Search PubMed⌕ Search

Biomedical subjects

M C Soulen

Publications and source records attributed to M C Soulen.

At least 37 records · Page 2Linked to original sources
PubMed1995

Intentional reversible thrombosis of transjugular intrahepatic portosystemic shunts.

PURPOSE: To assess whether balloon occlusion of a transjugular intrahepatic portosystemic shunt (TIPS) will allow permanent yet reversible shunt thrombosis. MATERIALS AND METHODS: A balloon catheter was inflated in the midportion of the TIPS in two women with severe, uncontrollable encephalopathy or liver failure (aged 42 and 65 years, respectively) to allow occlusive thrombus to develop below the balloon. RESULTS: Balloon occlusion led to rapid TIPS thrombosis, which was readily reversible. CONCLUSION: Balloon thrombosis is a simple technique for complete occlusion of a TIPS. This technique may also be useful for occlusion of surgical mesocaval H-graft shunts or dialysis access shunts.

Adult↗
PubMed1995

Thrombosed hemodialysis grafts: percutaneous mechanical balloon declotting versus thrombolysis.

PURPOSE: To compare a technique of mechanical balloon declotting of thrombosed hemodialysis grafts with conventional pulsed-spray thrombolysis. MATERIALS AND METHODS: Forty patients had 53 episodes of graft thrombosis over a 19-month period. Twenty-nine grafts were randomly treated with thrombolysis with urokinase and 24 grafts with mechanical declotting by placement of crossed balloon catheters within the graft. Patency was determined by retrospective review of hemodialysis records. RESULTS: Successful hemodialysis for 1 week after the procedure was achieved in 21 (88%) of the 24 grafts treated mechanically and 26 (90%) of 29 grafts treated with thrombolysis. Continuous pulse oximetry showed no change in oxygen saturation in either group, and no clinical signs or symptoms of pulmonary embolism were noted. Average total procedure times were 2.2 hours for mechanical declotting and 3.5 hours for thrombolysis (P < .05). Probability of patency (mechanical vs thrombolysis) was 42% vs 45% at 3 months, 36% vs 25% at 6 months, and 8% vs 4% at 12 months. One major complication of ulnar artery embolization occurred in the thrombolysis group. CONCLUSION: Mechanical declotting of hemodialysis grafts is faster and as effective as thrombolysis.

Adult↗
PubMed1995

Thrombolysis of lower extremity embolic occlusions: a study of the results of the STAR Registry.

PURPOSE: To evaluate thrombolysis as primary therapy for lower extremity embolic occlusions. MATERIALS AND METHODS: Forty-five of 306 consecutive cases of lower extremity arterial occlusions treated with urokinase and registered in the Society of Cardiovascular and Interventional Radiology Transluminal Angioplasty and Revascularization Registry were believed on the basis of clinical and angiographic findings to be due to emboli. RESULTS: Comorbidity included atrial fibrillation in 50%, previous myocardial infarction in 40%, and a cerebrovascular event in 35%. Thirty-two (71%) limbs were viable, 12 (27%) were threatened, and one had irreversible ischemia. Mean symptom duration was 8.6 days. Average occlusion length was 17 cm. The distribution of emboli was 4% aortoiliac, 65% femoropopliteal, 24% tibial, and 7% graft. Major complications occurred in eight of 45 patients (18%). The technical success rate was 69%, with a 1- and 2-year primary patency of 79% for initially successful intraarterial thrombolyses. CONCLUSION: Thrombolysis of embolic occlusions is successful in most cases. Limb salvage and survival rates are similar to historical reports for surgical embolectomy.

Adult↗
PubMed1995

Transjugular intrahepatic portosystemic shunts for portal hypertension.

TIPS has rapidly become a proven effective therapy for treatment of acute variceal bleeding and is probably an effective therapy for intractable ascites. Nonetheless, it is important to define the appropriate subpopulation best suited for the TIPS procedure. Given the poor long-term patency of TIPS and the need for close follow-up, TIPS is not an optimal therapy for an unreliable patient who is not a candidate for liver transplantation. In contrast, TIPS is especially useful in the patient anticipating liver transplantation soon after TIPS placement. Further study is needed to define the optimal use for TIPS.

Contraindications↗
PubMed1994

Life-threatening pulmonary emboli and cor pulmonale: treatment with percutaneous pulmonary artery stent placement.

