Tigroid pattern on magnetic resonance imaging in Lowe syndrome.

Lowe (oculocerebrorenal) syndrome is an X-linked recessive disorder characterised by congenital cataract, glaucoma, cognitive developmental delay and renal tubular Fanconi syndrome. In this report we present a patient with Lowe syndrome with a tigroid pattern on cranial MRI, which has not been previously reported as an imaging feature of this syndrome.

Endovenous laser ablation for saphenous vein insufficiency: immediate and short-term results of our first 60 procedures.

PURPOSE: To present the immediate and short-term results of our first 60 endovenous laser (EVL) ablation procedures. MATERIALS AND METHODS: Between July 2005 and December 2006, 60 EVL ablations were performed in 36 symptomatic patients (26 females, 10 males; mean age +/- SD, 46 +/- 14 years). The incompetent veins included the great saphenous vein (GSV) (n = 52), small saphenous vein (n = 6), and major branches of the GSV (n = 2). In all cases incompetent veins were punctured under ultrasound (US) guidance and the laser fiber was placed into these veins through a vascular sheath or with the help of a catheter. After tumescent anesthesia was administered, the veins were ablated with laser by delivering 50-100 joules/cm energy to the vein wall. Following EVL ablations, 29 patients also underwent foam sclerotherapy to treat the remaining varicosities. After the EVL ablation +/- sclerotherapy, patients were followed- up with Doppler US at 1 week, and then 3, 6, and 12 months post procedure. RESULTS: In all patients EVL ablation was technically successful. Complications were minor and included transient visual disturbance due to foam sclerotherapy (n = 1), bruising/ ecchymoses (n = 24), postoperative pain (n = 16), and superficial thrombophlebitis (n = 6). All patients returned to normal activity within 2 days. During the 7 +/- 5 months (mean +/- SD) of follow-up, recurrent reflux was seen in only one patient, in both GSVs, which was successfully treated with foam sclerotherapy. CONCLUSION: EVL ablation is a safe and effective method for the management of saphenous vein insufficiency.

Aortoiliac kissing stents: long-term results and analysis of risk factors affecting patency.

PURPOSE: To present the early and long-term results of aortoiliac kissing stents implantation and evaluate the risk factors affecting patency. METHODS: The data were retrospectively reviewed on 68 patients (64 men; mean age 55+/-11, range 32-77) who underwent kissing stents implantation during a 12-year period. The majority of patients (64, 94%) had claudication; 4 patients had rest pain. All were smokers. There were bilateral or unilateral stenoses in 42 (62%) patients, and unilateral occlusion and contralateral stenosis in 26 (38%). Lesions were treated with simultaneous implantation of self-expanding (n=52) or balloon-expandable (n=16) stents. After the procedure, patency was determined with Doppler ultrasonography or angiography at 1, 3, 6, and 12 months and annually thereafter. Primary, assisted primary, and secondary patency rates were calculated with Kaplan-Meier analysis on an intention-to-treat basis, and risk factors affecting the patency rates were determined with the Cox regression analysis. RESULTS: All procedures were technically and clinically successful. Complications occurred in 12%, but none required surgery. The follow-up period was 35+/-31 months. Primary, assisted primary, and secondary patency rates, respectively, were 76%, 90%, and 94% at 1 year; 63%, 86%, and 92% at 3 years; and 63%, 64%, and 81% at 5 years. In multivariate analysis, age <50 years and presence of iliac occlusion were identified as risk factors for reduced primary and assisted primary patency; a crossed configuration of kissing stents was identified as a risk factor for reduced primary patency. CONCLUSION: Implantation of kissing stents is a safe and effective alternative in the treatment of aortoiliac obstructions. However, overall primary and assisted primary patency rates are inferior to those reported for surgery. Long-term patency comparable to surgery may be obtained in patients >50 years and in those without an iliac occlusion, particularly if a favorable stent configuration is achieved.

Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients.

PURPOSE: To assess the safety and efficacy of ultrasound (US) guidance during retrograde popliteal artery catheterization (RPAC) and identify the risk factors for late hemostasis and complications. METHODS: A retrospective review was undertaken of consecutive patients who underwent grayscale US-guided RPAC during the last 8 years. Chart review identified 174 patients (150 men; mean age 61+/-10 years, range 37-84) with 247 iliofemoral lesions, which were treated via US-guided RPAC. Complications were classified as puncture-related versus angioplasty-related and major versus minor. Risk factors for complications and late hemostasis were evaluated with logistic and linear regression analyses, respectively. RESULTS: All 234 US-guided RPACs were technically successful. No arteriovenous fistula (AVF) or dissection/thrombosis of the popliteal artery was observed. The mean time to hemostasis was 6.9+/-2.3 minutes. The presence of femoral stenosis (versus occlusion) and use of large (6 to 7-F) sheaths were significant risk factors for late hemostasis. In 234 procedures, 15 (6.4%) complications developed; 10 (4.3%) were puncture-related (3 major, 7 minor) and 5 (2.1%) were angioplasty-related (3 major, 2 minor). Intra-arterial fibrinolysis was found to be the only significant risk factor for overall and puncture-related complications. CONCLUSIONS: Our results suggest that US-guided RPAC is at least as safe as other RPAC methods described in the literature. In contrast to generally held concerns, hemostasis is easy to obtain, and multiple punctures and the use of large sheaths appear safe. These results should be taken into consideration during the selection of an access site for endovascular treatment of superficial femoral artery and tandem iliofemoral lesions.

