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Type 1 and type 2 cysts were included in the study, while type 3 cysts were included only in cases where daughter cysts constituted a small part of the cyst. Type 4 and 5 cysts were excluded from the study. Also, three cysts that were initially diagnosed as hydatid cyst but were later detected to be non-parasitic cysts, were excluded from the study.
Among these cysts, 99 had the appearance of type 1 cyst, four were type 2, and three were type 3 cysts. And and two cases were located in the liver and the peritoneal cavity next to the liver, respectively. The volume of the cysts varied between Albendazole treatment was continued for prophylaxis for two further weeks following the procedure[ 9 , 20 ]. Catheter placement was performed using two different techniques: the Seldinger technique and the Trocar technique.
An G gauge Chiba needle, F percutaneous drainage catheter or 5. This is a two-step procedure. Standard wires and guide wires were used for drainage. The cyst was approached primarily through an intervention needle. Subsequently, a guide wire was sent through this needle and the needle was withdrawn. Thus, the guide wire could be located in the area of intervention. With dilators of various diameters sent through this guide wire, a hole was created that would permit the passage of the catheter through both the skin and the region of drainage.
Finally, the drainage catheter was placed into the target area over the same guide wire, and the guide wire was withdrawn. This is a single step procedure and a standard trocar tip drainage catheter is composed of a sheath needle and a catheter coaxial system. A catheter and a straightening cannula of the same size were placed in the catheter and a needle mm longer than the catheter was placed one in the other.
Through this system, a direct puncture was made and it was forwarded to the field of drainage. Subsequently, the cannula and needle was withdrawn with the catheter remaining inside. Following the first puncture, the cyst fluid was sent for cytological examination. Mobile scolexes in the cyst, seen under direct microscopy, were accepted as evidence of viability.
Cysts without presence of evidence of viability, such as that of laminar membrane fragments and scolex hooks in cytological exam-ination and separation of the endocyst in radiological evaluation, were excluded from the study. We applied Puncture Aspiration Injection Reaspiration PAIR in cysts with a diameter of less than 6 cm and catheterization method in larger cysts[ 21 - 31 ]. Follow-up studies included the cyst diameter and morphological changes in the cyst wall, local recurrence and secondary dissemination.
Follow-up with US was performed at the 1, 3, 6, 12, 18 and 24 mo after the procedure. Annual whole abdominal CT and chest X-ray examinations were also performed. Positive criteria of healing were accepted to be a decrease in cyst diameter, progressive solidification of the cyst contents and disappearance of the cyst. Local recurrence was defined as increased cyst diameter and contents, and the appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst.
SPSS The analysis of difference in volume between Trocar and Seldinger methods was performed using Mann-Whitney U test. Separation of the endocyst from the pericyst was observed in out of cysts following injection of the sclerosing agent. The cyst was drained without observation of membrane separation in one case, due to severe abdominal pain subsequent to hypertonic saline injection.
In another patient, the procedure was terminated due to the development of anaphylaxis before the cyst contents could be aspirated, following catheter insertion. Cytological examination confirmed the diagnosis of hydatid cyst in cysts, while viability was detected in 98 cysts.
Sclerotherapy was used in 98 cysts. Mean duration of catheterization in 62 patients was 2. The mean duration of the follow-up of the hydatid cysts in 88 patients was Floating membranes were observed in the cyst fluid during the follow-up US examinations 12 mo after the percutaneous treatment, while none of the cysts had a pure anechoic image, which included dense internal echoes.
At mo follow-up, the cavity was seen to have collapsed, the cyst wall had thickened, and the cyst fluid was indiscernible. Statistical evaluation comparison of the changes in cyst volume between trocar and seldinger techniques Mann-Whitney U test. Type 1 hydatid cyst follow-up examinations conducted one to mo after the procedure.
A: US image prior to the procedure; B: CT image prior to the procedure; C: US image 6 mo after the procedure, wall thickness and irregularity of the cyst is seemed to be increased; D: US image 12 mo after the procedure, cyst dimension and tension is seemed to be markedly decreased and the contents can could be seen to have solidified; E: US image 18 mo after percutaneous drainage.
