Deposition of platelets and neutrophils in porcine iliac arteries after angioplasty and wallstent placement compared with angioplasty alone

Purpose This study was designed to compare deposition of¹¹¹In-labeled platelets and neutrophils after balloon angioplasty (PTA) alone and PTA plus Wallstents.Methods Histological investigation was performed with scanning electron microscopy (SEM). Fifty percent stenoses of both iliac arteries was created by resorbable ligature in 13 pigs. After 30 days, PTA was performed bilaterally with an additional stenting procedure done on one side. Autologous platelets were labeled and reinfused before the interventional procedure in six pigs, and labeled neutrophils were used in seven pigs. The deposition of the labeled cells was recorded itin vivo over 270 min using a scintillation camera. The results were correlated within vitro measurements.Results Scanning revealed significant increase in platelet and neutrophil deposition at the site of the stent compared with the site where PTA alone was undertaken.In vitro measurements confirmed these differences. SEM demonstrated a fibrin lining on the stent surface and numerous adherent platelets. The adjacent arterial lumen was almost completely covered by fibrinous material. The PTA-alone site demonstrated denudation of endothelial cells and less fibrinous material, as well as platelets and leukocytes.Conclusion The complex interaction in the response of the vessel wall and flowing blood involves both platelet and neutrophil adhesion. The self-expandable vascular endoprosthesis contributes to increased deposition of platelets and neutrophils as seen in this experimental model of nonatheromatous stenosis.     

Aspirin inhibition of platelet deposition at angioplasty sites: demonstration by platelet scintigraphy

In-111 platelet scintigraphy was used to evaluate the effects of prior aspirin administration on the accumulation of In-111-labeled autologous platelets at sites of arterial injury resulting from iliac, femoral, or popliteal transluminal angioplasty in a nonrandomized study of 17 men. The degree of platelet localization at angioplasty sites was significantly less in nine men who had received aspirin in varying doses within the 4 days before angioplasty than in eight men who had not received aspirin for at least two weeks. Our results suggest that aspirin treatment before angioplasty limits the early platelet deposition at the angioplasty site in men.     

Evaluation of angiography performed by radiographers and nurses

AIM: To evaluate out-patient angiography performed by nurses and radiographers. MATERIALS AND METHODS: A protocol for out-patient angiography performed by nurses and radiographers was drawn up and approved by the Trust's Risk Management Committee. Following training, two experienced radiographers and one nurse undertook elective peripheral or renal angiography according to the protocol on 187 patients. Angiograms were performed using a 3F catheter introduced into the abdominal aorta from a femoral approach. Patients were discharged after 2 hours and contacted by telephone the following morning. RESULTS: No patient refused consent for the procedure. One hundred and seventy-two patients underwent successful catheterization without assistance from a radiologist. Radiologist assistance was required with femoral puncture or catheter/guidewire manipulation in 15 cases (8%). Images were considered diagnostic by the reporting radiologist in all but one case. This patient was recalled for further aortogram and pressure measurements. There was a single puncture site complication due to transient stenosis of the common femoral artery at the puncture site. This is thought to have been the result of subintimal injection of local anaesthetic, and it resolved spontaneously over 30 minutes. There were no delayed complications. CONCLUSION: Experienced nurses and radiographers can rapidly acquire the skills to perform diagnostic angiography safely and efficiently.     

Feasibility of early ambulation three hours after transfemoral angiography using a 4 French sheath

PURPOSE: Our objective was to evaluate the feasibility of early resumption of ambulation 3 hours after transfemoral angiography using a 4 French sheath. SUBJECTS AND METHODS: This prospective study was carried out in a selected group of men and women without impaired blood clotting (prothrombin time > 15 sec) or thrombocytopenia (platelet < 55,000/mm3). The subjects consisted of 66 men and 34 women with a mean age of 62.3 years (range 27-90 years). Incidences of rebleeding or hematoma at the site of femoral catheter insertion were investigated before and after ambulation. Rebleeding was defined as bleeding that required recompression. Hematoma was defined as a palpable, firm collection of subcutaneous blood. RESULTS: Of 100 patients who resumed full ambulation after three hours of bed rest, none (0%) had acute groin hematoma and only three (3%) showed rebleeding that had to be manually compressed. The remaining 97 patients (97%) had no problem after ambulation. CONCLUSION: Supervised resumption of ambulation 3 hours after angiography with a 4 French sheath is safe and feasible in most ambulatory patients undergoing transfemoral angiography.     

