To review safety and feasibility in a single center using transradial access (TRA) for noncoronary interventions.
Retrospective analysis was performed of 946 patients evaluated for 1,531 consecutive ...TRA procedures from April 2012 to July 2015. Exclusion criteria included sheath > 6 F, Barbeau D waveform, radial artery (RA) diameter < 2 mm on ultrasound, history of severe aortic tortuosity or RA occlusion, and dialysis. TRA was attempted in 936 patients (62% men; median age, 62.4 y) who underwent 1,512 consecutive procedures (chemoembolization n = 485, yttrium-90 mapping n = 391 and infusion n = 293, renal/visceral intervention n = 172, uterine artery embolization n = 116, peripheral intervention n = 43, endoleak repair n = 10, and other n = 2). Patients were evaluated for complications during follow-up at ~30 days.
Technical success was 98.2% (1,485/1,512). Major complications (0.13%) included pseudoaneurysm (n = 1) and seizure (n = 1). Minor complications (2.38%) included hematoma/bleeding (n = 13), RA occlusion (n = 11), arm pain (n = 6), and RA spasm (n = 6). Univariate analysis demonstrated a lower rate of adverse events in African American patients (hazard ratio HR, 0.25; 95% confidence interval CI, 0.07-0.86; P = .027). Twenty-seven cases (1.8%) required crossover to transfemoral access (TFA). Crossover rates were higher in female patients (P = .0055), height < 1.7 m (P = .024), renal/visceral interventions (P = .0003), and endoleak interventions (P = .0357). Multivariate analysis demonstrated intervention type to be the only significant predictor of TFA crossover (renal/visceral HR, 4.48; 95% CI, 1.84-10.9; P = .001; endoleak repair HR, 9.54; 95% CI, 1.09-83.8; P = .042).
TRA was safe and well tolerated in a heterogeneous patient population across a range of peripheral vascular interventions.
Mammalian seminal plasma contains membranous vesicles (exosomes), with a high content of cholesterol and sphingomyelin and a complex protein composition. Their physiological role is uncertain because ...sperm stabilization and activation effects have been reported. To analyze a putative modulatory role for semen exosomes on sperm activity in the boar, the effects of these vesicles on several sperm functional parameters were examined. Additionally, boar exosome proteins were sequenced and their incorporation into sperm was explored. Boar sperm were incubated under conditions that induce capacitation, manifested as increased tyrosine phosphorylation, cholesterol loss and greater fluidity in apical membranes, and the ability to undergo the lysophosphatidylcholine-induced acrosome reaction. After establishing this cluster of capacitation-dependent functional parameters, the effect produced by exosomes when present during or after sperm capacitation was analyzed. Exosomes inhibited the capacitation-dependent cholesterol efflux and fluidity increase in apical membranes, and the disappearance of a 14-kD phosphorylated polypeptide. In contrast, the acrosome reaction (spontaneous and lysophosphatidylcholine-induced) was not affected, and sperm binding to the oocyte zona pellucida was reduced only when vesicles were present during gamete coincubation. Liposomes with a lipid composition similar to that present in exosomes mimicked these effects, except the one on zona pellucida binding. Interaction between exosomes and sperm was confirmed by transfer of aminopeptidase activity. In addition, the major exosome protein, identified as actin, appeared to associate with sperm after coincubation. Exosome composition had a predominance for structural proteins (actin, plastin, ezrin, and condensin), enzymes, and several porcine seminal plasma-specific polypeptides (e.g., spermadhesins). Transfer of proteins from exosome to sperm and their ability to block cholesterol efflux supports a direct interaction between these vesicles and sperm, whereas inhibition of some capacitation-dependent features suggests a stabilizing function for exosomes in boar semen.
This study investigates the feasibility of performing uterine artery embolization (UAE) via transradial access (TRA). Growing evidence demonstrates significant benefits of TRA versus standard ...transfemoral access during percutaneous coronary intervention, now making it the preferred approach at many centers worldwide. At a single institution from March 2013 to October 2013, 29 consecutive patients were treated by transradial UAE. Technical success rate was 100%, with no immediate major or minor complications. The radial artery was patent at 1-month follow-up evaluation in all cases. These preliminary data suggest that transradial UAE is feasible and safe.
The purpose of this review is to describe the clinical factors related to balloon-occluded retrograde transvenous obliteration, including the preparation needed, the technique and challenges, and the ...outcomes.
Although the procedure can be performed when transjugular intrahepatic portosystemic shunt is contraindicated or when endoscopic management fails, balloon-occluded retrograde transvenous obliteration is successful as a first-line or second-line therapy. Gastric variceal rebleeding rates are low and serious complications are rare. Randomized controlled trials are required to evaluate the superiority of this procedure over other methods of treating gastric varices and to determine which sclerosant should be used. In the near future, this procedure may play a larger role in emergency care and in the management of nongastric varices.
