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Abstract No. 215 Percutaneous cholecystolithotomy: a single-institution experience with SpyGlass DS cholangioscopy. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract No. 441 Eventual outcomes of patients undergoing peritoneal dialysis catheter by interventional radiologist: a large single-institution 2-year observational study. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract No. 617 Technical predictors of initial transjugular intrahepatic portosystemic shunt dysfunction. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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3:09 PM Abstract No. 283 Propensity-matched comparison of transjugular intrahepatic portosytemic shunt placement techniques: intravascular ultrasound versus fluoroscopic guidance. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Effect of anticoagulation after inferior vena cava filter placement in gynecologic oncology patients on survival. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet 2009; 48:73-87. [PMID: 19553198 DOI: 10.1136/jmg.2009.069013] [Citation(s) in RCA: 652] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND HHT is an autosomal dominant disease with an estimated prevalence of at least 1/5000 which can frequently be complicated by the presence of clinically significant arteriovenous malformations in the brain, lung, gastrointestinal tract and liver. HHT is under-diagnosed and families may be unaware of the available screening and treatment, leading to unnecessary stroke and life-threatening hemorrhage in children and adults. OBJECTIVE The goal of this international HHT guidelines process was to develop evidence-informed consensus guidelines regarding the diagnosis of HHT and the prevention of HHT-related complications and treatment of symptomatic disease. METHODS The overall guidelines process was developed using the AGREE framework, using a systematic search strategy and literature retrieval with incorporation of expert evidence in a structured consensus process where published literature was lacking. The Guidelines Working Group included experts (clinical and genetic) from eleven countries, in all aspects of HHT, guidelines methodologists, health care workers, health care administrators, HHT clinic staff, medical trainees, patient advocacy representatives and patients with HHT. The Working Group determined clinically relevant questions during the pre-conference process. The literature search was conducted using the OVID MEDLINE database, from 1966 to October 2006. The Working Group subsequently convened at the Guidelines Conference to partake in a structured consensus process using the evidence tables generated from the systematic searches. RESULTS The outcome of the conference was the generation of 33 recommendations for the diagnosis and management of HHT, with at least 80% agreement amongst the expert panel for 30 of the 33 recommendations.
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Use of aortic cuffs to exclude iliac artery aneurysms during AneuRx stent-graft placement: initial experience. J Vasc Interv Radiol 2001; 12:1383-7. [PMID: 11742010 DOI: 10.1016/s1051-0443(07)61693-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE As many as 39% of patients who undergo aortic endografting for abdominal aortic aneurysm disease will have ectasia of the iliac arteries that will require intervention. Coil embolization of the internal iliac artery and extension of the graft to the external iliac artery is one solution to this problem. However, 19%-41% of these patients experience buttock claudication, which may be permanent, after unilateral embolization. The authors examined an alternative: the use of larger-sized aortic cuffs to seal the iliac limb. Outcomes and short-term results are presented in this article. MATERIALS AND METHODS From October 1999 to August 2000, 144 AneuRx stent-grafts were placed at the authors' institution. Among the population receiving stent-grafts, 14 patients had 15 aortic cuffs placed across the distal iliac graft limbs to seal them and preserve flow to the internal iliac artery. One patient had bilateral cuffs placed. Five patients had embolization of the contralateral internal iliac artery because of bilateral disease. Patients were followed with computed tomography (CT) at 1, 6, and 12 months to evaluate for endoleaks. RESULTS One- and 6-month endoleak rates, determined from only those patients with follow-up CT, were 0% and 10%, respectively. One type II endoleak was first discovered 9 months after graft placement. It sealed spontaneously at 15-month follow-up. One patient among the five who had internal iliac artery embolization had claudication. Mean CT follow-up was 7.8 months (range, 1-15). One patient declined CT but was alive and well 11 months after endografting. One patient moved across the country and declined follow-up. CONCLUSION Placement of aortic cuffs in dilated iliac arteries can preserve flow to the ipsilateral internal iliac artery and provide an adequate seal. Additionally, the option of later treatment is maintained. Patients with bilateral iliac ectasia can undergo stent-graft placement without bilateral internal iliac artery embolization. Longer-term follow-up in larger numbers of patients will be important to determine the ultimate durability of this technique.
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Endovascular abdominal aortic aneurysm repair in 144 patients: correlation of aneurysm size, proximal aortic neck length, and procedure-related complications. J Vasc Interv Radiol 2001; 12:1373-82. [PMID: 11742009 DOI: 10.1016/s1051-0443(07)61692-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE During endovascular abdominal aortic aneurysm (AAA) repair, larger aneurysms often present formidable anatomic challenges to the insertion of the delivery catheter and graft deployment. The authors sought to evaluate whether large-diameter aneurysms and those with short proximal aortic necks might be associated with a higher frequency of insertion-related and short-term complications. MATERIALS AND METHODS From October 1999 to August 2000, 144 patients underwent elective endovascular graft placement for infrarenal AAA disease at the authors' institution. These patients were treated with use of the AneuRx bifurcated endoprosthesis. AAA size (maximum aneurysm diameter) and proximal aortic neck length were compared to estimated blood loss, operative time, accuracy of graft placement, presence of endoleak, intraoperative and postoperative complications (such as limb occlusion or vascular injury), length of hospital stay, and mortality. Statistical methods included correlation analysis and logistic regression. RESULTS There were 121 men and 23 women whose aneurysms ranged in size from 3 cm to 9.8 cm (mean, 5.6 cm; 95% CI, 5.4-5.8 cm). Endograft insertion was successful in all cases. There were three deaths within 30 days (2.1%) and seven deaths overall (4.9%). There were 43 intraoperative complications (29.9%) in 31 patients (21.5%), most of them minor. Patients with major intraoperative complications had significantly longer procedure times than those without complications (337 vs. 149 min; P <.0001). In the postoperative period (within 30 days), 31 complications (21.5%) occurred in 28 patients (19.4%), again most of them minor. AAA size was unrelated in any way to the rate of complications, but short proximal aortic neck length was associated with more serious intraoperative and postoperative complications (P =.0404 and P =.0230, respectively), and decreased 30-day and overall survival (P =.0240 and P =.0152, respectively). CONCLUSIONS Endovascular repair of large AAAs can be challenging; however, the size of the AAA does not influence the rate of complications. A short proximal aortic neck is the only significant risk factor for more serious complications.