Early mobilization following angioplasty

AIM: To assess the incidence of puncture site complications in in-patients undergoing early mobilization following angioplasty with a view to performing day case angioplasty. MATERIALS AND METHODS: One hundred and twenty-eight patients undergoing peripheral and renal angioplasty using a sheath size of up to 6 French were recruited prospectively. The mobilization protocol consisted of supine bed rest for 2 h, followed by gradual mobilization, so that the patient was ambulant 4 h after the procedure. Mobilization was delayed if clinically appropriate. Puncture sites were scored for discomfort, paraesthesia, visible bruising and palpable haematoma after groin compression and the following morning. RESULTS: One hundred and forty-four puncture sites were studied. There were 44 haematomas in total, of which 37 (26%) were less than 2.5 cm and seven (4.9%) were between 2.5 cm and 7.5 cm. Four patients (2.8%) had visible bruising greater than 7.5 cm. No patient assessed discomfort higher than moderate at any stage. Mobilization was delayed in 15 patients. In 11 this was due to puncture site oozing, haematoma in one, two were hypertensive and one required surgery for limb ischaemia. All complications occurred within 4 h of angioplasty. No patient required surgery or transfusion for haemorrhagic complications. CONCLUSION: Mobilization at 4 h was successful in 90% of cases but 10% require more prolonged bed rest. No delayed complications occurred. These results suggest that day case angioplasty is feasible in most cases.Butterfield, J. S. (2000). Clinical Radiology55, 874-877 Copyright 2000 The Royal College of Radiologists.     

Externalization of Tunneled Hemodialysis Catheter in Patients with Tunnel or Exit-Site Infections and Limited Access Options

PurposeTo evaluate the viability and effectiveness of temporary externalization of a tunneled hemodialysis (HD) catheter in catheter-dependent HD patients presenting with catheter-related tunnel or exit-site infection, documented central venous stenosis, and limited alternative venous access.Materials and MethodsAll catheter-dependent HD patients with known central venous stenosis presenting with exit-site or tunnel infection and who subsequently underwent catheter externalization between February 2008 and May 2012 were reviewed. After catheter externalization, patients were concurrently treated with antibiotics for approximately 3 weeks before reinsertion of a new tunneled catheter. Treatment outcomes were collected, with treatment failures defined as reinfection with the same organism within 45 days of tunneled catheter reinsertion.ResultsThere were 42 catheter externalization procedures performed in 26 patients for 42 exit-site or tunnel infections. Technical success rate for catheter externalization was 100%, with no complications during the externalization procedure and preservation of all original access sites. Treatment failure occurred in 9.8% (4 of 41) of cases. Median infection-free survival after treatment and retunneling of a new dialysis catheter was 80 days. One major periprocedural complication of death occurred before reinsertion of a new tunneled catheter. Minor complications after the procedure occurred in four patients and included three cases of a small persistent wound at the temporary supraclavicular access site and one initially nonfunctioning externalized catheter.ConclusionsTemporary dialysis catheter externalization appears both technically feasible and effective for the treatment of exit-site and tunnel infections, while allowing preservation of the venous access site in catheter-dependent HD patients with central venous stenosis and limited alternative venous access.     

肾脏损伤的经导管栓塞治疗

目的 :探讨经导管栓塞治疗肾脏损伤的疗效、适应证和并发症。方法 :回顾性分析经导管栓塞治疗的肾脏损伤患者 3 8例 ,均以Seldinger技术穿刺右股动脉 ,以 5FPigtail导管行腹主动脉造影后 ,再更换为 5FCobra导管 ,插管至病变部位行栓塞治疗。结果 :3 8例患者栓塞后 6～ 2 4h内血尿停止。 3例患者在栓塞后出现发热 ,分别为胰源性腹膜炎及慢性支气管炎急性发作引起。 1例患者因穿刺点压迫不当发生皮下血肿。 1例经明胶海绵栓塞者在栓塞后 4个月血尿复发 ,用不锈钢圈再次栓塞后缓解。结论 :经导管栓塞治疗肾脏损伤安全、迅速、有效 ,能最大限度地保留有功能的肾组织。     

