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Rozenblit Q, Lebovics E, Savino JA, Rundback JH, Bashir S. Observation on intrarenal and intraperitoneal pressures in patients with tense ascites: Feasibility of unassisted ascites drainage into the urinary system. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709709152831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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2
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Poplausky MR, Rozenblit G, Rundback JH, Crea G, Maddineni S, Leonardo R. Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm formation: three case reports and a review of the literature. Chest 2001; 120:2105-11. [PMID: 11742949 DOI: 10.1378/chest.120.6.2105] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The use of Swan-Ganz catheters has increased tremendously since they were first introduced in 1970. Their ability to give vital hemodynamic measurements in critically ill patients makes their use invaluable when providing quality medical care. The formation of pulmonary artery (PA) pseudoaneurysm from a Swan-Ganz catheter-induced perforation of the PA is a rare but potentially fatal complication of Swan-Ganz catheter use. Three case presentations and a review of the literature are presented.
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Affiliation(s)
- M R Poplausky
- Department of Radiology, New York Medical College, Westchester Medical Center, Valhalla, NY 10595, USA.
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3
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Kandarpa K, Becker GJ, Hunink MG, McNamara TO, Rundback JH, Trost DW, Sos TA, Poplausky MR, Semba CP, Landow WJ. Transcatheter interventions for the treatment of peripheral atherosclerotic lesions: part I. J Vasc Interv Radiol 2001; 12:683-95. [PMID: 11389219 DOI: 10.1016/s1051-0443(07)61438-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Transcatheter endovascular procedures are increasingly used to treat symptomatic peripheral atherosclerosis. This two-part review identifies the existing evidence supportive of the application of transcatheter treatments for peripheral atherosclerotic lesions. The first part addresses the treatment of obstructive lesions that cause limb claudication and critical ischemia, renovascular hypertension and azotemia, and mesenteric ischemia. Studies were identified via a search of MEDLINE (January 1993 through April 1999) and reference lists of identified articles. When multicenter prospective randomized trials or other high-quality studies were unavailable, a preference was given to studies with at least 50 patients per treated group and a minimum mean follow-up duration of 6 months. Data presented in tables are proportionally weighted averages from included studies. For each application, the authors assessed the quality of evidence (QOE; efficacy, safety, and, where available, cost-effectiveness) and made recommendations with appropriate caveats. There is higher QOE supporting the more established treatments such as lower limb percutaneous transluminal angioplasty (PTA) with stent placement and thrombolysis. Treatments such as renal artery PTA and stent placement and mesenteric and brachiocephalic PTA are in wide use, but high QOE supporting general application is lacking. Blanket recommendations based on established efficacy and cost-effectiveness cannot be made. However, the use of transcatheter therapies can be supported in specific circumstances based on an expected reduction in procedure-related morbidity and/or mortality rates. It is hoped that the identification of deficiencies in the literature will inform and inspire critically needed research in this area.
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Affiliation(s)
- K Kandarpa
- Department of Radiology, Weill Medical College, Cornell University, New York, USA.
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4
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Affiliation(s)
- J H Rundback
- Departments of Radiology and Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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5
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Rundback JH, Rizvi A, Rozenblit GN, Poplausky M, Maddineni S, Crea G, Agrawal U, Olson C, Matalon TA. Percutaneous stent-graft management of renal artery aneurysms. J Vasc Interv Radiol 2000; 11:1189-93. [PMID: 11041477 DOI: 10.1016/s1051-0443(07)61362-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- J H Rundback
- Division of Vascular and Interventional Radiology, New York Medical College, Westchester Medical Center, Valhalla, USA.
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6
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Rundback JH, Rozenblat GN, Poplausky M, Crea G, Maddineni S, Olson C, Agrawal U. Re: jejunal artery angioplasty and coronary stent placement for acute mesenteric ischemia. Cardiovasc Intervent Radiol 2000; 23:410-2. [PMID: 11060377 DOI: 10.1007/s002700010095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Affiliation(s)
- D Sacks
- Department of Radiology, The Reading Hospital and Medical Center, Pennsylvania 19603, USA.
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Poplausky M, Nguyen GK, Rozenblit GN, Rundback JH, Moorthy CR, Maddineni S, Crea GA, Saleh N, Ghoniem A. Intravascular brachytherapy via the inferior vena cava: an adjunctive treatment for pancreatic cancer. J Vasc Interv Radiol 2000; 11:729-32. [PMID: 10877417 DOI: 10.1016/s1051-0443(07)61631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- M Poplausky
- Division of Vascular and Interventional Radiology, New York Medical College, Westchester Medical Center, Valhalla 10595, USA.
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9
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Rozenblit GN, Eisenberger E, Rundback JH, Poplausky MR, Crea GA, Maddineni S, Lebovics E. Percutaneous cholecystoduodenostomy: a case report. J Vasc Interv Radiol 2000; 11:629-33. [PMID: 10834496 DOI: 10.1016/s1051-0443(07)61617-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Affiliation(s)
- G N Rozenblit
- New York Medical College--Westchester Medical Center, Valhalla 10595, USA.