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Endoluminal graft repair for abdominal aortic aneurysms in high-risk patients and octogenarians: is it better than open repair? Ann Surg 2001; 234:427-35; discussion 435-7. [PMID: 11573036 PMCID: PMC1422066 DOI: 10.1097/00000658-200110000-00002] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the short-term and midterm results of open and endoluminal repair of abdominal aortic aneurysms (AAA) in a large single-center series and specifically in octogenarians. METHODS Between January 1997 and October 2000, 470 consecutive patients underwent elective repair of AAA. Conventional open repair (COR) was performed in 210 patients and endoluminal graft (ELG) repair in 260 patients. Ninety of the patients were 80 years of age or older; of these, 38 underwent COR and 52 ELG repair. RESULTS Patient characteristics and risk factors were similar for both the entire series and the subgroup of patients 80 years or older. The overall complication rate was reduced by 70% or more in the ELG versus the COR groups. The postoperative death rate was similar for the COR and ELG groups in the entire series and lower (but not significantly) in the ELG 80 years or older subgroup versus the COR group. The 36-month rates of freedom from endoleaks, surgical conversion, and secondary intervention were 81%, 98.2%, and 88%, respectively. CONCLUSION The short-term and midterm results of AAA repair by COR or ELG are similar. The death rate associated with this new technique is low and comparable, whereas the complication rate associated with COR in all patients and those 80 years or older in particular is greater and more serious than ELG repair. Long-term results will establish the role of ELG repair of AAA, especially in elderly and high-risk patients.
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Tc-99m sulfur colloid scintigraphy for detecting perigraft flow following endovascular aortic aneurysm repair: A feasibility study. Cardiovasc Intervent Radiol 1999; 22:447-51. [PMID: 10556401 DOI: 10.1007/s002709900430] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine if scintigraphy with Tc-99m sulfur colloid can be used to detect perigraft flow after stent-graft repair of abdominal aortic aneurysm (AAA). METHODS Twenty-three men and two women aged 56-84 years (mean 71 years) underwent endoluminal AAA repair as part of the EVT Phase II trial [EVT = Endovascular Technologies (Menlo Park, CA, USA)]. Aneurysm size averaged 5.4 cm (range 3-8 cm). Sixteen bifurcated, seven tube, and two aorto-uniiliac grafts were placed. Two days after stent-graft placement, patients underwent both contrast-enhanced computed tomography (CT), including delayed views, and Tc-99m sulfur colloid scintigraphy. RESULTS Perigraft flow was found in only one patient at completion of angiography. Four additional patients had perigraft flow, discovered during their postoperative follow-up CT. Four patients had leaks at an attachment site and one had retrograde branch flow. Tc-99m sulfur colloid scintigraphy failed to diagnose any of the five leaks prospectively. In two of these patients, however, some abnormal paraaortic activity was noted in retrospect. CONCLUSION Tc-99m sulfur colloid scintigraphy was unable to demonstrate endoleak with either rapid flow (attachment site leak) or slow filling (branch flow).
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The use of helical CT angiography for examination of living renal donors. AJR Am J Roentgenol 1998; 170:1668. [PMID: 9609197 DOI: 10.2214/ajr.170.6.9609197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
PURPOSE To determine the safety and diagnostic accuracy of a provocative protocol with heparin and urokinase to induce bleeding and determine the source in patients with chronic gastrointestinal hemorrhage. MATERIALS AND METHODS Nine patients had gastrointestinal bleeding from an indeterminate source and had negative results from esophagogastroduodenoscopy, colonoscopy, small-bowel examination, and angiography. Ten provocative bleeding studies were performed prospectively. Patients had no clinical evidence of bleeding within 2 days before the study. Intravenous administration of heparin and urokinase was performed systemically during a 4-hour period while scintigraphy was performed continuously. Mesenteric angiography was performed immediately in patients in whom substantial gastrointestinal bleeding was detected at scintigraphy. RESULTS The provocative protocol was successful in inducing scintigraphically detectable hemorrhage in four (40%) studies within 4 hours. In two of these four studies, the source of hemorrhage was determined and treated with embolization or surgery. Three (30%) studies demonstrated scintigraphic evidence of hemorrhage only at delayed imaging (8-24 hours after initiation of the study). The remaining three (30%) studies did not show active bleeding. No complications occurred, including hemodynamic instability or uncontrollable decreases in hematocrit. CONCLUSION Since this protocol with heparin and urokinase enabled determination of the bleeding source in only two of 10 studies, protocol modifications are necessary before this intervention is used widely.
