PubMed · 14299885
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K RANNIGER. 1965. ANGIOGRAPHY.. https://doi.org/10.1080/00325481.1965.11695541
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BACKGROUND: To evaluate the feasibility and safety of percutaneous implantation of a balloon-expandable valved stent in the inferior vena cava. MATERIAL/METHODS: A valve harvested from a bovine jugular vein, preserved in glutaraldehyde and mounted in a stent, was evaluated in animals. Six lambs, weighing 30 to 40 kg, were included in the study. Under general anesthesia, a valved stent with its 18-Fr delivery system was inserted through the right jugular vein, advanced, and delivered in the inferior vena cava. Hemodynamic and angiographic evaluations were performed prior to, immediately after, and two months after implantation. RESULTS: All valved stents were successfully implanted in the desired position. No early or late migration of the stent was noted in any animal. All valves were perfectly competent at the time of implantation. At 2 months, none of the valves were functional. The inferior vena cava was occluded at the site of valve insertion and collateral circulation was present in all animals. At autopsy, the valved stent was completely occluded. CONCLUSIONS: Valve implantation is feasible in the venous system through a percutaneous approach. The function of this valve in that position is limited by the absence of a high pressure gradient. Animal models and improvements in the device are mandatory before considering this technique as a reliable procedure to treat chronic venous insufficiency syndrome in humans.
UNLABELLED: We report the unusual case of a 2-month-old boy with systemic fibromuscular dysplasia (FMD). He presented with congenital renovascular hypertension due to stenosis of the right renal artery, and later developed renal infarction on the contralateral side resulting in renal failure. The boy subsequently died of intracranial haemorrhage at the age of 14 months. During the course, hemiconvulsion caused by a Moyamoya disease-like vascular lesion was noted. Stenotic lesions of both the abdominal aorta and its branches were also revealed by angiography. Post-mortem examination confirmed that the coronary, splenic and mesenteric arteries were also affected and their histological findings were compatible with FMD. To our knowledge, this is the first congenital case of FMD demonstrating a rapidly progressive course resulting in a fatal outcome. In this case, multivessels in both intracranial and extracranial arteries were involved. CONCLUSION: Our case suggests that the nature of fibromuscular dysplasia is congenital in origin and its aetiology, at least in some cases, is a systemic abnormality of vascular development.
In modern surgical and transplantation procedures the recognition of anatomic vascular abnormalities of the hepatic arteries is of greater importance than ever. The purpose of this study was to evaluate and classify these variations with respect to their impact on visceral surgery. A total of 604 selective celiac and superior mesenteric angiographies performed on patients with known or suspected liver cirrhosis or hepatic or pancreatic malignancies and on donors of partial liver grafts were analyzed retrospectively. The vascular anatomy of the liver was classified according to different established systems and with particular attention to rare variations. Hepatic arterial anatomy as considered normal in textbook descriptions was found in 79.1%, an aberrant or accessory left hepatic artery (LHA) arising from the left gastric artery in 3.0% and an aberrant or accessory right hepatic artery (RHA) branching off the superior mesenteric artery in 11.9% of the cases. In 1.4% of the cases there was a combination of anomalies of both the LHA and RHA. Variants of the celiac trunk, double hepatic arteries branching at the celiac trunk or hepatic arteries arising directly from the aorta, occurred in 4.1% of the cases. Further atypical branches of the LHA and RHA were found in 0.5% of the cases. Since the incidence and pattern of different types of hepatic arterial anatomy can require specialized preoperative diagnostic as well as intraoperative strategies, knowledge of these abnormalities and their frequency is of major importance for the surgeon as well as the radiologist.