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David O Kessel

Publications and source records attributed to David O Kessel.

9 recordsLinked to original sources
PubMed2003

Hepatic artery pseudoaneurysm after liver transplantation: treatment with percutaneous thrombin injection.

Pseudoaneurysms of the hepatic artery are a rare complication of liver transplantation. Early diagnosis and treatment are essential to avoid life-threatening hemorrhage. Conventional treatment consists of surgical resection and vascular reconstruction or transarterial coil embolization. More recently, percutaneous thrombin injection has been successfully used in the treatment of femoral artery pseudoaneurysms. We describe a 70-year-old woman who had a hepatic artery pseudoaneurysm after orthotopic liver transplantation, which was successfully treated by percutaneous thrombin injection.

Administration, Cutaneous↗
PubMed2003

Renal stenting from the radial artery: a novel approach.

PURPOSE: To describe the technique and feasibility of renal artery angioplasty and stenting from the radial artery. METHODS: A series of 19 patients were evaluated for transradial renal artery intervention. Procedures were performed using carbon dioxide gas (CO2) as the preferred angiographic contrast agent. Intervention was performed through a 5 Fr radial artery sheath using low-profile balloons and balloon-expandable stents. RESULTS: Nineteen patients with 26 stenosed renal arteries were considered for treatment via the radial route. A negative Allen's test precluded radial puncture in two (11%). In one patient the descending aorta could not be catheterized. Stenting from the radial route was successful in 22 renal arteries in 16 patients. On an intention-to-treat basis 16 of the 19 (84%) were treatable from the radial route. In the 17 patients with radial access technical success was 94% (16 of 17) patients and 91% (21 of 23) of renal arteries. One patient experienced a cerebrovascular event during intervention. CONCLUSION: Transradial renal artery intervention is technically feasible using low-profile angioplasty balloons and stents. This route offers advantages in renal arteries with a caudal angulation and in patients with diseases or tortuous iliac arteries.

Aged↗
PubMed2002

Carbon-dioxide-guided vascular interventions: technique and pitfalls.

PURPOSE: To evaluate the usefulness of carbon dioxide (CO2) angiography to guide vascular interventions. METHODS: A prospective study was carried out of 50 procedures (angioplasty, stenting, stent-grafting and embolization) using CO2 angiography. Indications for using CO2 were renal impairment, cardiac failure, previous reaction to conventional iodinated contrast, or likelihood of needing high doses of conventional contrast. CO2 was intended to be the sole contrast agent. The use of additional conventional contrast or gadolinium was recorded, as were procedural complications. Radiation dose was compared with similar procedures using conventional contrast. RESULTS: Angiographic quality was satisfactory in 44 (88%) procedures and CO2 guidance was all that was required; in 6 (12%) cases adjunctive use of conventional contrast or gadolinium was necessary. Contrast doses were significantly reduced and there was a trend toward decreased radiation doses with CO2. There were two significant complications but only one related to the use of CO2. CONCLUSION: CO2 angiography is well tolerated and can be successfully used to guide even complex vascular interventions. High-risk patients can be spared the risks of conventional contrast agents.

Aged↗
PubMed2002

Type II endoleaks: predictable, preventable, and sometimes treatable?

OBJECTIVE: The purpose of this study was to evaluate the effect of preoperative coil embolization of lumbar and inferior mesenteric arteries on the incidence of type II endoleak after endovascular abdominal aortic aneurysm repair. METHODS: The subjects were consecutive patients who underwent EVAR between January 1996 and January 2001. Patent aortic side branches were identified with preprocedural spiral computed tomographic scanning and calibrated angiography. Coil embolization was performed before EVAR. Patients were followed up with plain radiographs and ultrasound and dual phase spiral computed tomographic scans. Digital subtraction angiography was performed when endoleak was suspected. The outcome measures were the incidence of type II endoleaks and changes in maximum aortic sac diameter (Dmax). RESULTS: Forty patients underwent EVAR, with a median duration of follow-up of 24 months (range, 3 to 48 months). Before surgery, the inferior mesenteric artery was patent in 16 patients (45%) and the lumbar arteries in 21 patients (53%). Inferior mesenteric artery embolization was successful in 13 of 16 patients (81%). Lumbar embolization was attempted in 13 patients and was successful in eight (62%). During EVAR, successful sac exclusion was achieved in 38 patients (95%). None of the patients who underwent embolization before EVAR had type II endoleak develop, eight of 13 patients (62%) with patent lumbar arteries had endoleaks develop (P =.006), and three of these patients subsequently underwent successful coil embolization. Type II endoleak was associated with a 2.0-mm median increase in Dmax (P =.045). A 3.0-mm median reduction in Dmax was seen in the absence of type II endoleak (P =.002). CONCLUSION: Type II endoleaks are predictable, preventable, and sometimes treatable. Significant sac shrinkage occurs in the absence of lumbar endoleak but not in the presence of type II endoleak.

Aged↗
PubMed2002

Persistent sciatic vessels, varicose veins, and lower limb hypertrophy: an unusual case or discrete clinical syndrome?

Persistent sciatic artery is a rare congenital anomaly with a high incidence rate of aneurysmal degeneration and risk of thromboembolization or rupture. Despite a number of recognized associations, the presence of coexistent venous anomalies is extremely rare. We present the case of a 27-year-old woman with atypical left-sided varicose veins and soft tissue hypertrophy. Imaging showed persistence of both sciatic artery and vein. Whether these anomalies are an incidental finding or represent a discrete clinical syndrome remains unclear. We emphasize that unusual distribution varicose veins may be associated with underlying persistent sciatic vessels and recommend formal duplex scan assessment for these anomalies.

Adult↗
PubMed2002

Routine chest radiography following imaging-guided placement of tunneled central lines: a waste of time, money, and radiation.

BACKGROUND: This study sought to evaluate routine chest radiography following placement of tunneled central lines using combined ultrasound and fluoroscopic guidance. MATERIALS AND METHODS: A prospective study of 150 consecutive patients who underwent placement of tunneled central lines in the vascular radiology suite. Ultrasound-guided vein puncture was performed with an 18-gauge needle in each case, and the access site was noted. Line position was confirmed by fluoroscopy. Following the procedure, 50 patients had both an on-table digital chest radiograph and a conventional chest radiograph. Subsequent patients had a digital radiograph and a fluoroscopic image grab. Final line tip position was scored, and complications were recorded. RESULTS: Line placement was optimal (95%) or acceptable (5%) in all patients. Line tip position could be satisfactorily evaluated on supine fluoroscopy. Mean fluoroscopic x-ray dose was 0.5 cGy/cm2. Digital chest x-ray dose was 9.0 cGy/cm2, and formal chest radiography dose was 12.0 cGy/cm2. The only complications were 2 carotid artery punctures without clinical sequelae. CONCLUSION: When lines are placed under imaging guidance with ultrasound to direct the venous puncture, complications are rare and are not likely to be clinically important. Conventional and digital chest radiographs do not contribute clinically relevant information but do add to the radiation dose, time, and expense of the procedure.

Journal Article↗