Lymphatics have long been overshadowed by the remainder of the circulatory system. Historically, lymphatics were difficult to study because of their small and indistinct vessels, colorless fluid contents, and limited effective interventions. However, the past several decades have brought increased funding, advanced imaging technologies, and novel interventional techniques to the field. Understanding the history of lymphatic anatomy and physiology is vital to further realize the role lymphatics play in most major disease pathologies and innovate interventional solutions for them.
To compare the safety and effectiveness of CT-guided percutaneous pericardial drainage (PPD) with surgical pericardial drainage (SPD). Materials: Using a retrospective design including a chart review, 257 patients with symptomatic pericardial effusions were identified including 142 that were treated with a PPD and 115 with SPD. Primary outcomes of interest were short-term complications and recurrence (defined as occurring in 30 days' post-procedure). Examples of complications included pneumothorax, myocardial stick, arrhythmia, DVT, CVA, etc. Recurrence was evaluated based on the presence of pericardial effusion on post-procedural imaging necessitating repeat drainage. Additional variables analyzed as surrogates of effectiveness included but were not limited to days of hospitalization, duration of drainage catheter, and change in mean arterial pressure post intervention. Tests for differences in distributions between intervention groups were performed using Wilcoxon rank sum test. Tests for differences in explanatory variables between intervention groups were performed using chi-square tests. A result was considered significant if p < 0.002 using a Bonferroni correction for multiple tests. Results: Overall, 9% of the patients experienced short-term complications and 16% had a recurrence. A statistically significant association was observed between whether or not a patient experienced short-term complication and the intervention that the patient received (p < 0.001). Among patients who experienced short-term complications, the proportion of patients who underwent SPD, 17%, was significantly greater than the proportion of patients who were treated with PPD, 2%. The estimated odds of having complications if the patient received an SPD was 9 times greater than if the patient received PPD (OR¼9.3, 95% CI: 2.7 to 32.2). No statistically significant difference was observed between whether or not a patient experienced a recurrence within 30 days post SPD or PPD (OR¼0.86, 95% CI: 0.44 to 1.7). Conclusions: CT-guided PPD is a safer alternative to SPD in patients with symptomatic pericardial effusion and the odds of recurrence within 30 days are not significantly different between the two groups.
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