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Journal of vascular and interventional radiology: JVIR 11/2011; 23(1):11-8. · 1.81 Impact Factor
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John D Statler,
Donald L Miller,
Robert G Dixon,
Michael D Kuo,
Alan M Cohen,
James R Duncan,
Roy L Gordon,
Kathleen Gross,
Wael E A Saad,
James E Silberzweig, Michael S Stecker,
Rajeev Suri,
Raymond H Thornton,
Gabriel Bartal
Journal of vascular and interventional radiology: JVIR 09/2011; 22(11):1561-2. · 1.81 Impact Factor
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ABSTRACT: To assess the long-term safety and effectiveness of the OptEase inferior vena cava (IVC) filter.
In this Institutional Review Board-approved, retrospective study, we reviewed data of 71 patients who received an OptEase filter at our institution from 2002 to 2007. Thirty-nine (55%) patients had symptoms of venous thromboembolism before filter placement. The indications for filter included contraindication to anticoagulation in 31 (44%) patients, prophylaxis against pulmonary embolism (PE) in 29 (41%) patients, and failure of anticoagulation in 11 (15%) patients. Procedure-related complications, such as symptomatic post-filter PE, deep venous thrombosis (DVT), IVC occlusion, and incidental imaging-evident filter-related complications, were recorded. Safety was assessed by the occurrence of filter-related complications during placement and follow-up. Effectiveness was assessed by the occurrence of post-filter PE.
Sixty-five (92%) filters were placed under fluoroscopy, and 6 (8%) were placed using intravascular ultrasound guidance. Seventy (99%) filters were placed successfully. Seven (10%) filters were placed in the suprarenal cava. Retrieval was attempted in 14 (20%) patients, and 12 filters were successfully retrieved. Clinical follow-up was available for 20 ± 21 months. Symptoms of postfilter PE and DVT occurred in 15% (n = 11) and 10% (n = 7) patients, respectively. None of these patients had computed tomography (CT)-proven PE, and only one had ultrasound-proven new DVT. One patient had symptomatic IVC occlusion. Follow-up abdominal CT in 20 patients showed thrombus in the filter in two of them. There were no instances of filter migration, filter tilt, or caval wall penetration.
The OptEase filter appears to have an acceptable long-term safety profile. The filter was effective against PE.
CardioVascular and Interventional Radiology 04/2011; 34(2):331-7. · 2.09 Impact Factor
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ABSTRACT: To evaluate the clinical effectiveness and safety of uterine artery embolization (UAE) in the treatment of primary postpartum hemorrhage (PPH), secondary PPH, and PPH associated with cesarean section.
All women who underwent UAE for obstetric-related hemorrhage during a 52-month period culminating in April 2009 were included. Clinical success was defined as obviation of hysterectomy. Blood product requirements before and after UAE were calculated. Statistically significant associations between subject characteristics and clinical success were evaluated. The two subgroups of women with uterine artery pseudoaneurysms and women who underwent cesarean section were examined separately as well.
Sixty-six women (mean age, 33 years; range, 17-47 y) underwent UAE, with an overall clinical success rate of 95% (98% for primary PPH, 88% for secondary PPH, and 94% for PPH associated with cesarean section) and an overall complication rate of 4.5%. Mean pre- and postembolization transfusion requirements were 3.1 U and 0.4 U of packed red blood cells, respectively. The only significant characteristic identified for the cases that necessitated hysterectomy was an increased transfusion requirement after UAE (increase of 1.0 U ± 0.5; P = .02). Uterine artery pseudoaneurysms were associated with secondary PPH (P = .01) and cesarean section (P = .03).
The threshold for UAE in women with PPH should be low, as it is associated with a high clinical effectiveness rate and a low complication rate. Uterine artery pseudoaneurysms should be suspected in women presenting with secondary PPH after cesarean section.
