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Biomedical subjects

M R Crain

Publications and source records attributed to M R Crain.

At least 19 recordsLinked to original sources
PubMed2001

Lessons learned in adopting endovascular techniques for treating abdominal aortic aneurysm.

HYPOTHESIS: Endovascular exclusion of abdominal aortic and common iliac aneurysms can be performed safely, and in the short term represents a feasible alternative to traditional, open aneurysm repair. PATIENTS AND METHODS: Forty-one patients were treated with endovascular grafts for 39 abdominal aortic and 2 common iliac artery aneurysms. RESULTS: All devices were successfully deployed. The size of the abdominal aortic aneurysms varied from 4.9 to 11.9 cm (average, 6.13 cm). The median procedure time was 195 minutes. There was one iliac artery rupture, which required celiotomy for repair. The hospital stay varied from 2 to 39 days (average, 6.7 days). The perioperative mortality rate was 2.4%. Sixteen patients (39%) had groin wound complications. Ten patients (24%) had evidence of contrast (endoleak) within the aneurysm sac on completion of the procedure. There were no obvious direct leaks from either the point of proximal or distal fixation. Seven of these endoleaks have resolved spontaneously. Two patients required additional procedures in the postoperative period to treat endoleak. The final patient has evidence of persistent endoleak on 3-month surveillance computed tomography scan. Major late problems occurred in 3 patients. CONCLUSION: Patients with large abdominal aortic aneurysms and considerable cardiac comorbidity can safely undergo endovascular aneurysm repair. Femoral groin wound complications resulting in prolonged hospitalization remain the major cause of perioperative morbidity. In contradistinction to open aneurysm repair, long-term surveillance is essential to detect migration of the device and identify flow within the residual aneurysm sac-complications that could lead to aneurysm rupture following endovascular repair.

Aged↗
PubMed1999

Endovascular therapy of iliac arteries: routine application of intraluminal stents does not improve clinical patency.

Our objective in this study was to review our experience with endovascular therapy of iliac artery occlusive disease over the past decade, and to compare the results of angioplasty alone with the addition of endovascular stents to these procedures. This report details a retrospective analysis of clinical data on 141 consecutive patients with iliac artery occlusive disease, treated by balloon angioplasty alone, or with the addition of intraluminal stents. The procedures analyzed included 58 common iliac artery interventions (26 angioplasties and 32 stent insertions) and 83 external iliac artery procedures (43 angioplasties and 40 stent insertions). Early and continued success, and their components, are reported and compared according to published standards. While endovascular therapy of iliac artery occlusive disease is effective in relieving symptoms, clinical patency rates are lower than those reported for direct reconstruction. Primary stent placement has not enhanced clinical patency in the iliac arteries, and the selective insertion of these devices for more complicated angioplasty procedures seems warranted.

Adult↗
PubMed1997

Impact of peripherally inserted central catheters on phlebitic complications of peripheral intravenous therapy in spinal cord injury patients.

We investigated the impact of peripherally inserted central catheter (PICC) placement in spinal cord injury patients at high risk for infusion phlebitis. The rate and etiology of phlebitis was investigated in two phases. During Phase I, peripheral IV cannulae and conventional central venous catheters (CVC) were used. During Phase II, patients identified to be at risk for phlebitis received PICCs. The number of peripheral IVs, CVCs and PICCs was tabulated for both phases of the study. Technical, infectious and thrombotic complications were studied prospectively for PICCs and retrospectively for CVCs. We found the rate of phlebitis was 16.5 percent and 2.4 percent for Phases I and II, respectively (p = 0.0002). Three infections occurred in 38 PICCs and one infection was documented in 13 conventional CVCs. The number of peripheral IVs and conventional CVCs was reduced significantly from Phase I to Phase II. No procedural complications, catheter sepsis or clinically apparent venous thrombosis occurred. In conclusion, PICCs reduced the rate of phlebitis thresholds with a low complication rate and reduced the use of peripheral IVs and conventional CVCs.

Catheterization, Central Venous↗
PubMed1996

Fibrin sleeve stripping for salvage of failing hemodialysis catheters: technique and initial results.

PURPOSE: To evaluate percutaneous fibrin sleeve stripping (PFSS) to prolong functional patency in failing hemodialysis catheters. MATERIALS AND METHODS: Forty PFSS procedures were performed in 24 catheters in 23 consecutive patients with an inadequate blood flow rate (< 200 mL/min) during hemodialysis. The fibrin sleeve was mechanically stripped off the shaft of the catheter with a snare introduced via the common femoral vein. Durability of PFSS was determined with life-table analysis. RESULTS: Median time from catheter placement to initial failure was 3.5 months (range, 5 days to 22 months). The technical success rate for PFSS was 100%; initial patency was restored in 39 of 40 procedures (98%), and no symptomatic pulmonary embolism occurred. Primary patency after single PFSS was 45% at 3 months and 28% at 6 months (median added patency, 2.8 months). Postprocedure secondary patency with multiple PFSS procedures was 83% at 3 months and 72% at 6 months (P = .01) (overall catheter patency, 90% at 6 months and 81% at 1 year [P < .001]). CONCLUSION: Multiple PFSS procedures can prolong patency in hemodialysis catheters with a fibrin sleeve.

