James R. LePage

Selective catheterization of the portal vein and its tributaries. Preliminary report.

The portal vein and its tributaries were selectively catheterized in 90 patients. Only one complication required surgery. This technique not only provides information about the status of the portal circulation and liver parenchyma but can also be used in the treatment of bleeding esophageal varices by selective embolization of autologous clots or inert material.

Nonspecificity of Abnormal Vascularity in the Angiographic Diagnosis of Malignant Neoplasms

The angiographic changes associated with malignant visceral neoplasms are described. Changes include abnormalities of proximal large arteries, neovasculature, regional blood flow alteration, and obstruction of draining veins. These changes, however, are not specific and may be seen in nonmalignant conditions. Pathological vessels may not respond to the intra-arterial injection of epinephrine. Abnormal hypervascularity is not an exclusive feature of malignant neoplasias and has been seen in angiodysplasias, hamartomas, and inflammatory conditions. Despite the nonspecificity of abnormal vascularity, angiography remains the most useful technique for establishing the presence and extent of malignant neoplasms.

New techniques for interruption of gastroesophageal venous blood flow.

Enlarged gastroesophageal veins were successfully obliterated in 41 patients using embolization with modified autogenous clots and/or Gelfoam, balloon occlusion, iatrogenic perivenous hematoma, sclerosing agents (Sotradecol and Keflin), or a combination of these methods. Thirteen patients were actively bleeding when studied, and the site of bleeding was detected in 4. Surgical exploration of 16 patients and autopsy study of 5 showed persistent obliteration ranging between three weeks and seven months. No major complications requiring reparative surgery were encountered. Gelfoam soaked with Sotradecol is the preferred agent because it provides persistent obliteration of the embolized veins. Patients who are acutely bleeding or have done so previously are candidates for selective obliteration of the gastroesophageal veins.

Why Every Renal Mass is Not Always a Surgical Lesion. The Need for an Orderly, Logical, Diagnostic Approach

The fact that approximately 95 per cent of asymptomatic renal masses are benign is a compelling reason for the streamlined diagnostic approach which is described herein. Within the confines of these guidelines for the study of renal masses, when proceeding from simple to complex methods of evaluation, one should always consider the age of the patient, the status of the cardiovascular system, the radiologic appearance of the mass on drip infusion nephrotomography and the results of renal echography as qualifying determinants and then propose the logical sequence of individualized studies under the best possible circumstances.

Pitfalls in transhepatic portography.

Difficulties commonly encountered in transhepatic catheterization of the portal vein and interpretation of portograms are discussed. A long-sleeved trocar is recommended. Curved guide wires and deflector assemblies may assist in superselective catheterization of the tributaries of the portal vein. The judicious use of embolic material (small volumes, slowly injected) should guarantee the success and safety of this technique. Transhepatic obliteration of the gastroesophageal veins is a relatively simple and usually successful form of palliative treatment for actively bleeding and stable gastroesophageal varices. Thoroughness of the embolization procedure and of interruption of blood flow in the gastroesophageal veins is necessary to prevent early recurrence of bleeding.

Angiopyroplasty Using Electromagnetically Induced Focused Heat

A metal-tipped catheter capable of inducing and withstanding extremely high temperatures suitable for angiopyroplasty has been developed. The probe utilizes external radiofrequency (RF) energy focused on the tip. A relatively inexpensive catheter and RF source make this a very plausible alternative to laser systems.

Arteriographic bleeding: a new sign.

A new sign of arteriographic bleeding, diastolic clearance of angiographic contrast medium selectively from the bleeding vessel, is described. The use of this sign must be confined to rapidly bleeding end-vessel distributions or when nonopacified collateral circulation is not a consideration. It should not be confused with the normal washout of contrast substance in areas of multiple parent vessel collateral circulation where intermittent opacification is a normal feature.

Intravascular catheter rupture.

From the Department of Radiology, University of Miami School of Medicine and Jackson Memorial Hospital, Miami, Florida 33136. Supported in part by Grant No. HE05750-04, National Institutes of Health. With the advent of more specialized catheterization equipmcnt more unusual complications are being discovered. The purpose of this communication is to document one hazard encountered in the use of the lB1ediTech Selectro Cathe-