158 results on '"Paul V. Suhocki"'
Search Results
2. Cerebral venous biomarkers and veno-arterial gradients: untapped resources in Alzheimer’s disease
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Paul V. Suhocki and P. Murali Doraiswamy
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Alzheimer’s disease ,biomarkers ,radiology ,venous ,arterial ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Blood based biomarkers (BBB) derived from forearm veins for estimating brain changes is becoming ubiquitous in Alzheimer’s Disease (AD) research and could soon become standard in routine clinical diagnosis. However, there are many peripheral sources of contamination through which concentrations of these metabolites can be raised or lowered after leaving the brain and entering the central venous pool. This raises the issue of potential false conclusions that could lead to erroneous diagnosis or research findings. We propose the use of simultaneous sampling of internal jugular venous and arterial blood to calculate veno-arterial gradient, which can reveal either a surplus or a deficit of metabolites exiting the brain. Methods for sampling internal jugular venous and arterial blood are described along with examples of the use of the veno-arterial gradient in non-AD brain research. Such methods in turn could help better establish the accuracy of forearm venous biomarkers.
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- 2024
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3. Probing gut‐brain links in Alzheimer's disease with rifaximin
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Paul V. Suhocki, James S. Ronald, Anna Mae E. Diehl, David M. Murdoch, and P. Murali Doraiswamy
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antibiotics ,microbiome ,neurodegenerative disorders ,probiotics ,Neurology. Diseases of the nervous system ,RC346-429 ,Geriatrics ,RC952-954.6 - Abstract
Abstract Gut‐microbiome‐inflammation interactions have been linked to neurodegeneration in Alzheimer's disease (AD) and other disorders. We hypothesized that treatment with rifaximin, a minimally absorbed gut‐specific antibiotic, may modify the neurodegenerative process by changing gut flora and reducing neurotoxic microbial drivers of inflammation. In a pilot, open‐label trial, we treated 10 subjects with mild to moderate probable AD dementia (Mini‐Mental Status Examination (MMSE) = 17 ± 3) with rifaximin for 3 months. Treatment was associated with a significant reduction in serum neurofilament‐light levels (P
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- 2022
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4. Preemptive VAE—An Important Tool for Managing Blood Loss in MVT Candidates With PMT
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Deeplaxmi P. Borle, MD, Samuel J. Kesseli, MD, Andrew S. Barbas, MD, Aparna S. Rege, MD, Deepak Vikraman, MD, Ravindra Kadiyala, MD, Charles Y. Kim, MD, Tony P. Smith, MD, Paul V. Suhocki, MD, and Debra L. Sudan, MD
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Surgery ,RD1-811 - Abstract
Background. Explantation of native viscera in multivisceral transplant candidates, particularly in those with extensive portomesenteric thrombosis (PMT), carries considerable morbidity due to extensive vascularized adhesions. Preemptive visceral angioembolization has been previously described as a technique to minimize excessive blood loss during mobilization of the native viscera but is not well described specifically in patients with extensive PMT. Methods. In a series of 5 patients who underwent mutivisceral transplant for PMT from June 2015 to November 2018, we performed preoperative superior mesenteric, splenic, and hepatic artery embolization to reduce blood loss during explanation and evaluated the blood loss and blood product utilization, as well as 30-day rates of infectious complications. Results. Following preemptive embolization, median total blood loss was 6000 mL (range 800–7000 mL). The median transfusion requirements were as follows: 16 units packed red blood cells (range 2–47), 14 units fresh frozen plasma (range 0–29), 2 units cryoprecipitate (range 1–14), 4 units platelets (range 2–10), and 500 mL cell saver autotransfusion (range 0–1817). In the first 30 postoperative days, 2 out of 5 patients developed positive blood cultures and 3 out of 5 developed complex intra-abdominal infections. Two patients developed severe graft pancreatitis resulting in mycotic aneurysm of the aortic conduit; bleeding from the aneurysm led to 1 patient mortality. Conclusions. Preoperative embolization is an effective modality to mitigate exsanguinating blood loss during multivisceral transplant in patients with portomesenteric thrombosis; however, it is unclear if the resultant native organ ischemia during explant carries clinically relevant consequences.
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- 2021
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5. Tips and Techniques for Traversing the Impassable Biliary Stricture
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Nicholas T. Befera, Brendan C. Cline, Jonathan G. Martin, Paul V. Suhocki, and Charles Y. Kim
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Gastroenterology ,Radiology, Nuclear Medicine and imaging ,Surgery - Abstract
Biliary obstruction is a common indication for referral to interventional radiology, particularly when endoscopic retrograde cholangiopancreatography has failed or is not possible due to postsurgical anatomy. The standard approach to percutaneous transhepatic biliary drainage involves gaining needle access to a peripheral bile duct, followed by advancement of a guidewire and drainage catheter across the obstruction and into bowel to allow internal drainage. While most cases of biliary obstruction are managed successfully with this conventional approach, in some situations it is not possible to traverse the occlusion with a guidewire and catheter, and thus advanced techniques may be required. This article has reviewed the available strategies for managing the impassable biliary obstruction.
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- 2023
6. Safety Profile of Particle Embolization for Treatment of Acute Lower Gastrointestinal Bleeding
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Charles Y. Kim, Rui Dai, Elisabeth R. Seyferth, Nicholas T. Befera, Alan A. Sag, Jonathan G. Martin, Waleska M. Pabon-Ramos, Paul V. Suhocki, Tony P. Smith, and James Ronald
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Male ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Angiography ,Colonoscopy ,Retrospective cohort study ,Bowel resection ,Embolization, Therapeutic ,Surgery ,Safety profile ,Acute lower gastrointestinal bleeding ,Treatment Outcome ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Embolization ,Gastrointestinal Hemorrhage ,Cardiology and Cardiovascular Medicine ,Adverse effect ,business ,Aged ,Retrospective Studies - Abstract
Purpose To assess ischemic adverse events following particle embolization when used as a second-line embolic to coil embolization for treatment of acute lower gastrointestinal bleeding(LGIB). Materials and Methods This single-institution retrospective study examined 154 procedures where embolization was attempted for LGIB. In 122 patients (64 males, mean age 69.9 years), embolization was successfully performed using microcoils in 73 procedures, particles in 34 procedures, and both microcoils and particles in 27 procedures. Particles were used as second-line only when coil embolization was infeasible or inadequate. Technical success was defined as angiographic cessation of active extravasation after embolization. Clinical success was defined as absence of recurrent bleeding within 30 days of embolization. Results Technical success for embolization of LGIB was achieved in 87.0% of cases (134/154), and clinical success was 76.1%(102/134) among technically successful cases. Clinical success was 82.2%(60/73) for coils alone and 68.9%(42/61) for particles +/- coils. Severe adverse events involving embolization-induced bowel ischemia occurred in 3 of 56 patients who underwent particle embolization +/- coils (5.3%) versus zero out of 66 patients when coils alone were used (P=0.09). In patients who had colonoscopy or bowel resection within 2 weeks of embolization, ischemic findings attributable to the embolization were found in 3 of 15 who underwent embolization with coils alone, versus 8 of 18 who underwent embolization with particles +/- coils (p=0.27). Conclusion Particle embolization for treatment of LGIB as second line to coil embolization was associated with a 68.9% clinical success rate and a 5.3% rate of ischemia-related adverse events.
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- 2022
7. Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort
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Andrew J. Muir, Charles Y. Kim, Paul V. Suhocki, Nicholas T. Befera, Waleska M. Pabon-Ramos, Rui Dai, Alan A. Sag, Jonathan G. Martin, James Ronald, and Tony P. Smith
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Liver Cirrhosis ,Male ,medicine.medical_specialty ,medicine.drug_class ,Proton-pump inhibitor ,Rate ratio ,Gastroenterology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Poisson regression ,Hepatic encephalopathy ,Survival analysis ,Retrospective Studies ,business.industry ,Hazard ratio ,Proton Pump Inhibitors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Hepatic Encephalopathy ,030220 oncology & carcinogenesis ,Cohort ,symbols ,Portasystemic Shunt, Transjugular Intrahepatic ,business - Abstract
Purpose Proton pump inhibitor (PPI) use is a potential risk factor for hepatic encephalopathy (HE), but few studies have examined the effect on post-TIPS HE. The purpose of this study was to determine whether PPIs are associated with increased rates of post-TIPS HE in an independent patient cohort. Materials and methods This single-institution retrospective study analyzed 86 patients (54 male, mean age 58.2) following TIPS from 1/1/2017 to 12/31/2019. Dates of PPI usage and episodes of new or worsening HE were recorded. Poisson regression with generalized estimating equations was used to test for association between PPI use and post-TIPS HE and to test for dose dependence. Post-TIPS HE was also analyzed using the Andersen-Gill survival model for recurrent events. Results There were 1.88 episodes of new or worsening post-TIPS HE per person-year among 35 patients on uninterrupted PPIs therapy, 1.95 on PPIs and 0.94 off PPIs among 35 patients on intermittent therapy, and 0.47 among 16 patients never on PPIs. PPI use was significantly associated with post-TIPS HE in both univariable (incidence rate ratio (IRR) = 2.62; CI = 1.41–4.84; p = 0.002) and multivariable (IRR = 2.31; CI = 1.37–3.89; p = 0.002) regression. Analysis of only those patients on PPIs showed increased rates of HE with higher doses (IRR = 1.17 per 10 mg omeprazole equivalent; CI = 1.04–1.33; p = 0.011). Recurrent events survival analysis supported the association between PPI use and HE in univariable (hazard ratio (HR) = 2.17; CI = 1.19–3.95; p = 0.011) and multivariable (HR = 1.87; CI = 1.12–3.13; p = 0.017) analysis. Conclusion In an independent patient cohort PPI use was associated with increased rates of new or worsening post-TIPS HE.
