Chylothorax treatment with thoracic duct embolization

The authors present a case of a patient with non-traumatic right-sided chylothorax which was successfully treated by thoracic duct embolization. The procedure was performed through the cisterna chyli which was visualised by intranodal lymphography. The coils and acrylic tissue glues were used for embolization. The patient has been followed for 5 months and is free of recurrence of chylothorax.

Pulmonary arteriovenous malformation managed by VATS lobectomy.

Pulmonary arteriovenous malformation (PAVM) is formed by abnormal connections between pulmonary arteries and veins that bypass the pulmonary capillaries and transport deoxygenated blood through pulmonary veins to the left heart. This causes insufficient oxygenation of blood in the lungs. This condition remains symptomless for a long period of time. The most common symptoms include shortness of breath on exertion, nosebleeds, increased fatigue and a gradual development of cyanosis. Paradoxical embolism in the brain is a serious complication; it can present with a stroke or a brain abscess. Treatment of the disease consists of embolization of the pathological vascular connections, surgical resection of the affected pulmonary parenchyma and management of concomitant manifestations of the disease. PAVM in most common cases arises as a result of an autosomal dominant hereditary disorder referred to as hereditary hemorrhagic telangiectasia.  Case report: In our communication, we document the diagnostic and therapeutic management in a young patient diagnosed with PAVM after falling off his bicycle. Based on comprehensive assessments, AV malformations with a 40% shunt of the pulmonary circulation were detected. An angiographic procedure was not an appropriate option considering the type and extent of the condition. Therefore, video-assisted thoracic resection of the affected pulmonary lobe was indicated. Conclusion: PAVM is a rare finding. PAVM should be ruled out in all patients with hereditary hemorrhagic telangiectasia (HHT) signs in the oral cavity. Contrast sonography of the heart and contract CT of the chest are the methods of choice for the diagnosis. Conservative or pharmacological treat-ment fails to improve the patients status.  The condition is usually managed by embolization. Cases where PAVM is rather extensive or diffuse, where endovascular management would be inappropriate, can be well managed using endoscopic resection adequate to the extent of the condition.

Aetiology and management of persistent withdrawal occlusion in venous ports in oncology patients.

INTRODUCTION: Persistent withdrawal occlusion (PWO) is a specific catheter malfunction characterized by the inability to withdraw blood through the device. The most common cause of PWO in ports is the presence of a fibroblastic sleeve (FS). If malfunction occurs, medication can be applied incorrectly with the increased risk of complications. METHODS: One hundred seventy-seven cases of PWO in venous ports were managed. We focused on evaluating the cause of PWO, the frequency of occurrence of FS, and the options to address the malfunction. The patients underwent fluoroscopy with a contrast agent administration. Mechanical disruption (MD) with a syringe of saline using the flush method was used; in case of its failure, subsequent administration of a lock solution with taurolidine and urokinase, or low-dose thrombolysis with alteplase was indicated. Demographic data were compared with a control group. RESULTS: A significantly higher proportion of female patients was found in the cohort of patients with PWO (80.3% vs 66.3%, p = 0.004), dominantly patients with ovarian cancer (12.8% vs 4.8%, p = 0.022). No effect of the cannulated vein or the type of treatment on the incidence of PWO was demonstrated. The presence of FS was verified in 70% of cases. MD with a syringe was successful in 53.5% of cases. A significantly shorter time to referral (3 weeks) was demonstrated with successful management. The overall success rate of achieving desobliteration by MD alone or in combination with a thrombolytic (urokinase or alteplase) administration was 97.4%. CONCLUSION: We created a method for resolving PWO using MD +/- application of thrombolytics with 97.4% success rate. Current evidence showed that FS is not likely to be affected by thrombolytic drugs; however, we have ascertained an effect of these drugs, proposing a hypothesis of microthrombotic events at the tip of the catheter if fibroblastic sleeve is present.

[Endovascular treatment of obstetric hemorrhage]. / Endovaskulární lécba krvácení v souvislostis porodem a tehotenstvím.

