Basic Arterial Anatomy and Interpretation of CT Angiography for Intra-Abdominal or Gastrointestinal Bleeding: Correlation with Conventional Angiographic Findings for Beginners

It is essential to identify the causative artery in case of active intra-abdominal or gastrointestinal bleeding. A thorough understanding of the basic arterial anatomy is required to identify the causative artery on contrast-enhanced CT angiography and conventional catheter angiography. If one is familiar with the basic arterial anatomy, obtaining access to the bleeding artery will be easier, despite the variations in the origin and course of the vessels. We describe the basic arterial anatomy that will help beginners in diagnostic radiology to identify the blood vessels that can cause active intra-abdominal or gastrointestinal bleeding.

Clinical Findings and Interventional Treatment of Gastrointestinal Fistulae: Pictorial Essay

Gastrointestinal (GI) fistulae are defined as an abnormal communication between the gastrointestinal tract and the skin and/or the epithelial surface of an adjacent viscus. GI fistulae are the most feared complications caused by a variety of medical conditions including abdominal surgery, inflammatory bowel disease, abscess, radiation, or trauma. The management of GI fistulae is complex and requires a detailed, stepwise approach to achieve successful closure. The ultimate goal of management is to re-establish the continuity of the GI tract, while limiting the morbidity and mortality. Interventional radiology can play an important role in the diagnosis and treatment of GI fistulae. In this article, we review the clinical and radiologic features and interventional treatment of GI fistulae.

Incidentally Found Absence of the Left Brachiocephalic Vein with Venous Return Through the Left Superior Intercostal Vein in an Adult Patient: Venography and CT Findings

A 63-year-old male patient was referred for venography of the thoracic venous system and multidetector computed tomography (CT) due to the unusual location of the left subclavian catheter tip. His venogram and CT images showed an absence of the left brachiocephalic vein (LBCV). Instead of through the LBCV, the usual venous circulation of neck and left upper limb was carried out by the engorged left superior intercostal vein (LSIV); this subsequently drained into the accessory hemiazygos vein and then the azygos vein that drains into the superior vena cava. Here, we report a rare case of an incidentally found absence of the LBCV with venous return through the LSIV in an adult patient, and we present a brief review of the relevant literature.

Funtional significance of the intermediate lesion in a single coronary artery assessed by fractional flow reserve

No abstract available.

Acute regional myocarditis with normal ventricular wall motion diagnosed by two-dimensional speckle tracking imaging

No abstract available.

Percutaneous Placement of Self-Expandable Metallic Stents in Patients with Obstructive Jaundice Secondary to Metastatic Gastric Cancer after Gastrectomy

OBJECTIVE: To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. MATERIALS AND METHODS: Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. RESULTS: The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL +/- 6.8 before stent insertion, decreased to 4.58 mg/dL +/- 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 +/- 99 days, and the median patient survival was 179 +/- 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). CONCLUSION: Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

Outcomes of Bypass Surgery Versus Endovascular Therapy for TASC II C and D Femoro-Popliteal Lesions in Patients with Chronic Limb Ischemia

PURPOSE: We wanted to define the appropriate treatment modalities for Trans-Atlantic Inter-Society Consensus (TASC) II C and D femoro-popliteal lesions. So we compared the primary patency rate and several clinical factors between percutaneous balloon angioplasty with or without stenting (PTA/S) and bypass surgery (BP). METHODS: We reviewed the medical records of patients who underwent BP or PTA/S for TASC II C (BP-C, PTA/S-C) and D (BP-D, PTA/S-D) femoro-popliteal lesions from March 2001 to May 2009. We analyzed the primary and secondary patency rates, and the major limb salvage rates. RESULTS: Eighty two limbs in 74 patients (mean age: 68.7+/-10.2 years, males: 82.9%) were treated (PTA/S-C: 18, PTA/S-D 19: BP-C 12, BP-D 33). The mean follow-up duration was 30.0+/-19.0 months. The twenty four month primary patency rates was 82.4% for PTA/S-C and 73.3% for BP-C (P=0.876), and 45.3% for PTA/S-D and 66.6% for BP-D (P=0.034). The twenty four month secondary patency rates were 88.2% for PTA/S-C and 73.3% for BP-C (P=0.669), and 54.7% for PTA/S-D and 73.3% for BP-D (P=0.077). The twenty four month major limb salvage rates were 100.0% for PTA/S-C and 75.0% for BP-C (P=0.030) but there were no statistical differences between the TASC II D groups (P=0.377). CONCLUSION: Bypass surgery is a preferred initial therapeutic option for TASC II D femoro-popliteal lesions. However, several clinical factors must be carefully considered when selecting the primary treatment modality for TASC II C lesions.

Cerebral Infarction in a Young Female Patient With Renovascular Hypertension Caused by Fibromuscular Dysplasia

No abstract available.

The Incidence of Giacomini Vein and Its Association with Lower Extremity venous Insufficiency: An Ultrasonographic Study

PURPOSE: We wanted to evaluate the incidence of Giacomini vein and its association with lower extremity venous insufficiency by performing US. MATERIALS AND METHODS: From September 2006 to July 2007, 173 patients (58 males and 115 females, mean age: 52.7 years, age range: 22-72 years) who had been diagnosed with unilateral/bilateral varicose veins or telangiectasias were evaluated with duplex Doppler ultrasonography. The presence of Giacomini vein, superficial/deep vein reflux, the anatomical sites of the venous reflux and the abnormal perforating veins was investigated in 346 legs. RESULTS: Giacomini veins were found in 33 limbs (9.5%) of 21 patients (12.1%). Bilateral Giacomini veins were found in 12 patients. Of the 33 limbs that had Giacomini veins, 20 limbs had great saphenous vein (GSV) reflux and 4 limbs had small saphenous vein (SSV) reflux. The patients with Giacomini veins were classified into two groups according to the presence of Giacomini vein. There was no significant difference of the GSV reflux (p = 0.155), the SSV reflux (p = 0.760) and the mean velocity of the GSV reflux or the SSV reflux (p = 0.685, p = 0.431, respectively) between the two groups. CONCLUSIONS: Our results indicated that Giacomini vein is not associated with either GSV or SSV reflux, and this is contrary to conventional belief.

Assessing Primary Percutaneous Aspiration Thrombectomy for the Treatment of Deep Vein Thrombosis

PURPOSE: The aim of this study is to evaluate the role of percutaneous aspiration thrombectomy (AT) for the initial endovascular management of deep vein thrombosis (DVT) and to analyze the success rate and complications according to the symptom duration. METHODS: Forty patients who were diagnosed with DVT from June 2004 to January 2009 were retrospectively examined. The patients were divided into 3 groups; group I, those with symptoms lasting 28 days. All of the patients were initially treated with percutaneous AT using the Pullback technique. The incomplete elimination of large and hard thrombus was managed with overnight catheter directed thrombolysis (CDT) and additional AT. Successful recanalization was defined as successful restoration of antegrade flow in the treated veins with elimination of any underlying obstructive lesion. RESULTS: Initial successful recanalization with only AT was achieved in 24 (60%) patients. CDT was required in 16 (40%) patients who had remaining thrombus. Final successful recanalization was achieved in 37 (92.5%) patients. There were no significant differences in the final recanalization rate, the mean number of ATs and the duration of the procedure among groups I, II and III. There was one case (group I) of procedure-related complication, which was the occurrence of a retroperitoneal hematoma after overnight CDT. CONCLUSION: Percutaneous AT may be an initial therapeutic option for DVT, and it minimizes the risk of hemorrhagic complications. It is an effective treatment method for subacute and chronic DVT, as well as acute DVT.