Michael Knizhnik - Academia.edu (original) (raw)

Papers by Michael Knizhnik

Clinical transplantation, Sep 1, 2010

ABSTRACT Biliary complications after liver transplantation remain a serious cause of morbidity an... more ABSTRACT Biliary complications after liver transplantation remain a serious cause of morbidity and mortality. Direct invasive cholangiographic techniques, endoscopic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC), have procedure-related complications. Magnetic resonance cholangiopancreatography (MRCP) is non-invasive, safe, and accurate. The aim of this study was to evaluate MRCP in detecting biliary complications following liver transplantation and comparing findings with ERCP and PTC. Twenty-seven consecutive liver transplant recipients who presented with clinical and biochemical, ultrasonographic, or histological evidence of biliary complications were evaluated with MRCP. Patients were followed up for a median period of 36 months. The presence of a biliary complication was confirmed in 18 patients (66.6%): anastomotic biliary stricture in 12 (66.6%); diffuse intrahepatic biliary stricture in 5 (27.7%): ischemic (n = 3), recurrence of primary sclerosing cholangitis (n = 2), and choledocholithiasis in one. In nine patients (33.3%), MRCP was normal. Six patients underwent ERCP, and eight PTC. There was a statistically significant correlation between the MRCP and both ERCP and PTC (p = 0.01) findings. The sensitivity and specificity of the MRCP were 94.4% and 88.9%, respectively, and the positive and negative predictive values, 94.4% and 89.9%, respectively. MRCP is an accurate imaging tool for the assessment of biliary complications after liver transplantation. We recommend that MRCP be the diagnostic imaging modality of choice in this setting, reserving direct cholangiography for therapeutic procedures.

Acta Radiologica, 2012

Background Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA r... more Background Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. Purpose To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. Material and Methods CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. Results Endoleaks were detected in 17 patients during the follow-up ...

ANZ Journal of Surgery, 2005

Background: Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in th... more Background: Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in the setting of a patient with severe comorbidities where emergency cholecystectomy would carry significant mortality. The present study aims to assess the role, efficacy and complications of PC in acute cholecystitis. Methods: Retrospective review of case notes of patients who underwent PC at

The Journal of Urology, 1999

Purpose: Prenatal ultrasound leads to the early detection of hydronephrosis. When followed by the... more Purpose: Prenatal ultrasound leads to the early detection of hydronephrosis. When followed by the early diagnosis of ureteropelvic junction obstruction surgical treatment, if indicated, is associated with minimal morbidity. We attempt to prove the benefits of this therapeutical approach from the point of view of renal function. Materials and Methods: From 1979 to 1997, 452 patients with ureteropelvic junction obstruction underwent dismembered pyeloplasty. Of these patients 113 with comparable data were retrospectively evaluated. Patients were divided into group 1-50 who presented with prenatal hydronephrosis and group 2-63 with neonatal hydronephrosis who were lost to followup and who then presented with symptoms leading to the diagnosis of ureteropelvic junction obstruction. In each group the diagnostic criteria and indications for surgery were identical based on symptomatology, ultrasound and renal scan. Patients with bilateral disease, solitary kidney or vesicoureteral reflux were excluded from study. In groups 1 and 2 median patient age at surgery was 11 months and 5 years, and average postoperative followup was 4.2 and 3.2 years, respectively. Results: In 41 of the 50 group 1 and 60 of the 63 group 2 patients hydronephrosis was severe and the renal pelvis was more than 3 cm. wide. Poor relative renal function (less than 30%) was significantly more pronounced in group 2 than in group 1 (56 of 63 patients or 89% versus 6 of 50 or 12%, p <0.05). In all 113 patients postoperative followup ultrasound and renal scan revealed significant improvement in hydronephrosis and washout curve pattern. There was a significant difference in the 2 groups in regard to renal function improvement postoperatively (66% of group 1 versus 16% of group 2 patients, p <0.05). Conclusions: We believe that patients who undergo prenatal imaging and are diagnosed early with ureteropelvic junction obstruction should be carefully and meticulously followed. Special efforts should be made to ensure that patients are not lost to followup. ARer any sign of deterioration develops early surgery is indicated. According to our data operative treatment results in improved renal function.

