[Show abstract][Hide abstract] ABSTRACT: Purpose:
We report on the endovascular management of hemorrhage with stent-graft due to a misplaced central venous catheter in the vertebral artery (VA) during percutaneous internal jugular vein catheterization in a child.
A 16-year-old female was presented with the diagnosis of familial Mediterranean fever related chronic renal insufficiency. An attempt was made to place a central venous catheter via the right internal jugular vein without image guidance and the patient experienced dyspnea and pain at the catheter insertion site. Computerized tomography (CT) showed hemorrhage in the cervical region and upper mediastinum, also reformatted images showed that the catheter was passing through the proximal part of the VA and terminating in the right mediastinum. The catheter was removed during manual compression under angio-flouroscopic monitoring and ongoing extravasation was observed. A stent-graft was placed to the bleeding site of the VA.
Angiography immediately after the stent-graft placement revealed complete disappearance of extravasation and patency of vertebral and subclavian arteries.
Central venous catheterization (CVC) is not a risk-free procedure and arterial injuries are in a wide spectrum from a simple puncture to rupture of the artery. Inadvertent VA cannulation is a rare and serious complication necessitating prompt diagnosis and early treatment. If an arterial injury with a large-caliber catheter occurs, endovascular treatment with stent-graft seems to be a safe and effective option in terms of achieving hemostasis and preserving arterial patency. Recent findings suggest that endovascular management of inadvertent cervical arterial injury secondary to CVC seems to be the safest strategy.
The journal of vascular access 07/2014; DOI:10.5301/jva.5000267 · 0.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: Our aim was to assess the effect of adaptive statistical iterative reconstruction (ASIR) on pediatric head computed tomography (CT) examinations. METHODS: We retrospectively reviewed 305 pediatric head CT examinations. The study population consisted of standard dose (STD, n = 152) examinations reconstructed with filtered back projection and low dose (LD, n = 153) examinations reconstructed with 30% (LD30) and 0% (LD0) ASIR. We compared groups by means of radiation dose, noise measures, and visual grading. Student t test, 1-way analysis of variance test, and Mann-Whitney U test were used for statistical analysis. RESULTS: The dose in the LD30 group was significantly lower (29%) than that in the STD group (P < 0.001). The noise in the white matter (P < 0.001), SNR (P < 0.001), and subjective image noise (P = 0.044) was significantly better in the STD group than those in the LD30 group. There was no significant difference between LD30 and STD groups in the sharpness (P = 0.141), diagnostic acceptability (P = 0.079), and artifacts (P = 0.750) and contrast-to-noise ratio (P = 0.718). CONCLUSIONS: In conclusion, we found that a blend of 30% ASIR in a 16-slice multidetector CT produces diagnostically acceptable pediatric head CT examinations with a 29% less dose.
[Show abstract][Hide abstract] ABSTRACT: The patients who undergo neurosurgical procedures are at high risk for perioperative deep vein thrombosis and pulmonary embolism. Pharmacological prophylaxis with mechanic prophylaxis is a safe and effective way of preventing deep vein thrombosis and pulmonary thromboembolism in neurosurgery. However, pharmacological prophylaxis may increase the risk of hemorrhage after cranial or spinal operations.
Patients with vena cava inferior filter were retrospectively examined between 2003 and 2010.
Approximately 1600 patients per year are operated in our clinic. Deep vein thrombosis incidence is % 1.2 - 2.3 in our department. Vena cava inferior filter is used on 13 patients who operated for various diagnoses, during the 2003 - 2010 period. None of these patients had new pulmonary thromboembolism after inserting vena cava inferior filter but two of them died cause of initial respiratory distress.
We think that vena cava inferior filter in is safe and effective method for pulmonary thromboembolism prophylaxis, especially for patients with high bleeding risk and who cannot be anticoagulated. Further prospective studies with larger series are needed for evaluating long term complications and benefits.
[Show abstract][Hide abstract] ABSTRACT: Most imaging techniques used for the evaluation of obstructive epiphora, such as DS DCG, rely on undesired ionizing radiation. We evaluated the efficacy of topical contrast-enhanced MR DCG in comparison with DS DCG in patients with obstructive epiphora who underwent balloon DCG or stent placement.
Thirty-six LDSs of 21 patients treated with balloon DCG (n = 11) or stent placement (n = 11) were examined with MR DCG and DS DCG. Contralateral LDSs (n = 14) were also evaluated in patients with unilateral disease. A sterile 0.9% NaCl solution containing 1:100 diluted gadolinium chelate was instilled into conjunctival sacs. The 3D FSPGR sequence was used with a 1.5T scanner. MR and DS DCG findings were scored and compared according to morphology of the lacrimal sac, junction, and NLD and the presence of contrast media in the nasal cavity.