Cyst can could be seen to have completely collapsed and solidified in the image and a pseudotumor image is formed. Thirteen early complications developed in a total of 12 patients. The early complications were anaphylaxis in one patient, biliary fistula in four, minor reaction in one chills and tachycardia , abdominal pain in three, fever without signs of infection, entry site infection in one patient, infection in the cyst cavity abscess in one patient, in whom a biliary fistula also developed, and intra-abdominal extravasation in one patient.
Late complications developed in three patients that were secondary dissemination in one and local recurrence in two patients. During entry to the cavity with the Seldinger technique, following catheter placement and before aspiration of the cyst contents, anaphylaxis developed in a year-old male patient with a type 1 cyst. With the Seldinger technique, the catheter was placed in all cysts in which biliary fistula had developed.
These cysts were big cysts with a mean diameter of 8 cm range, Due to severe abdominal pain, the procedure was terminated in two patients treated with the Seldinger technique and in one patient treated with the Trocar technique. Fever, chills and tachycardia developed in one patient with the Seldinger technique; however these signs resolved spontaneously without any medical treatment.
Entry site infection was seen in a patient using the Seldinger technique, and the patient was treated with antibiotics. Cystography revealed leakage into the peritoneal cavity in two cysts subcapsularly located at the dome of the right lobe of the liver in a patient using the Seldinger technique. This patient was treated with albendazole for three months and no peritoneal cysts were detected during the mo follow-up period.
Local recurrence developed in two patients using the Seldinger technique, including the presence of multiple daughter cysts and increased dimensions in a cyst cavity that had collapsed and solidified. These two patients underwent surgical treatment.
Two new lesions secondary dissemination and recurrence were found at the 12 mo follow-up visit in a patient using Seldinger technique. These lesions were also treated by percutaneous methods. Hydatid cyst disease should be treated, due to the risks of severe infection, invasion to the biliary system and peritoneum and dissemination into other organs.
Although surgery is the gold standard treatment, various types of percutaneous treatment provide alternatives for the elimination of the parasite and preventing the disease from reoccurring[ 23 - 25 , 32 ]. The two step Seldinger technique or single step Trocar technique may be used for entry to the cyst cavity. The disadvantages in using the hydrophilic coated drainage catheters placed percutaneously with a guide wire, as required by the Seldinger technique, are the necessity for two individuals to perform the procedure and the relatively high cost of the technique.
Trocar type catheters can be placed by a single individual and are more cost effective. However, secondary to aging, the pleura and peritoneum lose their elasticity after surgery, making the insertion of trocar type catheters difficult in such cases. There is no publication in the literature reporting whether a difference exists between the two techniques used for the entry to the cyst cavity in terms of the efficacy of treatment and the development of complications[ 15 , 31 , 32 ].
A significant decrease was found in the cyst volume during the follow-up period. The most frequently seen early complication of percutaneous treatment is fever without signs of infection and minor hypersensitivity reactions probably due to signs that develop secondary to the antigenic stimulus of the parasite, and are treated successfully with symptomatic treatment, as was the case in the present study and in other series previously reported in the literature[ 3 , 8 , 22 ].
Fistula may develop between the cavity and the biliary system, due to the percutaneous procedure or prolonged drainage. Some of the fistulae may close spontaneously, while some necessitate an endoscopic approach in the treatment[ 8 , 23 , 28 ]. In the present study, biliary fistula developed in four patients, all of whom had undergone percutaneous drainage with the Seldinger technique. When we looked into the cases reported in the literature, spontaneous rupture does not always result in anaphylaxis[ 30 ].
In thE present study, an anaphylactic reaction developed in one patient during the PAIR procedure following catheter placement with Seldinger technique, however the medical treatment was successful. In the present study, local recurrence and secondary dissemination occurred in two patients and one patient, respectively.
In conclusion, no differences were found between the Seldinger and Trocar techniques that might be used in the entry to cyst cavity, in terms of the efficacy of the treatment and the rates of early and late complications. Although percutaneous cyst drainage, conducted with a trocar type catheter, is a practical method that is easier and more economical to apply compared with the drainage procedure conducted using a Seldinger needle, guide wire and a catheter, it should be considered in post-surgical and elderly patients that the trocar type catheter placement might be more difficult to apply, due to decreased elasticity of the pleura and peritoneum in such cases.