Large, central bilateral pulmonary emboli led to cor pulmonale and severe hypoxemia in a patient who had recently undergone cardiac surgery. After percutaneous catheter fragmentation and thrombolysis of the emboli failed, the left and right interlobal pulmonary arteries were recanalized by placement of self-expanding Wallstent endoprostheses through the clots. Pulmonary perfusion was restored to the lower lobes, and the patient demonstrated rapid clinical improvement.

Coronary Artery Bypass↗
PubMed1994

Transjugular intrahepatic portosystemic shunt stenosis and revision: early and midterm results.

OBJECTIVE: The purpose of this study was to define the pattern, rate, and interval during which stenosis develops in transjugular intrahepatic portosystemic shunts (TIPS) and to assess the effect of revision in prolonging shunt patency. MATERIALS AND METHODS: TIPS were created in 100 patients during a 34-month period. Sixty-one shunt venograms were obtained in 38 consecutive patients between 1 and 24 months after TIPS placement. Eighteen patients were examined because of recurrent symptoms, and all 38 had routine follow-up. RESULTS: Stenoses attributed to neointimal hyperplasia developed within both the TIPS stent and the outflow hepatic veins. Stenoses of greater than 50% developed in 12 patients within 6 months of TIPS placement. In addition to focal stenoses, the outflow hepatic veins diffusely shrank an average of 51% in diameter. Thirty-six shunt interventions were required: eleven balloon dilatations and 25 placements of an additional stent. Life-table analysis showed that patency of the primary shunt was 75% at 6 months, 50% at 1 year, and 32% at 2 years. The primary-assisted patency of the shunt was 85% at 12 months after shunt creation. CONCLUSION: The results indicate that TIPS are prone to significant and frequent early stenosis, warranting follow-up within 3-6 months in all cases. Stenosis of the outflow hepatic vein is the most common cause of shunt malfunction. Revision of a shunt significantly prolongs shunt patency.

Catheterization↗
PubMed1994

Chemoembolization of hepatic malignancies.

Chemoembolization has several theoretical advantages over intravenous or intraarterial infusion therapy for treatment of primary or metastatic liver tumors. This technique delivers highly concentrated drugs to the tumor, then arrests blood flow. This renders the tumor ischemic, while achieving a drug concentration in the tumor 10 to 25 times greater than can be achieved by infusion. The dwell time for the drug is markedly prolonged, with measurable drug levels present in tumor as long as a month after chemoembolization. Up to 85% of the administered drug is trapped in the liver, minimizing systemic toxicity. Worldwide experience has established chemoembolization as the treatment of choice for unresectable hepatoma. Metastatic lesions from ocular melanoma, neuroendocrine tumors, and sarcomas have been reported to respond well to chemoembolization. The technique also shows promise against colorectal metastases.

Antineoplastic Agents↗
PubMed1993

TIPS: a new alternative for the variceal bleeder.

BACKGROUND: Standard medical therapies for variceal bleeding secondary to portal hypertension (vasopressin, esophagogastric balloon tamponade and sclerotherapy) are associated with high rates of recurrent bleeding. Surgical shunting has a mortality rate of 15% to 50%. The transjugular intrahepatic portosystemic shunt offers a novel, minimally invasive procedure for nonsurgical portal decompression. METHOD: Following catheterization of the hepatic vein from a jugular vein approach, a needle is directed fluoroscopically from the hepatic vein into a branch of the portal vein along an intrahepatic tract. The intrahepatic tract is then dilated and held open with a stainless steel stent delivered on a balloon catheter. This creates a portosystemic shunt entirely within the liver. RESULTS: The collective experience of more than 300 cases from several centers has been reported. The technical success rate for the transjugular intrahepatic portosystemic shunt is 92% to 96%. Thirty-day mortality rates range from 0% to 14%, with less than 3% attributed to procedural complications. Primary shunt patency is about 90%, with a secondary patency rate of 100%. Rates of encephalopathy and rebleeding are 9% to 14%. Ascites resolves in 80% to 90% of patients. CONCLUSION: The transjugular intrahepatic portosystemic shunt appears to be a safe and effective procedure for management of variceal bleeding and holds promise for becoming the treatment of choice for portal hypertension.

Clinical Protocols↗
PubMed1992

Intraarterial chemotherapy with limb-sparing resection of large soft-tissue sarcomas of the extremities.

