Recanalization of portal vein thrombosis after pediatric liver transplantation: Efficacy and safety of the transsplenic access Aline Cristine Barbosa Santos Cavalcante, Francisco César Carnevale, Charles Edouard Zurstrassen, Renata Pereira Sustovich Pugliese, Airton Mota Moreira, André Moreira Assis, João Paulo Kawaoka Matushita Junior, Vera Lucia Baggio Danesi, Marcel Albeiro Ruiz Benavides, Adriana Porta M. Hirschfeld, Cristian B. V. Borges, Irene Kazue Miura, Gilda Porta, Eduardo Antunes Fonseca, Paulo ChapChap, João Seda Neto Pediatric Transplantation, 2024 BackgroundEndovascular management of portal vein thrombosis (PVT) is challenging. Transsplenic access (TSA) is growing as an access option to the portal system but with higher rates of bleeding complications. The aim of this article is to evaluate the efficacy and safety of transsplenic portal vein recanalization (PVR) using a metallic stent after pediatric liver transplantation.Materials and MethodsThis is a retrospective review of 15 patients with chronic PVT who underwent PVR via TSA between February 2016 and December 2020. Two children who had undergone catheterization of a mesenteric vein tributary by minilaparotomy were excluded from the patency analysis but included in the splenic access analysis. The technical and clinical success of PVR and complications related to the procedure via TSA were evaluated.ResultsThirteen children with PVT were treated primarily using the TSA. The mean age was 4.1 years (range, 1.5–13.7 years), and the most common clinical presentation was hypersplenism (60%). Technically successful PVR was performed in 11/13 (84.6%) children, and clinical success was achieved in 9/11 (81.8%) children. No major complications were observed, and one child presented moderate pain in the TSA (from a total of 17 TSA). The median follow‐up was 48.2 months. The median primary patency was 9.9 months. Primary patency in the first 4 years was 75%, and primary assisted patency was 100% in the follow‐up period.ConclusionsTranssplenic PVR is a safe and effective method for the treatment of PVT after pediatric liver transplantation.
Early postoperative outcomes among patients with delayed surgeries after preoperative positive test for SARS-CoV-2: A case-control study from a single institution Glauco Baiocchi, Samuel Aguiar, Joao P. Duprat, Felipe J. F. Coimbra, Fabiana B. Makdissi, José G. Vartanian, Stenio de C. Zequi, Jefferson L. Gross, Suely A. Nakagawa, Guilherme Yazbek, Thiago P. Diniz, Bruna T. Gonçalves, Charles E. Zurstrassen, Heloisa G. do A. Campos, Eduardo H. G. Joaquim, Ivan A. França e Silva, Luiz P. Kowalski Journal of Surgical Oncology, 2021 BackgroundThere are limited data on surgical complications for patients that have delayed surgery after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. We aimed to analyze the surgical outcomes of patients submitted to surgery after recovery from SARS‐CoV‐2 infection.MethodsAsymptomatic patients that had surgery delayed after preoperative reverse‐transcription polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 were matched in a 1:2 ratio for age, type of surgery and American Society of Anesthesiologists to patients with negative RT‐PCR for SARS‐CoV‐2.ResultsAbout 1253 patients underwent surgical procedures and were subjected to screening for SARS‐CoV‐2. Forty‐nine cases with a delayed surgery were included in the coronavirus disease (COVID) recovery (COVID‐rec) group and were matched to 98 patients included in the COVID negative (COVID‐neg) group. Overall, 22 (15%) patients had 30‐days postoperative complications, but there was no statistically difference between groups –16.3% for COVID‐rec and 14.3% for COVID‐neg, respectively (odds ratio [OR] 1.17:95% confidence interval [CI] 0.45–3.0; p = .74). Moreover, we did not find difference regarding grades more than or equal to 3 complication rates – 8.2% for COVID‐rec and 6.1% for COVID‐neg (OR 1.36:95%CI 0.36‐5.0; p = .64). There were no pulmonary complications or SARS‐CoV‐2 related infection and no deaths within the 30‐days after surgery.ConclusionsOur study suggests that patients with delayed elective surgeries due to asymptomatic preoperative positive SARS‐CoV‐2 test are not at higher risk of postoperative complications.
