Arteriographic Findings Research Articles

Arteriographic findings in radial and ulnar deficiencies

The arterial pattern in 13 cases of radial deficiency and six cases of ulnar deficiency was studied by arteriography. The radial artery was absent or hypoplastic in 84.6% of cases of radial deficiency and in 50% of cases of ulnar deficiency. A persistent median artery was seen in 76.9% of cases of radial deficiency and in 16.7% of cases of ulnar deficiency. In 12 hands, the deep palmar arch was small or absent, depending upon the degree of radial arterial dysplasia. The digital artery to the deficient digits was missing in some cases. The persistence of an embryonic vascular pattern in cases of radial deficiency and ulnar deficiency with dysplasia of the ulna suggests that the teratogenic injury may have been simultaneous, whereas ulnar deficiency without dysplasia of the ulna was not associated with arterial abnormalities in the forearm.

Ultrasound-guided balloon angioplasty is a new technique for vascular surgeons

A new catheter has been developed that can be accurately and precisely positioned using duplex ultrasonography alone. A piezoelectric transducer that functions as a passive, omnidirectional receiver is attached to the mid-balloon region of an angioplasty catheter. Integration to a standard duplex imaging system allows visualization of this receiver in all planes, with the location of the receiver represented by a flashing bright arrow superimposed on the ultrasound B-mode image. This catheter was tested successfully in 10 dogs with bilateral femoral arteriovenous fistulas. With the use of duplex guidance, eight arterial and three venous stenoses were dilated and two stents were placed. Catheter placements and therapeutic outcomes predicted by ultrasound correlated with arteriographic findings. Ultrasound guidance has several advantages. It eliminates the risks associated with radiographic imaging. It also reduces patient costs and discomfort. Furthermore, procedures can be monitored continuously in real time with the collection of anatomic and physiologic data.

An Unusual Angiographic Picture in Status Migrainosus

Arteriographic findings suggestive of inflammation are described in a 26-year-old woman presenting with headache and syncope. There were no clinical findings of angitis, and a diagnosis of status migrainosus was eventually made. We present her case, as well as a review of previous cases of arterial changes in patients with headache. Most previous cases report arterial narrowing, felt to reflect spasm, whereas our patient demonstrated segmental stenoses and dilatations, perhaps implicating inflammation. The inflammatory process has been postulated as the pathogenesis of migraine pain. As most migraineurs do not undergo arteriography, the incidence of arterial change in these patients is unknown. This finding has therapeutic implications for selecting the optimal anti-migraine agent.

Non-invasive Vascular Tests Reliably Exclude Occult Arterial Trauma in Injured Extremities

We evaluated the ability of noninvasive vascular tests to exclude clinically significant occult arterial damage in injured extremities. In a preliminary study, a Doppler arterial pressure index (API) (the systolic AP in the injured extremity divided by the AP in an uninvolved arm) of < 0.90 was found to have sensitivity and specificity of 95 and 97, respectively, for major arterial injury. The negative predictive value for an API > 0.90 was 99. Because these values suggested that noninvasive vascular tests might effectively be substituted for “exclusion” arteriography in patients at risk for silent extremity arterial injuries, we then conducted a trial in which arteriography was performed in extremity trauma victims only when the API was < 0.90. Among 100 traumatized limbs (84 penetrating, 16 blunt) in 96 consecutive patients, 16 of 17 limbs (94) with an API < 0.90 had positive arteriographic findings, and seven underwent arterial reconstruction. Among 83 limbs with an API > 0.90, followup (including duplex scanning in 64 limbs) revealed five minor arterial lesions (four pseudoaneurysms, one arteriovenous fistula) but no major injuries. Arteriograms for extremity trauma fell from 14 to 5.2 of all angiographic studies performed (p < 0.001, Chi-square). These studies suggest that noninvasive vascular tests can reliably exclude major occult arterial damage in injured extremities. Screening for such injuries with Doppler arterial pressure measurements, reserving arteriography for limbs in which the API is < 0.90, is safe, accurate, and cost effective.

