Jugular versus subclavian totally implantable access ports: Catheter position, complications and intrainterventional pain perception

Purpose

To determine the safest and most tolerable method for totally implantable access ports (TIAPs) particularly in regard to patient's pain perception and catheter-related complications.

Materials and methods

From January 2007 to October 2008 a subcutaneous TIAP (Bardport, Bard Access System, UT, USA) was implanted in 138 oncological patients (60 male, 78 female; 18-85 years old; mean age of 56 ± 6 years) by experienced interventional radiologists. 94 TIAP were implanted through the subclavian vein (subclavian group) and 44 TIAP were implanted through the internal jugular vein (jugular group). Intrainterventional pain perception (visual analogue scale from 1 to 10), postinterventional catheter tip migration and radiation dose were documented for each method and implantation side and differences were compared with Wilcoxon t-test. For ordinal variables, comparison of two groups was performed with the Fisher's exact test.

Results

No severe periinterventional complication occurred. Inadvertent arterial punctures without serious consequences were reported in one case for the jugular group versus four cases in the subclavian group. Significantly (p < 0.05) lower pain perception, radiation dose and tip migration rate were observed in the jugular group. Catheter occlusions occurred in 4% (n = 4) of the subclavian group versus 2% (n = 1) of the jugular group. The corresponding values for vein thrombosis and catheter dislocation were 3% (n = 3) and 1% (n = 1) in the subclavian group, while none of those complications occurred in the jugular group.

Conclusion

Both techniques, the TIAP implantation via fluoroscopy-guided subclavian vein puncture and via ultrasound-guided jugular vein puncture, are feasible and safe. Regarding intrainterventional pain perception, radiation dose, postinterventional catheter tip position and port function the jugular vein puncture under ultrasound guidance seems to be advantageous.     

Central venous infusion port inserted via high versus low jugular venous approaches: Retrospective comparison of outcome and complications

Purpose

To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches.

Materials and methods

The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n = 7), operation scar (n = 6), radiation scar (n = 5), failure of low jugular vein puncture (n = 2), and abnormal course of right subclavian artery (n = 1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port.

Results

The procedure-related complications were all minor (n = 14, 8.6%) in both groups; hematoma (n = 4, 2.8% in low jugular puncture group and n = 1, 4.8% in high jugular puncture group, p = 0.6295), air embolism (n = 2, 1.4% in low jugular puncture group and n = 0 in high jugular puncture group, p = 0.5842) and minor bleeding (n = 5, 3.5% in low jugular vein puncture group and n = 2, 9.5% in high jugular vein puncture group, p = 0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p = 0.0349).The reasons for catheter removal were patients’ death (59 in low jugular puncture group and 14 in high jugular puncture group, p = 0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p = 0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p = 0.6583). The catheter tip migrated upward an average of 1.86 cm (range, −0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein puncture group and there was no significant difference (p = 0.4232).

Conclusions

Right high jugular vein approach can be a feasible alternative to right low jugular vein approach.     

Pushable springcoil embolization of pseudoaneurysms caused by gluteal stab injuries

Purpose

To retrospectively review the outcomes of 21 patients with stab wounds to the gluteal region who underwent embolization for pseudoaneurysms causing active bleeding.

Materials and methods

Between 1997 and 2007, 3 superior gluteal artery, 2 inferior gluteal artery and 16 deep femoral artery muscular branch pseudoaneurysms detected by digital subtraction angiography were selectively catheterized with diagnostic catheters with hydrophilic coating and embolized with pushable springcoils. 17 of the 21 pseudoaneurysms were located in a distal end of an artery where outflow vessels could not be depicted. The other 4 lesions were side wall injuries which required the placement of coils distal and proximal to the injury site.

Results

Embolization was successful in controlling the bleeding in all of the patients. 16 patients required 1 or 2 coils, 4 patients required 3 coils and 1 patient required 5 coils. 2 patients had femoral puncture site hematomas which resolved spontaneously. 2 patients required surgical evacuation of large gluteal hematomas following the embolization because of symptoms second to mass effect. There were no procedure related major complications or mortality.

