CT mapping of the vertebral level of right adrenal vein.

PURPOSE: We aimed to evaluate the accuracy of multidetector computed tomography (MDCT) venous mapping for the localization of the right adrenal veins (RAV) in patients suffering from primary aldosteronism. METHODS: MDCT scans of 75 patients with primary aldosteronism between March 2008 and November 2011 were evaluated by two readers (a junior [R1] and a senior [R2] radiologist) according to the following criteria: quality of RAV depiction (scale, 1-5), localization of the RAV confluence with regard to the inferior vena cava, and depiction of anatomical variants. Results were compared with RAV venograms obtained during adrenal vein sampling and corroborated by laboratory testing of cortisol in selective RAV blood samples. Kappa statistics were calculated for interobserver agreement and for concordance of MDCT mapping with the gold standard. RESULTS: Successful RAV sampling was achieved in 69 of 75 patients (92%). Using MDCT mapping, adrenal veins could be visualized in 78% (R1, 54/69) and 77% (R2, 53/69) of patients. MDCT mapping led to correct identification of RAV in 70% (R1, 48/69) and 88% (R2, 61/69) of patients. Venograms revealed five cases of anatomical variants, which were correctly identified in 60% (R1, R2). MDCT-based localizations were false or misleading in 16% (R1, 11/69) and 7% (R2, 5/69) of cases. CONCLUSION: Preinterventional MDCT mapping may facilitate successful catheterization in adrenal vein sampling.

Endovascular treatment of abdominal aortic aneurysms combined with bilateral common and internal iliac aneurysms.

INTRODUCTION: Combined aneurysms of aortic and iliac arteries are rare with a prevalence of less than 0.1%. However, these combined aneurysms are associated with a high incidence of thrombosis, distal embolism, or rupture. Endovascular repair is a therapeutic option and includes embolization of the internal iliac artery in numerous cases. Embolization of the internal iliac artery may cause severe ischemia with hip and buttock complications in 2-5%. Therefore, preservation of internal iliac arteries is essential to reduce complications. PATIENT AND METHOD: We describe in detail an endovascular procedure for combined abdominal aortic (diameter of 8.6 cm) and bilateral common and internal iliac aneurysm (diameter of the left side: 6.4 cm; diameter of the right side: 4.3 cm) in a 44-year-old patient caused by media necrosis Erdheim-Gsell. The blood flow of both internal arteries was preserved in this patient. RESULT: Operation was done without any complications. Conversion to an open procedure was not necessary. During follow up (3, 6, and 12 months after operation) the patient did not develop any signs of severe hip and buttock complications. Furthermore, sonography and CT angiography revealed a good blood flow via the internal and external iliac arteries. CONCLUSION: Endovascular repair of abdominal aortic aneurysms combined with bilateral common and internal iliac aneurysms offers a promising minimal invasive procedure. Most importantly, this technique is less invasive than open operations and reduces complications by preserving the pelvic perfusion.

Penetrating aortic ulcer in the infrarenal stent-graft landing zone: treatment with coils and the ethylene vinyl alcohol copolymer onyx.

PURPOSE: To describe a technique to enable endovascular aneurysm repair in patients with penetrating aortic ulcer (PAU) in the infrarenal neck of an abdominal aortic aneurysm (AAA). TECHNIQUE: The technique is illustrated in a 76-year-old man with a 5.7-cm infrarenal AAA and a 2.3 × 1.8-cm PAU situated immediately distal to the right renal artery and covering 20% of the 28-mm-diameter proximal aortic neck. During the stent-graft repair, the PAU was successfully excluded by embolization with coils and the ethylene vinyl alcohol copolymer Onyx. The AAA and PAU were completely excluded without complications. At 6 months, there were no signs of endoleak, the AAA remained excluded, and there was no reperfusion of the Onyx cast in the PAU. CONCLUSION: This technique for treatment of a PAU in the proximal neck of an AAA is a reasonable alternative in cases involving severely diseased infrarenal necks that would otherwise require open surgery. The liquid embolic agent Onyx performed well, with fast embolization and excellent control of the growing cast maintained by the interventionist.

Rotational thrombectomy of acute peripheral vascular occlusions using the ThromCat XT device: techniques, indications and initial results.

PURPOSE: To gather initial procedural experiences with the ThromCat XT, a new rotational thrombectomy catheter primarily developed for coronary interventions. MATERIALS AND METHODS: The ThromCat XT is a 150-cm rapid exchange thrombectomy device consisting of an atraumatic tip and a steel helix with a kink-resistant covering. It was employed in native arteries, veins, grafts and stents in ten patients presenting with acute and subacute thrombembolic occlusions. RESULTS: Technical success with a restoration of flow was achieved in 70% of patients. The mean thrombectomy time was 8.0±2.33 min, and the aspirated blood volume ranged from 120 mL to 280 mL. Peripheral thrombembolism was detected in two cases, and embolic protection was applied in four cases. Vessel injuries and catheter failures were not observed in any of the cases. CONCLUSION: The ThromCat XT is an easy-to-handle, reliable and atraumatic device for the removal of fresh thrombi in native and artificial vessels. In our series, the thrombus age-especially if greater than five days-had a major impact on technical success.