Journal of vascular and interventional radiology : JVIR, 2014

To describe the transvenous application of intracardiac echocardiography (ICE) for guidance durin... more To describe the transvenous application of intracardiac echocardiography (ICE) for guidance during endovascular aortic repair (EVAR). Eight patients with an infrarenal abdominal aortic aneurysm (AAA) and chronic renal failure were determined suitable for EVAR. The procedure was performed by deploying the transcaval and transiliac vein guidance of an ICE catheter to reduce the dosage of iodinated contrast medium. Multiple guidance parameters were assessed. The present study describes the EVAR procedure and postprocedure transabdominal ultrasound (US) follow-up results at 3-4 months. The eight procedures were completed by using transvenous ICE guidance. No contrast medium was used in five patients, and 3-20 mL of isoosmolar contrast medium was administered in the other three. No endoleaks were detected by ICE immediately after stent deployment. One patient who had a single functioning kidney developed renal failure that was attributed to manipulation-related cholesterol embolization. ...

Journal of vascular and interventional radiology : JVIR, 2018

Systemic doxorubicin is effective for desmoid fibromatosis (DF), but its use is limited by dose-d... more Systemic doxorubicin is effective for desmoid fibromatosis (DF), but its use is limited by dose-dependent cardiotoxicity. A protocol of selective intra-arterial doxorubicin drug-eluting embolization (DEE) was designed to maximize target tissue efficacy of doxorubicin, while minimizing systemic exposure. Four children with recurrent or refractory DF were treated between 2014 and 2017. Tumor volumes were reduced by 54%-97% over a follow-up interval of 6-32 months. A single patient experienced transient lower extremity paresthesia (Common Terminology Criteria for Adverse Events grade I). Further investigation is needed to better establish these promising results for doxorubicin DEE in DF treatment.

The Israel Medical Association journal : IMAJ, 2003

BACKGROUND The mainstay of therapy for acute cholecystitis is cholecystectomy, which has a mortal... more BACKGROUND The mainstay of therapy for acute cholecystitis is cholecystectomy, which has a mortality of 14-30% in high risk patients. An alternative approach in patients suffering from acute cholecystitis with contraindications to emergency surgery is percutaneous cholecystostomy. OBJECTIVE To evaluate the efficacy and safety of percutaneous cholecystostomy as the initial treatment of acute cholecystitis in high risk patients. METHODS Eighty consecutive patients (42 men, 38 women) underwent ultrasound-guided percutaneous cholecystostomy over a 5 year period. Sixty-five patients suffered from acute calculous cholecystitis, 4 patients had acalculous cholecystitis, and 11 patients had sepsis of unknown origin. RESULTS Sixty-eight patients improved after the percutaneous gallbladder drainage, 10 patients died from co-morbid disease and 2 patients died from biliary peritonitis. During a 1 year follow-up, 32 of the patients underwent interval cholecystectomy, 4 additional patients died fr...

The Israel Medical Association journal : IMAJ, 2016

Various vena cava filters (VCF) are designed with the ability to be retrieved percutaneously. Yet... more Various vena cava filters (VCF) are designed with the ability to be retrieved percutaneously. Yet, despite this option most of them remain in the inferior vena cava (IVC). To report our experience in the placement and retrieval of three different types of VCFs, and to compare the indications for their insertion and retrieval as reported in the literature. During a 5 year period three types of retrievable VCF (ALN, OptEase, and Celect) were inserted in 306 patients at the Rabin Medical Center (Beilinson and Hasharon hospitals). Indications, retrieval rates, median time to retrieval, success and complication rates were viewed and assessed in the three groups of filter types and were compared with the data of similar studies in the literature. Of the 306 VCFs inserted, 31 (10.1%) were retrieved with equal distribution in the three groups. In most patients the reason for filter insertion was venous thromboembolic events (VTE) and contraindications to anticoagulant therapy. Mean age was ...

