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Biomedical subjects

J Triller

Publications and source records attributed to J Triller.

At least 19 recordsLinked to original sources
PubMed2002

Treatment of renal artery fibromuscular dysplasia with balloon angioplasty: a prospective follow-up study.

OBJECTIVES: to assess restenosis rates and blood pressure response after percutaneous transluminal renal angioplasty (PTRA) in patients treated for fibromuscular dysplastic renal artery stenosis. METHODS: a prospective 12-month follow-up study of 27 patients with 31 treated renal artery stenosis. Follow-up assessment included colour-coded duplex sonography (CCD) of renal arteries, monitoring of blood pressure, antihypertensive medication, and creatinine measurements before discharge and at 3, 6, and 12 months. Primary end point was defined as a haemodynamically significant restenosis >60% assessed by CCD. RESULTS: there was a cumulative 23% restenosis rate at 12 months. Arterial hypertension was cured or improved in 93% of patients immediately after the intervention and remained cured/improved in 74% of patients at 12 months of follow-up. Renal failure present in five patients before PTRA stabilised or improved in all patients. CONCLUSION: although restenosis rate after PTRA in fibromuscular dysplasia is as high as in non-ostial atherosclerotic lesions, there remains a considerable higher therapeutic effect. Profound pressure response and recurrent arterial hypertension with restenosis support the high probability of a renovascular origin of arterial hypertension in this young and otherwise healthy population compared to patients with atherosclerotic renal artery lesions.

Adult↗
PubMed2002

[Low-osmolar gadodiamide as alternative contrast agent for diagnostic angiography and angiographic interventions in patients with renal insufficiency].

PURPOSE: To evaluate the benefit and feasibility of gadolinium contrast agents for intra-arterial use in diagnostic and therapeutic angiography in patients with renal insufficiency. METHODS: In 15 patients with planned peripheral or renal vascular interventions digital subtraction angiography with intra-arterial administration of gadolinium (gadodiamide n = 14, gadolinium-DTPA n = 1) was performed. Gadolinium was used selectively after peripheral catheter placement, mainly as an adjunct to CO2 (n = 12), to assess the distal run-off vessels or to characterize stenotic lesions. RESULTS: In 14 cases gadolinium yielded good or satisfactory results that were superior to those of CO2 angiography in the femoropopliteal region and calf, but also to the aorto-iliac vessels and the renal arteries. A small amount of iodinated contrast media was administered due to insufficient contrast of gadolinium in one patient. Mean serum creatinine level after angiography (295 +/- 167 micromol/l; range 125 - 764 micromol/l) was not significantly different (p >/= 0,37) from the initial level (279 +/- 149 micromol/l; range 143 - 728 micromol/l). CONCLUSION: Gadolinium is a viable alternative contrast agent for digital subtraction angiography and percutaneous transluminal angioplasty in patients with renal insufficiency. It enhances the diagnostic evaluation of stenosis and run-off vessels.

Adult↗
PubMed2002

Establishing radiological percutaneous gastrostomy with balloon-retained tubes as an alternative to endoscopic and surgical gastrostomy in patients with tumours of the head and neck or oesophagus.

The purpose of this study was to report our experience introducing radiological percutaneous gastrostomy (RPG) catheters at a hospital where hitherto only endoscopic and surgical methods have been used. The feasibility, success, time requirements, and complications of RPG were prospectively evaluated during a 12-month period. 26 consecutive patients (median age 63 years, range 41-91 years) underwent gastropexy with T-fasteners followed by insertion of a 12-18 F balloon tube through a peel-away introducer and were followed-up clinically and radiologically. Success and complications occurring within 30 days were assessed. RPG was technically successful in all cases. Median procedure time was 34 min (range 20-90 min), median fluoroscopy time 6.9 min (range 2.3-30 min). 13 surgical gastrostomies were avoided. One minor complication (peristomal leakage) occurred in a patient with gastric reflux and atony. Another patient destroyed the balloon of his tube by injecting food into the balloon port, which led to tube dislocation and peritonitis. In conclusion, radiological gastrostomy can be quickly learned by radiologists and is readily accepted by clinicians. It is an alternative to surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible, but can also be used as the primary method instead of the endoscopic method.

