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retrograde access

Diogo Libânio, Sílvia Giestas, David Martinez-Ares, Frederico Ferreira, Jorge Canena, Manuela Certo, Luís Lopes
Introduction: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. Clinical Case: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum...
September 2018: GE Portuguese Journal of Gastroenterology
Igor Križnar, Franco Zanini, Aleš Fidler
OBJECTIVE: To evaluate the feasibility of synchrotron-based phase-contrast (PC) μCT for visualization of the gaps and differentiation between the gaps, restorative, and endodontic materials at the tooth-restoration interface. MATERIALS AND METHODS: Standardized access cavities were prepared in human maxillary molars and subjected to materials, simulating endodontic treatment: (1) saline irrigation; (2) NaOCl and 17% EDTA irrigation; (3) same as group 2, followed by application of Ca(OH)2 ; and (4) same as group 2, followed by application of root canal sealer...
October 9, 2018: Clinical Oral Investigations
Alberto Machado da Ponte-Neto, Wanderley M Bernardo, Lara M de A Coutinho, Iatagan Rocha Josino, Vitor Ottoboni Brunaldi, Diogo T H Moura, Paulo Sakai, Rogério Kuga, Eduardo G H de Moura
Although balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) is a well-described means of accessing the duodenal papilla in patients with Roux-en-Y gastric bypass (RYGB), it is associated with modest clinical success rates. Laparoscopy-assisted ERCP (LA-ERCP)-performed by advancing a standard duodenoscope through a gastrostomy into the excluded stomach and duodenum-has emerged as a viable alternative to BAE-ERCP, with apparently higher success rates. In this systematic review, we compare LA-ERCP with enteroscopy-based techniques in post-RYGB patients, including 22 case series that provided data on papilla identification, papilla cannulation, and complications...
October 4, 2018: Obesity Surgery
Aamir H Khan, Maryam H Khan, Hunaina Shahab, Qamaruddin Roziman
Antidromic atrioventricular reentrant tachycardia (aAVRT) is rare compared to orthodromic atrioventricular reentrant tachycardia (oAVRT). An aAVRT that is dependent on a unidirectional, decremental accessory pathway (AP) is even rarer. Idiopathic ventricular tachycardias (iVT) that have benign prognoses and respond well to medical therapy can be confused with aAVRTs dependent on APs having ventricular insertion sites close to the iVT focus and have a real risk of sudden death. The preferred approach of ablation for such tachycardias with anterograde conduction only is a retrograde aortic approach, which facilitates the mapping of the earliest ventricular activation during atrial pacing or tachycardia from the ventricular side...
July 27, 2018: Curēus
Ryan Robalino, Shinban Liu, George Ferzli
A 76-year-old woman with surgical history of Roux-en-Y gastric bypass presented with recurrent choledocholithiasis. Double balloon enteroscopy was unsuccessful in cannulating the biliary tree, thus, requiring surgically assisted endoscopic retrograde cholangiopancreaticogram (ERCP) access. Due to her stable clinical status, the non-urgent indication and multiple anticipated ERCPs for definitive biliary clearance, a more durable port of access to the ampulla was desired. A modified laparoscopic Janeway gastrostomy of the gastric remnant was performed and served as access for multiple subsequent endoscopic procedures with successful clearance of the biliary tree...
September 30, 2018: BMJ Case Reports
Jack Phu, Henrietta Wang, Sephora Miao, Lydia Zhou, Sieu K Khuu, Michael Kalloniatis
SIGNIFICANCE: We demonstrate that the visual field defects in patients with tilted disc syndrome can be reduced or eliminated by neutralizing the peripheral scotoma in the area of posterior retinal bowing, which may allow differentiation between a congenital anomaly and acquired pathology. PURPOSE: Tilted disc syndrome is a congenital and unchanging condition that may present with visual field defects mimicking loss seen in neurological diseases, such as transsynaptic retrograde degeneration...
October 2018: Optometry and Vision Science: Official Publication of the American Academy of Optometry
Neusa Lages, Diana Vieira, Joana Dias, Cláudia Antunes, Tiago Jesus, Telmo Santos, Carlos Correia
Ultrasound has increasingly growing applications in anesthesia. This procedure has proven to be a novel, non-invasive and simple technique for the upper airway management, proving to be a useful tool, not only in the operating room but also in the intensive care unit and emergency department. Indeed, over the years mounting evidence has showed an increasing role of ultrasound in airway management. In this review, the authors will discuss the importance of ultrasound in the airway preoperative assessment as a way of detecting signs of difficult intubation or to define the type and/or size of the endotracheal tube as well as to help airway procedures such as endotracheal intubation, cricothyrotomy, percutaneous tracheal intubation, retrograde intubation as well as the criteria for extubation...
