Juan A. Oleaga

Therapeutic applications of catheter cholangiography.

Percutaneous transhepatic catheterization of the biliary tree was performed in 23 patients. In 21 the catheter was advanced past an obstructing lesion into the distal common bile duct and duodenum to establish antegrade biliary drainage. The catheter was left permanently in place as a form of endoprosthesis in 5 patients.

Percutaneous transluminal angioplasty treatment of renal transplant artery stenosis.

Since June 1979, percutaneous transluminal angioplasty (PTA) has been the procedure of choice for renal transplant artery stenosis (RTAS) at the Hospital of the University of Pennsylvania. Of 241 renal allograft recipients, 17 (7%) when studied by arteriogram because of suspected RTAS proved to have

Transluminal Angioplasty of the Iliac, Femoral, and Popliteal Arteries

The recently developed Grüntzig balloon dilatation catheter has facilitated the performance of transluminal angioplasty. The authors used this catheter in 35 arteries supplying the lower extremities in 27 patients. Immediate relief of symptoms (claudication and rest pain) occurred in 30 vessels (86%) in 23 patients. The procedure was well tolerated by all patients. Over 90% of initially successful dilatations were patent at 3 to 10 months.

A Multihole Catheter for Maintaining Longterm Percutaneous Antegrade Biliary Drainage

The use of multihole catheters to achieve longterm antegrade biliary drainage in 43 patients with obstructive jaundice is described. Catheters were positioned with sideholes both above and below an obstruction and continued patency maintained. Better results were obtained using larger diameters and larger sideholes.

Successful long-term percutaneous decompression of the biliary tract☆

The efficacy of percutaneous transhepatic biliary drainage for long-term (greater than 3 months) decompression of biliary obstruction was evaluated in 35 patients with benign (10) and malignant (25) obstructing lesions. The results indicate that such drainage is a safe and effective means for long-term decompression of the biliary tract in selected patients, especially patients who are poor operative risks and those with metastatic or nonresectable malignancy. In addition, the procedure provides access to the biliary tract for percutaneous dilatation of selected common duct or anastomotic strictures.

Early experience with percutaneous transluminal angioplasty using a vinyl balloon catheter.

The technique of transluminal dilatation of arterial stenoses has been greatly facilitated with the recent development of the vinyl balloon catheter by Gruntzig. Since these catheters became available to us in early 1978, we have utilized them to attempt dilatation of 62 arteries, including iliac, femoral and renal vessels. Immediate success was achieved in 57 of these vessels. There were five early complications (two distal embolizations and three prompt occlusions) and three late complications (two restenoses and one occlusion at ten days). The occlusions were all treated promptly surgically with good results and the stenoses redilated. Noninvasive pressure measurements were obtained on all patients whose iliac or femoral arteries were dilated both before and after the procedure, with objective improvement demonstrated by this method. The procedure itself is well tolerated by patients. It involves only minimal discomfort and risk and a markedly shortened hospital stay. The procedure can be easily accomplished by physicians who are thoroughly familiar with routine femoral catheterization techniques and it is believed that this technique will have a definite place in the future therapy of many cases of arterial stenosis.

Thin needle biopsy in the diagnosis of ureteral obstruction with malignancy

Ureteral obstruction after treatment for abdominal cancers is a common situation in which the thin needle biopsy presents an attractive low morbidity alternative to laparotomy for the diagnosis of malignant disease. A negative biopsy is still nonconclusive, although helpful in determining the next step in the patients management. In our own series, biopsy in the region of ureteral obstruction revealed tumor rather than benign disease in four of five patients. No morbidity was encountered.

Comparison of the Effect of Vasopressin Infusions on the Mesenteric Arteries of Different Species

Superior mesenteric arteriography was performed following infusions of vasopressin, epinephrine and saline into the superior mesenteric arteries of dogs, pigs, rabbits and monkeys and compared with the well-known effects in human beings. Species-specific effects were noted and compared with the known differences in various vascular beds in human beings. In non-primate animals, vasopressin appeared to act at a more distal site than in primates, but with a similar decrease in superior mesenteric arterial flow. The results in primates were similar to those in human beings.

Percutaneous Transluminal Angioplasty Treatment of Renal Transplant Artery Stenosis

Since June 1979, percutaneous transluminal angioplasty (PTA) has been the procedure of choice for renal transplant artery stenosis (RTAS) at the Hospital of the University of Pennsylvania. Of 241 renal allograft recipients, 17 (7%) when studied by arteriogram because of suspected RTAS proved to have significant stenosis (the mean reduction in luminal width for the group being 68%) and underwent PTA. RTAS was equally prevalent in cadaver and related kidney allografts and was no less common in HLA-identical related donor grafts, arguing against the importance of immune factors in etiology. RTAS was equally prevalent whether the anastomotic technique was end to end or end to side. However, when RTAS occurred after end to side anastomoses, it was usually postanastomotic. Fifteen of 17 of the attempts at dilation by PTA were successful by angiographic analysis. Thirteen of the 15 successfully dilated patients had long-term allograft survival and in all of these instances blood pressure (BP) was decreased after PTA. After a mean of 67 weeks, BP decreased from a systolic of 184 ± 24 mm Hg pre-PTA to 135 ± 15 mm Hg (P < 0.001) and from a diastolic of 115 ± 10 mm Hg pre-PTA to 87 ± 11 mm Hg (P < 0.001). The majority of patients continue to require antihypertensive drugs but in a less vigorous regimen than pre-PTA. Serum creatinine level fell following PTA from 1.9 ± 0.6 to 1.7 ± 0.5 mg/100 ml (P < 0.01). Repeat angiographic study was done in nine patients, an average of 61 weeks after PTA, and no recurrent RTAS was identified. Three minor complications of PTA occurred but none led to long-term sequelae. Thus, we believe PTA of RTAS is relatively safe, carrying less mortality and morbidity than operative treatment, and is capable of improving BP control and renal allograft function.

Current Status of Angiographic Techniques in the Management of Gastrointestinal Bleeding

Angiography is one of several methods available for demonstrating active arterial or capillary bleeding sites in the gastrointestinal tract. Bleeding at a rate greater than 0.5 cc/minute is readily identified. Selective infusions of vaso-constricting drugs and embolic therapy have been highly successful in the management of both gastric mucosal and lower gastrointestinal bleeding and represent a reasonable alternative to surgery for these conditions. Bleeding duodenal ulcers are much less responsive to transcatheter therapy and are usually best managed surgically.