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Sample records for guided percutaneous vertebroplasty

  1. Percutaneous vertebroplasty.

    PubMed

    Hurley, Michael C; Kaakaji, Rami; Dabus, Guilherme; Shaibani, Ali; Walker, Mathew T; Fessler, Richard G; Bendok, Bernard R

    2009-07-01

    Vertebroplasty, the augmentation of vertebral compression fractures by image-controlled intracorporeal injection of polymethylmethacrylate cement, has shown a steady increase in use. Its chief indication is to palliate pain after a failure of noninvasive therapies. Other benefits include preventing further compression of the treated vertebra and fusing unstable fractures. Controversies include questions regarding its long-term benefit compared with natural history, claims of height restoration, biomechanical compromise of adjacent vertebrae, and its performance compared with kyphoplasty. Complications are uncommon but can be devastating with reported cases of procedural death and paralysis. New operators should be adequately trained and respect the dangers of this procedure. PMID:19778703

  2. Complications of percutaneous vertebroplasty

    PubMed Central

    Saracen, Agnieszka; Kotwica, Zbigniew

    2016-01-01

    Abstract Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins—osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve  hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues—20%; paravertebral vein embolism—13%; intradiscal leakage—8%; and PMMA leakage into the spinal canal—0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed

  3. Orthopedic surgical analyzer for percutaneous vertebroplasty

    NASA Astrophysics Data System (ADS)

    Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.

    2001-05-01

    Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically

  4. Percutaneous Cervical Vertebroplasty in a MultifunctionalImage-Guided Therapy Suite: Hybrid Lateral Approach to C1 andC4 Under CT and Fluoroscopic Guidance

    SciTech Connect

    Huegli, R.W. Schaeren, S.; Jacob, A.L.; Martin, J.B.; Wetzel, S.G.

    2005-06-15

    A 76-year-old patient suffering from two painful osteolytic metastases in C1 and C4 underwent percutaneous vertebroplasty by a hybrid technique in a multi-functional image-guided therapy suite (MIGTS). Two trocars were first placed into the respective bodies of C1 and C4 under fluoroscopic computed tomography guidance using a lateral approach. Thereafter, the patient was transferred on a moving table to the digital subtraction angiography unit in the same room for implant injection. Good pain relief was achieved by this minimally invasive procedure without complications. A hybrid approach for vertebroplasty in a MIGTS appears to be safe and feasible and might be indicated in selected cases for difficult accessible lesions.

  5. Patient skin dose measurements using a cable free system MOSFETs based in fluoroscopically guided percutaneous vertebroplasty, percutaneous disc decompression, radiofrequency medial branch neurolysis, and endovascular critical limb ischemia.

    PubMed

    Falco, Maria D; Masala, Salvatore; Stefanini, Matteo; Fiori, Roberto; Gandini, Roberto; Bagalà, Paolo; Morosetti, Daniele; Calabria, Eros; Tonnetti, Alessia; Verona-Rinati, Gianluca; Santoni, Riccardo; Simonetti, Giovanni

    2015-01-01

    The purpose of this work has been to dosimetrically investigate four fluoroscopically guided interventions: the percutaneous vertebroplasty (PVP), the percutaneous disc decompression (PDD), the radiofrequency medial branch neurolysis (RF) (hereafter named spine procedures), and the endovascular treatment for the critical limb ischemia (CLI). The X-ray equipment used was a Philips Integris Allura Xper FD20 imaging system provided with a dose-area product (DAP) meter. The parameters investigated were: maximum skin dose (MSD), air kerma (Ka,r), DAP, and fluoroscopy time (FT). In order to measure the maximum skin dose, we employed a system based on MOSFET detectors. Before using the system on patients, a calibration factor Fc and correction factors for energy (CkV) and field size (CFD) dependence were determined. Ka,r, DAP, and FT were extrapolated from the X-ray equipment. The analysis was carried out on 40 patients, 10 for each procedure. The average fluoroscopy time and DAP values were compared with the reference levels (RLs) proposed in literature. Finally, the correlations between MSD, FT, Ka,r, and DAP values, as well as between DAP and FT values, were studied in terms of Pearson's product-moment coefficients for spine procedures only. An Fc value of 0.20 and a very low dependence of CFD on field size were found. A third-order polynomial function was chosen for CkV. The mean values of MSD ranged from 2.3 to 10.8cGy for CLI and PVP, respectively. For these procedures, the DAP and FT values were within the proposed RL values. The statistical analysis showed little correlation between the investigated parameters. The interventional procedures investigated were found to be both safe with regard to deterministic effects and optimized for stochastic ones. In the spine procedures, the observed correlations indicated that the estimation of MSD from Ka,r or DAP was not accurate and a direct measure of MSD is therefore recommended. PMID:25679159

  6. Percutaneous Vertebroplasty in Painful Schmorl Nodes

    SciTech Connect

    Masala, Salvatore Pipitone, Vincenzo; Tomassini, Marco; Massari, Francesco; Romagnoli, Andrea; Simonetti, Giovanni

    2006-02-15

    The Schmorl node represents displacement of intervertebral disc tissue into the vertebral body. Both Schmorl nodes and degenerative disc disease are common in the human spine. We performed a retrospective study, for the period from January 2003 to February 2005, evaluating 23 patients affected by painful Schmorl nodes, who underwent in our department percutaneous transpedicular injection of polymethylmethacrylate (vertebroplasty) in order to solve their back pain not responsive to medical and physical management. Eighteen patients reported improvement of the back pain and no one reported a worsening of symptoms. Improvement was swift and persistent in reducing symptoms. Painful Schmorl nodes, refractory to medical or physical therapy, should be considered as a new indication within those vertebral lesions adequately treatable utilizing Vertebroplasty procedure.

  7. Percutaneous cryoablation and vertebroplasty: a case report.

    PubMed

    Masala, Salvatore; Roselli, Mario; Manenti, Guglielmo; Mammucari, Matteo; Bartolucci, Dario Alberto; Simonetti, Giovanni

    2008-01-01

    A 70-year-old man with a painful vertebral metastasis was treated with combined percutaneous cryoablation and vertebroplasty therapy (CVT) in one session. The patient was suffering from diffuse visceral metastasized cholangiocarcinoma. After several weeks of back pain, magnetic resonance imaging documented a single L2 bone metastasis. In consultation with the oncologists, palliative combined CVT was administered with the aim of obtaining pain relief and bone stabilization. In our experience this combined treatment is safe and effective for immediate pain relief in painful bone metastases when other standard palliative treatments have failed. PMID:18459032

  8. Percutaneous Cryoablation and Vertebroplasty: A Case Report

    SciTech Connect

    Masala, Salvatore; Roselli, Mario; Manenti, Guglielmo; Mammucari, Matteo; Bartolucci, Dario Alberto Simonetti, Giovanni

    2008-05-15

    A 70-year-old man with a painful vertebral metastasis was treated with combined percutaneous cryoablation and vertebroplasty therapy (CVT) in one session. The patient was suffering from diffuse visceral metastasized cholangiocarcinoma. After several weeks of back pain, magnetic resonance imaging documented a single L2 bone metastasis. In consultation with the oncologists, palliative combined CVT was administered with the aim of obtaining pain relief and bone stabilization. In our experience this combined treatment is safe and effective for immediate pain relief in painful bone metastases when other standard palliative treatments have failed.

  9. Vertebroplasty

    PubMed Central

    Jay, Bryan; Ahn, Sun Ho

    2013-01-01

    Percutaneous vertebroplasty has become widely accepted as a safe and effective minimally invasive procedure for the treatment of painful vertebral body compression fractures refractory to medical therapy. In this article, the authors review the indications and contraindications for vertebroplasty, principles of appropriate patient selection, useful techniques to achieve optimal outcomes, and the potential risks and complications of the procedure. PMID:24436552

  10. Percutaneous Extraction of Cement Leakage After Vertebroplasty Under CT and Fluoroscopy Guidance: A New Technique

    SciTech Connect

    Amoretti, Nicolas Huwart, Laurent

    2012-12-15

    Purpose: We report a new minimally invasive technique of extraction of cement leakage following percutaneous vertebroplasty in adults. Methods: Seven adult patients (five women, two men; mean age: 81 years) treated for vertebral compression fractures by percutaneous vertebroplasty had cement leakage into perivertebral soft tissues along the needle route. Immediately after vertebroplasty, the procedure of extraction was performed under computed tomography (CT) and fluoroscopy guidance: a Chiba needle was first inserted using the same route as the vertebroplasty until contact was obtained with the cement fragment. This needle was then used as a guide for an 11-gauge Trocar t'am (Thiebaud, France). After needle withdrawal, a 13-gauge endoscopy clamp was inserted through the cannula to extract the cement fragments. The whole procedure was performed under local anesthesia. Results: In each patient, all cement fragments were withdrawn within 10 min, without complication. Conclusions: This report suggests that this CT- and fluoroscopy-guided percutaneous technique of extraction could reduce the rate of cement leakage-related complications.

  11. Robotic-Assisted Removal of Intracardiac Cement After Percutaneous Vertebroplasty.

    PubMed

    Molloy, Thomas; Kos, Allison; Piwowarski, Amy

    2016-05-01

    Percutaneous vertebroplasty (PVP) is an increasingly common intervention, and complications resulting from embolization are increasingly observed. We report a case of polymethyl methacrylate (PMMA) embolization resulting in cardiac complications in a frail patient, which was managed with endoscopic robotic-assisted removal of the embolized material. PMID:27106432

  12. Percutaneous vertebroplasty with a high-quality rotational angiographic unit.

    PubMed

    Pedicelli, Alessandro; Rollo, Massimo; Piano, Mariangela; Re, Thomas J; Cipriani, Maria C; Colosimo, Cesare; Bonomo, Lorenzo

    2009-02-01

    We evaluated the reliability of a rotational angiographic unit (RA) with flat-panel detector as a single technique to guide percutaneous vertebroplasty (PVP) and for post-procedure assessment by 2D and 3D reformatted images. Fifty-five consecutive patients (104 vertebral bodies) were treated under RA fluoroscopy. Rotational acquisitions with 2D and 3D reconstruction were obtained in all patients for immediate post-procedure assessment. In complex cases, this technique was also used to evaluate the needle position during the procedure. All patients underwent CT scan after the procedure. RA and CT findings were compared. In all cases, a safe trans-pedicular access and an accurate control of the bone-cement injection were successfully performed with high-quality fluoroscopy, even at the thoracic levels and in case of vertebra plana. 2D and 3D rotational reconstructions permitted CT-like images that clearly showed needle position and were similar to CT findings in depicting intrasomatic implant-distribution. RA detected 40 cement leakages compared to 42 demonstrated by CT and showed overall 95% sensitivity and 100% specificity compared to CT for final post-procedure assessment. Our preliminary results suggest that high-quality RA is reliable and safe as a single technique for PVP guidance, control and post-procedure assessment. It permits fast and cost-effective procedures avoiding multi-modality imaging. PMID:19230069

  13. Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review.

    PubMed

    Ploeg, Wendy T; Veldhuizen, Albert G; The, Bertram; Sietsma, Maurits S

    2006-12-01

    Percutaneous vertebroplasty has been performed for more than ten years to treat painful osteoporotic vertebral compression fractures. Clinical results have been encouraging, but little is known about the efficacy and safety of this minimally invasive procedure. We therefore performed a systematic review to assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures. A search was conducted using Medline, Embase and The Cochrane Controlled Trials Register. The search yielded fifteen studies, eleven prospective, three retrospective and one controlled trial. Totally 1,136 interventions were performed on 793 patients. Mean pain scores, measured using a 0 to 10 VAS score, improved significantly from 7.8 to 3.1 (-60.3%) immediately after percutaneous vertebroplasty. The short-term complication rate varied between 0.4 and 75.6%. Leakage of cement outside the vertebral body was markedly common, ranging from 3.3 to 75.6%. Although the majority was asymptomatic, a few devastating clinical adverse effects were reported (mean 2.4%). Although percutaneous vertebroplasty is a widely accepted treatment for osteoporotic vertebral fractures, we revealed only a single controlled trial. We conclude that there are insufficient data available to reliably assess efficacy of percutaneous vertebroplasty. The procedure has a low rate of clinical complications, but potential complications can be devastating. In the future, assessing the efficacy of percutaneous vertebroplasty requires controlled trials with long-term follow-up. PMID:16823557

  14. Cement Leakage into Adjacent Vertebral Body Following Percutaneous Vertebroplasty

    PubMed Central

    Park, Jae Hoo; Kim, Hyeun Sung

    2016-01-01

    Percutaneous vertebroplasty (PV) is a minimally invasive procedure for osteoporotic vertebral compression fractures that fail to respond to conventional conservative treatment. It significantly improves intolerable back pain within hours, and has a low complication rate. Although rare, PV is not free of complications, most of which are directly related to cement leakage. Because of its association with new adjacent fracture, the importance of cement leakage into the adjacent disc space is paramount. Here, we report an interesting case of cement leakage into the adjacent upper vertebral body as well as disc space following PV. To the best of our knowledge, there has been no report of cement leakage into the adjacent vertebral body following PV. This rare case is presented along with a review of the literature. PMID:27437018

  15. Percutaneous vertebroplasty: the radiologist’s point of view

    PubMed Central

    Masala, Salvatore; Mammucari, Matteo; Fucci, Francesco Paolo Maria; Massari, Francesco; Simonetti, Giovanni

    2010-01-01

    Introduction: Vertebral compression fractures (VCFs), usually caused by osteoporosis, is a disabling pathology associated with back pain, low quality of life and high costs. We report a retrospective study of 852 patients who underwent Percutaneous Vertebroplasty (PVP) in our department, for treatment of refractory back pain caused by osteoporotic vertebral fractures. Objectives: To evaluate the safety and the helpfulness of the PVP in vertebral osteoporotic fractures treatment and, particularly on durable pain reduction, mobility improvement and analgesic drugs need. Materials and Methods: Follow-up analysis was made through a questionnaire filled by the patients before and after PVP (1-6 months), designed to measure pain, ambulation capacity, ability to perform activities of daily living (ADL) and analgesic drugs administration. Results: A statistically significant difference between visual analogue scale (VAS) values before and after treatment has been observed. No difference between VAS values were observed at 1 and 6 months post-treatment period. The treated vertebrae number did not influence post-treatment VAS values during all the follow-up. Ambulation capacity and the ability to perform ADL have been improved following PVP. Patients also reported significant reduction in administration of medications after PVP. Conclusions: PVP is a safe and useful procedure in painful osteoporotic VCFs treatment, able to reduce pain, improve patients mobility and decrease analgesic drugs need. PMID:22461290

  16. Current status of percutaneous vertebroplasty and percutaneous kyphoplasty--a review.

    PubMed

    Yimin, Yang; Zhiwei, Ren; Wei, Ma; Jha, Rajiv

    2013-01-01

    Percutaneous vertebroplasty (PV) and kyphoplasty (PK) are the 2vertebral augmentation procedures that have emerged as minimally invasive surgical options to treat painful vertebral compression fractures (VCF) during the last 2 decades. VCF may either be osteoporotic or tumor-associated. Two hundred million women are affected by osteoporosis globally. Vertebral fracture may result in acute pain around the fracture site, loss of vertebral height due to vertebral collapse, spinal instability, and kyphotic deformity. The main goal of the PV and PK procedures is to give immediate pain relief to patients and restore the vertebral height lost due to fracture. In percutaneous vertebroplasty, bone cement is injected through a minimal incision into the fractured site. Kyphoplasty involves insertion of a balloon into the fractured site, followed by inflation-deflation to create a cavity into which the filler material is injected, and the balloon is taken out prior to cement injection. This literature review presents a qualitative overview on the current status of vertebral augmentation procedures,especially PV and PK, and compares the efficacy and safety of these 2 procedures. The review consists of a brief history of the development of these 2 techniques, a discussion on the current research on the bone cement, clinical outcome of the 2 procedures, and it also sheds light on ongoing and future research to maximize the efficacy and safety of vertebral augmentation procedures. PMID:24097261

  17. Current status of percutaneous vertebroplasty and percutaneous kyphoplasty – a review

    PubMed Central

    Yimin, Yang; Zhiwei, Ren; Wei, Ma; Jha, Rajiv

    2013-01-01

    Percutaneous vertebroplasty (PV) and kyphoplasty (PK) are the 2 vertebral augmentation procedures that have emerged as minimally invasive surgical options to treat painful vertebral compression fractures (VCF) during the last 2 decades. VCF may either be osteoporotic or tumor-associated. Two hundred million women are affected by osteoporosis globally. Vertebral fracture may result in acute pain around the fracture site, loss of vertebral height due to vertebral collapse, spinal instability, and kyphotic deformity. The main goal of the PV and PK procedures is to give immediate pain relief to patients and restore the vertebral height lost due to fracture. In percutaneous vertebroplasty, bone cement is injected through a minimal incision into the fractured site. Kyphoplasty involves insertion of a balloon into the fractured site, followed by inflation-deflation to create a cavity into which the filler material is injected, and the balloon is taken out prior to cement injection. This literature review presents a qualitative overview on the current status of vertebral augmentation procedures, especially PV and PK, and compares the efficacy and safety of these 2 procedures. The review consists of a brief history of the development of these 2 techniques, a discussion on the current research on the bone cement, clinical outcome of the 2 procedures, and it also sheds light on ongoing and future research to maximize the efficacy and safety of vertebral augmentation procedures. PMID:24097261

  18. Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

    SciTech Connect

    Hierholzer, Johannes Fuchs, Heiko; Westphalen, Kerstin; Baumann, Clemens; Slotosch, Christine; Schulz, Rudolf

    2008-11-15

    The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe

  19. Retrieval of Cement Embolus from Inferior Vena Cava After Percutaneous Vertebroplasty

    SciTech Connect

    Athreya, S.; Mathias, N.; Rogers, P.; Edwards, R.

    2009-07-15

    Percutaneous vertebroplasty is an accepted treatment for painful vertebral compression fractures caused by osteoporosis and malignant disease. Venous leakage of cement and pulmonary cement embolism have been reported complications. We describe a paravertebral venous cement leak resulting in the deposition of a cement cast in the inferior vena cava and successful retrieval of the cement embolus.

  20. Cause Analysis of Open Surgery Used After Percutaneous Vertebroplasty and Kyphoplasty

    PubMed Central

    Xu, Zhengwei; Hao, Dingjun; Liu, Tuanjiang; He, Baorong; Guo, Hua; He, Limin

    2016-01-01

    Background The aim of this study was to analyze reasons why open surgery was done after percutaneous vertebroplasty and kyphoplasty. Material/Methods Patients (587 vertebral bodies) treated with percutaneous vertebroplasty or kyphoplasty in the Xi’an Honghui Hospital of Shanxi Province from January 2008 to January 2012 were retrospectively analyzed and 13 patients were enrolled in the study. These 13 patients had serious adverse events after percutaneous vertebroplasty or kyphoplasty. Their average age was 64.5 years old. Nine patients had spinal cord injury and 4 had nerve root injury. All the patients underwent open surgery within 4–12 h after definitive diagnosis. Results All 13 cases were followed up (average time 14.1 months, range 3–47 months). Reasons for open surgery included cement extravasation (6 cases, 46.2%), puncture mistake (3 cases, 23.1%), and false selection of indications (4 cases, 30.8%). At last follow-up, skin feeling was better than that before open surgery in 4 cases with nerve root injury, and muscle strength recovered to grade 5 (3 cases) and grade 4 (1 case). In 9 cases with spinal cord injury, 7 patients improved and 2 remained at the same ASIA level. Conclusions The main reasons for open surgery after percutaneous vertebroplasty and kyphoplasty were cement extravasation (the most common reason), puncture mistake, and false selection of indications. PMID:27444135

  1. A rare presentation of subacute progressive ascending myelopathy secondary to cement leakage in percutaneous vertebroplasty.

    PubMed

    Bhide, Rohit Prakash; Barman, Apurba; Varghese, Shiela Mary; Chatterjee, Ahana; Mammen, Suraj; George, Jacob; Thomas, Raji

    2014-05-01

    Percutaneous vertebroplasty is used to manage osteoporotic vertebral body compression fractures. Although it is relatively safe, complications after vertebroplasty ranging from minor to devastatingly major ones have been described. Cement leakage into the spinal canal is one such complication. Subacute progressive ascending myelopathy is an infrequent neurologic complication after spinal cord injury, typically presenting as ascending neurologic deficit within weeks after the initial insult. The precise cause of subacute progressive ascending myelopathy still remains an enigma, considering the rarity of this disorder. The authors present the case of a 62-yr-old woman with osteoporotic vertebral fracture who underwent percutaneous vertebroplasty and developed T6 complete paraplegia because of cement leakage. A few weeks later, the neurologic level ascended to higher cervical level (C3). To date, no case of subacute progressive ascending myelopathy secondary to cement leakage after percutaneous vertebroplasty has been reported. Literature is reviewed regarding subacute progressive ascending myelopathy, and the rehabilitation challenges in the management of this patient are discussed. PMID:24322431

  2. Percutaneous Vertebroplasty in Adult Degenerative Scoliosis for Spine Support: Study for Pain Evaluation and Mobility Improvement

    PubMed Central

    Filippiadis, Dimitrios K.; Papagelopoulos, Panagiotis; Kitsou, Maria; Oikonomopoulos, Nikolaos; Brountzos, Elias; Kelekis, Nikolaos; Kelekis, Alexis

    2013-01-01

    We evaluate the efficacy-safety of percutaneous vertebroplasty (PV) as primary treatment in adult degenerative scoliosis. During the last 4 years, PV was performed in 18 adult patients (68 vertebral bodies) with back pain due to degenerative scoliotic spine. Under anaesthesia and fluoroscopy, direct access to most deformed vertebral bodies was obtained by 13G needles, and PMMA for vertebroplasty was injected. Scoliosis' inner arch was supported. Clinical evaluation included immediate and delayed studies of patient's general condition and neurological status. An NVS scale helped assessing pain relief, life quality, and mobility improvement. Comparing patients' scores prior to (mean value 8.06 ± 1.3 NVS units), the morning after (mean value 3.11 ± 1.2 NVS units), at 12 (mean value 1.67 ± 1.5 NVS units), and 24 months after vertebroplasty (mean value 1.67 ± 1.5 NVS units) treatment, patients presented a mean decrease of 6.39 ± 1.6 NVS units on terms of life quality improvement and pain relief (P = 0.000). Overall mobility improved in 18/18 (100%) patients. No complications were observed. During follow-up period (mean value 17.66 months), all patients underwent a mean of 1.3 sessions for facet joint and nerve root infiltrations. Percutaneous vertebroplasty in the inner arch seems to be an effective technique for supporting adult degenerative scoliotic spine. PMID:24260742

  3. Percutaneous Vertebroplasty in a Broken Vertebral Titanium Implant (Titanium Mesh Cage)

    SciTech Connect

    Bierry, G.; Buy, X.; Mohan, P. Chandra; Cupelli, J.; Steib, J.P.; Gangi, A.

    2006-08-15

    We report the case of a percutaneous consolidation of a broken vertebral implant (Surgical Titanium Mesh Implants; DePuy Spine, Raynham, MA, USA) by vertebroplasty. Four years after anterior spondylectomy with cage implantation and stabilization with posterior instrumentation, the patient was admitted for excruciating back pain. Radiographs showed fracture of the cage, screw, and rod. An anterior surgical approach was deemed difficult and a percutaneous injection of polymethyl methacrylate into the cage was performed following posterior instrumentation replacement. This seems to be an interesting alternative to the classical anterior surgical approach, which is often difficult in postoperative conditions.

  4. [Ultrasound guided percutaneous nephrolithotripsy].

    PubMed

    Guliev, B G

    2014-01-01

    The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff. PMID:25807772

  5. The effectiveness of percutaneous vertebroplasty in the treatment of different aetiology Vertebral Body Fractures.

    PubMed

    Kloc, Wojciech; Libionka, Witold; Pierzak, Olaf; Liczbik, Wieslaw; Beldzinski, Piotr; Szopa, Beata; Roclawski, Marek; Pankowski, Rafal; Smoczynski, Andrzej; Ceynowa, Marcin

    2012-01-01

    Percutaneous Vertebroplasty (PV) has gained widespread popularity in the treatment of Vertebral Body Fractures (VBFs). The procedure involves the injection of polymethylmethacrylate (PMMA) cement into the fractured vertebral body via a needle that is placed percutaneously using either a transpedicular or extrapedicular approach. Health Related Quality of Life (HRQoL) evaluation is a widespread method of measure of the disease severity and the outcome of the treatment. The subjective feeling of pain in VBFs is crucial for the HRQoL. The aim of the study was to determine the effectiveness of percutaneous vertebroplasty in the treatment of VBFs. A group of 187 patients with VBFs of different etiology resulting from osteoporosis, trauma or tumors were treated with PV in Pomeranian Center of Traumatology in Gdansk from 2010 to 2011. The effectiveness of the treatment was evaluated with Visual Analog Scale (VAS), Hospital Anxiety and Depression Scale (HADS-M), Rolland Morris Scale (RMS), 36-Item Short Form Health Survey (SF-36) and Oswestry Disability Index (ODI) questionnaires administered before and one month after surgery. PV decreased significantly VAS score, depression and anxiety level, what improved significantly HRQoL in patients with VBFs. PMID:22744532

  6. Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

    SciTech Connect

    Orgera, Gianluigi; Krokidis, Miltiadis; Matteoli, Marco; Varano, Gianluca Maria; La Verde, Giacinto; David, Vincenzo; Rossi, Michele

    2013-05-08

    PurposeThis study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).MethodsThirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.ResultsTechnical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.ConclusionsThe use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients.

  7. Percutaneous Vertebroplasty Using Fresh Frozen Allogeneic Bone Chips as Filler

    PubMed Central

    Lee, Song; Kim, Dae Geun; Shin, Won Sik

    2014-01-01

    Background Vertebroplasty is not free from cement related complications. If an allograft is used as a filler, most of them can be averted. Methods Forty consecutive cases of osteoporotic vertebral fracture were divided into two groups by self-selection. The study and the control groups underwent vertebroplasty with fresh frozen allogeneic bone chips and bone cement, respectively. Clinical results were assessed at preoperation, postoperative day 1 and months 3, 6, and 12 by 10-grade visual analog scale (VAS), and radiological results were assessed at the same time by vertebral kyphotic angle (VKA) and local kyphotic angle (LKA). The results were compared within and between the groups. Survival function was analyzed. The criteria of an event were clinical or radiological deterioration versus pre-index surgery state. Results VAS was improved in the study group from 8.4 ± 0.8 to 5.2 ± 1.4, 6.4 ± 1.2, 5.5 ± 2.7, and 3.7 ± 1.4 at postoperative day 1 and months 3, 6, and 12, respectively, and in the control group from 8.4 ± 1.2 to 3.2 ± 1.1, 3.2 ± 1.7, 3.2 ± 2.7, and 2.5 ± 1.7, respectively (within group, p < 0.001; between groups, p < 0.001). VKA was improved in the study group from 18.9° ± 8.0° to 15.2° ± 6.1° (p = 0.046) and in the control group from 14.7° ± 5.2° to 10.3° ± 4.7° (p < 0.001) at postoperative day 1. LKA was not improved in the study group but was improved in the control group from 16.8° ± 11.7° to 14.3° ± 9.6° (p = 0.015). Correction angle was 2.7° ± 4.6°, -7.9° ± 5.3°, -7.2° ± 5.2°, and -7.4° ± 6.3° at postoperative day 1 and months 3, 6, and 12, respectively, in the study group and 4.3° ± 3.7°, 0.7° ± 3.6°, 0.7° ± 4.2°, and 0.1° ± 4.4°, respectively, in the control group. Correction loss was significant in both groups (p < 0.001) and more serious in the study group (p < 0.001). The 6-month survival rate was 16.7% in the study group and 64.3% in the control group (p = 0.003; odds ratio, 5

  8. Intraosseous Venography with Carbon Dioxide in Percutaneous Vertebroplasty: Carbon Dioxide Retention in Renal Veins

    SciTech Connect

    Komemushi, Atsushi Tanigawa, Noboru; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Tokuda, Takanori; Nomura, Motoo; Terada, Jiro; Kamata, Minoru; Sawada, Satoshi

    2008-11-15

    The objective of the present study was to determine the frequency of gas retention in the renal vein following carbon dioxide intraosseous venography in the prone position and, while citing references, to examine its onset mechanisms. All percutaneous vertebroplasties performed at our hospital from January to December 2005 were registered and retrospectively analyzed. Of 43 registered procedures treating 79 vertebrae, 28 procedures treating 54 vertebrae were analyzed. Vertebral intraosseous venography was performed using carbon dioxide as a contrast agent in all percutaneous vertebroplasty procedures. In preoperative and postoperative vertebral CT, gas retention in the renal vein and other areas was assessed. Preoperative CT did not show gas retention (0/28 procedures; 0%). Postoperative CT confirmed gas retention in the renal vein in 10 of the 28 procedures (35.7%). Gas retention was seen in the right renal vein in 8 procedures (28.6%), in the left renal vein in 5 procedures (17.9%), in the left and right renal veins in 3 procedures (10.7%), in vertebrae in 22 procedures (78.6%), in the soft tissue around vertebrae in 14 procedures (50.0%), in the spinal canal in 12 procedures (42.9%), and in the subcutaneous tissue in 5 procedures (17.9%). In conclusion, in our study, carbon dioxide gas injected into the vertebra frequently reached and remained in the renal vein.

  9. Successful thrombolysis, angioplasty, and stenting of delayed thrombosis in the vena cava following percutaneous vertebroplasty with polymethylmethacrylate cement.

    PubMed

    Kim, Suh Min; Min, Seung-Kee; Jae, Hwan Jun; Min, Sang-Il; Ha, Jongwon; Kim, Sang Joon

    2012-10-01

    Percutaneous vertebroplasty is a widely used treatment for vertebral compression fracture. It is relatively safe, but it can be complicated by pulmonary or cerebral embolism caused by the cement injected during the procedure. Here, we present a case of a 69-year-old male with extensive deep vein thrombosis from the inferior vena cava to the right iliac and left femoral veins, which occurred 10 months after vertebroplasty. He was treated successfully by catheter-directed thrombolysis, angioplasty, and stenting. To the best of our knowledge, this is the first report of the successful treatment of delayed thrombosis caused by migrated cement inside the inferior vena cava. PMID:22572011

  10. Biochemical Markers of Bone Turnover in Percutaneous Vertebroplasty for Osteoporotic Compression Fracture

    SciTech Connect

    Komemushi, Atsushi Tanigawa, Noboru; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Tokuda, Takanori; Nomura, Motoo; Terada, Jiro; Kamata, Minoru; Sawada, Satoshi

    2008-03-15

    Purpose. To evaluate relationships between biochemical markers of bone turnover, bone mineral density, and new compression fractures following vertebroplasty. Methods. Initially, we enrolled 30 consecutive patients with vertebral compression fractures caused by osteoporosis. Twenty-three of the 30 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. The patients were divided into two groups: patients with new fractures (group F) and patients with no new fractures (group N). We analyzed differences in the following parameters between these two groups: serum bone alkaline phosphatase, urinary crosslinked N-telopeptide of type I collagen, urinary deoxypyridinoline, and bone mineral density. Next, the patients were divided into another two groups: patients with higher risk (group H: urinary crosslinked N-telopeptide of type I collagen >54.3 nmol BCE/mmol Cr or urinary deoxypyridinoline >7.6 nmol/mmol Cr, and serum bone alkaline phosphatase <29.0 U/l) and patients with lower risk (group L). We analyzed the difference in the rate of new fractures between these two groups. Results. We identified 9 new fractures in 7 patients. There were no significant differences between groups F and N. We identified 5 new fractures in 3 of the 4 patients in group H, and 4 new fractures in 4 of the 19 patients in group L. There was a significant difference in the rate of new fractures between groups H and L. Conclusions. A combination of high levels of bone resorption markers and normal levels of bone formation markers may be associated with increased risk of new recurrent fractures after percutaneous vertebroplasty.

  11. Temperature Measurement During Polymerization of Bone Cement in Percutaneous Vertebroplasty: An In Vivo Study in Humans

    SciTech Connect

    Anselmetti, Giovanni Carlo Manca, Antonio; Kanika, Khanna; Murphy, Kieran; Eminefendic, Haris; Masala, Salvatore; Regge, Daniele

    2009-05-15

    Aim of the study was to 'in vivo' measure temperature, during percutaneous vertebroplasty (PV), within a vertebral body injected with different bone cements. According to the declaration of Helsinki, 22 women (60-80 years; mean, 75 years) with painful osteoporotic vertebral collapse underwent bilateral transpedicular PV on 22 lumbar vertebrae. Two 10-G vertebroplasty needles were introduced into the vertebra under digital fluoroscopy; a 16-G radiofrequency thermoablation needle (Starburst XL; RITA Medical System Inc., USA), carrying five thermocouples, was than coaxially inserted. Eleven different bone cements were injected and temperatures were measured every 30 s until temperatures dropped under 45{sup o}C. After the thermocouple needle was withdrawn, bilateral PV was completed with cement injection through the vertebroplasty needle. Unpaired Student's t-tests, Kruskal-Wallis test, and Wilcoxon signed rank test were used to evaluate significant differences (p < 0.05) in peak temperatures, variations between cements, and clinical outcome. All procedures were completed without complications, achieving good clinical outcomes (p < 0.0001). Regarding average peak temperature, cements were divided into three groups: A (over 60{sup o}C), B (from 50{sup o} to 60{sup o}C), and C (below 50{sup o}C). Peak temperature in Group A (86.7 {+-} 10.7{sup o}C) was significantly higher (p = 0.0172) than that in Groups B (60.5 {+-} 3.7{sup o}C) and C (44.8 {+-} 2.6{sup o}C). The average of all thermocouples showed an extremely significant difference (p = 0.0002) between groups. None of the tested cements maintained a temperature {>=}45{sup o}C for more than 30 min. These data suggest that back-pain improvement is obtained not by thermal necrosis but by mechanical consolidation only. The relative necrotic thermal effect in vertebral metastases seems to confirm that analgesia must be considered the main intent of PV.

  12. Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients.

    PubMed

    Kobayashi, Kiyokazu; Shimoyama, Keiji; Nakamura, Keiya; Murata, Kiyoshi

    2005-02-01

    To assess the immediate efficacy of percutaneous vertebroplasty (PVP) in relief of pain and improving mobility of patients with vertebral compression fractures (VCF) secondary to osteoporosis, 205 cases (175 patients) underwent 250 percutaneous injections of polymethylmethacrylate (PMMA; unilateral, 247 levels; bilateral, 3 levels) into vertebrae under CT and fluoroscopic guidance for 34 months. Patients were prospectively asked to quantify their pain on a visual analog scale (VAS) before and a day after PVP. The interval to mobilization was recorded in those who were immobilized because of pain and/or bed-rest therapy (115 cases). PVP was technically successful in all patients, with three cases of minimal complications. The mean VAS score available for 196 cases was improved from 7.22+/-1.89 (range, 3-10) to 2.07+/-1.19 (range, 0-10) by PVP. Ninety-four of 115 immobilized cases (81.7%) were mobile by 24 h after PVP, and the mean value was 1.9+/-2.8 days. The incidence of recurrent and new fractures was 15.6% in 4-25 months (mean, 15.3 months). PVP is a safe and effective treatment for relieving the pain associated with osteoporotic VCF and strengthening the vertebrae, avoiding refractures. This therapy leads to early mobilization and avoidance of the dangers of conservative therapy of bed-rest. PMID:15662480

  13. Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell's disease: A retrospective study

    PubMed Central

    Zhang, Guang-Quan; Gao, Yan-Zheng; Chen, Shu-Lian; Ding, Shuai; Gao, Kun; Wang, Hong-Qiang

    2015-01-01

    Background: Post traumatic osteonecrosis of a vertebral body occurring in a delayed fashion was first described by the German doctor Kümmell in 1895. Several studies have reported percutaneous vertebroplasty (PVP), or percutaneous kyphoplasty (PKP) for Kümmell's disease achieves good outcomes. However, it is unknown whether a technique is superior for the treatment of this disease. The objective of the study is to compare the efficacy of PVP and PKP for the treatment of Kümmell's disease. Materials and Methods: A retrospective review was conducted for 73 patients with Kümmell's disease. PVP was performed in 38 patients and PKP in 35 patients. Visual analogue score (VAS) was used to evaluate pain. The anterior vertebral height was measured. The operative time, the incidence of cement leakage and the costs were recorded. Results: In both PVP group and PKP group, the VAS and anterior vertebral height significantly improved at 1-day postoperatively (P < 0.05), and the improvement sustained at the final followup (P > 0.05). Between the PVP and PKP groups, there were no significant differences in VAS and the anterior vertebral height at 1-day postoperatively and at the final followup (P > 0.05). The operating time and expense in the PKP group were higher than the PVP group (P < 0.001). Cement leakages in the PKP group were fewer than PVP group (P < 0.05). Conclusions: PVP is a faster, less expensive option that still provides a comparable pain relief and restoration of vertebral height to PKP for the treatment of Kümmell's disease. PKP has a significant advantage over PVP in term of the fewer cement leakages. PMID:26806962

  14. Gold fiducials are a unique marker for localization in the thoracic spine: a cost comparison with percutaneous vertebroplasty.

