RESUMEN

The authors describe a technique for insertion of a hemodialysis catheter when the usual large neck veins are difficult to access. The essence of the procedure is the use of the Amplatz Goose Neck snare as a fluoroscopic target. The snare is used in its conventional mode to grasp the introduction wire. The dialysis line then can be placed in its usual fashion.

Asunto(s)

RESUMEN

OBJECTIVE: To assess the safety of performing iliac arterial stenting as an outpatient procedure. METHODS: Retrospective analysis of safety including all patients referred for elective iliac arterial stenting over a 1-year period. Sources of data for the analysis included pre- and post-stenting vascular surgical consultation records, hospital case notes, diagnostic and interventional angiography reports, computerized laboratory data, nursing records from our angiography holding area, and the results of routine post-stenting telephone follow-up. RESULTS: There were 29 outpatient iliac stenting procedures in 28 patients (19 men and 9 women, age range 41.0 to 79.8 years, mean age 66.1 years). Of these 29 procedures, 17 involved unilateral iliac stenting, and 12 involved bilateral iliac stenting. Adjunctive renal artery angioplasty was performed in 1 patient and internal iliac angioplasty and stenting were performed in 2 patients. A total of 51 stents were deployed through 42 femoral punctures via introducer sheaths ranging in size from 6 to 8 French. Percutaneous hemostatic closing devices were used in 6 punctures. Two patients required overnight inpatient observation for moderate-size hematomas; these had no clinical sequelae. All others were discharged safely 5 to 6 hours after sheath removal. No clinically significant sequelae were identified in any patient. CONCLUSION: Arterial stenting can be performed safely on an outpatient basis.

Asunto(s)

Asunto(s)

RESUMEN

A renal artery intimal injury induced by blunt trauma in a 23-year-old man was treated by percutaneous placement of a Palmaz endovascular stent. The patient was placed on anticoagulation for 2 months following stent insertion. Nuclide renal scans demonstrated recovery of normal renal function on the affected side at 9 months postprocedure.

Asunto(s)

RESUMEN

BACKGROUND: Patients who have had major trauma are at very high risk for venous thromboembolism if they do not receive thromboprophylaxis. We compared low-dose heparin and a low-molecular-weight heparin with regard to efficacy and safety in a randomized clinical trial in patients with trauma. METHODS: Consecutive adult patients admitted to a trauma center who had Injury Severity Scores of at least 9 and no intracranial bleeding were randomly assigned to heparin (5000 units) or enoxaprin (30 mg), each given subcutaneously every 12 hours in a double-blind manner, beginning within 36 hours after the injury. The primary outcome was deep-vein thrombosis as assessed by contrast venography performed on or before day 14 after randomization. RESULTS: Among 344 randomized patients, 136 who received low-dose heparin and 129 who received enoxaparin had venograms adequate for analysis. Sixty patients given heparin (44 percent) and 40 patients given enoxaparin (31 percent) had deep-vein thrombosis (P=0.014). The rates of proximal-vein thrombosis were 15 percent and 6 percent, respectively (P=0.012). The reductions in risk with enoxaparin as compared with heparin were 30 percent (95 percent confidence interval, 4 to 50 percent) for all deep-vein thrombosis and 58 percent (95 percent confidence interval, 12 to 87 percent) for proximal-vein thrombosis. Only six patients (1.7 percent) had major bleeding (one in the heparin group and five in the enoxaparin group, P=0.12). CONCLUSIONS: Low-molecular-weight heparin was more effective than low-dose heparin in preventing venous thromboembolism after major trauma. Both interventions were safe.

Asunto(s)

RESUMEN

The purpose of this study was to determine the extent of metastatic pelvic lymph nodes evident on bipedal lymphography in a group of patients under consideration for combined radiation therapy and chemotherapy as definitive treatment for carcinoma of the anal canal. Lymphography was attempted in 32 patients and successful bilateral cannulation and opacification of nodes was achieved in 28 (88%). Seven patients had lymphographic evidence of external iliac node metastases (25%). When patients were categorized according to the extent of clinically evident disease at presentation, 0/15 patients with T1/T2 tumours had positive lymphograms whereas 7/13 patients with T3/T4 tumours and/or positive inguinal or peri-rectal nodes had positive lymphograms (Fisher's exact test p = 0.0015). All patients with a positive lymphogram had undergone CT scanning of the pelvis and in only one patient was external iliac node involvement detected. In none of these patients was visceral or more extensive nodal metastases discovered. Subsequently, the external iliac nodes with radiological evidence of metastases on lymphography were included in the treatment volume taken to radical dosage. The projected cause specific actuarial 5 year survival for this cohort of patients is 86% (median follow-up 4 years). Since the prognosis for patients who relapse in pelvic nodes is poor, bipedal lymphography is advocated as a staging procedure in patients with advanced primary tumours and in all patients with clinically positive inguinal or peri-rectal lymph nodes who are being considered for curative therapy.

