic organs or asymmetric liver perfusion (ie, "misperfusion") is diagnosed by nuclear scintigraphy and precludes the use of HAIPs. The purpose of this study is to report experience in salvaging HAIPs with arterial embolization. MATERIALS AND METHODS: A single-center HAIP database was retrospectively reviewed for cases from 1999 to 2005 to identify patients who underwent angiography to treat misperfusion documented by nuclear scintigraphy. Patient demographics, nuclear scintigraphic findings before and after embolization, angiographic findings, embolization variables, and outcomes were recorded. Technical success (defined by cessation of flow to the vessel responsible for misperfusion) and clinical success (ie, successful use of the pump) were calculated. RESULTS: During the study period, 475 HAIPs were implanted. Of those, 43 (9%) had abnormal nuclear scintigraphic findings of misperfusion, but only 32 (7%) had angiographic abnormalities. In eight of 32 cases, hepatic arterial thrombosis and extravasation at the catheter tip were found, which precluded salvage by embolization. In 24 of 32 cases, a vessel presumed responsible for the misperfusion was identified and targeted for embolization. Technical success and clinical success were achieved in 21 of 24 patients (87.5%) and 19 of 24 patients (79%), respectively, who underwent 27 embolization procedures. The three technical failures (12.5%) were the result of inability to catheterize the identified vessel. CONCLUSIONS: Percutaneous arterial embolization of a vessel to correct misperfusion shown by nuclear scintigraphy is safe and effective. This approach can be expected to result in HAIP salvage in the majority of patients.

Angiography↗
PubMed2005

Safety and efficacy of preoperative portal vein embolization with polyvinyl alcohol in 58 patients with liver metastases.

OBJECTIVE: The objective of our study was to evaluate the safety and efficacy of transhepatic lobar portal vein embolization (PVE) using polyvinyl alcohol (PVA) particles to induce contralateral lobar hypertrophy in patients with liver-only metastases and normal underlying liver function. MATERIALS AND METHODS: Fifty-eight consecutive patients with small predicted future liver remnants (FLRs) underwent PVE with PVA particles to induce hypertrophy of the contralateral hemi-liver before surgical resection of liver metastases. Total liver, right hemi-liver, and left hemi-liver volumes were calculated before and after embolization using a 3D workstation. RESULTS: Eight patients underwent left PVE; 47, right PVE; and three, right and segment IV PVE. There were no major complications of the procedure. The mean increases in the ratio of the FLR to the total estimated liver volume after right, right and segment IV, and left PVE were 9%, 10%, and 3%, respectively; the corresponding mean hypertrophy ratios were 24.3%, 31.9%, and 1.5%, respectively. CONCLUSION: Right PVE using PVA particles alone as the embolic agent is safe and effective in achieving left hemi-liver hypertrophy. In contrast, left PVE did not induce significant right hemi-liver hypertrophy in this patient population.

Adult↗
PubMed2004

CT-guided transvenous or transcaval needle biopsy of pancreatic and peripancreatic lesions.

PURPOSE: To evaluate the safety and efficacy of direct computed tomography (CT)-guided fine needle aspiration biopsy (FNAB) of pancreatic and peripancreatic masses via a posterior approach that traverses the inferior vena cava (IVC) or renal vein. MATERIALS AND METHODS: From January 2000 to July 2003, 55 patients underwent 58 biopsies of masses located within the pancreas (n = 28) or in a peripancreatic location (n = 30) with use of a posterior approach that crossed the IVC or renal vein. Biopsies were performed with needles ranging in size from 18 to 22. Cytology reports and medical records of all patients were retrospectively reviewed to evaluate diagnostic accuracy and complication rates. RESULTS: Masses were safely accessed with a direct (noncoaxial) pathway traversing the IVC (n = 54), renal vein (n = 4), or both (n = 3). Overall diagnostic accuracy was 86% (50 of 58). Cytologic examination was positive for malignancy in 39 of 58 biopsies (67%). Benign lesions were demonstrated in 12 of 58 biopsies. In seven cases (12%), the sample was deemed nondiagnostic. Of those, four were diagnosed later by endoscopy (n = 1), surgical biopsy (n = 2), or repeat FNAB (n = 1). A false-negative result was noted in one case, which was later diagnosed by repeat biopsy. A total of four inadvertent passes through the right renal artery were recorded. CT evidence of perilesional blood was seen in eight of 55 patients (eight of 58 cases). Three of these occurred after a passage via the right renal artery. All patients remained asymptomatic, and no transfusion or change in management was necessary. No other complications occurred. CONCLUSION: CT-guided noncoaxial FNAB with an approach that traverses the IVC or renal vein is safe and effective in obtaining diagnostic specimens from pancreatic and peripancreatic masses.

