Stent Placement for Chronic Iliac Arterial Occlusive Disease: the Results of 10 Years Experience in a Single Institution

OBJECTIVE: We wanted to retrospectively evaluate the long-term therapeutic results of iliac arterial stent placement that was done in a single institution for 10 years. MATERIALS AND METHODS: From May 1994 to April 2004, 206 patients who underwent iliac arterial stent placement (mean age; 64+/-8.8) were followed up for evaluating the long term stent patency. Combined or subsequent bypass surgery was performed in 72 patients. The follow up period ranged from one month to 120 months (mean; 31+/-25.2 months). The factors that were analyzed for their effect on the patency of stents were age, the stent type and diameter, the lesion site, lesion shape, lesion length, the Society of Cardiovascular and Interventinal Radiology criteria, the total run off scores, the Fontaine stage and the cardiovascular risk factors (diabetes mellitus, hypertension and smoking). Follow-up included angiography and/or CT angiography, color Doppler sonography and clinical evaluation with the ankle-brachial index. RESULTS: Two hundred and eighty-four stents were placed in 249 limbs of 203 patients. The technical success rate was 98% (203/206). The primary patency rates of the stents at 3, 5, 7 and 10 year were 87%, 83%, 61% and 49%, respectively. One hundred seventy-seven patients maintained the primary stent patency until the final follow up and 26 patients showed stenosis or obstruction during the follow up. Secondary intervention was performed in thirteen patients. Lesions in the external iliac artery (EIA) or lesions in both the common iliac artery (CIA) and EIA were a poor prognostic factor for stent patency. The run off score and stent diameter also showed statistically significant influence on stent patency. The overall complication rate was 6%. CONCLUSION: Iliac arterial stent placement is a safe treatment with favorable long term patency. Lesions in the EIA or lesions in both the EIA and CIA, poor run off vessels and a stent having the same or a larger diameter than 10 mm were the poor prognostic factors for long term stent patency.

Radiologic Diagnosis and Treatment of Iatrogenic Acquired Uterine Arteriovenous Malformation

PURPOSE: To analyze gray-scale US, color and duplex Doppler US, and angiographic findings in patients with acquired uterine arteriovenous malformations (AVMs), and to evaluate the usefulness of these modalities in the diagnosis of this disease and the effect of transcatheter arterial embolization in its treatment. MATERIALS AND METHODS: During a recent seven-year period, we diagnosed 21 cases of acquired uterine AVM. Nineteen of these patients had a history of causative D&C (between one and seven D&C procedures per patient), one had a history of causative cesarean section, and one had cervical conization. All patients underwent transabdominal and endovaginal gray-scale, color Doppler, and duplex Doppler US and angiography, with therapeutic embolization of bilateral uterine arteries. The majority underwent follow-up Doppler US after embolization. RESULTS: The gray-scale US morphology of uterine AVMs included subtle myometrial inhomogeneity and multiple distinct, small anechoic spaces in the thickened myometrium or endometrium. Color Doppler US showed a tangle of tortuous vessels with multidirectional, high-velocity arterial flow, which was focally or asymmetrically distributed. Duplex Doppler US depicted a waveform of fast arterial flow with low resistance, while angiography demonstrated a complex tangle of vessels supplied by enlarged uterine arteries, in association with early venous drainage during the arterial phase, and stasis of contrast medium within abnormal vasculature. Where AVMs were combined with a pseudoaneurysm, this finding was observed. Transcatheter arterial embolization provided a complete cure, without recurrence. CONCLUSION: Color and duplex Doppler US is an appropriate modality for the detection and diagnosis of uterine AVMs and for follow-up after embolization. Transcatheter arterial embolization is a safe and effective method of treating this disease.

Transcatheter Arterial Embolization of Splanchnic Arterial Pseudonaneurysm: Focus on the Method of Embolization

