Clinical outcome of endovascular therapeutic occlusion of the celiac artery.

OBJECTIVE: Endovascular occlusion of the celiac artery can be performed along with occlusion of a celiac trunk aneurysm or stenting of a thoracoabdominal aortic aneurysm to prevent a type II endoleak. Because only a few individual cases have been previously available for study, the aim of this study was to examine the technical details, clinical course, and outcome of this procedure based on a group of patients. METHODS: This retrospective study included 10 patients who underwent endovascular occlusion of the celiac artery between 1998 and 2006 (female/male = 1:4, mean age, 62.5 +/- 9.8 years). There were five aneurysms of the celiac artery, two cases each of thoracoabdominal aortic aneurysms and dissecting thoracoabdominal aortic aneurysms, and one mycotic pseudoaneurysm of the aorta. The mean follow-up period was 21.4 +/- 29.1 months. RESULTS: The celiac artery was successfully occluded in all cases, along with exclusion of the celiac artery aneurysm or thoracoabdominal aortic aneurysm, respectively. The pancreaticoduodenal arteries were the main collateral pathways, but other anastomoses and, especially, vascular variations of the celiac artery and its territory were also significant. In one patient, abdominal angina was treated by percutaneous angioplasty and stenting of the superior mesenteric artery. CONCLUSIONS: Endovascular occlusion of the celiac artery is both safe and feasible. Some vascular variations may make occlusion of the celiac trunk impossible. Liver function disorder is a relative contraindication for this procedure.

Systematic screening and treatment evaluation of hereditary neck paragangliomas.

Familial paragangliomas of the neck are often bilateral and more aggressive than spontaneous forms. Tumors appear earlier (2nd-4th decade) often with diffuse, multifocal involvement. Without treatment, these tumors can lead to significant morbidity. Three families with succinate dehydrogenase subunit D (SDHD) germline mutations underwent clinical and genetic evaluation. Patients were screened using ultrasound and evaluated further with conventional and functional imaging. Tumors with a diameter >1.5 cm were surgically removed. Multicentric and bilateral tumors were detected in 9/13 (69%) and 8/13 (62%) patients, respectively. Surgical morbidity occurred in 64% of patients. Local recurrence was 57%, although this was lower in tumors with a diameter <2 cm. We recommend an algorithm for a systematic approach to the diagnosis, monitoring, and treatment of familial head and neck paragangliomas. Operative treatment in advanced stages often leads to unwanted morbidity, such that earlier detection and treatment of smaller tumors seems to be of benefit.

Traumatic arterial injuries of the extremities: initial evaluation with MDCT angiography.

OBJECTIVE: The purpose of this study was to retrospectively assess the accuracy of MDCT angiography as the initial diagnostic technique to depict arterial injury in patients with extremity trauma. MATERIALS AND METHODS: Over 36 months, 87 patients (16 females and 71 males; age range, 16-87 years) with clinically suspected arterial injury after extremity trauma underwent 4-MDCT angiography and 67 ultimately underwent surgery. Eighty patients had blunt injuries, and seven had penetrating injuries. The presence of arterial involvement was investigated prospectively by the radiologist in charge and retrospectively by two independent radiologists. Each detected arterial lesion was then characterized as a spasm, stenosis, occlusion, or rupture. The standard of reference was surgery in 67 patients, angiography in two patients, and clinical and radiologic follow-up findings in 18 patients. MDCT angiography was assessed by means of receiver operating characteristic (ROC) curve analysis for lesion detection and Spearman's rank correlation test for lesion characterization. Image quality, lesion depiction, and artifacts were subjectively assessed. RESULTS: Sixty-two traumatic arterial lesions were confirmed at surgery in 55 patients. MDCT angiography yielded high accuracy in detection (area under the ROC curve [Az] = 0.96; p < 0.001) and characterization (r = 0.94; p < 0.001) of traumatic arterial injuries and in recognizing an underlying dissection (Az= 0.82; p < 0.001). Prospective sensitivity and specificity were 95% and 87%, respectively, and retrospective sensitivity and specificity were 99% and 87%, respectively. MDCT angiography was considered to be sufficient for a reliable diagnosis in 83 patients (p < 0.001). Image quality and lesion depiction on MDCT angiograms were considered to be good and artifacts were considered mild with substantial interobserver agreement (kappa, 0.62-0.69). CONCLUSION: MDCT angiography provides significant and reproducible technique for the detection and characterization of arterial injuries to the extremities with high image quality and vascular delineation.

Hyperperfusion syndrome of the deltoid muscle after subclavian artery angioplasty and stenting.

PURPOSE: To report a case of hyperperfusion syndrome of the deltoid muscle after percutaneous transluminal angioplasty of a symptomatic high-grade subclavian artery stenosis. CASE REPORT: Immediately after balloon dilation of a left-sided subclavian artery stenosis, a 53-year-old man developed severe ipsilateral shoulder pain and swelling. Computed tomographic angiography revealed no extravasation or hematoma. Sonography showed massive edema and increased anteroposterior diameter of the left deltoid muscle (3.5 cm compared to 2.0 cm on the right). Hyperperfusion syndrome was suspected, and decompression by anterolateral fasciotomy was performed. Subsequently, both pain and swelling decreased. At day 3, the skin incision, which was temporarily covered with a synthetic skin substitute, was sutured; the wound healed uneventfully. Two weeks after surgery, both muscle strength and shoulder movements showed no restrictions. CONCLUSIONS: Hyperperfusion syndrome after endovascular treatment of subclavian artery stenosis should be considered in the differential diagnosis of atypical muscle pain in the upper extremity. It may present as a compartment syndrome requiring surgical decompression.