Amiel Z. Rudavsky

Preliminary clinical experience with the use of absorbable mesh splenorrhaphy.

Splenorrhaphy was performed in six patients using absorbable polyglycolic acid mesh. The sustained injuries included blunt and penetrating trauma and varied from through-and-through puncture with hematoma and deep lacerations to amputation of a portion of the spleen. A number of different splenorrhaphy techniques were required. In all six cases, the procedure was accomplished without abscess formation, postoperative bleeding, or complications related to the use of the mesh.

Isotope angiography: technique, validation and value in the assessment of arterial reconstruction.

Isotope angiography performed by intravenous injection of technetium 99m pertechnetate has been demonstrated to be of value in the diagnosis and management of a variety of disorders of the large arteries. An improved technique of isotope angiography is described and the technique validated (53 cases) in normal and diseased arteries by correlating it with conventional contrast arteriography and/or operative findings. Peripheral arteries as far distal as the wrist or mid-calf have been accurately visualized and quantitation of isotope arrival times and total isotope activity in different parts of the arterial tree has provided a means of evaluating the hemodynamic significance of stenosing lesions.Thirty-nine arterial reconstructions were studied by this technique. Seven of 27 (26%) clinically patent arterial reconstructions were found to be harboring significant and potentially dangerous imperfections which were clinically unsuspected. Nine of 12 (75%) arterial reconstructions thought clinically to be occluded were demonstrated to be patent, obviating the need for invasive contrast arteriography.Isotope angiography may be used with no risk for the immediate postoperative and long-term evaluation of arterial reconstructions. Only those patients with abnormalities identified on isotope angiography need have conventional contrast arteriography for further delineation of the abnormality so that it may be repaired before it causes failure of the reconstruction.

Radionuclide evaluation of peripheral vascular injuries

Radionuclide techniques have become an important modality for the detection and evaluation of peripheral vascular trauma. The presence of significant vascular injury can be diagnosed using essentially noninvasive procedures. A normal radionuclide angiogram reliably indicates the absence of injury to the major peripheral arterial vessels. An abnormal study suggests that further diagnostic maneuvers may be indicated.

Scintiangiographic demonstration of bleeding into a wrist ganglion.

Scintiangiography with delayed static scintiphotos may be used to demonstrate bleeding. Bleeding into a traumatic ganglion of the wrist was demonstrated by this technique following failure of conventional contrast arteriography. Scintiangiography with delayed scintiphotography is now performed in any case in which bleeding is suspected.

Radonuclide angiography in the evaluation of arterial and venous grafts

Isotope angiography has proven to be a safe, rapid, accurate, economical, and essentially painless minimally invasive technique for the evaluation of the integrity of native and transplanted vessels. It may be used as a screening procedure for preoperative evaluation of the major vascular tree and for periodic reevaluation of the continuing patency of native and transplanted vessels.