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- 2021
8. Influence of peritoneal dialysis catheter type on complications and long-term outcomes: an updated systematic review and meta-analysis
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Konstantinos P. Economopoulos, Muath Bishawi, Theodore N. Pappas, Dimitrios Spinos, Ruediger W. Lehrich, Nikolaos Syrigos, Anastasia Vasilopoulou, Stepan M. Esagian, John P. Middleton, and Paul V. Suhocki
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medicine.medical_specialty ,business.industry ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Cochrane Library ,Confidence interval ,law.invention ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,Randomized controlled trial ,Nephrology ,law ,Internal medicine ,Relative risk ,Meta-analysis ,Cuff ,medicine ,Complication ,business - Abstract
There is currently no consensus regarding the optimal type of peritoneal dialysis catheter (PDC). We compared the outcomes of PDCs according to the number of cuffs, intercuff and intraperitoneal segment shape, and presence of a weighted tip. A systematic review of the literature was performed using the MEDLINE and Cochrane Library databases (end-of-search date: October 16th, 2019). We included studies comparing double-cuff vs. single-cuff, swan-neck vs. straight-neck, coiled-tip vs. straight-tip, and weighted vs. non-weighted PDCs for the outcomes of interest. We performed meta-analyses using the random-effects model. We assessed the risk of bias using the Newcastle–Ottawa scale and the Cochrane Collaboration’s Tool. In total, 38 studies were identified, of which 20 were randomized controlled trials (RCTs) and 18 were observational studies. No statistically significant differences were detected between double-cuff vs. single-cuff, swan-neck vs. straight-neck, and coiled-tip vs. straight tip PDCs in any of the outcomes of interest. Weighted catheters were associated with significantly lower rates of tunnel infection (relative risk [RR] 0.52, 95% confidence interval [CI] 0.31–0.95, p = 0.03), migration (RR 0.07, 95% CI 0.03–0.16, p
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- 2021
9. Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach
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Paul V. Suhocki, Jonathan G. Martin, Tony P. Smith, Charles Y. Kim, Waleska M. Pabon-Ramos, James Ronald, Alan A. Sag, and Christopher J.R. Gallo
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Thorax ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Ultrasound ,Stent ,Hemothorax ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,Angioplasty ,Occlusion ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Coaxial ,Cardiology and Cardiovascular Medicine ,business - Abstract
To evaluate the technical success and safety of a steerable coaxial sharp recanalization technique that utilizes routine needles in patients with refractory thoracic central venous occlusions. This retrospective study was performed on 36-attempted sharp recanalizations in 35 patients (mean age 50 years, 23 male) performed via a supraclavicular approach. In all cases, an 18-gauge trocar needle was custom curved to provide directional control during fluoroscopic triangulation. A 22-gauge Chiba needle was then advanced coaxially across the occlusion. A tractogram was performed to assess for traversal of unintended structures. Procedures were completed by catheter placement, angioplasty, or stenting follow successful recanalizations. Sharp recanalization using this steerable coaxial needle technique demonstrated a technical success rate of 94% (34/36). The mean occlusion length was 30 mm (range 3–53 mm). In 11 patients, success was achieved using this technique after failure of other advanced techniques. In five procedures, stent interstices were traversed. Sharp recanalization was the direct cause of one major complication consisting of pleural transgression causing mild hemothorax treated successfully with a stent graft. The proposed technique is effective and safe for patients who have failed traditional blunt recanalization techniques. Level 4, Case Series.
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- 2021
10. Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis
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Muath Bishawi, Konstantinos P. Economopoulos, Stepan M. Esagian, Ioannis A. Ziogas, John P. Middleton, Ruediger W. Lehrich, Paul V. Suhocki, Theodore N. Pappas, and Georgios Antonios Sideris
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Dialysis catheter ,030204 cardiovascular system & hematology ,Cochrane Library ,medicine.disease ,Surgery ,Peritoneal dialysis ,law.invention ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,Randomized controlled trial ,Nephrology ,law ,Relative risk ,medicine ,Hernia ,business - Abstract
No consensus currently exists regarding the optimal approach for peritoneal dialysis catheter placement. We aimed to compare the outcomes of percutaneous and surgical peritoneal dialysis catheter placement. A systematic review of the literature was performed using the MEDLINE, Cochrane Library, and Scopus databases (end-of-search date: August 29th, 2020). We included studies comparing percutaneous (blind, under fluoroscopic/ultrasound guidance, and “half-perc”) and surgical peritoneal dialysis catheter placement (open and laparoscopic) in terms of their infectious complications (peritonitis, tunnel/exit-site infections), mechanical complications (leakage, inflow/outflow obstruction, migration, hemorrhage, hernia, bowel perforation) and long-term outcomes (malfunction, removal, replacement, surgery required, and mortality). Thirty-four studies were identified, including thirty-two observational studies (twenty-six retrospective and six prospective) and two randomized controlled trials. Percutaneous placement was associated with significantly lower rates of tunnel/exit-site infection [relative risk (RR) 0.72, 95% confidence interval (CI) 0.56–0.91], catheter migration (RR 0.68, 95% CI 0.49, 0.95), and catheter removal (RR 0.73, 95% CI 0.60–0.88). The 2-week and 4-week rates of early tunnel/exit-site infection were also lower in the percutaneous group (RR 0.45, 95% CI 0.22–0.93 and RR 0.41, 95% CI 0.27–0.63, respectively). No statistically significant difference was observed regarding other outcomes, including catheter survival and mechanical complications. Overall, the quality of published literature on the field of peritoneal dialysis catheter placement is poor, with a small percentage of studies being randomized clinical trials. Percutaneous peritoneal dialysis catheter placement is a safe procedure and may result in fewer complications, such as tunnel/exit-site infections, and catheter migration, compared to surgical placement. PROSPERO CRD42020154951.
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- 2020
11. Drainage Performance of a Novel Catheter Designed to Reduce Drainage Catheter Failure
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Paul V. Suhocki, Bradley Feiger, Muath Bishawi, Neel Kurupassery, George A. Truskey, Konstantinos P. Economopoulos, Amanda Randles, and Theodore N. Pappas
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,Materials science ,lcsh:R895-920 ,Pressure differential ,Compression (physics) ,innovation and design ,Volumetric flow rate ,catheter occlusion ,Catheter ,suction catheter ,Catheter drainage ,Fluid dynamics ,Analysis software ,Radiology, Nuclear Medicine and imaging ,Drainage ,Biomedical engineering - Abstract
Objective Efficient flow of fluids through drainage/infusion catheters is affected by surrounding tissue, organ compression, and scar tissue development, limiting or completely obstructing flow through drainage holes. In this work, we introduce a novel three-dimensional (3D) drainage catheter with protected side holes to reduce flow blockages. We then compare its drainage performance to standard straight and pigtail catheters using computer-generated catheter designs and flow analysis software. Methods Drainage performance was computed as flow rate through the catheter for a given pressure differential. Each catheter contained drainage holes on the distal (insertion) end and a single outlet (hub) hole open to atmosphere. Computational fluid dynamics using ANSYS AIM 18.2 was used to simulate flow through the catheter and examine drainage performance based on variations to the following parameters: (1) side hole shape, (2) cross-sectional area of the catheters, (3) number of side holes, and (4) cross-sectional area of the side holes. Results Drainage through the newly introduced catheter in all simulations was nearly identical to standard pigtail and straight catheters. While working to optimize the 3D catheter design, we found that the changes in side hole shape and side hole cross-sectional area had little effect on the total flow rate through the catheters but had a large impact on flow rate through the side hole nearest to the hub (proximal hole). Additionally, the majority of flow in all catheters occurred at the most proximal 1 to 3 side holes closest to hub, with relatively little flow occurring at side holes more distally located (closest to insertion end). The 3D catheter demonstrated no changes in flow characteristics when the coiled segment was occluded, giving it an advantage over other catheter types when the catheter is compressed by surrounding tissue or other external obstruction. Conclusions The majority of fluid flow in catheters with a diameter of 4.67 mm (14 Fr) or smaller occurred at the most proximal 1 to 3 side holes. A novel 3D coiled catheter design can protect these proximal holes from external blockage while maintaining drainage performance compared with standard straight and pigtail catheters.
