Percutaneous Cryoablation for Renal Cell Carcinoma

Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. Nephron sparing resection (partial nephrectomy) has been the “gold standard” for the treatment of resectable disease. With the widespread use of cross sectional imaging techniques, more cases of renal cell cancers are detected at an early stage, i.e. stage 1A or 1B.  This has provided an impetus for expanding the nephron sparing options and especially, percutaneous ablative techniques.  Percutaneous ablation for RCC is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection or when there is a need to preserve renal function due to comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. During the last few years, percutaneous cryoablation has been gaining acceptance as a curative treatment option for small renal cancers. Clinical studies to date indicate that cryoablation is a safe and effective therapeutic method with acceptable short and long term outcomes and with a low risk, in the appropriate setting.  In addition it seems to offer some advantages over radio frequency ablation (RFA) and other thermal ablation techniques for renal masses

Καινοτόμες θεραπείες επεμβατικής ογκολογίας

Εισαγωγή: Η επεμβατική ογκολογία αποτελεί μία ταχέως εξελισσόμενη ειδικότητα που προσφέρει καινοτόμες, ελάχιστα επεμβατικές θεραπείες στους ογκολογικούς ασθενείς. ‘Οσο αφορά τον ορθοκολικό καρκίνο, η επεμβατική ογκολογία έχει σημαντικό ρόλο στη θεραπεία της μεταστατικής νόσου του ήπατος, μέσω της διαδερμικής καταστροφής των μεταστάσεων και τον τοπικό έλεγχο της μεταστατικής ηπατικής νόσου με ενδαρτηριακές θεραπείες. Η διαδερμική θερμική κατάλυση με μικροκύματα (MWA) είναι μια σχετικά καινούρια μέθοδος θερμικής κατάλυσης που παρουσιάζει αυξανόμενη δημοτικότητα λόγω των πλεονεκτημάτων της έναντι της κατάλυσης με ραδιοσυχνότητες (RFA). Λόγω του ότι οι ενδείξεις υπεροχής του έναντι του RFA είναι υπαρκτές, παρά την έλλειψη σαφούς οριοθέτησης της χρήσης του, το MWA τείνει να χρησιμοποιείται ολοένα και περισσότερο σε παγκόσμια κλίμακα. Σκοπός: Σκοπός της παρούσας διατριβής αποτελεί καταρχήν η εκτίμηση της αποτελεσματικότητας και της ασφάλειας του διαδερμικού θερμικού καυτηριασμού με μικροκύματα σε ασθενείς με ορθοκολικό καρκίνο και ολιγομεταστατική νόσο εντοπιζόμενη στο ήπαρ, στα πλαίσια της κλινική πράξης. Επιπρόσθετα, αναλύεται η επιβίωση των ασθενών και οι δυνητικοί παράγοντες που την επηρεάζουν επί συνόλου πληθυσμού Ελλήνων ασθενών πασχόντων από μεταστατικό ορθοκολικό καρκίνο. Υλικό και Μέθοδος: Από τον Αύγουστο του 2012 έως και τον Σεπτέμβριο του 2018 μελετήθηκαν 32 ασθενείς με μετάχρονες ηπατικές μεταστάσεις από ορθοκολικό καρκίνο, οι οποίοι ήταν ακατάλληλοι για χειρουργική εκτομή ή ασθενείς που αρνήθηκαν χειρουργική αντιμετώπιση (συν:4). ‘Ολοι οι ασθενείς υποβλήθηκαν σε διαδερμικό καυτηριασμό με MW υπό αξονική καθοδήγηση. Αποτελέσματα: Στο σύνολο αντιμετωπίστηκαν 58 μεταστάσεις σε 45 συνεδρίες καυτηριασμού. Πρωτογενής τoπικός έλεγχος της νόσου επιτεύχθηκε σε 91,3% (53 από 58) των μεταστάσεων. Δευτερογενής τοπικός έλεγχος της νόσου επιτεύχθηκε σε 100% των ηπατικών αλλοιώσεων που υποβλήθηκαν σε δεύτερη συνεδρία καυτηριασμού άμεσα. Πλήρης νέκρωση επιτεύχθηκε σε 49/58 (84,4%) των ηπατικών αλλοιώσεων. Η περίοδος παρακολούθησης των ασθενών διήρκησε 5 έτη. Η συνολική επιβίωση στα 1, 3 και 5 χρόνια ήταν 96,8%, 68,7% και 34,3% αντίστοιχα. Αναδείχθηκε στατιστικά σημαντική διαφορά 5-ετούς συνολικής επιβίωσης μεταξύ των ασθενών με μονήρη ηπατική μετάσταση (συν=13) και των ασθενών με περισσότερες (συν=12) ηπατικές μεταστάσεις. Επίσης ασθενείς με τουλάχιστον μία μετάσταση διαμέτρου >2εκ εμφάνισαν στατιστικά σημαντικά μικρότερη επιβίωση ελεύθερης νόσου έναντι των ασθενών με ηπατικές μεταστάσεις <2εκ κατά την αρχική εμφάνιση. Συμπεράσματα: Ο διαδερμικός καυτηριασμός με MW αποτελεί μία ασφαλή και αποτελεσματική μέθοδο για την αντιμετώπιση ηπατικών μεταστάσεων από ορθοκολικό καρκίνο με συγκρίσιμα ποσοστά 5-ετούς επιβίωσης με αυτά της χειρουργικής εκτομής.Interventional oncology is developing rapidly as a result of advances in imaging and medical devices. Its role in the treatment of oncologic patients is expanding with various treatment options that offer locoregional therapies. Colorectal cancer is a leading cause of death both in Europe and worldwide. Unfortunately, 20%-25% of patients with colorectal cancer already have metastases at the time of diagnosis while 50–60% of the remainder will develop metastases later during the course of the disease. Although hepatic excision is the first-line treatment for patients with liver limited colorectal metastases and is reported to prolong the survival of these patients, only few patients are candidates. Locoregional therapies encompass minimally invasive techniques practiced by interventional radiology. Most widely used locoregional therapies include ablative treatments (radiofrequency ablation, microwave ablation) and transcatheter intra-arterial therapies (transarterial chemoembolization, and radioembolization with yttrium 90)