Conclusions

Our experience demonstrates that pushable coil embolization is a relatively simple, effective and economic method for the embolization of pseudoaneurysms caused by penetrating gluteal injuries. Experimenting with other embolization materials does not seem to be justified.     

The outcome of partial splenic embolization for hypersplenism in the cirrhotic patients

Background

Although partial splenic embolization (PSE) has been widely used for treatment of leucocytopaenia and thrombocytopaenia in cirrhosis, only few studies evaluate both benefits and complications of it.

Objective

To evaluate outcome of partial splenic embolization benefits on both platelet and leukocytes counts and its complications in treatment of cirrhotic patients.

Patients and methods

Cirrhotic patients with hypersplenism-induced thrombo-cytopenia underwent partial splenic embolization (PSE). From All patients complete history and full clinical examination were taken and subjected to Laboratory investigations. After PSE was performed, the precise extent of embolization was calculated on CT examinations 2 weeks after PSE. Prophylactic antibiotics was given for 5 days after PSE. All patients were then followed up at the outpatient clinic. Peripheral blood cell parameters including white blood cell (WBC), platelet (PLT) and red blood cell (RBC) counts were monitored prior to PSE, on the 3rd, 14th, 30th day after PSE, and subsequently at 3-month intervals during the 2-year follow-up period. The complications associated with PSE were appropriately recorded. All patients underwent abdominal CT scanning before and 2 weeks after PSE.

Results

Twenty three patients were included in this study. 13 (57%) males and 10 (43%) females with mean age 42.37 years. PSE was successfully performed in all 23 patients. Post-embolization syndrome 91.3% (21/23) was the most frequent side effect. Other minor complications as puncture site hematoma occurred to one patient at site of femoral artery. Severe complications occurred in eight patients (34.8%). two patients had a large amount of pleural effusion and ascites. One patients developed bacterial peritonitis and died of septicemia. One patient complicated by splenic abscess. One patient had recurrent thrombo-cytopenia and treated by PSE. Portal vein thrombosis was found in one patient. One patient presented with huge splenomegaly and improved after splenectomy. Post-PSE, the platelets and leukocytes counts showed increase in the number. Best results obtained with larger splenic infarction area but in the expense of more major complications.

Statistical analysis

Blood parameters were compared using paired t test. P < 0.05 means significant differences.

Conclusion

PSE is a useful treatment in patients with hypersplenism caused by cirrhosis. PSE is safe in advanced disease patients, not suitable for splenectomy, with good long-term effect on the hematological parameters and a reduction in bleeding episodes from esophageal varices.     

Arthrography of the shoulder: A modified ultrasound guided technique of joint injection at the rotator interval

Objective

To describe an ultrasound guided technique of shoulder joint injection at the rotator interval space, using an endocavitary transducer and performed by a radiologist with no previous experience with arthrography.

Materials and method

Accuracy of the intra-articular puncture and incidence of complications were evaluated in 180 consecutive patients submitted to joint puncture for shoulder MR arthrography.

Results

Puncture was accomplished successfully in all cases, of which 92% with one attempt, and 8% with two, both well tolerated by patients. No relevant complications were reported after the procedure.

Conclusion

This study has shown that puncture of the glenohumeral joint guided by ultrasound at the rotator interval space using an endocavitary transducer is easy and quick, even when performed by radiologists with no experience in arthrographic procedures.     

Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver

Background

To evaluate the triple-phase CT findings for the differentiation of fat-deficient angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver.

Methods

We retrospectively reviewed contrast-enhanced triple-phase CT images of 10 patients with fat-deficient hepatic angiomyolipoma and 28 patients with 29 hepatocellular carcinomas in non-cirrhotic liver proved on histologic examination. The CT findings for the two types of tumors were compared using Fisher's exact test.