CardioVascular and Interventional Radiology, 2014

After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, re... more After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, resulting in poor graft function and hypoxemia. Surgical repair has been the standard-of-care, although percutaneous angioplasty with stent insertion has been performed in patients unsuitable for surgery. We summarize our experience of pulmonary artery stent-graft placement in transplant recipients who were also fit for surgical repair. Retrospective review of five cases of single-lung transplant recipients (4 male, 1 female, median age 61 years) who underwent percutaneous angioplasty and insertion of stent-graft for severe PAS. Balloon-expandable stent-grafts were used that were tailored to the donor and recipient vessel diameters. Stenosis was diagnosed with computed tomography angiography at a median of 44 days (range 22-84) after transplantation. All stent placements were technically successful. There was only one periprocedural complication, a haemothorax that was drained. In four patients, the angioplasty improved the lung function; relative graft perfusion (as assessed by quantitative lung scintigraphy) improved by 26 % (IQR 13-37); and SpO2 improved by 8 % (IQR 4-9). Percutaneous angioplasty using stent-graft is a minimally invasive, safe, and efficacious procedure for treatment of posttransplantation PAS and should be considered as an alternative to surgery even when the patient is considered fit for surgical repair.

Diagn Interv Radiol, 2009

P ortal hypertension can be effectively reduced by the surgical creation of a portosystemic shunt... more P ortal hypertension can be effectively reduced by the surgical creation of a portosystemic shunt. However, in patients after liver transplantation, a preexisting portosystemic shunt may steal the portal blood flow, predisposing the patient to liver dysfunction and even to portal vein thrombosis (1). Moreover, alternate outflow due to a large, active portosystemic shunt has been linked to hepatic encephalopathy (2). Thus, surgical portosystemic shunts must be occluded during the transplantation procedure or soon thereafter. We describe the use of a stent graft to occlude a symptomatic surgical portosystemic shunt in a patient after orthotopic liver transplantation.

Cardiovascular and Interventional Radiology, May 30, 2009

The purpose of this study was to report our experience in elongating short distal necks of descen... more The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization -- only if the superior and inferior mesenteric arteries are patent -- is a good and safe way to elongate the neck and enable EVAR.

The Israel Medical Association journal : IMAJ, 2009

Critical limb ischemia is an increasingly common condition that has high surgical morbidity and l... more Critical limb ischemia is an increasingly common condition that has high surgical morbidity and limited non-surgical options. To evaluate the use of silicon carbide-coated Motion stents, as compared to reported data for bare metal stents, in elderly patients with infrapopliteal artery stenoses causing critical limb ischemia after failed or complicated percutaneous transluminal angioplasty. Between January 2003 and March 2004, 41 stents were inserted into 17 consecutive patients (11 males, 6 females, mean age 82 years, range 75-93) following unsuccessful or complicated PTA. Seven patients had one-vessel run-off, six had two-vessel and four had three vessel run-off. All patients suffered from CLI, had up to three lesions and more than one co-morbid condition, and were considered at high surgical risk. Silicon carbide-coated Motion coronary stents, 2.5-4 mm diameterand 25 and 30 mm length, were used. Pre-intervention assessment included clinical condition, ankle brachial index, Doppler...

Diagnostic and Interventional Radiology, 2009

P ortal hypertension can be effectively reduced by the surgical creation of a portosystemic shunt... more P ortal hypertension can be effectively reduced by the surgical creation of a portosystemic shunt. However, in patients after liver transplantation, a preexisting portosystemic shunt may steal the portal blood flow, predisposing the patient to liver dysfunction and even to portal vein thrombosis (1). Moreover, alternate outflow due to a large, active portosystemic shunt has been linked to hepatic encephalopathy (2). Thus, surgical portosystemic shunts must be occluded during the transplantation procedure or soon thereafter. We describe the use of a stent graft to occlude a symptomatic surgical portosystemic shunt in a patient after orthotopic liver transplantation.

