Angiography In Management Research Articles

Hemorrhagic Complications After Nephron-Sparing Surgery: Angiographic Diagnosis and Management by Transcatheter Embolization

Hemorrhagic Complications After Nephron-Sparing Surgery: Angiographic Diagnosis and Management by Transcatheter Embolization

Traumatismes du rein et de l'uretère

In France, renal lesions involve preferentially young men. They are often related to a multi organ trauma. Traumas of the upper urinary tract are likely to jeopardize the vital prognosis then nephrologic and urologic functional outcomes. Both the evaluation and the management of renal lesions were the subject of an international consensus in 2004. Clinical evaluation is based on trauma anamnesis, evaluation of the haemodynamic status of the patient, the presence of focal lumbar symptoms and hematuria. Except for the most benign traumas and life-threatening haemorrhages that necessitate immediate surgery, renal imaging may be indicated. Computed tomography is the best initial imaging technique that allows visualizing the anatomic lesion and evaluating the severity of the trauma. Renal pedicle and pyeloureteral junction avulsions are absolute indications for surgical exploration. For the other lesions, medical treatment or angiographic management can also be proposed. In any cases, conservative management should be preferred. The clinical and imaging follow up should focus on the vascular and secondary uro-nephrologic complications.

Duodenal Ulceration into the Cystic Artery with Resultant Massive Hemorrhage

Anterior duodenal ulceration with erosion into the cystic artery is an extremely rare source of upper gastrointestinal hemorrhage. Interventions that have previously been reported include open exploration with cholecystectomy, open exploration while leaving the gallbladder in situ, and angiographic management. We report a case of massive upper gastrointestinal bleeding related to duodenal ulcer penetration of the cystic artery and discuss potential management strategies.

706 Computed Tomographic Angiography Replacement of Catheter Angiography in Management of Patients with Subarachnoid Hemorrhage: More Information for Less Cost and Greater Safety

706 Computed Tomographic Angiography Replacement of Catheter Angiography in Management of Patients with Subarachnoid Hemorrhage: More Information for Less Cost and Greater Safety

706 Computed Tomographic Angiography Replacement of Catheter Angiography in Management of Patients with Subarachnoid Hemorrhage: More Information for Less Cost and Greater Safety

706 Computed Tomographic Angiography Replacement of Catheter Angiography in Management of Patients with Subarachnoid Hemorrhage: More Information for Less Cost and Greater Safety

Spontaneous Resolution of a Ruptured Dissecting PICA Aneurysm

Spontaneous dissecting aneurysms (SDAs) seldom involve the intradural vertebral artery VA, the posterior cerebral, basilar or postero inferior cerebellar arteries (PICAs), where they produce subarachnoid haemorrhage and/or ischaemia. These lesions may develop spontaneously or occasionally after minor trauma and occur in young people in whom there is no underlying abnormality to explain the appearance of the dissection in most cases. Spontaneous dissecting aneurysm of the PICA is rare and its natural history is not well understood. Surgery or endovascular treatment for PICA dissection remain controversial because they suggest vessel occlusion. Only in a few cases is the bypass between the occipital artery and the PICA possible with trapping of the dissected segment. Reinforcement of the arterial wall does not seem efficient and the surgical approach per se with sole exclusion of the aneurysm may be disastrous. We describe two cases of SDA of PICA that presented with subarachnoid haemorrhage (SAH), treated conservatively, with spontaneous cure of the lesions, angiographically confirmed at mid-time follow-up of five and four months. These favourable spontaneous thromboses, like 11 other similar case reported in the literature, did not show any rebleed. The possibility of a benign clinical course of this lesion exists; clinical and angiographic management of the patient before a decision for a aggressive treatment is proposed.

False aneurysm of the pulmonary artery induced by a Swan-Ganz catheter: clinical presentation and radiologic management.

