Showing papers in "CardioVascular and Interventional Radiology in 1990"
TL;DR: The technique has proved to be an effective method of treating occlusions of the femoral and popliteal arteries with an acceptable complication rate and may allow successful angioplasty where the standard intraluminal method fails, particularly when reconstructive surgery is the only option.
Abstract: A technique for recanalization of femoral and popliteal arterial occlusions by intentional subintimal dissection is described. Recanalization with this technique was attempted in 71 occlusions of the femoro-popliteal segment with a mean length of 11.4 cm. Primary technical success was achieved in 54 (76%) cases, with complications occurring in 4 (5.6%). Of 44 successful cases reviewed at a mean follow up of 6 months, 37 (84%) were either asymptomatic or improved. The technique has proved to be an effective method of treating occlusions of the femoral and popliteal arteries with an acceptable complication rate. It may allow successful angioplasty where the standard intraluminal method fails, particularly when reconstructive surgery is the only option.
315 citations
TL;DR: It was concluded that this technique does not adversely affect normal tissues, and it does reinforece the effect of TAE.
Abstract: Transcatheter hepatic segmental arterial chemoembolization using Lipiodol mixed with an anticancer drug followed by the injection of Gelfoam particles, introduced into the tumor-bearing hepatic segment as the target area (segemental Lipiodol-TAE), was carried out in 54 patients with hepatocellular carcinoma (HCC), 7 of whom were later resected. In 5 of the resected 7 cases, complete necrosis was histologically verified. No death due to HCC was encountered in 47 nonoperated cases, and better therapeutic results were obtained with segmental Lipiodol-TAE. It was concluded that this technique does not adversely affect normal tissues, and it does reinforece the effect of TAE.
198 citations
TL;DR: The new concept of TIPSS (Transjugular Intrahepatic Portosystemic Stent-Shunt) using the Palmaz iliac stent was successfully accomplished in 9 patients with severe portal hypertension and histories of multiple life-threatening upper GI bleeding.
Abstract: The new concept of TIPSS (Transjugular Intrahepatic Portosystemic Stent-Shunt) using the Palmaz iliac stent was successfully accomplished in 9 patients with severe portal hypertension (7 alcoholic, 2 postinfectious liver cirrhosis) and histories of multiple life-threatening upper GI bleeding. All patients were considered noncandidates for surgical portal decompression. An intrahepatic central connection was made transjugularly between the right hepatic vein and the right portal vein in 8 patients and the left portal vein in 1. The portosystemic gradient dropped from an average of 29±7.2 mmHg to 17.8±2.9 mmHg immediately after, and to 15.7±2.8 mmHg at the latest follow-up control after the procedure. Seven patients survived the procedure and progressed to Child's A stage during the observation period of 1–10 months (mean 5 months). One patient died as a direct complication from the procedure, and another patient 11 days after the procedure from a severe nosocomial infection. In none of the surviving patients has bleeding from varices recurred or encephalopathic coma developed. In one patient the shunt diameter was moderately increased by a routine PTA catheter to further decrease the portosystemic gradient (23 to 14 mmHg) 3 months after the primary procedure. Autopsy in the two patients who died demonstrated open stent-shunts with early neoendothelial incorporation.
129 citations
TL;DR: A new method called PAIR (Puncture-Aspiration of cyst contents—Injection of hypertonic saline solution—Reaspiration) was used as a percutaneous treatment of hydatid cysts, and good results were obtained in 70% of patients.
Abstract: A new method called PAIR (Puncture-Aspiration of cyst contents—Injection of hypertonic saline solution—Reaspiration) was used as a percutaneous treatment of hydatid cysts. In 37 patients, 120 cysts were punctured. All patients had not been considered surgical candidates. The cysts were localized in the liver, peritoneum, spleen, kidneys, muscles, and bones. In 70% of patients, good results were obtained. Recurrence occurred in 5 of 120 cysts, all at the beginning of our experience when a low concentration of sodium chloride solution was injected. Moderate allergic reactions occurred during seven cyst aspirations. No anaphylactic shock, sudden deaths or dissemination of cyst contents were observed.
