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ABSTRACT: We are reporting endovascular management of a renal artery aneurysm causing renal hypertension. The aneurysm by mass effect compressed the adjacent artery resulting in a hemodynamically significant stenosis. Endovascular management included embosphere embolization of the renal parenchyma distal to the stenosed segment and hydrocoil embolization of the aneurysm itself.
Clinical imaging 07/2012; 36(4):409-12. · 0.73 Impact Factor
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ABSTRACT: To report the outcomes associated with endovascular therapy for patients with chronic mesenteric ischemia (CMI).
A retrospective review of patients who underwent endovascular therapy for CMI between April 1981 and September 2009 at a single institution was performed. Procedural details, mesenteric arteries treated, technical and clinical success rates, outcomes per patient and per vessel were assessed.
In 166 patients treatment was attempted using a variety of balloon and stent platforms during the 28-year period. The technical success rate was 97% per patient and 94% per vessel. The technical success rate of stenting (99.4%) was higher than for percutaneous transluminal angioplasty (PTA; 86%; P = 0.0001). Immediate clinical improvement was seen in 146 out of 166 (88.2%). The type of guidewire or device platform, brachial vs. femoral artery access, balloon and/or stent diameters used, and stenosis vs. occlusion had no statistical impact on mortality or the primary patency of any mesenteric artery outcomes. The outcome of the superior mesenteric artery (SMA) with PTA appears to be superior to that of stenting (P = 0.014).
Technical success rates are improved with the use of stents; however, PTA use in the SMA seems to offer better primary patency rates.
• Superior mesenteric artery (SMA) stenosis is often responsible for ischaemic symptoms. • Treatment with percutaneous transluminal angioplasty (PTA) seems superior to stenting • Although technical success rates are improved with the use of stents. • Higher mortality in the elderly and those presenting with nausea/vomiting/bloody stools.
European Radiology 02/2012; 22(6):1372-84. · 3.22 Impact Factor
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ABSTRACT: Saad W, Lippert A, Davies M, Arslan B, Kumer S, Waldman D, Turba U, Schmitt T, Matsumoto A, Angle J. Prevalence, presentation, and endovascular management of hemodynamically or clinically significant arterio-portal fistulae in living and cadaveric donor liver transplant recipients. Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01547.x. © 2011 John Wiley & Sons A/S.Abstract: Purpose: To compare the prevalence (cadaveric vs. living donor transplants), clinical features, and the effectiveness of endovascular management of significant arterio-portal fistulae (APF) in liver transplant recipients.Methods: A retrospective audit of liver transplant recipients in two institutions was performed (1996–2009). Significant APF were included and were defined as symptomatic and/or hemodynamically significant (causing graft dysfunction and/or having abnormal Doppler findings in the portal vein). Patients with significant APF were evaluated for presenting symptoms, imaging features, size/branch order portal vein involvement, and effectiveness of the endovascular management (coil embolization).Results: Four significant APF were found in 1992 (0.2%) liver transplants. Two were symptomatic and two were asymptomatic but were hemodynamically significant with liver function test abnormalities. All four APF were found in cadaveric donor graft recipients (0.23%, N = 4/1753) and none in 239 living donor graft recipients. However, there was no statistical difference between cadaveric and living donor graft recipients (p = 1.0, odds ratio = 1.23). Coil embolization was technically and clinically successful in all 4 without complications and causing normalization of the abnormal Doppler findings.Conclusion: Significant APF are a rare diagnosis (0.2% of transplants). Coil embolization is a safe and effective treatment option for APF in transplants.
Clinical Transplantation 12/2011; · 1.67 Impact Factor
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ABSTRACT: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma.
A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes.
Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16-80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies.
Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.
CardioVascular and Interventional Radiology 06/2011; 35(4):795-806. · 2.09 Impact Factor
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ABSTRACT: Ehlers-Danlos syndrome type IV is a life-threatening genetic connective tissue disorder. We report a 24-year-old woman with EDS-IV who presented with metachronous bilateral aneurysms/pseudoaneurysms of the posterior tibial arteries 15 months apart. Both were treated successfully with transarterial coil embolization from a distal posterior tibial approach.