PURPOSE: To evaluate effectiveness and safety of hypogastric artery branches embolization in the treatment of postpartum hemorrhage, hemorrhage associated with cesarean section and termination of pregnancy. MATERIALS AND METHODS: All women with intractable bleeding and who were treated by embolization, were included from the period between 1996 to 2010. The retrospective study included 16 women of mean age 30.5 years. RESULTS: Intractable hemorrhage related to regular delivery occurred 7 times, five times after cesarean section and four times after termination of pregnancy. Seven women (44%) were in hemorrhagic shock during therapeutic embolization. Extravazation was angiographically proved in 50% cases. Embolization was successful in hemorrhage control in 87,5% of women, in two women embolization was repeated for persistent bleeding. There were 21 additional surgical procedures performed in 13 women before embolization including 2 hysterectomies. Two hysterectomies were done after embolization because of infection. In remaining 3 women embolization was done as a primary method of bleeding control. No patient died. In the group of 10 women with maximally 1 surgery before embolization length of hospital stay was 10.1 days in average, while in a group of six women having 2 to 3 surgeries before embolization the hospital stay was 21.2 days in average (p = 0.03). CONCLUSION: Embolization of hypogastric arteries decreases length of hospital stay in patients with obstetric hemorrhage and should be done soon if routine methods of bleeding control fail.

[Central venous cannulation under ultrasonographic and fluoroscopic navigation - 2 year experience]. / Centrální kanylace s vyuzitím sonografie a skiaskopie - 2leté zkusenosti.

INTRODUCTION: The aim of our study was to evaluate the influence of ultrasonographic and fluoroscopic navigation on the rate of procedural and early complications during central venous cannulation. MATERIAL AND METHODS: We retrospectively evaluated procedural and early complications in patients who had undergone central venous cannulation under sonographic and fluoroscopic control within a two year period (from January 2010 to December 2011). We studied procedural and early complications (within 24 hours after the procedure). We summarized all cases of pneumothorax, haemothorax and haematoma of soft tissue larger than 5 cm in long axis, and other severe complications e.g. ardiac arrhythmias or hypotension. The set of patients indicated for central venous cannulation included mainly oncological patients who were implanted central venous port systems, and a small group of patients who were cannulated either at the intensive care unit (ICU) or at the department of anesthesiology after unsuccessful blind cannulation. There were three patients cannulated because of transjugular liver biopsy. RESULTS: We cannulated 165 patients under sonographic control within two years. There were 66 men, the mean age of 58.6 years (20-82) and 99 women, the mean age of 58.3 years (36- 94). We cannulated internal jugular vein 148 times and subclavian vein 17 times. The primary technical success was 100% in our study group. Totally, we had 6 complications (3.6%). Immediatelly after the procedure we observed two pneumothoraxes (1.2%) which did not require chest drainage. We punctured artery wall three times, but without haematoma developement, and after a ten-minute commpression, all procedures were successfully finished. We had serious vagal reaction during the cannulation in one patient. We had no fatal procedural complication in our group. There are significantly fewer complications using jugular approach compared to subclavian one. CONCLUSION: We conclude that the ultrasonographic central venous cannulation is a very safe method with a low risk of procedural and early complications. There were significantly fewer complications in case of jugular cannulation compared to subclavian approach in our group of patients. Ultrasonographically navigated central venous cannulation should be used more fequently in emergency medicine as well as in case of non-acute central venous cannulation performed a tan intensive care unit or by anesthesiologists.

[Survival of patients after TIPS in the University Hospital Hradec Kralove]. / Prezívání nemocných po TIPS ve Fakultní nemocnici Hradec Králové.

AIM: To analyze survival of patients after TIPS (transjugular intrahepatic portosystemic shunt). PATIENT SAMPLE AND METHODOLOGY: Between September 1992 and August 2010, TIPS was created in 848 patients of the University Hospital Hradec Kralove. These patients were divided into groups. Survival was analyzed using Kaplan-Meier survival curves. Differences between groups were evaluated using log-rank test. RESULTS: Ten percent of patients do not survive one month after TIPS, 40% of patients survive 5 years and 20% of patients survive 10 years. There were statistically significant differences between groups divided according to Child-Pugh classification (A vs B p = 0.0053; B vs. C p < 0.0001), indication for surgery [prevention of bleeding recurrence differed from refractory ascites (p = 0.0001) and the indication to stop acute bleeding (p = 0.026)]; aetiology of the liver disease [patients with alcoholic cirrhosis differed from patients with Budd-Chiari syndrome (p < 0.0001) and from patients with chronic viral hepatitis (p = 0.024)]. CONCLUSION: Survival of patients after TIPS is influenced by Child-Pugh score, indication and aetiology of the liver disease.

[Late surgical conversion after endovascular treatment of the abdominal aortic aneurysm]. / Pozdní chirurgická konverze po endovaskulární lécbe aneuryzmatu brisní aorty.

