J.M.H. Hendriks

Isolated lung perfusion with melphalan prolongs survival in a rat model of metastatic pulmonary adenocarcinoma.

Introduction: Survival after isolated lung perfusion (ILuP) with melphalan was tested in a model of unilateral pulmonary adenocarcinoma. Methods: On day 0, rats were randomized into four groups: Group 1 (n = 9) reveived tumor cells intravenously for induction of bilateral lung metastases, whereas groups 2–4 (n = 21) underwent a 10-min occlusion of the right pulmonary artery during tumor cell injection for induction of unilateral left lung metastases. On day 7, groups 1 and 2 received no treatment. Group 3 underwent left ILuP with melphalan (2.0 mg/kg) while group 4 received melphalan intravenously (0.5 mg/kg). The end point of the study was death from metastatic disease. Results: Median survival of ILuP-treated animals (81 ± 12 days) was significantly longer compared to group 1 (18 ± 1 days; p = 0.0001), group 2 (28 ± 3 days; p = 0.0002) and group 4 (37 ± 6; p = 0.0004). Conclusions: ILuP with melphalan prolongs survival in the treatment of experimental metastatic pulmonary carcinoma.

Long-term results of primary stenting for long and complex iliac artery occlusions.

Abstract Objectives: To evaluate the long-term results of recanalization with primary stenting for long and complex iliac artery occlusions. Design: Retrospective non-randomized study. Methods: Between 1996 and 2004, 38 patients underwent recanalization of an occluded iliac artery with subsequent stenting for TASC B lesions in 12 patients, TASC C in 10 and TASC D in 16. Thirty-one patients had Fontaine stage 2 B, four patients had stage 3 and one patient had stage 4. Two patients (5.4%) presented with acute ischemia and received trombolysis before recanalization. Patency results were calculated using Kaplan and Meier analysis. The mean follow-up was 26 months. Results: Technical success was 97.4%. Thirty-day mortality was 2.7%. The primary patency rate was 94%, 89% and 77% at 1, 3 and 5 years respectively. Three re-occlusions (8.1%) and one restenosis (2.7%) were observed during follow-up. The secondary patency (SP) rate was 100%, 94% and 94% after 1, 2 and 3 years. Fifteen patients underwent an associated procedure. A kissing stent procedure in three patients, a contralateral PTA of an iliac stenosis in 8, a femoro-femoral bypass in 2, a femoropopliteal bypass in 1 and an femoral endarterectomy in 2. The procedure related complication rate was 5.4%. Conclusion: Long-term results of iliac recanalization are excellent without major complications if the procedure is technically successful. The endovascular procedure can be an alternative to an iliofemoral or aortobifemoral bypass in a high risk population.

Modified Technique of Isolated Left Lung Perfusion in the Rat

Isolated lung perfusion is a novel therapy for the treatment of pulmonary metastases to increase current low survival rates. Due to tumor heterogeneity, perfusion has to be evaluated in different rat species for efficacy and ideal drug regimens. The revised technique of isolated left lung perfusion as described by Wang and originally performed in the Fisher rat resulted in a high morbiditity in the Wag/Rij rat in our laboratory. Therefore, we modified techniques for intubation and anesthesia, and developed a new approach of catheterization with improved results.

Emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysms: an institutional experience.

Abstract Objectives: Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysms (rAAA) is still under investigation. Since installation of an urgent eEVAR kit in our hospital, all patients with a rAAA or urgent thoracic aortic aneurysm are candidates for eEVAR or eTEVAR (emergency thoracic evar), respectively. For this study, we analyzed all rAAA patients treated with eEVAR. Methods: Data were recorded prospectively. Criteria for an eEVAR were an infrarenal neck > 15mm, acceptable landing zone, angles below 70° and a good femoral approach. We prefer preoperative angio CT-scan but in case of instability, an intra-aortic balloon can stabilize the patient during angiography (in the OR) to decide between open or eEVAR repair. Follow-up was performed on regular intervals by duplex or CT-scan. Thirty-day mortality and overall survival were calculated. Results: Since 2006, nine male rAAA patients with a mean age of 73 years (range: 62–82) had eEVAR repair. Aneurysm diameter was 8 cm (range: 5.8–11). The Hardman index was 1.5 (range: 0–3). In eight patients an aorto-uni-iliac device was placed succesfully followed by a femorofemoral crossover bypass. The 30-day operative mortality was 12.5% (one patient with septic shock). Three patients showed a type 2 endoleak with stable diameter during follow-up but one patient showed expansion 4 years after treatment. Conclusions: Treating rAAA with eEVAR in selected patients with acceptable anatomy and a kit permanently available in the operating room yielded good results by a surgical team trained for both open and eEVAR repair. The conversion rate was low (11%) and the survival (immediate and 30-days) was excellent (87.5%).

Asymptomatic pheochromocytoma in the posterior mediastinum.

Abstract A 66-year-old female patient was treated for a posterior mediastinal tumour with unknown histology. During thoracotomy, repetitive hypertensive crises had to be treated. The tumour was completely resected. Pathology revealed an extra-adrenal pheochromocytoma. Diagnosis of pheochromocytoma is usually made on the basis of clinical presentation and elevated catecholamine levels in serum or urine. Imaging is used primarily for localizing tumours prior to surgery. Complete surgical excision is the primary treatment. The only absolute indicator of malignancy is the identification of distant metastases to bone, liver, lung or lymph nodes.

