A.M. Cook

The use of the wallstent endovascular prosthesis in the treatment of malignant obstruction of the superior vena cava

Seventeen patients (10 men and seven women) aged 48-76 years (mean 63.4) who were suffering from malignant superior vena caval obstruction had Wallstents implanted percutaneously to relieve the obstruction. Fifteen of the patients had previously been treated by radiotherapy or chemotherapy, with either failure to remit or later recurrence. Six patients required thrombolysis prior to stenting. All patients had rapid relief of the obstructive symptoms. This was sustained in 15 patients to date or at death. Two patients, both of whom had pre-stent lysis, developed stent thrombosis following withdrawal of anticoagulation at 4 months and 7 days respectively. Stenting has been shown to be extremely effective at relieving superior vena caval obstruction in these patients and is usually the only method available in this condition when other treatments fail. Whether all patients presenting with malignant superior vena caval obstruction should be stented de novo remains to be proven.

The use of the Wallstent in aorto-iliac vascular disease

Forty-three patients had self-expanding endovascular Wallstents inserted for aorto-iliac arterial disease. A total of 59 Wallstents were inserted into 50 iliac arteries. There were 27 males and 16 females with a mean age of 62.51 years. Included in the series were 19 iliac occlusions, 21 severe atheromatous disease of the aortoiliac segment, two severe dissections following conventional angioplasty and one re-stenosis of a previously dilated iliac segment. All of the stents were successfully deployed but there were five significant complications. One case of distal embolism was treated by surgical embolectomy but the other four were treated by an additional percutaneous technique. At follow-up after 6 months all patients remain symptomatically improved. Aorto-iliac stenting is a cost-effective treatment in selected cases of severe aorto-iliac disease.

Percutaneous angioplasty of the superior gluteal artery in the treatment of buttock claudication

A 65-year-old man developed bilateral buttock claudication due to stenosis of the main stem of the left internal iliac artery and stenoses of the left and right superior gluteal branches of the internal iliac arteries. These stenoses were successfully dilated by percutaneous angioplasty using coronary angioplasty equipment. Percutaneous angioplasty is shown to be an effective method of treatment of buttock claudication caused by stenoses of the internal iliac and superior gluteal arteries.

Rupture of a Non-Aneurysmal Salmonella Infected Aorta

A 65-year-old man with salmonella bacteraemia developed a retroperitoneal collection as a result of infection and subsequent rupture of the abdominal aorta. Computed tomography (CT) showed the collection but there was no aneurysm on CT or at surgery. The main diagnostic feature of salmonella aortitis is the presence of an aneurysm; this report indicates that a non-aneurysmal infected aorta can rupture. The importance of considering a ruptured aorta as the cause of retroperitoneal collections is emphasised, even when the aorta is of normal calibre.

Six cases of subclavian stenosis treated by percutaneous angioplasty

Percutaneous angioplasty was performed on six patients with proximal left subclavian artery stenosis. The lesions treated included short band like stenoses and longer atheromatous segments and were all haemodynamically significant. The subclavian arteries were all successfully dilated using a standard angioplasty technique and there were no residual complications. Percutaneous angioplasty is shown to be an effective method of treatment of subclavian stenosis.

Outpatient Arteriography- A Safe and Practical Proposition?

Ninety-five patients, who underwent fine catheter peripheral angiography as outpatients, were followed up and assessed to determine the safety of this procedure. No patients reported any major side effects and in particular no patients experienced a rebleed from the arterial puncture site. This procedure could be safely adopted in any radiology department.

Case report: Ultrasonic and comparative angiographic appearances of a spontaneous aorto-caval fistula

A 71-year-old man with an atherosclerotic abdominal aortic aneurysm developed a spontaneous aorto-caval fistula. The ultrasound appearances showing a direct fistulous communication between the inferior vena cava and the aorta are presented and these are correlated with the angiographic appearances.