Superior mesenteric artery obstruction by intraaortic counterpulsation balloon simulating embolism: A case report

The use of intraaortic counterpulsation balloons has been lifesaving in patients with cardiogenic shock, and indications for its use have expanded in recent years. Several complications of catheter placement and use have been reported. We report what we believe is the first instance of simulated embolization of the superior mesenteric artery by a balloon that was intermittently occluding the vessel's origin.     

Complications secondary to thrombectomy with the fogarty baloon catheter

Thrombectomy peformed with the Fogarty balloon catheter may, in a small percentage of cases, given rise to complications. In four cases reviewed, this procedure was associated with aneurysms or arteriovenous fistulae. Careful catheter manipulation and a judicious used of fluoroscopy or angiography during the procedure can reduce the number of such complications     

A new balloon catheter for coaxial embolization

Summary A new design for double lumen catheters which increases the size of the injection lumen by 30% is described.     

Carotid artery occlusion in the management of selected giant intracranial aneurysms and carotid cavernous fistula: Percutaneous use of the balloon catheter

The percutaneous technique of balloon catheter occlusion of internal and common carotid arteries can produce long-term obliteration of aneurysms and fistulae. Fourteen difficult aneurysms and one carotid-cavernous fistula of the internal carotid artery were thus treated, with success achieved in 13 cases. This technique permits careful control of the occlusion. If neurologic symptoms develop during the procedure, rapid balloon deflation can reverse the deficits in most cases.     

The glove rattling induction maneuver (GRIM): A valuable angiographic technique

A technique in which the attending radiologist can facilitate various angiographic maneuvers by the learning radiology resident is described. It is simple, quick, and inexpensive; its usefulness was demonstrated in a prospective study.     

A complication with the Gianturco coil and its non-surgical management

During the placement of a Gianturco coil in a patient with renal cell carcinoma, the cotton threads of the steel coil remained fixed to the introducing catheter tip, and the coil was unintentionally withdrawn from the selected renal artery back into the aorta. By snare technique the coil was caught with another angiographic catheter and withdrawn successfully via the transfemoral route by aid of a coaxial catheter sheath. There were no complications.     

Fatal atheromatous embolization during coronary angiography

Multiple fatal embolism following left heart catheterization is described in two patients. Postmortem examination showed friable atheromatous aortic plaques as the likely source of emboli that clinically involved the heart, peripheral blood vessels, brain, gastrointestinal system and solid organs. Histologic examination showed widespread arterial embolism by atheromatous material.     

Balloon occlusion versus wedged hepatic venography using carbon dioxide for portal vein opacification during TIPS

Balloon occlusion hepatic venography using carbon dioxide (CO2) is proposed as a safer yet simpler alternative to wedged catheter techniques that have caused hepatic lacerations during the transjugular intrahepatic portosystemic shunt (TIPS) procedure. The image quality of CO2 wedged catheter and balloon occlusion venograms was comparable in our small series, with no venographic-related complications occurring in the balloon occlusion group.     

Occlusion arteriography: Diagnostic and therapeutic applicability of balloon catheters

Occlusion arteriography using flow-directed Swan-Ganz balloon catheters is a safe and simple method, which opens up new technical, diagnostic, and therapeutic possibilities. Since 1976, occlusion arteriography with double-lumen Swan-Ganz balloon catheters and a percutaneous introducer system has been performed in 315 patients. The following advantages were found: (1) simplification of selective and subselective catheterization due to the flow-directed positioning of the balloon-tipped catheter; (2) high contrast of the arterial phase of the angiogram and demonstration of the smallest arteries as a result of a brief, complete occlusion of the main vessels (“standstill arteriogram”); (3) early and optimal demonstration of the corresponding venous system, especially optimization of the indirect splenoportogram and mesentericoportogram; (4) reduction of the volume of contrast agent usually needed for diagnostic reasons; (5) reliable and complete blockade of the tumor-feeding artery during transcatheter embolization with particulate substances; (6) reliable and complete blockade of the feeding artery as a preoperative protective measure in tumor nephrectomy and splenectomy. A preliminary report was presented at the Annual Meeting of the European Society of Cardiovascular Radiology, Uppsala, Sweden, May 1977 and the Annual Meeting of the American Roentgen Ray Society, Boston, Mass. USA, September 1977     

A femocerebral catheter for middle-aged patients of relatively small stature

Summary The authors describe a catheter for multiartery studies in middle aged patients of relatively small stature. Experience in more than a thousand cases proved its special usefulness in selecting the left common carotid artery with tortuous aortic arch.     

New catheter for retrograde left heart catheterization in aortic stenosis

Left heart catheterization in patients with aortic stenosis continues to be a difficult procedure to perform. A new catheter is described with three shapes that adjust to fit the width of the ascending aorta and which may be directed straight into the aortic orifice. Results of the catheterization of 120 patients with aortic and combined mitral valve diseases are presented. The proposed catheter should make such examinations simpler and safer and thereby obviate the need for transseptal catheterization.     

Formation of an undesirable guide wire loop with the cope introduction set

An undersirable loop of guide wire may occur with use of the Cope loop nephrostomy set. This complication, along with its recognition and prevention, is presented.     