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- 2020
12. Length of Stay Predicts Risk of Early Infection for Hospitalized Patients Undergoing Central Venous Port Placement
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Linnan Tang, Tony P. Smith, James Ronald, Alan A. Sag, Jonathan G. Martin, Waleska M. Pabon-Ramos, Paul V. Suhocki, and Charles Y. Kim
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Adult ,Male ,Catheterization, Central Venous ,medicine.medical_specialty ,Time Factors ,Hospitalized patients ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Catheters, Indwelling ,0302 clinical medicine ,Port (medical) ,Risk Factors ,Internal medicine ,Central Venous Catheters ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Young adult ,Survival analysis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Inpatients ,business.industry ,Decision Trees ,Hazard ratio ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Patient Discharge ,Confidence interval ,Catheter-Related Infections ,030220 oncology & carcinogenesis ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
To compare early totally implantable central venous port catheter-related infection rates after inpatient vs outpatient placement and to determine whether the risk associated with inpatient placement is influenced by length of hospital stay.In this single-institution retrospective study, 5,301 patients (3,618 women; mean age 57 y) underwent port placement by interventional radiologists between October 2004 and January 2018. The 30-day infection rate was compared between inpatients and outpatients using survival analysis. Among inpatients, the effect of time from admission to port placement and from placement to discharge was analyzed using a survival regression tree.The 30-day infection rate was 3.6% (95% confidence interval [CI] = 1.9%-6.1%) among 386 inpatients and 1.0% (95% CI = 0.7%-1.3%) among 4,915 outpatients (hazard ratio [HR] = 3.6, 95% CI = 2.0-6.6, P.001). Inpatient placement was a significant risk factor after accounting for covariates in multivariate analysis (HR = 2.2, 95% CI = 1.0-4.7, P = .05) and controlling for demographic differences by propensity score matching (HR = 2.8, 95% CI = 1.0-7.8, P = .04). Infection rate was 11% (95% CI = 4.7%-22%) among 65 inpatients in whom time from admission to placement was ≥ 7 days, 5.1% (95% CI = 1.9%-11%) among 129 inpatients in whom admission to placement was7 days and time to discharge was3 days, and 0% (95% CI = 0%-2.1%) among 192 inpatients in whom admission to placement was7 days and time to discharge was ≤ 3 days (P.001).Inpatient port placement was associated with a higher risk of early infection. However, a clinical decision tree based on shorter length of stay before and after placement may identify a subset of hospitalized patients not at increased risk for infection.
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- 2020
13. Relative Sarcopenia With Excess Adiposity Predicts Survival After Transjugular Intrahepatic Portosystemic Shunt Creation
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Paul V. Suhocki, Mustafa R. Bashir, Islam H Zaki, Matthew R. Kappus, Erol Bozdogan, Tony P. Smith, Steven S Choi, James Ronald, Charles Y. Kim, and Jonathan G. Martin
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Adult ,Male ,Sarcopenia ,medicine.medical_specialty ,medicine.medical_treatment ,Rate ratio ,Gastroenterology ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Obesity ,Risk factor ,Survival analysis ,Adiposity ,Aged ,Retrospective Studies ,Aged, 80 and over ,First episode ,Univariate analysis ,business.industry ,Hazard ratio ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Survival Rate ,030220 oncology & carcinogenesis ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
OBJECTIVE. The purpose of this study was to assess the impact of relative sarcopenia with excess adiposity on mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS. In this single-institution retrospective study, patients underwent abdominal CT scans within 100 days before or 30 days after TIPS creation. Subcutaneous and visceral adipose tissue and muscle were segmented at the L3 vertebral level. Relative sarcopenia with excess adiposity was defined as the lowest sex-specific quartile of muscle area divided by muscle plus adipose. Dates of death, liver transplantation, TIPS occlusion, and hepatic encephalopathy (HE) after TIPS creation were identified. Mortality was evaluated using competing risks survival analysis. Number of HE episodes and time to first episode were analyzed using negative binomial regression and competing risks survival analysis, respectively. RESULTS. A total of 141 patients (91 men; mean age, 56 years) were included in this study. In univariate analyses, Model for End-Stage Liver Disease (MELD) score (hazard ratio [HR], 1.09 per point; CI, 1.05-1.13; p < 0.001) and relative sarcopenia with excess adiposity (HR, 2.70; CI, 1.55-4.69; p < 0.001) were significant risk factors for shorter survival after TIPS. In multivariate analysis, both MELD score (HR, 1.09; CI, 1.03-1.15; p = 0.003) and relative sarcopenia with excess adiposity (HR, 2.65; CI, 1.56-4.51; p < 0.001) were significant predictors of worse survival. The C-index at 30 days was 0.71 for MELD score, 0.72 for relative sarcopenia with excess adiposity, and 0.80 for a model including both. There was no association between relative sarcopenia with excess adiposity and number of HE episodes (incidence rate ratio, 1.08; CI, 0.49-2.40; p = 0.84) or time to first HE episode (HR, 0.89; CI, 0.51-1.54; p = 0.67). CONCLUSION. Relative sarcopenia with excess adiposity is a risk factor for mortality after TIPS and contributes additional prognostic information beyond MELD score.
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- 2020
14. Probing Gut-Brain Links in Alzheimer’s Disease with Rifaximin
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Paul V. Suhocki, David M Murdoch, Anna Mae Diehl, P. Murali Doraiswamy, and James Ronald
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medicine.medical_specialty ,biology ,medicine.drug_class ,business.industry ,Antibiotics ,Neurodegeneration ,Disease ,Gut flora ,biology.organism_classification ,medicine.disease ,Gastroenterology ,Rifaximin ,chemistry.chemical_compound ,chemistry ,Internal medicine ,medicine ,Dementia ,Microbiome ,Alzheimer's disease ,business - Abstract
Gut-microbiome-inflammation interactions have been linked to neurodegeneration in Alzheimer’s disease (AD) and other disorders. We hypothesized that treatment with rifaximin, a minimally absorbed gut-specific antibiotic, may modify the neurodegenerative process by changing gut flora and reducing neurotoxic microbial drivers of inflammation. In a pilot, open-label trial, we treated 10 subjects with mild to moderate probable AD dementia (MMSE = 17 ± 3) with rifaximin for 3 months. Treatment was associated with a significant reduction in serum neurofilament-light levels (p Research in ContextSystematic ReviewPubMed reviews showed emerging evidence for gut-microbiome-inflammation links in Alzheimer’s disease (AD).InterpretationOur pilot study revealed that rifaximin, a minimally absorbed, gut-specific antibiotic, reduced surrogate markers of neurodegeneration while increasing, potentially beneficial, microbiota in phylum Firmicutes. These data provide initial support to the hypothesis that microbiome related products may play a role in neurodegenerative disorders.Future DirectionsWe plan to conduct additional human and pre-clinical studies to confirm these findings and determine the potential of rifaximin as a therapeutic for AD.
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- 2021
15. Gastrohepatic Fistula After Y-90 Embolization of Hepatocellular Carcinoma
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Paul V. Suhocki, Mariya L. Samoylova, Nikhil Kapila, M Cristina Segovia, and Lisa M. McElroy
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Gastric Fistula ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Fistula ,medicine.medical_treatment ,MEDLINE ,Article ,Text mining ,medicine ,Humans ,Yttrium Radioisotopes ,Embolization ,Aged ,Hepatology ,business.industry ,Liver Diseases ,Liver Neoplasms ,Gastroenterology ,Angiography ,Digestive System Fistula ,medicine.disease ,Embolization, Therapeutic ,Magnetic Resonance Imaging ,Hepatocellular carcinoma ,Radiology ,business - Published
- 2021
16. Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation
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Paul V. Suhocki, Meghana Konanur, Tzu-Hao Lee, James Ronald, Tony P. Smith, Waleska M. Pabon-Ramos, Charles Y. Kim, D. Lewis, Cole Ziegler, Melissa D. Hall, and Steven S Choi
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Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,medicine.medical_treatment ,Proton-pump inhibitor ,Rate ratio ,Risk Assessment ,Gastroenterology ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Young adult ,Hepatic encephalopathy ,Omeprazole ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Proton Pump Inhibitors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Treatment Outcome ,Hepatic Encephalopathy ,030220 oncology & carcinogenesis ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt ,medicine.drug - Abstract
PURPOSE To determine whether proton pump inhibitor (PPI) use increases the rate of new or worsening hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS In this retrospective study, 284 of 365 patients who underwent TIPS creation from January 1, 2005, to December 31, 2016, were analyzed (186 male, mean age 56 y, range 19-84 y). Dates of PPI use and dates of new or worsening HE, defined as hospitalization or escalation in outpatient medical management, were extracted from medical records. Mixed-effects negative binomial regression was used to test for an association between PPI usage and HE. RESULTS After TIPS creation, among 168 patients on PPIs chronically, there were 235 episodes of new or worsening HE in 106,101 person-days (0.81/person-year). Among 55 patients never on PPIs, there were 37 episodes in 31,066 person-days (0.43/person-year). Among 61 patients intermittently taking PPIs, there were 78 episodes in 37,710 person-days while on PPIs (0.75/person-year) and 25 episodes in 35,678 person-days while off PPIs (0.26/person-year). In univariate regression, PPI usage was associated with a 3.34-fold increased rate of new or worsening HE (incidence rate ratio [IRR] 3.34; P < .001). In multivariate regression, older age (IRR 1.05; P < .001), male sex (IRR 1.58; P = .023), higher Model for End-Stage Liver Disease score (IRR 1.06; P = .015), previous HE or HE-preventive medication use (IRR 1.51; P = .029), and PPI use (IRR 3.19; P < .001) were significant risk factors. Higher PPI doses were associated with higher rates of HE (IRR 1.16 per 10 mg omeprazole equivalent; P = .046). CONCLUSIONS PPI usage is associated with increased rates of new or worsening HE after TIPS creation.
