Case report: insertion of a covered stent for treatment of a popliteal artery pseudoaneurysm following total knee arthroplasty.

We report the use of a covered stent to successfully treat a pseudoaneurysm of the popliteal artery, which occurred following total knee arthroplasty. Percutaneous endovascular repair offers a safe alternative to surgical management of this condition.

Suitability for endovascular aneurysm repair in an unselected population.

BACKGROUND: Tertiary referral centres report that up to 60 per cent of patients may be suitable for endovascular repair of abdominal aortic aneurysm (EVAR). The aim of this study was to determine the percentage of abdominal aortic aneurysms (AAAs) presenting to a county-wide vascular service that were suitable for EVAR, and to examine the outcome of subsequent AAA repair in relation to aneurysm morphology. PATIENTS AND METHODS: All patients being assessed for AAA repair between January 1998 and December 1999 underwent spiral computed tomography angiography to determine aneurysm morphology and suitability for EVAR. Subsequent outcome for all patients in the study was recorded in a prospective vascular database. RESULTS: A total of 115 patients was assessed. Sixty-three aneurysms (55 per cent) had one or more absolute contraindications to EVAR, a further 13 (11 per cent) had at least one relative contraindication, and 39 (34 per cent) had no contraindication. Of patients with no absolute contraindication to EVAR, ten underwent successful EVAR, five did not meet recognized criteria for surgery, one awaits EVAR, four remain under observation, one awaits open repair, and 31 underwent open repair without death. CONCLUSION: Only 30 per cent of unselected AAAs presenting to a vascular service are entirely suitable for EVAR; most of these patients can safely undergo open AAA repair. These data suggest that increased use of EVAR is only possible by deploying devices in suboptimal morphology, and in treating patients who would not normally be considered for open AAA repair.

Multispiral three-dimensional computed tomography in the investigation of craniosynostosis: technique optimization.

21 infants with craniosynostosis were studied with a new three-dimensional (3D) computed tomography (CT) methodology. We describe technique optimization using multiple spiral data acquisitions with low dose (85 mAs) technique. One caudal volume of 3 mm slice thickness was obtained with a further two volumes of 1 mm slice thickness at the vertex. Image reconstruction of spiral raw data allowed overlapping 3 mm sections to be generated without the dose increase that would result from conventional axial CT scanning. We illustrate common technical artefacts of 3D CT and explain their cause and solution. A dramatic dose reduction to the lens was achieved with no loss in 3D image quality. Lens dose was 8.91 mSv compared with 24.6 mSv using the standard paediatric head technique.

Case report: central venous catheter fracture due to compression between the clavicle and first rib.

A central venous catheter inserted via the subclavian route may be compressed by the clavicle and adjacent first rib. This appearance on a radiograph has been previously described as the 'pinch-off sign' and indicates the need to remove the catheter, due to a significant risk of subsequent fracture. A case and its management are presented, followed by discussion of the radiographic appearances and their cause.

The risk of blood splash contamination during angiography.

Blood splash contamination of the conjunctivae or buccal mucosa may occur during angiography and angioplasty. Since there is a risk of contracting Hepatitis B or HIV via this route, staff should be aware of this potential source of infection. The use of protective masks and goggles or glasses should be considered. We have studied the risk of contamination by asking both the radiologist and angiography nurse to wear spectacles and disposable masks during 100 consecutive angiographic procedures. The number of splashes was counted at the end of each procedure. Blood splashes occurred in seven procedures and there was a total of 23 splashes during the study. In conclusion, we believe that there is a significant risk of conjunctival or mucosal contamination with blood during angiographic procedures and given the potential seriousness of transmission of Hepatitis B or HIV, radiologists and nursing staff must be aware of this risk.

Superficial siderosis of the central nervous system--diagnosis by magnetic resonance imaging.

Superficial siderosis of the central nervous system is a rare disorder characterized by the deposition of haemosiderin in the leptomeninges, cranial nerves and spinal cord. The clinical features include sensorineural deafness, ataxia and pyramidal tract signs. We describe two cases demonstrating the characteristic findings on magnetic resonance imaging of widespread peripheral low signal on T2-weighted images.

Useless hand of Oppenheim--magnetic resonance imaging findings.

A patient with multiple sclerosis developed a useless, deafferented left hand, as described previously by Oppenheim. Magnetic resonance imaging demonstrates that this is caused by an ipsilateral plaque of demyelination in the posterior columns of the cervical cord.

Fibrinolytic therapy for infra-inguinal synthetic graft occlusions.

The results of infra-inguinal graft fibrinolysis are variable, and the true success rates are frequently disguised by the inclusion of patients receiving adjunctive surgery, such as surgical thrombectomy, anastomosis revision and graft extension. Follow-up is sparse. As part of a larger prospective study, we have offered fibrinolysis using streptokinase to 10 patients with occluded infra-inguinal synthetic grafts. In one patient the graft could not be entered with a catheter. The remaining nine patients received local low-dose intra-arterial streptokinase. Six patients experienced complete lysis and were discharged with functioning grafts. Significant stenoses were dilated by transluminal angioplasty. The median graft patency duration was 7 months. Two patients have since required above-knee amputations. Our results using transluminal angioplasty are comparable to those results where adjunctive surgery has been used to treat underlying anastomotic stenoses. Further research into graft anastomotic stenosis management is indicated.

A radiological analysis of lateral ligament injuries of the ankle.

Patients who presented within 5 days of an inversion injury to the ankle joint, were clinically selected for early radiological investigation and diagnosis of rupture of the lateral ligament of the ankle. Stress tenography was performed in 142 cases, and normal ranges for talar tilt and anterior draws were established in 216 normal ankles. In addition 38 cadaveric ankles were examined by peroneal tenography. No normal connection between the tendon sheath and the ankle joint was demonstrated. Sixty-five patients had positive peroneal tenograms; nine of these were positive only after manipulation. No complications occurred. Surgery was performed on 20 patients and demonstrated that common peroneal tenography was 95% accurate in diagnosing rupture of the calcaneo-fibular ligament. Of the 19 patients with proven calcaneo-fibular ligament rupture, six had a positive anterior draw sign, and nine had talar tilt. In this series both the talar tilt and anterior draw signs were found to be inaccurate. Common peroneal tenography is recommended as the method of choice for demonstrating acute rupture of the calcaneo-fibular component of the lateral ligament.