Use of the 8-F angio-seal vascular closure device in large-caliber arteriotomies.

PURPOSE: To evaluate the feasibility and safety of using the 8-F Angio-Seal vascular closure device (VCD) to seal large-caliber (>8-F) access sites during percutaneous endovascular interventions. METHODS: A retrospective review was undertaken of 42 consecutive patients (34 men; mean age 67.8 years, range 36-94) undergoing percutaneous peripheral interventions with sheaths ranging from 9-F to 12-F and subsequent closure using 8-F Angio-Seal VCDs. Single-wall puncture (n = 48) of the common femoral artery was guided by ultrasound in 46 cases and palpation in 2. Forty procedures required therapeutic heparinization during the interventional procedure; protamine was administered in only 5. Per protocol, manual pressure was held for 15 minutes. Clinical and/or imaging follow-up was available in all cases within 3 months after the procedure. RESULTS: Immediate technical success was achieved in all cases, with hemostasis obtained within 5 minutes (no oozing or hematoma). The overall complication rate was 4.1% (2/48); one hematoma requiring surgical repair occurred 10 hours after VCD deployment. An asymptomatic pseudoaneurysm was discovered on follow-up imaging and was treated with ultrasound-guided thrombin injection with complete resolution. CONCLUSION: The use of the 8-F Angio-Seal VCD to close large-caliber arteriotomies ranging from 9-F to 12-F is feasible and safe, with a low complication rate.

Recombinant human bone morphogenetic protein 2-induced heterotopic ossification of the retroperitoneum, psoas muscle, pelvis and abdominal wall following lumbar spinal fusion.

A 45-year-old man presented with vertebral collapse at L5 as an initial manifestation of multiple myeloma and underwent spinal fusion surgery using recombinant human bone morphogenetic protein-2 (rhBMP-2). Subsequent computed tomography (CT) scans and X-rays revealed heterotopic ossification of the left psoas muscle, pelvis, and anterior abdominal wall. While the occurrence of heterotopic ossification has previously been reported when rhBMP-2 has been used for spinal fusion surgery, this case demonstrates that it can occur to a much greater degree than previously seen.

MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance.

OBJECTIVE: Anatomical variations of the median nerve and the persistent median artery (PMA) in the carpal tunnel (CT) are important to understand for their clinical and surgical significance. The aim of this cohort retrospective study was to investigate the prevalence of aberrant median nerve branches and persistent median artery in the CT in a selected population using magnetic resonance imaging (MRI). MATERIALS AND METHODS: MR wrist images of 194 patients, 77 males and 117 females, aged 12-80 years were randomly selected and retrieved from our clinical and radiology data base. The MR examinations were performed using either 1.5-T or 3.0-T magnet using a cylindrical receive-transmit wrist coil for all cases. The course of the bifurcation of the median nerve was followed on axial T2-weighted and axial proton density fat saturated images and classified as either proximal, within, or distal to the CT. The flexor retinaculum proximally and the metacarpal bases were used as anatomic landmarks to subdivide these three categories. In addition, the median artery was searched in order to assess the prevalence of its presence inside the CT. A total of 194 wrists were analyzed by two musculoskeletal-trained radiologists. They were blinded on the population age, gender, and the sides of the wrists. Agreement was reached by consensus. RESULTS: Among the 194 wrists, there was bifurcation of the nerve proximal to the CT in 12 (6.1%) wrists. There was nerve bifurcation within the CT in 36 (18%) wrists. Nerve bifurcation distal to the CT was more frequently observed, occurring in 147 (75%) wrists. Only one nerve trifurcation was seen within the CT. There was no gender predominance for the nerve bifurcation within the tunnel. There were 107 right wrists and 87 left wrists. On the right side, bifurcation of the nerve within the CT was seen in 21 (19.6%) wrists; and on the left side bifurcation of the nerve was present in 15 (17.2%) wrists. Statistically, we found no significant difference in the prevalence of the bifid nerve within the tunnel in the subgroups based on age, gender, or side of the wrists. A persistent median artery (PMA) within the tunnel was observed in 21 (11%) wrists--10 males and 11 females. Of these, four (19%) cases were presented with coexistent PMA and bifid median nerve within the tunnel. Statistically, we found that the two variations are not independent traits, and their covariance is not null. CONCLUSION: There was a high prevalence of bifid median nerve (19%) and PMA (11%) within the tunnel regardless of gender or age. The PMA was more frequent on the left side.