September 20, 2018: Revista Brasileira de Anestesiologia
Johannes Grüntzig, Frank Hollmann
Due to its accessible position and tissue heterogeneity, the eye is ideally suited for studying the lymphatic system. As early as the 19th century, questions about the origin and function of this system were discussed. For example, whether Schlemm's canal, which is of particular importance in the pathogenesis of glaucoma, is a lymphatic vessel, or does this vascular system begin with finger-shaped protuberances? Despite the discovery of lymphatic endothelial molecules and the use of molecular imaging technologies, these questions are still discussed controversially today...
September 18, 2018: Annals of Anatomy, Anatomischer Anzeiger: Official Organ of the Anatomische Gesellschaft
Thomas J Wang, Marvin Ryou
PURPOSE OF REVIEW: The present review describes the current and evolving techniques available in approaching endoscopic retrograde cholangiopancreatography (ERCP) for patients with Roux-en-Y gastric bypass (RYGB) anatomy. RECENT FINDINGS: Recent studies have demonstrated that device-assisted enteroscopy (DAE) approaches have high failures rates when performing ERCP, but are currently considered the first-line approach for patients with RYGB anatomy because of lower costs and risks compared to surgery...
November 2018: Current Opinion in Gastroenterology
Lakshmi Leishangthem, Pooja Sir Deshpande, Dharti Dua, Sudhakar R Satti
BACKGROUND: Dural venous sinus stenting (DVSS) is an accepted treatment option in selected patients with medically refractory idiopathic intracranial hypertension and obstructive venous outflow physiology prior to cerebrospinal flow diversion (CSFD) surgery. There are no randomized controlled studies focusing on outcomes and complication rates for dural venous sinus stenting. PURPOSE: We present the largest comprehensive meta-analysis on DVSS for idiopathic intracranial hypertension (IIH) focusing on success rates, complications, and re-stenting rates to date...
September 13, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Jordan R Stern, Danielle E Cafasso, Peter H Connolly, Sharif H Ellozy, Darren B Schneider, Andrew J Meltzer
INTRODUCTION: and Objectives: Retrograde arterial access (RA) of the popliteal, tibial or pedal arteries may facilitate endovascular treatment of complex infrainguinal lesions in patients with critical limb ischemia (CLI). Here, we assess the safety and efficacy of this technique. METHODS: A retrospective review of prospectively collected institutional data (consecutive M2S entries) was performed to identify patients with CLI undergoing peripheral vascular intervention from February, 2012 through December, 2017...
September 11, 2018: Annals of Vascular Surgery
Dániel Pécsi, Péter Hegyi, Andrea Szentesi, Szilárd Gódi, Ferenc Pakodi, Áron Vincze
INTRODUCTION: The continuous monitoring of quality indicators in gastrointestinal endoscopy has become an essential requirement nowadays. Most of these data cannot be extracted from the currently used free text reports, therefore a structured web-based data-collecting system was developed to record the indicators of pancreatobiliary endoscopy. AIM: A structured data-collecting system, the ERCP Registry, was initiated to monitor endoscopic retrograde cholangiopancreatography (ERCP) examinations prospectively, and to verify its usability...
September 2018: Orvosi Hetilap
Nicholas Befera, Andrew S Griffin, Erik F Hauck
A 48-year-old woman presented with an acute ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) 21) six hours after symptom onset. Workup revealed a left cervical internal carotid artery (ICA) occlusive dissection, which was emergently reconstructed with a flow-diverting stent. A routine Duplex scan one hour later suggested reocclusion of the ICA, confirmed by angiography. The true lumen of the ICA could not be accessed and therefore the "false lumen" of the ICA dissection was entered proximally...
September 6, 2018: Interventional Neuroradiology
Kintur A Sanghvi, Joseph Kusick, Courtney Krathen
OBJECTIVE: We studied the safety and efficacy of tibio-pedal access (TPA) as the sole primary access (ie, the "pedal-first" strategy) for revascularization of peripheral artery disease (PAD). METHODS: We reviewed a prospectively maintained database of patients where TPA was used as a primary access for retrograde diagnostic angiography and intervention. Patients suffering from symptomatic PAD and abnormal non-invasive testing were treated with the intention of using only ipsilateral TPA if there was antegrade flow in one of the three run-off vessels on ultrasound (US)...