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- 2019
17. No Increased Mortality After TIPS Compared with Serial Large Volume Paracenteses in Patients with Higher Model for End-Stage Liver Disease Score and Refractory Ascites
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Tony P. Smith, Charles Y. Kim, Matthew R. Kappus, Steven S Choi, Paul V. Suhocki, Jonathan G. Martin, James Ronald, Alan A. Sag, Rajiv Rao, and Waleska M. Pabon-Ramos
- Subjects
Adult ,Male ,endocrine system ,medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology ,030218 nuclear medicine & medical imaging ,End Stage Liver Disease ,Young Adult ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Model for End-Stage Liver Disease ,Internal medicine ,Ascites ,medicine ,Humans ,Paracentesis ,Radiology, Nuclear Medicine and imaging ,Hepatic encephalopathy ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Proportional hazards model ,Hazard ratio ,Middle Aged ,medicine.disease ,Survival Analysis ,body regions ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Varices ,Transjugular intrahepatic portosystemic shunt - Abstract
To compare survival after transjugular intrahepatic portosystemic shunt (TIPS) creation versus serial large volume paracenteses (LVP) in patients with refractory ascites and higher Model for End-Stage Liver Disease (MELD) scores.In this retrospective study, from 1/1/2013 to 10/1/2018, 478 patients (294 male; mean age 58, range 23-89) underwent serial LVP (n = 386) or TIPS (n = 92) for ascites. Propensity-matched cohorts were constructed based on age, MELD, Charlson comorbidity index, varices, and hepatic encephalopathy. Survival was analyzed using a Cox proportional hazards model in which MELD score and TIPS were treated as time-dependent covariates. An interaction term was used to assess the impact of TIPS versus serial LVP on survival as a function of increasing MELD.In the overall patient sample, higher MELD score predicted worse survival after either serial LVP or TIPS [hazard ratio (HR) = 1.13; p 0.001], but there was no significant interaction between TIPS and higher MELD score conferring worse survival (HR = 1.01; p = 0.55). In 92 propensity-matched serial LVP and 92 TIPS patients, higher MELD score predicted worse survival after either serial LVP or TIPS (HR = 1.19; p 0.001), but there was no significant survival interaction between TIPS and higher MELD (HR = 0.97; p = 0.22). In 30 propensity-matched serial LVP patients and 30 TIPS patients with baseline MELD greater than 18, TIPS did not predict worse survival (HR = 0.97; p = 0.94).Higher MELD predicts poorer survival after either serial LVP or TIPS, but TIPS creation is not associated with worse survival compared to serial LVP in patients with higher MELD scores LEVEL OF EVIDENCE: Level 4, case series.
- Published
- 2019
18. Preemptive VAE—An Important Tool for Managing Blood Loss in MVT Candidates With PMT
- Author
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Aparna Rege, Samuel J. Kesseli, Debra L. Sudan, Tony P. Smith, Deeplaxmi Borle, Deepak Vikraman, Paul V. Suhocki, Charles Y. Kim, Andrew S. Barbas, and Ravindra Kadiyala
- Subjects
Transplantation ,medicine.medical_specialty ,Intestinal Transplantation ,RD1-811 ,business.industry ,medicine.medical_treatment ,030230 surgery ,medicine.disease ,Thrombosis ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Blood product ,Cryoprecipitate ,medicine ,030211 gastroenterology & hepatology ,Hepatic artery embolization ,Fresh frozen plasma ,Embolization ,business ,Packed red blood cells ,Autotransfusion - Abstract
Background. Explantation of native viscera in multivisceral transplant candidates, particularly in those with extensive portomesenteric thrombosis (PMT), carries considerable morbidity due to extensive vascularized adhesions. Preemptive visceral angioembolization has been previously described as a technique to minimize excessive blood loss during mobilization of the native viscera but is not well described specifically in patients with extensive PMT. Methods. In a series of 5 patients who underwent mutivisceral transplant for PMT from June 2015 to November 2018, we performed preoperative superior mesenteric, splenic, and hepatic artery embolization to reduce blood loss during explanation and evaluated the blood loss and blood product utilization, as well as 30-day rates of infectious complications. Results. Following preemptive embolization, median total blood loss was 6000 mL (range 800–7000 mL). The median transfusion requirements were as follows: 16 units packed red blood cells (range 2–47), 14 units fresh frozen plasma (range 0–29), 2 units cryoprecipitate (range 1–14), 4 units platelets (range 2–10), and 500 mL cell saver autotransfusion (range 0–1817). In the first 30 postoperative days, 2 out of 5 patients developed positive blood cultures and 3 out of 5 developed complex intra-abdominal infections. Two patients developed severe graft pancreatitis resulting in mycotic aneurysm of the aortic conduit; bleeding from the aneurysm led to 1 patient mortality. Conclusions. Preoperative embolization is an effective modality to mitigate exsanguinating blood loss during multivisceral transplant in patients with portomesenteric thrombosis; however, it is unclear if the resultant native organ ischemia during explant carries clinically relevant consequences.
- Published
- 2021
19. Percutaneous gastrojejunostomy tubes: Identification of predictors of retrograde jejunal limb migration into the stomach
- Author
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Andre M. Agassi, Waleska M. Pabon-Ramos, Tony P. Smith, Charles Y. Kim, Paul V. Suhocki, Alan A. Sag, Jonathan G. Martin, Christopher J.R. Gallo, James Ronald, and David Y. Johnson
- Subjects
Male ,medicine.medical_specialty ,Gastric Bypass ,Lower risk ,Percutaneous gastrojejunostomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Enteral Nutrition ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Gastric antrum ,Antrum ,Intubation, Gastrointestinal ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Stomach ,Infant ,Interventional radiology ,Pylorus ,Surgery ,medicine.anatomical_structure ,Fundus (uterus) ,030220 oncology & carcinogenesis ,business - Abstract
To identify whether technically modifiable factors during gastrojejunostomy (GJ) tube insertion are predictive of retrograde jejunal limb migration into the stomach.Retrospective review of our procedural database over a 5-year period revealed 988 successful primary GJ tube insertions. Medical records and imaging were reviewed for cases of retrograde jejunal limb migration. Primary analysis was performed on 74 patients with retrograde tip migration within 3 months after placement (37 males, mean age = 57). Comparison was performed on 67 control patients (34 males, mean age = 51) who had radiologically confirmed GJ tube stability for at least 6 months. Procedural fluoroscopic images were analyzed for multiple GJ tube configuration parameters. The stomach was designated into antrum, body, and fundus. Predictors of retrograde tip migration were analyzed with univariate and multivariate logistic regression analysis.A total of 110 patients (11.1%) had retrograde jejunal limb migration, with 74 (7.5%) occurring within 3 months of placement. On multivariate analysis, the factors associated with a significantly lower risk of tip malposition included gastric puncture site in the antrum (OR: 0.27, 95% CI: 0.13-0.56, p 0.001) and GJ tract angle less than 30 degrees away from the pylorus (OR: 0.35, 95% CI: 0.16-0.76, p = 0.008). No patient in either cohort had a major complication within 30 days of procedure.To minimize the risk of retrograde tip migration, GJ tubes should be inserted into the gastric antrum with an entry tract oriented as directly towards the pylorus as possible.
