Burcak Gumus

Percutaneous aspiration thrombectomy in the treatment of lower extremity thromboembolic occlusions.

PURPOSE To report the immediate and midterm results of manual aspiration thrombectomy as the first thrombus removal method in the treatment of acute or early chronic arterial thromboembolism in the lower extremity. MATERIALS AND METHODS Retrospective review of 40 limbs in 37 nonconsecutive patients between March 2006 and March 2008 (21 female [57%], 16 male; mean age, 67 +/- 10 years; age range, 42-84 years) who had percutaneous aspiration thrombectomy for lower limb arterial thromboembolism. Twenty-nine legs had acute ( < 14 days) and 11 legs had early chronic (15-60 days) thromboembolism. Clinical categories of limb ischemia were stage I in 12 limbs, stage IIa in 17 limbs, and stage IIb in 11 limbs. RESULTS Technical success was achieved in 35 limbs (88%). Complete thrombus removal was achieved in 26 of 29 limbs (90%) with acute occlusions and 4 of 11 limbs (36%) with early chronic occlusions (P < 0.05, chi(2) test). Amputation-free survival rate was 100% at one month, 93% at one year, and 93% at two years with Kaplan-Meier survival analysis. Freedom from symptoms of claudication or critical limb ischemia was achieved in 31 of 39 limbs (80%) at one month and 25 of 35 limbs (71%) at one year. There were three major complications and ten minor complications. CONCLUSION Percutaneous aspiration thrombectomy is a rapid and effective way of removing thrombus in thromboembolic occlusions of the limb arteries below the inguinal ligament. It can be used in patients with acute limb ischemia (Rutherford clinical category IIb).

Cutting Balloon Angioplasty of Bilateral Renal Artery Stenosis Due to Takayasu Arteritis in a 5-Year-Old Child with Midterm Follow-Up

The aim of this report is to demonstrate the successful endovascular treatment of bilateral renal artery stenosis due to Takayasu arteritis by cutting balloon angioplasty in a 5-year-old child with mid-term follow-up.

Percutaneous Cholecystostomy as a First-Line Therapy in Chronic Hemodialysis Patients with Acute Cholecystitis with Midterm Follow-up

PurposeThe purpose of this article was to share midterm results of percutaneous cholecystostomy (PC) as a first-line therapy in chronic hemodialysis patients with acute cholecystitis.MethodsFourteen chronic hemodialysis patients with acute cholecystitis underwent PC between March 2007 and May 2009 at our institute. On preoperative assessment, the patients were classified into the ASA score by the anesthesiology team. All patients were class IV because of severe underlying comorbidities. The patients were referred to interventional radiology unit for PC by consensus of the multidisciplinary team.ResultsThe PC was technically successful in all the patients without minor or major complications related to the procedure. Clinical symptoms in three patients who presented with sepsis and multiorgan failure did not resolve after PC, and these patients died following urgent surgery, including open cholecystectomy and common bile duct exploration. A new cholecystitis attack was detected in one patient in the acalculous group at the sixth month of the follow-up period. The mean catheterization time was 31.7 (range, 28–41) days. The mean follow-up time was 13.3 (range 4–21) months.ConclusionsThe PC may come into consideration as a first-line treatment modality in the management of acute cholecystitis in poor surgical candidate chronic hemodialysis patients. This is the first report focusing on the midterm results of PC as a first-line therapy in hemodialysis patients with acute cholecystitis who could be operated on.

Percutaneous Embolization of Hemodialysis Fistulas by AMPLATZER Vascular Plug with Midterm Follow-up

PURPOSE To determine the midterm technical and clinical results of endovascular occlusion of native hemodialysis fistulas with the use of the AMPLATZER Vascular Plug (AVP) I and AVP II. MATERIALS AND METHODS Data from 21 patients who underwent endovascular occlusion of their native fistulas between March 2008 and October 2009 were retrospectively evaluated. The reasons for closing the fistulas were hyperdynamic heart failure (n = 2), venous aneurysm with skin ulceration and nipple formation with impending rupture (n = 5), central venous occlusion that could not be recanalized by an endovascular approach (n = 7), dialysis-associated steal syndrome (n = 2), and critical hand ischemia with a nonhealing ulcer or necrosis (n = 5). RESULTS All fistulas were embolized successfully by the end of the intervention. No procedure-related complications were observed after the intervention. The follow-up time ranged from 5 months to 24 months, with a mean of 13.5 months. CONCLUSIONS The results of this study suggest that the AVP is a safe and effective device for the endovascular occlusion of hemodialysis fistulas in selected cases.

Targeted endovenous treatment of Giacomini vein insufficiency- associated varicose disease: considering the reflux patterns

PURPOSE We aimed to assess the technical feasibility of targeted endovenous treatment of Giacomini vein insufficiency (GVI)-associated varicose disease and report our early results. METHODS We retrospectively screened 335 patients with varicose disease who underwent endovenous laser ablation from September 2011 to January 2013, and determined 17 patients who underwent Giacomini vein ablation. Using a targeted endovenous treatment approach considering the reflux pattern, all healthy great saphenous veins (GSV) or vein segments were preserved while all insufficient veins (Giacomini vein, perforator veins, small saphenous vein, anterior accessory GSV, major tributary veins, or incompetent segments of the GSV) were ablated. Treatment success was analysed using Doppler findings and clinical assessment scores before and after treatment. RESULTS Targeted endovenous treatment was technically successful in all cases. Seven GSVs were preserved totally and three GSVs were preserved partially (10/17, 58%), with no major complications. Clinical assessment scores and Doppler findings were improved in all cases. CONCLUSION Targeted endovenous treatment of GVI-associated varicose disease is safe and effective. In majority of GVI cases saphenous vein can be preserved using this approach.

