An unopened titanium greenfield IVC filter: Intravascular ultrasound to reveal associated thrombus and aid in filter opening

A titanium Greenfield filter did not open following placement in the infrarenal inferior vena cava (IVC). Abdominal radiograph and cavogram showed no definite reason for filter malfunction. Intravascular ultrasound (IVUS) demonstrated the unopened filter in the IVC with thrombus binding the legs. The thrombus was disrupted with a catheter, and the filter completely expanded with a balloon. IVUS documented full-filter opening in addition to residual thrombus in the filter following manipulation.     

Transmural migration of an intracavernous carotid detachable balloon used to control surgically induced haemorrhage

We report a case in which a balloon detached in the carotid siphon for control of iatrogenic bleeding migrated to the oesophagus. We discuss the pathophysiology. Received: 22 September 1997 Accepted: 11 November 1997     

血管内超声在1例颈内动脉闭塞患者介入治疗中的应用

目的 探讨血管内超声(IVUS)技术在颈内动脉闭塞经皮腔内血管成形术(PTA)中的应用价值.方法 1例患者CTA明确颈内动脉闭塞,脑灌注成像见低灌注区与缺血相关症状符合,在IVUS导引下接受PTA治疗.采用微导丝及微导管同轴技术通过闭塞段,IVUS确认位于真腔内,微导管造影确认闭塞远端血管通畅,调整后放置栓塞保护器;IVUS测评斑块及管腔情况,球囊预扩张后再次测评;血管内恢复正向血流后通过IVUS虚拟组织学序列分析斑块稳定性,斑块纤维帽稳定且管腔狭窄率＜40％仅作单纯球囊扩张治疗.结果 单纯球囊扩张治疗后闭塞血管再通,恢复正向血流.IVUS全程检测狭窄段斑块纤维帽稳定,管腔狭窄率＜40％,脑灌注成像显示低灌注状态明显改善.结论 IVUS技术在PTA治疗颈内动脉闭塞中起重要导引作用,可增加再通手术成功率,降低并发症发生率.     

由恶性肿瘤引起的上腔静脉阻塞综合征的血管内支架介入治疗

目的：探讨恶性肿瘤所致上腔静脉综合征的介入治疗方法和疗效。方法：经股静脉入路对12例因恶性肿瘤所致上腔静脉综合征患者行介入治疗。结果：12例患者均采用经股静脉穿刺插管入路,经球囊预扩张后置入支架,所有患者均一次治疗成功,无严重并发症发生。结论：介入治疗是治疗晚期恶性肿瘤所致上腔静脉综合征的首选方法。     

Malignant Esophagogastric Junction Obstruction: Efficacy of Balloon Dilation Combined with Chemotherapy and/or Radiation Therapy

Purpose: To assess the efficacy of balloon dilation combined with chemotherapy and/or radiation therapy for palliation of dysphagia due to malignant esophagogastric junction strictures. Methods: Fluoroscopically guided balloon dilation was attempted in 20 patients. The causes of strictures were gastric adenocarcinoma (n = 10) and esophageal squamous cell carcinoma (n = 10). Scheduled chemotherapy and/or radiation therapy followed balloon dilation in all patients. Results: There were no technical failures or major complications. After balloon dilation, 15 (75%) patients showed improvement of dysphagia. No patient complained of reflux esophagitis during the follow-up period. Among the 15 patients, seven needed no further treatment for palliation of dysphagia until their deaths. The remaining eight patients underwent repeat balloon dilation (n = 4) or stent placement (n = 4) 3–43 weeks (mean 15 weeks) after the initial balloon dilation because of recurrent dysphagia. Conclusion: Balloon dilation combined with chemotherapy and/or radiation therapy seems to be an easy and reasonably effective palliative treatment for malignant esophagogastric strictures.     

Six-month follow-up after thermal balloon angioplasty in canine iliac arteries

We performed thermal balloon angioplasty in 10 iliac arteries in 5 mongrel dogs. By perfusing a modified angioplasty balloon with hot (100°C) saline, a mean balloon temperature of 84°C was obtained. Angiographic and histologic follow-up at 6 months revealed no thrombosis or aneurysm formation but it did reveal fibrotic transformation of the media. Initial overdilatation was maintained in 9 of 10 arteries. We conclude that medial sclerosis induced by thermal balloon angioplasty does not result in aneurysm or thrombosis in dogs.     

