Xin-Wei Han

Gastrotracheal and gastrobronchial fistulas: management with covered expandable metallic stents.

PURPOSEnThe present study evaluated the clinical results of covered tracheobronchial metallic stent placement in the management of gastrotracheal fistulas (GTFs) and gastrobronchial fistulas (GBFs).nnnMATERIALS AND METHODSnSixteen patients with GTFs or GBFs after esophagogastrectomy were treated with one of two types of covered tracheobronchial metallic stents: a hinged stent or a straight stent. These included 12 GTFs and four GBFs. Thirteen hinged stents and three straight stents were placed during the initial procedure. Data regarding the technical success of stent placement, initial clinical success and failure, fistula reopening, and complications were obtained.nnnRESULTSnStent placement was technically successful in all patients. The stent completely sealed off the fistula in 12 of 16 patients (75% initial clinical success rate), whereas the remaining four patients (25%) had persistent aspiration symptoms as a result of incomplete GTF or GBF closure (ie, initial clinical failure). During follow-up, the fistula reopened in three of the 12 patients in whom initial clinical success was achieved (25%). Two reopened fistulas were sealed off with stent placement, and one was treated with a nasoenteric feeding tube and a nasogastric decompression tube. All patients died during the 1-year follow-up period; mean survival time was 17 +/- 3.02 weeks (range, 1-42 weeks) after stent placement. Mean survival in patients in whom initial clinical success was achieved was significantly longer than in patients with initial clinical failure (P = .003; log-rank test).nnnCONCLUSIONnUse of covered metallic stents appears to be a safe and moderately effective procedure to occlude GTFs and GBFs.

Caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation for the management of placenta accreta

AIMnTo determine the efficacy and safety of caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation (UAE) for the treatment of patients with placenta accreta.nnnMATERIALS AND METHODSnThis retrospective study involved 42 patients with placenta accreta. All patients underwent caesarean section combined with temporary aortic balloon occlusion followed by UAE through the right femoral approach.nnnRESULTSnAll patients were confirmed to have placenta praevia and accreta, including five patients with placenta percreta, at the time of delivery. The technical success rate of the combined treatment was 97.6% (41/42). Forty-one patients underwent successful caesarean section with conservation of the uterus. Hysterectomy was required in one (3.1%) patient. The amount of blood loss and blood transfusion, and the operation time were was 586xa0±xa0355xa0ml, 422xa0±xa083xa0ml and 65.5xa0±xa010.6 minutes, respectively. The mean postoperative hospital stay, occlusion time and fetal radiation dose were 5.5xa0±xa02.6 days, 22.4xa0±xa07.2 minutes and 4.2xa0±xa02.9xa0mGy, respectively. There were no significant changes before and 7 days after the endovascular procedure in creatinine levels (56.8xa0±xa013.8xa0μmol/l versus 63.4xa0±xa016.7xa0μmol/l, pxa0=xa00.09) or urea nitrogen (6.3xa0±xa02.5xa0μmol/l versus 7.4xa0±xa03.8xa0μmol/l, pxa0=xa00.17). There were no access-site complications after the endovascular procedure and no complications related to the intervention during follow-up.nnnCONCLUSIONnTemporary aortic balloon occlusion followed by UAE can effectively control postpartum haemorrhage during placental dissection, and reduce transfusion requirements, hysterectomy rate, and operation time in patients with placenta accreta.

Overcoming the Delivery Limitation: Results of an Approach to Implanting an Integrated Self-expanding Y-shaped Metallic Stent in the Carina