Adult↗
PubMed2001

[Percutaneous gastrostomy with balloon PEG balloon replacement tubes by the radiologist. An interventional technique for simple placement of feeding catheters without surgical or endoscopic intervention].

Patients afflicted with stenotic head and neck or esophageal tumors often require artificial enteral feeding. Frequently passage of an endoscope through the esophagus is impossible in these patients. Interventional, fluoroscopically assisted, percutaneous gastrostomy (PG) by balloon replacement tubes is a feasible and successful alternative to percutaneous endoscopic gastrostomy (PEG) and the method of choice in patients where the esophagus cannot be passed with an endoscope anymore. Technical success rate is very high and serious complications are rare. Radiological PG is a feasible, equivalent alternative to PEG also in all other patients. We recommend PG with balloon gastrostomy tubes in conjunction with gastropexy performed with three to four T-fasteners, which are left in place for seven days in order to prevent dislocation and leakage.

Catheterization↗
PubMed2001

[Preoperative arterial embolization of intralobar lung sequestration].

A case of a 43-year-old patient with recurrent pulmonary infections due to pulmonary sequestration is presented. MR-angiography revealed an aberrant artery originating from the abdominal aorta feeding the intralobar pulmonary sequestration. Platinum coil embolization of the aberrant artery was performed preoperatively to allow safe surgical resection on the following day. To our knowledge this is the first case in the literature in which elective coil embolization has been performed before resection of lung sequestration.

Adult↗
PubMed2001

Emphysematous cystitis in a patient presenting with paradoxical arterial embolism and intestinal mycobacteriosis without evidence of diabetes.

We describe the case of a 72-year-old woman who displayed massive multiple intramural gas collections of the bladder wall as an incidental finding on CT. The patient presented with critical ischemia of the left leg caused by paradoxical arterial embolism, raised corpuscular sedimentation rate, anemia by gastrointestinal blood loss, hypoproteinemia, diarrhea, malabsorption, and exudative enteropathia caused by mycobacterial ileocolitis. The patient had no dysuria and there was no evidence of diabetes. The intramural gas collections of the bladder wall, as shown by CT, were compatible with emphysematous cystitis. Urine samples proved infection by a multi-resistant strain of E. coli. Emphysematous cystitis is a rare form of bladder infection that can be diagnosed by plain-film radiograms or CT.

Aged↗
PubMed2001

Embolization of a ruptured intercostal artery aneurysm in type I neurofibromatosis.

We present the case of a female with history of a ruptured lumbar aneurysm years ago. She was known to have neurofibromatosis type I with the typical clinical signs. The patient was transferred to us with a hematothorax and an aortic lesion was suspected on the outside CT scan. Reevaluation of the investigation raised suspicion of a ruptured intercostal artery aneurysm, which was consequently demonstrated on angiography. The aneurysm was embolized and the patient recovered uneventful. We will discuss the optimal therapy for vessel lesions in neurofibromatosis type I.

Adult↗
PubMed2001

[Primary and long-term success of percutaneous biliary metallic endoprotheses (Wallstents) in malignant obstructive jaundice].

