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.

Impact of stent design on the outcome of intervention for carotid bifurcation stenosis.

Over the past several years, there has been continued significant interest in refinement of patient selection, devices, procedures and protocols in an effort to optimize the outcome of percutaneous intervention for carotid bifurcation stenosis, including: ongoing National Institutes of Health and manufacturer trials and registries; the further refinement of existing devices and emergence of new platforms to attain distal embolic protection; ongoing study of what really constitutes a high-risk carotid surgery or stenting patient; and attention to device characteristics and patient-device matching. Within the latter area, considerable interest has focused on stent characteristics that have the potential to impact short and long-term outcome when compared with other stent design strategies when studied in large series. The stent in carotid artery intervention occupies a unique role in that after the embolic protection system has been removed, it is the main line of defense (in concert with aggressive dual antiplatelet therapy) from embolic and thromboembolic complications that may arise from the newly remodeled plaque after post-stent angioplasty.

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.

Interim report of the SENTIS trial: cerebral perfusion augmentation via partial aortic occlusion in acute ischemic stroke.

Aim: The aim of this paper was to present the interim results of the the Safety and Efficacy of NeuroFlo Technology in Ischemic Stroke (SENTIS) trial.

Methods: The SENTIS study is a phase III, multi-center randomized prospective study to evaluate cerebral perfusion augmentation with partial aortic occlusion in acute ischemic stroke. The trial was designed to compare conventional management of stroke patients with stroke patients treated by partial occlusion of the abdominal aorta by the NeuroFlo device.

Use of percutaneous closure devices in the removal of central venous catheters from inadvertent arterial catheterizations.

Although rare, misplacement of central venous catheters in supra-aortic arteries is potentially fatal. Five patients had safe catheters removal using percutaneous closure devices. Three patients were coagulopathic, 3 under intensive care and 1 in immediate postoperative limb amputation.

Percutaneous interventions for pulmonary embolism.

Venous thromboembolism and pulmonary embolism (PE) is the third most common cardiovascular disease and a leading cause of death in the US. There are many risk factors related to PE. Traditional treatments are anticoagulation, systemic thrombolysis, and surgical thrombectomy.

Stent-graft treatment of trauma to the supra-aortic arteries. A review.

Trauma to the carotid, subclavian, vertebral, or innominate arteries may be blunt or penetrating. Some injuries, such as those caused by central venous catheterization, are iatrogenic. Trauma-induced fistulas and pseudoaneurysms of the supra-aortic arteries are relatively rare, but may result in disabling neurologic symptoms or death.

How to optimize carotid artery stenting.

Carotid angioplasty and stenting is now an alternative to surgical endarterectomy to treat carotid occlusive disease and is becoming mainstream in medical practice. However, the information available, the procedure techniques and the technologies are still evolving and several issues are still being discussed. Mandatory training, familiarity with the indications and contraindications, knowledge of the technology and devices are paramount for the success, however, the devices for carotid stenting are still under development.

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.

Filling of the aneurysmal sac with DEAC-glucosamine in an animal model of abdominal aortic aneurysm following stent-graft repair.

Aim: The aim of this study was to present the preliminary results of a technique of abdominal aortic aneurysm (AAA) sac filling in an attempt to obliterate the sac in a swine AAA model, using deacetylated-poly-N-acetyl glucosamine (DEAC-poly-N-acetyl glucosamine).

Methods: Eleven Yucatan pigs, 6 months of age, 40 kg -60 kg, were used to create an AAA with a Dacron pouch implanted surgically and left to mature for 2 weeks. One animal was used to establish the AAA creation procedures.

Is there evidence that cerebral protection is beneficial? Clinical data.

Advances in angioplasty techniques and the development of low-profile, flexible, tapered nitinol stents designed specifically for carotid applications have made carotid artery stenting a viable alternative to carotid endarterectomy for treatment of occlusive disease of the carotid arteries. During the stenting process, however, debris may be released and cause distal embolization that can lead to stroke or death. Thus, several embolic protection devices have been developed for use in carotid stenting, two of which are available in the United States.

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.

Techniques for carotid artery stenting under cerebral protection.

Carotid angioplasty and stenting is an alternative to carotid endarterectomy in the treatment of carotid artery stenosis. During the stenting process, however, distal embolization usually occurs, and the particles released may cause neurologic problems or death. Thus, the safety of carotid stenting depends partly on use of a cerebral protection device during the procedure.