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Abstract
BACKGROUND Controversy exists concerning the use of preoperative imaging studies in patients with islet cell tumors. Since 1993 we have evaluated the use of provocative angiography in patients with insulinoma or Zollinger-Ellison syndrome (ZES). METHODS Twelve patients with a working diagnosis of insulinoma (n = 4) or ZES (n = 8) were studied. Of the eight patients with ZES, four were known to have multiple endocrine neoplasia type 1. All patients underwent conventional imaging studies followed by provocative angiography. Angiograms were graded based on the ability to detect tumor and regionalize it within the pancreas. RESULTS Of the three patients with a working diagnosis of ZES but equivocal results of biochemical studies, none had arteriographic imaging of an islet cell tumor or a positive provocative study result (true negative result). Of the nine patients with documented islet cell tumor, seven (78%) underwent arteriographic imaging of the tumor and eight (89%) had correct regional localization by provocative angiography. Sensitivity and specificity for imaging were 78% and 100%, respectively, and for regional localization 89% and 100%, respectively. CONCLUSIONS Provocative angiography is the localization study of choice for both gastrinoma and insulinoma. Having few false-negative results, it can be used to corroborate the diagnosis and, having few false-positive results, it detects tumor and biochemically confirms localization in nearly every patient.
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Interventional radiologic placement of chest wall ports: results and complications in 161 consecutive placements. J Vasc Interv Radiol 1997; 8:189-95. [PMID: 9083981 DOI: 10.1016/s1051-0443(97)70537-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To review the technical results and long-term follow-up of the first 157 consecutive patients undergoing placement of 161 chest wall ports at the authors' institution. PATIENTS AND METHODS All ports were placed in the interventional radiology suite with use of fluoroscopic and/or ultrasound guidance with a combination of standard interventional radiology and surgical techniques. The hospital records of all patients were reviewed, and telephone contact made when possible. Patients ranged in age from 21 to 87 years (average, 57 years). The most common indication for port placement was chemotherapy (88%). RESULTS Placement was technically successful in all 161 procedures. Minor procedural complications occurred in eight patients (5%). There were no major complications related to the procedure. Cumulative follow-up to date includes 35,992 port-days (average, 226 days per patient). The long-term complication rate was 8.7% or .39 per 1,000 access days, which includes nine infections and five migration-related complications. CONCLUSION Interventional radiologic placement of chest wall ports is safe and has a high technical success rate, in large part due to the integration of interventional radiology techniques to the procedure. The short and long-term complication rates are equal to or less than those of current surgical series.
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Long-term outcome of flexible ureterorenoscopy in the diagnosis and treatment of lateralizing essential hematuria. J Urol 1997; 157:776-9. [PMID: 9072565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We identified the long-term outcome of ureterorenoscopic diagnosis and treatment of patients with lateralizing essential hematuria. MATERIALS AND METHODS We reviewed retrospectively 17 patients with lateralizing essential hematuria treated with flexible ureterorenoscopy (15) or flexible percutaneous nephroscopy (2) with or without biopsy and electrocoagulation. Followup was longer than 24 months (average 60, range 24 to 116) in all patients. RESULTS At followup 9 of the 17 patients (59%) were cured and 7 (41%) had recurrent bleeding. Discrete lesions occurred in 11 patients (64%), who were treated with electrocoagulation with 9 (82%) cured. All 3 patients (18%) with diffuse lesions had recurrent bleeding as did 2 of 3 (66%, 18% overall) with negative examinations. CONCLUSIONS Ureterorenoscopy is an effective means of diagnosis and treatment of lateralizing essential hematuria. The majority of patients with lateralizing hematuria will have a discrete lesion that will respond to ureterorenoscopic electrocoagulation in the long-term. However, if the lesions are diffuse or the diagnostic examination is unreliable recurrent bleeding is likely.
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Nonsurgical management of gastric or duodenal perforation from a Wills-Oglesby-type gastrostomy tube. J Vasc Interv Radiol 1996; 7:737-41. [PMID: 8897344 DOI: 10.1016/s1051-0443(96)70842-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To describe the clinical and radiologic appearance of gastrointestinal perforation related to a Wills-Oglesby-type gastrostomy tube, as well as techniques for nonsurgical management. MATERIALS AND METHODS Five patients with a previously placed 14-F modified Wills-Oglesby-type gastrostomy catheter experienced viscus perforation by the distal limb of the catheter during a 30-month period. RESULTS The average interval between tube placement and perforation event was 4.3 months. Three patients had migration of the gastrostomy tube into the duodenum and subsequent duodenal perforation. One patient had posterior perforation of the stomach, and one patient developed a gastrocolic fistula. Generalized peritonitis was not present in any patient. All patients were treated successfully without surgery, and tube feedings were re-established in 4-14 days. CONCLUSIONS Gastrostomy tube-related perforation is an uncommon, delayed complication of percutaneous gastrostomy with the modified Wills-Oglesby-type catheter. Nonsurgical management is feasible in select instances. Because of these gastrointestinal perforations, the gastrostomy tube has been modified (eliminating the distal tip), and no gastrostomy-associated gastrointestinal perforation has been experienced since.
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Abstract
PURPOSE To determine whether prothrombin time (PT), partial thromboplastin time (PTT), and platelet count are useful predictors of postangiographic hematoma. MATERIALS AND METHODS The authors prospectively studied 1,000 consecutive patients who underwent femoral arterial puncture for a diagnostic or therapeutic vascular procedure. Demographic and procedural variables were recorded, including patient age and sex, history of medications and bleeding, procedure type and length, catheter size, and experience level of radiologist applying compression for hemostasis. RESULTS Abnormal results of coagulation tests were not correlated with an increased occurrence of hemorrhagic complications, but bleeding complications did occur more often in patients with thrombocytopenia. Hematomas occurred in 8.1% (10 of 123) of patients with any abnormal coagulation test results and 9.7% (85 of 877) of patients with normal test results. A platelet count of less than 100 X 10(9)/L was correlated with a higher occurrence of hematoma (P = .002). CONCLUSION Abnormal PT and PTTs do not correlate with an increased risk of postangiographic hematoma, but a low platelet count is associated with more bleeding complications.
