Fluoroscopically guided peritoneal catheter placement for intraperitoneal chemotherapy.

PURPOSE: Surgical placement of intraperitoneal catheters for intraperitoneal chemotherapy is associated with bowel perforation, peritonitis, and catheter occlusion. The authors evaluated the safety and efficacy of fluoroscopically guided placement of temporary intraperitoneal catheters for chemotherapy. PATIENTS AND METHODS: Two hundred one intraperitoneal catheter placements were attempted in 88 patients with peritoneal carcinomatosis or sarcomatosis. The peritoneum was punctured with 22-gauge needles and exchange was made with use of Seldinger technique and liberal injections of contrast material at each step for 8.3- or 8.5-F multiple-side-hole catheters. Placement sites included all four quadrants and the midline. Computed tomographic (CT) peritoneography was performed prior to chemotherapy. RESULTS: One hundred ninety (94.5%) of 201 attempted catheter insertions were technically successful. Results of CT peritoneography were available in 175 cases and showed free distribution of peritoneal contrast material in 39% (n = 69), partial loculation in 38% (n = 67), and extensive loculation in 22% (n = 39). Catheters remained in place for a median of 5 days (range, 2-6 days). Significant complications occurred in 11 procedures (5.5%). There were seven unintended bowel intubations; all were treated conservatively except one that required surgical repair. One other patient developed necrotizing fasciitis requiring surgical débridement. Three other patients (1.5%) developed mild peritonitis responsive to antibiotics. Technical success, complications, and peritoneal distribution of contrast material did not correlate with the site of catheter placement. CONCLUSION: Percutaneous catheter placement with use of small-gauge needles for initial puncture is safe and efficacious in patients requiring short-term peritoneal access for chemotherapy.

Dilation of difficult strictures of the esophagus.

In managing difficult esophageal strictures not amenable to the usual methods of dilation, a technique of fluoroscopic placement of a guide wire followed by controlled gradual dilation of the stricture has been described. The method is fully explained and is easily performed by a team of endoscopists-radiologists. Since this article was submitted, six additional patients have been dilated by the authors. In each, a stent was used to maintain patency of the strictured lumen.

Preoperative embolization of hypervascular head and neck neoplasms using microfibrillar collagen.

Microfibrillar collagen is a bovine collagen material that promotes hemostasis. When mixed with contrast material it makes a fine slurry that is easily injected through small catheters. Experience with preoperative embolization of head and neck neoplasms in six patients indicates that microfibrillar collagen slurry is a highly effective, easy to use embolic material for occlusion of highly vascular neoplasms.

Translumbar selective coronary arteriography.

Translumbar selective coronary arteriography was performed using a preshaped 7 French coronary catheter introduced over the long translumbar needle. The patient had abdominal aortic occlusion, left subclavian artery occlusion, and innominate artery stenosis, which precluded the usual angiographic approaches.

Fluoroscopic control for dilation of esophagogastric anastomotic stricture.

A radiologic technique is described for dilating a strictured side-to-side anastomosis between the upper esophagus and the fundus of the stomach. Traditional dilatation methods could not be employed because of the lateral position of the anastomosis.

Wedged catheter management of a bleeding renal pseudoaneurysm.

A patient with significant gross hematuria following renal biopsy is managed successfully with subselective wedged arterial occlusion.