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Biomedical subjects

J Triller

Publications and source records attributed to J Triller.

At least 55 records · Page 3Linked to original sources
PubMed1998

A New Approach to Plaque Removal: The Redha-Cut Device.

PURPOSE: To prospectively determine the safety, feasibility and efficacy of a new atherectomy device. Methods. Seventy patients with 93 symptomatic femoro-popliteal lesions underwent percutaneous atherectomy with Redha-cut, a metallic, flexible catheter. The device works on pull-back with two umbrella-like blades and enables cutting, retaining and removing of material. Quantitative analysis of the angiograms was performed. RESULTS: Obtaining of atherectomized samples was successful in all cases. The mean atherectomy time was 5 +/- 2 minutes. The stenoses were reduced from 74 +/- 2.3% before to 26 +/- 2% after atherectomy (p < 0.001). Subsequent PTA, which was performed to optimize the results, further decreased the degree of stenosis to 17% (p > 0.5). No perforations, acute closure or early re-thrombosis occurred. Cumulative patency rates according to the findings of non-invasiveive examinations were 83% at 6 months and 66% at 12 months. Conclusions. The Redha-cut device is a simple, safe and efficacious tool for biopsy sampling and atherectomy. Further studies randomizing patients either to balloon or atherectomy are planned to compare this technique with others in regard to long-term patency.

Journal Article↗
PubMed1998

Power-based colour coded duplex sonography for evaluation of calf veins.

BACKGROUND: Power-based colour coded duplex sonography (PD) has been described to display lower flow velocities compared to frequency-based colour coded duplex sonography (CD). This study was undertaken to study the clinical usefulness of PD in the evaluation of calf veins in suspected deep vein thrombosis. METHODS EXPERIMENTAL DESIGN: A prospective, comparative study. SETTING: University hospital, Switzerland. PATIENTS AND MEASURES: CD of the complete deep venous system and complementary PD of paired calf veins were performed in 50 consecutive patients with clinically suspected DVT. All except three patients, with failed vein puncture at the dorsum of the foot, had a venography used as reference test for confirmatory diagnosis of DVT. RESULTS: Complete identification of calf veins increased from 80.5% using CD to 97.9% using complementary PD (p=0.007). Overall accuracy to detect an acute calf DVT was 96% (95% Ci, 85-99%) and 95% (95% CI, 83-99%), respectively. Accuracy was 95% (95% CI, 83-99%) using CD vs 94% (95% CI, 82-98%) using PD in posterior tibial, 87% (95% CI, 74-95%) vs 85% (95% CI, 71-94%) in anterior tibial, and 95% (95% CI, 83-99%) vs 96% (95% CI, 85-99%) in peroneal veins. Chronic post-thrombotic changes (10.6%) were more reliably recognized using CD (accuracy 83% [95% CI, 72-94%]) compared to PD (accuracy 66% [95% CI, 59-85%]) due to tissue motion artifacts and inability to discriminate the direction of blood flow. CONCLUSIONS: PD used complementary with CD is capable of significantly improving identification of paired calf veins without loss of diagnostic accuracy in the diagnosis of acute DVT.

Blood Flow Velocity↗
PubMed1998

Discrepancy of clinical and angiographic results in the follow-up of percutaneous transluminal renal angioplasty (PTRA).

BACKGROUND: To investigate the value of recurrent hypertension as indicator for renal artery patency after PTRA clinical and angiographic follow-up results were analysed. PATIENTS AND METHODS: results of 66 follow-up angiographies and blood pressure measurements were available in 55 patients after technically and clinically successful PTRA. Out of 43 patients with atherosclerosis, in 33 was recurrent hypertension present, and in ten patients none. Of 12 angiographies in patients with fibromuscular dysplasia nine were done because of recurrent hypertension. RESULTS: In atherosclerosis, 21 (64%) out of 33 patients with recurrent hypertension showed a re-stenosis by > 70%, and 12 (36%) none. Out of the ten follow-up angiographies performed in patients with no recurrence, two showed an unexpected stenosis. In fibromuscular dysplasia, stenoses were present in seven cases (77%). Four of them were at the site of PTRA (44%), while three were at a new site (33%). The follow-up angiographies in three patients with no recurrence showed patent arteries. Out of 11 further angiographies carried out because of hypertension after repeated PTRA, only three revealed re-stenosis. CONCLUSIONS: In only about 35% of all patients with recurrent hypertension re-stenosis was shown in angiography but in 15% of asymptomatic patients. Recurrence of hypertension after PTRA and renal artery stenosis is not well correlated. Thus, follow-up should be performed not only clinically but also by direct examination of renal artery patency such as by ultrasound.

Adult↗
PubMed1997

Patency of percutaneous transluminal renal angioplasty: a prospective sonographic study.

