Relief of Mesenteric Ischemia by Z-Stent Placement into the Superior Mesenteric Artery Compressed by the False Lumen of an Aortic Dissection

In a 58-year-old man acute aortic dissection compromised the origin of the superior mesenteric artery (SMA), resulting in mesenteric ischemia. After failed balloon angioplasty a Gianturco Z-stent was placed. The stenosis improved immediately, followed by resolution of the clinical signs of mesenteric ischemia. SMA flow was well preserved 1 year after stenting. Received: 0/00/00/Accepted: 0/00/00     

Brachial Artery Access for Percutaneous Renal Artery Interventions

Purpose: To evaluate the suitability of transbrachial access for endovascular renal artery interventions. Methods: During 37 consecutive endovascular renal artery interventions, the transbrachial approach was used on nine patients (mean age 63 years; range 41–76 years) for 11 renal artery procedures on native kidneys and one percutaneous transluminal angioplasty (PTA) on a transplanted kidney. The reason for using transbrachial access was a steep aorta-renal angle in five, and severe aorta-iliac atherosclerosis in the remaining patients. In addition to the intervention catheter in the left brachial artery, an additional nonselective catheter for controlling the procedure was inserted transfemorally (six patients) or via the contralateral brachial artery. Results: Eleven interventions (six PTAs, five stents) were successfully completed. The one failure resulted from impenetrable subclavian artery stenosis. The only major complication was a brachial artery pseudoaneurysm requiring surgical treatment. Conclusion: Transbrachial access is an effective and relatively safe technique for renal artery interventions when transfemoral access is not possible. Received: 0/00/00/Accepted: 0/00/00     

Stent Treatment of Obstructing Dissection After Percutaneous Transluminal Angioplasty of Aortic Stenosis Caused by Nonspecific Aortitis

We report the follow-up of a patient with nonspecific aortitis (Takayasu's disease) in whom a self-expanding stent was used to successfully treat an obstructing dissection after percutaneous transluminal angioplasty of a descending thoracic stenosis. Received: 0/00/00/Accepted: 0/00/00     

Therapeutic Consequences of Variation in Intraarterial Pressure Measurements After Iliac Angioplasty

Purpose: To assess the accuracy of intraarterial measurement of transstenotic pressure gradients for the detection of hemodynamically suboptimal iliac angioplasty. Methods: In 14 patients, referred for diagnostic angiography, mean pressure gradients in the aorta and iliac artery were obtained twice, using a double-sensor pressure catheter. Additional iliac measurements were performed during pharmacologically induced flow augmentation. Repeatability was assessed by calculation of the mean difference plus standard deviation (MD ± SD) and repeatability coefficient (2 × SD). These results were extrapolated to 137 iliac angioplasty procedures with secondary stenting where there was a residual pressure gradient > 10 mmHg. Results: MD ± SD for repeated measurements at rest and during flow augmentation were 0 ± 2 mmHg and 1 ± 3 mmHg, respectively. Repeatability coefficients were 3 and 6 mmHg. Mean pressure gradients after hemodynamically insufficient angioplasty were 8 ± 7 mmHg at rest and 17 ± 5 mmHg following vasodilatation. Inaccurate pressure recordings may have led to inappropriate stent placement in less than 2.5%, and inappropriate denial of stent placement in less than 5% of the lesions. Conclusion: Variability of intraarterial pressure measurements has little consequence in the detection of hemodynamically significant stenosis after angioplasty. Received: 0/00/00/Accepted: 0/00/00     

Left Lobe Recurrent Hepatocellular Carcinoma Treated with Lipiodol-TAE via the Left Internal Mammary Artery

A multinodular hepatocellular carcinoma (HCC) was treated with seven transarterial interventions via the hepatic artery over a 2-year, 5-month period before the eighth angiography showed a recurrent HCC in the anterior portion of the left hepatic lobe. The left internal mammary artery (IMA) was feeding the tumor. This was successfully treated with Lipiodol-transcatheter arterial embolization using a coaxial system via a branch of the left IMA. No complications resulted from the procedure. The left IMA should be considered as a possible feeding artery to an HCC occurring in the anterior portion of the left hepatic lobe. Received: 0/00/00/Accepted: 0/00/00     