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Abstract
PURPOSE This study was designed to determine the yield of anaerobic cultures from percutaneous radiologic drainage procedures. PATIENTS AND METHODS Anaerobic culture results in 317 patients from June 1992 to May 1994 were retrospectively examined. Anaerobic specimens were placed in specially designed anaerobic culture tubes and not blood culture media. Patients had undergone the following procedures: percutaneous nephrostomy (105 patients), biliary drainage (65 patients), and abdominal abscess drainage (147 patients). Aerobic culture results were tabulated in those patients with positive anaerobic cultures. RESULTS Overall, 10% of patients (n = 32) had positive anaerobic cultures (Bacteroides species, n = 25; Clostridium, n = 6; other organisms, n = 4). Anaerobes were isolated in 13% (n = 19) of abdominal abscess drainages, 8% (n = 8) of nephrostomy drainages, and 8% (n = 5) of biliary drainages. Aerobic isolates were present in 78% (n = 25) of patients with anaerobic infection. CONCLUSION The yield for anaerobic cultures varies for different types of percutaneous drainage procedures from 8% to 13%. When isolated, anaerobic bacteria are frequently mixed with aerobic bacteria. Anaerobic culture usage is recommended with abdominal abscess and biliary drainages. Anaerobic bacterial cultures are not recommended for percutaneous nephrostomy unless the patient has a urinary tract malignancy or has undergone urinary instrumentation.
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Prospective anatomic study of the inferior vena cava and renal veins: comparison of selective renal venography with cavography and relevance in filter placement. J Vasc Interv Radiol 1995; 6:721-9. [PMID: 8541675 DOI: 10.1016/s1051-0443(95)71174-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To compare the sensitivity of selective renal venography with that of cavography in the detection of variant anatomic structures of the renal vein that may affect the placement of inferior vena caval (IVC) filters and to define IVC dimensions. PATIENTS AND METHODS Flush cavography, selective bilateral renal venography, and bilateral iliac venography were performed in 108 patients referred for IVC filter placement or vena cavography. Infrarenal IVC length and width were determined with a sizing catheter during cavography. Anomalies were considered significant if they altered placement or selection of the vena cava filter or if they represented a potential collateral pathway for clot to bypass a filter. RESULTS Variant anatomic structures in the renal vein were found in 11% of patients with cavography and in 37% of patients with selective renal vein injection. Detected anomalies included circumaortic veins (n = 11), multiple veins (n = 25), retroaortic veins (n = 2), and a partially duplicated IVC (n = 1). Selective venography depicted anomalies not suspected at standard cavography in 28 cases (26%); in 20 cases (18% of population) they were significant. The average infrarenal width was 20 mm on the anteroposterior view and was 17 mm on the lateral projection. CONCLUSION IVC anomalies are common, and selective renal venography can depict significant anomalies in renal vein anatomic structures not shown at standard cavography.
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Percutaneous ablation of a pancreatic remnant with intraductal injection of neoprene. J Vasc Interv Radiol 1995; 6:762-4. [PMID: 8541681 DOI: 10.1016/s1051-0443(95)71182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Abstract
PURPOSE To evaluate the accuracy of intraarterial digital subtraction angiography (DSA) in the demonstration of patent infrapopliteal vessels. PATIENTS AND METHODS One-hundred sixty-five arteriograms were obtained in 153 consecutive patients prospectively enrolled to evaluate lower extremity ischemia. In 86 cases a follow-up angiogram of the infrapopliteal vessels was obtained during surgery or after endovascular intervention (n = 57). Twenty-nine arteriograms were followed by surgical exploration of the infrapopliteal vessels. Standard angiographic technique was performed with intraarterial DSA of the most symptomatic foot. Visualization of distal vessels was compared with intraoperative or postintervention imaging or with the results of surgical exploration. RESULTS Of the 57 procedures after which either intraoperative or post-endovascular intervention angiography was performed, DSA results were equivalent in 47 (82%) and worse in five (9%). When individual vessels were evaluated, the sensitivity of DSA in the identification of patent named vessels was 95%, and the specificity was 92%. Among 29 cases with a surgical standard of reference, 28 patients underwent bypass to a vessel correctly identified as patent at DSA; one patient was incorrectly identified as having no patent named vessels. CONCLUSION Intraarterial DSA is accurate and reliable in the assessment of patency in infrapopliteal vessels before surgery or endovascular intervention in patients with infrainguinal atherosclerotic disease.
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High-output congestive heart failure following transjugular intrahepatic portal-systemic shunting. Chest 1995; 107:1467-9. [PMID: 7750353 DOI: 10.1378/chest.107.5.1467] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A hyperdynamic circulatory state with elevated cardiac output, decreased peripheral vascular resistance, and sodium retention occurs in patients with portal cirrhosis. Surgical portal-systemic shunts and transjugular intrahepatic portal-systemic shunts (TIPS) have been shown to worsen the high-output state in these patients. However, clinical evidence of high-output congestive heart failure has been reported only rarely to complicate cirrhosis. We describe a patient who developed high-output congestive heart failure with markedly elevated filling pressures after TIPS and had complete resolution of heart failure after liver transplantation.
