Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.
measured and recorded procedure and fluoroscopy time with both approaches. Results: Procedure and fluoroscopy time was reduced by reducing number of catheter and guide wire exchanges. Average procedure time with standard angioplasty versus Chameleon™ was 101 seconds versus 16.5 seconds which represents an 89% reduction. Average fluoroscopy time with standard angioplasty versus Chameleon was 16 seconds versus 6.6 seconds which represents a 60% reduction in fluoroscopy time. The differences were statistically significant (po0.05). Conclusions: Proximal injection angioplasty balloon catheter reduces catheter exchanges and guide wire removals and eliminates the need for manual compression reflux angiography. This technique seamlessly reduces patient and personnel radiation exposure by reducing fluoroscopy time.
Purpose: Stenosis within TIPS reduces its effectiveness to lower portal hypertension (PH), increasing the risk of variceal bleeding/ ascites. Reports have variably suggested both positive and negative correlations between abnormal duplex ultrasonography (DU) and TIPS dysfunction. At our institution, all TIPS patients with abnormal DU undergo angiographic/hemodynamic studies prior to shunt revision. This study examines the effectiveness of DU for surveillance after TIPS for PH with ascites. Materials: A 12 year retrospective review of TIPS procedures for ascites was performed. Using Medical Imaging/IR databases, patients with abnormal DU studies were extracted; TIPS dysfunction on ultrasound was suggested by hepatopetal branch portal vein flow, marked focal increase in TIPS velocity, TIPS velocity 8mm Hg. The patients' angiographic and hemodynamic records were compared with DU exams to determine the effectiveness of DU. Results: 134 angiographic/hemodynamic studies were performed on 69 TIPS patients whose DU surveillance study suggested TIPS dysfunction. 71 had focal or diffuse TIPS stenosis (53% DU positive predictive value), and 63 had no stenosis (47% false positive rate). PSG (N ¼ 128) was > 8mm Hg in 72 studies (56% DU positive predictive value), and ¼ /< 8mm Hg in 56 studies )44% false positive rate). Based on the angiographic/hemodynamic results, intervention was avoided in 42/134 (32%). Conclusions: DU is not an effective non-invasive surveillance tool after TIPS, since there is no positive correlation between abnormal DU and angiographic/hemodynamic studies. However, since there is presently no better non-invasive test demonstrating TIPS dysfunction, angiographic/hemodynamic studies remain necessary to confirm the results of DU studies prior to intervention.
Abstract No. 611Left-sided portal hypertension in the presence or absence of splenic vein thrombosis: a single tertiary center experience
Upper extremity deep vein thrombosis (UEDVT) is responsible for 4 to 10% of all deep vein thrombosis (DVT). Untreated UEDVT can lead to significant disability secondary to the postthrombotic syndrome. To date, there are no randomized trials specifically comparing different therapeutic strategies. Ultimately, optimal management of UEDVT depends on the underlying etiology, patient symptoms, and degree of thrombosis, with supporting evidence primarily extrapolated from lower extremity DVT data. This article will review the classification, presentation, and diagnosis of both primary and secondary UEDVT. In addition, it will discuss updates in clinical guidelines, anticoagulation, endovascular and surgical treatment strategies.
TIPS) placement. Pre-TIPS right heart pressure may serve as a valuable prognostic indicator since patients with an elevated baseline right atrial pressure are more prone to post-TIPS heart failure. (1,2) Materials: This is a single-center, IRB-approved, retrospective study evaluating all patients who underwent TIPS from 1997 to 2017. Demographic data was collected, as well as diagnosis and indication for TIPS, elective vs. emergent TIPS placement, pre-TIPS MELD score, pre-TIPS ECHO, and pre and post TIPS intraoperative direct right atrial pressure measurements. A mean and standard deviation of the absolute difference between measurements obtained by echocardiography and right heart catheterization was obtained. Results: 392 patients underwent TIPS placement over the 20year period. Of those, 113 had pre-TIPS ECHO and pre-TIPS direct right atrial pressure measurements. The study group was 56% male, 44% female, with a mean age of 56±9.8 years. The average calculated MELD score was 13.6±5.9. 70% of patients were treated electively and the remaining 30% underwent emergent treatment. The mean and standard deviation absolute difference between measurements obtained by ECHO and direct right atrial pressure measurements was 8.1±5.3 mm Hg. Conclusions: ECHO measurements in patients undergoing evaluation for TIPS placement should be viewed with caution. Correlation of cardiac status with direct measurements of right heart pressures during TIPS placement remains imperative to accurately evaluate patient's risk for post TIPS cardiac complications.
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