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10
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Rundback JH, Matalon TA. Around here, you have to run as fast as you can just to stay in the same place... Heart Dis 2000; 2:101. [PMID: 11794143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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11
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Abstract
Injuries to branches of the superior mesenteric artery are unusual and often difficult to diagnose, yet require prompt recognition and treatment to prevent exsanguinating hemorrhage or bowel ischemia. This report describes a unique case of an ileocolic artery pseudoaneurysm diagnosed using delayed CT imaging and definitively treated by transcatheter embolization. Cathet. Cardiovasc. Intervent. 48:217-219, 1999.
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Affiliation(s)
- J H Rundback
- Department of Radiology, New York Medical College, Westchester Medical Center, Valhalla, New York 10595, USA.
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12
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Rundback JH, Manoni T, Rozenblit GN, Poplausky M, Maddineni S, Crea G, Matalon TA. Balloon angioplasty or stent placement in patients with azotemic renovascular disease: a retrospective comparison of clinical outcomes. Heart Dis 1999; 1:121-5. [PMID: 11720613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
In this study comparing functional outcomes of renal angioplasty alone (PTRA) or angioplasty with stent placement in patients with renal artery stenosis (> or =60%) and renal insufficiency, 69 patients were treated with PTRA or stent placement. After censoring, the PTRA group included 15 patients with a mean age of 75 years, mean serum creatinine (Cr) of 2.9 +/- 1.4 mg/dL, and mean follow-up of 10 months. The stent placement group included 40 patients with a mean age of 71 years, mean Cr of 2.6 +/- 1.2 mg/dL, and mean follow-up of 12 months. Stenting was performed primarily in four cases and after suboptimal angioplasty in the remainder. Benefit was defined as either stabilization (+/-20%) or improvement in serum Cr levels. Technical success was achieved in 16 of 17 (94%) PTRA patients and 55 of 58 (95%) patients receiving stents. Complications included one surgically repaired axillary pseudoaneurysm, one distal stent positioning requiring a second stent, one stent protruding 5 mm into the aorta, two dissections requiring additional stents, one retroperitoneal hematoma, and one intrarenal atheroembolism treated with thrombolysis. Three patients (mean initial Cr 3.9 mg/dL) required hemodialysis within 30 days of stenting. One patient discontinued dialysis after stenting. There were two procedure-related deaths. An overall benefit was seen in 40% of patients after PTRA and 66% of patients after stent placement. For the stent placement and PTRA groups, cumulative clinical benefit was 77% and 80%, respectively, at 3 months; 69% and 64%, respectively, at 6 months; 61% and 41%, respectively, at 12 months; and 48% and 14%, respectively, at 24 months. A 50% loss of cumulative benefit was seen 34 months after stenting and 11.5 months after PTRA. In the stent and PTRA groups, benefit was noted in 77% and 57%, respectively, of patients with an initial Cr of 2.3 or less, 53% and 25%, respectively, of patients with an initial Cr level higher than 2.3, and 44% and 17%, respectively, of patients with an initial Cr level of 3.0 mg/dL or more. For patients with renal insufficiency, renal artery stenting provides superior clinical results compared with PTRA, mostly because late deterioration occurs after PTRA. Outcomes are related to pretreatment serum Cr level.
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Affiliation(s)
- J H Rundback
- New York Medical College, Westchester Medical Center, Valhalla, New York 10595, USA
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Rozenblit GN, Del Guercio LR, Rundback JH, Poplausky MR, Lebovics E. Peritoneal-urinary drainage for treatment of refractory ascites: a pilot study. J Vasc Interv Radiol 1998; 9:998-1005. [PMID: 9840049 DOI: 10.1016/s1051-0443(98)70440-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- G N Rozenblit
- Department of Radiology, The New York Medical College-Westchester Medical Center, Valhalla 10595, USA
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15
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Rundback JH, Leonardo RF, Poplausky MR, Rozenblit G. Venous rupture complicating hemodialysis access angioplasty: percutaneous treatment and outcomes in seven patients. AJR Am J Roentgenol 1998; 171:1081-4. [PMID: 9763001 DOI: 10.2214/ajr.171.4.9763001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate percutaneous treatment options for preserving hemodialysis access after angioplasty-related venous rupture, we retrospectively reviewed the charts for all dialysis access angioplasties performed over a 33-month period. Seven cases of venous rupture after venous angioplasty were identified (four men and three women; mean age, 63.5 years). Treatment included observation only (n = 1), a second prolonged balloon inflation at the rupture site (n = 2), stent insertion (n = 5), and manual graft occlusion (n = 1). Treatment was successful in eliminating contrast extravasation in all patients while maintaining immediate graft function in six out of seven patients. None of the patients required emergent surgical intervention. The mean primary and secondary patency rates of the salvaged grafts after intervention were 2.3 and 9.3 months, respectively. Five of seven access sites were still patent at the most recent follow-up. CONCLUSION Prolonged balloon inflation or placement of a stent may salvage hemodialysis access in most patients after angioplasty-related venous rupture. Primary and secondary patency have proven to be satisfactory.
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Affiliation(s)
- J H Rundback
- Department of Radiology, New York Medical College, Valhalla 10595, USA
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16
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Rundback JH, Rozenblit G, