John J. Borsa

Treatment of inferior vena cava anastomotic stenoses with the Wallstent endoprosthesis after orthotopic liver transplantation.

PURPOSEnTo evaluate the efficacy of the Wallstent endoprosthesis for treatment of stenotic or occlusive inferior vena cava (IVC) lesions refractory to balloon angioplasty in patients after orthotopic liver transplantation.nnnMATERIALS AND METHODSnWallstent endoprostheses were implanted in six patients with IVC anastomotic stenoses or occlusions that were refractory to balloon angioplasty. Follow-up included both duplex ultrasound (US) and clinical evaluations.nnnRESULTSnTen stents were successfully implanted in six patients. Five of six patients (83%) demonstrated primary patency on duplex US for a mean period of 11 months (range, 4-17 months). One patients symptoms recurred within 3 weeks after intervention. This patient underwent repeated stent placement. Follow-up duplex US in this patient demonstrated primary assisted patency at 7 months. Mean clinical follow-up was 12 months (range, 7-18 months). Other than the previously described case, no patient developed recurrent symptoms of IVC stenosis or occlusion. Two patients who experienced hemorrhagic complications secondary to anticoagulation were treated successfully.nnnCONCLUSIONSnThe Wallstent endoprosthesis is a useful adjunct for treatment of IVC stenosis or occlusions in patients who have undergone orthotopic liver transplantation when these lesions are refractory to simple balloon angioplasty.

CT-guided transfemoral portocaval shunt creation.

A patient with superior vena cava (SVC) occlusion presented with severe ascites and urgent transjugular intrahepatic portosystemic shunt (TIPS) was requested. The patient had a chronically occluded SVC. An alternative to classic TIPS was employed using CT guidance to traverse the left portal vein to the inferior vena cava with a small gauge needle. Fluoroscopic guidance was then used to snare a wire placed through the needle and then work from the femoral vein to create a portocaval shunt that passed through the caudate lobe. This procedure was a technical success and improved the patient’s ascites.

Ehlers-Danlos Syndrome Mimicking Mesenteric Vasculitis: Therapy, then Diagnosis

The etiology of acute intraabdominal bleeding is often unclear at the time emergent arteriography is performed. During localization and embolization, the arteriogram may suggest the diagnosis of vasculitis. However, controlling the bleeding remains the priority. Connective tissue diseases such as Ehlers-Danlos syndrome (EDS) may also cause bleeding and mimic vasculitis and must be included in the differential diagnosis. We present such a case in which the initial findings were misleading.

Transjugular intrahepatic portosystemic shunt for trauma

We report a case of successful emergency TIPS placement to control intra-abdominal bleeding after blunt abdominal trauma in a patient with severe cirrhosis and portal hypertension.

Endovascular Treatment of Life-threatening Peripheral Pulmonary Artery Stenosis☆

From the Departments of Radiology (A.B.F., J.J.B., M.T.D., E.K.H.) and Surgery (D.E.W.), University of Washington Medical Center, Box 357115, 1959 NE Pacific St., RR215, Seattle WA 98195; and the Department of Pediatrics (T.K.J.), Childrens Hospital and Regional Medical Center, Seattle, Washington. Received June 16, 1997; revision requested July 23; revision received April 9, 1998; accepted April 15. Address correspondence to A.B.F.