Pre- and Intraoperative Transcranial Doppler: Prediction and Surveillance of Tolerance to Carotid Clamping

We report 91 patients (mean age 70 years) operated upon, prospectively for a total of 100 carotid revascularizations (nine bilateral). Eighty-five of these patients had pre-, intra-, and postoperative transcranial Doppler investigations. Preoperatively, these 85 patients (92 procedures) were classified into two groups based on the results of their Doppler examinations: Group A (65 patients, 72 procedures), those who did not require an intraoperative indwelling shunt and Group B (20 patients, 20 procedures), those who did. The shunt was inserted only when the mean stump (back) pressure was less than 50 mmHg after cross-clamping. Group A all had satisfactory collaterality with a functional anterior and one or two posterior communicating arteries. Group B had no communicating arteries (anterior or posterior) identified by transcranial Doppler. In 17 of 20 patients in this group, the stump pressure was less than 50 mmHg and a shunt was placed. The overall prediction based on Doppler examination of whether or not patients would need a shunt during operation for the two groups A and B (i.e., 92 procedures) was correct in 95.6% (88/92) of cases. Moreover, six hemodynamically significant stenoses (four in the cavernous portion, two in the middle cerebral artery) were disclosed. Sensitivity and specificity of transcranial Doppler as correlated with arteriographic findings were 70 and 90%. Preoperative transcranial Doppler can measure the velocities of the principal cerebral arteries and the collateral capacity of the circle of Willis, and can forecast tolerance to carotid cross-clamping. Intraoperatively, the velocity of flow in the middle carotid artery was correlated with stump pressure, which allowed for surveillance of the shunt.

Angiodynography (Color-Coded Duplex Sonography) in the Evaluation of Vasculogenic Impotence

The penile arteries of 18 men with erectile dysfunction were examined by angiodynography (color-coded duplex sonography). Blood flow velocity was measured before and after intracavernous injection of papaverine/phentolamine. The angiodynographic findings were compared to arteriography. Normal values of peak flow velocity (after injection) were obtained from 6 men with normal arteriographic findings (deep artery greater than 25 cm/s, superficial artery greater than 30 cm/s). Angiodynography enables good imaging of the four penile arteries superior to duplex sonography. A strong correlation with the arteriographic findings could be found. Thus noninvasive angiodynography may replace penile arteriography for the routine evaluation of impotence.

ST Segment Change on Treadmill Exercise Electrocardiogram and Coronary Arteriographic Findings in Patients with Angina Pectoris

ST Segment Change on Treadmill Exercise Electrocardiogram and Coronary Arteriographic Findings in Patients with Angina Pectoris

Constrictive Effect of Serotonin on Visible Renal Arteries

Serotonin (5HT) has been implicated in the pathogenesis of several arterial disorders. Experimental intrarenal infusion of 5HT has produced initial decreases, and later sustained increases in total renal blood flow in the dog, and flow limiting renal artery spasm in other species. We assessed renal angiographic responses to 5HT infused into one renal artery of nine dogs before and after treatment with indomethacin (I). On blinded assessment of arteriograms, 5HT-induced narrowing was detected (p less than 0.001), and the effect was accentuated by I (p less than 0.001). Ketanserin (K), a 5HT-2 receptor antagonist, reversed the arteriographic vasoconstrictor effect of 5HT in five I-treated dogs (p less than 0.05). Linear cortical defects and decreased contrast intensity were seen in the nephrogram phase during 5HT infusion after I. This appearance resembled the arteriographic findings in hemorrhagic shock, suggesting profound impairment of renal cortical perfusion. This study suggests that 5HT constricts visible renal arteries via interaction with the 5HT-2 receptor, and that this in vivo effect is modified by arterial synthesis of vasodilator prostaglandins in the anesthetized dog.

A case of hepatocellular carcinoma with the sign of leser-trelat: A possible role of a cutaneous marker for internal malignancy.

