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Anthony C Venbrux

Publications and source records attributed to Anthony C Venbrux.

17 recordsLinked to original sources
PubMed2006

Embolotherapy for pelvic congestion syndrome: long-term results.

PURPOSE: To evaluate the long-term clinical outcome of transcatheter embolotherapy in women with chronic pelvic pain caused by ovarian and pelvic varices. MATERIALS AND METHODS: The study population included consecutive patients referred to a tertiary-care interventional radiology service from 1998 to 2003 because of a high degree of clinical suspicion of pelvic and ovarian varices. Visual analog scales and questionnaires during clinic visits were used to measure pain perception levels. Basal female hormonal levels were obtained and compared. RESULTS: Of 131 patients referred (mean age, 34.0 years+/-12.5), percutaneous transfemoral venography confirmed the presence of ovarian varices in 127 (97.0%), all of whom were treated with embolotherapy. Internal iliac embolotherapy was performed in 108 of 127 patients (85.0%). Ninety-seven patients completed long-term clinical follow-up (mean 45 months+/-18). The mean pelvic pain level had improved significantly from 7.6+/-1.8 before embolotherapy to 2.9+/-2.8 after embolotherapy (P<.0001). Significant improvement in each category of specific symptoms was also noted (P<.0001). Overall, 83% of the patients exhibited clinical improvement at long-term follow-up, 13% had no significant change, and 4% exhibited worsened condition. No significant change was noted in hormone levels after embolotherapy. Two successful pregnancies were noted after ovarian and pelvic vein embolotherapy. CONCLUSION: Direct venographic evaluation with embolotherapy can achieve significant improvement in pain perception levels in patients with chronic pelvic pain caused by pelvic venous congestion.

Adult↗
PubMed2005

Intravascular bullet migration: a report of two cases.

In the trauma setting, penetrating vascular injuries secondary to gunshot wounds need to be addressed promptly and carefully. By identifying the entry and exit sites, the pathway of injury can usually be determined. Vessel injury is typically related to direct vascular trauma or secondary blast injury. On rare occasions, the involved vessels can serve as conduits, transporting projectiles to various locations remote from the entry wounds. The cases described demonstrate different manifestations of bullet embolism within the arterial and venous systems. We provide a literature review and we discuss therapeutic options available in these unique scenarios.

Adolescent↗
PubMed2004

Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy: a decade of experience.

BACKGROUND: The 1990s were associated with a dramatic increase in bile duct injuries with the widespread use of laparoscopic cholecystectomy (LC). Interventional radiology has an integral role in diagnosing and managing these injuries. Definitive percutaneous management with balloon dilatation might be possible in select patients with intact biliary-enteric continuity, but longterm data are limited. STUDY DESIGN: Data were collected prospectively on 51 consecutive patients with major bile duct stricture or injury associated with LC, treated with percutaneous management, January 1, 1990, to December 31, 1999. Percutaneous transhepatic cholangiography and biliary catheter placement were followed by balloon dilatation and stenting. Outcomes were assessed with direct patient contact or hospital records. RESULTS: All patients completed treatment, and 50 (98%) were stent free at mean followup of 76 months. The success rate of percutaneous management was 58.8%, without need for subsequent intervention. Presenting symptoms, level of injury, and number of stents or dilatations did not predict outcomes. Percutaneous treatment was more likely to fail in patients stented for less than 4 months (p < 0.001). Operative repair at Hopkins before percutaneous management was predictive of a successful outcome (p < 0.05). Including subsequent operations or percutaneous management, successful outcomes were achieved in 98% of patients. CONCLUSIONS: Major bile duct injuries after LC remain a clinical challenge. Although surgical reconstruction is the treatment cornerstone, selected patients with biliary-enteric continuity can achieve successful long-term results with definitive percutaneous management. The combination of percutaneous management and surgical reconstruction results in successful outcomes in virtually all patients.

Adult↗
PubMed2003

An evaluation of commonly employed central venous catheter kits and their potential risk for complications of excess guidewire introduction.