Results

Early draining vein depicted on arterial or portal phases was seen in eight (80%) angiomyolipomas and two hepatocellular carcinomas (7%) (p < 0.001), in which the early draining vein was connected with tumoral vessels. The tumoral vessels in the angiomyolipoma were more prominent and ectatic, were distributed both centrally and peripherally, and were seen in smaller tumors than in the hepatocellular carcinoma. Tumor capsule enhancement was absent in all angiomyolipomas as compared with two (7%) hepatocellular carcinomas with no tumor capsule (p < 0.001). The other CT findings were not significantly different for the two different types of tumors.

Conclusions

The presence of early draining vein connecting with prominent tumoral vessels and absent tumor capsule were useful CT findings for the differentiation of fat-deficient angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver.     

HydroSoft coil versus HydroCoil for endovascular aneurysm occlusion study: A single center experience

Background and purpose

The HydroCoil Embolic System (HES) was developed to reduce recurrences of aneurysms relative to platinum coils. But the HydroCoil Embolic System was characterized with many limitations. The manufacturer had recognized the challenge and recently a new design of hydrogel-coated coil—HydroSoft has become available in the market as the new generation HydroCoil. We reported our initial experience using HydroSoft coil versus HydroCoil in our center.

Methods

75 aneurysms embolized primarily using HydroSoft Coils from July 2008 to May 2009 were compared with 66 volume- and shape-matched aneurysms treated with HydroCoils from March 2006 to August 2008. Outcome measures included length and number of coils used, contrast volume, and length of hospital stay. During embolization, a stable framework was first established with bare coils, and hydrogel-coated coils were used subsequently to increase the packing density. Follow-up angiographic results 6 months after treatment were evaluated among some of the patients.

Results

Successful coil embolization was achieved in all patients. There were no differences in average total coil length used per aneurysm. There were no differences in length of hospital stay and packing density. HydroSoft coils were more suitable using as the finishing or final coil. HydroSoft coil decreased the procedure-related retreated rates, and aneurysm packing was finished with soft, flexible HydroSoft coil and decreased the neck remnant rates. Follow-up angiography in HydroSoft-treated patients at 6 months revealed aneurysm stability without significant residual neck.

Conclusions

HydroSoft coil allowed us to deploy coated coils with good packing density. A slight expansion of these coils at the neck can be expected to reduce neck remnant and potentially inhibit recurrence.     

Treatment response evaluation with three-dimensional contrast-enhanced ultrasound for liver cancer after local therapies

Objective

To investigate the potential usefulness of three-dimensional contrast-enhanced ultrasound (3D-CEUS) in evaluating the treatment response for liver cancer after local therapies.

Methods

A total of 107 lesions in 95 consecutive patients with liver cancer underwent local therapies and thereafter received low acoustic power 3D-CEUS examination. The LOGIQ 9 ultrasound scanner and a volume transducer were used and the ultrasound contrast agent was SonoVue. The image quality of 3D-CEUS images was evaluated and the influence of 3D-CEUS to clinical outcome was investigated.

Results

The image quality of 3D-CEUS was defined as high in 102 (102/107, 95.3%) lesions and common in 5 (5/107, 4.7%) lesions. 3D-CEUS did not change the diagnosis in any patient compared with 2D-CEUS. However, 3D-CEUS changed the management in 3 (2.8%) of 107 lesions, increased confidence but made no change in diagnosis in 85 (79.5%) lesions, added some information but did not change management or diagnosis in 15 (14.0%), and made no change in 4 (3.7%), respectively, in comparison with 2D-CEUS.

Conclusion

3D-CEUS enhances the diagnostic confidence in the majority of the patients and even changes the management in some patients. 3D-CEUS has potential usefulness in evaluating treatment response for liver cancer after local therapies.     

Endovascular treatment of abdominal aortic paraanastomotic pseudoaneurysms after surgical reconstruction

Purpose

To evaluate the efficacy of endovascular treatment of paraaortic postoperative abdominal aortic pseudoaneurysms.