OBJECTIVE: To assess the primary and long-term success of percutaneous metallic endoprotheses (wallstent) in malignant jaundice. METHODS: Retrospective, uncensored analysis of 86 consecutive patients (42 men, 44 women, age 34 to 90 years, mean 62 years), who were percutaneously treated with wallstents for malignant jaundice within a six-year time interval. Indications were pancreatic cancer in 9, gallbladder cancer in 15, Klatskin's tumor in 31, and metastatic disease in 31 cases. The indication for percutaneous stenting was inoperability and lack of endoscopic access. The level of the obstruction was within the liver hilus in 44, extrahepatic in 20, and within a biliodigestive anastomosis in 22 cases. Forty-five patients had undergone abdominal surgery previously. Mean survival was 8.0 months (range, 3 days to 57 months). RESULTS: In 85 of 86 cases (99 %) biliary stenting was feasible. In 82 cases (95 %) laboratory tests indicated regression of the biliary obstruction. Sixty-six patients (77 %) also experienced a clinical benefit from the procedure and in 65 (76 %) patients long-term palliation was achieved and lasted for at least three-quarters of the remaining time of survival. Technical problems with the procedure, usually stent foreshortening, were encountered in 12 cases (14 %). Thirty-days morbidity was 26 % (cholangitis in 15, pancreatitis in 3, liver failure in 2, effusion in 1, hemobilia in 1 case), thirty-day mortality was 15 %, procedure-related in one case. The reintervention rate was 20 %, the patency rate was 91 %, 73 %, and 58 % after 3, 6, and 12 months, respectively. CONCLUSION: Even after exhaustion of both surgical and endoscopic therapy options percutaneously deployed wallstents enable effective long-term palliation of malignant jaundice.

Adult↗
PubMed2000

Hepatic artery embolisation with a novel radiopaque polymer causes extended liver necrosis in pigs due to occlusion of the concomitant portal vein.

BACKGROUND/AIM: In an attempt to overcome some of the problems encountered with the materials available for liver embolisation, we investigated a novel radiopaque polymer of the polyurethane family (Degra-Bloc). METHODS: Hepatic artery embolisation of one liver lobe using polyurethane was performed in 19 healthy pigs. Microcirculatory changes were assessed by laser Doppler flowmetry. Radiological and pathological examinations of the livers, hearts and lungs removed provided information about the extent and effect of the embolisation. RESULTS: None of the pigs died due to hepatic failure or toxicity of polyurethane. Microcirculation of embolised liver lobes significantly decreased from 106 (+/-15) perfusion units (PU) to 45 (+/-6) PU immediately after embolisation and further to 28 (+/-7) PU before euthanasia. At this time conventional and angiographic X-ray controls demonstrated the radiopaque casts extending up to the peripheral arteries with signs of degradation over time but without formation of collateral vessels. The main pathological findings consisted of destruction of the portal tract structures and also of large areas of liver necrosis. Polyurethane was encountered in arterioles as small as 10-20 microm, but not in liver sinusoids, hearts or lungs. CONCLUSIONS: The novel polymer called DegraBloc is a biocompatible, slowly degradable, radiopaque embolic agent. The occlusion of the arterial tree up to the smallest arteriolar diameter combined with concomitant portal vein occlusion leads to sharp segmental necrosis in pig livers without formation of significant collaterals and without systemic embolism. In the treatment of liver tumours polyurethane might provide a promising alternative to conventional embolic materials, provided that it is used with care in patients with advanced liver cirrhosis.

Animals↗
PubMed2000

Renal artery stenting following acute aortic dissection: implantation and follow-up.

Two patients with renal artery involvement in type B dissection of the aorta were treated by percutaneous stent implantation. Both of them were hypertensive and showed increasing serum creatinine levels. After stent implantation in the renal arteries blood pressure and renal function improved, and the renal arteries were patent in duplex ultrasound 15 and 30 months after treatment respectively.

Aged↗
PubMed2000

Percutaneous catheter thrombus aspiration for acute or subacute arterial occlusion of the legs: how much thrombolysis is needed?

OBJECTIVE: To evaluate the role of a combined percutaneous endovascular approach including thrombus aspiration, catheter thrombolysis, and percutaneous transluminal angioplasty (PTA) to treat acute and subacute occlusions of native leg arteries. MATERIALS AND METHODS: Retrospective evaluation of the effectiveness and safety of this catheter therapy in 89 consecutive patients (93 legs) in a single centre. RESULTS: Treatment was initially successful in 90% of legs. Mortality at 30 days was 8%, and at 12 months 19%. Amputation-free survival at 12 months was 78%. Aspiration alone was sufficient in 31% of cases, urokinase (mean dose 112 500+/-55 900 IU) was used in 22%, PTA was added in 69%. There was no major bleeding except for one false aneurysm treated by ultrasound-guided compression. Secondary interventions within 12 months were required in 30% of cases (14 endovascular, 16 open surgical procedures). CONCLUSIONS: Catheter thrombus aspiration in combination with thrombolysis and/or PTA is highly effective. Only in a minority of patients are thrombolytics in modest doses necessary, and serious bleeding complications are rare. We recommend this procedure as first-line treatment for acute or subacute infrainguinal arterial occlusions.

