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Procedural Complications (procedural + complications)
Selected AbstractsTechnique of endoscopic retrograde puncture and dilatation of total esophageal stenosis in patients with radiation-induced stricturesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2004Ronald J. Lew MD Abstract Background. Complete esophageal stenosis can occur after external beam radiation therapy for malignancies. Treatment for this complication has traditionally involved surgery. Methods. A new technique to reestablish luminal patency is described. This minimally invasive technique involves retrograde endoscopy by means of gastrostomy tube tract and puncture of the stenotic occlusion followed by stricture dilatation. The procedure is performed under combined endoscopic and laryngoscopic guidance. Results. Five consecutive patients who had complete esophageal stenoses develop after radiation therapy for malignant disease underwent retrograde endoscopy by way of gastrostomy tube tracts. Stenoses were punctured under endoscopic and laryngoscopic guidance with guide wires. Strictures were dilated with wire-guided balloons or polyvinyl dilators. Luminal patency was established in all patients using this technique without procedural complications. Conclusions. Endoscopic retrograde puncture and dilatation of total esophageal stenoses is safe, effective, and useful to reestablish luminal patency for radiation-induced strictures. This technique should be attempted before more invasive treatments. © 2004 Wiley Periodicals, Inc. Head Neck26: 179,183, 2004 [source] Single-Center Experience with the HelexÔ Septal Occluder for Closure of Atrial Septal Defects in ChildrenJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003ROBERT N. VINCENT M.D. Catheter closure of atrial septal defects (ASDs) is an accepted procedure among pediatric cardiologists. We report our early experience with the newest of these devices in clinical trials in the United States. Between April and October 2001, 14 patients were enrolled in an FDA phase II multicenter trial comparing the results of ASD closure using the HELEXÔ Septal Occluder to a surgical control group. Of the 14 patients, devices were placed and left in 13, one being removed for an excessive residual leak despite placing the largest device available. Of the remaining 13 patients, all patients had successful closure of their defects. An average of 1.8 devices/patient were deployed, reflecting the learning curve for this new device and new delivery style. Six devices were replaced because of excessive residual leaks, three for premature lock release, and two for improper seating of the device. There were no procedural complications, however, one patient required device removal 4 months postimplant for possible allergic reaction to nickel. The same patient had removal of stainless steel sternal wires for the same reason. At the 6-month follow-up, 11 of 13 patients had complete closure of the ASD, the other two having small, hemodynamically insignificant left to right shunts. In one of these patients, there was complete closure at the 12-month follow-up, whereas the other patient awaits the 1-year evaluation. Early experience at our institution has demonstrated the ease of use of this device, its complete retrievability, and excellent closure of small to moderate ASDs in children. (J Interven Cardiol 2003;16:79,82) [source] Intravascular low-power laser irradiation after coronary stenting: Long-term follow-upLASERS IN SURGERY AND MEDICINE, Issue 3 2001Ivan K. De Scheerder MD Abstract Background and Objective A high restenosis rate remains a limiting factor for percutaneous transluminal coronary angioplasty and stenting. The objective of this study was to evaluate the effect of intravascular red laser therapy (IRLT) on restenosis after stenting procedures in de novo lesions. Study Design/Materials and Methods A total of 68 consecutive patients were treated with IRLT in conjunction with coronary stenting procedures. Mean lesion length was 16.5,±,2.4,mm. Reference vessel diameter (RVD) and pre-minimal lumen diameter (MLD) were 2.90,±,0.15,mm and 1.12,±,0.26,mm, respectively. Results After treatment, MLD was 2.76,±,0.32 mm with no procedural complications or in-hospital adverse events. Angiographic follow-up (n,=,61) revealed restenosis in nine patients (14.7%) with rate by artery size of >,3 mm (n,=,21) 0%; 2.5,3.0 mm (n,=,28) 14.2%; and <,2.5 mm (n,=,12) 41.6%. Conclusion Intravascular red light therapy is safe, feasible, and reduces expected