The Laryngoscope, 2013

To present our 8-year experience with transarterial embolization for head and neck bleeding, with... more To present our 8-year experience with transarterial embolization for head and neck bleeding, with an emphasis on the need for repeated procedures in patients treated for head and neck cancer. Retrospective case series. Tertiary university-affiliated medical center. The cohort included 49 patients who underwent transarterial embolization for acute head and neck bleeding in 2004 to 2012. Outcome measures included procedural success, recurrence, complications, and outcome. Mean patient age was 60.3 years. Indications for transarterial embolization were bleeding from a tumor (42%), nasal bleeding (36%), bleeding related to neck trauma (8%), tracheal stomal bleeding (8%), and other (4%). Twelve of 21 patients with tumors had been treated by chemoradiation. At least one repeated procedure was required in 11 patients, of whom nine had a history of chemoradiation and surgery for cancer; four of them required a stent for exclusion of pseudoaneurysm, and in six the recurrence presented late after the initial procedure (1 month to 5 years). Major complications included cerebrovascular accident in one patient and death due to major bleeding in two cases. Twenty-one patients died during follow-up, including nine patients with cancer. Eleven deaths occurred up to 4 years after embolization. Transarterial embolization is an important tool for the control of head and neck bleeding. Special attention should be given to patients after chemoradiation for cancer. Every effort should be made to control the bleeding because some patients may gain a reasonable lifespan and improved quality of life. 4.

Journal of Vascular and Interventional Radiology, 2014

CardioVascular and Interventional Radiology, 2010

The purpose of this study was to evaluate the effectiveness and safety of transjugular liver biop... more The purpose of this study was to evaluate the effectiveness and safety of transjugular liver biopsy (TJLB) and plugged-percutaneous liver biopsy (PB) in consecutive patients with severe liver disease associated with impaired coagulation, ascites, or both and to verify the in-house protocol used to select the appropriate procedure. In 2000-2006, 329 patients (208 male [62.8%] and 121 female [37.2%]), aged 1 month to 81 years (mean, 46.8 years), underwent 150 TJLBs (39.1%) or 233 PBs (60.9%) procedures at a major tertiary center, as determined by an in-house protocol. The groups were compared for specimen characteristics, technical success, and complications. Technical success rates were 97.4% for TJLB (146/150) and 99.1% for PB (231/233). TJLB was associated with a lower average core length (1.29 vs. 1.43 cm) and lower average number of specimens obtained (2.44 vs. 2.8), but both methods yielded sufficient tissue for a definitive diagnosis. There were no major complications in either group. TJLB and PB can be safely and effectively performed for the diagnosis of hepatic disease in patients with contraindications for standard percutaneous liver biopsy. When both are technically available, we suggest PB as the procedure of choice, especially in transplanted livers.

CardioVascular and Interventional Radiology, 2009

The purpose of this study was to report our experience in elongating short distal necks of descen... more The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization -- only if the superior and inferior mesenteric arteries are patent -- is a good and safe way to elongate the neck and enable EVAR.

CardioVascular and Interventional Radiology, 2014

After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, re... more After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, resulting in poor graft function and hypoxemia. Surgical repair has been the standard-of-care, although percutaneous angioplasty with stent insertion has been performed in patients unsuitable for surgery. We summarize our experience of pulmonary artery stent-graft placement in transplant recipients who were also fit for surgical repair. Retrospective review of five cases of single-lung transplant recipients (4 male, 1 female, median age 61 years) who underwent percutaneous angioplasty and insertion of stent-graft for severe PAS. Balloon-expandable stent-grafts were used that were tailored to the donor and recipient vessel diameters. Stenosis was diagnosed with computed tomography angiography at a median of 44 days (range 22-84) after transplantation. All stent placements were technically successful. There was only one periprocedural complication, a haemothorax that was drained. In four patients, the angioplasty improved the lung function; relative graft perfusion (as assessed by quantitative lung scintigraphy) improved by 26 % (IQR 13-37); and SpO2 improved by 8 % (IQR 4-9). Percutaneous angioplasty using stent-graft is a minimally invasive, safe, and efficacious procedure for treatment of posttransplantation PAS and should be considered as an alternative to surgery even when the patient is considered fit for surgical repair.