    PubMed

    Macki, Mohamed; Bydon, Mohamad; McGovern, Kelly; Abt, Nicholas; de la Garza-Ramos, Rafael; Naff, Neal; Bydon, Ali

    2014-10-01

    We present a unique application of the gold fiducial as a preoperative, radiographic marker placed in the thoracic spine and used for intraoperative localization. In comparison to percutaneous vertebroplasty marking of thoracic spinal levels with polymethyl methacrylate (PMMA) cement, implantation of the gold fiducial is technically facile with a minimal learning curve. The fiducial markers are also associated with significantly less financial resources. Following 2013 Current Procedural Terminology (CPT) coding, the cost of vertebroplasty under fluoroscopic guidance, $3195·43, or under computed tomography (CT) guidance, $3232·54, is more than double the cost of the gold fiducial implantation - $1237·55 and $1267·03, under similar imaging techniques, respectively. In the first description of gold fiducials in the thoracic spine, we conclude that the marker is a safe and cost-effective method for preoperative localization of the thoracic levels. PMID:24963696

  15. Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

    SciTech Connect

    Anselmetti, Giovanni Carlo Manca, Antonio; Montemurro, Filippo; Hirsch, Joshua; Chiara, Gabriele; Grignani, Giovanni Carnevale Schianca, Fabrizio Capaldi, Antonio Rota Scalabrini, Delia; Sardo, Elena Debernardi, Felicino; Iussich, Gabriella; Regge, Daniele

    2012-02-15

    Purpose: Percutaneous vertebroplasty (PV) is a minimally invasive procedure involving the injection of bone cement within a collapsed vertebral body. Although this procedure was demonstrated to be effective in osteoporosis and metastases, few studies have been reported in cases of multiple myeloma (MM). We prospectively evaluated the safety and efficacy of PV in the treatment of vertebral compression fractures (VCFs) resulting from MM. Materials and Methods: PV was performed in 106 consecutive MM patients who had back pain due to VCFs, the treatment of which had failed conservative therapies. Follow-up (28.2 {+-} 12.1 months) was evaluated at 7 and 15 days as well as at 1, 3, 6, 12, 18, and every 6 months after PV. Visual analog scale (VAS) pain score, opioid use, external brace support, and Oswestry Disability Index (ODI) score were recorded. Results: The median pretreatment VAS score of 9 (range 4-10) significantly (P < 0.001) decreased to 1 (range 0-9) after PV. Median pre-ODI values of 82% (range 36-89%) significantly improved to 7% (range 0-82%) (P < 0.001). Differences in pretreatment and posttreatment use of analgesic drug were statistically significant (P < 0.001). The majority of patients (70 of 81; 86%) did not use an external brace after PV (P < 0.001). Conclusion: PV is a safe, effective, and long-lasting procedure for the treatment of vertebral compression pain resulting from MM.

  16. Efficacy of Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft

    PubMed Central

    Nakamae, Toshio; Fujimoto, Yoshinori; Yamada, Kiyotaka; Hashimoto, Takashi; Olmarker, Kjell

    2015-01-01

    Intravertebral cleft (IVC) is frequently observed in patients with painful osteoporotic vertebral compression fracture (OVCF). Some studies reported the usefulness of percutaneous vertebroplasty (PVP) for treating OVCF with IVC. However, systematic studies are scarce, and their results are conflicting. The purpose of this study was to evaluate the clinical and radiographic results of PVP in the treatment of painful OVCF with IVC. Two hundred ninety-one patients with OVCF with IVC underwent PVP. Back pain was measured using a visual analog scale (VAS), and physical disability was assessed using the Oswestry Disability Index (ODI). Three radiological parameters were assessed: the local kyphotic angle, percentage spinal canal cross-sectional area of compromise, and intravertebral instability of the affected vertebra. The mean follow-up period was 28 months. The mean values for the VAS and ODI were 8.4 and 60.0%, respectively, before PVP, versus 3.9 and 35.4%, respectively, at the final follow-up. The average local kyphotic angle, percentage spinal canal cross-sectional area of compromise, and intravertebral instability were 10.5°, 17.9% and 6.1°, respectively, before PVP and 8.1°, 15.2%, and 0.8°, respectively, at the final follow-up. There were no neurological or systemic complications due to cement leakage. PVP is an effective and safe intervention for treating OVCF with IVC. PMID:26157525

  17. Effectiveness of percutaneous vertebroplasty in patients with multiple myeloma having vertebral pain

    PubMed Central

    Nas, Ömer Fatih; İnecikli, Mehmet Fatih; Hacıkurt, Kadir; Büyükkaya, Ramazan; Özkaya, Güven; Özkalemkaş, Fahir; Ali, Rıdvan; Erdoğan, Cüneyt; Hakyemez, Bahattin

    2016-01-01

    PURPOSE We aimed to assess the effectiveness, benefits, and reliability of percutaneous vertebroplasty (PV) in patients with vertebral involvement of multiple myeloma. METHODS PV procedures performed on 166 vertebrae of 41 patients with multiple myeloma were retrospectively evaluated. Most of our patients were using level 3 (moderate to severe pain) analgesics. Magnetic resonance imaging was performed before the procedure to assess vertebral involvement of multiple myeloma. The following variables were evaluated: affected vertebral levels, loss of vertebral body height, polymethylmethacrylate (PMMA) cement amount applied to the vertebral body during PV, PMMA cement leakages, and pain before and after PV as assessed by a visual analogue scale (VAS). RESULTS Median VAS scores of patients decreased from 9 one day before PV, to 6 one day after the procedure, to 3 one week after the procedure, and eventually to 1 three months after the procedure (P < 0.001). During the PV procedure, cement leakage was observed at 68 vertebral levels (41%). The median value of PMMA applied to the vertebral body was 6 mL. CONCLUSION Being a minimally invasive and easily performed procedure with low complication rates, PV should be preferred for serious back pain of multiple myeloma patients. PMID:26912107

  18. Percutaneous Vertebroplasty in Vertebral Metastases from Breast Cancer: Interest in Terms of Pain Relief and Quality of Life

    PubMed Central

    Barragán-Campos, Héctor Manuel; Le Faou, Anne-Laurence; Rose, Michèle; Livartowski, Alain; Doz, Marianne; Astagneau, Pascal; Cormier, Evelyne; Chiras, Jacques

    2014-01-01

    Summary Percutaneous vertebroplasty (PV) is a therapeutic option in patients with vertebral metastases (VM). However its efficacy in pain relief, improvement in quality of life and safety in patients with VM from breast cancer has not been reported. We present a longitudinal retrospective study of 31 consecutively treated female patients with VM from breast cancer where 88 vertebrae were treated in 44 sessions of PV, in which osteolytic, osteoblastic and mixed lesions were recorded. The visual analogue pain scale (VAS) was used to evaluate pain pre-PV, at one, three, six and 12 months post-PV. The Eastern Cooperative Group (ECOG) performance status scale was used at the same time intervals to measure quality of life: 90.3% pain relief was identified with a VAS reduction from 5.7 ± 2.0 pre-PV to 2.9 ± 2.2 post-PV at one-month follow-up (p<0.001) and 0.6 ± 1.0 at 12-month follow-up (p<0.001). In our series 48.4% of patients were classified as having an ECOG grade 0 and 1 pre-PV, which increased to 80.8% at the 12-month follow-up. While 22.6% of the patients were classified at ECOG grades 3 and 4 pre-PV, this improved to 0% at 12 months follow-up. The morbidity rate for this procedure was 12.9% immediately and only 3.2% at 30 days post-PV with all complications being resolved medically or with CT-guided infiltration. PV is a safe procedure with a high efficacy in pain relief, and improvement of quality of life in patients with diverse types of VM from breast cancer. PMID:25363262

  19. Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients.

    PubMed

    Saracen, Agnieszka; Kotwica, Zbigniew

    2016-06-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins-osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve  hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues-20%; paravertebral vein embolism-13%; intradiscal leakage-8%; and PMMA leakage into the spinal canal-0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed after surgery

  20. Percutaneous Vertebroplasty: Preliminary Experiences with Rotational Acquisitions and 3D Reconstructions for Therapy Control

    SciTech Connect

    Hodek-Wuerz, Roman Martin, Jean-Baptiste; Wilhelm, Kai; Lovblad, Karl O.; Babic, Drazenko; Rufenacht, Daniel A.; Wetzel, Stefan G.

    2006-10-15

    Percutaneous vertebroplasty (PVP) is carried out under fluoroscopic control in most centers. The exclusion of implant leakage and the assessment of implant distribution might be difficult to assess based on two-dimensional radiographic projection images only. We evaluated the feasibility of performing a follow-up examination after PVP with rotational acquisitions and volumetric reconstructions in the angio suite. Twenty consecutive patients underwent standard PVP procedures under fluoroscopic control. Immediate postprocedure evaluation of the implant distribution in the angio suite (BV 3000; Philips, The Netherlands) was performed using rotational acquisitions (typical parameters for the image acquisition included a 17-cm field-of-view, 200 acquired images for a total angular range of 180{sup o}). Postprocessing of acquired volumetric datasets included multiplanar reconstruction (MPR), maximum intensity projection (MIP), and volume rendering technique (VRT) images that were displayed as two-dimensional slabs or as entire three-dimensional volumes. Image evaluation included lesion and implant assessment with special attention given to implant leakage. Findings from rotational acquisitions were compared to findings from postinterventional CT. The time to perform and to postprocess the rotational acquisitions was in all cases less then 10 min. Assessment of implant distribution after PVP using rotational image acquisition methods and volumetric reconstructions was possible in all patients. Cement distribution and potential leakage sites were visualized best on MIP images presented as slabs. From a total of 33 detected leakages with CT, 30 could be correctly detected by rotational image acquisition. Rotational image acquisitions and volumetric reconstruction methods provided a fast method to control radiographically the result of PVP in our cases.

  1. Radiological Follow-up of New Compression Fractures Following Percutaneous Vertebroplasty

    SciTech Connect

    Tanigawa, Noboru Komemushi, Atsushi; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Sawada, Satoshi

    2006-02-15

    The purpose of the present study was to ascertain chronological changes in the analgesic effects of percutaneous vertebroplasty (PVP) on osteoporotic vertebral compression factures and to radiologically follow new compression fractures after PVP. Seventy-six patients (206 vertebral bodies) were followed radiologically for a mean of 11.5 months. A visual analog scale (VAS; 0-10) was used to assess pain severity, and frontal and lateral plain radiographs of the thoracic and lumbar vertebrae were taken 1-3 days and 1, 4, 10, and 22 months after PVP.The average VAS score was 7.2 {+-} 2.0 (mean pain score {+-} standard deviation) before PVP, 2.5 {+-} 2.3 at 1-3 days after PVP, 2.2 {+-} 2.3 at 1 month, 1.9 {+-} 2.2 at 4 months, 1.8 {+-} 2.4 at 10 months, and 1.0 {+-} 0.2 at 22 months. A new compression fracture was confirmed in 56 vertebral bodies in 28 patients (36.8%), affecting 38 adjacent vertebral bodies (67.8%), 17 nonadjacent vertebral bodies (30.4%), and 1 treated vertebral body (1.8%). A new compression fracture occurred within 1 week of PVP in 2 vertebral bodies (3.6%), between 1 week and 1 month after PVP in 22 (39.3%), between 1 and 3 months in 12 (21.4%), between 3 and 6 months in 12 (21.4%), and after more than 6 months in 8 (14.3%). PVP was highly effective in relieving the pain associated with osteoporosis-induced vertebral compression fractures, and this analgesia was long lasting. Radiological follow-up observation revealed new compression fractures in about one-third of patients. More than half of these new compression fractures occurred in adjacent vertebral bodies within 3 months of PVP.

  2. Ultrasound-guided percutaneous thoracoabdominal biopsy.

    PubMed

    Ojalehto, M; Tikkakoski, T; Rissanen, T; Apaja-Sarkkinen, M

    2002-03-01

    This review will discuss the benefits and disadvantages of ultrasound-guided percutaneous fine-needle aspiration and cutting needle biopsies. Clinical efficacy, cost-effectiveness, some controversies and safety will be reviewed. PMID:12010294

  3. Percutaneous vertebroplasty for Langerhans cell histiocytosis of the lumbar spine in an adult: Case report and review of the literature

    PubMed Central

    FENG, FEI; TANG, HAI; CHEN, HAO; JIA, PU; BAO, LI; LI, JIN-JUN

    2013-01-01

    Langerhans cell histiocytosis (LCH) is extremely rare in the lumbar spine of adults. The radiological features typically manifest as vertebral tumors. The exact etiology of LCH remains unknown. Langerhans cells may cause local or systemic effects. The most frequent sites of these bony lesions are the skull, femur, mandible, pelvis and spine. To date, only 3 spinal LCH cases treated by percutaneous vertebroplasty (PVP) have been reported. The present study reports a case of LCH of the fourth lumbar vertebra (L4) in a 51-year-old male with a 10-day history of low back pain, limited waist motion and right lower limb numbness. The patient was treated using PVP. The use of PVP for treating LCH of the spine was successful. The present study provides an up-to-date literature overview of LCH. PMID:23251253

  4. Long-term Follow-up of Percutaneous Vertebroplasty in Osteoporotic Compression Fracture: Minimum of 5 Years Follow-up

    PubMed Central

    Kim, Jin Hwan; Yoo, Si Hoon

    2012-01-01

    Study Design This was designed as a retrospective study. Purpose We assessed the radiographic and clinical outcome of patients who underwent percutaneous vertebroplasty (PVP) in osteoporotic compression fractures with a minimum of 5 years follow-up. Overview of Literature Percutaneous vertebroplasty is effective surgical method for treating osteoporotic compression fracture. Methods Between January 2000 and August 2005, 159 patients were treated with PVP for osteoporotic compression fracture at our department; 43 patients died during follow-up, and 69 patients (121 vertebras) were available for follow-up for over 5 years. We analyzed the clinical and radiologic outcome including cement feature. Results The mean follow-up period was 5.7 years. Clinical outcome by mean visual analogue scale (VAS) score revealed a decreased 4.9 points perioperatively. A decreased score was maintained over 5 years in 46% of patients. A new adjacent vertebral fracture was documented by 33 vertebral bodies in 22 patients. During the follow-up period, 43 patients (38%) in 112 patients died. Anterior body heig ht in the last follow-up was improved about 0.3 mm compared with the preprocedural value, but was not statistically significant. Also, the focal kyphotic angle was reduced from 12.3° at the preprocedural state to 11.7° at the postprocedural state, but was not statistically significant (p > 0.05). Conclusions PVP for osteoporotic compression fracture is an efficient procedure for pain relief by long term follow-up. The cement injected vertebrae showed stable radiologic progression without significant changes in vertebral height or kyphotic angle. PMID:22439082

  5. The Early Stage Adjacent Disc Degeneration after Percutaneous Vertebroplasty and Kyphoplasty in The Treatment of Osteoporotic VCFs

    PubMed Central

    Qian, Jun; Yang, Huilin; Jing, Juehua; Zhao, Hong; Ni, Li; Tian, Dasheng; Wang, Zhengfei

    2012-01-01

    Background The purpose of this paper is to determine the early incidence of disc de- generation adjacent to the vertebral body of osteoporotic fracture treated with percutaneous vertebroplasty or balloon kyphoplasty and whether adjacent disc degeneration is accelerated by this two procedures. Methods 182 patients with painful vertebral compression fractures were treated. A total of 97 patients were enrolled in this prospective study. 97 patients with a mean age of 65.3 years were classified into control group and surgical treatment group of non-random. 35 patients were in contol group and 62 patients who were performed percutaneous vertebroplasty or balloon kyphoplasty in treatment group. X-ray and Magnetic resonance imaging were done at the first and final visit. The grade of disc degeneration above the fractured vertebral was confirmed by evaluation of bony oedema in the fat suppressed sequences and T2-weighted image of magnetic resonance imaging. The height of degenerative disc was measured on X-ray film. Results All patients were followed up two years after the first visit and the follow-up rate was 90.7% (88/97). The incidence of degeneration of adjacent disc above the fractured vertebral was 29.0% (9/31) in control group and 52.6% (30/57) in treatment group. It presented a statistically significant difference between two groups about the incidence of adjacent disc degeneration (P = 0.033). The percentage of adjacent disc height reduction in control group was 13.5% and 17.6% in treatment group. Statistically significant difference of VAS score and ODI was not found between the first evaluation postoperatively and the final follow-up in treatment group (P>0.05). Conclusions Disc degeneration adjacent to the fractured vertebral is accelerated by VP and BK procedures in the early stage, but clinical outcomes has not been weakened even in the presence of accelerated disc degeneration. PMID:23056283

  6. Vertebral Stenting and Vertebroplasty Guided by an Angiographic 3D Rotational Unit

    PubMed Central

    Víctor Hugo, Escobar-de la Garma; Henry Luis, Jorge-Barroso; Felipe, Padilla-Vázquez; Luis, Balderrama-Bañares Jorge

    2015-01-01

    Introduction. Use of interventional imaging systems in minimally invasion procedures such as kyphoplasty and vertebroplasty gives the advantage of high-resolution images, various zoom levels, different working angles, and intraprocedure image processing such as three-dimensional reconstructions to minimize complication rate. Due to the recent technological improvement of rotational angiographic units (RAU) with flat-panel detectors, the useful interventional features of CT have been combined with high-quality fluoroscopy into one single machine. Intraprocedural 3D images offer an alternative way to guide needle insertion and the safe injection of cement to avoid leakages. Case Report. We present the case of a 72-year-old female patient with insidious lumbar pain. Computed tomography revealed a wedge-shaped osteoporotic compression fracture of T10 vertebrae, which was treated successfully with the installation of vertebral stenting system and vertebroplasty with methacrylate guided with a rotational interventional imaging system. Conclusion. Rotational angiographic technology may provide a suitable place for the realization of high-quality minimally invasive spinal procedures, such as kyphoplasty, vertebroplasty, and vertebral stenting. New software programs available nowadays offer the option to make three-dimensional reconstructions with no need of CT scans with the same degree of specificity. PMID:25802784

  7. Percutaneous Vertebroplasty for Osteoporotic Compression Fracture: Multivariate Study of Predictors of New Vertebral Body Fracture

    SciTech Connect

    Komemushi, Atsushi Tanigawa, Noboru; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Komemushi, Sadao; Sawada, Satoshi

    2006-08-15

    Purpose. To investigate the risk factors and relative risk of new compression fractures following vertebroplasty. Methods. Initially, we enrolled 104 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 83 of the 104 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. Logistic regression analysis of the data obtained from these 83 patients was used to determine relative risks of recurrent compression fractures, using 13 different factors. Results. We identified 59 new fractures in 30 of the 83 patients: 41 new fractures in vertebrae adjacent to treated vertebrae; and 18 new fractures in vertebrae not adjacent to treated vertebrae. New fractures occurred in vertebrae adjacent to treated vertebrae significantly more frequently than in vertebrae not adjacent to treated vertebrae. Only cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty (odds ratio = 4.633). None of the following covariates were associated with increased risk of new fracture: age, gender, bone mineral density, the number of vertebroplasty procedures, the number of vertebrae treated per procedure, the cumulative number of vertebrae treated, the presence of a single untreated vertebra between treated vertebrae, the presence of multiple untreated vertebrae between treated vertebrae, the amount of bone cement injected per procedure, the cumulative amount of bone cement injected, cement leakage into the soft tissue around the vertebra, and cement leakage into the vein.

  8. [Ultrasound-guided percutaneous nephrostomy].

    PubMed

    Martino, P

    2000-12-01

    Percutaneous nephrostomy is a mini-invasive technique that creates an external outlet from the renal excretory tract through a catheter inserted through the flank. Indications for this procedure are of both diagnostic and therapeutic type. The nephrostomic catheter is generally positioned under ultrasound guidance, which has the advantages of showing the localization of the renal cavities and the depth of the kidney, and can be used during pregnancy and in subjects with allergy to contrast medium or with reduced renal function. When possible, it is best to associate US with fluoroscopic guidance, as this association has been found to guarantee a success rate exceeding 98%. Within the kidney, the zone known as Broedel's avascular plane, where the terminal branches of the posterior and anterior arterial systems meet, is the safest place to pass the nephrostomic catheter through, as there is little vascularization in this zone. Access is generally posterior and at the level of the inferior calyx, by means of Seldinger's, the one step or a mixed access technique involving a catheter sheathing a metal cannula. Seldinger's access technique is most commonly used, entailing explorative puncture of the renal cavity with a 22 G needle. We prefer to puncture the kidney direct, under US guidance and using an 18 G needle: a metal wire is passed through the needle and then after withdrawing the needle, the fascia dilators are inserted, of scaled widths increasing up to 2 G wider than the nephrostomic catheter. Care must be taken not to go beyond the curve of the guide wire to avoid trauma to the renal parenchyma. The most critical moment is when the catheter is inserted along the wire at the point of passage through the peri-renal fat: the catheter tends to deflect the point of the guide wire away from the desired direction as the peri-renal fat offers less resistance. The metal wire may be of variable rigidity and length, hydrophilic. The catheter may also be made of various

  9. Percutaneous Vertebroplasty: A New Serial Injection Technique to Minimize Cement Leak

    PubMed Central

    2015-01-01

    Study Design This is a prospective cohort study. Purpose This study discusses a new technique for injecting cement in the affected vertebrae. Overview of Literature Since introduction of vertebroplasty to clinical practice, the cement leak is considered the most frequent and hazardous complication. In literature, the cement extravasation occurred in 26%-97% of the cases. Methods A hundred and twenty-three patients underwent vertebroplasty using the serial injection technique. The package of the cement powder and the solvent was divided into five equal parts. Each part of the powder and the solvent was mixed as a single dose and injected to the affected vertebra. The duration between subsequent injections was 10 minutes. Each injection consisted of 1-1.5 mL of cement. Results This new technique gives the surgeon enough time to make multiple separate injections using the same package. The time interval between injections hardens the cement just enough so that it does not get displaced by the next cement injection. This technique gives time to the preceding injected cement to seal off the cracks and cavities in the vertebra, and subsequently leads to a significant decrease in cement leak (p<0.001), as compared to literature. Conclusions This study demonstrates a previously unreported technique for vertebroplasty that adds more safety to the procedure by significantly decreasing cement leak. It also makes the surgeon more relaxed due to time intervals, giving him more self-confidence whilst performing the procedure. PMID:26713116

  10. Ultrasound-guided percutaneous breast biopsy.

    PubMed

    Newell, Mary S; Mahoney, Mary C

    2014-03-01

    Ultrasound-guided percutaneous tissue sampling of the breast has positively altered the management of breast lesions, both benign and malignant, since its inception in the 1980s and subsequent widespread acceptance in the 1990s. Its safety, accuracy, and cost-effectiveness have been validated in several studies. However, percutaneous biopsy serves a patient best when performed by an operator with full awareness of patient׳s salient imaging findings; a knowledge of the benefits, limitations, and technical requirements of breast ultrasound; and a thorough understanding of what constitutes an adequate and concordant pathologic specimen. This article outlines a general approach to ultrasound (US)-guided percutaneous breast biopsy and discusses indications, potential complications, and technical aspects of the procedure. PMID:24636328

  11. Relationship between trabecular texture features of CT images and an amount of bone cement volume injection in percutaneous vertebroplasty

    NASA Astrophysics Data System (ADS)

    Tack, Gye Rae; Choi, Hyung Guen; Shin, Kyu-Chul; Lee, Sung J.

    2001-06-01

    Percutaneous vertebroplasty is a surgical procedure that was introduced for the treatment of compression fracture of the vertebrae. This procedure includes puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to disproportionate PMMA volume injection have been reported as one of complications in vertebroplasty. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. In this study, appropriate amount of PMMA volume was assessed based on the imaging data of a given patient under the following hypotheses: (1) a relationship can be drawn between the volume of PMMA injection and textural features of the trabecular bone in preoperative CT images and (2) the volume of PMMA injection can be estimated based on 3D reconstruction of postoperative CT images. Gray-level run length analysis was used to determine the textural features of the trabecular bone. The width of trabecular (T-texture) and the width of intertrabecular spaces (I-texture) were calculated. The correlation between PMMA volume and textural features of patient's CT images was also examined to evaluate the appropriate PMMA amount. Results indicated that there was a strong correlation between the actual PMMA injection volume and the area of the intertrabecular space and that of trabecular bone calculated from the CT image (correlation coefficient, requals0.96 and requals-0.95, respectively). T- texture (requals-0.93) did correlate better with the actual PMMA volume more than the I-texture (requals0.57). Therefore, it was demonstrated that appropriate PMMA injection volume could be predicted based on the textural analysis for better clinical management of the osteoporotic spine.

  12. Influence of Vertebral Bone Marrow Edema on Outcome in Non-Acute Osteoporotic Patients Treated with Percutaneous Vertebroplasty

    PubMed Central

    2016-01-01

    Study Design Prospective cohort study. Purpose To prospectively investigate the influence of presence of bone marrow edema (BME) in non acute osteoporotic verterbral compression fractures on postoperative clinical outcome in patients treated by percutaneous vertebroplasty (PV). Overview of Literature Although PV is widely used to treat osteoporotic collapsed vertebral compression fractures (VCF); little is known about the influence of BME in osteoporotic VCF or about its relation with relief of pain. Methods Sixty seven patients with non acute osteoporotic verterbral compression fractures treated with PV. They were divided into edema group (56 patients with apparent vertebral BME in their magnetic resonance [MR] images), and non edema group (11 patients with no vertebral BME detected in their MR images). Pain was evaluated one week, one month, six months, and one year post procedure using visual analogue scale. Statistical analysis including a 2-tailed t test comparing postoperative data with preoperative values was done. Results A good clinical response to PV procedure was seen in all patients. Significant difference was seen between two groups in one week, and one month follow up periods. Regarding pain relief in the other periods of follow up, no significant difference was seen between two groups. Conclusions PV resulted in significantly clinical improvement in patients with BME pattern than in those without in one week and one month follow up periods. But the absence of vertebral BME did not influence pain relief in patients with osteoporotic VCFs in six months, and one year post procedure. PMID:27340521

  13. Pain Relief Following Percutaneous Vertebroplasty: Results of a Series of 283 Consecutive Patients Treated in a Single Institution

    SciTech Connect

    Anselmetti, Giovanni Carlo Corrao, Giovanni; Monica, Patrizia Della; Tartaglia, Vincenzo; Manca, Antonio; Eminefendic, Haris; Russo, Filippo; Tosetti, Irene; Regge, Daniele

    2007-06-15

    The aim of this study was to assess if percutaneous vertebroplasty (PVP) could relieve back pain, reduce drug consumption, and improve the mobility of patients with metastases and vertebral compression fractures. From August 2002 to July 2004, 283 patients (216 females; mean age: 73.8 {+-} 9.9 years) underwent PVP on 749 vertebrae. Pain was evaluated with the pain intensity numeric rating scale (PI-NRS) (0 = no pain; 10 = worst pain) before the procedure and at the end point in September 2004 (follow-up:1-24 months; median: 7 months). A reduction of at least two points of the PI-NRS score was considered clinically relevant. Two hundred four patients were available for evaluation at the end point. Overall results showed a reduction of the median pain score from 8 at baseline to 1 at the end point (p < 0.0001); a clinically relevant pain reduction was observed in 176/205 patients (86%); 89/147 patients (61%) gave up a brace support (p < 0.0001); and 117/190 patients (62%) gave up drug therapy. Results were similar in different subgroups stratified according to age, underlying pathology, number of fractured or treated vertebrae, and length of follow-up. This study adds evidence that PVP is effective in treating painful vertebral fractures. A significant reduction in drug assumption and significant mobility improvement can also be achieved.

  14. Feasibility Study of Needle Placement in Percutaneous Vertebroplasty: Cone-Beam Computed Tomography Guidance Versus Conventional Fluoroscopy

    SciTech Connect

    Braak, Sicco J.; Zuurmond, Kirsten Aerts, Hans C. J.; Leersum, Marc van Overtoom, Timotheus T. Th. Heesewijk, Johannes P. M. van Strijen, Marco J. L. van

    2013-08-01

    ObjectiveTo investigate the accuracy, procedure time, fluoroscopy time, and dose area product (DAP) of needle placement during percutaneous vertebroplasty (PVP) using cone-beam computed tomography (CBCT) guidance versus fluoroscopy.Materials and MethodsOn 4 spine phantoms with 11 vertebrae (Th7-L5), 4 interventional radiologists (2 experienced with CBCT guidance and two inexperienced) punctured all vertebrae in a bipedicular fashion. Each side was randomization to either CBCT guidance or fluoroscopy. CBCT guidance is a sophisticated needle guidance technique using CBCT, navigation software, and real-time fluoroscopy. The placement of the needle had to be to a specific target point. After the procedure, CBCT was performed to determine the accuracy, procedure time, fluoroscopy time, and DAP. Analysis of the difference between methods and experience level was performed.ResultsMean accuracy using CBCT guidance (2.61 mm) was significantly better compared with fluoroscopy (5.86 mm) (p < 0.0001). Procedure time was in favor of fluoroscopy (7.39 vs. 10.13 min; p = 0.001). Fluoroscopy time during CBCT guidance was lower, but this difference is not significant (71.3 vs. 95.8 s; p = 0.056). DAP values for CBCT guidance and fluoroscopy were 514 and 174 mGy cm{sup 2}, respectively (p < 0.0001). There was a significant difference in favor of experienced CBCT guidance users regarding accuracy for both methods, procedure time of CBCT guidance, and added DAP values for fluoroscopy.ConclusionCBCT guidance allows users to perform PVP more accurately at the cost of higher patient dose and longer procedure time. Because procedural complications (e.g., cement leakage) are related to the accuracy of the needle placement, improvements in accuracy are clinically relevant. Training in CBCT guidance is essential to achieve greater accuracy and decrease procedure time/dose values.

  15. Transgluteal CT-Guided Percutaneous Renal Access for Percutaneous Nephrolithotomy in a Pelvic Horseshoe Kidney

    PubMed Central

    Mullins, Ryan J.; Dauw, Casey A.; Borofsky, Michael S.; York, Nadya; Patel, Aashish A.

    2015-01-01

    Abstract CT-guided percutaneous renal access has been described as a safe and effective access technique in patients with complex anatomy, including ectopic kidney, retrorenal colon, spinal dysraphism, hepatomegaly, and splenomegaly. In comparison to conventional intraoperative fluoroscopic-guided access, CT imaging allows for delineation of surrounding structures that are at risk for injury during percutaneous access. However, previous reports indicate that pelvic kidneys might be inaccessible percutaneously without laparoscopic assistance. Herein, we present a novel transgluteal route to renal access for percutaneous nephrolithotomy (PCNL) in a patient with a pelvic horseshoe kidney and severe spinal deformity.

  16. Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC

    PubMed Central

    Li, Yi; Qing, Yi; Zhang, Zhimin; Li, Mengxia; Xie, Jiaying; Wang, Ge; Wang, Dong

    2015-01-01

    Objective This study aimed to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) combined with intensity-modulated radiotherapy (IMRT) for metastatic lesions of patients with non-small-cell lung cancer (NSCLC) at centrum vertebrae. Methods A total of 39 patients with spinal metastatic NSCLC (stage IV) were treated with PVP followed by IMRT (30 Gy/10F/2 W) for metastatic lesion at centrum vertebrae under local anesthesia. Retrospective analysis was done with medical records and radiological data. The change of visual analog scale (VAS), activities of daily living, and kyphotic angle was measured preoperatively. The presence of complications was assessed preoperatively (baseline) at 24 hours, 1 week, and 1, 3, 6, 12, and 24 months postoperatively, or until the patient died or was lost to follow-up. Survival was assessed in the group. Results A total of 39 consecutive patients were successfully treated with PVP via a translateral approach and IMRT. Their mean VAS score decreased from 7.93±1.09 preoperatively to 4.14±1.15 by the 24-hour postoperative time point and was 3.92±1.23 at 1 week, 4.27±1.93 at 1 month, 3.24±1.35 at 3 months, 2.27±0.96 at 6 months, and 2.59±1.55 at 12 months after the procedure. The mean VAS score at all of the postoperative time points was decreased significantly from the preoperative baseline score (P<0.05). Activities of daily living evaluation showed that the patients had a significantly high life quality after the combined approach (50.9±11.7 vs 82.3±9.9, P<0.05). No severe complications were observed. Mild complications included two cases (5.13%) of asymptomatic cement leakage into the epidural space and one case (2.56%) of paravertebral leakage. Median survival time was extended to 13 months. Conclusion The safety and efficacy of PVP combined with IMRT in patients with NSCLC with metastatic lesions at centrum vertebrae and the ability to prevent the diseased vertebrae from further deformation and tumor

  17. Significantly reduced radiation dose to operators during percutaneous vertebroplasty using a new cement delivery device

    PubMed Central

    2014-01-01

    Background Percutaneous vertebroplasy (PVP) might lead to significant radiation exposure to patients, operators, and operating room personnel. Therefore, radiaton exposure is a concern. The aim of this study was to present a remote control cement delivery device and study whether it can reduce dose exposue to operators. Methods After meticulous preoperative preparation, a series of 40 osteoporosis patients were treated with unilateral approach PVP using the new cement delivery divice. We compared levels of fluoroscopic exposure to operator standing on different places during operation. group A: operator stood about 4 meters away from X-ray tube behind the lead sheet. group B: operator stood adjacent to patient as using conventional manual cement delivery device. Results During whole operation process, radiation dose to the operator (group A) was 0.10 ± 0.03 (0.07-0.15) μSv, group B was 12.09 ± 4.67 (10–20) μSv. a difference that was found to be statistically significant (P < 0.001) between group A and group B. Conclusion New cement delivery device plus meticulous preoperative preparation can significantly decrease radiation dose to operators. PMID:25084860

  18. The Effectiveness of Percutaneous Vertebroplasty Is Determined by the Patient-Specific Bone Condition and the Treatment Strategy

    PubMed Central

    Hazrati Marangalou, Javad; van den Bergh, Joop P.; van Rietbergen, Bert; Ferguson, Stephen J.

    2016-01-01

    Purpose Vertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment. Methods A Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments. Results The results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture. Conclusions We conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy. PMID:27100630

  19. Comparative Prospective Study of Load Distribution Projection Among Patients with Vertebral Fractures Treated with Percutaneous Vertebroplasty and a Control Group of Healthy Volunteers

    SciTech Connect

    Kelekis, Alexios Filippiadis, Dimitrios K. Vergadis, Chrysovalantis Tsitskari, Maria Nasis, Nikolaos Malagari, Aikaterini Kelekis, Nikolaos

    2013-04-12

    PurposeThrough a prospective comparison of patients with vertebral fractures and normal population, we illustrate effect of percutaneous vertebroplasty (PV) upon projection of load distribution changes.MethodsVertebroplasty group (36 symptomatic patients with osteoporotic vertebral fractures) was evaluated on an electronic baropodometer registering projection of weight bearing areas on feet. Load distribution between right and left foot (including rear-front of the same foot) during standing and walking was recorded and compared before (group V1) and the day after (group V2) PV. Control group (30 healthy asymptomatic volunteers-no surgery record) were evaluated on the same baropodometer.ResultsMean value of load distribution difference between rear-front of the same foot was 9.45 ± 6.79 % (54.72–45.28 %) upon standing and 14.76 ± 7.09 % (57.38–42.62 %) upon walking in the control group. Respective load distribution values before PV were 16.52 ± 11.23 and 30.91 ± 19.26 % and after PV were 10.08 ± 6.26 and 14.25 ± 7.68 % upon standing and walking respectively. Mean value of load distribution variation between the two feet was 6.36 and 14.6 % before and 4.62 and 10.4 % after PV upon standing and walking respectively. Comparison of load distribution variation (group V1–V2, group V1-control group) is statistically significant. Comparison of load distribution variation (group V2-control group) is not statistically significant. Comparison of load distribution variation among the two feet is statistically significant during walking but not statistically significant during standing.ConclusionsThere is a statistically significant difference when comparing load distribution variation prior vertebroplasty and that of normal population. After vertebroplasty, this difference normalizes in a statistically significant way. PV is efficient on equilibrium-load distribution improvement as well.