CardioVascular and Interventional Radiology 04/2011; 34(2):413-8. · 2.09 Impact Factor
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Ashok Tholpady,
Daniel E Hendricks,
Ugur Bozlar,
Ulku C Turba,
Saher S Sabri,
John F Angle, Bulent Arslan,
Kenneth J Cherry,
Michael D Dake,
Alan H Matsumoto,
Wael E A Saad,
Auh Whan Park,
Hugo Bonatti,
Klaus D Hagspiel
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ABSTRACT: To review an experience with the Amplatzer vascular plug (AVP) for prevention of type II endoleaks during endovascular aneurysm repair (EVAR) of thoracic and thoracoabdominal aneurysms.
Retrospective review was undertaken of 14 patients undergoing transcatheter occlusion of the left subclavian (n = 12) or celiac artery (n = 2) with the AVP as part of EVAR of thoracic and thoracoabdominal aneurysms at a single institution. Procedural criteria evaluated were success at target vessel occlusion, the number of AVPs used, use of adjunctive embolization devices, and embolization-related ischemic end-organ events. Follow-up imaging criteria included evaluation of persistent target vessel occlusion, evidence of device migration, and the presence and characterization of endoleak secondary to AVP failure.
Complete target vessel occlusion was documented for all cases. In six cases, more than one AVP was placed, with an average of 1.5 devices per patient. In two cases, adjunctive coils were placed. Computed tomographic or magnetic resonance angiography follow-up was available for all patients (mean follow-up, 419 days; range 28-930 d). No case showed evidence of device migration or type II endoleak resulting from AVP failure. There was a single instance of left subclavian artery recanalization without type II endoleak. There were no embolization-related ischemic end-organ events.
Transcatheter arterial occlusion of the subclavian and celiac arteries with the AVP is a valuable adjunct to endografting in cases in which side branch embolization is necessary to extend the landing zone.
Journal of vascular and interventional radiology: JVIR 10/2010; 21(10):1501-7. · 1.81 Impact Factor
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ABSTRACT: To review the outcomes with the use of balloon-expandable covered iliac kissing stents as compared with bare metal stents in the treatment of atherosclerotic disease at the aortic bifurcation.
A review of consecutive patients from a single institution with atherosclerotic occlusive disease at the aortic bifurcation treated with balloon-expandable kissing stents was performed between January 1, 2002, and September 1, 2007. Fifty-four patients were identified and divided into two groups: those with bare metal stents and those with covered stents. Technical and clinical success (Fontaine classification), complications, and patency at follow-up were documented.
Twenty-six patients (17 men, nine women; mean age, 61 years; age range, 39-79 years) received covered stents and 28 patients (15 men, 13 women; mean age, 61 years; age range, 38-82 years) received bare metal stents. Technical success was achieved in 100% of patients in both groups. Major complications occurred in three of the 26 (11%) with covered stents (P = .66) and two of the 28 patients (7%) with bare metal stents. The median follow-up was 21 months (20 months for covered stents vs 25 months for bare metal stents; range, 1-62 months). Twenty-two of the 26 patients (85%) with covered stents had sustained improvement in clinical symptoms during the follow-up period compared with 15 of the 28 patients (54%) with bare metal stents (P = .02). Primary patency rates at 1 and 2 years were 92% and 92%, respectively, for covered stents and 78% and 62% for bare metal stents (P = .023).
The use of covered balloon-expandable kissing stents for atherosclerotic aortic bifurcation occlusive disease provides superior patency at 2 years as compared with bare metal balloon-expandable stents.
Journal of vascular and interventional radiology: JVIR 07/2010; 21(7):995-1003. · 1.81 Impact Factor
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Journal of vascular and interventional radiology: JVIR 06/2010; 21(6):950-2. · 1.81 Impact Factor
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ABSTRACT: We report our experience with Günter Tulip filter placement indications, retrievals, and procedural problems, with emphasis on alternative retrieval techniques. We have identified 92 consecutive patients in whom a Günter Tulip filter was placed and filter removal attempted. We recorded patient demographic information, filter placement and retrieval indications, procedures, standard and nonstandard filter retrieval techniques, complications, and clinical outcomes. The mean time to retrieval for those who experienced filter strut penetration was statistically significant [F(1,90) = 8.55, p = 0.004]. Filter strut(s) IVC penetration and successful retrieval were found to be statistically significant (p = 0.043). The filter hook-IVC relationship correlated with successful retrieval. A modified guidewire loop technique was applied in 8 of 10 cases where the hook appeared to penetrate the IVC wall and could not be engaged with a loop snare catheter, providing additional technical success in 6 of 8 (75%). Therefore, the total filter retrieval success increased from 88 to 95%. In conclusion, the Günter Tulip filter has high successful retrieval rates with low rates of complication. Additional maneuvers such as a guidewire loop method can be used to improve retrieval success rates when the filter hook is endothelialized.