A rare case of hepatocellular carcinoma who developed the complication of the sign of Leser-Trelat is reported. The patient, a 57-year-old male, visited our hospital with complaints of generalized malaise and anorexia. A diagnosis of hepatocellular carcinoma was made based on elevated alpha-fetoprotein measurement, ultrasonography, and hepatic arteriography findings. Chest x-ray film suggested pulmonary metastases of hepatocellular carcinoma. Thereafter, complications of the seborrheic keratosis developed in the trunk and the skin lesion was diagnosed as the sign of Leser-Trelat associated with hepatocellular carcinoma. The patient died of pneumonia 9 months after development of the sign of Leser-Trelat.

Traumatic Left Renal Artery Stenosis Managed with Splenorenal Bypass

Splenorenal arterial bypass is a well established technique for the treatment of left renal artery occlusive disease. The following is a case report of the use of splenorenal bypass in the management of concomitant traumatic left renal artery intimal dissection and splenic laceration. Arteriographic and intraoperative findings are presented as well as a review of pertinent literature.

Intraabdominal hemorrhage as a result of segmental mediolytic arteritis of an omental artery: Case report

This article describes the fifth reported case of segmental mediolytic arteritis and the second in a survivor. The patient had intraabdominal bleeding as a result of a ruptured omental artery. The pathologic and arteriographic findings are described. The pathology is characterized by segmental disruption of the medial smooth muscle cells and the initiation of mediolysis. Mediolysis is associated with marked segmental thinning of the vessel wall, often with only the adventitia intact. Fibrin is deposited at the adventitial and medial surfaces, and hemorrhage into the media may occur. As in this reported case, lysis of the adventitia leads to sudden, often catastrophic intraabdominal hemorrhage. Little associated adventitial inflammation occurred. Segmental mediolytic arteritis seems to involve the intra-abdominal muscular arteries in elderly patients with nonspecific abdominal symptoms. An angiogram showed patchy areas of narrowing involving ileal, gastroduodenal, and renal arteries that correlated with the pathologic findings observed in the excised omental arteries.

Free-floating Thrombus of the Extracranial Internal Carotid Artery

Free-floating clots of the extracranial internal carotid artery are generally considered as surgical emergencies. This retrospective study analyzes six free-floating clots diagnosed by arteriography. Three of these patients had a fixed stroke while the other three had an evolving stroke. Three patients had antecedent ocular or hemispheric transient ischemic attacks. The causes of free-floating clots in the internal carotid artery were atheromatous stenosis in two cases, ulcerated plaque in three cases, and carotid artery dissection in one. All six patients were seen late, approximately 15 hours after their neurologic accident. They were treated with intravenous heparin over a two to five week period. Repeat arteriograms demonstrated complete clot lysis in four instances, while partial lysis was seen in one case. Moderate extension of thrombus occurred in one case only. No further neurologic complications were noted during the treatment by heparin. As indicated by follow-up arteriographic findings, secondary surgery was performed for major carotid lesions and residual clots in five cases. The free-floating thrombus syndrome of the carotid artery should not be considered as a surgical emergency when discovered late in the wake of an acute neurologic accident.

Diagnosis of left atrial thrombi in mitral valve disease by coronary arteriography

Arteriographic findings of neovascularity and fistula formation between coronary arteries and left atrium have occasionally been described in association with left atrial thrombosis in patients with mitral valve disease. The validity of these coronary arteriographic findings in diagnosis of atrial thrombi has been evaluated in 112 patients with mitral valve disease. Comparison was made with surgery. The study furnished these diagnostic values: sensitivity 70%, specificity 85%, positive predictive value 72%. Even if this angiographic finding is complementary in diagnosis of atrial thrombosis, its identification during coronary arteriography in patients with mitral valve disease is useful. Its detection could improve diagnostic prediction of thrombosis, especially in patients without previous embolic events or where echocardiography failed to reveal thrombi.

