ABSTRACT
OBJECTIVE: The purpose of this study was to determine the clinical and radiographic findings in seven adults with congenital esophageal stenosis. CONCLUSION: In young or middle-aged individuals, particularly men with long-standing dysphagia, an upper or mid esophageal stricture with multiple ringlike constrictions is a characteristic appearance of congenital esophageal stenosis on double-contrast esophagography.
Subject(s)
Esophageal Stenosis/congenital , Esophageal Stenosis/diagnostic imaging , Adult , Esophageal Stenosis/diagnosis , Esophagoscopy , Humans , Male , Middle Aged , RadiographyABSTRACT
PURPOSE: To evaluate the efficacy, safety, and primary patency of percutaneous mechanical declotting of thrombosed dialysis grafts using latex balloons. MATERIALS AND METHODS: Fifty-nine patients with 86 episodes of dialysis graft thrombosis underwent percutaneous mechanical declotting with balloons using crossing catheter or transjugular technique. Vital signs, peripheral oxygenation, technical success, procedure time, and complications were recorded prospectively. Technical success was defined as a patent graft at the completion of the procedure. Clinical success, defined as successful dialysis for 1 week, and primary patency were obtained retrospectively from review of the dialysis records. RESULTS: Technical success was achieved in 74 of 86 procedures (86%). Median procedure time was 115 minutes, including failed cases. Ten of the 12 technical failures were due to resistant vascular stenoses precluding graft patency, despite removal of thrombus. There were no immediate complications. One patient died of sepsis 4 days after declotting. Clinical success was achieved after 65 of 86 procedures (76%); nine grafts thrombosed within 1 week of a technically successful declotting procedure. Primary patency (including technical failures) was 37% at 3 months, 31% at 6 months, and 17% at 12 months. CONCLUSION: Mechanical declotting is an effective means of restoring patency to thrombosed dialysis grafts.
Subject(s)
Catheters, Indwelling/adverse effects , Thrombectomy/methods , Thromboembolism/surgery , Adult , Aged , Aged, 80 and over , Follow-Up Studies , Humans , Middle Aged , Phlebography , Postoperative Complications , Renal Dialysis/adverse effects , Reoperation , Retrospective Studies , Safety , Thromboembolism/diagnostic imaging , Thromboembolism/etiology , Thrombophlebitis/diagnostic imaging , Thrombophlebitis/etiology , Thrombophlebitis/surgery , Treatment OutcomeABSTRACT
Two patients with pancreatic malignancies presented with biliary obstruction which could not be treated from an endoscopic approach. Standard transhepatic biliary drainage was relatively contraindicated because of moderate ascites and coagulopathy related to underlying liver disease. In one patient, a transjugular, transvenous approach was used to deliver a Wallstent endoprosthesis across the distal common bile duct obstruction in a single step procedure. In the second case, a previously placed biliary Wallstent was revised with an additional stent from a similar approach. Transjugular biliary catheterization offers a valuable alternative approach for primary stent placement or revision in patients with contraindication to standard transhepatic drainage.
Subject(s)
Ascites/therapy , Catheterization, Central Venous/instrumentation , Cholestasis, Extrahepatic/therapy , Common Bile Duct Neoplasms/therapy , Mesenteric Artery, Superior , Mesenteric Vascular Occlusion/therapy , Pancreatic Neoplasms/therapy , Portal Vein , Stents , Thrombosis/therapy , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/therapy , Ascites/diagnostic imaging , Carcinoma/diagnostic imaging , Carcinoma/therapy , Catheterization/instrumentation , Cholestasis, Extrahepatic/diagnostic imaging , Common Bile Duct Neoplasms/diagnostic imaging , Female , Humans , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Vascular Occlusion/diagnostic imaging , Middle Aged , Pancreatic Neoplasms/diagnostic imaging , Portal Vein/diagnostic imaging , Radiography , Suction/instrumentation , Thrombosis/diagnostic imagingABSTRACT
PURPOSE: To compare a technique of mechanical balloon declotting of thrombosed hemodialysis grafts with conventional pulsed-spray thrombolysis. MATERIALS AND METHODS: Forty patients had 53 episodes of graft thrombosis over a 19-month period. Twenty-nine grafts were randomly treated with thrombolysis with urokinase and 24 grafts with mechanical declotting by placement of crossed balloon catheters within the graft. Patency was determined by retrospective review of hemodialysis records. RESULTS: Successful hemodialysis for 1 week after the procedure was achieved in 21 (88%) of the 24 grafts treated mechanically and 26 (90%) of 29 grafts treated with thrombolysis. Continuous pulse oximetry showed no change in oxygen saturation in either group, and no clinical signs or symptoms of pulmonary embolism were noted. Average total procedure times were 2.2 hours for mechanical declotting and 3.5 hours for thrombolysis (P < .05). Probability of patency (mechanical vs thrombolysis) was 42% vs 45% at 3 months, 36% vs 25% at 6 months, and 8% vs 4% at 12 months. One major complication of ulnar artery embolization occurred in the thrombolysis group. CONCLUSION: Mechanical declotting of hemodialysis grafts is faster and as effective as thrombolysis.