Journal of vascular and interventional radiology: JVIR 02/2011; 22(2):169-76. · 1.81 Impact Factor
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Michael S Stecker
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ABSTRACT: Protection of patients from excessive medical radiation has become a high priority in health care. As clinical physicians, interventional radiologists must remain cognizant of the radiation we use in daily practice. Radiation reduction begins before the procedure itself, as with appropriate preprocedural planning the amount of fluoroscopy and angiography used can then be reduced. Patients should be counseled regarding the potential for use of significant amounts of radiation when procedures associated with such doses are planned, as part of the process of obtaining informed consent. If significant radiation is used, patients should be alerted to have appropriate follow-up. The amount of radiation used can be reduced by careful attention to imaging technique.
Techniques in vascular and interventional radiology 09/2010; 13(3):176-82.
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Matthew S Johnson,
Albert A Nemcek,
James F Benenati,
Dirk S Baumann,
Bart L Dolmatch,
John A Kaufman,
Mark J Garcia, Michael S Stecker,
Anthony C Venbrux,
Ziv J Haskal,
Rui L Avelar
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ABSTRACT: To evaluate the safety and effectiveness of the retrievable Option inferior vena cava (IVC) filter in patients at risk for pulmonary embolism (PE).
This was a prospective, multicenter, single-arm clinical trial. Subjects (N = 100) underwent implantation of the IVC filter and were followed for 180 days; subjects whose filters were later removed were followed for 30 days thereafter. The primary objective was to determine whether the one-sided lower limit of the 95% CI for the observed clinical success rate was at least 80%. Clinical success was defined as technical success (deployment of the filter such that it was judged suitable for mechanical protection from PE) without subsequent PE, significant filter migration or embolization, symptomatic caval thrombosis, or other complications.
Technical success was achieved in 100% of subjects. There were eight cases of recurrent PE, two cases of filter migration (23 mm), and three cases of symptomatic caval occlusion/thrombosis (one in a subject who also experienced filter migration). No filter embolization or fracture occurred. Clinical success was achieved in 88% of subjects; the one-sided lower limit of the 95% CI was 81%. Retrieval was successful at a mean of 67.1 days after implantation (range, 1-175 d) for 36 of 39 subjects (92.3%). All deaths (n = 17) and deep vein thromboses (n = 18) were judged to have resulted from preexisting or intercurrent illnesses or interventions and unrelated to the filter device; all deaths were judged to be unrelated to PE.
Placement and retrieval of the Option IVC filter were performed safely and with high rates of clinical success.
Journal of vascular and interventional radiology: JVIR 08/2010; 21(8):1173-84. · 1.81 Impact Factor
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Michael S Stecker,
Stephen Balter,
Richard B Towbin,
Donald L Miller,
Eliseo Vañó,
Gabriel Bartal,
J Fritz Angle,
Christine P Chao,
Alan M Cohen,
Robert G Dixon,
Kathleen Gross,
George G Hartnell,
Beth Schueler,
John D Statler,
Thierry de Baère,
John F Cardella
Journal of vascular and interventional radiology: JVIR 07/2009; 20(7 Suppl):S263-73. · 1.81 Impact Factor
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Journal of Vascular and Interventional Radiology 01/2008; 18(12):1479-80. · 2.08 Impact Factor
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ABSTRACT: Many patients undergo placement of tunneled cuffed central venous catheters (TCCVCs) for indications including administration of medical therapy and hemodialysis. They are removed when no longer needed or if there is a device complication. There is no consensus regarding the necessity of routine preremoval coagulation studies or platelet count, so this study was performed to determine if abnormal coagulation status affects the time to hemostasis (TH) after traction removal of TCCVCs.
Adult patients referred to our group for removal of a TCCVC placed via a jugular or subclavian route were considered candidates for inclusion. Blood was submitted for evaluation of prothrombin time (PT) and International Normalized Ratio (INR), activated partial thromboplastin time (aPTT), and platelet count. Catheters were removed with the traction technique, and presence of hemostasis was assessed at 5-minute intervals of manual compression.
