PURPOSE: The Günther basket inferior vena cava filter (GBF) has been withdrawn from the market because of its mechanical instability, but a number of patients still live with the device. METHODS: In a two-center study, we evaluated the long-term follow-up of the GBF, based on clinical data in 78 patients, and on imaging studies including plain radiographs, Doppler ultrasound, angiography, or computed tomography (CT) in 50 patients. RESULTS: In a mean period of 3 years, pulmonary embolism was diagnosed in five patients (6.4%), with an overall rate of 0.02 embolic episodes per patient per year. None of these patients required hospitalization, and there were no deaths due to pulmonary embolism. Inferior vena cava thrombosis was documented in three patients (3.9%), and occlusive venous thrombosis at the access site in seven patients (9%). Spontaneous migration was documented in 43% of the examined filters and spontaneous disruption in 77%. Dislocated filter fragments were localized by CT in the adjacent retroperitoneum in 11%, in the aortic lumen in 2%, and in a peripheral pulmonary artery in 7%. None of the patients had symptoms attributable to filter migration or disruption. CONCLUSION: Our results indicate that the rate of clinically relevant complications with the GBF is no higher than with other vena cava filters. Because mechanical instability of the GBF had no clinical consequences, we conclude that patients who live with this device may be observed and treated in a manner similar to patients with other vena cava filters.

Adolescent↗

PubMedDate not supplied

Comparison of percutaneous and endoscopic retrograde removal of postoperatively retained bile duct stones.

Forty-one patients underwent nonsurgical removal of postoperatively retained bile duct stones in two nonrandomized groups. The endoscopic-retrograde technique was used in 21 patients, and succeeded in 19. The percutaneous approach through the T-tube tract was used in 22 patients, including the two in whom endoscopic stone removal had failed, and was successful in 21 patients. Individual preferences and prior history introduced a selection bias against the percutaneous technique. Auxiliary extracorporeal shockwave lithotripsy (ESWL) was used in 2 patients whose stones could not be fragmented mechanically by the percutaneous basket technique. ESWL was successful in one patient but failed in the second. Because endoscopy had also failed in this case, the patient subsequently underwent repeat surgery. Procedure-related complications were minor with both techniques and were readily treated by conservative measures. We conclude that both the retrograde and the percutaneous approaches are effective and safe. The endoscopic approach appears convenient because there is no need to await maturation of the percutaneous tract, but sphincterotomy carries a small but distinctive risk. Because the percutaneous approach uses an existing tract, is only minimally invasive and leaves the sphincter of Oddi intact, it is preferable in those patients who have T-tubes of appropriate size and position in place.

Adult↗

PubMedDate not supplied

Successful treatment of a ruptured mycotic aneurysm of the ileocolic artery with transcatheter embolization and antibiotic therapy.

We report a case of mycotic aneurysm of the ileocolic artery due to Streptococcus bovis endocarditis and acute septicemia complicated by active hemorrhage, that was treated successfully with transcatheter embolization and subsequent intravenous antibiotic treatment. This case suggests that a mycotic aneurysm can be treated successfully by percutaneous embolization in an emergent situation (active bleeding, septicemia) even without previous antibiotic therapy.

Aneurysm, Infected↗

PubMedDate not supplied

Specificity of SPIO particles for characterization of liver hemangiomas using MRI.

We investigated the specificity of superparamagnetic iron oxide (SPIO)-enhanced T1-weighted spin-echo (SE) magnetic resonance (MR) images for the characterization of liver hemangiomas. When imaging liver hemangiomas, which are the most frequent benign liver tumors, a method with very high specificity is required, which will obviate other studies, follow-up, or invasive diagnostic procedures such as percutaneous biopsy. Eighty-three lesions were examined by MR imaging at 1.5 T before and after intravenous injection of SPIO particles. Lesions were categorized as follows according to the final diagnosis: 37 hemangiomas, nine focal nodular hyperplasias (FNHs), 19 hepatocellular carcinomas (HCCs), and 18 metastases. Their signal intensity values were normalized to muscle and compared. The only lesions showing a significant increase in signal intensity ratio (lesion to muscle) on postcontrast T1-weighted SE images were hemangiomas (p < 0.001). The signal intensity ratio of hemangiomas increased on average by 70%. Based on receiver operating characteristic analysis and using a cutoff level of 50% signal increase, the specificity and sensitivity of SPIO-enhanced MR imaging for the characterization of hemangiomas would be 100% and 70%, respectively. The T1 effect of SPIO particles can help differentiate hemangiomas from other focal liver lesions such as FNHs, HCCs, and metastases and may obviate biopsy. When using SPIO particles for liver imaging, it is useful to add a T1-weighted sequence to T2-weighted images, thereby providing additional information for lesion characterization.