128 citations
TL;DR: Transcatheter arterial chemoembolization using gelatin sponge particles soaked in a solution of Mitomycin C and Adriamycin serves both as embolic therapy and targeted chemotherapy.
Abstract: Seven hundred thirty-nine patients with unresectable hepatocellular carcinoma have been treated by transcatheter arterial chemoembolization using gelatin sponge particles soaked in a solution of Mitomycin C and Adriamycin. This therapy can be equal, or superior to surgical resection and serves both as embolic therapy and targeted chemotherapy.
75 citations
TL;DR: Percutaneous transluminal renal angioplasty was successful in 201 of 250 patients with 250 stenoses, and results were better for postostial atherosclerotic lesions, fibromuscular lesions, and transplant kidneys than for ostials.
Abstract: Percutaneous transluminal renal angioplasty was performed in 202 patients with 250 stenoses. The procedure was successful in 201 of 250 (83%). Results were better for postostial atherosclerotic lesions (94%), fibromuscular lesions (83%), and transplant kidneys (71%) than for ostial atherosclerotic lesions (29%). Of all the patients, 61% had reduced blood pressures following the procedure, with cure (diastolic blood pressure ≤90 mm Hg) in 31% of the patients. Cure rate with a mean follow-up of 25.8±19.4 months was 21% in bilateral atheromatous lesions, 30% in unilateral atheromatosis, 65% in unilateral fibromuscular disease, and 40% in bilateral fibromuscular dysplasia. Of the transplanted patients, 60% were cured. Complications occurred in 23 (11%) of the patients. Recurrence of stenoses occurred in 16 lesions (8%). 80% within the first year after the procedure.
74 citations
TL;DR: Intraarterial infusion of chemotherapy, embolization, and chemoembolization for hepatic metastases is based on the dual blood supply of the normal liver and that of the tumors and enhances the delivery of therapeutic agents to the liver.
Abstract: Hepatic metastases rather than the primary neoplasm usually dictate the course of the disease and the patient's survival. For unresectable disease, intraarterial infusion of chemotherapy, embolization, and chemoembolization are viable alternatives. Intraarterial therapy for hepatic metastases is based on the dual blood supply of the normal liver (portal vein, 75%, and hepatic artery, 25%) and that of the tumors (hepatic artery, 90%). Intraarterial infusion delivers a higher concentration of chemotherapy, whereas chemoembolization adds ischemia and increased contact time with the tumor. Selective vascular occlusion for infusion, redistribution of the blood supply and pulsatile flow enhance the delivery of therapeutic agents to the liver.
66 citations
TL;DR: PEI seems to be the better treatment for operable HCC smaller than 3 cm, and for lesions smaller than 5 cm in patients with high surgical risk, in comparison with the survival curves of untreated and surgically treated patients.
Abstract: Percutaneous ethanol injection (PEI) under ultrasound guidance is a new therapeutic possibility for patients with small hepatocellular carcinoma (HCC). In our series, 35 patients with a total of 50 tumors were treated (tumor size 0.8–5.0 cm). No significant complications occurred after 502 sessions of ethanol injection. Thirty patients presented complete remission, as no evidence of residual HCC was revealed during the follow-up (mean 16 months). Five patients with lesions larger than 3.5 cm presented only partial remission. The survival curves at 1, 2, and 3 years (Kaplan Meier method) were 100%, 100%, and 80%, respectively. In comparison with the survival curves of untreated and surgically treated patients. PEI seems to be the better treatment for operable HCC smaller than 3 cm, and for lesions smaller than 5 cm in patients with high surgical risk.
47 citations
TL;DR: Interventional radiologic procedures were an integral part of the diagnostic and therapeutic management of patients with terminal liver disease; reoperation was, nonetheless, occasionally required.