Adult↗
PubMed2004

Displacement of endoscopically placed plastic biliary endoprostheses into the duodenum with a simple transhepatic technique.

The authors to describe the technique and report the results of percutaneous displacement of endoscopically placed plastic biliary endoprostheses into the duodenum at the time of transhepatic intervention in 34 patients. Displacement into the duodenum was effected by simply passing a guide wire through the stent, and then pushing it into the gut with a catheter. Thirty-three of 36 stents (92%) were successfully displaced in this manner. No complications related to stent passage out of the gastrointestinal tract were encountered. Plastic biliary stents can be safely displaced into the duodenum when patients undergo transhepatic biliary procedures, thus avoiding repeated endoscopy.

Adult↗
PubMed2004

Histopathologic evaluation of tissue extracted on the radiofrequency probe after ablation of liver tumors: preliminary findings.

OBJECTIVE: Our aim was to evaluate the histologic characteristics of tissue extracted on the probe immediately after radiofrequency ablation of malignant tumors in the liver. MATERIALS AND METHODS: From April to December 2001, 20 radiofrequency ablations were performed in 19 patients with primary (n = 17) and metastatic (n = 2) liver masses. Track ablation according to device protocol was performed after each ablation. Tissue was adherent to the probe after all radiofrequency probe passes. All pieces of tissue found on the probe were collected and preserved in formalin. RESULTS: Tissue was examined by the study pathologist. In eight (40%) of 20 specimens, coagulation necrosis was present. In five (25%) of 20 specimens, possibly nonviable tissue was extracted, although some cell characteristics were identified. In seven (35%) of 20 specimens with hepatocellular carcinoma, possibly viable tissue was found. Five specimens were identified as hepatocellular carcinoma, and two, as cirrhotic nodules. CONCLUSION: Histopathologic evaluation of the tissue extracted on the radiofrequency probe after ablation is feasible. This study showed that coagulation necrosis was clearly present in at least 40% of the patients, which proves that nonviable tissue can be seen immediately after ablation. Whether this pathologic finding has prognostic value is not known.

Adult↗
PubMed2004

Incidence, patterns, and clinical relevance of variant portal vein anatomy.

OBJECTIVE: The purpose of this study was to determine the incidence of variant intrahepatic portal vein anatomy detected on CT portography and to discuss surgical implications. CONCLUSION: Variant portal vein anatomy is nearly as common as variant hepatic artery anatomy. The complexity of hepatic interventions now performed by interventional radiologists and surgeons, including portal vein embolization, anatomic resection, and transplantation, make recognition and understanding of normal and variant portal vein anatomy increasingly important.

Female↗
PubMed2003

Percutaneous treatment of complications occurring during hemodialysis graft recanalization.

INTRODUCTION/OBJECTIVE: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. METHODS AND MATERIALS: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. RESULTS: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. DISCUSSIONS AND CONCLUSION: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.

Angioplasty↗
PubMed2002

Transvenous transjugular renal core biopsy with a redesigned biopsy set including a blunt-tipped needle.

A novel 19-gauge, blunt-tipped, side cutting single throw, 70-cm long transjugular needle, specifically designed for transvenous kidney biopsy, was used in seven patients with high risk for bleeding. A mean of 4 device-passes (3-6) per patient resulted in a satisfactory specimen for pathological diagnosis. Immediate post-biopsy nonenhanced CT was performed to evaluate for bleeding at the biopsy site. All patients were observed for 2 hr after the procedure. No clinically significant immediate or late complication was noted.