Although various methods have been developed as interventional procedures, there is no knowledge in the literature on which technique should be used when entering the liver cyst hydatid cavity. Two step Seldinger technique or single step Trocar technique may be used for entry to the cavity.
The objective of this study was to compare two different techniques of percutaneous entry and to evaluate their efficacy. The weakness points are the small sample of patients and the retrospective design of the study but it can represent an interesting report for literature as first evaluation comparing two different techniques of percutaneous entry.
Further studies with a larger number of patients will be needed to confirm the data. No differences were found between the seldinger and Trocar techniques that might be used in the entry to cyst cavity, in terms of the efficacy of the treatment and the rates of early and late complications. Although percutaneous cyst drainage, conducted with a trocar type catheter, is a practical method that is easier and more economical to apply compared with the drainage procedure conducted using a Seldinger needle, guide wire and a catheter, it should be considered in post-surgical and elderly patients that the trocar type catheter placement might be more difficult to apply, due to decreased elasticity of the pleura and peritoneum, in such cases.
Seldinger technique is a two-step procedure, and standard wires and guide wires were used for drainage. Trocar technique is a single step procedure, and a standard trocar tip drainage catheter is composed of a sheath needle and a catheter coaxial system. PAIR technique: The Puncture Aspiration Injection Reaspiration technique is performed using either ultrasound or CT guidance, involves aspiration of the cyst contents via a special cannula, followed by injection of a scolicidal agent and then reaspiration of the cystic contents.
This study compared two percutaneous techniques on treatment of hydatid cysts. Manuscript source: Unsolicited manuscript. Specialty type: Radiology, nuclear medicine and medical imaging. Country of origin: Turkey. Peer-review report classification. Grade A Excellent : 0. Grade B Very good : B. Informed consent statement: Written informed consent was obtained for each procedure from all patients.
Conflict-of-interest statement: All authors have no conflict-of-interest related to this study. Data sharing statement: Participants gave informed consent for data sharing, and no additional data are available. Peer-review started: January 7, First decision: February 17, Article in press: June 13, National Center for Biotechnology Information , U.
Journal List World J Radiol v. World J Radiol. Published online Nov Sven Ivar Seldinger — , a Swedish radiologist who introduced the procedure in The Seldinger technique is used for angiography , insertion of chest drains and central venous catheters , insertion of PEG tubes using the push technique, insertion of the leads for an artificial pacemaker or implantable cardioverter-defibrillator , and numerous other interventional medical procedures.
The initial puncture is with a sharp instrument, and this may lead to hemorrhage or perforation of the organ in question. Infection is a possible complication, and hence asepsis is practiced during most Seldinger procedures. Loss of the guidewire into the cavity or blood vessel is a significant and generally preventable complication. The desired vessel or cavity is punctured with a sharp hollow needle, with ultrasound guidance if necessary.
A round-tipped guidewire is then advanced through the lumen of the needle, and the needle is withdrawn. A sheath or blunt cannula can now be passed over the guidewire into the cavity or vessel. Alternatively, drainage tubes are passed over the guidewire as in chest drains or nephrostomies. After passing a sheath or tube, the guidewire is withdrawn.
An introducer sheath can be used to introduce catheters or other devices to perform endoluminal inside the hollow organ procedures, such as angioplasty. Fluoroscopy may be used to confirm the position of the catheter and to manoeuvre it to the desired location. Injection of radiocontrast may be used to visualize organs. Interventional procedures, such as thermoablation , angioplasty, embolisation or biopsy , may be performed. Upon completion of the desired procedure, the sheath is withdrawn.
In certain settings, a sealing device may be used to close the hole made by the procedure. A modified technique, known as the accelerated Seldinger technique, has also been described where the needle, guidewire, dilator, and sheath are inserted as one unit. Prior to the description of the Seldinger technique, sharp trocars were used to create lumens through which devices could be passed. This had a high rate of complications.
From Wikipedia, the free encyclopedia. Medical procedure to obtain safe access to blood vessels and other hollow organs. Acta Radiologica. British Journal of Anaesthesia. The Journal of Emergency Medicine. Intravenous therapy.
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