Eric Reiner

Initial Experience with 3% Sodium Tetradecyl Sulfate Foam and Fibered Coils for Management of Adolescent Varicocele

PURPOSE To report the results of treatment of adolescent patients with varicocele with use of 3% sodium tetradecyl sulfate foam (STS) in combination with pushable fibered coils. MATERIALS AND METHODS From September 2004 to September 2006, 16 adolescent patients (age 12-19 y) with symptomatic varicocele, testicular atrophy, or surgical recurrence underwent embolization with STS foam and coils. The left internal spermatic vein (ISV) was coaxially catheterized from the right femoral vein. Three percent STS foam was placed distally in the ISV during compression so minimal foam entered the pampiniform plexus. A second nest of coils was placed in the ISV at a position over the sacroiliac (SI) joint that occluded most of the parallel collateral vessels. Coils were not placed above the SI joint in most instances. Additional foam was injected in the ISV at the upper level of the SI joint. The upper ISV was left unoccluded. Our standard follow-up consisting of ultrasound and/or physical examination after varicocele occlusion was performed 2-12 months after the procedure. RESULTS All occlusions were technically successful, and 15 of 16 patients (94%) exhibited proven disappearance of the varicocele. All patients were asymptomatic except one who had pain despite disappearance of the varicocele. One patient with a bleeding disorder had 48 hours of scrotal discomfort as a result of pampiniform phlebitis caused by the deliberate passage of foam into the pampiniform plexus. CONCLUSIONS The use of 3% STS foam in combination with pushable fibered coils is a safe and effective sclerosing procedure for adolescent subjects with varicocele.

Extraction of a Micra Transcatheter Pacing System: First-in-human experience

Clinical trials investigating the safety and effectiveness of transcatheter leadless pacemakers in humans are ongoing. These devices offer the benefits of cardiac pacing with the potential for a significant decrease in many of the risks associated with conventional pacing systems, including hematoma formation, pneumothorax, lead-related complications, and vascular obstruction. Human evaluation of the Medtronic Micra Transcatheter Pacing System (Medtronic, Minneapolis, MN) began in 2013, and the device is currently undergoing clinical investigation. The devices are implanted via a femoral venous approach and use a novel tined system for fixation to the right ventricular endocardium. The pacemakers can be readily retrieved at the time of implantation, but no data exist regarding the ability to remove these devices in humans after the initial implantation procedure. We report the first successful extraction of a Micra Transcatheter Pacing System, 3 weeks after initial device implantation.

Management of Bilateral Phlegmasia Cerulea Dolens in a Patient with Subacute Splenic Laceration

Phlegmasia cerulea dolens (PCD) is a rare but limb-threatening complication of deep vein thrombosis. We report a case of a 76-year-old man with recent splenic trauma and inferior vena cava (IVC) filter placement, who developed bilateral lower extremity PCD. Utilizing an endoluminal approach, the patient underwent mechanical thrombectomy and thrombolysis through bilateral infusion catheters placed antegrade from bothpopliteal veins. Clot lysis and return of palpable pedal pulses occurred within 24 hours. We demonstrate that the endoluminal management of this disease may be cautiously applied to the trauma patient, and that the judicious use of thrombolytic therapy can be beneficial even in the patient with a high potential for hemorrhage.

Emphysematous Cholecystitis Resulting in Secondary Biliary Cirrhosis: A Rare Complication of Endoscopic Retrograde Cholangiopancreatography.

A 48-year-old female developed acute emphysematous cholecystitis after an endoscopic retrograde cholangiopancreatography (ERCP) for evaluation of sphincter of Oddi dysfunction. Cholecystectomy was performed 2 days later. Cultures grew Clostridium perfringens. The patient received broad-spectrum antibiotics but developed recurrent cholangitic abscesses and intra- and extra-hepatic biliary necrosis. She was managed by percutaneous transhepatic biliary drains. For next 3 years, patient had recurrent episodes of biliary obstruction, cholangitis, and sepsis, resulting in secondary biliary cirrhosis requiring a liver transplantation. Emphysematous cholecystitis is a rare complication of ERCP. Prompt diagnosis and surgical management can prevent further spread of infection to biliary tree.

The impact of antiangiogenic therapy combined with Transarterial Chemoembolization on enhancement based quantitative tumor response assessment in patients with hepatocellular carcinoma

PURPOSE To investigate whether bevacizumab compromises early response assessment after Transarterial Chemoembolization (TACE) in patients with hepatocellular carcinoma by 3D quantitative European Association for the Study of the Liver (qEASL) criteria in comparison to other imaging-based criteria. MATERIALS AND METHODS Each of 14 patients receiving TACE and bevacizumab was matched with two patients receiving TACE alone. Baseline and Follow-up MRI was retrospectively analyzed regarding qEASL and other imaging-based criteria. RESULTS Percentage-based qEASL achieved significant separation in both therapy arms (p=0.046 and p=0.015). Response and Overall Survival showed similar association among treatment groups (p=0.749). CONCLUSIONS Anti-angiogenic therapy with bevacizumab does not impede early response assessment by qEASL.

Image-Guided Transvesicular Drainage of Pelvic Fluid Collections: A Safe and Effective Alternative Approach

To evaluate the safety and efficacy of percutaneous transvesicular drainage of pathologic pelvic fluid collections, a series of 15 patients who underwent 16 transvesicular drainage catheter placements was retrospectively reviewed. All patients had collections suspicious for infection that were posterior to the bladder or superior to the bladder behind loops of bowel, and were otherwise inaccessible. All 15 collections were percutaneously accessed via the bladder with standard drainage catheters. All collections resolved completely with no complications. Percutaneous transvesicular drainage was a safe and effective technique in this series, and can be considered when no direct percutaneous access routes are available.