Minimally invasive image-guided therapies
Case Report:
Complete Long-Term Response to Radioembolization of Hepatic Metastases from Undifferentiated Uterine Sarcoma
F. Barakat , A. Volker , D. Warth , M. Binnenhei , P. Reimer , K. Tatsch
Abstract:
https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0043-1775725
HTML:
https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0043-1775725
PDF:
https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0043-1775725.pdf
Join us at VIO - a global virtual event dedicated to the latest in vascular treatment strategies to support better patient outcomes.
MynxGrip Vascular Closure Device
https://cordis.showpad.com/share/87xQk88fEzE8oDPUu7nCE/1
Protected Carotid Artery Stenting with a new micromesh carotid stent
https://www.incathlab.com/en/videos/20-endovascular/109-
carotid/2974-protectedcarotidarterystentingwithanewmicromeshcarotidstent?autoplay=1&utm_source=altemail&utm_medium=email&utm_campaign=2022-11-04+CoTM+Nov+2022
successful management of an acute bleeding from the right superficial femoral artery.
The patient suverd under an iatrogenic injury following a coronary intervention and developed a large femoral hemorrhage.
The procedure was performed in a cross-over technique using a stent graft.
Fuad Barakat
successful management of an acute bleeding from the right inferior epigastric artery as a complication of a coronary intervention.
A short (6 cm) 5F sheath with a radiopaque tip was used as an access in the very calcified commen femoral artery rightseid.
The coil embolization of the injuried artery was performed using a 2.4F microcatheter and 18coils.
Coil emolization distal ( back door) and proximal ( front door) to the bleeding localisation.
The procedure was carried out in our interventional suite
under a local anethesia.
Fuad Barakat
-interventional_complications
CT- guided percutaneous drainage of a paravertebral abscess using a PerkuCess® BASKET Drainage.
MRI showed acute spondylodiscitis T7/T8 and a small paravertebral abscess.
The microbiology study showed an bacterial infection with hemolytic streptococcus, group g.
The Patient was treated with AMOCLAV 875mg+125mg
Fuad Barakat
-guided_Intervention
®BASKET
endovascular repair of an internal iliac artery aneurysm
The procedure was performed via crossover technique from a contralateral retrograde groin access.
The aneurysm was successfully treated using a balloon expandable stentgraft (8 x 79 mm VBX).
Fuad Barakat
Refractory haematuria of prostatic origin (RHPO) treated by prostate artery embolization (PAE).
https://www.eurorad.org/case/14295
Eurorad is the largest database for peer-reviewed radiological case reports, operated by the European Society of Radiology (ESR).
5 Jahre Erfahrung mit der Prostataarterienembolisation (PAE) in Karlsruhe / Deutschland
Heute vor 5 Jahren habe ich die erste PAE zur Behandlung eines Patienten mit Miktionsbeschwerden (LUTS) aufgrund einer gutartigen Vergrößerung der Prostata (BPH) mit Erfolg durchgeführt.
Es war für mich damals nicht die erste PAE, da ich vorher, doch die gleiche Technik zur Behandlung von Makrohämaturie z. B. bei Patienten mit inoperablem Prostatakarzinom, immer wieder durchgeführt hatte.
Doch das Anbieten der Prostataembolisation als alternative Therapie zu den üblichen chirurgischen bzw. urologischen Verfahren wie TUR-Prostata, war gar nicht einfach und die Reaktion der Kollegen der Urologie gegenüber die neue Methodik war generell sehr ablehnend.
Zuerst haben die Patienten über unsere Leistung durch unsere Homepage erfahren, mittlerweile kommen die Patienten zu uns doch auch zunehmend durch Empfehlungen anderer Patienten, die sich bei uns mittels PAE erfolgreich behandeln lassen hatten.
Zudem überweisen urologische Kollegen ihre Patienten mittlerweile zunehmend zur Behandlung mittels PAE, nachdem sie von den Ergebnissen der PAE bei anderen Patienten doch überzeugt wurden.
