Staged endovascular occlusion of giant idiopathic renal arteriovenous fistula with platinum microcoils and silk suture threads.

Large symptomatic aneurysmal renal arteriovenous (AV) fistulas usually present with a flank bruit, uncontrolled hypertension, and high-output cardiac failure. Traditionally, these have been treated surgically because of the risk of inadvertent pulmonary embolism with use of embolization techniques. The authors report a case of a giant renal AV fistula successfully treated with staged embolization with use of metallic coils and silk suture. This resulted in a graded reduction in the extreme flow through the fistula, followed by delayed thrombosis and cure of the patient's symptoms.

Cryodynamic hand angiography in the diagnosis and management of Raynaud's syndrome.

Cryodynamic hand angiography (CHA) with angiograms done before, just after, and during rewarming following hand immersion in ice water was performed in 39 patients with Raynaud's syndrome and eight volunteers without it. The normal response to cold stimulus was angiographically evident as mild, transient digital arterial constriction. Most of the patients with Raynaud's syndrome, in addition to organic obstructive disease, exhibited basal vasoconstriction and exaggerated persisting cryogenic vasospasm of the hand arteries. Similar angiographic studies done in 32 cases two days after the selective intra-arterial administration of reserpine revealed no differences in normal subjects but substantially decreased vasospasm in patients with Raynaud's syndrome. CHA with postreserpine studies was found to be diagnostically useful in Raynaud's syndrome, revealing the degree of organic arterial disease and functional vasospasm. In addition, correlation of postreserpine studies with observed clinical responses to long-term vasodilator drug therapy indicated that CHA has a good chance to predict the probable outcome of such therapy in Raynaud's syndrome.

Angiography in the diagnosis and therapy of frostbite.

Five patients with frostbite injury were studied by selective angiography and treated by selective intra-arterial application of reserpine with follow-up angiography two days later. Control angiograms showed various degrees of vascular spasm as well as organic stenosis and occlusion. Intra-arterial reserpine produced dramatic subsiding of vasospasm, as evidenced by angiography and relief of clinical symptoms. Complete healing without tissue loss occurred in 4 patients. Amputation was necessary in one case, due at least in part to pre-existing peripheral atherosclerotic disease. Selective angiography was found to contribute significantly to both the diagnosis and therapy of frostbite injury.