- Published
- 2020
20. Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach
- Author
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Christopher J R, Gallo, James, Ronald, Waleska M, Pabon-Ramos, Paul V, Suhocki, Alan A, Sag, Jonathan G, Martin, Tony P, Smith, and Charles Y, Kim
- Subjects
Adult ,Male ,Catheterization, Central Venous ,Angioplasty ,Middle Aged ,Thorax ,Treatment Outcome ,Chronic Disease ,Humans ,Female ,Stents ,Vascular Diseases ,Aged ,Retrospective Studies - Abstract
To evaluate the technical success and safety of a steerable coaxial sharp recanalization technique that utilizes routine needles in patients with refractory thoracic central venous occlusions.This retrospective study was performed on 36-attempted sharp recanalizations in 35 patients (mean age 50 years, 23 male) performed via a supraclavicular approach. In all cases, an 18-gauge trocar needle was custom curved to provide directional control during fluoroscopic triangulation. A 22-gauge Chiba needle was then advanced coaxially across the occlusion. A tractogram was performed to assess for traversal of unintended structures. Procedures were completed by catheter placement, angioplasty, or stenting follow successful recanalizations.Sharp recanalization using this steerable coaxial needle technique demonstrated a technical success rate of 94% (34/36). The mean occlusion length was 30 mm (range 3-53 mm). In 11 patients, success was achieved using this technique after failure of other advanced techniques. In five procedures, stent interstices were traversed. Sharp recanalization was the direct cause of one major complication consisting of pleural transgression causing mild hemothorax treated successfully with a stent graft.The proposed technique is effective and safe for patients who have failed traditional blunt recanalization techniques.Level 4, Case Series.
- Published
- 2020
21. Percutaneous Gastrojejunostomy Tube Insertion in Patients with Surgical Gastrojejunal Anastomoses: Analysis of Success Rates and Durability
- Author
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Tony P. Smith, James Ronald, David Y. Johnson, Andre M. Agassi, Dan G. Blazer, Jonathan G. Martin, Christopher J.R. Gallo, Paul V. Suhocki, Charles Y. Kim, Alan A. Sag, and Waleska M. Pabon-Ramos
- Subjects
Male ,medicine.medical_specialty ,Gastroparesis ,Time Factors ,Technical success ,Gastric Bypass ,Punctures ,Anastomosis ,Radiography, Interventional ,Percutaneous gastrojejunostomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Enteral Nutrition ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Aged ,Aged, 80 and over ,business.industry ,Stomach ,Anastomosis, Surgical ,Mean age ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Gastric Emptying ,030220 oncology & carcinogenesis ,Tube placement ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Patients with a gastrojejunal anastomosis pose challenging anatomy for percutaneous gastrojejunostomy (GJ)-tube placement. A retrospective review of 24 patients (mean age 67.8 years, 13 males) with GJ anastomoses who underwent attempted GJ tube placement revealed infeasible placement in 6 patients (25%) due to an inadequate window for puncture. When a gastric puncture was achieved, GJ tube insertion was technically successful in 83% (15/18) of attempts, resulting in an overall technical success rate of 63% (15/24). The most common tube-related complication was the migration of the jejunal limb into the stomach, which occurred in 40% (6/15) of successful cases. No major procedure related complications were encountered.
- Published
- 2020
22. Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis
- Author
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Stepan M, Esagian, Georgios A, Sideris, Muath, Bishawi, Ioannis A, Ziogas, Ruediger W, Lehrich, John P, Middleton, Paul V, Suhocki, Theodore N, Pappas, and Konstantinos P, Economopoulos
- Subjects
Catheters, Indwelling ,Humans ,Prospective Studies ,Peritonitis ,Peritoneal Dialysis ,Retrospective Studies - Abstract
No consensus currently exists regarding the optimal approach for peritoneal dialysis catheter placement. We aimed to compare the outcomes of percutaneous and surgical peritoneal dialysis catheter placement.A systematic review of the literature was performed using the MEDLINE, Cochrane Library, and Scopus databases (end-of-search date: August 29th, 2020). We included studies comparing percutaneous (blind, under fluoroscopic/ultrasound guidance, and "half-perc") and surgical peritoneal dialysis catheter placement (open and laparoscopic) in terms of their infectious complications (peritonitis, tunnel/exit-site infections), mechanical complications (leakage, inflow/outflow obstruction, migration, hemorrhage, hernia, bowel perforation) and long-term outcomes (malfunction, removal, replacement, surgery required, and mortality).Thirty-four studies were identified, including thirty-two observational studies (twenty-six retrospective and six prospective) and two randomized controlled trials. Percutaneous placement was associated with significantly lower rates of tunnel/exit-site infection [relative risk (RR) 0.72, 95% confidence interval (CI) 0.56-0.91], catheter migration (RR 0.68, 95% CI 0.49, 0.95), and catheter removal (RR 0.73, 95% CI 0.60-0.88). The 2-week and 4-week rates of early tunnel/exit-site infection were also lower in the percutaneous group (RR 0.45, 95% CI 0.22-0.93 and RR 0.41, 95% CI 0.27-0.63, respectively). No statistically significant difference was observed regarding other outcomes, including catheter survival and mechanical complications.Overall, the quality of published literature on the field of peritoneal dialysis catheter placement is poor, with a small percentage of studies being randomized clinical trials. Percutaneous peritoneal dialysis catheter placement is a safe procedure and may result in fewer complications, such as tunnel/exit-site infections, and catheter migration, compared to surgical placement.PROSPERO CRD42020154951.
- Published
- 2020
23. High-risk third trimester pregnancy with decompensated cirrhosis safely delivered following emergent preoperative interventional radiology for mitigation of variceal bleeding
- Author
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Linnan Tang, Claire Dorsey, Yuval A. Patel, Jennifer Gilner, Paul V. Suhocki, Christine Park, and Nikhil Kapila
- Subjects
Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Pregnancy Trimester, Third ,Radiology, Interventional ,Esophageal and Gastric Varices ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Risk of mortality ,Coagulopathy ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Portal hypertension ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Gastrointestinal Hemorrhage ,Transjugular intrahepatic portosystemic shunt - Abstract
Coagulopathy coupled with severe portal hypertension in the setting of cirrhosis increases the risk of mortality from variceal bleeding in pregnant women. Studies suggest transjugular intrahepatic portosystemic shunt (TIPS) creation to be a safe procedure during pregnancy in preventing variceal bleeding complications; however, it is not typically employed in severely decompensated cirrhosis. This case report of a pregnant woman presenting at 34.7 weeks' gestation demonstrates successful variceal mapping, emergent TIPS creation and variceal embolization to allow safe cesarean delivery despite severe hypofibrinogenemia and decompensated alcoholic cirrhosis. With careful medical optimization, angiographic imaging and vascular interventional radiology may be employed outside of usual indications to achieve safe pregnancy delivery and postpartum recovery.
- Published
- 2020
24. Foreign Body Retrieval
- Author
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Paul V. Suhocki
- Subjects
Communication ,business.industry ,medicine ,Foreign body ,business ,medicine.disease - Published
- 2020
25. Minimal Risk of Biliary Tract Complications, Including Hepatic Abscess, After Transarterial Embolization for Hepatocellular Carcinoma Using Concentrated Antibiotics Mixed with Particles
- Author
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Charles Y. Kim, M.S. Hodavance, James Ronald, Paul V. Suhocki, and Q. Wang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Biliary Tract Diseases ,medicine.medical_treatment ,Liver Abscess ,Radiology, Interventional ,Anastomosis ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Chemoembolization, Therapeutic ,Abscess ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Incidence ,Liver Neoplasms ,Interventional radiology ,Middle Aged ,medicine.disease ,Anti-Bacterial Agents ,Surgery ,Treatment Outcome ,Biliary tract ,Hepatocellular carcinoma ,Cholecystitis ,Female ,030211 gastroenterology & hepatology ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Liver abscess - Abstract
To assess the incidence of biliary complications, cholecystitis, and abscess formation in HCC patients following transarterial embolization (TAE) using particles mixed with concentrated antibiotics. Retrospective review of HCC patients treated with embolization over a 10-year period revealed 499 procedures in 257 patients. TAE was performed with particles mixed with concentrated antibiotics in addition to IV antibiotics. All follow-up imaging after treatment was retrospectively reviewed for the development of bilomas, biliary strictures, acute cholecystitis, and hepatic abscess. Clinical notes and laboratory tests were also reviewed. Mean follow-up duration was 18.2 months. In total, there was one biliary complication consisting of biloma formation. This patient had subsegmental hepatic infarction identified on imaging 8 days post-embolization in the setting of subsegmental portal vein thrombus, with subsequent biloma development. There were no cases of new biliary strictures in the embolized portion of the liver at any point after treatment. One patient developed acute gangrenous cholecystitis 10 days post-procedure. No patients developed a hepatic abscess, although 10 patients had bilioenteric anastomoses or incompetent sphincters of Oddi. Biliary complications and cholecystitis occurred extremely rarely after TAE, at a markedly lower rate than historical data on TACE. Despite significant risk factors for abscess formation in 10 patients, TAE with particles mixed with concentrated antibiotics resulted in zero abscesses, in contrast to a very high rate after TACE in the literature.
