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1.
Cardiovasc Intervent Radiol ; 40(9): 1367-1371, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28378050

ABSTRACT

OBJECTIVE: For evaluation of primary aldosteronism, international guidelines recommend a 4-6 week withdrawal of spironolactone, eplerenone, and amiloride prior to adrenal vein sampling (AVS). It is not always feasible to withdraw these drugs in patients with severe hypertension and hypokalemia. We present our experience evaluating the efficacy and clinical outcomes of a 2-week protocol for withdrawal of renin-stimulating antihypertensives prior to AVS. DESIGN: A single-center retrospective review of all patients who underwent AVS for primary aldosteronism between January 2014 and December 2015. PATIENTS: 32 patients (24 M:8F, mean age 54y) underwent AVS with the 2-week protocol, and 32 held their renin-stimulating antihypertensives for 2 weeks instead of the recommended 4-6 weeks. MEASUREMENTS: Plasma renin activity (PRA) was measured immediately before venous sampling to assess for renin suppression (PRA < 0.5 ng/ml/hr). Demographics, antihypertensive medications, plasma aldosterone, plasma renin activity, and outcomes were reviewed. RESULTS: 100% of procedures were diagnostic (selectivity index ≥ 3) and lateralization (lateralization index ≥ 4) was confirmed in 22/32 patients. 19/32 patients had contralateral suppression. PRA confirmed to be suppressed in 30/32 (94%) of patients. Of the 2 patients with unsuppressed renin, 1/2 lateralized diagnosing an aldosterone producing adenoma. CONCLUSIONS: Renin was suppressed in nearly all patients following a 2-week withdrawal of renin-stimulating antihypertensives. Patients who cannot tolerate stopping these medications for 4-6 weeks as recommended by current guidelines may undergo a 2-week withdrawal without affecting the diagnostic outcome of AVS, provided renin suppression is confirmed. LEVEL OF EVIDENCE: Level 4, Case Series.


Subject(s)
Adrenal Glands/blood supply , Aldosterone/blood , Hyperaldosteronism/blood , Hyperaldosteronism/diagnosis , Aged , Antihypertensive Agents/therapeutic use , Female , Humans , Male , Middle Aged , Renin , Veins
3.
J Vasc Interv Radiol ; 27(1): 73-9, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26611883

ABSTRACT

PURPOSE: To evaluate the efficacy and clinical outcomes associated with stent-graft placement and coil embolization for postpancreatectomy arterial hemorrhage (PPAH). MATERIALS AND METHODS: Retrospective review of 38 stent-graft and/or embolization procedures in 28 patients (23 men; mean age, 65.1 y) for PPAH between 2007 and 2014 was performed. Time of bleeding, source of hemorrhage, intervention and devices used, repeat intervention rate, time to recurrent bleeding, complications, and 30-day mortality were assessed. Independent risk factors for recurrent bleeding and 30-day mortality were identified. RESULTS: Median onset of hemorrhage was at 39 days (mean, 27.9 d; range, 5-182 d). Covered stents were used in 65.7% of interventions, coil embolization in 23.6%, stent-assisted embolization in 5.2%, and stent-graft angioplasty in 2.6%. A total of 28 stent-grafts were placed, of which 19 were self-expandable and nine were balloon-mounted. Mean stent-graft diameter was 6.6 mm (range, 5-10 mm). Recurrent bleeding occurred following 26.3% of interventions in seven patients at a mean interval of 22 days. The site of recurrent bleeding was new in 80% of cases. There was no significant difference in recurrent bleeding rate in early-onset (< 30 d; n = 22) versus late-onset PPAH (> 30 d; n = 6; P > .05). No ischemic hepatic or bowel complications were identified. The 30-day mortality rate was 7.1% (n = 2) and was significantly higher in patients with initial PPAH at ≥ 39 days (n = 5; P = .007). CONCLUSIONS: Covered stents and coil embolization are effective for managing PPAH and maintaining distal organ perfusion to minimize morbidity and mortality. Recurrent bleeding is common and most often occurs from new sites of vascular injury rather than previously treated ones.


Subject(s)
Embolization, Therapeutic , Hepatic Artery , Pancreatectomy/adverse effects , Postoperative Hemorrhage/therapy , Stents , Adult , Aged , Aged, 80 and over , Blood Vessel Prosthesis Implantation , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
4.
AJR Am J Roentgenol ; 206(1): 20-5, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26700333

ABSTRACT

OBJECTIVE: Headaches due to CSF leak are a well-described complication of dural puncture. It is uncertain how long patients should be observed after dural puncture to reduce the risk of headache. Most of the literature has focused on dural punctures performed without fluoroscopic guidance. The purpose of this study was to determine the incidence of complications from fluoroscopically guided dural punctures, with attention to predictive factors such as the length of bed rest after the procedure. MATERIALS AND METHODS: We retrospectively reviewed 2141 fluoroscopically guided dural punctures performed over a 5-year period by a single radiology practitioner assistant. All patients were contacted 48-72 hours after the procedure to assess for complications. Complications were categorized according to whether the patient reported having severe headache (requiring epidural blood patch for treatment), any headache, or any complaint. Using a multivariate logistic regression model, we assessed several possible predictors of complication: patient age, patient sex, needle caliber, puncture site, distance driven after recovery, length of postprocedural bed rest, contrast concentration, and contrast volume. RESULTS: In all, 0.8% of patients reported having a severe headache, 2.2% reported having any headache, and 2.6% reported having any complaint. In the multivariate analysis, age and sex were predictive of complication rates (with younger women having higher rates), but the other variables were not predictive. In particular, length of postprocedural bed rest showed statistical equivalence. CONCLUSION: Fluoroscopically guided dural punctures result in few complications compared with lumbar punctures performed without fluoroscopic guidance. Postprocedural bed rest greater than 2 hours does not reduce complication rates for fluoroscopically guided lumbar punctures.


