| 1. |
- Karlson, Britt-Marie, et al.
(författare)
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Intraarterial chemoembolisation with lipiodol and epirubicin in hepatocellular cancer : improved survival in some patients?
- 1999
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Ingår i: Annales Chirurgiae et Gynaecologiae. - 0355-9521. ; 88:4, s. 264-268
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Arterial chemoembolisation with lipiodol and a cytotoxic drug is reported to give equivocal results in irresectable primary hepatocellular cancer (HCC). In order to further elucidate the possible response to this treatment, we analysed the results of all patients with irresectable HCC treated with chemoembolisation at our hospital. MATERIAL AND METHODS: 58 consecutive patients with HCC were treated with lipiodolepirubicin chemoembolisation between February 1988 - October 1994 and followed until death or October 1998. RESULTS: The average survival was 11.7 months and median survival was 6 months. 17 patients had only one treatment mostly due to death within 6 weeks after the first treatment. Patients with an open portal system at inclusion (50% of all) were found to have significantly increased survival after 6 and 12 months compared to those with portal obstruction. The subgroup of patients displaying a decrease in tumour size as judged by repeated CT scan 6 months after inclusion had significantly increased survival; all survived more than 12 months (median survival 30 months). CONCLUSIONS: Chemoembolisation with lipiodol-epirubicin may have an impact on survival on selected patients with irresectable hepatocellular cancer. The treatment may justifiably be offered patients with an open portal venous system and without liver failure.
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| 2. |
- Smedby, Örjan, et al.
(författare)
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Magnetic resonance angiography in the resectability assessment of suspected pancreatic tumours
- 1997
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Ingår i: European Radiology. - 0938-7994 .- 1432-1084. ; 7:5, s. 649-653
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this prospective study was to evaluate MRI, including MR angiography (MRA), in the preoperative assessment of the resectability of suspected malignancy of the pancreas. A total of 17 patients with suspected pancreatic carcinoma and planned surgery were investigated with conventional angiography, ultrasonography with Doppler technique, MRI and MRA. The MRA protocol included both 2D inflow angiography and 3D phase-contrast angiography. Surgery was carried out in 13 patients. The image quality of MRA was judged satisfactory in all cases. The findings with respect to vascular involvement agreed between the radiological methods in all but 3 cases. When the findings were correlated with the final diagnosis, one false-negative case was found for each of the three methods. The results suggest that MRI with MRA, including both the phase-contrast and inflow techniques, has a similar diagnostic value to that of conventional angiography and ultrasonography in the preoperative assessment of the portal venous system in patients with pancreatic carcinoma. Further studies are needed to establish the optimal diagnostic procedure.
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| 3. |
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| 4. |
- Eriksson, B. K., et al.
(författare)
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Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors
- 1998
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Ingår i: Cancer. - 0008-543X .- 1097-0142. ; 83:11, s. 2293-2301
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Patients with neuroendocrine gastrointestinal tumors usually present with inoperable metastatic disease and severe hormonal symptoms. Specific chemotherapy, interferon-alpha (IFN), and somatostatin analogs are established therapies for these patients, but all of them eventually fail. Hepatic arterial embolization can provide reduction of both hormonal symptoms and tumor burden in these patients. METHODS Between 1981 and 1995, a total of 55 liver embolizations with gel foam powder were performed on 41 patients with histopathologically verified neuroendocrine tumors; 29 had carcinoid tumors and 12 had endocrine pancreatic tumors (EPTs). All patients had received medical treatment, including chemotherapy (n = 18), IFN (n = 31), and octreotide (n = 19), and were experiencing treatment failure when liver embolization was performed at a median of 37 months after diagnosis of liver metastases. Medical treatment was continued after embolization. RESULTS An overall objective response was noted in 15 of 29 patients with carcinoid tumors (52%). The median duration of effect was 12 months in patients with midgut carcinoid tumors. An overall objective response was observed in 6 of 12 patients with EPTs (50%), with a median duration of effect of 10 months. Adverse events were observed, and, in agreement with earlier reports, the rate of serious complications was 10%. Survival analyses showed a median survival of 80 months and a 5-year survival rate of 60% from the performance of embolization on patients with midgut carcinoid tumors, whereas for patients with EPTs the median survival from embolization was only 20 months. CONCLUSIONS Liver embolizations performed relatively late in the clinical course in our series appeared to be as effective as "early" embolizations in other series of patients with carcinoid tumors. The results for those with EPTs were poorer, and earlier embolizations may result in better outcomes for these patients. Considering the morbidity associated with the procedure, it is imperative to select patients according to extent of liver involvement, severity of carcinoid heart disease, and somatostatin receptor status.
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| 5. |
- Karacagil, Sadettin, et al.
