Background: Acute lower-extremity ischemia (ALI) is associated with high in-hospital amputation r... more Background: Acute lower-extremity ischemia (ALI) is associated with high in-hospital amputation rates of 10%-30%, 1-year mortality rates of 15%-20%, and low amputation-free survival rates of 50%-65%. Although catheter-directed thrombolysis (CDT) is associated with a lower morbidity rate and is as effective as surgery for stage I and IIa ALI, it takes substantial time to be effective. The Indigo System (Penumbra, inc) is designed for aspiration thromboembolectomy available from 3 f to 8 f in size. The size-matched "separator" allows the catheter to be cleared of occlusive material without catheter removal from the area of thrombus. It has a pump-driven vacuum for consistent aspiration.r preliminary results of this device in the treatment of ali have been recently published. We want to report our single center experience with percutaneous aspiration thrombectomy (pat) as a first line treatment for acute lower limb ischemia (ALI). Method(s): Twenty-one patients who underwent pat for ali from March 2017 to June 2018 were included. The primary end-point was complete thrombus aspiration with return to patency of the target vessel. Adjunctive treatment for underlying stenosis or occlusion was not considered indicating technical failure, while the use of additional treatment for thrombus removal was considered as a technical failure. Result(s): The technical success was obtained in 18/21 patients (85.7%); 2 of the remaining 3 patients required additional treatment for thrombus removal and in 1 the pat failed to restored patency and the patient underwent open surgical treatment. No complications related to pad were reported. Conclusion(s): The technical success was obtained in 18/21 patients (85.7%); 2 of the remaining 3 patients required additional treatment for thrombus removal and in 1 the pat failed to restored patency and the patient underwent open surgical treatment. No complications related to pad were reported.
position, and were subjected to DRE. TRUS with a color Doppler for the detection of prostatic les... more position, and were subjected to DRE. TRUS with a color Doppler for the detection of prostatic lesion using G. E. LOGIQ 5 PRO ultrasound color Doppler machine (with a TRUS probe [6-10 MHz]). Later, a TRUS-guided biopsy was performed using an 18G biopsy gun to confirm the radiological diagnosis. Results: Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM, New York, USA). A Chi-square test and a "t-" test of independent samples were used to compare the data. P < 0.05 indicated a significant association. Diagnostic efficacy was expressed in terms of sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy. The age of patients ranged from 51 to 77 years. The mean age of patients was 63.80 ± 6.76 years. A majority of the patients were <65 years of age (65%); on DRE, a total of 17 (42.5%) patients had induration while 23 (57.5%) had nodular lesions. PSA values ranged from 5.8 to 9.8 ng/ml. Exactly half of the patients had PSA <8 ng/ml; histopathologically, 13 (32.5%) cases were malignant. On TRUS evaluation, a total of 10 (25%) cases were malignant. TRUS findings combined with color Doppler vascularity findings diagnosed malignancy in 15 (37.5%) cases. Conclusion: The findings of the present study showed that TRUS with color Doppler flowmetry can play an important role in the detection of prostate malignancy, with high sensitivity as well as specificity. The high NPV, as observed in the present study, could avoid unnecessary diagnostic invasive intervention. In the present study, TRUS diagnosis established 30 (75%) cases as benign and 10 (25%) cases as malignant, showing the rate of cancer detection to be close to that diagnosed through histopathology. Among different TRUS characteristics, irregular shape, heterogeneous echotexture, loss of differentiation between the peripheral and internal zones, increased mean prostate weight, and capsular invasion were found to be significantly associated with malignancy.
Poster: "ECR 2017 / C-2215 / The radiologist’s role in acute ischemic stroke: From patient s... more Poster: "ECR 2017 / C-2215 / The radiologist’s role in acute ischemic stroke: From patient selection to endovascular treatment" by: "R. N. M. Abdalla1, A. Mugahid2, A. H. A. H. Ibrahim2, A. K. K. Aly2, E. T. E. Abdullah2, P. M. A. D. Mohamed Abouelhoda2, E. Hashem2; 1Cairo, ca/EG, 2Cairo/EG"
arteriomegaly rather than an atheromatous disease. Once the diagnosis is made and the indication ... more arteriomegaly rather than an atheromatous disease. Once the diagnosis is made and the indication retained, the patients had to be treated to prevent the complications caused by this type of lesions. This poster illustrates some cases of popliteal aneurysms treated with endovascular technique successfully in our department. Methods: We performed a single-center retrospective cohort study of 11 patients who underwent stenting of the popliteal artery for aneurysmal diseases of lower limbs between January 2010 and October 2017. Clinical improvement, permeability, stent thrombosis, intra-stent stenosis, and stent fracture were evaluated. Results: Eleven patients were treated for aneurysmal lesions of the popliteal artery, including 2 false aneurysms and 9 aneurysms. All our patients evolved well postoperatively. Clinical improvement was observed in all patients: no fracture or stent disconnection with aneurysms, without endoleak. One patient presented stent thrombosis after 2 years of follow-up. Conclusion: it seems reasonable to think that endovascular repair should be considered, case by case, as an alternative for open repair of popliteal artery's aneurysms. The technical improvements of covered endoprostheses and prospective studies gathering multiple observations will allow in future to affirm the interest of this treatment.
