Derek L. West

Islet Transplantation for Brittle Type 1 Diabetes: The UIC Protocol

This prospective phase 1/2 trial investigated the safety and reproducibility of allogeneic islet transplantation (Tx) in type I diabetic (T1DM) patients and tested a strategy to achieve insulin‐independence with lower islet mass. Ten C‐peptide negative T1DM subjects with hypoglycemic unawareness received 1–3 intraportal allogeneic islet Tx and were followed for 15 months. Four subjects (Group 1) received the Edmonton immunosuppression regimen (daclizumab, sirolimus, tacrolimus). Six subjects (Group 2) received the University of Illinois protocol (etanercept, exenatide and the Edmonton regimen). All subjects became insulin‐ independent. Group 1 received a mean total number of islets (EIN) of 1460u2003080 ± 418u2003330 in 2 (n = 2) or 3 (n = 2) Tx, whereas Group 2 became insulin‐ independent after 1 Tx (537u2003495 ± 190u2003968 EIN, p = 0.028). All Group 1 subjects remained insulin free through the follow‐up. Two Group 2 subjects resumed insulin: one after immunosuppression reduction during an infectious complication, the other with exenatide intolerance. HbA1c reached normal range in both groups (6.5 ± 0.6 at baseline to 5.6 ± 0.5 after 2–3 Tx in Group 1 vs. 7.8 ± 1.1 to 5.8 ± 0.3 after 1 Tx in Group 2). HYPO scores markedly decreased in both groups. Combined treatment of etanercept and exenatide improves islet graft function and facilitates achievement of insulin‐independence with less islets.

Right Ventricular Migration and Endovascular Removal of an Inferior Vena Cava Filter

A G2 inferior vena cava (IVC) filter was discovered in the right ventricle of an asymptomatic patient 3 months after placement. The present report describes an endovascular approach to remove the filter with use of two 35-mm Amplatz Goose Neck snares while the patients cardiac rhythm was monitored and controlled by a cardiothoracic anesthesiologist.

Covered Stent Treatment of Carotid Blowout Syndrome

Carotid artery blowout is a devastating complication of head and neck malignancy, irradiation, and trauma. New endovascular therapies of acute carotid artery rupture involve stent-directed, carotid-sparing treatment strategies. We report a case of successful covered stent treatment of carotid artery hemorrhage in the setting of head and neck cancer and review the literature describing the use of this therapeutic method. Evaluation of 19 recently reported cases of covered stent treatment of carotid artery blowout due to head and neck cancer and presenting with sentinel or acute hemorrhage demonstrates that this method is a fast and effective means of controlling bleeding, with a technical success rate of ~95%. A significant early recurrent hemorrhage rate raises concern regarding the short-term safety and efficacy of this therapy, however, and suggests that stent graft treatment of carotid artery rupture due to head and neck malignancy is best suited as a temporizing measure before more definitive therapy.

Use of the Amplatzer Vascular Plug as a Coil Constrainer During Endovascular Occlusion of a Dialysis Shunt

Limb ischemia or ischemic steal syndrome is an uncommon complication, occurring in 1% to 10% of patients following construction of arteriovenous dialysis grafts and fistulas [1, 2]. In this Technical Note we describe the percutaneous closure of an 8-mm dialysis graft causing symptoms of ischemic steal syndrome. Our technique involves the use of an Amplatzer Vascular Plug (AGA Medical Corp.,, Golden Valley, MN) as a coil constainer to avoid unintended distal coil migration during occlusion of a high flow vascular system.

Endovascular treatment of intimomedial mucoid degeneration.

Intimomedial degeneration is a rare and poorly understood vascular disorder involving the circumferential deposition of large amounts of mucoid material within the intima and media of the arterial wall, causing weakening that results in aneurysm formation of the involved segment. The cause of the disease is unknown at this time. The authors describe the endovascular treatment of a large symptomatic superior gluteal artery aneurysm in a patient with multiple arterial aneurysms and the histologic diagnosis of intimomedial mucoid degeneration. In addition, they perform a review of the literature on this unusual vasculopathy.

Use of a Hydrogel-Coated Self-Expandable Coil to Salvage a Failed Transcatheter Embolization of a Mesenteric Hemorrhage

HydroCoil (MicroVention, Aliso Viejo, CA, USA) is a self-expanding detachable coil developed to improve the endovascular occlusion of intracranial aneurysms. The hydrogel polymer covering the microcoil expands to several times its original diameter to enhance thrombosis of the intended vessel. We made use of this new technology to occlude a mesenteric artery pseudoaneurysm that failed superselective embolization with standard microcoils.

A Case of Pancreatic Islet Cell Transplantation in a Patient with Situs Ambiguous: Anatomical and Radiological Considerations

Pancreatic islet cell transplantation is an evolving treatment of severe, refractory type 1 diabetes that has been gaining more use, particularly after one year rates of insulin independence post-transplantation were found to approach 80% under the Edmonton protocol. Islet cell transplantation involves percutaneous delivery of harvested allogeneic β cells into the portal venous circulation for implantation into the liver. We present the case of a 35-year-old woman with type 1 diabetes and situs ambiguous with left isomerism and resultant variant anatomy of her portal venous anatomy who underwent islet cell transplantation, which, to our knowledge, has not been previously reported.