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    Effect of Percutaneous Endobiliary Radiofrequency Ablation in Malignant Bile Stenosis
    (Duzce Univ, Fac Medicine, 2023) Ozer, Hamza; Sayin, Bige; Akmangit, Ilkay
    Abant Aim: This study aimed to demonstrate the feasibility of the percutaneous endobiliary radiofrequency ablation (ERFA) method, which is used to increase stent patency in malignant biliary strictures. Material and Methods: A total of 25 patients, 9 (36%) female and 16 (64%) male, who developed malignant biliary stenosis secondary to various advanced tumors and underwent ERFA and metallic stenting after percutaneous biliary drainage were retrospectively evaluated. The types of malignancies causing obstruction and the follow-up after the procedure were evaluated to demonstrate the median survival and stent patency values of the patients. Stent patency and survival rates were calculated using the Kaplan -Meier method. Results: The results of the study demonstrated that 17 (68%) out of these 25 patients displayed a significant decrease in their first -week postoperative bilirubin values, with a reduction of greater than 50% compared to the pre-biliary drainage values. The study determined that this treatment approach's overall clinical success rate was 68%. Stent occlusion developed within 180 days in 8 (32%) out of the 25 patients who underwent ERFA and metallic stenting. Additionally, 18 (%72) patients died as a result of malignancy progression. The mortality rates at post -treatment 30 and 180 days were determined to be 24% and 72%, respectively. The median survival and stent patency times were 65 and 70 days, respectively. Conclusion: Percutaneous ERFA and metallic stenting have the potential to improve survival and stent patency, especially in selected patient groups with distal biliary stenosis. Randomized controlled studies are needed to confirm these results.
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    A rare and late complication of lung cancer: bronchial rupture
    (Springer, 2024) Afsin, Emine; Koscu, Ozge; Kucuk, Furkan; Haktanir, Muhammed Yavuz; Ozer, Hamza; Kilicgun, Haciali
    Background Tracheobronchial injuries generally occur due to iatrogenic or traumatic causes. Although bronchial rupture due to teratoma and germ cell tumors has been reported in the literature, no cases related to lung cancer have been determined. Our case is presented because of the refusal to be examined for the mass in the lung and the detection of bronchial rupture afterward when he presented with massive hemoptysis.Case presentation A 65-year-old male patient was admitted to the emergency department with the complaint of massive hemoptysis. Six months ago, bronchoscopy was recommended due to the 8 x 7 cm cavitary lesion obliterating the bronchus in the anterior upper lobe of the right lung on chest computed tomography, but the patient refused. The sputum sample, requested 3 times, was negative for acid-resistant bacteria, and no growth was detected in the mycobacterial culture. In the new pulmonary CT angiography, a progressive cavitary lesion invading the right main bronchus, carina, and vena cava superior was observed. Following tranexamic acid treatment and bronchial artery embolization, hemoptysis significantly decreased in the follow-up. In the flexible bronchoscopy performed for diagnostic purposes, the carina was pushed to the left and invaded, and there was damage to the right main bronchus. A biopsy was not performed due to the risk of bleeding, and lavage was performed. Lavage was negative for ARB, there was no growth in the mycobacteria culture, and cytology did not reveal malignant cells. The patient, diagnosed with right main bronchial rupture, was considered inoperable and died 1 month later due to respiratory failure.Conclusions Examinations should be initiated as soon as malignancy is suspected. When diagnosis and treatment are delayed, complications that would be challenging to intervene may develop.
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    Retrieval of n-Butyl Cyanoacrylate Cast Migrated to the Dorsalis Pedis and Posterior Tibial Artery During Embolization of the Deep Circumflex Iliac Artery Using the Stent Retriever Device: A Case Report
    (Sage Publications Inc, 2024) Genez, Samet; Yilmazsoy, Yunus; Ozer, Hamza
    N-butyl cyanoacrylate (NBCA) is commonly used in interventional radiology procedures for its efficacy in vessel occlusion, yet it poses risks of embolic material migration. We present a unique case of NBCA cast migration during deep circumflex iliac artery (DCIA) embolization, leading to occlusion of the dorsalis pedis and posterior tibial arteries, subsequently retrieved using a stent retriever device. A 68-year-old woman with a history of heart valve replacement presented with a large intramuscular hematoma. N-butyl cyanoacrylate embolization of DCIA resulted in cast migration, occluding distal arteries. Retrieval was attempted using a stent retriever device, successfully restoring arterial flow. N-butyl cyanoacrylate use necessitates attention to vascular anatomy and test injections to mitigate complications. Stent retriever devices, originally designed for acute stroke thrombectomy, offer a viable solution for embolic material retrieval in vascular interventions. This case highlights successful NBCA cast retrieval in lower extremity arterial occlusion using a stent retriever device. Prompt recognition and intervention are crucial in mitigating complications associated with NBCA use. Stent retriever devices present a valuable tool for NBCA cast retrieval, preserving arterial perfusion in affected areas. Clinical Impact This case highlights the innovative application of stent retriever devices for retrieving migrated NBCA casts, traditionally used for stroke management in peripheral arterial occlusions. This adaptation offers clinicians a new, effective tool for managing embolization complications, such as unintended material migration that can cause severe ischemia. Implementing this technique could change clinical practice by providing a reliable method to swiftly address and resolve potentially limb-threatening situations, thereby improving patient outcomes and procedural safety. This advancement in interventional radiology enhances clinicians' ability to handle complex embolic events with greater confidence and efficacy.