Monitoring functional patency of percutaneous transluminal angioplasty.

Duplex scanning and Doppler-derived blood pressure measurements were used to serially monitor lower limb hemodynamics in 73 patients who underwent percutaneous transluminal angioplasty. Ninety percutaneous transluminal angioplasty sites judged technically satisfactory by arteriography were evaluated. Significant hemodynamic improvement was seen in 81 (90%) of the 90 limbs, although both hemodynamic and clinical improvement were achieved in only 77 (86%) limbs. Duplex scanning within 1 week of successful angioplasty identified moderate (20% to 49% diameter reduction) or severe (greater than 50% diameter reduction) residual stenosis in 49 (63%) of 77 balloon-dilated arterial segments. The presence of a greater than 50% diameter reduction residual stenosis predicted further restenosis and late clinical failure (11% success rate at 1 year). When the degree of residual stenosis at the percutaneous transluminal angioplasty site was less than 50% diameter reduction by duplex scanning, the procedure was durable (80% success rate at 2 years), even in patients with critical ischemia, poor runoff, or diabetes mellitus.

Percutaneous brachial artery catheterization.

We describe modifications and suggestions for safer percutaneous catheterization of the brachial artery based in part on the anatomy of the axillary-brachial artery and surrounding nerves of the brachial plexus. The brachial artery approach should be nearly as safe as the femoral artery approach for percutaneous catheterization and should not be avoided if the femoral arteries cannot be used.

Phlegmasia cerulea dolens.

Phlegmasia cerulea dolens is a severe form of venous thrombosis presenting as an edematous, painful, purplish-blue lower extremity. Its rapid recognition as venous thrombosis rather than arterial insufficiency is important in avoiding gangrene and other life threatening complications. Three cases illustrating the presentation of this disorder are reported.

Contrast media hyperemia and Doppler measurements in peripheral arterial disease.

The addition of Doppler measurements of ankle/brachial artery pressure ratios just before and after the hyperemia of routine angiography is a simple, quick, and efficient method in the determination of the hemodynamic significance of arterial narrowings. In a series of 21 patients (35 limbs) this test was found to be particularly helpful for those patients who could not undergo stress exercise testing, who had borderline significant physiologic test results, and who had angiographically indeterminate severe vessel narrowings.

Transvenous liver biopsy in critically ill patients: adequacy of tissue samples.

In a consecutive series of 33 patients (38 biopsies), the authors analyzed the pathologic specimens obtained with their relatively new transvenous biopsy method. From the point of view of establishing a useful pathologic diagnosis, the method proved worthwhile in the series of predominantly critically ill patients. A specific diagnosis or a later confirmatory tissue diagnosis was achieved in 18 patients, and a strong clinical correlation was achieved in 10 more. There were no complications from this repeatable, technically relatively simple, and safe procedure.

Development and regression of visceral artery aneurysms following liver transplantation: case report.

We describe a case of spontaneous development and regression of two visceral artery aneurysms in a patient with a liver transplant. We speculate on etiologies and regression modes which occurred over a few months. The regression rate of visceral aneurysms is unknown.

Hemorrhagic tension cyst of the kidney.

A case of a benign renal cyst, which was filled with blood under pressure and causing acute flank pain, is presented. The pain was relieved after cyst puncture and aspiration. Although benign hemorrhagic renal cysts are well recognized, this is the first report of a benign renal cyst filled with blood under pressure.

Serial long-term phlebography after documented lower leg thrombosis.

Representative phlebograms from a series of 38 patients (86 phlebograms) followed up from 2 weeks to 6 years after the initial thrombotic episode are presented. The veins cleared earliest and most completely in patients with thrombosis, limited to the calf. Totally occluded veins cleared more slowly and less completely than non- or partially occluded veins. Post-thrombotic restoration of normal venous and valvular structures was commonly seen. The authors describe a phlebographic pattern which corresponds to previously documented pathological material, illustrating intimal thickening as a sequel to organization of thrombi onto the walls of the veins.

Brachiocephalic vessels in the elderly: technique for catheterization.

Selective catheterization and angiography of brachiocephalic vessels in the elderly may be difficult because of tortuosity and unfolding of the thoracic aorta. Use of a special guide wire contributed to the successful performance of safe femorocerebral angiography with the Simmons sidewinder catheter in the 47 of 48 elderly patients in whom it was performed. All 47 had patent left subclavian arteries.

Evaluation of traumatic aortic injury: does dynamic contrast-enhanced CT play a role?

To investigate the value of 5-mm contrast material-enhanced computed tomography (CT) in patients with moderate to low probability of aortic laceration after a substantial deceleration injury, scans were obtained through the upper mediastinum in 160 consecutive patients. Thoracic angiography and aortography were performed in patients with evidence of mediastinal hemorrhage at CT. There was no evidence of mediastinal hemorrhage in 132 patients with normal admission chest radiographs. In the 28 patients with abnormal admission chest radiographs, CT helped exclude mediastinal hemorrhage in 22 patients (78%), and 19 patients (68%) were treated without undergoing angiography. Six patients had mediastinal hematoma at CT. Only one had an aortic laceration at angiography. The authors conclude that 5-mm contrast-enhanced CT can help exclude mediastinal hemorrhage and reduce the angiography rate in low-to-moderate-risk patients with a widened or indeterminate mediastinum. There were no unsuspected cases of mediastinal hemorrhage in patients with normal chest radiographs. Angiography is recommended for patients considered to be at high risk for aortic laceration.

Liver biopsy through the femoral vein.

A technique to perform a liver biopsy through the femoral vein with the Mansfield biopsy forceps is described. Nine liver biopsy procedures were performed in seven patients who were considered at high risk of bleeding, precluding a conventional transperitoneal biopsy. The technique is an easy, safe, and well-tolerated procedure and is an alternative to the traditional transjugular approach.

Evaluation of ECG gating for selective intraarterial carotid DSA.

A study comparing ECG-gated and nongated acquisition for selective carotid digital subtraction arteriography was performed on 116 bifurcations in 63 patients. For ECG acquisition, three exposures (systole, early diastole, and late diastole) were obtained for each cardiac cycle. There was no significant difference in the frequency of plaque misregistration between gated (18%) and nongated (23%) acquisitions. In gated studies, the frequency of plaque misregistration was equivalent in systole, early diastole, and late diastole. Gated and nongated studies provided equivalent image quality for selective carotid digital subtraction angiographic studies.