Subject(s)
Embolization, Therapeutic/methods , Endoleak/therapy , Postoperative Complications/therapy , Vertebral Artery , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/surgery , Cerebrovascular Circulation , Computed Tomography Angiography , Endoleak/diagnostic imaging , Female , Humans , Middle AgedABSTRACT
Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general anesthesia and morbidity associated with surgical shunt placement and has been successful in several case reports. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement.
ABSTRACT
The use of catheter-based techniques to treat upper gastrointestinal hemorrhage has evolved considerably over the past few decades. At present, the state-of-the-art interventional suites provide optimal imaging. Coupled with advanced catheter technology, the two may be used to manage and treat the patient with acute upper gastrointestinal hemorrhage. This article summarizes these techniques and, when possible, compares them with other methods such as surgery and endoscopy. The specific role of transcatheter embolotherapy is highlighted, alongside an additional discussion on pharmacologic infusion of vasopressin.
Subject(s)
Angiography/methods , Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/therapy , Radiography, Interventional/methods , Upper Gastrointestinal Tract , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/etiology , Humans , Upper Gastrointestinal Tract/blood supply , Vasopressins/administration & dosageABSTRACT
Venous bullet embolism is a rare and complicated occurrence reported in approximately 0.3% of penetrating trauma. The management of bullet emboli is decided on a case-by-case basis, balancing the risk of the embolus itself against those associated with extraction. We report a case of a 19-year-old man who sustained a gunshot wound to the anterior chest, which migrated to the left internal iliac vein in a retrograde fashion. We were able to successfully retrieve the missile using an endovascular approach, thereby minimizing the morbidity associated with an open procedure.
Subject(s)
Embolism/therapy , Endovascular Procedures , Foreign-Body Migration/therapy , Iliac Vein , Wounds, Gunshot/therapy , Adult , Anticoagulants/therapeutic use , Embolism/diagnostic imaging , Embolism/etiology , Enoxaparin , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/etiology , Humans , Iliac Vein/diagnostic imaging , Male , Tomography, X-Ray Computed , Treatment Outcome , Wounds, Gunshot/complications , Wounds, Gunshot/diagnostic imagingABSTRACT
Retrievable inferior vena cava (IVC) filters are generally retrieved without difficulties. However, when filters are tilted against the IVC wall, engaging the tip or hook of the filter can be difficult with the use of standard techniques. This report describes an alternative method of successful IVC filter retrieval by creating a wire loop between the filter legs, including the tip of the filter. This loop snare was successfully applied in eight cases after filter retrieval failed with the Recovery Cone or simple snare technique.