RESUMEN
Endovascular reconstruction has become the standard treatment of chronic obstruction of large veins. Stenting is done with increasing frequency to treat iliac venous obstructions, with or without associated inferior vena caval or femoral vein occlusions. Open reconstruction with venous bypass is performed today in patients who fail attempts at venous stenting or who are not candidates for endovascular reconstructions. Patients with primary or secondary malignancies invading the vena cava undergo open caval reconstruction at the time of tumour excision. Open venous reconstructions are still preferred in patients with large vein injuries due to blunt or penetrating trauma or in those who suffer iatrogenic venous injuries. Hybrid reconstruction can be performed with endophlebectomy of the common femoral or femoral veins combined with iliofemoral stenting.
Asunto(s)
Procedimientos Endovasculares/métodos , Vena Ilíaca/cirugía , Neoplasias/cirugía , Stents , Enfermedades Vasculares/cirugía , Vena Cava Inferior/cirugía , Humanos , Vena Ilíaca/lesiones , Neoplasias/complicaciones , Enfermedades Vasculares/etiologíaRESUMEN
Splenic artery and vein aneurysm with splenic arteriovenous fistula (SAVF) is a rare entity. We report the case of a 72-year-old woman who presented with signs and symptoms of portal hypertension after a laparoscopic Nissen fundoplication. The diagnosis of a 37-mm SAVF was confirmed by a computed tomographic angiogram. The arteriovenous fistula was successfully treated with placement of a 20-mm Amplatz occlusion device. Surgical ligation and percutaneous embolization have been reported to be equally successful in managing SAVF. We present a review of the literature and report on a novel approach to this rare and challenging diagnosis.
Asunto(s)
Fístula Arteriovenosa/terapia , Procedimientos Endovasculares/instrumentación , Fundoplicación/efectos adversos , Laparoscopía/efectos adversos , Arteria Esplénica , Vena Esplénica , Lesiones del Sistema Vascular/terapia , Anciano , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/etiología , Diseño de Equipo , Femenino , Humanos , Hipertensión Portal/etiología , Arteria Esplénica/diagnóstico por imagen , Arteria Esplénica/lesiones , Vena Esplénica/diagnóstico por imagen , Vena Esplénica/lesiones , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiologíaRESUMEN
Kidney stones are a common problem for which inadequate prevention exists. We recruited ten recurrent kidney stone formers with documented calcium oxalate stones into a two phased study to assess safety and effectiveness of Cystone(®), an herbal treatment for prevention of kidney stones. The first phase was a randomized double-blinded 12 week cross over study assessing the effect of Cystone(®) vs. placebo on urinary supersaturation. The second phase was an open label one year study of Cystone(®) to determine if renal stone burden decreased, as assessed by quantitative and subjective assessment of CT. Results revealed no statistically significant effect of Cystone(®) on urinary composition short (6 weeks) or long (52 weeks) term. Average renal stone burden increased rather than decreased on Cystone(®). Therefore, this study does not support the efficacy of Cystone(®) to treat calcium oxalate stone formers. Future studies will be needed to assess effects on stone passage, or on other stone types.
Asunto(s)
Oxalato de Calcio/metabolismo , Cálculos Renales/prevención & control , Extractos Vegetales/farmacología , Vigilancia de Productos Comercializados , Orina/química , Adulto , Anciano , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placebos , Extractos Vegetales/administración & dosificación , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate image quality and dose for abdominal imaging techniques that could be used as part of a computed tomographic (CT) urographic examination: screen-film (S-F) radiography or computed radiography (CR), performed with moving and stationary grids, and CT scanned projection radiography (CT SPR). MATERIALS AND METHODS: An image quality phantom underwent imaging with moving and stationary grids with both a clinical S-F combination and CR plate. CT SPR was performed with six CT scanners at various milliampere second and kilovolt peak settings. Entrance skin exposure (ESE); spatial, contrast, and temporal resolutions; geometric accuracy; and artifacts were assessed. RESULTS: S-F or CR images, with either grid, provided image quality equivalent to that with the clinical standard, S-F with a moving grid. ESE values for both S-F and CR were 435 mR (112.2 microC/kg [1 mR = 0.258 microC/kg]) with a moving grid and 226 mR (58.3 microC/kg) with a stationary grid. All CT SPR images provided inferior spatial resolution compared with S-F or CR images. High-contrast objects generated substantial artifacts on CT SPR images. Compared with S-F, CR and CT SPR provided improved resolution of small low-contrast objects. The contrast between iodine and soft-tissue-mimicking structures on CT SPR images acquired at 80 kVp was twice that at 120 kVp. CT SPR images with acceptable noise levels required a midline ESE value of approximately 300 mR (77.4 microC/kg) at 80 kVp. CONCLUSION: S-F and CR provided better spatial resolution than did CT SPR. However, CT SPR provided improved low-contrast resolution compared with S-F, at exposures comparable to those used for S-F or CR.
