Distal arterial splenic embolization via collaterals: report of two cases.

Two patients were treated for bleeding gastric varices, developed due to splenic vein occlusion. In one patient with occlusion of the main splenic artery, splenic embolization performed via collaterals facilitated open splenectomy with minimal blood loss. In another patient, bleeding from the gastric varices stopped after partial arterial splenic embolization performed via the accessory left gastric and inferior phrenic arteries. No complications were encountered.

Emergent treatment of variceal bleeding in two infants.

Two infants with portal hypertension were treated on an emergency basis for life-threatening uncontrollable variceal bleeding. One 9-month-old girl had portal vein thrombosis, and the other 28-months-old girl had liver cirrhosis secondary to biliary atresia. Following percutaneous transhepatic embolization of the varices, successful bleeding control was achieved in both patients.

Endovascular treatment of a pulmonary artery pseudoaneurysm with a stent graft: report of two cases.

Two patients with hemoptysis secondary to pulmonary artery pseudoaneurysm were treated by endovascular placement of stent grafts. Aneurysms were effectively excluded and hemoptysis stopped. Stent grafts were occluded in both patients. However, endovascular treatment of the pulmonary artery pseudoaneurysm with a stent graft is a safe alternative to coil embolization or surgery.

Percutaneous removal of two self-expanding stent grafts following failed deployment.

Insertion of self-expanding stent grafts was attempted in two patients with venous obstruction following unsuccessful venoplasty. One patient with end-stage renal disease had stenosis at the caudal end of the previously placed stent in the right external iliac vein. The second patient was treated for occlusion of multiple stents in the left iliac vein. Two of the stent grafts failed deployment and were subsequently removed percutaneously. New stent grafts were inserted in the intended positions. Despite additional venous access sites with large caliber sheaths, required for retrieval of the failed stent grafts, there were no major complications.

Interventional procedures involving portal vein circulation: a review.

Rapid development of diagnostic radiological methods during recent decades has been followed by development of new interventional procedures involving portal circulation. The majority of these interventions were developed for treatment of patients with symptoms secondary to portal hypertension (PH). Interventions involving portal vein circulation have an established position in the treatment of PH and other diseases, and further development of these methods can be expected.

Interventional treatment of children with portal hypertension secondary to portal vein occlusion.

PURPOSE: To present methods and results of interventional treatment of children with portal hypertension (PH) secondary to portal vein occlusion (PVO). MATERIAL AND METHODS: Five children, four boys and one girl, 8 - 14 years old, with symptomatic PH secondary to PVO were treated. All children had one or more episodes of bleeding from oesophageal varices, enlarged spleen and thrombocytopenia. Partial embolisation of the spleen was performed in four children. Attempts to recanalize the occluded part of the portal vein were done in all children using transjugular (n = 4), transhepatic (n = 4) and transsplenic (n = 3) approaches. RESULTS: All procedures were carried out without serious complications and were followed by normalisation of the platelet count, decrease in splenic size and disappearance of bleeding. Recanalisation of the occluded portal vein with a stent was possible in one child and partial stent recanalisation was possible in another child. Transjugular intrahepatic portosystemic shunt (TIPS) with partly extrahepatic, intraperitoneal route was created in one patient. All children were scheduled for follow-up. During the observation time of 22 months (5 - 46 months), additional balloon dilation and placement of new stents were necessary in two children. CONCLUSION: Interventional procedures are valuable in the treatment of children with symptoms secondary to PVO. Treatment should be customized and scheduled follow-ups of the patients are necessary.

Embolization of hepatic hemangiomas in infants.

A small number of cavernous liver hemangiomas in infants cause serious symptoms, requiring active treatment. We report two newborns with giant liver hemangiomas, treated by intra-arterial embolization. The babies presented at 2 - 8 days after birth with tachypnoea and cardiac dilation. A giant liver hemangioma located in the right liver lobe in one infant and in the left liver lobe in the other was found at ultrasonography and computed tomography. Dilated liver veins indicated abnormal shunting of the blood through the hemangiomas. Because of progress of symptoms superselective embolization of the arteries feeding the hemangiomas and arising from the celiac trunk was performed with a mixture of Lipoidol and Histoacryl. A decrease of tachypnoea and of heart volume was noted after embolization. In one infant surgery was necessary due to gastrointestinal bleeding. The intra-arterial embolization is a valuable method for the treatment of newborns with symptomatic cavernous liver hemangiomas.

Stenting of the biliary tract in children.