  20. Midterm Follow-Up of Vertebral Geometry and Remodeling of the Vertebral Bidisk Unit (VDU) After Percutaneous Vertebroplasty of Osteoporotic Vertebral Fractures

    SciTech Connect

    Pitton, Michael Bernhard Koch, Ulrike; Drees, Philip; Dueber, Christoph

    2009-09-15

    The purpose of this study was to investigate geometrical stability and preservation of height gain of vertebral bodies after percutaneous vertebroplasty during 2 years' follow-up and to elucidate the geometric remodeling process of the vertebral bidisk unit (VDU) of the affected segment. Patients with osteoporotic vertebral compression fractures with pain resistant to analgetic drugs were treated with polymethylmethacrylate vertebroplasty. Mean {+-} standard error cement volume was 5.1 {+-} 2.0 ml. Vertebral geometry was documented by sagittal and coronal reformations from multidetector computed tomography data sets: anterior, posterior, and lateral vertebral heights, end plate angles, and compression index (CI = anterior/posterior height). Additionally, the VDU (vertebral bodies plus both adjacent disk spaces) was calculated from the multidetector computed tomography data sets: anterior, posterior, and both lateral aspects. Patients were assigned to two groups: moderate compression with CI of >0.75 (group 1) and severe compression with CI of <0.75 (group 2). A total of 83 vertebral bodies of 30 patients (7 men, 23 women, age 70.7 {+-} 9.7 years, range 40-82 years) were treated with vertebroplasty and prospectively followed for 24 months. In the moderate compression group (group 1), the vertebral heights were stabilized over time at the preinterventional levels. Compared with group 1, group 2 showed a greater anterior height gain (+2.8 {+-} 2.2 mm vs. +0.8 {+-} 2.0 mm, P < 0.001), better reduction of end plate angle (-4.9 {+-} 4.8{sup o} vs. -1.0 {+-} 2.7{sup o}, P < 0.01), and improved CI (+0.12 {+-} 0.13 vs. +0.02 {+-} 0.07, P < 0.01) and demonstrated preserved anterior height gain at 2 years (+1.2 {+-} 3.2 mm, P < 0.01) as well as improved end plate angles (-5.2 {+-} 5.0{sup o}, P < 0.01) and compression indices (+0.11 {+-} 0.15, P < 0.01). Thus, posterior height loss of vertebrae and adjacent intervertebral disk spaces contributed to a remodeling of the VDU

  1. Percutaneous ultrasound-guided renal biopsy.

    PubMed

    Mishra, Anuj; Tarsin, Rajab; Elhabbash, Basma; Zagan, Nuri; Markus, Rabia; Drebeka, Sawsen; Abdelmola, Khaled; Shawish, Taib; Shebani, Abdulhafidh; Abdelmola, Tamer; Elusta, Ahmad; Ehtuish, Ehtuish Faraj

    2011-07-01

    This study was done to assess the safety and efficacy of real-time ultrasound-guided percutaneous renal biopsy (PRB) and to determine the optimal period of observation required as well as to ascertain the risk factors for any ensuing complications. Between 1 st February 2006 and 31 st January 2008, a total of 86 PRBs were performed by the radiologist using an automated biopsy gun with 16-gauge needle at the National Organ Transplant Centre, Central Hospital, Tripoli, Libya. Prior to the procedure coagulation profile was done in all the patients. All patients were kept on strict bed rest for 6-hours post-procedure. Of the 86 renal biopsies performed, 78 patients were referred from Rheumatology Department and 8 were post-kidney transplant recipients. There were 23 males with age ranging from 15 to 56 years and 63 females with age ranging from 16 to 66 years. A mean of 17.5 glomeruli were present in each specimen. A glomerular yield of less than five glomeruli was seen in only four biopsies. Class I lupus nephritis (LN) was seen in one patient, class II LN in seven patients, class III LN in 13 patients and class IV LN in 29 patients. All the eight renal allografts were diagnosed as either acute tubular necrosis or acute interstitial rejection. The overall complication rate was 5.8% and these complications were observed within 6 hours of biopsy. No late complications were seen. PRB under real-time ultra-sound guidance is a safe and efficacious procedure to establish the histological diagnosis of the renal disease and may be done as an out-patient procedure. A post-biopsy observation time of 6 hours appears to be optimal. PMID:21743221

  2. CT guided percutaneous needle biopsy of the chest: initial experience

    PubMed Central

    Lazguet, Younes; Maarouf, Rachid; Karrou, Marouan; Skiker, Imane; Alloubi, Ihsan

    2016-01-01

    The objective of this article is to report our first experience of CT guided percutaneous thoracic biopsy and to demonstrate the accuracy and safety of this procedure. This was a retrospective study of 28 CT-Guided Percutaneous Needle Biopsies of the Chest performed on 24 patients between November 2014 and April 2015. Diagnosis was achieved in 18 patients (75%), negative results were found in 3 patients (12,5%). Biopsy was repeated in these cases with two positive results. Complications were seen in 7 patients (29%), Hemoptysis in 5 patients (20%), Pneumothorax in 1 patient (4,1%) and vaso-vagal shock in 1 patient (4,1%). CT Guided Percutaneous Needle Biopsy of the Chest is a safe, minimally invasive procedure with high sensitivity, specificity and accuracy for diagnosis of lung lesions.

  3. Accuracy analysis of an image-guided system for vertebroplasty spinal therapy based on electromagnetic tracking of instruments

    NASA Astrophysics Data System (ADS)

    Ding, Jienan; Khan, Noureen; Cheng, Patrick; Wilson, Emmanuel; Watson, Vance; Cleary, Kevin; Yaniv, Ziv

    2008-03-01

    Vertebroplasty is a minimally invasive procedure in which bone cement is pumped into a fractured vertebral body that has been weakened by osteoporosis, long-term steroid use, or cancer. In this therapy, a trocar (large bore hollow needle) is inserted through the pedicle of the vertebral body which is a narrow passage and requires great skill on the part of the physician to avoid going outside of the pathway. In clinical practice, this procedure is typically done using 2D X-ray fluoroscopy. To investigate the feasibility of providing 3D image guidance, we developed an image-guided system based on electromagnetic tracking and our open source software platform the Image-Guided Surgery Toolkit (IGSTK). The system includes path planning, interactive 3D navigation, and dynamic referencing. This paper will describe the system and our initial evaluation.

  4. The Obturator Guiding Technique in Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    Han, In Ho; Cho, Won Ho; Nam, Kyoung Hyup

    2012-01-01

    In conventional percutaneous disc surgery, introducing instruments into disc space starts by inserting a guide needle into the triangular working zone. However, landing the guide needle tip on the annular window is a challenging step in endoscopic discectomy. Surgeons tend to repeat the needling procedure to reach an optimal position on the annular target. Obturator guiding technique is a modification of standard endoscopic lumbar discectomy, in which, obturator is used to access triangular working zone instead of a guide needle. Obturator guiding technique provides more vivid feedback and easy manipulation. This technique decreases the steps of inserting instruments and takes safer route from the peritoneum. PMID:22639720

  5. VERTOS II: Percutaneous vertebroplasty versus conservative therapy in patients with painful osteoporotic vertebral compression fractures; rationale, objectives and design of a multicenter randomized controlled trial

    PubMed Central

    Klazen, CAH; Verhaar, HJJ; Lampmann, LEH; Juttmann, JR; Blonk, MC; Jansen, FH; Tielbeek, AV; Schoemaker, MC; Buskens, E; van der Graaf, Y; Janssens, X; Fransen, H; van Everdingen, KJ; Muller, AF; Mali, WPThM; Lohle, PNM

    2007-01-01

    Background The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF) is conservative therapy. Percutaneous vertebroplasty (PV), a minimally invasive technique, is gaining popularity as a new treatment option. Many prospective and retrospective studies have reported on the effectiveness and safety of PV, but no large randomized controlled trial (RCT) has been published. Objective To estimate cost-effectiveness of PV compared to conservative therapy in terms of: pain reduction, quality of life, complications, secondary fractures and mortality. Materials and methods The VERTOS II study is designed as a prospective, multicenter RCT. Patients with a painful VCF with bone edema on MR imaging, local back pain for 6 weeks or less, osteopenia and aged 50 years or older, after obtaining informed consent are included and randomized for PV or conservative therapy. In total 200 patients will be enrolled. Follow-up is at regular intervals during a 1-year period with standard questionnaires, addressing: clinical symptoms, pain medication, Visual Analogue Scale (VAS) score, quality of life and cost-effectiveness. Secondary fractures, necessary additional therapies and complications are recorded. Conclusion The VERTOS II study is the first methodologically sound RCT designed to assess the cost-effectiveness of PV compared to conservative therapy in patients with an acute osteoporotic VCF. Trial registration , NCT00232466 PMID:17973983

  6. CT-guided percutaneous biopsies of head and neck masses

    SciTech Connect

    Gatenby, R.A.; Mulhern, C.B. Jr.; Strawitz, J.

    1983-03-01

    Six patients underwent CT-guided percutaneous pharyngeal or laryngeal biopsies. A retromandibular approach was used in five of these patients. Accurate cytologic information was obtained in all six cases, and no complications were encountered. This technique can be helpful in certain clinical settings.

  7. Ultrasound-guided percutaneous cholecystostomy for acute neonatal biliary obstruction.

    PubMed

    Helin, Radley; Bhat, Rama; Rao, Bhaskara

    2007-01-01

    Use of a percutaneously-inserted cholecystostomy drainage tube is an effective therapeutic option for acute hyperbilirubinemia in severely-ill adult patients, but to our knowledge has not been previously reported in infants. We describe an infant who developed acute extrahepatic biliary tract obstruction with marked conjugated (direct) hyperbilirubinemia, and who was determined to be an unsuitable surgical candidate. Ultrasound-guided percutaneous cholecystostomy was performed and resulted in prompt, significant, and sustained decline in serum bilirubin levels. Potential risks and benefits, as well as suggested indications for the procedure are discussed. PMID:17568158

  8. Radiographically guided percutaneous catheter drainage of pleural fluid collections.

    PubMed

    Merriam, M A; Cronan, J J; Dorfman, G S; Lambiase, R E; Haas, R A

    1988-12-01

    We reviewed the outcome of guided percutaneous catheter drainage of pleural fluid collections in 18 patients over a 5-year period. Catheter positioning was guided by fluoroscopy in 10 (56%) cases, CT in seven (39%), and sonography in one (6%). Included were 16 patients with empyemas and one each with a sterile hematoma and transudate. In nine of the patients, previous surgical chest tube drainage had been unsuccessful. The majority of collections were treated with a 12- or 14-French catheter and closed underwater seal drainage. Twelve (80%) of the 15 patients who had an adequate trial of guided drainage were cured. Propyliodone oil suspension contrast sinography after catheter placement showed two clinically unsuspected bronchopleural fistulas. Although an extensive multilocular pleural collection was a contraindication to percutaneous catheter drainage, the thick fibrous peel of a chronic empyema was not. Drainage of pleural fluid collections with radiographic guidance ensures proper catheter placement and is successful in a high percentage of cases. PMID:3055887

  9. Major Bleeding after Percutaneous Image-Guided Biopsies: Frequency, Predictors, and Periprocedural Management

    PubMed Central

    Kennedy, Sean A.; Milovanovic, Lazar; Midia, Mehran

    2015-01-01

    Major bleeding remains an uncommon yet potentially devastating complication following percutaneous image-guided biopsy. This article reviews two cases of major bleeding after percutaneous biopsy and discusses the frequency, predictors, and periprocedural management of major postprocedural bleeding. PMID:25762845

  10. Percutaneous Vertebroplasty and Bone Cement Leakage: Clinical Experience with a New High-Viscosity Bone Cement and Delivery System for Vertebral Augmentation in Benign and Malignant Compression Fractures

    SciTech Connect

    Anselmetti, Giovanni Carlo; Zoarski, Gregg; Manca, Antonio; Masala, Salvatore; Eminefendic, Haris; Russo, Filippo; Regge, Daniele

    2008-09-15

    The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 {+-} 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p < 0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p < 0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1%). In Group B, a venous leak was seen in 38 of 92 (41.3%) and a discoidal leak in 12 of 92 (13.0%). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p < 0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications.

  11. Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures.

    PubMed

    Anselmetti, Giovanni Carlo; Zoarski, Gregg; Manca, Antonio; Masala, Salvatore; Eminefendic, Haris; Russo, Filippo; Regge, Daniele

    2008-01-01

    The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 +/- 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p < 0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p < 0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1%). In Group B, a venous leak was seen in 38 of 92 (41.3%) and a discoidal leak in 12 of 92 (13.0%). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p < 0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications. PMID:18389186

  12. CT-Guided Percutaneous Biopsy of Intrathoracic Lesions

    PubMed Central

    Lal, Hira; Nath, Alok; Borah, Samudra

    2012-01-01

    Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications. In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications. PMID:22438689

  13. Feasibility of percutaneous contrast ultrasound-guided cholecystography in dogs.

    PubMed

    Ji, Seoyeoun; Jung, Sunyoung; Kim, Boeun; Jung, Joohyun; Yoon, Junghee; Choi, Mincheol

    2015-01-01

    Differentiating hepatocellular disease versus biliary obstruction can be challenging in dogs presented for icterus. The purpose of this prospective study was to determine the feasibility of percutaneous contrast ultrasound-guided cholecystography in dogs. Ten normal dogs weighing 7.6-13.0 kg (median 9.8 kg) were recruited. All dogs were considered normal based on complete blood count, serum chemistry profile, ultrasound examination, and percutaneous radiographic cholecystography. Percutaneous contrast ultrasound-guided cholecystography was performed using 0.5 ml of commercially available contrast agent and two conventional ultrasound machines for simultaneous scanning at two different locations. Two observers independently evaluated the time to initial detection of contrast in the proximal duodenum and duration of contrast enhancement via visual monitoring. Dynamic contrast enhancement was calculated using time-intensity curves. Mean (± SD) and median (range) of time to initial detection were 8.60 s (± 3.35) and 8.0 s (2.0-11.0), respectively, and mean and median duration were 50.45 s (± 23.24) and 53.0 s (20.0 - 70.0), respectively. Mean, median, and range of peak intensity were 114.1 mean pixel value (MPV) (SD ± 30.7), 109.2 MPV, and 79.7-166.7, respectively, and mean, median, and range of time to peak intensity were 26.1 s (SD ± 7.1 s), 24.0 s, and 19.0-41.0 s, respectively. Findings indicated that percutaneous contrast ultrasound-guided cholecystography is a feasible technique for detecting and quantifying patency of the bile duct in normal dogs. Future studies are needed to assess the diagnostic utility of this technique for dogs with biliary obstruction. PMID:25403172

  14. Fluoroscopy guided percutaneous renal access in prone position.

    PubMed

    Sharma, Gyanendra R; Maheshwari, Pankaj N; Sharma, Anshu G; Maheshwari, Reeta P; Heda, Ritwik S; Maheshwari, Sakshi P

    2015-03-16

    Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably the most crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access. PMID:25789297

  15. Fluoroscopy guided percutaneous renal access in prone position

    PubMed Central

    Sharma, Gyanendra R; Maheshwari, Pankaj N; Sharma, Anshu G; Maheshwari, Reeta P; Heda, Ritwik S; Maheshwari, Sakshi P

    2015-01-01

    Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably the most crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access. PMID:25789297

  16. Real time ultrasound-guided percutaneous tracheostomy: Is it a better option than bronchoscopic guided percutaneous tracheostomy?

    PubMed Central

    Ravi, Parli Raghavan; Vijay, M.N.

    2015-01-01

    Background The purpose of this study was to evaluate the efficacy of ultrasound guided percutaneous tracheostomy (USPCT) and bronchoscopic guided percutaneous tracheostomy (BPCT) and the incidence of complications in critically ill, obese patients. Methods Seventy four consecutive patients were included in a prospective study and randomly divided into USPCT and BPCT. Incidence of complications, ease and efficacy were compared in obese USPCT (n = 38)and BPCT (n = 36). Results are expressed as the median (25th–75th percentile) or number (percentage). Results The median times for tracheostomy were 12 min (9–14) in USPCT patients and 18 min (12–21.5) in BPCT (p = 0.05). The overall complication rate was higher in BPCT than USPCT patient group (75% vs. 321%, p < 0.05). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding) and of higher number in the BPCT. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths. Conclusions This study demonstrated that real US-guided PCT is a favourable alternative to BPCT with a low complication rate and ease, thus proving more efficacious. A US examination provides information on cervical anatomy, vasculature etc. and hence modifies and guides choice of the PCT puncture site. PMID:25859079

  17. Cone-Beam Computed Tomography-Guided Percutaneous Radiologic Gastrostomy

    SciTech Connect

    Moehlenbruch, Markus; Nelles, Michael; Thomas, Daniel; Willinek, Winfried; Gerstner, Andreas; Schild, Hans H.; Wilhelm, Kai

    2010-04-15

    The purpose of this study was to investigate the feasibility of a flat-detector C-arm-guided radiographic technique (cone-beam computed tomography [CBCT]) for percutaneous radiologic gastrostomy (PRG) insertion. Eighteen patients (13 men and 5 women; mean age 62 years) in whom percutaneous endoscopic gastrostomy (PEG) had failed underwent CBCT-guided PRG insertion. PEG failure or unsuitability was caused by upper gastrointestinal tract obstruction in all cases. Indications for gastrostomy were esophageal and head and neck malignancies, respectively. Before the PRG procedure, initial C-arm CBCT scans were acquired. Three- and 2-dimensional soft-tissue reconstructions of the epigastrium region were generated on a dedicated workstation. Subsequently, gastropexy was performed with T-fasteners after CBCT-guided puncture of the stomach bubble, followed by insertion of an 14F balloon-retained catheter through a peel-away introducer. Puncture of the stomach bubble and PRG insertion was technically successful in all patients without alteration of the epigastric region. There was no malpositioning of the tube or other major periprocedural complications. In 2 patients, minor complications occurred during the first 30 days of follow-up (PRG malfunction: n = 1; slight infection: n = 1). Late complications, which were mainly tube disturbances, were observed in 2 patients. The mean follow-up time was 212 days. CBCT-guided PRG is a safe, well-tolerated, and successful method of gastrostomy insertion in patients in whom endoscopic gastrostomy is not feasible. CBCT provides detailed imaging of the soft tissue and surrounding structures of the epigastric region in one diagnostic tour and thus significantly improves the planning of PRG procedures.

  18. Ultrasound-Guided Percutaneous Management of Splenic Ectopic Pregnancy.

    PubMed

    Python, Johanne L; Wakefield, Brian W; Kondo, Kimi L; Bang, Tami J; Stamm, Elizabeth R; Hurt, K Joseph

    2016-01-01

    Splenic ectopic pregnancies are a rare cause of abdominal pain in reproductive-age women. A 21-year-old woman with worsening abdominal pain and a positive pregnancy test presented with hemoperitoneum and no intrauterine pregnancy on transvaginal ultrasound. After 2 nondiagnostic laparoscopies, a splenic pregnancy was diagnosed by computed tomography scan and abdominal ultrasound. Currently, diagnosis and treatment of splenic pregnancies involve exploratory surgery and splenectomy. We report the successful treatment of this splenic ectopic pregnancy with combined intramuscular plus ultrasound-guided percutaneous methotrexate injection, with preservation of the patient's spleen. Abdominal implantation must be considered in patients with pregnancy of unknown location, and in carefully selected patients splenic ectopic pregnancy can be successfully managed by minimally invasive methods. PMID:27221066

  19. Imaging guided mediastinal percutaneal core biopsy--technique and complications.

    PubMed

    Azrumelashvili, T; Mizandari, M; Magalashvili, D; Dundua, T

    2015-05-01

    165 percutaneous biopsies of anterior, middle and posterior mediastinum lesions were performed to 156 patients. Procedure was guided by US in 40 cases, by CT - in 125 cases. Hydrodissection was used in 5 cases, artificial pneumothorax - in 3 cases in order to avoid transpulmonary needle pass. Post-biopsy CT scan was performed and patients observed for any complications. Adequate tissue for histological diagnosis was obtained in 156 (94.5%) cases at the first attempt; in 9 (5.5%) cases the repeated procedure was needed. No major complications were detected after biopsy procedures; minor complications (pneumothorax, hemothorax and hemophtysis) were detected in 23 (13.9%) cases. No complications were detected after US guided procedures; In 17 (10.3% of all complications) cases pneumothorax, in 4 (2.4%) cases - hemothorax and in 2 (1.2%) cases hemophtisis was detected on CT guided procedures. All hemothorax and hemophtisis and 10 pneumothorax cases happened to be self-limited; in 3 pneumothorax cases aspiration and in 4 cases - pleural drainage was needed. Percutaneous image-guided core biopsy of mediastinal lesions is an accurate and safe procedure, which enables to get the tissue material from all mediastinum compartments. Ultrasound is the most efficient for biopsy guidance, if the target is adequately imaged by it; the advantages of US guidance are: a) possibility of real-time needle movement control b) possibility of real-time blood flow imaging b) noninvasiveness c) cost-effectiveness d) possibility to perform the biopsy at the bedside, in a semiupright position; so, ultrasound is a "Gold Standard" for procedure guidance if the 'target" can be adequately imaged by this technique. If US guidance is impossible biopsy should be performed under CT guidance. Hydrodissection and artificial pneumothorax enables to avoid the lung tissue penetration related complications. Pneumothorax was associated with multiple Needle passes and larger diameter needle use. The safety

  20. Ultrasonography guided percutaneous radiofrequency ablation for hepatic cavernous hemangioma

    PubMed Central

    Cui, Yan; Zhou, Li-Yan; Dong, Man-Ku; Wang, Ping; Ji, Min; Li, Xiao-Ou; Chen, Chang-Wei; Liu, Zi-Pei; Xu, Yong-Jie; Zhang, Hong-Wen

    2003-01-01

    AIM: Hepatic cavernous hemangioma (HCH) is the most common benign tumor of the liver and its management is still controversial. Recent success in situ radiofrequency ablation of hepatic malignancies has led us to consider using this technique in patients with HCH. This study was to assess the efficacy, safety, and complications of percutaneous radiofrequency ablation (PRFA) under ultrasonography guidance in patients with HCH. METHODS: Twelve patients (four men and eight women, age ranged 33-56 years, mean age was 41.7 years) with 15 hepatic cavernous hemangiomas (2.5 cm to 9.5 cm) were treated using the RF-2000 generator and 10-needle LeVeen electrode percutaneously guided by B-ultrasound. Lesions larger than 3 cm were treated by multiple overlapping ablations that encompass the entire lesion as well as a rim of normal liver tissue (approximately 0.5 cm). RESULTS: All the patients who received PRFA therapy had no severe pain, bleeding or bile leakage during and after the procedures. Nine to 34 months’ follow-up (mean, 21 months) by ultrasound and/or spiral CT scan demonstrated that the ablated lesions in this group were shrunk remarkably, and the shrunken range was 38%-79% (mean, 67% per 21 months). The contrast enhancement was disappeared within the tumor or at its periphery in all cases on spiral CT scans obtained 3 to 6 months after treatment. CONCLUSION: The results of this study suggest that PRFA therapy is a mini-invasive, simple, safe, and effective method for the treatment of selected patients with HCH. PMID:12970923

  1. Single-Institution Results of Image-Guided Nonplugged Percutaneous Versus Transjugular Liver Biopsy

    SciTech Connect

    Hardman, Rulon L.; Perrich, Kiley D.; Silas, Anne M.

    2011-04-15

    Purpose: To retrospectively review patients who underwent transjugular and image-guided percutaneous biopsy and compare the relative risk of ascites, thrombocytopenia, and coagulopathy. Materials and Methods: From August 2001 through February 2006, a total of 238 liver biopsies were performed. The radiologist reviewed all patient referrals for transjugular biopsy. These patients either underwent transjugular biopsy or were reassigned to percutaneous biopsy (crossover group). Patients referred to percutaneous image-guided liver biopsy underwent this same procedure. Biopsies were considered successful if a tissue diagnosis could be made from the samples obtained. Results: A total of 36 transjugular biopsies were performed with 3 total (8.3%) and 1 major (2.8%) complications. A total of 171 percutaneous biopsies were performed with 10 (5.8%) total and 3 (1.8%) major complications. The crossover group showed a total of 4 (12.9%) complications with 1 (3.2%) major complication. Sample adequacy was 91.9% for transjugular and 99.5% for percutaneous biopsy. Conclusion: Both transjugular and percutaneous liver biopsy techniques are efficacious and safe. Contraindications such as thrombocytopenia, coagulopathy, and ascites are indicators of greater complications but are not necessarily prevented by transjugular biopsy. Percutaneous biopsy more frequently yields a diagnostic specimen than transjugular biopsy.

  2. Image-Guided Percutaneous Ablation of Bone and Soft Tissue Tumors

    PubMed Central

    Kurup, A. Nicholas; Callstrom, Matthew R.

    2010-01-01

    Image-guided percutaneous ablation of bone and soft tissue tumors is an effective minimally invasive alternative to conventional therapies, such as surgery and external beam radiotherapy. Proven applications include treatment of benign primary bone tumors, particularly osteoid osteoma, as well as palliation of painful bone metastases. Use of percutaneous ablation in combination with cementoplasty can provide stabilization of metastases at risk for fracture. Local control of oligometastatic disease and treatment of desmoid tumors are emerging applications. PMID:22550367

  3. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    PubMed Central

    Arias-Buría, José L.; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A.; Fernández-de-las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P < 0.01): individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

  4. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial.

    PubMed

    Arias-Buría, José L; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A; Fernández-de-Las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P < 0.01): individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

  5. CT-guided interventional procedures for pain management in the lumbosacral spine.

    PubMed

    Gangi, A; Dietemann, J L; Mortazavi, R; Pfleger, D; Kauff, C; Roy, C

    1998-01-01

    The lumbosacral spine is the source of pain, suffering, and disability more frequently than any other part of the body. Pain in the lower back can be managed with computed tomography-guided analgesic interventional procedures, such as periradicular infiltration, percutaneous laser disk decompression, facet joint block, and percutaneous vertebroplasty. Periradicular injection of steroids provides short-term and sometimes even long-term relief of low back pain. Percutaneous laser disk decompression is used to treat radiculalgia caused by disk herniation. Facet joint block is useful in diagnosis and treatment of facet syndrome. Percutaneous vertebroplasty provides short- and long-term pain relief in patients with vertebral body disease. However, precise patient selection is essential to the success of each of these techniques. The interventional radiologist has an active role to play in minimally invasive management of lower back pain and should be part of an interdisciplinary team that determines the appropriate therapy. PMID:9599387

  6. Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma.

    PubMed

    Fader, Ryan R; Mitchell, Justin J; Chadayammuri, Vivek P; Hill, John; Wolcott, Michelle L

    2015-11-01

    Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms. PMID:26558670

  7. Percutaneous ultrasound-guided renal biopsy: A Libyan experience

    PubMed Central

    Mishra, A.; Tarsin, R.; ElHabbash, B.; Zagan, N.; Markus, R.; Drebeka, S.; AbdElmola, K.; Shawish, T.; Shebani, A.; AbdElmola, T.; ElUsta, A.; Ehtuish, E. F.

    2010-01-01

    This study was done to assess the safety and efficacy of ultrasound-guided percutaneous renal biopsy (PRB), to ascertain the risk factors for complications and determine the optimal period of observation. The radiologist (A.M.) at the National Organ Transplant Centre, Central Hospital, Tripoli, Libya, performed 86 PRBs between February 1, 2006, and January 31, 2008, using an automated biopsy gun with 16-gauge needle. Coagulation profile was done in all the patients. All patients were kept on strict bed rest for six hours post-procedure. Eighty six renal biopsies were performed on 78 patients referred from rheumatology department and eight post-kidney transplant recipients; 23 were males with age range 15 – 56 years and 63 females with age range 16 – 66 years. A mean of 17.5 glomeruli were present in each specimen. A glomerular yield of less than five glomeruli was seen in four biopsies. Class I lupus nephritis (LN) was seen in 1 patient, class II lupus nephritis in 7 patients, class III LN in 13 patients and class IV LN in 29 patients. All the eight renal allografts were diagnosed as acute tubular necrosis or acute interstitial rejection. The risk of post-biopsy bleeding was higher in women, older patients and higher PTT. The overall complication rate was 5.8%. Three complications were observed within six hours of biopsy. No late complication was seen. PRB under real-time ultrasound-guidance is a safe and efficacious procedure to establish the histological diagnosis and should be done as out-patient procedure. Observation time of six hours post-biopsy is optimal. PMID:20835320

  8. Pulmonary Artery Cement Embolism after a Vertebroplasty

    PubMed Central

    Nooh, Anas; Abduljabbar, Fahad H.; Abduljabbar, Ahmed H.; Jarzem, Peter

    2015-01-01

    Background Context. Vertebroplasty is a minimally invasive procedure most commonly used for the treatment of vertebral compression fractures. Although it is relatively safe, complications have been reported over time. Among those complications, massive cement pulmonary embolism is considered a rare complication. Here we report a case of massive diffuse cement pulmonary embolism following percutaneous vertebroplasty for a vertebral compression fracture. Study Design. Case report. Methods. This is a 70-year-old female who underwent vertebroplasty for T11 and T12 vertebral compression fracture. Results. CT-scan revealed an incidental finding of cement embolism in the pulmonary trunk and both pulmonary arteries. Since the patient was asymptomatic, she was monitored closely and she did not need any intervention. Conclusion. Vertebroplasty is a minimally invasive procedure used for treatment of vertebral compression fracture. Despite the low rate of complications, a pulmonary cement embolism can occur. The consequences of cement embolism range widely from being asymptomatic to embolism that can cause paralysis, radiculopathy, or a fatal pulmonary embolism. PMID:26221556

  9. Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy

    PubMed Central

    Liang, Ping; Yu, Jie; Lu, Ming-De; Dong, Bao-Wei; Yu, Xiao-Ling; Zhou, Xiao-Dong; Hu, Bing; Xie, Ming-Xing; Cheng, Wen; He, Wen; Jia, Jian-Wen; Lu, Guo-Rong

    2013-01-01

    Primary liver cancer and liver metastases are among the most frequent malignancies worldwide, with an increasing number of new cases and deaths every year. Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy. This synopsis outlines the first clinical practice guidelines for ultrasound-guided percutaneous microwave ablation therapy for hepatic malignancy, which was created by a joint task force of the Society of Chinese Interventional Ultrasound. The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment, as well as proposing the criteria for the treatment candidates. PMID:24023485

  10. [CT-guided percutaneous drainage in the treatment of acute necrotizing pancreatitis].

    PubMed

    Szentkereszty, Z; Kerekes, L; Hallay, J; Péter, M; Sápy, P

    2001-02-01

    The authors analysed the results of the treatment of 24 patients with acute necrotizing pancreatitis. Besides intensive and operative treatment prophylactic antibiotics, early naso-jejunal feeding, CT guided percutaneous peripancreatic drainage are favourable to avoid septic complications and to postpone the first operation. In 11 patients percutaneous drainage was performed. Using percutaneous drainage three patients (33.3%) recovered without operation, the mean drainage time was 23.4 days. The first operation could be postponed in the other 8 patients after percutaneous drainage. No complications occurred as result of the interventions, although in one patient the drain slipped out spontaneously. Due to the complex treatment the total mortality rate was 12.5%. PMID:11299857

  11. Image-Guided Percutaneous Splenic Biopsy and Drainage

    PubMed Central

    Sammon, Jennifer; Twomey, Maria; Crush, Lee; Maher, Michael M.; O'Connor, Owen J.

    2012-01-01

    Percutaneous splenic biopsy and drainage are relatively safe and accurate procedures. The risk of major complication (1.3%) following percutaneous splenic biopsy does not exceed that of other solid intra-abdominal organ biopsies, and it has less morbidity and mortality than splenectomy. Both computed tomography and ultrasound can be used to provide image guidance for biopsy and drainage. The safety profile of fine-needle aspiration cytology is better than core needle biopsy, but core biopsy has superior diagnostic accuracy. PMID:24293803

  12. The role of intraoperative scrape cytology in vertebroplasty

    PubMed Central

    Inuganti, Renuka Venkata; Mettu, Rami Reddy; Surath, Harsha Vardhan; Surath, Amarnath

    2016-01-01

    Aims: To assess the adequacy of intraoperative scrape cytology during percutaneous vertebroplasty by correlating results with corresponding histopathology. Settings and Design: Vertebroplasty is a procedure increasingly used to treat painful vertebral compression fractures. The history and presentation of osteoporotic fractures are straightforward, but difficulty arises in differentiating infective from neoplastic lesions, especially in cases where the magnetic resonance imaging is equivocal. The procedure involves injection of polymethyl methacrylate (bone cement) into the pathological vertebral body and gives dramatic pain relief. It is indicated in osteoporotic and neoplastic lesions but contraindicated in infections. Hence, intraoperative evaluation of a specimen is essential to aid in the decision of performing vertebroplasty. Subjects and Methods: A total of 128 patients with vertebral lesions underwent core biopsy and scrape cytology from June 2006 to June 2015. Based on the findings of cytological examination, malignant lesions were subjected to vertebroplasty. In lesions with infective etiology, vertebroplasty was abandoned and antibiotic or antituberculous therapy started. Results: The overall diagnostic accuracy of scrape cytology was excellent with 97.58% cases correlating with the final histopathological diagnosis. Specificity was 100%, positive predictive value was 100% and negative predictive value was 33.33%. Conclusion: Scrape cytology is a simple, rapid, accurate cytodiagnostic technique and should be routinely utilized in vertebral lesions for intraoperative consultation and decision making during vertebroplasty. PMID:27298628

  13. Sclerotic Vertebral Metastases: Pain Palliation Using Percutaneous Image-Guided Cryoablation

    SciTech Connect

    Costa de Freitas, Ricardo Miguel Menezes, Marcos Roberto de; Cerri, Giovanni Guido; Gangi, Afshin

    2011-02-15

    Cryoablative therapies have been proposed to palliate pain from soft-tissue or osteolytic bone tumors. A case of a patient with painful thoracic and sacral spine sclerotic metastases successfully treated by image-guided percutaneous cryoablation with the aid of insulation techniques and thermosensors is reported in this case report.

  14. Percutaneous Ultrasound-Guided Thrombin Injection as First-Line Treatment of Pancreatic Pseudoaneurysm

    SciTech Connect

    McErlean, Aoife; Looby, Seamus; Lee, Michael J.

    2007-06-15

    Pancreatic pseudoaneurysms are a rare but potentially fatal complication of pancreatitis. Surgical intervention and transcatheter embolization are not always feasible therapeutic options. In this report we present a case of a pseudoaneurysm secondary to pancreatitis which, despite being angiographically invisible, was successfully embolized with a single ultrasound-guided percutaneous injection of thrombin.

  15. Image-guided percutaneous internal fixation of sacral fracture.

    PubMed

    Kinon, Merritt D; Desai, Rupen; Loriaux, Daniel; Houten, John K

    2016-01-01

    Percutaneous iliosacral screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. The use of stereotactic image guidance has been shown to provide superior accuracy in the placement of spinal instrumentation. Here, the authors describe a novel application of O-arm technology (Medtronic Sofamor Danek, Memphis, TN, USA) to help safely place iliosacral screws for the treatment of a traumatic sacral fracture. PMID:26433323

  16. Magnetic Resonance-Guided Percutaneous Cryoablation of Uterine Fibroids: Early Clinical Experiences

    SciTech Connect

    Sakuhara, Yusuke Shimizu, Tadashi; Kodama, Yoshihisa; Sawada, Akihiro; Endo, Hideho; Abo, Daisuke; Hasegawa, Tenshu; Miyasaka, Kazuo

    2006-08-15

    Purpose. Uterine fibroids (leiomyomas) are the most common tumors of the uterus. The present study evaluated the feasibility and effectiveness of magnetic resonance (MR)-guided percutaneous cryoablation for uterine fibroids as a minimally invasive treatment alternative. Methods. From August 2001 to June 2002, MR-guided percutaneous cryoablation was performed on seven uterine fibroids in 6 patients who displayed clinical symptoms related to tumors. Using a horizontal-type open MR system, cryoablation probes were percutaneously placed in fibroids. Fibroids were ablated, and the site and size of ice balls were monitored on MR imaging. Postoperatively, patients completed a questionnaire to assess changes in presenting clinical symptoms, and MR images were obtained for all patients at follow-up. Changes in clinical symptoms and tumor volume were evaluated in each patient. Results. All treated patients showed reductions in tumor size. Mean volume reduction rate was 40.3% at 6 weeks postoperatively, and 79.4% at 9-12 months. All patients reported fever after treatment. Surgical drainage was required for abscess in the probe channel in one patient, and transient liver damage occurred in another. Subjective symptoms improved in all patients except one who had multiple tumors, and no patient complained of new symptoms after cryoablation during follow-up. Conclusion. MR-guided percutaneous cryoablation represents a feasible and effective treatment for uterine fibroids.