Chronic bile peritonitis with progressive bile ascites: A complication of percutaneous biliary drainage

Percutaneous transhepatic biliary drainage procedures are associated with a small but definite incidence of complications. One of the most feared complications, leakage of bile, is commonly presumed to be a catastrophic clinical event. We present an unusual case in which a patient manifested only minimal abdominal symptoms associated with a massive biliary ascites. The bile leakage was first detected by diisopropyl iminodiacetic acid (DISIDA) scanning.     

A new catheter configuration for selective antegrade catheterization of the superficial femoral artery: Technical note

A new 5 F catheter configuration is presented with a very short, 90 degrees angled tip that allows safe catheter tip rotation near the puncture site. This facilitates catheterization of the superficial femoral artery and permits easy conversion of a retrograde into an antegrade guidewire placement after puncture of the common femoral artery.     

Vessel occlusion with transcatheter electrocoagulation

Transcatheter intravascular electrocoagulation for therapeutic occlusion of vessels has been experimentally developed and successfully used clinically as an alternative to, and in conjunction with, more routine methods of vessel occlusion. A constant current power source and a steelguide wire anode are used for the occlusion. The subject is grounded with a standard bovie plate insulated from the skin by a highly lubricated sponge. Permanent occlusion of strategic vessels at accurately controlled sites has been achieved with little risk of embolization of non-target areas. There has been minimal damage to vessel walls, and complete occlusion has been possible despite heparinization and/or thrombocytopenia. One limitation is the inconstant ability to position the anode precisely at the desired site of occlusion. Also, a long time may be required (up to one hour) to occlude larger vessels with presently available anodes. Wider use must await refinements in development of the anode material and in its delivery system.     

Circumferential rupture of an angioplasty balloon with detachment from the shaft: Case report

Rapidly evolving angioplasty balloon techniques need continual evaluation for the type or frequency of balloon-related complications. We recently encountered a case where a new narrow shaft polyethylene terephthalate balloon completely separated from the catheter following circumferential rupture. The balloon was successfully retrieved using grasping forceps and a basket. Patterns of balloon rupture and subsequent management are discussed. Problems of this type were more frequent in the early days of balloon angioplasty, but have since become rare. Close surveillance of new low profile balloons is recommended to determine whether this represents an isolated occurrence or a return to the earlier experience.     

Central venous access: techniques and indications in oncology

Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters are cancer patients undergoing long-term chemotherapy. The most important issues, in addition to the patency of central veins and the history of previous indwelling catheters, pacewires or venous thrombosis, are the patient's performance status, body mass index, medical history and respiratory status, and the relevant technique. The present article will give an overview of the radiological and surgical implantation techniques and will highlight the impact of imaging means on the technical feasibility, assessment and treatment of device-related complications.     

Transcatheter vessel occlusion: Selection of methods and materials

Transcatheter vessel occlusion (TCVO) is increasingly used for control of hemorrhage, palliative and preoperative tumor embolization, organ function ablation, and obliteration of arteriovenous fistulae and malformations. Methods for TCVO include transcather electrocoagulation, “staining” with contrast, the use of balloon-tipped catheters, and embolization. The choice of method and material depends on whether proximal occlusion of feeding vessels or arteriocapillary occlusion is desired, the vascular anatomy of the lesion, the safety with which the lesion can be embolized, and the type of lesion being treated. Embolization is the most frequently employed modality. Available materials include autologous tissue, absorbable hemostatics, synthetic particulates, and liquid polymers. Each material has advantages and disadvantages that make it desirable in certain situations and less useful in others. Complications of TCVO may be disastrous, but can be avoided with careful attention to detail. The specific features of the lesion determine the choice of materials and techniques.     

Recanalization of obstructed tenckhoff peritoneal dialysis catheter: Wire/stylet manipulation combined with endoluminal electrocauterization

We report the results of fluoroscopically guided wire/stylet manipulation combined with endoluminal electrocauterization in seven patients with obstructed Tenckhoff peritoneal dialysis catheters. In preparation for clinical application, electrocauterization was performed using a stone basket to recanalize surgically removed Tenckhoff catheters obstructed with omental fat ingrowing through the side holes. All ingrowing omental fat was removed easily by electrocauterization with the rotating movement of a stone basket. The technique was then applied in vivo in seven cases with ingrowing omental fat and malpositioned catheter; six (86%) were successfully recanalized. Among those six cases with initial success, four maintained good catheter function with durable patency (mean 261.3 days). No significant complication was noted.     

Therapeutic embolization with detachable balloons

In our first 18 months' clinical experience with embolization in the chest and abdomen using detachable ballons, successful results were obtained in 34 of 38 patients. One and 2-mm detachable silicone balloons, which can occlude vessels 4–8 mm in diameter, were employed. Prolonged balloon inflation was routinely achieved using iso-osmotic iodipamide meglumine as the filler and limiting inflation volumes to experimentally determined maximums. Improvements in introducer catheter design simplified delivery of the balloon into a variety of circulations. Detachable balloons are not suitable for all embolization purposes, and they are frequently used in conjunction with other agents. When used properly, balloons produce a permanent occlusion that is extremely selective and potentially reversible up to a certain point in the procedure. The balloon technique enables the angiographer to occlude vessels at distances of 2–10 mm beyond the introducer catheter, thus avoiding the need for subselective catheterization and minimizing the dangers of inadvertent embolization. Biomedical Engineer, Becton-Dickinson Corporation, Rutherford, New Jersey 07070, USA Supported in part by a grant from Becton-Dickinson Corporation, Rutherford, New Jersey 07070, USA