Adult↗

PubMedDate not supplied

Treatment of gastrointestinal hemorrhage.

BACKGROUND: We assessed the value of selective arteriography in the diagnosis and management of acute gastrointestinal hemorrhage. METHODS: We reviewed the records of 107 consecutive patients who had gastrointestinal hemorrhage and underwent selective arteriography between January 1992 and October 2003: 10 had upper gastrointestinal bleeding, 79 had lower gastrointestinal bleeding, and 18 had varicose bleeding with portal hypertension. Selective embolization was attempted in 15 patients to obtain hemostasis. Angiographic findings were reviewed and prospective reports were compared with the final diagnosis and outcome. RESULTS: Of 129 angiographic studies, 36 correctly revealed the bleeding site and 93 were negative. Extravasation was seen in 24 cases at the level of stomach (n = 2), duodenum (n = 1), small bowel (n = 5), or colon (n = 16). Indirect signs of bleeding sources were identified in 12 patients (stomach in one, small bowel in four, large bowel in four, liver in three). Transcatheter embolization induced definitive hemostasis in 11 of 15 patients (73%), namely in the stomach (n = 2), small bowel (n = 3), colon (n = 7), and liver (n = 3). Three patients required surgery after embolization. CONCLUSION: Abdominal arteriography may localize gastrointestinal bleeding sources in approximately one-third of cases. Selective embolization may provide definitive hemostasis in most instances.

Adolescent↗

PubMedDate not supplied

Ablation of hepatocellular carcinoma by percutaneous ethanol injection: imaging findings.

Since PEI is a treatment based on imaging techniques, the radiologist should be familiar with the various findings that may be observed after PEI on US, CT, and MR images immediately after treatment and during later follow-up. Although US is well suited for performing PEI, contrast-enhanced CT currently is the most commonly used imaging method to evaluate the effect of PEI. Residual, nodular areas of contrast enhancement correlate well with residual tumor and warrant additional treatment. Although the findings on MR images obtained after PEI are more complex, MR imaging may be used as an alternative to CT.

Antineoplastic Agents↗

PubMedDate not supplied

Percutaneous palliation of malignant obstructive jaundice with the Wallstent endoprosthesis: follow-up and reintervention in patients with hilar and non-hilar obstruction.

PURPOSE: The authors analyzed the follow-up data of 58 patients with malignant obstructive jaundice who underwent percutaneous palliative treatment with Wallstents over a 4-year period. PATIENTS AND METHODS: Thirty-nine patients had obstruction at the hilar level, and 19 patients had common bile duct obstruction without hilar involvement. Stent patency and survival were calculated with the Kaplan-Meier method. RESULTS: Early complications occurred in 14 patients (24%) and were managed conservatively. There were two procedure-related deaths (3.4%) due to sepsis and pancreatitis, and the overall 30-day mortality was 14%. Forty-eight patients have died, nine patients are surviving (average, 11 months), and one patient was lost to follow-up. Forty-four patients (77%) experienced relief of their initial symptoms, with bilirubin levels returning to normal in 63%. The 12-month patency rate of the endoprostheses was 46% in patients with hilar obstruction and 89% in patients with non-hilar obstruction (P = .029). Late biliary complications were documented in 20 patients (35%). Thirteen patients with hilar obstruction and two patients with common duct obstruction required at least one reintervention; stent patency was restored in all patients but one. The overall 6-month survival rate was 50%, and the 12-month survival rate, 36%; no significant difference was found between patients with hilar and non-hilar obstruction. CONCLUSION: The long-term patency of the Wallstent endoprosthesis was excellent if common duct obstruction was treated but was significantly lower in the presence of hilar involvement. Use of the Wallstent did not result in a lower complication rate compared with the reported results of plastic endoprostheses. Reinterventions to restore stent patency were successful in almost all cases. The survival of patients with hilar and with non-hilar obstruction was similar.

Adult↗

PubMedDate not supplied

CT evaluation of patients undergoing transhiatal esophagectomy for cancer.

Preoperative CT of 50 patients undergoing transhiatal esophagectomy for esophageal carcinoma was reviewed and compared with the surgical and histopathologic findings. Computed tomography was highly accurate in identifying those cases in which blunt esophagectomy was impossible owing to involvement of the airways or the aorta by the tumor. Preoperative detection of such involvement is important, because tumors of the upper thoracic esophagus are poorly visualized at transhiatal esophagectomy, and sharp or forced blunt dissection may result in accidental laceration of the trachea, mainstem bronchi, or aorta. In contrast, CT was of little value for guiding surgical management of tumors located in the middle thoracic and lower esophagus. Using the staging criteria of the International Union Against Cancer (UICC), the staging accuracy of CT was limited by its low sensitivity in detecting abdominal lymph node metastases.

Adenocarcinoma↗