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.

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).