Nevzat Ozcan

Endovascular Treatment of Lower Limb Penetrating Arterial Traumas

Purpose:The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma.Materials and Methods:Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients.Results:On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient.Conclusions:We conclude that embolization—particularly n-butyl cyanoacrylate embolization—is technically feasible in patients with penetrating peripheral arterial trauma.

Popliteal artery branching patterns detected by digital subtraction angiography.

PURPOSE To describe the popliteal and distal branching patterns detected by digital subtraction angiography. MATERIALS AND METHODS The popliteal branching patterns were analyzed in 535 extremities (270 right, 265 left). Of these, 226 limbs were evaluated bilaterally, while 83 were evaluated unilaterally. The branching patterns were classified according to the level of branching and the presence of hypoplasia or aplasia of the distal branches. RESULTS Four hundred and seventy-two (88.1%) limbs had a normal level of popliteal artery branching. Type IA was the most frequently encountered pattern. High division of the popliteal artery was seen in 30 (5.6%) limbs. Type IIA was the most frequently encountered pattern among these limbs. Type IIC was not seen. We encountered a new pattern characterized by high division of the peroneal artery with a trifurcation pattern and an anterior tibial artery with a proximal medial course and a distal lateral course. We called this pattern Type IID. Thirty-three (6.1%) limbs exhibited hypoplasia/aplasia of the distal branches. Type IIIA was the most frequently encountered pattern among these limbs. CONCLUSION Variations that occur in nearly 10% of patients should be understood because they may affect the choice of management strategy.

Direct CT Venography for Evaluation of the Lower Extremity Venous Anomalies of Klippel-Trénaunay Syndrome

OBJECTIVE Our aim was to describe the technique of direct CT venography and to describe various forms of venous anomalies detected with CT venography in patients with Klippel-Trénaunay syndrome. CONCLUSION MDCT is helpful for visualizing the full length of extremities and for evaluating length and thickness on one image.

Bilateral round ligament varicosities mimicking an inguinal hernia in pregnancy: case report.

A 22‐year‐old pregnant woman presented with a painful swelling in the right groin. Sonography was performed to confirm a presumptive diagnosis of inguinal hernia based on physical examination. Gray‐scale sonography examination revealed bilateral inguinal cystic lesion expanding with the Valsalva maneuver. Color Doppler imaging demonstrated multiple prominent vessels with retrograde venous flow during Valsalva maneuver. Bilateral round ligament varicosities were diagnosed and inguinal hernia was excluded by sonographic findings. Round ligament varicosities should be considered in the differential diagnosis of groin swelling during pregnancy.

Embolization of postbiopsy and postnephrostomy complications in transplanted kidney: a case report.

Complications such as arteriovenous, arteriocalyceal fistula, pseudoaneurysm, or perinephric hematoma occur in allografted and native kidneys after interventional procedures. When these complications are not detected and treated immediately, they might be associated with a poor allograft prognosis. Reoperation may produce parenchymal injuries, therefore, endovascular embolization may be a preferred treatment modality. Herein we report an arteriocalyceal fistula and an arteriovenous fistula in a transplant kidney that were detected after biopsy and nephrostomy, respectively, they were treated with endovascular coil embolization. Percutaneous treatment is a safe and effective method for arteriocalyceal fistula and arteriovenous fistula following interventional procedures in renal allografts.

Common Bile Duct Stones Detected After Cholecystectomy:Advancement into the Duodenum via the Percutaneous Route

AbstractPurpose: To report our experience in the use of percutaneous extraction of common bile duct stones detected in the post-cholecystectomy period. Methods: Forty-two patients in whom endoscopic cannulation and/or sphincterotomy had failed or could not be done due to several reasons underwent balloon dilatation of the ampulla of Vater and subsequent advancement of the stones via the percutaneous transhepatic route or T-tube tract. Results: The procedure was successful in 42 cases. In three patients, stones were crushed in the common bile duct and pushed as fragments into the duodenum. In all cases transient adverse effects were observed. There were no major complications. All cases were checked with ultrasonography for 6 months after the procedure. Conclusion: Percutaneous extraction of common bile duct stones is an effective method of treatment with a high success rate, low complication rate and shorter hospital stay. It may serve as an alternative method in cases where endoscopic removal of stones fails.

