Stephen K. Ohki

Angioplasty for the Treatment of Visceral Ischemia

PURPOSE To evaluate percutaneous transluminal angioplasty (PTA) in the treatment of visceral ischemia. PATIENTS AND METHODS Over a 14-year period, 25 focal visceral artery stenoses were treated with PTA in 16 patients with acute or chronic visceral ischemia. Thirteen patients were women and three were men, with a mean age of 64.7 years (range, 54-79 years). PTA was performed in seven celiac arteries, 17 superior mesenteric arteries, and one inferior mesenteric artery. RESULTS PTA was technically successful in 14 of 16 patients (88%). Two patients were lost to follow-up. Nine of 12 patients (75%) demonstrated primary patency with relief of clinical symptoms at a mean follow-up of 2.3 years (range, 0.3-5 years). The remaining three patients underwent successful repeat PTA for recurrent symptoms. There was one postprocedural death, and one patient subsequently underwent successful surgical bypass for recurrent visceral ischemia. CONCLUSIONS Angioplasty of the visceral arteries may provide relief for select patients with intestinal ischemia, but redilation may be required in some patients.

Noninvasive evaluation of active lower gastrointestinal bleeding: comparison between contrast-enhanced MDCT and 99mTc-labeled RBC scintigraphy.

OBJECTIVE The purpose of our study was to compare contrast-enhanced MDCT and (99m)Tc-labeled RBC scanning for the evaluation of active lower gastrointestinal bleeding. SUBJECTS AND METHODS Over 17 months, 55 patients (32 men, 23 women; age range, 21-92 years) were evaluated prospectively with contrast-enhanced MDCT using 100 mL of iopromide 300 mg I/mL. Technetium-99m-labeled RBC scans were obtained on 41 of 55 patients and select patients underwent angiography for attempted embolization. Each imaging technique was reviewed in a blinded fashion for sensitivity for detection of active bleeding as well as the active lower gastrointestinal bleeding location. RESULTS Findings were positive on both examinations in eight patients and negative on both examinations in 20 patients. Findings were positive on contrast-enhanced MDCT and negative on (99m)Tc-labeled RBC in two patients; findings were negative on contrast-enhanced MDCT and positive on (99m)Tc-labeled RBC in 11 patients. Statistics showed significant disagreement, with simple agreement = 68.3%, kappa = 0.341, and p = 0.014. Sixteen of 60 (26.7%) contrast-enhanced MDCT scans were positive prospectively, with all accurately localizing the site of bleeding and identification of the underlying lesion in eight of 16 (50%). Nineteen of 41 (46.3%) (99m)Tc-labeled RBC scans were positive. Eighteen of 41 matched patients went on to angiography. In four of these 18 (22.2%) patients, the site of bleeding was confirmed by angiography, but in 14 of 18 (77.8%), the findings were negative. CONCLUSION Contrast-enhanced MDCT and (99m)Tc-labeled RBC scanning show significant disagreement for evaluation of active lower gastrointestinal bleeding. Contrast-enhanced MDCT appears effective for detection and localization in cases of active lower gastrointestinal bleeding in which hemorrhage is active at the time of CT.

Evaluation of a New Percutaneous Stainless Steel Greenfield Filter

PURPOSE To evaluate a new percutaneous Greenfield filter with an alternating hook design and over-the-wire delivery system. MATERIALS AND METHODS The alternating hook stainless steel Greenfield filter was evaluated in a prospective clinical trial between March 10, 1994, and January 27, 1995. Filters were placed in 75 patients in nine clinical centers and follow-up with radiographs and ultrasound scans was carried out at 30 days. RESULTS Clinical trial results revealed successful placement in all patients. There were four cases of filter limb asymmetry (5.3%) without clinical sequelae, with one incidence of failure to span the cava. No significant migration was found. There were no clinically suspected pulmonary emboli, but one instance of probable caval penetration (1.7%) did occur. Caval occlusion was documented in three patients (5%). CONCLUSION The percutaneous stainless steel Greenfield filter provides ease of insertion and improved deployment while maintaining the high standards of efficacy and safety associated with the standard and titanium Greenfield filters.

Angiographic diagnosis and transarterial embolization of iatrogenic ovarian artery injury.

PELVIC and genital bleeding remains a major cause of morbidity and mortality in the female reproductive tract. Its management is an important issue to obstetricians and gynecologists. Endovascular embolization is a well-documented technique that has been employed for controlling pelvic hemorrhage. This technique has been used to treat postpartum hemorrhage (1), as well as hemorrhage related to postoperative gynecologic surgery (2). We present two cases in which patients underwent salpingo-oophorectomies that were complicated by postoperative hemorrhage, requiring emergent endovascular embolization. In both patients, selective bilateral internal iliac angiography failed to demonstrate an active bleeding site. Consequently, selective catheterization of the ovarian artery confirmed it as the source of hemorrhage, which was then successfully treated with intravascular embolization.