Symptomatic filter penetration presenting as pancreatitis.

Herein, the authors describe a case of symptomatic, enzymatically positive pancreatitis secondary to inferior vena cava (IVC) penetration by an IVC filter. Computed tomography revealed evidence of a filter strut in the head of the pancreas. Although caval penetration has been shown to be a complication associated with the use of IVC filters, to the authors' knowledge symptomatic pancreatitis is a rare manifestation of filter penetration.

Percutaneous angioplasty and stenting of left subclavian artery stenosis in patients with left internal mammary-coronary bypass grafts: clinical experience and long-term follow-up.

The authors report their experience with percutaneous transluminal angioplasty (PTA) and stenting of the left subclavian artery (LSA) in patients with recurrent angina and a left internal mammary (LIMA)-coronary bypass graft or in patients who will be undergoing LIMA-coronary artery bypass grafting. From November 1990 to February 2001, 21 patients (11 men and 10 women) with significant left subclavian artery stenosis were treated; 18 patients had a prior LIMA bypass graft, and 3 patients were treated before coronary artery bypass surgery. Angiographic follow-up was performed in 12 patients and clinical follow-up was obtained in all patients. All lesions were atherosclerotic in etiology and located in the proximal left subclavian artery. The mean stenosis was 81% (range 50-100%). All patients initially underwent PTA. Stents were placed in 7 patients for suboptimal PTA results. Technical success was achieved in all patients. Pressure gradient measurements were available in 6 patients. Mean pretreatment gradient was 29 mm Hg (range, 10-50 mm Hg) and fell to 3 mm Hg (0-8 mm Hg) posttreatment. There were 2 minor and 2 major complications. The 30-day mortality rate was 9.5% (2 patients). The remaining 19 patients had clinical or angiographic follow-up of 4-68 months (mean, 27 months). Three patients were found to have recurrent stenoses by angiography 8-43 months after PTA and 3 more had clinical signs of recurrent stenosis. Therefore, the long-term clinical patency rate of LSA PTA and stent was 15 of 19 (79%). One was managed with bypass surgery, 1 with repeat PTA and stent placement, and 1 was managed conservatively. Therefore, the assisted patency was 15 of 19 (79%). Eleven of 19 (58%) of the patients in long-term follow-up had cardiac symptoms, but repeat angiography excluded recurrent LSA stenosis as the cause of their symptoms in 7 cases. Only 4/19 (21%) had cardiac symptoms potentially attributable to LSA restenosis. Four patients expired during follow-up, but 3 had no evidence of subclavian stenosis. PTA and stenting is an effective treatment of proximal left subclavian artery stenosis in patients who develop angina after a LIMA-coronary artery bypass, or in patients before a LIMA-CABG. Cardiac symptoms after LSA PTA and stent are most often due to progressive coronary artery disease rather than to recurrent LSA stenosis.

Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up.

PURPOSE: To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with vertebral body compression fractures. MATERIALS AND METHODS: One hundred patients (79 women, 21 men; mean age, 73.7 y) underwent 156 percutaneous injections of polymethylmethacrylate (PMMA) into a vertebra (68 thoracic and 88 lumbar) under fluoroscopic guidance over a 35-month period. Before the procedure and at follow-up, patients were asked to quantify their pain on a visual analog scale (VAS) and complete a follow-up questionnaire of our own design. RESULTS: The procedure was technically successful in all patients. There were two complications. One patient sustained a sternal fracture and one experienced a transient radiculopathy. Ninety-seven patients (97%) reported significant pain relief 24 hours after treatment. Mean follow-up duration was 21.5 months (6-44 mo) in 99 patients. Ninety-two patients (93%) reported significant improvement in back pain previously associated with their compression fractures as well as improved ambulatory ability. Before vertebroplasty, the VAS score for the 99 patients was 8.91 +/- 1.12 compared to a score of 2.02 +/- 1.95 at follow-up. The mean difference in VAS scores was significant (P <.0001). CONCLUSION: Percutaneous vertebroplasty of symptomatic vertebral body compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain.

Percutaneous vertebroplasty in the treatment of vertebral body compression fracture secondary to osteogenesis imperfecta.

Percutaneous vertebroplasty, a minimally invasive interventional radiological procedure, has recently been used effectively for the treatment of symptomatic vertebral body compression fractures. Primary indications for vertebroplasty include osteoporotic compression fracture, osteolytic vertebral metastasis and myeloma, and vertebral hemangioma. We present a case and extend the indication of percutaneous vertebroplasty in a patient with a vertebral body compression fracture secondary to osteogenesis imperfecta.

Predictive value of intraosseous venography before percutaneous vertebroplasty.

PURPOSE: Percutaneous vertebroplasty is a novel approach for treating patients with painful vertebral body compression fractures. The use of intraosseous venography before the percutaneous injection of polymethylmethacrylate (PMMA) is not universally accepted. The purpose of this study was to determine if intraosseous venography predicts PMMA flow characteristics when injected into a vertebral body. MATERIALS AND METHODS: One hundred thirty-five intraosseous venograms were obtained during 96 vertebroplasty procedures (39 thoracic, 57 lumbar) in 61 patients (49 women, 12 men; age, 36-94 y) over a 32-month period. All venograms were obtained by injecting water-soluble contrast material through the vertebroplasty needle that had been placed percutaneously via a transpedicular approach. The venograms were retrospectively reviewed by the authors and compared in a blinded fashion with the subsequent final vertebroplasty result. RESULTS: Several venographic patterns were observed: bilateral or unilateral marrow blush with or without venous filling, direct venous filling, leakage of contrast material through an endplate or cortical defect, and stasis within the marrow space. Venograms that demonstrated a bilateral marrow blush predicted flow of PMMA across the midline to adequately fill the contralateral hemivertebrae 95% of the time (40 of 42 cases). A unilateral marrow blush predicted the necessity of a second puncture 97% of the time (32 of 33 cases). Intraosseous venography predicted PMMA entering endplate/cortical defects in all cases (22 of 22) and venous structures in 29% (22 of 75) of cases. Direct venous filling was observed during two vertebroplasty procedures and gelatin foam embolization was performed before PMMA instillation. Stasis of contrast material in the marrow space was observed in 15 cases. Overall, in 83% (80 of 96) of the vertebroplasty procedures, intraosseous venography was believed to predict the flow characteristics of PMMA. CONCLUSION: Intraosseous venography provides useful information in predicting PMMA flow characteristics within the vertebral body and in predicting potential undesirable sites of cement deposition, such as through cortical defects and within venous structures.