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Biomedical subjects

P F Jaques

Publications and source records attributed to P F Jaques.

At least 19 recordsLinked to original sources
PubMed2000

Primary Gianturco stent placement for inferior vena cava abnormalities following liver transplantation.

PURPOSE: To determine the efficacy of primary Gianturco stent placement for patients with inferior vena caval (IVC) abnormalities following liver transplantation. MATERIALS AND METHODS: From August 1996 through March 1999, nine adult patients developed significant IVC abnormalities following liver transplantation. Patients were referred for vena cavography on the basis of abnormal clinical findings, laboratory values, liver biopsy results, Doppler findings, or a combination. Those patients demonstrating a significant caval or hepatic venous gradient were treated with primary Gianturco stent placement. Patients were followed clinically (nine patients), with duplex ultrasound (nine patients), vena cavography (four patients), and biopsy (seven patients). RESULTS: Original pressure gradients ranged from 3 to 14 mm Hg, with a mean of 9 mm Hg. Gradients were reduced to 3 mm Hg or less in all nine patients; presenting signs and symptoms either resolved or improved in eight of nine patients. The ninth patient required repeated transplantation 2 days later. A second patient died 433 days after stent placement of recurrent hepatitis C. Another initially improved following caval stent placement, but underwent repeated transplantation 7 days later due to hepatic necrosis from hepatic arterial thrombosis. Follow-up for the remaining six patients has averaged 491 days, with no clinical, venographic, or ultrasound evidence for recurrent caval stenosis. CONCLUSIONS: Intermediate term results suggest that primary Gianturco stent placement for IVC stenosis, compression, or torsion resulting after liver transplantation is safe and effective.

Adult↗
PubMed1999

Resource requirements for interventional radiologic management of long-term ambulatory hemodialysis patients.

OBJECTIVE: The purpose of this study was to determine how many and what type of procedures a vascular and interventional radiology service should provide for patients at ambulatory-patient dialysis centers and to determine the necessary resource requirements. These data may provide a realistic starting point for those engaged in the planning and provision of contractual services to dialysis centers. MATERIALS AND METHODS: Patient records at three dialysis centers for a recent 3-year period were examined, and demographic and clinical data were recorded. Records were cross-correlated with records from the vascular and interventional radiology service that had contractually provided all dialysis-related procedures. These data generated a monthly procedure volume and case mix per 100 dialysis patients. Facility usage times for 121 dialysis-related procedures were obtained prospectively and used to calculate the expected resources needed to service the dialysis patients. RESULTS: The three centers provided 5795 hemodialysis-months to 386 patients. Of the 386 patients over the 36-month period, 101 died and 92 transferred from the centers. Three hundred and sixteen patients required 1580 interventional procedures. Monthly procedure volume per 100 dialysis patients averaged 27.1 procedures. Observed procedure times were used to calculate expected room-time hours required to service the monthly procedural volume and case mix per 100 dialysis patients. CONCLUSION: On average, 500 ambulatory dialysis patients will require the full-time use of an interventional suite and the services of a full-time technologist, nurse, and physician to provide necessary dialysis-related procedures. If resources cannot accommodate this volume, the quality and timeliness of care for these patients is jeopardized.

Ambulatory Care Facilities↗
PubMed1998

Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis.

Hemoptysis is common in patients with cystic fibrosis (CF). Bleeding may vary in severity, ranging from minor blood-streaking of sputum to expectoration of significant quantities of blood. Major hemoptysis, defined as bleeding greater than 240 ml/24 h, represents a medical emergency. Bronchial artery embolization (BAE) is one of the treatment options for hemoptysis. We reviewed the 10-yr experience at the University of North Carolina Hospitals in the treatment of hemoptysis by BAE. Eighteen patients with CF were hospitalized on 29 occasions and underwent 36 BAE procedures for the control of hemoptysis. Most patients (n = 11) had very severe lung disease (FEV1 < 35%) with a high incidence (n = 9, 50%) of multi-drug-resistant bacteria. Fifteen patients (n = 33 procedures) were followed for a mean of approximately 22 mo after BAE. The overall efficacy of BAE for initial control of hemoptysis was 75% (n = 22) after one session, 89% (n = 26) after two sessions, and 93% (n = 27) after three sessions. The overall recurrence rate per episode was 46% (12/26 presentations in four patients) with a mean time for recurrence of approximately 12 mo. There was a high incidence (75%) of bleeding from nonbronchial systemic collateral vessels among patients (n = 7) who had undergone a previous BAE. There were two deaths associated with massive hemoptysis despite BAE. Three patients had transient neurologic deficits during BAE. We concluded that BAE is a relatively safe and effective means of treating significant hemoptysis in patients with CF.

