ABSTRACT
A 79-year-old woman with a complaint of persistent upper abdominal pain was admitted to our hospital for the treatment of thrombosed acute type B aortic dissection. Computed tomography showed the complete static occlusion of the celiac artery. Because of progressive symptom with elevation of liver enzymes and metabolic acidosis 11 h after admission, endovascular revascularization was attempted on an emergent basis. After a failed catheterization of the celiac ostium in an antegrade fashion due to a hard occlusion, we succeeded in a retrograde recanalization through the pancreaticoduodenal arcade via the superior mesenteric artery with stent placement using a pull-through technique. This technique is useful and safe when an antegrade approach seems difficult.
Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Celiac Artery , Endovascular Procedures , Aged , Aortic Dissection/diagnostic imaging , Angiography , Aortic Aneurysm/diagnostic imaging , Female , Humans , Tomography, X-Ray ComputedABSTRACT
We report three cases of hepatic artery pseudoaneurysm, which were all treated successfully using a combination of coil embolization and a side-holed 5F indwelling catheter for maintaining minimal hepatic artery blood flow with exclusion of the pseudoaneurysm. The tip of an infusion catheter was placed in the right hepatic artery and a side hole was positioned at the celiac axis. Coil embolization was then performed from the proper to the common hepatic artery using detachable coils. Hemostasis was achieved in all patients, with a final angiogram showing the hepatic arteries through the indwelling catheter. One major hepatic infarction and one focal liver abscess caused by reflux cholangitis manifested on postoperative days (PODs) 11 and 87, respectively. All patients survived and the indwelling catheter was removed on POD 136382 without complication.
Subject(s)
Aneurysm, False/therapy , Catheters, Indwelling , Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/methods , Hepatic Artery , Aged , Aged, 80 and over , Contraindications , Female , Humans , Ischemia/prevention & control , Liver/blood supply , Male , Stents , Treatment OutcomeABSTRACT
PURPOSE: To compare the MR findings including diffusion-weighted imaging (DWI) between symptomatic and asymptomatic patients with autoimmune pancreatitis (AIP) and to determine whether DWI can be used as an objective biomarker for symptomatic AIP, which is considered an indication for steroid therapy. MATERIALS AND METHODS: This retrospective study was approved by our institutional review board. MRI scans from 37 patients with AIP (symptomatic, n = 19; asymptomatic, n = 18) were retrospectively evaluated. The imaging studies were performed on a 1.5 Tesla scanner and assessed for parenchymal enlargement, narrowing of the main pancreatic duct, hypointensity on fat-suppressed T1-weighted images (FS-T1WI), a capsule-like rim, extrapancreatic lesions, and hyperintensity on DWI. The findings were compared by univariate and multivariate logistic regression analysis. Apparent diffusion coefficient (ADC) values were also calculated. RESULTS: Multivariate analysis showed that hyperintensity on DWI were most significantly associated with the symptoms of AIP (odds ratio = 28.2; P = 0.003). Interobserver agreement for DWI was also high. The ADC values were significantly lower in symptomatic than in asymptomatic patients (0.94 ± 0.17 versus 1.16 ± 0.16 × 10(-3) mm(2)/s, P < 0.001). Receiver operating characteristic curve analysis of the ADC values to differentiate between symptomatic and asymptomatic patients showed that sensitivity was 68.4%, specificity 83.3%, and AUC 0.74. CONCLUSION: Signal intensity on DWI and ADC value were well correlated with the active symptoms of AIP patients. DWI may be useful as an objective biomarker for determining the indication for steroid therapy.
Subject(s)
Autoimmune Diseases/diagnosis , Diffusion Magnetic Resonance Imaging/methods , Pancreas/pathology , Pancreatitis/diagnosis , Aged , Aged, 80 and over , Female , Humans , Image Processing, Computer-Assisted/methods , Male , Middle Aged , Observer Variation , ROC Curve , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Seven patients with superior mesenteric artery embolism were treated by aspiration with the use of a 6-F angled guiding sheath and a 6-F guiding catheter through an 8-F short sheath by direct advancement using a telescopic and "biting-off" technique. Aspiration of the trunk took between 30 and 60 minutes (median, 44.0 min), and total procedure time ranged from 34 to 94 minutes (median, 60 min). Five of six trunk lesions and six of nine branch lesions were successfully aspirated. One dissection was observed. Six patients underwent bowel resection. Two patients died and the remaining five survived for a median of 868.2 days without complications.