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Belgaumkar, A Day, C Gilbert, B Oyewole, P Narayan, H Dent, A Sandhya, T De Silva, S Waheed, A Day, K Kapoor, A P Belgaumkar, P Narayan, M Fahim, T Gala, R Mithany, R Morgan, M Abdelkarim, S Ibrahim, A Maw, A Asqalan, G Sundaram Venkatesan, S Singh, S Mukherjee, D Ferguson, C Smith, A Mansuri, A Thakrar, L Wickramarachchi, R Cuthbert, S Sivayoganathan, K Chui, E Karam, C Dott, S Shankar, K Madhvani, M Hampton, A P Hormis, M Thomas, L Pearce, D M Fountain, R Laurente, K V Sigamoney, M Dasa, K George, Z Naqui, M Galhoum, C Lipede, A Gabr, A Radhakrishnan, M T Hasan, R Kalenderov, O Pathmanaban, F Colombo, R Chelva, G Branagan, L Longstaff, D Ding, C Barlow, J Foster, J Edwards, A Ward, D Tadross, L Majkowski, C Blundell, S Forlani, R Nair, S Guha, S R Brown, C Steele, C J Kelty, T Newman, M Lee, G Chetty, G Lye, S P Balasubramanian, N Sureshkumar Shah, M Sherif, A Al-mukhtar, E Whitehall, A Giblin, F Wells, A Sharkey, A Adamec, S Madan, B Narice, M Sterrenburg, A Thompson, I Varley, M 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Powell, C Magee, K Agarwal, E Mangos, T Nambirajan, R Vidya, G Chauhan, J Kaur, A Burahee, S Bleibleh, N Pigadas, D Snee, S Bhasin, A Crichton, A Habeebullah, A S Bodla, N Yassin, M Mondragon, V Dewan, I Flindall, V Mahendran, A Hanson, E Jenner, J Richards, K Thomas-Fernandez, R Wall, A Alqallaf, A Ben-Sassi, I Mohamed, K Mellor, P Joshi, Y Joshi, R Young, V Miu, K Sheridan, L MacDonald, S Green, L Onos, J J Wong, L Napolitano, M Hemmila, D Amin, S Abramowicz, S M Roser, K A Olson, C Riley, C Heron, T Cardenas, E Leede, M Thornhill, A B Haynes, K McElhinney, S Roward, M D Trust, C E Hill, P G Teixeira, E Etchill, K Stevens, M R Ladd, C Long, J Rose, A Kent, P Yesantharao, D Vervoort, H Jenny, A Gabre-Kidan, A Margalit, L Tsai, H Malapati, L Yesantharao, H Abdou, J Diaz, M Richmond, J Clark, L O'Meara, N Hanna, Y Ying, J Fleming, A Ovaitt, J Gigliotti, A Fuson, Z Cooper, A Salim, S A Hirji, A Brown, C Chung, L Hansen, B U Okafor, V Roxo, C P Raut, J S Jolissaint, D A Mahvi, H Kaafarani, K Breen, B Bankhead-Kendall, O Alser, H Mashbari, G Velmahos, L R Maurer, M El Moheb, A Gaitanidis, L Naar, M A Christensen, C Kapoen, K Langeveld, M El Hechi, A Mokhtari, M H Haqqani, F T Drake, A Goldenberg-Sandau, B Galbreath, C Reinke, S Ross, K Thompson, D Manning, R Perkins, E Eriksson, H Evans, M Masrur, P Giulianotti, E Benedetti, G Chang, J Ourieff, D Dehart, A Dorafshar, T Price, A R Bhama, A Torquati, E Cherullo, R Kennedy, J Myers, K Rubin, V S Ban, S G Aoun, H H Batjer, J Caruso, H Carmichael, C G Velopulos, F L Wright, S Urban, R C McIntyre, T J Schroeppel, E A Hennessy, J Dunn, L Zier, C Burlew, J Coleman, K P Colling, B Hall, H E Rice, E S Hwang, S A Olson, D Moris, R Verma, R Hassan, A Volpe, S Merola, L A O'Banion, J Lilienstein, R Dirks, H Marwan, M Almasri, G Kulkarni, M Mehdi, A Abouassi, M Abdallah, M San Andrés, J Eid, E Aigbivbalu, J Sundaresan, B George, A Ssentongo, P Ssentongo, J S Oh, J Hazelton, J Maines, N Gusani, M Garner, S Horvath, F Zheng, M Ujiki, G