The authors present a case report of long- term follow up of 66-year old male with the abdominal aortic aneurysm treated with aortouniiliac stent-graft implantation in combination with the cross-over femoro-femoral bypass 14 years ago. Various leaks type Ia, IIb and III developed during follow-up. In spite of endovascular treatment of these complications the size of the aneurysmal sac enlarged and the patient was successfully treated by the aortobifemoral bypass.

[Peripheral arterial disease and diabetes]. / Ischemická choroba dolních koncetin a diabetes.

Peripheral arterial disease (PAD) is a disease characterised by narrowing and blockade of peripheral arteries, usually based on underlying obliterating atherosclerosis. According to the results of large epidemiological studies, the risk of PAD in patients with diabetes mellitus (DM) is fourfold higher compared to non-diabetic population. Patients with DM and PAD have a high risk of cardiovascular morbidity and mortality. Diabetes worsens the prognosis of patients with PAD; the onset of PAD in diabetics occurs at an earlier age, the course is faster than in non-diabetic patients and the disease is often diagnosed at its advanced stages. All these factors reduce the likelihood of revascularisation in DM patients with PAD. A range of factors (higher age, arterial hypertension, smoking, obesity, hyperfibrinogenaemia, insulin resistance etc.) contribute to the development of PAD in DM. Diabetes control is an independent risk factor of PAD as every 1% increase of hemoglobin A1C is associated with 28% increase of PAD. There are different clinical signs of PAD in diabetic and non-diabetic patients. In addition to the history of claudications, PAD diagnostic criteria include the presence of murmur over the large arteries, signs of chronic ischemia on the skin and distal ulcerations and gangrene. Among the imaging techniques, non-invasive investigations including Doppler pressure measurement, ankle brachial pressure index, color duplex ultrasonography, plethysmography, transcutaneous tension measurement, MR and CT angiography are preferred. Ankle brachial pressure index measurement is the easiest and the main investigation technique. The key principles of PAD treatment in diabetic patients include modification of risk factors, pharmacotherapy and revascularisation interventions aimed at improving clinical signs and prevention of cardiovascular morbidity and mortality. Antiplatelet treatment may prevent PAD progression and reduce cardiovascular events in DM patients. Early diagnosis of PAD in DM patients, rigorous prevention and aggressive management of the risk factors may significantly impact on the high incidence of amputations and decrease cardiovascular morbidity and mortality.

[Endovascular treatment of spontaneous hemothorax in patient with neurofibromatosis type I]. / Endovaskulárni lécba spontánního hemotoraxu u neurofibromatózy I. typu.

Authors present possibility of endovascular treatment of spontaneous hemothorax in the patient with neurofibromatosis type I. CT angiography was crucial in diagnostic algorithm because revealed false aneurysm of the thyreocervical artery. This artery was embolised with acrylic glue. The patient has been without signs of recurrent bleeding.

Quality of life and arterial endovascular intervention by means of balloon angioplasty.

AIM: The aim of this study was to evaluate the quality of life (QoL) and the effect of arterial balloon angioplasty (ABA) on QoL of patients with peripheral arterial occlusive disease (PAOD). METHODS: The study is a prospective and longitudinal one and was carried out at the 2nd Internal Clinic of Charles University Hospital in Hradec Kralove, Czech Republic. Forty-two patients with PAOD, hospitalized for the endovascular intervention by means of percutaneous transluminal angiography, were evaluated for QoL. Thirty patients with PAOD (20 male, 10 female) were treated by endovascular intervention by means of ABA. The evaluation of QoL was performed by means of the Czech version of the international generic European Quality of Life Questionnaire EQ-5D. Statistical analysis was determined by means of analysis of variance and paired t-test. The QoL questionnaires were evaluated by means of descriptive analysis. RESULTS: The study has shown the following results: patients with PAOD had low global QoL; a statistically significant relation between QoL of patient with PAOD and the their age (P<0.01); a statistically significant relation between global QoL and stage of PAOD by Fontaine classification (P<0.01); and a statistically significant relation between global QoL and ABA (P<0.0001). CONCLUSION: The QoL of patients with PAOD is low. The QoL is lower with increasing age and with severity of PAOD. The results show the existence of a positive effect of ABA on QoL in patients with PAOD.