Percutaneous ultrasound-guided core needle biopsy of solid pancreatic masses: Results in 250 patients

To determine the diagnostic accuracy and complications of percutaneous sonographic (US)‐guided core needle‐needle biopsy in the diagnosis of solid pancreatic masses.

Does Radical Nephrectomy with Immunochemotherapy Have Any Superiority over Embolization Alone in Metastatic Renal Cell Carcinoma

Introduction: We evaluated the results and effects of radical nephrectomy followed by immunochemotherapy and embolization alone on the survival of patients with metastatic renal cell carcinoma. Patients and Methods: The study included 20 patients with histologically confirmed renal cell carcinoma. Ten patients were in the combined therapy group and the other 10 patients who were unable to undergo nephrectomy because of poor performance status or unresectable tumor were in the embolization group. Radical nephrectomy was performed on patients with good performance status (WHO criteria 0–1). Immunochemotherapy (interferon alpha 2a and 5-fluorouracil) was started within 1 month after surgery. A dose of 9 × 106 U/day interferon alpha 2a was subcutaneously administered 3 times a week. A dose of 750 mg/m2 5-fluorouracil was administered intravenously during 4 h in the first 5 days of treatment. 5-Fluorouracil therapy was converted to weekly intervals after the first 12 days. Combined therapy was continued for 3 months. Ethanol was used for transarterial embolization. The main renal arteries and parasitic arteries of the tumor were embolized. Results: There were no significant differences in age distribution, sex, affected side, tumor size and T stage between the groups. After completion of the combined therapy, 6 patients showed progression at the first control. Only 1 patient (10 %) had stable disease throughout the 10 months after combined therapy. One patient died of myocardial infarction on the 4th day in the embolization group. While progressive disease within the first 3 months was detected in 6 patients, the other 3 patients (30%) had stable disease for 14, 17 and 55 months, respectively. There was no complete response in any group and no patient was alive (died of renal cell carcinoma) at the time of the analysis of the study data. Whereas the median survival time was 11 months (1–80) (mean ± SE: 22.2 ± 9.1) in the combined group, this time was a median of 1 month (1–74) (mean ± SE: 17.5 ± 8.6) in the embolization group. There was no statistically significant difference in survival time between the groups (p > 0.05). Conclusion: In this preliminary report, the clinical findings in embolization-group patients were definitively worse than the nephrectomy plus immunochemotherapy-group patients. In spite of these differences, combination therapy using radical nephrectomy and immunochemotherapy could not show superiority to embolization alone, especially in terms of survival time.

Percutaneous treatment of liver hydatid cysts in 190 patients: a retrospective study:

Background Hydatid liver disease (HLD) is a significant health problem, especially in endemic areas worldwide. Percutaneous treatment is an effective alternative therapeutic option. Purpose To present the clinical and radiological results of percutaneous treatment of HLD in 190 patients. Material and Methods Percutaneous treatment of HLD between April 2005 and March 2015 was analyzed retrospectively. The demographic data, numbers and types of cysts, initial and final volumes of the cysts, types of percutaneous treatment, and procedure-related complications were determined. Results A total of 190 patients (95 male patients and 95 female patients; age range, 5–82 years) with 283 liver hydatid cysts who underwent percutaneous treatment were included in the study. Of the 283 cysts, 234 (83%) were cystic echinococcosis CE1, 31 (11%) were CE3a, and 18 (6%) were CE2 cysts, according to the World Health Organization (WHO) classification. The percutaneous procedure was successful in all patients. A total of 12 (6.3%) major complications, including anaphylaxis, allergic skin reaction, perihepatic hemorrhage, and cavity infection, were seen. No mortality was noted. Recurrence in one patient and an additional cyst in one patient were seen. All patients were asymptomatic during the follow-up period. Mean volume reduction was 77.5%, with a mean follow-up period of 18 months. Conclusion Percutaneous treatment is an effective and safe method for the treatment of HLD. It should be regarded as a first-line treatment method for uncomplicated hydatid cysts.

Transrectal ultrasound guided multi-core prostate biopsy: Pain control: Results of 106 patients

To determine the efficacy of periprostatic nerve block (PPNB) for control of transrectal ultrasound (TRUS)‐guided multicore prostate biopsy‐related pain.