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Abstract
The development of small-diameter flexible endoscopes has expanded the role of biliary endoscopy to include percutaneous interventions. Percutaneous biliary endoscopy is a technique that is easily learned. The equipment for percutaneous biliary endoscopy is readily available since most hospitals have an appropriate-sized choledochoscope and light source for intraoperative use. Therefore, the initial capital costs associated with flexible biliary endoscopy are minimal. Percutaneous biliary endoscopy in the interventional radiology suite is an ideal arrangement to facilitate a wide variety of biliary diagnostic and interventional procedures.
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Abstract
PURPOSE To determine the distribution of stenoses and results of angioplasty in patients with similar forearm dialysis grafts made of polytetrafluoroethylene (PTFE). MATERIALS AND METHODS Diagnostic radiographs of the fistula obtained in 215 patients were reviewed; 90 patients had similar, unrevised forearm PTFE loop dialysis grafts. The location, morphology, and results of angioplasty were reviewed for each measurable stenosis. Surgical, radiologic, and dialysis records were reviewed to document the subsequent patency rate of each patient's dialysis access. RESULTS On the initial diagnostic fistulogram, 93 stenoses were identified. The anatomic distribution included 47% at the venous anastomosis and 11% within 1 cm of the anastomosis. Life table analysis revealed a 6-month patency rate of 63% and a 1-year patency rate of 41% for the first angioplasty in a given graft, and a 6-month patency rate of 44% and a 1-year patency rate of 22% [corrected] for the second angioplasty. CONCLUSION Performance of serial venous angioplasty procedures may help prolong the life of a graft, but the patency rates diminish with subsequent interventions.
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Ovarian artery pseudoaneurysm: diagnosis by Doppler sonography and treatment with transcatheter embolization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 1995; 14:250-252. [PMID: 7760472 DOI: 10.7863/jum.1995.14.3.250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Gastrostomy button placement through percutaneous gastrostomy tracts created with fluoroscopic guidance: experience in 27 children. J Vasc Interv Radiol 1995; 6:179-83. [PMID: 7787350 DOI: 10.1016/s1051-0443(95)71089-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The authors report their experience with skin level (button) gastrostomy placement through radiologically created gastrostomy tracts. PATIENTS AND METHODS Fifty-two gastrostomy buttons have been placed in 27 children (average age, 73 months; range, 9-235 months). All buttons were placed through tracts created during earlier fluoroscopically guided percutaneous gastrostomy. Fifteen Bard mushroom-type buttons and 12 MIC-Key balloon-type buttons were initially placed. Patients have been followed up for an average of 13.4 months. RESULTS Button placement was successful at the initial attempt in 25 of 27 patients (93%). Tract age at button placement averaged 18.5 weeks. The average tract length measured 3.5 cm (1.7-6.0 cm). Tract rupture and peritoneal leakage occurred in three patients; one patient had the button immediately repositioned without sequela, and the remaining two patients underwent replacement of the gastrostomy tube into the stomach and successful button placement approximately 1 week later. There were no major complications. Minor problems (leak, granulation tissue, valve malfunction, balloon breakage) occurred in 19 patients. CONCLUSION Button gastrostomy is a useful alternative to the traditional gastrostomy tube for the pediatric population. Conversion with use of existing radiologically created tracts is possible and safe. Attention to tract integrity and proper button position is required to avoid complications.
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Subcutaneous urinary diversion utilizing a nephrovesical stent: a superior alternative to long-term external drainage? Urology 1995; 45:538-41. [PMID: 7879349 DOI: 10.1016/s0090-4295(99)80033-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The use of external percutaneous nephrostomy drainage in patients with end-stage ureteral obstruction in whom ureteral stenting has failed presents significant compromises in the patient's quality of life. Toward this end, we present the initial experience in the United States with an intracorporeal nephrovesical stent. METHODS We performed successful subcutaneous urinary diversion in 2 patients with malignant, metastatic periureteral obstruction. Both patients had previously been managed with a chronic percutaneous nephrostomy that was both painful and inconvenient. The nephrovesical stent was inserted utilizing percutaneous access to both the kidney and bladder followed by creation of a subcutaneous tunnel between the two sites. RESULTS The nephrovesical stents are patent at 6 and 9 weeks postoperatively and both patients have had their nephrostomy tubes removed. Both patients have noted a marked improvement in their overall comfort and quality of life since the stent has been in place. CONCLUSIONS Subcutaneous urinary diversion with a nephrovesical stent provides effective urinary drainage and may improve the quality of life of patients with malignant metastatic ureteral obstruction. Further long-term studies are needed.
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Abstract
OBJECTIVE To measure the reliability and preliminary validity of a grading instrument for editors to evaluate the quality of peer reviews. DESIGN The consecutive sample design included 53 reviews of 23 manuscripts. Reviews were systematically assigned to interrater reliability (n = 41; power greater than 0.90 to detect a difference of greater than one point) and preliminary criterion-related validity (n = 12) subsamples. Content validity was closely examined. SETTING Nonclinical. PARTICIPANTS Three graders evaluated reliability. One individual examined content validity and two editors tested preliminary criterion-related validity. INTERVENTION (INSTRUMENT)--Attributes reflecting two basic dimensions, review content and format, were identified and scored (values are possible points/percent contribution): timeliness, 3/21%; grade sheet, 1/7%; etiquette, 1/7%; sectional narratives, 3/21%; citations, 2/14%; narrative summary, 2/14%; and insights, 2/14%. A scoring guide was provided. MAIN OUTCOME MEASURES Statistical analyses used to test the interrater reliability of the total score included the intraclass correlation coefficient and analysis of variance with the expectation to uphold the null hypothesis. Kendall's coefficient of concordance was used to test preliminary criterion-related validity. RESULTS The intraclass correlation coefficient was .84 (P < .001) and a lack of difference between mean scores was demonstrated by analysis of variance (P = .46). Content validity was confirmed and preliminary criterion-related validity was indicated (Kendall's coefficient of concordance = .94, P = .038). CONCLUSIONS The instrument is reliable. Content validation has been completed, and further criterion-related validation is warranted.