- Published
- 2018
26. Progression of Treated versus Untreated Liver Imaging Reporting and Data System Category 4 Masses after Transcatheter Arterial Embolization Therapy
- Author
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Nicholas Durocher, Rajan T. Gupta, James Ronald, Q. Wang, Paul V. Suhocki, Charles Y. Kim, and Daniele Marin
- Subjects
Adult ,Male ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Arterial Embolization ,Liver Neoplasms ,Magnetic resonance imaging ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Magnetic Resonance Imaging ,Log-rank test ,Treatment Outcome ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Disease Progression ,Female ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Purpose To compare outcomes of treated vs untreated Liver Imaging Reporting and Data System category 4 (LR-4) masses after transcatheter arterial embolization. Materials and Methods In 167 patients undergoing embolization for HCC from January 2005 to December 2012, LR-4 masses were retrospectively identified on CT and MR imaging examinations performed before embolization. In 149 patients undergoing embolization from January 2013 to December 2016, masses prospectively classified as LR-4 were identified. In total, there were 81 LR-4 masses in 62 patients (16 women; mean age 62 y; range 29-83 y). Procedures were reviewed to determine whether LR-4 masses were within or outside the liver volume that received embolization during treatment of dominant masses. Time to progression to LR-5 and by modified Response Evaluation Criteria in Solid Tumors (mRECIST) was estimated for treated vs untreated LR-4 masses using the Kaplan-Meier method and compared using the log rank test. Results LR-4 masses averaged 1.8 cm; 88%, 60%, 14%, and 14% demonstrated arterial phase hyperenhancement, washout, a capsule, and growth. Of LR-4 masses, 62 were within the liver volume that received embolization and considered treated, and 19 were outside and considered untreated. Response rates according to mRECIST were 37% vs 21% for treated vs untreated masses ( P = .27). The 6- and 12-month rates of progression to LR-5 were 7% and 26% for treated masses vs 27% and 75% for untreated masses ( P = .001). According to mRECIST, 7% and 27% of treated masses progressed vs 30% and 65% of untreated masses ( P = .001). Conclusions LR-4 masses that receive embolization in the setting of dominant masses elsewhere show lower rates of progression compared with untreated masses.
- Published
- 2018
27. Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience
- Author
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Nicholas T. Befera, Paul V. Suhocki, Alan A. Sag, Tracy A. Jaffe, Waleska M. Pabon-Ramos, Charles Y. Kim, Rajan T. Gupta, Christopher Swenson, Jonathan G. Martin, Tony P. Smith, and James Ronald
- Subjects
Image-Guided Biopsy ,medicine.medical_specialty ,Femoral vein ,Malignancy ,Inferior vena cava ,Pelvis ,Abdomen ,Intravascular ultrasound ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Interventional ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Venous thrombosis ,medicine.anatomical_structure ,medicine.vein ,Biopsy, Large-Core Needle ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters. Materials and Methods In this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed. Results Intravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique. Conclusions Intravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.
- Published
- 2021
28. Abstract No. 76 ▪ FEATURED ABSTRACT Intravascular ultrasound-guided transvenous biopsy of retroperitoneal targets inaccessible by percutaneous iopsy: technique and initial clinical experience
- Author
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Paul V. Suhocki, Waleska M. Pabon-Ramos, Rajan T. Gupta, Alan A. Sag, Jonathan G. Martin, Tracy A. Jaffe, Thomas J. Smith, Charles Y. Kim, Christopher Swenson, and James Ronald
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Intravascular ultrasound ,Biopsy ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
29. Abstract No. 27 Proton pump inhibitor use is associated with increased risk of post–transjugular intrahepatic portosystemic shunt hepatic encephalopathy: replication in an independent patient cohort
- Author
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Rui Dai, Paul V. Suhocki, B. Wildman-Tobriner, Charles Y. Kim, James Ronald, Thomas J. Smith, Jonathan G. Martin, Alan A. Sag, and Waleska M. Pabon-Ramos
- Subjects
medicine.medical_specialty ,medicine.drug_class ,business.industry ,medicine.medical_treatment ,Proton-pump inhibitor ,medicine.disease ,Gastroenterology ,Increased risk ,Internal medicine ,Cohort ,Replication (statistics) ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt ,Hepatic encephalopathy - Published
- 2021
30. Pilot Evaluation of Angiogenesis Signaling Factor Response after Transcatheter Arterial Embolization for Hepatocellular Carcinoma
- Author
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Paul V. Suhocki, Willa J. Chen, Herbert Hurwitz, Charles Y. Kim, Rajan T. Gupta, Waleska M. Pabon-Ramos, D. Sopko, John C. Brady, Daniele Marin, Gemini Janas, Andrew B. Nixon, James Ronald, and Mark D. Starr
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Angiogenesis ,Pilot Projects ,03 medical and health sciences ,0302 clinical medicine ,Downregulation and upregulation ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Osteopontin ,Angiogenic Proteins ,Chemoembolization, Therapeutic ,Prospective cohort study ,Interleukin 6 ,Aged ,Aged, 80 and over ,biology ,business.industry ,Arterial Embolization ,Liver Neoplasms ,Middle Aged ,medicine.disease ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,biology.protein ,Cancer research ,Female ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
Purpose To identify changes in a broad panel of circulating angiogenesis factors after bland transcatheter arterial embolization (TAE), a purely ischemic treatment for hepatocellular carcinoma (HCC). Materials and Methods This prospective HIPAA-compliant study was approved by the institutional review board. Informed written consent was obtained from all participants prior to entry into the study. Twenty-five patients (21 men; mean age, 61 years; range, 30-81 years) with Liver Imaging Reporting and Data System category 5 or biopsy-proven HCC and who were undergoing TAE were enrolled from October 15, 2014, through December 2, 2015. Nineteen plasma angiogenesis factors (angiopoietin 2; hepatocyte growth factor; platelet-derived growth factor AA and BB; placental growth factor; vascular endothelial growth factor A and D; vascular endothelial growth factor receptor 1, 2, and 3; osteopontin; transforming growth factor β1 and β2; thrombospondin 2; intercellular adhesion molecule 1; interleukin 6 [IL-6]; stromal cell-derived factor 1; tissue inhibitor of metalloproteinases 1; and vascular cell adhesion molecule 1 [VCAM-1]) were measured by using enzyme-linked immunosorbent assays at 1 day, 2 weeks, and 5 weeks after TAE and were compared with baseline levels by using paired Wilcoxon tests. Tumor response was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Angiogenesis factor levels were compared between responders and nonresponders by mRECIST criteria by using unpaired Wilcoxon tests. Results All procedures were technically successful with no complications. Fourteen angiogenesis factors showed statistically significant changes following TAE, but most changes were transient. IL-6 was upregulated only 1 day after the procedure, but showed the largest increases of any factor. Osteopontin and VCAM-1 demonstrated sustained upregulation at all time points following TAE. At 3-month follow-up imaging, 11 patients had responses to TAE (complete response, n = 6; partial response, n = 5) and 11 patients were nonresponders (stable disease, n = 9; progressive disease, n = 2). In nonresponders, the percent change in IL-6 on the day after TAE (P = .033) and the mean percent change in osteopontin after TAE (P = .024) were significantly greater compared with those of responders. Conclusion Multiple angiogenesis factors demonstrated significant upregulation after TAE. VCAM-1 and osteopontin demonstrated sustained upregulation, whereas the rest were transient. IL-6 and osteopontin correlated significantly with radiologic response after TAE.