Fifteen patients with large (average, 15-cm), high-grade soft-tissue sarcomas of the extremities received prolonged selective intraarterial infusions of chemotherapeutic agents in an attempt to permit limb-sparing resection of these tumors, which would otherwise have required amputation. There were seven malignant fibrous histiocytomas, four liposarcomas, two fibrosarcomas, one leiomyosarcoma, and one rhabdomyosarcoma; 73% were grade III. Seven patients underwent two catheterizations, for a total of 22 infusions, which averaged 11.3 days each. There were four catheterization-related complications, including catheter occlusion or dislodgement in one patient each and two cases of arterial thromboembolism in patients in whom anticoagulant dose was not adequate. Both of the latter patients required thrombectomy; one developed gangrene, which precluded limb-sparing surgery. Thirteen of the 15 patients underwent limb-sparing resections, and two underwent amputations. No wound complications occurred. With a median follow-up of 36 months (mean, 34 months), life-table analysis indicates overall and disease-free survivals of 72% and 59%, respectively, at 2 years and 64% and 59% at 3 years. In comparison to other reported therapies, this technique permits limb salvage in most patients without the high wound complication rate associated with preoperative radiation therapy, with equivalent local disease control and survival.

Adult↗
PubMed1992

Gallstone lithotripsy: in vitro comparison of fragmentation with a tunable-dye laser and an ultrasonic wire.

Large bile duct stones require fragmentation prior to extraction through the papilla or through a percutaneous tract. This can be attempted with dissolution therapy, crushing baskets, or lithotripsy. Lithotripsy can be accomplished safely and effectively with tunable-dye laser energy delivered through a flexible, 1-F optical fiber under endoscopic or fluoroscopic guidance, but laser technology is very costly. A prototype, flexible ball-tipped wire coupled to an ultrasonic generator via a piezoelectric crystal has been developed for sonolysis of atheroma and thrombus in humans. The purpose of this experiment was to compare human gallstone fragmentation in vitro with a tunable-dye laser and this prototype wire to see if the less expensive ultrasound device might provide an alternative to costly laser technology. Gallstones from 17 patients were subjected to lithotripsy in a water bath with each device until completely fragmented or 60 seconds had elapsed. Neither device effectively fragmented cholesterol stones under these conditions. The ultrasonic wire completely fragmented 57% of bilirubinate stones in 60 seconds. The tunable-dye laser completely fragmented 100% of bilirubinate stones in less than 35 seconds (P = .04). Tunable-dye laser lithotripsy appears superior to the ultrasonic device for percutaneous treatment of bile duct stones.

Cholelithiasis↗
PubMed1991

Changes in renal artery Doppler indexes following renal angioplasty.

Doppler indexes were measured in 14 renal arteries in 13 patients before and after percutaneous transluminal angioplasty to determine if changes in these parameters occurred after the procedure. Angioplasty was technically and clinically successful in 12 cases, and adequate Doppler signals were obtained from 13 of 14 arteries. The pulsatility index, resistive index, and acceleration of the distal main renal artery Doppler waveform increased significantly after angioplasty, while the time to systolic peak and the renal-aortic ratio remained unchanged. The former may be useful noninvasive indexes to screen patients for restenosis of the renal artery before it becomes clinically evident. A long-term follow-up study is needed to test this hypothesis.

Adult↗
PubMed1991

Recanalization of an occluded aortoiliac bypass graft with Palmaz stents.

Four tandem Palmaz balloon-expandable vascular stents were used to recanalize the completely occluded limb of an aortoiliac bypass graft after failure of thrombolysis and conventional angioplasty. The resting peak-systolic pressure gradient across the occluded limb was reduced from 68 to 13 mm Hg. The patient's rest pain resolved, and the ankle-brachial index rose from 0.54 to 0.78. No embolization or stent-related complications occurred. The graft remains patent as determined with noninvasive studies obtained 8 months later.

Anastomosis, Surgical↗
PubMed1991

Transhepatic laser lithotripsy of choledocholithiasis: initial clinical experience.

Three patients with symptomatic intra- and extrahepatic choledocholithiasis who were not good candidates for retrograde endoscopy, surgery, or extracorporeal shock wave lithotripsy (ESWL) were treated successfully with endoscopically guided tunable dye laser lithotripsy via a 12-F transhepatic sheath. There were no complications secondary to the use of the laser. On the basis of this initial experience, transhepatic laser lithotripsy is a technically feasible and safe alternative when choledocholithiasis cannot be managed with retrograde endoscopy, ESWL, or surgery. Its role in the management of choledocholithiasis relative to other transhepatic techniques remains to be determined.

Adult↗