@article{ThurnerAugustinBleyetal.2022,
  author    = {Thurner, Annette and Augustin, Anne Marie and Bley, Thorsten Alexander and Kickuth, Ralph},
  title     = {2D-perfusion angiography for intra-procedural endovascular treatment response assessment in chronic mesenteric ischemia: a feasibility study},
  series = {BMC Medical Imaging},
  volume    = {22},
  journal   = {BMC Medical Imaging},
  doi       = {10.1186/s12880-022-00820-7},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-301131},
  year      = {2022},
  abstract  = {Background Endovascular revascularization has become the first-line treatment of chronic mesenteric ischemia (CMI). The qualitative visual analysis of digital subtraction angiography (DSA) is dependent on observer experience and prone to interpretation errors. We evaluate the feasibility of 2D-Perfusion Angiography (2D-PA) for objective, quantitative treatment response assessment in CMI. Methods 49 revascularizations in 39 patients with imaging based evidence of mesenteric vascular occlusive disease and clinical signs of CMI were included in this retrospective study. To assess perfusion changes by 2D-PA, DSA-series were post-processed using a dedicated, commercially available software. Regions of interest (ROI) were placed in the pre- and post-stenotic artery segment. In aorto-ostial disease, the inflow ROI was positioned at the mesenteric artery orifice. The ratios outflow to inflow ROI for peak density (PD), time to peak and area-under-the-curve (AUC) were computed and compared pre- and post-interventionally. We graded motion artifacts by means of a four-point scale. Feasibility of 2D-PA and changes of flow parameters were evaluated. Results Motion artifacts due to a mobile vessel location beneath the diaphragm or within the mesenteric root, branch vessel superimposition and inadequate contrast enhancement at the inflow ROI during manually conducted DSA-series via selective catheters owing to steep vessel angulation, necessitated exclusion of 26 measurements from quantitative flow evaluation. The feasibility rate was 47\%. In 23 technically feasible assessments, PD\(_{outflow}\)/PD\(_{inflow}\) increased by 65\% (p < 0.001) and AUC\(_{outflow}\)/AUC\(_{inflow}\) increased by 85\% (p < 0.001). The time to peak density values in the outflow ROI accelerated only minimally without reaching statistical significance. Age, BMI, target vessel (celiac trunk, SMA or IMA), stenosis location (ostial or truncal), calcification severity, plaque composition or the presence of a complex stenosis did not reach statistical significance in their distribution among the feasible and non-feasible group (p > 0.05). Conclusions Compared to other vascular territories and indications, the feasibility of 2D-PA in mesenteric revascularization for CMI was limited. Unfavorable anatomic conditions contributed to a high rate of inconclusive 2D-PA results.},
  language  = {en}
}
@article{AugustinLuciusThurneretal.2022,
  author    = {Augustin, Anne Marie and Lucius, Leonie Johanna and Thurner, Annette and Kickuth, Ralph},
  title     = {Malignant obstruction of the inferior vena cava: clinical experience with the self-expanding Sinus-XL stent system},
  series = {Abdominal Radiology},
  volume    = {47},
  journal   = {Abdominal Radiology},
  number    = {10},
  doi       = {10.1007/s00261-022-03587-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324951},
  pages     = {3604-3614},
  year      = {2022},
  abstract  = {Purpose To evaluate the technical and clinical outcome of Sinus-XL stent placement in patients with malignant obstruction syndrome of the inferior vena cava. Methods Between October 2010 and January 2021, 21 patients with different malignant primary disease causing inferior vena cava obstruction were treated with Sinus-XL stent implantation. Procedural data, technical and clinical outcome parameters were retrospectively analyzed. Results Technical success was 100\%. Analysis of available manometry data revealed a significant reduction of the mean translesional pressure gradient following the procedure (p = 0.008). Reintervention rate was 4.8\% (1/21). The available follow-up imaging studies showed primary and primary-assisted stent patency rates of 93\% (13/14) and 100\% (14/14), respectively. Major complications did not occur. The clinical success regarding lower extremity edema was 82.4\% (14/17) for the first and 85.7\% (18/21) for the last follow-up. Longer lengths of IVC obstruction were associated with reduced clinical improvement after the procedure (p = 0.025). Improvement of intraprocedural manometry results and lower extremity edema revealed only minor correlation. Ascites and anasarca were not significantly positively affected by the procedure. Conclusion Sinus-XL stent placement in patients with malignant inferior vena cava obstruction showed high technical success and low complication rates. Regarding the clinical outcome, significant symptom improvement could be achieved in lower extremity edema, whereas ascites and anasarca lacked satisfying symptom relief. Based on our results, this procedure should be considered as a suitable therapy in a palliative care setting for patients with advanced malignant disease.},
  language  = {en}
}
@article{AugustinKertelsWiegeringetal.2022,
  author    = {Augustin, Anne Marie and Kertels, Olivia and Wiegering, Verena and Thurner, Annette and Kickuth, Ralph},
  title     = {Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients},
  series = {Pediatric Radiology},
  volume    = {52},
  journal   = {Pediatric Radiology},
  number    = {8},
  doi       = {10.1007/s00247-022-05321-x},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324947},
  pages     = {1550-1558},
  year      = {2022},
  abstract  = {Background Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts. Objective To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents. Materials and methods Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal. Results Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1\%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur. Conclusion Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.},
  language  = {en}
}