Die Möglichkeit eines direkten Kontakts zwischen den Patienten und unserem Team in der Radiologie, per E-Mail, per Telefon und sogar persönlich im Rahmen der von uns dafür angebotenen Sprechstunde hat aus unserer Sicht einen wichtigen Beitrag zum Erfolg beim Akquirieren von Patienten geleistet.
Mittlerweile wurden im Institut für diagnostische und interventionelle Radiologie des städt. Klinikum Karlsruhe zahlreiche Patienten aus 6 verschiedenen deutschen Bundesländer und teilweise aus dem Ausland erfolgreich behandelt.
Zum 5 Jahren Jubiläum möchte ich dem ganzen Team (Ärzte, MTRA, Pflegepersonal und Sekretariat) für ihren wichtigen Beitrag und ihre wertvolle Leistungen sehr herzlich danken.
Auch bei meinen damaligen Supervisor im Bereich der interventionellen Radiologie, Herrn Professor Kröncke und Herrn Professor Gebauer (Weiterbildung / Charité-Berlin) sowie Herrn Professor Wagner (Fellowship / Vivantes-Berlin) möchte ich mich nachträglich sehr herzlich bedanken.
Einen herzlichen Dank möchte ich an meinem Chefarzt, Herrn Professor Reimer, für seine fachliche Unterstützung und freundliche Betreuung aussprechen.
Unseren Patienten wünsche ich vom Herzen eine schnelle und gute Besserung.
Fuad Barakat
Interventioneller Radiologe
unsere Homepage
https://lnkd.in/gSER8rXm
Endovascular management of a traumatic renal artery pseudoaneurysm
a 70-year-old patient suffered from a blunt abdominal trauma (BAT)
An enhanced ct scan showed a renal parenchymal injury, a pseudoaneurysm and a perirenalis hematoma.
The Treatment was performed using a C2 Cobra guiding catheter and a 2F microcatheter for superselective probing.
Peripheral pushable 0.018 coils (2/5 mm) were used to embolize the injured vessel.
The patient was hemodynamically stable, so the procedure could be performed under local anesthesia.
Fuad Barakat
interventional radiologist
Endovascular treatment of an acute thoracic hemorrhage in a 95-year-old patient using a coil embolization.
The acute hemorrhage was a complication following drainage of a pleural effusion that was performed by Internists.
An enhanced CT-scan confirmed severe bleeding in the chest wall (in the ninth intercostal space) with a large hemorrhagic pleural effusion and a mediastinal shift towards the opposite side.
The patient was hemodynamically unstable. General anesthesia was induced and a blood transfusion was performed.
A selective angiography of the ninth intercostal artery confirmed the active bleeding from a peripheral branch, which was probed super-selectively using a 2F microcatheter and successfully embolized with micro coils.
This was achieved by performing the Coil embolization of the bleeding source distally (back door) and proximally (front door).
After appropriate further monitoring in an intensive care unit, the patient was transferred to a peripheral unit for further treatment.
Fuad Barakat
Interventional Radiologist
Treatment of a hepatic artery pseudoaneurysm using stent-graft implantation
On the 7th postoperative day after Whipple operation (pancreaticoduodenectomy), the patient developed an acute abdominal bleeding. A CT scan was performed and a hepatic artery pseudoaneurysm was seen.
An endovascular therapy was successfully performed with a stent graft through a transfemoral approach.
Fuad Barakat
interventional Radiologist
Hemorrhoidal artery coil embolization
Hemorrhoidal artery coil embolization represents a new alternative for the treatment of hemorrhoids of II and III. Degree.
Indications:
Embolization is recommended if the conservative or drug therapy fails or if there is no improvement despite surgical therapy. Embolization is suitable for chronic bleeding as well as for acute bleeding.
Embolization is also recommended for patients unsuitable for surgery including:
-Inflammatory bowel disease
-anticoagulant Therapy
-coagulation disorder
-Paraplegie
-Immunsuppression
-Anore**al injury
Embolization can also be offered as an alternative if surgery is not desired.
In general, embolization is suitable for the treatment of internal hemorrhoids of II and III Degree.