Abstract: Hepatic transplantation is now an accepted therapeutic option for selected patients with terminal liver disease. Biliary complications are, however, relatively common after transplantation. We reviewed our experience with diagnostic and therapeutic biliary radiologic procedures in 151 hepatic recipients. Biliary complications were seen in 25% of patients. Interventional radiologic procedures were an integral part of the diagnostic and therapeutic management of these patients; reoperation was, nonetheless, occasionally required.
42 citations
TL;DR: In this article, transcatheter coil embolization was used to treat pulmonary arteriovenous malformations (PAVMs) in 11 patients with only one symptomatic complication, deep venous thrombosis.
Abstract: Pulmonary arteriovenous malformations (PAVMs) are uncommon lesions that can be treated by surgery or interventional radiology. Forty-four PAVMs in 11 patients were occluded by transcatheter coil embolization with only one symptomatic complication, deep venous thrombosis, attributable to the procedure. There was a significant improvement in symptoms and a reduction in pulmonary AV shunting in the 9 patients in whom embolization of all visible discrete lesions was successfully completed. Coil embolization is an effective alternative to other methods of treating PAVMs.
40 citations
TL;DR: Hemobilia in two liver transplantation patients who experienced severe hemobilia following percutaneous placement of a transhepatic biliary drainage catheter was successfully treated using selective embolization techniques.
Abstract: Two liver transplantation patients are reported who experienced severe hemobilia following percutaneous placement of a transhepatic biliary drainage catheter. In both, hepatic angiography demonstrated the source of bleeding from a traumatic pseudoaneourysm of a right hepatic artery branch. Hemobilia in both patients was successfully treated using selective embolization techniques. Follow-up computed tomography of the liver showed no evidence of allograft necrosis or abscess formation. One patient developed an intrahepatic biliary stricture adjacent to the embolized branch artery nine months following the procedure. Hepatic artery embolization techniques are effective in the treatment of life-threatening hemobilia posttransplantation.
TL;DR: Percutaneous transluminal angioplasty was performed in 8 patients with segmental obstruction of the hepatic inferior vena cava without any complications and long-term patency was obtained in 3 patients in whom the lumen was opened to 13 mm or more in diameter.
Abstract: Percutaneous transluminal angioplasty (PTA) was performed in 8 patients with segmental obstruction of the hepatic inferior vena cava. Using Gruntzig balloon catheters, canalization and dilatation were initially successful in all 8 patients without any complications. In long-term observation of 12–48 months, recurrence of obstruction was confirmed in 5 patients. These were recanalized easily by repeat PTA. Long-term patency was obtained in 3 patients in whom the lumen was opened to 13 mm or more in diameter as seen in lateral views of the vena cavogram.
TL;DR: The pathophysiology of this complication of bronchial artery embolization and recommendations on how it may possibly be avoided are discussed.
Abstract: Left bronchial-esophageal fistula is a rare complication of bronchial artery embolization. A case is presented with pathologic correlation. The pathophysiology of this complication is discussed as well as recommendations on how it may possibly be avoided.
TL;DR: Transjugular intrahepatic portal systemic shunts using expendable stents have been successfully created in patients and have effectively controlled portal hypertension and variceal bleeding.
Abstract: Hepatic aneurysms, pseudoaneurysms and fistulas (arterial biliary and arterial portal) causing blecding or portal hypertension, and arteriovenous malformations causing high output cardiac failure in adults can be successfully managed by embolization techniques. Results of embolization in infantile hemangioendotheliomas are less uniform and tumors with massive arteriovenous shunting are difficult to manage. Transjugular intrahepatic portal systemic shunts using expendable stents have been successfully created in patients and have effectively controlled portal hypertension and variceal bleeding.
TL;DR: Over the last 6 years, 15 percutaneous thoracic biopsies have been performed in 15 children, and the peripheral nature of most of the lesions allowed ultrasound guidance in ten and needles larger than 21 gauge in ten.
Abstract: Over the last 6 years, 15 percutaneous thoracic biopsies have been performed in 15 children. The peripheral nature of most of the lesions allowed ultrasound guidance in ten and needles larger than 21 gauge in ten. No pneumothorax developed. Of the 15, 12 biopsies were sufficient for final diagnosis; 3 required surgical biopsy for more definitive tissue typing.