Annals of Thoracic and Cardiovascular Surgery, 2013

ANZ Journal of Surgery, 2005

Clinical transplantation, Sep 1, 2010

ABSTRACT Biliary complications after liver transplantation remain a serious cause of morbidity an... more ABSTRACT Biliary complications after liver transplantation remain a serious cause of morbidity and mortality. Direct invasive cholangiographic techniques, endoscopic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC), have procedure-related complications. Magnetic resonance cholangiopancreatography (MRCP) is non-invasive, safe, and accurate. The aim of this study was to evaluate MRCP in detecting biliary complications following liver transplantation and comparing findings with ERCP and PTC. Twenty-seven consecutive liver transplant recipients who presented with clinical and biochemical, ultrasonographic, or histological evidence of biliary complications were evaluated with MRCP. Patients were followed up for a median period of 36 months. The presence of a biliary complication was confirmed in 18 patients (66.6%): anastomotic biliary stricture in 12 (66.6%); diffuse intrahepatic biliary stricture in 5 (27.7%): ischemic (n = 3), recurrence of primary sclerosing cholangitis (n = 2), and choledocholithiasis in one. In nine patients (33.3%), MRCP was normal. Six patients underwent ERCP, and eight PTC. There was a statistically significant correlation between the MRCP and both ERCP and PTC (p = 0.01) findings. The sensitivity and specificity of the MRCP were 94.4% and 88.9%, respectively, and the positive and negative predictive values, 94.4% and 89.9%, respectively. MRCP is an accurate imaging tool for the assessment of biliary complications after liver transplantation. We recommend that MRCP be the diagnostic imaging modality of choice in this setting, reserving direct cholangiography for therapeutic procedures.

Acta Radiologica, 2012

Background Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA r... more Background Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. Purpose To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. Material and Methods CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. Results Endoleaks were detected in 17 patients during the follow-up ...

ANZ Journal of Surgery, 2005

Background: Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in th... more Background: Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in the setting of a patient with severe comorbidities where emergency cholecystectomy would carry significant mortality. The present study aims to assess the role, efficacy and complications of PC in acute cholecystitis. Methods: Retrospective review of case notes of patients who underwent PC at

The Journal of Urology, 1999

Purpose: Prenatal ultrasound leads to the early detection of hydronephrosis. When followed by the... more Purpose: Prenatal ultrasound leads to the early detection of hydronephrosis. When followed by the early diagnosis of ureteropelvic junction obstruction surgical treatment, if indicated, is associated with minimal morbidity. We attempt to prove the benefits of this therapeutical approach from the point of view of renal function. Materials and Methods: From 1979 to 1997, 452 patients with ureteropelvic junction obstruction underwent dismembered pyeloplasty. Of these patients 113 with comparable data were retrospectively evaluated. Patients were divided into group 1-50 who presented with prenatal hydronephrosis and group 2-63 with neonatal hydronephrosis who were lost to followup and who then presented with symptoms leading to the diagnosis of ureteropelvic junction obstruction. In each group the diagnostic criteria and indications for surgery were identical based on symptomatology, ultrasound and renal scan. Patients with bilateral disease, solitary kidney or vesicoureteral reflux were excluded from study. In groups 1 and 2 median patient age at surgery was 11 months and 5 years, and average postoperative followup was 4.2 and 3.2 years, respectively. Results: In 41 of the 50 group 1 and 60 of the 63 group 2 patients hydronephrosis was severe and the renal pelvis was more than 3 cm. wide. Poor relative renal function (less than 30%) was significantly more pronounced in group 2 than in group 1 (56 of 63 patients or 89% versus 6 of 50 or 12%, p <0.05). In all 113 patients postoperative followup ultrasound and renal scan revealed significant improvement in hydronephrosis and washout curve pattern. There was a significant difference in the 2 groups in regard to renal function improvement postoperatively (66% of group 1 versus 16% of group 2 patients, p <0.05). Conclusions: We believe that patients who undergo prenatal imaging and are diagnosed early with ureteropelvic junction obstruction should be carefully and meticulously followed. Special efforts should be made to ensure that patients are not lost to followup. ARer any sign of deterioration develops early surgery is indicated. According to our data operative treatment results in improved renal function.