Comparison of MR DCG and DS DCG findings showed no significant statistical differences in reference to anatomic locations according to the McNemar test (P > .05). Good or very good agreement (κ value > 0.61) was observed according to the κ statistics.
Topical contrast-enhanced MR DCG is an effective and reliable noninvasive method for evaluation of the LDS in patients treated with IR procedures. This method avoids both cannulation and ionizing radiation and can, therefore, be repeated as often as is necessary in these complex patients.
American Journal of Neuroradiology 12/2011; 33(1):141-7. DOI:10.3174/ajnr.A2889 · 3.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While CT has found wide use in medical practice, it is also a substantial source of radiation exposure and is associated with an increased lifetime risk of cancer. There is an urgent need for new approaches to reduce the radiation dose in CT. In this regard, ASIR is an alternative method to FBP. We assessed the effect of ASIR on dose reduction in adult head CT.
We retrospectively evaluated a sample of 149 adult head CT examinations that were divided into 2 groups, STD and LD. We lowered the tube current and used ASIR in the LD group. SNR and CNR were analyzed. Dose parameters were recorded while subjective image noise, sharpness, diagnostic acceptability, and artifacts were graded. The Student t test, the Mann-Whitney U test, and κ statistics were used for statistical analyses.
We achieved a dose reduction of 31% in the LD group (STD, 2.3 ± 0.1 mSv; LD, 1.6 ± 0.1 mSv; P < .001). There was no significant difference in the noise measured in the air between the 2 comparison groups (P = .273). Noise in the CSF was higher in the STD group (P < .001), while the noise in the WM was higher in the LD group (P < .001). Differences in the CNR between groups were insignificant, but the STD group displayed better SNR values. There was no significant difference in the modal scores of diagnostic acceptability (P = .062) and the artifacts (P = .148) between the 2 groups. Better scores for subjective image noise (P < .001) and sharpness (P = .04) were observed in the STD group.
ASIR appears to be useful in reducing the dose in adult head CT examinations. While the effect of ASIR on noise reduction observed in the present study of head CT is less than that reported previously in abdomen and chest CT, these findings encourage further prospective studies in larger patient samples.
American Journal of Neuroradiology 08/2011; 32(9):1578-82. DOI:10.3174/ajnr.A2585 · 3.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 44 year old male was admitted to hospital with chest pain. Complex coronary artery fistula drained into pulmonary artery was depicted but not clearly demonstrated with conventional angiography despite various projections. CT angiography was demonstrated that the fistula was fed by both left anterior descending (LAD) and right coronary artery (RCA) branches. A feeder aneurysm was found on a LAD branch. The fistula was associated with RCA and LAD artery via small caliber vessel web which was also associated with right ventricular outlet. 64-MDCT is superior to catheter angiography in its capability to demonstrate beyond the lumen of coronary arteries and extra-anatomical structures like fistulas.
European Journal of Radiology Extra 04/2011; DOI:10.1016/j.ejrex.2011.01.004
[Show abstract][Hide abstract] ABSTRACT: Coronary artery fistulae are very rare congenital anomalies which constitute 0.2-0.4% of all congenital heart diseases. The right chambers of the heart are the most frequent communication site of the coronary fistulae and may cause hemodynamic impairment in the coronary circulation. The fistulae arise frequently from right coronary and left anterior descending arteries. Fistulae from left circumflex artery are very rare. We report a case in which transcatheter embolization was performed with 3-mm Guglielmi detachable coils in a young adult with a rare type of congenital fistula originating from the circumflex artery and draining into the coronary sinus.
Journal of Cardiology 10/2009; 54(2):317-21. DOI:10.1016/j.jjcc.2008.12.009 · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Endothelin-1 (ET-1) has been implicated in the pathophysiology of cerebral vasospasm. Chloride (Cl-) channels exist in vascular smooth muscle and activation of these channels leads to depolarization and contraction. The aim of the present study was to test the effect of 5-nitro-2-(3-phenylpropylamino)-benzoate (NPPB), a Cl- channel antagonist, on the ET-1-induced cerebral vasospasm in rabbit basilar artery and thus investigate the contribution of Cl- channels.
Thirty rabbits were divided into five groups and received intra-arterial injection of isotonic saline (Group I, n=6), ET-1 (group II, n=6), ET-1 plus NPPB (Group III, n=6), dimethylsulfate (DMSO4) (Group IV, n = 6) and NPPB (Group V, n=6). Pre and post injection basilar artery diameters were measured in each group and transmission electron microscopic investigations on basilar arteries were performed.