Significant hepatic artery stenosis after liver transplantation can lead to thrombosis with assoc... more Significant hepatic artery stenosis after liver transplantation can lead to thrombosis with associated high morbidity and mortality. The aim of our study is to evaluate our technical success rate, clinical outcomes and complications. Method(s): It's a retrospective study in 13 patients who underwent liver transplantation between 2010 and 2018. Recipients demographics, type of liver transplant, clinical presentations methods of diagnosing hepatic artery stenosis, types of anastomosis, approached for intervention, hepatic artery stenosis grading, primary angioplasty and in some cases assisted stenting were evaluated. All patients were assessed after intervention by clinical outcomes, Doppler examination. Result(s): Out of 13 patients, 5 patients after angioplasty were assisted by stenting, 11 patients have good flow (84%), in 1 patient no change in flow and 1 have poor flow,1 patient complicated by non flow limiting dissection, 1 underwent for surgical redo, 10 patients are still alive. Conclusion(s): Our results suggest hepatic artery angioplasty and stenting in liver recipients are minimally and safe procedures good alternative option to open surgeries.
1Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt 2Depar... more 1Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt 2Department of Department of Diagnostic and Interventional Radiology, Ain Shams University, King’s College Hospital, Cairo, Egypt 3National Center for Radiation Research and Technology, Cairo, Egypt Address for correspondence Mohamed Shaker, MD, 13 Mostafa Refaat, Sheraton Al Matar, El Nozha, Cairo Governorate 11799, Egypt (e-mail: [email protected]).
Prostate artery embolization (PAE) is a minimally invasive technique in managing men with lower u... more Prostate artery embolization (PAE) is a minimally invasive technique in managing men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is one of the commonest causes of LUTS in men, associated with high morbidity and economic burden. Patients suffering from LUTS secondary to BPH, severe enough to warrant intervention traditionally underwent transurethral resection of the prostate or open prostatectomy. PAE is an emerging alterative technique with promising data. In this paper we review important elements to running a safe PAE practice including careful patient selection, exclusion criteria, complications, and efficacy of PAE compared to other techniques. This paper also reviews the basic anatomy and techniques relevant to PAE, including common anatomical variants.
Prostate artery embolization (PAE) is a minimally invasive, safe, and effective treatment for ben... more Prostate artery embolization (PAE) is a minimally invasive, safe, and effective treatment for benign prostatic hyperplasia. PAE can often be technically challenging due to atherosclerosis and tortuous anatomy, leading to failure of catheterizing one side of prostatic supply, resulting in unilateral PAE, which markedly reduces clinical success. Major anastomosis between both prostatic halves can be exploited for embolizing the entire prostate from a unilateral approach when one side cannot be catheterized. If this anastomosis is extensive enough, clinical success is assumed to be equivalent to bilateral PAE. There is a limited number of published cases in this regard; our case report shows how to detect and exploit this anastomosis.
Background: Large hepatic artery aneurysms are rare, especially spontaneous ones without history ... more Background: Large hepatic artery aneurysms are rare, especially spontaneous ones without history of hepatopancreatobiliary surgery or trauma. They are serious and need attention due to risk of spontaneous rupture. Management depends on local expertise with endovascular management being the preferred option, and surgical repair usually reserved to ruptured aneurysms in hemodynamically unstable patients. Methods: A 54-year-old female patient was referred to our hospital for treatment of incidentally discovered large hepatic artery aneurysm without obvious etiology. The decision was made to attempt percutaneous endovascular management at the interventional radiology unit. Result: The aneurysm sac was successfully excluded using covered stents. This was complicated by right hepatic artery occlusion and clinically insignificant contrast extravasation. These complications did not have any clinical sequel in terms of hemodynamic stability or impaired liver function. The patient was safely ...
BACKGROUND Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radio... more BACKGROUND Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK. METHODS This was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0-2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form. RESULTS Eleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27...