Materials and methods

From April 1996 to November 2007 five men with paraaortic postoperative abdominal aortic pseudoaneurysm underwent endovascular treatment. Average age was 64.2 years (range 54-73). The average time interval between the primary surgery and endovascular treatment was 12.4 years (4 months-23 years). Three patients were treated by aortouniiliacal stentgrafts and two patients by tube stentgrafts.

Results

Technical success rate was 100%. Pseudoaneurysms were primarily excluded from circulation without perioperative complications in all patients. At follow-up (mean 38.5 months) there were no deaths and no endoleaks. In one patient thrombosis of stentgraft was found and it was successfully treated by thrombectomy. All pseudoaneurysms still continued to be excluded from circulation in the last follow-up.

Conclusion

Endovascular treatment is minimally invasive, effective and safe option of surgery for paraaortic postoperative pseudoaneurysms.     

Percutaneous Access via the Recanalized Paraumbilical Vein for Varix Embolization in Seven Patients

Objective

To evaluate the feasibility of percutaneous access via the recanalized paraumbilical vein for varix embolization.

Materials and Methods

Between July 2008 and Jan 2014, percutaneous access via the recanalized paraumbilical vein for varix embolization was attempted in seven patients with variceal bleeding. Paraumbilical vein puncture was performed under ultrasonographic guidance, followed by introduction of a 5-Fr sheath. We retrospectively evaluated the technical feasibility, procedure-related complications, and clinical outcomes of each patient.

Results

Recanalized paraumbilical vein catheterization was performed successfully in all patients. Gastroesophageal varix embolization was performed in six patients, and umbilical varix embolization was performed in one patient. Embolic materials used are N-butyl cyanoacrylate (n = 6) and coil with N-butyl cyanoacrylate (n = 1). There were no procedure-related complications. One patient underwent repeated variceal embolization 6 hours after initial procedure via recanalized paraumbilical vein, due to rebleeding from gastric varix.

Conclusion

Percutaneous access via the paraumbilical vein for varix embolization is a simple alternative in patients with portal hypertension.     

Outcome of emergency endovascular treatment of large internal iliac artery aneurysms with guidewires

Purpose

Guidewires have been reported as a useful occlusion material for large aneurysms of different locations with good short-term results. In this study we retrospectively evaluate long-term results of emergency embolization technique with guidewires in symptomatic internal iliac artery aneurysm (IIAA) impending rupture.

Patients and methods

In four patients presented with acute abdominal pain, multidetector computed tomography revealed unstable, 7-14 cm large, IIAAs. Two patients were treated with coil embolization of distal branches followed by occlusion of aneurysmal sac with guidewires. In two patients embolization of aneurysmal sac alone was performed.

Results

In three patients complete or near complete occlusion of the aneurysmal sac was achieved and abdominal pain ceased within hours. Two patients treated with embolization of distal iliac artery branches and aneurysmal sac developed claudication that lasted up to 1 year. Their aneurysms remained thrombosed and they were without symptoms until they died 31 and 56 months later of causes unrelated to IIAA. Two patients treated with embolization of the aneurysm alone were free of ischemic symptoms. Because of incomplete embolization of the sac in one patient open surgery treatment in a non-emergency setting was performed. Complete filling of aneurysmal sac was achieved in other patient but 2 years later his aneurysm re-opened and required open surgery treatment.

Conclusion

Embolization of aneurysmal sac of large IIAA with guidewires may be effective for immediate treatment of impending rupture. Long-term results were better when embolization of the aneurysmal sac was combined with embolization of distal IIA branches.     

Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease

Purpose

To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases.

Methods

Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue.

Results

Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients.

Conclusion

Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.     

Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: Technical and clinical results

Objectives

To report our experience with transarterial glue embolization of the bronchial artery for life-threatening hemoptysis.

Materials and methods

Twenty-five patients underwent bronchial artery embolization, using coaxial microcatheter technique, with a liquid agent, n-butyl-2-cyanoacrylate (NBCA), named glue, for life-threatening hemoptysis. The technical and clinical outcomes were followed in terms of immediate control of bleeding, recurrence of hemoptysis and complications of the procedure.

