Magnetic resonance angiography: the nuts and bolts.

Magnetic resonance angiography (MRA) has matured into an extremely reliable and valuable diagnostic vascular tool. We are now able to acquire clinically diagnostic angiograms in all the major vascular territories by using MRA, thereby replacing invasive angiography. This paradigm shift has enormous clinical and financial ramifications, as MRA is safer, cheaper, and far more convenient for our patients than invasive angiography. Future magnetic resonance imaging research developments that are on the verge of being incorporated into clinical practice include real-time magnetic resonance fluoroscopy and endovascular therapeutic ability. It should therefore be incumbent upon the vascular and interventional community to embrace this powerful technology by collaborating and integrating with those physicians who possess the skills to perform high-quality magnetic resonance imaging. This article provides basic key fundamental concepts and protocol guidelines for state-of-the art MRA performance and elucidates future directions of this technology as it pertains to the interventional and vascular radiologist.

Evaluation of a new percutaneous stainless steel Greenfield filter.

PURPOSE: To evaluate a new percutaneous Greenfield filter with an alternating hook design and over-the-wire delivery system. MATERIALS AND METHODS: The alternating hook stainless steel Greenfield filter was evaluated in a prospective clinical trial between March 10, 1994, and January 27, 1995. Filters were placed in 75 patients in nine clinical centers and follow-up with radiographs and ultrasound scans was carried out at 30 days. RESULTS: Clinical trial results revealed successful placement in all patients. There were four cases of filter limb asymmetry (5.3%) without clinical sequelae, with one incidence of failure to span the cava. No significant migration was found. There were no clinically suspected pulmonary emboli, but one instance of probable caval penetration (1.7%) did occur. Caval occlusion was documented in three patients (5%). CONCLUSION: The percutaneous stainless steel Greenfield filter provides ease of insertion and improved deployment while maintaining the high standards of efficacy and safety associated with the standard and titanium Greenfield filters.

Percutaneous cholecystostomy treatment of acute cholecystitis in pregnancy.

BACKGROUND: Medical treatment of acute cholecystitis in pregnancy may lead to prolonged management and recurrent hospitalizations, whereas surgical management predisposes the mother and fetus to the inherent risks of surgery and general anesthesia. Although percutaneous cholecystostomy has been proven to be an efficacious treatment in critically ill and general surgery patients who are at high risk for surgery, this technique has not been used routinely as a treatment for acute cholecystitis in pregnancy. CASES: We report two women (at 30 and 32 weeks' gestation, respectively) who presented with acute calculus cholecystitis. The first patient was a 33-year-old female who failed endoscopic retrograde cholangiopancreatography and papillotomy and had multiple return visits for nausea and vomiting. The second patient was a 23-year-old female with three previous admissions for cholecystitis during the pregnancy. These two patients underwent emergency ultrasound-guided percutaneous transhepatic cholecystostomy. Percutaneous cholecystostomy provided adequate biliary decompression for the remainder of the pregnancy; the patients delivered healthy infants and underwent successful uncomplicated elective laparoscopic cholecystectomy within 3 months of delivery. CONCLUSION: Percutaneous cholecystostomy may provide a safe and effective alternative for the palliation of acute cholecystitis in pregnancy until a postpartum cholecystectomy can be performed.

Angioplasty for the treatment of visceral ischemia.

PURPOSE: To evaluate percutaneous transluminal angioplasty (PTA) in the treatment of visceral ischemia. PATIENTS AND METHODS: Over a 14-year period, 25 focal visceral artery stenoses were treated with PTA in 16 patients with acute or chronic visceral ischemia. Thirteen patients were women and three were men, with a mean age of 64.7 years (range, 54-79 years). PTA was performed in seven celiac arteries, 17 superior mesenteric arteries, and one inferior mesenteric artery. RESULTS: PTA was technically successful in 14 of 16 patients (88%). Two patients were lost to follow-up. Nine of 12 patients (75%) demonstrated primary patency with relief of clinical symptoms at a mean follow-up of 2.3 years (range, 0.3-5 years). The remaining three patients underwent successful repeat PTA for recurrent symptoms. There was one postprocedural death, and one patient subsequently underwent successful surgical bypass for recurrent visceral ischemia. CONCLUSIONS: Angioplasty of the visceral arteries may provide relief for select patients with intestinal ischemia, but redilation may be required in some patients.