restenosis rate after coronary stenting. Lasers Surg. Med. 28:212,215, 2001. © 2001 Wiley-Liss, Inc. [source] Initial Experience of Pacing with a Lumenless Lead System in Patients with Congenital Heart DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2009SANTABHANU CHAKRABARTI M.D. Background: Long-term pacing is frequently necessary in patients with congenital heart disease (CHD). Preservation of ventricular function and avoidance of venous occlusion is important in these patients. Site-selective pacing with a smaller diameter lead is achievable with the model 3830 lead (SelectSecure®, Medtronic Inc., Minneapolis, MN, USA), which was specifically designed to target these complications. We describe our initial experience with the Model 3830 lead in patients with CHD. Methods: Retrospective analysis of all patients undergoing site-selective implantation of a Model 3830 lead(s) from two congenital heart centers (Bristol, UK, and Dublin, Ireland) from October 2004 until February 2008. Results: We implanted 139 SelectSecure® leads (atrial n = 70; ventricular n = 69) in 90 patients (57 male) with CHD. Median age at implantation: 13.4 years (1.1,59.2 years), median weight: 43 kg. Sixty-nine patients (76%) were children (<18 years). Indications for lead implantation included atrioventricular block (n = 55), sinus node disease (n = 18), implantable cardiac defibrillator (n = 12), antitachycardia pacing (n = 4), and cardiac resynchronization (n = 1). Twenty-two patients underwent pre-existing lead extraction during the same procedure. All the attempted procedures resulted in successful pacing. One patient had a significantly raised threshold at implantation. There was no procedural mortality. There were two procedural complications. Three patients required lead repositioning for increasing thresholds early postprocedure (<6 weeks). Four leads (2.9%) had displaced on median follow-up of 21.8 months (0.5,42 months). Conclusions: The Model 3830 lead is safe and effective in patients with CHD. This is a technically challenging patient group yet procedural complication and lead displacement rates are acceptable. [source] Esophageal Acid Levels after Pulmonary Vein Isolation for Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2009GEORG NÖLKER M.D. Background: Pulmonary vein antrum isolation (PVAI) is a potentially curative, nonpharmacologic treatment of atrial fibrillation (AF). Several procedural complications have been described, including esophageal wall lesions ranging from erythema and esophagitis, necrosis and ulcer, to atrio-esophageal fistula. We prospectively studied changes in esophageal acid levels before and after PVAI. Methods: We performed 24-hour pH-metry before and 1.3 ± 1.6 days after PVAI, in 25 patients (mean age = 62 ± 12 years, 17 men) with symptomatic AF. A 2-mm transnasal probe was inserted into the inferior part of the esophagus and into the stomach to measure pH levels at fixed intervals. DeMeester scores, indicating acidic gastro-esophageal reflux, were calculated. Results: The mean number of reflux episodes increased from 89 ± 80 before to 107 ± 94 after PVAI. The mean percentage of time with esophageal pH < 4 was shorter after (108 ± 193 minutes) than before PVAI (159 ± 245 minutes). The mean DeMeester score decreased from 49 ± 68 before to 31 ± 41 after PVAI (P < 0.05). We observed erythema or esophagitis in five patients, necrosis or ulcer in seven, and atrio-esophageal fistula in no patient. Conclusions: Our hypothesis of increased acid levels caused by stimulation of the right vagal nerve during isolation of the right upper pulmonary vein was not verified. [source] Noncatheter-Based Delivery of a Single-Chamber Lumenless Pacing Lead in Small ChildrenPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2007DAMIEN KENNY M.B.Ch.B., M.R.C.P.C.H. Objectives:The model 3830 lead (SelectSecureÔ Medtronic, Minneapolis, MN, USA) is a bipolar, fixed-screw, 4.1-F pacing lead designed for site-selective pacing. Implantation is usually performed using an 8-F deflectable catheter system. This catheter is not ideal for smaller children because of both the sheath size and the relatively large deflected curves. We describe a simpler noncatheter-based delivery system in seven children. Methods:A 4.1-F SelectSecure lead was introduced via a 5-F SafeSheath (Thomas Medical, Malvern, PA, USA) placed in the left subclavian vein. The SelectSecure lead was passed into the inferior vena cava (IVC) and a loop created, which was then withdrawn into the right atrium. Once in position, the lead was screwed