Background: Acute lower-extremity ischemia (ALI) is associated with high in-hospital amputation r... more Background: Acute lower-extremity ischemia (ALI) is associated with high in-hospital amputation rates of 10%-30%, 1-year mortality rates of 15%-20%, and low amputation-free survival rates of 50%-65%. Although catheter-directed thrombolysis (CDT) is associated with a lower morbidity rate and is as effective as surgery for stage I and IIa ALI, it takes substantial time to be effective. The Indigo System (Penumbra, inc) is designed for aspiration thromboembolectomy available from 3 f to 8 f in size. The size-matched "separator" allows the catheter to be cleared of occlusive material without catheter removal from the area of thrombus. It has a pump-driven vacuum for consistent aspiration.r preliminary results of this device in the treatment of ali have been recently published. We want to report our single center experience with percutaneous aspiration thrombectomy (pat) as a first line treatment for acute lower limb ischemia (ALI). Method(s): Twenty-one patients who underwent pat for ali from March 2017 to June 2018 were included. The primary end-point was complete thrombus aspiration with return to patency of the target vessel. Adjunctive treatment for underlying stenosis or occlusion was not considered indicating technical failure, while the use of additional treatment for thrombus removal was considered as a technical failure. Result(s): The technical success was obtained in 18/21 patients (85.7%); 2 of the remaining 3 patients required additional treatment for thrombus removal and in 1 the pat failed to restored patency and the patient underwent open surgical treatment. No complications related to pad were reported. Conclusion(s): The technical success was obtained in 18/21 patients (85.7%); 2 of the remaining 3 patients required additional treatment for thrombus removal and in 1 the pat failed to restored patency and the patient underwent open surgical treatment. No complications related to pad were reported.
position, and were subjected to DRE. TRUS with a color Doppler for the detection of prostatic les... more position, and were subjected to DRE. TRUS with a color Doppler for the detection of prostatic lesion using G. E. LOGIQ 5 PRO ultrasound color Doppler machine (with a TRUS probe [6-10 MHz]). Later, a TRUS-guided biopsy was performed using an 18G biopsy gun to confirm the radiological diagnosis. Results: Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM, New York, USA). A Chi-square test and a "t-" test of independent samples were used to compare the data. P < 0.05 indicated a significant association. Diagnostic efficacy was expressed in terms of sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy. The age of patients ranged from 51 to 77 years. The mean age of patients was 63.80 ± 6.76 years. A majority of the patients were <65 years of age (65%); on DRE, a total of 17 (42.5%) patients had induration while 23 (57.5%) had nodular lesions. PSA values ranged from 5.8 to 9.8 ng/ml. Exactly half of the patients had PSA <8 ng/ml; histopathologically, 13 (32.5%) cases were malignant. On TRUS evaluation, a total of 10 (25%) cases were malignant. TRUS findings combined with color Doppler vascularity findings diagnosed malignancy in 15 (37.5%) cases. Conclusion: The findings of the present study showed that TRUS with color Doppler flowmetry can play an important role in the detection of prostate malignancy, with high sensitivity as well as specificity. The high NPV, as observed in the present study, could avoid unnecessary diagnostic invasive intervention. In the present study, TRUS diagnosis established 30 (75%) cases as benign and 10 (25%) cases as malignant, showing the rate of cancer detection to be close to that diagnosed through histopathology. Among different TRUS characteristics, irregular shape, heterogeneous echotexture, loss of differentiation between the peripheral and internal zones, increased mean prostate weight, and capsular invasion were found to be significantly associated with malignancy.
Poster: "ECR 2017 / C-2215 / The radiologist’s role in acute ischemic stroke: From patient s... more Poster: "ECR 2017 / C-2215 / The radiologist’s role in acute ischemic stroke: From patient selection to endovascular treatment" by: "R. N. M. Abdalla1, A. Mugahid2, A. H. A. H. Ibrahim2, A. K. K. Aly2, E. T. E. Abdullah2, P. M. A. D. Mohamed Abouelhoda2, E. Hashem2; 1Cairo, ca/EG, 2Cairo/EG"
arteriomegaly rather than an atheromatous disease. Once the diagnosis is made and the indication ... more arteriomegaly rather than an atheromatous disease. Once the diagnosis is made and the indication retained, the patients had to be treated to prevent the complications caused by this type of lesions. This poster illustrates some cases of popliteal aneurysms treated with endovascular technique successfully in our department. Methods: We performed a single-center retrospective cohort study of 11 patients who underwent stenting of the popliteal artery for aneurysmal diseases of lower limbs between January 2010 and October 2017. Clinical improvement, permeability, stent thrombosis, intra-stent stenosis, and stent fracture were evaluated. Results: Eleven patients were treated for aneurysmal lesions of the popliteal artery, including 2 false aneurysms and 9 aneurysms. All our patients evolved well postoperatively. Clinical improvement was observed in all patients: no fracture or stent disconnection with aneurysms, without endoleak. One patient presented stent thrombosis after 2 years of follow-up. Conclusion: it seems reasonable to think that endovascular repair should be considered, case by case, as an alternative for open repair of popliteal artery's aneurysms. The technical improvements of covered endoprostheses and prospective studies gathering multiple observations will allow in future to affirm the interest of this treatment.