CardioVascular and Interventional Radiology 09/2009; 33(4):732-8. · 2.09 Impact Factor
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ABSTRACT: Significant advances in the technology and techniques in the field of endovascular thoracic and abdominal aortic aneurysm repair have been made since its introduction in the early 1990s. The low incidence of periprocedural complications combined with comparable early outcomes to open surgery have made the endovascular treatment option the first choice of therapy in patients whose aortic anatomy is suitable for endografting. All currently available endografts for aortic aneurysm repair have delivery systems at least 21-French in outer diameter and have traditionally been inserted via surgical cutdowns. More recently, attempts to validate a totally percutaneous approach to the placement of these devices have been introduced by utilizing suture-mediated closure devices. This article will provide an overview of suture-mediated closure devices, our experience with the off-label application of suture-mediated devices for percutaneous closure of arterial access sites during endovascular aneurysm repair, and a review of the literature on this topic.
Seminars in Interventional Radiology 03/2009; 26(1):67-73.
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ABSTRACT: Subclavian artery injuries after central venous catheter placement constitute a rare but potentially fatal complication. In this case series, the authors describe several endovascular treatment options in the management of iatrogenic subclavian arterial injuries resulting from inadvertent arterial placement of central catheters.
Journal of vascular and interventional radiology: JVIR 02/2009; 20(3):396-402. · 1.81 Impact Factor
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ABSTRACT: Endovascular repair of thoracic aortic disease is rapidly progressing as an alternative to open surgical therapy. In March of 2005, the Gore TAG thoracic endoprosthesis (W. L. Gore & Associates, Inc, Flagstaff, Ariz) received Food and Drug Administration (FDA) approval for the treatment of descending thoracic aortic aneurysms. Subsequently, off-label use of the technology expanded to include additional thoracic aortic diseases. The purpose of this study was to examine whether the outcomes with this device changed after the inclusion and exclusion criteria of FDA-controlled trials no longer governed patient selection.
A retrospective analysis was performed on all patients who underwent endovascular repair of the thoracic aorta with the Gore TAG device at our institution between March 23, 2005, and September 8, 2006.
Fifty consecutive patients with a broad range of aortic pathologic conditions were included in the study. The results in this group compared with those of the phase II trial included the following: length of stay, 7.5 versus 7.6 days (P = .97); intensive care unit stay, 3.7 versus 2.6 days (P = .61); 30-day mortality, 2.0% versus 1.5% (P = .68); spinal cord injury, 2% versus 3% (P = .89); stroke, 4% versus 4% (P = .67); early endoleaks, 26% versus 4% (P < .01); and late endoleaks, 18% versus 7% (P = .08). At 1 year, overall survival was 92% compared with 82% in the phase II trial.
In the post-FDA approval era, endovascular stent-graft therapy is frequently applied to patients with more challenging thoracic aortic anatomy and a wide range of pathologic conditions. Our results in this group are similar to outcomes reported for patients with descending thoracic aortic aneurysm exclusively.
The Journal of thoracic and cardiovascular surgery 01/2009; 137(1):117-23. · 3.41 Impact Factor
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ABSTRACT: Endovascular stent-grafts are increasingly being used for treatment of abdominal and thoracic aortic aneurysms. Postprocedural complications include development of endoleaks. Recently, an embolic agent known as Onyx has been employed to treat type II endoleaks. Onyx is a biocompatible copolymer dissolved in dimethyl sulfoxide (DMSO). Although DMSO is known to damage some angiographic catheters, little is known concerning whether this compound damages stent-graft material. The current study was undertaken to directly explore this issue.