into the myocardium, the SafeSheath was peeled off, and the lead connected to the generator. Results:From March 2005 until September 2006, five right atrial leads and two right ventricular leads were implanted in seven patients (six female) with a median weight of 15 kg (8.1,19.4). All leads were successfully placed with excellent pacing thresholds. The median screening time was 7.1 minutes (4.8,11.4) with a median radiation dose of 83 cGy cm2. There were no procedural complications and no lead displacements seen on a median follow-up of 10 months. Conclusions:Delivery of the 4.1-F SelectSecure pacing lead to the right heart is possible using a noncatheter-based delivery system. This is effective and safe and does not require the use of a larger delivery system. This allows these thin isodiametric pacing leads to be used advantageously in small children. [source] Flexible Endoscopic Clip-Assisted Zenker's Diverticulotomy: The First Case Series (With Videos),THE LARYNGOSCOPE, Issue 7 2008Shou-jiang Tang MD Abstract Background: In treating Zenker's diverticulum (ZD), there are potential risks associated with performing flexible endoscopic diverticulotomy without suturing or stapling. We recently introduced flexible endoscopic clip-assisted diverticulotomy (ECD) in treating ZD by securing the septum prior to dissection. Objective: To evaluate the feasibility and safety of ECD for complete septum dissection. Study Design: Case series at an academic center. Seven consecutive patients (mean age 71 y; range 48,91 y) with symptomatic ZD of various craniocaudal sizes based on radiographic measurements (mean 2.6 cm; range 0.8 cm,4.5 cm) were included. The mean depth of the septum was 1.73 cm (range 0.3 cm,3.1 cm). The mean duration of symptoms was 4.8 years (range 0.5,10 y). Methods: After endoclips were placed on either side of the cricopharyngeal bar, the septum was dissected between these two clips down to the inferior end of the diverticulum with a needle-knife. Procedures including "one-step ECD" (n = 1), "stepwise ECD" (n = 3), and "bottom ECD" (n = 2) were performed based on the septum depth of the ZD during endoscopy. ECD was not performed on one patient due to severe mucosal fragility of the esophageal inlet. Iatrogenic blunt dissection of the septum by the endoscopic hood occurred secondary to patient retching during the procedure. Main outcome measurements were symptom resolution and complications. Results: All patients (n = 6) who underwent ECD had complete resolution of esophageal symptoms at a minimum 6-month follow-up. There were no procedural complications. The patient who did not undergo ECD developed an esophageal perforation. She was managed conservatively without surgical intervention. On follow-up, her dysphagia was completely resolved. Conclusions: ECD is feasible, safe, and effective for complete septum dissection. ECD and endoscopic stapler-assisted diverticulotomy are complimentary rather than competing strategies in approaching ZD. Study limitations include the case series design and limited follow-up period. [source] Carotid artery stenting: Do procedural complications relate to the side intervened upon?,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2009Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK), Results From the Carotid Artery Stent (CAS) Abstract Objectives: To determine the influence of the side intervened upon on outcomes during carotid artery stenting (CAS). Background: Anatomic and technical aspects may influence the results of CAS. The value of the side intervened upon has not been analyzed yet. Methods: We analyzed data from the Carotid Artery Stent (CAS) , Registry.Results: A total of 3,165 CAS procedures, 1,613 (51%) at the left and 1,552 (49%) at the right carotid artery were included. There was a higher proportion of patients treated for symptomatic stenoses when CAS was performed at the left carotid artery (50.1% versus 45.8%, P = 0.016) and more patients already had prior carotid endarterectomy (8.5% versus 5.8%, P = 0.003). Interventions at the left side took 3 min longer than interventions at the right side (46.6 ± 24.3 versus 43.8 ± 23.6, P = 0.003). In patients treated at the left carotid artery amaurosis fugax (0.7% versus 0.1%, P = 0.005), ipsilateral stroke (3.1% versus 1.8%, P = 0.017), and the primary endpoint of in-hospital death or stroke (4.1% versus 2.3%, P = 0.005) occurred significantly more often. Even after adjusting for confounding parameters, CAS procedures performed at the left carotid arteries remained an independent predictor