Results

Four patients had acute hemoptysis when they were evaluated. The average number of arteries embolized per patient was 2.9. BAEs were successful in controlling hemoptysis immediately in all 25 patients (100%) and in 24 patients (96%) at 1 month follow-ups. One patient had recurrent hemoptysis on the tenth day after embolization. The follow-up time ranged from 2 to 63 months (mean 14 months). Six patients (25%) died all as a result of their disease process. Bleeding recurred in 3 patients after 30 days (7th, 11th, 12th months). One patient had vomitting attacks with dysphagia after the procedure that lasted 24 h. Three patients had transient thoracic pain lasting 3-5 days. There were no procedure related spinal or vascular complications.

Conclusions

Glue embolization with microcatheter technique is a safe and effective treatment in cases of life-threatening hemoptysis with a very high rate of success and low rate of complications.     

Pseudotumor of the distal common bile duct at endoscopic retrograde cholangiopancreatography

Background

Prior studies have described a pseudocalculus appearance in the distal common bile duct as a normal variant at cholangiography. The objective of this study was to describe the occurrence of pseudotumor in the distal common bile duct at endoscopic retrograde cholangiopancreatography (ERCP).

Methods

Nine patients who underwent ERCP between May 2004 and July 2008 were identified as having a transient eccentric mural-based filling defect in the distal common bile duct. A single reader systematically reviewed all studies and recorded the imaging findings.

Results

The mean diameter of the filling defect was 9 mm (range, 5 to 11). Eight patients had resolution of the filling defect during the same ERCP or on a subsequent ERCP, and in two of these patients the inferior border of the filling defect was not well visualized. The other patient underwent surgical resection of a presumed tumor with no evidence of malignancy on surgical pathology.

Conclusion

An eccentric mural-based filling defect in the distal common bile duct can be artifactual in nature and may reflect transient contraction of the sphincter of Oddi. Recognition of this pseudotumor may help avoid unnecessary surgery.     

Embolization of intracranial dural arteriovenous fistulas with Onyx-18

Background and purpose

The use of Onyx in the treatment of AVMs has been reported in the literature, but experience in the treatment of DAVF is lacking. We report the clinical outcome obtained in the treatment of dural arteriovenous fistulas (DAVFs) using a new liquid embolic agent, Onyx-18.

Methods

The present series included 21 patients; 9 had DAVFs draining directly into the cortical veins, 6 had DAVFs draining directly into the dural sinus, 4 had DAVFs draining through the ophthalmic veins and 2 had DAVFs involving the dural sinus with leptomeningeal retrograde venous drainage Clinical data were extracted from hospital files and all patients were followed.

Results

In 14 patients (70%) there was complete angiographic elimination of the shunts and resolution of the symptoms. The remaining 7(30%) patients was not cured with residual shunts. Adverse events occurred in 6(30%) of 21 patients with 1 DAVF located at the transverse sigmoid sinus, 2 at tentorium, and 3 at the cavernous sinus. Cranial deficits occurred in 3(15%) patients, brain infarction in 1(5%) patient and microcatheter gluing in 1(3.2%) patient. At final follow up, 20 patients were asymptomatic with 1 showed clinical improvement.

Conclusion

Definitive cure may be attained effectively with Onyx in dural arteriovenous fistulas and adjunctive to surgery and radiotherapy. Location of the DAVFs affected the outcome of transarterial embolization.     

Value of multislice computed tomography angiography of the thorax in preparation for catheter ablation for the treatment of atrial fibrillation: the impact of unexpected cardiac and extracardiac findings on patient care

Objective

In patients referred for catheter ablation for the treatment of atrial fibrillation, multislice computed tomography angiography of the thorax is routinely performed to assess pulmonary vein anatomy. We sought to investigate the incidence of unexpected cardiac and extracardiac findings in this select patient population and to establish how these findings influence subsequent patient care.