The mean pre-injection and post-injection vessel diameters were 0.8833 mm and 0.7000 mm in ET-1 group, 0.6833 mm and 0.8500 mm in ET-1 + NPPB group. NPPB administered prior to ET-1 injection, prevented the ET-1-induced vasoconstriction. Additionally, NPPB prevents the ET-1 induced changes in vessel wall and neurons in the brain stem.
The results of this study add further insights to our armamentarium against cerebral vasospasm.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the long-term patency of lacrimal drainage system (LDS) after balloon dacryocystoplasty (BD) and to give the long-term success rates according to the severity and localization of the obstruction.
Between May 1993 and December 2003, BD was attempted in 117 eyes of 108 patients with idiopathic-acquired LDS obstruction. Patients with active dacryocystitis, dacryolithiasis, traumatic obstruction or lacrimal mass, obstructions at the superior or inferior canaliculi lateral to the common canaliculus, and follow-up period less than 36 months were excluded from the study.
The results of BD were evaluated in 99 eyes of 94 cases. The obstruction was seen at the common canaliculus in seven eyes, proximal nasolacrimal duct in 70 eyes, and distal nasolacrimal duct in 22 eyes. The mean follow-up period was 100.0+/-38.4 months (range: 36-142 months). The long-term overall success rate was 40.8% (20/49 eyes) in complete obstruction and 68% (34/50 eyes) in partial obstruction. The clinical success rate was 57.1% in common canalicular (complete: 33.3%, partial: 75%), 50% in proximal nasolacrimal duct (complete: 38.5%, partial: 64.5%), and 68.2% in distal nasolacrimal duct (complete: 57.1%, partial: 73.3%) obstructions. The overall success was 54.5% (54/99 eyes) for the entire series at the last clinical follow-up visit.
The long-tem success rate of BD for the treatment of epiphora is low and is not comparable to conventional dacryocystorhinostomy. More predictable results can only be achieved in carefully selected patients and this procedure can be recommended in cases demonstrating partial obstruction of the distal nasolacrimal duct.
[Show abstract][Hide abstract] ABSTRACT: We report a case of an iatrogenic femoral arteriovenous fistula (AVF) in a 67-year-old man presenting with right femoral bruit on the day after sheath removal for cardiac catheterization. This was successfully treated with embolization using N-butyl-cynoacrylate (NBCA) through a coaxial microcatheter. Transcatheter embolization of iatrogenic femoral AVFs with NBCA in selected cases may be a safe and effective treatment in the presence of long fistula tracts. It is then easy to perform in experienced hands and relatively inexpensive.
[Show abstract][Hide abstract] ABSTRACT: The present study was designed to evaluate angiotensinogen (AGT) M235T and plasminogen activator inhibitor-1 (PAI-1) (4G/5G) polymorphisims in relation to the occurrence of atherosclerotic renal artery stenosis (ARAS) and recurrent stenosis. In this study, 30 patients were enrolled after angiographic demonstration of ARAS; 100 healthy subjects for AGT polymorphism and 80 healthy subjects for PAI-1 polymorphism were considered the control group. The patients were followed for a mean 46.1 +/- 9.2 months. The patients had significantly higher frequencies of the MT genotype and the T allele than control group (chi(2) = 18.2, p < 0.001 and chi(2) = 11.5 p < 0.001). There were no significant differences in the PAI-1 genotype and allele findings when the data for all patients were compared with that for the controls (chi(2)= 2.45, p = 0.29 and chi(2) = 0.019, p = 0.89). There were no significant differences in the genotype and allele findings for the patients with and without restenosis (p > 0.05). The C-reactive protein (CRP) level was higher in the patients with restenosis than in the patients without restenosis (7.694 +/- 0.39 mg/L and 1.56 +/- 1.08 mg/L) (p = 0.001). Our results suggest that the M235T MT genotype and T allele might be associated with increased risk of atherosclerotic renal artery stenosis. The CRP level might be an independent predictor for recurrent stenosis.
[Show abstract][Hide abstract] ABSTRACT: The radiation dose to the lens of the eye, skin, thyroid and brain of patients who underwent diagnostic and interventional radiological procedures of the lacrimal drainage system have been measured with thermoluminescent dosimeters (TLD-100 and TLD-700) by using an adult male and female Rando phantom. All dose values for one second of fluoroscopic exposure and one frame of digital subtraction dacryocystography (DS-DCG) exposure have been obtained individually in the pastero-anterior (PA) and lateral (LAT) projections.
