Assuntos
Angioplastia com Balão , Hipertensão Renal/terapia , Obstrução da Artéria Renal/terapia , Adulto , Idoso , Angioplastia com Balão/efeitos adversos , Criança , Diagnóstico por Imagem , Humanos , Hipertensão Renal/diagnóstico , Hipertensão Renal/etiologia , Recidiva , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/etiologia , Resultado do TratamentoAssuntos
Angioplastia com Balão , Arteriopatias Oclusivas/terapia , Artéria Ilíaca , Angiografia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/terapia , Perna (Membro)/irrigação sanguínea , Recidiva , Retratamento , Resultado do TratamentoAssuntos
Biópsia por Agulha , Carcinoma Broncogênico/patologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Biópsia por Agulha/efeitos adversos , Contraindicações , Diagnóstico Diferencial , Humanos , Pulmão/patologia , Neoplasias Pulmonares/secundário , Linfonodos/patologia , Metástase Linfática , Estadiamento de Neoplasias , Valor Preditivo dos TestesAssuntos
Arteriopatias Oclusivas/tratamento farmacológico , Oclusão de Enxerto Vascular/tratamento farmacológico , Isquemia/tratamento farmacológico , Perna (Membro)/irrigação sanguínea , Terapia Trombolítica , Angiografia , Angioplastia com Balão , Arteriopatias Oclusivas/diagnóstico , Relação Dose-Resposta a Droga , Oclusão de Enxerto Vascular/diagnóstico , Humanos , Infusões Intravenosas , Resultado do Tratamento , Ultrassonografia DopplerAssuntos
Neoplasias dos Ductos Biliares/terapia , Colestase/terapia , Drenagem/instrumentação , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/diagnóstico , Cateteres de Demora , Colestase/diagnóstico , Colestase/etiologia , Diagnóstico por Imagem , Humanos , Cuidados Paliativos , Stents , Resultado do TratamentoAssuntos
Abscesso Abdominal/cirurgia , Cateteres de Demora , Drenagem/instrumentação , Paracentese/instrumentação , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/etiologia , Estudos de Casos e Controles , Cuidados Críticos , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
To help improve patient acceptance of long-term internal/external catheter access to the biliary tract in those with benign biliary obstruction, a simple design allows the catheter end to remain flush with the skin. It consists of a clothes button affixed to the drainage catheter with a wood screw after the catheter has been cut off at the skin exit. This button/screw device has been used successfully in 22 patients over the last 10 years; catheter exchanges were easily accomplished.
Assuntos
Sistema Biliar , Drenagem/instrumentação , Humanos , Fatores de TempoRESUMO
PURPOSE: The authors examined the nephrotoxicity of carbon dioxide injected directly into the renal arteries as an arterial contrast agent. MATERIALS AND METHODS: Fourteen anesthetized dogs received selective renal infusions of CO2 ranging from a normal dose of 7 cm3/kg to high doses of 11-54 cm3/kg. Two dogs received conventional iodinated contrast media. The effects on renal function and histologic appearance were evaluated by means of radionuclide studies (iodine-131 iodohippurate sodium and technetium-99m dimercaptosuccinate) and histopathologic examination (light, transmission, and scanning electron microscopy). RESULTS: Although there was a mean decrease in renal blood flow of 11.86% (standard error [SE], 7.1) immediately after the injection of CO2, flow had returned to baseline (0.17%; SE, 5.27) after 24 hours. Although the sample size was small, there was no dose-dependent effect of CO2 on renal function and histologic appearance. Mild histologic changes and one case of moderate acute tubular necrosis were seen only in cases in which the kidney was positioned vertically rather than laterally. CONCLUSION: Although formal studies in patients are required, the results of this investigation suggest that CO2 may be a safe contrast agent and less nephrotoxic than existing contrast agents, providing care is taken to ensure that CO2 is not trapped in a vertically positioned kidney, as might occur in renal transplant recipients.
Assuntos
Dióxido de Carbono/toxicidade , Meios de Contraste/toxicidade , Rim/efeitos dos fármacos , Animais , Cães , Infusões Intra-Arteriais , Rim/patologia , Rim/fisiologia , Túbulos Renais/patologia , Necrose , Artéria RenalRESUMO
This case report demonstrates a role for transesophageal echocardiography in defining the course of anomalous coronary arteries. Origin of the right coronary artery (RCA) from the left main (LM) (single coronary artery) is an exceedingly rare congenital anomaly. It is not always benign and may result in myocardial infarction. This may be due to compression between the aorta and the pulmonary artery. Transesophageal echocardiography offers a low-risk, noninvasive means of imaging the proximal coronary arteries. In the majority of patients, the proximal segments of the three major coronaries can be clearly visualized. With the addition of color flow, it is possible to visualize flow in most patients. Proximal obstructive lesions can be seen in some patients although sensitivity thus far seems low.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia/instrumentação , Interpretação de Imagem Assistida por Computador/instrumentação , Velocidade do Fluxo Sanguíneo/fisiologia , Ponte de Artéria Coronária , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia Doppler/instrumentação , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The limitations of angiography, when it is used as the sole method of vascular assessment, are increasingly apparent as vascular intervention becomes more sophisticated. Angioscopy could be an adjunctive diagnostic modality by differentiating among thrombus, dissection, and atheroma, and by monitoring the response to therapy. However, angioscopy requires a blood-free field for adequate visibility, and this may be difficult to obtain. The feasibility of carbon dioxide (CO2) and various saline delivery methods for clarifying the viewing field for percutaneous angioscopy was investigated. Angioscopy of femoral and iliac arteries on nine dogs was performed. Saline was infused by hand injection, pressure bag infusion, or mechanical power injection, and CO2 gas was injected using a special gas injector. The clarity of the viewing field was graded for each medium and method. Excellent quality antegrade femoral angioscopy was obtained with CO2. The superiority of CO2 injection in comparison with power-injected saline approached statistical significance (P = .06). Power-injected CO2 and power saline were superior to hand-injected or pressure bag-injected saline for maintaining sufficient visibility. Retrograde iliac angioscopy was possible without inflow occlusion, but required high flow rates (only possible with power-injected saline or CO2). CO2 injected under controlled circumstances holds promise as a medium to improve angioscopic visibility.
