The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt ...trauma.
Twelve patients (11 men) aged 35.8±11.3 years (range: 18-56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed. Selective coil embolization was performed on 11 patients and particle embolization of the injured vessel was performed on 1 patient. Criteria for endovascular treatment included active extravasation or pseudoaneurysm on contrast-enhanced computed tomography and decrease in hemoglobin level or temporary hemodynamic instability.
Arterial injuries were secondary to penetrating injury due to gunshot wound in 4 patients and stab wound in 5, and blunt abdominal injury as result of traffic accident in 3 patients. Traumatic lesions were in the right hepatic artery (n=3), left hepatic (n=2), right hepatic and right renal (n=1), left inferior epigastric (n=2), left facial (n=1), anterior tibial (n=1), and deep femoral (n=1) arteries. Technical success with no procedural complications was seen in all cases. Two patients died due to coexisting injuries on 29th and 43rd days of hospitalization. Median hospitalization period was 6.0 days (range: 1-43 days) and mean intensive care unit hospitalization was 7.7 days (range: 0-43 days).
In our experience, endovascular treatment was a safe and effective option for acute traumatic peripheral and visceral arterial lesions.
Here, we compare the success of percutaneous transcatheter sclerosant alcohol therapy (PTSAT) for the postoperative treatment of benign pelvic cysts that occurred after gynecologic surgery.
The study ...is a retrospective case-control trial. Gynecological patients who had symptoms due to postoperative pelvic cysts and received PTSAT after gynecologic surgery, between October 2008 and January 2018, were examined in a single training and research hospital in Turkey. Some factors were investigated for associations with postoperative pelvic cyst formation in patients who underwent gynecologic operations for malignancies or benign conditions. Statistical analysis used: The association between two independent and nonnormally distributed continuous variables was analyzed with the Mann-Whitney U-test. Spearman's rho correlation analysis was conducted to determine the correlation of two nonnormally distributed variables. Chi-square (or Fisher's exact test, when more suitable) was used to examine the correlation between categorical variables.
Statistically significant differences were found in terms of the average age was higher in patients with malignancies, and the average postoperative pelvic cyst detection time was higher in patients with benign pelvic cysts. While all patients were treated with PTSAT, repetitive PTSAT was required for seven benign and ten malign cases.
Patients with pelvic cysts that occurred after gynecologic surgery for malignant conditions, large volume pelvic cysts and patients with benign cysts who underwent more than one surgery required recurrent PTSAT.
Objective: The purpose of this study is to evaluate the safety and efficacy of transarterial embolization for the treatment of symptomatic renal angiomyolipomas.
Methods: All medical records of the ...patients who were presented with bleeding due to renal angiomyolipoma and received transarterial embolization at our department between
September 2016 and December 2018 were reviewed. All of the feeding arteries were superselectively catheterized and microparticle embolization was performed. Microparticle and
coil embolization was performed for active extravasation and pseudoaneurysm formation.
Results: In the study period 14 angio myo lipomas (AML) in 13 consecutive symptomatic patients were embolized. The technical success rate was 100% with total embolization
of all of the AMLs. 6 patients had acute retroperitoneal hemorrhage and procedures of these patients were performed in an emergency setting. All of the patients were discharged
without symptoms, so clinical success rate was also 100%. No major complication nor mortality was observed. Median volume decrease was 42% (12%-76%) during the follow-up
period.
Conclusion: Treatment of symptomatic renal AMLs with selective transcatheter arterial embolization is safe, feasible and effective. Embolization of acutely ruptured AMLs with
retroperitoneal hemorrhage using microparticles and coils can effectively stop bleeding.
Objective: We aimed to present the treatment and follow-up results of 41 patients who were treated for intracranial
aneurysm with flow diverter stents.
Method: Forty-one patients (Age range 27-68 ...years) were treated with the flow- diverting devices during January 2010 and
January 2014. Aneurysms ranged in size from small to large (1-30 mm) and include wide-necked aneurysms, multiple,
saccular, blister, dissecan, fusiform and recurrent intracranial aneurysms. Control skull X-Ray Graphy was typically performed
at 1, 3 and 6 months after treatment. A follow-up digital subtraction angiogram (DSA) was performed first day, 6 and 12
months after treatment.
Conclusions: Complete angiographic occlusion was achieved in 36 patients (88%) at follow-up digital subtraction angiogram.
