[Endoprosthesis in the treatment of renovascular hypertension]. / Endopróteses no tratamento da hipertensão renovascular.

Stents were placed in the renal artery in 6 patients, with renal artery stenosis and hypertension, 2 of them had azotemia. The indications were residual stenosis greater than 30% (4 cases) and restenosis following angioplasty (2 cases). The technique and results are described. Cure or improvement of arterial hypertension was obtained in 5 patients and normalization of creatinine in 2 patients with azotemia. We conclude that stent placement improve the immediate and late results of renal angioplasty.

[Endovascular treatment of iliac artery aneurysm]. / Tratamento endovascular de aneurisma da artéria ilíaca.

The authors report a case of an aneurysm of the common iliac artery of atherosclerotic etiology, treated by percutaneous endoluminal stent-graft placement. They describe the technique and review the medical literature.

[The embolization of complicated renal angiomyolipoma]. / Embolizaçao de angiomiolipoma renal complicado.

A case of complicated renal angiomyolipoma with tumoral bleeding in a 44-year-old woman is presented. The contribution of angiography to the diagnosis helped clarify the degree of vascularity, and the contribution of embolization treatment (safe and well tolerated) is discussed.

[The use of endoprosthesis in superior vena cava syndrome caused by lung neoplasms]. / A Utilização de Endopróteses na Síndrome da Veia Cava Superior por Neoplasia do Pulmão.

We present six cases of superior vena cava syndrome caused by a malignant tumor that were treated by percutaneous endoprostheses. The technique is described and the results evaluated. In one case there was acute thrombosis of the endoprosthesis that was treated by urokinase. No other complications were observed. A patient died one month later due to progression of the tumor. The remaining cases were asymptomatic for longer than 6 months. It was concluded that endoprostheses for superior vena cava syndrome are efficient, with quick improvement of the symptomatology.

[Angiography in thoracic outlet syndrome]. / Angiografia no síndrome do desfiladeiro.

The thoracic outlet syndrome is a changeable clinical syndrome caused by compression of the neurovascular bundle of the upper extremity, within the cervicoaxillary channel. From April 1980 through May 1995, 24 patients with clinical thoracic outlet syndrome were evaluated by selective arteriography. The diagnosis was confirmed in seven patients, in 14 the exam was normal and in the last three cases another arterial pathology was detected--subclavian artery occlusion, subclavian artery kinking and vertebral steal syndrome. The authors' aim is to emphasize arteriography as a diagnostic exam for thoracic outlet syndrome, very useful in the detection and localization of arterial compression. It also allows the diagnosis of other arterial entities.

[Therapeutic angiography]. / Angiografia terapêutica.

After a brief reference to the most important pioneers of angiography, the author describes the techniques performed, lesions treated and future perspectives. The following techniques are performed: embolizations, selective infusion of drugs, placement of inferior vena cava filter, removal of intra-vascular bodies, revascularisation techniques and porta-cava shunt. Reference was made to the following lesions treated: tumours, hemorrhages, arteriovenous malformations, hypersplenism, pulmonary embolism, varicocele, ischemic lesions and portal hypertension.

[Hemangiopericytoma]. / Hemangiopericitoma.

A case of hemangiopericytoma located in the left upper thigh is presented. The literature is reviewed, particularly the clinical aspects and reference is made to arteriography and preoperative embolization.

Changes in the vasa vasorum following percutaneous transluminal angioplasty in a canine model of aortic stenosis.

PURPOSE: To investigate the effects of percutaneous transluminal angioplasty on the vasa vasorum in dogs with experimentally created abdominal aortic stenoses. MATERIALS AND METHODS: Two stenoses were created in the abdominal aorta in each of 21 dogs. After 6 weeks, the more cephalic stenosis was dilated; the other stenosis served as an untreated control. Groups of three dogs were killed at 24 hours, 3 and 6 weeks, and 4, 8, 12, and 18 months after angioplasty. The aortae were studied by means of histologic examination, microangiography, scanning electron microscopy, and the Spalteholz technique. RESULTS: At nondilated stenoses, the vasa vasorum was interrupted in the outer adventitia and unchanged in the outer media. At dilated stenoses, the number of precapillary arterioles in the outer media progressively increased up to 8 months; thereafter, the number of precapillary arterioles began to decrease. At 18 months, the number was normal. CONCLUSION: Angioplasty brings about changes in the number of precapillary arterioles in the outer media of the aorta in our canine model of focal abdominal aortic stenosis.

[The transjugular intrahepatic portosystemic shunt]. / Shunt porto-sistémico intra-hepático transjugular.

The case of a 66-year-old woman with several episodes of hemorrhage by esophageal varices and ascites due to portal hypertension is presented. Despite 4 sessions of endoscopic sclerotherapy bleeding recurred. A transjugular intrahepatic portosystemic shunt was performed. In the 10 months following the intervention, there was no further hemorrhage, the ascites disappeared and the shunt is open.

Vasa vasorum changes following stent placement in experimental arterial stenoses.

PURPOSE: Experimental stenoses were created in canine aortae to compare the effects of stent placement and balloon angioplasty on the vasa vasorum. MATERIALS AND METHODS: A balloon-expandable Palmaz stent was placed in the proximal stenosis, and angioplasty was performed in the distal stenosis in each of eight dogs. Two dogs were killed at 4, 8, 12, and 18 months, respectively. Specimens were studied by means of microangiography, histology, scanning electronic microscopy, and Spalteholz technique. RESULTS: At up to 12 months, there was proliferation of the vasa vasorum and a rich plexus formed in each of the animals at each treated site. More vasa vasorum were seen after stent placement than after angioplasty. The new vessels were mainly venules located in the media. At 18 months, there was regression of the venules and the vasa vasorum distribution returned to baseline. CONCLUSION: The authors conclude that the effects of stents on the vasa vasorum are temporary.

Percutaneous placement of inferior vena cava filters.

Pulmonary embolism is a serious and difficult problem. Many approaches for the prevention of recurrent pulmonary embolism have been tried. Percutaneous placement of inferior vena cava filters is an easy, safe, available and well established procedure for the prevention of pulmonary embolism. The authors review the indications for use of IVC filters, and they review the main filters available in terms of ease of use, the physical characteristics, the technique of introduction, the efficacy and morbidity, and the potential complications associated with their use. Insertion of IVC filters by percutaneous approach was successfully performed in 6 patients with recurrent pulmonary embolism. Following the intervention procedure without complication there were no further pulmonary emboli.

Percutaneous sclerotherapy of varicocele.

Percutaneous sclerotherapy of varicocele was considered in 21 patients with left sided varicocele, 16 of whom had recurrences after left spermatic vein ligation in the past. Percutaneous sclerotherapy was possible in 17 patients (80.9%). There were no serious complications with venography or sclerotherapy, and the recurrence rate was 17.6%. Percutaneous sclerotherapy is therefore a simple, safe and effective treatment of testicular vein insufficiency.

Percutaneous splenic embolization of the splenic artery in the treatment of hypersplenism.

Percutaneous splenectomy was performed in 6 patients with hypersplenism. Peripheral blood cell counts improved in 5 of the patients. The authors review the indications, technique and complications of percutaneous splenic embolization. It is concluded that medical splenectomy is an effective method particularly to alleviate symptoms of hypersplenism.

[Angioplasty of the arteries of the aorto-iliac region]. / Angioplastia das artérias do sector aorto-ilíaco.

Percutaneous transluminal angioplasty (PTA) of the aorto-iliac arteries was performed in 92 patients with atherosclerotic lesions. The initial success was 87.8% and the late one was 69.4%. The late results were evaluated objectively in 58 patients, 36 of which were studied by angiography and the remaining by Doppler. There were 6.6% of complications, in 2.8% of which surgery was performed. There was no mortality. The good initial and late results and the low morbility suggest that PTA is a good revascularization procedure. The best results were obtained in symptomatic patients with a short and significant stenosis or occlusion.

[Angioplasty of the arteries of the femoro-popliteal region]. / Angioplastia das artérias do sector femoro-popliteo.

Percutaneous transluminal angioplasty (PTA) of the femuro-popliteal arteries with atherosclerotic lesions, was performed in 66 patients. There was an initial clinical success in 80.3% and a late one in 60.7%. Better results were obtained when there was good distal circulation, and the differences were significant. There was no mortality. These results show that PTA is an useful procedure in the treatment of obstructive lesions of femuro popliteal arteries.

[Renal artery angioplasty]. / Angioplastia da artéria renal.

In the 59 hypertensive patients submitted to percutaneous transluminal angioplasty (PTA) of the renal artery, there was an immediate success in the blood pressure in 91.5% and a later one of 79.6%. In these patients we obtained better results: 81.4% in the unilateral lesions, more than in the bilateral ones--72.7%; 82.5% in the renal artery trunk lesions, more than in the ostium ones--71.4%; 88.9% in the lesions of fibromuscular origin, more than in the aterosclerotic ones--75%; 84.4% in up to 55 years old patients, more than in older ones--71.4%. These differences were not significant. The results of renal angioplasty in renovascular hypertension suggest this type of intervention as an alternative treatment.

Pulmonar vascular changes in the plain chest film of cardiac patients.

The correct interpretation of chest film on cardiac patients is very important. The most important feature is the radiographic appearance of the pulmonary vascularity. Four different patterns of pulmonary vascularity are considered: normal, decreased, increased and uneven. The different diseases associated with each type are mentioned. From the pulmonary vascular pattern one can deduct hemodynamic data which are important for the diagnosis, grade of severity and follow-up.

Internal iliac artery: embolization to control hemorrhage from pelvic neoplasms.

The control of the massive and often fatal hemorrhage from pelvic neoplasms is a major therapeutic problem. Transcatheter embolization of the internal iliac arteries was performed in 108 patients with uncontrollable hemorrhage due to pelvic neoplasms (urinary bladder in 50, uterus in 39, ovary in 16, and prostate in three). Complete control of the hemorrhage was achieved in 74 patients, partial control in 23, and no control in 11. Seventy patients experienced postembolization syndrome (nausea, vomiting, gluteal pain, and fever due to tissue necrosis), and three had transient acute tubular necrosis caused by the contrast medium. It is important for success that the embolization be bilateral and that the embolic agent used be a permanent one.