Subject(s)
Headache/epidemiology , Myelography/methods , Postoperative Complications/epidemiology , Radiography, Interventional , Spinal Puncture , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Bed Rest , Contrast Media , Female , Fluoroscopy , Humans , Incidence , Male , Middle Aged , Needles , Retrospective Studies , Risk Factors , Sex Factors , Travel
5.
Obstet Gynecol Int ; 2015: 283576, 2015.
Article in English | MEDLINE | ID: mdl-26113862

ABSTRACT

Objectives. To evaluate clinical outcomes following transvaginal catheter placement using transabdominal ultrasound guidance for management of pelvic fluid collections. Methods. A retrospective review was performed for all patients who underwent transvaginal catheter drainage of pelvic fluid collections utilizing transabdominal ultrasound guidance between July 2008 and July 2013. 24 consecutive patients were identified and 24 catheters were placed. Results. The mean age of patients was 48.1 years (range = 27-76 y). 88% of collections were postoperative (n = 21), 8% were from pelvic inflammatory disease (n = 2), and 4% were idiopathic (n = 1). Of the 24 patients, 83% of patients (n = 20) had previously undergone a hysterectomy and 1 patient (4%) was pregnant at the time of drainage. The mean volume of initial drainage was 108 mL (range = 5 to 570). Catheters were left in place for an average of 4.3 days (range = 1-17 d). Microbial sampling was performed in all patients with 71% (n = 17) returning a positive culture. All collections were successfully managed percutaneously. There were no technical complications. Conclusions. Transvaginal catheter drainage of pelvic fluid collections using transabdominal ultrasound guidance is a safe and clinically effective procedure. Appropriate percutaneous management can avoid the need for surgery.

6.
Case Rep Vasc Med ; 2014: 506067, 2014.
Article in English | MEDLINE | ID: mdl-25349770

ABSTRACT

Peroneal artery arteriovenous fistulas and pseudoaneurysms are extremely rare with the majority of reported cases due to penetrating, orthopedic, or iatrogenic trauma. Failure to diagnose this unusual vascular pathology may lead to massive hemorrhage or limb threatening ischemia. We report an interesting case of a 14-year-old male who presented with acute musculoskeletal pain of his lower extremity. Initial radiographs were negative. Further imaging workup revealed a peroneal arteriovenous fistula with a large pseudoaneurysm. After initial endovascular intervention was unsuccessful, the vessels were surgically ligated in the operating room. Pathology revealed papillary endothelial hyperplasia consistent with an aneurysm and later genetic testing was consistent with Ehlers-Danlos syndrome Type IV. This case illustrates an unusual cause of acute atraumatic musculoskeletal pain and uncommon presentation of Ehlers-Danlos syndrome.

7.
Cardiovasc Intervent Radiol ; 37(4): 1103-6, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24318463

ABSTRACT

Lymphangiography and thoracic duct embolization are well-described techniques for the diagnosis and treatment of thoracic lymphatic leaks refractory to conservative treatment. However, thoracic duct embolization is not an option in patients with abdominal chylous leaks. The present report describes a 68-year-old man who underwent an aortomesenteric bypass complicated by a high-output postoperative chylothorax (>2,000 ml/day) and chylous ascites (>7,000 ml/paracentesis). Ultrasound-guided intranodal lymphangiography demonstrated a retroperitoneal lymphatic leak tracking along the vascular graft into the peritoneal cavity. Computed tomography-guided lymphatic duct occlusion with N-butyl cyanoacrylate glue was performed, resulting in successful treatment of both chylothorax and chylous ascites.


Subject(s)
Adhesives/therapeutic use , Aorta, Abdominal/surgery , Chylothorax/therapy , Enbucrilate/therapeutic use , Mesenteric Vascular Occlusion/surgery , Postoperative Complications/therapy , Radiography, Interventional , Tomography, X-Ray Computed , Aged , Aorta, Abdominal/diagnostic imaging , Chylothorax/diagnostic imaging , Chylothorax/etiology , Contrast Media , Ethiodized Oil , Humans , Lymphography , Male , Mesenteric Vascular Occlusion/diagnostic imaging , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Ultrasonography, Interventional
8.
Case Rep Radiol ; 2013: 180735, 2013.
Article in English | MEDLINE | ID: mdl-23781371

ABSTRACT

We present the case of a 56-year-old double lung transplant recipient with chest pain who underwent an attempted endovascular retrieval of what was described as a retained guide wire in the azygos vein. After successfully grasping the tip, the object further migrated to the right pulmonary artery complicating the retrieval. It was realized that the "wire" was extravasated methyl methacrylate from a recent percutaneous kyphoplasty. This is believed to be the first report of attempted endovascular retrieval of extravasated methyl methacrylate in the azygos system. We include the details of this case and briefly review the current literature on the management of extravasated methyl methacrylate from vertebral augmentation procedures. Extravasated methyl methacrylate in the venous system is a common finding after vertebral augmentation procedures and any radiopaque stripe arising from a cemented vertebral body should be first described as probable cement leakage.

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