Elevated levels of endothelin-1 in hepatic venous blood are associated with intrapulmonary vasodilatation in humans.

Background: Hepatopulmonary syndrome is a pulmonary vascular complication of cirrhosis in which intrapulmonary vasodilatation (IPV) results in hypoxemia. Endothelin-1 (ET-1), produced by proliferating cholangiocytes, has been identified as a mediator of IPV in an animal model of HPS, but the pathophysiology of IPV in humans has not been defined.

Aim: The purpose of this study was to assess whether cirrhosis with IPV, which often leads to HPS, is associated with increased hepatic venous ET-1 blood levels.

Angiographic and histologic comparison of injectable, expansile hydrogel embolic and pushable AZUR embolic devices in porcine arteries.

Purpose: To compare an injectable hydrogel embolic device with a pushable AZUR device procedurally, angiographically, and histologically in the embolization of porcine arteries.

Materials And Methods: In 12 pigs, embolization of renal, gluteal, and hepatic or thoracic arteries was performed with either injectable hydrogel embolic devices (two arteries per pig) or an AZUR device (one artery per pig). Follow-up angiography was performed before sacrifice in five pigs at 7 days after embolization and seven pigs at 90 days after embolization.

Locoregional therapy for hepatocellular carcinoma.

Locoregional therapies for hepatocellular carcinoma have progressed greatly in the last 30 years, beginning with the introduction of chemoembolization. Embolization techniques have evolved with the use of drug-eluting beads and radioembolization with yttrium-90. In the last 10 years, several new ablation techniques were developed including radiofrequency ablation, microwave ablation, cryoablation, laser ablation, and irreversible electroporation.

Percutaneous transhepatic islet cell autotransplantation after pancreatectomy for chronic pancreatitis: a novel approach.

Background: In selected patients with chronic pancreatitis, extensive pancreatectomy can be effective for the treatment of intractable pain. The resultant morbid diabetes can be ameliorated with islet autotransplantation (IAT). Conventionally, islet infusion occurs intraoperatively after islet processing.

Predictive factors for the development of type II endoleaks.

Purpose: To define predictive factors for endoleak type II (EL-II) based on quantifiable factors in the imaging studies of patients undergoing endovascular aneurysm repair (EVAR).

Methods: The data on 208 consecutive patients (137 men; mean age 75.2 years, range 62-84) who underwent EVAR between the years 2003 and 2008 were retrospectively reviewed.

The rise and fall of arterial interventions: presentations at the Society of Interventional Radiology annual scientific meeting.

Purpose: To address hypotheses concerning a decline in presentations pertaining to vascular interventions by interventional radiologists and the loss of ground in other areas, such as oncology, of presentations in vascular interventions at the Society of Interventional Radiology (SIR) Annual Scientific Meeting.

Materials And Methods: All abstracts for scientific presentations and scientific exhibits from the program book of the SIR annual meeting were reviewed from the period 1996-2006. The abstracts were grouped in different classes, such as (a) type of methodology, (b) reports on arterial interventions, (c) reports on oncologic interventions, and (d) geographic origin.

Successful recanalization of bile duct occlusion with a radiofrequency puncture wire technique.

A radiofrequency (RF) wire puncture technique was used in the recanalization of biliary anastomotic occlusions in five patients. The technical success of recanalization, which was defined as successful puncture and crossing of the obstruction followed by balloon cholangioplasty and internal-external biliary drainage without evidence of complications, was 100%. The average follow-up was 13 months (range, 11-16 months).

Normal renal arterial anatomy assessed by multidetector CT angiography: are there differences between men and women?

The purpose of this study was to determine renal arterial anatomy and gender differences in adults without renovascular disease using multidetector computed tomography angiography (MDCTA). MDCTA datasets of 399 patients were retrospectively reviewed. Measurements of the aortorenal diameters, the angulation of the renal ostia and pedicles as well as the distance between the origins of the renal arteries were measured.

Clinical experience with a customized fenestrated endograft for juxtarenal abdominal aortic aneurysm repair.

Despite the numerous stent-graft devices available, unsuitable anatomy is still the greatest exclusion criterion for endovascular abdominal aortic aneurysm (AAA) repair (EVAR). The present report describes an on-site preprocedural customization of a conventional Zenith stent-graft device just before the endovascular procedure that includes the creation of fenestrations and scallops as necessary for the patient's anatomy. Three patients with difficult anatomy in whom conventional AAA repair posed a high degree of risk were treated with customization of the stent-graft device to fit disparate renal arteries.