Significant hepatic artery stenosis after liver transplantation can lead to thrombosis with assoc... more Significant hepatic artery stenosis after liver transplantation can lead to thrombosis with associated high morbidity and mortality. The aim of our study is to evaluate our technical success rate, clinical outcomes and complications. Method(s): It's a retrospective study in 13 patients who underwent liver transplantation between 2010 and 2018. Recipients demographics, type of liver transplant, clinical presentations methods of diagnosing hepatic artery stenosis, types of anastomosis, approached for intervention, hepatic artery stenosis grading, primary angioplasty and in some cases assisted stenting were evaluated. All patients were assessed after intervention by clinical outcomes, Doppler examination. Result(s): Out of 13 patients, 5 patients after angioplasty were assisted by stenting, 11 patients have good flow (84%), in 1 patient no change in flow and 1 have poor flow,1 patient complicated by non flow limiting dissection, 1 underwent for surgical redo, 10 patients are still alive. Conclusion(s): Our results suggest hepatic artery angioplasty and stenting in liver recipients are minimally and safe procedures good alternative option to open surgeries.
1Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt 2Depar... more 1Department of Diagnostic and Interventional Radiology, Ain Shams University, Cairo, Egypt 2Department of Department of Diagnostic and Interventional Radiology, Ain Shams University, King’s College Hospital, Cairo, Egypt 3National Center for Radiation Research and Technology, Cairo, Egypt Address for correspondence Mohamed Shaker, MD, 13 Mostafa Refaat, Sheraton Al Matar, El Nozha, Cairo Governorate 11799, Egypt (e-mail: [email protected]).
Prostate artery embolization (PAE) is a minimally invasive technique in managing men with lower u... more Prostate artery embolization (PAE) is a minimally invasive technique in managing men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is one of the commonest causes of LUTS in men, associated with high morbidity and economic burden. Patients suffering from LUTS secondary to BPH, severe enough to warrant intervention traditionally underwent transurethral resection of the prostate or open prostatectomy. PAE is an emerging alterative technique with promising data. In this paper we review important elements to running a safe PAE practice including careful patient selection, exclusion criteria, complications, and efficacy of PAE compared to other techniques. This paper also reviews the basic anatomy and techniques relevant to PAE, including common anatomical variants.
Prostate artery embolization (PAE) is a minimally invasive, safe, and effective treatment for ben... more Prostate artery embolization (PAE) is a minimally invasive, safe, and effective treatment for benign prostatic hyperplasia. PAE can often be technically challenging due to atherosclerosis and tortuous anatomy, leading to failure of catheterizing one side of prostatic supply, resulting in unilateral PAE, which markedly reduces clinical success. Major anastomosis between both prostatic halves can be exploited for embolizing the entire prostate from a unilateral approach when one side cannot be catheterized. If this anastomosis is extensive enough, clinical success is assumed to be equivalent to bilateral PAE. There is a limited number of published cases in this regard; our case report shows how to detect and exploit this anastomosis.
Background: Large hepatic artery aneurysms are rare, especially spontaneous ones without history ... more Background: Large hepatic artery aneurysms are rare, especially spontaneous ones without history of hepatopancreatobiliary surgery or trauma. They are serious and need attention due to risk of spontaneous rupture. Management depends on local expertise with endovascular management being the preferred option, and surgical repair usually reserved to ruptured aneurysms in hemodynamically unstable patients. Methods: A 54-year-old female patient was referred to our hospital for treatment of incidentally discovered large hepatic artery aneurysm without obvious etiology. The decision was made to attempt percutaneous endovascular management at the interventional radiology unit. Result: The aneurysm sac was successfully excluded using covered stents. This was complicated by right hepatic artery occlusion and clinically insignificant contrast extravasation. These complications did not have any clinical sequel in terms of hemodynamic stability or impaired liver function. The patient was safely ...
BACKGROUND Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radio... more BACKGROUND Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK. METHODS This was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0-2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form. RESULTS Eleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27...
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