Delayed complication of iliac artery aneurysm repair-from critical limb ischemia to mixed shock: a case report.

Background: Iliac artery aneurysms (IAA) can exist in isolation or in combination abdominal aortic aneurysmal disease. Isolated IAA are rare, often asymptomatic and will present with compression of local structures or incidentally on imaging. Treatment depends on symptomology and size.

Percutaneous management of benign biliary strictures.

The interventional radiologist plays an increasing role in the management of patients with benign biliary disease. This article summarizes the percutaneous management of patients with benign biliary strictures and includes a discussion of currently available techniques. The techniques of percutaneous transhepatic cholangiography and biliary drainage will be reviewed.

Family functioning of recovered alcohol-addicted patients: a comparative study.

Regaining the communication, concentration on role conflicts and strengthening of emotional ties are the central issues of socio-therapeutic approach to alcoholism. The aim of the present cross-sectional study was to compare family functioning between two groups of recovered alcohol-addicted patients. They were all participants of treatment program where complex therapeutic interventions were used, and were abstaining for at least 1 year.

Rapid parathyroid hormone measurement during venous localization.

The development of a rapid format for intact parathyroid hormone (PTH) immunometric assays has facilitated the use of these assays intraoperatively as a guide to parathyroid surgery. The near real-time characteristics of this rapid PTH assay led us to evaluate its utility in the angiography suite in a patient who underwent venous localization for persistent primary hyperparathyroidism. The assay provided the angiographers with almost immediate feedback and thereby facilitated accurate parathyroid adenoma localization.

Fenestration of extracardiac fontan and reversal of protein-losing enteropathy: case report.

We describe a patient with protein-losing enteropathy who presented 6 months after undergoing a modified Fontan operation. After failing to respond to medical therapy, the Fontan tunnel was fenestrated by catheter intervention with immediate improvement and resolution of hypoproteinemia and enteric protein loss.

Portal venous system thrombosis: helical CT angiography before transjugular intrahepatic portosystemic shunt creation.

Purpose: To evaluate the utility of helical computed tomographic (CT) angiography for depiction of thrombi in the portal venous system in patients under consideration for transjugular intrahepatic portosystemic shunt (TIPS) creation.

Materials And Methods: Contrast material-enhanced helical CT was performed before TIPS creation in 25 patients. Axial, multiplanar, and three-dimensional images were evaluated to determine whether thrombus was present in the portal system and whether TIPS creation was contraindicated.

Guide wire directed manipulation of malfunctioning peritoneal dialysis catheters: a critical analysis.

Purpose: To evaluate patency rates after guide wire directed manipulation of malfunctioning continuous ambulatory peritoneal dialysis (CAPD) catheters.

Materials And Methods: During a 58-month period, 23 patients underwent 34 outpatient guide wire directed manipulations of their CAPD catheter to improve function (n = 30) or reduce pain and improve function (n = 4) during dialysis. Catheter patency rates were subsequently determined by review of departmental, hospital, and dialysis center charts; procedural reports; and patient telephone interviews.

Influence of prognostic groupings and treatment results in the management of unresectable hepatoma: experience with Cisplatinum-based chemoradiotherapy in 76 patients.

Purpose: Internationally, hepatoma is a common cause of cancer death. Although the only curative therapy is surgical, most tumors are unresectable and cause death. The value of nonsurgical, antineoplastic therapy for such tumors is controversial.

Major bile duct injuries during laparoscopic cholecystectomy. Follow-up after combined surgical and radiologic management.

Objective: The authors provide the results of follow-up evaluation after combined surgical and radiologic management of 89 patients with major bile duct injuries during laparoscopic cholecystectomy.

Summary Background Data: The incidence and mechanism of injury of major bile duct injuries during laparoscopic cholecystectomy has been clearly defined. Furthermore, a number of series have described the management of these injuries by surgical, endoscopic, and radiologic techniques with excellent short-term results.

Volumetric evaluation of blood flow in normal renal arteries with a Doppler flow wire: a feasibility study.

Purpose: To evaluate the feasibility of direct intravascular determination of renal artery (RA) blood flow with a Doppler probetipped guide wire.

Materials And Methods: Potential renal donors (n = 10) with normal RAs (n = 23) underwent evaluation of RA blood flow velocity with use of a 0.018-inch, 12-MHz Doppler guide wire.

Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster.

Objective: This study was designed to evaluate the total costs associated with repair of laparoscopic cholecystectomy (LC)-related bile duct injuries.

Summary Background Data: The popularity of LC with both patients and surgeons is such that this procedure now exceeds open cholecystectomy by a ratio of approximately 4 to 10:1. However, costs associated with LC-related injuries, particularly regarding treatment patterns, have up to now not been explored fully.

Intraductal biliary biopsy: comparison of three techniques.

Purpose: To compare the results obtained with three different techniques for percutaneous transhepatic intraductal biopsy.

Materials And Methods: Eighty-eight patients with obstructive jaundice underwent placement of percutaneous biliary drainage catheters for biliary decompression. As part of the initial procedure or at a subsequent date, intraductal biliary biopsy (n = 109) was performed with use of one or more of three techniques including cytologic brush (n = 53), clamshell forceps under choledochoscopic guidance (n = 31), and clamshell forceps under fluoroscopic guidance (n = 25).

In situ formation of a loop snare for retrieval of a foreign body without a free end.

A technique is described that allowed percutaneous retrieval of an endoscopically placed, obstructed biliary stent using loop snare capture of an angled hydrophilic wire which was wrapped around the stent initially.

Pyogenic hepatic abscess. Changing trends over 42 years.

Objective: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades.

Summary Background Data: Pyogenic hepatic abscess is a highly lethal problem. Over the past 2 decades, new roentgenographic methods, such as ultrasound, computed tomographic scanning, direct cholangiography, guided aspiration, and percutaneous drainage, have altered both the diagnosis and treatment of these patients.

Outcome of tunneled hemodialysis catheters placed by radiologists.

Purpose: To compare the outcomes of hemodialysis catheters placed by interventional radiologists with those placed by surgeons.

Materials And Methods: The outcomes were retrospectively analyzed of 237 hemodialysis catheters placed in 140 patients by a radiology service from January 1991 through December 1992. Follow-up data were available for 222 catheters (94%).

Percutaneous jejunostomy replacement in patients who have undergone esophagectomy.

Purpose: The authors expand their experience with a technique for the percutaneous replacement of a feeding jejunostomy tube in patients who have undergone esophagectomy, in which markers placed during the initial surgical jejunostomy are used.

Patients And Methods: During esophagectomy in eight patients, a loop of jejunum was intubated with a surgical jejunostomy tube. This loop was then fixed to the anterior abdominal wall and marked with metal clips.

Subcutaneously tethered temporary filter: pathologic effects in swine.

Purpose: To evaluate the histopathologic effects of the Tempo-filter, a temporary caval filter, on the caval wall and determine the feasibility of deployment and removal of the device in swine.

Materials And Methods: Filters were placed in the infrarenal inferior vena cava of 11 swine. The tethering catheter was sutured in a subcutaneous pocket near the puncture site.

Percutaneous transluminal atherectomy of the superficial femoral and popliteal arteries: long-term results in 48 patients.

Purpose: Evaluate retrospectively the long-term primary patency of directional atherectomy (DA) in the femoropopliteal arteries.

Materials And Methods: DA was used alone in 59 patients (47%) or in combination with predilatation to allow passage of the device (43%) or after thrombolysis (10%) to treat 127 (93%) excentric atherosclerotic stenoses and nine (7%) occlusions of the femoropopliteal arteries. Forty-eight patients were followed by telephone interview, scheduled outpatient visits, color-flow Doppler evaluation, and angiography for 1-36 months (mean 16.

Biliary manometry versus clinical trial: value as predictors of success after treatment of biliary tract strictures.

Purpose: To evaluate the biliary manometric-perfusion test (BMPT) and clinical trial as predictors of long-term success after percutaneous and surgical treatment of biliary tract strictures.

Patients And Methods: After percutaneous intervention or surgical repair of extrahepatic bile duct strictures, 43 patients underwent long-term biliary intubation (mean, 13 months) with 61 internal-external stents. Before removal of the stents, all 43 patients underwent a BMPT (n = 65) and 24 underwent a 2-3-week clinical trial (n = 27) with stents positioned above the treated region.

Selective vascular embolization in benign gynecologic conditions.

Eight patients with benign obstetric and gynecologic conditions required embolization. There was a total of 11 embolizations, and embolizing agents were chosen depending on the abnormality requiring embolization. Gelfoam, Ivalon and alcohol were used to treat vascular malformations.

Thrombosed dialysis access grafts: percutaneous mechanical declotting without urokinase.

Purpose: To evaluate percutaneous declotting of dialysis access grafts with available catheters without urokinase.

Materials And Methods: Thirty-four clotted grafts were treated in 24 patients. Clot was macerated and pushed into the central circulation with balloon catheters.

Intrahepatic stones. The transhepatic team approach.

Objective: The authors reviewed the combined interventional radiologic and surgical management of 54 patients with intrahepatic stones at the Johns Hopkins Hospital. The team approach used large-bore transhepatic stents to access the intrahepatic ducts until they were stone free.

Summary Background Data: Intrahepatic stones are uncommon in western countries.

Repeat dilation of Palmaz stents in pulmonary arteries: study of safety and effectiveness in a growing animal model.

Purpose: This study assessed the technical feasibility and safety of repeat dilation of Palmaz stents in growing pulmonary arteries.

Materials And Methods: Palmaz stents (1.2 cm long) were placed percutaneously into the pulmonary arteries of 20 newborn lambs.

Percutaneous varicocele occlusion: long-term follow-up.

Purpose: The authors summarize their 11-year experience with percutaneous varicocele occlusion at the Johns Hopkins Hospital.

Patients And Methods: Data were obtained from the patients' medical records and from a mailed questionnaire. Most of the data analysis is based on the 182 patients who responded to the questionnaire.