This study evaluates retrospectively the clinical presentation, radiographic findings, and angiographic management of false aneurysm of the pulmonary artery resulting from Swan-Ganz catheter placement. Over a 4-year period, seven false aneurysms of the pulmonary artery were diagnosed in five patients (four women, one man) who were 67-81 years old. All five patients underwent Swan-Ganz catheter placement to monitor cardiac surgery--coronary artery bypass grafting in four and mitral valve replacement in one. All patients were anticoagulated. For five patients, we reviewed the medical records and the results of chest radiography, digital subtraction pulmonary angiography, and pulmonary artery embolization. For two patients, we reviewed the results of CT scanning. Non-life-threatening hemoptysis was noted in all cases and occurred in three patients after the Swan-Ganz catheter had been removed (elapsed time of 1-19 days). Chest radiographs revealed a pulmonary infiltrate in one patient and a pulmonary mass in two patients. The results were unremarkable in the other two patients. CT depicted two false aneurysms of the pulmonary artery as round masses with eccentrically enhanced lumina circumscribed by thrombosis. Pulmonary angiography revealed a single false aneurysm in three patients and two false aneurysms in two patients. All false aneurysms were localized in segmental or subsegmental branches of the right middle pulmonary artery (n = 4) or the right lower pulmonary artery (n = 3). All patients were successfully treated with transcatheter steel-coil embolization. Even when the chest radiograph appears unremarkable, patients clinically suspected of developing a false aneurysm of the pulmonary artery after Swan-Ganz catheter placement require enhanced CT or pulmonary angiography to establish the diagnosis. False aneurysms of the pulmonary artery can be treated at the time of pulmonary angiography by steel-coil embolization.

Angiographic management of massive hemobilia due to iatrogenic trauma

Ten patients with massive hemobilia in shock or preshock status were treated with angiography. The hemobilia had been induced by iatrogenic trauma: biliary drainage in seven patients, and surgery, liver biopsy, and angiography in one patient each. Angiography was performed on all patients. Embolization was performed in nine, and in the one remaining patient, spasm of the right anterior hepatic artery and catheter manipulation injured the intima and obliterated the artery. In seven patients with hepatic artery pseudoaneurysm, gelfoam particles were injected in five, however, extravasation could not be prevented in four of these patients. Permanent embolic materials were added and complete hemostatis was obtained. Hemobilia never recurred in any patient. Emergency embolization should be considered as the initial treatment of choice for hemobilia and when pseudoaneurysms are discovered, they should be obliterated by permanent embolic materials. Moreover, tumor thrombus in the portal vein is not a contraindication for this procedure.

Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management.

The high risk of exsanguinating hemorrhage in patients with pelvic ring disruption demands aggressive, yet balanced orthopedic and angiographic management as soon as patients are admitted to the emergency department. We present a perspective of our experience in two trauma centers and propose a logical approach to early prediction, diagnosis, and management of hemorrhage associated with pelvic fractures. Our method is based on knowledge of pelvic anatomy and an understanding of the mechanisms of injury and their wounding capacity, given that the mechanism of injury determines the type of pelvic ring disruption and that the probability of arterial hemorrhage is--to a great extent--a function of the type of pelvic fracture. The risks of diagnostic peritoneal lavage and of excessive radiologic studies of noncritical injuries are emphasized. The principles guiding arterial embolization and the application of external fixators are discussed.

Angiographic Management of Retroperitoneal Hemorrhage from Renal Angiomyolipoma in Polycystic Kidney Disease

AbstractAngiographic management of bilateral angiomyolipomas complicated by hemorrhage in autosomal dominant polycystic kidney disease is presented. The patient had mild stigmata of tuberous sclerosis, and a family history of tuberous sclerosis and autosomal dominant polycystic kidney disease. The radiographic features at diagnosis, and those present during and after embolization are described. Radiological criteria for diagnosis and successful control of bleeding with intra-arterial selective embolization are discussed. Radiographic features before, during and after embolization are exhibited.

Bleeding following endoscopic sphincterotomy: angiographic management by transcatheter embolization

Transcatheter embolization is a well-established and effective method for the control of bleeding from the upper gastrointestinal tract and often represents the preferred alternative to more invasive surgical management. The applications of this technique for the management of bleeding following endoscopic sphincterotomy have not been reported previously. Of five patients referred for arteriography with life-threatening postsphincterotomy bleeding, active bleeding from branches of the gastroduodenal artery was demonstrated in four. Embolization of this vessel with Gelfoam controlled the bleeding in all three patients in whom it was attempted. Arterial stenosis and spasm precluded such treatment in one patient. The fifth patient was not bleeding at the time of arteriography. There were no complications from these procedures. Our experience shows that postsphincterotomy bleeding can be safely and effectively controlled by transcatheter embolization, thereby avoiding surgery which is associated with significant morbidity and mortality in this setting.