PURPOSEnTo evaluate the technical success and initial clinical safety and effectiveness of the use of a Y-shaped metallic stent for complex stenoses involving the carina.nnnMATERIALS AND METHODSnThirty-five consecutive patients with complex tracheobronchial stenoses involving the carina were treated with an integrated self-expandable inverted Y-shaped metallic stent and delivery system. The Y-shaped metallic stents were placed in the tracheobronchial tree with fluoroscopic guidance. Technical success, clinical success, Hugh-Jones classification, and complications were assessed during follow-up.nnnRESULTSnThe delivery of the integrated self-expandable Y-shaped metallic stent in the carinal areas was technically successful and well-tolerated in all patients. Clinical success was achieved in 31 patients (89%) 1-7 days after stent placement; the procedure failed in four patients (11%). The improvement between pre- and postoperative Hugh-Jones classification grade was statistically significant (P<.001). During follow-up (mean follow-up, 192 days+/-169), all stenoses were resolved, and general physical examination of the 31 patents showed improvement with no obvious dyspnea or bleeding. Twenty-one patients were healthy without evidence of dyspnea, and the remaining 14 patients died (mean survival, 189 days+/-172) at the time of this report. The mean and median survival periods were 217 days+/-30 and 215 days+/-108, respectively. The mean and median stent patency periods were 216 days+/-30 and 215 days+/-119, respectively.nnnCONCLUSIONSnDeployment of an integrated, self-expandable inverted Y-shaped metallic stent with the delivery system was a safe and effective procedure for the treatment of complex tracheobronchial stenoses involving the carina.

Novel experimental model of enlarging abdominal aortic aneurysm in rabbits.

OBJECTIVEnThis study tested the hypothesis that an experimental model of abdominal aortic aneurysm in rabbits results in progressive enlargement when induced by a combination of periaortic elastase administration and aortic coarctation.nnnMETHODSnMale New Zealand white rabbits were randomly divided into four groups: (A) stenosis (n = 12), (B) elastase (n = 12), (C) aneurysm (n = 15), and (D) control (n = 12). The stenosis group received an extrinsic coarctation below the right renal artery, the elastase group received a 10-minute administration of 60 μL elastase (1 U/μL) in a 1.5-cm aortic segment, the aneurysm group received stenosis and elastase, and a sham operation was performed in the control group. The aortic diameter was measured after 1, 2, 4, 8, and 16 weeks, and animals were subsequently euthanized for histopathologic and immunohistochemical studies.nnnRESULTSnAll animals in the aneurysm group developed aneurysm by 2 weeks after treatment, with average diameters of 5.21 ± 0.74 mm by 2 weeks, 6.23 ± 1.10 mm by 4 weeks, 7.87 ± 0.50 mm by 8 weeks, and 9.40 ± 0.36 mm by 16 weeks. Aortic diameter dilated progressively, and all aneurysms developed by 4 weeks in the stenosis group (4.17 ± 0.22 mm). Only one aneurysm was seen in the elastase group by week 1 (3.60 ± 0.64 mm), and no aneurysm formed in the control group by week 8 (2.47 ± 0.38 mm). The aneurysm group exhibited less media thickness, elastin content, and endothelial recovery, but stronger expression of matrix metalloproteinase 2 and 9 and rabbit macrophage compared with the control group.nnnCONCLUSIONSnThis novel rabbit abdominal aortic aneurysm model with a gradually enlarging diameter is simply and reliably induced, appropriately mimicking human aortic aneurysm disease.

Clinical applications of the C-arm cone-beam CT-based 3D needle guidance system in performing percutaneous transthoracic needle biopsy of pulmonary lesions.

PURPOSEnThis study explored the value of flat detector C-arm CT-guidance system in performing percutaneous transthoracic needle biopsy (PTNB) for lung lesions in clinical practice.nnnMETHODSnA total of 110 patients with solid lung lesions were enrolled to undergo PTNB procedures. The mean diameter of lesions was 4.63 cm (range, 0.6-15cm). The needle path was carefully planned and calculated on the C-arm CT system, which acquired three-dimensional CT-like cross-sectional images. The PTNB procedures were performed under needle guidance with fluoroscopic feedbacks.nnnRESULTSnHistopathologic tissue was successfully obtained from 108 patients with a puncture success rate of 98.2% (108/110). The diagnostic accuracy rate was found to be 96.3% (104/108). There was only one case of pneumothorax (0.9%) requiring therapy. The rates of mild pneumothorax and hemoptysis were low (12.0% and 6.5%, respectively). In addition, procedural time could be limited with this technique, which helped to reduce X-ray exposure.nnnCONCLUSIONnOur study shows that C-arm CT-based needle guidance enables reliable and efficient needle positioning and progression by providing real-time intraoperative guidance.

Microwave ablation treatment of liver cancer with a 2,450-MHz cooled-shaft antenna: pilot study on safety and efficacy.