Randomized controlled trial of sheaths in diagnostic neuroangiography

PURPOSE: To determine the value of arterial sheaths in diagnostic neuroangiography in a randomized controlled trial. MATERIALS AND METHODS: A total of 842 patients (411 men, 431 women; mean age, 59.4 years; age range, 29.5-94.3 years) undergoing diagnostic neuroangiography were randomly assigned to groups in which a sheath was introduced immediately after puncture of the femoral artery (sheath group) or in which a diagnostic catheter was introduced without a sheath (control group). Two hundred twenty-four (26.7%) of 839 patients were receiving anticoagulants immediately prior to the procedure. RESULTS: Complications (mostly small hematomas of the groin) occurred in 106 (12.6%) of 842 patients, with no difference between groups (53 [12.6%] of 421 patients in both; P >.99). Ease of catheter manipulation was greater in the sheath group than in the control group. Incidence of bleeding at the femoral puncture site during the procedure was less in the sheath group (seven [1.7%] of 421 patients) versus the control group (150 [35.6%] of 421 patients), with a P value less than.001. Because of bleeding, sheath insertion was necessary in 165 (39.2%) of 421 patients in the control group. This crossover group also had a higher rate of local complications (28 [17.0%] of 165 patients) than the sheath and control groups. Serious complications, such as stroke (one [0.12%] of 842 patients) and transient ischemic attacks (five [0.60%] of 842 patients), occurred with equal frequency in both the sheath and control groups. CONCLUSION: Use of arterial sheaths lessens the incidence of intraprocedural bleeding at the femoral puncture site and increases ease of catheter manipulation without increasing the number of groin complications.     

经桡动脉途径行全脑血管造影的临床应用

目的 评价经桡动脉行全脑血管造影的安全性及有效性,探讨其技术要点、主要优缺点及适应证、禁忌证.方法 对52例不适合经股动脉途径造影或不愿意术后卧床的患者进行经桡动脉全脑血管造影检查(桡动脉组),统计其穿刺成功率、造影成功率及并发症发生率.并与同期进行的83例经股动脉全脑血管造影(股动脉组)结果进行比较.数据分析采用X2检验.结果 两组患者的穿刺成功率、造影成功率及并发症发生率在桡动脉组分别为96.2%(50/52)、94.2%(49/52)、9.6%(5/52),股动脉组分别为100%(83/83)、95.2%(79/83)、8.4%(7/83),两者差异无统计学意义(X2值均为0.000,P值均>0.05).桡动脉组患者发生穿刺部位轻微淤血2例,无血肿、假性动脉瘤和动静脉瘘等严重并发症发生.结论 经桡动脉途径选择性全脑血管造影术安全有效,患者痛苦小、并发症发生率低,可作为脑血管造影的选择途径之一.     

Percutaneous transfemoral arterial placement of 3 Fr. balloon infusion catheter for infusion chemotherapy of liver tumors

A 3 Fr. single lumen balloon catheter was successfully introduced for arterial infusion chemotherapy by percutaneous transfemoral arterial insertion. This balloon catheter was used combined with 6.3 Fr. outer catheter coaxially. After placing the catheter into the target artery, the balloon catheter was ruptured by injecting 1 ml contrast medium. On the other hand the balloon was made as a leak balloon catheter by a small needle puncture before use. Some merits of this system were as follows: Transarterial infusion chemotherapy can be followed immediately after making a diagnosis by transfemoral angiography. At the time of rupturing the balloon, we can see the area that must be infused under the conventional fluoroscopy. In the case of leak balloon catheter no blood regurgitation through the catheter was occurred during the procedure because of elasticity of the rubber. In 40 patients having liver tumor we performed this method combined with continuous infusion of 5-fluorouracil for 3 to 5 weeks and also once a week intra-arterial administration of mitomycin C and adriamycin. In some patients hyperthermia therapy was also carried out for the purpose of potentiation of cellular chemosensitivity by low temperature hyperthermia. The result of this therapy was as follows: CR; 10.3%, PR; 20.7%, NC; 63.9% and PD; 5.1%. No serious complications were encountered in our series except for some minor arterial troubles caused by catheter tip.     

Radioisotopic techniques for noninvasive detection of platelet deposition in bovine-tissue mitral-valve prostheses and in vitro quantification of visceral microembolism in dogs

Platelet deposition on bovine pericardial-tissue mitral-valve prostheses in 11 dogs was observed noninvasively by use of 111In-labeled platelets and quantified after sacrifice at one (n = 3), 14 (n = 3), and 30 (n = 5) days postimplantation (300-400 microCi of labeled platelets having been injected 24 hours previously). Thrombosis on the sewing ring and pericardial leaflets at one and 14 days and on the leaflets at 30 days was delineated in scintiphotos. In vitro quantification (% injected dose) indicated that the leaflets, sewing ring, and perivalvular tissue retained 0.904% of labeled platelets at one day postimplantation, 0.198% at 14 days, and 0.040% at 30 days. Platelet half-life was reduced to 38 hours at 21 days postimplantation but returned toward the normal (50 hours) with fibrous ingrowth in the sewing ring. Microembolism in lung and kidney, as measured by tissue/blood radioactivity ratio, also was decreased significantly at 30 days. 111In-labeled platelets thus provide a sensitive marker for noninvasive imaging and in vitro quantification of platelet deposition on valvular prostheses and microemboli trapped in viscera, although histochemical confirmation will be necessary to correlate the increase in tissue/blood ratio with the presence of microembolism.     