Kinnaman, A Meagher, I Sharma, E Holler, K McKenzie, J Chan, K Fretwell, W Nugent III, A Khalil, D Chen, N Post, T Rostkowski, D Brahmbhatt, K Huynh, M L Hibbard, M Schellenberg, R C G Martin, N Bhutiani, E Giorgakis, J Laryea, A Bhavaraju, K Sexton, M Roberts, M Kost, M Kimbrough, L Burdine, K Kalkwarf, R Robertson, A Gosain, L Camp, R Lewit, J P Kronenfeld, E Urrechaga, N Goel, R Rattan, V Hart, M Allen, G Gilna, A Cioci, G Ruiz, M Allen, K Rakoczy, W Pavlis, R Saberi, R Morris, B S Karam, C E M Brathwaite, H Liu, P Petrone, H Hakmi, A H Sohail, G Baltazar, R Heckburn, R M Nygaard, E T Colonna, F W Endorf, M J Hill, A Maiga, B Dennis, J H Levin, M Lallemand, R Choron, G Peck, F Soliman, S Rehman, N Glass, B Juthani, D Deisher, N M Ruzgar, S J Ullrich, M Sion, C Paranjape, M El Moheb, A R Kar, C Gillezeau, J Rapp, E Taioli, B A Miles, N Alpert, D Podolsky, N L Coleman, M P Callahan, I Ganly, L Brown, J R T Monson, A Dehal, A Abbas, A Soliman, B Kim, C Jones, E Dauer, E Renza-Stingone, E Hernandez, E Gokcen, E Kropf, H Sufrin, H Hirsch, H Ross, J Engel, J Sewards, J Diaz, J Poggio, K Sanserino, L Rae, M Philp, M Metro, P McNelis, R Petrov, S Rehman, T Pazionis, B Till, R Lamm, A J Rios-Diaz, F Palazzo, M Rosengart, K Nicholson, M M Carrick, K Rodkey, A Suri, R Callcut, S Nicholson, N Talathoti, D Klaristenfeld, W* Biffl, C Marsh, K Schaffer, A E Berndtson, S Averbachs, T Curry, R Kwan-Feinberg, E Consorti, R Gonzalez, R Grolman, T Liu, O Merzlikin, M K Abel, D Ozgediz, M Boeck, L Z Kornblith, B Nunez-Garcia, B Robinson, P Park, A F Utria, S E Rice-Townsend, P Javid, J Hauptman, K Kieran, D Nehra, A Walters, J Cuschieri, G H Davidson, J Nunez, R Cosker, S Eckhouse, A Choudhry, W Marx, T Jamil, S Seegert, S Al-Embideen, M Quintana, H Jackson, S D Wexner, I Kent, P N Martins, M Alshehari, H Al-Naggar, M Alsayadi, M Alyazidi, S Shream, W Alhaddad, A Maqus, M Abu Hamra'a, R Alsayadi, R Ghannam, S Al-Maqtari, S Masdoos, Y Al-Harazi, H Bajjah, S Al-Ameri, M Aldawbali, G P Gwini, D Mazingi, Laura Bravo, Dmitri Nepogodiev, James C Glasbey, Elizabeth Li, Joana FF Simoes, Sivesh K Kamarajah, Maria Picciochi, Tom EF Abbott, Adesoji O Ademuyiwa, Alexis P Arnaud, Arnav Agarwal, Amanpreet Brar, Muhammed Elhadi, Dennis Mazingi, Victor Roth Cardoso, Samuel Lawday, Raza Sayyed, Omar M Omar, Antonio Ramos de la Madina, Luke Slater, Mary Venn, Georgios Gkoutos, Aneel Bhangu, Laura Bravo, Victor Roth Cardoso, Luke Slater, Andreas Karwath, Georgios Gkoutos, Dmitri Nepogodiev, Laura Bravo, Aneel Bhangu, Kwabena Siaw-Acheampong, Leah Argus, Daoud Chaudhry, Brett E Dawson, James C Glasbey, Rohan R Gujjuri, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, James M Keatley, Samuel Lawday, Elizabeth Li, Harvinder Mann, Ella J Marson, Kenneth A Mclean, Maria Picciochi, Elliott H Taylor, Abhinav Tiwari, Joana F F Simoes, Isobel M Trout, Mary L Venn, Richard J W Wilkin, Aneel Bhangu, Dmitri Nepogodiev, Irida Dajti, Arben Gjata, Luis Boccalatte, Maria Marta Modolo, Daniel Cox, Peter Pockney, Philip Townend, Felix Aigner, Irmgard Kronberger, Kamral Hossain, Gabrielle