[Intravascular echography].
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Biomedical subjects
Publications and source records attributed to J A Reekers.
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Four patients with a solitary arteriovenous fistula were treated by transvascular balloon embolization technique, which resulted in complete fistula closure in three patients and partial closure in one. There were two vertebral arteriovenous fistulas, one peroneal arteriovenous fistula, and one radial arteriovenous fistula. The first two fistulas were spontaneous, the other two were traumatic. The only partial occlusion of the peroneal fistula was, in our opinion, due to a technical failure, the balloon was inflated slightly proximal to the fistular orificium instead of in the orificium itself. There were no complications, and there was no morbidity. In our opinion transvascular balloon embolization technique is the treatment of choice for solitary arteriovenous fistulas.
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A patient is described with nontraumatic subcapsular haematomas of both kidneys, complicated by severe retroperitoneal bleeding. A diagnosis of polyarteritis nodosa was reached using renal angiography. Bilateral nephrectomy had to be performed because of uncontrollable renal bleeding. A review of the literature on this complication of polyarteritis nodosa is given.
Two patients are presented with an occlusion of the infrarenal vena cava caused by a vena cava aneurysm. This rare congenital vena caval anomaly may mimic retroperitoneal lymphadenopathy, especially on CT- imaging without contrast enhancement.
Two cases are described in which a tortuous pulmonary density, suspicious of vascular anomaly, was studied using venous digital subtraction angiography. One proved to be a pulmonary varix, the other an A-V fistula. The establishment of the diagnosis of such lesions is discussed and the value of D.S.A. is emphasized in comparison with conventional pulmonary angiography by right heart catheterization.
Perforation is the most important complication of laser angioplasty and leads to a decrease in success because the procedure has to be discontinued. In 3 patients we continued despite perforation and were able to stop extravasation with percutaneous transluminal angioplasty (PTA) and to finish the procedure with a good final result. From our experience we conclude that laser perforation is not an absolute indication to stop the procedure if PTA in the recanalized lumen is possible.