TL;DR: Transcatheter embolization was performed with stainless steel coils in a patient with bilateral pulmonary arterial aneurysms of unknown etiology and endobronchial migration of one of the coils was found which required surgery.
Abstract: Transcatheter embolization was performed with stainless steel coils in a patient with bilateral pulmonary arterial aneurysms of unknown etiology. After a successful initial procedure, endobronchial migration of one of the coils was found which required surgical treatment. Indications of embolization and different types of materials are discussed.
TL;DR: Embolization of the main trunk of the superior mesenteric artery is reported for control of a ruptured aneurysm without subsequent ischemia.
Abstract: Reports of superior mesenteric artery embolization without the sequela of bowel ischemia or infarction are sparse. We report embolization of the main trunk of the superior mesenteric artery for control of a ruptured aneurysm without subsequent ischemia.
TL;DR: Of the invasive anatomic approaches, quantitative coronary arteriography is the optimum for determining stenosis flow reserve from all stenosis dimensions under standard conditions and is applicable to cine x-ray film-based systems or to on-line digital angiographic cath lab facilities for quantifying effects of therapeutic interventions.
Abstract: Quantitation of stenosis severity has become an essential part of cardiac diagnosis and therapy, not only in research but also in clinical practice. Since our introduction of the concept 15 years ago, arterial coronary flow reserve for assessing effects of coronary narrowing has evolved into two independent but complementary measurements: coronary flow reserve and stenosis flow reserve. Coronary artery flow reserve and/or myocardial perfusion reserve takes into account not only stenosis geometry but also collateral function and physiologic conditions of perfusion pressure, vasomotor tone, coronary venous pressure, and myocardial vascular bed size. Coronary artery flow reserve is measured invasively by flowmeter or by Doppler catheter. Its noninvasive equivalent is myocardial perfusion reserve, assessed by myocardial perfusion imaging with positron emission tomography before and after intravenous dipyridamole with hand grip stress. Both have been experimentally and clinically validated for identifying and/or quantifying severity of coronary artery disease. By either invasive or noninvasive methods, coronary artery or myocardial perfusion reserve may be subcategorized as either absolute flow or perfusion reserve (max flow/resting flow) and/or relative flow or perfusion reserve (max flow through stenotic artery/max flow through normal artery). Absolute flow reserve depends not only on stenosis severity but also on unrelated physiologic parameters such as aortic pressure and the vasodilatory state of the distal coronary vascular bed; in contrast, relative flow reserve is independent of these physiologic variables and reflects stenosis severity alone. Stenosis flow reserve is invasively determined by automated, quantitative coronary arteriography accounting for all stenosis dimensions and is independent of ambient physiologic conditions such as pressure, vasomotor tone, or other variables affecting the distal coronary vascular bed. It has also been validated experimentally, tested clinically, and is applicable to cine x-ray film-based systems or to on-line digital angiographic cath lab facilities for quantifying effects of therapeutic interventions. Both functional and anatomic measurements are necessary to completely define stenosis severity. Of noninvasive functional approaches for assessing stenosis severity, cardiac positron emission tomography (PET) is the optimum for assessing relative and absolute myocardial perfusion reserve. Of the invasive anatomic approaches, quantitative coronary arteriography is the optimum for determining stenosis flow reserve from all stenosis dimensions under standard conditions.
TL;DR: Percutaneous transhepatic removal of common bile duct stones was performed 57 times in 53 patients with a success rate of 93%, results which compare favorably with those of surgery.
Abstract: Percutaneous transhepatic removal of common bile duct stones was performed 57 times in 53 patients with a success rate of 93%. All patients had contraindications to surgery or had undergone unsuccessful attempts at endoscopic retrograde cholangiopancreatography and papillotomy. A modified Dormia basket was inserted through a percutaneous transhepatic approach and the stones or fragments were advanced into the duodenum. Monooctanoin (26 patients) or methyl tertiary butyl ether (4 patients) was infused to reduce stone size or remove residual debris. The average time for complete stone removal was 8.5 days. Morbidity was 12% and mortality was 4%, results which compare favorably with those of surgery.