We report on the technique and results of percutaneous transhepatic biliary drainage (PTBD) in children with obstructive jaundice. Three patients aged 8 - 15 years were treated, two of them for a benign and one for a malignant stricture. Endoscopic treatment was not possible and all the PTBD procedures were done under general anaesthesia. One of the children was treated with external-internal drainage, and the two others by insertion of a plastic endoprosthesis. There were no immediate complications. The PTBD had a good palliative effect in two cases, and in one case surgical treatment was necessary. We conclude that PTBD is a safe modality and that it can be used in children for the relief of obstructive jaundice.

Long-term results of combined surgical and radiological intervention in complicated aortic dissection type-A. A case report.

We report the long-term results of combined surgical and radiological intervention in a patient with complicated aortic dissection, type-A. Following surgical graft-repair of a dissected part of the ascending aorta, embolization of the splenic artery, and stenting of the major abdominal arteries and of the left renal artery, was performed. The patient was able to return to normal active life, and all stented arteries remained patent after 32 months. A stent that was mispositioned across the aortic lumen did not cause any symptoms.

Double-balloon catheter for isolated liver perfusion: an experimental study.

PURPOSE: Further development of a previously described interventional method for isolated liver perfusion (ILP) with a new double-lumen balloon catheter, and evaluation of the side-effects of such isolation. METHODS: In six pigs a double-balloon occlusion catheter was placed via the transjugular approach with its tip in the portal vein. One of the balloons was positioned in the inferior vena cava (IVC), cranial to the origin of the hepatic veins and the other balloon in the portal vein. By the transfemoral approach, a single-balloon occlusion catheter was placed in the IVC caudal to the origin of the hepatic veins. A third catheter was placed by the transfemoral route with the occlusion balloon in the proper hepatic artery. After inflation of all balloons 99Tc(m)-labelled human serum albumin was recirculated through the liver. The isolation was evaluated by repeated measurement of radioactivity levels in peripheral blood. Laboratory tests of liver and pancreas function, and hemoglobin, were taken before, at the end of, and 3 days after the procedure. Blood gases were tested at the beginning and end of the procedure. RESULTS: One pig died during the procedure due to technical failure and was excluded from the study. In the other pigs leakage from the isolated liver to the systemic circulation increased slowly, up to 9.7% (mean) during 30 min of recirculation of the perfusate through the liver. Laboratory tests were normal in all pigs except insignificant acidosis directly after the procedure and the slight elevation of s-ALAT after 3 days. CONCLUSIONS: Only minor leakage from the liver to the systemic circulation was noted during ILP performed with a new, double-balloon catheter. There were no serious side effects.

A new stent designed for carotid artery application. An experimental study.

PURPOSE: To evaluate a new stent developed for treating arterial stenoses located adjacent to the bifurcation of the carotid artery. MATERIAL AND METHODS: Eight 4-cm-long nitinol stents, each with a diameter of 6 mm in its distal half and 9 mm in its proximal half, were tested in 4 pigs. In each animal, the abdominal aorta was catheterized through the left common carotid artery, and 2 stents were inserted into the right and left iliac arteries, respectively, with the wider portion in the common iliac artery and the narrower portion in the corresponding external iliac artery. The pigs were killed after 24 hours, or 1, 4 or 8 weeks, following control angiography. The arteries were examined macroscopically and by scanning electron microscopy. RESULTS: All stents remained in the intended position, fitting the arterial wall, following successive expansion to their maximum diameter and after 4 weeks were completely covered by endothelium. The arteries remained patent, with preserved flow to the side branches through the stent mesh. A small thrombus was found in I artery CONCLUSION: In animal experiments, the new stent was safely inserted over the arterial bifurcation, remained in place and was covered by endothelium while flow through side branches was preserved.

Stent recanalization of chronic portal vein occlusion in a child.

An 8-year-old boy with a 21/2 year history of portal hypertension and repeated bleedings from esophageal varices, was referred for treatment. The 3.5-cm-long occlusion of the portal vein was passed and the channel created was stabilized with a balloon-expandable stent; a portosystemic stent-shunt was also created. The portosystemic shunt closed spontaneously within 1 month, while the recanalized segment of the portal vein remained open. The pressure gradient between the intrahepatic and extrahepatic portal vein branches dropped from 17 mmHg to 0 mmHg. The pressure in the portal vein dropped from 30 mmHg to 17 mmHg and the bleedings stopped. The next dilation of the stent was performed 12 months later due to an increased pressure gradient; the gastroesophageal varices disappeared completely. Further dilation of the stent was planned after 2, 4, and 6 years.

Percutaneous management of occluded biliary duct endoprostheses.