[Dysfunction of transjugular intrahepatic portosystemic shunt (TIPS) and applicable solutions]. / Dysfunkce transjugulární intrahepatální portosystémové spojky (TIPS) a jelí resení.

A synoptic article providing a comprehensive view of TIPS dysfunction. The article covers current terminology, definition, etiology, pathogenesis, diagnostics, therapy and prevention of TIPS dysfunction.

[The impact of secondary insertion of ePTFE-coated stent on sustainable TIPS patency]. / Vliv sekundárniho zavedení ePTFE potahovaného stentu na udrzdení pruchodnosti TIPS.

OBJECTIVE: Retrospective evaluation of the effect of secondary insertion of ePTFE-coated stent in the treatment of TIPS dysfunction versus other current options (simple angioplasty, insertion of additional non-coated stent). PATIENT SET AND METHODOLOGY: From the beginning of 2000 to the end of 2004, there were 121 interventions for TIPS dysfunction performed in our centre in which a non-coated stent was used to make up the shunt at the time of intervention. Depending on the type of intervention, the patient set was divided in 4 groups: simple angioplasty (52 cases, 43%), insertion of non-coated stent (35 cases, 28.9%), insertion of non-dedicated ePTFE-coated stent (15 cases, 12.4%), and insertion of dedicated ePTFE-coated stent (19 cases, 15.7%). All patients were monitored on a regular basis after the intervention for shunt patency with the use of clinical examination and Doppler ultrasonography, or also portal venography. Primary shunt patency after the intervention was evaluated in all four groups by Kaplan-Meier analysis. The primary shunt patency results after the intervention were compared with the use Cox F text and logrank test. RESULTS: The intervention was successful in 120 cases (the overall technical success rate of all interventions was 99.2%). The primary shunt patency was 49.7 % after 12 months and 25.3 % after 24 months following sole angioplasty intervention; 74.9% after 12 and 64.9% after 24 months following intervention involving the insertion of non-coated stent; 75.2 % after 12 months and 64.5% after 24 months following intervention involving the insertion of non-dedicated ePTFE-coated stent, and 88.1% after 12 months and 80.8% after 24 months following intervention involving the insertion of a dedicated ePTFE-coated stent. A statistically significant improvement in shunt patency was obtained in the group of interventions involving the insertion of dedicated ePTFE-coated stent and in the group of interventions involving the insertion of non-coated stent as compared with the group of interventions involving sole angioplasty (p < 0.01). CONCLUSION: From among all the currently used methods of therapeutic intervention for TIPS dysfunction, the best, the best subsequent TIPS patency was obtained after intervention involving insertion of dedicated ePTFE-coated stent.

[Endovascular treatment of carotid artery stenosis with cerebral protection: 5-year experience]. / Endovaskulární lécba stenóz karotických tepen s pouzitím cerebrální protekce: petileté zkusenosti.

BACKGROUND: Percutaneous transluminal angioplasty and stenting with cerebral protection is a minimally invasive method for carotid artery stenosis treatment, which may be an alternative to surgical endarterectomy. The aim of our study is to evaluate results of endovascular treatment in patients at high risk of endarterectomy. PATIENTS AND METHODS: Between years 2001-2006, 210 carotid artery stenoses in 204 patients were treated in our department. Fourty seven percent of patients suffered from symptomatic stenosis, asymptomatic stenosis was proved in 53% of patients. All asymptomatic patients had stenosis more than 70% measured according to NASCET, mostly with contralateral carotid artery occlusion. RESULTS: The procedure was technically successful in 99% of patients, mortality was 0.49%. Periprocedural embolic complications based on transient ischemic attack were observed in 2.39% of patients, symptoms of minor stroke in 0.47% and symptoms of major stroke in 0.47% of patients. The mortality and disabled morbidity rate in the whole group was 0.96%. One hundred and fifty three patients (73%) were followed up, during this time, 7 patients (3.9%) developed hemodynamically significant restenosis. CONCLUSION: Endovascular carotid artery stenosis treatment with cerebral protection seems to be a safe method of treatment with acceptable short-term results. However, long-term follow-up is needed to get enough data about safety and effectiveness of this method compared to endarterectomy and best medical therapy.

[Ischemic disease of the lower extremities versus depression symptoms and quality of life]. / Ischemická choroba dolních koncetin versus depresivní symptomatika a kvalita zivota.

