Mustafa Özdemir

Large Pulmonary Arteriovenous Malformations: Long-Term Results of Embolization with AMPLATZER Vascular Plugs

PURPOSE To analyze the long-term results of endovascular treatment of large pulmonary arteriovenous malformations (PAVMs) using the AMPLATZER vascular plug (AVP; AGA Medical Corp, Golden Valley, Minnesota). MATERIALS AND METHODS Between May 2007 and April 2011, 18 patients with 24 large PAVMs, defined as PAVMs that had a feeding artery with a diameter of ≥ 8 mm, were treated with AVP I or AVP II. A single AVP device was used for each PAVM. Aneurysmal sac diameters, sac perfusion, sac shrinkage, and complete resolution before and after the intervention were analyzed. Complete histories, laboratory values, physical examinations, and multidetector computed tomography images were reviewed. The mean occlusion time for AVP I and AVP II and the mean arterial oxygen saturation (SaO2) before and after the intervention were compared. RESULTS The mean diameter of the feeding artery was 11.46 mm ± 2.18 (range, 8-13.3 mm). The mean occlusion time was 7.34 minutes ± 1.23 for AVP I and 6.25 minutes ± 1.12 for AVP II (P = .11). The mean SaO2 before and after the intervention was 63.71% ± 8.10% (range, 51%-76%) and 96.28% ± 0.49% (range, 96%-97%), respectively (P = .045). No major periprocedural complications were observed. The mean follow-up duration was 36.33 months ± 10.63 (range, 28-56 mo). During the follow-up period, there were no persistent sac perfusions, migration of the AVPs, major complications, or recanalizations. CONCLUSIONS Treatment of large PAVMs with AVPs is an effective method for obtaining excellent long-term results. Embolization of large feeding arteries can be accomplished with AVPs without major complications.

A Single-Center Retrospective Comparison of Doxorubicin-Loaded HepaSphere Transarterial Chemoembolization with Conventional Transarterial Chemoembolization for Patients with Unresectable Hepatocellular Carcinoma

PURPOSE To compare doxorubicin-loaded HepaSphere transarterial chemoembolization versus conventional transarterial chemoembolization in terms of survival, time to recurrence, acute reversible hepatotoxicity, postembolization syndrome, and chemoembolization-related mortality and morbidity. MATERIALS AND METHODS One hundred twenty-six patients (103 men, 23 women; mean age, 64.3 y) with unresectable hepatocellular carcinoma (HCC) who underwent conventional chemoembolization between January 2007 and March 2011 or drug-eluting embolic (DEE) chemoembolization (after the protocol change) between March 2011 and October 2014 were included in a retrospective analysis. Primary outcome measures were survival and time to recurrence. Secondary outcome measures were frequency of recurrence, technical success, acute reversible hepatotoxicity, postembolization syndrome, and chemoembolization-related mortality and morbidity. RESULTS The technical success rate was 97.1%. There were no significant differences between the conventional and DEE chemoembolization groups with regard to mean survival duration (39.0 vs 37.4 mo), recurrence (32.9% vs 39.6%), postembolization syndrome (90% vs 89%), and chemoembolization-related mortality (5.5% vs 1.9%) and morbidity (9.6% vs 9.4%; P > .05). The time to recurrence was shorter in DEE chemoembolization-treated patients than in conventional chemoembolization-treated patients (5.0 vs 11.5 mo; P = .006), and acute reversible hepatotoxicity occurred more frequently after conventional chemoembolization (P = .019). CONCLUSIONS Conventional chemoembolization and DEE chemoembolization were safe and effective interventions for unresectable HCC. DEE chemoembolization was not better than conventional chemoembolization in terms of survival and was associated with a shorter time to recurrence. Acute reversible hepatotoxicity occurred more frequently after conventional chemoembolization.

Idiopathic abdominal cocoon syndrome: Preoperative diagnosis with computed tomography.

A 52-year-old man with abdominal pain was referred to our radiology department. Written informed consent was obtained from the patient. Contrast-enhanced computed tomography (CECT) of the abdomen showed clustered, distended small intestinal loops within a contrast-enhanced sac-like structure (Figure 1). On laparotomy, the fibrous membrane that encapsulated almost the whole small intestine was carefully dissected and completely excised. Histopathological examination of the excised tissue revealed intense peritoneal fibrosis.

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts

AIM To comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease. METHODS Trocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years (range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes in the cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays. RESULTS The positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo (range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination (P = 0.384, 0.069, 0.215 and 0.533, respectively). CONCLUSION There are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

Karaciğer sağ lob canlı donör adaylarında hepatik vasküler anatominin multidedektör bilgisayarlı tomografik anjiyografi ile değerlendirilmesi

Background and Aims: The purpose of this study was to demonstrate the hepatic vascular anatomy and the variations in living right lobe donors by multidetector computed tomography angiography before the transplantation surgery and to detect the prevalence of these variations. Materials and Methods:Fifty-one potential liver donors (20 females, 31 males) underwent hepatic vascular computed tomography angiography in the arterial, portal and venous phases with a 16-row computed tomography scanner in our clinic. Two- and three-dimensional images were obtained using multiplanar reformat, maximum intensity projection and volume rendering techniques. Results:Thirty-five of the 51 patients (68,6%) had conventional arterial anatomic pattern (type I) and 16 patients (31,4%) had hepatic arterial variations. In 30 patients (58,8%), the portal vein had normal intrahepatic anatomy, while 21 patients (41,2%) had portal vein variations. Eight patients (15,7%) had normal hepatic venous anatomy and 43 patients (84,3%) had hepatic venous variations. Conclusions:Due to the high-speed volumetric scanning and high-quality two- and three-dimensional imaging with the use of thin slices, multidetector computed tomography angiography is a useful method for evaluating hepatic arterial, hepatic and portal venous systems in living liver right lobe donors.