RESUMEN
This study intended to determine the precise diameter of the popliteal artery in patients at risk for popliteal aneurysms. Accurate sizing is necessary to develop devices for endovascular treatment of popliteal aneurysms. Fifty-four patients with abdominal aortic aneurysms (AAAs) had computed tomography (CT) scans of the popliteal arteries. Age- and gender-matched control subjects were measured by ultrasound. NIH Image was used to measure the minor diameter at the adductor hiatus (proximal) and femoral condyles (midpopliteal artery). There were 4 unsuspected popliteal aneurysms (7.4%). The proximal popliteal artery was ectatic in these patients: 13.4 +/- 5.2 mm. Proximal and midpopliteal arteries were significantly larger in the other patients with AAAs compared with controls: 9.6 +/- 1.8 mm vs 7.9 +/- 1.1 mm at the hiatus (p<0.001) and 10.2 +/- 2 mm vs 7.9 +/- 0.9 mm at the condyles (p<0.001). The popliteal artery was focally larger in patients with AAAs without popliteal aneurysms. The popliteal artery was larger in men compared with women; 9.8 +/- 1.8 mm vs 8.8 +/- 1.9 mm at the hiatus (p=0.024) and 10.5 +/- 1.9 mm vs 9.0 +/- 2.4 mm at the condyles (p=0.005). The proximal popliteal artery was 2 mm larger in patients at risk for popliteal aneurysms and 5 mm larger in patients with popliteal aneurysms compared to controls. Focal ectasia of the midpopliteal artery was common. Planning for endovascular treatment of popliteal aneurysms must incorporate this striking enlargement.
Asunto(s)
Aneurisma/diagnóstico por imagen , Aneurisma/etiología , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Implantación de Prótesis Vascular , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/cirugía , Tomografía Computarizada por Rayos X , Anciano , Aneurisma/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Velocidad del Flujo Sanguíneo/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Poplítea/fisiopatología , Cuidados Preoperatorios , Medición de Riesgo , Factores de RiesgoRESUMEN
PURPOSE: The etiology of premature ovarian failure after uterine artery embolization (UAE) is unknown. The authors prospectively assessed ovarian arterial circulation before and after UAE with use of ultrasonography (US). The authors hypothesize that nontarget embolization of the ovary occurs during routine UAE. MATERIALS AND METHODS: Twenty-three women (mean age of 42.6 years; range, 35-51 y) participated in the study. Grayscale, color, and pulsed-wave Doppler US studies were performed immediately before and after UAE. Resistive index (RI) and pulsatility index (PI) were calculated. The proportion of women who developed increased vascular impedance after UAE was statistically assessed with use of the Yates-corrected chi(2) test. RESULTS: Seventeen of 23 patients (74%) completed the study. Nine of 17 (54%) showed complete loss of ovarian arterial perfusion after UAE. Six of 17 (35%) had increases in RI and PI, whereas two of 17 (11%) had decreases in RI and PI. The increase in vascular impedance after UAE in 15 of 17 patients was significant (P <.0001). CONCLUSION: Loss of detectable ovarian arterial perfusion occurs in the majority of patients undergoing UAE. Ovarian vascular impedance increases in nearly all patients as a result of UAE. The authors conclude that inadvertent nontarget embolization of the ovarian arterial bed occurs during routine UAE.
Asunto(s)
Embolización Terapéutica/efectos adversos , Ovario/irrigación sanguínea , Ovario/diagnóstico por imagen , Adulto , Femenino , Humanos , Leiomioma/terapia , Persona de Mediana Edad , Ovario/fisiopatología , Estudios Prospectivos , Flujo Sanguíneo Regional , Ultrasonografía Doppler en Color , Neoplasias Uterinas/terapia , Útero/irrigación sanguíneaRESUMEN
We report a case in which recurrent hemorrhage from stomal varices was successfully treated by placement of a TIPS in a patient with prior colectomy for inflammatory bowel disease. Although several treatment options have been reported for this entity we believe that TIPS offers minimally invasive and definitive treatment.