It is advisable to carry out non-invasive imaging such as CT or MRI in order to demonstrate the patency of the main supply artery before planning the embolization.
The contraindications include:
• Grade IV internal hemorrhoids
• Planning of surgical interventions on the colon and re**um
• chronic a**l fissure
• Intolerance to contrast media
The attached images show a technically successful endovascular treatment in an elderly multimorbid patient who has bled under anticoagulation therapy.
The Embolization of the branches of the superior re**al artery occurred above the dentate line.
Probing was done using a 2.4F microcatheter. Pushable coils were used for embolization.
The intervention was carried out under local anesthesia.
Fuad Barakat
interventional radiologist
# hemorrhoids
# hemorrhoidal disease
# embolization
endovascular treatment of a gastroduodenal artery pseudoaneurysm (GDA).
A 80 years old patient developed signs of an abdominal bleeding in the first days postoperative after a Surgical treatment of a hilar cholangiocarcinoma (klastkin tumor).
The CT-Scan exam schowed a big pseudoaneurysm of the GDA.
Suscessful coil embolization of the GDA beginning with the coiling distal to the pseudoaneruysm " back door" und ending proximal to the pseudoaneurysm " front door".
Fuad Barakat
Interventional radiologist
coil embolization of a wide-Neck splenic artery aneurysm using balloon remodelling technique
Endovascular Treatment of Internal Iliac Artery Aneurysms
Embolization therapy
An 80-year-old patient has developed an asymptomatic big aneurysm of the left internal iliac artery, which was discovered accidently.
He has a history of surgical treatment of an abdominal aortic aneurysm using aorto-bi-iliac prosthesis (open aortic repair).
After creating an ipsilateral access, the aneurysm was successfully isolated by embolization of the proximal main branches of the internal iliac artery directly distal to the aneurysm (back door) and the proximal internal iliac artery ( front door) .
Macro-coils (0.035 inch) as well as two Amplatzer™ Vascular Plugs (Type IV) distally and one Amplatzer™ Vascular Plug (Type II) proximally were used for embolization.
The follow up CT angiography showed a complete thrombosis of the aneurysm.
Fuad Barakat
interventional radiologist
Which Medical Device Explained
https://www.youtube.com/watch?v=2WWi_Rz1zDM
This short video shows Dr Phil Haslam and Mr Craig Gerrand explaining the purpose and and motivation behind the Which Medical Device website.
This video shows stenting the SMA from start to finish using the balloon mounted Terumo Tsunami stent
https://www.youtube.com/watch?v=tHKCVHu6hm4
This 15 minute video will take you through the whole procedure of SMA stenting from local anaesthetic to closure device at the end.Devices used:Terumo Pinnac...
Watch this video showing a challenging TIPSS procedure using the Gore Viatorr stent
https://www.youtube.com/watch?v=00DN5EsL2d8
This TIPSS was performed under GA to lower the portal venous pressure in a patient with ascites. Access to the portal vein proved difficult!The stent used is...
safari technique
an example for a safari technique to cross a very calcified occlusion of the popliteal artery.
Since no crossing antegrade possible, it was decided to use the safari technique. A puncture of the anterior tibial artery was performed under floroskopy using a micro puncture set.
After a successfully crossing the occlusion, snaring the wire and pulling it through the sheath, the procedure was continued antegrade and the angioplasy was succesfully compelted with a good acceptable result.
The final run shows a good flow without any relevant residuale stenosis.
Fuad Barakat
Angioplasty below the knee
A 82 year old male patient with chronic ischemia of the right foot.
The MRI Angiography shows multiple stenoses and occlusions of all three arteries below the knee.
The angioplasty was performed using a curved microwire (GLIDEWIRE ADVANTAGE 0,018inch, 300 cm) and a low-profile Balloon 2 mm / 150 mm (Pacific™ Plus PTA Catheter).
In the final angiography no evidence of relevant residual stenoses.
Jetstream atherectomy system
successful atherectomy of a very calcified stenosis of the popliteal artery in a case of a claudication intermittens stage 2
No significant residual stenosis after atherectomy and balloon angioplasty.