Assuntos
Vasos Sanguíneos , Dióxido de Carbono/administração & dosagem , Endoscopia , Angiografia , Animais , Cães , Endoscopia/métodos , Feminino , Artéria Femoral , Masculino , Cloreto de Sódio/administração & dosagemRESUMO
Bacterial endocarditis usually affects the valve leaflets, but erosion into the valve anulus and adjacent myocardium may form a myocardial abscess. Perivalvular abscesses can drain into the ventricles or aorta, forming a life-threatening pseudoaneurysm. We reviewed our experience with cardiac MR imaging of this disorder. Fourteen patients with complicated bacterial endocarditis underwent ECG-gated spin-echo cardiac MR imaging in addition to conventional duplex two-dimensional echocardiography (2-D echo). Angiography was performed in seven patients, six of whom underwent surgery for valve replacement. MR imaging detected the pseudoaneurysms in all five of the surgically proved cases, while 2-D echo detected only three. Clinical follow-up suggested there were no false-negative examinations, but no autopsy data were available for confirmation. Postoperative MR imaging studies were conducted in three patients, revealing two recurrent pseudoaneurysms and one thrombosed aneurysm. Cardiac MR imaging provides useful pre- and postoperative information in patients with perivalvular pseudoaneurysms due to endocarditis.
Assuntos
Aneurisma Infectado/diagnóstico , Endocardite Bacteriana/diagnóstico , Imageamento por Ressonância Magnética , Infecções Estafilocócicas/diagnóstico , Aneurisma Infectado/etiologia , Valva Aórtica/patologia , Ecocardiografia , Eletrocardiografia , Endocardite Bacteriana/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In this study we evaluated methods for reducing high-flow jets from 5-French catheters that occur when injection pressures approach catheter tolerance (1000 psi [6.9 MPa]). This "jet effect" has been responsible for subintimal extravasation of contrast material in patients. We designed a physical model that accurately measures flow rates through the end hole and each side hole of 5-French high-flow catheters under simulated physiologic arterial pressure. When a standard catheter commonly used for injection of contrast material was studied, flow of contrast material was 34% through the end hole and 31% through the distal side-hole pair at high injection pressures (1000 psi). We examined the effect of altering the size and configuration of catheter side holes and end hole in an effort to create an improved flow profile, and thus a safer angiographic catheter. End-hole flow rate was reduced by 73% to 9% of total flow by tapering the 5-French catheter to 0.018 in. (0.046 cm) and by using smaller 0.015-in. (0.038-cm) side holes for even flow distribution. The high-flow jets present with standard high-flow 5-French catheters do not occur when flow-restrictive end holes and side holes are used. A uniform flow profile can be obtained without sacrificing delivery of contrast material through small catheters.
Assuntos
Angiografia/métodos , Cateterismo/métodos , Humanos , Modelos Estruturais , ReologiaRESUMO
The authors developed a technique to increase the size of a guide wire and permit single-step placement of catheters and large sheath systems over previously inserted small-caliber guide wires. The technique involves compression of metal cannula against a smaller in-dwelling wire or inner cannula. It has been used successfully during laser-assisted balloon angioplasty and percutaneous nephrolithotomy.
Assuntos
Cateterismo/métodos , Angiografia/instrumentação , Cateterismo/instrumentação , HumanosRESUMO
The authors describe a new angiographic catheter, which delivers equal flow rates through the side holes and reduced flow through the end hole compared with conventional catheters. Computer analysis of catheter-flow models revealed that placement of larger side holes proximally and smaller side holes distally produces more uniform flow rates out of the holes. This decreases the risk of potentially hazardous delivery of high-pressure jets of contrast material from the end hole. The flow pattern is so uniform that it resembles a cloud of contrast material on injection. This catheter design is particularly applicable for 3-5-F catheters, which require high-pressure injections. Clinical testing in 50 cases revealed no extravasations or unintentional selective injections with use of this catheter.
Assuntos
Angiografia/instrumentação , Cateterismo/instrumentação , Meios de Contraste/administração & dosagem , Angiografia/métodos , HumanosRESUMO
Miniature techniques offer many advantages for performance of routine angiography, as well as invasive vascular procedures. On the basis of the authors' experience with over 16,000 diagnostic and interventional procedures, this report describes the equipment and methods used for miniangiography. Development of sturdy, high-flow 3-5-F catheters and 0.014-0.018-inch guide wires, combined with the use of small needle puncture techniques, has improved the safety of angiography and intervention such that outpatient procedures are now routine. Miniature catheter systems are now preferable to larger catheter systems in most instances.
Assuntos
Angiografia/instrumentação , Cateterismo/instrumentação , HumanosRESUMO
Biplane Fourier amplitude and phase images from radionuclide ventriculograms were analyzed for the presence of regional wall motion abnormalities in 25 patients who had a total of 33 healed myocardial infarctions (nonviable scar tissue) documented by contrast ventriculography and ECG. This indirect evidence was validated by MRI, which permits direct visualization of healed myocardial infarction. The use of amplitude and phase images in both projections resulted in the detection of more healed myocardial infarctions (91%) than did the use of conventional radionuclide ventriculography with left anterior oblique images alone (67%), because inferior wall infarcts are more readily visualized in the left posterior oblique projection.