Rectal balloon for CT of rectal cancer

The use of a balloon catheter to distend the rectum for pelvic CT in patients with rectal cancer is described. The 20-cm long balloon, inserted over a 12F catheter and inflated with 180-200 ml of water, is simple to use, well tolerated by patients and allows high-quality CT scans. Preliminary results of the presurgical staging of rectal cancer by CT with rectal balloon in a series of 15 patients show a high accuracy when comapred with the pathological findings: involvement of perirectal nodes and adjacent structures was correctly identified in all cases, while CT overestimated the invasion of perirectal fat in two cases, due to the impossibility of distinguishing neoplastic from inflammatorry tissue. The operability statement (site and dimensions of the tumour) allowed correct surgical planning in all cases. Correspondence to: M. Bellomi     

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.     

Use of a cutting balloon for dilatation of a resistant venous stenosis of a hemodialysis fistula

In a 71-year-old patient with a Brescia-Cimino hemodialysis fistula, high-pressure balloon dilatation failed to open the stenosis completely and a constant waist of the balloon was found. The use of a 3.5-mm coronary cutting balloon (Barath balloon) was helpful in preparing the stenosis for subsequent successful dilatation.     

Evaluation of three rhenium-188 candidates for intravascular radiation therapy with liquid-filled balloons to prevent restenosis

BACKGROUND: Intravascular brachytherapy is an effective method for inhibiting coronary restenosis after percutaneous transluminal coronary angioplasty. A new concept for preventing restenosis is the use of a liquid-filled balloon containing a beta-ray-emitting radioisotope. Generator-produced rhenium-188 (Re-188) is a good candidate for intravascular brachytherapy. However, in the unlikely event of balloon rupture, release of Re-188 perrhenate may cause a high radiation dose to the thyroid and stomach. In this study, we compared the biodistributions of three Re-188 preparations (Re-188 perrhenate, Re-188 pentetic acid [DTPA], and Re-188 MAG3) to assess the radiation dose to organs in a rat model that mimicked balloon rupture. METHODS AND RESULTS: After injection of Re-188 preparations intravenously, rats were killed at 10 minutes, 30 minutes, 60 minutes, 2 hours, and 6 hours (n = 5/group). Tissue concentrations were calculated and expressed as percent injected dose per gram or per milliliter. In addition, urine excretion and thyroid gland uptake were evaluated in rats (n = 5/group) with a gamma camera after administration of 37 MBq (1 mCi) of each agent. Our data showed all 3 agents were excreted primarily via urine. In the Re-188 MAG3 group, 82% was excreted within 1 hour, but in the Re-188 perrhenate group, only 28% was excreted. The biodistribution data for these agents revealed that radioactivity levels in the stomach and the thyroid gland were high in the perrhenate group but low in the Re-188 DTPA and Re-188 MAG3 groups. The concentration levels in other tissues including lung, liver, testis, muscle, and blood were low throughout this study for all 3 agents. The thyroid radiation values were 0.163, 0.0167, and 0.00728 mGy/MBq for Re-188 perrhenate, Re-188 DTPA, and Re-188 MAG3, respectively. The stomach radiation values were 0.127 mGy/MBq for Re-188 perrhenate, 0.013 mGy/MBq for Re-188 DTPA, and 0.0104 mGy/MBq for Re-188 MAG3. CONCLUSIONS: In the event of balloon rupture, the release of Re-188 MAG3 or Re-188 DTPA results in lower radiation doses than release of Re-188 perrhenate, especially to the thyroid gland and the stomach.     

介入治疗肺动脉栓塞疗效探讨

目的：评价介入溶栓球囊扩张术对肺动脉栓塞治疗的效果。方法：8例肺动脉栓塞患者,经股静脉穿刺插管。导管导丝置于肺动脉内进行碎栓,采用尿激酶冲击溶栓、球囊扩张术和24h持续灌注溶栓,同时给予肝素抗凝治疗。结果：完全开通3例,部分开通5例;3例氧分压均达到100％,5例氧分压在93％以上。结论：介入治疗肺动脉栓塞能及时开通肺动脉,恢复肺动脉血供,纠正低氧血症,是治疗肺动脉栓塞一种有效的方法。     

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.     

Inadvertent arteriovenous stenting during transjugular intrahepatic portosystemic shunt procedure and the importance of hepatic artery perfusion

Penetrating the hepatic artery during transjugular intrahepatic portosystemic shunt (TIPS) is a relatively frequent but almost always benign complication. We report a patient in whom the right hepatic artery, originating from the superior mesenteric artery, was inadvertently catheterized and stented. The arteriovenous fistula was treated with a detachable balloon positioned within the hepatic artery. A second TIPS was attempted and successfully created during the same session. The patient died of cardiac failure, attributed to rapid resolution of massive ascites after TIPS with circulatory overload. At autopsy, the liver distal to the arterial occlusion balloon was infarcted, illustrating the importance of hepatic artery perfusion in liver cirrhosis.     