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Abstract
PURPOSE To assess the adequacy of prophylaxis for interventional radiologic biliary procedures and the etiologic organisms of subsequent bloodstream infections. MATERIALS AND METHODS Data from 148 patients who underwent 480 interventional radiologic biliary procedures were evaluated for evidence of bloodstream infection. Data analyzed included type of procedure performed, whether an antibiotic was used, and evidence of infectious complications occurring during and within 72 hours after the procedure. All culture data obtained before and after the procedure were recorded. RESULTS Seven cases of new bloodstream infection were identified, five of which were caused by Enterococcus species. No substantial risk factors for bloodstream infection were identified, although it occurred only in patients who had recently undergone biliary surgery or underwent manipulations other than simple cholangiography. Microbial colonization of the bile was associated with older age. Evidence of possible or proved infection after the first interventional procedure was more common in patients with positive bile cultures. CONCLUSION Although the importance of enterococcal bacteremia is uncertain, current recommendations for cephalosporin prophylaxis for interventional radiologic biliary procedures should be reevaluated.
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Abstract
OBJECTIVE Fistulas between the iliac artery and the ureter are extremely uncommon, life-threatening conditions usually seen in patients who have had pelvic irradiation or have indwelling ureteral stents. We describe our experience in the angiographic evaluation and therapy of these fistulas. MATERIALS AND METHODS We retrospectively reviewed medical records for diagnoses of ureteroarterial fistulas. Patients' records were evaluated for potentially associated etiologic factors, clinical features and course, radiographic evaluation and findings, and therapy. RESULTS Our review showed that four patients treated at our institution (all since 1990) had ureteroarterial fistulas. All four patients had indwelling ureteral stents and had had irradiation for pelvic cancer. Three had spontaneous brisk hemorrhage in the urinary tract. The fourth had hemorrhage after balloon dilatation of a ureteral stricture. Initial diagnosis was based on findings on iliac arteriography in three patients and on findings on retrograde ureterography in one. Angiographic techniques required to visualize the fistulas included selective arterial catheterization, use of multiple projections, and provocative maneuvers. Treatment of the ureteroarterial fistulas involved surgery in one case, isolated embolotherapy in one case, and a combination of embolotherapy and surgery in two cases. CONCLUSION Specific angiographic maneuvers are often required to identify ureteroarterial fistulas. Transcatheter embolotherapy (with or without surgical bypass) is an effective form of treatment for this rare abnormality.
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Abstract
PURPOSE To prospectively evaluate stepping digital subtraction angiography (S-DSA), which enables peripheral digital subtraction angiography (DSA) of both lower extremities after one injection of contrast material, in comparison with conventional screen-film angiography (SFA) for evaluation of lower-extremity vascular disease. MATERIALS AND METHODS Fifty consecutive patients were prospectively examined. Each study was performed without knowledge of the findings in the other. Additional stationary DSA images were obtained whenever necessary. All studies were individually evaluated for diagnostic adequacy and then side by side for vascular opacification, timing of contrast enhancement, ease of reading, and overall superiority. RESULTS The diagnostic adequacy of S-DSA was not statistically different from that of SFA (P > .30). SFA was subjectively considered superior in opacification (P < .003), ease of reading (P < .003), and subjective overall superiority (P < .005). S-DSA was superior in timing of contrast enhancement (P < .001). CONCLUSION The advantages of S-DSA can be achieved while the diagnostic adequacy of SFA is maintained. However, SFA was considered superior in three of four subjective characteristics.
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Interventional radiologic placement of Hohn central venous catheters: results and complications in 100 consecutive patients. J Vasc Interv Radiol 1994; 5:111-5. [PMID: 8136586 DOI: 10.1016/s1051-0443(94)71464-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Hohn catheters are single- or double-lumen catheters used for intermediate-length central venous access. The authors report their technique, results, and long-term follow-up in a prospective study of their first 100 consecutive patients. PATIENTS AND METHODS Indications for Hohn subclavian catheter placement included chemotherapy in 53%, antibiotic therapy in 30%, and total parenteral nutrition in 8%. Patients' ages ranged from 21 to 82 years, and 80% of catheters were placed in inpatients. Hohn catheters were placed with fluoroscopic and/or ultrasound guidance. Patients were followed up for the duration of the study or until their catheters were removed. RESULTS The technical success rate for catheter placement was 100%. No major procedural complications occurred. Duration of catheter placement varied between 5 and 276 days (mean, 70 days). The catheter infection rate was 8%, which corresponds to 1.1 infections per 1,000 catheter days. Catheter thrombosis occurred in nine cases (9%) and was successfully treated with urokinase in six of these nine. Subclavian vein thrombosis occurred in 3% of patients. CONCLUSION Technical success, complication, and long-term patency rates for the Hohn catheter are comparable to or better than those in most surgical series involving tunneled external catheters. The Hohn catheter is an excellent alternative for intermediate-length central venous access. Hohn subclavian catheter placement has become a standard part of the authors' interventional radiology service and is easily adaptable to all interventional practices.