VanRamshorst, Ismail Lawani, Gustavo Ataide, Glauco Baiocchi, Igor Buarque, Muhammad Gohar, Mihail Slavchev, Arnav Agarwal, Amanpreet Brar, Janet Martin, Maria Marta Modolo, Maricarmen Olivos, Jose Calvache, Carlos Jose Perez Rivera, Ana Danic Hadzibegovic, Tomislav Kopjar, Jakov Mihanovic, Jaroslav Klat, René Novysedlak, Peter Christensen, Alaa El-Hussuna, Sylvia Batista, Eddy Lincango, Sameh H Emile, Mengistu Gebreyohanes Mengesha, Samuel Hailu, Hailu Tamiru, Joonas Kauppila, Johanna Laukkarinen, Alexis Arnaud, Markus Albertsmeiers, Hans Lederhuber, Markus Loffler, Stephen Tabiri, Symeon Metallidis, Georgios Tsoulfas, Maria Aguilera Lorena, Gustavo Grecinos, Tamas Mersich, Daniel Wettstein, Dhruv Ghosh, Gabriele Kembuan, Peiman Brouk, Mohammad Khosravi, Masoud Mozafari, Ahmed Adil, Helen M Mohan, Oded Zmora, Marco Fiore, Gaetano Gallo, Francesco Pata, Gianluca Pellino, Sohei Satoi, Faris Ayasra, Mohammad Chaar, Ildar R Fakhradiyev, Mohammad Jamal, Muhammed Elhadi, Aiste Gulla, April Roslani, Laura Martinez, Antonio Ramos De La Medina, Oumaima Outani, Pascal Jonker, Schelto Kruijff, Milou Noltes, Pieter Steinkamp, Willemijn van der Plas, Adesoji Ademuyiwa, Babatunde Osinaike, Justina Seyi-olajide, Emmanuel Williams, Sofija Pejkova, Knut Magne Augestad, Kjetil Soreide, Zainab Al Balushi, Ahmad Qureshi, Raza Sayyed, Mustafa Abu Mohsen Daraghmeh, Sadi Abukhalaf, Moises Cukier, Hugo Gomez, Sebastian Shu, Ximena Vasquez, Marie Dione Parreno-Sacdalan, Piotr Major, José Azevedo, Miguel Cunha, Irene Santos, Ahmad Zarour, Eduard-Alexandru Bonci, Ionut Negoi, Sergey Efetov, Andrey Litvin, Faustin Ntirenganya, Ehab AlAmeer, Dejan Radenkovic, Frederick Koh Hong Xiang, Chew Min Hoe, James Ngu Chi Yong, Rachel Moore, Ncamsile Nhlabathi, Ruth Blanco Colino, Ana Minaya Bravo, Ana Minaya-Bravo, Umesh Jayarajah, Dakshitha Wickramasinghe, Mohammed Elmujtaba, William Jebril, Martin Rutegård, Malin Sund, Arda Isik, Sezai Leventoğlu, Tom E F Abbott, Ruth Benson, Ed Caruna, Sohini Chakrabortee, Andreas Demetriades, Anant Desai, Thomas D Drake, John G Edwards, Jonathan P Evans, Samuel Ford, Christina Fotopoulou, Ewen Griffiths, Peter Hutchinson, Michael D Jenkinson, Tabassum Khan, Stephen Knight, Angelos Kolias, Elaine Leung, Siobhan McKay, Lisa Norman, Riinu Ots, Vidya Raghavan, Keith Roberts, Andrew Schache, Richard Shaw, Katie Shaw, Neil Smart, Grant Stewart, Sudha Sundar, Dale Vimalchandran, Naomi Wright, Sattar Alshryda, Osaid Alser, Kerry Breen, Ian Ganly, Haytham Kaafarani, Brittany Kendall, Hassan Mashbari, Hamza Al Naggar, Dennis Mazingi, Joana F F Simoes British Journal of Surgery, 2021 To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Functional and metabolic imaging in transthoracic biopsies guided by computed tomography Charles E. Zurstrassen, Chiang J. Tyng, Marcos D. Guimarães, Paula N. V. P. Barbosa, Clovis A. L. Pinto, Almir G. V. Bitencourt, Jeffersson L. Gross, Eduardo N. P. Lima, Aline C. B. S. Cavalcante, João P. K. Matushita Junior, Rubens Chojniak European Radiology, 2020