PURPOSE: To evaluate the effectiveness of transarterial embolization of splanchnic arterial pseudoaneurysm and to analyze the embolization technique. MATERIALS AND METHODS: Between 1991 and 1999, 38 patients with splanchnic arterial pseudoaneurysm underwent tarnsarterial coil embolization. The parent artery was embolized just distal and proximal to the neck of the pseudoaneurysm in 26 cases, and proximal to the aneurysmal neck in nine. In four patients, embolization involved the use of gelfoam, and in the other two patients, coil packing of the pseudoaneurysm sac was performed. RESULTS: Initial bleeding was controlled in 34 of the 38 patients (89%) treated by transarterial embolization (in 24 of 26 who underwent distal and proximal embolization, in seven of nine whose treatment involved proximal embolization and in two of four in whom gelfoam embolization was undertaken). In seven patients (18%), rebleeding occurred within 0 -14 (mean, 6.4) days of initial embolization. In two cases, bleeding reoccurred from the same artery initially treated by gelfoam embolization, in two others from that in which coil packing of the pseudoaneurysmal sac had been performed, and in three, from a different artery. Among these seven patients, one died from bleeding and the remaining six were successfully treated by repeated embolization. In spite of successful bleeding control, nine patients (24%) died of subsequent bleeding-related complications, namely sepsis (n=4), acute respiratory failure (n=3), and multi-organ failure (n=2). CONCLUSION: For the treatment of splanchnic arterial Pseudoaneurysm, transarterial embolization was a relatively simple and effective procedure. Proximal and distal coil embolization at the pseudoaneurysmal neck successfully isolated the of pseudoaneurysm and prevented the recanalization of blood flow.

Efficiency of Ultrasonography and CT Angiography in Follow-up Studies of Carotid Stent and Percutaneous Transluminal Angioplasty

PURPOSE: The aim of this study was to determine a more appropriate method for follow-up of carotid stenting by comparing the efficiency of US and CT angiography. MATERIALS AND METHODS: Eleven carotid arteries of seven patients(men: 5, women: 2, mean age: 56.4years) who underwent stent placement and percutaneous transluminal angioplasty(PTA) because of carotid stenosis were studied. The follow-up periods ranged from three to eleven(mean, five) months, and US and CT angiography were performed in one day. Color duplex sonography was performed with a 10 MHz linear array transducer. After spiral CT scan were obtained, MPR images were reconstructed on a workstation. Retrospective imaging analysis specifically focused on [1] stent configuration, [2] the accuracy of internal diameter measurement, [3] the detection of blood flow and the measurement of blood flow velocity, [4] the presence of atheroma and intraluminal thrombi, [5] the measurement of stent location, and [6] artifacts. RESULT: US was more accurate than CT angiography for measuring internal diameter. In all cases, US and CT angiography were able to detect the blood flow at carotid artery, and utilizing the Doppler spectrum, flow velocity was measured. US showed atheromas in all cases but CT angiography demonstrated calcified atheromas in three cases only. In six cases, US failed to determine stent location, though in this respect CT angiography was successful in all cases. Artifacts of US were small reverbe ration artifact(11/11) of the stent and a defective color Doppler signal caused by acoustic shadowing of atheroma calcification(3/11). Artifacts of CT angiogrpahy were hard-beam artifact of the stent(11/11) and motion artifact(3/11). CONCLUSION: US was superior to CT angiography in accuracy of measuring stent diameter, hemodynamic assessment, high-resolution views of the luminal state of the stent and minimal artifacts for the non-inva s i ve follow-up studies of carotid stenting.

Transcatheter embolization for splanchnic pseudoaneurysm

PURPOSE: To determine the therapeutic effect of transcatheter embolization in the treatment of splanchnicpseudoaneurysm. MATERIALS AND METHODS: This study involved eleven patients who underwent embolization for thetreatment of splanchnic pseudoaneurysm. Nine were men and two were women ; their ages ranged from 8 to 74 (mean,51) years. The etiology of these cases included postoperative pseudoaneurysm(n=4), pancreatitis(n=3), stabinjury(n=1), and suspected infection(n=1), while two cases were uncertain. The locations of the pseudoaneurysmwere the splenic artery(n=4), the gastroduodenal artery(n=3), the hepatic artery(n=2), the celiac artery(n=1), andboth the right renal and lumbar artery(n=1). All patients underwent angiography prior to embolization. Thematerials used during embolization were a microcoil, a 5-cm metallic guide wire, and a detachable balloon. RESULTS: Embolization was successful in all eleven cases. Among nine cases in which follow-up was possible, angiographywas performed in four, and five cases of thrombus were confirmed by abdominal CT. Three of these nine patientsunderwent re-embolization. One patient underwent elective surgery for a pseudocyst due to pancreatitis. CONCLUSION: Transcatheter embolization is a safe and convenient modality for the treatment of splanchnic pseudoaneurysm.