Four stent-grafts were evaluated: the Excluder, Zenith, AneuRx, and Talent. Stent-grafts were incubated for 24 hours at 37 degrees C under each of the following conditions: DMSO alone, 50/50 mixture of DMSO/Onyx, mixture of 1 part 50/50 DMSO/Onyx and 9 parts whole blood, and untreated control. Stent-grafts were microdissected into 15-mm sections, after which they were evaluated with scanning electron microscopy.
No appreciable differences between stent-grafts exposed to DMSO and untreated controls were seen. Although liquid embolic agent was seen coating stent-grafts exposed to a 50/50 mixture of DMSO and Onyx, no evidence of fiber breakdown was noted. Stent-grafts exposed to DMSO/Onyx/whole blood demonstrated a thin coating of clot and Onyx without visual evidence of fiber compromise.
The current study provides compelling evidence that short-term exposure of endograft material to DMSO, DMSO/Onyx, or DMSO/Onyx/whole blood is not associated with acute structural compromise of four commonly used aortic endografts. Future in vivo studies will help to further establish the safety of this agent.
Journal of vascular and interventional radiology: JVIR 12/2008; 20(1):107-12. · 1.81 Impact Factor
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ABSTRACT: The purpose of this article is to discuss the occurrence of abdominal pain associated with severe tilting of the Bard G-2 inferior vena cava filters. Potential reasons for the occurrence of tilting and management of tilting of the filters are discussed.
Journal of Vascular and Interventional Radiology 04/2008; 19(3):449-53. · 2.08 Impact Factor
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ABSTRACT: The authors report a case of a thrombosed persistent sciatic vein in a patient with Klippel-Trénaunay syndrome diagnosed at magnetic resonance (MR) venography and its treatment with endovascular interventional techniques.
Journal of Vascular and Interventional Radiology 09/2007; 18(8):1028-32. · 2.08 Impact Factor
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ABSTRACT: Mechanical thrombectomy devices are increasingly being used in selected patients with acute venous thromboembolic disease to rapidly decrease thrombus burden and establish venous patency. Hemolysis and hemoglobinuria secondary to red blood cell fragmentation is known to occur after the use of these devices. In this article we describe a case in which a 16-year-old female patient developed acute renal failure after use of a mechanical thrombectomy device for treatment of symptomatic iliocaval venous thrombosis.
Seminars in Interventional Radiology 09/2007; 24(3):288-95.
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ABSTRACT: Aortic endograft placement is evolving into the standard of care for treatment of patients with anatomically suitable thoracic aortic aneurysms. Application of this technique and these devices in other thoracic aortic pathology, such as traumatic pseudoaneurysms, symptomatic type B aortic dissections, penetrating ulcers, and even mycotic aneurysms, appears to be promising. We report a case in which a stent graft was used to treat a post-traumatic pseudoaneurysm of the thoracic aorta. The case was complicated by delayed collapse of the endograft, which led to hypoperfusion of the extremities, kidneys, and intestines. Reestablishment of endograft patency and distal reperfusion was achieved by placement of two balloon-expandable stents within the endograft. Potential factors leading to the development of this complication are discussed.
Seminars in Interventional Radiology 09/2007; 24(3):279-87.
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ABSTRACT: The objective of this study is to define the role of three-dimensional (3D) rotational angiography (RA) in the evaluation of transplant hepatic arteries and compare it with digital subtraction angiography (DSA).
The patency of the arteries and anastomoses, confidence in the ability to make a therapeutic decision, and the value of the study for the definition of the optimal projection for an intervention were graded on a scale from 0 to 10.
Forty-three vascular segments in five patients were available for analysis. Complete concordance between 3D RA and DSA was present in 92.9% of the major (extrahepatic) segments. Three-dimensional RA demonstrated two major hepatic segments that were not visualized on DSA. There was no difference in diagnostic confidence, but 3D RA was considered superior for planning the optimal projection for intervention (10+/-0 vs. 6.4+/-1.8).
Three-dimensional RA DSA allows a more complete depiction of the hepatic allograft arterial system than DSA with comparable accuracy. Three-dimensional RA provides similar degrees of confidence in the ability to make a treatment decision, and its appropriate implementation could help reduce overall contrast and radiation dose.
Clinical imaging 33(2):102-9. · 0.73 Impact Factor