The Usefulness of Radioisotope Angiography in Management of Reflex Sympathetic Dystrophy Syndrome

The Usefulness of Radioisotope Angiography in Management of Reflex Sympathetic Dystrophy Syndrome

Angiographic Management of Severe Gastrointestinal Bleeding in the Immediate Postoperative Period

Angiographic Management of Severe Gastrointestinal Bleeding in the Immediate Postoperative Period

Angiographic Management of Massive Hemorrhage Caused by Pancreatic Disease

Angiographic Management of Massive Hemorrhage Caused by Pancreatic Disease

A practical and effective protocol for the post angiographic management of patients with critical stenosis of the left main coronary artery.

The management of newly diagnosed left main obstruction varies throughout institutions. At some Centers, very aggressive measures including intra-aortic balloon counterpulsation and emergent revascularization are routine protocol. Twenty consecutive patients with greater than 50% luminal narrowing of the left main coronary artery were treated over a 1 year period. Routine post catheterization protocol for 19 patients included intensive care observation, continuation of nonparenteral anti-anginal agents, and coronary revascularization within 24 hours of diagnosis. One patient experienced severe hemodynamic embarrassment at the time of catheterization and underwent emergency coronary bypass. All patients were discharged uneventfully following successful surgery. Based on this experience, it is felt that with surgical support, patients with significant left main stenosis can be treated with standard anti-anginal therapy, and undergo elective revascularization without complications.

Percutaneous transluminal angioplasty and valvectomy in a failing in situ saphenous graft.

A patient is described who experienced increasing ischemia in the follow-up period of femoral-peroneal artery graft surgery. Transcatheter angiographic management was successful in improving the long-term patency of the graft. The procedure is described, and the applications are discussed.

Report of a successful delivery after nonsurgical management of a choriocarcinoma-related pelvic arteriovenous fistula

A case of a pelvic arteriovenous fistula is described 5 years after treatment of trophoblastic disease. Hypogastric embolization, rather than an operation, was used to obliterate the fistula. Pregnancy occurred 1 year later and a healthy infant was delivered. This is the first report of a delivery after angiographic management alone.

The Role of Venography and Sclerotherapy in the Management of Varicocele

Venography has recently been introduced in routine diagnostic evaluation of varicocele, and a pathogenetic classification based on venographic findings has been proposed. Transcatheter sclerotization of the internal spermatic vein completes the angiographic management of varicocele. After venographic classification of 56 cases, the patients with type-1 varicocele (reno-spermatic reflux) were treated by transcatheter sclerotization (group A, 25 patients) or high inguinal surgical ligation (group B, 15 patients). The results were quite similar, whereas the cost/benefit ratio was favorable to sclerotherapy.

The Role of Venography and Sclerotherapy in the Management of Varicocele

Venography has recently been introduced in routine diagnostic evaluation of varicocele, and a pathogenetic classification based on venographic findings has been proposed. Transcatheter sclerotization of the internal spermatic vein completes the angiographic management of varicocele. After venographic classification of 56 cases, the patients with type-1 varicocele (reno-spermatic reflux) were treated by transcatheter sclerotization (group A, 25 patients) or high inguinal surgical ligation (group B, 15 patients). The results were quite similar, whereas the cost/benefit ratio was favorable to sclerotherapy.

Spontaneous Dissecting Subclavian Aneurysm — A Case Report

Dissecting aneurysms of the peripheral arteries are rare lesions. In 1969, Wychulis reviewed the medical literature and found one hundred and eight reported cases of primary dissecting aneurysms of peripheral arteries and added two cases of his own.1Of these, only one case of primary dissecting aneurysm of the subclavian artery was reported. This one was associated with trauma. In 1968, Persaud reported the first case of dissecting aneurysm of the subclavian artery secondary to idiopathic cystic medial necrosis (ICMN).2Later in 1968, Fee reported a case of dissecting aneurysms of both subclavian arteries also associated with ICMN.3 To our knowledge, there has been no reported cases of primary dissecting aneurysms of the subclavian artery occurring spontaneously without associated recognizable trauma, ICMN, syphilis, or congenital defects. Such a case is the subject of this report. Plain x-rays and angiographic presentation, intra-operative appearance, and management are presented. Histologic findings are briefly discussed.