Acute Disease↗
PubMed2000

Stent placement in ostial and nonostial atherosclerotic renal arterial stenoses: a prospective follow-up study.

PURPOSE: To compare the results of balloon percutaneous transluminal renal angioplasty (PTRA) and stent placement in atherosclerotic ostial, proximal, and isolated truncal stenoses. MATERIALS AND METHODS: Between January 1994 and April 1998 the authors prospectively followed up 163 consecutive patients with 200 atherosclerotic renal arterial lesions after primary PTRA or primary stent placement. Duplex ultrasonography was performed 1 day and 3, 6, and 12 months later. RESULTS: The primary 12-month PTRA patency rates were 34% (21 of 33 atherosclerotic lesions) for ostial stenoses, 65% (20 of 60) for proximal stenoses, and 83% (five of 30) for truncal stenoses (chi(2) value, 15.63; P <.001). The corresponding stent patency rates were 80% (four of 21), 72% (nine of 34), and 66% (five of nine), respectively (chi(2) value, 4.11; not significant). Significant stent-related reduction in risk of restenosis was limited to the ostial stenoses (P =.002). CONCLUSION: Renal arterial stent placement considerably improves patency in ostial stenoses, but compared with the technically successful PTRA, it does not significantly improve primary patency in proximal and isolated truncal renal arterial stenoses.

Adult↗
PubMed1999

Splenic infarction complicating ligation of a gastroduodenal artery aneurysm.

BACKGROUND: Aneurysms of visceral arteries are rare, but may lead to dramatic situations of intraabdominal or retroperitoneal hemorrhage in case of rupture. CASE REPORT: We report the case of a 72-year-old patient who developed a hemorrhagic shock following a total hip replacement due to the rupture of an aneurysm of the gastroduodenal artery. Angiography also demonstrated a high-grade stenosis of the celiac trunk. The ruptured aneurysm was ligated as a live-saving procedure, but due to the stenosis in the celiac trunk the patient developed a splenic infarction followed by partial tissue liquefication. This was treated conservatively and after 3 months, the computed tomography showed an atrophic residual spleen. SUMMARY: Diagnostic and therapeutic approaches to visceral vascular aneurysms are discussed including the potential complications of splenic infarction.

Aged↗
PubMed1999

Multidisciplinary approach to palliation of obstructive jaundice caused by a central hepatocellular carcinoma.

BACKGROUND/AIMS: Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC). METHODS: We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. Cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before. RESULTS: With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved. CONCLUSION: The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.

Aged↗
PubMed1999

Acute hemorrhage in chronic pancreatitis: diagnosis and treatment options including superselective microcoil embolization.

Acute hemorrhage in the course of chronic pancreatitis is the most serious and challenging complication, and its treatment has been the subject of controversy for years. We relate our experience in the management of this complication by superselective microcoil embolization. Five patients with acute hemorrhage resulting from chronic pancreatitis between 1994 and 1997 were included in this study. All patients were men with a median age of 44 years (range, 29-59 years). The bleeding occurred into a pseudocyst in all patients, with the splenic artery as feeding vessel. In all instances, the bleeding was successfully controlled by superselective microcoil embolization. Two patients underwent subsequent uneventful elective pseudocystojejunostomy. There was no mortality or morbidity, and no rebleeding occurred during a median follow-up of 22 months (range, 8-36 months). In appropriate patients, diagnostic angiography and superselective microcoil embolization may obviate the need for emergency surgery and should be considered as treatment alternative.

Acute Disease↗