Adolescent↗
PubMed1997

Prospective randomized comparison of surgical versus endovascular management of thrombosed dialysis access grafts.

PURPOSE: Salvage of thrombosed prosthetic dialysis shunts can be performed using surgical or endovascular techniques. A prospective randomized trial was designed to compare the efficacy of these two methods in restoring dialysis access function. METHODS: One hundred fifteen patients with thrombosed dialysis shunts were randomized prospectively to surgical (n = 56) or endovascular (n = 59) therapy. In the surgical group, salvage was attempted with thrombectomy alone in 22% and with thrombectomy plus graft revision in 78%. In the endovascular group, graft function was restored with mechanical (82%) or thrombolytic (18%) graft thrombectomy followed by percutaneous angioplasty. RESULTS: Stenosis limited to the venous anastomotic area was the cause of shunt thrombosis in 55% of patients, and long-segment venous outflow stenosis or occlusion was the cause in 30%. In 83% of the surgical group and in 72% of the endovascular group, graft function was immediately restored (p = NS). The postoperative graft function rate was significantly better in the surgical group (p < 0.05). Thirty-six percent of grafts managed surgically remained functional at 6 months and 25% at 12 months. In the endovascular group, 11% were functional at 6 months and 9% by 12 months. Patients with long-segment venous outflow stenosis or occlusion had a significantly worse patency rate than those with venous anastomotic stenosis (p < 0.05). CONCLUSIONS: Neither surgical nor endovascular management resulted in long-term function for the majority of shunts after thrombosis. However, surgical management resulted in significantly longer primary patency in this patient population, supporting its use as the primary method of management in most patients in whom shunt thrombosis develops.

Angioplasty, Balloon↗
PubMed1996

Comparison of measures for prospective identification of venous stenoses.

OBJECTIVE: To compare two methods, venous dialysis pressure (VDP) and intra-access static flow pressure (VPO), for the prospective identification of venous stenoses in high-risk PTFE grafts. DESIGN: Comparative. SAMPLE/SETTING: Twenty patients with upper extremity loop grafts in an outpatient chronic hemodialysis population. METHODS: VDP and VPO were measured for three consecutive treatments within subjects followed by angiography. VDP > 150 mmHg/200 ml/min, VPO > 0.40, and stenoses > 50% were considered positive findings. RESULTS: In paired t-tests, VPO identified elevated venous pressure more frequently than VDP in patients positive on angiography (mean difference = 77.8%, p < 0.0001). Frequency analysis yielded a sensitivity of 36% for VDP and 93% for VPO (p < 0.05). CONCLUSION: This study found that while VDP is the simpler method to use, VPO is significantly more accurate at predicting venous stenoses.

Adult↗
PubMed1994

Proximal venous outflow obstruction in patients with upper extremity arteriovenous dialysis access.

To evaluate the impact of central venous obstruction on upper extremity hemodialysis access failure, we retrospectively analyzed our recent experience in managing this problem. We reviewed 158 upper extremity hemodialysis access procedures performed in 122 patients during a 1-year period. Fourteen (11.5%) patients had central vein obstruction as the cause of severe arm swelling, graft thrombosis, or graft malfunction. All 14 patients had had bilateral temporary subclavian vein dialysis catheters and failed upper extremity arteriovenous access. Seventeen lesions were treated in 14 patients including eight subclavian vein occlusions, six subclavian vein stenoses, two internal jugular vein stenoses, and one superior vena cava stenosis. Twenty-one procedures were performed including 17 percutaneous transluminal balloon angioplasties (PTAs) with stent placement in 13, two axillary to innominate vein bypasses, and two axillary to internal jugular vein bypasses. All patients had resolution of symptoms. Thirteen (76%) PTAs were initially successful but in four (24%) cases it was impossible to recanalize the vein. Eight (47%) PTAs provided functional hemodialysis access for 2 to 9 months, two (12%) restenosed at 3 and 10 months and were successfully redilated, two occluded at 2 and 4 months and were unable to be recanalized, and one failed immediately after a successful PTA. Four PTA failures were followed by venous bypass, which remained patent and provided functional access 7 to 13 months after surgery. Of nine stenotic venous lesions six (67%) were successfully dilated without restenosis, whereas of eight occluded veins only two (25%) were successfully treated without recurrence. Temporary central hemodialysis catheters produce a significant number of symptomatic central vein obstructions in patients with upper extremity arteriovenous access.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1993

The spleen and its vasculature in pancreatitis: CT findings.