[Mammography-related pain and anxiety]. / Mamografi çekimine bagli agri ve kaygi.

PURPOSE: To investigate whether informing patients about mammographic compression changed the anxiety and pain that they experience during mammography. MATERIALS AND METHODS: Five hundred and one patients were enrolled in the study. Two hundred and fifty seven (51.3%) were informed before the procedure by written forms explaining the necessity of compression. The remaining 244 (48.7%) didn't get any pre-procedural information. All participants completed demographic form and Spielberger's State Anxiety Inventory while they were waiting for mammography. They marked the level of pain due to compression on a 100-mm visual analog scale (VAS) after the procedure. Chi square, Pearson's correlation and Student's t tests were used for statistical analyses. RESULTS: We didn't find any significant difference between the anxiety scores of the informed (41.4+/-7.9) and uninformed (40.9+/-7.7) women, but the pain level was significantly lower in the informed group (16.5+/-22.4) than in the uninformed group (24.5+/-28.1). There was no statistically significant relationship between the anxiety and pain levels. Women who had recently felt tense and nervous or had a fear of breast cancer diagnosis had higher anxiety levels. CONCLUSION: Our data shows that informing patients about examination decreases the level of pain due to mammographic compression, but does not alter the anxiety level. The main cause of anxiety appears to be the fear of a malignant diagnosis. Any intervention to decrease this fear may increase the compliance rates for screening mammography.

Primary stenting of focal atherosclerotic infrarenal aortic stenoses: long-term results in 13 patients and a literature review.

We conducted this study to investigate the value of primary stent implantation for the endovascular treatment of focal atherosclerotic stenoses of the infrarenal abdominal aorta. The data of 13 patients with a localized complex infrarenal aortic stenosis who underwent primary stenting was retrospectively evaluated. The patients (6 females, 7 males) had a mean age of 57.3 +/- 9.1 years (mean +/- SD). In all patients, the aortic diameter was measured on CT sections, and a self-expanding endoprosthesis was primarily implanted followed by dilatation with single or double balloons. In 3 patients, additional distal stenoses were also endovascularly treated. The procedure was technically successful in all patients. No complications occurred except for 2 minor groin hematomas. During the 43 +/- 23 months (mean +/- SD) follow-up (range: 12-96 months), all stented aortic segments remained patent. Clinical patency was lost in 4 patients, which was due to atherosclerosis or restenosis distal to the aorta. In view of the excellent early and long-term results, we believe that primary stenting should be considered the first line treatment in properly selected patients with focal atherosclerotic infrarenal stenoses of the abdominal aorta.

Transvenous embolization and stent placement for an internal iliac arteriovenous fistula with central iliac vein occlusion.

The authors present a case of traumatic arteriovenous fistula of the internal iliac vessels treated with attempted surgical ligation of the common iliac artery and external iliac artery. The fistula persisted after the operation, and because the patient received no further treatment for the following 6 years, a venous outflow occlusion also developed as a result of high-flow angiopathy. Because the arterial route was eliminated at previous surgery, the fistula and venous occlusion were percutaneously treated via a transvenous approach.

Subintimal versus intraluminal recanalization of chronic iliac occlusions.

PURPOSE: To present our experience with subintimal recanalization of chronic iliac occlusions and retrospectively compare the results of this technique with those of standard intraluminal recanalization. METHODS: A retrospective review was conducted of 98 patients (91 men; mean age 61+/-10 years, range 37-77) with unilateral chronic iliac occlusions who underwent standard intraluminal recanalization or subintimal recanalization if intraluminal wire passage failed. The technical success, complications, and patency rates were statistically compared between groups. RESULTS: In 59 (60%) of 98 patients, the occlusions were successfully crossed with ipsilateral intraluminal recanalization, while failure of intraluminal recanalization in the remaining 39 led to attempted subintimal recanalization (ipsilateral in 17 and antegrade-retrograde in 22). Overall, ipsilateral intraluminal recanalization was technically successful in 56 (57%) of 98 patients; subintimal recanalization was successful in 35 (90%) of 39 patients. Technical success was only 29% in 17 patients who underwent subintimal recanalization via an ipsilateral retrograde approach. During a follow of 27+/-16 months, primary and assisted primary patencies were not significantly different between the patients treated with intraluminal versus subintimal recanalization (p=0.81 and 0.64, respectively). CONCLUSIONS: Subintimal recanalization is a safe and effective supplement to standard intraluminal recanalization techniques in the endovascular treatment of chronic iliac occlusions. Because of the poor outcome associated with the ipsilateral route, subintimal recanalization of these lesions should preferably be performed via a combined antegrade-retrograde approach.