Biopsy, Needle↗
PubMed2002

Dialysis access.

Explore the source record for details and available documents.

Angiography↗
PubMed2002

Alteplase for hemodialysis access graft thrombolysis.

PURPOSE: To evaluate the efficacy and safety of alteplase, a recombinant tissue plasminogen activator, in hemodialysis access graft thrombolysis. MATERIALS AND METHODS: From November 1999 to May 2001, 68 episodes of occlusion in 50 grafts (in 49 patients) were included in the study. Occlusion was treated with pulse-spray (n = 41) or lyse-and-wait (n = 27) thrombolysis with use of alteplase. Balloon angioplasty of all identified stenoses was performed. The arterial plug was mobilized with the Fogarty maneuver. RESULTS: Procedural success was achieved in 64 of 68 episodes (94%) with a dose of 2-10 mg (mean = 4.13 mg) of alteplase, allowing successful hemodialysis within 24 hours. Failures (6%) were the result of PTA perforation (one of 68), nonnegotiable outflow occlusion (one of 68), delayed bleeding (one of 68), and balloon bursting and shearing becoming occlusive within the graft (one of 68). Primary and secondary patency rates were 72% and 87% at 30 days, 57% and 80% at 90 days, and 44% and 72% at 180 days, respectively. Arterial emboli (two of 68) were treated by Fogarty balloon retrieval and alteplase infusion locally over the course of 20 minutes. One of two PTA perforations was controlled by balloon tamponade. CONCLUSION: Alteplase can be used successfully for hemodialysis graft thrombolysis.

Adult↗
PubMedDate not supplied

Embolization of isolated lumbar artery injuries in trauma patients.

PURPOSE: The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. METHODS: All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. RESULTS: In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. CONCLUSIONS: In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery.

Adolescent↗
PubMedDate not supplied

Angiographic findings and embolotherapy in renal arterial trauma.

PURPOSE: To evaluate the angiographic findings and embolotherapy in the management of traumatic renal arterial injury. METHODS: This is a retrospective review of 22 patients with renal trauma who underwent arteriography and percutaneous embolization from December 1995 to January 2002. Medical records, imaging studies and procedural reports were reviewed to assess the type of injury, arteriographic findings and immediate embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians and by clinical chart review. RESULTS: Arteriography was performed in 125 patients admitted to a State Trauma Center with suspected internal bleeding. Renal arterial injury was documented in 22 and was the result of a motor-vehicle accident (10), auto-pedestrian accident (1), gunshot (4) or stab wounds (6) and a fall (1). Percutaneous renal arterial embolization was undertaken in 22 of 125 (18%) patients to treat extravasation (11), arterial pedicle rupture (5), abnormal arteriovenous (3) or arteriocalyceal (2) communication and pseudoaneurysm (3). One of the pseudoaneurysms and one of the arteriovenous fistulae were found in addition to extravasation. All 22 patients (16 men, 6 women) were hemodynamically stable, or controlled during arteriography and embolotherapy. Selective and/or superselective embolization of the abnormal vessels was performed using coils in 9 patients, microcoils in 9 patients and Gelfoam pledgets in 3 patients. In one patient Gelfoam pledgets mixed with polyvinyl alcohol (PVA) particles were used for embolization. Immediate angiographic evidence of hemostasis was demonstrated in all cases. Two initial technical failures were treated with repeat arteriography and embolization. There was no procedure-related death. There was no non-target embolization. One episode of renal abscess after embolization was treated by nephrectomy and 3 patients underwent elective post-embolization nephrectomy to prevent infection. Follow-up ranged from 1 month to 7 years (mean 31 months). No procedure-related or delayed onset of renal insufficiency occurred. CONCLUSION: In hemodynamically stable and controlled patients selective and superselective embolization is a safe and effective method for the management of renal vascular injury.

Abdominal Injuries↗