Complications in percutaneous transluminal angioplasty: relationships with patient age.

Five hundred consecutive attempted lower limb angioplasties for ischaemic disease (370 patients, mean age 65.6 years, range 33-91 years) were reviewed. Significant complications occurred in 44 cases (8.8%). Nine patients (1.8%) underwent emergency surgery related to a complication. A further 12 patients (2.4%) underwent elective surgery related to a complication. In addition, four patients died within 30 days of the procedure; one following surgery performed because of a complication of angioplasty, one following a myocardial infarction, one following severe bleeding associated with subsequent thrombolytic therapy and one during emergency surgery related to a complication of angioplasty. A correlation was found between complication rate and age. This relationship was independent of the approach to, the position of, and the severity of the treated lesion. Elderly patients are at increased risk of complication in lower limb angioplasty.     

Fatal Pericardial Tamponade After Superior Vena Cava Stenting

We discuss a fatal complication of percutaneous superior vena cava (SVC) self-expandable stent placement in a patient with superior vena cava syndrome (SVCS). The SVCS was caused by a malignant mediastinal mass with total occlusion of the SVC. Twenty-four hours after the procedure, the patient died of a hemopericardial tamponade. In the literature, only seven cases have been described with this life-threatening complication. Patients with a necrotic tumor mass are more likely to develop this complication. Knowledge of this complication may increase patient survival.     

Endovascular repair of a recurrent aortocaval fistula and anastamotic false aneurysm

Aortocaval fistula (ACF) and false aneurysm are a recognized complication of open abdominal aortic aneurysm (AAA) repair. Untreated they are often fatal. However, open surgical repair of this complication is associated with a high operative mortality and a significant complication rate. Endovascular management using a stent-graft to exclude the false aneurysm and fistula is a technically feasible alternative and confers many advantages over open repair by virtue of its minimally invasive nature. We report the endovascular management of this rare but serious complication of open AAA repair.     

Complications after the surgical treatment of malignant thyroid disease

OBJECTIVES: Our objectives were to document the complication rates after total thyroidectomy or lobectomy for malignant thyroid disease and to compare these rates with previously documented complication rates after operations for benign thyroid disease. METHODS: This is a retrospective chart review of patients diagnosed with thyroid carcinoma at a tertiary military medical center from 1996 to 2000. RESULTS: Eighty-two patients were identified with thyroid carcinoma, of which 81 underwent surgical treatment. Nine patients had complications related to their treatment, four were permanent. This included two cases of permanent postoperative hypoparathyroidism, one case of phrenic nerve injury, and one case of unilateral vocal cord paralysis. There is a statistically significant higher overall complication rate of this series (10%) in comparison to a similar series of patients surgically treated for benign thyroid disease (2%) when comparing only recurrent laryngeal nerve injury and hypoparathyroidism (p = 0.02). There is also a higher overall complication rate (11% vs. 4.9%); however, this does not reach statistical significance (p = 0.16). CONCLUSION: Recurrent laryngeal nerve injury and hypoparathyroidism complication rates after operations for malignant thyroid disease are statistically higher in this series than complication rates after operations for benign thyroid disease. Overall complication rates are also higher for malignant thyroid disease as compared to benign thyroid disease. Before surgical treatment for malignant thyroid disease, patients should be counseled accordingly.     

X-ray computerised tomographic diagnosis of false aneurysm of the gastroduodenal artery complicating chronic pancreatitis

Pseudoaneurysm formation is a serious complication of pancreatitis. The authors, in reference to a case, emphasize the value of computed tomography in the early diagnosis of this complication.     

Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis

BACKGROUND: The optimal management strategy for acute Achilles tendon rupture is controversial. PURPOSE: To determine the optimal management by using expected-value decision analysis. STUDY DESIGN: Cross-sectional study. METHODS: Outcome probabilities were determined from a systematic literature review, and patient-derived utility values were obtained from a visual analog scale questionnaire. A decision tree was constructed, and fold-back analysis was used to determine optimal treatment. Sensitivity analyses were used to determine the effect of varying outcome probabilities and utilities on decision-making. RESULTS: Outcome probabilities (expressed as operative; nonoperative) were as follows: well (0.762; 0.846), rerupture (0.022; 0.121), major complication (0.030; 0.025), moderate complication (0.075; 0.003), and mild complication (0.111; 0.005). Outcome utility values were well operative (7.9), well nonoperative (7.0), rerupture (2.6), major complication (1.0), moderate complication (3.5), and mild complication (4.7). Fold-back analysis revealed operative treatment as the optimal management strategy (6.89 versus 6.30). Threshold values were determined for the probability of a moderate complication from operative treatment (0.21) and the utility of rerupture (6.8). CONCLUSIONS: Operative management was the optimal strategy, given the outcome probabilities and patient utilities we studied. Nonoperative management was favored by increasing rates of operative complications; operative, by decreasing utility of rerupture. We advocate a model of doctor-patient shared decision-making in which both outcome probabilities and patient preferences are considered.     

Complication rate of venous access procedures performed by a radiology practitioner assistant compared with interventional radiology physicians and supervised trainees

PURPOSE: To compare venous access complication rates associated with procedures performed by radiology practitioner assistants (RPAs) versus interventional radiology (IR) faculty members, IR fellows, and radiology residents. MATERIALS AND METHODS: A retrospective review of venous access procedures in the IR department for 12 consecutive months at a single university hospital was performed. Procedural primary operators included 12 radiology residents, two IR fellows, four IR faculty members, and one board-certified RPA with 2 years of university training. Data examined included immediate and short-term complications separated into major and overall categories. RESULTS: A total of 2093 venous access procedures were performed. The RPA performed 670 procedures (temporary central venous catheter placement, n = 274; peripherally inserted central catheter, n = 67; venous access catheter change, n = 99; venous port placement, n = 126; tunneled central venous catheter placement, n = 39; catheter check, n = 32; and venous explant, n = 43). Similar procedure ratios were noted with faculty members, fellows, and residents. Procedures by the RPA had a major complication rate of 0.29% and an overall complication rate of 0.89%. Four IR faculty members performed 291 procedures, with no major complications and an overall complication rate of 1.71%. Two IR fellows performed 562 procedures, with a major complication rate of 0.35% and an overall complication rate of 1.06%. Twelve residents performed 570 procedures, with a major complication rate of 0.52% (range, 0%-2.46%) and an overall complication rate of 1.39% (range, 0%-3.70%). No significant difference was found among groups (P = .7). CONCLUSION: A properly trained and monitored RPA can safely perform selected venous access procedures with complication rates equal to those of IR faculty members, fellows, and residents.     

超脉冲CO_2激光根治腋臭的经验总结

目的　总结CO2 激光根治腋臭并发症的防治方法。方法　 2 5 8例腋臭患者接受UltrupauseCO2 激光治疗。治疗时应把握激光治疗腋臭的适应证 ,操作中尽量从小剂量开始 ,术后常规包扎、换药 ,局部应用抗生素软膏 ,红外线照射等。结果　所有病例均取得了良好的治疗效果 ,但有 32例出现程度不等的并发症 ,经治疗后均完全康复。结论　超脉冲CO2 激光根治腋臭的并发症是可以防治的     

Foot Drop after Ethanol Embolization of Calf Vascular Malformation: A Lesson on Nerve Injury

Ethanol is often used in sclerotherapy to treat vascular malformations. Nerve injury is a known complication of this procedure. However, the management of this complication is not well described in literature. This case describes a 10-year-old boy with a slow flow vascular malformation in the right calf who underwent transarterial ethanol embolization following prior unsuccessful direct percutaneous sclerotherapy. The development of a dense foot drop that subsequently recovered is described, and the management of this uncommon but distressful complication is discussed.     

Complications in arthroscopic meniscal surgery

Arthroscopic meniscal procedures as a whole have an acceptably low complication rate. The rate is no higher than the average for all arthroscopic procedures. In the hands of experienced arthroscopic surgeons the complication rate for meniscal repair is slightly lower than that for arthroscopic partial meniscectomy. Attention to anatomic detail, knee positioning, and proper surgical technique has resulted in a significant decrease in the incidence of major neurovascular injuries. The complication rate for outside-in meniscal repair is no lower than that for inside-out meniscal repair. Further refinements in surgical technique, suture materials, and instrumentation should result in an even lower complication rate. Ongoing studies to determine when the repaired meniscus has achieved clinical stability may allow earlier range of motion and further lessen postoperative stiffness.     

