Percutaneous mechanical thrombectomy in acute and subacute lower-extremity ischemia: impact of adjunctive, solely nonthrombolytic endovascular procedures

PURPOSEWe aimed to evaluate the role of adjunctive, solely nonthrombolytic endovascular therapy in treatment of acute lower-extremity ischemia by rotational percutaneous mechanical thrombectomy.METHODSA retrospective, single-center evaluation of 165 patients (167 limbs) that underwent rotational percutaneous mechanical thrombectomy between 2009 and 2016 was performed.RESULTSRotational percutaneous mechanical thrombectomy was used as a single therapy in 9.0% (15 limbs), followed by percutaneous aspiration thrombectomy in 6.0% (10 limbs), percutaneous transluminal angioplasty in 19.8% (33 limbs) and stenting in 25.7% (43 limbs). Rotational percutaneous mechanical thrombectomy was followed by any combination of these three interventions in 39.5%. Clinical and technical success was documented in 92.2%, complications in 10.3% (n=17). No significant difference in clinical and technical success was observed using rotational percutaneous mechanical thrombectomy alone or with additional endovascular therapy. On a long-term basis, the re-ischemia-free survival was nearly twice as high as in previous studies that reported more cases treated by rotational percutaneous mechanical thrombectomy alone.CONCLUSIONTo assure a long-lasting primary patency after percutaneous mechanical thrombectomy, concomitant treatment of underlying lesions with adjunctive, nonthrombolytic endovascular methods should be considered

Percutaneous endobiliary forceps biopsy of biliary strictures for histopathologic examination

PURPOSEWe aimed to investigate the feasibility, accuracy and safety of percutaneous endobiliary cholangio-forceps biopsy of biliary strictures in our institution.METHODSA total of 13 percutaneous transhepatic endobiliary biopsies (7 men and 6 women, mean age 66.85±16.76 years) were performed between January 2015 and March 2019 using a transluminal forceps biopsy device. Technical success, rate of complications, number of biopsy specimens, procedure and fluoroscopy time, mean radiation exposure were evaluated; sensitivity and accuracy were calculated.RESULTSTechnical success, i.e., acquisition of at least three (median, 3.00; range, 3–5) macroscopic representative samples, could be achieved in all 13 biopsies. Access was gained via the right liver lobe in 12 of 13 cases (92.3%). All patients presented blood work indicative of cholestasis prior the intervention, with mean bilirubin 4.72±3.72 µmol/L, mean γ-glutamyl transferase 574.16 ± 360.92 IU/L, and median alkaline phosphatase 407 IU/L (165–1366 IU/L). In 12 of 13 cases (92.3%), biopsied material was sufficient for the pathologist to make a histopathologic diagnosis. Analysis revealed cases of malignancy in eight of 13 cases (61.5%), all of which turned out to be cases of cholangiocarcinoma. In four benign cases (30.8%), diagnosis was considered to be confirmed by further imaging or clinical follow-ups, which showed no signs of progressive disease. There was one case (7.7%) of a false-negative result with proof of malignancy in subsequent surgical tissue extraction. A calculation of diagnostic performance yielded a sensitivity rate of 88.9% and an accuracy rate of 92.3%. There was one case of minor and one case of major complication in our study collective, leading to an overall complication rate of 15.4%.CONCLUSIONPercutaneous transhepatic biliary drainage (PTBD)-based forceps biopsy via the transhepatic drainage tract in patients with biliary obstruction of unknown origin is a technically feasible and safe technique with good diagnostic value rates. The procedure should be considered in patients not suitable for endoscopic strategies with indication for establishment of PTBD