Primary stenting of embolic occlusions in iliac arteries.

PURPOSE: To present our experience with the use of primary stenting to treat embolic iliac artery occlusions. METHODS AND RESULTS: Six patients (5 men; mean age 50.6+/-14.1 years range 37-72) underwent primary stenting for embolic occlusions lodged in the common iliac and/or external iliac arteries and were retrospectively evaluated. The probable reason for the embolism was atrial fibrillation in 4 patients and acute myocardial infarction in 2. In 5 patients, an additional embolus was demonstrated in the renal, mesenteric, popliteal, and middle cerebral arteries. Iliac emboli were treated with primary implantation of self-expanding stents followed by very low-pressure balloon dilation. In all cases, primary stenting was technically successful and provided immediate recanalization with elimination or reduction of symptoms. There was no procedure-related complication. During the mean 11-month follow-up (range 1-18), all stented iliac arteries remained patient. One patient died due to cerebral embolism at 21 months. CONCLUSIONS: Although this experience is limited, excellent midterm results suggest that primary stenting may be a valuable alternative in the treatment of embolic occlusions of the iliac arteries in selected cases.

Subintimal angioplasty of long superficial femoral artery occlusions.

PURPOSE: To investigate the value of subintimal angioplasty (SA) and selective stent placement in the treatment of long (> or =15 cm) superficial femoral artery (SFA) occlusions. MATERIALS AND METHODS: During a period of 4.5 years, 67 long SFA occlusions in 61 patients (52 male, 9 female) were intended to be treated with SA, either retrogradely (n = 55) or antegradely (n = 12). Postprocedural medical treatment included aspirin + ticlopidine/clopidogrel (AT/C) combination. In 25 patients warfarin was also given for 3-6 months. Patients were followed up for 1-30 months (mean 12.5 +/- 9.0 months). Hemodynamic patencies were determined with the Kaplan-Meier method, risk factors affecting patency were evaluated with the Cox model, and the patencies of the subgroups were compared with log-rank test. RESULTS: Subintimal recanalization was technically successful in 59 of 67 occlusions. Technical success was 83% in the first 30 procedures, 92% in the last 37, and 100% in the last 29. Forty-six occlusions were treated with SA alone and 13 with SA and stent placement. On an intention-to-treat basis, primary patency at 6 and 12 months was 49% and 22%, respectively, and assisted primary patency at 6 and 12 months was 69% and 57%, respectively. Patency rates were not significantly different in patients with claudication versus critical limb ischemia, or in those treated with SA alone versus SA and stent placement. With the multivariate Cox model, medical treatment with AT/C combination was identified as the only significant risk factor for both primary patency and assisted primary patency. With the Kaplan-Meier analysis, primary and assisted primary patencies were significantly higher in the warfarin group than the AT/C group (P =.0002 and.0001, respectively). CONCLUSION: SA is a simple and safe method with a high technical success rate in the endovascular treatment of long SFA occlusions. Long-term patency rates, however, seem unsatisfactory, despite early reports. Subintimal stent placement provides cumulative patency at least as good as SA alone. Warfarin may significantly improve both primary patency and assisted primary patency after subintimal recanalization, but even with this treatment patency rates are still lower than those reported for bypass surgery. Therefore, in long SFA occlusions, SA is not recommended for claudicants but may be valuable in patients with critical limb ischemia.

Endovascular treatment of a recipient celiac trunk stenosis after orthotopic liver transplantation.

PURPOSE: To present the successful endovascular treatment of a severe recipient celiac trunk stenosis that led to allograft ischemia following liver transplantation. CASE REPORT: A 56-year-old woman underwent orthotopic liver transplantation because of hepatitis C-induced cirrhosis. After the operation, routine hepatic Doppler ultrasonography showed a tardus parvus flow pattern in the hepatic artery, suggesting an impending hepatic artery thrombosis. Digital subtraction angiography (DSA), however, showed severe stenosis of the recipient celiac trunk and moderate splenic artery steal. The stenosis was dilated and stented in the same session. The postprocedural DSA showed good dilation of the lesion with immediate improvement of hepatic opacification. Follow-up Doppler ultrasound scans showed normal flow patterns in the hepatic artery at 3 and 6 months. CONCLUSIONS: In the presence of a tardus parvus flow pattern on Doppler ultrasound after liver transplantation, the possibility of an undetected recipient celiac stenosis should be considered in the differential diagnosis. Such lesions can successfully be treated with angioplasty and stenting.