Transjugular intrahepatic portosystemic shunt for the treatment of Budd-Chiari syndrome patients : results from a single center

Purpose: To evaluate the outcome of transjugular intrahepatic portosystemic shunt (TIPS) in patients with Budd-Chiari syndrome (BCS). Patients and methods: Fourteen patients (11 female, mean age 45.8 years), with symptomatic BCS refractory to conventional therapy, were treated with TIPS placement in our department within a period of 9 years. Stent grafts were primarily used in 12 patients. Mean follow-up time was 38.1 ± 36.1 months (range 7-114). Model for end-stage liver disease (MELD) score, BCS Rotterdam index, and Child-Pugh score were calculated for all patients. In addition, the recently suggested BCS-TIPS prognostic index score (BSC-TIPS PI) was applied. Results: BCS-TIPS PI score was ≤7 in all patients. Most of our patients (12 of 14) had good or intermediate prognosis according to MELD, Rotterdam and Child-Pugh scores. Technical success was achieved in all 14 patients and was accompanied by complete resolution of the symptoms. In 3 patients, the procedure was complicated by hemoperitoneum, which was successfully treated in two patients with coils or stent-graft placement, whereas 1 patient was managed in the operating room. Thirteen patients are symptom and orthotopic liver transplantation-free. Primary patency was 92.8, 84.7, and 58.7 % at 6, 12, and 24 months, respectively. Secondary patency was 100, 100 and 84.6 % at 6, 12, and 24 months respectively. Conclusion: In symptomatic BCS patients with moderate prognosis according to MELD, Child-Pugh, and BCS Rotterdam scores, as well as BCS-TIPS PI score ≤7, TIPS has high clinical success, low morbidity, and no mortality, and it offers durable mid-term resolution of the symptoms and OLT-free survival.</p