PURPOSE: To present interventional methods for percutaneous treatment of patients with occluded bile duct endoprostheses. MATERIAL AND METHODS: Thirteen patients with endoscopically inserted occluded or damaged bile duct endoprostheses and recurrent jaundice were treated percutaneously. Endoscopic treatment was not available in 2 cases and unsuccessful in 11 other patients. Eleven interventions were performed under systemic sedation and local anaesthesia and 2 under general anaesthesia. The endoprostheses were dislodged to the bowel using different interventional devices. Adequate bile duct drainage was subsequently achieved by insertion of self-expanding metallic stents. RESULTS: All procedures were accomplished successfully and without immediate serious complications. Two metallic stents and 18 plastic endoprostheses were dislodged to the bowel using percutaneous interventional techniques. One plastic endoprosthesis became bent in the duodenum and had to be removed endoscopically due to abdominal pain. None of the other endoprostheses left in the bowel caused any symptoms. Two patients died during the first week after the procedure due to progressive liver failure. CONCLUSION: Occluded bile duct endoprostheses can be safely dislodged to the bowel and replaced by metallic stents using percutaneous interventional techniques.

Differences in endothelial injury after balloon angioplasty, insertion of balloon-expanded stents or release of self-expanding stents: An electron microscopic experimental study.

PURPOSE: To evaluate which of six different commonly available stents inserted into an artery without percutaneous transluminal angioplasty (PTA) causes the least endothelial damage. To compare the degree of endothelial injury after insertion of such a stent with injury caused by PTA. METHODS: Twelve healthy pigs were used in the experiments. In the first part of the study six different types of stents were inserted into the common iliac arteries. In the second part of the study self-expanding stents with large spaces between the wires were used. PTA was performed in the contralateral iliac artery. The pigs were killed immediately after the procedure and resected specimens examined after fixation, using scanning electron microscopy. RESULTS: All procedures but two were accomplished successfully. More endothelium was preserved after insertion of self-expanding stents with large spaces between the wires, compared with stents with small spaces and balloon-expanded stents. After insertion of self-expanding stents with large spaces, 50.1% +/- 16.4% of the endothelium remained intact, compared with only 5.6% +/- 7.7% after PTA. The difference was statistically significant (p < 0.001). CONCLUSION: Self-expanding stents with large spaces between the wires, inserted without PTA, cause less damage to the endothelium than other stents and significantly less damage than PTA.

Malignant dysphagia: palliation with esophageal stents--long-term results in 100 patients.

PURPOSE: To evaluate the long-term palliative effect of self-expanding nitinol esophageal stents in patients with malignant dysphagia. MATERIALS AND METHODS: One hundred patients with severe dysphagia secondary to malignant esophageal strictures were treated with self-expanding nitinol stents. The strictures were caused by squamous carcinoma (n = 43), adenocarcinoma (n = 28), anastomotic tumor recurrence (n = 14), and mediastinal tumor (n = 15). RESULTS: One hundred six stents were successfully positioned in 100 patients. Attempts to insert a second, coaxial stent were unsuccessful in two patients; a second stent was placed incorrectly in another patient. Statistically significant (P < .001) reduction of dysphagia was noted after expansion of the stents. Complications consisted of incomplete expansion secondary to stent twisting (n = 4), stent migration (n = 4), tumor ingrowth (n = 17), tumor overgrowth (n = 3), food impaction (n = 5), fracture of stent wires (n = 2), benign strictures at stent edges (n = 2), tumor bleeding (n = 3), and esophagorespiratory fistula (n = 5). The primary patency rate was 75% (77 of 102 stents); the secondary patency rate was 94% (96 of 102 stents). The survival time (mean, 6.2 months; range, 0.1-47 months) varied with the diagnosis. CONCLUSION: Placement of self-expanding nitinol stents is safe and has a good long-term palliative effect on dysphagia in patients with malignant esophageal strictures.

Electrolytic stent in the normal bile duct. An experimental study.

PURPOSE: To evaluate and compare changes in the bile-duct wall after the insertion of electrolytic and nonelectrolytic stents. MATERIAL AND METHODS: The electrolytic stents were composed of 3 different layers (iron, isolating polyethylene and tantalum) and were implanted surgically in the bile duct of 8 healthy pigs. The nonelectrolytic stents were also composed of 3 layers (2 layers of tantalum and an isolating layer of polyethylene) and were implanted surgically in the bile ducts of 9 healthy pigs. After an observation time of 8 weeks, the pigs were killed and the bile ducts were excised and sent for histopathological examination. RESULTS: One pig was killed after the procedure owing to postoperative complications; all the other pigs survived without complications. Migration of the stent to the bowel occurred in 4 pigs. A slight inflammatory reaction was seen at histopathological examination in 6 pigs with the electrolytic stent and in 6 pigs with the nonelectrolytic stent. There was no difference in the specimens from pigs with electrolytic and nonelectrolytic stents. CONCLUSIONS: The electrolytic stents did not cause more changes in the normal bile-duct wall than the nonelectrolytic stents.