September 2018: Journal of Invasive Cardiology
Zaghloul Elsafy Gouda, Mahmoud Mohamed Emara, Hany Said Elbarbary, Mahmoud Abdel Aziz Koura, Ahmed Rabie Elarbagy
INTRODUCTION: Internal jugular vein occlusion often makes necessary the use of less desirable routes as external jugular, subclavian, and femoral vein approaches in addition to inferior vena cava approaches. This a prospective cross-sectional follow-up study of the alternative approaches for placement of cuffed hemodialysis catheters in end-stage renal disease patients with bilateral internal jugular vein occlusion from the interventional nephrology point of view. METHOD: The study was conducted on 134 end-stage renal disease patients who were referred for insertion of a challenging hemodialysis catheter due to bilateral internal jugular vein occlusion...
August 24, 2018: Journal of Vascular Access
Takashi Yoshida, Takaaki Inoue, Taiji Abe, Tadashi Matsuda
BACKGROUND AND PURPOSE: Although several different ureteral access sheaths (UASs) of ≤10/12F are commercially available, their advantages and disadvantages during retrograde intrarenal surgery (RIRS) are still unknown. This study aimed to evaluate the difference in intrapelvic pressure (IPP) between different UASs of ≤10/12F with several irrigation pressure settings. MATERIALS AND METHODS: Five different commercially available UASs (9.5/11.5F Flexor® , 10/12F ReTrace® , 10/12F Bi-Flex® , 10/12F Proxis® , and 10/12F UroPass® ) with the thinnest ureteroscope (UFR-P6® ) were tested with eight different irrigation pressures (40-180 mbar) in an ex vivo porcine kidney model...
October 2, 2018: Journal of Endourology
Wagih Ben Hassen, Claire Malley, Grégoire Boulouis, Frédéric Clarençon, Bruno Bartolini, Romain Bourcier, Christine Rodriguez Régent, Nicolas Bricout, Marc Antoine Labeyrie, Jean Christophe Gentric, Aymeric Rouchaud, Sébastien Soize, Suzana Saleme, Hélène Raoult, Sophie Gallas, François Eugène, René Anxionnat, Denis Herbreteau, Serge Bracard, Olivier Naggara
BACKGROUND: The adequacy of leptomeningeal collateral flow has a pivotal role in determining clinical outcome in acute ischemic stroke. The American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score is among the most commonly used scales for measuring this flow. It is based on the extent and rate of retrograde collateral flow to the impaired territory on angiography. OBJECTIVE: To evaluate inter- and intraobserver agreementin angiographic leptomeningeal collateral flow assessment...
August 21, 2018: Journal of Neurointerventional Surgery
Dennis Lawin, Bert Hansky, Philipp Baumann, Christoph Stellbrink
This case highlights the difficulties in pacing lead implantation for transvenous phrenic nerve stimulation to treat central sleep apnea in heart failure. Cannulation of the left pericardiacophrenic vein (PPV) initially failed due to vessel tortuosity. On the basis of sound knowledge of collateral vessels, the inferior phrenic vein (IPV), which drains into the inferior vena cava, was intubated using a guide catheter. A guidewire could be retrogradely advanced via the IPV to the left PPV and brachiocephalic vein...
September 2018: Herzschrittmachertherapie & Elektrophysiologie
Michele Silvestro, Luis Mariano Palena, Marco Manzi, Efrem Gómez-Jabalera, Deepak Vishwanath, Andrea Casini, Roberto Ferraresi
OBJECTIVES: To describe and assess the safety of a technique for the percutaneous retrograde access to either the P3 segment of the popliteal artery or the tibioperoneal trunk (TPT) through the anterior muscle compartment of the leg to treat distal femoropopliteal chronic total occlusion (CTO). METHODS: After a failed antegrade attempt of endovascular recanalization of a femoropopliteal CTO, 41 symptomatic patients (29 men; mean age of 75.8 ± 8.4 years) underwent a percutaneous retrograde access by means of the puncture of the TPT in 15 cases (36...
August 17, 2018: Journal of Vascular Surgery
Gal Atlan, Anna Terem, Noa Peretz-Rivlin, Kamini Sehrawat, Ben Jerry Gonzales, Guy Pozner, Gen-Ichi Tasaka, Yael Goll, Ron Refaeli, Ori Zviran, Byung Kook Lim, Maya Groysman, Inbal Goshen, Adi Mizrahi, Israel Nelken, Ami Citri
A barrage of information constantly assaults our senses, of which only a fraction is relevant at any given point in time. However, the neural circuitry supporting the suppression of irrelevant sensory distractors is not completely understood. The claustrum, a circuit hub with vast cortical connectivity, is an intriguing brain structure, whose restrictive anatomy, thin and elongated, has precluded functional investigation. Here, we describe the use of Egr2-CRE mice to access genetically defined claustral neurons...
September 10, 2018: Current Biology: CB
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