RESUMEN
PURPOSE: Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS. METHODS: Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up. RESULTS: The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482-0.977] at 6 months and 72.7 % (95 % CI 0.390-0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587-0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156-2,282). CONCLUSION: The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.
Asunto(s)
Angioplastia de Balón/métodos , Derivación Arteriovenosa Quirúrgica/efectos adversos , Oclusión de Injerto Vascular/terapia , Diálisis Renal/efectos adversos , Stents , Adulto , Anciano , Angioplastia de Balón/instrumentación , Estudios de Cohortes , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/etiología , Supervivencia de Injerto , Humanos , Venas Yugulares/diagnóstico por imagen , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Diseño de Prótesis , Radiografía , Diálisis Renal/métodos , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Grado de Desobstrucción Vascular/fisiologíaRESUMEN
INTRODUCTION: Retrievable plastic biliary stents are usually inserted endoscopically. When endoscopic placement fails, radiological percutaneous transhepatic placement is indicated. We report the occurrence of a case of delayed duodenal perforation with abscess formation after radiological placement of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting. CASE PRESENTATION: A 58-year-old Caucasian man had a mass 30 mm in size in the head of the pancreas and obstructive jaundice. He was referred for radiological insertion of plastic biliary stents after a failed endoscopic attempt. The procedure was uneventful, and the patient was discharged. Two weeks after the procedure, the patient presented with an acute abdomen and signs of sepsis. Computed tomography revealed erosion of the posterior duodenal wall from the plastic stent, and a large retroperitoneal abscess. The abscess was drained under computed tomography guidance, and the migrated stent was removed percutaneously with a snare under fluoroscopic guidance. Our patient had an uneventful recovery and was discharged after a week. CONCLUSION: Late retroperitoneal duodenal perforation is a very rare but severe complication of biliary stenting with plastic stents. Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management.
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OBJECTIVES: To evaluate the safety and efficacy of combined percutaneous, image-guided, radiofrequency (RF) ablation and ethanol injection of renal tumours, and to present our midterm results. METHODS: Since February 2002, 27 consecutive patients (22 men, 5 women; age range: 39-84 yr; mean: 69) with 28 renal tumours (mean diameter: 2.87cm) were treated with combined percutaneous RF and ethanol ablation, and were prospectively evaluated. Twenty-five patients were considered nonsurgical candidates because of comorbid conditions (16 patients) or had previous nephrectomy (9 patients), and 2 had refused surgery. Thirty-three ablation sessions were performed, with computed tomography (26 sessions), ultrasound (6), or combined magnetic resonance imaging/fluoroscopic guidance in 1. Absolute ethanol (0.5-3ml; mean: 1.7) was injected into the tumour immediately before treatment with radiofrequency. Mean follow-up period was 18.6 mo (range: 3-56). RESULTS: Twenty-seven of the 28 tumours were completely ablated with either one (21 tumours) or two treatment sessions (6 tumours). One patient with residual disease refused further treatment. Only three minor complications, including a subcapsular haematoma and two patients with loin pain, occurred; all three patients were treated conservatively. None of the complications was related to the ethanol injection. During the follow-up period, no evidence of local recurrence or metastatic disease was seen. Creatinine levels have not changed significantly in any of the patients following ablation. CONCLUSIONS: Combined use of percutaneous RF and ethanol ablation is a safe and effective alternative treatment for selective patients with renal tumours.