TL;DR: Percutaneous management of benign biliary strictures may well become the initial treatment in many patients in view of midterm results, and moderate fever for 1–2 days was a common finding after percutaneous puncture and balloon dilation.
Abstract: Seventy patients with benign biliary strictures were treated by means of percutaneous balloon dilation and stenting. Patients with stenoses relapsing during catheter stenting (18/70) were treated with self-expanding metallic stents. Results were evaluated in 56 patients; in patients without sclerosing cholangitis (n=47) the patency rate with both modalities of treatment was 96%, while in the patients with secondary sclerosing cholangitis (n=9), it was 33%, for a total success rate of 86%. The average follow-up was 23 months (range 3–72 months). Major complications included one death for septic shock (1%), three severe hemorrhages (4%), two of which required arterial embolization, two pleural effusions (3%), and one liver abscess following arterial embolization. Moderate fever for 1–2 days was a common finding after percutaneous puncture and balloon dilation. Percutaneous management of benign biliary strictures so far has been attempted only in surgical failures or in complicated cases. In view of our midterm results it may well become the initial treatment in many patients.
TL;DR: Gelfoam embolization of a jejunal artery branch aneurysm was performed using an openended guidewire to exclude collateral filling.
Abstract: Gelfoam embolization of a jejunal artery branch aneurysm was performed using an openended guidewire. The outflow vessel was embolized first, followed by occlusion of the feeding artery, to exclude collateral filling.
TL;DR: Emergency embolization using Gelfoam particles alone, or in combination with stainless steel coils or epinephrine, was attempted in 4 patients with severe blunt hepatic trauma complicated by hypovolemic shock to control exsanguinating hemorrhage to become the treatment of choice for more unstable and complicated patients.
Abstract: Emergency embolization using Gelfoam particles alone, or in combination with stainless steel coils or epinephrine, was attempted in 4 patients with severe blunt hepatic trauma complicated by hypovolemic shock to control exsanguinating hemorrhage. Angiography prior to embolization revealed extravasation in all cases. None of the patients rebled or required further intervention. Postembolization course was uneventful in each case. Embolization could become the treatment of choice for more unstable and complicated patients than previously considered.
TL;DR: Comparing the use of ethanol and ethanol-Ethiodol for transcatheter renal arterial embolization and adding Ethiodol to ethanol should decrease the latter's complications since administration can be monitored fluoroscopically and a smaller volume of ethanol could perhaps be used to achieve the desired result.
Abstract: Adult mongrel dogs were used to evaluate and compare the use of ethanol and ethanol-Ethiodol for transcatheter renal arterial embolization. Each agent was administered into a main renal artery in five dogs and evaluated with regard to ease of use, radiopacity, arterial occlusion, parenchymal damage, and toxicity. Both agents were easy to inject, and no complications were encountered in any of the animals. Ethiodol added the ability to fluoroscopically monitor the infusate for reflux and distribution, yielded a more homogeneous distribution of the ethanol within the renal vasculature, and increased the embolic effects of the ethanol. Adding Ethiodol to ethanol should decrease the latter's complications since administration can be monitored fluoroscopically and a smaller volume of ethanol could perhaps be used to achieve the desired result. Additional research is needed to determine the safety of administering larger volumes of Ethiodol into the renal artery.
TL;DR: The indications for the procedure are examined, some aspects of technique are discussed, and the potential benefits and complications of the method are assessed.
Abstract: Hepatic arterial embolization has been shown to be a safe and effective method for the palliation of symptoms in patients with metastatic disease, particularly those with secondary deposits from endocrine tumors. This review examines the indications for the procedure, discusses some aspects of technique, and assesses the potential benefits and complications of the method.
