John D. Harley

Color Doppler imaging of infrainguinal arterial occlusive disease

Few reports in the literature validate the use of color Doppler imaging (CDI) for the evaluation of lower extremity arterial occlusive disease, particularly in the tibial and peroneal arteries. This prospective, blinded study compares CDI to arteriography to address the following questions: (1) how well does CDI visualize arterial segments, including those below the knee? and (2) can CDI alone accurately classify the degree of occlusive disease? Twenty-nine men undergoing arteriography before a lower extremity arterial reconstructive procedure were studied with a color ultrasound scanner from the level of the inguinal ligament to the ankle. Color images were examined for the presence or absence of triphasic flow, poststenotic turbulence, color bruits, and collateral vessels. Among 636 arterial segments adequately visualized by arteriography, > or = 90% were identified with color Doppler imaging, including the tibial and peroneal arteries. With color criteria only, specificity was > or = 92% for distinguishing < 50% from > = 50% lesions and > or = 93% for differentiating patent from occluded arteries. Sensitivity for detecting an occlusion was > or = 97% in the superficial femoral (SFA) and popliteal arteries and 83% in the tibial vessels. For identifying a > or = 50% stenosis, sensitivity was > or = 85% in the SFA and popliteal arteries but only 79% and 86% in the posterior and anterior tibial arteries, respectively. CDI reliably identifies vessel location from the level of the groin to the ankle. For the detection of occlusions, CDI is an accurate screening tool in the SFA and popliteal arteries but is less accurate in the tibial vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous drainage of abscesses in the postoperative abdomen that is difficult to explore

We have evaluated our experience with computerized tomography and ultrasonography guided percutaneous drainage of extrahepatic abdominal fluid collections in a group of 22 patients. The most common goal was to avoid or delay surgery on abdomens in which reoperation would be difficult, mainly in high-risk patients. Drainage of pancreatic fluid collections or abscesses was also attempted in a small number of the patients. Percutaneous drainage was curative in 69 percent of those with nonpancreatic abscesses but in only 33 percent of those with abscesses associated with the pancreas. There were no complications attributable to the procedure or to delays in subsequent surgical drainage. Two patients died from problems not directly related to the use of percutaneous drainage. Percutaneous catheter drainage of nonpancreatic abdominal abscesses can play a useful role in patients who are carefully selected because they possess a complex abdominal anatomy distorted by previous surgery and infection or they are at high risk if surgical exploration is carried out.

Preliminary report : penile vein occlusion therapy : selection criteria and methods used for the transcatheter treatment of impotence caused by venous-sinusoidal incompetence

Penile vein occlusion therapy is a fluoroscopic guided technique developed for treating venous-sinusoidal incompetence in patients with erectile dysfunction. We report our experience with 22 patients who have been followed for greater than 1 year. Catheterization of the veins draining the penis was technically possible in 20 of 22 patients (91%). Of these 20 patients 5 (25%) were cured and 9 (45%) had significantly improved erectile function. All 5 patients (100%) with venous-sinusoidal incompetence plus normal cavernous arterial flow, no glans or corpus spongiosal shunts, and bilateral complete coil occlusion of the crural and common crural veins were cured. No deterioration of function was noted at 1 and 2 years. Patient selection and bilateral occlusion of the penile veins are essential to achieve successful penile vein occlusion therapy.

Lateral Approach for Radiocarpal Wrist Arthrography

OBJECTIVE We describe a technique of radiocarpal arthrography using the lateral approach. This technique may be used as an alternative to conventional dorsal techniques. CONCLUSION Radiocarpal injection using the lateral approach can be considered as an alternative to conventional dorsal approaches in the evaluation of wrist pain and instability.

Successful treatment of early postoperative aortic graft infection by percutaneous catheter drainage

Successful treatment by percutaneous catheter drainage of an acute aortic graft infection with an associated pancreatic fistula is reported. Percutaneous catheter drainage can be considered in selected patients when the risk of reoperation is deemed unacceptable or when other reasonable treatment options do not exist.

Treatment of acute renal artery occlusion after percutaneous transluminal angioplasty

Four patients with occlusive complications after percutaneous transluminal renal artery angioplasty (PTA) have been treated from July 1, 1984, to March 14, 1988. During this interval such renal artery angioplasties were performed in 44 patients. Two resulted in complete main renal artery occlusion, one angioplasty resulted in occlusion of a stenotic renal artery bypass graft, and one renal PTA resulted in segmental branch renal artery narrowing, which was thought to represent a dissection. The latter segmental renal artery narrowing was treated expectantly with good long-term results. One of the main renal artery occlusions was treated by radiologic means by reentry and repeat transluminal dilation. The other two acute complete occlusions, one of an autogenous artery and the other of an aortorenal bypass graft, were treated by aortorenal or ileorenal bypass grafting, respectively. The overall incidence of main renal artery occlusion (including the bypass graft occlusion) after PTA requiring operative intervention was 4.5% (2/44). Revascularization was accomplished after 6 and 8 hours of renal ischemia time for the two surgical procedures. Despite this, the bypass grafts done emergently remain patent, and the involved kidneys appear to be functional. The incidence of main renal artery occlusion after PTA is not as low as would be apparent from a review of the literature. It is proposed that main renal artery occlusion after PTA can be treated successfully by surgical and interventional radiologic techniques because of the presence of protective renal collateral circulation whose formation was stimulated by the renal artery lesion that prompted PTA.