Steven K. Sussman

STENT PLACEMENT FOR TREATMENT OF MESENTERIC ARTERY STENOSES OR OCCLUSIONS

PURPOSE To evaluate stent placement in the treatment of mesenteric ischemia. PATIENTS AND METHODS Twelve patients (eight women, four men; mean age, 63 years) with chronic mesenteric ischemia underwent stent placement for stenoses or occlusions during a 5.5-year period. Nine patients with 10 stenoses (three celiac arteries, seven superior mesenteric arteries) and three patients with three chronic occlusions (two superior mesenteric arteries, one aortosuperior mesenteric artery bypass graft) were treated. RESULTS Initial technical success was achieved in 11 of the 12 patients (92%), including all three patients with chronic occlusions. There were no technical complications. There was one postprocedural death (<30 days) due to bowel ischemia and infarction, despite a technically successful procedure. Clinical follow-up was available in all 12 patients, with a mean follow-up of 15.7 months (range, 0-38.5 months). Primary and primary-assisted patency up to 18 months was 74% (standard error [SE], 13%) and 83% (SE, 11%), respectively. Secondary patency was 83% (SE, 11%) at 3 years. All three patients (100%) with chronic occlusions had relief of clinical signs and symptoms at a mean follow-up of 22 months (range, 13-38.5 months). CONCLUSIONS Stent placement is safe and clinically effective as an adjunctive therapy to angioplasty or as a primary method of treatment for chronic mesenteric ischemia in patients with focal visceral artery stenoses or occlusions.

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.

Time-dependent scar enhancement in magnetic resonance imaging of the postoperative lumbar spine

Magnetic resonance imaging (MRI) has become a principal modality in the evaluation of the postoperative lumbar spine. Gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) can often facilitate differentiation of scar from recurrent disc herniation according to established criteria. Scar has been believed to enhance predictably. We reviewed the contrast-enhanced MR scans of 44 patients who were examined for recurrent back pain following disc surgery and attempted to assess the enhancement characteristics of scar as a function of the time interval between initial surgery and the imaging study. In 44 patients, scar was believed to be present at 32 of 49 disc levels. The degree of enhancement was related to the postoperative interval; those studies performed no later than 9 months after surgery tended to exhibit the greatest degree of enhancement. Surgical confirmation of these MRI findings was available in 12 patients.In patients examined long after surgery, scar enhancement may be less intense than in those examined shortly after surgery, or even nonexistent. This temporal factor should be considered when using contrast material to differentiate scar from recurrent disc herniation in postoperative examinations of the lumbar spine.

Mesenteric panniculitis: findings on CT, MRI, and angiography case report

The computed tomography (CT), magnetic resonance (MR), and angiographic features of a case of mesenteric panniculitis are presented. The MR characteristics of this rare disorder have not previously been reported. The value of MR in arriving at the preoperative diagnosis of this disorder is discussed.

PERINEPHRIC HEMORRHAGE SECONDARY TO ADRENAL MYELOLIPOMA CASE REPORT

Spontaneous perinephric hemorrhage has been described as occurring secondary to a number of primary renal abnormalities, but rarely from other causes. We describe the computed tomography (CT) and ultrasound findings of this event resulting from hemorrhage from an adrenal myelolipoma.

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.

Optimizing Heparin Utilization in Angiographic Flush Solutions

Various concentrations of heparin in angiographic flush solutions are em ployed during angiography. In an effort to determine whether differences in outcome are seen when either high or low concentrations of heparin in an giographic flush solutions are utilized, two groups of patients were evaluated. There was no difference in outcome and a small systemic effect from heparin was seen in both groups. Use of a low concentration of heparin is suggested for routine angiography.