Venous recanalization by metallic stents after failure of balloon angioplasty or surgery: four-year experience.

PURPOSE: This retrospective study describes our updated experience in treating venous stenoses and occlusions with metallic endovascular stents. METHODS: Gianturco, Palmaz, and Wallstent stents were placed in 55 patients over a 4-year period. Stent sites included the subclavian veins (9), innominate veins (3), superior vena cava (4), inferior vena cava (3), iliac veins (29), femoral veins (5), and portal veins (6). The most common indications for stent placement were malignant stenoses and chronic pelvic venous occlusions. Venoplasty and/or urokinase were used as ancillary therapy. Patients were anticoagulated for 3-6 months. Follow-up included clinical assessment and duplex ultrasound. RESULTS: Lifetable analysis shows 59%, 63%, and 72% primary, primary assisted, and secondary 1-year patency rates, respectively. The 4-year primary patency rates were the same. Duration of patency depended on the venous site. Death was a complication of stent placement in 2 patients and 12 patients died within 6 months after stent placement from primary disease progression. Although early failures were more common in stents placed across occlusions than stenoses, 1-year secondary patency rates were comparable. Primary patency rates were only slightly lower in patients with malignant obstruction than in patients with benign disease. CONCLUSION: Endovascular stent placement provides a nonsurgical alternative for reestablishment of venous flow and symptomatic relief in patients with benign as well as malignant venous obstruction.

Refractory ascites: early experience in treatment with transjugular intrahepatic portosystemic shunt.

PURPOSE: To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) in treatment of refractory ascites. MATERIALS AND METHODS: Fourteen patients with chronic liver disease and portal hypertension were included in a prospective study. Six patients had Child-Pugh class B disease; eight had class C disease. Indications for TIPS were three previous hospital admissions over 9 months for treatment of tense ascites, no response to diuretic therapy, or an occluded peritoneovenous shunt with tense ascites. The volume of ascitic fluid was sonographically evaluated before and after TIPS placement. RESULTS: The technical success rate for TIPS creation was 93%. Mean portosystemic gradient decreased from 22.8 mm Hg +/- 7.2 before TIPS placement to 11.3 mm Hg +/- 3.6 after TIPS (P = .005). Complete resolution of ascites was achieved in seven (50%) patients. Treatment failed in seven; five had Child-Pugh class C disease, and four of these had a Child-Pugh score greater than 11. CONCLUSION: These results are comparable to those for other forms of treatment of ascites. The authors do not, however, recommend TIPS in patients with a Child-Pugh score greater than 11.

Placement of the Palmaz stent with use of an 8-F introducer sheath and Olbert balloons.

PURPOSE: The authors describe a modified technique for delivering Palmaz 30-mm stents. MATERIALS AND METHODS: The modification is based on the use of an 8-mm Olbert balloon mounted on a 5.8-F shaft. The Palmaz stent is crimped onto the balloon by using finger pressure only. An 8-F introducer sheath can be used instead of a 10-F sheath. The surface material of the balloon prevents the stent from moving as it is introduced through the sheath and lesion. The balloon has a very small profile after deflation, which means it can be easily removed without dislodging the stent. The balloon can be used for placement of more than one stent. RESULTS: Nineteen Palmaz 30-mm stents have been placed with this method, and there have been no complications or difficulties related to this method. In one case, four stents were delivered by using the same balloon. CONCLUSION: This modification should reduce the complications of stent delivery, especially in small iliofemoral systems.

Renal pseudoenlargement secondary to retroperitoneal liposarcoma.

A case of renal pseudoenlargement caused by a large retroperitoneal mass is reported. An intravenous urogram showed apparent enlargement of the right kidney and a normal left kidney. Computed tomography showed a normal-sized right kidney. The discrepancy was due to magnification produced by marked anterior displacement of the right kidney by a retroperitoneal liposarcoma.

CT evaluation of wall thickening in the alimentary tract.

Computed tomography (CT) of the alimentary tract, when performed with adequate distention of the organ being examined and in the true axial plane, provides valuable information about the intramural or extramural extent of pathologic conditions. Neoplastic, vascular, and inflammatory diseases can all result in wall thickening of the alimentary tract. Wall thicknesses greater than 5 mm in the esophagus, stomach, and colon and 4 mm or greater in the small bowel are considered abnormal. If the thickened wall has a target or double-ringed appearance, it is most likely caused by benign disease. In general, the CT findings of asymmetric or focal wall thickening, nodularity, and thickening greater than 1.5 cm suggest a malignant process. Although it is commonly associated with benign disease, diffuse thickening can also result from some infiltrating malignant diseases. Careful review of CT scans for evidence of metastatic disease and adenopathy and correlation with clinical information aid in the differential diagnosis.

Comparison of digital and conventional musculoskeletal radiography: an observer performance study.

Interpretations of 122 musculoskeletal radiographs were compared with interpretations of their digital counterparts at a resolution of 1,024 X 840 X 12 bits. Images were evaluated by four readers and included subtle and nonsubtle abnormalities and normal findings. Joint receiver operating characteristic (ROC) analysis results were averaged over all readers and demonstrated no statistically significant difference between the two imaging methods. High interobserver variability limited identifiable differences. Review of cases with subtle findings on the digital system at a resolution of 2,048 X 1,680 X 12 bits (2.5 line pairs per millimeter) revealed adequate visualization of the abnormality in every case. It is concluded that a resolution of 1,024 X 840 X 12 bits is adequate for the interpretation of many musculoskeletal abnormalities but that a resolution of 2,048 X 1,680 X 12 bits is needed for visualization of some subtle abnormalities.