Asunto(s)
Fantasmas de Imagen , Tomografía Computarizada por Rayos X , Urografía/métodos , Pantallas Intensificadoras de Rayos X , Diseño de Equipo , Humanos , Dosis de Radiación , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/métodosRESUMEN
PURPOSE: Superior vena cava (SVC) reconstructions are rarely performed; therefore the need for surveillance and the results of secondary interventions are unknown. METHODS: During a 14-year period 19 patients (11 male, 8 female; mean age 41.9 years, range 8 to 69 years) underwent SVC reconstruction for symptomatic nonmalignant disease. Causes included mediastinal fibrosis (n = 12), indwelling foreign bodies (n = 4), idiopathic thrombosis (n = 2), and antithrombin III deficiency (n = 1). Spiral saphenous vein graft (n = 14), polytetrafluoroethylene (n = 4), or human allograft (n = 1) was implanted. RESULTS: No early death or pulmonary embolism occurred. Four early graft stenoses or thromboses (spiral saphenous vein graft, n = 2, polytetrafluoroethylene, n = 2) required thrombectomy, with success in three. During a mean follow-up of 49.5 months (range, 4.7 to 137 months), 95 imaging studies were performed (average, five per patient; range, one to 10 studies). Venography detected mild or moderate graft stenosis in seven patients; two progressed to severe stenosis. Two additional grafts developed early into severe stenosis. Four of 19 grafts occluded during follow-up (two polytetrafluoroethylene, two spiral saphenous vein graft). Computed tomography failed to identify stenosis in two grafts, magnetic resonance imaging failed to confirm one stenosis and one graft occlusion, and duplex scanning was inconclusive on graft patency in 10 patients. Angioplasty was performed in all four patients with severe stenosis, with simultaneous placement of Wallstents in two. One of the Wallstents occluded at 9 months. Repeat percutaneous transluminal angioplasty was necessary in two patients, with placement of Palmaz stents in one. Only one graft occlusion and one severe graft stenosis occurred beyond 1 year. The primary, primary-assisted, and secondary patency rates were 61%, 78%, and 83% at 1 year and 53%, 70%, and 74% at 5 years, respectively. CONCLUSION: Long-term secondary patency rates justify SVC grafting for benign disease. Postoperative surveillance with contrast venography is indicated in the first year to detect graft problems. Endovascular techniques may salvage and improve the patency of SVC grafts.
Asunto(s)
Implantación de Prótesis Vascular , Oclusión de Injerto Vascular/diagnóstico , Oclusión de Injerto Vascular/terapia , Politetrafluoroetileno , Vena Safena/trasplante , Síndrome de la Vena Cava Superior/cirugía , Vena Cava Superior/cirugía , Adulto , Angioplastia de Balón , Diagnóstico por Imagen , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/epidemiología , Humanos , Masculino , Stents , Síndrome de la Vena Cava Superior/epidemiología , Trombectomía , Factores de Tiempo , Grado de Desobstrucción VascularRESUMEN
Eighty-three patients with radiographically opaque renal stones were evaluated prospectively with ultrasound and compared to KUB (kidneys, ureters, bladder) with tomograms (KUB/T) to further define the use of ultrasound in the evaluation of renal calculi. The presence or absence and the size, number, and location of stones were analyzed and correlated for each modality. Ultrasound detected the presence of renal stones in 77 of 83 (93%) patients. However, all of the stones were detected on ultrasound in only 60% of these patients. Thirty percent (80 of 269) of the papillary-calyceal stones seen on KUB/T were missed on US; 66% of the stones missed measured 2 mm or less. Although ultrasound can be used for detection of intrarenal stones, KUB/T is a more accurate imaging examination for determination of size and number of small stones.