To evaluate efficacy of microwave ablation in a primary clinical study, sixty patients (44 men, 16 women; mean age 53 years) with 96, 1-8 cm (mean 3.20 ± 0.17 cm) liver cancers were treated with 2,450-MHz internally cooled-shaft antenna. Complete ablation (CA) and local tumor progression (LTP) rates as well as complications were determined. CA rates in small (<3.0 cm), intermediate (3.1-5.0 cm) and large (5.1-8.0 cm) liver cancers were 96.4% (54/56), 92.3% (24/26) and 78.6% (11/14), respectively. During a mean follow-up period of 17.17 ∓ 6.52 months, LTP occurred in five (5.21%) treated cases. There was no significant difference in the CA and LTP rates between the HCC and liver metastasis patient subgroups (P<0.05). Microwave ablation provides a reliable, efficient, and safe technique to perform hepatic tumor ablation.

Agitation thrombolysis for fresh iatrogenic IVC thrombosis in patients with Budd-Chiari syndrome

Three patients with Budd-Chiari syndrome (BCS) and fresh inferior vena cava (IVC) thrombosis were treated by agitation thrombolysis as a mechanical thrombectomy procedure and followed up by duplex ultrasonography. Agitation thrombolysis was technically and clinically successful in all patients. Inferior vena cavagrams after the procedure showed complete resolution of the iatrogenic, fresh IVC thrombi without occurrence of pulmonary embolism. Duplex ultrasonography follow-ups after 12, 24, and 28 months, respectively, confirmed complete patency of the IVC without rethrombosis and reobstruction. The results indicate that agitation thrombolysis may be a safe and feasible approach for BCS patients with iatrogenic, fresh IVC thrombosis.

Treatment of Budd-Chiari syndrome with urokinase following predilation in patients with old inferior vena cava thrombosis.

PurposeThis study was undertaken to evaluate the safety and feasibility of thrombolytic urokinase treatment after predilation in patients with Budd-Chiari syndrome (BCS) with chronic inferior vena cava (IVC) thrombosis.Materials and methodsBetween December 2006 and September 2009, 13 consecutive BCS patients with chronic IVC thrombosis were treated with continuous urokinase infusion after predilation and subsequent (i.e. after thrombus resolution) IVC dilation with a 30-mm dilator. The procedural technical and angiographic, and ultrasonic results, as well as mortality, morbidity and the final clinical outcome, were evaluated immediately after the treatment or at 1 week and 1, 3, 6 and 12 months and then annually thereafter.ResultsThe immediate and long-term procedural technical outcome was successful in all patients. Follow-up inferior vena cavagrams demonstrated complete resolution of the chronic IVC thrombi and full IVC patency, without occurrence of pulmonary embolism at any time during the study. Colour-Doppler ultrasound (US) follow-up for 16.92 months (±12.04) showed full patency of the IVC, without thrombosis, restenosis or reobstruction, in all patients and resolution of all clinical symptoms. All patients were alive at the time of this report.ConclusionsOur preliminary results indicate that thrombolysis with continuous infusion of urokinase after predilation is a safe and feasible approach for treating BCS patients with chronic IVC thrombosis.RiassuntoObiettivoQuesto studio è stato condotto per valutare la sicurezza e la fattibilità del trattamento trombolitico con urochinasi dopo pre-dilatazione in pazienti con sindrome di Budd-Chiari (BCS) con trombosi cronica della vena cava inferiore (IVC).Materiali e metodiTra il dicembre 2006 e il settembre 2009, 13 pazienti BCS con trombosi cronica dell’IVC sono stati trattati con infusione urochinasica continua dopo predilatazione e successiva (i.e. in seguito alla risoluzione del trombo) dilatazione dell’ IVC con un dilatatore di 30 mm. Le procedure tecniche ed angiografiche, e i risultati ecografici, cosi come la mortalità, la morbidità, e i risultati clinici finali, sono stati valutati immediatamente dopo il trattamento, a una settimana e a 1, 3, 6, e 12 mesi e infine annualmente.RisultatiI risultati immediati ed a lungo termine della tecnica procedurale hanno avuto successo in tutti pazienti. Le flebografie di follow-up della vena cava inferiore hanno dimostrato una completa risoluzione della trombosi cronica dell’ IVC e totale pervieta’ dell’ IVC, senza alcun caso di embolia polmonare durante lo studio. Il follow-up con ecografia Color-Doppler (US) a 16.92 mesi (±12.04) ha mostrato completa pervietà dell’ IVC, senza trombosi, restenosi o riostruzione, in tutti i pazienti e risoluzione di tutti i sintomi clinici. Ad oggi tutti i pazienti sono sopravvissuti.ConclusioniI nostri risultati preliminari indicano che la trombolisi con infusione continua di urochinasi dopo predilatazione è un approccio sicuro e fattibile per il trattamento dei pazienti BCS con trombosi cronica dell’ IVC.