Isolated Lung Perfusion for the Treatment of Pulmonary Metastatic Disease: a Review

Abstract Isolated lung perfusion with chemotherapeutic agents is an experimental technique for the treatment of lung metastatic disease from certain solid tumours. The technique had already been developed in the late 1950s but underwent a revival in the early 1980s. By that time, experimental work in large and small animals induced extensive clinical work with different agents such as doxorubicin, tumour necrosis factor, melphalan and cisplatin for which safety profiles and maximal tolerated doses were defined. A review of current work is presented in this article.

Endarterectomy combined with retrograde stenting for tandem lesions of the carotid artery

Abstract Objectives : Due to its location in the chest wall, surgical treatment of lesions at the origin of the brachiocephalic trunk or common carotid artery (CCA) is unattractive. Complete endovascular treatment of lesions at the origin of the common carotid artery or brachiocephalic trunk combined with high-grade lesions at the carotid bifurcation carries a high risk for distal emboli before cerebral protection is installed. Therefore, the combination of open carotid endarterectomy with retrograde stenting of the proximal lesion through one stage is most attractive. Methods : Eleven patients were treated with a combined procedure for tandem lesions at the origin of the brachiocephalic trunk or common carotid artery (CCA) and the carotid bifurcation. Endpoint of this evaluation was the 30-day MACE (Major Adverse Cardiovascular Events). Results : All procedures were finished as planned and no conversion was necessary. Thirty-day mortality was 0%. One patient developed a restenosis after only 4 days for which he underwent a re-PTA procedure. The 30-day MACE was 0%. None of the patients needed additional treatment during follow-up (mean follow-up 33 months; range: 11 to 60) although one patient developed a non-significant stenosis during follow-up. Conclusions : Combined treatment of tandem lesions of the carotid artery is safe and effective in the long-term.

Mycotic aneurysm of the descending thoracic aorta review and case report

Abstract A 74-year-old male presented with bilateral invalidating claudication. A bilateral percutaneous transluminal angioplasty (PTA) with stenting of both superficial femoral arteries was performed but complicated by an urosepsis with Escherichia coli and a septic phlebitis at the site of an intravenous line. The phlebitis was complicated by a local abcedation for which incision and drainage were performed. One month after discharge he was readmitted at our hospital with septic fever and positive hemocultures for Escherichia coli. Positron emission tomography-computed tomographic scan (PET/CT-scan) showed a mycotic aneurysm of the thoracic aorta. Because no cryopreserved donor aorta was available and the aneurysm size rapidly increased, an open in situ repair was performed with a Dacron silver prosthesis soaked in rifampicin. His recovery was further complicated by a perforated toxic megacolon for which a subtotal colectomy was performed. Further recovery was uncomplicated and 10 months after the aortic repair patient is still free from infection.

Preclose Percutaneous Endurant™ Endografting with the Proglide™ Device: a Safe and Feasible Combination.

Abstract Background : Endovascular repair of abdominal aortic aneurysms has been revolutionized over the last two decades. Opening the doors for a percutaneous approach by avoiding surgical exposure of the vascular access site. The goal of this report is to analyze the feasibility and efficacy of using Perclose Proglide™ through a preclose technique in a percutaneous approach to Endurant™ endografting for Asymptomatisch infrarenal aortic aneurysms in an elective setting. Methods : Between April 2011 and April 2014, 45 consecutive patients underwent percutaneous endovascular aortic aneurysm repair (PEVAR) for an asymptomatic infrarenal aortic aneurysm. Closure of percutaneous access sites was ensured with Perclose Proglide in a “preclose” technique. Data were collected in a prospective maintained database with a follow-up period of one month. Patient demographics, aneurysmal characteristics, procedural details and complications were recorded. Results : A total of 170 Proglide devices were used to close 85 access sites. Adequate hemostasis was obtained in 96.5 percent (82 of 85 access sites). Conversion to a femoral cutdown was necessary in 2.4% (2 of 85 access sites). The mean hospitalization was 2.6 days and 86.7 percent of patients were discharged within 2 days. The incidence of post-procedural access-related complications was 2.2%. Conclusions : PEVAR using the Perclose Proglide in preclosing 14Fr to 20Fr access sites for Endurant endografting in the treatment of asymptomatic infrarenal aortic aneurysms is feasible and effective. Moreover, the percutaneous approach allows for procedures to be performed under local anesthesia, while providing a low risk for access-related complications and a relatively short hospitalization.

Minimally invasive resection of ectopic mediastinal parathyroid adenoma with use of the Da Vinci Xi robot

An 83-year-old woman was referred for treatment of an ectopic parathyroid adenoma. She suffered from neuromuscular symptoms due to hypercalcaemia. A chest X-ray followed by a thoracic CT revealed a mass of 4.9 by 5.7 cm adjacent to the ascending aorta and the superior caval vein. A right-sided thoracoscopic resection of the mass was performed using the Da Vinci Xi® surgical system. Pathologic examination confirmed the mass to be an ectopic parathyroid adenoma. The postoperative course was uneventful. Hypercalcaemia had disappeared within 3 days. A 1-year follow-up showed a complete restoration of the patient’s quality of life. The Da Vinci Xi® surgical system proved to be beneficial for resecting this mediastinal tumour in a minimally invasive fashion.