Diagnostyka i leczenie pourazowej przetoki tętniczo-żylnej podudzia – opis przypadku

External injuries are one of the common reasons for reporting to hospital emergency departments. Peripheral vascular injuries occur in up to about 25% of upper and lower extremity injury cases. Arteriovenous fistula is a type of arterial injury. Doppler ultrasound is currently the primary diagnostic method for vascular injuries as it allows for the implementation of appropriately targeted treatment, indicating the potential need for extended diagnosis or patient qualification for endovascular or classical surgery. Endovascular procedures are currently an acknowledged treatment method in peripheral vascular injuries. We present a case of endovascular treatment in a patient with posttraumatic arteriovenous fistula in the lower leg. Patient qualification and treatment efficacy assessment were performed using Doppler ultrasound.Urazy zewnętrzne są jedną z częstszych przyczyn zgłaszania się chorych do szpitalnych oddziałów ratunkowych. Wśród urazów kończyn górnych i dolnych uszkodzenia naczyń obwodowych występują nawet w około 25% przypadków. Jednym z typów uszkodzenia tętnicy jest przetoka tętniczo-żylna. Dopplerowskie badanie ultrasonograficzne stanowi obecnie podstawową metodę w diagnostyce urazów naczyń, pozwala bowiem odpowiednio ukierunkować dalsze postępowanie, wskazując potrzebę ewentualnego rozszerzenia diagnostyki bądź zakwalifikowania chorego na zabieg wewnątrznaczyniowy lub klasyczną operację. W przypadku urazów naczyń obwodowych zabiegi wewnątrznaczyniowe są obecnie uznaną metodą leczenia. Przedstawiamy opis przypadku wewnątrznaczyniowego leczenia chorego z pourazową przetoką tętniczo-żylną podudzia. Kwalifikację do leczenia oraz ocenę jego skuteczności przeprowadzono przy pomocy badania ultrasonograficznego z opcją dopplera

Computed Tomography-Guided Percutaneous Radiofrequency Ablation of the Splanchnic Nerves as a Single Treatment for Pain Reduction in Patients with Pancreatic Cancer

The aim of this paper is to prospectively evaluate the efficacy and safety of percutaneous computed tomography (CT)-guided radiofrequency (RF) neurolysis of splanchnic nerves as a single treatment for pain reduction in patients with pancreatic cancer. Patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication who underwent CT-guided neurolysis of splanchnic nerves by means of continuous radiofrequency were prospectively evaluated for pain and analgesics reduction as well as for survival. In all patients, percutaneous neurolysis was performed with a bilateral retrocrural paravertebral approach at T12 level using a 20 Gauge RF blunt curved cannula with a 1cm active tip electrode. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with numeric visual scale (NVS) units. The mean patient age was 65.4 ± 10.8 years (male-female: 19-11). The mean pain score prior to RF neurolysis of splanchnic nerves was 9.0 NVS units; this score was reduced to 2.9, 3.1, 3.6, 3.8, and 3.9 NVS units at 1 week, 1, 3, 6, and 12 months respectively (p < 0.001). Significantly reduced analgesic usage was reported in 28/30 patients. Two grade I complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. According to the results of the present study, solely performed computed tomography-guided radiofrequency neurolysis of splanchnic nerves can be considered a safe and efficacious single-session technique for pain palliation in patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication. Although effective in pain reduction the technique seems to have no effect upon survival improvement

Diagnosis and treatment of posttraumatic arteriovenous fistula in the lower leg – a case report

External injuries are one of the common reasons for reporting to hospital emergency departments. Peripheral vascular injuries occur in up to about 25% of upper and lower extremity injury cases. Arteriovenous fistula is a type of arterial injury. Doppler ultrasound is currently the primary diagnostic method for vascular injuries as it allows for the implementation of appropriately targeted treatment, indicating the potential need for extended diagnosis or patient qualification for endovascular or classical surgery. Endovascular procedures are currently an acknowledged treatment method in peripheral vascular injuries. We present a case of endovascular treatment in a patient with posttraumatic arteriovenous fistula in the lower leg. Patient qualification and treatment efficacy assessment were performed using Doppler ultrasound