Endovascular treatment of an acute superior mesenteric artery occlusion following failed surgical embolectomy.

PURPOSE: To present the successful primary stenting of a superior mesenteric artery (SMA) occlusion following failed surgical embolectomy. CASE REPORT: A 65-year-old woman with a history of atrial fibrillation underwent surgical embolectomy of an acute embolic occlusion of the superior mesenteric artery (SMA). The following day, symptom recurrence suggested reocclusion, which was confirmed with emergent arteriography. Two balloon-expandable stents were deployed primarily, which ameliorated the patient's symptoms. Follow-up angiography at 3 months showed continued SMA patency, with no evidence of distal embolization or restenosis. The patient remains asymptomatic at 9 months after the stent procedure. CONCLUSIONS: Although more experience is required, primary stenting may be a valuable alternative in the treatment of acute SMA occlusions, in particular, for reocclusions after failed surgery.

Optic neuritis: evaluation with orbital Doppler sonography.

PURPOSE: To evaluate orbital blood flow velocities with Doppler sonography in patients with acute unilateral optic neuritis. MATERIALS AND METHODS: Orbital Doppler sonography was performed in 20 patients with acute unilateral optic neuritis. Optic neuritis was diagnosed by a neurologist on the basis of clinical presentation, presence of decreased visual acuity, and assessment of visual evoked potentials. The peak systolic and end diastolic velocities and the resistive index were measured in the ophthalmic and central retinal arteries of both orbits. The values obtained from affected and unaffected orbits were compared by using the paired t test. RESULTS: The peak systolic and end diastolic velocities in the ophthalmic artery were significantly increased in the affected orbits (for peak systolic velocity P <.001, for end diastolic velocity P <.05). Resistive indexes in the ophthalmic arteries did not differ (P >.05). The difference between the peak systolic and end diastolic velocities and resistive indexes in the central retinal arteries of affected and normal eyes was not statistically significant (P >.05). CONCLUSION: Peak systolic and end diastolic velocities in the ophthalmic artery are increased in patients with acute optic neuritis.

Human fascioliasis: MR imaging findings of hepatic lesions.

Our objective was to describe MR imaging findings of liver lesions in human fascioliasis. The MR imaging of the liver was performed in 29 patients with fascioliasis. Seventeen patients were women and 12 were men, with a mean age of 47.5 years (age range 17-75 years). Hepatic lesions were grouped into five types based on their signal characteristics. Three patients had normal imaging findings. One or more lesions were observed in the other 26 patients. The lesion types and the frequency of appearances were as follows: hyperintensity of the liver capsule on T2-weighted images (n=16, 55.2%); ill-defined slightly hyperintense areas on T2-weighted images (n=18, 62.1%); lesions which were hypointense on T1-weighted and hyperintense on T2-weighted images (n=10, 34.5%); hypointense on T1-weighted images and centrally hypo- or hyperintense, surrounded by peripherally less hyperintense area on T2-weighted images (n=4, 13.8%); and hypointense foci or ill-defined hypointense areas on T1- and T2-weighted images (n=10, 34.5%). We describe the MR imaging features of the disease. Our findings may help the differential diagnosis in which fascioliasis should be added to the list.

Hematoma after percutaneous transpopliteal stenting and remote suturing of the popliteal artery.

PURPOSE: To present a case of extensive thigh hematoma that developed after use of a percutaneous suturing device for retrograde popliteal artery puncture. CASE REPORT: A 55-year-old woman underwent endovascular treatment for a short occlusion of the right superficial femoral artery via a retrograde popliteal approach, after which the puncture site was closed with a Closer suture-mediated device. Several hours later, massive hematoma of the right thigh developed, which was noticed only after the patient's leg became markedly swollen and hypotension developed. CONCLUSIONS: The use of a suture-mediated closure device for a retrograde popliteal artery puncture may not be recommended.

Aneurysmal bone cyst of the orbit.

Aneurysmal bone cysts of the skull are rare, and orbital involvement of these cysts is even less frequent. We present CT, MR imaging, and histopathologic findings of an aneurysmal bone cyst of the orbit in a 13-year-old female adolescent. The tumor mainly involved the frontal bone. MR imaging findings of the aneurysmal bone cyst of the skull were highly suggestive of the diagnosis.