STUDY OBJECTIVE: To evaluate the components of commonly used central venous catheter kits with respect to the potential for guidewire-mediated complications during catheter placement.Prospective, nonrandomized, observational study. SETTING: Six academic hospitals across the United States. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 30 commercially manufactured catheter kits (15 tunneled, 15 nontunneled) were opened and evaluated. The catheter or sheath to be introduced was measured and a corresponding ideal guidewire length was calculated. The ideal length was then compared to the actual length, and differences were tabulated. Wire tip configuration and the presence and pattern of distance markings were recorded and, in conjunction with the catheter and wire length discrepancies, were used to grade the relative risk of introducing excess guidewire during catheter placement. Of 30 kits evaluated, 14 (46.7%) had guidewires more than 20 cm longer than necessary. The mean excess wire length was 15 cm (range: 8 to 55 cm) and did not differ significantly between tunneled and nontunneled catheter kits. Only 10 kits (33.3%) had distance markings of any type, and there was no standardization among them; none corresponded to previously published recommendations. There was potential risk of excess wire introduction in 18 catheter kits, of which seven were nontunneled devices designed for bedside placement. CONCLUSIONS: The design of commonly employed central venous access catheter kits is such that there is a mismatch between guidewire and catheter length and a general lack of guidewire markings. We believe that these designs may predispose to the introduction of excess guidewire and result in guidewire-mediated complications during catheter placement. This risk can likely be reduced by matching the guidewires to the devices placed over them and by standardizing guidewire distance markings.

Catheterization, Central Venous↗
PubMed2003

Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications.

Although the mortality rate after pancreaticoduodenectomy has decreased, the morbidity rate remains high. Major morbidity is often managed with the aid of interventional radiologists. The objective of this study was to evaluate the cooperative roles of interventional radiologists and pancreatic surgeons in complex pancreatic surgery, specifically pancreaticoduodenectomy. Our pancreaticoduodenectomy database was reviewed for all patients undergoing pancreaticoduodenectomy between January 1, 1995 and December 31, 2000. The interventional radiologic procedures for each patient were evaluated. A total of 1061 patients underwent pancreaticoduodenectomy. The overall mortality and morbidity rates were 2.3% and 35%, respectively. Five hundred ninety patients (56%) had no interventional radiologic procedures, whereas 471 patients (44%) had interventional radiologic procedures. Of those, 342 (32%) had preoperative biliary drainage (PBD) and 129 (12%) required postoperative interventional radiologic procedures. Percutaneous aspiration/catheter drainage was required in 84 patients for intra-abdominal abscess, biloma, or lymphocele, with 24 requiring two or more abscess drains. Thirty-nine patients underwent postoperative PBD for bile leaks due to anastomotic disruption, undrained biliary segments, or T-tube/bile stent dislodgment. Eighteen patients had hemobilia/gastrointestinal bleeding treated by angiography with embolization. The reoperation rate for the entire cohort of 1061 patients was 4.1% (n = 43). Nineteen of the 129 patients (15%) requiring postoperative radiologic intervention required reoperation. Although 4 of 18 patients who required embolization for bleeding subsequently required surgical intervention for the same reason, only 4 of 84 patients undergoing abscess drainage later required operation for anastomotic disruption or unsuccessful percutaneous drainage. As would be expected, the patients who required postoperative radiologic intervention (n = 129) had a higher incidence of postoperative complications including pancreatic fistula (20% vs. 6%, P < 0.01), bile leakage (22% vs. 1%, P < 0.01), and wound infection (16% vs. 8%, P < 0.01). With the complications in these 129 patients, the postoperative mortality rate was only 6.2% compared to 1.7% in patients who did not require radiologic intervention (n = 932, P < 0.01). The median postoperative length of stay was 15 days in those patients requiring postoperative radiologic intervention, 10 days in those not requiring intervention (P < 0.01; postoperative interventional radiology vs. no postoperative interventional radiology), and 29.5 days for patients needing reoperation. Interventional radiologists play a critical role in the management of some patients undergoing pancreaticoduodenectomy. Although complications such as anastomotic leaks, abscess formation, and bleeding can result in increased mortality and a longer hospital stay, the skills of the interventional radiology team provide expert management of some life-threatening complications, thus avoiding reoperation, speeding recovery times, and minimizing morbidity.

Adenocarcinoma↗
PubMed2003

Image-guided percutaneous radiofrequency ablation for osteoid osteomas.

