The Experts below are selected from a list of 294 Experts worldwide ranked by ideXlab platform

Ung Rae Kang - One of the best experts on this subject based on the ideXlab platform.

John F Angle - One of the best experts on this subject based on the ideXlab platform.

  • management of stomal varices with transvenous obliteration utilizing Sodium Tetradecyl Sulfate foam sclerosis
    CardioVascular and Interventional Radiology, 2014
    Co-Authors: Wael E A Saad, Sandra L Schwaner, Allison Lippert, S S Sabri, Abdullah M S Alosaimi, Alan H Matsumoto, John F Angle, Stephen H Caldwell
    Abstract:

    The management of parastomal varices is not established. Transjugular intrahepatic portosystemic shunt (TIPS) creation is the most commonly described treatment; however, the rebleed rate after TIPS is 21–37 %. The purpose of the study is to determine the effectiveness of transvenous obliteration using Sodium Tetradecyl Sulfate (STS) and to describe a new simplified technique in obliterating these varices. Four patients are presented who underwent transvenous obliteration using STS. One was obliterated using balloon occlusion from the systemic veins, the second was obliterated without balloon from a transhepatic antegrade approach, and the last two patients were obliterated using the direct antegrade technique. This simplified technique requires only a micropuncture kit (not requiring balloons or coils) and ultrasound transducer compression of the systemic draining veins, relying on high portal pressure to keep the sclerosant confined to the varices. The sclerosant is essentially trapped between the portal pressure and the ultrasound-transducer compression (10–15 min). Technical success was achieved in all four patients without procedural or postprocedural complications and no rebleeding for a mean follow-up of 17 (range 2–33) months. Transvenous obliteration of parastomal varices utilizing STS as a sclerosant is safe and effective. The newly described technique is simple, feasible, and requires minimal equipment (no balloons or coils or catheters).

  • balloon occlusion catheter rupture during balloon occluded retrograde transvenous obliteration of gastric varices utilizing Sodium Tetradecyl Sulfate incidence and consequences
    Vascular and Endovascular Surgery, 2012
    Co-Authors: Wael E A Saad, Allison Lippert, S S Sabri, Alan H Matsumoto, David Nicholson, Cynthia E Wagner, Cenk U Turba, Mark G Davies, John F Angle
    Abstract:

    Balloon-occluded retrograde transvenous obliteration (BRTO) is an established procedure for the management of bleeding gastric varices in Asia. Invariably, the sclerosant utilized in Asia is ethanolamine oleate and the inventory used (vascular sheaths, balloon-occlusion catheters, and microcatheters) is not available outside Asia. A total of 41 BRTO procedures were performed with a technical and obliterative (gastric varix obliteration) success rate of 95% (n = 39 of 41) and 85% (n = 35 of 41), respectively. Complications were 4.9% (n = 2/41). A total of 6 balloon ruptures occurred (14.6%, n = 6 of 41). One rupture (16.7%, n = 1 of 6 of ruptures) lead to a technical failure and 2 ruptures (33.3%, n = 2 of 6 of ruptures) lead to an obliterative failure. Balloon rupture contributed to 50% of technical failures (n = 1/2, P = .274) and 33% of obliteration failures (n = 2/6, P = .148). In conclusion, the incidence of balloon-occlusion catheter rupture utilizing 3% Sodium Tetradecyl Sulfate (STS) and inventory ...

  • bleeding gastric varices obliteration with balloon occluded retrograde transvenous obliteration using Sodium Tetradecyl Sulfate foam
    Journal of Vascular and Interventional Radiology, 2011
    Co-Authors: S S Sabri, Wael E A Saad, Abdullah M S Alosaimi, Alan H Matsumoto, Stephen H Caldwell, Warren Swee, Ulku C Turba, A Park, John F Angle
    Abstract:

    Abstract Purpose Balloon-occluded retrograde transvenous obliteration (BRTO) of bleeding gastric varices (GV) is well described in the literature. Using Ethanolamine oleate as the sclerosing agent in BRTO, but it is not readily available in the United States in the desired concentrations. The authors' aim is to describe their initial experience with BRTO using Sodium Tetradecyl Sulfate (STS) foam as an alternative sclerosing agent. Materials and Methods The authors performed a retrospective review of their initial series in which STS foam was used to treat bleeding GV using BRTO. All study subjects had endoscopic evidence of gastric variceal bleeding. STS foam was made using a combination of agents with a 3:2:1 ratio of gas: 3% STS: Lipiodol (Ethiodol; Savage Laboratories, Melville, New York). Mean values and ranges were calculated for each variable, and clinical and imaging outcomes were assessed. Results The authors performed BRTO in 22 cirrhotic patients (11 men and 11 women) with a mean age of 52 years (range, 23–83 years). Technical success was achieved in 20 of 22 (91%) patients. Complications occurred in three of 22 (14%) patients. The overall mean dose of STS used was 300 mg (range, 30–600 mg) with mean total volume of sclerosant mixture of 34.1 mL (range, 10–65 mL). Follow-up imaging was available for 18 of 20 (90%) technically successful procedures with a mean period of 89 days (range, 1–359 days). Complete obliteration of GV was achieved in 16 of 18 (89%) patients. There were no cases of recurrent variceal bleeding with a mean clinical follow-up period of 130 days (range, 1–510). Conclusions BRTO utilizing STS foam appears effective in obliterating bleeding GVs with good short-term outcomes.

Wael E A Saad - One of the best experts on this subject based on the ideXlab platform.

  • management of stomal varices with transvenous obliteration utilizing Sodium Tetradecyl Sulfate foam sclerosis
    CardioVascular and Interventional Radiology, 2014
    Co-Authors: Wael E A Saad, Sandra L Schwaner, Allison Lippert, S S Sabri, Abdullah M S Alosaimi, Alan H Matsumoto, John F Angle, Stephen H Caldwell
    Abstract:

    The management of parastomal varices is not established. Transjugular intrahepatic portosystemic shunt (TIPS) creation is the most commonly described treatment; however, the rebleed rate after TIPS is 21–37 %. The purpose of the study is to determine the effectiveness of transvenous obliteration using Sodium Tetradecyl Sulfate (STS) and to describe a new simplified technique in obliterating these varices. Four patients are presented who underwent transvenous obliteration using STS. One was obliterated using balloon occlusion from the systemic veins, the second was obliterated without balloon from a transhepatic antegrade approach, and the last two patients were obliterated using the direct antegrade technique. This simplified technique requires only a micropuncture kit (not requiring balloons or coils) and ultrasound transducer compression of the systemic draining veins, relying on high portal pressure to keep the sclerosant confined to the varices. The sclerosant is essentially trapped between the portal pressure and the ultrasound-transducer compression (10–15 min). Technical success was achieved in all four patients without procedural or postprocedural complications and no rebleeding for a mean follow-up of 17 (range 2–33) months. Transvenous obliteration of parastomal varices utilizing STS as a sclerosant is safe and effective. The newly described technique is simple, feasible, and requires minimal equipment (no balloons or coils or catheters).

  • management of bleeding duodenal varices with combined tips decompression and trans tips transvenous obliteration utilizing 3 Sodium Tetradecyl Sulfate foam sclerosis
    Journal of clinical imaging science, 2014
    Co-Authors: Wael E A Saad, Sandra L Schwaner, Allison Lippert, S S Sabri, Abdullah M S Alosaimi, Nael Saad
    Abstract:

    Objectives: Endoscopic experience in the management of duodenal varices (DVs) is limited and challenging given the anatomic constraints and limited experience. The endovascular management of DVs is not yet established and the controversy of whether to manage them by decompression with a transjugular intrahepatic portosystemic shunt (TIPS) or by transvenous obliteration is unresolved. In the literature, the 6-12 month rebleeding rate of DVs after TIPS is 21-37% and after transvenous obliteration is 13%. The purpose of the study is to evaluate the clinical outcome of combined TIPS decompression and transvenous obliteration/sclerosis. Materials and Methods: This is a retrospective study (case series) of two institutions, evaluating patients who underwent TIPS and/or transvenous obliteration/sclerosis for bleeding DVs (from January 2009 to June 2013). TIPS was performed according to a standard procedure using covered stents. Transvenous obliteration (variceal sclerosis) from the systemic and/or portal venous circulation was performed utilizing 3% Sodium Tetradecyl Sulfate foam. Transvenous obliteration was commonly augmented with coils and/or vascular plugs. Technical (technical success of establishing TIPS and completely obliterating the DVs) and clinical outcomes (rebleeding rate and survival) were evaluated. Results: Five patients with liver cirrhosis presenting with bleeding DVs were included in the study with all eventually (and coincidentally) receiving TIPS and transvenous obliteration. Two of the five patients underwent concomitant TIPS and transvenous obliteration in the same procedural setting. However, three patients underwent transvenous obliteration due to bleeding despite a patent TIPS that had been previously placed. The average time from TIPS placement to transvenous obliteration was 125 days (range: 3-324 days). After having both procedures, there was no rebleeding in the patients during a mean follow-up period of 22 months (6-50 months). Coils and/or metallic vascular plugs were used to augment the sclerosant obliteration in four of five patients. Conclusion: The combination of TIPS decompression and foam sclerosant transvenous obliteration appears to be effective in preventing rebleeding in this limited case series and compares favorably with the existing evidence for either approach [TIPS or balloon-occluded retrograde transvenous obliteration (BRTO)] alone.

  • balloon occlusion catheter rupture during balloon occluded retrograde transvenous obliteration of gastric varices utilizing Sodium Tetradecyl Sulfate incidence and consequences
    Vascular and Endovascular Surgery, 2012
    Co-Authors: Wael E A Saad, Allison Lippert, S S Sabri, Alan H Matsumoto, David Nicholson, Cynthia E Wagner, Cenk U Turba, Mark G Davies, John F Angle
    Abstract:

    Balloon-occluded retrograde transvenous obliteration (BRTO) is an established procedure for the management of bleeding gastric varices in Asia. Invariably, the sclerosant utilized in Asia is ethanolamine oleate and the inventory used (vascular sheaths, balloon-occlusion catheters, and microcatheters) is not available outside Asia. A total of 41 BRTO procedures were performed with a technical and obliterative (gastric varix obliteration) success rate of 95% (n = 39 of 41) and 85% (n = 35 of 41), respectively. Complications were 4.9% (n = 2/41). A total of 6 balloon ruptures occurred (14.6%, n = 6 of 41). One rupture (16.7%, n = 1 of 6 of ruptures) lead to a technical failure and 2 ruptures (33.3%, n = 2 of 6 of ruptures) lead to an obliterative failure. Balloon rupture contributed to 50% of technical failures (n = 1/2, P = .274) and 33% of obliteration failures (n = 2/6, P = .148). In conclusion, the incidence of balloon-occlusion catheter rupture utilizing 3% Sodium Tetradecyl Sulfate (STS) and inventory ...

  • bleeding gastric varices obliteration with balloon occluded retrograde transvenous obliteration using Sodium Tetradecyl Sulfate foam
    Journal of Vascular and Interventional Radiology, 2011
    Co-Authors: S S Sabri, Wael E A Saad, Abdullah M S Alosaimi, Alan H Matsumoto, Stephen H Caldwell, Warren Swee, Ulku C Turba, A Park, John F Angle
    Abstract:

    Abstract Purpose Balloon-occluded retrograde transvenous obliteration (BRTO) of bleeding gastric varices (GV) is well described in the literature. Using Ethanolamine oleate as the sclerosing agent in BRTO, but it is not readily available in the United States in the desired concentrations. The authors' aim is to describe their initial experience with BRTO using Sodium Tetradecyl Sulfate (STS) foam as an alternative sclerosing agent. Materials and Methods The authors performed a retrospective review of their initial series in which STS foam was used to treat bleeding GV using BRTO. All study subjects had endoscopic evidence of gastric variceal bleeding. STS foam was made using a combination of agents with a 3:2:1 ratio of gas: 3% STS: Lipiodol (Ethiodol; Savage Laboratories, Melville, New York). Mean values and ranges were calculated for each variable, and clinical and imaging outcomes were assessed. Results The authors performed BRTO in 22 cirrhotic patients (11 men and 11 women) with a mean age of 52 years (range, 23–83 years). Technical success was achieved in 20 of 22 (91%) patients. Complications occurred in three of 22 (14%) patients. The overall mean dose of STS used was 300 mg (range, 30–600 mg) with mean total volume of sclerosant mixture of 34.1 mL (range, 10–65 mL). Follow-up imaging was available for 18 of 20 (90%) technically successful procedures with a mean period of 89 days (range, 1–359 days). Complete obliteration of GV was achieved in 16 of 18 (89%) patients. There were no cases of recurrent variceal bleeding with a mean clinical follow-up period of 130 days (range, 1–510). Conclusions BRTO utilizing STS foam appears effective in obliterating bleeding GVs with good short-term outcomes.

S S Sabri - One of the best experts on this subject based on the ideXlab platform.

  • management of stomal varices with transvenous obliteration utilizing Sodium Tetradecyl Sulfate foam sclerosis
    CardioVascular and Interventional Radiology, 2014
    Co-Authors: Wael E A Saad, Sandra L Schwaner, Allison Lippert, S S Sabri, Abdullah M S Alosaimi, Alan H Matsumoto, John F Angle, Stephen H Caldwell
    Abstract:

    The management of parastomal varices is not established. Transjugular intrahepatic portosystemic shunt (TIPS) creation is the most commonly described treatment; however, the rebleed rate after TIPS is 21–37 %. The purpose of the study is to determine the effectiveness of transvenous obliteration using Sodium Tetradecyl Sulfate (STS) and to describe a new simplified technique in obliterating these varices. Four patients are presented who underwent transvenous obliteration using STS. One was obliterated using balloon occlusion from the systemic veins, the second was obliterated without balloon from a transhepatic antegrade approach, and the last two patients were obliterated using the direct antegrade technique. This simplified technique requires only a micropuncture kit (not requiring balloons or coils) and ultrasound transducer compression of the systemic draining veins, relying on high portal pressure to keep the sclerosant confined to the varices. The sclerosant is essentially trapped between the portal pressure and the ultrasound-transducer compression (10–15 min). Technical success was achieved in all four patients without procedural or postprocedural complications and no rebleeding for a mean follow-up of 17 (range 2–33) months. Transvenous obliteration of parastomal varices utilizing STS as a sclerosant is safe and effective. The newly described technique is simple, feasible, and requires minimal equipment (no balloons or coils or catheters).

  • management of bleeding duodenal varices with combined tips decompression and trans tips transvenous obliteration utilizing 3 Sodium Tetradecyl Sulfate foam sclerosis
    Journal of clinical imaging science, 2014
    Co-Authors: Wael E A Saad, Sandra L Schwaner, Allison Lippert, S S Sabri, Abdullah M S Alosaimi, Nael Saad
    Abstract:

    Objectives: Endoscopic experience in the management of duodenal varices (DVs) is limited and challenging given the anatomic constraints and limited experience. The endovascular management of DVs is not yet established and the controversy of whether to manage them by decompression with a transjugular intrahepatic portosystemic shunt (TIPS) or by transvenous obliteration is unresolved. In the literature, the 6-12 month rebleeding rate of DVs after TIPS is 21-37% and after transvenous obliteration is 13%. The purpose of the study is to evaluate the clinical outcome of combined TIPS decompression and transvenous obliteration/sclerosis. Materials and Methods: This is a retrospective study (case series) of two institutions, evaluating patients who underwent TIPS and/or transvenous obliteration/sclerosis for bleeding DVs (from January 2009 to June 2013). TIPS was performed according to a standard procedure using covered stents. Transvenous obliteration (variceal sclerosis) from the systemic and/or portal venous circulation was performed utilizing 3% Sodium Tetradecyl Sulfate foam. Transvenous obliteration was commonly augmented with coils and/or vascular plugs. Technical (technical success of establishing TIPS and completely obliterating the DVs) and clinical outcomes (rebleeding rate and survival) were evaluated. Results: Five patients with liver cirrhosis presenting with bleeding DVs were included in the study with all eventually (and coincidentally) receiving TIPS and transvenous obliteration. Two of the five patients underwent concomitant TIPS and transvenous obliteration in the same procedural setting. However, three patients underwent transvenous obliteration due to bleeding despite a patent TIPS that had been previously placed. The average time from TIPS placement to transvenous obliteration was 125 days (range: 3-324 days). After having both procedures, there was no rebleeding in the patients during a mean follow-up period of 22 months (6-50 months). Coils and/or metallic vascular plugs were used to augment the sclerosant obliteration in four of five patients. Conclusion: The combination of TIPS decompression and foam sclerosant transvenous obliteration appears to be effective in preventing rebleeding in this limited case series and compares favorably with the existing evidence for either approach [TIPS or balloon-occluded retrograde transvenous obliteration (BRTO)] alone.

