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Biomedical subjects

Barbaros E Cil

Publications and source records attributed to Barbaros E Cil.

At least 19 recordsLinked to original sources
PubMed2007

Takayasu arteritis in children: preliminary experience with cyclophosphamide induction and corticosteroids followed by methotrexate.

OBJECTIVE: To review the results of our treatment protocol in the last 7 years. STUDY DESIGN: Six patients (4 girls, 2 boys) with an age range of 12 to 17 years were diagnosed with Takayasu arteritis (TA) during this period. Patients were allocated to receive (1) oral steroids and methotrexate (MTX) (12.5 mg/m(2)/week) if they had disease limited to one side of the diaphragm only without pulmonary disease involvement (two patients); and (2) oral steroids and oral cyclophosphamide (CYC) (maximum total dose 150 mg/kg) followed by oral MTX for maintenance as above if the disease was more widespread (four patients). RESULTS: One patient died of pulmonary vasculitis during the first month of therapy. The remaining three patients with involvement of both the thoracic and abdominal aorta and branches received the second protocol for 12 to 18 months. All entered remission. Aortic bypass, aortorenal bypass, balloon dilatation, and unilateral nephrectomy were performed in these patients. CONCLUSIONS: The presented single-center experience suggests that CYC induction and corticosteroids followed by MTX is an effective and safe treatment for childhood TA.

Administration, Oral↗
PubMed2006

Iatrogenic femoral arteriovenous fistula: endovascular treatment with covered stent implantation and 4-year follow-up.

Puncture site complications such as arteriovenous fistula after femoral arterial catheterizations are becoming more common with the increasing number of endovascular procedures being performed by interventional radiologists and cardiologists. Covered stent placement with endovascular technique for these lesions represents an appealing treatment alternative because it is only minimally invasive and requires less hospitalization and recovery time compared to surgical repair. Herein, we present an adult patient with a post-catheterization deep femoral artery- to-femoral vein fistula, which was successfully treated with a balloon-expandable Jostent peripheral stent-graft placement. Fourth year follow-up angiography showed the covered stent to be patent.

Aged↗
PubMed2005

An unusual presentation of classic polyarteritis nodosa in a child.

Classic polyarteritis nodosa (c-PAN) is a rare disease in adults and extremely rare in children. We report a 3-year-old girl with c-PAN who presented with disturbances of consciousness and hypertension. Cranial tomography showed a subarachnoid hemorrhage. Subsequent magnetic resonance imaging and magnetic resonance angiography demonstrated subarachnoid hemorrhage and acute ischemic lesions. Renal angiography revealed bilateral multiple aneurysms. Due to her constitutional symptoms and hypertension and radiological findings she was diagnosed as having c-PAN. She was successfully treated with hydralazine followed by angiotensin-converting enzyme inhibitor, calcium channel blocker, intravenous pulse methylprednisolone, and subsequently oral prednisolone and oral cyclophosphamide. To our knowledge this is the youngest patient with c-PAN presenting with subarachnoid hemorrhage. Malign hypertension at this young age deserves a meticulous investigation of the vascular origin. Furthermore, treatment with pulse methyl prednisolone followed by oral prednisolone and oral cyclophosphamide is a successful modality of treatment in such a life-threatening presentation of c-PAN in childhood.

Acute Disease↗
PubMed2005

Embolization of a giant pulmonary artery aneurysm from Behcet disease with use of cyanoacrylate and the "bubble technique".

Pulmonary artery aneurysm (PAA) is a common manifestation and leading cause of mortality related to Behcet disease. Endovascular treatment is usually required when medical therapy alone fails to control progression. Successful superselective embolization of a giant PAA with the "bubble technique" was performed with use of a high concentration (75%) of n-butyl-cyanoacrylate in a patient with Behcet disease who had recurrent hemoptysis.

Adolescent↗
PubMed2004

Radiological placement of chest ports in pediatric oncology patients.