The authors present a retrospective analysis of the technical and clinical successes, complications, and clinical follow-up of image-guided percutaneous radiofrequency (RF) ablation of osteoid osteomas. Nine patients with osteoid osteomas underwent image-guided localization of osteoid osteomas. Outpatient percutaneous therapy (13 procedures) was performed under general anesthesia after image-guided localization of the nidus. Initial technical success was achieved in seven of nine patients. Two initial technical and clinical failures occurred early in this experience because of failure to adequately enter the nidus with use of fluoroscopic imaging alone. Clinical success was achieved in eight of nine patients. No major immediate or delayed complications were observed.

Adolescent↗
PubMed2003

A new optional vena cava filter: retrieval at 12 weeks in an animal model.

PURPOSE: To test the feasibility and safety of percutaneous retrieval of a new inferior vena cava (IVC) filter, the Recovery Filter (RF), acutely and after 12-week implantation in sheep. MATERIALS AND METHODS: The RF is a bilevel filter with stabilizing arms and elastic hooks that allow retrieval with a unique retrieval cone after incorporation into the wall of the IVC. Twenty-four filters were placed in the infrarenal IVCs of 18 sheep. In six sheep, two filters were placed and then removed immediately; three sheep were killed acutely and three were killed after a healing period of 3 weeks. In 12 sheep, a single filter was placed and then removed 12 weeks later; six were killed after retrieval and six were killed after an 8-week healing period. RESULTS: The mean (+/-SD) transverse vena caval diameter was 15.3 mm +/- 2. All filters were deployed as intended and retrieved without difficulty. At sacrifice, there was no evidence of IVC perforation or retroperitoneal abnormality. The IVCs of the animals in the acute retrieval group showed minimal acute superficial injury that was largely reversed at 3 weeks. At 12 weeks, there was evidence of transmural incorporation of filter elements with narrowing of the IVCs. Solitary fibrotic abnormalities were present in the aorta adjacent to IVC lesions in nine of the 12 animals in the 12-week group. The IVC and aortic abnormalities were largely healed, with reversal of IVC narrowing after 8 weeks. CONCLUSION: The recovery filter can be reliably and safely retrieved acutely and 12 weeks after implantation in sheep.

Animals↗
PubMed2003

Rapid parathyroid hormone analysis during venous localization.

OBJECTIVE: To determine the usefulness of the rapid parathyroid hormone (PTH) assay during venous localization for primary hyperparathyroidism (1 degrees HPTH). SUMMARY BACKGROUND DATA: Remedial exploration for persistent 1 degrees HPTH poses a significant challenge when noninvasive preoperative localization studies are negative. Based on experience with the intraoperative rapid PTH assay, this technique was extrapolated to the interventional radiology suite and generated near real-time data for the interventional radiologist employing on-site hormone analysis, with a 12-minute turnaround time from blood sampling to assay result. METHODS: Between November 1997 and July 2002, 446 patients with 1 degrees HPTH were referred for treatment. Of these, 56 (12.5%) represented remedial patients who had each undergone one or more previous cervical explorations. Noninvasive imaging studies were positive for or suggestive of localized disease in 49/56 (87.5%) of these patients, who therefore proceeded directly to surgical exploration. Seven patients with persistent 1 degrees HPTH and negative noninvasive studies underwent selective venous sampling employing a rapid PTH assay in the interventional suite. RESULTS: Venous localization demonstrated an apparent PTH gradient in six of the seven patients. In three, a subtle gradient demonstrated in near real-time prompted additional sampling, which confirmed an unequivocal hormone gradient. In an additional case, the absence of a gradient on initial sampling prompted further sampling, which was positive. All of the patients were explored, and in five of the six patients with a positive PTH gradient, a parathyroid adenoma (mean weight 636 +/- 196 mg) was resected from a location predicted by venous localization. In the sixth patient with a positive gradient, parathyroid tissue was not identified; however, there was a significant fall in the intraoperative PTH values, and immediate postoperative and follow-up laboratory data at 1 month are indicative of a cure. In the one patient with negative localization, abnormal parathyroid tissue could not be located during surgical exploration. CONCLUSIONS: The rapid PTH assay is a major adjunct for obtaining informative venous localization in patients with persistent 1 degrees HPTH. This information is extremely helpful to the surgeon in this challenging group of patients and resulted in a 100% cure rate when a venous gradient was demonstrated. The authors now employ this technique routinely in remedial patients with negative noninvasive imaging studies.