  17. A modified technique for real time ultrasound guided pediatric percutaneous renal biopsy: the angled tangential approach

    PubMed Central

    Caliskan, Kosti Can; Turkoglu, Ozlem Kolcak; Cakmakci, Selma; Ozcelik, Gul; Yilmaz, Engin; Turk, Sebnem; Ozagari, Aysim; Ucan, Berna

    2014-01-01

    Aim Pediatric renal biopsy may result in serious hemorrhagic complications, requiring additional diagnostic procedures, blood transfusion, vascular interventions, and prolongation of hospitalization. The aim of the present study was to propose the angled tangential approach technique for real-time ultrasound-guided pediatric percutaneous renal biopsy. Methods A retrospective analysis of 166 percutaneous biopsies from June 2004 to May 2009 was performed. Patients’ medical records, pathology results, and complications were reviewed. Results No major complications were seen in the study group. The most frequently occurring minor complication was macroscopic hematuria, which occurred at the rate of 9.6%. Hematoma was detected in three cases and regressed spontaneously in all cases. Conclusions The angled tangential approach is a safe technique and an alternative option in pediatric percutaneous renal biopsies. PMID:24914420

  18. Vertebroplasty for Spine Fracture Pain

    MedlinePlus

    MENU Return to Web version Vertebroplasty for Spine Fracture Pain Vertebroplasty for Spine Fracture Pain More than 40 million people in the United States have osteoporosis (a decrease in the amount ...

  19. Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: A Systematic Review

    PubMed Central

    2016-01-01

    Background Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies, including bed rest, bracing, and analgesic use, can be ineffective, resulting in continued pain and progressive functional disability limiting mobility and self-care. Surgery is not usually an option for cancer patients in advanced disease states because of their poor medical health or functional status and limited life expectancy. The objectives of this review were to evaluate the effectiveness and safety of percutaneous image-guided vertebral augmentation techniques, vertebroplasty and kyphoplasty, for palliation of cancer-related vertebral compression fractures. Methods We performed a systematic literature search for studies on vertebral augmentation of cancer-related vertebral compression fractures published from January 1, 2000, to October 2014; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. Owing to the heterogeneity of the clinical reports, we performed a narrative synthesis based on an analytical framework constructed for the type of cancer-related vertebral fractures and the diversity of the vertebral augmentation interventions. Results The evidence review identified 3,391 citations, of which 111 clinical reports (4,235 patients) evaluated the effectiveness of vertebroplasty (78 reports, 2,545 patients) or kyphoplasty (33 reports, 1,690 patients) for patients with mixed primary spinal metastatic cancers, multiple myeloma, or hemangiomas. Overall the mean pain intensity scores often reported within 48 hours of vertebral augmentation (kyphoplasty or vertebroplasty), were significantly reduced. Analgesic use, although variably reported, usually involved parallel decreases, particularly in opioids, and mean pain-related disability scores were also significantly improved. In a randomized controlled

  20. Percutaneous Ultrasound Guided Implantation of VX2 for Creation of a Rabbit Hepatic Tumor Model

    PubMed Central

    White, Sarah B.; Chen, Jeane; Gordon, Andrew C.; Harris, Kathleen R.; Nicolai, Jodi R.; West, Derek L.; Larson, Andrew C.

    2015-01-01

    Creation of a VX2 tumor model has traditionally required a laparotomy and surgical implantation of tumor fragments. Open surgical procedures are invasive and require long procedure times and recovery that can result in post-operative morbidity and mortality. The purpose of this study is to report the results of a percutaneous ultrasound guided method for creation of a VX2 model in rabbit livers. A total of 27 New Zealand white rabbits underwent a percutaneous ultrasound guided approach, where a VX2 tumor fragment was implanted in the liver. Magnetic resonance imaging was used to assess for tumor growth and necropsy was performed to determine rates of tract seeding and metastatic disease. Ultrasound guided tumor implantation was successful in all 27 rabbits. One rabbit died 2 days following the implantation procedure. Two rabbits had no tumors seen on follow-up imaging. Therefore, tumor development was seen in 24/26 (92%) rabbits. During the follow-up period, tract seeding was seen in 8% of rabbits and 38% had extra-hepatic metastatic disease. Therefore, percutaneous ultrasound guided tumor implantation safely provides reliable tumor growth for establishing hepatic VX2 tumors in a rabbit model with decreased rates of tract seeding, compared to previously reported methods. PMID:25853660

  1. Safety and Efficacy of Percutaneous CT-Guided Drainage in the Management of Abdominopelvic Abscess

    PubMed Central

    Shahnazi, Makhtoom; Khatami, Alireza; Jamzad, Abbas; Shohitavi, Shomal

    2014-01-01

    Background: Abdominopelvic fluid collection and abscess management and their outcomes have improved in the recent years due to innovation of the image-guided drainage technique and improvement of surgical procedures Objectives: This study was undertaken to evaluate the efficacy of CT-guided percutaneous drainage in treating abdominopelvic abscesses. Patients and Methods: In this study, the data of 41 patients who had abdominal abscess or fluid collections, and underwent treatment by percutaneous CT-guided drainage were analyzed. Treatment was assessed by reduction of collection size, relief of symptoms and signs including abdominal pain and fever and imaging findings. Any morbidity such as wound infection, sepsis, hematoma formation or peritonitis was followed up to six months after the procedure. Results: The average age of the patients was 54 years (range 12 to 79), including 21 (51%) men and 20 (49%) women. The common signs and symptoms were pain (83%) and fever (80.5%). The most prevalent abdominal abscess etiology was previous surgery in 31 cases (75.5%). Abscess diameter ranged between 5 and 12 cm (mean, 7.8 cm). The average hospital stay was 8 days (4-15). Thirty five cases (86%) were successfully treated. Only one case (2.5%) developed complication (peritonitis) after the procedure. Conclusions: According to our findings, CT-guided percutaneous drainage is a safe and effective procedure in the treatment of abdominal abscess and fluid collection. PMID:25763077

  2. [Ultrasonically-guided percutaneous needle biopsy in the diagnosis of malignant abdominal diseases].

    PubMed

    Pesić, V; Lisanin, Lj; Lukac, S; Zica, D; Kupresanin, S; Spasić, V

    1998-01-01

    In 3-year period 340 percutaneous ultrasonographically guided needle biopsies of abdominal organs and tissues were performed in suspected neoprocesses. Positive cytologic results were obtained in 77.6% and histological in 74.8% of patients. These results were obtained thanks to good choice of a bioptic needle and the technique of performing percutaneous needle biopsy under ultrasonographic control and sometimes in combination with radioscopy, too. Experience of both a biopsy performer and a cytologist or histologist with this kind of material is of great importance. Thanks to early histologic diagnosis, made in this way, percutaneous biopsy is classified as a high sensitive method and as such it forces on to be one of the first methods in algorithm of diagnostic procedures. Even the aim of this paper is to point out not only the authors ultrasonographic experience but also reliability, simplicity and safety of percutaneous guided needle biopsies, what excludes the necessity for more difficult and more expensive diagnostic procedures significantly reducing the examination. PMID:9612124

  3. Image-Guided Percutaneous Ablation of Hepatic Malignancies

    PubMed Central

    Foltz, Gretchen

    2014-01-01

    The liver is a common site of primary and secondary malignancies, often resulting in significant morbidity and mortality. Evaluating these patients in a multidisciplinary setting allows for optimal utilization of all oncologic therapies including surgery, radiation, systemic chemotherapy, transarterial therapies, and ablation. While surgical intervention often provides the best outcomes when treating most hepatic tumors, many patients are not surgical candidates due to extensive tumor burden, underlying liver disease, or other comorbid conditions. The evolution of imaging and ablation devices has allowed for the increased utilization of percutaneous ablation as definitive and palliative treatment of primary and metastatic hepatic malignancies. Ablation induces tumor necrosis by injection of chemicals (chemical ablation) or temperature modification (thermal ablation). The goal of this review is to provide an overview of different ablation techniques commonly used for hepatic malignancies, discuss the oncologic outcomes of these interventions, and outline the current indications, contraindications, and reported complications of these therapies. PMID:25071304

  4. Percutaneous ultrasound-guided insertion of ventriculo-atrial shunts.

    PubMed

    McCracken, James Albert; Bahl, Anuj; McMullan, John

    2016-08-01

    Ventriculo-atrial (VA) shunts have been in use for >60 years but less frequently so of late. This is due to a combination of the risk of cardiac complications, lack of expertise and a lengthy operation. We present our consecutive prospective series of 10 VA shunts inserted using a percutaneous method employing the Sonowand Invite™ neuronavigation system for both the distal and proximal catheters, over a 13-month period. We had two complications of cases needing revision, but our series highlights a safe and reproducible method of inserting a VA shunt. About 30% of the procedures were carried out by a trainee as the primary surgeon. This technique does not necessarily require the expertise of a complex hydrocephalus surgeon and is thus able to be in the armoury of any neurosurgeon needing to do a VA shunt procedure. The indications, operative data and outcomes of our patients are discussed. PMID:27025913

  5. Ultrasound-Guided Percutaneous Drainage of Neonatal Pyometrocolpos Under Local Anesthesia

    SciTech Connect

    Algin, Oktay; Erdogan, Cuneyt; Kilic, Nizamettin

    2011-02-15

    Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.

  6. Ultrasound-Guided Percutaneous Tenotomy of Biceps Tendon: Technical Feasibility on Cadavers.

    PubMed

    Sconfienza, Luca Maria; Mauri, Giovanni; Messina, Carmelo; Aliprandi, Alberto; Secchi, Francesco; Sardanelli, Francesco; Randelli, Pietro Simone

    2016-10-01

    We tested the technical feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon (LHBT) in cadavers. Both shoulders of two fresh cadavers were scanned anteriorly to evaluate the extra-articular portion of the LHBT. Under ultrasound monitoring, a scalpel was advanced obliquely up to touch the superficial medial side of the LHBT, cutting it until the tendon was not visible anymore. Ultrasound evaluation was repeated after the procedure, and anatomic dissection was performed. The procedure was 100% feasible: four cuts were made to completely sever the tendon; the duration was less than 1 min. Skin incision measured 5 mm in two cases and 6 mm in two cases. Anatomic dissection confirmed complete tendon cut in all cases with proximal and distal tendon stumps very close to each other. Ultrasound-guided percutaneous LHBT tenotomy was 100% technically feasible in cadavers with a quick procedure and minimal cutaneous incision. PMID:27471117

  7. Multiple large splenic abscesses managed with computed tomography-guided percutaneous catheter drainage in children.

    PubMed

    Yeom, Jung Sook; Park, Ji Sook; Seo, Ji-Hyun; Park, Eun Sil; Lim, Jae-Young; Park, Chan Hoo; Woo, Hyang Ok; Park, Jung Je; Cho, Jae Min; Youn, Hee-Shang

    2013-12-01

    Splenic abscess is a rare finding in children. Splenectomy combined with broad-spectrum antibiotics has been the treatment of choice for multiple splenic abscesses. Herein, we report the case of a 14-year-old girl with multiple large splenic abscesses that were successfully managed after two image-guided percutaneous drainage procedures and administration of intravenous antibiotics. Initially, an abscess located at the periphery in the lower pole of the spleen was aspirated under ultrasound guidance. Finally, another abscess located near the hilum of the spleen was drained under computed tomography guidance. To the best of our knowledge, this is the first report of multiple large splenic abscesses treated with computed tomography-guided percutaneous drainage. PMID:23597527

  8. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    SciTech Connect

    Becce, Fabio; Mouhsine, Elyazid; Mosimann, Pascal John; Anaye, Anass; Letovanec, Igor; Theumann, Nicolas

    2012-08-15

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

  9. Role of ultrasound-guided percutaneous antegrade pyelography in malignant obstructive uropathy: A Nigerian experience.

    PubMed

    Balogun, Babajide Olawale; Owolabi, James Idowu; Saliu, Abdulwaid Niran; Bankole, Michael Akintayo

    2015-01-01

    Ultrasound-guided percutaneous nephrostomy of the renal pelvis is a technique that is widely acceptable especially when contrast media is introduced in the procedure of antegrade pyelography. It is a relatively safe procedure that effectively improves renal function in obstructed kidneys. It can be performed in most cases as an alternative to retrograde pyelography. We present our experience and its role in obstructive uropathy due to malignancy. PMID:26229234

  10. Role of ultrasound-guided percutaneous antegrade pyelography in malignant obstructive uropathy: A Nigerian experience

    PubMed Central

    Balogun, Babajide Olawale; Owolabi, James Idowu; Saliu, Abdulwaid Niran; Bankole, Michael Akintayo

    2015-01-01

    Ultrasound-guided percutaneous nephrostomy of the renal pelvis is a technique that is widely acceptable especially when contrast media is introduced in the procedure of antegrade pyelography. It is a relatively safe procedure that effectively improves renal function in obstructed kidneys. It can be performed in most cases as an alternative to retrograde pyelography. We present our experience and its role in obstructive uropathy due to malignancy. PMID:26229234

  11. Percutaneous Repair of Radial Artery Pseudoaneurysm in a Hemodialysis Patient Using Sonographically Guided Thrombin Injection

    SciTech Connect

    Corso, Rocco Rampoldi, Antonio; Vercelli, Ruggero; Leni, Davide; Vanzulli, Angelo

    2006-02-15

    We report a case of a radial artery pseudoaneurysm complicating an incorrect puncture of a Brescia-Cimino hemodialysis fistula that was treated with percutaneous ultrasound-guided thrombin injection. The pseudoaneurysm recurred after the initial successful thrombin injection. With a second injection we obtained permanent pseudoaneurysm occlusion. Our case illustrates that this procedure is an effective treatment in this type of arteriovenous fistula complication. We compare this case with the only similar one we could find in the literature.

  12. Thrombotic Occlusion during Intravascular Ultrasonography-Guided Percutaneous Coronary Intervention of Stumpless Chronic Total Occlusion.

    PubMed

    Lee, Un Joo; Kim, Hyun Soo; Lee, Cheolhyun; Kim, Kwang-Yeol; Kim, Weon

    2014-12-01

    Percutaneous coronary intervention (PCI) of stumpless chronic total occlusion (CTO) lesions with a side branch stemming from the occlusion have a significantly lower treatment success rate because physicians cannot identify an accurate entry point with only conventional angiographic images. An intravascular ultrasonography (IVUS)-guided wiring technique might be useful for the penetration of stumpless CTO. We recently experienced thrombotic occlusion during an IVUS-guided stumpless CTO procedure. The cause of the thrombosis is not completely understood; the thrombosis may have been associated with the long use of the IVUS catheter. Special precautions should be taken to prevent thrombus in such cases. PMID:25568847

  13. In vivo intracardiac OCT imaging through percutaneous access: towards image guided radio-frequency ablation

    NASA Astrophysics Data System (ADS)

    Wang, Hui; Kang, Wei; Carrigan, Thomas; Bishop, Austin; Rosenthal, Noah; Arruda, Mauricio; Rollins, Andrew M.

    2012-01-01

    BACKGROUND Complete catheter-tissue contact and permanent tissue destruction are essential for efficient radio-frequency ablation (RFA) during cardiac arrhythmia treatment. Current methods of monitoring lesion formation are indirect and unreliable. We aim to develop optical coherence tomography (OCT) as an imaging guidance for RFA. OBJECTIVES The purpose of this study is to evaluate the feasibility of using OCT catheter to image endocardia wall in active beating hearts through percutaneous access. This is a critical step toward image guided RFA in a clinic setting. METHODS A cone-scanning forward-viewing OCT catheter was advanced into active beating hearts through percutaneous access in four swine. The OCT catheter was steered by an introducer to touch the endocardia wall. The images were then acquired at 10 frames per second at an axial resolution and lateral resolution of 15 μm. RESULTS We report the first in vivo intracardiac OCT imaging through percutaneous access with a thin and flexible OCT catheter. We are able to acquire high quality OCT images in active beating hearts, observe the polarization-related artifacts induced by the birefringence of myocardium and readily evaluate catheter-tissue contact. CONCLUSIONS It is feasible to acquire OCT images in beating hearts through percutaneous access. The observations indicate that OCT could be a promising technique for in vivo guidance of RFA.

  14. Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique

    PubMed Central

    Dave, Bharat R; Kurupati, Ranganatha Babu; Shah, Dipak; Degulamadi, Devanand; Borgohain, Nitu; Krishnan, Ajay

    2014-01-01

    Background: Percutaneous aspiration of abscesses under ultrasonography (USG) and computer tomography (CT) scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD) has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome. Materials and Methods: Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index) score at 2 years. Results: PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts (n = 2), persistent discharge (n = 1) for 2 weeks, blocked catheter (n = 2) and catheter pull out (n = 1) occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years. Conclusions: Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess. PMID:24600066

  15. Image-guided percutaneous needle biopsy in cancer diagnosis and staging.

    PubMed

    Gupta, Sanjay; Madoff, David C

    2007-06-01

    Image-guided percutaneous biopsy is a well-established and safe technique and plays a crucial role in management of cancer patients. Improvements in needle designs, development of new biopsy techniques, and continual advances in image-guidance technology have improved the safety and efficacy of the procedure. Lesions previously considered relatively inaccessible can now be safely biopsied. In this article, we review the various needle types, biopsy techniques, methods of safely assessing difficult-to-reach lesions, the advantages and disadvantages of various imaging modalities, and specific biopsy techniques applicable to different regions of the body. PMID:18070687

  16. Conversion of Percutaneous Cholecystostomy to Internal Transmural Gallbladder Drainage Using an Endoscopic Ultrasound-Guided, Lumen-Apposing Metal Stent.

    PubMed

    Law, Ryan; Grimm, Ian S; Stavas, Joseph M; Baron, Todd H

    2016-03-01

    Patients with acute cholecystitis sometimes require placement of percutaneous cholecystostomy catheters, either as a bridge to surgery or as primary therapy. In patients who cannot undergo surgery, subsequent removal of the catheter can lead to recurrence of cholecystitis, whereas leaving the drain in place can cause adverse events. We investigated internalization of percutaneous cholecystostomy drainage catheters, using endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMS) as an alternative treatment strategy. Seven patients (median age, 57 years; 6 men) underwent EUS-guided cholecystoenterostomy for internalization of gallbladder drainage with EUS-guided placement of a 10- or 15-mm LAMS. All had initially been treated with placement of a percutaneous cholecystostomy catheter for cholecystitis and were later deemed unfit for cholecystectomy. Technical success was achieved in all patients in 1 endoscopic session, with subsequent removal of all percutaneous drains. Two patients required placement of self-expandable metal stents within the LAMS to successfully bridge the gallbladder and gastrointestinal lumen. No adverse events occurred after a median follow-up of 2.5 months. EUS-guided cholecystoenterostomy using a LAMS is therefore a viable option for internal gallbladder drainage in patients who have a percutaneous cholecystostomy catheter and are poor candidates for cholecystectomy. PMID:26528802

  17. Unusual Presentation of Infected Vertebroplasty with Delayed Cement Dislodgment in an Immunocompromised Patient: Case Report and Review of Literature

    SciTech Connect

    Lin Weiche; Lee Chenhsiang; Chen Shihhao; Lui Chunchung

    2008-07-15

    Percutaneous vertebroplasty has been established as a safe and effective treatment for compression fractures of osteoporotic vertebrae. Complications of vertebroplasty, such as infection or anterior cement extrusion, are rare. Herein, we report an unusual presentation in an immunocompromised patient with an insidious infection of the disk. This infection resulted in dislodgment of the cement inferiorly and a compression fracture of the adjacent vertebra 6 months after vertebroplasty. We discuss the significance of this case and compare it with 7 others found in the literature.

  18. Optimization of volar percutaneous screw fixation for scaphoid waist fractures using traction, positioning, imaging, and an angiocatheter guide.

    PubMed

    Zlotolow, Dan A; Knutsen, Elisa; Yao, Jeffrey

    2011-05-01

    Percutaneous screw fixation of nondisplaced or reducible scaphoid fractures has become more popular as techniques and implants have improved. Many authors have advocated for the dorsal approach, citing difficulties with adequate screw placement from the volar approach. We have developed a straightforward and reproducible technique for volar percutaneous scaphoid screw fixation that mitigates most of the drawbacks of the approach. The wrist is held in extension and ulnar deviation with traction through the thumb. A 14-gauge angiocatheter needle is then used to localize the starting point and as a cannula for the guide wire. Specific fluoroscopic views help to confirm optimal guide wire placement. PMID:21527146

  19. Have Recent Vertebroplasty Trials Changed the Indications for Vertebroplasty?

    SciTech Connect

    Gangi, Afshin; Clark, William A.

    2010-08-15

    Two different investigators in the New England Journal of Medicine recently published two randomized controlled trials (RCTs) regarding the efficacy of vertebroplasty for painful osteoporotic vertebral compression fractures. In their results, both investigators concluded that there was no significant difference in pain relief between the vertebroplasty group and control group 1 month after treatment. The trials described a different patient cohort from the one we treat with vertebroplasty. Both enrolled patients had back pain for {<=}12 months. This duration of pain was far too long for a vertebroplasty trial, resulting in parallel trials of vertebroplasty on healed fractures. Where a study is needed, it should be comprised of patients with acute osteoporotic compression fractures, particularly those who are hospitalized or bedridden because of the pain of such fractures. Magnetic resonance imaging was not systematically performed before vertebroplasty, and inpatients were excluded. Inpatients with acute fracture pain are the group most likely to respond well to vertebroplasty. Enrolment was a problem in both trials. Randomization in both RCTs took >4 years for completion. We advise that vertebroplasty be offered to patients with recent fractures <8 weeks old who have uncontrolled pain as well as patients progressing to osteonecrosis and the intravertebral vacuum phenomenon (Kummels disease). The availability of recent MRI scanning is also critical to proper patient selection.

  20. Ultrasound guided percutaneous treatment for splenic abscesses: The significance in treatment of critically ill patients

    PubMed Central

    Zerem, Enver; Bergsland, Jacob

    2006-01-01

    AIM: To analyze the results of ultrasound guided percu-taneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess. METHODS: Thirty-six patients (14 females and 22 males, with an average age of 54.1 ± 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess ≥ 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed. RESULTS: Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was definitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure. CONCLUSION: Percutaneous treatmnet of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those ≥ 50 mm in diameter and for bilocular abscesses. PMID:17143953

  1. Posttraumatic lingual artery pseudoaneurysm treated with ultrasound-guided percutaneous thrombin injection.

    PubMed

    Masella, Pamela C; Hanson, Megan M; Hall, Brian T; Verghese, John J; Kellicut, Dwight C

    2014-07-01

    Pseudoaneurysms of the lingual artery are extremely rare and are commonly iatrogenic in nature or less frequently a result of blunt or penetrating trauma. Traditionally, these vascular abnormalities have been repaired with open or endovascular techniques. Although ultrasound-guided percutaneous thrombin injection has become a standard treatment for superficial pseudoaneurysms, there are no reports of this being used in the treatment of lingual artery pseudoaneurysms. We report the case of a 26-year-old man who suffered a penetrating head and neck injury after an improvised explosive device blast in Iraq who presented with persistent oropharyngeal swelling. Color-flow Doppler ultrasonography revealed the classic yin/yang sign of a pseudoaneurysm, and a computed tomography scan was obtained that revealed a right lingual artery pseudoaneurysm. With the lack of endovascular capabilities and the excessive risk of open surgery, thrombin was injected directly into the pseudoaneurysm under ultrasound guidance. A computed tomography scan and Doppler ultrasonography revealed complete resolution of the aneurysm. This article presents the first reported case in the English literature of a lingual artery aneurysm after penetrating trauma managed successfully with ultrasound-guided percutaneous thrombin injection. PMID:24365080

  2. CT-Guided Percutaneous Radiofrequency Thermocoagulation for Recurrent Trigeminal Neuralgia After Microvascular Decompression

    PubMed Central

    Lai, Guang-Hui; Tang, Yuan-Zhang; Wang, Xiao-Ping; Qin, Hong-Jun; Ni, Jia-Xiang

    2015-01-01

    Abstract This article evaluates the long-term outcomes of computed tomography (CT)-guided percutaneous radiofrequency thermocoagulation (PRT) for patients with recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD). This is a retrospective study of 41 patients with intractable TN who after MVD underwent CT-guided PRT procedures between 2002 and 2012. The mean length of follow-up after PRT was 44.4 months. Immediate pain relief was in 37 patients (90.2%); the percentage of patients who remained in “excellent” or “good” pain relief condition after CT-guided PRT procedure was 85% at 1 year, 80% at 2 years, 51% at 5 years, and 41% at 10 years. Six patients received the second PRT and all achieved “excellent” or “good” pain relief. In total, 34 of these patients (82.9%) received multi-PRT procedure and remained satisfied with their pain relief during the follow-up period. Postoperative complications included facial numbness in 36 patients, limited eyes opening in 1 patient, ear paresthesia in 1 patient, no tears in 1 patient, and taste hypesthesia in 1 patient; these symptoms were all improved in the process of follow-up and their life had not severely affected. No mortality was observed during and after CT-guided PRT procedures. CT-guided PRT should be considered as an alternative treatment for patients with recurrent TN after MVD. PMID:26266350

  3. Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications

    PubMed Central

    Prasad, Narayan; Kumar, Shashi; Manjunath, Revanasiddappa; Bhadauria, Dharmendra; Kaul, Anupama; Sharma, Raj K; Gupta, Amit; Lal, Hira; Jain, Manoj; Agrawal, Vinita

    2015-01-01

    Background Percutaneous renal biopsy (PRB) can result in serious complications. The study is aimed to compare the biopsy yield and complications rate of the real-time ultrasonagram (USG)-guided PRB and needle tracking with and without needle guide in two different study periods. Methods We compared the yield and complications of 2138 kidney biopsies performed in two different periods, 1510 biopsies during the first period from April 2004–December 2010 and 628 biopsies during second period from January 2011–March 2013. All biopsies in both periods were performed by nephrologists. Radiologists provided the real-time image without needle guide during the first period while nephrologists performed both imaging and biopsy with needle guide during the second period. Results Of all the 2138 patients, 226 (10.5%) patients developed 118 minor and 108 major complications. Only 13 (2.1%) major complications occurred in the second period and 95 (6.7%) in the first period (P < 0.001). The relative risk of developing a major complication without guide was 3.04 times greater than that of the biopsies performed with use of the guide. The mean number of glomeruli per biopsy obtained during the second period (17.98 ± 6.75) was significantly greater than that of the first period (14.14 ± 6.01) (P = 0.004). The number of passes to acquire adequate tissue (P = 0.001) and percentage of cortex on biopsy (P = 0.001) were also significantly better in the second period. The optimal observation period post biopsy is 24 h. Conclusions Real-time USG imaging supported by needle guide device is associated with better biopsy yield and fewer complications. PMID:25815170

  4. Ultrasound-guided percutaneous antegrade hydropropulsion to relieve ureteral obstruction in a pet guinea pig (Cavia porcellus)

    PubMed Central

    Eshar, David; Lee-Chow, Bridget; Chalmers, Heather J.

    2013-01-01

    Severe hydroureter and hydronephrosis secondary to ureteral obstruction by calculus were present in a guinea pig. A palliative ultrasound-guided percutaneous antegrade hydropropulsion was performed under general anesthesia to relieve the ureteral obstruction and the associated clinical signs. We describe the technique and the considerations for its potential application in similar cases. PMID:24293674

  5. Using an abdominal phantom to teach urology residents ultrasound-guided percutaneous needle placement

    PubMed Central

    Filippou, Pauline; Odisho, Anobel; Ramaswamy, Krishna; Usawachintachit, Manint; Hu, Weiguo; Li, Jianxing; Chi, Thomas

    2016-01-01

    ABSTRACT Introduction: To assess the effect of a hands-on ultrasound training session to teach urologic trainees ultrasound-guided percutaneous needle placement. Materials and methods: University of California, San Francisco (UCSF) urology residents completed a time trial, placing a needle into a phantom model target under ultrasound guidance. Participants were randomized into three educational exposure groups: Group 1's time trial occurred prior to any teaching intervention, group 2's after experiencing a hands-on training module, and group 3's after exposure to both the training module and one-on-one attending feedback. Needle placement speed and accuracy as well as trainees' perceived confidence in utilizing ultrasound were measured. Results: The study cohort consisted of 15 resident trainees. Seven were randomized to group 1, three to group 2, and five to group 3. All residents reported minimal prior ultrasound experience. Their confidence in using ultrasound improved significantly after completing the training module with the most significant improvement seen among junior residents. Time to needle placement was fastest after receiving attending feedback (46.6sec in group 3 vs. 82.7sec in groups 1 and 2, p<0.01). Accuracy also improved with attending feedback, though the number of repositioning attempts did not differ significantly between groups. Conclusions: A hands-on training module and use of an abdominal phantom trainer increased resident confidence and skill in their use of ultrasound to guide percutaneous needle positioning. Attending feedback is critical for improving accuracy in needle guidance toward a target. Ultrasound-guided needle positioning is a teachable skill and can be applicable to multiple urologic procedures. PMID:27564282

  6. Effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts

    PubMed Central

    Özgen, Ali

    2016-01-01

    PURPOSE We aimed to evaluate the effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts. METHODS From January 2002 to January 2014, 35 simple breast cysts (mean volume, 8.2 mL; range, 4–33 mL) in 28 females (mean age, 39 years) were evaluated. In a single session, all cysts were aspirated using 20G needles, refilled with 99% ethanol (90% of the volume of the aspirated fluid), and reaspirated completely after 10 minutes of exposure under ultrasound guidance. Follow-up ultrasonography examinations were performed at one week, one month, three months, and six months for all patients and 12 months, 18 months, and 24 months for available patients. Follow-up duration varied between 6 and 24 months (mean, 15 months). RESULTS The technical success rate of ultrasound-guided percutaneous ethanol sclerotherapy was 97%. The needle tip was dislocated and ethanol was given into the breast parenchyma in one patient (3%). One cyst (3%) was reaspirated at the first week follow-up due to intracystic hemorrhage. Of the 34 cysts treated, 25 (74%) completely responded to therapy and were no longer detectable on follow-up examinations. Eight cysts (24%) significantly decreased in size and then completely disappeared at six months. At the end of the follow-up period, the clinical success rate reached 100%, and none of the cysts were visible. Except mild to moderate sensation of burning or pain which disappeared or subsided significantly in a couple of minutes, no other complications were observed in patients. CONCLUSION Ultrasound-guided ethanol sclerotherapy is a fast, safe, and highly effective method in the treatment of simple breast cysts. PMID:27087190

  7. Feasibility of CT-Guided Percutaneous Needle Biopsy in Early Diagnosis of BOOP

    SciTech Connect

    Poulou, Loukia S. Tsangaridou, Iris; Filippoussis, Petros; Sidiropoulou, Nektaria; Apostolopoulou, Sofia; Thanos, Loukas

    2008-09-15

    Bronchiolitis obliterans organizing pneumonia (BOOP) is a nonneoplastic, noninfectious lung disease with a diverse spectrum of imaging abnormalities and nonspecific symptoms diagnosed by open lung biopsy, transbroncial biopsy, and/or video-assisted thoracoscopy. The objective of this study was to retrospectively assess the role of percutaneous computed tomography (CT)-guided biopsy in early diagnosis of the disorder. Fourteen BOOP cases diagnosed by CT-guided biopsy were analyzed in terms of imaging abnormalities and complication rate. All had previously undergone a nondiagnostic procedure (bronchoscopy, transbronchial biopsy, bronchoalveolar lavage) to exclude infection or lung cancer. The most common imaging abnormalities in descending order were bilateral consolidations (5/14), unilateral tumor-like lesions (5/14), unilateral consolidations (3/14), and diffuse reticular pattern (1/14). Coexistent abnormalities (pleural effusions, nodules, ground-glass opacities) were observed in five patients. The complication rate was 4 of 14 (28.6%), including 2 cases of subclinical pneumothorax and 1 case of minor hemoptysis and local lung injury. None required intervention. We conclude that transthoracic CT-guided biopsy may be used in the diagnosis of BOOP in selected patients with mild complications. For the focal consolidation nodule/mass imaging pattern, CT-guided biopsy may prove to be a reasonable alternative to more invasive procedures.

  8. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

    PubMed Central

    Kim, Yong Joo; Shin, Tae Beom

    2011-01-01

    Objective To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Materials and Methods Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Results Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Conclusion Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis. PMID:21430938

  9. Percutaneous stone clearance of the gallbladder through an access cholecystostomy. Laparoscopic-guided technique.

    PubMed

    Abd el Ghany, A B; Holley, M P; Cuschieri, A

    1989-01-01

    A laparoscopic-guided technique of percutaneous gallstone fragmentation/removal has been developed in the pig. The procedure entails the creation of a percutaneous access cholecystostomy. The access tract can be safely dilated after 7 days to F16, thereby allowing the introduction of both the Olympus flexible and the Berci-Shore rigid choledochoscopes. Following endoscopic occlusion of the cystic duct by a biliary balloon catheter, stone fragmentation can be conducted under direct visual control. In this particular study, electrohydraulic lithotripsy was performed of human cholesterol and bile-pigment stones inserted into the gallbladder of 16 pigs. The gallstone debris resulting from lithotripsy was then washed out with saline. Larger residual fragments could easily be extracted with the Dormia basket under visual guidance. There was a significant positive correlation between stone size (r = 0.98) and weight (r = 0.96) and the number of pulses needed to achieve satisfactory stone fragmentation. The gross composition of the stones (predominantly cholesterol or pigment) did not influence the number of pulses required. Electrohydraulic lithotripsy caused an explosion effect (the fragments hit the gallbladder wall), causing submucosal haematoma formation. This, however, was not followed by any untoward effect until sacrifice of the animals 10-16 weeks later. Electrohydraulic shocks delivered to the gallbladder wall itself resulted in larger haematoma formation and breach of the gallbladder mucosa with active bleeding into the gallbladder lumen, but again no instance of gallbladder perforation was encountered.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2530642

  10. Ultrasound-Guided Percutaneous Microwave Ablation for Hepatocellular Carcinoma in the Caudate Lobe.

    PubMed

    Dou, Jian-Ping; Yu, Jie; Cheng, Zhi-Gang; Han, Zhi-Yu; Liu, Fang-Yi; Yu, Xiao-Ling; Liang, Ping

    2016-08-01

    Treatment for liver tumors in the caudate lobe is challenging because of their location and complex anatomy. This study was intended to evaluate the feasibility, efficacy and tolerability of ultrasound-guided percutaneous microwave (MW) ablation for treating hepatocellular carcinoma (HCC) in the caudate lobe. From December 2011 to May 2015, a total of 20 patients (mean age: 62 ± 11 y) with HCC in the caudate lobe were enrolled in this study. Patient characteristics and tumor features were analyzed. The epigastric approach, intercostal approach and the combination were used in 4, 14 and 2 patients, respectively. Contrast-enhanced ultrasound (CEUS) guidance and temperature monitoring were applied as ancillary techniques. Ethanol injection was performed for tumors adjacent to the inferior vena cava or hepatic hilum. Contrast images were performed to evaluate treatment response after ablation. Technical success, technique efficacy, local tumor progression and complications were documented. Technique efficacy was achieved in 18 patients (18/20, 90%). Two patients received (125)I brachytherapy as palliative therapy for residual tumors that could not be ablated technically after the first ablation. Technical success was achieved in 16 patients (16/20, 80%). In 2 patients, ablation was completed after two sessions. CEUS was applied in 5 patients and temperature monitoring in 2 patients. Eight patients received an ethanol injection during ablation. Eleven patients achieved a minimum 5-mm safety margins. Local tumor progression was detected in 3 patients (16.7%, 3/18) during a median follow-up of 18.4 mo (range: 3-45 mo). Tumors in these 3 patients were all larger than 2.0 cm. No major or minor complications were observed. In conclusion, ultrasound-guided percutaneous microwave ablation combined with CEUS, temperature monitoring, and ethanol injection is a tolerable and relatively effective treatment for HCC in the caudate lobe. PMID:27126238

  11. Endoscopic ultrasound-guided biliary drainage as an alternative to percutaneous drainage and surgical bypass.

    PubMed

    Prachayakul, Varayu; Aswakul, Pitulak

    2015-01-16

    Endoscopic retrograde cholangiopancreatography had been a treatment modality of choice for both benign and malignant biliary tract obstruction for more than half century, with a very high clinical success rate and low complications. But in certain circumstances, such as advanced and locally advanced pancreatobiliary malignancies (pancreatic cancer, cholangiocarcinoma, ampullary tumor) and tight benign strictures, endoscopic retrograde cholangiopancreatography (ERCP) fails. Up to this point, the only alternative interventions for these conditions were percutaneous transhepatic biliary drainage or surgery. Endoscopic ultrasound guided interventions was introduced for a couple decades with the better visualization and achievement of the pancreatobiliary tract. And it's still in the process of ongoing development. The inventions of new techniques and accessories lead to more feasibility of high-ended procedures. Endoscopic ultrasound guided biliary drainage was a novel treatment modality for the patient who failed ERCP with the less invasive technique comparing to surgical bypass. The technical and clinical success was high with acceptable complications. Regarded the ability to drain the biliary tract internally without an exploratory laparotomy, this treatment modality became a very interesting procedures for many endosonographers, worldwide, in a short period. We have reviewed the literature and suggest that endoscopic ultrasound-guided biliary drainage is also an option, and one with a high probability of success, for biliary drainage in the patients who failed conventional endoscopic drainage. PMID:25610532

  12. Percutaneous inner-ear access via an image-guided industrial robot system

    PubMed Central

    Baron, S; Eilers, H; Munske, B; Toennies, JL; Balachandran, R; Labadie, RF; Ortmaier, T; Webster, RJ

    2014-01-01

    Image-guided robots have been widely used for bone shaping and percutaneous access to interventional sites. However, due to high-accuracy requirements and proximity to sensitive nerves and brain tissues, the adoption of robots in inner-ear surgery has been slower. In this paper the authors present their recent work towards developing two image-guided industrial robot systems for accessing challenging inner-ear targets. Features of the systems include optical tracking of the robot base and tool relative to the patient and Kalman filter-based data fusion of redundant sensory information (from encoders and optical tracking systems) for enhanced patient safety. The approach enables control of differential robot positions rather than absolute positions, permitting simplified calibration procedures and reducing the reliance of the system on robot calibration in order to ensure overall accuracy. Lastly, the authors present the results of two phantom validation experiments simulating the use of image-guided robots in inner-ear surgeries such as cochlear implantation and petrous apex access. PMID:20718268

  13. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report.