Journal of vascular and interventional radiology : JVIR, 2014

To describe the transvenous application of intracardiac echocardiography (ICE) for guidance durin... more To describe the transvenous application of intracardiac echocardiography (ICE) for guidance during endovascular aortic repair (EVAR). Eight patients with an infrarenal abdominal aortic aneurysm (AAA) and chronic renal failure were determined suitable for EVAR. The procedure was performed by deploying the transcaval and transiliac vein guidance of an ICE catheter to reduce the dosage of iodinated contrast medium. Multiple guidance parameters were assessed. The present study describes the EVAR procedure and postprocedure transabdominal ultrasound (US) follow-up results at 3-4 months. The eight procedures were completed by using transvenous ICE guidance. No contrast medium was used in five patients, and 3-20 mL of isoosmolar contrast medium was administered in the other three. No endoleaks were detected by ICE immediately after stent deployment. One patient who had a single functioning kidney developed renal failure that was attributed to manipulation-related cholesterol embolization. ...

Journal of vascular and interventional radiology : JVIR, 2018

Systemic doxorubicin is effective for desmoid fibromatosis (DF), but its use is limited by dose-d... more Systemic doxorubicin is effective for desmoid fibromatosis (DF), but its use is limited by dose-dependent cardiotoxicity. A protocol of selective intra-arterial doxorubicin drug-eluting embolization (DEE) was designed to maximize target tissue efficacy of doxorubicin, while minimizing systemic exposure. Four children with recurrent or refractory DF were treated between 2014 and 2017. Tumor volumes were reduced by 54%-97% over a follow-up interval of 6-32 months. A single patient experienced transient lower extremity paresthesia (Common Terminology Criteria for Adverse Events grade I). Further investigation is needed to better establish these promising results for doxorubicin DEE in DF treatment.

The Israel Medical Association journal : IMAJ, 2003

BACKGROUND The mainstay of therapy for acute cholecystitis is cholecystectomy, which has a mortal... more BACKGROUND The mainstay of therapy for acute cholecystitis is cholecystectomy, which has a mortality of 14-30% in high risk patients. An alternative approach in patients suffering from acute cholecystitis with contraindications to emergency surgery is percutaneous cholecystostomy. OBJECTIVE To evaluate the efficacy and safety of percutaneous cholecystostomy as the initial treatment of acute cholecystitis in high risk patients. METHODS Eighty consecutive patients (42 men, 38 women) underwent ultrasound-guided percutaneous cholecystostomy over a 5 year period. Sixty-five patients suffered from acute calculous cholecystitis, 4 patients had acalculous cholecystitis, and 11 patients had sepsis of unknown origin. RESULTS Sixty-eight patients improved after the percutaneous gallbladder drainage, 10 patients died from co-morbid disease and 2 patients died from biliary peritonitis. During a 1 year follow-up, 32 of the patients underwent interval cholecystectomy, 4 additional patients died fr...

The Israel Medical Association journal : IMAJ, 2016

Various vena cava filters (VCF) are designed with the ability to be retrieved percutaneously. Yet... more Various vena cava filters (VCF) are designed with the ability to be retrieved percutaneously. Yet, despite this option most of them remain in the inferior vena cava (IVC). To report our experience in the placement and retrieval of three different types of VCFs, and to compare the indications for their insertion and retrieval as reported in the literature. During a 5 year period three types of retrievable VCF (ALN, OptEase, and Celect) were inserted in 306 patients at the Rabin Medical Center (Beilinson and Hasharon hospitals). Indications, retrieval rates, median time to retrieval, success and complication rates were viewed and assessed in the three groups of filter types and were compared with the data of similar studies in the literature. Of the 306 VCFs inserted, 31 (10.1%) were retrieved with equal distribution in the three groups. In most patients the reason for filter insertion was venous thromboembolic events (VTE) and contraindications to anticoagulant therapy. Mean age was ...