  • balloon occlusion catheter rupture during balloon occluded retrograde transvenous obliteration of gastric varices utilizing Sodium Tetradecyl Sulfate incidence and consequences
    Vascular and Endovascular Surgery, 2012
    Co-Authors: Wael E A Saad, Allison Lippert, S S Sabri, Alan H Matsumoto, David Nicholson, Cynthia E Wagner, Cenk U Turba, Mark G Davies, John F Angle
    Abstract:

    Balloon-occluded retrograde transvenous obliteration (BRTO) is an established procedure for the management of bleeding gastric varices in Asia. Invariably, the sclerosant utilized in Asia is ethanolamine oleate and the inventory used (vascular sheaths, balloon-occlusion catheters, and microcatheters) is not available outside Asia. A total of 41 BRTO procedures were performed with a technical and obliterative (gastric varix obliteration) success rate of 95% (n = 39 of 41) and 85% (n = 35 of 41), respectively. Complications were 4.9% (n = 2/41). A total of 6 balloon ruptures occurred (14.6%, n = 6 of 41). One rupture (16.7%, n = 1 of 6 of ruptures) lead to a technical failure and 2 ruptures (33.3%, n = 2 of 6 of ruptures) lead to an obliterative failure. Balloon rupture contributed to 50% of technical failures (n = 1/2, P = .274) and 33% of obliteration failures (n = 2/6, P = .148). In conclusion, the incidence of balloon-occlusion catheter rupture utilizing 3% Sodium Tetradecyl Sulfate (STS) and inventory ...

  • bleeding gastric varices obliteration with balloon occluded retrograde transvenous obliteration using Sodium Tetradecyl Sulfate foam
    Journal of Vascular and Interventional Radiology, 2011
    Co-Authors: S S Sabri, Wael E A Saad, Abdullah M S Alosaimi, Alan H Matsumoto, Stephen H Caldwell, Warren Swee, Ulku C Turba, A Park, John F Angle
    Abstract:

    Abstract Purpose Balloon-occluded retrograde transvenous obliteration (BRTO) of bleeding gastric varices (GV) is well described in the literature. Using Ethanolamine oleate as the sclerosing agent in BRTO, but it is not readily available in the United States in the desired concentrations. The authors' aim is to describe their initial experience with BRTO using Sodium Tetradecyl Sulfate (STS) foam as an alternative sclerosing agent. Materials and Methods The authors performed a retrospective review of their initial series in which STS foam was used to treat bleeding GV using BRTO. All study subjects had endoscopic evidence of gastric variceal bleeding. STS foam was made using a combination of agents with a 3:2:1 ratio of gas: 3% STS: Lipiodol (Ethiodol; Savage Laboratories, Melville, New York). Mean values and ranges were calculated for each variable, and clinical and imaging outcomes were assessed. Results The authors performed BRTO in 22 cirrhotic patients (11 men and 11 women) with a mean age of 52 years (range, 23–83 years). Technical success was achieved in 20 of 22 (91%) patients. Complications occurred in three of 22 (14%) patients. The overall mean dose of STS used was 300 mg (range, 30–600 mg) with mean total volume of sclerosant mixture of 34.1 mL (range, 10–65 mL). Follow-up imaging was available for 18 of 20 (90%) technically successful procedures with a mean period of 89 days (range, 1–359 days). Complete obliteration of GV was achieved in 16 of 18 (89%) patients. There were no cases of recurrent variceal bleeding with a mean clinical follow-up period of 130 days (range, 1–510). Conclusions BRTO utilizing STS foam appears effective in obliterating bleeding GVs with good short-term outcomes.