A single center's procedural and follow-up results of radiological chest port placement in pediatric oncology patients are presented. Between July 2002 and December 2003, 37 children (20 boys, 17 girls; age range, 4 months to 16 years; mean 6.7 years) underwent chest port placement. All patients received only one port through the internal jugular vein access, and all of the implantations were performed in the interventional radiology suite. Our database and electronic charts were retrospectively reviewed to obtain follow-up data. All chest ports were successfully implanted. The mean catheter life was 223 days (range: 15-450 days), with a total of 8,258 catheter days. Twenty-eight ports are still in use, four patient deceased, one port was prematurely removed because of a late infection, and four patients were lost to follow-up. Infection rate was 2.7% (0.12/1,000 catheter days). Malfunction due to partial catheter thrombosis and fibrin sheath formation was observed in three patients (8.1% or 0.36/1,000 catheter days), and all were relieved with rt-TPA dwell. None of the ports were revised or removed because of blockage, malposition or difficulty accessing the port. The peri-procedural complication rate was 0%. Chest ports in children can be inserted in interventional radiology suites under imaging guidance with high rates of technical success. The rates of infection and complications are comparable to that of surgically placed ports.

Adolescent↗
PubMed2004

[Endosaccular Onyx injection and endovascular treatment with parent artery reconstruction technique in cerebral aneurysms].

PURPOSE: The aim of this study was to test the feasibility and efficacy of the treatment of wide-necked and giant intracranial aneurysms with a new liquid embolic agent. MATERIALS AND METHODS: During injection of Onyx, an occlusion balloon with or without an intracranial stent was inflated in the parent artery. Sixty-seven patients harboring 72 intracranial aneurysms, most of which being giant or wide-necked, were successfully treated with this technique. RESULTS: Seventy of 72 aneurysms were internal carotid artery aneurysms. Of these, 37 were ophthalmic (53%), 18 were cavernous (26%) and 15 were petrous (21%) internal carotid artery aneurysms. One patient had 2 aneurysms located at the basilar and superior cerebellar arteries. Fifty-three aneurysms were treated with the balloon remodelling technique and 19 were treated with the use of an intracranial stent. Recanalisation was found in 8 of 15 giant aneurysms which were treated with the balloon remodelling technique and 3 of these underwent a second treatment in which stents were used. Mortality occurred in 3 patients. CONCLUSION: Onyx embolisation with balloon or stent remodelling technique is a feasible and effective method in the treatment of high-risk giant or wide-necked intracranial aneurysms which are difficult to treat with other endovascular or microsurgical techniques.

Adolescent↗
PubMed2004

Utility of covered stents for extracranial internal carotid artery stenosis.

To our knowledge, the utility of coronary covered stents in the treatment of atherosclerotic carotid artery stenosis has not been defined in the English-language literature. Covered stents may prevent microembolic complications in select atherosclerotic carotid lesions, as they exclude the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Our early clinical experience has shown that use of these stents can be a therapeutic option in select cases of atherosclerotic stenosis of the cervical internal carotid artery.

Aged↗
PubMed2002

Hereditary intraosseous vascular malformation of the craniofacial region: an apparently novel disorder.

Primary intraosseous vascular anomaly, previously called intraosseous hemangioma, is a very rare malformation that is usually seen in the vertebral column and in the skull. It is exclusively described in sporadic cases and no hereditary component has yet been reported. The most commonly affected bones in the skull are the mandible and the maxilla, and life-threatening bleeding after a simple tooth extraction is frequently observed. Here, we report two consanguineous families containing a total of four affected patients manifesting primary intraosseous vascular malformation (VMOS (vascular malformation osseous)) of the craniofacial region. The phenotypic expression is remarkably similar in both families. The characteristic findings include severe blood vessel expansions within the craniofacial bones and midline abnormalities such as diastasis recti, supraumbilical raphe, and hiatus hernia. Malformation is restricted to the mandibular and maxillary area in the prepubertal age, and rapid expansion starts after age 12 or 13. A 15-year follow-up of one of the patients demonstrated that the vascular malformation did not extend beyond the craniofacial region despite severe involvement of almost all bones in the skull. Detailed clinical and radiological evaluation provided neither evidence of soft-tissue involvement nor any sign of gross arterial, venous, or combined malformations, indicating that bone changes are a primary rather than a secondary effect due to any other vascular anomaly in the craniofacial region. An antibody against a universal proliferation marker, Ki-67, detected nonproliferative, single-layered endothelial cells, suggesting that this abnormality is a vascular malformation rather than a hemangioma. alpha-actin staining (antibody against perivascular tissue such as smooth muscle cells (SMCs) and/or pericytes) demonstrated that pathologic vessels lost their surrounding supportive tissues, as was previously seen in other types of vascular anomaly. Homozygosity mapping excluded the following loci and/or genes: multiple cutaneous venous malformation (VMCM1; gene, TIE2) on chromosome 9p21; venous malformation with glomus cells (VMGLOM) on chromosome 1p22-p21; hereditary hemorrhagic telangiectasia type 1 (HHT1; gene, endoglin) and type 2 (HHT2; gene, activin) on chromosomes 9q34.1 and 12q11-q14, respectively; and cerebral cavernous malformation type 1 (CCM1; gene, KRIT1), type 2 (CCM2), and type 3 (CCM3) on chromosomes 7q11.2-q21, 7p15-p13, and 3q35.2-q27, respectively. To the best of our knowledge, this is a new disorder, which we call hereditary intraosseous vascular malformation of the craniofacial region.