Dissection of the Abdominal Aorta in Blunt Trauma: Management by Percutaneous Stent Placement

We implanted stents in three patients who had traumatic abdominal aortic dissections, complicated by right limb ischemia in one case. The circulating false channel extended to the left iliac artery in one case and to both iliac arteries in the last case. Diagnosis and radiological follow-up included ultrasound, computed tomography, and arteriography. Two patients were treated with Wallstents, one with a Palmaz stent. The occlusion of the false channel was obtained in all patients without any significant residual stenosis. No early or late complication was noted in any of the patients. The longest follow-up was 2 years. We conclude that stent placement is an efficient method for the treatment of noniatrogenic inframesenteric aortic dissections. Received: 0/00/00/Accepted: 0/00/00     

Dilatation Mechanism of Balloon Angioplasty in Children: Assessment by Angiography and Intravascular Ultrasound

Purpose: Little information is available about the dilatation mechanism in children. This prospective study aimed to (1) evaluate the dilatation mechanism of balloon angioplasty in children with arterial stenosis, and (2) compare the morphological changes seen by intravascular ultrasound (IVUS) and angiography. Methods: Twenty consecutive patients, who had undergone a total of 23 procedures, were examined before and immediately after balloon angioplasty with a 4.3 Fr, 30 MHz rotational tip IVUS system. The lesions for IVUS study had resulted from coarctation of the aorta in six patients, pulmonary arterial stenosis in five, Blalock-Taussig shunt stenosis in three, subclavian artery stenosis in two, renal artery stenosis in two, coronary artery stenosis in one and ductus arteriosus in one. Results: Four distinctive morphological types were identified: type I with arterial stretching, type IIa with superficial tearing, type IIb with deep intimal-medial tearing, type III with flap formation, and type IV with dissection. The diameter of the narrowest site before and after balloon angioplasty increased significantly from 2.1 ± 1.4 mm to 4.6 ± 3.4 mm (p < 0.001). Eighteen of the 23 angioplasty procedures (78%) were considered to be successful, with a dilatation ratio of more than 50%. In most patients with successful dilatation, non-stretch mechanisms such as tearing, flap formation, or dissection were found. The positive percent (70%) of non-stretch mechanisms seen by IVUS was significantly higher than the positive findings (39%) by angiography (Χ²= 6.47, p < 0.02). Conclusions: Non-stretch morphology of the arterial wall may be a common mechanism of dilatation after balloon angioplasty in children with arterial stenosis. IVUS is a useful modality for evaluating the effectiveness of balloon angioplasty and the mechanism of dilatation in individual cases.     

Balloon Angioplasty Combined with Primary Stenting Versus Balloon Angioplasty Alone in Femoropopliteal Obstructions: A Comparative Randomized Study

Purpose: To evaluate whether balloon angioplasty combined with stenting (ST) of symptomatic femoropopliteal disease would provide better results compared with balloon angioplasty alone (BA). Methods: Fifty-one patients were randomized between ST (24 patients) and BA (27 patients). Follow-up comprised clinical and hemodynamic assessment and color-flow duplex ultrasound examinations. Results: Residual stenosis (≥ 30% diameter reduction) occurred in three BA patients, but not in the ST patients. By life-table analysis the cumulative rate of clinical and hemodynamic success after 1 year with ST was 74% (SE 9%) and for those with BA 85% (SE 7%) (p= 0.25). The primary patency at 1 year assessed by color-flow duplex ultrasound was 62% (SE 9%) for ST-treated patients and 74% (SE 8%) for BA patients (p= 0.22). Occlusion occurred in five ST patients (21%) compared with two BA patients (7%). Conclusion: ST does not improve clinical and hemodynamic outcome compared with BA. Moreover, the occlusion rate in ST-treated patients is higher. Received: 0/00/00/Accepted: 0/00/00     