CardioVascular and Interventional Radiology, 2014

After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, re... more After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, resulting in poor graft function and hypoxemia. Surgical repair has been the standard-of-care, although percutaneous angioplasty with stent insertion has been performed in patients unsuitable for surgery. We summarize our experience of pulmonary artery stent-graft placement in transplant recipients who were also fit for surgical repair. Retrospective review of five cases of single-lung transplant recipients (4 male, 1 female, median age 61 years) who underwent percutaneous angioplasty and insertion of stent-graft for severe PAS. Balloon-expandable stent-grafts were used that were tailored to the donor and recipient vessel diameters. Stenosis was diagnosed with computed tomography angiography at a median of 44 days (range 22-84) after transplantation. All stent placements were technically successful. There was only one periprocedural complication, a haemothorax that was drained. In four patients, the angioplasty improved the lung function; relative graft perfusion (as assessed by quantitative lung scintigraphy) improved by 26 % (IQR 13-37); and SpO2 improved by 8 % (IQR 4-9). Percutaneous angioplasty using stent-graft is a minimally invasive, safe, and efficacious procedure for treatment of posttransplantation PAS and should be considered as an alternative to surgery even when the patient is considered fit for surgical repair.

Diagn Interv Radiol, 2009

P ortal hypertension can be effectively reduced by the surgical creation of a portosystemic shunt... more P ortal hypertension can be effectively reduced by the surgical creation of a portosystemic shunt. However, in patients after liver transplantation, a preexisting portosystemic shunt may steal the portal blood flow, predisposing the patient to liver dysfunction and even to portal vein thrombosis (1). Moreover, alternate outflow due to a large, active portosystemic shunt has been linked to hepatic encephalopathy (2). Thus, surgical portosystemic shunts must be occluded during the transplantation procedure or soon thereafter. We describe the use of a stent graft to occlude a symptomatic surgical portosystemic shunt in a patient after orthotopic liver transplantation.

Cardiovascular and Interventional Radiology, May 30, 2009

The purpose of this study was to report our experience in elongating short distal necks of descen... more The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization -- only if the superior and inferior mesenteric arteries are patent -- is a good and safe way to elongate the neck and enable EVAR.

The Israel Medical Association journal : IMAJ, 2009

Critical limb ischemia is an increasingly common condition that has high surgical morbidity and l... more Critical limb ischemia is an increasingly common condition that has high surgical morbidity and limited non-surgical options. To evaluate the use of silicon carbide-coated Motion stents, as compared to reported data for bare metal stents, in elderly patients with infrapopliteal artery stenoses causing critical limb ischemia after failed or complicated percutaneous transluminal angioplasty. Between January 2003 and March 2004, 41 stents were inserted into 17 consecutive patients (11 males, 6 females, mean age 82 years, range 75-93) following unsuccessful or complicated PTA. Seven patients had one-vessel run-off, six had two-vessel and four had three vessel run-off. All patients suffered from CLI, had up to three lesions and more than one co-morbid condition, and were considered at high surgical risk. Silicon carbide-coated Motion coronary stents, 2.5-4 mm diameterand 25 and 30 mm length, were used. Pre-intervention assessment included clinical condition, ankle brachial index, Doppler...

Diagnostic and Interventional Radiology, 2009

P ortal hypertension can be effectively reduced by the surgical creation of a portosystemic shunt... more P ortal hypertension can be effectively reduced by the surgical creation of a portosystemic shunt. However, in patients after liver transplantation, a preexisting portosystemic shunt may steal the portal blood flow, predisposing the patient to liver dysfunction and even to portal vein thrombosis (1). Moreover, alternate outflow due to a large, active portosystemic shunt has been linked to hepatic encephalopathy (2). Thus, surgical portosystemic shunts must be occluded during the transplantation procedure or soon thereafter. We describe the use of a stent graft to occlude a symptomatic surgical portosystemic shunt in a patient after orthotopic liver transplantation.

