Fluorescein labeling of lymphatic vessels for lymphangiography.

A simple technique for identification of pedal lymphatic vessels for lymphangiography was developed. A fluorescein-lidocaine mixture is injected subcutaneously into the foot, and within 20 minutes, local lymphatic vessels absorb the solution and fluoresce vividly under ultraviolet light. These labeled lymphatic channels are readily isolated and cannulated. The technique has proved highly successful, with no documented allergic complications after use in more than 1,000 cases.

Embolization of bleeding esophageal varices via umbilical vein. An alternative approach.

Embolization of bleeding esophageal varices via the umbilical vein can be used as an alternative technique to percutaneous transhepatic coronary vein occlusion (PTCVO). Both techniques can stop acute bleeding from esophageal varices and allow the cirrhotic patient with portal hypertension to be prepared for an elective rather than an emergency shunt. Embolization via the umbilical vein can be performed with a patient under local anesthesia, can be effective when other methods fail, and can be done safely in the presence of both ascites and a bleeding diathesis, which are two contraindications to PTCVO.

Radiographic evaluation of patency of interposition mesocaval shunts.

The technique of side-to-side mesocaval anastomosis with the interposition of a prosthetic graft was described in 1970. We report the result of venographic evaluation of patency of this type of shunt in our patients. Demonstration of an unoccluded graft; resistance to retrograde injection of dye against the blood stream into the superior mesenteric vein; rapid clearing of dye from superior mesenteric vein following injection and "lamellar flow defect" in the vena cava above the site of anastomosis during vena cavogram, were considered criteria of patency of the interposition mesocaval shunt.