Irwin S. Johnsrude

Left Gastric Artery Embolization for Control of Gastric Bleeding: A Complication

A case is reported in which an autogenous blood clot was embolized into the left gastric artery in an attempt to control massive bleeding from a lesser curvature gastric ulcer. Postmortem examination revealed full-thickness necrosis of the gastric wall in the distribution of the left gastric artery. Factors which may have contributed to this complication are discussed.

Transrenal Ureteral Occlusion with Gianturco Coils and Gelatin Sponge

The authors report the use of Gianturco coils and gelatin sponge plugs to achieve complete occlusion of nine ureters in five patients with advanced pelvic malignancies and lower urinary tract fistulas. The method is simple to apply, is readily available, and to date has been associated with no significant complications. These results suggest that, before more elaborate methods of ureteral occlusion are applied, the use of coils and gelatin sponge should be considered as the primary method of ureteral occlusion. Further work is needed to elaborate the exact mechanism by which these materials cause occlusion.

Late complications of abdominal aortic reconstructive surgery: roentgen evaluation.

During a 5-year period from 1969 to 1974, 53 (8.5%) of 631 patients developed late complications following abdominal aortic reconstructive surgery. Occlusion was the most frequent complication and occurred in 4%. Others included stenosis, false aneurysm, enteric fistula and infection. Late complications were demonstrated by roentgenographic methods. Angiography was the most valuable roentgen study. It is indicated in all patients suspected of having delayed complications except those with unstable life-threatening hemorrhage. Additional roentgenographic studies including the barium enema and barium meal may help make the diagnosis and exclude other entities. In any patient with an abdominal aortic graft and gastrointestinal bleeding, the diagnosis of an aorto-enteric fistula should be considered until otherwise proven.

Experimental Closure of Arteriovenous Fistula by Transcatheter Electrocoagulation

Introduction of a small electric current by way of a catheter-placed electrode can completely occlude experimentally produced arteriovenous fistula. The occlusion appears permanent and without morbidity in experimental animals. This technique might be clinically useful in obliterating an arteriovenous fistula and controlling gastrointestinal hemorrhage.

Vessel Occlusion with Transcatheter Electrocoagulation: Initial Clinical Experience

Transcatheter electrocoagulation (TCEC) was used for vessel occlusion in combination with embolization by Gelfoam and/or Ivalon in six patients in whom other interventional or surgical techniques were considered dangerous or unfeasible. The technique was effective in decreasing or obliterating the blood supply to variously located lesions in all cases. The only complications were small skin burns in one patient and a small ulceration of the upper lip in another.

Transcatheter electrocoagulation: a therapeutic angiographic technique for vessel occlusion.

Previous work has shown that localized electrocoagulation of blood vessels using direct current applied by catheter placed electrodes is feasible. In vitro and in vivo experiments showed that clot size and thrombosis of vessels are directly related to the product of the amount and duration of the current. Surgically created splenic hemorrhage was well controlled in 9 of 10 animals. The vessels remained permanently occluded after electrocoagulation in 8 of 9 animals. Pathological studies of all the vessels showed intimal damage at the sites of occlusion. These experiments indicate that clot formation may be a product of both intimal damage and platelet attraction to the positive electrode. The technique has advantages over embolization since no foreign material is injected and a localized clot is produced at the tip of the guidewire. There are certain disadvantages and further refinements must be developed to establish transcatheter electrocoagulation as a useful clinical technique for vessel occlusion.

Clinical Use of Transcatheter Electrocoagulation

Transcatheter electrocoagulation is an effective method of experimental vessel occlusion even in the presence of thrombocytopenia and heparinization. This technique was used to occlude 13 arteries in 3 patients. In vitro testing suggests that intra-arterial bipolar platinum electrodes may achieve the therapeutic objectives more rapidly and with less risk, but more investigative work is required.

Transcatheter electrocoagulation: experimental evaluation of the anode.

Transcatheter electrocoagulation using direct current has been shown to be an effective method for vessel occlusion. To date, the stainless steel anode has not been entirely satisfactory. Thus, an evaluation of bipolar platinum electrodes and a comparison of monopolar platinum and stainless steel electrodes have been performed. Experimental results have shown that both monopolar and bipolar platinum electrodes caused perforation in most cases. At the present time, we have not found a satisfactory replacement for the unipolar stainless steel anode.

Coronary arterial-left atrial fistula. Case with obstruction of the inferior vena cava by a giant left atrium.

Abstract A 64 year old man with a life-long history of known heart disease and irregular heart action presented with a continuous parasternal bruit, a massively enlarged heart and incomplete inferior vena cava obstruction. Angiocardiograms demonstrated marked distortion of all of the heart chambers, particularly the right atrium, and partial obstruction of the inferior vena cava by a large mass presumably invading the heart. Aortogram demonstrated a large anomalous branch of the right coronary artery, but it was not possible to determine angiographically the termination of the vessel. On exploratory thoracotomy, the mass distorting the heart was determined to be a giant left atrium that was presumably the result of a coronary arteriovenous fistula between the right coronary artery and the left atrium. The angiocardiographic findings are presented in detail, and the postulated factors in the development of giant atriomegaly are discussed.

Angiographic Demonstration of Arteriovenous Shunts in Pulmonary Metastatic Choriocarcinoma

Arteriovenous shunting through uterine choriocarcinoma has been well demonstrated angiographically, but, despite physiologic evidence for similar communications through metastatic nodules in the lungs, angiographic documentation has not been reported. Two cases of respiratory distress, persistent arterial oxygen desaturation, and angiographic evidence of pulmonary arteriovenous shunting in metastatic pulmonary nodules are presented. Since even the most advanced form of this disease need not have a poor prognosis, an aggressive angiographic approach may differentiate it from pulmonary embolism causing similar symptoms and findings.