Methods

Ninety-five patients (mean age 62 ± 10 years, 35% female) referred to our institution for ablation therapy for atrial fibrillation between July 2003 and October 2007 underwent multislice computed tomography angiography of the thorax. Radiologists interpreted all images. Need for additional testing, consultation and eventual diagnosis were assessed by electronic record review.

Results

A total of 83 (5 cardiac, 78 extracardiac) unexpected findings were observed in 50/95 (53%) of patients. The findings prompted 23 additional tests (5 cardiac, 18 noncardiac) in 15/95 (16%) of patients and 8 subsequent referrals in 7/95 (7%) patients. In 6 patients the findings significantly altered future patient care and resulted in postponement of ablation therapy in 4 patients. In 2 patients, extracardiac findings (pulmonary emboli and adenocarcinoma of the lung) were of potentially life-saving consequence.

Conclusions

In patients undergoing multislice computed tomography angiography of the thorax in anticipation of planned catheter ablation therapy for the treatment of atrial fibrillation, unexpected findings are common and of potentially significant value. In comparison, there is a higher prevalence of unexpected extracardiac, rather than cardiac findings. Further investigation of these findings may lead to postponement of ablation therapy, but may also be of potentially lifesaving consequence.     

Superior cerebellar artery infarction in endovascular treatment for tentorial dural arteriovenous fistulas

Background

Superior cerebellar artery (SCA) syndrome shows ipsilateral cerebellar ataxia and Horner's syndrome, contralateral superficial sensory disturbance, as well as nystagmus toward the impaired side, vertigo, and nausea. Occasionally, unilateral lesions may produce bilateral hypogeusia and contralateral hypoacusia.

Objective

To report 2 patients with unilateral lower midbrain ischemic lesions of the inferior colliculus level caused by transarterial embolization for tentorial dural arteriovenous fistulas (TDAVFs).

Methods

Hospital records for 21 patients with TDAVFs mainly treated by endovascular techniques between 2005 and 2008 were reviewed. Two patients with MRI evidence of unilateral SCA territory infarction were investigated.

Results

Of 21 patients, 2 treated transarterially with Onyx-18 (a nonahesive liquid embolic agent) developed infarctions in the territory of SCA. One patient had lateral SCA infarction characterized by ipsilateral gait ataxia, contralateral hemihypoesthesia, with additional ipsilateral ocular motor palsy and bilateral gustatory loss. And the other patient had medial SCA infarction characterized by ipsilateral ataxia contralateral hemihypoesthesia with additional contralateral hypoacusia.

Conclusion

SCA infarction can be caused by transarterial injection of Onyx-18 via SCA or the posterior cerebral artery (PCA) for TDAVFs and additionally presented with gustatory loss and deafness, which is generally not a feature of the SCA syndrome.     

Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

Introduction

Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications.

Materials and methods

Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite.

Results

Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient.

Conclusion

Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.     

Percutaneous transvenous packing of cavernous sinus with Onyx for cavernous dural arteriovenous fistula

Objective

The aim of this study is to describe the technique and results of the transvenous approach for occlusion of cavernous dural arteriovenous fistulas (DAVFs) with Onyx.

Methods

Eleven patients presenting with clinically symptomatic DAVFs, were treated between August 2005 and February 2007 at Beijing Tiantan Hospital. We were able to navigate small hydrophilic catheters and microguidwires through the facial vein or inferior petrosal sinus (IPS) into the ipsilateral cavernous sinus. After reaching the fistula site the cavernous sinus was packed with Onyx or combining with detachable platinum coils.

Results

We were able to reach the fistula site and to achieve a good packing of Onyx or combining with coils within the arteriovenous shunting zone in 10 patients. The final angiogram showed complete occlusion of the arteriovenous fistula. Two (18.2%) patients developed a bradycardia during DMSO injection. No complications related to the approach were observed.

Conclusions

Transvenous occlusion of cavernous DAVFs is a feasible approach, even via facial vein or via IPS. Onyx may be another option for cavernous packing other than detachable platinum coils.