Asunto(s)

Asunto(s)

RESUMEN

The author describes a 43-year-old man in whom an intravascular stent was dislodged into the inferior vena cava during repair of a transjugular intrahepatic portosystemic shunt. The malpositioned stent was fixed in position by another stent to prevent central embolization.

Asunto(s)

RESUMEN

The authors describe what they believe is the first report in the radiology literature of two coexisting, adjacent false aneurysms of the radial artery. They occurred in a 33-year-old man who had had cannulation of the radial artery during the management of multiple injuries sustained in a motor vehicle accident. Radial artery aneurysms are uncommon. Definitive treatment of false aneurysms of the radial artery consists of surgical excision with ligation of the artery or, if obstruction is demonstrated preoperatively, end-to-end anastomosis of the artery.

Asunto(s)

RESUMEN

Catheterization of the totally occluded iliac artery prior to percutaneous transluminal angioplasty is frequently difficult. We report a patient in whom such an occlusion was traversed by a combined antegrade-retrograde approach, following which angioplasty was successfully performed.

Asunto(s)

RESUMEN

A patient with traumatic disruption of the thoracic duct resulting in a chylothorax and a 'chyloma' in the left supraclavicular region is described. Supradiaphragmatic ligation of the thoracic duct was necessary for treatment of the chyloma.

Asunto(s)

RESUMEN

We describe a patient who developed a subcutaneous lymphocele in the chest wall following traumatic chylothorax. The diagnosis was suggested clinically and confirmed by computed tomography and lymphangiography.

Asunto(s)

RESUMEN

The role of percutaneous transluminal angioplasty in treating advanced peripheral vascular disease is unknown. The authors therefore reviewed the experience of Sunnybrook Medical Centre in Toronto with 85 consecutive patients who had rest pain, ulceration, pregangrene or gangrene as a result of peripheral vascular disease and who underwent percutaneous transluminal angioplasty. Seventy-four percent were smokers and 91% were at increased risk due to one or more of the following: coronary or cerebral ischemic disease, diabetes mellitus, obesity and hypertension. Thirty-six patients underwent dilatation of iliac lesions, 46 of superficial femoral or popliteal and 3 of more distal lesions. In nine patients angioplasty was repeated on the same lesion. In 16 patients, the procedure was technically unsatisfactory. The morbidity and 30-day mortality were 5% and 2%, respectively. When the procedure was technically satisfactory, surgery was avoided and the limb was salvaged at 1, 2 and 5 years in 69%, 62% and 54% of cases, respectively (life-table analysis). The authors conclude that percutaneous transluminal angioplasty is acceptable treatment for patients with advanced peripheral vascular disease, because the morbidity and mortality are low and the long-term results are good.

Asunto(s)

RESUMEN

The unusual complication of an atherosclerotic abdominal aneurysm rupturing into a retro-aortic left renal vein is presented. Angiographic findings and the anatomic variations of the left renal vein are discussed.

Asunto(s)

RESUMEN

Angiography plays a vital role in the investigation of the patient suffering from multiple trauma. The commonest injuries have been rupture of the thoracic aorta, renal lacerations, arterial bleeding associated with fractures and soft-tissue injuries to the pelvis, and occlusions of the arteries supplying the limbs. Transcatheter arterial embolization may be the definitive therapeutic procedure in pelvic bleeding.

Asunto(s)

RESUMEN

Portal pressure was determined in 10 patients with chronic liver disease before and after an infusion of cimetidine. The drug had no significant effect on portal hypertension. Suggestions that histamine H2-receptor antagonists, by decreasing portal pressure, may be useful in the management of bleeding from esophageal varices are not supported by these results.

Asunto(s)

RESUMEN

Nine patients with gastric varices secondary to occlusion of the splenic vein, which resulted from pancreatic disease, were treated by the authors between 1973 and 1981. Profuse hemorrhage, recurrent bleeding and hypochromic anemia were investigated by endoscopy, gastrointestinal roentgenography and selective angiography. Pancreatic disease was defined by ultrasonography, endoscopic retrograde pancreatography and operation. There were three cases of chronic pancreatitis, three of pancreatic abscess, two of pseudocyst and one of carcinoma of the pancreas. Definitive control of upper gastrointestinal bleeding from gastric varices was achieved by combining splenectomy with selective pancreatic surgical procedures. Two patients did not undergo operation. One death resulted from an unresectable carcinoma. Bleeding did not recur in six patients followed for up to 8 years after operation.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Inter- and intraobserver variability in the measurement of coronary artery stenosis using 35 mm cine and 70 mm spot film angiography was examined. Three experienced observers measured 52 lesions on two occasions. The 35 mm cine was evaluated visually, and a single 70 mm frame demonstrating the stenosis was assessed both visually and with a calibrated magnifying device (jeweler's eyepiece). Higher correlation coefficients within and between observers were obtained using the cine method compared to the 70 mm visual and eyepiece techniques. Observer variability was decreased further by using an average of several readings from the 35 mm cine to assess the degree of stenosis. The data suggest that neither higher resolution film (70 mm) nor calibrated magnifying devices diminish observer variability in the measurement of coronary artery lesions.

Asunto(s)