The warm knee sign—An evaluation

The presence of an area of warmth at the knee has been described in cases of arterial occlusion at the popliteal fossa. A study was carried out to evaluate the significance of this sign by comparing clinical and thermographic findings with arteriographic results in a group of 30 patients. The clinical and thermographic findings were described with reference to the symptomatic limb. Clinically, 14/30 (47%) and thermographically, 16/30 (53%) had "positive" warm knee signs. The overall agreement between clinical impressions and thermographic findings was 28/30 (93%). The commonest arteriographic finding in patients with a positive warm knee sign was that the occlusion or stenosis ended at the adductor hiatus. Comparing this arteriographic finding with a positive warm knee sign, sensitivity, specificity, positive and negative predictive values of 73%, 75%, 79% and 69% respectively were obtained suggesting that this is a useful sign, is of proven value and deserves its place in the initial screening of patients with peripheral vascular disease.

Iatrogenic superior mesenteric arteriovenous fistula: Ultrasonographic, CT and angiographic features and histological findings of the liver biopsy

Iatrogenic superior mesenteric arteriovenous fistula is rare. We treated a patient with this problem 6 years after small bowel resection for intestinal obstruction. The symptoms and signs were those of intestinal ischaemia and portal hypertension with an abdominal bruit. Ultrasonography and enhanced computerized tomography of the abdomen suggested the presence of superior mesenteric arteriovenous fistula, with a dilated portal vein and a communication between the dilated superior mesenteric vein and its artery. The exact location of the fistula was then determined by selective superior mesenteric arteriography. The fistula was ligated in an emergency operation to prevent cardiac or renal failure and to relieve portal hypertension. Liver biopsy showed no cirrhotic changes, but fibrosis was seen around the portal veins. We describe here not only the diagnostic arteriographic findings of superior mesenteric arteriovenous fistula, but also the interesting and suggestive ultrasonographic and computed tomographic findings. Early correction of such fistulas is recommended to prevent cardiac or liver failure.

NON-INVASIVE VASCULAR TESTS RELIABLY EXCLUDE OCCULT ARTERIAL TRAUMA IN INJURED EXTREMITIES

We evaluated the ability of noninvasive vascular tests to exclude clinically significant occult arterial damage in injured extremities. In a preliminary study, a Doppler arterial pressure index (API) (the systolic AP in the injured extremity divided by the AP in an uninvolved arm) of less than 0.90 was found to have sensitivity and specificity of 95% and 97%, respectively, for major arterial injury. The negative predictive value for an API greater than 0.90 was 99%. Because these values suggested that noninvasive vascular tests might effectively be substituted for "exclusion" arteriography in patients at risk for silent extremity arterial injuries, we then conducted a trail in which arteriography was performed in extremity trauma victims only when the API was less than 0.90. Among 100 traumatized limbs (84 penetrating, 16 blunt) in 96 consecutive patients, 16 of 17 limbs (94%) with an API less than 0.90 had positive arteriographic findings, and seven underwent arterial reconstruction. Among 83 limbs with an API greater than 0.90, followup (including duplex scanning in 64 limbs) revealed five minor arterial lesions (four pseudoaneurysms, one arteriovenous fistula) but no major injuries. Arteriograms for extremity trauma fell from 14% to 5.2% of all angiographic studies performed (p less than 0.001, Chi-square). These studies suggest that noninvasive vascular tests can reliably exclude major occult arterial damage in injured extremities. Screening for such injuries with Doppler arterial pressure measurements, reserving arteriography for limbs in which the API is less than 0.90, is safe, accurate, and cost effective.

Duplex carotid sonography. Peak systolic velocity in quantifying internal carotid artery stenosis.