Evaluation of percutaneous transluminal renal angioplasty (PTRA) is today based primarily on clinical criteria rather than direct investigation of luminal width. In this study, we examined renal blood flow by color-coded duplex sonography (CCD) in order to correlate blood pressure as well as renal function with the true renovascular patency. Fifty consecutive patients suspected of suffering from renovascular disease and treated by PTRA were included for a prospective sonographic study. In all PTRA was performed on 63 renal arteries. Thirty-seven patients were diagnosed to have atherosclerosis and 13 patients to have fibromuscular dysplasia (FMD). Examinations were performed using CCD before PTRA, and one day, three months, six months and 12 months after PTRA. If CCD showed a restenosis > or = 60%, CCD was non-conclusive or hypertension deteriorated, angiography and, if necessary, catheter re-intervention were performed. The primary patency rate after 12 months was 73%, and could be improved to 94% overall when treated restenosis (N = 22) were included. Restenosis was more frequent in patients with mild residual stenosis identified by CCD one day after PTRA (P = 0.002). There was neither a significant difference in the restenosis rate in patients with atherosclerosis versus FMD, nor in patients with ostial versus non-ostial lesions. Hypertension was improved or cured in 70% of patients with atherosclerosis, and in 85% of those with FMD. Nevertheless, hypertension deteriorated in 12% of the patients without restenosis, and no deterioration was present in 14% of the patients with restenosis. A decrease in serum creatinine levels by more than 15% was observed in 12 of 22 patients with impaired renal function and patent renal artery during follow-up. These results suggest that optimal therapeutic efficiency can be obtained using PTRA followed by systematic CCD.

Adult↗
PubMed1997

Acute inflammatory reaction associated with endoluminal bypass grafts.

PURPOSE: Nonspecific inflammatory reactions characterized by local tenderness, fever, and flu-like discomfort have been seen in patients undergoing endoluminal graft placement in the abdominal aorta or the femoral arteries. We undertook a study to assess the clinical and laboratory parameters of this inflammation. METHODS: Ten patients with femoropopliteal artery (n = 9) or aortic (n = 1) lesions were treated with EndoPro System 1 stent-grafts made of nitinol alloy and covered with a polyester (Dacron) fabric. Eleven patients implanted with a bare nitinol stent served as the control group. RESULTS: In the stent-graft group, four patients showed clinical signs of acute inflammation manifested by fever and local tenderness. Three of these patients suffered thrombosis of the stent-grafts during the first month of follow-up. Plasma levels of interleukin-1 beta and interleukin-6 in all stent-graft patients were markedly increased 1 day after intervention (7.3 +/- 2.8 versus 90.2 +/- 34.1 pg/mL and 15.6 +/- 5.8 versus 175.5 +/- 66.3 pg/mL, respectively; p < 0.01). This was followed by an increase in fibrinogen (3.0 +/- 0.2 versus 5.0 +/- 0.2 g/L; p < 0.05) and C-reactive protein (14.6 +/- 3.3 versus 77.5 +/- 15.0 mg/L; p < 0.01) at 1 week. No direct correlation between the inflammatory markers and symptoms could be found. In vitro analysis showed that individual components of the stent-graft did not activate human neutrophils, whereas the intact stent-graft itself induced a marked neutrophil activation. CONCLUSIONS: The component of the self-expanding stent-graft responsible for the nonspecific inflammatory reaction was not identified in this study. It is likely that the stent-graft itself or some as yet unrecognized element of the device other than the Dacron fabric or metal alloy may be a potent in vivo inducer of cytokine reaction by neutrophils.

Aged↗
PubMed1997

Blue toes due to floating plaque of the abdominal aorta: endovascular repair with stent.

A 60 year old male patient was admitted with so-called blue toes on both sides. Investigation, including real-time ultrasound, revealed a floating plaque on the dorsal side of the abdominal aorta as the most probable cause of the blue toes. By means of simultaneous fluoroscopy and ultrasound guided implantation of a stent it was possible to restore a free lumen of the aorta. The patient had an uncomplicated recovery. Post-operative colour coded Doppler ultrasound showed normal flow in the aorta. Follow-up examination one year after the procedure demonstrated no evidence of further embolic events and a patent aorta.

Aorta, Abdominal↗
PubMed1996

Epithelioid hemangioendothelioma of the liver. A rare hepatic tumor.

BACKGROUND: Epithelioid hemangioendothelioma (EH) is a rare neoplasm of vascular origin that may develop at different sites, such as in soft tissue, the lungs, or the liver. It usually affects adult females, and its unpredictable malignant potential has a range between benign hemangioma and clearly malignant hemangioendotheliosarcoma. METHODS: In the current study, the authors describe 2 patients with primary EH of the liver and review 127 previously published cases found in the literature. RESULTS: Most patients presented with nonspecific symptoms, such as right upper quadrant abdominal pain or weight loss. The tumors usually presented as multiple nodular lesions involving both lobes of the liver. Overall metastasis rate was 45.1%, with preferential involvement of the lungs and bones. In general, the key to diagnosis was the demonstration of cells containing factor-VIII-related antigen. CONCLUSIONS: EH of the liver is a very rare clinical entity. The primary treatments of choice are radical hepatic resection or orthotopic liver transplantation. The 5-year survival of 55.5% is significantly better than for other hepatic malignancies.

Adult↗
PubMed1996

Total anomalous pulmonary venous connection to the portal and splenic vein associated with unilateral hypoplasia of pulmonary veins.

Total anomalous pulmonary venous return (TAPVR) represents a rare congenital anomaly with wide anatomical and physiological variability. We report a case of a newborn with a challenging form of obstructed infracardiac TAPVR, in whom left and right pulmonary veins drained separately into the portal system. The right pulmonary venous sinus connected to the left branch of the portal vein, whereas the left venous sinus connected to the splenic vein. Surgical repair consisted of the creation of a common retrocardiac venous trunk which was anastomosed to the left atrium. The postoperative course was characterized by persisting congestion of the right lung. Two months later, right pulmonary vein hypoplasia was successfully enlarged with autologous pericardium.

Angiography↗
PubMed1996

[Pelvic fracture with shock-inducing retroperitoneal bleeding and concomitant lower extremity ischemia syndrome: discussion of management exemplified by a case report].

BACKGROUND: Initial treatment of severe pelvic fracture consists of appropriate resuscitation and early pelvic reposition and stabilization. Concomitant retroperitoneal arterial bleeding in a hemodynamically unstable patient in combination with lower extremity ischemia make early management decisions very difficult and the mortality rate of this entity of injuries is extremely high. CASE REPORT: We report on a successful treatment of a 36 year old skier, referred in hemorrhagic shock, who had sustained a severely displaced both column fracture of the right acetabulum, an unstable pelvic ring injury on the left and a retroperitoneal bladder rupture. He developed complete ischemia of the right lower extremity. Angiography revealed an obliteration without extravasation of the external iliac artery and allowed treatment of a right superior gluteal artery disruption by embolization. The right lower extremity ischemia was revascularized with a subcutaneous femoro-femoral bypass graft. Delayed internal fixation of the right acetabulum and exploration of the iliac vasculature was done through an ilio-inguinal approach. Simultaneously, the cross-over bypass could be removed. After 18 months, the patient recovered without any ischemic symptoms, but continues with a mixed sciatic nerve lesion. DISCUSSION AND CONCLUSIONS: The combination of severe retroperitoneal arterial bleeding and total ischemia of the lower extremity requires immediate surgical therapy. Direct exploration of the retroperitoneum, however, can be fatal and should be avoided if the iliac vessels are angiographically intact or if a hemorrhage is controllable by an embolization procedure. Extraanatomic temporary revascularization of the lower extremity should be envisaged when a lower leg ischemia due to obliteration or compression of major intrapelvic vessels cannot be directly and immediately treated.

Abdominal Injuries↗
PubMed1995

[Results in stent implants in pelvic arteries: follow-up with color-coded duplex ultrasonography].

Thirty-one patients (26 males, 5 females), treated with percutaneously inserted endoprostheses (stents) in the iliac artery were followed up a mean 1 year (2-60 months) with regard to clinical and non-invasive results, by color duplex ultrasound and (8 cases) angiography. With one exception self-expandable stents (Wallstents) were applied. The indications for stent implantation were PTA-resistant lesions in 78% and treatment of acute complications after PTA in 22%. Primary technical success with an open stent was achieved in all patients. The ankle-arm systolic pressure index (ASPI) increased from mean 0.67 +/- 0.14 to 0.88 +/- 0.17 (p < 0.001). Early stent occlusion occurred in 1 patient (3%), and 9 (24%) further complications (thrombosis, distal embolization, puncture site problems) were treated either by conservative or interventional procedures, and only once by surgical revision. Color duplex ultrasound showed all stents open without stenosis of hemodynamic significance. Angiography demonstrated intimal hyperplasia in 2 patients with stenosis of about 20-25%. At follow-up 61% of the patients were asymptomatic, 32% were improved. Remaining symptoms were due to lesions of the distal arteries and not to obstructions of the stents. Stenting of iliac arteries is a safe and effective treatment for recurrent and/or complex iliac lesions and has become a valuable adjunct in catheter interventions. We conclude that color duplex ultrasound is not only applicable in native arteries but also in stents, and gives reliable results with regard to hemodynamically relevant obstructions.

Aged↗
PubMed1995

Renal pathology after arterial yttrium-90 microsphere administration in pigs. A model for superselective radioembolization therapy.