Two transient morbidities and one permanent morbidity occurred due to stent thrombosis. There was no mortality observed.
Flow diverter stents are an effective tool in the treatment of large wide neck, high growth rates, and technical problematic
aneurysms to treat with conventional endovascular methods.
Objective: We aimed to examine the technical success, early-stage clinical results and radiological follow up findings of uterine artery
embolization (UAE) treatment for symptomatic uterine fibroids ...in patients.
Method: In the present study, we retrospectively evaluated the patients who were admitted to our hospital. Between February 2017 and July
2019 with symptoms due to uterine fibroids namely myomas and underwent endovascular embolization treatment. Patients with complaints
of excessive, prolonged, irregular, and frequent episodes of uterine bleeding, anemia, abdominal pain, palpable mass, and pollakiuria
associated with uterine myoma which impaired quality life of the patients were included in this study. In addition, Magnetic Resonance
Imaging (MRI) findings, and clinical symptoms of all patients before UAE, and 6th months after UAE were recorded.
Results: In our study, a total of 40 patients aged between 23-50 years (mean 41.3), one of whom had a history of hysterectomy underwent
UAE procedure in our hospital. In our series, clinical symptoms, MRI and digital subtraction angiography (DSA) findings were presented.
Uterine fibroid volumes as estimated based on MRI images obtained before - and 6 months after UAE were recorded (234,47±76,48 vs
17,27±43,53 (p=0,001). Embolization was cancelled due to intense atherosclerotic causes in one patient, and embolization of unilateral
uterine artery could be achieved. The remaining 39 patients underwent successful UAE procedure bilaterally. There were no complications
associated with endovascular procedure. After the procedure, all of these 39 patients were discharged on the same day following bed rest
and one patient could be discharged one week later due to the development of urosepsis.
Conclusion: UAE is a novel treatment modality which is being increasingly used in patients with symptomatic uterine fibroids, and it is an
important and effective treatment option since it is much less invasive compared to hysterectomy, does not require hospitalization after the
procedure and can be performed under simple sedation or spinal anesthesia.
We aimed to present our preliminary single-center experience of the endovascular management of thoracic and abdominal aortic ruptures.
Between September 2010 and May 2012, 11 consecutive patients ...(nine males, two females; age range, 26-80 years) with thoracic and abdominal aortic ruptures underwent endovascular repair in our unit. Thoracoabdominal computed tomography (CT) angiography was performed for diagnosis and follow-up. Patients were selected for endovascular repair by a cardiovascular surgeon, anesthesiologist, and interventional radiologist. All repairs were performed using commercially available stent-grafts. The patients were followed up with CT angiography before discharge, at six months, and yearly thereafter.
Three patients died by day 30. One patient died due to an unsuccessful procedure and hemodynamic instability; two patients died because of comorbidities. The other eight patients were followed for six to 24 months after the procedure. No endoleaks or late ruptures were observed during the follow-up period. The patient with iatrogenic thoracic aortic rupture developed paraplegia after the procedure.
Reduced mortality due to aortic rupture has been reported with the expanding use of endovascular repair. Reports of small centers are important because of the rarity of these pathologies, and because transferring patients with aortic rupture to a referral center is not usually possible.
OBJECTIVESThis study aims to present the importance of a multidisciplinary approach to radiofrequency ablation (RFA) treatment in osteoid osteoma (OO) patients by a team of experts in their field in ...preventing recurrence and complications. PATIENTS AND METHODSFor this retrospective study, a team of two orthopedists, two interventional radiologists, and one anesthesiologist was established in January 2013 to manage the diagnosis, follow-up, and treatment process of patients with OO at Bakırköy Dr. Sadi Konuk Training and Research Hospital. A total of 27 patients (15 males, 12 females; mean age 22.9 years; range, 9 to 54 years) were treated by this team between February 2013 and September 2016. The anatomic localization included iliac crest in four patients, the femur in 12 patients, fibula in two patients, humerus in three patients, radius in one patient, tibia in three patients, talus in one patient, and metacarpal in one patient. The procedures were carried out by the same interventional radiologists, same orthopedic surgeons, and same anesthesiologist in the computed tomography (CT) unit under aseptic conditions. After appropriate anesthesia for the localization of OO, the patient was positioned on the CT bed and the localization of the lesion was confirmed with a CT scan mapping. Then, a bone penetration cannula was advanced and bone cortex was penetrated with a charged motor and Kirschner (K)-wire. When the cannula reached the nidus, it was replaced with RFA probe. Ablation of the nidus was performed for five minutes at 90°C. RESULTSThe mean follow-up period was 46 months (range, 25 to 66 months). Patients were evaluated with visual analog scale (VAS) scores preoperatively and at postoperative 15th day, sixth month, and first year. In the last evaluation of the study data, the patients were called by telephone and questioned whether there were any changes in their final status. The mean preoperative VAS score was 7.2. The mean postoperative VAS scores of the 15th day, sixth month, and first year were 1.3, 0.6, and 0, respectively. In the last follow-up, the OO-related pain completely disappeared and none of the patients had any recurrence. There was a significant difference between preoperative and postoperative 15th day and sixth month VAS score measurements. CONCLUSIONRadiofrequency ablation treatment of OOs is a minimally invasive, safe, low-cost, and efficient method. We believe that with experienced teams and appropriate planning, RFA will take part in practice as the standard treatment of OO.
