Percutaneous recanalization of peripheral arterial occlusions.

The aim of this paper is to summarize the current status of percutaneous methods for recanalizing peripheral arterial occlusions. Emphasis is placed on the role of peripheral intraarterial thrombolysis (PIAT) in the treatment of acute lower limb ischemia. Results of three prospective, randomized trials comparing PIAT with surgical revascularization are analyzed in the context of the existing, largely retrospective literature.

Polyarteritis with symptomatic intracerebral aneurysms at initial presentation.

Polyarteritis rarely involves the cerebral vasculature, and has not been reported to have an initial presentation with intracerebral aneurysms. We describe the first case of polyarteritis presenting with symptomatic intracerebral aneurysms. A literature review from 1966 to 1997 identified 5 additional cases with evidence of intracerebral aneurysms and polyarteritis.

Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.

Objective: This study examines the anatomic distribution of emboli on pulmonary angiography and attempts to determine the relationship of vessel size to interobserver agreement, two factors having important implications in comparing pulmonary angiography with cross-sectional imaging for pulmonary embolism.

Materials And Methods: One hundred twenty-five consecutive pulmonary angiograms were reviewed retrospectively by three interventional radiologists. Initial interpretations were recorded and compared to determine interobserver agreement on a per-patient and per-embolus basis.

Single institution prospective evaluation of the over-the-wire Greenfield vena caval filter.

Purpose: To assess the technical and clinical success of the over-the-wire (OTW) Greenfield inferior vena caval (IVC) filter.

Materials And Methods: Prospective evaluation of the OTW Greenfield filter in 47 patients was performed during the course of 18 months. Technical success and deployment problems were documented.

The role of infrapopliteal MR angiography in patients undergoing optimal contrast angiography for chronic limb-threatening ischemia.

Purpose: To determine the benefit of infrapopliteal magnetic resonance angiography (MRA) in patients with chronic limb-threatening ischemia who have undergone optimal contrast angiography (CA).

Patients And Methods: Thirty-four patients (37 limbs) with limb-threatening chronic lower extremity ischemia underwent MRA and CA of the symptomatic extremity. Selective, vasodilator-enhanced digital subtraction angiography of the infrapopliteal vessels was possible for 34 limbs.

MR angiography of the portal venous system: techniques, interpretation, and clinical applications.

Magnetic resonance (MR) angiography is a noninvasive means of assessing the portal venous system that has potential advantages over currently used modalities. Time-of-flight and phase-contrast MR angiography are useful techniques that differ fundamentally in their means of data acquisition but are comparable in their ability to demonstrate normal anatomy as well as abnormalities of the portal venous system. Occasionally, artifacts caused by respiratory motion, implanted metallic devices or surgical clips, in-plane saturation, or areas of complex flow are seen at MR angiography of the portal venous system.

Time-of-flight MR arteriography of below-knee arteries with maximum-intensity-projection reconstruction: is interpretation of the axial source images helpful?

Objective: We evaluated the extent to which detailed review of axial source images enhances the interpretation of projectional reconstructions of two-dimensional time-of-flight MR arteriograms of the tibial vessels.

Subjects And Methods: Thirty-one patients (34 limbs) with limb-threatening ischemia underwent two-dimensional time-of-flight imaging and contrast-enhanced angiography of the below-knee arteries. Maximum-intensity-projection (MIP) reconstructions of the MR arteriograms were independently interpreted by three observers.

Transjugular portosystemic shunts in pediatric patients awaiting liver transplantation.

Three pediatric patients from 6 to 11 years of age awaiting liver transplantation for end stage liver disease underwent transjugular intrahepatic portosystemic shunt (TIPS) placement for control of variceal bleeding. Two of the three procedures were performed emergently after endoscopic sclerotherapy failed to stop active bleeding. One procedure was performed electively after multiple prior bleeding episodes.

Assessment of peripheral intraarterial thrombolysis versus surgical revascularization in acute lower-limb ischemia: a review of limb-salvage and mortality statistics.

Purpose: To review the risks and benefits of using peripheral intraarterial thrombolysis (PIAT) versus surgical revascularization (SR) as the initial treatment of acute lower-limb ischemia (ALLI).

Materials And Methods: Two prospective, randomized trials that compared PIAT with SR in the treatment of ALLI were analyzed along with recent large, retrospective studies. Overall, 1,051 SR cases and 895 PIAT cases were included; when possible, the ischemic events were further categorized as acute, chronic, embolic, or thrombotic.