Duplex ultrasonography combining high-resolution imaging and Doppler spectrum analysis was performed in 92 consecutive patients (total, 180 vessels) and compared with the findings of conventional arteriography. All duplex studies were categorized into four groups based upon the maximum internal carotid artery (ICA) velocity: group 1: less than 125 cm/sec; group 2: 125 to 224 cm/sec; group 3: greater than 225 cm/sec; and group 4: no flow. Sensitivities and specificities were highest when peak ICA velocity was used as one of several criteria in quantifying the degree of ICA stenosis. These additional criteria were: (1) the presence of extensive sonographically visible plaque within the ICA; (2) an abnormal spectral waveform with elevated diastolic velocity (greater than 100 cm/sec); (3) resistive pattern ("externalization") of the common carotid artery (CCA) waveform; and (4) the ratio of the right CCA peak velocity to the left of less than 0.7 or greater than 1.3. The overall accuracy for the combined groups using all criteria was 94%.

Dieulafoy Disease: Arteriographic Findings and Treatment

Dieulafoy disease is an unusual cause of massive and frequently fatal gastrointestinal tract hemorrhage that results from the erosion of a submucosal artery. Although the lesion has been found throughout the gastrointestinal tract, it most commonly occurs in the proximal stomach. Nine patients with this condition have been treated at the authors' institution during the past 5 years. The bleeding lesion was located before surgery with selective visceral arteriography in three patients. Rapid extravasation was demonstrated from an eroded but otherwise normal-appearing artery in all three cases. Hemorrhage was controlled successfully in one patient with selective embolization of the involved left gastric artery branch. The remaining eight patients were treated with surgical ligation.

Segmental diastolic narrowing of epicardial coronary arteries in aortic regurgitation. Phase analysis by quantitative angiography of coronary artery diameter change during cardiac cycles

A new finding of a segmental narrowing of the left anterior descending coronary artery in diastole (diastolic narrowing: DN) was reported. DN was found in 6 out of 45 patients (13.3%, 5 males, 1 female) with chronic aortic regurgitation (AR). It is likely that aortic regurgitation was more severe in terms of the history of heart failure, regurgitant fraction, left ventricular end-diastolic volume index and pressure, and aortic diastolic pressure in the patients with DN compared with those without DN. The phasic change of DN in cardiac cycles was analyzed by quantitative angiography, and indicated that DN commences at a point in mid-diastole when coronary vascular driving pressure (the instantaneous aortic and LV pressure difference) becomes abnormally reduced, reaches its maximum at end-diastole, and gradually recovers as aortic pressure increases during systole. In two patients, DN was no longer evident after valve replacement. We concluded that DN, a new coronary arteriographic finding, reflects the integrated severity of AR.

Quantitation of left ventricular asynchrony on radionuclide angiography phase images

Quantitation of left ventricular (LV) asynchrony is relevant in clinical cardiology, as well as in evaluating LV mechanical properties. Radionuclide angiography (RA) phase images are extensively used, and asynchrony is usually assessed by computing the standard deviation of phase angle distribution (SD). However, SD is dependent on count statistics and does not take into account the spatial distribution of asynchrony. In this study a new index to evaluate asynchrony on phase images is presented (differential uniformity parameter, DUP). DUP is based on the frequency analysis of phase images. Diagnostic accuracy and reproducibility of either SD or DUP were tested. Reproducibility was evaluated in 15 patients studied by RA twice within a few minutes. DUP showed a better reproducibility than SD. Diagnostic accuracy was estimated in 84 patients, divided into four subgroups on the basis of coronary arteriography and contrast ventriculography findings: (a) 25 control subjects, (b) 16 patients with coronary artery disease (CAD) and normal LV wall motion, (c) 23 patients with CAD and LV hypokinesia and (d) 20 patients with CAD and LV dyskinesia. Relative diagnostic ability was assessed by comparing the areas under receiver-operating characteristic curves. DUP's area was larger than SD's when group D was tested against all the other groups (DUP's area = 87% +/- 5%, SD's area = 76% +/- 7%; P less than 0.01). Thus, our study indicates that DUP is more reproducible and more accurate than SD in identifying patients with CAD and LV dyskinesia.