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T Enden,
N-E Kløw,
L Sandvik,
C-E Slagsvold,
W Ghanima, G Hafsahl,
P A Holme,
L O Holmen,
A M Njaastad,
G Sandbaek,
P M Sandset
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ABSTRACT: Approximately one in four patients with acute proximal deep vein thrombosis (DVT) given anticoagulation and compression therapy develop post-thrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase patency and prevent PTS.
To assess short-term efficacy of additional catheter-directed thrombolysis (CDT) compared with standard treatment alone.
Open, multicenter, randomized, controlled trial. Patients (18-75 years) with iliofemoral DVT and symptoms < 21 days were randomized to receive additional CDT or standard treatment alone. After 6 months, iliofemoral patency was investigated using duplex ultrasound and air-plethysmography assessed by an investigator blinded to previous treatment.
One hundred and three patients (64 men, mean age 52 years) were allocated additional CDT (n = 50) or standard treatment alone (n = 53). After CDT, grade III (complete) lysis was achieved in 24 and grade II (50%-90%) lysis in 20 patients. One patient suffered major bleeding and two had clinically relevant bleeding related to the CDT procedure. After 6 months, iliofemoral patency was found in 32 (64.0%) in the CDT group vs. 19 (35.8%) controls, corresponding to an absolute risk reduction (RR) of 28.2% (95% CI: 9.7%-46.7%; P = 0.004). Venous obstruction was found in 10 (20.0%) in the CDT group vs. 26 (49.1%) controls; absolute RR 29.1% (95% CI: 20.0%-38.0%; P = 0.004). Femoral venous insufficiency did not differ between the two groups.
After 6 months, additional CDT increased iliofemoral patency from 36% to 64%. The ongoing long-term follow-up of this study will document whether patency is related to improved functional outcome.
Journal of Thrombosis and Haemostasis 04/2009; 7(8):1268-75. · 5.73 Impact Factor
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ABSTRACT: To evaluate the radiation dose to the skin, uterus, and ovaries during uterine artery embolization.
Guided uterine artery embolization for leiomyomata and two types of X-ray equipment with different dose levels were utilized during fluoroscopy in 20 women (ages ranging from 32 to 52 years, body weights from 55 to 68 kg). The first 13 women were treated using a non-pulsed system A, with 3.3 mm Al filtering and, for simplicity, a fixed peak voltage 80 kV. During treatment of the other 7 women, a pulsed system B with 5.4 mm Al filtering and an identical fixed voltage was used. The dose area product (DAP) was recorded. The vaginal dose of the first 13 patients and the peak skin dose of all patients were measured with thermoluminescent dosimeters (TLDs). TLDs were placed in the posterior vaginal fornix and on the skin at the beam entrance site. The uterine and ovarian doses were estimated based on the measured skin doses, normalized depth dose, and organ depth values. The effective dose (Deff) was estimated based on the observed DAP values. The measured vaginal doses and the corresponding estimated uterine doses were compared statistically, as were the DAP values from systems A and B.
For system A, the mean fluoroscopic time was 20.9 min (range 12.7-31.1), and for system B 35.9 min (range 16.4-55.4). The mean numbers of angiographic exposures for systems A and B were 82 (range 30-164) and 37 (range 20-72), respectively. The mean peak skin dose for system A was 601.5 mGy (range 279-1030) and for system B 453 mGy (range 257-875). The mean DAP for system A was 88.6 Gycm2 (range 41.4-161.0) and for system B 52.5 Gy-cm2 (range 20.1-107.9). Statistical analysis showed a significant difference between the DAP values, the DAP for system B being the lower one. The mean estimated effective doses from systems A and B were 32 mSv (range 15.1-58.4) and 22 mSv (range 9-46), respectively. The mean estimated maximum uterine and ovarian doses using system A were 81 mGy (range 30-247) and 85 mGy (range 24-207-), respectively; when using system B, the respective doses were 101 mGy (range 45-12) and 105 mGy (range 31-246). The measured vaginal doses had a mean value of 52.5 mGy (range 12-124). Statistical analysis revealed a significant difference between the estimated uterine doses and the measured vaginal doses.
A significant difference was found between the estimated uterine doses and the corresponding measured vaginal doses. This has to be kept in mind when using vaginal doses as a substitute for the uterine dose. There was also a significant difference between the DAP values from systems A and B. System B, with pulsed fluoroscopy and greater filtration, gave the lower exposure. The maximum skin dose indicates that skin injuries are unlikely to occur. The ovarian doses are also below the threshold for temporary or permanent sterility. The stochastic risk for radiation-induced cancer and genetic injury to the patient's future children is not considered as substantial.
Acta Radiologica 04/2006; 47(2):179-85. · 1.37 Impact Factor
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ABSTRACT: To evaluate the efficacy and completeness of uterine fibroid embolization (UFE) measured by changes in volume and signal intensity at magnetic resonance imaging (MRI), and to compare with clinical outcome.
