RESUMEN
PURPOSE: The most quoted literature on arteriographic complications is based on self-reports collected during the mid 1970s. We sought to determine whether those results remain valid despite changes in arteriographic practice and whether patient subgroups at increased risk could be identified. METHODS: Five hundred forty-nine consecutive patients were examined after arteriography and twice over 72 hours. Patients were telephoned at least 2 weeks later to identify delayed complications. The sample was divided into two groups to allow independent validation of suspected prognostic factors. RESULTS: The rate of major complications was 2.9% (16/549), but varied from 0.7% to 9.1% among three strata of relative risk. Rates were highest in patients studied for suspected aortic dissection, mesenteric ischemia, gastrointestinal bleeding, or symptomatic carotid artery stenosis and lowest in patients with trauma or aneurysmal disease. Patients studied for claudication or limb-threatening ischemia had intermediate risk (2.0%). Within these strata, congestive heart failure and furosemide use were the only variables independently associated with a significantly increased complication rate. CONCLUSIONS: Previous reports have overestimated the risk of arteriography for trauma or aneurysm but substantially underestimate the risk for patients with other common conditions. Such stratified complication rates are essential to understand relative costs and benefits of arteriography and other vascular imaging modalities in specific clinical situations.
Asunto(s)
Angiografía/efectos adversos , Lesión Renal Aguda/etiología , Vasos Sanguíneos/lesiones , Medios de Contraste/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de RiesgoAsunto(s)
Neoplasias Óseas/secundario , Ácido Etidrónico/uso terapéutico , Compuestos Organometálicos/uso terapéutico , Compuestos Organofosforados/uso terapéutico , Neoplasias de la Próstata/patología , Radioisótopos/uso terapéutico , Renio/uso terapéutico , Samario/uso terapéutico , Suramina/uso terapéutico , Animales , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/radioterapia , Perros , Ensayos de Selección de Medicamentos Antitumorales , Sustancias de Crecimiento/fisiología , Humanos , Masculino , Proteínas de Neoplasias/fisiología , Cuidados Paliativos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/tratamiento farmacológico , Radioisótopos/administración & dosificación , Radioisótopos/farmacocinética , Cintigrafía , Samario/administración & dosificación , Samario/farmacocinética , Suramina/efectos adversosRESUMEN
A patient was shown by computed tomography (CT) to have a rare developmental anomaly of the inferior vena cava (IVC), in which the iliac venous confluence is located anterior (rather than posterior) to the right common iliac artery. Recognition of the anomaly is important prior to surgical intervention in that area, as well as to prevent misinterpretation of the anomaly as representing adenopathy.
Asunto(s)
Aorta Abdominal/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Vena Ilíaca/anomalías , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias Ováricas/cirugía , Vena Cava Inferior/anomalías , Femenino , Hemorragia/etiología , Hemorragia/prevención & control , Humanos , Vena Ilíaca/diagnóstico por imagen , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Persona de Mediana Edad , Neoplasias de Células Germinales y Embrionarias/irrigación sanguínea , Neoplasias Ováricas/irrigación sanguínea , Cuidados Preoperatorios , Tomografía Computarizada por Rayos X , Vena Cava Inferior/diagnóstico por imagenRESUMEN
One hundred eighty-seven diagnostic and therapeutic interventional procedures in the pleural space were performed by using sonographic guidance. These consisted of diagnostic aspiration (118), drainage of malignant and nonmalignant effusions (41), empyema drainage (17), pleural sclerotherapy with tetracycline or bleomycin (7), and pleural biopsy (4). Diagnostic aspiration was performed with 20-gauge needles, and therapeutic and empyema drainages were performed by trocar technique with either a 7-French Sacks catheter or a specially designed empyema drainage catheter. Pneumothoraces were seen in 3% of the patients, and most of these were treated by the radiologist with placement of a Heimlich valve. We conclude that the use of sonography allows rapid localization of pleural fluid collections and instant monitoring of drainage of noninfected fluid collections and empyemas.