Embolization of iatrogenic renal arteriovenous fistula – a case report

Renal artery pseudoaneurysms and arteriovenous fistulae most often occur as an iatrogenic complication. The article discusses a case of a patient diagnosed with an arteriovenous fistula and a pseudoaneurysm. A 64-year-old woman was admitted to the hospital due to nonspecific pain in the lumbar region. Imaging showed a typical picture of clear cell renal carcinoma. The patient was qualified for surgical treatment. After tumor resection, the patient developed microhematuria. Arteriovenous fistula and renal pseudoaneurysm were diagnosed using Doppler and computed tomography scans. The patient was qualified for arteriography with simultaneous embolization of the lesion. A follow-up evaluation confirmed the exclusion of aneurysm and fistula. Treatment outcomes were monitored using Doppler ultrasound. Doppler ultrasonography is the first method of choice in detecting and monitoring renal artery irregularities. Safety, non-invasiveness and easy access to this tool make it play a key role in the diagnosis of renal artery fistulas and pseudoaneurysms

Embolizacja jatrogennej przetoki tętniczo-żylnej w nerce – opis przypadku

Renal artery pseudoaneurysms and arteriovenous fistulae most often occur as an iatrogenic complication. The article discusses a case of a patient diagnosed with an arteriovenous fistula and a pseudoaneurysm. A 64-year-old woman was admitted to the hospital due to nonspecific pain in the lumbar region. Imaging showed a typical picture of clear cell renal carcinoma. The patient was qualified for surgical treatment. After tumor resection, the patient developed microhematuria. Arteriovenous fistula and renal pseudoaneurysm were diagnosed using Doppler and computed tomography scans. The patient was qualified for arteriography with simultaneous embolization of the lesion. A follow-up evaluation confirmed the exclusion of aneurysm and fistula. Treatment outcomes were monitored using Doppler ultrasound. Doppler ultrasonography is the first method of choice in detecting and monitoring renal artery irregularities. Safety, non-invasiveness and easy access to this tool make it play a key role in the diagnosis of renal artery fistulas and pseudoaneurysms.Pseudotętniaki tętnic nerkowych i przetoki tętniczo-żylne nerek pojawiają się najczęściej jako powikłania jatrogenne. W pracy omówiono przypadek chorej, u której w badaniu ultrasonograficznym i tomografii komputerowej rozpoznano przetokę tętniczo-żylną i tętniaka rzekomego, zlokalizowane w nerce prawej, a następnie leczonej metodami wewnątrznaczyniowymi. Sześćdziesięcioczteroletnia kobieta została przyjęta do szpitala z powodu niespecyficznych dolegliwości bólowych w okolicy lędźwiowej. Badania obrazowe wykazały typowy obraz dla jasnokomórkowego raka nerki. Chorą zakwalifikowano do leczenia chirurgicznego. Po resekcji klinowej u pacjentki obserwowano okresowy krwinkomocz. Za pomocą badania dopplerowskiego i tomografii komputerowej zdiagnozowano przetokę tętniczo-żylną i tętniaka rzekomego nerki prawej. Chorą zakwalifikowano do arteriografii z równoczasową embolizacją. Po zabiegu embolizacji badania kontrolne potwierdziły wyłączenie tętniaka i przetoki z krążenia. Wyniki leczenia monitorowano za pomocą badań dopplerowskich. Ultrasonografia dopplerowska jest metodą z wyboru w wykrywaniu i monitorowaniu nieprawidłowości tętnic nerkowych. Bezpieczeństwo, nieinwazyjność i dostępność badania sprawiają, że odgrywa ono kluczową rolę w diagnozowaniu przetok tętnic nerkowych i pseudotętniaków