Between November 19, 2001, and April 20, 2004, 179 subjects were enrolled and completed the study. There were 165 subjects in whom TH was within the first 5-minute interval and 14 in whom more than 5 minutes was required. Statistically significant factors associated with prolonged TH were primary diagnosis of end-stage renal disease (P = .005), use of antiplatelet agents (P = .03), and procedure performed by a "low-volume" operator (P = .002).
Routine preremoval evaluation of coagulation parameters is not necessary. Patients who are likely to have abnormal platelet function but not abnormal platelet number appear to be at risk for prolonged TH, but even in those cases, the THs are rarely more than 15 minutes.
Journal of Vascular and Interventional Radiology 11/2007; 18(10):1232-9; quiz 1240. · 2.08 Impact Factor
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ABSTRACT: To describe a case of transpopliteal retrieval of an inferior vena cava (IVC) filter.
A paraplegic patient had an IVC filter placed for deep venous thrombosis (DVT) after anticoagulant therapy was stopped. Two weeks later, he developed massive scrotal and bilateral lower extremity swelling due to iliocaval thrombosis, which was treated by power pulse-spray thrombectomy and catheter-directed thrombolytic infusion via bilateral popliteal approaches. Following successful thrombus removal, the filter was uniquely retrieved via the right popliteal access; the patient was discharged on warfarin anticoagulation.
Transpopliteal IVC filter retrieval is feasible and may be a useful alternative technique in selected instances.
Journal of Endovascular Therapy 07/2007; 14(3):411-5. · 2.86 Impact Factor
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Michael S Stecker
Journal of Vascular and Interventional Radiology 02/2007; 18(1 Pt 1):5-8. · 2.08 Impact Factor
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ABSTRACT: Interventional radiology (IR) is a clinical subspecialty; as such, there is a large amount of direct patient care. However, until recently, this topic has not been a major focus in radiology training programs. Additionally, as interventional radiologists develop busier and busier practices, there is less time to spend with individual patients. Physician extenders such as physician assistants (PAs) represent an excellent way to improve clinical patient care. This article describes what PAs are and how they work together with physicians. It illustrates differences between PAs and other physician extenders and describes the duties that may be delegated to PAs in the IR setting.
Journal of Vascular and Interventional Radiology 04/2004; 15(3):221-7. · 2.08 Impact Factor
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Scott O Trerotola,
Michael Kraus,
Himanshu Shah,
Jan Namyslowski,
Matthew S Johnson, Michael S Stecker,
Iftikhar Ahmad,
Gordon McLennan,
Nilesh H Patel,
Elaine O'Brien,
Kathleen A Lane,
Walter T Ambrosius
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ABSTRACT: Our purpose was to compare the function and complications of two high-flow polyurethane hemodialysis catheters.
This prospective, randomized trial compared the Ash-Split (MedComp) and Opti-Flow (Bard Access Systems) catheters. All patients referred for tunneled hemodialysis catheter placement were offered entry in the study, provided they met inclusion criteria. Catheters were placed by interventional radiologists using ultrasound and fluoroscopic guidance. Procedure time and initial complications were recorded. Effective (QbEff) catheter flow rates and recirculation were studied at baseline, one month, three and six months using ultrasonic dilution (Transonic) at various pump speeds (Qb). Episodes of catheter malfunction and infection were recorded. Catheter removal or six months was the study endpoint.
A total of 132 patients were enrolled in the trial. The groups did not differ as to age, sex distribution, height or weight (P> 0.05). Initial complications included kinking resulting in catheter failure (Optiflow N = 3), and tunnel bleeding (Optiflow N = 1; Ash N = 3). Adjusted mean flow rates (QbEff) at Qb300 were 299 mL/min Ash and 305 mL/min Optiflow (P = 0.06), at Qb400 were 365 mL/min Ash and 382 mL/min Optiflow (P = 0.01), and at QbMax were 414 mL/min Ash and 433 mL/min Optiflow (P = 0.03). Recirculation was significantly higher with the Optiflow catheter at most measurement points. Total late complications were lower in the Ash group (P = 0.04), and catheter survival was significantly higher in the Ash group (P = 0.02).
