Tobias Waggershauser

Publications (11)20.05 Total impact

• Article: Interventional radiological procedures in impaired function of surgically implanted catheter-port systems

  Karin Anna Herrmann, Tobias Waggershauser, Volker Heinemann, Maximilian Reiser
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  ABSTRACT: Purpose: System-related complications in surgically implanted catheter-port systems (CPS) for intraarterial (i.a.) chemotherapy are well known. In most cases of complications, the treatment must be interrupted and the catheter-port system must be repaired surgically. We describe microinvasive interventional radiological procedures to correct some dysfunctions of CPS. Methods: Five patients with repetitive dysfunction of CPS were treated with interventional techniques. Two patients presented with perfusion impairment, one patient had a pseudoaneurysm of the hepatic artery, and two patients presented with catheter displacement. Radiological interventions included mechanical recanalization with a guidewire, vascular stenting, and correction of catheter dislocation with a gooseneck snare. Results: In all cases, correct function of the CPS was restored. No intervention-related complications occurred and surgery was avoided. Chemotherapy could be continued for a period of 4–10 months. Conclusion: For some system-related complications, minimally invasive radiological interventions can be used to restore the function of CPS for i.a. chemotherapy.
  CardioVascular and Interventional Radiology 04/2012; 24(1):31-36. · 2.09 Impact Factor
• Article: C-arm computed tomography compared with positron emission tomography/computed tomography for treatment planning before radioembolization.

  Christoph Becker, Tobias Waggershauser, Reinhold Tiling, Sabine Weckbach, Thorsten Johnson, Oliver Meissner, Klaus Klingenbeck-Regn, Maximilian Reiser, Ralf Thorsten Hoffmann
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  ABSTRACT: The purpose of this study was to determine whether rotational C-arm computed tomography (CT) allows visualization of liver metastases and adds relevant information for radioembolization (RE) treatment planning. Technetium angiography, together with C-arm CT, was performed in 47 patients to determine the feasibility for RE. C-arm CT images were compared with positron emission tomography (PET)/CT images for the detection of liver tumors. The images were also rated according one of the following three categories: (1) images that provide no additional information compared with DSA alone; (2) images that do provide additional information compared with DSA; and (2) images that had an impact on eligibility determination for and planning of the RE procedure. In all patients, 283 FDG-positive liver lesions were detected by PET. In venous contrast-phase CT, 221 (78.1%) and 15 (5.3%) of these lesions were either hypodense or hyperdense, respectively. In C-arm CT, 103 (36.4%) liver lesions were not detectable because they were outside of either the field of view or the contrast-enhanced liver segment. Another 25 (8.8%) and 98 (34.6%) of the liver lesions were either hyperdense or presented primarily as hypodense lesions with a rim enhancement, respectively. With PET/CT as the standard of reference, venous CT and C-arm CT failed to detect 47 (16.6%) and 57 (20.1%) of all liver lesions, respectively. For RE planning, C-arm CT provided no further information, provide some additional information, or had an impact on the procedure in 20 (42.5%), 15 (31.9%) and 12 (25.6%) of patients, respectively. We conclude that C-arm CT may add decisive information in patients scheduled for RE.
  CardioVascular and Interventional Radiology 06/2011; 34(3):550-6. · 2.09 Impact Factor
• Article: Arterio-venous malformations of the liver in hereditary hemorrhagic telangiectasia (Rendu–Osler–Weber disease) causing right heart failure—Successful treatment with transarterial coil embolization

  Sabine Weckbacha, Svetlana Lyadova, Tobias Waggershauser, Olaf Muehling Maximilan Reiser, Ralf-Thorsten Hoffmann
  European Journal of Radiology Extra. 05/2009; 70:e69-e73.
• Source

  Available from: Tobias F Jakobs

  Article: Chemoembolization combined with pravastatin improves survival in patients with hepatocellular carcinoma.

  Hannah Graf, Christoph Jüngst, Gundula Straub, Selin Dogan, Ralf-Thorsten Hoffmann, Tobias Jakobs, Maximilian Reiser, Tobias Waggershauser, Thomas Helmberger, Andreas Walter, Autar Walli, Dietrich Seidel, Burkhard Goke, Dieter Jüngst
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  ABSTRACT: Pravastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, has been shown to inhibit growth and to induce apoptosis in human hepatocellular carcinoma (HCC) cells. However, the potential benefit of pravastatin in HCC patients has still not been characterized, which prompted us to test the efficacy of pravastatin in patients with advanced HCC. We investigated prospectively a cohort of 183 HCC patients who had been selected for palliative treatment by transarterial chemoembolization (TACE). Fifty-two patients received TACE combined with pravastatin (20-40 mg/day) and 131 patients received chemoembolization alone. Six independent predictors of survival according to the Vienna survival model for HCC were equally distributed in both groups. During the observation period of up to 5 years, 31 (23.7%) out of 131 patients treated by TACE alone and 19 (36.5%) out of 52 patients treated by TACE and pravastatin survived. Median survival was significantly longer in HCC patients treated by TACE and pravastatin (20.9 months, 95% CI 15.5-26.3, p = 0.003) than in HCC patients treated by TACE alone (12.0 months, 95% CI 10.3-13.7). Combined treatment of chemoembolization and pravastatin improves survival of patients with advanced HCC in comparison to patients receiving chemoembolization alone.
  Digestion 10/2008; 78(1):34-8. · 2.05 Impact Factor
• Article: Liver resection or combined chemoembolization and radiofrequency ablation improve survival in patients with hepatocellular carcinoma.