Objective: This study aimed to investigate the effectiveness of percutaneous cholecystostomy (PC) as a step treatment in patients who underwent PC for acute cholecystitis. Methods: Data of 248 ...patients who underwent PC for acute cholecystitis between January 2015 and December 2019 were retrospectively analyzed. All patients who underwent PC were evaluated for a distal transition by cholangiography taken by the interventional radiology department in the third week after discharge. In addition, all patients were re-evaluated by the anesthesia department. Patients were retrospectively evaluated in terms of age, gender, American Society of Anesthesiologists physical status (ASA-PS) class, surgical procedure, complications after PC, and termination of PC. Results: A total of 231 patients were included in the study. The mean age of patients was 68.6 (minimum-maximum: 32-92 years) and the male/ female ratio was 1.04. The anesthesia evaluation of the patients categorized 44 patients (19.05%) as ASA-PS class I-II and 187 (80.95%) as ASAPS III-IV. A total of 17 (7.35%) patients died in the 30-day follow-up period. The examination of the remaining patient revealed that PC was used as a step treatment in the transition to elective cholecystostomy in 106 (45.8%) patients, whereas 108 (50.4%) had it as a final treatment method since an operation is impossible. The median follow-up period in these patients was 2.6 years. Recurrent cholecystitis developed in 14 (12.96%) patients in the group who underwent PC. Conclusion: PC should be noted as an alternative step treatment method for acute cholecystitis but maybe a final treatment option in patients with high comorbidity.
Purpose
The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70–99%) stenosis of a major intracranial ...artery with Enterprise stent.
Methods
This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70–99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period.
Results
A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6–72) and none of the patients experienced recurrent TIA or stroke during the follow-up period.
Conclusion
In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.
Objectıve: Acute Kidney Injury (AKI) and subsequent renal failure are the leading causes of morbidity and mortality in the intensive care unit (ICU). In this study, it was planned to compare ...Neutrophil Gelatinase-associated Lipocalin (NGAL) and creatinine values in patients diagnosed with AKI and to determine the effect of renal dose dopamine use on renal blood flow, development of chronic renal failure (CRF) and mortality. Materıals and methods: This prospective study was planned with 35 patients developed AKI in the ICU of Bakırköy Dr. Sadi Konuk Training and Research Hospital. The patients were randomized into 2 groups as 18 patients who received dopamine treatment with the recommendation of the cardiology clinic and 17 patients who did not receive dopamine treatment. Urea, creatinine and NGAL plasma levels were compared between groups. Results: There was no difference between the groups in terms of age, gender and AKI stage. The 0th, 24th hour results and 24-hour changes of urea, creatinine and NGAL values of dopamine patient, who took dopamine, were found to be similar to those of patients who did not take dopamine. A significant positive correlation was found between the 24-hour change in creatinine value and the 24-hour change in NGAL (r=0.374; p<0.05). There was no significant change in the diameter and flow of renal arteries between measurements in patients who received dopamine. The rates of patients who regain normal kidney functions, develop CRF or develop mortality between the two groups were found to be similar. Conclusıon: Treatment results of AKI developing in ICU are not satisfactory. Low-dose dopamine treatment has no effect on patient outcomes in these patients. NGAL is a biomarker that has the ability to show renal damage at an early stage. Serial measurement of NGAL concentration during ICU stay may benefit the clinician in early diagnosis and follow-up of AKI.
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