Stent-graft treatment of pseudoaneurysms and arteriovenous fistulae in the carotid artery.

The purpose of this study was to assess the safety and efficacy of stent-graft placement in the management of arteriovenous fistulae (AVF) and pseudoaneurysms (PAs) involving the carotid artery (CA). Twenty-two patients (16 men, 6 women) with a CA AVF (n = 5) or PA (n = 17) owing to a gunshot or stab wound, carotid endarterectomy, blunt trauma, a tumor, spontaneous dissection, or a central venous catheter were treated with percutaneous placement of stent grafts. The patients presented with tumor, bruit, headache, mouth and tracheostomy bleeding, transitory hemiparesis, seizure, or stroke.

Comparative results of Doppler sonography after TIPS using covered and bare stents.

Objective: Our purpose was to evaluate the role of sonography in the early follow-up of patients with a covered transjugular intrahepatic portosystemic shunt (TIPS).

Conclusion: Routine baseline Doppler sonography should occur 7-14 days after shunt placement unless malfunction or procedural complications are suspected.

Stent migration complicating treatment of inferior vena cava stenosis after orthotopic liver transplantation.

A case of inferior vena cava (IVC) stenosis after orthotopic liver transplantation was treated with balloon angioplasty and Wallstent placement. There was stent migration into the right atrium (RA), and percutaneous removal of the stent was attempted without success. Open cardiac surgery was required for stent removal and repair of aortic/RA fistula.

Isolated right segmental hepatic duct injury following laparoscopic cholecystectomy.

Purpose: Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis.

Anatomic relationship of the internal jugular vein and the common carotid artery applied to percutaneous transjugular procedures.

Purpose: To demonstrate the anatomic relationship of the internal jugular vein (IJV) with the common carotid artery (CCA) in order to avoid inadvertent puncture of the CCA during percutaneous central venous access or transjugular interventional procedures.

Methods: One hundred and eighty-eight consecutive patients requiring either central venous access or interventional procedures via the IJV were included in the analysis. The position of the IJV in relation to the CCA was demonstrated by portable ultrasonography.

Thrombosed dialysis access grafts: randomized comparison of the Amplatz thrombectomy device and surgical thromboembolectomy.

We report the final results of the trial comparing the Amplatz thrombectomy device (ATD) with surgical thromboembolectomy (ST) to declot thrombosed dialysis access grafts (DAG). The study population consisted of 174 DAG, 109 of which were randomized to mechanical thrombectomy using the ATD and 65 of which were randomized to conventional surgical thromboembolectomy. Forty grafts were re-enrolled in the trial when they failed beyond the 90 days follow-up after the initial treatment.

Angiographic findings in biliary atresia.

We present the angiographic findings of 46 patients with biliary atresia (BA). There were 25 males and 21 females, with a mean age of 22.5 months (range - 1.

Applications of percutaneous mechanical thrombectomy in transjugular intrahepatic portosystemic shunt and portal vein thrombosis.

Portal vein thrombosis (PVT) is an uncommon cause for presinusoidal portal hypertension. PVT can be caused by one of three broad mechanisms: (1) spontaneous thrombosis when thrombosis develops in the absence of mechanical obstruction, usually in the presence of inherited or acquired hypercoagulable states; (2) intrinsic mechanical obstruction because of vascular injury and scarring or invasion by an intrahepatic or adjacent tumor; or (3) extrinsic constriction by adjacent tumor, lymphadenopathy or inflammatory process. Usually, several combined factors are necessary to result in PVT.

Stent graft infection after abdominal aortic aneurysm repair: a case report.

A 77-year-old man had clinical and radiologic signs of graft infection develop 1 year after stent grafting for abdominal aortic aneurysm. Blood cultures grew Bacteroides fragilis, and cultures of the aneurysm sac grew Enterococcus. The patient's condition was successfully managed with staged extraanatomic revascularization followed by graft excision.

Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation.

Purpose: To review some aspects of the problem of splenic artery steal syndrome as cause of ischemia in transplanted livers and treatment by selective splenic artery occlusion.

Materials And Methods: Eleven liver transplant patients from a group of 350 patients, nine men and two women, ranging in age from 40 years to 61 years (mean 52 years), presented with biochemical evidences of liver ischemia and failure, ranging from one to 60 days following orthotopic liver transplantation. Diagnosis of splenic artery steal syndrome was suspected by elevated enzymes, Doppler ultrasound and confirmed by celiac angiogram.