Alexander Garniek

Ethanol and Polyvinyl Alcohol Mixture for Transcatheter Embolization of Renal Angiomyolipoma

OBJECTIVEnThe purpose of this study was to assess the immediate and midterm effects of embolization of the angiogenic component of renal angiomyolipoma in which a mixture of ethanol and polyvinyl alcohol is used as a permanent obliterator.nnnMATERIALS AND METHODSnSeventeen patients with 18 renal angiomyolipomas (size range, 5.5-20 cm; mean size, 10 cm) were treated with transcatheter embolization over an 8-year period. Embolization was performed with a mixture of 96% ethanol and polyvinyl alcohol particles. Follow-up with CT (mean follow-up period, 22.4 months) and one (mean, 14 months) or two (mean, 27 months) angiographic examinations were conducted to evaluate changes in the size of the tumor and to look for recurrence of the angiogenic component.nnnRESULTSnAll initial angiograms showed the characteristic tortuous, hypervascular, and aneurysm-forming angiogenic component. Immediate complete obliteration was achieved in 17 tumors (94.4% technical success rate). There was one partial technical failure. Mean tumor size was reduced to 7.6 cm (mean size reduction, 24%). Fourteen patients with 15 tumors underwent one angiographic follow-up examination (mean time after treatment, 14 months), and four patients underwent two angiographic follow-up examinations (mean time after treatment, 27 months). Reduction of the angiogenic component occurred in 10 (66.6%) of the tumors and complete obliteration in five (33.3%) of the tumors. No retroperitoneal hemorrhage or tumor growth was seen during the follow-up period. No complications were encountered.nnnCONCLUSIONnWe found a mixture of ethanol and polyvinyl alcohol an efficient embolizing agent with a sustained midterm effect in the management of renal angiomyolipoma. Repeated embolization was needed in tumors with a large angiogenic component. Tumor shrinkage after embolization was minimal.

Optease vena cava filter optimal indwelling time and retrievability.

The purpose of this study was to assess the indwelling time and retrievability of the Optease IVC filter. Between 2002 and 2009, a total of 811 Optease filters were inserted: 382 for prophylaxis in multitrauma patients and 429 for patients with venous thromboembolic (VTE) disease. In 139 patients [97 men and 42 women; mean age, 36 (range, 17–82) years], filter retrieval was attempted. They were divided into two groups to compare change in retrieval policy during the years: group A, 60 patients with filter retrievals performed before December 31 2006; and group B, 79 patients with filter retrievals from January 2007 to October 2009. A total of 128 filters were successfully removed (57 in group A, and 71 in group B). The mean filter indwelling time in the study group was 25 (range, 3–122)xa0days. In group A the mean indwelling time was 18 (range, 7–55)xa0days and in group B 31xa0days (range, 8–122). There were 11 retrieval failures: 4 for inability to engage the filter hook and 7 for inability to sheathe the filter due to intimal overgrowth. The mean indwelling time of group A retrieval failures was 16 (range, 15–18)xa0days and in group B 54 (range, 17–122)xa0days. Mean fluoroscopy time for successful retrieval was 3.5 (range, 1–16.6)xa0min and for retrieval failures 25.2 (range, 7.2–62)xa0min. Attempts to retrieve the Optease filter can be performed up to 60xa0days, but more failures will be encountered with this approach.

Amplatzer Vascular Plug: Expanding the Applications Spectrum

The Amplatzer Vascular Plug is a new embolization device which has been used in different vascular anomalies, especially by cardiologists in the cardiac and pulmonary circulations. It is underused by interventional radiologists. We used this device in three different vascular conditions, which we present here.

Endovascular closure of a large renal arteriovenous fistula

A case is described of a large renal arteriovenous fistula causing long‐term cardiovascular complications. Successful percutaneous embolization was achieved using temporary occlusion balloons, Guglielmi detachable coils, regular nondetachable spring coils, and cyanacrylate. The advanced therapeutic tools we used can improve the prognosis of patients with large and complicated arteriovenuos fistulas and prevent surgery. Cathet Cardiovasc Intervent 2003;59:66–70.

