[Flat-panel CT as a new perinterventional imaging modality in aortic stentgraft procedures--work in progress]. / Flachdetektor-CT als ergänzende Untersuchung bei der endoluminalen Behandlung von thorakalen und abdominellen Aortenaneurysmen--Erste klinische Erfahrungen.

PURPOSE: To evaluate the value of flat-panel CT (FP-CT) as a new perinterventional imaging modality in aortic stentgraft procedures. MATERIALS AND METHODS: FP-CT was performed in 21 patients (19 males, mean age 77, range 54 to 90) from June 2005 to February 2007 immediately after endovascular treatment of thoracic and abdominal aortic aneurysms on the angiographic table. Nine thoracic aortic aneurysms were treated with Zenith-endoprosthesis. Nine of twelve abdominal aortic aneurysms were treated with Zenith-endoprosthesis and three with an Excluder-endoprosthesis. Images were acquired with a rotating C-arm and the following parameters: during an acquisition time of 20 seconds and at a rotation of 217 degrees, 538 projections were acquired. Contrast agent was administered in 14 patients. Images were displayed in MIP, MPR and VRT mode. RESULTS: In all patients the stentgraft was shown exactly and the alignment of the prosthesis along the landing zones was well displayed. The aneurismal sack was well shown in all patients. 1 x an endoleak II was detected, 1 x an angiographically verified endoleak I was not detected. In one patient distal extension was considered due to suspected short stentgraft at the distal neck. Flat-panel CT showed sufficient neck coverage and no extension was inserted. Due to artifacts of the prosthesis, the platinum markers and the guide wire as well as due to pulsation of the aorta, the resolution of detail decreased and reduced the visualization of the alignment. CONCLUSION: FP-CT is a promising tool and may provide additional information, but further studies are necessary to define the value of flat-panel CT in thoracic and abdominal aortic stentgraft procedures.

PTA versus Palmaz stent placement in femoropopliteal artery obstructions: a multicenter prospective randomized study.

PURPOSE: To evaluate if stent placement is superior to percutaneous transluminal angioplasty (PTA) in the treatment of chronic symptoms in short femoropopliteal arterial lesions. MATERIALS AND METHODS: One hundred fifty-four limbs in 141 patients who ranged in age from 39 to 87 years (mean age, 67 years) were randomized to PTA (n = 77) versus PTA followed by implantation of Palmaz stents (n = 77). Inclusion criteria were patients with intermittent claudication (n = 108, Society of Vascular Surgery/International Society of Cardiovascular Surgery [SVS-ISCVS] categories 1-3) or chronic critical limb ischemia (n = 46 with either ischemic rest pain [category 4] or minor tissue loss [category 5]), short stenosis or occlusion (lesion length < or = 5 cm), and at least one patent run-off vessel at angiography. Follow-up included clinical assessment, measurement of ankle/ brachial index (ABI), color duplex ultrasound, and/or angiography at 6 or 12 months. Angiographic follow-up between 12 and 36 months was available in 46 limbs (29.9%). RESULTS: In the PTA group, initial technical success was achieved in 65 of 77 limbs (84%) versus 76 of 77 (99%) limbs in the stent group (chi2 value = 0.009). Overall, major complications occurred in 3.9% (n = 6); n = 4 in the PTA group compared to n = 2 in the stent group. There was no difference between groups of treatment: hemodynamic/clinical success at 1 and 2 years in the PTA group was 72% and 65% versus 77% and 65% in the stent group (Gehan P value = .26). The cumulative 1- and 2-year angiographic primary patency rates were 63% and 53%, respectively, for both groups. The secondary 1- and 2-year angiographic patency rates were 86% and 74% in the PTA group versus 79% and 73% in the stent group (P = .5). CONCLUSION: After stent placement, the primary success rate was significantly higher than after PTA. However, 1-year angiographic and clinical/hemodynamic success was not improved.

Cerebral sinus thrombosis in a patient with hereditary protein S deficiency: case report and review of the literature.

Hereditary protein S deficiency is an established risk factor for venous thrombosis. The common sites of thrombosis are the deep leg and pelvic veins. We report on a 38-year-old female patient with hereditary protein S deficiency and a previous history of deep leg vein thrombosis, who developed thrombosis of the cerebral straight and superior sagittal sinus while taking oral contraceptives. The diagnosis was established by computerized tomography and carotid angiography. Lysis of the thrombus occurred during heparin treatment. The hereditary nature of protein S deficiency was documented by family studies, since nine additional family members deficient in protein S were identified. Nineteen published cases of cerebral vein thrombosis and a deficiency of either anti-thrombin III, protein C, or protein S were reviewed. Compared with patients without a deficiency state, the clinical features of cerebral vein thrombosis were similar except for an earlier onset and a positive medical history of venous thromboembolic events in a considerable number of patients.