George Behrens

Adventist Hinsdale Hospital

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Héctor Ferral

Louisiana State University Health Sciences Center New Orleans

Nilesh H. Patel

Total Rehab

Yanki Tumer

Northwestern University

Sebouh Gueyikian

NorthShore University HealthSystem

Nilesh Patel

B. K. Mody Government Pharmacy College

Deborah Giusto

Rush University Medical Center

Antonio Jiménez

Sylvester Comprehensive Cancer Center

David H. Van Thiel

Rush University Medical Center

Edward F. Hollinger

Rush University Medical Center

Héctor Ferral

NorthShore University HealthSystem

Cooperative Institutions

Rush University Medical Center

Society of Interventional Radiology

Rush University

University of Michigan–Ann Arbor

Universidad de Zaragoza

Michigan Medicine

Northwestern University

Presbyterian St. Luke's Medical Center

University of Illinois Chicago

Oregon Health & Science University

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Visceral Artery Aneurysms

Springer eBooks (2013)

George Behrens M. Goldin Héctor Ferral

Computed Tomography Angiography

10.1007/978-1-4614-7312-1_40

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Citations (0)

Tract Embolization

Springer eBooks (2010)

George Behrens Nilesh H. Patel

10.1007/978-1-84800-897-7_31

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Citations (1)

Endovascular Diagnosis and Management of Chronic Cerebrospinal Venous Insufficiency: Retrospective Analysis of 30-Day Morbidity and Mortality in 95 Consecutive Patients

American Journal of Roentgenology (2013)

Héctor Ferral George Behrens Yanki Tumer Magdalene Riemenschneider

The purpose of this study is to report the 30-day morbidity and mortality associated with the endovascular diagnosis and management of chronic cerebrospinal venous insufficiency.The medical records of 95 consecutive patients (60 women and 35 men) with a mean age of 48 years (age range, 25-66 years) who underwent diagnostic endovascular evaluation and intervention for chronic cerebrospinal venous insufficiency between June 2010 and September 2011 were reviewed retrospectively. All patients had a diagnosis of multiple sclerosis by McDonald criteria. Endovascular evaluation of the internal jugular and azygos veins was performed with digital subtraction venography and intravascular ultrasound. Indications for percutaneous transluminal angioplasty (PTA) were venographic findings of a greater than 50% diameter stenosis, the presence of reflux on digital subtraction venography, greater than 50% cross-sectional area stenosis by intravascular ultra-sound, or a finding of abnormal thick valves or webs by either method. The primary endpoint of this study was the 30-day mortality, and the secondary endpoint was the presence of major complications. Results are presented as means and percentages.A total of 107 procedures were performed in 95 patients. Endovascular evaluation showed venous lesions requiring intervention in 90 of 95 patients (94.7%) and was negative in five of 95 patients (5.3%). A total of 193 venous lesions were treated; angioplasty was technically successful in 188 of 193 (97.4%) lesions. Internal jugular vein thrombosis after PTA was identified in three of 95 (3.2%) of the treated patients. Bleeding at the puncture site not requiring transfusion occurred in four of 95 patients (4.2%). There were no reported procedure-related deaths.The results of the current study suggest that endovascular evaluation and management of chronic cerebrospinal venous insufficiency is safe, with low morbidity and no procedure-related mortality.

Chronic Venous Insufficiency

10.2214/ajr.12.8938

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Citations (6)

Successful transjugular intrahepatic portal-systemic shunt in an ineligible liver transplant patient with primary biliary cirrhosis with refractory ascites and aplastic anemia

Open Journal of Gastroenterology (2013)

Christopher M. Moore George Behrens Héctor Ferral David H. Van Thiel

A transjugular intrahepatic portal-systemic shunt (TIPS) is a standard way to decompress the portal system in cirrhotic patients as a bridge to orthotopic liver transplantation (OLT). Traditionally, TIPS has been indicated for certain portal hypertensive sequelae such as refractory ascites, varices treatment and even hepato-hydrothorax. Herein is a case report on the efficacy of TIPS in an OLT ineligible patient with primary biliary cirrhosis and aplastic anemia who had developed refractive ascites requiring serial paracentesis and esophageal varices. He survived 2.5 years post-TIPS placement and died from complications related to severe leucopenia and the development of sepsis.

