P. Chabrot

Cardiac tamponade after malignant superior vena cava stenting: Two case reports and brief review of the literature

Percutaneous stenting of the superior vena cava (SVC) is usually recommended as a palliative procedure for malignant SVC obstruction with low reported morbidity. Complications are uncommon and usually of minor consequence. We report two unusual cases of cardiac tamponade following SVC stenting in patients with malignant SVC syndrome. Echocardiography allows rapid diagnosis and guides pericardial drainage in the interventional radiology suite.

Traitement endovasculaire du syndrome cave supérieur d'origine néoplasique : à propos de 34 patients

Endovascular treatment of SVC syndrome from neoplastic origin: a review of 34 cases. Purpose. To report our experience with the treatment of 34 patients with SVC syndrome from neoplastic origin using the Wallstent. Materials and methods. Thirty-four patients were treated between January 2000 and February 2007xa0: 21 males and 13 females, aged 44-81 years, with non-small-cell lung carcinoma in 27 cases (79%), small-cell lung carcinoma in 5 cases (15%) and metastatic breast adenocarcinoma to the mediastinum in 2 cases (6%). All patients were treated using the stainless steel self-expanding Wallstent. A dual brachial-femoral access was used in all cases. Results. Stent placement was possible in all cases. Per procedure acute respiratory distress occurred in 2 casesxa0: 1 case of acute pulmonary edema and 1 case of tamponade. Symptoms resolved within 24 hours. Twenty-six patients died from disease progression, 8 during the first month, and 16 within 32-545 days post-procedure (meanxa0: 213.4 days). Five patients with recurrent SVC syndrome underwent repeat treatment (restenosis in 3 cases, fracture in 1 case, thrombosis in 1 case), for primary and secondary patency rates of 81% and 100%. Conclusion. Palliative stent treatment of neoplastic SVC syndrome is reliable, safe and provides long-standing improvement in quality of life.

[Preoperative portal vein embolization with Amplatzer(®) vascular plugs (AVP): a review of 17 cases].

The purpose was to determine the efficacy and technical particularities related to the use of Amplatzer(®) Vascular Plugs (AVP) for preoperative portal vein embolization. Between 2005 and 2009, a total of 48 type I AVP were embolized into the portal venous system of 17 patients (51-83 years) prior to extended hepatic resection where the residual liver volume (RLV) was deemed sufficient (RLV < 35-40% in patients with underlying hepatocellular disease, < 25-30% in patients with normal liver). AVP were used alone in seven patients and combined to other embolization agents in 10 patients (coils: n=5, microparticles: n=1, resorbable gel foam: n=4). The procedure was technically successful in 100% of cases with immediate success rate of 94.1% (imcomplete embolization of a segmental branch of segment VIII). The procedure was well tolerated clinically in 94.1% of cases, and in 100% of cases based on laboratory values. The rate of recanalization on follow-up CT at 5 weeks (2-22) was 11.7%. The rate of complications, major (left portal vein thrombosis following right portal vein embolization) and minor (one case of portovenous fistula), was 11.7%. The rate of RLV growth was from +13 to +285 cm(3) (mean at +122 cm(3)), or +4.98 to +78.51% (mean at +33.3%) (hepatocellular carcinoma: mean of +30.7%, metastases: mean of +19.7%). The rate of surgical candicacy was 94.1% (two patients were excluded: insufficient growth of RLV, development of peritoneal carcinomatosis). AVP appear to be reliable and effective for the preoperative embolization of the portal vein, with low morbidity and sufficient growth of RLV.

Embolisation portale préopératoire par Amplatzer® Vascular Plugs (AVP) : 17 patients

The purpose was to determine the efficacy and technical particularities related to the use of Amplatzer(®) Vascular Plugs (AVP) for preoperative portal vein embolization. Between 2005 and 2009, a total of 48 type I AVP were embolized into the portal venous system of 17 patients (51-83 years) prior to extended hepatic resection where the residual liver volume (RLV) was deemed sufficient (RLV < 35-40% in patients with underlying hepatocellular disease, < 25-30% in patients with normal liver). AVP were used alone in seven patients and combined to other embolization agents in 10 patients (coils: n=5, microparticles: n=1, resorbable gel foam: n=4). The procedure was technically successful in 100% of cases with immediate success rate of 94.1% (imcomplete embolization of a segmental branch of segment VIII). The procedure was well tolerated clinically in 94.1% of cases, and in 100% of cases based on laboratory values. The rate of recanalization on follow-up CT at 5 weeks (2-22) was 11.7%. The rate of complications, major (left portal vein thrombosis following right portal vein embolization) and minor (one case of portovenous fistula), was 11.7%. The rate of RLV growth was from +13 to +285 cm(3) (mean at +122 cm(3)), or +4.98 to +78.51% (mean at +33.3%) (hepatocellular carcinoma: mean of +30.7%, metastases: mean of +19.7%). The rate of surgical candicacy was 94.1% (two patients were excluded: insufficient growth of RLV, development of peritoneal carcinomatosis). AVP appear to be reliable and effective for the preoperative embolization of the portal vein, with low morbidity and sufficient growth of RLV.

Portal vein stenosis and occlusion stenting after liver transplantation in two adults

We report two cases of percutaneous transhepatic stenting of the portal vein to treat stenosis and occlusion disclosed 5 and 18 months, respectively, after orthotopic liver transplantation in two adult patients. If long-term patency is satisfactory, this technique should allow long-term management of portal vein stenosis and occlusion without the use of thrombolysis.

Indications de l’angioplastie des artères rénales : à revisiter ?

Presentation in several international conferences, at the stage of design and interim results of randomized trials regarding the appropriateness of percutaneous endovascular correction of renal artery stenosis has raised some questions among clinicians, including nephrologists. What lessons should get the interventional radiologist now published the first results?

Angioplastie et stenting des syndromes caves supérieurs

Le syndrome cave superieur (SCS) est lie a l’obstruction de la veine cave superieure (VCS) et/ou des troncs veineux brachio-cephaliques. Le retentissement clinique depend de la vitesse et du degre d’obstruction du systeme cave superieur et de la qualite de sa suppleance par des reseaux anastomotiques. Alors que la part des etiologies non tumorales a tendance a augmenter, en particulier du fait de l’utilisation de plus en plus frequente des catheters veineux centraux, le SCS reste majoritairement lie a une lesion maligne dans 74 a 95 % des cas [1] (cancer broncho-pulmonaire: 80 % ; lymphome: 15 % ; metastases de neoplasie extrathoracique : 5 %) [2].

Article originalCardiovasculaireEmbolisation portale préopératoire par Amplatzer® Vascular Plugs (AVP) : 17 patientsPreoperative portal vein embolization with Amplatzer® vascular plugs (AVP): A review of 17 cases

The purpose was to determine the efficacy and technical particularities related to the use of Amplatzer(®) Vascular Plugs (AVP) for preoperative portal vein embolization. Between 2005 and 2009, a total of 48 type I AVP were embolized into the portal venous system of 17 patients (51-83 years) prior to extended hepatic resection where the residual liver volume (RLV) was deemed sufficient (RLV < 35-40% in patients with underlying hepatocellular disease, < 25-30% in patients with normal liver). AVP were used alone in seven patients and combined to other embolization agents in 10 patients (coils: n=5, microparticles: n=1, resorbable gel foam: n=4). The procedure was technically successful in 100% of cases with immediate success rate of 94.1% (imcomplete embolization of a segmental branch of segment VIII). The procedure was well tolerated clinically in 94.1% of cases, and in 100% of cases based on laboratory values. The rate of recanalization on follow-up CT at 5 weeks (2-22) was 11.7%. The rate of complications, major (left portal vein thrombosis following right portal vein embolization) and minor (one case of portovenous fistula), was 11.7%. The rate of RLV growth was from +13 to +285 cm(3) (mean at +122 cm(3)), or +4.98 to +78.51% (mean at +33.3%) (hepatocellular carcinoma: mean of +30.7%, metastases: mean of +19.7%). The rate of surgical candicacy was 94.1% (two patients were excluded: insufficient growth of RLV, development of peritoneal carcinomatosis). AVP appear to be reliable and effective for the preoperative embolization of the portal vein, with low morbidity and sufficient growth of RLV.

Comment je surveille un syndrome aortique aigu traité médicalement au scanner ou en IRM

The follow-up of medically treated acute aortic syndromes relies on CT and MR imaging. Comparison with prior examinations is essential. For aortic dissections, progressive enlargement of the false lumen, visceral hypoperfusion, and extension should be excluded. Mural hematomas and ulcers also undergo close follow-up to detect progression and recanalization. It is important to be familiar with the risk factors of disease progression for medically treated acute aortic syndromes and their management. It is also important to be familiar with the imaging features of disease progression. Acute aortic syndromes managed medically should undergo routine follow-up with CT or MR because these lesions may evolve silently over time and present with complications.

Chimioembolisation lipiodolee (CELH) de CHC : a propos de patients avec plus de 3 cures

Objectifs Rapporter notre experience des complications arterielles, difficultes techniques et interet de la CELH apres plus de 3 cures pour CHC. Materiels et methodes Etude retrospective monocentrique (novembre 2005-septembre 2008) incluant 15 patients dont 1 femme (65xa0±xa08 ans) : une hemochromatose et 14 cirrhoses CHILD A, dont 73 % d’origine alcoolique. Apres 3 cures, la deuxieme serie de CELH, etait motivee par la recidive du CHC dans 94 % des cas. Resultats Nombre total moyen de cures : 4,7xa0±xa00,7. Seuls 2 patients ont eu un total de 6 cures. Quantites moyennes utilisees pour les deux series ; anthracyclines : 287xa0±xa0120xa0mg ; lipiodol : 48xa0±xa09xa0ml. A cote du syndrome post-embolique, un OAP, une necrose hepatique et des complications arterielles etaient observees chez 47 % des patients : occlusion de l’artere hepatique propre responsable de l’arret de la CELH chez 2 patients, faisant recours au micro-catheterisme pour un autre. Une stabilite lesionnelle en TDM etait constatee chez 50 % des patients. Survie : 100 % a 1 an, 67 % a 2 ans, 11 % a 3 ans ; mediane de survie : 25 mois (12-43). Conclusion La CELH induit des complications arterielles pouvant etre limitees par technique supra-selective et adaptation de la quantite de drogue. Elle semble pouvoir etre repetee chez le cirrhotique tant qu’existe une reponse tumorale que la fonction hepatique et le lit arteriel le permettent.