Endovascular abdominal aortic aneurysm repair using transvenous intravascular US catheter guidance in patients with chronic renal failure.

PURPOSE: To describe the transvenous application of intracardiac echocardiography (ICE) for guidance during endovascular aortic repair (EVAR). MATERIALS AND METHODS: Eight patients with an infrarenal abdominal aortic aneurysm (AAA) and chronic renal failure were determined suitable for EVAR. The procedure was performed by deploying the transcaval and transiliac vein guidance of an ICE catheter to reduce the dosage of iodinated contrast medium. Multiple guidance parameters were assessed. The present study describes the EVAR procedure and postprocedure transabdominal ultrasound (US) follow-up results at 3-4 months. RESULTS: The eight procedures were completed by using transvenous ICE guidance. No contrast medium was used in five patients, and 3-20 mL of isoosmolar contrast medium was administered in the other three. No endoleaks were detected by ICE immediately after stent deployment. One patient who had a single functioning kidney developed renal failure that was attributed to manipulation-related cholesterol embolization. That patient became dependent on dialysis and died 3.5 months after the procedure. No endoleaks were detected at 3-4-month US follow-up in the other seven patients. CONCLUSIONS: Transvenous ICE guidance is a promising method to reduce the dosage of iodinated contrast medium in patients with renal dysfunction undergoing EVAR. A prospective trial comparing this modality versus digital subtraction angiography guidance with iodinated contrast medium in terms of safety, accuracy, and long-term efficacy is recommended.

Percutaneous trans-papillary elimination of common bile duct stones using an existing gallbladder drain for access.

BACKGROUND: The presence of stones in the common bile duct (CBD) may cause complications such as obstructing jaundice or ascending cholangitis, and the stones should be removed. OBJECTIVES: To assess the efficacy of percutaneous elimination of CBD stones from the gallbladder through the papilla. METHODS: During a 4 year period, six patients (five men and one woman, mean age 71.5 years) who had CBD stones and an existing gallbladder drain underwent percutaneous stone push into the duodenum after balloon dilatation of the papilla, with a diameter equal to that of the largest stone. Access into the CBD was from the gallbladder, using an already existing percutaneous gallbladder drain (cholecystostomy tube). RESULTS: Each patient had one to three CBD stones measuring 7-14 mm. Successful CBD stone elimination into the duodenum was achieved in five of the six patients. The single failure occurred in a patient with choledochal diverticulum, who was operated successfully. There were no major or minor complications during or after the procedures. CONCLUSIONS: Trans-cholecystic CBD stone elimination is a safe and feasible percutaneous technique that utilizes existing tracts, thus obviating the need to create new percutaneous access. This procedure can replace endoscopic or surgical CBD exploration.