Arterial catheter embolization followed by surgery for large chemodectoma.

We report on the first successful preoperative arterial catheter embolization of a large neck chemodectoma followed by its surgical removal. A 21-year-old man presented with a large mass in the right neck diagnosed 5 years previously by biopsy as a chemodectoma. The patient previously had refused therapy. Because of concern over the large size of the mass and increasing difficulty in swallowing, he agreed to undergo therapy. The patient underwent selective occlusion of the occipital and posterior auricular arteries and the thyrocervical trunk using Ivalon sponge emboli injected through a No. 5 Fr Hanafee catheter. A postembolization arteriogram showed 90% occlusion of tumor vascularity and 30% decrease in size of the tumor. This was followed by removal of the tumor surgically. A review of the difficult management of the patient is presented, and implications for future use of the combined procedures are discussed.

Bilateral aortoiliac pressure measurements from a single puncture site.

Bilateral aortoiliac pressure measurements were obtained at the time of aortography by performing contralateral iliac artery catheterization in 102 patients with peripheral vascular disease. Patients studied had mild-to-moderate aortoiliac disease and in their cases the additional information was believed to be important in therapeutic decision making. Patients with severe ulcerative disease, peripheral thromboembolism, and significant aortic aneurysms were excluded. Pressure gradients out of proportion to the degree of stenosis as measured on the arteriograms were frequently found, particularly during high flow states with intraarterial injections of a vasodilator. There were two failures of catheterization and three minor complications, none embolic. We conclude that contralateral iliac artery catheterization in selected patients is both safe and generally easily performed by experienced angiographers.