Urokinase perfusion for axillary-subclavian vein thrombosis.

We report a single case of urokinase perfusion of axillary-subclavian vein thrombosis with the restoration of normal venous outflow of the arm. It is hoped that this will halt the usual sequelae causing chronic venous insufficiency.

Percutaneous management of benign biliary disease.

Thirty-two patients had percutaneous drainage for benign disease of the biliary system, and in 81% of the patients the catheter could be removed. The patients' conditions were of 3 types: choledocholithiasis, biliary strictures, and primary sclerosing cholangitis. Fourteen patients had balloon dilatation of strictures in the biliary tract. As in malignant disease, many patients may be managed entirely by percutaneous methods and surgery avoided, but the results with percutaneous drainage are more gratifying.

Percutaneous drainage of abscesses: a report of 100 patients.

One hundred patients had abscesses drained percutaneously in a variety of sites. Eighty-five per cent were treated successfully with a 6% mortality. There are now several large series in the literature, totalling over 250 patients with an average cure rate of over 80% and a mortality of under 5%. Percutaneous drainage of abscesses should become the treatment of choice in a vast majority of patients in whom the abscess can safely be reached.

The radiological management of malignant biliary obstruction.

Percutaneous transhepatic biliary drainage has become widely accepted as a safe and effective palliative therapy for malignant biliary obstruction. The results of drainage were reviewed over a 3-year period and patients divided by the response to decompression as measured by change in serum bilirubin. Patients with good response survived an average of 198 days, while patients with a poor response survived an average of 12 days. No procedural mortality was encountered. However, despite the generally good results, a 30-day mortality rate of 28% was seen, with good responders having a mortality of 10% and poor responders a mortality of 88%. Patients with hepatic metastatic disease as documented by liver-spleen scan, ultrasonography or computed tomography do poorly, surviving an average of 39 days, despite a good biochemical response. The success of percutaneous biliary decompression has allowed surgeons to select cases for cholecystenterostomy from the group of good responders. A more selective clinical approach is suggested for radiologists on the basis of these results.

Percutaneous drainage of pancreatic pseudocysts and abscesses.

The use of percutaneous drainage is reported in 6 patients with pancreatic pseudocysts and 6 patients with pancreatic abscesses. There have been no recurrences in the patients with pseudocysts. The success of the procedure is attributed to providing catheter drainage until the cavity was obliterated (mean time, 8 days), rather than using a single-needle aspiration. Percutaneous drainage of 6 pancreatic abscesses allowed desperately ill patients to improve enough to undergo elective surgery, and obviated surgery in 3 patients. The technique was performed without complications in all cases. Percutaneous drainage should find a significant place in the management of patients with complications of pancreatitis.

Percutaneous abscess drainage.

Forty-two abscess collections in the abdomen, pelvis and mediastinum were drained in 40 patients. Thirty-two were drained completely and required no operative treatment. The high success rate combined with the low morbidity rate and low mortality suggest that, if possible, percutaneous drainage of abscesses is preferable to operative drainage.

Percutaneous drainage of postoperative intraabdominal abscesses.

Twenty-two major intraabdominal abscesses in 19 postoperative patients were drained percutaneously using cross-sectional imaging techniques (computed tomography and sonography) for localization. Sixteen lesions were cured in 14 patients without reexploration. All patients were palliated by the percutaneous drainage procedure. All 22 abscess cavities were entered without complication or compromise of adjacent normal organs. Percutaneous abscess drainage is recommended as a safe, effective method of treating a major intraabdominal abscess in the postoperative patient.

Angioplasty for femoral artery occlusion: comparison with surgery.

Forty-six patients with superficial femoral artery occlusions (range, 1-20 cm) had percutaneous transluminal angioplasty. The primary success rate was 76% with a late closure in six patients. Life table analysis showed a 1 year patency of 56.8%, maintained at 2 years among the group in whom the successful was 4 cm, while in those in whom the lesion was not crossed, it was 9 cm. Over the same period, 133 femoropopliteal bypass grafts were performed. The patients were comparable as to runoff, incidence of diabetes, and distal ischemia. The 1 year patency was 60.2% and the 2 year patency, 42.1%, largely because of the poor performance of grafts other than saphenous vein. Angioplasty seems to be the treatment of choice for short segment occlusions, and should be used in longer occlusions if saphenous vein is not going to be used.

Renal angioplasty for hypertension: predictive factors for long-term success.

Percutaneous transluminal angioplasty was performed in 31 hypertensive patients with primary success in 26 patients (83%). Twenty-three patients had a mean follow-up of 13 months. The cure rate was 30% with a further 26% being improved. However, in the group of patients with lateralizing renal vein renin values, the cure rate rose to 47% with a further 33% improved. Of the eight patients with fibromuscular disease, 83% were normotensive without medication at follow-up; in the 13 patients with atherosclerotic disease, 22% were cured and 44% were classified as improved. Patients with fibromuscular disease and lateralization of renin production are the best candidates for long-term success.

Non-surgical drainage of intra-abdominal and mediastinal abscesses: a report of twelve cases.

Twelve patients with intra-abdominal or mediastinal abscesses were treated by percutaneous drainage. Three abscesses were subphrenic, three were adjacent to enteric leaks, two were intrahepatic, two were pancreatic pseudocysts, one was a pancreatic abscess extending to the lesser sac, and one was an infected adrenal hematoma. All 12 lesions were entered percutaneously using fluoroscopic guidance without traumatizing the adjacent normal tissue. Localization was frequently aided by computed tomography. Various catheters were positioned using basic angiographic techniques. Following drainage all patients had a favorable clinical response. Seven of the 12 patients required no surgical management. Careful radiologic follow-up and frequent changing of catheters was necessary in six of the patients. Two patients benefited from the addition of auxiliary drains. Five of the 12 patients were electively operated upon because of incomplete drainage of the abscess cavity. Causes of failure were: persistent anastomotic leak (two patients), sequestered, loculated extension of abscess cavity (two patients), or necrotic, viscous hepatic tissue requiring removal at laparotomy (one patient).