To review the effect of preoperative embolization of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) on subsequent endoleaks and aneurysm growth.
Between August 2002 ...and May 2010, 108 patients underwent IMA embolization before EVAR. Coil embolization was performed in all patients in whom the IMA was successfully visualized and accessed during preoperative conventional angiography. In this cohort, the incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and repeat intervention were compared with a group of 158 consecutive patients with a patent IMA on preoperative computed tomography angiography but not on conventional angiography, who therefore did not undergo preoperative embolization.
The incidence of type II endoleak was significantly higher in patients not treated with embolization (49.4% 78 of 158 vs 34.3% 37 of 108; P = .015). The incidence of secondary intervention for type II endoleak embolization was also significantly higher in those who did not undergo embolization (7.6% 12 of 158 vs 0.9% one of 108; P = .013). At 24 months, an increase in aneurysm sac volume was observed in 47% of patients in the nonembolized cohort (21 of 45), compared with 26% of patients in the embolized cohort (13 of 51; P = .03). No aneurysm ruptures or aneurysm-related deaths were observed in either group. One patient in the embolization group developed mesenteric ischemia and ultimately died.
Preoperative embolization of the IMA was associated with reduced incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and secondary intervention.
To compare outcomes of yttrium-90 radioembolization performed with resin-based ((90)Y-resin) and glass-based ((90)Y-glass) microspheres in the treatment of hepatocellular carcinoma (HCC) with ...associated portal vein invasion.
A single-center retrospective review (January 2005-September 2014) identified 90 patients ((90)Y-resin, 21; (90)Y-glass, 69) with HCC and ipsilateral portal vein thrombosis (PVT). Patients were stratified according to age, sex, ethnicity, Child-Pugh class, Eastern Cooperative Oncology Group status, α-fetoprotein > 400 ng/mL, extent of PVT, tumor burden, and sorafenib therapy. Outcome variables included clinical and laboratory toxicities (Common Terminology Criteria Adverse Events, Version 4.03), imaging response (modified Response Evaluation Criteria in Solid Tumors), time to progression (TTP), and overall survival (OS).
Grade 3/4 bilirubin and aspartate aminotransferase toxicities developed at a 2.8-fold (95% confidence interval CI, 1.3-6.1) and 2.6-fold (95% CI, 1.1-6.1) greater rate in the (90)Y-resin group. The disease control rate was 37.5% in the (90)Y-resin group and 54.5% in the (90)Y-glass group (P = .39). The median (95% CI) TTP was 2.8 (1.9-4.3) months in the (90)Y-resin group and 5.9 (4.2-9.1) months in the (90)Y-glass group (P = .48). Median (95% CI) survival was 3.7 (2.3-6.0) months in the (90)Y-resin group and 9.4 (7.6-15.0) months in the (90)Y-glass group (hazard ratio, 2.6; 95% CI, 1.5-4.3, P < .001). Additional multivariate predictors of improved OS included age < 65 years, Eastern Cooperative Oncology Group status < 1, α-fetoprotein ≤ 400 ng/mL, and unilobar tumor distribution.
Imaging response of (90)Y treatment in patients with HCC and PVT was not significantly different between (90)Y-glass and (90)Y-resin groups. Lower toxicity and improved OS were observed in the (90)Y-glass group.
To evaluate the safety and efficacy of portal vein embolization (PVE) with sodium tetradecyl sulfate (STS) foam.
A single-center retrospective review of 35 patients (27 men and 8 women; mean age, 61 ...y) who underwent PVE with STS foam was performed. The technical success rate, rate of PVE at producing adequate future liver remnant (FLR) hypertrophy, and rate of disease progression precluding resection after PVE were analyzed. Complications of PVE and liver resection after PVE were recorded.
PVE was performed on 35 patients before right hepatic resection for both primary and secondary hepatic malignancies (22 hepatocellular carcinoma, 10 metastasis, 2 cholangiocarcinoma, 1 invasive gallbladder carcinoma). Technical success was achieved in 97.1% (34 of 35) of patients. Mean FLR of the total estimated liver volume increased from 24.5% (SD, 7.7%) to 36.5% (SD, 14.5%), a mean percentage increase of 48.8% (SD, 34.3%). PVE produced adequate FLR hypertrophy in 31 of 35 patients (88.6%). Proposed right hepatectomy was subsequently performed in 27 patients (77.1%). One patient remains scheduled for surgery, two had peritoneal spread at surgery and resection was aborted, two had disease progression on imaging after PVE, and three had inadequate FLR hypertrophy with no surgery. One major complication was observed related to PVE that involved nontarget embolization to segment III, which was managed conservatively.