    PubMed

    Scroop, Rebecca; Eskridge, Joseph; Britz, Gavin W

    2002-05-01

    Paradoxical cerebral embolism of cement occurred in a 78-year-old woman after cement-assisted transpedicular spinal fixation surgery. Multiple pulmonary emboli of polymethylmethacrylate precipitated pulmonary hypertension and right-to-left shunting into the systemic circulation through a patent foramen ovale. This rare complication occurred because of failure to recognize venous migration of cement during the procedure and the injection of multiple levels in one setting. Although this was an open procedure, the technical aspects were the same as for vertebroplasty and the precautions should be applied to percutaneous vertebroplasty. PMID:12006295

  14. Long-term outcomes of fractional flow reserve-guided vs. angiography-guided percutaneous coronary intervention in contemporary practice

    PubMed Central

    Li, Jing; Elrashidi, Muhamad Y.; Flammer, Andreas J.; Lennon, Ryan J.; Bell, Malcolm R.; Holmes, David R.; Bresnahan, John F.; Rihal, Charanjit S.; Lerman, Lilach O.; Lerman, Amir

    2013-01-01

    Aims Fractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but is underutilized in daily clinical practice. We aimed to study long-term outcomes of FFR-guided percutaneous coronary intervention (PCI) in the general clinical practice. Methods and results In this retrospective study, consecutive patients (n = 7358), referred for PCI at the Mayo Clinic between October 2002 and December 2009, were divided in two groups: those undergoing PCI without (PCI-only, n = 6268) or with FFR measurements (FFR-guided, n = 1090). The latter group was further classified as the FFR-Perform group (n = 369) if followed by PCI, and the FFR-Defer group (n = 721) if PCI was deferred. Clinical events were compared during a median follow-up of 50.9 months. The Kaplan–Meier fraction of major adverse cardiac events at 7 years was 57.0% in the PCI-only vs. 50.0% in the FFR-guided group (P = 0.016). Patients with FFR-guided interventions had a non-significantly lower rate of death or myocardial infarction compared with those with angiography-guided interventions [hazard ratio (HR): 0.85, 95% CI: 0.71–1.01, P = 0.06]; the FFR-guided deferred-PCI strategy was independently associated with reduced rate of myocardial infarction (HR: 0.46, 95% CI: 0.26–0.82, P = 0.008). After excluding patients with FFR of 0.75–0.80 and deferring PCI, the use of FFR was significantly associated with reduced rate of death or myocardial infarction (HR: 0.80, 95% CI: 0.66–0.96, P = 0.02). Conclusion In the contemporary practice, an FFR-guided treatment strategy is associated with a favourable long-term outcome. The current study supports the use of the FFR for decision-making in patients undergoing cardiac catheterization. PMID:23344979

  15. Imaging-Guided Percutaneous Radiofrequency Ablation of Adrenal Metastases: Preliminary Results at a Single Institution with a Single Device

    SciTech Connect

    Carrafiello, G.; Lagana, D.; Recaldini, C.; Giorgianni, A.; Ianniello, A.; Lumia, D.; D'Ambrosio, A.; Petulla, M.; Dionigi, G.; Fugazzola, C.

    2008-07-15

    The aim of this study was to show the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of adrenal metastases (AM). Seven imaging-guided percutaneous RFA treatments were performed in six patients (two men and four women; mean age, 67.2 years; range, 55-74 years) with six AM who were referred to our institution from 2003 to 2006. One patient was treated twice for recurrence after first treatment. The average diameter of the treated AM was 29 mm (range, 15-40 mm). In all patients, the diagnosis was obtained with CT current protocols in use at our institution and confirmed by pathology with an image-guided biopsy. No major complications occurred. In one patient shortly after initiation of the procedure, severe hypertension was noted; another patient developed post-RFA syndrome. In five of six lesions, there was no residual enhancement of the treated tumor. In one patient CT examination showed areas of residual enhancement of the tumor after treatment. Our preliminary results suggest that imaging-guided percutaneous RFA is effective for local control of AM, without major complications and with a low morbidity rate related to the procedure. Long-term follow-up will need to be performed and appropriate patient selection criteria will need to be determined in future randomized trials.

  16. Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy

    PubMed Central

    Su, Hao; Shang, Weijian; Cole, Gregory; Li, Gang; Harrington, Kevin; Camilo, Alexander; Tokuda, Junichi; Tempany, Clare M.; Hata, Nobuhiko; Fischer, Gregory S.

    2014-01-01

    This paper presents a fully-actuated robotic system for percutaneous prostate therapy under continuously acquired live magnetic resonance imaging (MRI) guidance. The system is composed of modular hardware and software to support the surgical workflow of intra-operative MRI-guided surgical procedures. We present the development of a 6-degree-of-freedom (DOF) needle placement robot for transperineal prostate interventions. The robot consists of a 3-DOF needle driver module and a 3-DOF Cartesian motion module. The needle driver provides needle cannula translation and rotation (2-DOF) and stylet translation (1-DOF). A custom robot controller consisting of multiple piezoelectric motor drivers provides precision closed-loop control of piezoelectric motors and enables simultaneous robot motion and MR imaging. The developed modular robot control interface software performs image-based registration, kinematics calculation, and exchanges robot commands and coordinates between the navigation software and the robot controller with a new implementation of the open network communication protocol OpenIGTLink. Comprehensive compatibility of the robot is evaluated inside a 3-Tesla MRI scanner using standard imaging sequences and the signal-to-noise ratio (SNR) loss is limited to 15%. The image deterioration due to the present and motion of robot demonstrates unobservable image interference. Twenty-five targeted needle placements inside gelatin phantoms utilizing an 18-gauge ceramic needle demonstrated 0.87 mm root mean square (RMS) error in 3D Euclidean distance based on MRI volume segmentation of the image-guided robotic needle placement procedure. PMID:26412962

  17. Diagnostic Accuracy of MRI-guided Percutaneous Transthoracic Needle Biopsy of Solitary Pulmonary Nodules

    SciTech Connect

    Liu, Shangang; Li, Chengli; Yu, Xuejuan; Liu, Ming; Fan, Tingyong Chen, Dong Zhang, Pinliang Ren, Ruimei

    2015-04-15

    ObjectiveThe purpose of our study was to evaluate the diagnostic accuracy of MRI-guided percutaneous transthoracic needle biopsy (PTNB) of solitary pulmonary nodules (SPNs).MethodsRetrospective review of 69 patients who underwent MR-guided PTNB of SPNs was performed. Each case was reviewed for complications. The final diagnosis was established by surgical pathology of the nodule or clinical and imaging follow-up. Pneumothorax rate and diagnostic accuracy were compared between two groups according to nodule diameter (≤2 vs. >2 cm) using χ{sup 2} chest and Fisher’s exact test, respectively.ResultsThe success rate of single puncture was 95.6 %. Twelve (17.4 %) patients had pneumothorax, with 1 (1.4 %) requiring chest tube insertion. Mild hemoptysis occurred in 7 (7.2 %) patients. All of the sample material was sufficient for histological diagnostic evaluation. Pathological analysis of biopsy specimens showed 46 malignant, 22 benign, and 1 nondiagnostic nodule. The final diagnoses were 49 malignant nodules and 20 benign nodules basing on postoperative histopathology and clinical follow-up data. One nondiagnostic sample was excluded from calculating diagnostic performance. A sensitivity, specificity, accuracy, positive predictive value, and negative predictive value in diagnosing SPNs were 95.8, 100, 97.0, 100, and 90.9 %, respectively. Pneumothorax rate, diagnostic sensitivity, and accuracy were not significantly different between the two groups (P > 0.05).ConclusionsMRI-guided PTNB is safe, feasible, and high accurate diagnostic technique for pathologic diagnosis of pulmonary nodules.

  18. CT-guided percutaneous aspiration of Tarlov cyst as a useful diagnostic procedure prior to operative intervention.

    PubMed

    Lee, J-Y; Impekoven, P; Stenzel, W; Löhr, M; Ernestus, R-I; Klug, N

    2004-07-01

    Tarlov or perineural cysts are lesions of the nerve root most often found in the sacral region. Several authors recommend surgical treatment of symptomatic Tarlov cysts. However, successful surgical treatment is dependent on appropriate patient selection. In this article, we report three cases of a sacral perineural cyst, causing sciatic pain, and emphasize the usefulness of CT-guided percutaneous aspiration as an important diagnostic and prognostic procedure prior to definitive operative treatment. PMID:15197609

  19. Percutaneous ultrasound-guided aspiration of an anterior cruciate ligament ganglion cyst: description of technique and case presentation.

    PubMed

    Krill, Michael; Peck, Evan

    2014-12-01

    An anterior cruciate ligament ganglion cyst is an infrequent but potentially clinically significant cause of knee pain. Although the cyst may be removed surgically, percutaneous ultrasound-guided anterior cruciate ligament ganglion cyst aspiration and injection is feasible. To our knowledge, we present the first reported case description of the utilization of ultrasound guidance to perform this procedure with a successful clinical outcome. PMID:25088315

  20. CT-guided percutaneous transthoracic needle biopsy for paramediastinal and nonparamediastinal lung lesions

    PubMed Central

    Wang, Ye; Jiang, Faming; Tan, Xiaobo; Tian, Panwen

    2016-01-01

    Abstract Computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) is used for identifying paramediastinal lung lesions that cannot be diagnosed by bronchoscopy, but the diagnostic performance and complication rate are unreported. This retrospective study was approved by the institutional review board committee. A total of 1484 patients who underwent PTNB between April 2012 and April 2015 were enrolled. The cohort was divided into a paramediastinal (n = 195) and a nonparamediastinal group (n = 1289) based on lesion location. Diagnostic yield for malignancy and complication rates were analyzed in both groups. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for hemoptysis complication in the paramediastinal group. Percutaneous transthoracic needle biopsy showed 95.6% (109/114) sensitivity and 100% (77/77) specificity for the diagnosis of lesions in the paramediastinal group, with similar accuracy (95.4%, 186/195) to that in the nonparamediastinal group (94.7%, 1221/1289; P = 0.699). Compared with PTNB for nonparamediastinal lesions, PTNB for paramediastinal lesions demonstrated a comparable pneumothorax rate (8.21% vs 8.69%; P = 0.823) and hemothorax rate (2.56% vs 1.47%; P = 0.261), and a higher hemoptysis rate (28.2% vs 19.4%; P = 0.005). Among 6 defined paramediastinal regions, the overall complication rate was the highest in the posterior region (42.4%) and the lowest in the paraventricular region (13.6%). Multivariate analysis revealed that lesion size of 2 to 3 cm (odds ratio [OR] 3.22), intrapulmonary length of needle path >2 cm (OR 8.85), and proximal to pulmonary artery (OR 10.33) were independent risk factors for hemoptysis in the paramediastinal group. Computed tomography-guided PTNB can diagnose paramediastinal lesions with high yield and acceptable complication rates. Given higher rate of hemoptysis in PTNB for paramediastinal lesions, more attention

  1. Percutaneous CT-guided fine-needle aspiration of pulmonary lesions: Results and complications in 409 patients.

    PubMed

    Laspas, F; Roussakis, A; Efthimiadou, R; Papaioannou, D; Papadopoulos, S; Andreou, J

    2008-10-01

    The purpose of this study was to report our centre's experience in the results and complications of percutaneous CT-guided lung biopsy. A retrospective review of 409 patients who underwent percutaneous CT-guided fine-needle aspiration of suspicious lung lesions for more than 5 years was carried out. Nodule sizes ranged from 0.6 to 10 cm. The calibre of the needle used was 21-23 G. Specimen adequacy and patient outcome were evaluated. Each case was reviewed for complications. Sufficient diagnostic material was obtained in 369 (90%) of the 409 fine-needle aspirations. Diagnosis was malignancy in 290 (70%) samples, four (1%) samples were suspicious for malignancy, 65 (16%) samples were negative for malignancy and definite benign findings were identified in 10 (3%) specimens. There were 25 false-negative cases and one false-positive case. Sensitivity was 92% and specificity 98%. Pneumothorax was the most common complication and occurred in 17 (4%) patients. Only one of them required thoracic drainage. Blood effusion around the lesion or along the needle track was detected on the post-biopsy CT in 8 (2%) patients. However, only one of them suffered from a mild haemoptysis. Percutaneous CT-guided biopsy is an effective and fast procedure for diagnosis of suspected pulmonary malignancy, with a low complication rate. PMID:19032391

  2. Acute Calcific Bursitis After Ultrasound-Guided Percutaneous Barbotage of Rotator Cuff Calcific Tendinopathy: A Case Report.

    PubMed

    Kang, Bo-Sung; Lee, Seung Hak; Cho, Yung; Chung, Sun Gun

    2016-08-01

    Ultrasound-guided percutaneous barbotage is an effective treatment for rotator cuff calcific tendinopathy, providing rapid and substantial pain relief. We present the case of a 49-year-old woman with aggravated pain early after ultrasound-guided barbotage of a large calcific deposit in the supraspinatus tendon. Subsequent examination revealed a thick calcification spreading along the subacromial-subdeltoid bursa space, suggesting acute calcific bursitis complicated by barbotage. Additional barbotage alleviated her pain completely. Therefore, a high index of suspicion for acute calcific bursitis is required in patients with unresolved or aggravated pain after barbotage. Repeated barbotage could be effective for this condition. PMID:26902864

  3. Diagnostic Accuracy of PET/CT-Guided Percutaneous Biopsies for Malignant Peripheral Nerve Sheath Tumors in Neurofibromatosis Type 1 Patients

    PubMed Central

    Brahmi, Mehdi; Combemale, Patrick

    2015-01-01

    Background Malignant peripheral nerve sheath tumors (MPNST) are one of the most frequent causes of death in patients with neurofibromatosis type 1 (NF1). Early detection is crucial because complete surgical resection is the only curative treatment. It has been previously reported that an 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) image with a T/L (Tumor/Liver) SUVmax ratio > 1.5 provides a high negative predictive value; however, it is not specific enough to make a NF1-related MPNST diagnosis. A formal proof of malignant transformation from a histological analysis is necessary before surgical excision because the procedure can cause mutilation. The objective of the present work was to investigate the effectiveness of and complications associated with PET/CT-guided percutaneous biopsies for an NF1-related MPNST diagnosis. Methods PET/CT-guided percutaneous biopsy procedures performed on 26 NF1 patients with a clinical suspicion of MPNST and a suspect lesion from a PET/CT scan (T/L SUVmax ratio > 1.5) were retrospectively evaluated. The localization of the suspected malignant site was determined using PET/CT. A stereotactic (ultrasonic and CT control) core biopsy technique was used with a local anesthesia. Results The first PET/CT-guided percutaneous biopsies enabled a pathological diagnosis for all of the patients (no "inconclusive " results were obtained), and no secondary procedures were needed. Among the 26 patients, the histopathological results from the biopsy were malignant in 17 cases and benign (BPNST with atypical cells) in nine cases. No complications from the diagnostic procedure were observed. A surgical resection was performed in 18 patients (seven benign and 11 malignant biopsies), removing the fine needle biopsy scar. In addition, six locally advanced/metastatic MPNST were treated with chemo/radiotherapy, and two BPNST had no progression after a follow-up of 14 and 39 months, respectively. The PET/CT-guided

  4. Dens Axis Vertebroplasty Combined with C 3 Vertebral Body Arthroplasty. Case Study.

    PubMed

    Guzik, Grzegorz

    2015-01-01

    Spinal tumors are most commonly located in the thoracic and lumbar spine, less commonly in the cervical section of the spine. Diagnosis is usually late and surgery is not radical. Myeloma is one of the most frequent metastatic spinal tumors. Surgical treatment of osteolytic lesions in the spine involves posterior and anterior stabilization, full or partial tumorectomies as well as decompression of neural structures. Bone cement injection has been increasingly used in plastic surgery of vertebral bodies and is most frequently performed percutaneously in the thoracic and lumbar spine. Cervical vertebroplasty can be performed both percutaneously and after anterior exposure of the spine. The dens axis can also be approached transorally. The safest surgical technique seems to be the Southwick approach, which allows exposure of the spine at C2-Th2 and, if necessary, can be extended both proximally and distally. Cemented cervical vertebroplasty, especially dens axis vertebroplasty, shows good results, yet this technique has rarely been described in the literature. It has the advantage of early patient mobility and little limitation of motion of the spine. Cervical vertebroplasty can be successfully combined with other procedures utilizing the same surgical approach in a single-stage operation. Post-resection anterior stabilization of the cervical spine with plates and vertebral body prosthesis allows for good stability of the spine and makes it possible to restore the spinal axis and curvatures. PMID:26468178

  5. Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Tumors: How We Do It Safely and Completely.

    PubMed

    Kim, Jin Woong; Shin, Sang Soo; Heo, Suk Hee; Hong, Jun Hyung; Lim, Hyo Soon; Seon, Hyun Ju; Hur, Young Hoe; Park, Chang Hwan; Jeong, Yong Yeon; Kang, Heoung Keun

    2015-01-01

    Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations. PMID:26576111

  6. Percutaneous Image-Guided Aspiration and Sclerosis of Adventitial Cystic Disease of the Femoral Vein

    SciTech Connect

    Johnson, Jason M.; Kiankhooy, Armin; Bertges, Daniel J.; Morris, Christopher S.

    2009-07-15

    Adventitial cystic disease (ACD), also known as cystic mucoid or myxomatous degeneration, is a rare vascular disease mainly seen in arteries. Seventeen cases have been reported in the world literature. We report the first known case of ACD successfully treated with percutaneous image-guided ethanol sclerosis. Computed tomography showed a cystic mass adherent to the wall of the common femoral vein. An ultrasound examination revealed a deep venous thrombosis of the leg, secondary to extrinsic compression of the common femoral vein. Three years prior to our procedure, the cyst was aspirated, which partially relieved the patient's symptoms. Over the following 3 years the patient's symptoms worsened and a 10-cm discrepancy in thigh size developed, in addition to the deep venous thrombosis associated with lower-extremity edema. Using ultrasound guidance and fluoroscopic control, the cyst was drained and then sclerosed with absolute ethanol. The patient's symptoms and leg swelling resolved completely within several weeks. Follow-up physical examination and duplex ultrasound 6 months following sclerosis demonstrated resolution of the symptoms and elimination of the extrinsic compression effect of the ACD on the common femoral vein.

  7. First Experience of Ultrasound-guided Percutaneous Ablation for Recurrent Hepatoblastoma after Liver Resection in Children

    PubMed Central

    Liu, Baoxian; Zhou, Luyao; Huang, Guangliang; Zhong, Zhihai; Jiang, Chunlin; Shan, Quanyuan; Xu, Ming; Kuang, Ming; Xie, Xiaoyan

    2015-01-01

    This study aimed to summarize the first experience with ultrasound-guided percutaneous ablation treatment (PAT) for recurrent hepatoblastoma (HB) after liver resection in children. From August 2013 to October 2014, PAT was used to treat 5 children with a total of 8 recurrent HB (mean size, 1.4 ± 0.8 cm; size range, 0.7–3.1 cm), including 4 patients with 7 tumors in the liver and 1 patient with 1 tumor in the lung. Technical success was achieved in all patients (5/5, 100%). The complete ablation rate after the first ablation session was 80% (4/5) on a patient-by-patient basis and 87.5% (7/8) on a tumor-by-tumor basis. Only 1 patient developed a fever with temperature >39 °C; it lasted 4 days after radiofrequency ablation (RFA) and was resolved by conservative therapy. During the follow-up period, new intrahepatic recurrences after PAT were detected in two patients. One died due to tumor progression 4 months after ablation. The median overall survival time after PAT was 13.8 months. PAT is a safe and promising therapy for children with recurrent HB after liver resection, and further investigation in large-scale randomized clinical trials is required to determine its role in the treatment of this disease. PMID:26578035

  8. Ultrasound-Guided Percutaneous Removal of Wooden Foreign Bodies in the Extremities with Hydro-Dissection Technique

    PubMed Central

    Park, Hee Jin; Lee, So Yeon; Son, Eun Seok; Chung, Eun Chul; Rho, Myung Ho; Lee, Sun Joo

    2015-01-01

    Objective We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases. Materials and Methods Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydrodissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed. Results The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance. Conclusion Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps. PMID:26576123

  9. Percutaneous CT-Guided Biopsy of C3 Vertebral Body: Modified Approach for an Old Procedure

    SciTech Connect

    Pua, Uei; Chan, Stephen Yung-Wei

    2013-06-15

    Percutaneous biopsy of upper cervical vertebrae is challenging due to the various critical structures in the location and often requires difficult trajectory such as transoral or paramaxillary approaches. The purpose of this manuscript is to illustrate the utility of head rotation in creating a potential space for direct percutaneous access to C3 vertebral body for safe biopsy.

  10. Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

    SciTech Connect

    Thompson, Scott M.; Callstrom, Matthew R. McKusick, Michael A. Woodrum, David A.

    2015-10-15

    PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA.

  11. Variables associated with vaginal discharge after ultrasound-guided percutaneous microwave ablation for adenomyosis.

    PubMed

    Xu, Rui-Fang; Zhang, Jing; Han, Zhi-Yu; Zhang, Bing-Song; Liu, Hui; Li, Xiu-Mei; Ge, Hai-Long; Dong, Xue-Juan

    2016-08-01

    Objective The aim of this study was to analyse the significant variables for vaginal discharge after ultrasound-guided percutaneous microwave ablation (PMWA) therapy. Materials and methods PMWA was performed on 117 patients with adenomyosis from October 2012 to July 2014. The presence or absence, colour, quantity and duration of vaginal discharge, which was different from pre-ablation, were recorded within 1 year after PMWA. Patients were categorised into G1 (n = 26, without vaginal discharge), G2 (n = 40, vaginal discharge lasting 1 to 19 days), and G3 (n = 51, vaginal discharge lasting ≥20 days) groups. The potentially correlative variables were analysed. Variables with significant correlations with vaginal discharge post-ablation were identified via binary logistic regression analysis. Results The differences in adenomyosis type, pre-ablation uterine volume, total microwave ablation energy, total non-perfused volume (NPV) and minimum distance from the non-perfused lesion (NPL) margin to the endomyometrial junction (EMJ) among groups were statistically significant (p = 0.005, p = 0.000, p = 0.000, p = 0.005 and p = 0.000, respectively). Minimum distance from the NPL margin to the EMJ was the strongest predictor of vaginal discharge post-ablation with odds ratio (OR) 0.632, p = 0.018, 95% CI 0.432-0.923. Patients with diffuse adenomyosis were more likely to have prolonged vaginal discharge (≥20 days) post-ablation (OR 3.461, p = 0.000, 95% CI 1.759-7.536). Conclusion The minimum distance from the NPL margin to the EMJ and adenomyosis type were significantly associated with vaginal discharge post-ablation. PMID:27087631

  12. Computed tomography-guided percutaneous biopsy for vertebral neoplasms: a department's experience and hybrid biopsy technique to improve yield.

    PubMed

    Garg, Vasant; Kosmas, Christos; Josan, Enambir S; Partovi, Sasan; Bhojwani, Nicholas; Fergus, Nathan; Young, Peter C; Robbin, Mark R

    2016-08-01

    OBJECTIVE Recent articles have identified the poor diagnostic yield of percutaneous needle biopsy for vertebral osteomyelitis. The current study aimed to confirm the higher accuracy of CT-guided spinal biopsy for vertebral neoplasms and to identify which biopsy technique provides the highest yield. METHODS Over a 9-year period, the radiology department at University Hospitals Case Medical Center performed 222 CT-guided biopsies of vertebral lesions, of which clinicians indicated a concern for vertebral neoplasms in 122 patients. A retrospective chart review was performed to confirm the higher sensitivity of the percutaneous intervention for vertebral neoplasms. RESULTS A core sample was obtained for all 122 biopsies of concern (100.0%). Only 6 cases (4.9%) were reported as nondiagnostic per histological sampling, and 12 cases (9.8%) were negative for disease. The question of vertebral neoplastic involvement warrants follow-up, and the current study was able to determine the subsequent diagnosis of each lesion. Of the 122 total, 94 (77.0%) core samples provided true-positive results, and the sensitivity of core biopsy measured 87.9%. The technical approach did not demonstrate any significant difference in diagnostic yield. However, when the vertebral cortex was initially pierced with a coaxial bone biopsy system and subsequently a 14-gauge spring-loaded cutting biopsy needle was coaxially advanced into lytic lesions, 14 true positives were obtained with a corresponding sensitivity of 100.0%. CONCLUSIONS This study confirms the higher sensitivity of image-guided percutaneous needle biopsy for vertebral neoplasms. In addition, it demonstrates how the use of a novel cutting needle biopsy approach, performed coaxially through a core biopsy track, provides the highest yield. PMID:27476841

  13. Safety and effectiveness of CT-guided percutaneous pulmonary paracentesis and tuberculoma perfusing chemotherapy for the treatment of pleural tuberculosis

    PubMed Central

    Geng, Shujun; Li, Lijuan; Liu, Jianling; Song, Tao

    2016-01-01

    The aim of the study was to compare the mid- and long-term effects of different treatments such as CT-guided percutaneous pulmonary paracentesis, tuberculoma perfusing chemotherapy and whole-body standard chemotherapy or extended chemotherapy on safety and effectiveness for pleural chemotherapy. A total of 60 subjects diagnosed to have pleural tuberculosis between February 2010 and February 2014 were prospectively selected for this study and were considered as the experimental group. Seventy pleural tuberculosis patients who underwent treatment between February 2006 and February 2010 were considered as the control group. The patients in the experimental group were treated with CT-guided percutaneous pulmonary paracentesis and tuberculoma perfusing chemotherapy of not more than three courses with each course consisting of administration of 0.1 g isoniazid, n 0.5 gkanamyci, 0.2 g levofloxacin, and 1 ml lidocaine once a week for four times. The patients in the control group were treated with whole-body standard or extended chemotherapy regimen 3~6HRZE(S)/6~12HR. The patients were followed up for 18 months and the treatment effects were compared. The diameter of tuberculoma in patients of the experimental group during 6, 12 and 18 months was shorter than that of the control group (P<0.05). The total effective rate of treatment and the duration of treatment in experimental group during 18 months were higher than that of control group (P<0.05). The frequency of drug-related complications were lower in comparison with the control group (P<0.05). No surgically acquired complications were observed in the experimental group. Thus, treatments such as CT-guided percutaneous pulmonary paracentesis and tuberculoma perfusing chemotherapy for pleural tuberculosis are safe and effective, which has greater value and can be promoted for use in the clinical setting. PMID:27446302

  14. CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

    SciTech Connect

    Kelogrigoris, M. Sotiropoulou, E.; Stathopoulos, K.; Georgiadou, V.; Philippousis, P.; Thanos, L.

    2011-06-15

    This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26-52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

  15. Two Cases of Lethal Complications Following Ultrasound-Guided Percutaneous Fine-Needle Biopsy of the Liver

    SciTech Connect

    Drinkovic, Ivan; Brkljacic, Boris

    1996-09-15

    Two cases with lethal complications are reported among 1750 ultrasound (US)-guided percutaneous fine-needle liver biopsies performed in our department. The first patient had angiosarcoma of the liver which was not suspected after computed tomography (CT) and US studies had been performed. The other patient had hepatocellular carcinoma in advanced hepatic cirrhosis. Death was due to bleeding in both cases. Pre-procedure laboratory tests did not reveal the existence of major bleeding disorders in either case. Normal liver tissue was interposed in the needle track between the liver capsule and the lesions which were targeted.

  16. Single-Session CT-Guided Percutaneous Microwave Ablation of Bilateral Adrenal Gland Hyperplasia Due to Ectopic ACTH Syndrome

    SciTech Connect

    Sarma, Asha Shyn, Paul B.; Vivian, Mark A.; Ng, Ju-Mei; Tuncali, Kemal; Lorch, Jorchen H.; Zaheer, Sarah N.; Gordon, Michael S.; Silverman, Stuart G.

    2015-10-15

    Bilateral adrenalectomy is currently the only available treatment for adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome (ectopic ACTH syndrome) that is refractory to pharmacologic therapy. We describe two patients with refractory ectopic ACTH syndrome who were treated with CT-guided percutaneous microwave ablation of both hyperplastic adrenal glands in a single session: One was not a surgical candidate, and the other had undergone unsuccessful surgery. Following the procedure, both patients achieved substantial decreases in serum cortisol, symptomatic improvement, and decreased anti-hypertensive medication requirements.

  17. Ultrasound-Guided, Percutaneous Needle Fascial Fenestration for the Treatment of Chronic Exertional Compartment Syndrome: A Case Report.

    PubMed

    Finnoff, Jonathan T; Rajasekaran, Sathish

    2016-03-01

    Chronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest. The most common site for CECS in the lower extremity is the anterior leg compartment. We report a case of a collegiate athlete with bilateral anterior and lateral leg compartment CECS who was successfully treated with an ultrasound-guided, percutaneous needle fascial fenestration of the affected compartments in both legs and was able to return to full, unrestricted activity within 1 week of the procedure. This case highlights the potential application of this procedure for the treatment of anterior and lateral leg CECS. PMID:26344477

  18. In vivo intracardiac optical coherence tomography imaging through percutaneous access: toward image-guided radio-frequency ablation

    PubMed Central

    Wang, Hui; Kang, Wei; Carrigan, Thomas; Bishop, Austin; Rosenthal, Noah; Arruda, Mauricio; Rollins, Andrew M.

    2011-01-01

    Complete catheter-tissue contact and permanent tissue destruction are essential for efficient radio-frequency ablation (RFA) during cardiac arrhythmia treatment. Current methods of monitoring lesion formation are indirect and unreliable. The purpose of this study is to evaluate the feasibility of using optical coherence tomography (OCT) catheter to image endocardial wall in actively beating hearts through percutaneous access. We reported the first in vivo intracardiac OCT imaging through percutaneous access with a thin and flexible OCT catheter. This is a critical step toward image-guided RFA in a clinical setting. A cone-scanning forward-viewing OCT catheter was advanced into beating hearts through percutaneous access in four swine. The OCT catheter was steered by an introducer to touch the endocardial wall. We are able to acquire high quality OCT images in beating hearts, observe the polarization-related artifacts induced by the birefringence of myocardium, and readily evaluate catheter-tissue contact. The observations indicate that OCT could be a promising technique for in vivo guidance of RFA. PMID:22112101

  19. In vivo intracardiac optical coherence tomography imaging through percutaneous access: toward image-guided radio-frequency ablation

    NASA Astrophysics Data System (ADS)

    Wang, Hui; Kang, Wei; Carrigan, Thomas; Bishop, Austin; Rosenthal, Noah; Arruda, Mauricio; Rollins, Andrew M.

    2011-11-01

    Complete catheter-tissue contact and permanent tissue destruction are essential for efficient radio-frequency ablation (RFA) during cardiac arrhythmia treatment. Current methods of monitoring lesion formation are indirect and unreliable. The purpose of this study is to evaluate the feasibility of using optical coherence tomography (OCT) catheter to image endocardial wall in actively beating hearts through percutaneous access. We reported the first in vivo intracardiac OCT imaging through percutaneous access with a thin and flexible OCT catheter. This is a critical step toward image-guided RFA in a clinical setting. A cone-scanning forward-viewing OCT catheter was advanced into beating hearts through percutaneous access in four swine. The OCT catheter was steered by an introducer to touch the endocardial wall. We are able to acquire high quality OCT images in beating hearts, observe the polarization-related artifacts induced by the birefringence of myocardium, and readily evaluate catheter-tissue contact. The observations indicate that OCT could be a promising technique for in vivo guidance of RFA.

  20. Vertebral augmentation by kyphoplasty and vertebroplasty: 8 years experience outcomes and complications

    PubMed Central

    Yaltirik, Kaan; Ashour, Ahmed M; Reis, Conner R; Özdoğan, Selçuk; Atalay, Başar

    2016-01-01

    Background and Context: Minimally invasive percutaneous vertebral augmentation techniques; vertebroplasty, and kyphoplasty have been treatment choices for vertebral compression fractures (VCFs). The purpose of this study is to evaluate the outcomes of the patients who underwent vertebroplasty or kyphoplasty regarding complications, correction of vertebral body height, kyphosis angle and pain relief assessment using visual analog score (VAS) for pain. Materials and Methods: A retrospective review of the hospital records for 100 consecutive patients treated with kyphoplasty or vertebroplasty in our department database. Patients with osteoporotic compression fractures, traumatic compressions, and osteolytic vertebral lesions, including metastases, hemangiomas, and multiple myeloma, were included in the study. Preoperative and postoperative VAS pain scores, percentages of vertebral compression and kyphotic angles were measured and compared as well as demographic characteristics and postoperative complications. Mobilization and length of stay (LOS) were recorded. Results: One hundred patients were treated by 110 procedures. 64 patients were operated on due to osteoporosis (72 procedures). Twelve patients were operated on because of metastasis (13 procedures), 8 patients were operated on because of multiple myeloma (9 procedures). Five patients had two surgeries, 1 patient had 3 surgeries, and 1 patient had 5 surgeries. The mean preoperative VAS was 74.05 ± 9.8. In total, 175 levels were treated, 46 levels by kyphoplasty and 129 by vertebroplasty. The mean postoperative VAS was 20.94 ± 11.8. Most of the patients were mobilized in the same day they of surgery. Mean LOS was 1.83 days. Six patients had nonsymptomatic leakage of polymethlymethacrylate, and patient had epidural hematoma, which was operated on performing hemi-laminectomy. Conclusions: Percutaneous vertebroplasty and balloon kyphoplasty are both effective and safe minimally invasive procedures for the

  1. The clinical application and efficacy of percutaneous kyphoplasty via unilateral pedicular approach guided by CT image measurement

    PubMed Central

    Zhai, Weifeng; Jia, Yongwei; Wang, Jianjie; Cheng, Liming

    2015-01-01

    This study aimed to investigate the clinical application and efficacy of percutaneous kyphoplasty via unilateral pedicular approach with the reference of preoperative CT image data. 73 cases (a total of 112 vertebrae) with thoracic and lumbar osteoporotic vertebral compression fractures (OVCF) received in our department were collected in this study and underwent percutaneous kyphoplasty via unilateral pedicular approach directed by CT image measurement with the operative time and fluoroscopic times recorded. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the pain status and functional activity before and after operation and at the last follow-up, while X-ray and CT image were used to measure the height of the injured spinal middle column and kyphotic Cobb angle before and after operation. 73 cases (112 vertebrae) underwent percutaneous kyphoplasty successfully. Cement leakage occurred in 7 cases without obvious neurological symptoms, and they were followed up for 10 to 60 months with the average of 23 months; adjacent vertebral refractures occurred in 3 cases during the follow-up, and their symptoms were relieved after the second surgery. There was significant difference in the height of the injured spinal middle column and kyphotic Cobb angle before and after operation (P<0.05); there was significant difference in preoperative and postoperative VAS score and ODI values (P<0.05). Postoperative CT image data showed that puncture paths of the 110 vertebrae were consistent with preoperative ones sketched using the CT image, and the consistent rate of preoperative and postoperative measurement data was 98%. All patients could ambulate with brace within 2 days after operation without serious complications. In conclusion, percutaneous kyphoplasty via unilateral pedicular approach guided by preoperative CT image data is effective in treatment of osteoporotic vertebral compression fractures, and it is convenient and safe with high

  2. Intraprocedural Diffusion-Weighted PROPELLER MRI to Guide Percutaneous Biopsy Needle Placement within Rabbit VX2 Liver Tumors

    PubMed Central

    Deng, Jie; Virmani, Sumeet; Yang, Guang-Yu; Tang, Richard; Woloschak, Gayle; Omary, Reed A.; Larson, Andrew C.