Long-term outcomes of transmesenteric portal vein recanalization for the treatment of chronic portal vein thrombosis after pediatric liver transplantation A.C.B.S. Cavalcante, C.E. Zurstrassen, F.C. Carnevale, R.P.S. Pugliese, E.A. Fonseca, A.M. Moreira, J.P.K. Matushita Jr, H.L.L. Cândido, M.A.R. Benavides, I.K. Miura, V.L.B. Danesi, A.P.M. Hirschfeld, C.B.V. Borges, G. Porta, P. ChapChap, J. Seda-Neto American Journal of Transplantation, 2018 Portal vein thrombosis (PVT) may occur at any time following liver transplantation. We describe our experience with portal vein recanalization in cases of thrombosis after liver transplantation. Twenty-eight children (5%) out of 566 liver transplant recipients underwent portal vein recanalization using a transmesenteric approach. All children received left hepatic segments, developed PVT, and had symptoms or signs of portal hypertension. Portal vein recanalization was performed via the transmesenteric route in all cases. Twenty-two (78.6%) patients underwent successful recanalization and stent placement. They received oral anticoagulants after the procedure, and clinical symptoms subsided. Symptoms recurred due to portal vein restenosis/thrombosis in seven patients. On an intention-to-treat basis, the success rate of the proposed treatment was 60.7%. Only 17 out of 28 children with posttransplant chronic PVT retained stent patency (primary + assisted) at the end of the study period. In cases of portal vein obstruction, the transmesenteric approach via minilaparotomy is technically feasible with good clinical and hemodynamic results. It is an alternative procedure to reestablish the portal flow to the liver graft that can be performed in selected cases and a therapeutic addition to other treatment strategies currently used to treat chronic PVT. Portal vein thrombosis (PVT) may occur at any time following liver transplantation. We describe our experience with portal vein recanalization in cases of thrombosis after liver transplantation. Twenty-eight children (5%) out of 566 liver transplant recipients underwent portal vein recanalization using a transmesenteric approach. All children received left hepatic segments, developed PVT, and had symptoms or signs of portal hypertension. Portal vein recanalization was performed via the transmesenteric route in all cases. Twenty-two (78.6%) patients underwent successful recanalization and stent placement. They received oral anticoagulants after the procedure, and clinical symptoms subsided. Symptoms recurred due to portal vein restenosis/thrombosis in seven patients. On an intention-to-treat basis, the success rate of the proposed treatment was 60.7%. Only 17 out of 28 children with posttransplant chronic PVT retained stent patency (primary + assisted) at the end of the study period. In cases of portal vein obstruction, the transmesenteric approach via minilaparotomy is technically feasible with good clinical and hemodynamic results. It is an alternative procedure to reestablish the portal flow to the liver graft that can be performed in selected cases and a therapeutic addition to other treatment strategies currently used to treat chronic PVT.