Stephen H Caldwell - One of the best experts on this subject based on the ideXlab platform.

  • management of stomal varices with transvenous obliteration utilizing Sodium Tetradecyl Sulfate foam sclerosis
    CardioVascular and Interventional Radiology, 2014
    Co-Authors: Wael E A Saad, Sandra L Schwaner, Allison Lippert, S S Sabri, Abdullah M S Alosaimi, Alan H Matsumoto, John F Angle, Stephen H Caldwell
    Abstract:

    The management of parastomal varices is not established. Transjugular intrahepatic portosystemic shunt (TIPS) creation is the most commonly described treatment; however, the rebleed rate after TIPS is 21–37 %. The purpose of the study is to determine the effectiveness of transvenous obliteration using Sodium Tetradecyl Sulfate (STS) and to describe a new simplified technique in obliterating these varices. Four patients are presented who underwent transvenous obliteration using STS. One was obliterated using balloon occlusion from the systemic veins, the second was obliterated without balloon from a transhepatic antegrade approach, and the last two patients were obliterated using the direct antegrade technique. This simplified technique requires only a micropuncture kit (not requiring balloons or coils) and ultrasound transducer compression of the systemic draining veins, relying on high portal pressure to keep the sclerosant confined to the varices. The sclerosant is essentially trapped between the portal pressure and the ultrasound-transducer compression (10–15 min). Technical success was achieved in all four patients without procedural or postprocedural complications and no rebleeding for a mean follow-up of 17 (range 2–33) months. Transvenous obliteration of parastomal varices utilizing STS as a sclerosant is safe and effective. The newly described technique is simple, feasible, and requires minimal equipment (no balloons or coils or catheters).

  • bleeding gastric varices obliteration with balloon occluded retrograde transvenous obliteration using Sodium Tetradecyl Sulfate foam
    Journal of Vascular and Interventional Radiology, 2011
    Co-Authors: S S Sabri, Wael E A Saad, Abdullah M S Alosaimi, Alan H Matsumoto, Stephen H Caldwell, Warren Swee, Ulku C Turba, A Park, John F Angle
    Abstract:

    Abstract Purpose Balloon-occluded retrograde transvenous obliteration (BRTO) of bleeding gastric varices (GV) is well described in the literature. Using Ethanolamine oleate as the sclerosing agent in BRTO, but it is not readily available in the United States in the desired concentrations. The authors' aim is to describe their initial experience with BRTO using Sodium Tetradecyl Sulfate (STS) foam as an alternative sclerosing agent. Materials and Methods The authors performed a retrospective review of their initial series in which STS foam was used to treat bleeding GV using BRTO. All study subjects had endoscopic evidence of gastric variceal bleeding. STS foam was made using a combination of agents with a 3:2:1 ratio of gas: 3% STS: Lipiodol (Ethiodol; Savage Laboratories, Melville, New York). Mean values and ranges were calculated for each variable, and clinical and imaging outcomes were assessed. Results The authors performed BRTO in 22 cirrhotic patients (11 men and 11 women) with a mean age of 52 years (range, 23–83 years). Technical success was achieved in 20 of 22 (91%) patients. Complications occurred in three of 22 (14%) patients. The overall mean dose of STS used was 300 mg (range, 30–600 mg) with mean total volume of sclerosant mixture of 34.1 mL (range, 10–65 mL). Follow-up imaging was available for 18 of 20 (90%) technically successful procedures with a mean period of 89 days (range, 1–359 days). Complete obliteration of GV was achieved in 16 of 18 (89%) patients. There were no cases of recurrent variceal bleeding with a mean clinical follow-up period of 130 days (range, 1–510). Conclusions BRTO utilizing STS foam appears effective in obliterating bleeding GVs with good short-term outcomes.