(författare)
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Value of duplex scanning in evaluation of crural and foot arteries in limbs with severe lower limb ischaemia : a prospective comparison with angiography
- 1996
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1078-5884 .- 1532-2165. ; 12:3, s. 300-303
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare Duplex scanning with angiography for evaluation of crural and pedal arteries in limbs with lower limb ischaemia. DESIGN: The findings obtained during Duplex scanning and angiography were prospectively compared in a blinded manner. SETTING: Departments of Surgery, Diagnostic Radiology and Clinical Physiology, University Hospital. MATERIALS: Duplex scanning and selective angiography of femoropopliteal, crural and foot arteries were performed in 40 limbs (38 patients, 480 segments) with intermittent claudication (n = 6), rest pain (n = 13) and ulcer/gangrene (n = 19). Each arterial segment were graded into four categories: normal, < or = 50% diameter reduction, > 50% diameter reduction and occlusion. Pedal arteries were evaluated as patency or occlusion of dorsal pedal artery and plantar arch. Chief outcome measures: Accuracy (AC), sensitivity (SE), specificity (SP), positive predictive (PPV), negative predictive (NPV) and kappa values. MAIN RESULTS: The Duplex scanning of the tibioperoneal trunk, crural and pedal arteries had an accuracy of 80% (kappa = 0.6). The SE, SP, PPV and NPV values were 83%, 77%, 79% and 81%, respectively. The SP was relatively low for the peroneal artery (58%) compared to the others. CONCLUSIONS: The results demonstrate the feasibility and reliability of Duplex scanning in detecting crural and pedal artery lesions in lower limbs with severe ischaemia.
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| 6. |
- Liss, Per, et al.
(författare)
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Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention : a prospective, randomized study
- 2005
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Ingår i: Journal of Vascular and Interventional Radiology. - 1051-0443 .- 1535-7732. ; 16:1, s. 57-65
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: CO2 gas has been proposed for use instead of iodinated contrast media in angiographic examinations in patients at risk of developing renal failure from contrast media. The influence of intraarterial injection of CO2 with small added amounts of ioxaglate (200 mgI/mL) or ioxaglate alone on renal function in patients with suspected renal artery stenosis was studied in a prospective, randomized study. MATERIALS AND METHODS: One hundred twenty-three patients underwent renovascular intervention (n = 83) and/or renal angiography (n = 40) for suspected renal artery stenosis. Patients with a serum creatinine concentration less than 200 micromol/L (n = 82) were randomized prospectively to receive CO2 with small added amounts of ioxaglate (n = 37) or only ioxaglate (n = 45). Patients with serum creatinine levels greater than 200 micromol/L (n = 41) were not randomized and initially received CO2. Serum creatinine concentrations were measured within 1 day before and 1 day, 2 days, and 2-3 weeks after the procedure. RESULTS: The amount of injected CO2 did not relate to an increase in serum creatinine level. In the randomized groups, and also when the whole patient sample was considered, the amount of injected iodine was significantly correlated (P = .011) with an increase in serum creatinine level and a decrease in estimated creatinine clearance after 2 days. Among the randomized patients, one in the CO2 group and three in the ioxaglate group had a more than 25% increase in serum creatinine level within the first 2 days after the intervention. CONCLUSION: The risk of impairment of renal function is lower after injection of CO2 with small amounts of added ioxaglate compared with injection of a larger amount of ioxaglate alone. The larger the amount of administered iodinated contrast medium, the greater the risk of development of renal failure.
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| 7. |
- Löfberg, Anne-Marie, et al.
(författare)
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Distal percutaneous transluminal angioplasty through infrainguinal bypass grafts
- 2002
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 23:3, s. 212-219
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Tidskriftsartikel (refereegranskat)abstract
- AIM: to evaluate the results of transluminal angioplasty (PTA) performed through infrainguinal bypass grafts for stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries. Design: retrospective clinical study. MATERIAL AND METHODS: forty-one patients underwent 57 procedures at the distal anastomosis (n=13), in the runoff arteries (n=32) or at both locations (n=12) at a median of 9.6 months (range, 2-76 months) after infrainguinal bypass grafting. Nineteen procedures were on the popliteal artery, the rest on the crural arteries. Eleven procedures related to occlusions less than 5 cm in length. RESULTS: technical success was achieved in 91%. Primary and primary assisted graft patency rates at 3 years were 32% and 53%, respectively. There were no significant differences in patency rates with regard to the graft material, the type of lesion, the level of PTA, the status of runoff and the use of thrombolysis before PTA. No patients underwent amputation as a direct consequence of failed PTA or graft occlusion. One patient underwent acute surgical intervention due to graft occlusion at the time of attempted PTA. CONCLUSION: the results of PTA at the distal anastomosis and/or in the runoff arteries in limbs with infrainguinal bypass seemed to be inferior to the results of surgical revisions reported in literature. However, as failed PTA did not jeopardise vein-patch angioplasty or jump grafting, it is a reasonable alternative to surgical intervention in selected cases.
