Interventional radiological retrieval of embolized vascular access device fragments.

PURPOSE: Vascular access device fragment embolization is a relatively rare but potentially serious complication. The purpose of this study was to report our experience with endovascular retrieval of embolized vascular access device fragments by interventional radiological means. MATERIALS AND METHODS: Ten patients with a vascular access device fragment embolism were treated between 2004 and 2010. Attempted retrieval from the vascular bed was performed for five port catheter fragments, two temporary catheter fragments and three guide wires. The demographic data, underlying disease of the patients, type of inserted catheters, interval between implantation and discovery of embolism, interval between discovery of embolization and retrieval and localization and length of the embolized fragments were identified from the patient charts. RESULTS: In nine of the ten patients (90%), radiologic intervention retrieval of the embolized vascular access device fragments was successful. The reasons for intravascular fragment embolism consisted of rupture at the connection site of the chamber or the external hub and the intravascular catheter (n=4), pinchoff syndrome (n=3), operator inexperience (n=3). Embolized catheter fragments or guide wires were retrieved under fluoroscopy by a gooseneck snare. The postprocedural course was uneventful. CONCLUSION: The radiological retrieval of embolized vascular access device fragments is the preferred method, and it has a high success rate. Considering the potential for devastating complications, patients should be referred to interventional radiology, and the embolized catheters should be retrieved using interventional endovascular techniques.

Postcatheterization femoral arteriovenous fistula: endovascular treatment with N-butyl-cyanoacrylate embolization.

We report a case of an iatrogenic femoral arteriovenous fistula (AVF) in a 67-year-old man presenting with right femoral bruit on the day after sheath removal for cardiac catheterization. This was successfully treated with embolization using N-butyl-cynoacrylate (NBCA) through a coaxial microcatheter. Transcatheter embolization of iatrogenic femoral AVFs with NBCA in selected cases may be a safe and effective treatment in the presence of long fistula tracts. It is then easy to perform in experienced hands and relatively inexpensive.

Radiation dose in balloon dacryocystoplasty: a study using Rando phantoms and thermoluminescent dosimetry.

PURPOSE: The radiation dose to the lens of the eye, skin, thyroid and brain of patients who underwent diagnostic and interventional radiological procedures of the lacrimal drainage system have been measured with thermoluminescent dosimeters (TLD-100 and TLD-700) by using an adult male and female Rando phantom. All dose values for one second of fluoroscopic exposure and one frame of digital subtraction dacryocystography (DS-DCG) exposure have been obtained individually in the pastero-anterior (PA) and lateral (LAT) projections. MATERIALS AND METHODS: An adult male and female Rando phantom was used instead of the patients. The procedures were performed by using an Advantx AFM C-arm unit coupled with a DX Hiline digital image acquisition and processing system. The 6-inch mode of a triplefield image intensifier (II) was used, with a circular collimation of the same or a slightly smaller size. Two different lithium floride (LiF) thermoluminescent chips were used for absorbed dose measurements: TLD700, approximately 4.5 mm in diameter and 0.9 mm in thickness; TLD100, 3.7 mm square and 0.9 mm in thickness. RESULTS: The average values of absorbed doses (lens of the eye, skin, thyroid and brain) measured separately with TLD100 and TLD700 dosimeters after irradiation of the male and female Rando phantom are presented for LAT and PA projections. CONCLUSION: This study suggests that useful information for dose determination can be obtained by use of the radiation dose to the lens of the eye, thyroid and brain received during radiological procedure of the LDS for one frame of DS-DCG and one second of fluoroscopy.

Endovascular treatment of peripheral vascular lesions with stent-grafts.

PURPOSE: To evaluate our results of stent-graft implantation for the endovascular treatment of peripheral vascular lesions. MATERIALS AND METHODS: Seventeen patients underwent repair of iatrogenic, traumatic, or spontaneous vascular lesions by means of endovascular stent-grafts. The study cases consisted of 10 cardiac catheterization-induced femoral arteriovenous fistulas (AVFs) located between the deep femoral artery and the femoral vein, one iatrogenic AVF between the common iliac artery and vein, one penetrating trauma-induced AVF between the superficial femoral artery and vein, two penetrating trauma-induced pseudoaneurysms in the axillary and popliteal arteries, and three spontaneous or atherosclerosis- related iliac artery aneurysms. Balloon-expandable or self-expandable stent-grafts were used in all 17 cases. RESULTS: All the stent-grafts were deployed successfully. In catheterization-induced femoral AVFs, complete closure of the fistulas was immediately accomplished in 9 of the 10 cases. Blood flow within the pseudoaneurysms of the axillary artery and the popliteal artery, and aneurysms of the iliac arteries were stopped. Partial closure was achieved in two patients with traumatic iliac and femoral AVFs. For the patients who reported subsided complaints, mean follow-up for 24 months with clinical examination and color Doppler ultrasound revealed patency of the stented segments. CONCLUSION: Our results suggest that endovascular treatment of various types of peripheral vascular lesions with stent-grafts is a low-risk procedure, which appears to be less invasive than surgery.