  Thomas Helmberger, Selin Dogan, Gundula Straub, Angelika Schrader, Christoph Jüngst, Maximilian Reiser, Tobias Waggershauser, Tobias Jakobs, Ralf-Thorsten Hoffmann, Florian Löhe, Christian Graeb, Horst-Günter Rau, Rolf Schauer, Karl-Walter Jauch, Wolfgang H Caselmann, Burkhard Göke, Dieter Jüngst
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  ABSTRACT: To evaluate the long-term outcome of surgical and non-surgical local treatments of patients with hepatocellular carcinoma (HCC). We stratified a cohort of 278 HCC patients using six independent predictors of survival according to the Vienna survival model for HCC (VISUM-HCC). Prior to therapy, 224 HCC patients presented with VISUM stage 1 (median survival 18 months) while 29 patients were classified as VISUM stage 2 (median survival 4 months) and 25 patients as VISUM stage 3 (median survival 3 months). A highly significant (p < 0.001) improved survival time was observed in VISUM stage 1 patients treated with liver resection (n = 52; median survival 37 months) or chemoembolization (TACE) and subsequent radiofrequency ablation (RFA) (n = 44; median survival 45 months) as compared to patients receiving chemoembolization alone (n = 107; median survival 13 months) or patients treated by tamoxifen only (n = 21; median survival 6 months). Chemoembolization alone significantly (p < or = 0.004) improved survival time in VISUM stage 1-2 patients but not (p = 0.341) in VISUM stage 3 patients in comparison to those treated by tamoxifen. Both liver resection or combined chemoembolization and RFA improve markedly the survival of patients with HCC.
  Digestion 02/2007; 75(2-3):104-12. · 2.05 Impact Factor
• Article: Immediate endovascular treatment of an aortoiliac aneurysm ruptured into the inferior vena cava.

  Reinhard Kopp, Rolf Weidenhagen, Ralf Hoffmann, Tobias Waggershauser, Georgios Meimarakis, Joachim Andrassy, Dirk Clevert, Stephan Czerner, Karl-Walter Jauch
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  ABSTRACT: An aortocaval fistula is a severe complication of an aortoiliac aneurysm, usually associated with high perioperative morbidity and mortality during open operative repair. We describe the successful endovascular treatment of a symptomatic infrarenal aortic aneurysm ruptured into the inferior vena cava with secondary interventional coiling of a persistent type II endoleak because of retrograde perfusion of the inferior mesenteric artery. Endovascular exclusion of ruptured abdominal aneurysms seems to be a valuable treatment option for selected patients even with complicated vascular conditions like an aortocaval fistula.
  Annals of Vascular Surgery 08/2006; 20(4):525-8. · 1.03 Impact Factor
• Article: High-spatial-resolution MR angiography of renal arteries with integrated parallel acquisitions: comparison with digital subtraction angiography and US.

  Stefan O Schoenberg, Johannes Rieger, Christof H Weber, Henrik J Michaely, Tobias Waggershauser, Carina Ittrich, Olaf Dietrich, Maximilian F Reiser
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  ABSTRACT: To retrospectively compare three-dimensional gadolinium-enhanced magnetic resonance (MR) angiography, performed with an integrated parallel acquisition technique for high isotropic spatial resolution, with selective digital subtraction angiography (DSA) and intravascular ultrasonography (US) for accuracy of diameter and area measurements in renal artery stenosis. The study was approved by the institutional review board, and consent was obtained from all patients. Forty-five patients (17 women, 28 men; mean age, 62.2 years) were evaluated for suspected renal artery stenosis. Three-dimensional gadolinium-enhanced MR angiograms were acquired with isotropic spatial resolution of 0.8 x 0.8 x 0.9 mm in 23-second breath-hold with an integrated parallel acquisition technique. In-plane diameter of stenosis was measured along vessel axis, and perpendicular diameter and area of stenosis were assessed in cross sections orthogonal to vessel axis, on multiplanar reformations. Interobserver agreement between two radiologists in measurements of in-plane and perpendicular diameters of stenosis and perpendicular area of stenosis was assessed with mean percentage of difference. In a subset of patients, degree of stenosis at MR angiography was compared with that at DSA (n = 20) and intravascular US (n = 11) by using Bland-Altman plots and correlation analyses. Mean percentage of difference in stenosis measurement was reduced from 39.3% +/- 78.4 (standard deviation) with use of in-plane views to 12.6% +/- 9.5 with use of cross-sectional views (P < .05). Interobserver agreement for stenosis grading based on perpendicular area of stenosis was significantly better than that for stenosis grading based on in-plane diameter of stenosis (mean percentage of difference, 15.2% +/- 24.2 vs 54.9% +/- 186.9; P < .001). Measurements of perpendicular area of stenosis on MR angiograms correlated well with those on intravascular US images (r(2) = 0.90). Evaluation of cross-sectional images reconstructed from high-spatial-resolution three-dimensional gadolinium-enhanced MR renal angiographic data increases the accuracy of the technique and decreases interobserver variability.
  Radiology 06/2005; 235(2):687-98. · 5.73 Impact Factor
• Article: In-vivo quantification of hepatic 11beta-hydroxysteroid dehydrogenase type I activity--a preliminary study.

