Periaortitis complicating chronic aortic dissection.
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Adult↗
Biomedical subjects
Peter T Kennedy
Publications and source records attributed to Peter T Kennedy.
Diagnostic value of CT virtual intravascular endoscopy in aortic stent-grafting.
PURPOSE: To investigate the diagnostic value of postprocessing techniques for 3-dimensional (3D) computed tomography (CT), with emphasis on CT virtual intravascular endoscopy (VIE), in patients with abdominal aortic aneurysms (AAA) treated with suprarenal stent-grafts. METHODS: The preprocedural and postprocedural CT datasets from 47 AAA patients (40 men; mean age 75 years, range 61-87) undergoing aortic stent-grafting with suprarenal fixation were examined. The CT datasets were processed to create various 3D reconstructions: shaded surface display (SSD), maximum intensity projection (MIP), and VIE. Three independent radiologists assessed various diagnostic parameters for each 3D reconstruction method and compared them to axial CT images. RESULTS: Scores for VIE reconstructions were inferior to axial CT images in the visualization of normal arterial branches, measurement of the aneurysm diameter and neck length, as well as assessment of vessel patency and presence of endoleaks. VIE was rated superior to axial CT and other 3D imaging methods in visualizing the configuration of stent struts relative to the aortic branch ostia and the number of stent wires crossing the ostia in >80% of cases. CONCLUSIONS: VIE was not found to play a role in most preoperative situations compared to axial CT images. However, VIE provided additional postgrafting information on the 3D relationship of the suprarenal stent struts to the aortic branch ostia (in particular the renal and superior mesenteric arteries). VIE findings might aid clinicians in accurately assessing the effect of suprarenal stent-grafting on the renal arteries.
Aged↗
Image-guided 25-gauge needle biopsy for thoracic lesions: diagnostic feasibility and safety.
PURPOSE: To report our experience regarding the feasibility and safety of 25-gauge needles for biopsy of thoracic lesions. MATERIALS AND METHODS: Twenty-six patients with thoracic lesions, predominately pulmonary nodules, measuring 0.7-5.2 cm (mean, 1.6 cm) underwent biopsy with computed tomographic (n = 24), ultrasonographic (n = 1), or fluoroscopic (n = 1) guidance. Nineteen patients had severe chronic obstructive pulmonary disease (COPD), one had severe restrictive lung disease, and one had a coagulopathy; the other five patients had nonpulmonary primary tumors. Biopsy with an inner 25-gauge needle traversing an outer extrapleural coaxial cannula was performed in all patients. Cytologic quick staining was performed routinely to determine specimen adequacy and to establish a preliminary diagnosis. Complications, specimen adequacy, and need for larger specimens were evaluated. RESULTS: Adequate specimens (as determined by cytopathologists) were obtained in 24 (92%) of 26 patients, with a definitive diagnosis achieved in 23 (88%) patients during initial quick staining (17 malignant and six benign diagnoses). Two cases initially considered suspicious for malignancy were reclassified as benign (thymoma and histoplasmosis). At the request of cytopathologists, a larger needle was used to supplement the 25-gauge needle in six patients: In one patient, it provided further diagnostic information; in four, it did not; and in one, it confirmed non-Hodgkin lymphoma. Five patients developed a small pneumothorax (<10%) with use of the 25-gauge needle alone; one other patient, in whom larger needles were placed, received a radiologic chest catheter to evacuate the pneumothorax, thereby allowing the biopsy to continue. CONCLUSION: Image-guided 25-gauge needle biopsy is both feasible and safe.
Adult↗
Arterial reconstruction using the basilic vein from the zone of injury in pediatric supracondylar humeral fractures: a clinical and radiological series.
The authors describe the advantages of using the basilic vein as an arterial conduit in the management of children with supracondylar humeral fractures requiring vascular repair. Eight children, aged 3 to 10 years, presented with supracondylar humeral fractures and vascular injury. In all eight children, the arteries were successfully reconstructed with a reversed, interposition basilic vein graft harvested from the ipsilateral arm. The basilic vein was anatomically consistent with few side branches and was an excellent size match for the brachial artery. There were no postoperative thromboses. At a minimum follow-up of 1 year, all children had palpable radial pulses and the vein grafts were patent with no anastomotic or other focal stenoses. This series confirms the safety of using a donor vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. Benefits include a single surgical wound on the less conspicuous medial side of the arm, reduced operating time, and preservation of donor veins that may be subsequently required for the management of atherosclerotic disease.
Angiography↗
Transosseous access for decompression of an obstructed pelvic kidney.
We report a case of an obstructed pelvic kidney which was decompressed using a transosseous access route. The patient presented with obstructive uropathy and fever, necessitating decompression. Initial access was gained to the kidney by traversing the ilium, allowing subsequent retrograde placement of a double-J ureteric catheter.
Aged↗
Successful exclusion of a high internal carotid pseudoaneurysm using the Wallgraft endoprosthesis.
A 43-year-old woman presented with a several-month history of transient ischemic attacks 7 years following surgery for a malignant carotid body tumor. Angiography revealed a pseudoaneurysm at the distal vein graft anastomosis and a stenosis related to the proximal anastomosis. Due to the extensive previous surgery an endovascular approach was advocated and the pseudoaneurysm was successfully excluded using a covered stent (Wallgraft). This is, to our knowledge, the first time such an approach has been used following carotid body tumor excision.
Adult↗
The use of direct thrombin injection to treat a type II endoleak following endovascular repair of abdominal aortic aneurysm.
This report describes the use of thrombin to treat a type II endoleak which was causing continued abdominal aortic aneurysm expansion in a patient who had undergone endovascular repair. A small quantity of thrombin was injected into the leak by a percutaneous approach directly into the aneurysm sac using color doppler ultrasound. The procedure was successful and required only a few minutes to perform. We believe this procedure is an alternative to some of the more complex and technically challenging means of treating this lesion.
Administration, Cutaneous↗
Percutaneous ultrasound-guided thrombin injection of endoleaks.
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Aged↗
Assessment of VIE image quality using helical CT angiography: in vitro phantom study.
The aim of this study is to quantify the effects of helical CT acquisitions parameters on the magnitude of three-dimensional stair-step artefacts, visualization of renal ostium and morphologies of suprarenal stents observed using virtual intravascular endoscopy. This was performed in a phantom of the human abdominal aorta with a stent graft in situ. Stair-step artefacts were quantified by measuring the standard deviation of signal intensity on surface shaded images and the influence of these artefacts on the visualization of arterial ostia and stent morphologies were assessed by three radiologists. The methodology may be used to optimise the CT system performance for helical CT angiography in aortic stent grafting.
Angiography↗