Congenital vs. Acquired | A Discussion of Tarlov Cyst Treatment with Long Term Follow Up
Congenital vs. Acquired | A Discussion of Tarlov Cyst Treatment with Long Term Follow Up
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I came to the conclusion that there are essentially There are those who have as part of a connective tissue disorder and this includes diseases

Ehlers-Danlos and possibly cutis laxa sometimes neurofibromatosis And these folks have family histories of things like bicuspid aortic valves being stretchy having chronic back

cataract problems lens problems and things consistent with And then there appears And this acquired group have had an event and in their 50s approximately they begin to become symptomatic.

Animal studies have been done. A lot of them. In general, what we've found with animal studies is that PAE induces prostatic volume reduction.

In general, there is no injuries to other organs. We see evidence of cystic changes, and some area of glandular necrosis. Here is one example showing a cystic change in the prostate after embolization in an animal model. And this is an example of one of our patients,

where we see before embolization a prostate of 90-something grams. After embolization, you see this area of necrosed glandular tissues.

In conclusion, our study finds that retrievable inferior vena cava filters have a significantly higher rate of self-reported, device associated complications when compared to permanent filters. Thank you!

Do we have any questions from the audience? That's surprising! So I had a question regarding the differences you found between retrievable and permanent. Was there a likelihood that there was under reporting of permanent filter complications because of, in

general lack of follow up for those types of patients? It's definitely a good question because several of the reports didn't involve filters that were imaged on follow up pending retrieval, and that's something that we took into account

when we assumed that 75% prevalence. I mean, that's kind of one of the limitations of the MAUDE database itself reporting biases are going to exist. So, it is possible. Any questions from the audience?

We have a couple of minutes left for the abstract. Right. Was there any data on some of the other brands such as the option which sort of

came into use [inaudible]? Okay, so I just want to repeat that for the microphone and the reporting. The question form the gentleman in the audience is, was there any data from a newer device the option filter available for analysis?

So, the vast majority were the Bird devices, recovery etc. So there were a few reports of the option filters but they were kind of under represented in the MAUDE database, if that answers your question.

And can you clarify again the percentage of penetration among the Cook Celect device that was reported in the written part of your abstract? For the Cook Celect, the IVC penetration that comprise

about 30% of all adverse events among the Cook devices. It's interesting to know because in the literature published in the last few years, the penetration rate from Celect were reported

to be as high as over 90% at least in the study by Dr. Gerald from UCSF. Other studies have had high penetration rates as we'll see subsequently in this very session. Why do you think there may

have been a discrepancy between the penetration rates reported in your study versus the published literature? So we can only actually report on the relative frequency of complications

rather than the rates of complications among these filters. It just so happen at 30% of all of Celect filters complications reported in the MAUDE database happen to

be penetration. That could be due to the reporting biases, like I said, maybe people are more apt to report something to review as more serious such

as a Fracture, that was about 15% of complications among Cook Celect. Okay, all right, thank you very much! Well, I think that's probably the self-reporting nature. I think many people may not consider penetration a complication.

Until patients have a complication that penetration, they may not report it. So I think it's one of the limitations. That's a good point to make especially if the patient's asymptomatic, perhaps the ones being reported are the

more severe cases, good point indeed.

The superior hypograstric block is becoming kind of more commonly seen. In those practices that are doing it, a lot of uterine artery embolization, this is a really nice way to improve patients'

crampy abdominal pain or crampy pelvic pain that's related to uterine ischemia after uterine artery embolization. There have been authors that have proposed that to do UAE as an outpatient procedure, that we should couple the UAE procedure with this block.

It's good for pelvic pain, both uterine contractile pain, but also for cervical, vaginal pain, rectal, as well as bladder related pain. For those cancer patients, this is also a good block to consider. These are all palliative interventions

that are very simple to perform and can really improve patients' quality of life. Again, getting back to this really busy slide, if you target this lower hypogastric region, you're basically picking up the splanchnic nerves that innervate the large intestine,

the small intestine, the ovaries, the scrotum, the urinary bladder, and the perineum. On the right hand side, you can see the fluoroscopic guided way to do this, which is basically just to target the disc space between L5 and S1.

The other way that people do it is that during their uterine artery embolization, they'll take a catheter and put it up and over the bifurcation so that you basically then outline where the bifurcation is and then you just stick your needle right there in the V of your aortic bifurcation.

You take the needle just underneath the aortic bifurcation and dock it up against the vertebral body, pull your needle back, do your block, and you have a significant improvement in the patient's pain.

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