Logistics of a university interventional radiology practice.
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Connecticut↗
Biomedical subjects
D F Denny
Publications and source records attributed to D F Denny.
Intraluminal stents in atherosclerotic iliac artery stenosis: preliminary report of a multicenter study.
Fifteen patients with symptomatic iliac artery stenosis were treated with intraluminal placement of balloon-expandable stents. Before treatment, 14 patients had intermittent claudication, and one had a limb at risk for amputation. One patient had diabetes mellitus, nine had hypertension, and all were long-term smokers. Two patients had surgical placement of the stent; in one patient this was part of a combined revascularization procedure. All other stents were placed percutaneously. The transstenotic gradient after injection of vasodilating drugs distal to the lesion decreased from a mean of 32.3 mm Hg +/- 16.7 to 3.1 mm Hg +/- 4.2 after stent placement. Ankle-arm Doppler systolic pressure index increased from a mean of 0.68 +/- 0.22 to 0.96 +/- 0.24 after the procedure. The treatment eliminated intermittent claudication in 14 patients and increased exercise tolerance to 500 m in the patient with a limb at risk for amputation before the procedure. The improved condition persisted in all patients during the follow-up of 6-12 months. Stent placement may be a valuable adjunct in the management of iliac artery disease.
Angiography↗
Greenfield filter: percutaneous placement in 50 patients.
Greenfield filters for prevention of pulmonary emboli may be placed in the inferior vena cava by surgical cutdown or by percutaneous insertion through the femoral or jugular veins. We evaluated the use of the percutaneous techniques 52 times in 50 patients. The right femoral vein was used in 37 of the procedures, the right internal jugular vein in 12, and the left femoral vein in three. Twenty-two patients had altered coagulation factors: 11 were receiving heparin, four were receiving warfarin sodium, six had hepatic cirrhosis, and one had disseminated intravascular coagulation and had been receiving warfarin sodium. Filter placement was successful in 51 of 52 procedures. In the unsuccessful case, placement was attempted via the left femoral vein; the carrier could not be advanced from the common iliac vein to the inferior vena cava. This patient required surgical occlusion of the cava. There was one major complication, a hematoma in the right side of the groin that required transfusion. This occurred in the patient with disseminated intravascular coagulation who had extensive scarring from multiple previous vascular surgical procedures. Two patients required second filters because of severe angulation of the filter found 1 and 4 days after implantation. Clinical thrombosis of the femoral vein after femoral vein access occurred in two (5%) of 40 patients and was proved by venogram in one. Our experience shows that the percutaneous method is highly successful and suggests that this technique should be the primary method for filter placement in the inferior vena cava.
Adult↗
Traumatic aortic rupture: false-positive aortographic diagnosis due to atypical ductus diverticulum.
The interpretations of 314 thoracic aortograms obtained over a 4 1/2-year period for possible traumatic rupture were reviewed to determine the frequency and causes of false-positive examinations. The radiographs and clinical records of all patients whose aortograms were abnormal or equivocal were examined. Two hundred consecutive thoracic aortograms that had been interpreted as normal were reviewed to determine the frequency and character of normal morphologic variations at the aortic isthmus, with particular attention to ductus diverticula, in an attempt to identify means of reducing the number of examinations that were equivocal or false-positive for aortic rupture. Aortic rupture was diagnosed with confidence in 12 patients (4%), and all were surgically proved. Another nine aortograms (3%) were equivocal when standard aortographic criteria for rupture were used. For four of the nine, further imaging studies indicated normal aortas, but five patients underwent thoracotomy. Two of these had aortic rupture, two had ductus diverticula, and one had an ulcerated plaque at the site of aortographic abnormality. Thus, false-positive aortograms led to unnecessary surgery in three cases--1% of all 314 aortograms and 14% of the 21 aortograms that were not clearly normal. In summary, two (14%) of 14 aortic ruptures in our series could not be distinguished at aortography from anatomic variants or disease not requiring surgery. To avoid false-negative diagnosis, we must accept occasional false-positive diagnoses, necessitating exploratory thoracotomy with its attendant risks.
Adolescent↗
Obstetric and nonmalignant gynecologic bleeding: treatment with angiographic embolization.
Eight patients (seven post partum, one post abortion) with massive pelvic hemorrhage related to pregnancy and one patient with uncontrollable bleeding following a cervical biopsy underwent angiography to facilitate the identification and treatment of bleeding sites. In all nine patients pelvic hemorrhage was successfully controlled with embolization under angiographic guidance. Angiographic embolization allowed preservation of the uterus in six patients referred prior to hysterectomy, and one patient subsequently became pregnant. When conservative measures and minor surgical repairs have failed, embolization should be the next step in the treatment of postpartum hemorrhage to avoid major surgery in an unstable patient and to maintain reproductive function.
Acute Disease↗
Occult pulmonary embolism: a common occurrence in deep venous thrombosis.
Ventilation-perfusion scans were used in a prospective study to determine the prevalence of occult pulmonary embolus in proven deep venous thrombosis. Fifty-eight patients without symptoms of pulmonary embolism, but with venographically proven deep venous thrombosis, were subjected to chest radiographs, 99mTc macroaggregated-albumin perfusion scans, and 133Xe ventilation scans. Of the 49 patients with deep venous thrombosis proximal to the calf veins, 17 (35%) had high-probability scans. Of all 58 patients, only 12 (21%) had normal scans. When the study population was compared with a group of 430 patients described in reports of pulmonary perfusion in asymptomatic persons, a significantly higher percentage of high-probability scans was found in the study population with deep venous thrombosis. Baseline ventilation-perfusion lung scanning is valuable for patients with proven above-knee deep venous thrombosis.