The spleen and its vasculature are susceptible to damage from pancreatic inflammatory exudates. Fourteen patients were identified who demonstrated splenic or splenic vascular involvement from pancreatitis on computed tomography. Findings included intra- and perisplenic inflammatory fluid collections (n = 6), acute splenic hematomas (n = 3), splenic infarction (n = 1), splenic artery pseudoaneurysm (n = 1), and splenic vein thrombosis (n = 6). Eight of the 14 patients went on to urgent interventions including percutaneous catheter drainage (n = 2) and transcatheter embolotherapy (n = 6) based on the CT findings.

Aneurysm, False↗
PubMed1992

Percutaneous translumbar and transhepatic inferior vena caval catheters for prolonged vascular access in children.

Central venous access for children with caval occlusion remains a major challenge to pediatric surgeons. Traditionally, children with superior and inferior vena cava (SVC, IVC) thrombosis have often required a thoracotomy to directly cannulate the azygos system or right atrium (RA). Recently, the possibility of placing tunneled RA catheters (RACs) by a percutaneous translumbar or transhepatic approach has become available. We report our experience of seven children with SVC and IVC obstruction who have received 11 transhepatic and 4 translumbar RACs from 1987 to 1991. All but one child was less than 2.5 years old and all were chronically dependent on parenteral nutrition. All catheters were placed in the angiography suite under general anesthesia using ultrasound guidance and Seldinger technique. This technique was successful in all seven children. Perioperative complications included accidental extubation in one patient and aspiration pneumonia in another. Mechanical complications requiring RAC replacement occurred 5 times in three infants (greater than 2,650 catheter days) and included catheter dislodgement (2) and thrombosis (3). In the patients with catheter thrombosis, the existing tract was successfully wired and the catheter exchanged on three occasions. Thrombolytic therapy was effective in restoring catheter patency on three other occassions. Nine episodes of catheter sepsis occurred in five children. Two late deaths occurred from infection. Of the five remaining children, four are dependent on total parenteral nutrition and have a translumbar or transhepatic catheter in situ and one child has adapted successfully to enteral feedings. Percutaneous translumbar or transhepatic IVC catheters provide excellent alternative routes for prolonged central venous access in those patients whose traditional vascular access sites are no longer available. Complications of the technique itself were minimal and although late catheter complications were not infrequent, they appear to be comparable to the standard approaches reported.

Adolescent↗
PubMed1992

US guidance for vascular access. Technical note.

Real-time ultrasonography (US) is frequently used to access the biliary tree, urinary system, and pleural cavity, as well as abscesses and other fluid collections, but is rarely used to access blood vessels. This article describes the clinically indicated circumstances and technical aspects of US-guided access to veins and arteries. The authors' experience suggests that appropriate use of this modality significantly simplifies vascular access difficulties, reduces procedure time and morbidity, and is cost-effective.

Blood Vessels↗
PubMed1992

Radiology-assisted placement of implantable subcutaneous infusion ports for long-term venous access.

Implantable infusion port devices are generally placed surgically. A technique for radiology-guided placement in adults is described, and the experience with 103 attempted port placements between June 1989 and October 1991 is analyzed. Placements were successful in 102 attempts (99%). Minor procedural difficulties occurred in six patients (5.9%). One major procedural complication (large hematoma) precluded port placement. Two patients were lost to follow-up after uncomplicated placements. There were four (4.0% of 100 patients) minor late complications. Major late complications requiring port removal occurred in 13 (13.0%): five suspected catheter-related infections, four catheter-related venous thromboses refractory to thrombolysis, and one each of wound dehiscence, formation of hematoma near the port, extraluminal migration of the catheter, and poor blood return. With a cumulative follow-up of 15,880 days (43.5 patient-years) available, a rate of major complications of 13.6%, or 0.86% per 1,000 access days, is comparable to the rates of large surgical series. Radiology-guided placement of infusion ports is safe and may offer advantages over surgical implantation.

