L W Chespak | PubMed Health

PubMed1989

Multidisciplinary approach to complex endoscopic biliary intervention.

Endoscopy is frequently used to treat biliary abnormalities; however, controlling the catheter is difficult when tortuous structures or specific intrahepatic ducts must be negotiated. Intraductal manipulation with conventional angiographic guidance is difficult, and combined transhepatic approaches are painful, associated with risk, and cumbersome. The authors describe a multidisciplinary approach to complex endoscopic procedures in which the interventional radiologist controls catheter and guide wire placement. Of 344 procedures attempted over a 3-year period, 304 were accomplished with transendoscopic- or fluoroscopic-guided methods alone. Combined transhepatic procedures were performed in the other 40 cases. The success rate of endoscopic procedures and the number of conditions treatable with nonoperative interventional methods are increased with a multidisciplinary approach.

Catheterization↗

PubMed1989

Vena caval filter splaying: potential complication of use of the titanium Greenfield filter.

Significant structural and mechanical differences exist between the titanium and stainless steel versions of the Greenfield filter (GF). The titanium GF has a longer leg length (49 mm vs 43 mm), a greater span (38.5 mm vs 28.0 mm), and a larger hook angle (41 degrees vs 23.5 degrees). In vitro tests demonstrated approximately sevenfold greater filter length shortening (a measure of filter splaying) for the titanium GF in response to a given applied load. These differences resulted in marked filter splaying and inferior vena cava (IVC) perforation in three patients in whom a titanium GF had been inserted. The aorta was penetrated by a filter leg in one patient, and abdominal or back pain was present in all three patients. In vitro tests involving thrombosis within a latex balloon revealed that the titanium GF, but not the stainless steel GF, remained splayed even in the face of clot retraction. Design modifications, possibly using shorter, thicker filter legs and using reduced hook angles, should be made in the titanium GF to decrease the risk of filter splaying and IVC perforation before widespread use of this device.

Adult↗