    2010-01-01

    Purpose To test the hypothesis that diffusion-weighted (DW)-PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction) magnetic resonance imaging (MRI) can be used to guide biopsy needle placement during percutaneous interventional procedures to selectively target viable and necrotic tissues within VX2 rabbit liver tumors. Materials and Methods Our institutional Animal Care and Use Committee approved all experiments. In six rabbits implanted with 15 VX2 liver tumors, baseline DWPROPELLER images acquired prior to the interventional procedure were used for apparent diffusion coefficient (ADC) measurements. Next, intraprocedural DW-PROPELLER scans were performed with needle position iteratively adjusted to target viable, necrotic, or intermediate border tissue regions. DW-PROPELLER ADC measurements at the selected needle tip locations were compared with the percentage of tumor necrosis qualitatively assessed at histopathology. Results DW-PROPELLER images demonstrated intratumoral tissue heterogeneity and clearly depicted the needle tip position within viable and necrotic tumor tissues. Mean ADC measurements within the region-of-interest encompassing the needle tip were highly correlated with histopathologic tumor necrotic tissue assessments. Conclusion DW-PROPELLER is an effective method to selectively position the biopsy needle tip within viable and necrotic tumor tissues. The DW-PROPELLER method may offer an important complementary tool for functional guidance during MR-guided percutaneous procedures. PMID:19629976

  3. Fluoroscopically guided percutaneous suprapubic cystostomy for long-term bladder drainage: an alternative to surgical cystostomy.

    PubMed

    Lee, M J; Papanicolaou, N; Nocks, B N; Valdez, J A; Yoder, I C

    1993-09-01

    Percutaneous large-bore suprapubic cystostomy catheters were placed under fluoroscopic guidance in 60 patients as an alternative to surgical cystostomy. Foley catheters (16-20 F) were placed in 57 of the patients in a one-stage procedure. Ten-French catheters were initially placed in three patients because of difficulty in dilating percutaneous tracks because of obesity (one patient) or dense scar tissue (two patients). Three weeks later, 18-F Foley catheters were placed in these three patients when mature tracks had developed, making dilation easier. Minor complications occurred in three patients, including superficial track bleeding in two and urosepsis in one. Fifteen patients were lost to follow-up. Suprapubic catheters provided excellent long-term drainage (range, 0.5-36 months; mean, 16 months; median, 18 months) in the remaining 45 patients. The authors conclude that percutaneous suprapubic catheter placement is a safe and effective procedure that provides excellent long-term bladder drainage. PMID:8351348

  4. Percutaneous pediculoplasty: polymethylmethacrylate injection into lytic vertebral pedicle lesions.

    PubMed

    Gailloud, Philippe; Beauchamp, Norman J; Martin, Jean-Baptiste; Murphy, Kieran J

    2002-05-01

    Two patients with painful lytic lesions of the vertebral pedicle were treated with percutaneous pediculoplasty. This technique, similar to vertebroplasty but with increased procedural risks because of the immediate vicinity of neural structures, was performed under high-quality biplane fluoroscopic guidance. For lesions involving both the pedicle and the vertebral body, a double-needle unipedicular technique is advocated. PMID:11997361

  5. Percutaneous Transthoracic Computed Tomography-Guided AICD Insertion in a Patient with Extracardiac Fontan Conduit

    SciTech Connect

    Murphy, Darra T. Moynagh, Michael R.; Walsh, Kevin P.; Noelke, Lars; Murray, John G.

    2011-02-15

    Percutaneous pulmonary venous atrial puncture was performed under computed tomography guidance to successfully place an automated implantable cardiac defibrillator into a 26-year-old patient with extracardiac Fontan conduit who had presented with two out-of-hospital cardiac arrests. The procedure avoided the need for lead placement at thoracotomy.

  6. GuideLiner Catheter Use for Percutaneous Intervention Involving Anomalous Origin of a Single Coronary Trunk Arising from the Ascending Aorta

    PubMed Central

    Matsumoto, Mitsunari; Tamanaha, Yusuke; Tsurumaki, Yoshimasa

    2016-01-01

    Cases in which an anomalous single coronary trunk arises from the ascending aorta are extremely rare. In percutaneous coronary intervention for the lesion of a coronary artery anomaly, several problems may occur, including selection of a guide catheter, insufficient backup force, and difficulties of stent delivery. The GuideLiner catheter, which is a coaxial guide extension having the advantage of rapid exchange, facilitates coronary intervention for complex lesions. We report a case of angina having a lesion in the left anterior descending artery of a single coronary trunk arising from the ascending aorta. We successfully performed revascularization by using the GuideLiner catheter. PMID:27529036

  7. Post-sternotomy intercostal artery pseudoaneurysm. Sonographic diagnosis and thrombosis by ultrasound-guided percutaneous thrombin injection.

    PubMed

    Alonso, Sebastian Fernandez; Azcona, Covadonga Mendieta; Heredero, Alvaro Fernandez; de Cubas, Luis Riera

    2009-10-01

    Intercostal artery pseudoaneurysms are extremely rare. We present a case of an intercostal artery pseudoaneurysm after median sternotomy that was treated by ultrasound-guided percutaneous thrombin injection. They are a potential source of complications, especially haemothorax, and treatment is mandatory. Different methods may be used for the confirmatory diagnosis of false aneurysms. Doppler ultrasound (DUS) and CT are the two most commonly used methods, but pseudoaneurysms have also been diagnosed by means of arteriography (AR), which enables endovascular treatment of the pseudoaneurysm in a single procedure. We used Doppler sonography alone, because this technique yielded a definitive diagnosis without the need for other complementary imaging modalities to treat the lesion. There are various possible treatments for lesions of this kind. Endovascular embolization is the commonly used treatment for intercostal pseudoaneurysm but also stent grafting has been described. Surgical aneurysmectomy with proximal ligation of the intercostal artery is an option described for the treatment of the pseudoaneurysm. To date only seven cases have been published in the literature. Our case is the only published instance of treatment of an intercostal artery pseudoaneurysm by direct percutaneous thrombin injection under sonographic guidance. PMID:19602496

  8. Percutaneous Ultrasound-Guided TOPAZ Radiofrequency Coblation: A Novel Coaxial Technique for the Treatment of Recalcitrant Plantar Fasciitis-Our Experience.

    PubMed

    Shah, Amit; Best, Alistair J; Rennie, Winston J

    2016-06-01

    Various therapeutic options are available for treatment of recalcitrant plantar fasciitis. Studies using TOPAZ coblation (ArthroCare, Sunnyvale, CA) have had good early results. The current coblation technique involves a surgical incision or breach of the highly specialized plantar fat pad, which can be associated with risks. We describe a novel technique of ultrasound-guided percutaneous coblation with a lateral heel approach. Advantages include precise targeting of the plantar fascia by direct dynamic visualization of the coblation tip, a true percutaneous approach with a needle skin puncture (<5 mm), and preservation of the plantar fat pad by using a lateral heel approach. PMID:27162283

  9. Single incision laparoscopic surgery approach for obscure small intestine bleeding localized by CT guided percutaneous injection of methylene blue

    PubMed Central

    Martinez, Juan Carlos; Thomas, Jamie L.; Lukaszczyk, John J.

    2014-01-01

    INTRODUCTION Traditionally, localization of small intestine sources of obscure gastrointestinal bleeding has been a challenge. Advances in the field of endoscopy with the introduction of capsule endoscopy and radiographic imaging with computed tomography angiography and visceral angiography have facilitated more accurate visualization of the small intestine. If a bleeding lesion is identified on angiography and surgery is indicated, the use of methylene blue for enteric mapping is very effective to aid intraoperative localization of the culprit. However, when this is not an option, more invasive surgical techniques are required. PRESENTATION OF CASE We present a new technique used in a patient with angiodysplasia of the small intestine, in where preoperative localization was done using percutaneous computed tomography (CT) guided injection of methylene blue dye. This allowed us to perform a single incision laparoscopic small intestine resection of the culprit. PMID:25460480

  10. Percutaneous transluminal laser guide wire recanalization of chronic subclavian artery occlusion in symptomatic coronary-subclavian steal syndrome.

    PubMed

    Eggebrecht, H; Naber, C K; Oldenburg, O; Herrmann, J; Haude, M; Erbel, R; Baumgart, D

    2000-12-01

    Treatment of subclavian artery stenosis by percutaneous balloon angioplasty and adjunctive stent placement was shown to be safe and efficacious, but it may be limited in tight stenoses and long occlusions. We describe the case of a patient who experienced progressive angina pectoris associated with signs of cerebrovertebral insufficiency 9 yr after bypass surgery, including left internal mammary artery (LIMA) grafting to the left anterior descending coronary artery. Angiography showed reversed flow through the LIMA graft into the subclavian artery and a 4-cm occlusion beginning at the origin of the left subclavian artery, representing a rare coronary-subclavian steal syndrome. After a conventional approach failed, recanalization was performed successfully using laser guide wire angioplasty with adjunctive stent placement in a combined radial and femoral approach. PMID:11108691

  11. Percutaneous ultrasound-guided treatment of shoulder tendon calcifications: Clinical and radiological follow-up at 6 months☆

    PubMed Central

    De Conti, G.; Marchioro, U.; Dorigo, A.; Boscolo, N.; Vio, S.; Trevisan, M.; Meneghini, A.; Baldo, V.; Angelini, F.

    2010-01-01

    Introduction Calcific tendinitis of the shoulder is a common condition characterized by chronic pain and/or very painful acute episodes. Different treatments are used during painful flare-up, but they are often ineffective. US-guided percutaneous needle aspiration/lavage is proving to be an effective means for eliminating these calcifications. Materials and methods We treated 123 consecutive patients (mean age 48 years) with calcific tendinitis of the shoulder. Fifty-five patients had persistent symptoms requiring 2 or more treatments with lavage and intrabursal steroid infiltration. Before and after treatment, US studies were done independently by 2 radiologists with experience in musculoskeletal ultrasound. Results were concordant in over 90% of the cases. Constant Shoulder Scores were calculated before and 6 months after treatment. At 6 months, MRI was performed to identify impingement and/or bursitis. Results Post-treatment Constant scores were significantly improved in all 68 patients treated once (Group 1: mean scores 28.6 vs. 81.4) and in 52 of the 55 treated twice or more (Group 2: mean scores 34.1 vs. 71.1) (p < 0.0001 in both cases). Pretreatment Constant scores were similar in patients with and without shoulder impingement on MRI (31.2 vs. 30.9, respectively), but after treatment the impingement group’s scores were significantly higher (82.2 vs. 73.3, respectively; p < 0.001). Conclusions US-guided percutaneous needle aspiration/lavage is an effective and economic treatment for calcific tendinitis of the shoulder. Pretreatment MRI should be done to check for impingement since it is often associated with an incomplete response to the first treatment. PMID:23396318

  12. Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Percutaneous Ultrasound-Guided Fine Needle Aspiration in Diagnosis of Focal Pancreatic Masses

    PubMed Central

    Okasha, Hussein Hassan; Naga, Mazen Ibrahim; Esmat, Serag; Naguib, Mohamed; Hassanein, Mohamed; Hassani, Mohamed; El-Kassas, Mohamed; Mahdy, Reem Ezzat; El-Gemeie, Emad; Farag, Ali Hassan; Foda, Ayman Mohamed

    2013-01-01

    Objective: Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer. Patients and Methods: A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2). Results: EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%). Conclusion: EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate. PMID:24949394

  13. CT- and fluoroscopy-guided percutaneous screw fixation of a "carrot-stick" spinal fracture in an elderly man with ankylosing spondylitis.

    PubMed

    Huwart, Laurent; Amoretti, Nicolas

    2013-12-01

    We present a case of percutaneous fixation of a "carrot-stick" spinal fracture in an elderly patient with ankylosing spondylitis (AS). A surgical stabilization was not possible in this 83-year-old man with comorbidities. Under local anesthesia, percutaneous screw fixation of a transdiscal shear fracture at the level T10-T11 was performed using computed tomography (CT) and fluoroscopy guidance. Two 4.0-mm Asnis III cannulated screws were placed to fix facet joints using transfacet pedicle pathway. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 10, preoperatively, to 1 after the procedure. Radiographic fusion was observed at a 3-month post-procedural CT scan. CT- and fluoroscopy-guided percutaneous screw fixation of spinal fractures could potentially be an alternative to surgery in elderly AS patients with poor performance status. PMID:23842576

  14. Changes in disc herniation after CT-guided Percutaneous Laser Disc Decompression (PLDD): MR findings

    NASA Astrophysics Data System (ADS)

    Brat, Hugues G.; Bouziane, Tarik; Lambert, Jean; Divano, Luisa

    2004-09-01

    The aim of Percutaneous Laser Disc Decompression (PLDD) is to vaporize a small portion of the nucleus pulposus. Clinical efficacy of this technique is largely proven. However, time-evolution of intervertebral disc and its hernia after PLDD is not known. This study analyses changes in disc herniation and its native intervertebral disc at a mean follow-up of 7.5 months after PLDD in asymptomatic patients. Main observations at MRI are appearance of a high signal on T2WI in the hernia in 59%, shrinking of the hernia in 66% and overall stability of disc height.

  15. Percutaneous Imaging-Guided Access for the Treatment of Calculi in Continent Urinary Reservoirs

    SciTech Connect

    Davis, Winston Brooks; Trerotola, Scott O.; Johnson, Matthew S.; Patel, Nilesh H.; Namyslowski, Jan; Stecker, Michael S.; McLennan, Gordon; Shah, Himanshu; Bihrle, Richard; Foster, Richard

    2002-03-15

    Purpose: To describe our long-term experience with percutaneous access to continent urinary reservoirs for calculus removal. Patients and Methods: A retrospective study of 13 procedures in 10 patients was performed. In 2 of the 13 procedures, access and calculus removal was performed in a single session. In the other 11 procedures, initial access was obtained using ultrasonography,fluoroscopy, and/or computed tomography. The patients then returned ata later date for a second step where the access was dilated and the calculi were removed. Results: Access was achieved successfully in all cases with no complications. At mean follow-up time of 13.6 months (range 1-94 months) one patient had died of complications unrelated to her continent urinary reservoir. Another patient had been placed on suppressive antibiotics for recurrent calculi. The remaining patients were stone free and without late complication. Conclusions: Percutaneous removal of reservoir calculi can be performed safely, avoiding potential injury to the continence valve mechanism by a direct cystoscopic approach. We propose a two-stage procedure using CT guidance for initial access as the preferred technique.

  16. Ultrasound-guided percutaneous aspiration of hyperreactio luteinalis avoids laparoscopic untwisting of ovarian torsion.

    PubMed

    Sakae, C; Sato, Y; Taga, A; Satake, Y; Emoto, I; Maruyama, S; Kim, T

    2015-08-01

    Hyperreactio luteinalis (HL) is characterized by multicystic bilateral enlargement of the ovaries and is a self-limiting benign condition associated with pregnancy or trophoblastic disease. Since HL regresses spontaneously over time, it should be managed conservatively as long as the patient's condition permits; torsion of the enlarged ovaries is believed to be the only exception that mandates surgical intervention. Here, we describe a case of HL complicated by ovarian torsion that was treated successfully without surgical intervention. A 33-year-old woman was admitted to our hospital owing to acute abdomen. Nine days previously, she had had a stillbirth caused by hydrops fetalis at 24 weeks' gestation. The characteristic findings observed on magnetic resonance imaging (MRI) led to the diagnosis of HL complicated by torsion of the enlarged left ovary. Emergency laparoscopic detorsion of the ischemic left ovary was planned. Aiming to reduce the risk of cystic injury and bleeding at the trocar insertion site, volume reduction of the left ovarian cyst was performed by percutaneous aspiration. The patient's pain diminished rapidly and laparoscopic surgery was deferred. Subsequent MRI revealed that gadolinium enhancement of the left ovarian tumor had been restored, indicating spontaneous detorsion of the left ovary. The patient remained asymptomatic and was discharged from the hospital 12 days after aspiration of the cyst. From this experience, we propose that, in cases of ovarian torsion occurring in large functional cysts, including HL, volume reduction by percutaneous cyst aspiration should be considered before performing emergency laparoscopic surgery. PMID:25810122

  17. Echocardiography-guided percutaneous per-ventricular laser ablation of ventricular septum: in vivo study in a canine model.

    PubMed

    He, Guangbin; Sun, Chao; Zhang, Xiangkong; Zuo, Lei; Qin, Haiying; Zheng, Minjuan; Zhou, Xiaodong; Liu, Liwen

    2016-05-01

    Surgical myectomy and ethanol ablation are established intervention strategies for left ventricular outflow obstruction in hypertrophic cardiomyopathy. Safety and efficacy limitations of these interventions call for a minimally invasive, potentially safer, and more efficacious strategy. In this study, we aimed to evaluate the feasibility of echocardiography-guided percutaneous per-ventricular laser ablation of a ventricular septum in a canine model. Six domestic dogs were chosen for the study. A 21G needle was inserted into the right ventricle with its tip reaching the targeted basal to mid-septum, after which laser ablation was performed as follows: 1-W laser for 3 min (180 J) at the basal segment and 5 min (300 J) at middle segment of the septum, respectively. Echocardiography, blood chemistry tests, and pathology examination were performed to assess the results of laser ablation. No death or major complications, i.e., tamponade, pericardial effusion, or ventricular fibrillation, occurred. The laser-ablated areas were well demarcated in the results of the pathological examination. The diameters of the ablated regions were 4.42 ± 0.57 and 5.28 ± 0.83 mm for 3 and 5 min ablation, respectively. Pre-ablation and post-ablation, cardiac enzymes were found to increase significantly while no significant differences were found among M-mode, 2D (LVEF), pulsed-wave (PW) Doppler, and tissue Doppler imaging (TDI) measurements. Contrast echocardiography confirmed the perfusion defects in the ablated regions. Microscopically, the ablated myocardium showed coagulative changes and a sparse distribution of disappearing nuclei and an increase in eosinophil number were observed. Our study suggests that percutaneous and per-ventricular laser ablation of the septum is feasible, potentially safe and efficacious, and warrants further investigation and validation. PMID:26861985

  18. Dual phase MIBI scintigraphy in diagnosis of parathyroid adenoma followed by ultrasound guided percutaneous alcoholic ablation.

    PubMed

    Ahmad, Shakil; Jielani, Amjad Aziz Khan Asif; Khan, Kamran; Fatima, Tatheer; Zia, Nadeem; ud Duha, Mazhar; Samad, Abdul; Memon, Khalid

    2008-01-01

    Primary Hyperparathyroidism (HPT) is an inappropriate hyper secretion of parathyroid hormone (PTH). Primary HPT is caused by parathyroid adenoma in 80-85% of patients. Clinical manifestations are kidney stones, abdominal groans, painful bones, psychic moans, and fatigue overtones. Ultrasonography is widely used in suspected cases for localization of parathyroid adenoma. There is considerable intra-observer variation and it is difficult for ultrasound alone to differentiate parathyroid lesion form that of thyroid. Dual phase Tc-99m MIBI scinitigraphy for detection of parathyroid adenomas has sensitivity and specificity values ranging from 82% to 100% and from 89% to 100%, respectively. Percutaneous ethanol injection for parathyroid glands can be applied effectively in selected cases when surgery is unadvisable either for technical reasons (e.g., recurrence ofhyperplastic glands in the neck after subtotal surgery or intrathyroideal parathyroid tumors or the poor clinical state of the patient. PMID:19610543

  19. CT-guided Percutaneous Laser Disc Decompression (PLDD): prospective clinical outcome

    NASA Astrophysics Data System (ADS)

    Brat, Hugues G.; Bouziane, Tarik; Lambert, Jean; Divano, Luisa

    2004-09-01

    Percutaneous Laser Disc Decompression (PLDD) is a minimal invasive and effective treatment for contained lumbar disc hernias with correspondent radicular pain. This prospective study evaluates clinical efficacy of patients treated with PLDD under CT-fluoroscopic guidance. An independent observer assessed clinical outcome in a series of 40 consecutive patients at a mean follow-up of 7.5 months after treatment. According to Mac Nab criteria, 80% of patients experienced a good response to PLDD, 12.5% a fair response and 7.5% a poor response. 37 patients (92.5%) were back at work after 3 weeks. This technique could represent an alternative and secure treatment to conventional surgery for contained disc hernias.

  20. Mechanically assisted 3D ultrasound for pre-operative assessment and guiding percutaneous treatment of focal liver tumors

    NASA Astrophysics Data System (ADS)

    Sadeghi Neshat, Hamid; Bax, Jeffery; Barker, Kevin; Gardi, Lori; Chedalavada, Jason; Kakani, Nirmal; Fenster, Aaron

    2014-03-01

    Image-guided percutaneous ablation is the standard treatment for focal liver tumors deemed inoperable and is commonly used to maintain eligibility for patients on transplant waitlists. Radiofrequency (RFA), microwave (MWA) and cryoablation technologies are all delivered via one or a number of needle-shaped probes inserted directly into the tumor. Planning is mostly based on contrast CT/MRI. While intra-procedural CT is commonly used to confirm the intended probe placement, 2D ultrasound (US) remains the main, and in some centers the only imaging modality used for needle guidance. Corresponding intraoperative 2D US with planning and other intra-procedural imaging modalities is essential for accurate needle placement. However, identification of matching features of interest among these images is often challenging given the limited field-of-view (FOV) and low quality of 2D US images. We have developed a passive tracking arm with a motorized scan-head and software tools to improve guiding capabilities of conventional US by large FOV 3D US scans that provides more anatomical landmarks that can facilitate registration of US with both planning and intra-procedural images. The tracker arm is used to scan the whole liver with a high geometrical accuracy that facilitates multi-modality landmark based image registration. Software tools are provided to assist with the segmentation of the ablation probes and tumors, find the 2D view that best shows the probe(s) from a 3D US image, and to identify the corresponding image from planning CT scans. In this paper, evaluation results from laboratory testing and a phase 1 clinical trial for planning and guiding RFA and MWA procedures using the developed system will be presented. Early clinical results show a comparable performance to intra-procedural CT that suggests 3D US as a cost-effective alternative with no side-effects in centers where CT is not available.

  1. Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results

    PubMed Central

    Valera-Garrido, Fermín; Minaya-Muñoz, Francisco; Medina-Mirapeix, Francesc

    2014-01-01

    Background Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach which consists of the application of a galvanic current through an acupuncture needle. Objective To evaluate the clinical and ultrasonographic effectiveness of a multimodal programme (PNE, eccentric exercise (EccEx) and stretching) in the short term for patients with chronic lateral epicondylitis, and to determine whether the clinical outcomes achieved decline over time. Methods A one-way repeated measures study was performed in a clinical setting in 36 patients presenting with lateral epicondylitis. The patients received one session of US-guided PNE per week over 4–6 weeks, associated with a home programme of EccEx and stretching. The main outcome measures were severity of pain, disability (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), structural tendon changes (US), hypervascularity and patients’ perceptions of overall outcome. Measurements at 6, 26 and 52 weeks follow-up included recurrence rates (increase in severity of pain or disability compared with discharge), perception of overall outcome and success rates. Results All outcome measures registered significant improvements between pre-intervention and discharge. Most patients (n=30, 83.3%) rated the overall outcome as ‘successful’ at 6 weeks. The ultrasonographic findings showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly. At 26 and 52 weeks, all participants (n=32) perceived a ‘successful’ outcome. Recurrence rates were null after discharge and at follow-up at 6, 26 and 52 weeks. Conclusions Symptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term. Trial registration number ClinicalTrials.gov identifier: NCT02085928. PMID:25122629

  2. Ultrasonographic percutaneous anatomy of the atlanto-occipital region and indirect ultrasound-guided cisternal puncture in the dog and the cat.

    PubMed

    Etienne, A-L; Audigié, F; Peeters, D; Gabriel, A; Busoni, V

    2015-04-01

    Cisternal puncture in dogs and cats is commonly carried out. This article describes the percutaneous ultrasound anatomy of the cisternal region in the dog and the cat and an indirect technique for ultrasound-guided cisternal puncture. Ultrasound images obtained ex vivo and in vivo were compared with anatomic sections and used to identify the landmarks for ultrasound-guided cisternal puncture. The ultrasound-guided procedure was established in cadavers and then applied in vivo in seven dogs and two cats. The anatomic landmarks for the ultrasound-guided puncture are the cisterna magna, the spinal cord, the two occipital condyles on transverse images, the external occipital crest and the dorsal arch of the first cervical vertebra on longitudinal images. Using these ultrasound anatomic landmarks, an indirect ultrasound-guided technique for cisternal puncture is applicable in the dog and the cat. PMID:24712312

  3. Percutaneous retrieval of malpositioned, kinked and unraveled guide wire under fluoroscopic guidance during central venous cannulation

    PubMed Central

    Jalwal, Gopal Krishan; Rajagopalan, Vanitha; Bindra, Ashish; Rath, Girija Prasad; Goyal, Keshav; Kumar, Atin; Gamanagatti, Shivanand

    2014-01-01

    The placement of central venous catheter using Seldinger's technique, remains a commonly performed procedure with its own risks and benefits. Various complications have been reported with the use of guide wire as well as catheter. We report a unique problem during subclavian vein cannulation due to guidewire malposition which led to its kinking and difficult retrieval requiring removal in fluoroscopy suit. The probable mechanism of guide wire entrapment and possible bedside management of similar problems is described. PMID:24803771

  4. First-in-Man Computed Tomography-Guided Percutaneous Revascularization of Coronary Chronic Total Occlusion Using a Wearable Computer: Proof of Concept.

    PubMed

    Opolski, Maksymilian P; Debski, Artur; Borucki, Bartosz A; Szpak, Marcin; Staruch, Adam D; Kepka, Cezary; Witkowski, Adam

    2016-06-01

    We report a case of successful computed tomography-guided percutaneous revascularization of a chronically occluded right coronary artery using a wearable, hands-free computer with a head-mounted display worn by interventional cardiologists in the catheterization laboratory. The projection of 3-dimensional computed tomographic reconstructions onto the screen of virtual reality glass allowed the operators to clearly visualize the distal coronary vessel, and verify the direction of the guide wire advancement relative to the course of the occluded vessel segment. This case provides proof of concept that wearable computers can improve operator comfort and procedure efficiency in interventional cardiology. PMID:26608117

  5. Percutaneous puncture of renal calyxes guided by a novel device coupled with ultrasound

    PubMed Central

    Chan, Chen Jen; Srougi, Victor; Tanno, Fabio Yoshiaki; Jordão, Ricardo Duarte; Srougi, Miguel

    2015-01-01

    ABSTRACT Purpose: To evaluate the efficiency of a novel device coupled with ultrassound for renal percutaneous puncture. Materials and Methods: After establishing hydronephrosis, ten pigs had three calyxes of each kidney punctured by the same urology resident, with and without the new device (“Punctiometer”). Time for procedure completion, number of attempts to reach the calyx, puncture precision and puncture complications were recorded in both groups and compared. Results: Puncture success on the first attempt was achieved in 25 punctures (83%) with the Punctiometer and in 13 punctures (43%) without the Punctiometer (p=0.011). The mean time required to perform three punctures in each kidney was 14.5 minutes with the Punctiometer and 22.4 minutes without the Punctiometer (p=0.025). The only complications noted were renal hematomas. In the Punctiometer group, all kidneys had small hematomas. In the no Punctiometer group 80% had small hematomas, 10% had a medium hematoma and 10% had a big hematoma. There was no difference in complications between both groups. Conclusions: The Punctiometer is an effective device to increase the likelihood of an accurate renal calyx puncture during PCNL, with a shorter time required to perform the procedure. PMID:26689521

  6. Wireless Mobile Technology to Improve Workflow and Feasibility of MR-Guided Percutaneous Interventions

    PubMed Central

    Rube, Martin A.; Holbrook, Andrew B.; Cox, Benjamin F.; Buciuc, Razvan; Melzer, Andreas

    2015-01-01

    Purpose A wireless interactive display and control device combined with a platform-independent web-based User Interface (UI) was developed to improve the workflow for interventional Magnetic Resonance Imaging (iMRI). Methods The iMRI-UI enables image acquisition of up to three independent slices using various pulse sequences with different contrast weighting. Pulse sequence, scan geometry and related parameters can be changed on the fly via the iMRI-UI using a tablet computer for improved lesion detection and interventional device targeting. The iMRI-UI was validated for core biopsies with a liver phantom (n=40) and Thiel soft-embalmed human cadavers (n=24) in a clinical 1.5T MRI scanner. Results The iMRI-UI components and setup were tested and found conditionally MRI-safe to use according to current ASTM standards. Despite minor temporary touchscreen interference at a close distance to the bore (<20 cm), no other issues regarding quality or imaging artefacts were observed. The 3D root-mean-square distance error was 2.8±1.0 (phantom) / 2.9±0.8 mm (cadaver) and overall procedure times ranged between 12–22 (phantom) / 20–55 minutes (cadaver). Conclusions The wireless iMRI-UI control setup enabled fast and accurate interventional biopsy needle placements along complex trajectories and improved the workflow for percutaneous interventions under MRI guidance in a preclinical trial. PMID:25179151

  7. Image-guided percutaneous microwave ablation of small renal tumours: short- and mid-term outcomes

    PubMed Central

    Genson, Pierre-Yves; Mourey, Eric; Moulin, Morgan; Favelier, Sylvain; Di Marco, Lucy; Chevallier, Olivier; Cercueil, Jean-Pierre; Krausé, Denis; Cormier, Luc

    2015-01-01

    Background The purpose is to assess the short- and mid-term outcomes of microwave ablation (MWA) of small renal tumours in selected patients. Methods From August 2012 to February 2015, 29 renal tumours in 23 patients (17 male, 6 female, mean age 75 years) were treated by percutaneous MWA under imaging guidance. The tumours were 1-4.7 cm in diameter (mean size, 2.7 cm). Therapeutic effects were assessed at follow-up with magnetic resonance imaging (MRI). All patients were followed up for 2-25 months (mean, 12.2 months) to observe the therapeutic effects and complications. Changes in renal function at day 1 after treatment were statistically analyzed using the Student paired t-test or the paired Wilcoxon test. Results Technical success was achieved in all cases. One severe bleeding complication post-procedure occurred leading to death. No other unexpected side effects were observed after the MWA procedures. Clinical effectiveness was 100%. None of the patients showed recurrence on MRI imaging follow-up. No significant changes in renal function were noted after treatment (P=0.57). Conclusions Our preliminary study demonstrates that the use of MWA for the treatment of small renal tumours can be applied as safely and efficiently as other ablative techniques in selected patients not eligible for surgery. PMID:26682134

  8. Percutaneous Access of the Petrous Apex In Vitro Using Customized Micro-stereotactic Frames based on Image Guided Surgical Technology

    PubMed Central

    Wanna, George B; Balachandran, Ramya; Majdani, Omid; Mitchell, Jason; Labadie, Robert F.

    2015-01-01

    Conclusion Our study demonstrates - in cadavers - the ability to obtain a minimally-invasive approach to access the petrous apex using patient-customized microstereotactic frames based on pre-intervention radiographic studies. Objectives To conduct in vitro studies to demonstrate the feasibility of percutaneous petrous apex access using customized, bone-mounted, micro-stereotactic frames. Methods Cadaveric temporal bone specimens (n = 10) were affixed with three bone-implanted fiducial markers. CT scans were obtained and used in planning, in reference to the fiducial markers, a straight transmastoid infralabyrinthine trajectory from the mastoid surface to the petrous apex without violating the basal turn of the cochlea or the carotid artery. A drill press was mounted on the customized-frame and used to guide a 2 mm drill bit on the desired trajectory. The course of the drill bit and its relationship to surrounding vital anatomy (cochlea, carotid artery, facial nerve and internal jugular vein) were determined by repeat CT scanning. Results In 10 of 10 specimens, the drill bit trajectory was accurate with clearance (mean ± standard deviation in mm) from the cochlea, facial nerve, carotid artery, and jugular vein of 3.43 ± 1.57, 3.14 ± 1.15, 4.57 ± 1.52, and 6.05 ± 2.98, respectively. PMID:19707904

  9. Stent underexpansion in angiographic guided percutaneous coronary intervention, despite adjunctive balloon post-dilatation, in drug eluting stent era

    PubMed Central

    Taherioun, Mehrdad; Namazi, Mohammad Hassan; Safi, Morteza; Saadat, Habibolah; Vakili, Hossein; Alipour-Parsa, Saeed; Rajabi-Moghadam, Hasan; Pedari, Shamsedin

    2014-01-01

    BACKGROUND Stent underexpansion is the most powerful predictor of long-term stent patency and clinical outcome. The purpose of this study was to evaluate the incidence and predictors of stent underexpansion despite adjunctive post-dilatation with non-compliant balloon. METHODS After elective coronary stent implantation and adjunctive post-dilatation with non-compliant balloon and optimal angiographic result confirmed by the operator, intravascular ultrasound (IVUS) was performed for all the treated lesions. If the treated lesions fulfilled the IVUS criteria, they are considered as the optimal stent group; if not, they are considered as the suboptimal group. RESULTS From 50 patients enrolled in this study 39 (78%) had optimal stent deployment and 11 (22%) had suboptimal stent deployment. In the suboptimal group 7 (14%) had underexpansion, 2 (4%) malposition, and 2 (4%) had asymmetry. There were no stent edge dissections detected by IVUS. We did not find any correlation between lesion calcification, ostial lesions, stent length, and stent underexpansion. Stent diameter ≤ 2.75 mm had a strong correlation with stent underexpansion. CONCLUSION Despite adjunctive post-dilatation with noncompliant balloon, using a relatively small stent diameter was a strong predictor for underexpansion. IVUS guided percutaneous coronary intervention (PCI) may be considered for drug eluting stent (DES) implantation in relatively small vessels. PMID:24963308

  10. Unplanned pregnancy after ultrasound-guided percutaneous microwave ablation of uterine fibroids: A follow-up study.

    PubMed

    Bing-song, Zhang; Jing, Zhang; Zhi-Yu, Han; Chang-tao, Xu; Rui-fang, Xu; Xiu-mei, Li; Hui, Liu

    2016-01-01

    A follow-up study was performed with 169 women of childbearing age who underwent ultrasound-guided percutaneous microwave ablation (UPMWA) therapy for symptomatic uterine fibroids in the Chinese PLA General Hospital from June 2007 to December 2014. This study aimed to observe the incidence of unplanned pregnancies in these women after UPMWA treatment in order to evaluate its effect on natural conception. Ten unplanned pregnancies in nine women were occurred. Of the nine patients, six did not want the pregnancy and chose for induced abortion to end the pregnancy at an early stage. Three chose to continue with the pregnancy and gave birth to a healthy term infant delivered by cesarean section (of these three patients, two had been previously diagnosed as infertility). None of the patients had any serious obstetric complications. After UPMWA treatment for uterine fibroids, patients may conceive naturally, the impact of the procedure on fertility and pregnancy outcomes is worthy of further prospective study in larger sample. PMID:26733265

  11. Unplanned pregnancy after ultrasound-guided percutaneous microwave ablation of uterine fibroids: A follow-up study

    PubMed Central

    Bing-song, Zhang; Jing, Zhang; Zhi-yu, Han; Chang-tao, Xu; Rui-fang, Xu; Xiu-mei, Li; Hui, Liu

    2016-01-01

    A follow-up study was performed with 169 women of childbearing age who underwent ultrasound-guided percutaneous microwave ablation (UPMWA) therapy for symptomatic uterine fibroids in the Chinese PLA General Hospital from June 2007 to December 2014. This study aimed to observe the incidence of unplanned pregnancies in these women after UPMWA treatment in order to evaluate its effect on natural conception. Ten unplanned pregnancies in nine women were occurred. Of the nine patients, six did not want the pregnancy and chose for induced abortion to end the pregnancy at an early stage. Three chose to continue with the pregnancy and gave birth to a healthy term infant delivered by cesarean section (of these three patients, two had been previously diagnosed as infertility). None of the patients had any serious obstetric complications. After UPMWA treatment for uterine fibroids, patients may conceive naturally, the impact of the procedure on fertility and pregnancy outcomes is worthy of further prospective study in larger sample. PMID:26733265

  12. Image fusion and navigation platforms for percutaneous image-guided interventions.

    PubMed

    Rajagopal, Manoj; Venkatesan, Aradhana M

    2016-04-01

    Image-guided interventional procedures, particularly image guided biopsy and ablation, serve an important role in the care of the oncology patient. The need for tumor genomic and proteomic profiling, early tumor response assessment and confirmation of early recurrence are common scenarios that may necessitate successful biopsies of targets, including those that are small, anatomically unfavorable or inconspicuous. As image-guided ablation is increasingly incorporated into interventional oncology practice, similar obstacles are posed for the ablation of technically challenging tumor targets. Navigation tools, including image fusion and device tracking, can enable abdominal interventionalists to more accurately target challenging biopsy and ablation targets. Image fusion technologies enable multimodality fusion and real-time co-displays of US, CT, MRI, and PET/CT data, with navigational technologies including electromagnetic tracking, robotic, cone beam CT, optical, and laser guidance of interventional devices. Image fusion and navigational platform technology is reviewed in this article, including the results of studies implementing their use for interventional procedures. Pre-clinical and clinical experiences to date suggest these technologies have the potential to reduce procedure risk, time, and radiation dose to both the patient and the operator, with a valuable role to play for complex image-guided interventions. PMID:26826086

  13. Percutaneous Ultrasound-Guided Laser Ablation with Contrast-Enhanced Ultrasonography for Hyperfunctioning Parathyroid Adenoma: A Preliminary Case Series

    PubMed Central

    Jiang, Tianan; Chen, Fen; Zhou, Xiang; Hu, Ying; Zhao, Qiyu

    2015-01-01

    The study was to evaluate the safety and effectiveness of ultrasound-guided percutaneous laser ablation (pLA) as a nonsurgical treatment for primary parathyroid adenoma. Surgery was contraindicated in, or refused by, the included patients. No lesion enhancement on contrast-enhanced ultrasound immediately after pLA was considered “complete ablation.” Nodule size, serum calcium, and parathyroid hormone level were compared before and after pLA. Complete ablation was achieved in all 21 patients with 1 (n = 20) or 2 (n = 1) sessions. Nodule volume decreased from 0.93 ± 0.58 mL at baseline to 0.53 ± 0.38 and 0.48 ± 0.34 mL at 6 and 12 months after pLA (P < 0.05). At 1 day, 6 months, and 12 months after pLA, serum PTH decreased from 15.23 ± 3.00 pmol/L at baseline to 7.41 ± 2.79, 6.95 ± 1.78, and 6.90 ± 1.46 pmol/L, serum calcium decreased from 3.77 ± 0.77 mmol/L at baseline to 2.50 ± 0.72, 2.41 ± 0.37, and 2.28 ± 0.26 mmol/L, respectively (P < 0.05). At 12 months, treatment success (normalization of PTH and serum calcium) was achieved in 81%. No serious complications were observed. Ultrasound-guided pLA with contrast-enhanced ultrasound is a viable alternative to surgery for primary parathyroid adenoma. PMID:26788059

  14. Percutaneous Ultrasound-Guided Laser Ablation with Contrast-Enhanced Ultrasonography for Hyperfunctioning Parathyroid Adenoma: A Preliminary Case Series.

