Introduction: The fresh frozen plasma (FFP) is frequently prescribed either for therapeutic or prophylactic transfusion. The international normalised ratio (INR) value of 1.50 and above is frequently reported to be a transfusion trigger for FFP prior to interventional procedure. This study aimed to evaluate the efficacy of prophylactic FFP transfusion in normalising the INR and to determine the post-transfusion outcomes. Methods: A prospective cross-sectional study involved 81 patients who received prophylactic FFP transfusion over a period of three months. All demographic, clinical data and outcomes of FFP transfusion were captured and filled in the research proforma. Results: The proportion of patients achieved posttransfusion INR below 1.51 was 30.30% (n=27). The majority of patients underwent the interventional procedures with posttransfusion INR > 1.50 (n=52) without experiencing any bleeding episodes. Overall, FFP transfusion resulted in significant median INR difference from 1.89 (IQR, 0.53) to 1.60 (IQR, 0.25); p< 0.001. The greater median INR difference was observed in group with pretransfusion INR > 2.00 and who received FFP doses between 10.00 to 20.00 ml kg-1 (p < 0.001). The INR difference showed the significant, positive correlation with pretransfusion INR values (rs= 0.83, p < 0.001) and FFP doses (rs= 0.72, p< 0.001). Conclusions: The interventional procedures were safely carried out despite abnormal posttransfusion INR. The prophylactic FFP transfusions could be avoided in patients with mild coagulopathy (INR 1.50 - 2.00) prior interventional procedures.
Interventional procedures

With the continuous advances in modern medical technology and equipment,minimally invasive surgery (MIS) is widely applied in clinical practice.Ultrasound (US) as a real-time,portable,and radiation-free medical imaging method can be used for the intraoperative guidance in MIS to ensure safe and effective surgery.However,the physical characteristics of conventional US fail to display some tissue structures of the human body due to the existence of gas and bone.US-based navigation can make up for the deficiencies by advanced imaging technologies including spatial orientation,image reconstruction,and multi-modality image fusion,being real-time,accurate,and radiation-free.Therefore,US-guided robots can achieve safe,effective,and minimally invasive operation in MIS.This paper reviews the studies of US-guided robots in MIS and prospects the development of this field.
Humans ; Robotics/methods* ; Minimally Invasive Surgical Procedures/methods* ; Ultrasonography ; Spinal Fusion/methods* ; Ultrasonography, Interventional/methods*

We report a case of functional parathyroid cyst treated by ultrasound-guided anhydrous ethanol sclerotherapy and microwave ablation. The 63-year-old female patient was diagnosed to have functional parathyroid cyst with hypercalcemia, high PTH and cystic space-occupying lesions in the neck by ultrasound, radionuclide scanning and PTH measurement of the cystic fluid. The patient refused to receive cyst resection, and anhydrous ethanol sclerotherapy with microwave ablation was performed under ultrasound guidance. The procedure was completed smoothly without any complications either during or after the operation. Follow-up examination of the patient at 18 months after the operation showed a significant reduction of the mass and normal blood calcium and iPTH levels, demonstrating a clinical cure of the patient. Ablative treatment of functional parathyroid cyst has not been documented so far. This approach provides a minimally invasive treatment modality for such cases where surgical resection is not an option, but its efficacy and safety need to be evaluated in more cases with longer follow-up time.
Female ; Humans ; Middle Aged ; Microwaves/therapeutic use* ; Plastic Surgery Procedures ; Cysts ; Ethanol/therapeutic use* ; Ultrasonography, Interventional

Anterior choroidal artery (AChA) syndrome is widely known to be composed of a triad of hemiparesis, hemisensory loss and homonymous hemianopia. AChA syndrome is an unusual complication of aneurysmal treatment. This report documents two cases of AChA syndrome that occurred after an endovascular aneurysmal coiling procedure. Both cases showed complete recovery of the neurologic deficit at the time of discharge. To avoid this complication, meticulous caution is required to preserve the posterior communicating artery, the AChA and the various perforators during an endovascular procedure. When AChA syndrome occurs, immediate treatment is necessary, including vasodilators, thrombolytics and close observation of the patient's clinical status.
Adenosine ; Aneurysm ; Arteries ; Cerebral Infarction ; Choroid ; Endovascular Procedures ; Hemianopsia ; Intracranial Aneurysm ; Neurologic Manifestations ; Paresis ; Radiology, Interventional ; Vasodilator Agents

PURPOSE: The aim of this study was to investigate whether intraoperative ultrasonography (IOUS) helped the surgeon navigate towards the tumor as seen in preoperative magnetic resonance imaging and whether IOUS was able to distinguish between tumor margins and the surrounding tissue. METHODS: Twenty-five patients suffering from high-grade gliomas who were previously treated by surgery and radiotherapy were included. Intraoperatively, two histopathologic samples were obtained a sample of unequivocal tumor tissue (according to anatomical landmarks and the surgeon’s visual and tactile impressions) and a small tissue sample obtained using a navigated needle when the surgeon decided to stop the resection. This specimen was considered to be a boundary specimen, where no tumor tissue was apparent. The decision to take the second sample was not influenced by IOUS. The effect of IOUS was analyzed semi-quantitatively. RESULTS: All 25 samples of unequivocal tumor tissue were histopathologically classified as tumor tissue and were hyperechoic on IOUS. Of the boundary specimens, eight were hypoechoic. Only one harbored tumor tissue (P=0.150). Seventeen boundaries were moderately hyperechoic, and these samples contained all possible histological results (i.e., tumor, infiltration, or no tumor). CONCLUSION: During surgery performed on relapsed, irradiated, high-grade gliomas, IOUS provided a reliable method of navigating towards the core of the tumor. At borders, it did not reliably distinguish between remnants or tumor-free tissue, but hypoechoic areas seldom contained tumor tissue.
Brain* ; Glioblastoma ; Glioma* ; Humans ; Magnetic Resonance Imaging ; Methods ; Needles ; Neoplasm, Residual ; Neurosurgical Procedures ; Radiotherapy ; Ultrasonography* ; Ultrasonography, Interventional

