ABSTRACT
BACKGROUND: Antegrade femoral access is a routinely used technique for infra-inguinal interventions. However, it can be challenging in cases of high femoral bifurcations, obliterative disease process and obese patients. PURPOSE: A simple method of antegrade access using a Fogarty catheter and guide wires, under flouroscopic control is presented , which has lead to easy access in obliterative disease of SFA with minimal complications. RESULTS: We have done fourteen successful punctures using this technique over the past 6 months. In obese patients or patients with a pannus another assistant was used to pull the pannus back while doing the procedure. However, in two cases, while withdrawing the sheath into the CFA, there was inadvertent slippage of sheath outside the lumen of CFA. Immediate haemostasis was ensured by pulling the inflated Fogarty catheter backwards followed by manual compression before reintroducing the sheath inside the lumen. In both these cases, the patients were obese with a pannus and our puncture angle was more vertical which most probably led to this complication. However, post intervention results were satisfactory with no evidence of any pseudoaneurysm formation. CONCLUSION: This simple method allows to achieve antegrade SFA access in a safe and secure manner.
Subject(s)
Femoral Artery , Obesity , Humans , Treatment Outcome , Femoral Artery/diagnostic imaging , Groin , CathetersABSTRACT
BACKGROUND: To compare the efficacy of intralesional bleomycin and sodium tetradecyl sulphate in treatment of haemangiomas and lymphangiomas. PATIENTS AND METHODS: Between July 2007 and May 2009, 120 patients, sixty each of peripheral haemangiomas and lymphangiomas, were administered intralesional injection of bleomycin in a dose of 0.5-1 U/kg in children less than one year of age and 1 to 15 units in children more than one year of age and 1 to 3 ml of 2% sodium tetradecyl sulphate, depending on the size of the lesion at intervals of 14 days. Patients more than 20 years of age and those with diffuse or visceral lesions were excluded from the study. RESULTS: Complete resolution occurred in 16 patients (53%) of haemangiomas and 14 patients (47%) of lymphangiomas treated with bleomycin, while the results were 12 patients (40%) and 10 patients (33%), respectively, in sodium tetradecyl sulphate group. The satisfactory resolution (resolution more than 50%) occurred in eight patients (27%) of haemangiomas and lymphangiomas groups treated with bleomycin, while the results were six patients (20%) and eight patients (27%), respectively, in sodium tetradecyl sulphate group. Poor response rate was observed in six patients (20%) of haemangiomas and eight patients (27%) of lymphangiomas of bleomycin group and 12 patients (40%) of haemangiomas and lymphangiomas in sodium tetradecyl sulphate group. No pulmonary fibrosis or other serious side effects were found. CONCLUSIONS: Intralesional bleomycin and sodium tetradecyl sulphate are effective sclerosants in peripheral haemangiomas and lymphangiomas, but bleomycin was found to be more efficacious.