40 women with symptomatic uterine fibroids underwent bilateral uterine artery embolization. At MRI studies, including post-contrast sequences before and repeatedly after treatment, the uterus and dominant fibroids were evaluated for volume, location, and contrast enhancement. Prior to treatment, all myomas showed significant contrast enhancement. The mean uterine volume was 929 ml. Clinical examinations with emphasis on menorrhagia, pelvic pain, and urinary dysfunction were performed before and 6 and 12 months after treatment.
UFE was bilaterally successful in 38 patients. After UFE, MRI showed no enhancement of myomas in 30 patients. In 8 patients, post-procedural MRI revealed partially remaining vascularization of fibroids despite angiographically complete embolization of the uterine arteries. On average, uterine volume decreased by 46.2% at 12 months. There was significant improvement of symptoms in the majority of patients, but slightly less improvement in patients with partially remaining vascularization of myomas.
UFE causes significant volume reduction of myomas and clinical improvement. MRI can reveal remaining vascularization in myomas despite angiographically complete embolization of uterine arteries.
Acta Radiologica 09/2005; 46(5):547-53. · 1.37 Impact Factor
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J Lundbom,
S Hatlinghus,
J Wirsching,
S Amundsen,
L E Staxrud,
T GjŁlberg, G Hafsahl,
W Oskarsson,
K Krohg-SŁrensen,
M Brekke,
H O Myhre
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ABSTRACT: to present the first 100 consecutive endograft implantations for abdominal aortic aneurysms (AAAs) in Norway.
retrospective study of 100 consecutive graft implantations, performed at five University Hospitals during 1995 to 1997.
one hundred patients with a median age of 70 years were included. In all patients the Vanguard modular system (Boston Scientific Corp.) was used. Ninety-four of the 100 patients were treated under regional anaesthesia. A completion angiography was done to evaluate the position of the graft and whether endoleaks were present.
two patients died within 30 days, one due to cardiac insufficiency and another due to haemorrhage during the procedure. There were four early conversions to open repair. At discharge eight patients had an endoleak, while retrograde flow into the aneurysmal sac was observed in four patients. During the follow-up period one conversion to open repair became necessary due to graft migration. Four late leaks were all repaired successfully using endovascular techniques. Five cases of retrograde filling were detected and embolisation with coils was performed in two cases, while three were observed. Seven graft-limb occlusions occurred during the follow-up period and four of these required treatment.
endovascular AAA repair should be regarded as an experimental treatment, although the short term results are promising. Close follow-up of patients with CT scans or arteriography is necessary.
European Journal of Vascular and Endovascular Surgery 01/2000; 18(6):506-9. · 2.99 Impact Factor
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ABSTRACT: During performance of embolectomy or thrombectomy one often encounters arterial stenoses. These may be treated by adjunctive intraoperative angioplasty during the operation or delayed percutaneous angioplasty (PTA) may be performed in the interventional radiology department. Delayed PTA may have to wait until the wound has healed, and during this time there is a risk of re-occlusion. It may often be desirable to perform the radiologic intervention at a later time than the thrombo-embolectomy for logistic reasons. The vascular surgeon and interventional radiologist may perform best when working in the environment that they are accustomed to. Also, measurement of vascular diameters, and selection of proper balloon and stent sizes can usually be performed most accurately with the equipment that is available in the X-ray department. We treated selected patients who underwent thromboembolectomy or thrombendarterectomy in the groin for critical ischemia, and who also had clinically important proximal or distal stenoses, in the following way: an arterial sheath was inserted through the wound and the patients were transferred to the interventional radiology laboratory where they underwent PTA. A continuous over and over suture with 3 bites of a 6-0 polypropylene suture in the arteriotomy for the sheath appeared to be the best way to secure hemostasis. The wound was closed around this suture and the arterial sheath. After removal of the sheath slight traction was applied to the polypropylene suture and maintained for 1-2 days by application of a hemostat at skin level. The technique is illustrated with a case report.
The Journal of cardiovascular surgery 02/1998; 39(1):43-5. · 1.56 Impact Factor
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ABSTRACT: With the introduction of balloon catheters in 1974, dilatation of arteriosclerotic stenoses has become an important treatment for this condition. During the years 1979-88, 368 such procedures were performed in 270 patients. Two patients (0.7%) died from complications. In 8%, revascularisation was unsuccessful. Long occlusions appeared especially difficult to recanalize. 81% of the patients were improved by the treatment. The long term results were best in the iliac segment with 5-year patency of 90% after dilatation of short stenoses (< 4 cm) and 65% after dilatation of longer stenoses. In the femoropopliteal segment, the 5-year patency rates were 65% and 50% respectively. Results after recanalisation of occlusions were poor. Percutaneous transluminal angioplasty is an important supplement to surgery, applying mainly to patients with limited arteriosclerosis and moderate symptoms.