Adenoma↗
PubMed2002

Percutaneous removal of a fractured endostent remnant from the portal vein.

We report the case of a liver transplant patient who developed a biliary stricture 3 years postoperatively which was treated with an endostent. During endoscopic removal, the stent fractured and a portion of it lodged itself within the intrahepatic portion of a portal vein branch. The endostent fragment was retrieved percutaneously using interventional radiology techniques. Risk factors for endostent fracture and migration as well as various percutaneous retrieval methods are reviewed in this article.

Blood Vessel Prosthesis↗
PubMed2002

Experimental evaluation of a new transcatheter vascular embolization device in the swine model.

PURPOSE: To evaluate a new transcatheter device suitable for arterial embolization in an animal model. MATERIALS AND METHODS: A new prototype self-expanding braided embolic device (Embolizor), consisting of nitinol wire strands fixed at either end with platinum-iridium bands and covered with a film of polyethylene, was deployed through 5-F diagnostic catheters into renal artery branches in five swine. Standard stainless-steel spring coils were deployed in other renal branches and served as controls. The animals underwent follow-up selective renal arteriography to determine presence or absence of vessel recanalization or device migration 15-23 days after device deployment. Histopathologic evaluation of target vessels and peripheral renal parenchyma was also performed. RESULTS: Ten Embolizors and 10 stainless-steel coils were deployed in arteries ranging in size from 1.8 to 3.0 mm in diameter. The Embolizor was easily and precisely deployed. Angiographic evidence of vascular occlusion in the Embolizor group was noted within 30 seconds in eight device deployments and within 5 minutes in two. No early or delayed device migration was noted on follow-up arteriography. In the control group, seven of 10 previously occluded arteries were recanalized. No recanalization was noted in the Embolizor group. Light microscopy revealed evidence of infarction in all specimens examined. Whereas three specimens in the Embolizor group contained occasional giant cells, there were numerous multinucleated giant cells present within the interstices of all control spring coils. CONCLUSION: The Embolizor was easily, precisely, and successfully deployed through standard selective diagnostic angiographic catheters. Short-term follow-up demonstrated no recanalization or migration of the device. The Embolizor was shown on histopathologic analysis to have no significant foreign body reaction.

Alloys↗
PubMed2002

Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain.

PURPOSE: The purpose of this study was to analyze the impact of transcatheter embolotherapy on pain perception and menstrual cycle in women with chronic pelvic pain caused by the presence of ovarian and pelvic varices (ie, women with pelvic congestion syndrome or pelvic venous incompetence). MATERIALS AND METHODS: From July 1998 to August 2000, 56 patients (mean age, 32.3 y) were treated for chronic pelvic pain. Diagnostic venography of the ovarian veins was followed by transcatheter embolotherapy with a sclerosing agent and coils. A second session was completed to embolize the internal iliac veins in 43 of 56 patients. Visual analog scales (VAS) used to measure pain were administered before embolization and at 3-, 6-, and 12-month follow-up. Questionnaires regarding menstrual history were used as part of the postprocedural analysis. RESULTS: Percutaneous transcatheter embolotherapy of ovarian and pelvic varices was technically successful in 56 of 56 patients (100%); three patients developed recurrent varices, two of whom were treated with repeat transcatheter embolotherapy. Two patients, early in the experience, had complications in which coils placed in the internal iliac veins embolized to the pulmonary circulation; the coils were snared without clinical sequelae. On the VAS, the mean baseline pain level was 7.8 (range, 3.2-9.8; n = 56); at 3-month follow-up, it was 4.2 (range, 0.0-7.2; n = 56); at 6 months, 3.8 (range, 0.0-6.7; n = 41); and at 12 months, 2.7 (range, 0.0-6.9; n = 32). Differences were significant (P <.001) between baseline pain levels and those at all follow-up intervals (ie, 3, 6, and 12 months). The mean decrease in VAS was 5.1 (65% decrease). The clinical follow-up in this series ranged between 6 and 38 months; the mean was 22.1 months. Regarding the impact of embolization on menstruation, all 24 patients responding to questionnaires indicated no change in menstrual cycle. CONCLUSION: For patients with ovarian/internal iliac varices, transcatheter embolotherapy provides a nonsurgical treatment option. There is a significant decrease in pain based on VAS without any notable impact on menstrual cycle.

Adolescent↗