Asunto(s)
Colostomía/efectos adversos , Hemorragia Gastrointestinal/cirugía , Derivación Portosistémica Intrahepática Transyugular , Estomas Quirúrgicos/irrigación sanguínea , Várices/cirugía , Femenino , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Humanos , Persona de Mediana Edad , Portografía , Recurrencia , Várices/complicaciones , Várices/diagnóstico por imagenRESUMEN
PURPOSE: To evaluate the effect of uterine fibroid embolization (UFE) on menstruation and ovarian function. METHODS: The authors performed an observational study of UFE for the treatment of symptomatic fibroids. All patients had regular predictable menses before intervention and none had clinical or laboratory findings of menopause. UFE was performed with use of standard methods with 355-700-microm-diameter polyvinyl alcohol (PVA) foam particles. The incidence of ovarian failure was calculated for women younger than 45 years and for those 45 years or older, based on retrospective stratification by age. The authors assessed statistical differences in ovarian failure between the two age groups with use of the X2 test. RESULTS: Sixty-six premenopausal women (age range, 30-55 years) underwent bilateral UFE and were followed for an average of 21 weeks (range, 12-77 weeks). In 56 of 66 (85%) patients, regular menses resumed after an average of 3.5 (range, 1-8) weeks. In 10 of 66 (15%) patients, regular menses did not resume. Clinical and biochemical findings consistent with ovarian failure and presumed menopause were seen in nine of 10 patients without resumption of menses (14% of total patients). Ovarian failure occurred in nine of 21 (43%) women older than 45 years and in none of the 45 women younger than 45 years (P < .05). There were no differences in presenting symptoms, amount of PVA used, or fibroid size between patients who did and did not resume menses. CONCLUSION: The majority of patients undergoing UFE will have resumption of menses, but the incidence of postprocedure ovarian failure is considerably higher than reported to date. Loss of menses induced by UFE is significantly more likely to occur in women older than 45 years.
Asunto(s)
Embolización Terapéutica , Leiomioma/terapia , Ciclo Menstrual/fisiología , Ovario/fisiología , Recuperación de la Función/fisiología , Neoplasias Uterinas/terapia , Adulto , Angiografía , Femenino , Humanos , Inyecciones Intraarteriales , Leiomioma/irrigación sanguínea , Leiomioma/diagnóstico por imagen , Persona de Mediana Edad , Alcohol Polivinílico/administración & dosificación , Estudios Retrospectivos , Neoplasias Uterinas/irrigación sanguínea , Neoplasias Uterinas/diagnóstico por imagenAsunto(s)
Oclusión de Injerto Vascular/patología , Falla de Prótesis , Stents , Angiografía , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/patología , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/cirugía , Arteriosclerosis/diagnóstico por imagen , Arteriosclerosis/patología , Arteriosclerosis/cirugía , Implantación de Prótesis Vascular , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/cirugía , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/patología , Persona de Mediana Edad , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To compare technical success and initial complication rates of peripherally inserted central catheters (PICCs) by interventional radiologists using ultrasound (US) or venographic guidance. MATERIALS AND METHODS: With use of a computer database, the authors retrospectively reviewed 2,650 procedures, 2,126 of which were performed with US and 524 with venography. Technical success was defined as placement of a PICC. Initial complications were defined as development of a hematoma, inadvertent arterial puncture, or neuropathy. Statistical significance was assessed using the chi2 test. RESULTS: During 33 consecutive months, 2,650 procedures were performed with a complication rate of 1.0%. The technical success rate was 95.8% for venography and 99.6% for US. The initial complication rate was 0.75% for venography and 1.08% for US. There was no statistically significant difference in immediate complication rates (P = .50); however, there is statistical significance in regard to technical success (P < .001). CONCLUSION: There is no difference in initial complication rates when comparing US and venographic guidance for PICC insertion. The decision to use either method can be based on clinical grounds and/or physician preference, although US has a higher initial success rate.