Percutaneous transluminal aortic angioplasty: Early and late results

Percutaneous transluminal angioplasty of the infrarenal abdominal aorta (13 patients) and its bifurcation (15 patients) was performed in 28 patients with a total of 32 dilatation procedures. The group consisted of 16 female and 12 male patients and initial successful dilatation was achieved in all Recurrence within 1 month requiring bypass surgery occurred in 1 patient. Three patients were lost to follow-up. Long-term follow-up in the remaining 24 patients ranged from 1 to 9 years with a mean of 4.5 years. During the follow-up period, repeat angioplasty of the original stenosis was performed in 3 patients and another patient underwent dilatation of a new lesion which developed in the aorta. According to clinical and noninvasive studies, these 4 patients, as well as the other 20, have maintained patency of the treated lesions and are symptom free. No immediate complications requiring surgery occurred. We conclude that angioplasty is the initial treatment of choice in focal lesions of the distal abdominal aorta and its bifurcation.

Preoperative angiography and embolization of large pelvic tumors

Pelvic tumors are often large and difficult to excise with appropriate surgical margins due to their size, proximity to neurovascular structures, and major intraoperative bleeding. The purpose of this study is to evaluate the yield of preoperative angiography and embolization so as to facilitate achievement of good surgical results.

Errors and pitfalls in intraarterial thrombolytic therapy

Sixty complications occurred during 138 courses of intraarterial thrombolytic therapy in 122 patients during a 5-year period. These complications were recorded and analyzed prospectively to identify underlying errors in management. There were 31 bleeding episodes, 15 vascular complications, and 14 other complications. Twelve of the bleeding episodes occurred at the puncture site, and 19 occurred at remote sites, accounting for six of the eight deaths in the series. Management errors were clearly identified in 27 of the 60 complications. The three following patterns of errors were recognized: (1) mismanagement of bleeding (12 instances), (2) wrong patient selection (nine instances), and (3) breach of the administration protocol (six instances). The group of 27 complications with underlying management errors included seven of the eight deaths in the present series. Efforts to prevent complications from thrombolytic therapy should concentrate on the specific patterns of management errors identified. This study indicates that low-dose intraarterial thrombolytic therapy is not a low-risk alternative to surgical intervention but should be viewed as a prelude or possible alternative to surgery in selected patients despite the risks involved.

True sagittal CT scanning of the elbow

Objective A new method to obtain true sagittal CT scans of the elbow joint is described. Materials and Methods The patient is placed prone on the CT table with the arm around and under the table. Results True sagittal images of the elbow joints and all the articulating surfaces were easily obtained in a standard and reproducible manner. Conclusion For CT scanning of the elbow, true sagittal scanning is superior to axial views and is readily obtained by the described method.

Resolved Abdominal Aortic Aneurysms Following Stent Graft Treatment: A Report of Five Cases

Complete aneurysm resolution is the hallmark of successful endoluminal stent-graft treatment. We describe 5 patients in whom an abdominal aortic aneurysm (AAA) disappeared completely at mid-term follow-up after endovascular stent-graft placement. We reviewed 45 patients (43 men and 2 women) who underwent AAA repair using an endovascular technique, from April 1997 to December 2001. Mean AAA diameter was 58.3 mm. On 48-month follow-up, 12 aneurysms had not changed in size, 4 had grown, 16 had shrunk, and 5 had resolved completely. We describe these 5 patients in detail. The 5 patients were all men, mean age 68 years; their mean aneurysmal sac diameter was 54 mm. The only common finding in all of them was patency of lumbar and inferior mesenteric arteries at pre-procedure evaluation as well as at follow-up. Mean time to complete resolution was 18 months. No major complications were encountered. AAA may resolve completely after endovascular stent-graft implantation. Patent side branches may perhaps contribute to AAA disappearance by antegrade flow. A larger patient population should be reviewed, however, before any statistical conclusion can be drawn.