Biomedical subjects
Publications and source records attributed to S Kadir.
The length of an arterial occlusion is one criterion for selection of patients for transluminal angioplasty. A technique is described to fully evaluate the length of a superficial femoral artery occlusion during diagnostic peripheral arteriography.
Renal angioplasty was attempted on 38 renal arteries in 34 patients and was technically successful in 84.2%. Twenty-four patients were followed for 1 to 36 months (mean 15.3 months). The hypertension was cured or improved in 18 (75%), unchanged in 2 and recurrent after an initial period of improvement in four. Six patients were not available for further evaluation as five had additional renovascular surgery and one was lost to followup. Four patients had major complications; loss of the kidney occurred in one patient (2.9%). Respiratory renal mobility, predilatation with tapered teflon catheters and the contralateral femoral approach were found to be important technical aids for successful renal artery angioplasty.
Intraarterial digital subtraction angiography (DSA) was performed in 133 diagnostic arteriographic procedures during a 10-month period. The increased contrast resolution of DSA permitted the use of a dilute (15%) contrast material. A significant reduction in contrast material dose compared with conventional film-screen arteriography and intravenous DSA was thus achieved. This was especially advantageous in patients with diminished renal function. The dilute contrast material also resulted in less patient discomfort. Subtracted images were available immediately on cathode ray tube display, resulting in faster procedures, and a considerable saving in film cost compared with conventional arteriography. It is concluded that intraarterial DSA is a useful technique that may replace conventional film-screen arteriography in many applications.
Chronic and acute unilateral iliac artery occlusions were successfully treated in 7 of 8 patients using low-dose intrathrombus streptokinase infusions ranging from 6 to 43 hours in combination with percutaneous transluminal angioplasty. Angioplasty of an underlying stenosis was performed as soon as clot lysis was maximal and an underlying stenosis was demonstrated. Long-term follow-up to date has been excellent. This approach to unilateral iliac occlusion appears to be safer than previously reported angioplasty of iliac artery occlusion.
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Intraarterial digital subtraction angiography (DSA) was used an an adjunct to interventional vascular procedures (embolotherapy and transluminal angioplasty) in 56 patients. The advantages of intraarterial DSA include improved contrast resolution, instantaneous subtraction capability, and immediate image availability. A considerable reduction in contrast dose and concentration, procedure time, and patient discomfort can be expected when interventional vascular procedures are performed with the assistance of intraarterial DSA.
A tailored approach for evaluating patients with peripheral vascular disease has been developed using intravenous digital subtraction angiography (IV DSA). This approach includes a history, physical examination, and correlation with Doppler pressure measurements to predict the location of the dominant lesion. In 60 patients, two views of the aortoiliac segment plus three or four views of the femoral and runoff circulation in the most symptomatic leg were obtained. Of the 60 patients, 36% had percutaneous transluminal angioplasty as a primary form of therapy, 32% were treated surgically, and 32% were followed clinically. Only 10% of these patients required further evaluation by conventional angiography. By omitting inpatient arteriography, considerable financial savings and increased patient comfort result.
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The mesoatrial shunt is the indicated treatment in the Budd-Chiari syndrome when the inferior vena cava is occluded and not usable for the standard portasystemic shunts. As the mesoatrial shunt courses from the abdomen into the right side of the chest, it passes posterior to the xiphoid and sternum and frequently is compressed at this point. A prosthesis modification is reported whereby an exterior silicone rubber cuff is bonded to the Dacron or Gortex graft at the point at which it passes posterior to the sternum. This obviates the possibility of graft compression and should increase long-term patency.
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Intraarterial digital subtraction angiography (IA DSA) was performed in 122 patients undergoing a variety of diagnostic and interventional angiographic procedures. Owing to the increased contrast resolution of DSA, diluted contrast material in concentrations of from 12-19% could be employed, thereby significantly reducing contrast material doses compared to doses used with conventional film-screen angiography or intravenous DSA. Patient discomfort was convincingly reduced due to the injection of dilute contrast material. Subtracted digital images could be viewed immediately on a cathode ray tube (CRT) resulting in faster procedures with less catheter time. Savings in film costs relative to conventional angiography were also achieved.