Transjugular Core Liver Biopsy with a 19-Gauge Spring-Loaded Cutting Needle

One hundred and five sequential transjugular core liver biopsies (TJLBx) were performed in 101 patients with coagulopathy and/or ascites using the 19-gauge Quick-Core Biopsy (QCB) needle. Two-hundred and seventy-three cores were obtained in 295 passes (92.5%). One-hundred and two of the 105 procedures (97.1%) led to a histopathologic diagnosis. One of the three nondiagnostic biopsies was done because of severe autolysis of the liver. There was one subcapsular hematoma, one hepatic arteriovenous fistula, and one liver capsular puncture. Two minor neck hematomas occurred. One death was reported (unrelated to the procedure). QCB needle TJLBx is an effective and relatively safe way to obtain core liver samples. Received: 0/00/00/Accepted: 0/00/00     

Amplatz Thrombectomy Device: Unexpected Interaction with the Cragg Endoprosthesis

In a 74-year-old woman, a Dacron-covered Cragg endoprosthesis was implanted into the left superficial femoral artery after successful recanalization of a 6-cm-long occlusion. At 4.5 months after discharge the endoprosthesis was occluded. In order to perform a thrombectomy, an Amplatz thrombectomy device (ATD) was activated and advanced into the occluded graft. Suddenly, a mechanical failure of the ATD occurred. Extraction of the ATD was achieved only after repeated attempts at rotating motion and jerky pullback maneuvers. The most likely explanation is that one of the graft-struts had advanced into the tip of the ATD and resulted in a broken drive shaft. Recanalization was completed by performing percutaneous transluminal angioplasty and pharmacological thrombolysis with recombinant human-tissue plasminogen activator. In conclusion, users of the ATD have to be aware of interactions of the ATD with the struts of implanted stents or grafts during thrombectomy. Received: 0/00/00/Accepted: 0/00/00     

Ascites due to anastomotic stenosis after liver transplantation using the piggyback technique: Treatment with endovascular prosthesis

Liver transplantation preserving the retrohepatic inferior vena cava, the so-called piggyback technique, is becoming more frequently used because it avoids caval cross-clamping during the anhepatic phase of surgery. However, hepatic venous outflow blockade causing ascites seems to be less infrequent after piggyback than with cavo-caval anastomosis. We report a 62-year-old patient who underwent liver transplantation using the piggyback technique and developed a stenosis in the anastomosis between the hepatic veins and the inferior vena cava leading to severe postoperative ascites. Ascites was unresponsive to diuretic therapy and was associated with renal function impairment. Since the etiology of the stenosis was mechanical (torsion), percutaneous transluminal angioplasty was unsuccessful. Finally, an autoexpandable prosthesis was placed across the anastomosis resulting in rapid and permanent (3 years of follow-up) resolution of ascites.     

Superselective Urokinase Infusion Therapy for Dorsalis Pedis Artery Occlusion in Buerger's Disease

Occlusion of the proximal left dorsalis pedis artery (DPA) in a patient with Buerger's disease was treated by continuous urokinase intraarterial infusion using a microcatheter. Recanalization of the DPA and healing of a toe ulcer were achieved. The patient remains asymptomatic during a 4-year follow-up. Received: 0/00/00/Accepted: 0/00/00     

Interventional Sialography: A Single-Center Experience

Purpose: To evaluate interventional sialography for the treatment of chronic recurrent sialadenitis due to calculus and/or stricture. Methods: We performed a retrospective review and follow-up of 12 patients treated over a 3-year period. The techniques for calculus extraction by papillotomy and basket extraction, and stricture dilatation by a combination of predilation with lacrimal dilators and then angioplasty balloons are described and the literature is reviewed. Results: Follow-up of 1–40 months (mean 14.6 months) showed that 7 of 12 patients remained symptom free and 2 others became asymptomatic after an interval. There were no major complications from the procedure. Conclusion: Interventional sialography is a safe and acceptable alternative to surgery and can be considered as first-line therapy for symptomatic salivary duct calculus and stricture. Received: 0/00/00/Accepted: 0/00/00     

Simultaneous Thrombolysis of Superior Mesenteric Artery and Bilateral Renal Artery Thromboembolisms with Three Transfemoral Catheters

Successful treatment was achieved for a patient with superior mesenteric artery thromboembolism concomitant with bilateral renal artery thromboembolism. Thrombi of the three vessels were lysed simultaneously with a three-catheter technique using short-term, high-dose urokinase followed by overnight infusion with low-dose urokinase. Received: 0/00/00/Accepted: 0/00/00     