Adult↗
PubMed1996

Interventional procedures in the intensive care unit patient.

Image-guided interventional techniques have markedly altered the management of many cardiothoracic problems in the intensive care unit. These techniques are less invasive, more patient friendly, and cost-effective. This article covers venous line placement and management, transpleural and transpulmonary biopsy and drainage procedures and interventions for variceal bleeding, massive hemoptysis, massive pulmonary embolism, and veno-occlusive disease.

Biopsy, Needle↗
PubMed1995

Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography.

OBJECTIVE: This study was designed to prospectively compare helical CT with pulmonary angiography in the detection of pulmonary embolism in patients with an unresolved clinical and scintigraphic diagnosis. SUBJECTS AND METHODS: Twenty patients with an unresolved suspicion of pulmonary embolism were evaluated with contrast-enhanced helical CT and with selective pulmonary angiography. An average of 11 hr separated the two studies. The CT scans were obtained during one 24-sec or two 12-sec breath-holds. CT scans were interpreted without knowledge of the results of scintigraphy or angiography. Selective pulmonary angiograms were obtained with knowledge of the findings on the ventilation/perfusion scan only. The sensitivity and specificity of CT were compared with those of angiography for central vessels (segmental and larger) only and for all vessels. RESULTS: Eleven of the 20 patients had proved pulmonary embolism (seven in central vessels and four in subsegmental vessels only). When only central vessels were analyzed, CT sensitivity was 86%, specificity was 92%, and the likelihood ratio was 10.7. However, when subsegmental vessels were included, CT results were 63%, 89%, and 5.7, respectively. CONCLUSION: In our subset of patients, helical CT was only 63% sensitive. Subsegmental emboli are difficult to diagnose. Pulmonary angiography remains the study of choice. CT has a limited role in the evaluation of acute pulmonary embolism.

Acute Disease↗
PubMed1991

MR evaluation of CNS tumors: dose comparison study with gadopentetate dimeglumine and gadoteridol.

In phase II and III trials of gadoteridol (Gd-HP-D03A), a new nonionic, low-osmolar contrast agent, 40 patients with intracranial neoplasms underwent magnetic resonance (MR) imaging with experimental doses of 0.05-0.3 mmol/kg. Fifteen patients also underwent contrast studies with the standard dose (0.1 mmol/kg) of gadopentetate dimeglumine. Both gadopentetate dimeglumine and gadoteridol appear to have a similar effect when given in equal doses (0.1 mmol/kg, n = 5). Lesion enhancement and delineation were better at higher experimental doses (0.2 or 0.3 mmol/kg, n = 7) and worse at a lower experimental dose (0.05 mmol/kg, n = 3). Quantitative analysis of 10 lesions examined with identical imaging protocols revealed a directly proportional relationship (r = .975) between lesion contrast ratio and dose over a range of 0.05-0.3 mmol/kg. Phantom experiments support the clinical results. Improved enhancement, detection, and delineation of central nervous system (CNS) neoplasms resulting from increased injected doses of gadoteridol have the potential to be clinically significant and may justify the possibly higher cost of increased contrast material dosage. Lower doses may not be adequate for the evaluation of most CNS tumors.

Adult↗
PubMedDate not supplied

Placement of the Palmaz stent with use of an 8-F introducer sheath and Olbert balloons.

PURPOSE: The authors describe a modified technique for delivering Palmaz 30-mm stents. MATERIALS AND METHODS: The modification is based on the use of an 8-mm Olbert balloon mounted on a 5.8-F shaft. The Palmaz stent is crimped onto the balloon by using finger pressure only. An 8-F introducer sheath can be used instead of a 10-F sheath. The surface material of the balloon prevents the stent from moving as it is introduced through the sheath and lesion. The balloon has a very small profile after deflation, which means it can be easily removed without dislodging the stent. The balloon can be used for placement of more than one stent. RESULTS: Nineteen Palmaz 30-mm stents have been placed with this method, and there have been no complications or difficulties related to this method. In one case, four stents were delivered by using the same balloon. CONCLUSION: This modification should reduce the complications of stent delivery, especially in small iliofemoral systems.

Arteries↗