Stewart R. Reuter

Balloon-expandable intracoronary stents in the adult dog.

We studied the acute and chronic biological reaction to balloon-expandable intracoronary stents in the adult dog. Twenty stainless steel stents were placed, by standard angioplasty techniques, into the left anterior descending, left main, or circumflex coronary arteries of 20 dogs. Angiography was performed at 1, 3, 6, and 12 months and animals were killed in groups of three at 1, 3, 8, and 32 weeks, for gross, light, and electronmicroscopic analysis. All dogs survived, all stents were patent, and there was no evidence of myocardial infarction, spasm, rupture, or aneurysm formation during follow-up (longest 18 months; average, 12 months). The stent was initially covered by a thin layer of thrombus that was replaced later by neointimal muscular proliferation that reached its maximal thickness by 8 weeks (p less than .01). This neointima gradually thinned as it became more sclerotic and less cellular. The stents were covered completely by immature endothelium by 1 week without loss of side branches. We conclude that balloon-expandable intraluminal stents can be safely placed percutaneously into normal canine coronary arteries. Because of rapid endothelialization high patency rates can be expected, thus offering promise for clinical applications in man.

Mesenteric angiography in the evaluation of inflammatory and neoplastic disease of the intestine.

The Role of mesenteric angiography has not yet been defined in the investigation of inflammatory or neoplastic disease of the intestines. The angiographically demonstrated cases which have been published are too few to permit conclusions about the diagnostic potential of the method (1, 2, 4, 6, 8, 9–11, 15, 16). It has not been shown if benign tumors can be distinguished from the malignant, or if tumors can be differentiated from inflammatory disease. Microangiography has shown that differences exist in the vascular patterns of different intestinal lesions (14). The detail that can be achieved with this technic, however, is impossible to obtain by percutaneous angiography. Serial angiography, on the other hand, yields more information about the pathophysiologic changes. To assess the usefulness of present angiographic technics, we have evaluated the angiographic findings in 61 patients with histologically proved intestinal neoplastic or inflammatory lesions. These patients have been investigated at the Un...

Arterial Collaterals in the Liver Hilus

Abstract Arterial collaterals in the hilus of the liver may develop in a variety of clinical situations including neoplasm, atherosclerosis, operative ligation and other vascular stenoses, and cirrhosis. They are normally present but are not demonstrated angiographically unless they are functioning as collaterals. Hilar collaterals are an important factor in maintaining liver viability following accidental or purposeful hepatic arterial ligation. The authors base their discussion on personal experience with 16 cases.

Histamine Release by Contrast Media

The blood draining organs with a high histamine content was sampled and elevation of plasma histamine was found to result from injections of certain contrast media. All methylglucamine contrast media tested to date (acetrizoate, diatrizoate, and iodipamide) produced such elevations. Methylglucamine chloride also caused elevation of plasma histamine. Some “allergic” reactions to contrast media may be explained on this basis.

Angiography of Massive Hemorrhage Secondary to Pancreatic Disease

Twenty patients with massive abdominal hemorrhage related to chronic pancreatitis, pancreatic neoplasms and arteriovenous malformations were studied angiographically. Abdominal hemorrhage drained most frequently into the gastrointestinal tract, but also flowed through cutaneous drain sites and fistulas, intraperitoneally, into pseudocysts and once into a large pancreatic tumor. The most common angiographic observation in pancreatitis was pseudoaneurysm formation. Both patients with arteriovenous malformation had dilated, racemose feeding arteries and early dense filling of the draining veins. Three patients had pancreatic carcinoma and documented bleeding from gastroesophageal varices related to portal or splenic vein occlusion by the tumor. Five patients were treated by vasopressin infusion, balloon tamponade, or therapeutic embolization.

Angiographic Evaluation of Pancreatic Carcinoma

There is considerable divergence of opinion regarding the reliability of angiography in the evaluation of adenocarcinoma of the pancreas. The incidence of angiographic abnormalities in proved cases ranges from 90 per cent in a retrospective analysis by Lunderquist (1) to 29 per cent in a prospective analysis by Nebesar and Pollard (3). Ranniger and Saldino (4) reported positive findings in 58 per cent of cases. Moskowitz et al. (2) emphasized the difficulty in distinguishing the angiographic features of chronic pancreatitis from those of carcinoma. In view of these conflicting reports, we recently reviewed our own angiographic experience in pancreatic carcinoma. The results indicate that pancreatic angiography is reliable in the detection of pancreatic carcinoma, usually reliable in differentiating carcinoma from pancreatitis, and helpful in evaluating inoperability. Material and Methods Since 1964, 300 patients with suspected pancreatic carcinoma have had angiographic evaluation at The University of Mich...

Intra-Adrenal Hemorrhage as a Complication of Adrenal Venography in Primary Aldosteronism

In a recent article (5), we reported our experience with adrenal venography in 45 patients. At the present time, over 80 patients have been examined. Adrenal venography is proving to be safe and reliable except in primary aldosteronism, a condition in which we had expected it to be very helpful, On the contrary, in patients with primary aldosteronism the technic has some important limitations and hazards which constitute the basis of this report. Material Adrenal venography has been performed in 6 patients with primary aldosteronism. Both glands were examined in 3 and a single gland in 3, for a total of 9 venograms. Gross intra-adrenal extravasation of blood and contrast medium occurred bilaterally in one patient and unilaterally in two. In a fourth patient, minimal intra- and para-adrenal reaction, probably due to some venous rupture, was found at the time of surgery despite an apparently uncomplicated venogram. No apparent extravasation occurred in the other 2 patients. Thus, of 9 glands studied, gross ...

The Spectrum of Angiographic Findings in Hepatoma

The angiographic findings are presented in 5 patients with hepatoma. Three cases had the usual hypervascular angiographic appearance, but two were quite hypovascular. Such poorly vascularized hepatomas can probably not be differentiated from metastases or locally invasive carcinomas, such as cholangiocarcinoma and carcinoma of the pancreas.

Stenosis of the Celiac Artery

The celiac axis is commonly involved by generalized atherosclerosis and other vascular diseases. Derrick, Pollard, and Moore (3) found its diameter narrowed in 44 per cent of 110 unselected autopsy cases. In 21 per cent of these cases, moreover, the narrowing was more than 50 per cent. In spite of this high incidence of severe celiac stenosis, surprisingly little note is made of celiac occlusive disease by authors writing about abdominal angina. Since the pancreaticoduodenal arcades connect major branches of the celiac and superior mesenteric arteries, an evaluation of both vessels, as well as of the inferior mesenteric artery, is necessary in the investigation of intestinal vascular insufficiency. Several authors point out that two of these three major aortic visceral branches must be narrowed before symptoms of the syndrome appear (8, 10). When such is the case, the perfusion pressure distal to the stenoses is quite low, providing flow adequate to preserve the life, but not the function, of the intestin...

Accentuation of Celiac Compression by the Median Arcuate Ligament of the Diaphragm During Deep Expiration

Abstract In an attempt to demonstrate the cause of change in bruit with respiration, the author observed changes in the configuration of the celiac axis during deep inspiration and deep expiration lateral aortography of 12 patients. Three of the 12 had no bruits during quiet respiration, but in deep expiration a bruit occurred; compression by the median arcuate ligament of the diaphragm caused a notch on the cephalad surface of the celiac artery. A fourth patient had an epigastric bruit during quiet respiration; aortography showed approximately 80% stenosis of the celiac artery during inspiration and occlusion during expiration.