Sadashiv S. Shenoy

Stent-Related Iliac Artery and Iliac Vein Infections: Two Unreported Presentations and Review of the Literature

Purpose: To discuss the presentation, diagnosis, and treatment of stent-related infections on the basis of 2 new cases and historical review. Case Reports: Two previously unreported cases of vascular stent infection are presented with a summary of cases from the literature. One case involved an iliac artery stent infection secondary to a remote bacteremia 6 months after stent placement. The other case was an early iliac vein stent infection, a previously unreported site of this complication. Both cases were diagnosed by use of computed tomography and were treated surgically after medical management failed. Both patients survived. Conclusions: A high index of suspicion is necessary for the diagnosis of stent infections, and an aggressive treatment is usually necessary for survival. Prophylactic antibiotics should definitely be considered in cases involving repeat interventions and prolonged catheterization, as well as before bacteremia-inducing therapies.

The role of thrombolytic therapy in the management of paradoxical embolism

Paradoxical emboli are considered a rare event, representing less than 2% of all arterial emboli. The most common intracardiac defect associated with paradoxical emboli is a patent foramen ovale. Most commonly, a pulmonary embolism is the cause of the acute increase in right atrial pressure leading to a reversal of intracardiac flow and passage of venous embolic material to the left heart. We present a patient with a pulmonary embolism and paradoxical emboli, and discuss therapeutic approach. We suggest that the treatment of choice for the patient with pulmonary embolism and non-limb-threatening acute ischemia due to a paradoxical emboli should be thrombolytic therapy and intracaval filter placement, followed by patent foramen ovale repair.

Colonic Ischemic Necrosis Following Therapeutic Embolization

Transcatheter embolization of the middle colic artery for diverticular bleeding was followed by ischemic necrosis in the transverse colon at the site of previous anastomosis and stricture formation. This is a potential complication of intra-arterial embolization for colonic bleeding.

Light and ultrastructural studies of renal oncocytic adenoma

An asymptomatic renal oncocytoma was found in the upper left quadrant of an eighty-five-year-old woman during a routine physical examination. Ultrastructurally, the tumor was composed entirely of epithelial cells filled with normal and abnormal mitochondria. Selective renal angiography showed two renal arteries supplying a lobulated, highly vascular mass. The mass contained irregular and tortuous vessels without any arteriovenous shunting.

Balloon Angioplasty for Arteriovenous Graft Stenosis

Purpose: To retrospectively review the long-term outcome as well as the cost effectiveness of thrombolytic therapy and balloon angioplasty (TBA) versus surgical thrombectomy and balloon angioplasty (SBA) in the treatment of prosthetic dialysis access grafts. Methods: Between February 1996 and February 1999, 63 hemodialysis patients (35 women; mean age 62.2 years) were treated for 105 thromboses in 6-mm polytetrafluoroethylene straight or loop bridge arteriovenous grafts. Choice of treatment was at the discretion of the surgeon or interventional radiologist: either Fogarty balloon thrombectomy followed by balloon dilation of the venous anastomotic stenosis or urokinase thrombolysis followed by angioplasty. Results: Forty-eight SBAs and 55 TBAs were performed in 63 patients without complications. The primary patency rates in the entire cohort were 34%, 29%, and 17% at 1, 2, and 3 months, respectively. Primary patency after TBA was 29%, 18%, and 11%, and that for SBA, 45%, 45%, and 33% over the same time intervals. The mean graft survival was 10 days for TBA versus 31 days for SBA. Repeat angioplasty performed in 23 grafts produced secondary patency rates of 52% at 1 month, 34% at 3 months, and 5% at 5 months. The Medicare reimbursement for both treatments was identical (

Arteriovenous malformations as a cause of gastrointestinal bleeding: the importance of triple-vessel angiographic studies in diagnosis and prevention of rebleeding.

1638 for TBA and

Sidewinder catheter for conversion of retrograde into antegrade catheterization

1670 for SBA). Conclusions: The poor patency rate and high cost of TBA and SBA suggests that these procedures should not be routinely used for salvage of thrombosed arteriovenous grafts with outflow stenosis. Patch angioplasty or creation of simultaneous temporary and new permanent accesses may be a more cost-effective approach in these patients.

Arterial embolization for traumatic hemobilia with hepato-portal fistula.

Arteriovenous malformations of the gastrointestinal tract are a source of upper and lower gastrointestinal bleeding. We studied 40 patients with arteriovenous malformations. Eighteen percent had single lesions in either the distal transverse colon or the left colon (the angiographic distribution of the inferior mesenteric artery). Seventeen percent had concomitant colonic and extracolonic arteriovenous malformations. Only 6% of those who underwent surgery for removal of arteriovenous malformations rebled. We also studied the incidence of angiodysplastic lesions of the colon of 159 patients over the age of 55 with lower gastrointestinal bleeding; associated arteriovenous malformations were present in 21%. These data suggest: that to evaluate arteriovenous malformations as a cause of gastrointestinal bleeding, one must perform inferior and superior mesenteric and celiac angiography; the incidence of rebleeding is reduced when triple-vessel selective visceral angiography precedes surgical removal of arteriovenous malformations; and the incidence of associated arteriovenous malformations approaches that of diverticulosis in elderly patients with lower gastrointestinal bleeding.

Arteriovenous Malformation of the Cecum: Report of Six Cases*

Conversion of retrograde into antegrade catheterization is accomplished through the use of a sidewinder catheter with a reformed loop that is subsequently lost during advancement of the catheter tip. This technique was used to perform eight percutaneous dilatations (PTD) in seven patients (one had bilateral disease). Other applications for antegrade catheterization are considered.

Renal carbuncle: Simulation of tumor response to epinephrine

A case of blunt liver trauma complicated by delayed upper gastrointestinal bleeding, probably hemobilia, was successfully treated by intra-arterial embolization. Laparotomy with liver resection or hepatic artery ligation—procedures that carry a high morbidity and mortality in a critically ill patient—were avoided. Embolization techniques can be a valuable alterantive to surgery in the mangement of hepatic trauma with delayed hemorrhage in selected, high-risk cases