Asunto(s)
Cateterismo Venoso Central/instrumentación , Flebografía , Radiografía Intervencional , Ultrasonografía Intervencional , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brazo/irrigación sanguínea , Arterias/lesiones , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/estadística & datos numéricos , Distribución de Chi-Cuadrado , Bases de Datos como Asunto , Femenino , Hematoma/epidemiología , Humanos , Illinois/epidemiología , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Enfermedades del Sistema Nervioso Periférico/epidemiología , Flebografía/estadística & datos numéricos , Radiografía Intervencional/estadística & datos numéricos , Estudios Retrospectivos , Ultrasonografía Intervencional/estadística & datos numéricos , VenasRESUMEN
OBJECTIVE: Our purpose was to determine the value of triphasic helical CT (unenhanced, hepatic arterial, and portal venous phases) in the detection and characterization of focal hepatic lesions due to hepatomas or metastases. MATERIALS AND METHODS: One hundred two patients with known or suspected hepatomas or liver metastases underwent triphasic CT. The number and conspicuity of lesions were evaluated on each phase. RESULTS: Five hundred eighty-four lesions were detected in 102 patients. Patients with hypovascular malignancies had more lesions detected on the portal venous phase with increased conspicuity than on the other phases. Patients with hypervascular malignancies had lesions best detected on the hepatic arterial phase, which revealed small lesions that were not seen on the other phases in seven (21%) of the 33 patients with hypervascular metastases and hepatomas. No lesions were detected on the unenhanced phase that were not seen on the other phases. However, arterial phase images introduced new diagnostic dilemmas because not all lesions seen on the arterial phase alone were caused by hepatomas or metastases, even in patients with known malignancies; several lesions represented benign abnormalities that included focal nodular hyperplasia. CONCLUSION: The unenhanced phase is not routinely necessary for the detection of metastases or hepatomas. Hypovascular malignancies are best evaluated during the portal venous phase. Small lesions due to hypervascular metastases and hepatomas are best evaluated and may be detected only during the hepatic arterial phase, which should be used routinely in these patients. New dilemmas may develop from the increased sensitivity of the hepatic arterial phase for lesions. However, the hepatic arterial phase is of limited value with hypovascular malignancies.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Tomografía Computarizada por Rayos X/métodos , Carcinoma Hepatocelular/irrigación sanguínea , Medios de Contraste , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Yopamidol , Neoplasias Hepáticas/irrigación sanguínea , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Hepatic artery chemoembolization represents an alternative treatment for patients whose neoplastic lesions are not amenable or have become refractory to other treatment modalities. This project was designed to test the feasibility of regional chemoembolization for patients with colorectal carcinoma metastasis to the liver who had experienced failure with one or more systemic treatments. METHODS: Thirty patients who met the study entry criteria underwent one to three hepatic artery chemoembolizations. The chemoembolization regimen consisted of an injection of a bovine collagen material with cisplatin (10 mg/mL), doxorubicin (3 mg/mL), and mitomycin C (3 mg/mL). Repeat treatments were performed at 6- to 8-week intervals. RESULTS: Radiologic responses, as measured by a decrease in lesion density of at least 75% of the lesion or a 25% decrease in the size of the lesion, occurred in 63% of the cases. A decrease of at least 25% of the baseline carcinoembryonic antigen level occurred in 95% of the cases. All responses were transient. Median survival for all 30 patients was 8.6 months after the initiation of chemoembolization and 29 months after the initial diagnosis of metastasis to the liver. Common toxicities included a "postembolization syndrome," which consisted of fever > 101 degrees F (83%), pain in the right upper quadrant (100%), nausea, and vomiting. Lethargy was a common occurrence (in 60+% of cases) and lasted up to 6 weeks. Hematologic toxicities included leukocytosis, anemia, and thrombocytopenia. CONCLUSIONS: Chemoembolization is a feasible treatment modality for patients with colorectal carcinoma metastasis to the liver who have experienced failure with other systemic treatments. It results in high response rates with transient mild-to-moderate toxicity. Responses are measured in months, however, and all patients have eventual progression of disease. Patients who are able to undergo three or more chemoembolization procedures may receive the most clinical benefit.