RATIONALE AND OBJECTIVES: To test the selectivity of tissue damage in radioembolization, the authors performed an experimental study using superselective administration of yttrium-90 particles to deliver up to 100 Gy to the porcine kidney. Patterns and severity of damage in test organs were compared with controls, and the feasibility of this model is discussed. METHODS: Eight sows were included in the study. Bio-Rex 70 particles were applied via selective catheterization of the renal artery. Four pigs received inactive particles and four pigs received active particles. Organ distribution and shunting of yttrium-90 were determined, and kidney damage patterns were histologically analyzed. RESULTS AND CONCLUSIONS: The model demonstrates that yttrium-90-labeled resin particles can superselectively be applied. Retention of beta activity in the target organ was more than 95%. In addition to tissue shrinkage from mechanical obstruction, considerable damage ensued mainly by radiation-induced arterial necrosis and arteritis.

Animals↗
PubMed1994

[Methods for the superselective radioembolization of liver tumors with 90yttrium-resin particles].

An improved technique for radioembolization of non-resectable liver tumours is described. 90yttrium-labelled Bio-Rex-70 particles which show high stability and good tissue tolerance are applied superselectively via the tumour-feeding artery using a microcatheter. The procedure includes both diagnostic and therapeutic angiography. Angiography is complemented by angioscintigraphy (99mTc-MAP) and an i.v. 99mTc-colloid scan of the liver. Thus it is possible pretherapeutically to evaluate tumour volume and dose distribution both in and outside of the liver, and in the lung due to shunt. These estimates were re-evaluated posttherapeutically. Radioembolization can thus be quantified and the doses absorbed by the tumour as well as the liver and lung can be calculated.

Adult↗
PubMed1994

Superselective radioembolization of hepatocellular carcinoma: 5-year results of a prospective study.

Twenty patients with unresectable hepatocellular carcinoma (HCC) were followed up to 5 years after transarterial radiotherapy with 90Y-resin particles. Diagnostic radioembolizations of 99mTc-macroaggregates facilitated scintigraphic assessment of activity distribution, dose evaluation and final procedural verification. The overall survival rates were 56, 38 and 14% (after 1, 2 and 3 years, resp.). Patients with unifocal HCC and a single feeding artery (n = 7) even presented 83, 67 and 40% (2 alive after 2.75 and 4 years). With multiple arteries (n = 7), the longest survival was 26 months. Patients with multifocal HCC survived up to 33 months after selective radioembolization. Quality of life was improved in all. Survival was positively correlated with absorbed dose but residual/recurrent tumour occurred even after > or = 300 Gy. Post-treatment symptoms were minimal (35 applications), pulmonary shunt rates were correctly predicted and pulmonary complications avoided.

Adult↗
PubMed1994

[Catheter embolization of renal hemorrhages of benign origin].

Catheter embolization was performed in 13 patients with persistent hematuria after an iatrogenic injury of the renal artery (n = 7), due to a vascular malformation (n = 4), or after renal trauma (n = 2). On angiography the following vascular changes were found: extravasation of contrast medium due to a severe vascular laceration (n = 2), pseudoaneurysms (n = 2), arteriovenous fistulas or malformations (n = 3) or combined vascular injuries (n = 2). The embolization was done using the monoaxial technique in nine patients, while in four patients a coaxial technique with micro-catheters was used. The method of choice is the use of micro-catheters with micro-coils. This technique allows the superselective embolization of small renal arteries without damaging the surrounding parenchyma.

Adult↗
PubMed1993

[Clinical significance and histological classification of atrophy/hypertrophy complexes of the liver].

Biliary, portal, biliary/portal and hepatovenous obstruction have been recognized as the etiological factors leading to the atrophy/hypertrophy complex (AHC) of the liver. From 1987 to 1990 30 patients were evaluated in our department with documented significant AHC of the liver. The evaluation of these patients was performed at an interdisciplinary meeting of surgeons, gastroenterologists, radiologists and hepatologists. All patients were studied in regard to clinical, radiological and gastroenterological investigations, intraoperative findings and histology. We present the diagnostic pathway, which included ultrasound in 29 patients as the first diagnostic step and 26 patients in whom computed tomography was added. In 21 patients hepato-iodide scintigraphy was performed, in 14 patients ERCP and angiography, and in 8 patients PTC. Etiologically we found in 12 patients a post-cholecystectomy stricture (PCS) in 12 patients, a tumour obstruction in 9 patients, different etiologies (Echinococcus, Budd-Chiari syndrome, primary biliary cirrhosis [PBC], Mirizzi-syndrome) in 9 patients and an unclear etiology in 4 patients. On the basis of our study we present a new histological classification of the AHC. Severe histological changes were prognostically worse, even in benign diseases. Therapy planning is always dependent on a very precise diagnostic pathway and early recognition of AHC is essential for the planning of therapy and for the prognosis of the disease.

Adult↗