Retroperitoneal bleeding after L4–L5 diskectomy in a patient with crossed-fused renal ectopia: Treatment by selective embolization

We present a complication of L4–L5 disk surgery and its treatment by interventional radiology which has not previously been reported. An accessory inferior polar artery of a crossed-fused renal ectopia was injured and the bleeding was successfully managed by selective embolization. Received: 0/00/00/Accepted: 0/00/00     

Traumatic fistula between the left anterior descending coronary artery and a left ventricular pseudoaneurysm

A 44-year-old man presented with a fistula of the left anterior descending (LAD) coronary artery to a left ventricular pseudoaneurysm 6 months after a stab injury in the left anterior chest. The color Doppler echocardiography suggested, and angiography confirmed, the diagnosis and the lesion was treated successfully. Traumatic coronary artery fistulas are rare complications, and color Doppler echocardiography proved useful for the diagnosis. Received: 0/00/00/Accepted: 0/00/00     

Per Oral Balloon Sialoplasty: Results in the Treatment of Salivary Duct Stenosis

Purpose: To evaluate the results of balloon dilatation of salivary duct stenosis and to discuss the technique and its limitations. Methods: Balloon dilatation of 30 salivary duct stenoses (24 parotid, 6 submandibular) was carried out in 29 patients over a 5-year period. Duct dilatation was performed with a 3-mm-diameter balloon on a 0.035-inch wire passed into the salivary duct under fluoroscopic guidance. The follow-up period ranged from 1 month to 5 years. Results: In 25 patients balloon dilatation was technically successful in 26 of 30 ducts (87%). Ninety-six percent of parotid duct dilatations and 50% of submandibular duct dilatations were technically successful. Early clinical follow-up after parotid duct dilatation showed that 57% of patients were asymptomatic, 39% showed an improvement in symptoms, and 4% showed no improvement in symptoms. Following technically successful submandibular duct dilatation (3 cases), 1 patient showed complete resolution of symptoms and 1 showed no change in symptoms. No follow-up was available for 1 patient. No significant complications were seen. The longer-term results are presented. Conclusion: Balloon dilatation of salivary duct stenosis is a simple, safe, and clinically effective method of relieving obstructive symptoms of parotid duct stenosis. Received: 0/00/00/Accepted: 0/00/00     

Percutaneous transluminal angioplasty and stent placement for subclavian and brachiocephalic artery stenosis in aortitis syndrome

A 43-year-old man with progressive right common carotid, subclavian artery, and brachiocephalic artery stenoses due to aortitis syndrome is presented. The patient's right common carotid artery had been treated by percutaneous transluminal angioplasty (PTA) four times previously, but it was finally occluded. The right subclavian artery was treated by PTA once, which resulted in restenosis. The stenosis extended to the brachiocephalic artery. For this patient, PTA followed by stent placement was performed for the right subclavian and brachiocephalic artery stenosis. Because arterial stenosis is progressive in cases of aortitis syndrome, simple PTA alone does not appear to be sufficient for treatment. We suggest that PTA followed by stent placement may be an alternative treatment for recurrent stenosis in aortitis syndrome.     

Partial Renal Embolization for Pediatric Renovascular Hypertension Secondary to Fibromuscular Dysplasia

We report a 7-year-old boy with renovascular hypertension showing multiple stenoses and microaneurysms of the dorsal branch of the left renal artery caused by fibromuscular dysplasia. Hypertension was successfully treated with transcatheter alcohol and gelatin sponge embolization of the dorsal branch and its distribution. The vertebral branch remained intact. No severe complication was encountered. Loss of renal function by renal scintigraphy was minimal. The patient remains asymptomatic at 1 year. Received: 0/00/00/Accepted: 0/00/00     

Traumatic Intimal Tear of the Renal Artery Treated by Insertion of a Palmaz Stent

A renal artery intimal injury induced by blunt trauma in a 23-year-old man was treated by percutaneous placement of a Palmaz endovascular stent. The patient was placed on anticoagulation for 2 months following stent insertion. Nuclide renal scans demonstrated recovery of normal renal function on the affected side at 9 months postprocedure. Received: 0/00/00/Accepted: 0/00/00