Adolescent↗
PubMed1992

Long term results of percutaneous catheter drainage of pancreatic pseudocysts.

Percutaneous catheter drainage (PCD) has become an established and often preferred alternative to surgical treatment in the management of pancreatic pseudocysts. However, the long term results of percutaneous drainage of pancreatic pseudocysts remain uncertain. In an effort to determine the long term outcome of this therapy, 42 patients undergoing PCD of a pancreatic pseudocyst were analyzed retrospectively. Forty-two pancreatic pseudocysts were drained percutaneously in 42 patients. Sixty-seven percutaneous drainage procedures were performed--22 patients underwent one, 15 had two and five patients required three procedures. Percutaneous drainage was considered not to be effective when the pseudocyst persisted or when it recurred after initial resolution. Twenty-three pseudocysts were infected at the time of drainage and 19 were not infected. In 30 patients, the cause of the pseudocyst was alcoholic pancreatitis. There were no deaths related to the procedures and seven complications occurred, including hemorrhage, pancreatic fistula and empyema. Mean follow-up evaluation time of the patients was ten months. In nine patients, the pseudocyst was successfully drained and resolved. There were 33 treatment failures, among which 26 pseudocysts failed to resolve and seven recurred after initial resolution. Eventually, 25 patients underwent a surgical procedure, 20 for persistent pseudocyst and five for recurrence. Using contingency table analysis, the size of the pseudocyst, amount of fluid drained, amylase concentration in the aspirate, presence of infection, number of drainage procedures performed and duration of catheter drainage had no influence on the likelihood of success in long term pseudocyst resolution after PCD. Pseudocysts not related to alcoholic pancreatitis seemed to be less likely (p < 0.05) to resolve with percutaneous drainage than those caused by alcohol. PCD is a safe and valuable procedure in the acute management of patients with pancreatic pseudocyst. However, the current data suggest that despite early success with percutaneous drainage, the lack of resolution and recurrence rate of pancreatic pseudocyst is high. Therefore, it should not be considered as the definitive form of therapy in most patients. Close surveillance of patients undergoing percutaneous drainage and communication between surgeons and radiologists are critical in the management of pancreatic pseudocysts.

Adult↗
PubMed1991

Chronic posttraumatic aortic pseudoaneurysm. Recognition before rupture.

Few patients survive transection of the aorta caused by blunt trauma. However, among those who do are a small number who go on to live with an unrecognized pseudoaneurysm that may rupture at any time. Because these aneurysms may be mistaken for more common disease processes, such as hilar adenopathy, atherosclerotic aneurysm, or neoplasia, the authors describe radiographic findings that suggest the correct diagnosis.

Aorta, Thoracic↗
PubMed1991

Radiologic insertion of Hickman catheters in HIV-positive patients: infectious complications.

Ninety-six patients undergoing radiologically guided placement of 104 Hickman catheters were grouped according to their human immunodeficiency virus (HIV) serologic status. Infectious complications were categorized according to their severity (local or systemic) and time of occurrence (periprocedural or late). The number of infectious complications per 100 indwelling catheter days was calculated. Among the 14 catheter placements in 13 HIV-positive patients, two systemic infections occurred, resulting in a 14% overall infection rate and 0.18 infectious complications per 100 indwelling catheter days. The remaining 83 HIV-negative patients underwent 90 Hickman catheter placements. Nine infectious complications (10%) were noted in the 90 catheters, translating into 0.19 infectious complications per 100 indwelling catheters days. These results suggest no significant (relative risk [RR] of 1.4 and .95) difference in infectious complication rates encountered in HIV-positive patients compared with the general population. This supports the clinical usefulness of Hickman catheter placement in HIV-positive patients, although many additional HIV-positive patients must be evaluated to achieve an acceptable level of statistical confidence.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Percutaneous inferior vena cava placement of tunneled silastic catheters for prolonged vascular access in infants.

In infants and children requiring prolonged and multiple central venous catheterizations, conventional cannulation sites may become thrombosed or stenotic, making inability to gain vascular access a life-threatening problem. The technique we use for the percutaneous placement of inferior vena caval tunneled silastic catheters via the translumbar and transhepatic approaches is described. Three translumbar placements and one transhepatic placement in three children without immediate complications have been performed. We conclude that percutaneous inferior vena caval cannulation via the translumbar or transhepatic routes offers a viable alternative in these patients with difficult vascular access.

Catheterization, Central Venous↗