Percutaneous Treatment of Extrahepatic Bile Duct Stones Assisted by Balloon Sphincteroplasty and Occlusion Balloon

Objective

To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing.

Materials and Methods

Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated.

Results

Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patient, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis.

Conclusion

Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.     

Thermal laser-assisted angioplasty of renal artery stenosis for renovascular hypertension

Percutaneous transluminal laser-assisted angioplasty of a renal artery stenosis was performed in a 16-year-old woman with renovascular hypertension. The stenotic portion of the renal artery was predilated by delivering Nd-YAG laser energy to the terminal tip of a laser catheter. Although the luminal diameter did not increase sufficiently with laser angioplasty alone, it allowed passage of the balloon catheter and subsequent successful balloon angioplasty. Immediately after dilatation, the patient's blood pressure fell to normal, and plasma renin activity decreased. There were no serious complications. Thermal laser angioplasty seems to be an effective adjunct technique for the treatment of severe renal artery stenosis which does not allow initial passage of a balloon catheter.     

Preoperative local staging of rectal carcinoma with MR imaging and a rectal balloon

Magnetic resonance (MR) imaging for the preoperative assessment of rectal carcinoma was evaluated. Thirty-three patients underwent MR imaging with a 1.5-T unit. On the basis of results of barium enema studies and/or digital examination, a balloon catheter was inserted to the level of the lesion before MR imaging. Both T1-and T2-weighted axial spin-echo images were obtained in all patients. With the balloon catheter, the three layers of the normal bowel wall could be seen on T2-weighted images. Muscular invasion was detected with a sensitivity of 90%, a specificity of 84%, a positive predictive value of 90%, a negative predictive value of 84%, and an overall accuracy of 88%. False-positive results were related to chemical shift artifact and intramural lymph node metastases. Perirectal fat invasion was detected with a sensitivity of 64%, a specificity of 89%, a positive predictive value of 82%, a negative predictive value of 77%, and an overall accuracy of 79%. One of the false-positive results was related to intramural lymph node metastases and the other to perirectal vessels. Evaluation of adjacent organ invasion was accurate in all patients. Lymph node metastasis was correctly detected in six of nine patients. Absence of lymph node metastasis was correctly predicted in 23 of 24 patients. Thus, MR imaging with a balloon catheter was useful for detection of tumor invasion into muscularis propria and adjacent organs; however, its demonstration of perirectal fat and lymph node involvement was less accurate.     

Transjugular intrahepatic portocaval shunt after thrombus disruption in partially thrombosed portal veins

Portal vein (PV) thrombosis increases the risk of variceal bleeding in cirrhotic patients with portal hypertension. Its presence also complicates PV access during transjugular porto-caval shunt (TIPS) placement. We overcame this obstacle by using ultrasound (US) guidance for PV entry. Clot disruption by balloon catheters was then performed before placing the vascular endoprostheses for portal-venous shunting. We treated 3 cirrhotic patients in such fashion with good clinical results. Portal thrombi progressively disappeared after shunting due to both balloon disruption and the rise in portal blood flow velocity.     

Esophageal balloon dilatation: A follow-up study in 74 patients

Balloon esophageal dilatation was performed in 74 patients, 60 of whom had malignant neoplasia of the esophagus, 11 had benign esophageal stenoses, and 3 had esophageal stenoses caused by nonesophageal cancer. Sixteen patients underwent preoperative balloon dilatations and 15 were able to swallow until surgery. In 49 patients receiving palliative treatment for esophageal cancer, balloon dilatation allowed 40 (82%) to swallow until near death. We experienced one esophageal rupture.     

Renal vein ethanol concentration during ablation of renal cell carcinoma

Absolute ethanol is an effective embolizing material for the ablation of renal cell carcinoma with a balloon catheter. We have measured the renal vein ethanol concentration during embolization in 9 patients in order to determine whether toxic levels are achieved. Total occlusion of the embolized arteries was obtained using an average of 12.9 ml (range 8–18) ethanol. Renal vein ethanol concentration varied from trace amounts to 0.79%. There was a significant correlation of the maximum renal vein concentration with the ethanol dose per tumor size. The authors conclude that the renal vein ethanol concentration remains sufficiently low to be harmless when a proper balloon occlusion is used. The optimum ethanol dose may be a function of tumor size.     

Olbert dilatation catheter system: Complication due to inexpert handling

A complication of inexpert handling of the Olbert catheter system is presented. The balloon was inflated while the clamp at the proximal end of the catheter was closed. This resulted in kinking of the distal end of the catheter within the balloon. Difficulty in catheter removal resulted but was overcome by an improvised coaxial sheath technique.