BACKGROUND: The study has three main aims: 1. it evaluates occurrence of depression symptoms in patients with peripheral arterial occlusive disease (PAOD), 2. it evaluates global quality of life (QoL) in patients with PAOD and 3. it evaluates effect of age and stage of PAD on seriousness of depression symptoms and on the QoL in patients with PAOD. PATIENTS AND METHOD: the study is local, prospective and cross-sectional. It was carried out at the 2nd Internal Clinic of University Hospital in Hradec Králové. Data were obtained during the year 2006. METHODS AND RESULTS: The total number of respondents with PAOD was 42 (28 male, 14 female). The average age of all respondents with PAOD was 65.4 years and age range was 45-79 years. The evaluation of occurrence of depression symptoms in patients with PAOD was performed by means of self-assessment Zung-SDS and evaluation of QoL in patients with PAOD was performed by means of Czech version of international generic European Quality of Life Questionnaire-EQ-5D Version. Statistical significance was determined by means of analysis of variance. Main The mean SDS index certifies the presence of signs of minimum or light depression in patients with PAOD. The QoL in patients with PAOD is on the low level. The above-mentioned aspects proved statistically significant dependence of QoL in patients with PAOD on depression (p<0.001), on age (p<0.01) and on stage of PAOD (p<0,01). We proved statistically significant dependence of depression in patients with PAOD on age (p<0.01) and on stage of PAOD (p<0.01). CONCLUSIONS: The results show the existence of the association between PAOD and depression symptoms with its negative effect on QoL in patients.

[Penetrating aortic ulcers--case report on endovascular therapy]. / Penetrující aortální vred: kazuistická sdelení endovaskulární lécby.

We report our experience with two cases of endovascular treatment of penetrating aortic ulcers (PAU). The first patient was a 71-year-old woman with 30 mm width aortic ulcer accompanied by intramural hematoma of the descending thoracic aorta. The second patient was an 80-year-old obese woman with 50 mm pseudoaneurysma of the abdominal aorta, which was result of PAU. Both patients were successfully treated by means of tubular stentgraft, implanted from surgical cut down of the right femoral artery. Penetrating aortic ulcer represents localized, potentially lethal pathology of the aorta. Together with dissection and intramural hematoma belongs among the acute aortic syndromes. During nature course PAU can progress to the acute classic dissection, pseudoaneurysma or rupture of the aorta. It is principally disease of elderly hypertensive patients. Early diagnosis and appropriate therapy improves prognosis of patients with PAU. Open surgical repair with synthetic graft has been the gold standard of treatment but endovascular therapy is an attractive option in risk elderly patients. It seems to be a safe, effective treatment but stability of results of this method should be proved.

[The role of bronchial artery embolization in the treatment of hemoptysis]. / Postavení embolizace bronchiální tepny v terapii klinicky významné hemoptýzy.

BACKGROUND: Moderate and severe hemoptysis is a potential life-threatening condition which requires immediate medical examination and intervention. AIM: Retrospective evaluation of the effectiveness of bronchial artery embolization in the management of hemoptysis (over 50 ml per 24 hours) in the university hospital (from 1998 to 2005). METHODS: A retrospective case study. Forty seven consecutive patients with hemoptysis over 50 ml per 24 hours were reviewed and data collected from medical documentation (medical history, chest X-ray, bronchoscopy, thorax spiral CT, pulmonary and bronchial angiography). RESULTS: Forty seven patients, 34 men and 13 women aged between 19-87 years, mean age of 57.1 years, were included in this study. All patients had clinically important hemoptysis (more than 50 ml blood in 24 hours), 23 patients 50-200 ml, 14 patients 200-500 ml, 10 patients over 500 ml. Twenty eight patients had reccurent hemoptysis and nineteen patients had the first stage of hemoptysis. Within the study group we recorded the following clinical causes of hemoptysis: 12 COPD with bronchiectasis, 11 pulmonary malignancy, 11 idiopatic hemoptysis, 5 arterioarterial shunts, 3 pneumonia, 2 aspergillomas, 1 posttuberculous scars, 1 pulmonary trauma, 1 pulmonary arteriovenous malformation. All 47 patients underwent angiography. Thirty seven bronchial artery embolizations (BAE) were performed on the side with greater bronchoscopy and CT abnormality. Polyvinyl-alcohol (sponge particles 45-350 pm) or acrylate glue were used as embolizing agents. We did not observe any complication during this procedures (BAE). Immediate success i.e. cessation of hemoptysis was achieved in 36 patients (97%). Follow-up lasted 4-63 months (33 patients). BAE resulted in long-term success i.e. no recurrent hemoptysis for 28 patients (85%). CONCLUSION: Transcatheter bronchial artery embolization is an effective and safe procedure for patients suffering from clinically important hemoptysis. Short-term control of hemoptysis can be achieved in 97% and long-term control in 85% of cases. Bronchial artery embolization is a treatment which can reduce the need for acute thoracic surgery.

Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience.

PURPOSE: Retrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA). MATERIALS AND METHODS: From 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised. RESULTS: We achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %. CONCLUSION: Primary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

[Preservation of venous grafts]. / Príspevek ke konzervaci zilních stepu.

The objective of the work was to find an optimal preservation medium for short-term preservation of venous grafts which could be subsequently used to line metal stents. The external jugular vein of dogs (n = 15) was removed surgically, divided into portions and immersed into preservation media. For hypothermic preservation (+4 degrees C) solutions of Optisol (Chiron, USA), University of Wisconsin (Baxter, USA), Eurocollins (Fresenius, GFR) and saline (Bieffe Medital, Italy) were used. For normothermic preservation (+37 degrees C) in an atmosphere with 5% CO2 Dulbecc's medium for tissue cultures (Sigma, USA) was used. During hypothermic preservation the specimens were kept for 24 hours, 3 and 7 days, during normothermic preservation in Dulbecc s medium also for 24 hours, 3 and 7 days. The specimens were evaluated by light microscopy and raster electron microscopy. The results revealed that minimal changes on the endothelia of venous grafts occurred during normothermic preservation in Dulbecc's medium where after 7 days the endothelium did not become detached and the vitality of cells did not change. During hypothermic preservation the solution of Wisconsin University proved most suitable. By addition of 5% human albumin to this solution it proved possible moreover to reduce pyknosis of the endothelial cell nuclei. The specimens kept in saline displayed deformities of the nuclei, oedema and loss of endothelia incl. incipient oedema of the cellular wall already after 24 hours of hypothermic preservation. The authors consider the use of this solution unsuitable for preservation.

[Diagnosis of spontaneous arteriovenous fistula complicating aortoiliac aneurysm using spiral CT. Report of 3 cases]. / Diagnóza spontánní arteriovenózní pístele u aortoilického aneuryzmatu pomocí spirálního CT. Tri kazuistiky.

Acute spontaneous arterio-venous fistula complicating atherosclerotic abdominal aortic aneurysm (AAA) is rare. This life-threatening setting is observed in 1-2% of all AAAs and 2-4% of ruptured of AAAs. The triad of abdominal or lower back pain, pulsatile abdominal mass, and continual abdominal machinery-like bruit is seen only in half of cases. Currently, CT angiography is a noninvasive technique which enables a rapid and exact preoperative diagnosis. The authors describe three cases of aortoiliac aneurysm complicated by an acute arteriovenous fistula which were diagnosed using spiral CT.

Temporary liver blood-outflow occlusion increases effectiveness of radiofrequency ablation: an experimental study on pigs.

AIM: To evaluate the feasibility of liver blood outflow (LBOF) occlusion and its impact on the effectiveness of radiofrequency ablation (RFA). METHODS: The experiment was performed on 10 pigs. The animals were divided into groups A and B according to RFA protocol. In group A (n=5) the RFA time was that taken to reach the target temperature of 105 degrees C, whereas group B (n=5) had a constant RFA temperature of 105 degrees C and constant time of 8min. The liver blood flow (LBF) was quantified using Doppler ultrasonography before LBOF occlusion and after that. RFA were performed using an expandable 3cm RF needle. Two liver ablations created in different liver lobes were compared; the first ablation was created before balloon inflation and the second one was created under LBOF occlusion. The time required for RFA procedure, liver ablation volumes, shape and microscopic changes of the thermoablated zones were recorded. RESULTS: The LBF dropped significantly in all liver vessels after balloon inflation. The volume of the ablated area was 8.2+/-2.2cm(3) and increased significantly after LBOF occlusion to 17.4+/-3.8cm(3) (p<0.001), in group A. A significant enlargement of the ablated area with occluded LBF was registered in group B, it was 6.7+/-2.8cm(3) versus 19.4+/-1.8cm(3) respectively (p<0.01). CONCLUSIONS: Temporary LBOF occlusion led to a significant reduction in liver blood flow, enlargement of the thermoablated area volume and homogeneity of the coagulated zones.