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| 8. |
- Löfberg, Anne-Marie
(författare)
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Infrainguinal Percutaneous Transluminal Angioplasty in Limbs with Severe Lower Limb Ischaemia
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Infrainguinal bypass grafting is an established method in the treatment of patients with femoropopliteal and crural occlusive disease leading to critical lower limb ischaemia (CLI). However, complications related to surgical procedure are not negligible and percutaneous transluminal angioplasty (PTA) has emerged as an alternative. The present thesis covers some aspects of infrainguinal PTA in patients with chronic severe lower limb ischaemia.The records of 217 patients undergoing 272 PTA procedures at various infrainguinal arterial segments were analysed. The indication for intervention was subcritical ischaemia in 76 limbs and critical ischaemia in 177 limbs. The role of duplex ultrasound examination in the selection of patients for PTA was retrospectively evaluated following a prospective validation of the method against angiography.A technically successful PTA was achieved in 89%. The overall 30-day mortality was 2.7%. No patient underwent amputation directly related to failed PTA. The primary success rates at 12 and 60 months following femoropopliteal PTA were 40% and 27% compared, to 51% and 36% in limbs undergoing crural artery PTA. Primary success rate in limbs with SFA occlusion longer than 5 cm was only 12% after 5 years, compared to 32% if the occlusion was equal or less than 5 cm in length (p<0.01). In patients undergoing distal PTA through patent infrainguinal grafts, the primary and primary assisted patency rates at 3 years were 32% and 53%, respectively. The sensitivity of duplex scanning in the selection of lesions for PTA was less satisfactory in the popliteal and crural arteries compared to the superficial femoral arteries.In conclusion, the results of infrainguinal PTA performed for treatment of subcritical or CLI seemed to be inferior to the results of surgical interventions reported in the literature. However, due to the fact that the PTA procedure does not preclude the performance of bypass grafting, it might be an alternative to surgical intervention in limbs with stenotic or short occlusive lesions.
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| 9. |
- Löfberg, Anne-Marie, et al.
(författare)
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Percutaneous transluminal angioplasty of the femoropopliteal arteries in limbs with chronic critical lower limb ischemia
- 2001
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Ingår i: Journal of vascular surgery. - : Elsevier BV. - 0741-5214. ; 34:1, s. 114-121
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the study was to evaluate the results of percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries in patients with subcritical or critical lower limb ischemia. Materials and Methods: Ninety-two patients underwent 121 PTA procedures, 68 were of the superficial femoral artery (SFA), 13 of the popliteal and 40 of both arteries. Fifty-seven procedures were performed for treatment of occlusions. Eighty-four patients (94 procedures) were monitored with duplex scanning. RESULTS: Technical success rate was 88%. Primary success rates at 12 and 60 months in the whole series were 40% and 27%, respectively. The primary success rate in limbs with SFA occlusion of longer than 5 cm was only 12% after 5 years compared with 32% if the occlusion was CONCLUSION: The results of femoropopliteal PTA performed for treatment of subcritical or critical lower limb ischemia seemed to be inferior to the results of infrainguinal bypass grafting reported in literature. However, because the PTA procedure does not preclude the performance of bypass grafting, it might be an alternative to surgical intervention in limbs with stenotic femoropopliteal lesions. PTA might also be considered in patients with high surgical risk and limited life expectancy, having short occlusive lesions (< 5 cm).
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| 10. |
- Löfberg, Anne-Marie, et al.
(författare)
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The role of duplex scanning in the selection of patients with critical lower-limb ischemia for infrainguinal percutaneous transluminal angioplasty
- 2001
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Ingår i: Cardiovascular and Interventional Radiology. - : Springer Science and Business Media LLC. - 0174-1551 .- 1432-086X. ; 24:4, s. 229-232
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate the role of duplex scanning in the selection of patients with critical lower-limb ischemia (CLI) for infrainguinal percutaneous transluminal angioplasty (PTA). METHODS: One hundred and sixty-two limbs with CLI (150 patients) that underwent duplex scanning within 3 months prior to conventional diagnostic angiography (n = 88) or infrainguinal PTA (n = 74) were retrospectively studied. The findings obtained from duplex scanning and angiography were analyzed in a masked fashion by two different investigators. RESULTS: The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning in the selection of patients for infrainguinal PTA were 86%, 84%, 89%, 86%, and 87% respectively. Forty-two procedures (57%) were performed at multiple arterial segments. The accuracy of duplex scanning in the selection of femoropopliteal and crural lesions for PTA was over 85%. However, the sensitivity of duplex scanning in the selection of popliteal and crural lesions for PTA was 49% and 38% respectively, compared with 80% for superior femoral artery lesions. In 39% of patients who were correctly selected for PTA, duplex scanning misdiagnosed one of the multiple lesions treated by PTA. CONCLUSION: Duplex scanning can safely be used for the selection of patients for infrainguinal PTA. The sensitivity of duplex scanning in the selection of lesions for PTA was less satisfactory in the popliteal and crural arteries compared with the femoropopliteal arteries.
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