Complications of diagnostic arteriography performed by a vascular surgeon in a recent series of 558 patients.

This article analyzes the complication rates of diagnostic arteriographies performed by a single vascular surgeon and compares them to those previously published by interventional radiologists. Five hundred fifty-eight consecutive patients who underwent diagnostic arteriographies were analyzed. A modification of one study's criteria was used to compile perioperative complications. The technical success rate was 99%. These included 345 aortoiliofemoral arteriograms with runoff, 64 aortoiliofemoral arteriograms for abdominal aortic aneurysms, 83 aortoiliofemoral arteriograms with contralateral selective iliacs, 35 aortoiliofemoral arteriograms with carotids, and 27 aortoiliofemoral arteriograms with selective visceral/renal. Femoral artery puncture was used in 93%, and left brachial artery in 7%. The mean amount of contrast was 97 cc and the mean operative time was 25 minutes. The overall complication rate was 3.8% (1.3% major), which was comparable to what was published previously (1.9% and 2.9%) but superior to what we published previously as performed by our radiologists (7%, p <.001). A logistic regression could not find any variables that were significant for the prediction of a major complication. However, increased age, a longer operating time (>or= 30 minutes), and smoking were associated with an increase in overall complications. It was determined that diagnostic arteriography can be done safely by experienced vascular surgeons with low complication rates that compare favorably with what was published by interventional radiologists.

Complications of diagnostic carotid/cerebral arteriography when performed by a vascular surgeon.

Carotid stenting has recently been considered as an alternative treatment to carotid endarterectomy for certain patients with carotid stenosis. Hence, performing carotid arteriography with minimal morbidity and mortality is essential. The purpose of this study was to audit complications of diagnostic carotid/cerebral arteriography performed by a vascular surgeon with experience in endovascular interventions. One hundred one consecutive patients underwent 4-vessel arch aortography with selective carotid, subclavian, and/or vertebral arteriography with use of the Seldinger technique. Demographic data, indications, procedure approach (transfemoral, brachial), number of arteries punctured, type of selective injection, contrast volume, and procedure time were analyzed. Minor complications were those that do not significantly alter the health or activity of the patient or require extra hospitalization or treatment. Other complications were defined as major complications. The technical success rate was 99% (100/101 patients). These included the following: 82 patients with right carotid artery, 82 with left carotid artery, 15 with right subclavian artery, 21 with left subclavian artery, 11 with right vertebral artery, and 17 with left vertebral artery (a total of 228 selective injections). Indications for procedures included the following: transient ischemic attack (TIA)/stroke symptoms in 66%, asymptomatic carotid stenosis in 22%, upper limb claudication in 4%, and vertebrobasilar insufficiency in 4%. Right femoral puncture was used in 79%, left femoral in 12%, and left brachial in 9%. The mean amount of contrast used was 101 cc (45-250 cc) and the mean procedure time was 46 minutes (22-132 minutes). There were 5 complications in the whole series: 3 major complications (3%), including 1 minor stroke (1%) with carotid injection, 1 TIA, and 1 major retroperitoneal bleeding; and 2 (2%) minor complications. The major complication rate in this series compares favorably to published rates of 5.7% to 9.1%. There was no association between complications and specific risk factors except for a longer catheterization time (66 minutes versus 45 minutes, p=0.011). Carotid/cerebral arteriography can be done safely by experienced vascular surgeons with minimal perioperative complications that compare favorably with what has been reported in the radiology literature.

Tension pneumoperitoneum resulting from endoscopic duodenal perforation: a case report.

Tension pneumoperitoneum is defined as an accumulation of free air within the peritoneal cavity sufficient to cause respiratory or hemodynamic compromise. We report a case of a 75-year-old woman who underwent upper endoscopy for evaluation of severe upper gastrointestinal hemorrhage. During the procedure, she developed massive abdominal distension, raising concern about possible perforation. Endoscopy was terminated and prompt surgical consultation obtained. This revealed massive abdominal distension, hypotension, and elevated airway pressures. Tension pneumoperitoneum was suspected. There was immediate decompression via a small umbilical incision, after which the patient's condition stabilized. A full exploration was then carried out, allowing definitive surgical treatment of both the source of bleeding and the perforation. We review the literature regarding this unusual event.

Computed tomography versus color duplex ultrasound for surveillance of abdominal aortic stent-grafts.

PURPOSE: To compare the ability of computed tomography (CT) and color duplex ultrasound (CDUS) to detect endoleak and accurately measure aortic aneurysm diameters after endovascular repair. METHODS: Between February 2000 and October 2004, 178 consecutive patients (156 men; mean age 74 years, range 49-89) were treated with aortic stent-grafts (86 Ancure, 55 AneuRx, and 37 Excluder). The follow-up protocol included serial CT and CDUS at 1 month and every 6 months thereafter. Sensitivity, specificity, positive predictive value, negative predictive value, and Kappa statistics (kappa) were calculated using CT as the gold standard; Bland-Altman analysis was used to determine the 95% limits of agreement. Paired and unpaired t tests and correlation coefficients were used to compare the methods. RESULTS: Follow-up ranged from 1 to 53 months (mean 16), during which 367 paired CT and CDUS studies were acquired. The mean diameter of the AAA sac after repair was 5.15 cm by CT versus 4.99 cm by CDUS (p=0.07); 93% of paired studies were somewhat similar (