Outcome of a retrieval stent filter and 30 mm balloon dilator for patients with Budd–Chiari syndrome and chronic inferior vena cava thrombosis: a prospective pilot study

AIMnTo evaluate the mid-term safety and efficacy of a retrieval stent filter and 30mm balloon dilator in the treatment of Budd-Chiari syndrome (BCS) patients with chronic inferior vena cava (IVC) thrombosis.nnnMATERIALS AND METHODSnTwenty-three consecutive patients with BCS and chronic IVC thrombosis were treated with a retrieval stent filter and a 30mm balloon dilator, and subsequently underwent color Doppler ultrasound follow-up at our hospital. Data relating to the technical success, angiographic and ultrasound results, mortality, morbidity, and final clinical outcome were collected retrospectively and follow-ups were performed 1, 3, 6, and 12 months after placement of the stent, and annually thereafter.nnnRESULTSnStent filter placement and balloon dilation were technically successful in all patients, with no procedure-related complications. Removal of the stent filter was technically successful in 22 of 23 attempts, yielding a technical successful rate of 95.7% (95% confidence intervals (CI): 87%, 105%). Inferior vena cavagrams performed immediately before stent removal demonstrated that the IVC thrombus had completely resolved in all patients without pulmonary embolism. The mean primary patency rate 3, 6, 12, and 24 months after venoplasty was 0.91 (95% CI: 0.79-1.04), 0.87 (95% CI: 0.72-1.02), 0.87 (95% CI: 0.72-1.02), and 0.87 (95% CI: 0.72-1.02), respectively. The secondary patency rates were 1.00 throughout the follow-up period. All patients are alive with resolution of the symptoms at the time of this report.nnnCONCLUSIONSnThe preliminary results indicate that the retrieval stent filter and 30mm balloon dilator are a safe and effective treatment for BCS patients with chronic IVC thrombosis.

Right bronchopleural fistula treated with a novel, Y-shaped, single-plugged, covered, metallic airway stent

Background Bronchopleural fistula (BPF) is an infrequent but life-threatening complication after pneumonectomy. The incidence of BPF reported in the literature varies from 0.3% to 20%. Purpose To determine the feasibility and efficacy of using Y-shaped, single-plugged, covered, metallic stents to treat right bronchopleural fistulas. Material and Methods We have designed a Y-shaped, single-plugged, covered, self-expandable, metallic airway stent to fit the specific anatomy of the right main bronchus. The stent has a main tube and two branches, resembling an inverted “Y”. One of the branches is closed (plugged) and bullet-shaped; the other one tubular and open. The entire stent is encased in a nitinol wire mesh. Stent size can be individualized using multislice spiral computed tomography (MSCT) measurements of the airways. Under fluoroscopic guidance, we have implanted 15 Y-shaped stents in 15 patients with right bronchopleural fistulas. Results Stent insertion was successful in all patients. All fistulas were successfully closed immediately after stent placement. Follow-up was performed for 1–34 months. Positive clinical outcomes were seen in 13 of 15 patients. Two patients died of intractable pulmonary infection and multiorgan failure. The fistula completely healed and the stent could be removed in five patients; however, two of them were left with a small, aseptic, residual right lung cavity. The remaining eight patients are still alive with the stent in situ. Conclusion The placement of Y-shaped, single-plugged, covered, self-expandable metallic airway stents seems to be a feasible and safe method for the treatment of bronchopleural fistulas involving the right main bronchus. This stent is a promising therapeutic alternative for bronchopleural fistulas involving the right main bronchus.