Adolescent↗
Translumbar inferior vena cava Hickman catheter placement for total parenteral nutrition.
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Catheterization↗
Liver transplant rejection arteritis: serial hepatic arteriography.
Two liver transplant recipients underwent serial hepatic arteriography, demonstrating a severe, rapidly progressive arteritis involving the hilar hepatic arteries. Liver biopsies in these patients demonstrated ischemic necrosis as a prominent feature. The angiographic appearance and therapeutic implications of liver transplant rejection arteritis are presented.
Arteritis↗
Percutaneous retrieval of an unusually large, nonopaque intravascular foreign body.
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Foreign Bodies↗
Comparison of the response of the renal blood supply to acetylcholine and to a calcium channel blocking agent, diltiazem, in the dog.
Several vasodilators, including acetylcholine, are capable of inducing maximal renal vasodilatation when infused into the renal artery. Despite substantial interest in the renal vascular response to calcium channel blocking agents, there has been no systematic comparison of any of these agents to an index vasodilator, such as acetylcholine. We compared the renal vascular angiographic response to acetylcholine and diltiazem, infused into the renal artery in graded dosage, in 14 dogs. In eight of the dogs renal blood flow was measured with an electromagnetic flowmeter. At peak, the acetylcholine-induced increase in renal blood flow (155 +/- 25 to 309 +/- 55 ml/min) slightly exceeded that induced by diltiazem (143 +/- 13 to 257 +/- 58 ml/min). A close correlation was found between the maximal blood flow increase induced by acetylcholine and by diltiazem (R = .95). Dilatation of the intrarenal arterial tree evident on the renal arteriogram was substantially less striking with diltiazem than with acetylcholine in these eight dogs. To ascertain the possible contributing role of the surgery required for blood flow measurement, the two agents were assessed in six additional dogs without blood flow measurement. In these six dogs diltiazem and acetylcholine induced essentially identical degrees of renal arterial vasodilatation. It is concluded that diltiazem, the calcium channel blocking agent, produces near maximal renal vasodilatation at the arteriolar level and that responses of more proximal elements of the renal arterial tree, visible during renal arteriography, are sensitive to the conditions of the experiment.
Acetylcholine↗
Retroperitoneal hemorrhage after percutaneous nephrostomy.
Sixty-two kidneys in 57 patients were studied by computed tomography (CT) after percutaneous nephrostomy. Clinically unsuspected retroperitoneal hematomas were detected in eight kidneys (13%). In eight other patients, extrarenal collections of contrast material were noted. In none of the cases was a large hematoma seen or surgical intervention required.
Adult↗
Percutaneous Kimray-Greenfield filter placement by femoral vein puncture.
Percutaneous placement of the Kimray-Greenfield vena cava filter was successfully performed in 12 consecutive patients, 10 from the right femoral vein, one from the left femoral vein, and one from the right internal jugular vein. Tract dilatation to allow placement of a 24-French sheath was easily performed and well tolerated. There was no occurrence of puncture site hematoma, significant blood loss, or postprocedural femoral vein thrombophlebitis. Percutaneous femoral vein approach is as effective as right internal jugular vein approach. The dependence on surgically obtained access for Kimray-Greenfield filter placement is no longer absolute.
Femoral Vein↗
Percutaneous inferior vena cava cannulation for long-term parenteral nutrition.
Thrombosis of the superior vena cava and its contributory veins from previous parenteral nutrition catheters precluded this approach for a new Hickman catheter in a patient with short-gut syndrome. Percutaneous puncture of the inferior vena cava with subcutaneous tunneling of the catheter to the anterior chest wall provided good access to the central venous circulation for long-term parenteral nutrition.
Catheterization↗
Percutaneous recanalization of an occluded renal artery and delayed ethanol ablation of the kidney resulting in control of hypertension.
An elderly woman presented with severe hypertension related to a renin producing kidney supplied only by collaterals. Recanalization of the artery to this kidney leads to incomplete blood pressure control. Subsequently, percutaneous, selective ethanol infusion ablated the kidney and lead to good control. This two-step approach allowed both evaluation of function and definitive, non-surgical therapy.
Aged↗
Management of large high-flow arteriovenous malformations of the shoulder and upper extremity with transcatheter embolotherapy.
PURPOSE: To evaluate the efficacy of transcatheter embolization of arteriovenous malformations (AVMs) of the shoulder and upper extremity. PATIENTS AND METHODS: Four men with large AVMs of the shoulder and upper extremity were treated with transcatheter arterial embolization. Symptoms included high cardiac output, pain, paresthesias, and disfigurement. Each patient underwent multiple sessions of embolotherapy. RESULTS: In two patients there was no decrease in cardiac output. In three patients, no permanent decrease in AVM size or resolution of pain was achieved. Two patients experienced postembolization skin necrosis, and one experienced permanent radial neuropathy. CONCLUSIONS: Large, high-flow AVMs in the shoulder and upper extremity may be relatively refractory to intravascular treatment because of the diffuse involvement of the soft tissues by the AVM and the lack of a well-defined nidus. Transcatheter embolotherapy in these lesions should be reserved for patients undergoing resection to help decrease intraoperative bleeding.
Adult↗