    PubMed

    Jiang, Tianan; Chen, Fen; Zhou, Xiang; Hu, Ying; Zhao, Qiyu

    2015-01-01

    The study was to evaluate the safety and effectiveness of ultrasound-guided percutaneous laser ablation (pLA) as a nonsurgical treatment for primary parathyroid adenoma. Surgery was contraindicated in, or refused by, the included patients. No lesion enhancement on contrast-enhanced ultrasound immediately after pLA was considered "complete ablation." Nodule size, serum calcium, and parathyroid hormone level were compared before and after pLA. Complete ablation was achieved in all 21 patients with 1 (n = 20) or 2 (n = 1) sessions. Nodule volume decreased from 0.93 ± 0.58 mL at baseline to 0.53 ± 0.38 and 0.48 ± 0.34 mL at 6 and 12 months after pLA (P < 0.05). At 1 day, 6 months, and 12 months after pLA, serum PTH decreased from 15.23 ± 3.00 pmol/L at baseline to 7.41 ± 2.79, 6.95 ± 1.78, and 6.90 ± 1.46 pmol/L, serum calcium decreased from 3.77 ± 0.77 mmol/L at baseline to 2.50 ± 0.72, 2.41 ± 0.37, and 2.28 ± 0.26 mmol/L, respectively (P < 0.05). At 12 months, treatment success (normalization of PTH and serum calcium) was achieved in 81%. No serious complications were observed. Ultrasound-guided pLA with contrast-enhanced ultrasound is a viable alternative to surgery for primary parathyroid adenoma. PMID:26788059

  15. Routine use of ultrasound-guided access reduces access-site related complications after lower extremity percutaneous revascularization

    PubMed Central

    Lo, Ruby C.; Fokkema, Margriet T.M.; Curran, Thomas; Darling, Jeremy; Hamdan, Allen D.; Wyers, Mark; Martin, Michelle; Schermerhorn, Marc L.

    2014-01-01

    Objectives We sought to elucidate the risks for access site-related complications (ASC) following percutaneous lower extremity revascularization and to evaluate benefit of routine ultrasound-guided access (RUS) in decreasing ASC. Methods We reviewed all consecutive percutaneous revascularizations (PTA or stent) performed for lower extremity atherosclerosis at our institution from 2002–2012. RUS began September 2007. Primary outcome was any ASC (bleeding, groin or retroperitoneal [RP] hematoma, vessel rupture, or thrombosis). Multivariable logistic regression was used to determine predictors of ASC. Results A total of 1,371 punctures were performed on 877 patients (43% women, median age 69 [IQR 60–78] yrs for claudication (29%), critical limb ischemia (59%), or bypass graft stenosis (12%) using 4–8Fr sheaths. There were 72 ASCs (5%): 52 instances of bleeding or groin hematoma, 9 pseudoaneurysms, 8 retroperitoneal hematomas, 2 artery lacerations, and 1 thrombosis. ASC were less frequent when RUS was used (4% vs. 7%, P=.02). Multivariable predictors of ASC were age >75 years (OR 2.0, 95% CI 1.1–3.7, P=.03), CHF (OR 1.9, 95% CI 1.1–1.3, P=.02), preoperative warfarin use (OR 2.0, 95% CI 1.1–3.5, P=.02), & RUS (OR 0.4, 95% CI 0.2–0.7, P<.01). Vascular closure devices (VCDs) were not associated with lower rates of ASCs (OR 1.1, 95% CI 0.2–0.7, P<.01). RUS lowered ASCs in those >75 years (5% vs. 12%, P<.01) but not those on warfarin preoperatively (10% vs. 13%, P=.47). RUS did not decrease VCD failure (6% vs. 4%, P=.79). Conclusions We were able to decrease the rate of ASCs during lower extremity revascularization with the implementation of RUS. VCDs did not impact ASCs. Particular care should be taken on patients >75 years old, those with CHF, and those on warfarin. PMID:25240244

  16. Percutaneous Transhepatic Catheterization of the Portal Vein: A Combined CT- and Fluoroscopy-Guided Technique

    SciTech Connect

    Weimar, Bernd; Rauber, Klaus; Brendel, Mathias D.; Bretzel, Reinhard G.; Rau, Wigbert S.

    1999-07-15

    Combined CT- and fluoroscopy-guided transhepatic portal vein catheterization was performed in 44 patients selected for pancreatic islet cell transplantation. The method allowed catheterization with a single puncture attempt in 39 patients. In four patients two attempts and in one patient four attempts were necessary. One minor hematoma of the liver capsule occurred that required no further treatment. Compared with other methods the average number of puncture attempts was reduced.

  17. Vertebroplasty

    MedlinePlus

    ... to the correct area in your lower back. Cement is then injected into the broken spine bone ... general anesthesia Nerve injuries Leakage of the bone cement into surrounding areas (this can cause pain if ...

  18. Manikin model with breathing tube for wire-guided percutaneous cricothyrotomy in patients applying an intermaxillary fixation.

    PubMed

    Hwang, Kun; Kim, Han Joon; Kim, Yoo Chan; Choi, Yong Soon; Hwang, Se Won

    2014-09-01

    Jaw fracture surgery or orthognathic surgery usually involves the application of an intermaxillary fixation (IMF). Obstructions that cannot be relieved by suction require an immediate release of IMF wires, but releasing the IMF may damage the surgical alignment of the facial bones. The mean time taken to release the jaws was an average of 2 minutes 9 seconds by hospital staff involved in caring for these patients. The aims of this study were to introduce a training model for wire-guided percutaneous cricothyrotomy in the patients applying an IMF and to perform the procedure for medical students. Our model consisted of a facial mannequin, a plastic breathing tube, 2 rolls of tapes, and a reservoir bag. The inner parts of the 2 used rolls of tape represent tracheal/cricoid rings (1-inch width for thyroid and half-inch width for cricoid), and the space between them represents the cricothyroid membrane, which is wrapped with Peha-Haft. A surgeon demonstrated the technique on the model, and then, 60 medical students who had never attended airway-training courses applied the Melker cricothyrotomy kit on the model. All 60 students completed the procedure successfully. The mean (SD) time needed to insert a cricothyrotomy catheter of the medical students was 175 (50) seconds (range, 76-297 s). Most of the students (54; 90%) performed it within 4 minutes; more than half (33; 55%), within 3 minutes. With our manikin model and Melker cricothyrotomy kit, 60 medical students completed the procedure successfully. This model can be useful to cricothyrotomy training for medical personnel. PMID:25203581

  19. Percutaneous CT-guided microwave ablation as maintenance after first-line treatment for patients with advanced NSCLC

    PubMed Central

    Ni, Xiang; Han, Jun-Qing; Ye, Xin; Wei, Zhi-Gang

    2015-01-01

    Background Systemic therapy is recommended for advanced non-small-cell lung cancer (NSCLC). However, conventional first-line treatment has generated a plateau in response rate of 25% to 35%. Few studies have shown patients benefit from microwave ablation (MWA) in combination with radiotherapy and chemotherapy. This study aims to evaluate safety and efficacy of percutaneous computed tomography-guided MWA as maintenance after first-line treatment for patients with advanced NSCLC. Methods Patients with histologically verified NSCLC stage IIIB or IV between January 2010 and March 2014 were involved. After completion of first-line treatment with partial response or stable disease, 35 patients with 39 tumors underwent 39 MWA procedures. Complications, progression-free survival (PFS), overall survival (OS), and correlated predictors were analyzed. Results During a median follow-up of 17.7 months and 10.8 months after initial MWA, local efficacy was 87.2%, median MWA-related local control time was 10.6 months, and tumor size was the only predictor (P=0.002). Median MWA-related PFS, MWA-related OS, PFS, and OS were 5.4, 10.6, 11.8 and 17.7 months, respectively. Local efficacy was significantly correlated with MWA-related PFS (P=0.003), MWA-related OS (P=0.000), and OS (P=0.001). There were no procedure-specific deaths. Total incidence of major complications was 12.8%, including pneumothorax resolved by closed pleural drainage and pneumonia controlled by antibiotics in a short time. Conclusion This study concluded two points, including: 1) patients benefited from MWA as maintenance both in local control and survival; 2) as maintenance MWA was superior to conventional maintenance therapy with improved survival and well-tolerated complications. Therefore, MWA was a safe and effective maintenance after first-line treatment in patients with advanced NSCLC. PMID:26604789

  20. Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules*

    PubMed Central

    Cardoso, Luciana Vargas; Souza, Arthur Soares

    2014-01-01

    OBJECTIVE: To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs). METHODS: We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions. RESULTS: Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively) CONCLUSIONS: In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy. PMID:25210960

  1. Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study

    PubMed Central

    Del Castillo-González, Federico; Ramos-Álvarez, Juan José; Rodríguez-Fabián, Guillermo; González-Pérez, José; Calderón-Montero, Javier

    2014-01-01

    Summary Purpose: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment. Methods: a 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10cm line, arranged horizontally or vertically. The “0” represents no pain and “10” represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder. Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first check-up (3 months) and was maintained for two year. Conclusion: we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients. PMID:25767776

  2. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

    PubMed Central

    Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian

    2013-01-01

    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  3. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design.

    PubMed

    Eslami, Sohrab; Fischer, Gregory S; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M; Iordachita, Iulian

    2013-12-31

    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  4. The chemistry of acrylic bone cements and implications for clinical use in image-guided therapy.

    PubMed

    Nussbaum, David A; Gailloud, Philippe; Murphy, Kieran

    2004-02-01

    Advances in image-guided therapy for vertebral fractures and other bone-related disorders have made acrylic bone cement an integral part of the interventional armamentarium. Unfortunately, information on the properties and chemistry of these compounds is mostly published in the biomaterial sciences literature, a source with which the interventional community is generally unfamiliar. This review focuses on the chemistry of bone cement polymerization and the properties of components in polymethylmethacrylate (PMMA)-based polymers, the most commonly used bone cements in interventional procedures such as percutaneous vertebroplasty. The effects of altering the concentration of components such as methylmethacrylate monomers, PMMA beads, benzoyl peroxide activator, N,N-dimethyl-p-toluidine (DMPT) initiator, and radiopacifiers on the setting time, polymerization temperature, and compressive strength of the cement are also considered. This information will allow interventional radiologists to manipulate bone cement characteristics for specific applications and maximize the clinical potential of image-guided interventions. PMID:14963178

  5. Various approaches for CT-guided percutaneous biopsy of deep pelvic lesions: anatomic and technical considerations.

    PubMed

    Gupta, Sanjay; Nguyen, Huan Luong; Morello, Frank A; Ahrar, Kamran; Wallace, Michael J; Madoff, David C; Murthy, Ravi; Hicks, Marshall E

    2004-01-01

    Access route planning for computed tomography-guided biopsy of deep pelvic masses remains challenging because vital structures often obstruct the projected needle path. The classical approach through the lower anterior abdominal wall allows access to lesions located anterior, superior, or lateral to the urinary bladder. However, this approach has limitations: Deep masses are difficult to reach because of intervening structures, the bowel or bladder may be unavoidably traversed, and peritoneal transgression is often painful. A transgluteal approach is useful for biopsy of presacral and perirectal lesions and lesions located posterolateral to the bladder. An anterolateral approach through the iliopsoas muscle allows safe extraperitoneal access to external and internal iliac nodes, masses located along the lateral pelvic sidewall, and adnexal lesions. A transosseous (transsacral or transiliac) approach can occasionally be used for otherwise inaccessible lesions. Use of a curved needle, change in patient position, or injection of saline solution to displace intervening structures may also be helpful. Familiarity with normal cross-sectional pelvic anatomy facilitates planning of a safe access route and helps avoid injury to adjacent structures. A thorough understanding of the advantages and disadvantages of each approach allows the clinician to choose the most appropriate approach in a given situation. PMID:14730045

  6. Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

    SciTech Connect

    Harding, James Mortimer, Alex; Kelly, Michael; Loveday, Eric

    2010-12-15

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  7. A novel radiographic targeting guide for percutaneous placement of transfacet screws in the cervical spine with limited fluoroscopy: A cadaveric feasibility study

    PubMed Central

    Jackson, David M.; Karp, Jacqueline E.; O'Brien, Joseph R.; Anderson, D. Greg; Gelb, Daniel E.; Ludwig, Steven C.

    2012-01-01

    Background We describe a technique for percutaneous transfacet screw placement in the cervical spine without the need for lateral-view fluoroscopy. Methods Previously established articular pillar morphometry was used to define the ideal trajectory for transfacet screw placement in the subaxial cervical spine. A unique targeting guide was developed to allow placement of Kirschner wires across the facet joint at 90° without the guidance of lateral-view fluoroscopy. Kirschner wires and cannulated screws were placed percutaneously in 7 cadaveric specimens. Placement of instrumentation was performed entirely under modified anteroposterior-view fluoroscopy. All specimens were assessed for acceptable screw placement by 2 fellowship-trained orthopaedic spine surgeons using computed tomography. Open dissection was used to confirm radiographic interpretation. Acceptable placement was defined as a screw crossing the facet joint, achieving purchase in the inferior and superior articular processes, and not violating critical structures. Malposition was defined as a violation of the transverse foramen, spinal canal, or nerve root or inadequate fixation. Results A total of 48 screws were placed. Placement of 45 screws was acceptable. The 3 instances of screw malposition included a facet fracture, a facet distraction, and a C6-7 screw contacting the C7 nerve root in a specimen with a small C7 superior articular process. Conclusions Our data show that with the appropriate radiographic technique and a targeting guide, percutaneous transfacet screws can be safely placed at C3-7 without the need for lateral-view fluoroscopy during the targeting phase. Because of the variable morphometry of the C7 lateral mass, however, care must be taken when placing a transfacet screw at C6-7. Clinical Relevance This study describes a technique that has the potential to provide a less invasive strategy for posterior instrumentation of the cervical spine. Further investigation is needed before this

  8. Experiences in US-Guided Percutaneous Radiofrequency Ablation of 44 Renal Tumors in 31 Patients: Analysis of Predictors for Complications and Technical Success

    SciTech Connect

    Veltri, Andrea Calvo, Amedeo; Tosetti, Irene; Pagano, Eva; Genovesio, Andrea; Virzi, Valentina; Ferrando, Ugo; Fontana, Dario; Gandini, Giovanni

    2006-10-15

    Purpose. Preliminary clinical studies have shown the feasibility, safety, and efficacy of radiofrequency thermal ablation (RFA) of renal tumors, but only a few have analyzed the prognostic factors for technical success and there are no long-term results. Our objective was to statistically evaluate our mid-term results of percutaneous US-guided RFA in order to define predictors for complications and technical success. Methods. We selected for treatment 44 tumors in 31 patients (24 with renal cell carcinoma, 7 with hereditary tumors, 15 with a solitary kidney), up to 5 cm in diameter. Results. Eight adverse events occurred; 3 (6.8%) were major complications, successfully treated with interventional radiology procedures in 2 cases. Exophytic extension of the tumor was protective against complications (p 0.040). Technical success was obtained in 38 lesions after one RFA session and in 39 (89%) after one more session, when possible. At the end of treatment, central extension was the only negative predictor for technical success (p = 0.007), while neither size >3 cm (p = 0.091) nor other prognostic factors were statistically significant. Conclusion. US-guided percutaneous RFA can be proposed for non-central renal tumors up to 5 cm, also in patients without surgical contraindications, thanks to a low incidence of complications and a high success rate. Randomized controlled trials versus surgery are now needed to investigate long-term comparative results.

  9. Tageted bipolar radiofrequency decompression with vertebroplasty for intractable radicular pain due to spinal metastasis: a case report

    PubMed Central

    Baek, Seong Jin; Lee, Eun Young

    2016-01-01

    Metastatic spinal tumors are usually quite difficult to treat. In patients with metastatic spinal tumors, conventional radiotherapy fails to relieve pain in 20–30% of cases and open surgery often causes considerable trauma and complications, which delays treatment of the primary disease. Percutaneous vertebroplasty (PVP) is considered to be useful in achieving rapid pain control and preventing further vertebral collapse due to spinal metastasis. However, symptoms of intraspinal neural compression can be contraindications to PVP. To overcome this problem, we performed PVP following targeted bipolar radiofrequency decompression, and examined the effect of the combined treatment in relieving severe radicular pain related to spinal cord compression caused by malignant metastatic tumors. PMID:27482319

  10. Tageted bipolar radiofrequency decompression with vertebroplasty for intractable radicular pain due to spinal metastasis: a case report.

    PubMed

    Baek, Seong Jin; Park, Hahck Soo; Lee, Eun Young

    2016-08-01

    Metastatic spinal tumors are usually quite difficult to treat. In patients with metastatic spinal tumors, conventional radiotherapy fails to relieve pain in 20-30% of cases and open surgery often causes considerable trauma and complications, which delays treatment of the primary disease. Percutaneous vertebroplasty (PVP) is considered to be useful in achieving rapid pain control and preventing further vertebral collapse due to spinal metastasis. However, symptoms of intraspinal neural compression can be contraindications to PVP. To overcome this problem, we performed PVP following targeted bipolar radiofrequency decompression, and examined the effect of the combined treatment in relieving severe radicular pain related to spinal cord compression caused by malignant metastatic tumors. PMID:27482319

  11. Occlusion of an Intraosseous Arteriovenous Malformation With Percutaneous Injection of Polymethylmethacrylate

    SciTech Connect

    Ierardi, Anna Maria; Mangini, Monica; Vaghi, Massimo; Cazzulani, Alberto; Mattassi, Raul; Carrafiello, Gianpaolo

    2011-02-15

    Primary intraosseous arteriovenous malformations are rare. Many minimally invasive procedures can be considered preoperative steps and/or definitive treatment. The case reported regards a young woman with a voluminous arteriovenous extratroncular infiltrating malformation of the humerus. She underwent several treatments, but none of them was completely occlusive. The last treatment consisted of direct percutaneous puncture of the intraosseous alteration and injection of polymethylmethacrylate (PMMA), which is normally used in percutaneous vertebroplasty. We obtained complete occlusion of the humerus lytic lesion. To the best of our knowledge, this represents the first case of intraosseous AVM treated by percutaneous injection of PMMA.

  12. Ultrasound-guided percutaneous sclerotherapy of simple renal cysts with n-butyl cyanoacrylate and iodized oil mixture as an outpatient procedure

    PubMed Central

    Ali, Tamer A.; Abdelaal, Mohamed A.; Enite, Ashraf; Badran, Yasser A.

    2016-01-01

    Objective: The aim of this study was to evaluate the efficacy and safety of ultrasound guided percutaneous sclerotherapy of symptomatic simple renal cysts with n-butyl cyanoacrylate (NBCA) and iodized oil mixture as an outpatient single session procedure. Materials and Methods: A total of ninety two patients with 100 symptomatic simple renal cysts (larger than 5 cm) were treated by ultrasound (US)-guided percutaneous aspiration and injection of NBCA and iodized oil mixture. The patients (68 men and 24 women, mean age, 42.4 ± 10.5 years) were treated with as out-patients. The volume of the treated cysts was calculated with periodic noncontrast enhanced CT examinations 3, 6 and 9, months after the procedure. The procedure was considered successful at follow-up CT when there was total ablation or greater than 80% reduction of size with resolution of symptoms, respectively. Failure was defined as less than 80% reduction and/or persistent symptoms. Results: The sclerotherapy was technically successful in all patients. The diameter of the cysts ranged between 5.5 and 13.5 cm (mean, 8.8 ± 1.4 cm), and 1.5 and 3.8 cm (mean, 2.1 ± 0.4 cm) before and after sclerotherapy, respectively (P < 0.001). Average diameter reduction was 83.7% during the follow-up period. The mean follow- up lasted 7.1 months (3–11 months). Flank pain resolved in 86 of 92 symptomatic patients (93.48%). In six patients, the symptoms decreased slightly. The procedure was successful in 98 of 100 cysts (98%), demonstrated by follow-up CT. The only two failed cyst was larger than 10 cm in diameter and don’t required any further treatment. We did not observe any procedure related complications. Conclusion: Ultrasound guided percutaneous sclerotherapy with NBCA and iodized oil mixture for management of symptomatic simple renal cysts was found to be a real time, effective, safe, well tolerated, alternative and simple technique that can be carried out by urologists as an outpatient procedure. PMID

  13. Image-guided percutaneous aspiration and gelfoam treatment of petrous apex cholesterol granuloma: a new theory and method for diagnosis and treatment.

    PubMed

    Lee, Thomas C; Raghavan, Deepak; Curtin, Hugh D

    2013-12-01

    Although diagnosis of cholesterol granulomas of the skull base can be straightforward with computed tomography (CT) and magnetic resonance imaging (MRI) appearance, treatment is controversial with various skull base approaches described in the literature. This report describes a 35-year-old man who presented with a symptomatic, enlarging cystic lesion in the left petrous apex and clivus that had imaging features of a cholesterol granuloma (cholesterol cyst). Due to a prior history of treated mediastinal germ cell tumor, pathologic confirmation of the lesion was requested. A CT-guided percutaneous aspiration revealed dark used motor oil-like fluid. Continued aspiration yielded a change in the character of the fluid to marrow red. Injection of contrast revealed no communication with cerebrospinal fluid. Gelfoam (Pfizer, New York, New York, USA) was subsequently injected percutaneously into the residual cavity. Histopathology showed no evidence of malignancy and follow-up MRI at 1 month, 3 months, 6 months, and 1 year demonstrated continued decrease in size and signal of the lesion. PMID:24436935

  14. 3D Image-Guided Percutaneous Radiofrequency Thermocoagulation of the Maxillary Branch of the Trigeminal Nerve Through Foramen Rotundum for the Treatment of Trigeminal Neuralgia.

    PubMed

    Xue, Tongqing; Yang, Weixi; Guo, Yunhu; Yuan, Weiwei; Dai, Jianhu; Zhao, Zhenxin

    2015-11-01

    Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion through the foramen ovale is a well-established procedure for the treatment of trigeminal neuralgia (TN). However, this approach can be tricky when individual trigeminal sub-branch nerve block is required. We report our initial experience of image-guided radiofrequency thermocoagulation of the maxillary branch through the use of foramen rotundum.From February 2012 to February 2015, we treated 25 patients with isolated TN of the maxillary branch. Radiofrequency thermocoagulation of the maxillary branch through the foramen rotundum was performed under fluoroscopy. TN pain was evaluated using the visual analogue scale both before and after the procedure.The mean preoperative visual analogue scale score was 8.6 ± 0.8. The pain completely disappeared after the initial procedure in 22 patients and after a second procedure in 2 patients. An additional patient had a postoperative visual analogue scale score of 2 and did not undergo further treatment. Facial numbness occurred in 23 patients but was tolerable. Patients were followed up for a mean of 14.74 months (range, 1-29 months). Recurrence was observed in 9 patients (36%) during the follow-up period. All recurrences were well managed with repeat procedures.Percutaneous radiofrequency thermocoagulation of the maxillary branch through the foramen rotundum under fluoroscopy is a safe and effective procedure for the treatment of isolated TN of the maxillary branch. PMID:26559267

  15. Retroperitoneal Bleeding and Arteriovenous Fistula after Percutaneous Coronary Intervention Successfully Treated with Intravascular Ultrasound-guided Covered Stent Implantation.

    PubMed

    Mogi, Satoshi; Maekawa, Yuichiro; Fukuda, Keiichi; Noma, Shigetaka

    2016-01-01

    The major puncture-site complications of the transfemoral approach are retroperitoneal bleeding (RPB), arteriovenous (AV) fistula, and arterial pseudoaneurysm. Although the management of RPB and AV fistula depends on individual cases, our experience shows that the use of a covered stent with intravascular ultrasound (IVUS) guidance can successfully manage percutaneous coronary intervention-associated RPB and AV fistula. IVUS guidance can therefore make it easy to use an optimal-size covered stent. PMID:27250054

  16. CT-guided percutaneous laser disc decompression with Ceralas D, a diode laser with 980-nm wavelength and 200-microm fiber optics.

    PubMed

    Gevargez, A; Groenemeyer, D W; Czerwinski, F

    2000-01-01

    The aim of this study was to evaluate the compact, portable Ceralas-D diode laser (CeramOptec; 980 + 30 nm wavelength, 200-microm optical fiber) concerning clinical usefulness, handling, and clinical results in the CT-guided treatment of herniated lumbar discs. The positioning of the canula in intradiscal space, the placement of the laser fiber into the disc through the lying canula, and the vaporization itself were carried out under CT-guidance. Due to the thin fiber optic, it was possible to use a thin 23-gauge canula. The laser procedure was performed in 0.1- to 1-s shots with 1-s pulse pause and 4-W power output. A total of 1650-2300 J was applied on each percutaneous laser disc decompression (PLDD). Results in 26 patients were established with a visual-analogue scale (VAS). On the follow-up examinations, 46% of the patients were absolutely pain free ( > 85 % VAS) and fully active in everyday life after 4 postoperative weeks. Thirty-one percent of patients were relieved of the leg pain but had occasional back pain without sensorimotor impairment. Fifteen percent sensed a slight alleviation ( > 50% VAS) of the radiate pain. Eight percent did not experience radicular or pseudo-radicular pain alleviation (< 25% VAS). Cerales-D proves to be an efficient tool for CT-guided PLDD on non-sequestered herniated lumbar discs. PMID:10939481

  17. High Retention and Safety of Percutaneously Implanted Endovascular Embolization Coils as Fiducial Markers for Image-Guided Stereotactic Ablative Radiotherapy of Pulmonary Tumors

    SciTech Connect

    Hong, Julian C.; Yu Yao; Rao, Aarti K.; Dieterich, Sonja; Maxim, Peter G.; Le, Quynh-Thu; Diehn, Maximilian; Sze, Daniel Y.; Kothary, Nishita; Loo, Billy W.

    2011-09-01

    Purpose: To compare the retention rates of two types of implanted fiducial markers for stereotactic ablative radiotherapy (SABR) of pulmonary tumors, smooth cylindrical gold 'seed' markers ('seeds') and platinum endovascular embolization coils ('coils'), and to compare the complication rates associated with the respective implantation procedures. Methods and Materials: We retrospectively analyzed the retention of percutaneously implanted markers in 54 consecutive patients between January 2004 and June 2009. A total of 270 markers (129 seeds, 141 coils) were implanted in or around 60 pulmonary tumors over 59 procedures. Markers were implanted using a percutaneous approach under computed tomography (CT) guidance. Postimplantation and follow-up imaging studies were analyzed to score marker retention relative to the number of markers implanted. Markers remaining near the tumor were scored as retained. Markers in a distant location (e.g., pleural space) were scored as lost. CT imaging artifacts near markers were quantified on radiation therapy planning scans. Results: Immediately after implantation, 140 of 141 coils (99.3%) were retained, compared to 110 of 129 seeds (85.3%); the difference was highly significant (p < 0.0001). Of the total number of lost markers, 45% were reported lost during implantation, but 55% were lost immediately afterwards. No additional markers were lost on longer-term follow-up. Implanted lesions were peripherally located for both seeds (mean distance, 0.33 cm from pleural surface) and coils (0.34 cm) (p = 0.96). Incidences of all pneumothorax (including asymptomatic) and pneumothorax requiring chest tube placement were lower in implantation of coils (23% and 3%, respectively) vs. seeds (54% and 29%, respectively; p = 0.02 and 0.01). The degree of CT artifact was similar between marker types. Conclusions: Retention of CT-guided percutaneously implanted coils is significantly better than that of seed markers. Furthermore, implanting coils is at

  18. Percutaneous CT-Guided Core Needle Biopsy Versus Fine Needle Aspiration in Diagnosing Pneumonia and Mimics of Pneumonia

    SciTech Connect

    Thanos, Loukas; Galani, Panagiota Mylona, Sophia; Pomoni, Maria; Mpatakis, Nikolaos

    2004-08-15

    The purpose of this study was to determine the diagnostic value of percutaneous core needle biopsy (CNB) relative to fine needle aspiration (FNA) in patients with pneumonia and pneumonia mimics. In this prospective study we present our experience with 48 thoracic FNAs and CNBs carried out on 48 patients with pneumonia and pneumonia mimics. Samples were obtained from all patients using both CNB (with an automated 18-G core biopsy needle and a gun) and FNA (with a 22-G needle). A specific diagnosis was made in 10/48 cases (20.83%) by FNA and in 42/48 (87.5%) by CNB. The main complications encountered were pneumothorax (n = 4) and hemoptysis (n = 2), yielding a total complication rate of 12.5%. We concluded that CNB using an automated biopsy gun results in a higher diagnostic accuracy for pneumonia and pneumonia mimic biopsies than FNA. Complications should be considered and proper patient observation should follow the procedure.

  19. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vessel dilator for percutaneous catheterization... Vessel dilator for percutaneous catheterization. (a) Identification. A vessel dilator for percutaneous catheterization is a device which is placed over the guide wire to enlarge the opening in the vessel, and which...

  20. Role of contrast-enhanced ultrasound in evaluating the efficiency of ultrasound guided percutaneous microwave ablation in patients with renal cell carcinoma

    PubMed Central

    Li, Xin; Liang, Ping; Yu, Jie; Yu, Xiao-Ling; Liu, Fang-Yi; Cheng, Zhi-Gang; Han, Zhi-Yu

    2013-01-01

    Background The aim of the study was to evaluate the efficiency and feasibility of contrast-enhanced ultrasound (CEUS) with Sonovue in assessing of renal cell carcinomas (RCCs) following ultrasound (US)-guided percutaneous microwave ablation (MWA). Patinets and methods Seventy-nine patients (60 males and 19 females) with 83 lesions (mean size 3.2±1.6 cm) were treated by US-guided percutaneous MWA. The CEUS results of the third day after the ablation were compared with the synchronous contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI) results and biopsy pathological results. The follow-up was performed by CEUS and CT/MRI after 1, 3, 6 months and every 6 months subsequently. The combination of clinical follow-up results and CT/MRI imaging findings was the reference standard of CEUS results for evaluating the therapeutic effect. The identification of residual or recurrence tumour was assessed by two blinded radiologists. Results On the third day after MWA, CEUS showed 68 of 83 lesions (68/83, 81.9%) successfully ablated and 15 of 83 (18.1%) with residual tumours. Among residual tumours, 13 (86.7%) were confirmed by contrast-enhanced CT/MRI findings and biopsy results. The sensitivity, specificity, accuracy, positive and negative predictive value of CEUS evaluating the short-term MWA effectiveness were 100%, 97.1%, 97.6%, 86.7% and 100%, respectively. During the six years follow-up (median 26 months), the CEUS showed recurrence in 7 patients, and six of them achieved consistent results on CEUS and CT/MRI imaging. The sensitivity, specificity, accuracy, positive and negative predictive value for CEUS evaluating long-term MWA effectiveness were 85.7%, 98.7%, 97.6%, 85.7% and 98.7%, respectively. Conclusions The post-procedural CEUS demonstrated as an effective and feasible method in evaluating a therapeutic effect of RCCs following MWA. PMID:24294186

  1. Diuretic Agent and Normal Saline Infusion Technique for Ultrasound-Guided Percutaneous Nephrostomies in Nondilated Pelvicaliceal Systems

    SciTech Connect

    Yagci, Cemil Ustuner, Evren Atman, Ebru Dusunceli; Baltaci, Sumer; Uzun, Caglar Akyar, Serdar

    2013-04-15

    Percutaneous nephrostomy (PCN) in a nondilated pelvicaliceal system is technically challenging. We describe an effective method to achieve transient dilatation of the pelvicaliceal system via induction of diuresis using infusion of a diuretic agent in normal saline, therefore allowing easier access to the pelvicaliceal system. Under real-time ultrasound guidance, the technique had been tested in 22 nephrostomies with nondilated system (a total of 20 patients with 2 patients having bilateral nephrostomies) during a 5-year period. Patients were given 40 mg of furosemide in 250 ml of normal saline solution intravenously by rapid infusion. As soon as maximum calyceal dilatation of more than 5 mm was observed, which is usually 15 min later after the end of rapid infusion, patients were positioned obliquely, and PCN procedure under ultrasound guidance was performed. The procedure was successful in 19 of the nephrostomies in 17 patients with a success rate of 86.36 % per procedure and 85 % per patient in nondilated pelvicaliceal systems. No major nephrostomy-, drug-, or technique-related complications were encountered. The technique failed to work in three patients due to the presence of double J catheters and preexisting calyceal perforation which avoided transient dilation of the pelvicaliceal system with diuresis. Diuretic infusion in saline is a feasible and effective method for PCN in nondilated pelvicaliceal systems.

