PURPOSE: To retrospectively evaluate the effectiveness and safety of tissue-type plasminogen activator (tPA) for drainage of abdominal and pelvic abscesses refractory to simple catheter drainage. MATERIALS AND METHODS: This HIPAA-compliant study was approved by the Institutional Review Board; informed consent was waived. Forty-three patients (17 men, 26 women; mean age, 46 years; age range, 10-89 years) with a total of 46 abscesses underwent percutaneous drainage with 8.5-14-F catheters. Etiology was postoperative in 28 abscesses (60.9%) and varied in 18 (39.1%). Intracavitary tPA was initiated on the basis of viscous contents yielding minimal drainage at initial placement or if follow-up imaging showed a large residual collection despite satisfactory catheter position. A treatment cycle was 4-6 mg of tPA in 0.9% saline administered twice daily for 3 days. Drainage success was defined as evacuation of the abscess without surgery. Safety was evaluated on the basis of complications. Statistical analysis was performed by using the Student t test and Fisher exact test. RESULTS: Forty-six abscesses were initially drained by 51 catheters. Complete evacuation was achieved in 41 (89.1%) abscesses, whereas five (10.9%) required surgical drainage. Three (60%) of these five had a documented fistula, a higher (P = .02) percentage than in successfully drained abscesses. Three (6.5%) of the 46 abscesses recurred (12-95 days after catheter removal). There were no tPA-linked bleeding complications despite four patients receiving full systemic anticoagulation and 24 receiving prophylactic anticoagulation. CONCLUSION: Intracavitary tPA is safe and effective for draining complex fluid collections, with most patients avoiding surgery. (c) RSNA, 2008.
PURPOSE: To retrospectively evaluate the effectiveness and safety of tissue-type plasminogen activator (tPA) for drainage of abdominal and pelvic abscesses refractory to simple catheter drainage. MATERIALS AND METHODS: This HIPAA-compliant study was approved by the Institutional Review Board; informed consent was waived. Forty-three patients (17 men, 26 women; mean age, 46 years; age range, 10-89 years) with a total of 46 abscesses underwent percutaneous drainage with 8.5-14-F catheters. Etiology was postoperative in 28 abscesses (60.9%) and varied in 18 (39.1%). Intracavitary tPA was initiated on the basis of viscous contents yielding minimal drainage at initial placement or if follow-up imaging showed a large residual collection despite satisfactory catheter position. A treatment cycle was 4-6 mg of tPA in 0.9% saline administered twice daily for 3 days. Drainage success was defined as evacuation of the abscess without surgery. Safety was evaluated on the basis of complications. Statistical analysis was performed by using the Student t test and Fisher exact test. RESULTS: Forty-six abscesses were initially drained by 51 catheters. Complete evacuation was achieved in 41 (89.1%) abscesses, whereas five (10.9%) required surgical drainage. Three (60%) of these five had a documented fistula, a higher (P = .02) percentage than in successfully drained abscesses. Three (6.5%) of the 46 abscesses recurred (12-95 days after catheter removal). There were no tPA-linked bleeding complications despite four patients receiving full systemic anticoagulation and 24 receiving prophylactic anticoagulation. CONCLUSION: Intracavitary tPA is safe and effective for draining complex fluid collections, with most patients avoiding surgery. (c) RSNA, 2008.
Authors: Jessica A Rotman; George I Getrajdman; Majid Maybody; Joseph P Erinjeri; Hooman Yarmohammadi; Constantinos T Sofocleous; Stephen B Solomon; F Edward Boas Journal: Am J Surg Date: 2016-08-17 Impact factor: 2.565
Authors: Anthony W Chow; Gerald A Evans; Avery B Nathens; Chad G Ball; Glen Hansen; Godfrey Km Harding; Andrew W Kirkpatrick; Karl Weiss; George G Zhanel Journal: Can J Infect Dis Med Microbiol Date: 2010 Impact factor: 2.471