Lipoma of the right atrium

A 66‐year‐old asymptomatic woman was admitted to our hospital with the diagnosis of a right atrial mass detected on an outside transthoracic echocardiogram and confirmed on transesophageal echocardiography. Physical examination and basal electrocardiogram were normal. Transthoracic echocardiography revealed a 3.8 × 2.5 cm echogenic mass in the right atrium. A multislice CT examination demonstrated a right atrial mass with a fat density ranging from −80 to −110 HU. The patient had a successful surgical excision of the mass, and the diagnosis of lipoma was confirmed on histopathological examination.

Anomalous Hepatic Vein Draining into the Coronary Sinus

A very rare anomaly of the hepatic vein is a single hepatic vein draining into the coronary sinus. This anomaly usually is related to the persistence of the left vitelline connection with the left sinus horn and the ductus venosus during the fetal period [1]. This type of venous anomaly without abnormal shunting of blood generally has no clinical importance but can give rise to technical difficulties in cardiac operations. We report a case with an anomalous left hepatic vein not diagnosed preoperatively but rather detected incidentally during the operation.

Percutaneous transhepatic cutting balloon papillotomy for removal of common bile duct stones.

We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones. Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon. All the stones were pushed successfully into the duodenum with a saline flush. No complications were encountered. Use of a peripheral cutting balloon for dilatation of the papilla seems to be safe and effective because it has the advantage of controlled incision and dilatation of the target at low pressures.

Percutaneous intervention strategies for the management of dysfunctioning biliary plastic endoprostheses in patients with malignant biliary obstruction.

PURPOSE To present our clinical experience and to suggest different strategies in the management of dysfunctioning plastic biliary stents in patients with malignant biliary obstruction. MATERIALS AND METHODS Twenty females and 23 males with a mean age of 64.8 years (range, 30-89 years) with malignant obstructive jaundice were referred to the interventional radiology department due to previously inserted dysfunctioning plastic endoprostheses. Pancreatic carcinoma (n=12), duodenal carcinoma (n=5), cholangiocarcinoma (n=16), gallbladder cancer (n=4), and metastatic disease (n=6) had been previously stented endoscopically. Nine of the patients had two plastic endoprostheses in the biliary tree. Forty-nine endoprostheses were straight polyethylene stents, and three were double-J type plastic stents (52 endoprostheses in total). RESULTS Forty-nine of the dysfunctioning plastic stents were cleared from the biliary tree. Of these, 31 were dislodged into the bowel with the help of a balloon catheter. Threading with an over-the-wire diagnostic and percutaneous biliary drainage catheter was performed in 12 of the plastic stents. Six dysfunctioning endoprostheses were removed by transhepatic access. Three plastic endoprostheses could not be removed or dislodged. No complication occurred due to intervention. The mean follow-up time was nine months (range, 1-19 months). All of the patients were evaluated in the first month, and then at three-month intervals. Percutaneous metallic stenting was performed on 29 patients. CONCLUSION Percutaneous intervention should be considered as an alternative treatment when a need for eliminating the dysfunctioning plastic stent arises. Both removal of the dysfunctioning stent and dislodgement into the bowel are safe and efficient strategies in the management of malignant biliary obstructions.PURPOSE To present our clinical experience and to suggest different strategies in the management of dysfunctioning plastic biliary stents in patients with malignant biliary obstruction. MATERIALS AND METHODS Twenty females and 23 males with a mean age of 64.8 years (range, 30-89 years) with malignant obstructive jaundice were referred to the interventional radiology department due to previously inserted dysfunctioning plastic endoprostheses. Pancreatic carcinoma (n=12), duodenal carcinoma (n=5), cholangiocarcinoma (n=16), gallbladder cancer (n=4), and metastatic disease (n=6) had been previously stented endoscopically. Nine of the patients had two plastic endoprostheses in the biliary tree. Forty-nine endoprostheses were straight polyethylene stents, and three were double-J type plastic stents (52 endoprostheses in total). RESULTS Forty-nine of the dysfunctioning plastic stents were cleared from the biliary tree. Of these, 31 were dislodged into the bowel with the help of a balloon catheter. Threading with an over-the-wire diagnostic and percutaneous biliary drainage catheter was performed in 12 of the plastic stents. Six dysfunctioning endoprostheses were removed by transhepatic access. Three plastic endoprostheses could not be removed or dislodged. No complication occurred due to intervention. The mean follow-up time was nine months (range, 1-19 months). All of the patients were evaluated in the first month, and then at three-month intervals. Percutaneous metallic stenting was performed on 29 patients. CONCLUSION Percutaneous intervention should be considered as an alternative treatment when a need for eliminating the dysfunctioning plastic stent arises. Both removal of the dysfunctioning stent and dislodgement into the bowel are safe and efficient strategies in the management of malignant biliary obstructions.

Interpedicular Approach in Percutaneous Sacroplasty for Treatment of Sacral Vertebral Body Pathologic Fractures

For this technique, bone needle is introduced into the S1 vertebral body through the interpedicular route by penetrating the central spinal canal at the level of S3-4 and passing through the vertebral body of S2-3 parallel to the anterior border of sacrum. With the interpedicular approach, two sacral vertebral bodies can be injected in one session and lower sacral body injection also is available. interpedicular technique is a safe, practical, and effective technique for the treatment of sacral vertebral body pathologic fractures.