Gelfoam embolization of a distal coronary artery guidewire perforation.

A guidewire-induced distal coronary artery perforation presenting with cardiac tamponade was occluded by distal Gelfoam embolization via an infusion catheter. This extends the treatment options for this rare complication of coronary interventional procedures. Cathet. Cardiovasc. Intervent. 49:214-217, 2000.

The value of pulmonary angiograms when lung scans disagree with clinical impressions about emboli.

When selective magnification pulmonary angiography was done within 48 hours of a Ventilation/Perfusion (VP) scan, disagreement between scan and angiogram findings was common. Correlation was poor in both high and low probability of embolism groups as defined by scan. Analysis of individual scan diagnostic criteria showed them to be as unreliable as all of them taken together. The patients coming to angiography were those in which the VP scan disagreed with clinical impressions about the probability of embolism. These problem cases have biased the results against scanning, but they reflect how pulmonary angiography is used in clinical practice. North American studies are reviewed in detail, to show that poor correlation between VP scan and angiography is neither a local aberration nor confined to retrospective analyses. If clinical and scan probabilities of embolism do not agree, pulmonary angiography can safely decide the issue.

Intractable postpartum haemorrhage managed by angiographic embolization: case report and review.

A case of intractable postpartum haemorrhage successfully managed by angiographic embolization is presented. The literature concerning angiographic embolization and internal iliac artery ligation is reviewed. Angiographic embolization is a superior method to internal iliac artery ligation in appropriately selected cases of obstetric haemorrhage, and may also be used successfully in cases where internal iliac ligation and/or hysterectomy has failed to control pelvic haemorrhage. Angiographic embolization is a potentially life- and fertility-saving procedure.

Extensive pulmonary embolism associated with lupus anticoagulant.

A female patient with extensive pulmonary emboli associated the lupus anticoagulant is described. She made a good recovery with heparin treatment.

Biplanar angiography through Swan-Ganz catheters.

Twenty-eight patients had biplanar angiography performed through wedged Swan-Ganz Catheters. In only five cases were the catheter tips symmetrically placed within the vessels in both AP and lateral views. The value of performing angiography immediately after placement of a Swan-Ganz catheter is discussed.

Coronary arteriography; method of presentation of the arteriogram report and a scoring system.

A coronary arteriographic report presentation consisting of a diagram on which the radiologist draws the coronary arterial anatomy of each individual case is described. The diagram allows a clear visual presentation of all the information gained from the analysis of the original arteriographic study including anatomical variations, the position and importance of each artery in terms of the myocardium it supplies, the sites and severity of obstructions and the presence of collateral pathways. A myocardial scoring system which expresses the severity of left ventricular arterial obstructive disease is also presented. The myocardial score takes into account not only the degree of stenosis of any number of arterial branches, but also their importance in terms of the amount of myocardium supplied.

Traumatic hemobilia: a complication of percutaneous liver biopsy.

Two patients with hemobilia are presented. The first patient, with alcoholic liver disease, had a percutaneous liver biopsy. Subsequently he developed jaundice, with an enlarged tender gallbladder, biliary colic, and gastrointestinal bleeding. Hemobilia was demonstrated by superselective hepatic angiography and bleeding was stopped by intraarterial infusion of epinephrine and propranolol. The second patient, with primary biliary cirrhosis at an advanced stage, had a percutaneous liver biopsy followed by gastrointestinal bleeding, severe abdominal pain, and finally death. In both cases hemobilia was suggested by gastroduodenoscopy.

Renal autotransplantation using hypothermic storage and pulsatile perfusion.

Three patients with severe hypertension secondary to renal artery stenosis were treated by renal autotransplantation. Of these 3 patients 2 had solitary kidneys and 1 had 2 renal arteries to each kidney, all of which were stenosed. Renal autotransplantation with hypothermia of the kidney was performed in all 3 patients rather than the more conventional arterial bypass or endarterectomy because 1) hypothermic preservation permitted a prolonged ischemia time and 2) there was improved exposure for the vascular anastomosis. Postoperatively 2 patients remained normotensive without drugs for 9 and 12 months and 1 patient died of septicemia not directly related to the autotransplant. All 3 patients required expansion of the intravascular volume postoperatively to overcome the loss of vasoconstrictor substances following restoration of renal blood flow.