Interventional radiology in the lacrimal drainage system.

This article presents a review of the interventional radiological procedures in the lacrimal drainage system. Balloon dacryocystoplasty and nasolacrimal polyurethane stent placement are the main fluoroscopically guided interventions for the treatment of epiphora by recanalizing the obstructed LDS. These procedures can also be used for dacryolith removal and lacrimal sac abscess treatment.

Bilateral persistence of type 1 proatlantal arteries: report of a case and review of the literature.

Persistent proatlantal artery type 1 is one of the four anastomotic vessels between the carotid and vertebrobasilar arterial systems. Persistence of this embryonic anastomosis is extremely rare. We present such a case with bilateral persistent proatlantal arteries that arose from internal carotid arteries, entered the skull via the foramen magnum and united with the horizontal portions of vertebral arteries. We also mention its embryology, potential clinical implications, and differentiating features between two types of proatlantal arteries.

Postcatheterization femoral arteriovenous fistulas: endovascular treatment with stent-grafts.

PURPOSE: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein. METHODS: Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach. RESULTS: All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs. CONCLUSION: Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.

Outcome of patients with nasolacrimal polyurethane stent implantation: do they keep tearing?

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction and the effects of obstructed nasolacrimal stent on subsequent dacryocystorhinostomy (DCR). METHODS: This study was designed as a nonrandomized, prospective clinical trial. Stent implantation was attempted in 53 obstructed lacrimal drainage systems of 47 patients. Stent placement was performed in a retrograde fashion through the external nare over a guide wire, which was introduced from the upper punctum. Occluded stents were removed either with nasal endoscopy or during DCR. External DCR surgery with silicone intubation was performed in cases with stent failure. RESULTS: The mean follow-up period was 23.4 months. The success rate of stent implantation was 60.4%, 37.5%, and 31.2% at 6-, 12-, and 18-month follow-up, respectively. Stent obstruction developed in 33 eyes. Twenty underwent external DCR with silicone intubation. During DCR surgery, varying degrees of chronic inflammatory reaction were detected in the lacrimal sac and nasolacrimal duct. The mean follow-up period after DCR was 10.3 months. Epiphora was relieved with DCR in all but one eye. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low and may induce inflammation and fibrous tissue formation. Although this may cause further difficulties in subsequent lacrimal surgery, epiphora could be relieved with meticulous technique.

[Percutaneous transluminal angioplasty in the prevention of bypass graft failure]. / Alt ekstremite bypass greft uygulamalari sonrasinda gelisen obstrüksiyonlarin tedavisinde perkütan transluminal anjiyoplasti.

PURPOSE: To evaluate the results of percutaneous transluminal angioplasty in the prevention of bypass graft failure with dilatation of the anastomotic and perianastomotic obstructions following surgery. MATERIALS AND METHODS: Fourteen proximal or distal anastomotic/perianastomotic obstructions in one illiofemoral, one aortofemoral and ten femoropopliteal bypass grafts in eleven patients were diagnosed by clinical examination, Doppler ultrasonography, intravenous and intraarterial DSA in a follow-up period of 4-24 months after surgery. Percutaneous transluminal angioplasty was attempted in these anastomotic or perianastomotic lesions including two occlusions. RESULTS: Percutaneous transluminal angioplasty was successful for all cases. In a follow-up period of 4-45 months, eight patients remained asymptomatic with patient grafts. In one patient, the graft was occluded in the fourth month. In two others, restenosis occurred at the seventh and seventeenth months and required redilatation. Cumulative primary patency rate for one year was 92 +/- 6.8%. CONCLUSION: Percutaneous transluminal angioplasty is an effective alternative treatment modality for anastomotic and perianastomotic bypass graft-related obstructions and may enhance the overall graft patency.

Percutaneous management of bile duct stones.

This article presents a review of the interventional radiological procedures in the percutaneous management of the bile duct stones through T-tube or transhepatic tracts. Interventional stone removal techniques mainly include extraction through the T-tube tract with baskets or forceps and expulsion into the duodenum by means of baskets or balloon catheters with the dilatation of the sphincter of Oddi. Fragmentation or size reduction of the stone, dilatation of the strictures and cholangioscopic assistance can facilitate the procedures.