Tidsskrift for Den norske legeforening 12/1994; 114(27):3195-8.
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ABSTRACT: The application of intraluminal stents after dilatation of arterial stenoses and occlusions has proved to be a valuable addition to the armamentarium of radiological interventions. During the last two years we have applied 70 stents to 59 arterial lesions of the lower extremities in 45 patients. 57, or 96.6%, of the procedures were primarily successful, while two patients needed bypass surgery within 1-3 weeks. Follow up at 3-24 months showed that two stents were occluded 12-18 months after insertion, while intravenous digital substraction angiography showed the rest to be still open. We conclude that intravascular stenting improves the overall results of percutaneous transluminal angioplasty, and consequently expands the indications for this therapeutic procedure.
Tidsskrift for Den norske legeforening 12/1994; 114(27):3199-201.
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ABSTRACT: A total of 41 injured patients examined by both chest radiography and axial computerized tomography (CT) of the chest within the first 24 h after the accident were reviewed. In all, 10 patients died, eight from cerebral or cervical injuries, two from haemorrhage. Of the 27 cases with a haemothorax, 13 were seen on a chest radiograph. In only one case was a haemothorax seen on CT large enough to warrant intervention. CT revealed one minor pneumothorax. Nine patients already treated with a chest drain had some residual air demonstrated by CT, two being significant pneumothoraces. CT showed 28 cases of lung contusion as opposed to 23 on a chest radiograph. Of five cases with a mediastinal haematoma, three were seen on a chest radiograph, including the only patient with aortic rupture. Clinically important pathology was revealed in ordinary chest radiographs. Contusions, small pneumothoraces and minor effusions were sometimes overlooked. CT scan of the chest alone is rarely warranted in the injured patient, given a liberal indication for chest drainage and ready access to arch aortography.
Injury 04/1993; 24(3):182-4. · 1.98 Impact Factor
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ABSTRACT: Twenty-four patients with severe lung contusion and multiple rib fractures were studied at a mean 4.9 years (range 2-9 years) after injury. All patients had been in good health before the accident. After the accident 15 (63 per cent) patients had respiratory symptoms such as dyspnoea at rest or moderate exercise (4), pain (8), cough or increased expectoration (11) and frequent bronchopulmonary infections (5). Three patients had changed their job because of respiratory disturbance. The average vital capacity, forced expiratory volume in 1 s, maximal voluntary ventilation and CO transfer factor were reduced respectively to 87, 88, 82 and 83 per cent of predicted values (P less than 0.01), while total lung capacity, residual volume and helium mixing time showed no definite changes (P greater than 0.05). Arterial blood gases at rest and at maximum exercise showed slight changes only. Maximal working capacity and ECG, as well as the ventilatory cost of moderate exercise were normal, where as the CO2 recovery time after moderate exercise was slightly increased (P less than 0.05). Overall there was a tendency towards poorer function in patients treated with artificial ventilation. Chest radiographs were normal in 10 patients (42 per cent), and moderate changes were seen in 14 patients. Diaphragmatic movements were essentially normal in all patients. Severe injury to the chest causes frequent respiratory symptoms. However, objective tests were only moderately reduced when compared with normal values. There was no unequivocal association between the subjective symptoms and the pulmonary function.
Injury 10/1989; 20(5):253-6. · 1.98 Impact Factor
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ABSTRACT: Calculi in the bile ducts are usually removed by surgery or endoscopic papillotomy. When these methods are contraindicated or fail, new and non-surgical alternatives can now be used. Percutaneous transhepatic balloon dilatation of the papilla of Vater enables expulsion of stones in the bile duct. Large stones in the bile ducts can be reduced in size using extracorporeal shock waves or completely dissolved by instillations of Methyl-tertiary-butyl ether in the common bile duct. We report the cases of three patients who were treated successfully for stones in the bile duct using combinations of these techniques.
Tidsskrift for Den norske legeforening 02/1989; 109(2):220-2.
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ABSTRACT: Six lactating women undergoing contrast media examination had milk and blood taken to determine the rate and extent of excretion of iohexol (Omnipaque) (four mothers) and metrizoate (Isopaque) (two mothers). Blood samples were taken up to 45 minutes and milk samples up to 48 hours after the contrast medium injection. The excretion was low, reaching a maximum at 3 to 6 hours and showing a slow decay curve (t1/2 = 15 to 108 hours). One mother, who was weaning her baby, showed a different excretion pattern. The amount excreted during 24 hours was about 0.5 per cent of the weight adjusted maternal dose for both iohexol and metrizoate. It is not likely, that such a low dose of poorly absorbed drug would cause any adverse effects in the infant, unless it is hypersensitive to the drug already. The authors consider breast feeding to be acceptable for mothers receiving iohexol or metrizoate.
Acta Radiologica 28(5):523-6. · 1.37 Impact Factor