Asunto(s)
Carcinoma/terapia , Neoplasias Colorrectales/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Antígeno Carcinoembrionario/análisis , Carcinoma/diagnóstico por imagen , Carcinoma/mortalidad , Carcinoma/secundario , Quimioembolización Terapéutica/efectos adversos , Neoplasias Colorrectales/mortalidad , Estudios de Factibilidad , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/mortalidad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: This study was performed to determine the detailed anatomy of the thoracic outlet in normal subjects using helical computed tomography (CT), with particular attention to vascular compression with arm movement. METHODS: Ten volunteers underwent detailed clinical evaluation and helical CT scanning of the upper thorax and neck with the arm in a neutral position and with the arm abducted 90 degrees or greater and externally rotated. Anterior scalene-clavicle distance (SC), costoclavicular distance (CC), and vessel diameters were measured with electronic calipers in each position. Comparisons were made with Student's t test. RESULTS: With abduction the SC decreased from 18.4 +/- 3.9 mm to 5.2 +/- 2.4 mm (p < 0.001), and the CC decreased from 12.6 +/- 2.7 mm to 6.3 +/- 3.3 mm (p = 0.005). At these same anatomic planes, the vein diameter decreased from 11.0 +/- 1.6 mm at the neutral position to 5.1 +/- 1.5 mm (p < 0.001) and from 16.1 +/- 3.0 mm to 7.4 +/- 2.6 mm with the arm abducted (p < 0.001). The artery diameter changed from 6.6 +/- 0.8 mm to 6.2 +/- 0.5 mm (p = 0.08) and from 7.2 +/- 0.8 mm to 6.0 +/- 0.5 mm (p = 0.001) with arm movement. CONCLUSIONS: Both the distances between the anterior scalene muscle and the clavicle and between the clavicle and the first rib are significantly reduced with abduction of the upper extremity. Venous compression is universal at both the SC and CC spaces in normal subjects with this maneuver. Arterial narrowing occurs less frequently and appears to be minor. Minor changes in these thoracic outlet dimensions (SC/CC) may produce venous compression without movement.
Asunto(s)
Clavícula/diagnóstico por imagen , Músculos del Cuello/diagnóstico por imagen , Costillas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Brazo , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Movimiento , Arteria Subclavia/diagnóstico por imagen , Vena Subclavia/diagnóstico por imagen , Síndrome del Desfiladero Torácico/diagnóstico por imagenAsunto(s)
Enfermedad de Crohn/diagnóstico por imagen , Arteria Mesentérica Superior/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Velocidad del Flujo Sanguíneo/fisiología , Humanos , Válvula Ileocecal/irrigación sanguínea , Válvula Ileocecal/diagnóstico por imagen , Circulación Esplácnica/fisiologíaAsunto(s)
Aorta Abdominal/patología , Fístula Arteriovenosa/diagnóstico , Angiografía por Resonancia Magnética , Vena Cava Inferior/patología , Anciano , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico , Fístula Arteriovenosa/etiología , Femenino , HumanosRESUMEN
BACKGROUND: Visceral artery aneurysms are an uncommon but important form of abdominal vascular disease. This study reviews a contemporary experience with special emphasis on newer methods of diagnosis and treatment. METHODS: From 1980 to 1994, 37 patients were diagnosed with 46 visceral artery aneurysms. These consisted of 22 splenic, 10 hepatic, 4 superior mesenteric, 2 gastroduodenal, 3 celiac, 2 left gastric, 1 pancreatoduodenal, 1 jejunal-ileal, and 1 inferior mesenteric artery aneurysms. Follow-up was complete for 28 patients, average of 37.7 months. There were 17 asymptomatic and 29 symptomatic aneurysms, including 11 presenting with rupture. RESULTS: Seventeen patients were treated surgically, with no surgical deaths. Surgical complications included splenic abscess (two) and failure to thrombose (one). Transcatheter embolization was used in 12 patients. Complications included splenic infarction (one) and recurrence (two), successfully treated with repeat embolization. Nine patients were treated with observation. Eight experienced no complications during follow-up; one died of a ruptured splenic artery aneurysm before treatment was initiated. CONCLUSIONS: The widespread use of computed tomography has led to increased detection of asymptomatic visceral artery aneurysms. Although surgery remains necessary in many patients, transcatheter embolization is effective in the treatment of selected visceral artery aneurysms with few complications and low recurrence.