In recent years, the interest in minimally invasive surgery has grown, and the same trend is observed in vascular surgery and interventional radiology, leading to what is called endovascular surgery. Since the first use of a stent-graft for the endovascular exclusion of an abdominal aortic aneurysm (AAA), endovascular aneurysm repair (EVAR) has greatly expanded, and more than 50,000 devices have been implanted until now. The endovascular graft can be implanted from a remote access site in the groin with a less anesthetic requirement. The endovascular graft is advanced over guidewires up the femoral and iliac arteries. Once in position, the graft is deployed immediately distal from the renal arteries. The aorta is not clamped and the blood loss is less than with open surgery. EVAR for AAA offers an important new alternative to open surgical procedure. The mortality rates after EVAR are reported between 0~5%. Long-term follow-up reports are not available, but mid-term follow-up of EVAR reveals an incidence of re-intervention between 10~20% and a rate of late rupture of between 0.5~1.5% per year. The problems of endoleaks and graft failure continue to be the challenges that require technological innovations. Based on the currently available evidence, EVAR is an appropriate treatment for selected patients, especially those at high risk for open surgical repair.
Aneurysm* ; Aorta ; Aortic Aneurysm, Abdominal ; Endoleak ; Groin ; Humans ; Iliac Artery ; Incidence ; Inventions ; Mortality ; Radiology, Interventional ; Renal Artery ; Rupture ; Stents ; Surgical Procedures, Minimally Invasive ; Transplants

Deep vein thrombosis (DVT) is a common disease; however, it can result in significant disabilities from pulmonary embolism and postphlebitic syndrome, especially when the iliofemoral vein is involved. Although anticoagulation can prevent thrombus propagation and recurrent venous thrombosis, it cannot dissolve the occluding thrombus or reduce venous outflow obstruction, leaving the patients suffering from postphlebitic syndrome. Catheter-directed thrombolysis, with direct delivery of a concentrated lytic agent into the clot, has been proposed as an alternative therapy to anticoagulation. Recent studies have demonstrated that early clot lysis through this technique rapidly restores venous patency, more effectively preserves valvular function, and reduces a risk of postphlebitic syndrome. To decrease clot burden, duration of treatment, and bleeding complications, mechanical thrombectomy may work synergistically with catheter-directed thrombolysis. After clot removal through those therapies, balloon angioplasty and stent placement are needed in patients with venous stricture (eg, iliac vein compression syndrome). Short- and long-term outcomes of stenting in iliofemoral DVT appear to be favorable. When used in conjunction with each other and anticoagulation, these minimally invasive endovascular techniques allow a better resolution of venous clot burden and have the potential to lead to improved long-term outcomes in patients with DVT. This review introduces endovascular treatments of acute DVT in the lower extremities performed in the interventional radiology section.
Angioplasty, Balloon ; Constriction, Pathologic ; Endovascular Procedures ; Hemorrhage ; Humans ; Iliac Vein ; Lower Extremity* ; Postphlebitic Syndrome ; Pulmonary Embolism ; Radiology, Interventional ; Stents ; Thrombectomy ; Thrombosis ; Veins ; Venous Thrombosis*

OBJECTIVE: To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. MATERIALS AND METHODS: A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. RESULTS: Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18-24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. CONCLUSION: Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.
Aneurysm, False ; Angiography ; Arteriovenous Fistula ; Demography ; Emergencies ; Endovascular Procedures ; Extremities ; Follow-Up Studies ; Humans ; Limb Salvage ; Male ; Popliteal Artery ; Radiology, Interventional ; Retrospective Studies ; Stents ; Thrombosis

OBJECTIVE: To discuss the preoperative, intraoperative, and postoperative application of echocardiography in mini-invasive surgical device closure of secundum atrial septal defects, including those special and difficulty-occluded defects. METHODS: We performed mini-invasive surgical device closure of secundum atrial septal defects on 287 patients. Before the surgery, transthoracic echocardiography was applied for screening; during the surgery we reassessed the sizes of the defects and their remaining margins, designated the suitable occluders, and guided the placement of the occluders by multiplane transesophageal echocardiography. The patients were postoperatively followed up at regular intervals by multiplane transesophageal echocardiography (MTEE) which was employed to assess the therapeutic efficacy. RESULTS: Out of the 287 atrial septal defects, 276 (96.17%) were successfully closed. There were 37 porous defects and 23 cases with short posterior-inferior margin of defects. Follow-ups at intervals showed the occluders stayed firmly and echoed clearly. No notable residual shunt or valve regurgitation was observed. CONCLUSION Echocardiography plays a vital and reliable role in mini-invasive surgical device closure of secundum atrial septal defects, especially those special and difficulty-occluded defects.
Adolescent ; Child ; Child, Preschool ; Echocardiography, Transesophageal ; methods ; Female ; Heart Septal Defects, Atrial ; surgery ; Humans ; Infant ; Male ; Minimally Invasive Surgical Procedures ; methods ; Septal Occluder Device ; Ultrasonography, Interventional

Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.
Diagnostic Imaging ; Embolization, Therapeutic/methods ; Hemostasis, Endoscopic ; Hemostatics/administration & dosage ; Humans ; Pancreatitis/*complications ; Stents ; Thrombin/administration & dosage ; Ultrasonography, Interventional ; Vascular Diseases/diagnosis/*etiology/physiopathology/*therapy ; Vascular Surgical Procedures/*methods