Antigens, CD34↗
PubMedDate not supplied

Transhepatic embolization of a recanalized congenital hepatic arterioportal fistula with NBCA and coils.

Congenital hepatic arterioportal fistula is a treatable cause of portal hypertension. Transarterial embolization is a widely accepted endovascular treatment approach. Here, a case of a recanalized congenital hepatic arterioportal fistula after prior transarterial coil embolization that was successfully treated with percutaneous transhepatic embolization with coils and N-butyl 2-cyanoacrylate is reported. The percutaneous transhepatic approach can be an effective alternative for patients with recanalized hepatic arterioportal fistula who have undergone prior transarterial coil embolization, and N-butyl 2-cyanoacrylate can be used as an embolic material in addition to metallic coils to achieve quick and total occlusion.

Arteriovenous Fistula↗
PubMedDate not supplied

Use of the TriSpan coil to facilitate the transcatheter occlusion of pulmonary arteriovenous malformation.

Pulmonary arteriovenous malformation (PAVM) is a rare vascular malformation of the lung which may occur as an isolated entity or in association with hereditary hemorrhagic telangiectasia (HHT). Because of considerable risk of serious complications such as cerebral embolism, brain abscess and pulmonary hemorrhage, definitive treatment should be considered in most patients. Embolization with coils or detachable balloons is currently the preferred treatment. Paradoxical embolization of coils and balloons may happen, especially in patients with PAVMs with large feeding arteries. In this report we present our initial experience with the use of the TriSpan coil to lower the risk of coil migration during the transcatheter occlusion of PAVMs.

Adult↗
PubMedDate not supplied

Successful endovascular treatment of a left common carotid artery aneurysm following failed surgery of a right common carotid artery aneurysm.

Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

Adult↗
PubMedDate not supplied

Percutaneous drainage of 300 intraperitoneal abscesses with long-term follow-up.

The purpose of the study was to evaluate the efficacy of percutaneous drainage of intraperitoneal abscesses with attention to recurrence and failure rates. A retrospective analysis of percutaneous treatment of 300 intraperitoneal abscesses in 255 patients (147 male, 108 female; average age: 38 years; range: 40 days to 90 years) for whom at least 1-year follow-up data were available was performed. Abscesses were drained with fluoroscopic, sonographic, or computed tomographic guidance. Nine abscesses were drained by simple aspiration; catheter drainage either by Seldinger or trocar technique was used in the remaining 291 abscesses with 6F to 14 F catheters. Initial cure and failure rates were 68% (203/300) and 12% (36/300), respectively. Sixty-one abscesses (20%) were either palliated or temporized. The recurrence rate was 4% (12/300) and nine of them were cured by recatheterization, whereas three of them were treated by medication or surgery. The overall success and failure rates were 91% (273/300) and 9% (27/300), respectively, with temporized, palliated, and recatheterized recurred abscesses. The 30-day mortality rate was 3.1% (8/255). The mean duration of catheterization was 13 days. Intraperitoneal abscesses with safe access routes should be drained percutaneously because of high success and low morbidity, mortality, and recurrence rates.

Abscess↗
PubMedDate not supplied

Spontaneous recanalization of superior mesenteric artery occlusion following angioplasty and stenting of inferior mesenteric artery.