- Published
- 2017
31. Abstract No. 460 Radiologists’ knowledge of procedural charges
- Author
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Alan A. Sag, M. Taussig, Jonathan G. Martin, Charles Y. Kim, Tony P. Smith, Paul V. Suhocki, James Ronald, and Waleska M. Pabon-Ramos
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
32. Abstract No. 594 Percutaneous gastrojejunostomy tubes: identification of predictors of retrograde tip migration into the stomach
- Author
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Alan A. Sag, Jonathan G. Martin, David Y. Johnson, Andre M. Agassi, Thomas J. Smith, Charles Y. Kim, Paul V. Suhocki, Waleska M. Pabon-Ramos, James Ronald, and Christopher J.R. Gallo
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Stomach ,medicine ,Radiology, Nuclear Medicine and imaging ,Identification (biology) ,Cardiology and Cardiovascular Medicine ,business ,Percutaneous gastrojejunostomy ,Surgery - Published
- 2020
33. Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden
- Author
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Herbert Hurwitz, Paul V. Suhocki, Michael A. Morse, Rebecca Burbridge, Tony P. Smith, Eun L. Langman, and Charles Y. Kim
- Subjects
medicine.medical_specialty ,Biliary drainage ,Catheter insertion ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Magnetic resonance imaging ,Malignancy ,medicine.disease ,Metastatic tumor ,behavioral disciplines and activities ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Original Article ,In patient ,Radiology ,business - Abstract
Patients with metastatic disease of the liver can have hyperbilirubinemia due to a number of reasons, including biliary obstruction. The purpose of this study was to analyze patient outcomes after percutaneous biliary drainage (PBD) catheter insertion in patients with extensive hepatic metastatic tumor burden.Out of 746 PBD insertions, 44 patients (24 males, 20 females, mean age 57.4 years, range, 34-80 years) had metastatic malignancy with a hepatic tumor burden of greater than 20% parenchymal volume based on pre-procedure computed tomography (CT) or magnetic resonance imaging (MRI). Laboratory data before and after PBD insertion were compared. Survival and outcomes analysis performed. A subanalysis was performed on patients with CT-demonstrated catheter traversal of tumoral tissue.A PBD catheter was successfully inserted in all patients. The mean serum bilirubin level decreased significantly from 10.9±6.4 mg/dL immediately prior to PBD insertion to 7.1±5.6 mg/dL (P0.001) within one month post PBD insertion. Four patients (11%) demonstrated normalization of bilirubin levels to less than 1.6 mg/dL. Of the 14 patients with a post-procedure CT or MRI, the PBD catheter traversed a tumor in 11 (79%). One of these patients required a transfusion after the procedure and one had recurrent catheter exchanges due to pericatheter leakage. The 30-day overall survival was 41% with a median survival of 19 days. The percentage decrease in serum bilirubin after PBD insertion and pre-procedure international normalized ratio (INR) were correlated with improved survival (OR =3.7, P=0.010 and OR =4.9, P=0.028 respectively). The PBD-associated major complication rate was 16%.In patients with hyperbilirubinemia and extensive hepatic metastatic disease burden, survival was dismal after PBD catheter insertion. Serum bilirubin level normalization occurred rarely.
- Published
- 2016
34. Postintervention Patency Rates and Predictors of Patency after Percutaneous Interventions on Intragraft Stenoses within Failing Prosthetic Arteriovenous Grafts
- Author
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Andre B. Bautista, Waleska M. Pabon-Ramos, Tony P. Smith, Michael J. Miller, Paul V. Suhocki, and Charles Y. Kim
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Comorbidity ,Risk Assessment ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,Interquartile range ,Internal medicine ,Angioplasty ,North Carolina ,medicine ,Humans ,Vascular Patency ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Hazard ratio ,Graft Occlusion, Vascular ,Stent ,Thrombosis ,Middle Aged ,Prognosis ,medicine.disease ,Prosthesis Failure ,Surgery ,Causality ,Radiography ,Stenosis ,Treatment Outcome ,surgical procedures, operative ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To determine postintervention patency rates after endovascular interventions on intragraft stenosis within failing prosthetic arteriovenous (AV) grafts, as well as predictors of patency. Materials and Methods Retrospective review of percutaneous interventions on prosthetic AV grafts presenting with first-time intragraft stenoses over a 7-year period revealed 183 patients (81 male; mean age, 59.7 y). "Intragraft" was defined as 2 cm or more from the arterial or venous anastomosis. Procedural imaging was retrospectively reviewed. Patency rates were estimated by Kaplan–Meier test. Predictors of patency were calculated by Cox proportional-hazards model. Results Two-hundred twenty-nine intragraft stenoses were identified in 183 grafts. Intragraft stenoses were treated at a median of 20.7 months (interquartile range, 12.0–33.9 mo) after graft creation. Graft thrombosis was present in 62%. The anatomic success rate of angioplasty was 85%. Fifteen percent required stent or stent-graft deployment because of inadequate response to angioplasty. A concurrent nonintragraft stenosis within the access circuit was identified in 76% of grafts. At 3, 6, and 12 months, postintervention primary patency rates were 56%, 40%, and 23%, respectively. Secondary patency rates were 84%, 77%, and 67%, respectively. The lesion-specific patency rates were 89, 75%, and 63%, respectively. Graft thrombosis (hazard ratio [HR], 1.43; P = .048) and concurrent nonintragraft lesion (HR, 1.51; P = .047) were independent negative predictors of primary patency. Graft thrombosis (HR, 1.81; P = .029) was a negative predictor of lesion patency, and stent or stent-graft deployment (HR, 0.42; P = .045) was a positive predictor of lesion patency. Conclusions Endovascular interventions on intragraft stenoses resulted in primary, secondary, and lesion-specific patency rates of 40%, 77%, and 75%, respectively, at 6 months. Stent or stent-graft deployment may prolong lesion patency.
- Published
- 2015
35. Abstract No. 477 Effectiveness of thoracic duct embolization using different embolic agents: glue and coils versus ethylene vinyl alcohol
- Author
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Tony P. Smith, Paul V. Suhocki, Jonathan G. Martin, James Ronald, E. Shropshire, Waleska M. Pabon-Ramos, Alan A. Sag, and Charles Y. Kim
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,medicine.medical_treatment ,medicine ,Radiology, Nuclear Medicine and imaging ,Embolization ,Cardiology and Cardiovascular Medicine ,business ,GLUE ,Thoracic duct ,Surgery - Published
- 2020
36. 3:18 PM Abstract No. 329 Delayed adoption of moderate sedation CPT code changes in interventional radiology: impact on revenue cycle and root cause analysis
- Author
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James Ronald, James Taylor, Gabriel Li, Waleska M. Pabon-Ramos, Alan A. Sag, Charles Y. Kim, Tony P. Smith, Jonathan G. Martin, and Paul V. Suhocki
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Emergency medicine ,Code (cryptography) ,Medicine ,Revenue ,Radiology, Nuclear Medicine and imaging ,Interventional radiology ,Cardiology and Cardiovascular Medicine ,business ,Root cause analysis ,Moderate sedation - Published
- 2020
37. 4:21 PM Abstract No. 326 Use of covered stent-graft for transjugular intrahepatic portosystemic shunt placement reduces variceal rebleeding rate with or without variceal embolization
- Author
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Charles Y. Kim, R. Rao, Waleska M. Pabon-Ramos, Paul V. Suhocki, James Ronald, M. Taussig, Jonathan G. Martin, W Perry, Elisabeth R. Seyferth, and Tony P. Smith
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine ,Radiology, Nuclear Medicine and imaging ,Embolization ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt ,Covered stent ,Surgery - Published
- 2020
38. 4:21 PM Abstract No. 31 Y90 radioembolization for hepatocellular carcinoma: impact of treatment distribution on hepatic function over time
- Author
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J. Li, Charles Y. Kim, Paul V. Suhocki, Jonathan G. Martin, James Ronald, X. Xia, Alan A. Sag, and S. Perkins
- Subjects
Hepatic function ,Pathology ,medicine.medical_specialty ,business.industry ,Hepatocellular carcinoma ,Medicine ,Distribution (pharmacology) ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2020
39. 3:45 PM Abstract No. 332 Financial impact of unbundling moderate sedation from procedural codes in radiology
- Author
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Paul V. Suhocki, Charles Y. Kim, Alan A. Sag, Jonathan G. Martin, James Ronald, Tony P. Smith, James Taylor, Gabriel Li, and Waleska M. Pabon-Ramos
- Subjects
business.industry ,Financial impact ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical emergency ,Unbundling ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Moderate sedation - Published
- 2020
40. Abstract No. 479 Fluoroscopy-guided, direct percutaneous retrograde thoracic duct access and catheterization for lymphangiography and embolization: feasibility, safety, and efficacy
- Author
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Waleska M. Pabon-Ramos, Alan A. Sag, Paul V. Suhocki, Tony P. Smith, Gabriel Li, Charles Y. Kim, Jonathan G. Martin, and James Ronald
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Thoracic duct ,medicine.anatomical_structure ,medicine ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Embolization ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
41. 3:27 PM Abstract No. 358 Increased port catheter related infection rates in inpatients with longer pre- and post procedure stays
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Paul V. Suhocki, Alan A. Sag, Tony P. Smith, James Ronald, Jonathan G. Martin, Waleska M. Pabon-Ramos, Charles Y. Kim, and Linnan Tang
- Subjects
medicine.medical_specialty ,Port (medical) ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Pre and post ,Catheter-Related Infections ,Surgery - Published
- 2020
42. Abstract No. 564 Treatment of right-sided primary colon cancer metastatic to liver in current clinical practice
- Author
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James Ronald, C. Robinson, Paul V. Suhocki, Alan A. Sag, Charles Y. Kim, and Jonathan G. Martin
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Clinical Practice ,medicine.medical_specialty ,Colorectal cancer ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2020
43. Management of Port Occlusions in Adults: Different-Site Replacement versus Same-Site Salvage
- Author
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Charles Y. Kim, Paul V. Suhocki, Tony P. Smith, Waleska M. Pabon-Ramos, James Ronald, and Oretunlewa Soyinka
- Subjects
Adult ,Catheter Obstruction ,Male ,medicine.medical_specialty ,Patient risk ,Statistical difference ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,symbols.namesake ,Young Adult ,0302 clinical medicine ,Catheters, Indwelling ,Interquartile range ,Risk Factors ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Young adult ,Fisher's exact test ,Device Removal ,Aged ,Retrospective Studies ,Aged, 80 and over ,Salvage Therapy ,Proportional hazards model ,business.industry ,Retrospective cohort study ,Middle Aged ,Surgery ,Catheter ,Treatment Outcome ,030220 oncology & carcinogenesis ,Catheter-Related Infections ,symbols ,Equipment Failure ,Female ,Cardiology and Cardiovascular Medicine ,business ,Vascular Access Devices - Abstract
Purpose To compare the safety and effectiveness of different-site port placement versus same-site port salvage in adult patients with occluded ports. Materials and Methods Ninety-five occluded subcutaneous infusion ports (ports) in 95 patients presenting between July 1, 2002, and June 30, 2017, were retrospectively reviewed: 48 (51%) different-site placements (replacements; same-day indwelling port removal and different-site new port placement) and 47 (49%) same-site salvages (salvages; 35 fibrin sheath strippings, 12 over-the-wire exchanges). Demographic information, indication for initial placement and replacement or salvage, procedural details, post-intervention primary catheter patency, and post-intervention port sequelae were recorded. Post-intervention primary catheter patency, and malfunction and infection rates were compared with Kaplan-Meier estimation and the log-rank test, and Fisher exact test, respectively. The association of patient risk factors and port patency was assessed with Cox regression. Results Median primary catheter patency after replacement was 254 days (interquartile range [IQR], 297) and after salvage was 391 days (IQR, 906) (P = .25). Within the salvage group, median primary catheter patency after stripping was 391 days (IQR, 658) and after exchange was 666 days (IQR, 1412) (P = .08). There was no statistical difference in malfunction (P = .12) and infection (P = .74) rates between the replaced and salvaged groups or in malfunction (P = .09) and infection (P = .1) rates between the exchanged and stripped subgroups. None of the patient or catheter characteristics assessed were significantly associated with primary catheter patency. Conclusions There was no statistical difference between patency, malfunctions, or infections after replacement and salvage, or after stripping and exchange, so technique selection should be based on the patient’s estimated lifetime venous access requirements, cost, and physician preference.