An adult male and female Rando phantom was used instead of the patients. The procedures were performed by using an Advantx AFM C-arm unit coupled with a DX Hiline digital image acquisition and processing system. The 6-inch mode of a triplefield image intensifier (II) was used, with a circular collimation of the same or a slightly smaller size. Two different lithium floride (LiF) thermoluminescent chips were used for absorbed dose measurements: TLD700, approximately 4.5 mm in diameter and 0.9 mm in thickness; TLD100, 3.7 mm square and 0.9 mm in thickness.
The average values of absorbed doses (lens of the eye, skin, thyroid and brain) measured separately with TLD100 and TLD700 dosimeters after irradiation of the male and female Rando phantom are presented for LAT and PA projections.
This study suggests that useful information for dose determination can be obtained by use of the radiation dose to the lens of the eye, thyroid and brain received during radiological procedure of the LDS for one frame of DS-DCG and one second of fluoroscopy.
[Show abstract][Hide abstract] ABSTRACT: To evaluate our results of stent-graft implantation for the endovascular treatment of peripheral vascular lesions.
Seventeen patients underwent repair of iatrogenic, traumatic, or spontaneous vascular lesions by means of endovascular stent-grafts. The study cases consisted of 10 cardiac catheterization-induced femoral arteriovenous fistulas (AVFs) located between the deep femoral artery and the femoral vein, one iatrogenic AVF between the common iliac artery and vein, one penetrating trauma-induced AVF between the superficial femoral artery and vein, two penetrating trauma-induced pseudoaneurysms in the axillary and popliteal arteries, and three spontaneous or atherosclerosis- related iliac artery aneurysms. Balloon-expandable or self-expandable stent-grafts were used in all 17 cases.
All the stent-grafts were deployed successfully. In catheterization-induced femoral AVFs, complete closure of the fistulas was immediately accomplished in 9 of the 10 cases. Blood flow within the pseudoaneurysms of the axillary artery and the popliteal artery, and aneurysms of the iliac arteries were stopped. Partial closure was achieved in two patients with traumatic iliac and femoral AVFs. For the patients who reported subsided complaints, mean follow-up for 24 months with clinical examination and color Doppler ultrasound revealed patency of the stented segments.
Our results suggest that endovascular treatment of various types of peripheral vascular lesions with stent-grafts is a low-risk procedure, which appears to be less invasive than surgery.
[Show abstract][Hide abstract] ABSTRACT: This article presents a review of the interventional radiological procedures in the lacrimal drainage system. Balloon dacryocystoplasty and nasolacrimal polyurethane stent placement are the main fluoroscopically guided interventions for the treatment of epiphora by recanalizing the obstructed LDS. These procedures can also be used for dacryolith removal and lacrimal sac abscess treatment.
European Journal of Radiology 10/2005; 55(3):331-9. DOI:10.1016/j.ejrad.2005.03.006 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To report our results from a study of the endovascular treatment of flow restricting chronic atherosclerotic or catheter-induced segmental iliac artery dissections with bare stents.
Thirty symptomatic patients with 32 lesions, including chronic atherosclerotic (n = 21) and catheter-induced (n = 11) segmental arterial dissections, were treated with primary stenting. The common iliac artery was involved in 19 lesions and the external iliac artery in the remaining 13. Two patients had two lesions in the same vessel. Technical success was defined as restoration of the smooth contoured luminal patency with no more than 20% residual stenosis in diameter in atherosclerotic dissections associated with plaque formation or total obliteration of the false lumen in catheter-induced dissections. Complete relief of, or marked improvements in, presenting symptoms, or at least single category improvement, was assessed for clinical success.
Technical success rate was 100%. No procedure-related complications such as distal emboli or early occlusions were observed. Complete symptom relief was achieved in all patients with catheter-induced dissection and in all but three cases with chronic spontaneous atherosclerotic dissection. In two cases, occlusion of the stents occurred during the follow-up period. Clinical and radiological mean follow-up for 24 months (range 3-55) revealed patency of all other stented segments. Cumulative primary patency rate was 97% over 12 months and 90% over 24 months.
Endovascular treatment of chronic atherosclerotic and catheter-induced short obstructive iliac arterial dissections with bare stents is safe and effective. Patency of the diseased arterial segment with a smooth lumen can be sustained for an extensive period.
[Show abstract][Hide abstract] ABSTRACT: Persistent proatlantal artery type 1 is one of the four anastomotic vessels between the carotid and vertebrobasilar arterial systems. Persistence of this embryonic anastomosis is extremely rare. We present such a case with bilateral persistent proatlantal arteries that arose from internal carotid arteries, entered the skull via the foramen magnum and united with the horizontal portions of vertebral arteries. We also mention its embryology, potential clinical implications, and differentiating features between two types of proatlantal arteries.
American Journal of Neuroradiology 11/2004; 25(9):1622-4. · 3.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein.
Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach.
All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs.
Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.