The Laryngoscope, 2013

To present our 8-year experience with transarterial embolization for head and neck bleeding, with... more To present our 8-year experience with transarterial embolization for head and neck bleeding, with an emphasis on the need for repeated procedures in patients treated for head and neck cancer. Retrospective case series. Tertiary university-affiliated medical center. The cohort included 49 patients who underwent transarterial embolization for acute head and neck bleeding in 2004 to 2012. Outcome measures included procedural success, recurrence, complications, and outcome. Mean patient age was 60.3 years. Indications for transarterial embolization were bleeding from a tumor (42%), nasal bleeding (36%), bleeding related to neck trauma (8%), tracheal stomal bleeding (8%), and other (4%). Twelve of 21 patients with tumors had been treated by chemoradiation. At least one repeated procedure was required in 11 patients, of whom nine had a history of chemoradiation and surgery for cancer; four of them required a stent for exclusion of pseudoaneurysm, and in six the recurrence presented late after the initial procedure (1 month to 5 years). Major complications included cerebrovascular accident in one patient and death due to major bleeding in two cases. Twenty-one patients died during follow-up, including nine patients with cancer. Eleven deaths occurred up to 4 years after embolization. Transarterial embolization is an important tool for the control of head and neck bleeding. Special attention should be given to patients after chemoradiation for cancer. Every effort should be made to control the bleeding because some patients may gain a reasonable lifespan and improved quality of life. 4.

Journal of Vascular and Interventional Radiology, 2014

CardioVascular and Interventional Radiology, 2010

The purpose of this study was to evaluate the effectiveness and safety of transjugular liver biop... more The purpose of this study was to evaluate the effectiveness and safety of transjugular liver biopsy (TJLB) and plugged-percutaneous liver biopsy (PB) in consecutive patients with severe liver disease associated with impaired coagulation, ascites, or both and to verify the in-house protocol used to select the appropriate procedure. In 2000-2006, 329 patients (208 male [62.8%] and 121 female [37.2%]), aged 1 month to 81 years (mean, 46.8 years), underwent 150 TJLBs (39.1%) or 233 PBs (60.9%) procedures at a major tertiary center, as determined by an in-house protocol. The groups were compared for specimen characteristics, technical success, and complications. Technical success rates were 97.4% for TJLB (146/150) and 99.1% for PB (231/233). TJLB was associated with a lower average core length (1.29 vs. 1.43 cm) and lower average number of specimens obtained (2.44 vs. 2.8), but both methods yielded sufficient tissue for a definitive diagnosis. There were no major complications in either group. TJLB and PB can be safely and effectively performed for the diagnosis of hepatic disease in patients with contraindications for standard percutaneous liver biopsy. When both are technically available, we suggest PB as the procedure of choice, especially in transplanted livers.

CardioVascular and Interventional Radiology, 2009

The purpose of this study was to report our experience in elongating short distal necks of descen... more The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization -- only if the superior and inferior mesenteric arteries are patent -- is a good and safe way to elongate the neck and enable EVAR.

CardioVascular and Interventional Radiology, 2014

After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, re... more After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, resulting in poor graft function and hypoxemia. Surgical repair has been the standard-of-care, although percutaneous angioplasty with stent insertion has been performed in patients unsuitable for surgery. We summarize our experience of pulmonary artery stent-graft placement in transplant recipients who were also fit for surgical repair. Retrospective review of five cases of single-lung transplant recipients (4 male, 1 female, median age 61 years) who underwent percutaneous angioplasty and insertion of stent-graft for severe PAS. Balloon-expandable stent-grafts were used that were tailored to the donor and recipient vessel diameters. Stenosis was diagnosed with computed tomography angiography at a median of 44 days (range 22-84) after transplantation. All stent placements were technically successful. There was only one periprocedural complication, a haemothorax that was drained. In four patients, the angioplasty improved the lung function; relative graft perfusion (as assessed by quantitative lung scintigraphy) improved by 26 % (IQR 13-37); and SpO2 improved by 8 % (IQR 4-9). Percutaneous angioplasty using stent-graft is a minimally invasive, safe, and efficacious procedure for treatment of posttransplantation PAS and should be considered as an alternative to surgery even when the patient is considered fit for surgical repair.

Annals of Thoracic and Cardiovascular Surgery, 2013

ANZ Journal of Surgery, 2005