S. Murthy Tadavarthy

Therapeutic transcatheter arterial embolization.

The authors present two cases of therapeutic embolization, utilizing two different foreign materials. In a case of massive gastrointestinal bleeding from a gastric ulcer which had eroded the splenic artery, Gelfoam (gelatin) plugs injected through a gray Kifa catheter resulted in immediate cessation of bleeding. In the other case, rupture of the suture line impended after iliac artery ligation in an infected artery. Injection of Ivalon (polyvinyl alcohol) resulted in thrombosis of the stump, preventing fatal hemorrhage. The procedure may be life-saving in patients who are poor surgical risks.

Mechanical Thrombectomy with the Amplatz Device: Human Experience

PURPOSE The authors present their early experience of mechanical arterial and graft thrombectomy with the Amplatz thrombectomy device. PATIENTS AND METHODS Preliminary data are presented for 14 patients treated with the Amplatz thrombectomy catheter. The procedure was carried out in 10 arterial polytetrafluorethylene grafts, in two native arteries, and in two patients with venous thrombosis. RESULTS The thrombectomy catheter completely removed the clot in 11 patients and partially removed clot in three patients. Mean thrombectomy time was 2 minutes 45 seconds. Despite distal blood pressure cuff occlusion, two instances of insignificant distal embolization occurred. Mechanical clot dissolution has consistently produced hemolysis without adverse clinical effects. The underlying causative factors such as stenoses were treated by means of angioplasty, atherectomy, or surgical endarterectomy. CONCLUSION Mechanical thrombectomy with this device is a new, effective technique and can rapidly remove the thrombus. From preliminary results, the device seems most promising in clearing out thrombi in occluded synthetic femoral-to-popliteal bypass grafts. The device could have wider application if it were steerable and if it could be introduced from the contralateral approach.

Intraparenchymal embolization for obliteration of an intramedullary AVM of the spinal cord

A new technique is presented in which expandable compressed Ivalon sponge emboli were used to obliterate an intramedullary arteriovenous malformation of the spinal cord by intraparenchymal embolization. A case is described in which this method was used.

Intraparenchymal embolization for obliteration of an intramedullary AVM of the spinal cord: Technical note

A new technique is presented in which expandable compressed Ivalon sponge emboli were used to obliterate an intramedullary arteriovenous malformation of the spinal cord by intraparenchymal embolization. A case is described in which this method was used.

«Pseudo» intramural injection following percutaneous transluminal angioplasty

An angiographic appearance of “pseudo” intramural injection is commonly produced following intraluminal balloon dilatation resulting from the dehiscence of the atheromatous intima that is an unavoidable consequence, and not a complication of angioplasty. These angioplasty-induced changes differ from true intramural dissections in that they are confined to the dilatation site and do not extend beyond this area.

Primary pulmonary artery sarcoma masquerading as pulmonary embolism: role of cardiac MRI.

A 49-year-old healthy man presented with 2 months history of progressive shortness of breath and hemoptysis. Physical examination was remarkable for new systolic heart murmur. Chest X-ray revealed a small opacity in the right lower lobe, and non-contrast computed tomography (CT) demonstrated two sub-pleural masses at the right lung base. Computed tomography-guided biopsy showed benign tissue with extensive necrosis and inflammation. To evaluate the heart murmur, echocardiogram was done and showed moderate pulmonary hypertension with flow acceleration in the main pulmonary artery (PA). Contrast CT revealed a large filling defect in the main PA …

Radiographic changes in the postoperative patient

I N RECENT YEARS many papers have appeared dealing with the clinical and hemodynamic changes associated with surgical correction of congenital heart disease. However, very little information is available concerning the radiographic and angiographic changes following corrective or palliative cardiac surgery. It is the purpose of this communication to fill in this gap and emphasize the importance of cardiovascular radiology in the postoperative management of these patients. Only the most important cardiac defects will be discussed, The postero-anterior (PA) and lateral film of the chest with the barium-filled esophagus is one of the simplest, most important noninvasive technique to follow these patients. Hemodynamic changes, chamber enlargement, and complications of surgery may be visualized leading to a more definitive diagnosis by angiocardiography. Radiographic observations which can be readily made on follow-up chest examinations are concerned with: (1) changes of the thoracic cage, (2) the change in cardiac configuration due to alteration of chamber size, (3) changing left atrial size, (4) decrease or increase of central or peripheral pulmonary arteries, and (5) changing appearance of the mediastinum. Follow-up roentgenograms are useful for comparison only if all technical factors are kept constant. 1-6 Attention should be paid to the position of the diaphragm which may significantly alter the radiographic size of the cardiac silhouette and the appearance of the vasculature. This factor alone is more important than the measurement of the cardiac-thoracic ratio which is conveniently used in follow-up examinations to determine heart size. 7,s Overexposure and underexposure should be strictly avoided.

Removal of large and small biliary duct stones.

Large biliary stones of 2.0 cm size are difficult to extract with the catheter basket technique of Burhenne. A special four-wire snare basket was made and the T-tube tract was dilated to 26 French in order to extract large stones. A new technique of flushing and aspiration was used to extract small stones.