Safety and efficacy of HepaSphere 50–100 μm in the treatment of hepatocellular carcinoma Charles Edouard Zurstrassen, Luiz Paulo De Oliveira Gireli, Chiang Jeng Tyng, Almir Galvão Vieira Bitencourt, Marcos Duarte Guimarães, Paula Nicole Vieira Barbosa, Aline Cristine Barbosa Santos Cavalcante, João Paulo Matushita Junior, Mauricio Kauark Amoedo, Felipe Jose Coimbra, Rogério Camargo Pinheiro Alves, Rubens Chojniak Minimally Invasive Therapy and Allied Technologies, 2017 AIM: To evaluate the effects of HepaSphere 50-100 μm (Merit Medical) as a doxorubicin carrier and embolization agent for the treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A prospective analysis of 18 patients recruited from a national cancer center was conducted. This analysis evaluated the efficacy and safety of HepaSphere, as expressed by the treatment response rate (measured by the modified Response Evaluation Criteria in Solid Tumors, mRECIST) and by the prevalence of treatment-related adverse events, respectively. RESULTS: The cohort was predominantly male, with a mean age of 69 years. The objective response rate (complete + partial response) was 53.3%. The variable most likely to be associated with objective response was Barcelona Clinic Liver Cancer (BCLC) staging. The most prevalent adverse events were nausea, vomiting and abdominal pain. CONCLUSION: HepaSphere chemoembolization yielded a substantial objective response rate with an acceptable toxicity profile and should be considered an option for HCC treatment.
BRAZILIAN CONSENSUS FOR MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 3: CONTROVERSIES AND UNRESECTABLE METASTASES Orlando Jorge Martins TORRES, Márcio Carmona MARQUES, Fabio Nasser SANTOS, Igor Correia de FARIAS, Anelisa Kruschewsky COUTINHO, Cássio Virgílio Cavalcante de OLIVEIRA, Antonio Nocchi KALIL, Celso Abdon Lopes de MELLO, Jaime Arthur Pirola KRUGER, Gustavo dos Santos FERNANDES, Claudemiro QUIREZE JR, André M. MURAD, Milton José de BARROS E SILVA, Charles Edouard ZURSTRASSEN, Helano Carioca FREITAS, Marcelo Rocha CRUZ, Rui WESCHENFELDER, Marcelo Moura LINHARES, Leonaldson dos Santos CASTRO, Charles VOLLMER, Elijah DIXON, Héber Salvador de Castro RIBEIRO, Felipe José Fernandez COIMBRA Arquivos Brasileiros De Cirurgia Digestiva Abcd Brazilian Archives of Digestive Surgery, 2016
Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients Flávia H. Feier, Paulo Chapchap, Renata Pugliese, Eduardo A. da Fonseca, Francisco C. Carnevale, Airton M. Moreira, Charles Zurstrassen, Aline C. Santos, Irene K. Miura, Vera Baggio, Adriana Porta, Teresa Guimarães, Helry Cândido, Marcel Benavides, Andre Godoy, Katia M. R. Leite, Gilda Porta, Mario Kondo, João Seda-Neto Liver Transplantation, 2014
Endovascular treatment of subclavian artery pseudoaneurysm in a hemophiliac child Emanuella Galvão de Sales e Silva, Ricardo Wagner da Costa Moreira, Elias Arcenio Neto, Camila de Campos Silva, Charles Edouard Zurstrassen, Flávio Roberto Cavalleiro de Macedo Ribeiro, Orlando da Costa Barros, Marcelo Calil Burihan, Felipe Nasser, José Carlos Ingrund, Adnan Neser Jornal Vascular Brasileiro, 2006