Computed tomographic evaluation of para-aortic hematoma following translumbar aortography.

Computed tomography provides an objective means of studying needle passage and para-aortic hematoma formation following translumbar aortography (TLA). CT scans from the puncture site to the aortic entry site were done in 13 patients before and after catheter removal to evaluate the incidence and extent of hematoma formation. Eleven (87%) demonstrated para-aortic hematomas following TLA; 8 were confined to the left para-aortic area and 3 involved both sides. The catheter passed through the left kidney in one patient; however, no hematoma was observed.     

Routine transradial access for conventional cerebral angiography: a single operator's experience of its feasibility and safety

The purpose of this study is to describe a single operator's experience with the feasibility and safety of transradial access in conventional cerebral angiography. 153 patients were enrolled consecutively. Among them, 20 patients were not suitable for transradial access. A Simmons catheter was used. Haemostasis was achieved using a compressive dressing of the wrist. We analysed the success rates of the arterial puncture and the successful catheterization rate for each supra-aortic vessel as well as all complications. The arterial access was successful in 96.3%. The supra-aortic vessels were catheterized with success rates of 99.2% (127/128) for the left subclavian artery and 100% for the other arteries. The mean procedure time was 19.3 min (range 10-55 min). Haemostasis was successfully achieved in every case. The most frequent complication was arm pain which occurred in 37 patients (28.9%). In conclusion, transradial selective cerebral angiography with a reversed-angle catheter is technically feasible and safe. It might be helpful in imaging follow-up of patients with arterial stenting or coil embolisation of the cerebral aneurysms. Modification of the catheter design is required to improve the selectivity of the supra-aortic branches.     

Femoral artery compression device for outpatient angiography

To avoid late bleeding from the femoral artery puncture site after outpatient femoral angiography, a compression device was designed to exert continuous pressure over the groin, even when the patient is upright. It has been successfully used in more than 2,000 arterial catheter procedures. The device can also help prevent bleeding in patients who are at increased risk because of hypertension or anticoagulant therapy.     

Comparison of oxine and tropolone methods for labeling human platelets with indium-111

The effect of the chelates oxine and tropolone, used to label platelets, on the kinetics of indium-111-(111In) labeled platelets was studied in twelve normal human subjects. Autologous platelets were labeled either in saline with 111In-oxine or in plasma with 111In-tropolone. Mean platelet lifespan was estimated by fitting the disappearance curve of platelets from the circulation to the multiple hit and other mathematical models. The in vivo distribution of platelets was quantitatively imaged with a scintillation camera. The in vivo recovery of 111In-oxine and 111In-tropolone did not differ, and the mean platelet lifespan was also similar (111In-oxine: 230 +/- 29 hr; 111In-tropolone: 226 +/- 13 hr). At equilibrium (90 min after reinjection of labeled platelets) and at the end of platelet lifespan, 111In-oxine and 111In-tropolone radioactivities in the spleen and liver were similar. These results demonstrate that the results of kinetics measured with 111In-oxine or 111In-tropolone do not differ significantly.     

Interventional radiology placement of twin Tesio catheters for dialysis access: review of 75 patients

PURPOSE: To evaluate the safety and efficacy of modern interventional radiology techniques and imaging guidance for placement of jugular vein twin Tesio hemodialysis catheters. MATERIALS AND METHODS: Eighty-two sets (75 patients) of twin Tesio catheters were percutaneously placed in the right (n = 70) and left (n = 12) internal jugular veins with use of ultrasound (US) and fluoroscopic guidance. Immediate procedural and late complications were recorded. The efficacy of the Tesio system was also evaluated. RESULTS: With US and fluoroscopic guidance, the technical success for access and catheter placement was 100%. Measured dialysis blood flow rate of greater than 375 mL/min was obtained in 95% of the patients and recirculation averaged 4.6% +/- 5%. An inadvertent common carotid artery puncture occurred in one (0.6%) patient and prolonged exit site bleeding occurred in another five patients (3%). Each of these was successfully controlled with compression. More chronically, catheter thrombosis and exit site infection occurred each at the rate of 0.16 episodes per 100 catheter days. All thrombosis and exit site infections responded to local thrombolysis and antibiotic therapy, respectively. Bacteremia occurred in 20 patients and required catheter removal in five patients. There was no clinical evidence of upper extremity or superior central vein thrombosis. CONCLUSION: Placement of internal jugular, twin Tesio catheters with use of imaging and interventional techniques provides a safe and efficacious means of either short or long-term hemodialysis.     