  2. Diagnosis of Cancer Spread Using Percutaneous Transhepatic Biliary Cholangioscopy-guided Ultrasonography for Malignant Bile Duct Stenosis

    PubMed Central

    2001-01-01

    The characteristics of sites of intramural cancer spread were examined by comparing the intraductal ultrasonography (IDUS) and wall thickening findings at sites of intramural cancer spread and non-spread, in patients with malignant bile duct stenosis who had undergone percutaneous transhepatic biliary drainage (PTBD). The subjects were ten patients with extrahepatic bile duct cancer, two with pancreatic cancer, one with cancer of the gallbladder, and one with cancer of the papilla of Vater who underwent preoperative IDUS. From these patients, 50 IDUS slices were examined with a congruent relationship with the histologic section of resected tissue. The maximum thickening, minimum thickening, maximum/minimum thickening ratio, and form factor of the medial and lateral margins of the medial hypoechoic layer were determined using diagnostic imaging, and the results were compared at sites of cancer spread and non-spread. Twelve slices were obtained from the site of stenosis, 14 from sites of cancer spread, and 24 from non-spread sites. The maximum thickening, minimum thickening, and maximum/minimum thickening ratio differed significantly between the sites of spread and the non-spread. The absolute values for wall thickening are useful for diagnosing the presence of intramural spread in patients with malignant biliary duct stenosis. PMID:18493560

  3. Treatment of Lumbar Intervertebral Disc Herniation Using C-Arm Fluoroscopy Guided Target Percutaneous Laser Disc Decompression

    PubMed Central

    Zhao, Xu-Li; Xu, Yong-Guang; Zhao, Xue-Jun; Song, Wen-Ge; Zheng, Hong

    2012-01-01

    Abstract Objective: To evaluate the safety and therapeutic efficacy of target percutaneous laser disc decompression (T-PLDD) for the treatment of lumbar disc herniation. Background data: PLDD using the Nd:YAG laser has been regarded as an effective alternative treatment for disc herniation. However, all the previous studies were concentrated on vaporizing the nucleus pulposus in the intervertebral space. We hypothesize that insertion of the needle into the extruded part of the nucleus pulposus will decrease its volume and provide superior clinical effects compared to therapies that decrease the volume of the intradiscal nucleus pulposus. Materials and methods: A total of 25 patients suffering from posterolateral extruded but nonsequestered lumbar intervertebral disc herniation were treated with T-PLDD. After treatment, the patients were followed up and the therapeutic effect was assessed at 1, 3, 6, and 12 months using the modified MacNab criteria. Results: The success rate was 80.0% (18 of 25), 88.0% (22 of 25), 92.0% (23 of 25), and 92.0% (23 of 25) at 1, 3, 6, and 12 months respectively. No serious complications occurred in any of the patients. Furthermore, we did not observe any neurological sequelae. Conclusions: T-PLDD can significantly decrease pain and improve function of patients who have extruded but nonsequestered lumbar intervertebral disc herniation. PMID:22150064

  4. Computed Tomography Guided Percutaneous Injection of a Mixture of Lipiodol and Methylene Blue in Rabbit Lungs: Evaluation of Localization Ability for Video-Assisted Thoracoscopic Surgery

    PubMed Central

    Jin, Kwang Nam; Kim, Tae Jung; Song, Yong Sub; Kim, Dong Il

    2014-01-01

    Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue. PMID:24431917

  5. Fractional flow reserve-guided percutaneous coronary intervention for an intermediate stenosis complicated by a coronary-to-pulmonary artery fistula.

    PubMed

    Ito, Tsuyoshi; Murai, Shunsuke; Fujita, Hiroshi; Tani, Tomomitsu; Ohte, Nobuyuki

    2016-05-01

    A 65-year-old man was referred to our hospital following repetitive chest pain. Invasive coronary angiography showed an intermediate stenosis of the proximal left anterior descending artery (LAD), and a coronary fistula originating distal to the stenosis draining into the main pulmonary artery. To evaluate the functional abnormality arising from the stenosis and coronary steal due to the fistula, fractional flow reserve (FFR) was measured using a pressure wire with pullback recording. The FFR value was 0.74 at the distal LAD, 0.78 distal to the fistula, 0.81 proximal to the fistula (distal to the stenosis), and abruptly increased to 1.0 proximal to the stenosis. Based on these FFR results, percutaneous coronary intervention was performed to the stenosis. After stent placement, the FFR value improved to 0.87 at the distal LAD, and no abrupt pressure gradient was observed beyond the fistula and the stent. FFR-guided intervention with pullback pressure recording could be a useful and practical method to apply in cases with coronary stenosis complicated by coronary fistula in the same vessel. PMID:25643760

  6. Long-term outcomes of intravascular ultrasound-guided implantation of bare metal stents versus drug-eluting stents in primary percutaneous coronary intervention

    PubMed Central

    Cho, Yun-Kyeong; Park, Nam-Hee; Choi, Sang-Woong; Sohn, Ji-Hyun; Cho, Hyun-Ok; Park, Hyoung-Seob; Yoon, Hyuck-Jun; Kim, Hyungseop; Nam, Chang-Wook; Kim, Yoon-Nyun; Kim, Kwon-Bae

    2014-01-01

    Background/Aims While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI. Methods In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated. Results There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE. Conclusions In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups. PMID:24574835

  7. Minimally Invasive Spinal Stabilization Using Fluoroscopic-Guided Percutaneous Screws as a Form of Palliative Surgery in Patients with Spinal Metastasis

    PubMed Central

    Kwan, Mun Keong; Chan, Chris Yin Wei

    2016-01-01

    Study Design Prospective cohort study. Purpose To report the outcome of 50 patients with spinal metastases treated with minimally invasive stabilization (MISt) using fluoroscopic guided percutaneous pedicle screws with/without minimally invasive decompression. Overview of Literature The advent of minimally invasive percutaneous pedicle screw stabilization system has revolutionized the treatment of spinal metastasis. Methods Between 2008 and 2013, 50 cases of spinal metastasis with pathological fracture(s) with/without neurology deficit were treated by MISt at our institution. The patients were assessed by Tomita score, pain score, operation time, blood loss, neurological recovery, time to ambulation and survival. Results The mean Tomita score was 6.3±2.4. Thirty seven patients (74.0%) required minimally invasive decompression in addition to MISt. The mean operating time was 2.3±0.5 hours for MISt alone and 3.4±1.2 hours for MISt with decompression. Mean blood loss for MISt alone and MISt with decompression was 0.4±0.2 L and 1.7±0.9 L, respectively. MISt provided a statistically significant reduction in visual analog scale pain score with mean preoperative score of 7.9±1.4 that was significantly decreased to 2.5±1.2 postoperatively (p=0.000). For patients with neurological deficit, 70% displayed improvement of one Frankel grade and 5% had an improvement of 2 Frankel grades. No patient was bed-ridden postoperatively, with the average time to ambulation of 3.4±1.8 days. The mean overall survival time was 11.3 months (range, 2–51 months). Those with a Tomita score <8 survived significantly longer than those a Tomita score ≥8 with a mean survival of 14.1±12.5 months and 6.8±4.9 months, respectively (p=0.019). There were no surgical complications, except one case of implant failure. Conclusions MISt is an acceptable treatment option for spinal metastatic patients, providing good relief of instability back pain with no major complications. PMID:26949465

  8. Quantitative Discomanometry: Correlation of Intradiscal Pressure Values to Pain Reduction in Patients With Intervertebral Disc Herniation Treated With Percutaneous, Minimally Invasive, Image-Guided Techniques

    SciTech Connect

    Filippiadis, Dimitrios K. Mazioti, A. Papakonstantinou, O. Brountzos, E.; Gouliamos, A.; Kelekis, N. Kelekis, A.

    2012-10-15

    Purpose: To illustrate quantitative discomanometry's (QD) diagnostic efficacy and predictive value in discogenic-pain evaluation in a prospective study correlating intradiscal pressure values with pain reduction after percutaneous image-guided technique (i.e., percutaneous decompression, PD). Materials and Methods: During the last 3 years, 36 patients [21 male and 15 female (mean age 36 {+-} 5.8 years)] with intervertebral disc hernia underwent QD before PD. Under absolute sterilization and fluoroscopy, a mixture of contrast medium and normal saline (3:1 ratio) was injected. A discmonitor performed a constant rate injection and recorded pressure and volume values, thus producing the relative pressure-volume curve. PD was then performed. Pain reduction and improved mobility were recorded at 3, 12, and 24 months after PD using clinical evaluation and a numeric visual scale (NVS; 0 to 10 units). Results: Mean pain values of 7.5 {+-} 1.9 (range 4 to 8) NVS units were recorded before PD; these decreased to 2.9 {+-} 2.44 at 3 months, 1.0 {+-} 1.9 at 12 months, and 1.0 {+-} 1.9 NVS units at 24 months after PD. Recorded correlations (pressure, volume, significant pain-reduction values) with bilateral statistical significance included a maximum injected volume of 2.4 ml (p = 0.045), P{sub o} < 14 psi [initial pressure required to inject 0.1 ml of the mixture inside the disc (p = 0.05)], P{sub max} {<=} 65 psi [greatest pressure value on the curve (p = 0.018)], and P{sub max} - P{sub o} {<=} 47 psi (p = 0.038). Patients meeting these pressure or volume cut-off points, either independently or as a total, had significant pain reduction (>4 NVS units) after PD. No complications were noted. Conclusions: QD is an efficient technique that may have predictive value for discogenic pain evaluation. It might serve as a useful tool for patient selection for intervertebral disc therapies.

  9. Effectiveness of Computed Tomography Guided Percutaneous Radiofrequency Ablation Therapy for Osteoid Osteoma: Initial Results and Review of the Literature

    PubMed Central

    Karagöz, Erdal; Özel, Deniz; Özkan, Fuat; Özel, Betül Duran; Özer, Özgur; Coşkun, Zafer Ünsal

    2016-01-01

    Summary Background The aim of this retrospective study is to determine our experience of technique success rate, complications and clinical results in long term follow up for computed tomography (CT)-guided radiofrequency ablation [RA] therapy for osteoid osteoma (OO). Material/Methods We performed RA therapy to 18 patients with OO referred to interventional radiology from other clinics primarily from orthopedics; between January 2011 to May 2014. Daytime and nighttime pain intensity of 18 patients was noted according to visual analog scale (VAS). After procedure pain intensity was compared with before one. We also discussed other factors can affect it. Results All procedures were completed technically successful for all patients [100%]. We did not experience any major complication or mortality. However we had 3 minor complications. Pain came back in 1 patient after 5 months from procedure and it was considered as recurrence. Dramatic pain intensity fall was seen in patients after procedure, both daytime and nighttime. However we did not find and statistically significant change in comparison of pain intensity reduce and time needed to return back to routine life when using patients demographic data and lesion size. Conclusions CT guided RA therapy of OO is minimally invasive, effective and secure procedure. PMID:27429671

  10. Percutaneous Sacroiliac Screw Technique.

    PubMed

    Tidwell, John; Cho, Rosa; Reid, J Spence; Boateng, Henry; Copeland, Carol; Sirlin, Edward

    2016-08-01

    Remembering that preoperative planning, surgical indications, and fracture reduction are paramount for this procedure, presented here is our technique for performing percutaneous sacroiliac screws, both transiliac-transsacral and sacral style. A combination of video, still pictures, and fluoroscopy images will guide the viewer through the process we routinely use highlighting specific details. Patient positioning and intraoperative fluoroscopy imaging are critical to a successful procedure. Although inlet and outlet films remain important, we find the procedure best started on the lateral sacral view to reduce the need for start site, trajectory, and imaging position changes during the case. A cannulated pig sticker (drill guide) used with long drill tip guide wires provide improved manual control to both finding a good start site and directing the trajectory. For patient safety, sacral anatomy and safe zones are discussed as well. Using these technical points will help make this a successful procedure. PMID:27441927

  11. Vertebroplasty reduces progressive ׳creep' deformity of fractured vertebrae.

    PubMed

    Luo, J; Pollintine, P; Annesley-Williams, D J; Dolan, P; Adams, M A

    2016-04-11

    Elderly vertebrae frequently develop an "anterior wedge" deformity as a result of fracture and creep mechanisms. Injecting cement into a damaged vertebral body (vertebroplasty) is known to help restore its shape and stiffness. We now hypothesise that vertebroplasty is also effective in reducing subsequent creep deformations. Twenty-eight spine specimens, comprising three complete vertebrae and the intervening discs, were obtained from cadavers aged 67-92 years. Each specimen was subjected to increasingly-severe compressive loading until one of its vertebrae was fractured, and the damaged vertebral body was then treated by vertebroplasty. Before and after fracture, and again after vertebroplasty, each specimen was subjected to a static compressive force of 1kN for 1h while elastic and creep deformations were measured in the anterior, middle and posterior regions of each adjacent vertebral body cortex, using a 2D MacReflex optical tracking system. After fracture, creep in the anterior and central regions of the vertebral body cortex increased from an average 4513 and 885 microstrains, respectively, to 54,107 and 34,378 microstrains (both increases: P<0.001). Elastic strains increased by a comparable amount. Vertebroplasty reduced creep in the anterior and central cortex by 61% (P=0.006) and 66% (P=0.017) respectively. Elastic strains were reduced by less than half this amount. Results suggest that the beneficial effects of vertebroplasty on the vertebral body continue long after the post-operative radiographs. Injected cement not only helps to restore vertebral shape and elastic properties, but also reduces subsequent creep deformation of the damaged vertebra. PMID:26459490

  12. Sensitivity analysis of textural parameters for vertebroplasty

    NASA Astrophysics Data System (ADS)

    Tack, Gye Rae; Lee, Seung Y.; Shin, Kyu-Chul; Lee, Sung J.

    2002-05-01

    Vertebroplasty is one of the newest surgical approaches for the treatment of the osteoporotic spine. Recent studies have shown that it is a minimally invasive, safe, promising procedure for patients with osteoporotic fractures while providing structural reinforcement of the osteoporotic vertebrae as well as immediate pain relief. However, treatment failures due to excessive bone cement injection have been reported as one of complications. It is believed that control of bone cement volume seems to be one of the most critical factors in preventing complications. We believed that an optimal bone cement volume could be assessed based on CT data of a patient. Gray-level run length analysis was used to extract textural information of the trabecular. At initial stage of the project, four indices were used to represent the textural information: mean width of intertrabecular space, mean width of trabecular, area of intertrabecular space, and area of trabecular. Finally, the area of intertrabecular space was selected as a parameter to estimate an optimal bone cement volume and it was found that there was a strong linear relationship between these 2 variables (correlation coefficient = 0.9433, standard deviation = 0.0246). In this study, we examined several factors affecting overall procedures. The threshold level, the radius of rolling ball and the size of region of interest were selected for the sensitivity analysis. As the level of threshold varied with 9, 10, and 11, the correlation coefficient varied from 0.9123 to 0.9534. As the radius of rolling ball varied with 45, 50, and 55, the correlation coefficient varied from 0.9265 to 0.9730. As the size of region of interest varied with 58 x 58, 64 x 64, and 70 x 70, the correlation coefficient varied from 0.9685 to 0.9468. Finally, we found that strong correlation between actual bone cement volume (Y) and the area (X) of the intertrabecular space calculated from the binary image and the linear equation Y = 0.001722 X - 2

  13. Treatment of liver cancer of middle and advanced stages using ultrasound-guided percutaneous ethanol injection combined with radiofrequency ablation: A clinical analysis

    PubMed Central

    SUN, XUE; LI, RU; ZHANG, BOTAO; YANG, YUEJIE; CUI, ZHIFEI

    2016-01-01

    Liver cancer is a malignancy of the digestive system and has a high morbidity and mortality rate. Local intervention has become a viable option in identifying liver treatment. The aim of the present study was to analyze the clinical effects of treating liver cancer in middle and advanced stages using ultrasound-guided percutaneous ethanol injection (PEI) in tumors combined with radiofrequency ablation (RFA). A total of 100 patients with stage III–IV liver cancers were selected to participate in the study. Patients were divided into groups. In group A, treatment was initiated with PEI and after 1–2 weeks RFA was applied while in group B treatment was initiated with RFA and after 1–2 weeks PEI was applied. Patients in group C received PEI and RFA simultaneously. The clinical effects in the 3 groups were compared after 6-month follow ups. The volume of tumor ablation necrosis in group A was significantly greater than that in the groups B and C, while the size was significantly smaller compared to groups B and C after ablation. For group A, the complete ablation rate was significantly higher than that in groups B and C, and the differences were statistically significant (P<0.05). Liver damage indices, including raising levels of glutamic-pyruvic transaminase and total bilirubin, were significantly decreased in group A (P<0.05). The survival rate in group A was also significantly higher than in groups B and C (P<0.05). In conclusion, for patients with liver cancer in middle and advanced stages, the treatment method using PEI followed by RFA was more beneficial in terms of improving the tumor ablation rate, alleviating liver damages and increasing survival rates. PMID:26998128

  14. Graphics processing unit-accelerated non-rigid registration of MR images to CT images during CT-guided percutaneous liver tumor ablations

    PubMed Central

    Tokuda, Junichi; Plishker, William; Torabi, Meysam; Olubiyi, Olutayo I; Zaki, George; Tatli, Servet; Silverman, Stuart G.; Shekhar, Raj; Hata, Nobuhiko

    2015-01-01

    Rationale and Objectives Accuracy and speed are essential for the intraprocedural nonrigid MR-to-CT image registration in the assessment of tumor margins during CT-guided liver tumor ablations. While both accuracy and speed can be improved by limiting the registration to a region of interest (ROI), manual contouring of the ROI prolongs the registration process substantially. To achieve accurate and fast registration without the use of an ROI, we combined a nonrigid registration technique based on volume subdivision with hardware acceleration using a graphical processing unit (GPU). We compared the registration accuracy and processing time of GPU-accelerated volume subdivision-based nonrigid registration technique to the conventional nonrigid B-spline registration technique. Materials and Methods Fourteen image data sets of preprocedural MR and intraprocedural CT images for percutaneous CT-guided liver tumor ablations were obtained. Each set of images was registered using the GPU-accelerated volume subdivision technique and the B-spline technique. Manual contouring of ROI was used only for the B-spline technique. Registration accuracies (Dice Similarity Coefficient (DSC) and 95% Hausdorff Distance (HD)), and total processing time including contouring of ROIs and computation were compared using a paired Student’s t-test. Results Accuracy of the GPU-accelerated registrations and B-spline registrations, respectively were 88.3 ± 3.7% vs 89.3 ± 4.9% (p = 0.41) for DSC and 13.1 ± 5.2 mm vs 11.4 ± 6.3 mm (p = 0.15) for HD. Total processing time of the GPU-accelerated registration and B-spline registration techniques was 88 ± 14 s vs 557 ± 116 s (p < 0.000000002), respectively; there was no significant difference in computation time despite the difference in the complexity of the algorithms (p = 0.71). Conclusion The GPU-accelerated volume subdivision technique was as accurate as the B-spline technique and required significantly less processing time. The GPU

  15. Computed tomography fluoroscopy-guided percutaneous 125I seed implantation for safe, effective and real-time monitoring radiotherapy of inoperable stage T1-3N0M0 non-small-cell lung cancer

    PubMed Central

    LI, JIAKAI; YU, MIAO; XIAO, YUEYONG; YANG, LI; ZHANG, JINSHAN; RAY, ERIK; YANG, XIAOMING

    2013-01-01

    The management of inoperable lung cancer remains a challenge. It has been proven that computed tomography (CT)-guided iodine-125 (125I) seed implantation is a safe and efficient method for treating lung cancer. Computed tomographic fluoroscopy (CTF) is superior to traditional CT for percutaneous management of lung lesions, due to the real-time guidance and accurate localization of the lesions. The aim of the present prospective study was to evaluate the feasibility, safety and efficacy of CTF-guided percutaneous permanent implantation of 125I seeds for the treatment of selected patients with inoperable stage T1-3N0M0 non-small-cell lung cancer (NSCLC). A total of 24 patients with resectable but inoperable stage T1-3N0 NSCLC, with a total of 28 lesions, underwent CTF-guided percutaneous implantation of radioactive 125I seeds. A prescription dose of 100–120 Gy was delivered to each lesion. The complications and local tumor control rates were documented. Survival was estimated using the Kaplan-Meier method. All the patients successfully completed the procedure, with a mean procedure duration of 45.7 min (range, 30–75 min). No severe complications occurred. Small asymptomatic pneumothorax with lung volume compression of <10% and minor hemorrhage along the needle track without hemoptysis occurred immediately after the procedure in 3 (12.5%) and 4 (16.7%) of the 24 patients, respectively. At a median follow-up of 31.5 months (range, 8–46 months), the local control rate (LCR) of the lesions was 78.6% (22/28). The 1-, 2- and 3-year overall survival rate was 95.8, 78 and 55%, respectively. In conclusion, CTF is the favourable imaging guidance method for the percutaneous implantation of 125I seeds. CTF-guided brachytherapy with implantation of 125I seeds is a safe, feasible and effective modality for the treatment of inoperable early-stage NSCLC and may be considered an alternative option in selected patients with medically inoperable NSCLC. PMID:24649287

  16. Percutaneous connectors

    NASA Technical Reports Server (NTRS)

    Picha, G. J.; Taylor, S. R.

    1981-01-01

    A surface possessing a regular array of micro-pillars was evaluated with regard to its ability to control epithelial downgrowth at the percutaneous interface. A range of pillar sizes were applied to the vertical segment of T shaped Biomer (R) implants. These percutaneous tabs were implanted into the dorsum of cats for a period of 6 weeks using a standardized surgical technique. Comments were made post-operatively and at the time of retrieval. A quantitative scoring system was applied to these observations as well as histological results. As observed, the pillar morphology used displayed the ability to control epithelial downgrowth. Collagen ingrowth into the interpillar spaces and possibly direct interactions of the epithelial cells with the morphology may account for the inhibition. The reproducibility of epithelial inhibition is, however, limited by other factors which are currently not well understood. These factors and potential methods of assessment are discussed.

  17. Vertebroplasty: Patient and treatment variations studied through parametric computational models☆

    PubMed Central

    Wijayathunga, Vithanage N.; Oakland, Robert J.; Jones, Alison C.; Hall, Richard M.; Wilcox, Ruth K.

    2013-01-01

    Background Vertebroplasty is increasingly used in the treatment of vertebral compression fractures. However there are concerns that this intervention may lead to further fractures in the adjacent vertebral segments. This study was designed to parametrically assess the influence of both treatment factors (cement volume and number of augmentations), and patient factors (bone and disc quality) on the biomechanical effects of vertebroplasty. Methods Specimen-specific finite element models of two experimentally-tested human three-vertebral-segments were developed from CT-scan data. Cement augmentation at one and two levels was represented in the respective models and good agreement in the predicted stiffness was found compared to the corresponding experimental specimens. Parametric variations of key variables associated with the procedure were then studied. Findings The segmental stiffness increased with disc degeneration, with increasing bone quality and to a lesser extent with increasing cement volume. Cement modulus did not have a great influence on the overall segmental stiffness and on the change in the elemental stress in the adjoining vertebrae. However, following augmentation, the stress distribution in the adjacent vertebra changed, indicating possible load redistribution effects of vertebroplasty. Interpretation This study demonstrates the importance of patient factors in the outcomes of vertebroplasty and suggests that these may be one reason for the variation in clinical results. PMID:23953004

  18. Acute right atrial and pulmonary artery bone cement mass emboli following vertebroplasty

    PubMed Central

    Diab, Amr; Dihmis, Walid; Diab, Samir

    2016-01-01

    Cardiac and pulmonary artery emboli are lethal complications following vertebroplasty. Clinicians should recognise these fatal complications immediately and surgical extraction is mandatory and provides the best outcome.

  19. Innovation in image-guided spine intervention.

    PubMed

    Murphy, Kieran J

    2011-04-01

    Image-guided spine intervention continues to evolve and is still an intellectually active field. But it is important not to confuse market and commercial success with intellectual, medical, or long-term success. What drives this evolution and innovation, and where is the activity currently? The history of vertebroplasty is a good case in point. PMID:21500137

  20. Specimen-Specific Nonlinear Finite Element Modeling to Predict Vertebrae Fracture Loads after Vertebroplasty

    PubMed Central

    Matsuura, Y.; Giambini, H.; Ogawa, Y.; Fang, Z.; Thoreson, A.R.; Yaszemski, M.J.; Lu, L.; An, K.N.

    2014-01-01

    Study Design Vertebral fracture load and stiffness from a metastatic vertebral defect model were predicted using nonlinear finite element models (FEM) and validated experimentally. Objective The study objective was to develop and validate an FEM-based tool for predicting polymer-augmented lytic vertebral fracture load and stiffness and the influence of metastatic filling materials. Summary of Background Data Percutaneous vertebroplasty has the potential to reduce vertebral fracture risk affected with lytic metastases by providing mechanical stabilization. However, it has been shown that the mismatch in mechanical properties between poly(methyl-methacrylate) (PMMA) and bone induces secondary fractures and intervertebral disc degeneration. A biodegradable co-polymer, poly(propylene fumarate-co-caprolactone) [P(PF-co-CL)], has been shown to possess the appropriate mechanical properties for bone defect repair. Methods Simulated metastatic lytic defects were created in 40 cadaveric vertebral bodies, which were randomized into four groups: intact vertebral body (Intact), simulated defect without treatment (Negative), defect treated with P(PF-co-CL) (Co-polymer), and defect treated with PMMA (PMMA). Spines were imaged with quantitative computerized tomography (QCT), and QCT/FEM-subject-specific, non-linear models were created. Predicted fracture loads and stiffness were identified and compared to experimentally measured values using Pearson’s correlation analysis and paired t-test. Results There was no significant difference between the measured and predicted fracture loads and stiffness for each group. Predicted fracture loads were larger for PMMA-augmentation (3960 N (1371 N)) compared to that of the co-polymer, negative and intact groups (3484 N (1497 N), 3237 N (1744 N) and 1747 N (702 N)). A similar trend was observed in the predicted stiffness. Moreover, predicted and experimental fracture loads were strongly correlated (R2 = 0.78), while stiffness showed moderate

  1. Percutaneous feeding tube method for use in children.

    PubMed

    Long, B; Rafert, J; Cory, D

    1991-01-01

    Surgical gastrostomy has been a widely accepted method for introducing a percutaneous feeding tube for many years. However, complications are frequent, and many children who need them are not good surgical candidates. This study examines imaging guided percutaneous placement of feeding gastrostomy catheters as a safe and effective alternative to surgery. PMID:1902957

  2. Image-guided Spine Stabilization for Traumatic or Osteoporotic Spine Injury: Radiological Accuracy and Neurological Outcome

    PubMed Central

    SHIMOKAWA, Nobuyuki; ABE, Junya; SATOH, Hidetoshi; ARIMA, Hironori; TAKAMI, Toshihiro

    2016-01-01

    Significant progress has been made in image-guided surgery (IGS) over the last few decades. IGS can be effectively applied to spinal instrumentation surgery. In the present study, we focused our attention on the feasibility and safety of image-guided spine stabilization for traumatic or osteoporotic spine injury. The IGS spine fixation with or without minimally invasive surgery (MIS) techniques such as percutaneous screw placement, balloon kyphoplasty (BKP), or vertebroplasty (VP) were accomplished in 80 patients with traumatic or osteoprotic spine injury between 2007 and 2015. The injured vertebral levels included the following: cervical spine, 41; thoracic spine, 22; and lumbar spine, 17. Neurological condition before and after surgery was assessed using the American Spinal Injury Association Impairment Scale (AIS). A total of 419 pedicle, lateral mass, or laminar screws were placed, and 399 screws (95.2%) were found to be placed correctly based on postoperative computed tomography scan. Although 20 screws (4.8%) were found to be unexpectedly placed incorrectly, no neural or vascular complications closely associated with screw placement were encountered. Neurological outcomes appeared to be acceptable or successful based on AIS. The IGS is a promising technique that can improve the accuracy of screw placement and reduce potential injury to critical neurovascular structures. The integration of MIS and IGS has proved feasible and safe in the treatment of traumatic or osteoporotic spine injury, although a thorough knowledge of surgical anatomy, spine biomechanics, and basic technique remain the most essential aspects for a successful surgery. PMID:27063144

  3. Image-guided Spine Stabilization for Traumatic Or Osteoporotic Spine Injury: Radiological Accuracy and Neurological Outcome.

    PubMed

    Shimokawa, Nobuyuki; Abe, Junya; Satoh, Hidetoshi; Arima, Hironori; Takami, Toshihiro

    2016-08-15

    Significant progress has been made in image-guided surgery (IGS) over the last few decades. IGS can be effectively applied to spinal instrumentation surgery. In the present study, we focused our attention on the feasibility and safety of image-guided spine stabilization for traumatic or osteoporotic spine injury. The IGS spine fixation with or without minimally invasive surgery (MIS) techniques such as percutaneous screw placement, balloon kyphoplasty (BKP), or vertebroplasty (VP) were accomplished in 80 patients with traumatic or osteoprotic spine injury between 2007 and 2015. The injured vertebral levels included the following: cervical spine, 41; thoracic spine, 22; and lumbar spine, 17. Neurological condition before and after surgery was assessed using the American Spinal Injury Association Impairment Scale (AIS). A total of 419 pedicle, lateral mass, or laminar screws were placed, and 399 screws (95.2%) were found to be placed correctly based on postoperative computed tomography scan. Although 20 screws (4.8%) were found to be unexpectedly placed incorrectly, no neural or vascular complications closely associated with screw placement were encountered. Neurological outcomes appeared to be acceptable or successful based on AIS. The IGS is a promising technique that can improve the accuracy of screw placement and reduce potential injury to critical neurovascular structures. The integration of MIS and IGS has proved feasible and safe in the treatment of traumatic or osteoporotic spine injury, although a thorough knowledge of surgical anatomy, spine biomechanics, and basic technique remain the most essential aspects for a successful surgery. PMID:27063144

  4. Percutaneous Cyanoacrylate Glue Injection into the Renal Pseudoaneurysm to Control Intractable Hematuria After Percutaneous Nephrolithotomy

    SciTech Connect

    Lal, Anupam Kumar, Ajay; Prakash, Mahesh; Singhal, Manphool; Agarwal, Mayank Mohan; Sarkar, Debansu; Khandelwal, Niranjan

    2009-07-15

    We report a case of a 43-year-old man who developed intractable hematuria after percutaneous nephrolithotomy. Angiography detected a pseudoaneurysm arising from the lower polar artery; however, embolization could not be performed because of unfavorable vascular anatomy. A percutaneous thrombin injection under ultrasound guidance initially controlled the bleeding, but hematuria subsequently recurred as a result of recanalization of the aneurysm. The case was successfully managed with ultrasound- and fluoroscopic-guided direct injection of cyanoacrylate glue into the pseudoaneurysm.

  5. Mitral paravalvular leak closure by antegrade percutaneous approach: three-dimensional transesophageal echocardiographic guided multiple Amplatzer implantation by a modified sequential anchoring-based technique.

    PubMed

    Tarantini, Giuseppe; Mojoli, Marco; Napodano, Massimo

    2013-10-01

    We describe the technical aspects and the possible advantages of a modified anchoring-based technique for the implantation of multiple Amplatzer devices, in a case of large anteroseptal mitral paravalvular leak causing massive regurgitation, which was manaed by antegrade transseptal, single-stage, percutaneous approach. Real-time three-dimensional transesophageal echocardiographic guidance was crucial to ensure successful recrossings of the target defect and the optimal anatomical closure. PMID:23613380

  6. Transjugular Intrahepatic Portosystemic Shunt Creation in Budd-Chiari Syndrome: Percutaneous Ultrasound-Guided Direct Simultaneous Puncture of the Portal Vein and Vena Cava

    SciTech Connect

    Boyvat, Fatih Aytekin, Cueneyt; Harman, Ali; Ozin, Yasemin

    2006-10-15

    Budd-Chiari syndrome (BCS) is an uncommon disorder that can be life-threatening, depending on the degree of hepatic venous outflow obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) provides decompression of the congested liver but the hepatic vein obstruction makes the procedure more difficult. We describe a modified method that involved a single percutaneous puncture of the portal vein and inferior vena cava simultaneously for TIPS creation in a patient with BCS.

  7. Safety and Efficacy Studies of Vertebroplasty, Kyphoplasty, and Mesh-Container-Plasty for the Treatment of Vertebral Compression Fractures: Preliminary Report.

    PubMed

    Chen, Chen; Li, Donghua; Wang, Zhiguo; Li, Tong; Liu, Xunwei; Zhong, Jian

    2016-01-01

    To evaluate the clinical safety and efficacies of percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP), and percutaneous mesh-container-plasty (PMCP) for the treatment of vertebral compression fractures (VCFs), a retrospective study of 90 patients with VCFs who had been treated by PVP (n = 30), PKP (n = 30), and PMCP (n = 30) was conducted. The clinical efficacies of these three treatments were evaluated by comparing their PMMA cement leakages, cement patterns, height restoration percentages, wedge angles, visual analogue scales (VAS), and oswestry disability index (ODI) at the pre- and post-operative time points. 6.67%, 3.33%, and 0% of patients had PMMA leakage in PVP, PKP, and PMCP groups, respectively. Three (solid, trabecular, and mixed patterns), two (solid and mixed patterns), and one (mixed patterns) types of cement patterns were observed in PVP, PKP, and PMCP groups, respectively. PKP and PMCP treatments had better height restoration ability than PVP treatment. PVP, PKP, and PMCP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of VCFs. These results indicate minimally invasive techniques were effective methods for the treatment of VCFs. Moreover, these initial outcomes suggest PMCP treatment may be better than both PVP treatment and PKP treatment. PMID:26963808

  8. Safety and Efficacy Studies of Vertebroplasty, Kyphoplasty, and Mesh-Container-Plasty for the Treatment of Vertebral Compression Fractures: Preliminary Report

    PubMed Central

    Chen, Chen; Li, Donghua; Wang, Zhiguo; Li, Tong; Liu, Xunwei; Zhong, Jian

    2016-01-01

    To evaluate the clinical safety and efficacies of percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP), and percutaneous mesh-container-plasty (PMCP) for the treatment of vertebral compression fractures (VCFs), a retrospective study of 90 patients with VCFs who had been treated by PVP (n = 30), PKP (n = 30), and PMCP (n = 30) was conducted. The clinical efficacies of these three treatments were evaluated by comparing their PMMA cement leakages, cement patterns, height restoration percentages, wedge angles, visual analogue scales (VAS), and oswestry disability index (ODI) at the pre- and post-operative time points. 6.67%, 3.33%, and 0% of patients had PMMA leakage in PVP, PKP, and PMCP groups, respectively. Three (solid, trabecular, and mixed patterns), two (solid and mixed patterns), and one (mixed patterns) types of cement patterns were observed in PVP, PKP, and PMCP groups, respectively. PKP and PMCP treatments had better height restoration ability than PVP treatment. PVP, PKP, and PMCP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of VCFs. These results indicate minimally invasive techniques were effective methods for the treatment of VCFs. Moreover, these initial outcomes suggest PMCP treatment may be better than both PVP treatment and PKP treatment. PMID:26963808

  9. Clinical Outcome and Safety of Multilevel Vertebroplasty: Clinical Experience and Results

    SciTech Connect

    Mailli, Leto Filippiadis, Dimitrios K.; Brountzos, Elias N.; Alexopoulou, Efthymia; Kelekis, Nikolaos; Kelekis, Alexios

    2013-02-15

    To compare safety and efficacy of percutaneous vertebroplasty (PVP) when treating up to three vertebrae or more than three vertebrae per session. We prospectively compared two groups of patients with symptomatic vertebral fractures who had no significant response to conservative therapy. Pathologic substrate included osteoporosis (n = 77), metastasis (n = 24), multiple myeloma (n = 13), hemangioma (n = 15), and lymphoma (n = 1). Group A patients (n = 94) underwent PVP of up to three treated vertebrae (n = 188). Group B patients (n = 36) underwent PVP with more than three treated vertebrae per session (n = 220). Decreased pain and improved mobility were recorded the day after surgery and at 12 and 24 months after surgery per clinical evaluation and the use of numeric visual scales (NVS): the Greek Brief Pain Inventory, a linear analogue self-assessment questionnaire, and a World Health Organization questionnaire. Group A presented with a mean pain score of 7.9 {+-} 1.1 NVS units before PVP, which decreased to 2.1 {+-} 1.6, 2.0 {+-} 1.5 and 2.0 {+-} 1.5 NVS units the day after surgery and at 12 and 24 months after surgery, respectively. Group B presented with a mean pain score of 8.1 {+-} 1.3 NVS units before PVP, which decreased to 2.2 {+-} 1.3, 2.0 {+-} 1.5, and 2.1 {+-} 1.6 NVS units the day after surgery and at 12 and 24 months after surgery, respectively. Overall pain decrease and mobility improvement throughout the follow-up period presented no statistical significance neither between the two groups nor between different underlying aetiology. Reported cement leakages presented no statistical significance between the two groups (p = 0.365). PVP is an efficient and safe technique for symptomatic vertebral fractures independently of the vertebrae number treated per session.

  10. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class...