Asunto(s)
Aneurisma/diagnóstico , Aneurisma/terapia , Arterias Mesentéricas/cirugía , Vísceras/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma/etiología , Arterias/cirugía , Embolización Terapéutica , Femenino , Arteria Hepática/patología , Arteria Hepática/cirugía , Humanos , Masculino , Arterias Mesentéricas/patología , Arteria Mesentérica Superior/patología , Arteria Mesentérica Superior/cirugía , Persona de Mediana Edad , Arteria Esplénica/patología , Arteria Esplénica/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The pancreas and the biliary tract are frequent sites of infectious, Inflammatory, and neoplastic disease in patients with HIV infection. However, the symptoms of pancreaticobiliary involvement may be relatively mild so that the prevalence of these disorders is probably underestimated. An appreciation of the imaging findings of HIV-associated pancreaticobiliary disorders is important because involvement of these organs may be the only criterion that establishes the diagnosis of AIDS (Table 1).
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedades de las Vías Biliares/complicaciones , Enfermedades Pancreáticas/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Adulto , Sistema Biliar/diagnóstico por imagen , Enfermedades de las Vías Biliares/diagnóstico , Humanos , Linfoma Relacionado con SIDA/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Enfermedades Pancreáticas/diagnóstico , Cintigrafía , Tomografía Computarizada por Rayos X , UltrasonografíaAsunto(s)
Hipertensión Portal/terapia , Enfermedades Vasculares Periféricas/terapia , Vena Porta , Stents , Adulto , Anciano , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/terapia , Humanos , Hipertensión Portal/diagnóstico por imagen , Masculino , Enfermedades Vasculares Periféricas/diagnóstico por imagen , RadiografíaRESUMEN
PURPOSE: To determine the safety, efficacy, and diagnostic utility of percutaneous cholecystostomy in patients with suspected calculous or acalculous cholecystitis. PATIENTS AND METHODS: Percutaneous cholecystostomy guided with ultrasound (US) was performed in 58 consecutive hospitalized patients with suspected acute cholecystitis (28 with calculous, 30 with acalculous disease) who were not surgical candidates. RESULTS: The gallbladder was successfully catheterized in all 58 patients; 48 patients (83%) had a final diagnosis of acute cholecystitis. Clinical benefit was seen in 26 of 28 patients (93%) with calculous cholecystitis and in 16 of 20 patients (80%) with acalculous disease. The six patients who did not respond had pathologic evidence of transmural inflammation, and five had a gangrenous wall. The gallbladder was excluded as the source of sepsis in 10 patients with suspected acalculous cholecystitis. These patients' conditions did not improve after percutaneous cholecystostomy. Of the 48 patients with cholecystitis, 18 underwent cholecystectomy, 25 recovered and had their catheters removed, and five died of other causes with their catheters in place. There was one major complication, and seven minor complications. CONCLUSION: Percutaneous cholecystostomy is efficacious in both calculous and acalculous cholecystitis, but it may be most useful in the diagnosis of acalculous cholecystitis.