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2.
Korean J Radiol ; 5(2): 134-8, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15235239

RESUMEN

Isolated spontaneous dissection of the superior mesenteric artery (SMA) is a rare cause of acute mesenteric ischemia. Two patients were successfully treated by percutaneous stent placement within the main trunk of the SMA. Emphasis is placed on the feasibility of nonsurgical management with percutaneous stent placement of isolated spontaneous dissection of the SMA.


Asunto(s)
Angioplastia de Balón , Disección Aórtica/terapia , Arteria Mesentérica Superior , Stents , Disección Aórtica/diagnóstico por imagen , Femenino , Humanos , Masculino , Arteria Mesentérica Superior/diagnóstico por imagen , Persona de Mediana Edad , Radiografía
3.
J Vasc Interv Radiol ; 13(10): 1021-7, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12397124

RESUMEN

PURPOSE: To compare conventional extracellular and blood-pool magnetic resonance (MR) contrast agents in "indirect" contrast-enhanced three-dimensional (3D) MR venography of the iliocaval veins. MATERIALS AND METHODS: Twenty-nine gadodiamide-enhanced 3D MR (Gd-MR) angiography studies and 12 MS-325-enhanced 3D MR (MS-325-MR) angiography studies were reviewed retrospectively. Abnormalities of the inferior vena cava (IVC) or iliac veins were not suspected before MR imaging. The MR angiography studies were reviewed with and without subtraction. Diagnostic conspicuity and subjective contrast of the various iliocaval venous segments (suprarenal IVC, infrarenal IVC, and iliac veins) and the presence of artifacts were subjectively scored by two blinded observers. RESULTS: In the Gd-MR angiography group, the infrarenal IVC and iliac veins were visualized with good conspicuity in only 55% of segments compared to 92%-100% of segments in the MS-325-MR angiography group. Although subtraction improved subjective conspicuity and contrast relative to background in the Gd-MR angiography group, it resulted in increased artifacts and luminal blurring. Subtraction offered little diagnostic advantage in the MS-325-MR angiography group. CONCLUSION: Indirect contrast-enhanced 3D MR venography with use of MS-325 offered significantly improved diagnostic conspicuity and contrast in iliocaval venous opacification compared to gadodiamide-enhanced studies.


Asunto(s)
Medios de Contraste , Gadolinio DTPA , Gadolinio , Vena Ilíaca/anatomía & histología , Imagen por Resonancia Magnética , Compuestos Organometálicos , Vena Cava Inferior/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Artefactos , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Retrospectivos , Técnica de Sustracción
4.
J Vasc Interv Radiol ; 14(4): 405-23, 2003 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12682198

RESUMEN

Acute complications of deep vein thrombosis (DVT) of the lower extremities include pulmonary embolism and venous ischemia. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Anticoagulation therapy is recognized as the mainstay of therapy in acute DVT. However, there are few data to suggest any major beneficial effect on PTS, which is thought to be mediated by valve damage and/or occlusive chronic thrombus and venous scarring. Endovascular catheter-directed thrombolysis techniques with pharmacologic thrombolytic agents, used alone or in combination with mechanical thrombectomy devices, have been proven highly effective in clearing acute DVT, which may allow the preservation of venous valve function and prevention of subsequent venous occlusive disease. Definitive management of underlying anatomic occlusive abnormalities can also be undertaken.


Asunto(s)
Arteriopatías Oclusivas/terapia , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/patología , Trombosis de la Vena/terapia , Arteriopatías Oclusivas/epidemiología , Arteriopatías Oclusivas/patología , Manejo de la Enfermedad , Humanos , Incidencia , Embolia Pulmonar/epidemiología , Embolia Pulmonar/patología , Embolia Pulmonar/terapia , Factores de Riesgo , Estados Unidos/epidemiología , Trombosis de la Vena/epidemiología , Trombosis de la Vena/patología
5.
AJR Am J Roentgenol ; 178(3): 583-8, 2002 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11856678

RESUMEN

OBJECTIVE: The purpose of this study was to evaluate associated knee injuries using MR imaging in patients with the "arcuate" sign, a term referring to avulsion fracture of the proximal fibula on conventional radiographs. MATERIAL AND METHODS: MR imaging of 18 cases (17 patients, both knees in one patient) with the arcuate sign on conventional radiographs was retrospectively interpreted to evaluate the associated meniscal, ligamentous, and bony injuries. In 12 cases, MR findings were correlated with surgical results. RESULTS: In all cases, avulsed bony fragments from the proximal pole of the fibula were attached to the fibular collateral ligament, the biceps femoris tendon, or both. Tear of the posterolateral capsule was seen in 12 cases (67%). Injury of the cruciate ligaments was noted in 16 cases (89%): injury to both the anterior cruciate ligament and posterior cruciate ligament was seen in nine cases (50%), injury to only the anterior cruciate ligament was seen in four, and injury to the posterior cruciate ligament only was noted in three. Bone bruises or gross fractures were seen in all cases: bone bruises on the anteromedial femoral condyle were noted in nine cases (50%) and were seen on the anteromedial tibial condyle in five cases (28%). Tear of the medial meniscus was seen in five cases (28%) and tear of the lateral meniscus in four cases (22%). Injury to the popliteus was seen in six cases (33%). Joint effusion was associated in all cases. CONCLUSION: MR imaging is useful for evaluation of associated soft-tissue injuries in patients with the arcuate sign on conventional radiographs. Avulsion injury to the proximal fibula is an important indicator of the internal derangement of the knee and for predicting the mechanism of an injury with varus stress. Cruciate ligament tear and bone bruises on the anteromedial condyle of the femur and tibia are common associated findings.