of death or stroke (OR = 1.77, 95% CI: 1.15,2.72, P = 0.009). Conclusions: In current clinical practice, CAS is performed frequently at the right carotid artery as at the left carotid artery. CAS interventions have a higher in-hospital complication rate if performed at the left carotid artery. Technical improvements might help to overcome this situation. © 2009 Wiley-Liss, Inc. [source] Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting.CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2007The discharge study Abstract Objectives: To assess the timeframe of postprocedural complications following transradial percutaneous intervention in selected nonlow-risk risk patients as a feasibility study for same day discharge. Background: Percutaneous coronary intervention (PCI) is traditionally performed as an inpatient procedure. Transradial access with its lower complication rate facilitates safe and same day discharge. We hypothesize that with current standards of pharmacotherapy and intervention, complications post transradial percutaneous coronary angioplasty even in a nonlow-risk patient cohort will be evident within 6 hr or occur more than 24 hr post procedure. Under these circumstances, overnight stay results in no improvement in patient safety. Methods: 2,189 patients underwent transradial PCI at our institution between January 2005 and June 2006. Of these 1,174 were assessed as intermediate or high risk and admitted postprocedure. The remaining 1,015 were assessed as low risk and discharged the day of procedure. All 1,174 inpatients were entered into our study database. Information was collected on patient demographics, angiographic characteristics, post procedural complications, and timing of post procedural events. Results: 1,543 ACC type B2 or C lesions were treated in 1,174 patients. All post-procedural complications were identified within 6 hr of the intervention or occurred more than 24 hr later when patients would have been discharged according to overnight admission protocols. Conclusions: Day case transradial percutaneous intervention with a 6-hr period of post procedure observation is a safe and feasible practice. The presence of higher-risk features should not be considered an absolute indication for overnight admission in patients considered clinically appropriate for discharge. © 2007 Wiley-Liss, Inc. [source] Virtual colonoscopy vs conventional colonoscopy in patients at high risk of colorectal cancer , a prospective trial of 150 patientsCOLORECTAL DISEASE, Issue 2 2009T. J. White Abstract Objective, Virtual colonoscopy (VC)/CT colonography has advantages over the well-documented limitations of colonoscopy/barium enema. This prospective blinded investigative comparison trial aimed to evaluate the ability of VC to assess the large bowel, compared to conventional colonoscopy (CC), in patients at high risk of colorectal cancer (CRC). Method, We studied 150 patients (73 males, mean age 60.9 years) at high risk of CRC. Following bowel preparation, VC was undertaken using colonic insufflation and 2D-spiral CT acquisition. Two radiologists reported the images and a consensual agreement reached. Direct comparison was made with CC (performed later the same day). Interobserver agreement was calculated using the Kappa method. Postal questionnaires sought patient preference. Results, Virtual colonoscopy visualized the caecum in all cases. Five (3.33%) VCs were classified as inadequate owing to poor distension/faecal residue. CC completion rate was 86%. Ultimately, 44 patients had normal findings, 44 had diverticular disease, 11 had inflammatory bowel disease, 18 had cancers, and 33 patients had 42 polyps. VC identified 19 cancers , a sensitivity and specificity of 100% and 99.2% respectively. For detecting polyps > 10 mm, VC had a sensitivity and specificity (per patient) of 91% and 99.2% respectively. VC identified four polyps proximal to stenosing carcinomas and extracolonic malignancies in nine patients (6%). No procedural complications occurred with either investigation. A Kappa score achieved for interobserver agreement was 0.777. Conclusion, Virtual colonoscopy is an effective and safe method for evaluating the bowel and was the investigation of choice amongst patients surveyed. VC provided information additional to CC on both proximal and extracolonic pathology. VC may become the diagnostic procedure of choice for symptomatic patients at high risk of CRC, with CC being reserved for therapeutic intervention, or where a tissue diagnosis is required. [source] | ||||||||||||||||||||||