- Published
- 2018
44. Percutaneous Hepaticojejunostomy across an Isolated Bile Duct after Klatskin Tumor Resection
- Author
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Hemant Desai, Raj Gondalia, and Paul V. Suhocki
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medicine.medical_specialty ,Percutaneous ,Bile duct ,business.industry ,Radiography ,medicine.medical_treatment ,Treatment outcome ,medicine.disease ,Resection ,Klatskin tumor ,medicine.anatomical_structure ,Text mining ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Hepatectomy ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
45. 03:00 PM Abstract No. 169 Proton pump inhibitor use is a major risk factor for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation
- Author
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M. Hall, Thomas J. Smith, Paul V. Suhocki, Tzu-Hao Lee, Steven S Choi, Waleska M. Pabon-Ramos, Meghana Konanur, James Ronald, D. Lewis, Cole Ziegler, and Charles Y. Kim
- Subjects
medicine.medical_specialty ,medicine.drug_class ,business.industry ,medicine.medical_treatment ,Proton-pump inhibitor ,medicine.disease ,Gastroenterology ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt ,Hepatic encephalopathy - Published
- 2019
46. Abstract No. 528 Bland embolization versus radioembolization for the treatment of HCC in cirrhotic patients: propensity score analysis of the impact on hepatic function
- Author
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J. Li, J. Ronald, Paul V. Suhocki, X. Xia, Charles Y. Kim, and S. Perkins
- Subjects
Hepatic function ,medicine.medical_specialty ,business.industry ,Internal medicine ,Propensity score matching ,Bland Embolization ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Gastroenterology - Published
- 2019
47. Use of Biloma Injection Cholangiography to Facilitate Percutaneous Biliary Drain Placement for Bile Leaks: Predictors of Technical Success and Complication Rates
- Author
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Charles Y. Kim, Doug Lewis, Paul V. Suhocki, Tony P. Smith, and James Ronald
- Subjects
medicine.medical_specialty ,Cholangiography ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Technical success ,medicine ,Complication ,business ,Surgery - Published
- 2017
48. Albumin-bilirubin grade versus MELD score for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation
- Author
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Paul V. Suhocki, Tony P. Smith, Charles Y. Kim, Q. Wang, M. Hall, James Ronald, and Steve S. Choi
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Bilirubin ,medicine.medical_treatment ,Hydrothorax ,Hemorrhage ,Gastroenterology ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,chemistry.chemical_compound ,Liver disease ,Young Adult ,0302 clinical medicine ,Internal medicine ,Ascites ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Survival analysis ,Serum Albumin ,Aged ,Retrospective Studies ,Aged, 80 and over ,Radiological and Ultrasound Technology ,business.industry ,Proportional hazards model ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,body regions ,chemistry ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
OBJECTIVES The purpose of this study was to compare the albumin-bilirubin (ALBI) grade and model for end-stage liver disease (MELD) scores for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS A retrospective study of pre-procedure ALBI and MELD scores was performed in 197 patients who underwent TIPS from 2005 to 2012. There were 140 men and 57 women, with a mean age of 56±11 (SD) (range: 19-90years). The prognostic capability of ALBI and MELD scores were evaluated using competing risks survival analysis. Discriminatory ability was compared between models using the C-index derived from cause specific Cox proportional hazards models. RESULTS TIPS were created for ascites or hydrothorax (128 patients), variceal hemorrhage (61 patients), or both (8 patients). Prior to TIPS, 5 patients were ALBI grade 1, 76 were grade 2, and 116 were grade 3. The average pre-TIPS MELD score was 14. Pre-TIPS ALBI score, ALBI grade, and MELD were each significant predictors of 30-day mortality from hepatic failure and overall survival (all P
- Published
- 2017
49. Hemorrhage risk with transjugular intrahepatic portosystemic shunt (TIPS) insertion at the main portal vein bifurcation with stent grafts
- Author
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Charles Y. Kim, Andrew S. Griffin, Tony P. Smith, S. Preece, James Ronald, and Paul V. Suhocki
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hemorrhage ,Risk Assessment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Acute hemorrhage ,Aged ,Retrospective Studies ,Aged, 80 and over ,Radiological and Ultrasound Technology ,business.industry ,Portal Vein ,Mortality rate ,Incidence ,Portal Vein Bifurcation ,Stent ,Mean age ,General Medicine ,Middle Aged ,Surgery ,Hemorrhagic complication ,Main portal vein ,030211 gastroenterology & hepatology ,Female ,Stents ,Radiology ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
Purpose The purpose of this study was to assess the incidence of major hemorrhage after transjugular intrahepatic portosystemic shunt (TIPS) insertion using a stent graft at the main portal vein bifurcation. Patients and methods TIPS insertion using stent grafts was performed in 215 patients due to non-variceal hemorrhage indications. There were 137 men and 78 women, with a mean age of 57 years ± 10.6 (SD) (range: 19–90 years). Based on retrospective review of portal venograms, TIPS inserted within 5 mm from the portal vein bifurcation were considered “bifurcation TIPS”, while those inserted 2 cm or greater from the bifurcation were considered intrahepatic. Suspicion for acute major periprocedural hemorrhage were categorized as low, moderate, and high, based on the number of signs of hemorrhage. Results Of 215 TIPS inserted for purposes other than hemorrhage, the TIPS was inserted at the portal bifurcation in 41 patients (29 men, 12 women; mean age, 55.9 ± 11.7 (SD); range: 26–79 years) and intrahepatic in 62 patients (37 men, 25 women; mean age, 57.6 ± 10.6 (SD), range: 34–82 years), whereas 112 were indeterminate in location. No active extravasations were identified on post-TIPS portal venograms. Suspicion for acute major hemorrhage was moderate or high in 3/41 (7%) of patients in the TIPS bifurcation group compared to 5/62 (8%) in the intrahepatic TIPS group (P > 0.99). There were no significant differences in 30-day mortality rates (1/41 [2%] and 3/62 [5%] respectively; P> 0.99). No deaths or interventions were attributed to acute hemorrhage. Conclusion TIPS insertion at the portal bifurcation with stent grafts did not incur an elevated risk of hemorrhagic complications.
- Published
- 2017
50. Prediction of Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation: Comparison of Albumin-Bilirubin Grade to Model for End-Stage Liver Disease Score
- Author
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M. Hall, Thomas J. Smith, James Ronald, Waleska M. Pabon-Ramos, Jessica K. Stewart, D. Sopko, Charles Y. Kim, Paul V. Suhocki, and Q. Wang
- Subjects
chemistry.chemical_compound ,medicine.medical_specialty ,Model for End-Stage Liver Disease ,chemistry ,business.industry ,Bilirubin ,Internal medicine ,medicine.medical_treatment ,Albumin ,Medicine ,business ,Gastroenterology ,Transjugular intrahepatic portosystemic shunt - Published
- 2017
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