PMT with the Rotarex atherothrombectomy catheter represents a safe and effective option in the treatment of acute and subacute femoropopliteal bypass occlusions because it can quickly restore blood flow.
This study demonstrates that local lysis of acute arterial occlusions using the Lysus Peripheral Catheter System is safe and effective. Blood flow is restored quickly.
Background: Mass-forming focal pancreatitis (FP) may mimic pancreatic cancer (PC) on magnetic resonance (MR) imaging, and the preoperative differential diagnosis is often difficult. Recently, the usefulness of diffusion-weighted imaging (DWI) in the diagnosis of pancreatic cancer has been reported in several studies. Purpose: To investigate if apparent diffusion coefficient (ADC) measurements based on diffusion-weighted echo-planar imaging (DW-EPI) may distinguish between normal pancreas parenchyma, mass-forming focal pancreatitis, and pancreas carcinoma. Material and Methods: MRI was performed on 64 patients: 24 with pancreas carcinoma (PC), 20 with massforming focal pancreatitis (FP), three patients with other focal pancreatic disease as well as 17 controls without any known pancreatic disease. Diffusion-weighted sequence with ADC maps and T2-weighted sequence for anatomical information was performed. Apparent diffusion coefficient (ADC) maps were automatically created and analyzed using a dedicated user interface. In the group with pancreas disease the abnormal parenchyma was detected by using T1-and T2-weighted images and the region of interest (ROI) was transferred exactly to the ADC map and the coefficients were registered. In the control group the ROI was set to the head of the pancreas followed by a similar registration of the ADCs. Results: ADC values for mass-forming FP and PC differed significantly from ADC values for normal pancreas parenchyma (P ¼ 0.001/P ¼ 0.002). Mean ADC values for mass-forming FP were 0.69 + 0.18 Â 10 23 mm 2 /s.
Introduction and objective In elderly patients with reduced bone quality, insufficiency fractures of the sacrum are relatively common and are typically accompanied by severe, disabling pain. The objective of this study was to evaluate the feasibility of cement augmentation by RFS, as well as to determine postinterventional leakages and present the patients' outcomes. Material and method In 20 patients (18 women, 2 men) with an average age of 80.4 (65-92) years, a fracture of the sacrum was detected by CT and MRI. Clinically manifest osteoporosis with QCT values of below 50 mg/ ml was found in all patients. An initially performed conservative treatment over a period of 3 weeks did not achieve a satisfactory reduction in the severe, disabling pain. The cement augmentation was performed under CT guidance by means of RFS under intubation anaesthesia. A Jamshidi needle was advanced into the respective fracture zone in the sacrum from dorsal to ventral (short axis) or from lateral to medial transiliac (transiliac axis).After removing the inner needle, a flexible osteotome was inserted through the positioned hollow needle and used to extend the spongious space in the fracture zone and thus prepare a cavity for the cement filling. The highly viscous polymethyl methacrylate (PMMA) cement, activated by radiofrequency, was then inserted into the prepared fracture zone through a substituted screw cannula. Cement filling was performed discontinuously under instrumental guidance at 1.3 ml/min under CT guidance. Cement leakages were determined in CT images and conventional X-rays on the day after the intervention. Pain was documented on a visual analogue scale (VAS) on the day before the intervention, on the second day, and after 6 and 12 months after the intervention. Additionally occurring complications were recorded, and the patients were asked to state how satisfied they were after 12 months. Results RFS was technically feasible in all patients. In the control CT scans and X-rays, sufficient cement distribution and interlocking with vital bone was found along the course of the fracture in the sacrum. 7.2 (4-9) ml of cement were inserted per fracture. Leakage could be ruled out. The mean pain score on the VAS was 8.8 ± 1.2 before the intervention, and a significant reduction in pain (p \ 0.001) was seen on the second postoperative day, with an average value of 2.3 ± 0.7, which was stable at 2.2 ± 1.3 after 6 months and 2.1 ± 1.1 after 12 months. All of the patients could be fully re-mobilised and discharged back home. A high level of patient satisfaction was found after 12 months, with 18 of the 20 patients stating that they would undergo the intervention again. One patient died of a stroke, another of cancer over the course. Conclusion As a minimally invasive procedure, RFS is an effective and safe method of treatment for rapid, significant and sustained pain reduction.
The atherectomy of lesions of the iliac and femoropopliteal arteries using the Rotarex® system is safe and effective. The low rate of peri-interventional stenting and the low rate of restenosis at 12 months appear to be promising.
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