An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with a progressively worsening diffuse abdominal pain. Computed tomography scan of the abdomen and angiography revealed occlusion of the origin and proximal portion of superior mesenteric artery. Aortography also showed severe origin stenosis of inferior mesenteric artery and that the distal part of the superior mesenteric artery was supplied by a prominent marginal artery of Drummond. Patient was effectively treated with percutaneous transluminal angioplasty and stenting of the inferior mesenteric artery. Follow-up imaging studies demonstrated patency of the stent and spontaneous recanalization of superior mesenteric artery occlusion.

Aged, 80 and over↗
PubMedDate not supplied

Transformation of a ruptured giant pulmonary artery aneurysm into an air cavity after transcatheter embolization in a Behçet's patient.

Pulmonary artery aneurysms due to Behçet's disease are mainly seen in young males and very rarely in females. To our knowledge there are only 10 cases reported in the related literature. Emergent transcatheter embolization was performed in a female patient with a known history of Behçet's disease in whom massive hemoptysis developed because of rupture of a giant pulmonary artery aneurysm. At 6-month follow-up, transformation of the aneurysm sac into an air cavity was detected. To our knowledge, such a transformation has never been reported in the literature before. Embolization of the pulmonary artery aneurysm and the mechanism of cavity transformation are reviewed and discussed.

Adult↗
PubMedDate not supplied

Distal embolization after stenting of the vertebral artery: diffusion-weighted magnetic resonance imaging findings.

PURPOSE: We retrospectively evaluated our experience with stenting of the vertebral artery in an effort to determine the risk of distal embolization associated with the procedure. METHODS: Between June 2000 and May 2005, 35 patients with 38 stenting procedures for atherosclerotic disease of the vertebral origin in our institution were identified. The average age of the patients was 60.3 years (range 32-76 years). Sixteen of these patients (with 18 stents) had MR imaging of the brain with diffusion-weighted imaging and an apparent diffusion coefficient map within 2 days before and after procedure. RESULTS: On seven of the 16 postprocedural diffusion-weighted MR images, a total of 57 new hyperintensities were visible. All these lesions were focal in nature. One patient demonstrated a new diffusion-weighted imaging abnormality in the anterior circulation without MR evidence of posterior circulation ischemia. Six of 16 patients had a total of 25 new lesions in the vertebrobasilar circulation in postprocedural diffusion-weighted MR images. One patient in this group was excluded from the final analysis because the procedure was complicated by basilar rupture during tandem stent deployment in the basilar artery. Hence, new diffusion-weighted imaging abnormalities were noted in the vertebrobasilar territory in 5 of 15 patients after 17 stenting procedures, giving a 29% rate of diffusion-weighted imaging abnormalities per procedure. No patient with bilateral stenting had new diffusion-weighted imaging abnormalities. CONCLUSION: Stenting of stenoses of the vertebral artery origin may be associated with a significant risk of asymptomatic distal embolization. Angiography, placement of the guiding catheter, inflation of the stent balloon, and crossing the lesion with guidewires or balloon catheters may potentially cause distal embolization. Further studies to evaluate measures to increase the safety of vertebral artery stenting, such as the use of distal protection devices or short-term postprocedural anticoagulation, should be considered for patients with clear indications for this procedure.

Adult↗
PubMedDate not supplied

Management of vertebral stenosis complicated by presence of acute thrombus.

A 44-year-old male presented with multiple punctate acute infarcts of the vertebrobasilar circulation and a computed tomographic angiogram showing stenosis of the right vertebral origin. A digital subtraction angiogram demonstrated a new intraluminal filling defect at the origin of the stenotic vertebral artery where antegrade flow was maintained. This filling defect was accepted to be an acute thrombus of the vertebral origin, most likely due to rupture of a vulnerable plaque. The patient was treated with intravenous heparin. A control angiogram revealed dissolution of the acute thrombus under anticoagulation and the patient was treated with stenting with distal protection. Diffusion-weighted magnetic resonance imaging demonstrated no additional acute ischemic lesions. We were unable to find a similar report in the English literature documenting successful management of an acute vertebral ostial thrombus with anticoagulation. Anticoagulation might be considered prior to endovascular treatment of symptomatic vertebral stenoses complicated by the presence of acute thrombus.

Acute Disease↗