Management of pancreaticoduodenal artery aneurysms: results of superselective transcatheter embolization.

OBJECTIVE: The purpose of our study was to assess the efficacy of transcatheter arterial embolization for pancreaticoduodenal artery aneurysms. CONCLUSION: We concluded that transcatheter arterial embolization is the initial and definitive therapeutic choice for pancreaticoduodenal artery aneurysms, with a possible option to perform surgery after embolization.

Transcatheter management for multiple liver tumors after hepatic artery obstruction following reservoir placement.

BACKGROUND/AIMS: Hepatic arterial infusion chemotherapy via an implantable port system has been widely used to treat unresectable liver neoplasms. Complications of the hepatic artery occlusion following reservoir placement, however, makes it impossible to continue the infusion therapy. The purpose of our study was to assess the possibility of transcatheter treatment after the hepatic artery obstruction following reservoir placement. METHODOLOGY: Between April 1999 and May 2002, 14 patients with liver tumors had the complication of hepatic artery obstruction following reservoir placement. We conducted a prospective trial to assess 1) the collateral pathways of feeding artery using angiography, 2) the possibility of transcatheter treatment or 3) re-reservoir placement for liver tumors. RESULTS: 1) Angiography revealed that the main collateral pathway of the feeding artery was the inferior phrenic artery in 7 patients (50%), the dorsal pancreatic artery in 4 patients (29%) and the anastomotic branch of the celiac axis in 1 patient (7%). The main collateral pathway could not be detected in 2 patients (14%). 2) Transcatheter treatment was successfully performed in all patients (100%). 3) Rereservoir placement failed in all cases. CONCLUSIONS: These results suggest that transcatheter treatment may be possible for patients with hepatic artery obstruction.

Manual aspiration thrombectomy with a standard PTCA guiding catheter for treatment of acute massive pulmonary thromboembolism.

PURPOSE: To evaluate the efficacy and safety of percutaneous manual aspiration thrombectomy for the treatment of acute massive pulmonary thromboembolism with hemodynamic impairment. MATERIALS AND METHODS: Over a period of 6 years and 9 months, 15 patients with hemodynamic impairment (4 men, 11 women; aged 27-79 years) were treated by manual clot aspiration with a standard, large-lumen percutaneous transluminal coronary angioplasty (PTCA) guiding catheter. RESULTS: After treatment, angiography demonstrated improvement of pulmonary perfusion in all patients (mean Miller score: before treatment 18.9, after treatment 12.1; P < 0.01). Mean pulmonary arterial pressure decreased from 29.6 to 22.5 mmHg (P < 0.01). The mean treatment time was 114.2 min. All of the patients survived and their clinical status improved. No patient had any significant complication. CONCLUSION: Percutaneous manual aspiration thrombectomy with a standard 8 Fr PTCA guiding catheter achieved rapid, safe improvement of the hemodynamic situation in cases of acute massive pulmonary thromboembolism, with low cost both in terms of time and money.

Clinical Usefulness of Hybrid Intervention for the Treatment of Primary Thrombosis of Axillary-subclavian Vein.

Untreated symptomatic patients with Paget-Schroetter syndrome can suffer chronic disability due to venous obstruction, with arm swelling, pain, and early exercise fatigue. Although systemic or catheter-directed thrombolysis followed by anticoagulation and surgical intervention is recommended, there is no definite consensus about treatment. Here, we report the clinical usefulness of hybrid intervention with a combination of thrombectomy, thrombo-aspiration and balloon PTA, which has not been reported previously for this condition. These procedures were successful, and the patient has been free of symptoms for 6 years.