Preoperative PVE with STS foam is a safe and effective method to induce hypertrophy of the FLR.
Transradial arterial access (TRA) has been employed for transcatheter coronary procedures for more than 25 years, with numerous studies demonstrating improved patient safety as compared with ...transfemoral arterial access. However, TRA remains underused by the interventional radiology and vascular surgery communities. Advantages of TRA over transfemoral arterial access include easier accomplishment of postprocedure hemostasis, decreased risk of hemorrhagic complications, shorter patient recovery leading to immediate ambulation and decreased procedure-related costs, and increased patient satisfaction. In particular, TRA may be advantageous in the population of patients with obesity. The primary patient selection factor to consider before attempting TRA is whether the patient has adequate collateral perfusion to the hand; this is assessed using the Barbeau test. Limitations of TRA may include operator unfamiliarity or learning curve and unavailability of adequate length catheters. The most common complication, although still rare, is localized access site hematoma, which is often asymptomatic. Radial artery occlusion is rare and rarely symptomatic owing to collateral perfusion to the hand. Theoretical increased risk of cerebral embolism during TRA may be minimized by preferentially accessing the left wrist during below-diaphragm procedures, which limits transcatheter manipulation of the aortic arch. Transulnar artery access is under investigation for use in patients who cannot undergo TRA. Providing patients the option of TRA can lead to improved outcomes, potentially increasing safety and patient satisfaction while decreasing procedure costs.
Cocaine is believed to work by blocking the dopamine transporter (DAT) and thereby increasing the availability of free dopamine within the brain. Although this concept is central to current cocaine ...research and to treatment development, a direct relationship between DAT blockade and the subjective effects of cocaine has not been demonstrated in humans. We have used positron emission tomography to determine what level of DAT occupancy is required to produce a subjective 'high' in human volunteers who regularly abuse cocaine. We report here that intravenous cocaine at doses commonly abused by humans (0.3-0.6 mg kg(-1)) blocked between 60 and 77% of DAT sites in these subjects. The magnitude of the self-reported high was correlated with the degree of DAT occupancy, and at least 47% of the transporters had to be blocked for subjects to perceive cocaine's effects. Furthermore, the time course for the high paralleled that of cocaine concentration within the striatum, a brain region implicated in the control of motivation and reward. This is the first demonstration in humans that the doses used by cocaine abusers lead to significant blockade of DAT, and that this blockade is associated with the subjective effects of cocaine. Although these findings provide justification to target the DAT for medication development they suggest that for drugs to be effective in blocking cocaine's effects they would have to be given at doses that achieve almost complete DAT occupancy.
Purpose
We describe the anatomic characteristics on preoperative CT angiography (CTA) that predispose to type-2 endoleaks after endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysms ...(AAA).
Methods
Between 1999 and 2010, 326 patients had a CTA before and after EVAR. CTAs were reviewed for maximal sac diameter, >50 % circumferential luminal thrombus, and patency of the infrarenal aortic side branches, including the inferior mesenteric artery (IMA) and L2-L5 lumbar arteries. Postoperative CTAs were reviewed for a persistent type-2 endoleak.
Results
Of 326 patients, 30.4 % had a type-2 endoleak on CTA. Univariate analysis demonstrated a patent IMA, increased patent individual L2, L3, and L4 lumbar arteries, and an increased number of total patent lumbar arteries in patients with type-2 endoleak compared to those without (
p
< 0.001, 0.002, <0.001, <0.001, and <0.001 respectively). Sac diameter, patent L5 lumbar arteries, and >50 % circumferential mural thrombus were not significantly different (
p
= 0.652, 0.617, and 0.16). Univariate logistic regression demonstrated increased risk of endoleak with each additional patent lumbar artery (odds ratio (OR) 1.26,
p
< 0.001). Multivariate analysis of the 326 patients resulted in the delineation of the optimal anatomic variables that predicted a type-2 endoleak: occluded L3 lumbar arteries (OR 0.1,
p
= 0.002), occluded L4 lumbar vertebral arteries (OR 0.31,
p
= 0.034), and IMA occlusion (OR 0.38,
p
= 0.008).
Conclusions
Univariate analysis demonstrated total patent lumbar arteries as a significant predictor of type-2 endoleak. Multivariate analysis demonstrated IMA occlusion, L3 lumbar artery occlusion, and L4 lumbar artery occlusion as independently protective against type-2 endoleak after EVAR.
PDF