Preoperative embolization of highly vascular soft tissue tumors was performed in four patients. Selective catheterization of branch vessels supplying the tumors successfully avoided inadvertent embolization of adjacent normal tissue. Operative blood loss was significantly less than anticipated, permitting an easier, more precise, and quicker operation. Two of the lesions were benign intramuscular hemangiomas; one was a fibrosarcoma, and one, a malignant schwannoma. Three tumors were resected completely. A small portion of one hemangioma could not be removed. All patients were free of recurrence during follow-up periods of 6 to 14 months.
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Detachable silicone balloons were used for therapeutic renal artery embolization in 14 patients. Hematuria was controlled by occlusion of the arteriovenous fistulas in 6 patients and aneurysms in 3. The method was used for preoperative occlusion of the renal artery in 4 patients with renal cell carcinoma and for renal ablation in an attempt to cure hypertension in 1 additional patient. Detachable silicone balloons offer a safe and precise method for the occlusion of traumatic arteriovenous fistulas and aneurysms of the renal artery branches. Although balloon embolization also can be applied to the preoperative occlusion of renal neoplasms the conventional embolization techniques using absorbable gelatin sponge and coils are equally effective with less expense. No complications were observed in our 14 patients.
A series of 27 patients with complex biliary problems secondary to previous biliary operations is presented. The patients are divided into two groups: (1) patients with acute perioperative biliary problems; all had biliary leak with abscess, biliary cutaneous fistula, and/or stricture following cholecystectomy or common duct exploration and (2) patients with chronic postoperative biliary problems; all had previous repair of biliary stricture or injuries with late stricture formation. Early management of all patients included placement of a percutaneous biliary stent. Abscesses were drained operatively, and biliary leaks or fistulas were allowed to close spontaneously. Jaundice and cholangitis were allowed to resolve. Following stabilization, management of stricture, if present, was addressed. Eight acute patients had strictures, of which four were partial and three were dilated percutaneously. Four were complete and required operative repair. All 12 chronic patients had strictures, of which six were partial and successfully managed with percutaneous dilatation. Four patients also had common duct stones which were successfully crushed percutaneously. The authors conclude that percutaneous transhepatic drainage offers significant advantages in the early stabilization and treatment of patients with complex biliary problems, and that partial strictures of the biliary tree may be managed successfully by percutaneous dilatation.
Computed tomography (CT) was used to monitor the response to therapeutic embolization in two cases of giant cavernous hemangiomas of the liver. Base-line tumor volume and rat of enhancement were calculated. Therapeutic embolization with a detachable balloon or Ivalon microsphere plus a detachable balloon was then performed. CT was repeated to evaluate both change in tumor volume and in rate of enhancement ("fill-in") of the lesion. It was possible to document the response to embolization by changes in the size and the degree of enhancement of the lesions. Thus, CT can be used to document the success or failure of embolization of hepatic hemangiomas.
Clinical recurrence of varicocele developed in eight of 70 patients (11%) who underwent balloon occlusion of the internal spermatic vein (ISV) at the level of the third or fourth lumbar vertebra. Five patients also underwent venography for postoperative recurrence of varicocele. Recurrence was due to either collateral veins that bypassed the balloon occlusion or surgical ligation. The ISV was reconstituted in the pelvis of five of the eight patients following balloon occlusion, and in all patients following surgical ligation. Two patients who had recurrence after balloon embolization had clinically undetected right sided varicoceles. The technique of balloon occlusion of the spermatic vein should be modified: in most cases the balloon should be placed in the inguinal segment of the vein below the point where the collateral veins enter the ISV. The best site for balloon detachment can be determined by test occlusion and ISV venography to observe for blood flow within the collateral veins beyond the balloon. Venography is performed prior to detachment, and if the anatomy suggests a likely recurrence, the position of the balloon is shifted, which offers an advantage over other methods of treatment.
Postoperative aortic graft anastomotic stenoses at nine sites in eight patients were successfully treated with percutaneous transluminal angioplasty. There was a decrease in peak systolic pressure gradient in all eight patients, and in seven of the eight patients symptoms of claudication disappeared immediately after angioplasty. Four of the eight patients remained asymptomatic at follow-up. Ankle/arm indices were obtained before and after angioplasty in five patients, with postangioplasty improvement in all five.