An addional Angioplasty using a Drug eluting balloon 5 mm was done.
no embolic events or any another comlications were seen.
The atherectomy was done using the Jetstream catheter 2.4/3.4 mm, 7F Sheath and a V14 wire (bosten scientifice).
A vascular closure Device Exoseal 7F was used.
Fuad Barakat
Here is a video about Jetstream, bosten scientific:
https://youtu.be/I9MDPsm611M
Successful mechanical rotational thrombectomy of in-stent acute thrombotic occlusion of the both SFA using an 8F Rotarex catheter bilaterally in the same session.
The intervention was performed through an antegrade transfemoral approach.
DEB Angioplasty was performed after the thrombectomy. No distal embolic events were seen.
A vascular closure device (ProGlide) was used at the end of the intervention.
A successful endovascular treatment of a proximal stenosis of the internal iliac artery (IIA) in a patient with buttock caudication right-side.
Performing the intervention in a crossover technique. A Balloon-expandable Stent (Genesis) was used to treat the proximal stenosis of the right internal iliac artery (IIA).
The Angiography showed a penetrating atherosclerotic ulcer (PAU) of the commen iliac artery (CIA) ipsilateral that was successfully treated using a stentgraft (lifestream) via the same access.
Fuad Barakat
A successful reca**lisation and Stent Angioplasty of an almost total occlusion of the right external iliac artery using a Re-Entry catheter
68 year old smoker male patient with claudication intermittends stage II b.
The MRI Angiography showed almost a total occlusion of the right external iliac artery with a very short stump distal.
Angiography of the pelvic arteries was first performing using a Pigtail catheter via an access in the left commen femoral artery. The Angiography showed the known occlusion of the right external iliac artery.
Placing a short 6 French sheath (6 cm) with a radiograph marker in the right commen femoral artery. All attempts to across the occlusion retrograd using hydrophilic coated wires and standard catheters were without any success.
Advancing the wire was only subintimal, no spontanous Re-Entry possible.
Decided to use a Re-Entry catheter (Outback) to get a Re-Entry, this manoeuvre was successful.
After documentation the intraluminal localisation, a pre dilatation using a 5 x 60 mm balloon, then a deployment of a 8 x 80 mm self-expanding stent and subsequent adaptation using the same balloon were done.
The final angiography showed a regular flow without any significant residual stenosis
An antegrad reca**lization via a crossover access was on purpose avoided in order to prevent a possible risk of any damage of the stump of the external iliac atery or of the commen femoral artery.
Fuad Barakat
Minimal invasive endovascular therapy of a long vascular occlusion (TASC D) in 66 year old smoker patient with a severe claudication intermittent.
Successful endovascular therapy of a focal high-grade stenosis of the left external iliac artery using a short self-expanding stent and an almost complete occlusion of the right common iliac artery and external iliac artery (TASC D) using 3 overlapping stents, starting here proximal with a balloon-mounted stent and extending it distally into the distal iliac artery with two further self-expanding stents.
Using a Vascular Closure Device Angioseal for both common femoral arteries. Applying a compression bandage for one night.
Long-term therapy using ASA 100 mg daily.
Fuad Barakat
Successful stent angioplasty in the kissing technique after probing in the crossover technique
A 82 year old patient with intermittent claudication due to a prox. Stenosis of the common iliac artery on both sides for treatment with kissing stents.
A retrograde probing of the right AIC was not possible due to massive calcification.
Probing was only possible using an SOS-Omnie catheter and a hydrophilic coated wire in the cross-over technique.
Successful wire pull through the ipislateral sheath using a Snare Kits (Gosse Neck 15mm).
Continuation of therapy and successful deployment of two balloon-mounted stents using the kissing technique after prior dilatation with kissing balloons.
The stent angioplasty was performed using the PALMATZ technique using two 25 cm 7F sheaths.
Close the puncture site using an Angioseal 8 French closure system.
Be the first to know and let us send you an email when IR. Barakat, MD, EBIR posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.
Send a message to IR. Barakat, MD, EBIR:
Want your business to be the top-listed Health & Beauty Business?