  Michael Vogeser, Veit Gülberg, Tobias Waggershauser, Alexander L Gerbes
  Clinical Biochemistry 12/2002; 35(8):655-7. · 2.08 Impact Factor
• Article: Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts.

  Veit Gülberg, Ingrid Liss, Manfred Bilzer, Tobias Waggershauser, Maximilian Reiser, Alexander L Gerbes
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  ABSTRACT: We have recently shown that the transjugular intrahepatic portosystemic shunt (TIPS) is more effective than paracentesis in the treatment of cirrhotic patients with severe ascites and can prolong survival in selected patients. Although an improved quality of life (QOL) has been suggested in these patients after the TIPS procedure, so far there are no data available to substantiate this assumption. Therefore, the aim of this study was to determine the effect of TIPS on the QOL in cirrhotic patients with refractory or recidivant ascites. 21 cirrhotic patients who underwent TIPS for refractory or recidivant ascites were investigated. All patients were pretreated with repeated paracentesis for at least 1 year. Before the procedure and at 3 and 6 months during follow-up, the patients themselves rated QOL, fatigue and physical performance on a visual analogue scale (range 0-100). Furthermore, QOL was determined by the QOL index (range 0-10) according to Spitzer. Patients' rating of the QOL on the visual analogue scale significantly increased from 35 +/- 25 (baseline) to 64 +/- 28 (3 months), and 66 +/- 24 (6 months; p = 0.02). Similarly, the QOL index significantly increased from 6.9 +/- 2.0 (baseline) to 8.3 +/- 2.1 (3 months), and 8.6 +/- 1.7 (6 months; p < 0.001). The increase of QOL was more pronounced in patients with complete response to TIPS. We demonstrate that TIPS for refractory or recidivant ascites improves the QOL in patients with cirrhosis. Our data indicates that this improvement is dependent on the response to therapy.
  Digestion 01/2002; 66(2):127-30. · 2.05 Impact Factor
• Article: Combined supra-aortic extra-anatomic revascularization and endovascular hybrid procedure for recurrent hemoptysis caused by a symptomatic aneurysm of the right subclavian artery.

  Reinhard Kopp, Georgios Meimarakis, Tim Strauss, Rudolph Hatz, Karl Walter Jauch, Tobias Waggershauser
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  ABSTRACT: Acute hemoptysis might be caused by aneurysms of the subclavian artery. We report a 75-year-old female patient presenting with recurrent hemoptysis, dyspnea, fever, and episodes of unclear pneumonia. Further examination revealed a large intrathoracic aneurysm of the right subclavian artery. After an initial transfemoral interventional attempt to occlude the entry of the aneurysm, the patient developed persistent thoracic pain. The patient was then treated by a combined extrathoracic hybrid procedure with a left to right carotid-carotid-axillary artery bypass and an endovascular aneurysm exclusion by insertion of two iliac artery occluder stent grafts in the proximal brachiocephalic trunk and the distal right subclavian artery. After this combined intervention, hemoptysis disappeared, and the patient recovered remarkably during a follow-up of 24 months.
  Vascular 17(3):172-5. · 0.89 Impact Factor
• Article: Arterio-venous malformations of the liver in hereditary hemorrhagic telangiectasia (Rendu–Osler–Weber disease) causing right heart failure—Successful treatment with transarterial coil embolization

  Sabine Weckbach, Svetlana Lyadova, Tobias Waggershauser, Olaf Muehling, Maximilan Reiser, Ralf-Thorsten Hoffmann
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  ABSTRACT: The presented case is a 66-year-old man with known hereditary hemorrhagic telangiectasia who presented with recurrent attacks of supraventricular tachycardia and dyspnoea. Cardiac catheterization revealed high cardiac output with peripheral shunting of about 50%.Three sessions of subsequent transarterial selective coil embolization were performed within 25 days after which no more AVMs were observed angiographically. The patient did not face any complications. Finally, the patient was in very good condition and reported neither tachycardia nor dyspnoea. Over a follow-up period of 12 months there were no biliary complications or recurrence of shunting observed.In summary, transarterial coil embolization of large parts of the hepatic arteries is a potent therapy to reduce the amount of arterio-venous blood shunting causing right heart failure.
  European Journal of Radiology Extra.