Both catheters can deliver flow rates well beyond those recommended by the Dialysis Outcomes Quality Initiative. While the Optiflow delivered higher flow rates at some measurement points, this was offset by higher recirculation. The Ash catheter showed a long-term survival advantage and fewer late complications.
Kidney International 07/2002; 62(1):282-9. · 6.61 Impact Factor
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ABSTRACT: In this article, a patient with extensive cerebrovascular disease who had previously undergone bilateral carotid endarterectomy and subsequent operative revision on the left side is described. The patient developed critical restenosis at the cephalic end of the previous left patch angioplasty as well as a severe stenosis of the left common carotid artery origin, which originated from a bovine aortic arch configuration. His right common and internal carotid arteries had become occluded. Endovascular treatment with two metallic stents was successfully performed through a surgical cutdown on the immediate supraclavicular portion of the left common carotid artery to establish antegrade and subsequently retrograde vascular access.
Journal of Vascular and Interventional Radiology 05/2002; 13(4):413-7. · 2.08 Impact Factor
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ABSTRACT: Thirteen patients underwent placement of a balloon-expandable stent either at initial transjugular intrahepatic portosystemic shunt (TIPS) creation (n = 3) because of immediate technical failure of the Wallstent or at shunt revision because of failure of the Wallstent to reduce the portosystemic gradient <or=12 mm Hg despite overdilation (n = 2), stenosis of the Wallstent (n = 1), or parenchymal tract shunt stenosis (n = 7). The mean duration of primary patency when balloon-expandable stents were used at initial shunt creation was 162.7 days +/- 110.1 (SD). The time from initial TIPS creation or shunt revision with a Wallstent to placement of a balloon-expandable stent was 88.6 days +/- 115.3. The time from balloon-expandable stent placement to shunt revision (n = 6), most recent follow-up (n = 2), death (n = 1), or liver transplantation (n = 1) was 171.9 days +/- 121.6. No significant difference in shunt patency was found between the Wallstent and balloon-expandable stent (P =.31). Because no added benefit in patency was seen between the balloon-expandable stent and Wallstent, it appears that balloon-expandable stent placement is valuable only when placement of a Wallstent technically fails as a result of its limited radial force or when precision in placement is needed to treat a hepatic vein stenosis near the confluence with the inferior vena cava.
Journal of Vascular and Interventional Radiology 04/2002; 13(4):405-8. · 2.08 Impact Factor
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ABSTRACT: A 40-year-old male with alcoholic cirrhosis and portal hypertension presented with acute variceal hemorrhage. Abdominal CT scan and endoscopy revealed large gastric varices. The patient underwent a TIPS procedure. Portal venography demonstrated persistent filling of the large gastric varices with associated high-flow spontaneous splenorenal shunt. Because of the large size of the varices, a Simon-Nitinol filter was used in conjunction with multiple embolization coils to enable successful occlusion of the varices.
CardioVascular and Interventional Radiology 27(4):366-9. · 2.09 Impact Factor
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ABSTRACT: A patient who had undergone his third orthotopic liver transplantation nearly 9 years prior to presentation developed worsening hepatic and renal function, as well as severe bilateral lower extremity edema. Magnetic resonance imaging demonstrated vena caval thrombosis from the suprahepatic venous anastomosis to the infrarenal inferior vena cava, obstructing the renal veins. This was treated by percutaneous placement of metallic stents from the renal veins to the right atrium. At 16 months clinical follow-up, the patient continues to do well.
CardioVascular and Interventional Radiology 29(1):147-50. · 2.09 Impact Factor
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ABSTRACT: To describe our long-term experience with percutaneous access to continent urinary reservoirs for calculus removal.
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 at a later date for a second step where the access was dilated and the calculi were removed.
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.
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.
CardioVascular and Interventional Radiology 25(2):119-22. · 2.09 Impact Factor