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Magnetic resonance imaging of angiographically occult run off vessels in peripheral arterial occlusive disease. Invest Radiol 1993; 28:656-8. [PMID: 8344819 DOI: 10.1097/00004424-199307000-00020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Laparoscopic cholecystectomy has become the operation of choice for symptomatic cholelithiasis. However, this operation may result in serious biliary complications. Our aims were to review our experience with biliary complications of laparoscopic cholecystectomy and to document the mechanisms of the injuries and the techniques of managing these complications. We treated 20 patients with biliary complications of laparoscopic cholecystectomy. Symptomatic collections of bile (bilomas) were present in five patients. One of these patients underwent operative ligation of an accessory bile duct in the gallbladder bed, whereas the others had percutaneous or endoscopic therapy. In the remaining 15 patients (of whom 13 were referred from other hospitals), injuries to the major bile ducts were managed by combined radiologic, endoscopic, and operative therapies. In 10 of these patients (67%), the mechanism of injury was the misidentification of the common bile duct as the cystic duct. In 3 of 15 patients, a noncircumferential injury to the lateral aspect of the common bile duct occurred. The Bismuth levels of the remaining bile duct injuries were type I in 3, type II in 4, type III in 3, and type IV in 2. Early outcome of therapy for these bile duct injuries has been favorable. One patient was lost to follow-up, and 2 died of nonbiliary causes, whereas 12 patients are alive and well with normal serum liver enzyme levels at 4 to 19 months postoperatively (mean: 14 months). The most common cause of major bile duct injury during laparoscopic cholecystectomy is mistaking the common bile duct for the cystic duct. Most bilomas can be managed successfully with noninvasive methods. Coordinated efforts by radiologists, endoscopists, and surgeons are necessary to optimize the management of patients with major bile duct injury, suggesting that patients with biliary complications of laparoscopic cholecystectomy should be referred to specialty centers for optimal care.
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Intrahepatic portosystemic vascular stents: a bridge to hepatic transplantation. Surgery 1993; 113:344-51. [PMID: 8441970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Refractory esophageal variceal hemorrhage (EVH) remains a formidable problem in patients awaiting liver transplantations. Transjugular intrahepatic portosystemic shunts (TIPS) have provided an alternative approach for managing EVH that may obviate the need for portosystemic shunt surgery. Experience with TIPS placement and subsequent successful hepatic transplantation in patients without previous portosystemic shunt surgery has not been previously reported. Two patients are reported who underwent TIPS placement and subsequent successful hepatic transplantation without previous portosystemic shunt surgery. This experience indicates that (1) TIPS can provide effective control of EVH for at least several weeks, (2) TIPS placement decreases portal hypertension, thus facilitating technical performance of the transplant procedure and minimizing blood loss, (3) TIPS may undergo vascular incorporation, thus requiring that they be accurately positioned so that the lengths of suprahepatic inferior vena cava and portal vein are not compromised at the time of transplantation, (4) TIPS thrombosis can be effectively treated and prolonged patency may be observed, and (5) deterioration in hepatic function and exacerbation of hepatic encephalopathy were not observed after TIPS placement. In summary, TIPS provide an attractive, effective means for managing refractory EVH in patients awaiting liver transplantation.
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Fragmentation of biliary calculi in 71 patients by use of intracorporeal electrohydraulic lithotripsy. J Vasc Interv Radiol 1993; 4:251-6. [PMID: 8481572 DOI: 10.1016/s1051-0443(93)71846-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Failure of percutaneous or endoscopic removal of biliary calculi is often associated with impacted stones or stones larger than 1.5 cm. In these difficult cases, intracorporeal electrohydraulic lithotripsy (EHL) is a method that allows large stones to be fragmented and removed percutaneously or endoscopically. In this study, the authors expand their experience with EHL and further evaluate the safety and efficacy of this technique to remove biliary tract calculi. PATIENTS AND METHODS Intracorporeal electrohydraulic lithotripsy was used to treat 71 patients with calculi in the bile ducts (n = 35) or gallbladder (n = 36). Access was obtained by means of a surgical T-tube tract (n = 16), percutaneous transhepatic biliary drainage (n = 14), percutaneous cholecystostomy (n = 36), an intraoperative approach during common duct exploration (n = 2), and at endoscopic retrograde cholangiopancreatography (n = 3). RESULTS EHL lithotripsy was effective in fragmenting all biliary stones in 69 of the 71 patients (97%). All of the stone fragments were removed in 67 of these 69 patients (94%). Major complications, including bile peritonitis and gallbladder necrosis, occurred in five patients; however, all major complications were related to the initial percutaneous drainage or tract dilation. No significant complications were directly attributable to the EHL procedure. CONCLUSION Intracorporeal EHL is a safe and effective method that can be used to improve the success of percutaneous and endoscopic biliary calculi removal.
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Percutaneous management of persistently immature cholecystostomy tracts. J Vasc Interv Radiol 1993; 4:97-101; discussion 101-2. [PMID: 8425098 DOI: 10.1016/s1051-0443(93)71827-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Abstract
We report a case of arteriovenous fistula and pseudoaneurysm formation following endopyelotomy. Presentation, successful management with interventional radiology techniques, and the relationship between variant renal artery anatomy and endopyelotomy are discussed.
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Abstract
Percutaneous gastrostomy was performed in 27 patients with ages ranging from 7 months to 18 years (mean, 8 years). Patient weights ranged from 4.7 to 73 kg (mean, 25 kg). Access to the stomach was planned and achieved with only fluoroscopic guidance. The technical success rate was 100%. Major procedure-related complications including death, sepsis, hemorrhage, peritonitis, or early tube removal did not occur. The minor complication of local skin infection occurred in six patients. Twenty-six patients (96%) tolerated tube feedings well. Mean follow-up was 184 days, and median follow-up was 103 days. At 30 days, 26 patients (96%) were alive. Percutaneous gastrostomy under fluoroscopic guidance is a safe and effective method of obtaining long-term nonparenteral nutritional access in pediatric patients.
