Optimal technique for antegrade femoral artery puncture

With the advent of transluminal popliteo-femoral angioplasty, lower limb arterial embolization for malignancy,catheter placement of intra-arterial thrombolysis and intra-arterial chemotherapy, optimal technique for antegrade femoral artery puncture has gained a crucial importance. The main object of our study was to devise an easier, convenient and accurate method to get a clean vessel wall antegrade puncture in the first attempt, at a safe level along femoral artery. The femoral artery puncture at the level of common femoral artery puncture was highly desirable as common femoral artery has larger caliber, best osseous support of femoral head and is in direct line of the superficial femoral artery. A constant landmark to identify the optimal level of entry into the common femoral artery would be helpful. On the basis of our data obtained from 50 patients, we conclude that beginning of common femoral artery is located proximal to the center of femoral head and the femoral artery bifurcation is located distal to the center of femoral head. If the arterial entry is chosen at the level of center of femoral head which is localized by fluoroscopy a safe puncture of common artery is ensured. With skin puncture site 1-2 cm proximal to this level needle is directed obliquely through the skin, the common femoral artery is entered at the level of center of femoral head

Transluminal angioplasty: an attractive alternate to surgery experience with balloon dilatation of abdominal aortic stenosis at Mayo hospital, Lahore

Percutaneous transluminal angioplasty [PTA] with balloon catheters has been available for almost 25 years. Initially applied to the peripheral vascular system, PTA is now technically feasible in almost any vessel that can be catheterized. PTA of abdominal aorta is not commonly performed because isolated aortic atherosclerotic disease is not usual. Aorto-iliac or aorto-femoral bypass grafting is the indicated procedure in diffuse or multi-focal aortoiliac disease. Angioplasty is the indicated procedure for focal infra-renal aortic stenosis or focal disease of the aorto-iliac junctions. A study of I8 patients undergoing abdominal aortic PTA between November 92 and Nov 97 at catheterization Lab Mayo Hospital is reported Success rate was 80% with almost complete relieve of symptoms, 13% partial relieve, 7% recurrence rate, 0% complication rate. This high success rate indicate that PTA has a major contribution to make in the management of stenotic abdominal aortic disease. Advantages include low morbidity and mortality, short rehabilitation time, can be repeated at ease if necessary and seldom precludes surgical management if PTA fails

Anterior renal fascia thickening: an ultrasound indicator for the side of tubal ruptures in ectopic pregnancy

The width of anterior extra renal tissue is known to be increased on U S examination in patients with abdominal inflammatory disease such as acute cholecystits, acute pancreatitis, acute appendicitis, perforated duodenal ulcer, liver abscess, leaking anastomosis. We have observed thickening of anterior renal fascia, especially of the lower poles more on the side of ruptured tubal pregnancy. Normal values were obtained in 200 females with otherwise normal intrauterine pregnancy and mean values were between 1- 4mm [mean 1-7mm]. The patients with ruptured tubal ectopic [proven post operatively], had values ranging from 7-12mm [mean 9mm] on the side of involved tube and 5-7mm [mean 6 mm] on the contralateral side. A normal measurement, however, does not preclude possibility of ectopic pregnancy

Relation between post angioplasty linear filling defects and severity of pain during angioplasty

There was a significant correlation between the severity of pain during angioplasty and linear filling defects at angioplasty site in post PTA angiograms. Mast interventional radiologists recognized that the pain daring halve no clinical consequences. Our study comprising of 55 angioplasties indicated that moderate to severe pain was associated with Development of linear filling defects at the angioplasty site. As these cracks represents local wall disc, a post angioplasty injections should never be made within the dilated segment, to avoid risk of propagating dissection