Hydrothorax

Paracentesis

Aplastic anemia

Spontaneous bacterial peritonitis

10.4236/ojgas.2013.31001

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Balloon-assisted over-the-wire technique for placement of the venous outflow component of the Hemodialysis Reliable Outflow (HeRO) device

Journal of Vascular Surgery (2013)

Héctor Ferral George Behrens Yanki Tumer Sebouh Gueyikian Edward F. Hollinger

Outflow

HERO

10.1016/j.jvs.2013.03.011

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Citations (1)

Budd-Chiari Syndrome

American Journal of Roentgenology (2012)

Héctor Ferral George Behrens Jorge E. Lopera

Budd-Chiari syndrome (BCS) is an uncommon condition characterized by obstruction of the hepatic venous outflow tract. Presentation may vary from a completely asymptomatic condition to fulminant liver failure. BCS is an example of postsinusoidal portal hypertension. The management can be divided into three main categories: medical, surgical, and endovascular. The purpose of this article is to present an overall perspective of the problem, diagnosis, and management.BCS requires accurate, prompt diagnosis and aggressive therapy. Treatment will vary depending on the clinical presentation, cause, and anatomic location of the problem. Patients with BCS are probably best treated in tertiary care centers where liver transplantation is available.

Budd–Chiari syndrome

Presentation (obstetrics)

Fulminant

Hepatic veins

10.2214/ajr.12.9098

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Citations (95)

Transjugular Intrahepatic Portosystemic Shunts in Liver Transplant Recipients: Technical Considerations and Review of the Literature

Seminars in Interventional Radiology (2005)

Nilesh H. Patel Jay Patel George Behrens Anthony M. Savo

Transjugular intrahepatic portosystemic shunt (TIPS) is an accepted therapeutic option for the treatment of complications of portal hypertension, such as refractory variceal bleeding, refractory ascites, refractory hepatic hydrothorax and Budd-Chiari syndrome, in cirrhotic livers. However, portal hypertension is uncommon after liver transplantation, and when it occurs, it has been related to hepatic vein outflow obstruction, small liver donor size, rejection, or recurrence of the original disease. There are few reports in the literature addressing TIPS experience in liver transplant patients. This review will address the published experience of TIPS procedures in liver transplant patients, including indications, technical issues, complications, and outcomes.

Refractory (planetary science)

Liver disease

Hydrothorax

Portosystemic shunt

10.1055/s-2005-925559

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Citations (9)

Arterial Embolization Post-percutaneous Biopsy or Drainage

Springer eBooks (2010)

George Behrens Nilesh H. Patel

Percutaneous biopsy

Arterial Embolization

Major bleeding

10.1007/978-1-84800-897-7_32

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Citations (0)

Transjugular Liver Biopsy: Comparison of Sample Adequacy with the Use of Two Automated Needle Systems

Journal of Vascular and Interventional Radiology (2010)

George Behrens Héctor Ferral Deborah Giusto Jay Patel David H. Van Thiel

Core biopsy

10.1016/j.jvir.2010.10.012

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Citations (16)

Hereditary inflammatory breast cancer associated with BRCA2 mutation: a rare disease presentation in mother and daughter.

PubMed (2012)

Antonio Jiménez A. Growney George Behrens Carol Corbridge Dianne D Chapman

A 40-year-old white woman of Irish descent presented with a 4-week history of a right breast mass associated with edema and enlargement of the breast. Her family history was significant for inflammatory breast cancer (IBC) in her mother, who was diagnosed and died at age 35, as well as for breast cancer in a paternal aunt diagnosed at age 55. On physical examination, she had an enlarged right breast with a palpable 9 cm mass in its inferolateral aspect, with peau d’orange skin changes around the right nipple (Figure 1) and associated ipsilateral axillary lymphadenopathy. Her left breast was unremarkable. Diagnostic ultrasound (Figure 2) showed an irregular 5-cm mass at the 9 o’clock position, bilateral nodular tissue densities seen throughout both breasts, and right axillary adenopathy. Thickened dermis was noticed in the periareolar area and the inferior aspect of the right breast. A core biopsy of the right breast mass revealed a grade III, infiltrating ductal carcinoma with associated high-grade ductal carcinoma in situ (DCIS). The tumor was estrogen receptor (ER)-positive (80%) and negative for progesterone (PR), human epidermal growth factor receptor 2 (HER2), and epidermal growth factor receptor (EGFR). A single-site skin punch biopsy did not show invasion of the dermal lymphatics; however, given the constellation of findings and the typical course, the clinical diagnosis of inflammatory breast cancer was made. A staging positron emission tomography (PET) scan demonstrated increased uptake in the right internal mammary, right paratracheal, and cervical lymph nodes. A biopsy of the paratracheal lymph node confirmed the presence of breast cancer metastasis.

Axillary lymph nodes

Breast ultrasound

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Citations (4)