Candida inferior vena cava filter infection and septic thrombophlebitis

Candida infection following central venous catheterization (CVC) is a well known complication, most common infection being that caused by Candida albicans. Less common is infection with Candida glabrata. Candida septic thrombophlebitis of the central veins is an uncommon complication after CVC. We report the first case of inferior vena cava filter infection with C. glabrata following septic thrombophlebitis of the femoral veins and discuss management of this rare complication.     

Popliteal pseudoaneurysm and arteriovenous shunt following arthroscopic meniscectomy: Case report

Arthroscopic procedures have a low complication rate regarding vascular injury. This report describes a pseudoaneurysm of the right popliteal artery with an arteriovenous shunt following arthroscopic resection of remnants of the posterior horn of the medial meniscus, a complication not previously reported.     

Bilateral pneumothorax secondary to metastatic angiosarcoma of the breast

Bilateral spontaneous pneumothorax is a rare complication of pulmonary metastases. We report a 44 year old woman who developed this complication a few months after undergoing mastectomy and postoperative radiotherapy for primary angiosarcoma of the breast.     

Fluoroscopic removal of transhepatic,transvenous, intracardiac chest tube with tract embolization: A case report

Chest tube placement is a commonly performed procedure, but it is not without complication. Our case report discusses a unique complication of chest tube placement with the use of minimally invasive techniques in order to treat it.     

Thermal necrosis after simultaneous tibial osteotomy and total knee arthroplasty using press-fit extension-stem

One-staged tibial corrective osteotomy and total knee arthroplasty is a challenging but effective treatment for arthritic knees with extra-articular deformity. Although osteocutaneous thermal necrosis is accepted as a complication of intramedullary reamed nailing following long bone fractures, only 15 cases have been reported in the English literature at present. This report illustrates a rare case of thermal necrosis in a patient undergoing tibial corrective osteotomy coincident with long-stemmed total knee arthroplasty. Excessive reaming with a machine reamer is hypothesized as the cause of this serious complication. In this report, we highlight this rare but serious complication after long-stemmed total knee arthroplasty.     

Sudden death due to rupture of the arteria pancreatica magna: a complication of an immature pseudocyst in chronic pancreatitis

Massive haemorrhage due to rupture of single pancreatic or peripancreatic vessels is a very rare but potentially lethal complication of acute and chronic pancreatitis. The splenic, gastroduodenal, and pancreatoduodenal arteries are the more commonly involved vessels, and rupture occurs mostly as a complication of large mature pseudocysts. We report a sudden death due to massive bleeding caused by rupture of the great pancreatic artery (arteria pancreatica magna), a complication of a small immature pseudocyst, in a 49-year-old male alcoholic with inactive chronic pancreatitis. Received: 24 January 2001 / Accepted: 20 June 2001     

Splenic and portal venous thrombosis: a vascular complication of pancreatic disease demonstrated on computed tomography

Portal and splenic venous thrombosis is a rare but well recognised complication of pancreatic carcinoma and pancreatitis. We report a series of five patients with pancreatic disease in whom CT detected this complication. The appearances on CT are of an enlarged vein with a centre of lower attenuation which does not enhance following intravenous contrast injection, ring enhancement and opacification of collateral veins. Splenic vein thrombosis following pancreatitis should be considered in all patients with pancreatic disease as this complication is increasingly recognised as a cause of upper gastrointestinal haemorrhage from varices.     

Disappearing liver sign

The development of a pneumothorax is a recognized complication of ultrasound-guided percutaneous liver biopsy. A way of detecting such a complication using real-time ultrasound is described, whereby the well-visualized liver disappears from the monitor screen. We also discuss the reasons for this occurrence.     

Arteriovenous fistula following pacemaker lead removal: CT diagnosis

Arteriovenous fistula formation is a very rare complication of pacemaker lead extraction. Rapid diagnosis is essential due to the life-threatening nature of this complication. CT angiography provides a noninvasive and quick method for assessment. Electronic Publication