Asunto(s)
Inestabilidad de la Articulación/diagnóstico , Traumatismos de la Rodilla/diagnóstico , Imagen por Resonancia Magnética , Adulto , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/diagnóstico por imagen , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/etiología , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/diagnóstico por imagen , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/lesiones , Ligamentos Articulares/patología , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos
6.
J Vasc Interv Radiol ; 13(1): 71-6, 2002 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-11788697

RESUMEN

PURPOSE: To prospectively assess the computed tomographic (CT) findings of iliofemoral deep venous thrombosis (DVT) and evaluate their relevance to the treatment of DVT with catheter-directed thrombolysis. MATERIALS AND METHODS: Twenty-four consecutive patients with symptomatic iliofemoral DVT were studied with both nonenhanced and contrast-enhanced CT before thrombolytic therapy. Mean duration of clinical symptom was 15.8 days +/- 20.8 (range, 1-90 d). Selected CT findings were prospectively evaluated and correlated with duration of symptoms and outcome of thrombolytic therapy, including attenuation number of the thrombus on nonenhanced CT (in HU), presence of venous distention (distention ratio: vein diameter divided by the diameter of corresponding normal contralateral vein), and poor venous wall demarcation. The following threshold variables were also evaluated: attenuation > or =60 HU and distention ratio > or =1.5. RESULTS: CT was suggestive of DVT in all patients, although different patterns were present. Higher attenuation on noncontrast CT was seen in patients who had favorable outcome of thrombolytic therapy compared to poor responders (66.1 +/- 8.7 vs 45.9 +/- 9.6; P <.0001). Distention ratio was also significantly higher in the good response group (2.6 +/- 1.4 vs 1.4 +/- 0.7; P <.05). Recent onset of clinical symptoms was associated with better outcome (9.4 d +/- 8.9 vs 28.6 d +/- 31.2; P <.03). Multiple-stepwise regression analysis of these variable produce the results of "attenuation >60" as the most predictive variable of favorable outcome of thrombolysis, followed by "distention ratio >1.5" and poor demarcation. CONCLUSION: Selected CT findings are better predictors of a favorable outcome of thrombolytic therapy than duration of clinical symptoms alone.


Asunto(s)
Vena Femoral/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagen , Activadores Plasminogénicos/uso terapéutico , Terapia Trombolítica , Tomografía Computarizada por Rayos X/métodos , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico , Trombosis de la Vena/diagnóstico por imagen , Adulto , Anciano , Cateterismo Periférico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Análisis de Regresión , Resultado del Tratamiento , Trombosis de la Vena/tratamiento farmacológico
7.
J Endovasc Ther ; 10(4): 752-9, 2003 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-14533967

RESUMEN

PURPOSE: To describe a newly designed bifurcated modular stent-graft and assess the feasibility and safety of its use in the treatment of abdominal aortic aneurysms (AAA). METHODS: Thirteen patients (10 men; mean age 61.2+/-16 years, range 57-78) with AAAs underwent treatment with a bifurcated stent-graft consisting of 4 components: an unsupported bifurcated stent-graft, an inner bare stent, and 2 stent-grafts. The system was placed sequentially through a percutaneously introduced 12-F sheath; the preloaded bifurcated main body of the stent-graft was deployed first, followed by the inner bare stent and individual stent-graft limbs through separate 10-F sheaths. Spiral computed tomography (CT) was performed before treatment and at 1 week, 3 months, and then at 6-month intervals. RESULTS: The stent-grafts were successfully deployed in all patients, although 3 types of procedure-related adverse events occurred: left limb kinking in 1, postimplantation syndrome (fever, leukocytosis, and decreased platelet count) in 5, and a small access site arteriovenous fistula in 1. Postprocedural angiography and 1-week follow-up CT scanning did not identify any endoleaks. At a mean 9.2+/-4.6-month follow-up, all devices were intact, with complete exclusion of the aneurysms and no endoleaks. CONCLUSIONS: This newly designed bifurcated modular stent-graft appears to be effective for percutaneous AAA repair; further investigation is warranted.


Asunto(s)
Aneurisma de la Aorta Abdominal/terapia , Implantación de Prótesis Vascular , Stents , Anciano , Aleaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Poliésteres , Politetrafluoroetileno , Diseño de Prótesis , Resultado del Tratamiento
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