Evaluation of arterial injury due to balloon angioplasty by 111In-labelled platelets

The sensitivity of 111In-labelled platelets for the detection of intimal trauma following balloon angioplasty was evaluated in 8 arteries in 6 patients. Focal platelet accumulation was detected at all 3 iliacs, one superficial femoral and the anterior tibial artery angioplasty sites. Minimal platelet accumulation was present at the superficial femoral artery angioplasty site in another patient whereas in both renal arteries no focal platelet accumulation was detectable. These results indicate that 111In-labelled platelets may provide a sensitive method for evaluation platelet accumulation at the balloon angioplasty site in the peripheral circulation.     

Safety and efficacy of the Perclose suture-mediated closure device following carotid artery stenting under clopidogrel platelet blockade

The aim of this study was evaluation of a closure device (Perclose, Menlo Park, Calif.) for closure of the femoral artery access site in patients undergoing aggressive anticoagulation and platelet blockade after carotid stenting. Fifty-five patients who received clopidogrel in addition to aspirin and heparin as medication for carotid stenting were included for suture of the femoral access site after using 7- or 8-F guide catheters. The technical success, the time for suture, the clotting parameters, and complications were examined. Follow-up investigations, including ultrasound and clinical examinations, were performed. The groin was checked for possible hematoma, pseudoaneurysm, arteriovenous fistula, and local infection. Technical success was obtained in 51 of 54 patients (94%) after a mean procedure time of 6 min (range 5–10 min). The suture device was not used in one patient (2%) for anatomical reasons and failed to obtain hemostasis in 3 of 54 (6%) patients. In 4 of 54 patients (7%) bleeding was observed at the punctured site 4–6 h after intervention which was treated by a compression bandage. The mean dedicated activated clotting time was 137 s (range 29–287 s) before intervention and 349 s (150–958 s) just before deploying the Perclose device. During follow-up after 2 days (range 2–6 days) and 6 months no further complications of the puncture site were observed except for two large groin hematomas. No major complications occurred. Closure of the femoral access site after carotid stenting using a Perclose closure device is safe and effective even in patients receiving an aggressive anticoagulation and antiplatelet therapy.     

Percutaneous cholecystostomy: does transhepatic puncture preclude a transperitoneal catheter route?

Percutaneous cholecystostomy is now commonly performed for the diagnosis and treatment of gallbladder and biliary disorders. The optimal method and route of percutaneous cholecystostomy catheter placement, however, remain controversial and may depend on the indication for the procedure. The ability to predict traversal of the extraperitoneal plane of fixation ("bare area") between the liver and gallbladder with a transhepatic approach was investigated. With sonographic guidance, 21 transhepatic catheterizations were attempted: 19 in cadavers and two in patients who subsequently underwent cholecystectomy. In all cases, 8-F or 5-F self-retaining catheters were used. At autopsy or surgery, the catheter course and gallbladder puncture site were evaluated. Of 21 punctures, 19 (90%) were transhepatic and two (10%) were transperitoneal. Among the 19 transhepatic punctures, eight catheters (42%) traversed the bare area, while 11 (58%) entered the free gallbladder wall adjacent to the serosal attachment. There were four instances of guide-wire dislodgment during catheter placement; all occurred following puncture of the free wall of the gallbladder. No guide-wire dislodgment occurred when the bare area was transversed. Transhepatic gallbladder puncture does not prevent puncture of the free gallbladder surface. However, the liver and bare area do seem to provide guide-wire stability during catheter placement.     

Imaging of platelets in right-sided extracardiac conduits in humans

As a connection between the systemic venous ventricle and the pulmonary artery, valved Dacron extracardiac conduits have remarkably influenced the surgical approach to many complex congenital heart defects. Obstruction of the conduit, however, can reduce the long-term effectiveness of this corrective procedure. In addition to stenosis of the porcine valve, formation of thick fibrous neointima plays a major role in the pathogenesis of conduit obstruction. The purpose of this study was to determine whether platelet deposition could be demonstrated in these conduits by external imaging with In-111-labeled autologous platelets. After injection of labeled platelets either immediately after operation or on the fifth to eighth postoperative day, imaging was performed by standard procedures. Eight of nine patients had platelet accumulation in the conduit, and treatment with aspirin and dipyridamole caused no recognizable change in platelet deposition. This study demonstrates the feasibility of imaging platelet deposition in Dacron conduits and shows that the pattern of deposition varies with time.