TL;DR: Transluminal angioplasty resulted in improvement of the right kidney function, and normalization of the blood pressure for one year, and the patient required only minimum medical therapy for blood pressure control.
Abstract: Severe hypertension and stenosis of the right renal artery developed in a 21 year old male, 14 years after completion of inverted Y radiation (4000 rads) for abdominal Hodgkin's disease. Transluminal angioplasty resulted in improvement of the right kidney function, and normalization of the blood pressure for one year. Subsequently, the patient required only minimum medical therapy for blood pressure control. Transluminal angioplasty may be effective immediately in the treatment of radiation induced renal artery stenosis, although long term success remains uncertain.
TL;DR: It is concluded that effort thrombosis leads to recurrent occlusion of the axillary-subclavian vein, short-term (12-month) recurrence of symptoms with exercise, and progressive compensatory collateral vein development.
Abstract: Effort thrombosis, a form of axillary-subclavian vein occlusion in young people, was identified in patients referred over a 5-year period. Eleven of 120 patients (9%) with venous occlusion from many causes had effort thrombosis. They were treated acutely with heparin and then by thrombolysis, angioplasty, surgical bypass, or a combination. Five of the 10 patients with thrombolysis or surgery had patent veins on follow-up venography, but 9 of these later developed axillary-subclavian reocclusion. By later follow-up, however, all patients were asymptomatic at the time of collateral vein formation. We conclude that effort thrombosis leads to recurrent occlusion of the axillary-subclavian vein, short-term (12-month) recurrence of symptoms with exercise, and progressive compensatory collateral vein development. Radiographic documentation of reestablished venous flow is important, and can be used to guide the completion of treatment.
TL;DR: It appears that the femoral crease was used as a landmark to establish the cutaneous entry point for vascular puncture and resulted in an excessively distal puncture site.
Abstract: Twelve iatrogenic femoral arteriovenous fistulas are reported, 11 of which arose from the superficial or deep femoral arteries. All but two occurred in association with cardiac angiographic procedures. It appears that the femoral crease was used as a landmark to establish the cutaneous entry point for vascular puncture and resulted in an excessively distal puncture site. The femoral crease is an unreliable landmark in many patients. This complication may be minimized by using physical examination to identify the level of the inguinal ligament or fluoroscopy to localize the distal half of the femoral head.
TL;DR: The radiologic findings on plain chest films and contrast-enhanced computed tomography of the thorax in a case of isolated persistence of the left superior vena cava associated with absence of the right azygos vein are described.
Abstract: The radiologic findings on plain chest films and contrast-enhanced computed tomography (CCT) of the thorax in a case of isolated persistence of the left superior vena cava associated with absence of the right azygos vein are described. Chest x-rays allowed a presumptive diagnosis of the vascular anomaly. Confirmation of this anomaly was achieved by CT.
TL;DR: The study concludes that bonding of the antibiotic cefoxitin to percutanoeus nephrostomy catheters did not influence the incidence of bacteriuria or urinary tract infection.
Abstract: A prospective controlled trial of the effectiveness of a cefoxitin-bonded nephrostomy catheter was undertaken to determine the effectiveness of an antibiotic bonded catheter in decreasing the infectious complications of percutaneous nephrostomy. The study concludes that bonding of the antibiotic cefoxitin to percutanoeus nephrostomy catheters did not influence the incidence of bacteriuria or urinary tract infection. In addition, observations on the overall incidence of complications from percutaneous nephrostomy are made.
TL;DR: Balloon debanding relieved the gradient almost completely in the two patients and in the future this may prove to be an efficient and reliable way to remove the effect of a pulmonary artery banding.
Abstract: Clinical balloon debanding of the pulmonary artery is reported in two patients, 6 months and 4 years of age. The band was made of Dacron, and was closed with one single polypropylene suture. This suture was subsequently ruptured with a balloon inflated within the pulmonary artery at the site of the band. Balloon debanding relieved the gradient almost completely in the two patients. No problems occurred during the procedure. In the future this may prove to be an efficient and reliable way to remove the effect of a pulmonary artery banding.