Archie A. Alexander

Treatment of iatrogenic femoral artery injuries with ultrasound-guided compression

Iatrogenic injuries of the groin are becoming more common after increasingly sophisticated vascular intervention. These injuries are accurately detected by duplex and color Doppler ultrasonography. Recent treatment of these lesions by ultrasound-guided compression repair (UGCR) has been described. During a 1-year period we identified 18 femoral artery injuries, including 17 pseudoaneurysms and one arteriovenous fistula. Three of the pseudoaneurysms thrombosed spontaneously before attempted treatment. The remaining 15 lesions underwent a trial of UGCR. Successful closure was accomplished in 10 patients (56%). Seven of these lesions were successfully treated during the initial session, and thrombosis was accomplished after repeat compression in three additional lesions. Three patients who were given anticoagulants had a failed UGCR, but their pseudoaneurysms thrombosed after administration of anticoagulants was discontinued. Two patients had failed UGCR and required operation. Seven (88%) of eight patients who were not given anticoagulants were successfully treated. In contrast only two (29%) of seven patients given therapeutic doses of anticoagulant medication were successfully treated by the technique. There was no statistical difference between mean pseudoaneurysm diameter, mean width and length of pseudoaneurysm neck, or depth of pseudoaneurysm neck from skin surface in patients in whom successful initial closure was achieved when compared with those patients in whom the initial attempt failed. UGCR is a safe, simple, noninvasive technique that can be used to treat many femoral artery injuries that traditionally were treated with surgery. The technique can be applied by any laboratory that has the necessary ultrasonography equipment and is currently the method of choice for treating uncomplicated iatrogenic femoral artery injuries at our institution.

Endoluminal sonographic evaluation of ureteral and renal pelvic neoplasms

The objective of this study was to demonstrate the feasibility of endoluminal ultrasonography as an adjunct to endoscopy for the evaluation of urothelial neoplasms. An endoluminal ultrasound system using a 12.5 or 20 MHz transducer housed in a 6.2 French catheter was used intraureterally in 38 patients being evaluated endoscopically for suspected tumors in the renal pelvis or ureter. The ultrasonographic, endoscopic, and pathologic findings were evaluated. The location, size, and sonographic characteristics of the tumors in the upper urinary tract were well demonstrated. The information obtained by this technique can be used to guide endoscopic biopsy and laser ablation of the tumor. Endoluminal ultrasonography also has proved helpful in defining the location of a tumor relative to an adjacent vessel and in identifying crossing vessels that cause extrinsic filling defects in the ureter. In a few pathologically correlated cases, endoluminal ultrasonography was accurate in assessing invasion. We have evaluated successfully a variety of non‐neoplastic filling defects in relatively few cases. Determination of the eventual usefulness of this technique awaits greater clinical experience and large clinical trials.

Color Doppler Sonographic Detection of Tumor Flow in Superficial Melanoma Metastases: Histologic Correlation

Color Doppler sonographic detection of tumor flow within superficial melanoma metastases was investigated to determine if tumor size, vessel size, or vessel number influences signal detection. Color Doppler imaging of 32 pathologically proved melanoma metastases was performed at 6 MHz with color Doppler imaging parameters optimized for each lesion scanned. All lesions were measured in three dimensions and the presence or absence of internal flow was documented. Seven surgically excised metastases underwent immunohistochemical staining for endothelial markers. Internal flow was detected in 21 of 32 masses and was completely absent in 11. In comparison to all masses without flow, the masses with flow had significantly greater anteroposterior dimensions (P < 0.00036) and volumes (P < 0.01). Histologically, mean vessel diameter in masses with flow was significantly greater (P < 0.05) than in those without flow, but mean vessel number was not significantly different. In conclusion, detectability of tumor blood flow in superficial melanoma metastasis may be related more to tumor size and vessel size than vessel number. Failure to detect color signal within a superficial melanoma mass does not indicate a lack of internal vascularity.

Intravesical growth of murine bladder tumors assessed by transrectal ultrasound

Experimental studies in the therapy of intravesically growing bladder tumors in mice have been hampered by an inability to monitor tumor growth before and during treatment. To establish a repeatable, noninvasive method to monitor the intravesical growth of bladder tumors, MB49 murine bladder tumor cells were instilled into the bladders of syngeneic C57BL/6 mice. Following 3 weeks of growth, the bladders of tumor-bearing and control mice were imaged using a 20 mHz, 6.2 F catheter-based ultrasound transducer inserted rectally. Bladders of tumor implanted and control mice were identified by high resolution endoluminal ultrasound after distension with 0.15 ml. of normal saline. When compared with the results of histologic analysis, transrectal ultrasound (TRUS) accurately identified tumor presence, size, and location.

Lipoblastoma: diagnosis with computed tomography, ultrasonography, and color Doppler imaging.

Lipoblastomas are benign tumors of embryonal fat cells typically occurring within the first few years of life. They can be found throughout the body but have a greater propensity to originate in sites that have the most primitive adipose tissue in newboms. • To provide the surgical team with accurate preoperative information, the radiologist must utilize a complete arsenal of diagnostic tools including computed tomog· raphy (CT), gray scale ultrasonographic imaging, and Doppler. In this case gray scale ultrasonography provided information that was not obtained by CT. Color Doppler gave additional information regarding the vascular supply and internal vascularity not available by other noninvasive means. This report demonstrates how current diagnostic tests can be combined to better characterize and define tumors of unknown origin.

Sequential penile ultrasound monitoring of patients treated with chronic intracavernous prostaglandin e1

OBJECTIVESnClinical outcome studies of prostaglandin E1 (PGE1) have shown a markedly decreased rate of palpable fibrosis and plaque formation. In this prospective study we investigate the potential of this agent to produce subclinical fibrotic changes.nnnMETHODSnReal-time high-resolution ultrasound scanning of the corpora was performed using a 7.5 to 10 MHz linear array transducer in 80 men on initiation of treatment with self-administered PGE1 and at quarterly intervals during the course of following (3 to 28 months). The dorsal portion of the penile shaft was scanned in the transverse and sagittal planes from base to glans for a side by side comparison of the cavernosal tissue, evaluating local abnormalities of tissue echogenicity.nnnRESULTSnPalpable lesions were not detected in any men on quarterly follow-up examination. Thirteen (16.5%) men developed new echogenic foci not present on pretreatment scanning at the following locations: proximal corpus cavernosum, subcutaneous tissues, and corpus spongiosum. These changes were observed both as single and multiple lesions ranging in size from 1 to 10 mm. The presence of these findings was independent of the etiology of impotence, dose frequency, and duration of intracavernous therapy.nnnCONCLUSIONSnThe significance of these subclinical changes is unknown but their low incidence should be recognized when considering long-term intracavernous therapy.