Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement.

PURPOSE: To evaluate use of catheter-directed thrombolysis and/or endovascular stent placement to treat superior vena cava (SVC) syndrome. MATERIALS AND METHODS: Fifty-nine consecutive patients with SVC syndrome were studied. The cause was underlying malignancy in 43 and benign disease in 16. All patients underwent bilateral upper-extremity venography. The SVC was occluded in 31 cases and stenosed in 28. Twenty-seven patients underwent catheter-directed thrombolysis; 51 underwent endovascular stent placement. Patency was defined in terms of absence of symptoms and signs of SVC syndrome. RESULTS: Technical success was achieved in 56 of 59 patients (95%). Among 42 patients with underlying malignancy (mean follow-up, 7.0 months; range, 1-34 months), primary clinical patency was achieved in 33 (79%) and secondary clinical patency was achieved in 39 (93%). Among 13 patients with benign disease (mean follow-up, 17.0 months; range, 1-27 months), primary clinical patency was achieved in 10 (77%) and secondary clinical patency was achieved in 11 (85%). Four patients were lost to follow-up. Periprocedural mortality and morbidity rates were 3% (two of 59 patients) and 10% (six of 59 patients), respectively. CONCLUSION: Catheter-directed thrombolysis and endovascular stent placement is a safe and effective treatment for SVC syndrome.

True lumen obliteration in complicated aortic dissection: endovascular treatment.

PURPOSE: To evaluate endovascular treatment of ischemic complications caused by true lumen obliteration in aortic dissection. MATERIALS AND METHODS: Endovascular techniques were used to treat true lumen obliteration in 11 patients with complicated aortic dissection. In all cases, the true lumen was compressed to a paper-thin sliver by the expanded false lumen. Two patients had Stanford type A (chronic) and nine had type B (six acute, three chronic) dissections. Obliteration of the true lumen was associated with branch vessel ischemia that included renal (n = 7), mesenteric (n = 6), and lower-extremity (n = 6) arterial compromise. Two patients were treated with aortic stents, four with balloon fenestration of the intimal flap, and three with both stent placement and fenestration. In two patients, ischemic complications caused by true lumen obliteration could not be treated with endovascular techniques. RESULTS: Revascularization was technically successful with relief of clinical symptoms in nine patients. Revascularization was unsuccessful in one patient in whom surgical revascularization of the superior mesenteric artery was necessary and in one in whom hypertension was managed medically. One patient developed thrombosis of a renal artery in which a stent had been placed. The 30-day mortality rate was 9%, and the mean follow-up was 10.1 months (range, 2 weeks to 39 months). CONCLUSION: True lumen obliteration can be safely and effectively treated with endovascular stent placement and balloon fenestration.

Percutaneous endoluminal placement of stent-grafts for the treatment of isolated iliac artery aneurysms.

PURPOSE: To evaluate the feasibility of stent-grafts for treatment of isolated iliac artery aneurysms (IAAs). MATERIALS AND METHODS: Nine IAAs in eight patients were treated with transluminally placed endovascular stent-grafts. All patients were men (median age, 72 years). In three, the aneurysm involved both the common and internal iliac arteries. In one, common and external iliac arteries were involved. The other aneurysms involved only the common iliac artery. Two aneurysms were treated with balloon-expandable stents covered with polytetrafluoroethylene (PTFE) graft material, three were treated with self-expanding Z-stents covered with a woven polyester graft, and four were treated with self-expanding Z-stents covered with PTFE. RESULTS: Transluminal placement of the stents was successful in all patients with thrombosis of the aneurysms. There were no distal thromboembolic events, deaths, or infections. The median follow-up period was 8.5 months. CONCLUSION: Initial results suggest that transluminal stent-graft placement for treating isolated IAAs is a safe and effective alternative to surgery in selected patients. Long-term follow-up data are needed before this approach can be recommended for the primary treatment of IAAs.

New intravesical contrast medium for CT: preliminary studies with arachis (peanut) oil.

Computed tomography is recognized as a valuable adjunct to clinical staging of bladder carcinomas, with a diagnostic accuracy of 70%-80%. Technique modifications in order to improve the diagnostic results include the use of various intravesical contrast agents. All hitherto described contrast agents suffer from drawbacks, either due to insufficient contrast resolution or to partial volume effect. Arachis (peanut) oil has been used in 69 patients and seems to meet many of the demands that can be made on a good intravesical contrast agent. Both bladder wall and tumor are well delineated, and diffuse and local thickening of the wall can be appreciated., The oil is nonhygroscopic and may therefore be used together with other contrast agents, if necessary.