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Biomedical subjects

K E Najarian

Publications and source records attributed to K E Najarian.

8 recordsLinked to original sources
PubMed2001

Nonsurgical treatment of acute iatrogenic renal artery injuries occurring after renal artery angioplasty and stenting.

OBJECTIVE: The objective of this study was to determine the success of the nonsurgical treatment of acute iatrogenic renal artery injuries that occur after renal artery angioplasty and stenting at a tertiary referral center. MATERIALS AND METHODS: During a 5-year period, 212 patients (308 renal arteries) underwent percutaneous transluminal angioplasty or stent dilatation of the renal artery. Through a retrospective review of medical and radiology records, we determined that 13 of these patients suffered iatrogenic renal artery injuries. RESULTS: The renal arterial complication rates were 4.2% per artery treated and 6.1% per patient treated. All 13 patients were successfully treated nonsurgically. Five patients with acute rupture of the renal artery were treated immediately with balloon tamponade or with placement of an additional stent or stent-graft. Six patients suffered acute thrombotic occlusion; five were successfully treated with thrombolysis, and one was successfully treated without thrombolysis by the placement of an additional stent. Presumed distal guidewire perforation caused subcapsular hematoma in one patient and a perirenal and pararenal hematoma in another; both were successfully treated with conservative management. During the clinical follow-up period (mean period, 19 months), one patient required long-term hemodialysis. No other patients required additional treatment. CONCLUSION: The nonsurgical treatment of acute iatrogenic renal artery injuries occurring after renal artery angioplasty and stenting can be successful and may obviate additional surgery.

Aged↗
PubMed2000

Transjugular intrahepatic portosystemic shunt for bleeding stomal varices associated with chronic portal vein occlusion: long-term angiographic, hemodynamic, and clinical follow-up.

The efficacy of the transjugular intrahepatic portosystemic shunt procedure (TIPS) in controlling refractory hemorrhage from stomal varices at the mucocutaneous junction has been previously described, but the durability of this procedure for this indication is unknown. Conservative therapy may be unsuccessful in preventing recurrent hemorrhage. Some authors believe that portosystemic shunting is the treatment of choice for patients with bleeding stomal varices who are good surgical candidates, because of the low incidence of recurrent bleeding and the longest survival. We report the 39-month angiographic and hemodynamic follow-up, and the 48-month clinical follow-up of a patient with refractory hemorrhage from stomal varices and coexistent chronic portal vein occlusion successfully treated with a TIPS procedure.

Aged↗
PubMed1998

Five-year follow-up of prophylactic vena cava filters in high-risk trauma patients.

OBJECTIVE: To assess the short- and long-term outcomes of vena cava filter (VCF) placement for prophylaxis against pulmonary embolism in patients at high risk due to trauma. DESIGN AND SETTING: Case series at a level I trauma center. PATIENTS: Patients were considered for prophylactic VCF placement if they met 1 of the injury criteria--spinal cord injuries with neurologic deficit, severe fractures of the pelvis or long bone (or both), and severe head injury--and had a contraindication to anticoagulation. INTERVENTION: Vena cava filters were placed percutaneously by the interventional radiologists when the acute trauma condition was stabilized following admission. MAIN OUTCOME MEASURES: Filter tilt of 14 degrees or more, strut malposition, insertion-related deep vein thrombosis, pulmonary embolism, or inferior vena cava patency. RESULTS: There were 132 prophylactic VCFs placed. A 3.1% rate of insertion-related deep vein thrombosis occurred, all of which were asymptomatic. Filter tilt occurred in 5.5% of patients and strut malposition in 38%. Three cases of pulmonary embolism (1 fatal) occurred in a prophylactic VCF, and all patients had either filter tilt or strut malposition. The risk of pulmonary embolism developing was higher in those patients with filter tilt or strut malposition than in those who did not have these complications (6.3% vs 0%; P=.05; Fisher exact test). The 1-, 2-, and 3-year inferior vena cava patency rates (+/-SD) were 97%+/-3%. CONCLUSIONS: Prophylactic VCF can be placed safely with an acceptable rate of insertion-related deep vein thrombosis and long-term inferior vena cava patency. Patients with prophylactic VCF remain at risk for pulmonary embolism if the filter is tilted 14 degrees or more or has strut malposition. In such patients, consideration should be given to placing a second filter.

Adult↗
PubMed1998

Arterial embolization in the chest.

Transcatheter therapy is an effective technique in the treatment of vascular abnormalities in the chest. Pulmonary arteriovenous malformations, associated with the clinical sequellae of dyspnea, stroke, brain abscess, and hemoptysis, can be treated by transcatheter embolization with metallic coils or occlusion balloons. The results of treatment are excellent, with improvement seen in symptoms and physiologic parameters. The bronchial arteries and systemic nonbronchial collateral arteries supplying the tracheobronchial tree are most frequently involved in massive hemoptysis, a serious disorder with associated high rates of morbidity and mortality. Transcatheter embolization of these arteries is both safe and effective, requiring a thorough understanding of the arterial anatomy and technique of embolization.

Angiography↗
PubMed1986

New observations in the sonographic evaluation of intrauterine contraceptive devices.

The in vitro sonographic appearance of the four currently available intrauterine contraceptive devices (IUDs) now used in the United States and Canada were analyzed and compared with in vivo scans. While plastic IUD limbs demonstrated entrance-exit echoes in all scan planes, copper IUDs showed posterior reverberation when optimal gain settings were used. Regardless of the transducer used, posterior acoustic shadowing was only seen when IUD limbs were scanned perpendicular to their long axis and at the junction of long and short limbs. The authors feel that these refined ultrasound characteristics will be helpful in accurately identifying IUDs within the uterus.

Equipment Design↗