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Abstract
Transvenous retrieval was attempted in five patients following surgical misplacement of stainless steel Greenfield filters. Four filters were located within the right atrium, and one was in the left hepatic vein. All retrievals were attempted within 5 days of placement. Retrieval was successful for the four filters in the right atrium and failed for the filter in the left hepatic vein. One air embolism occurred; this was the only filter- or retrieval-related complication. Transvenous retrieval is a safe and effective minimally invasive method of removing misplaced filters.
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Abstract
The authors reviewed their experience with percutaneous gastrostomy and gastrojejunostomy in 30 consecutive patients who had undergone prior gastric surgery consisting of either partial resections (n = 24) or alteration of normal gastric anatomy (n = 6). Parameters evaluated included indications for the procedure, procedural modifications, type of prior gastric surgery, major and minor procedural complications, tube efficacy, and follow-up data. Gastrostomy tubes were placed in 27 patients for enteral feeding and in three for decompression. The success rate (100%), as well as the prevalence of major (0%) and minor (23%) morbidity--transient fever, skin infection, and high gastric residuals--were similar to those reported in patients who had not undergone prior gastric surgery. Thirty-day mortality was 13% (four patients); no deaths were related to the gastrostomy tube placement. Minor procedural modifications such as an extra-long needle, a peel-away sheath, or additional rotational fluoroscopy were necessary in 18 patients (60%). Knowledge of the postsurgical gastric anatomy is crucial in this subset of patients. Prior gastric surgery is no longer a contraindication to percutaneous gastrostomy or gastrojejunostomy tube placement.
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Abstract
Percutaneous cholecystolithotomy was attempted in 58 consecutive patients. Patients were considered for percutaneous cholecystolithotomy only if they had symptomatic gallstones and a strong contraindication to surgical cholecystectomy. The procedure consisted of three parts: (a) initial percutaneous cholecystostomy, (b) tract dilation and stone removal, and (c) tract evaluation and tube removal. Local anaesthesia and intravenously administered analgesia were used in all procedures. Percutaneous cholecystolithotomy was successful in removing all of the stones in 56 patients (97%), including cystic duct calculi in 15 patients and common duct calculi in 10 patients. Major complications occurred in five patients (9%); in four cases, they were related to bile leakage after the cholecystostomy tube was removed. Thirty-day mortality was 3% (two patients). Advantages of percutaneous cholecystolithotomy include avoidance of general anesthesia and the ability to treat patients in any disease setting, including acute cholecystitis. Percutaneous cholecystolithotomy, although technically demanding, is an effective alternative to surgical cholecystectomy in elderly and debilitated patients.
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Percutaneous ureteral occlusion with use of Gianturco coils and gelatin sponge. Part II. Clinical experience. J Vasc Interv Radiol 1992; 3:319-21. [PMID: 1627880 DOI: 10.1016/s1051-0443(92)72034-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A previous report described the use of coils and gelatin sponge pledgets as a means of producing ureteral occlusion to achieve urinary diversion in patients with urinary fistulas. The authors have performed this procedure in nine ureters of six patients. Five of the patients had urinary leaks with extensive pelvic tumor, and one had severe chronic cystitis. Ureters were occluded with use of Gianturco coils and gelatin sponge pledgets placed via a sheath through a percutaneous nephrostomy tract. The procedure was successful in all patients as judged by means of antegrade nephrostogram or intravenous pyelogram and by marked improvement or complete resolution of symptoms.
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Percutaneous ureteral occlusion with use of Gianturco coils and gelatin sponge. Part I. Swine model. J Vasc Interv Radiol 1992; 3:313-7. [PMID: 1627879 DOI: 10.1016/s1051-0443(92)72032-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
An animal model was developed to study ureteral occlusion produced by steel coils and gelatin sponge. A coil nest was formed in the ureter, and in all but one pig, gelatin sponge pledgets were incorporated in the coil nest. Animals were killed at 2 hours, 1 week, 1 month, and 2 months. High-grade obstruction was present immediately following the procedure in all animals and was documented to be persistent by means of antegrade nephrostograms obtained just prior to death. At gross examination after death, ureteral thickening and strictures were evident. Histologic studies helped confirm the presence of acute and chronic inflammatory changes. In the in vivo model, gelatin sponge was not found necessary for acute ureteral occlusion. However, in an ancillary in vitro study in which a rigid plastic tube was used, gelatin sponge was necessary in addition to coil occlusion to provide acute total obstruction. The authors' findings suggest that in a compliant ureter, coil occlusion alone produces sufficient mechanical occlusion. Long-term obstruction is probably due to mechanical obstruction and stricture formation.
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Hemorrhagic complication of transgluteal pelvic abscess drainage: successful percutaneous treatment. J Vasc Interv Radiol 1992; 3:323-6; discussion 327-8. [PMID: 1627881 DOI: 10.1016/s1051-0443(92)72036-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Technical problems associated with placement of the Bird's Nest inferior vena cava filter. AJR Am J Roentgenol 1992; 158:875-80. [PMID: 1546609 DOI: 10.2214/ajr.158.4.1546609] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Technical problems encountered during percutaneous placement of 165 Bird's Nest filters over 16 months are described. Filter deployment was successful in all patients. Although frequent, the technical problems were all minor with no long-term sequelae. Several problems were inherent to the design of the filter. Other problems related to the patient's anatomy were seen as well. Because deployment of the Bird's Nest filter is more operator-dependent than is deployment of other types of inferior vena cava filters, knowledge of pitfalls and means to avoid problems are particularly important.
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