A. Kelekis

Common Femoral Artery Anastomotic Pseudoaneurysm: Endovascular Treatment with Hemobahn Stent-Grafts

JVIR 2000; 11:1179–1183 STENT-GRAFTS are gaining widespread acceptance in the endovascular treatment of aneurysms, pseudoaneurysms, and arteriovenous fistulas because of the less invasive nature of their use compared to standard surgical procedures (1). Fully supported stent-grafts are used in the treatment of thoracic aortic aneurysms (1), abdominal aortic aneurysms (2), iliac artery aneurysms (3–6), superficial femoral artery (SFA) and popliteal artery pseudoaneurysms (7–10), and subclavian artery aneurysms and fistulas (11). Vascular lesions near mobile skeletal joints (ie, hip joint), although potentially treatable with fully supported stents or stent-grafts, are still managed with surgery (12) because of the perceived risk of stent failure or vascular injury caused by motion. To our knowledge, there have been no reports of a fully supported stent-graft placement across the hip joint for the treatment of aneurysmal lesions in humans. We describe our experience of endovascular management of a patient presenting with a common femoral artery (CFA) anastomotic pseudoaneurysm, treated with placement of fully supported stentgrafts. This patient also had a common iliac artery anastomotic pseudoaneurysm that was likewise treated with placement of fully supported stent-grafts.

Percutaneous Biopsy and Radiofrequency Ablation of Osteoid Osteoma with Excess Reactive New Bone Formation and Cortical Thickening Using a Battery-Powered Drill for Access: A Technical Note.

PurposeTo report our experience with the use of a battery-powered drill in biopsy and radiofrequency ablation of osteoid osteoma with excess reactive new bone formation. The battery-powered drill enables obtaining the sample while drilling.Materials and MethodsDuring the last 18xa0months, 14 patients suffering from painful osteoid osteoma with excess reactive new bone formation underwent CT-guided biopsy and radiofrequency ablation. In order to assess and sample the nidus of the osteoid osteoma, a battery-powered drill was used. Biopsy was performed in all cases. Then, coaxially, a radiofrequency electrode was inserted and ablation was performed with osteoid osteoma protocol. Procedure time (i.e., drilling including local anesthesia), amount of scans, technical and clinical success, and the results of biopsy are reported.ResultsAccess to the nidus through the excess reactive new bone formation was feasible in all cases. Median procedure time was 50.5xa0min. Histologic verification of osteoid osteoma was performed in all cases. Radiofrequency electrode was coaxially inserted within the nidus and ablation was successfully performed in all lesions. Median amount CT scans, performed to control correct positioning of the drill and precise electrode placement within the nidus was 11. There were no complications or material failure reported in our study.ConclusionsThe use of battery-powered drill facilitates access to the osteoid osteoma nidus in cases where excess reactive new bone formation is present. Biopsy needle can be used for channel creation during the access offering at the same time the possibility to extract bone samples.

Microcatheter Use for Difficult Percutaneous Biliary Procedures

Percutaneous biliary drainage procedures in patients with nondilated ducts are demanding, resulting in lower success rates than in patients with bile duct dilatation. Pertinent clinical settings include patients with iatrogenic bile leaks, diffuse cholangiocarcinomas, and sclerosing cholangitis. We describe a method to facilitate these procedures with the combined use of a 2.7-Fr microcatheter and a 0.018–in. hydrophilic wire.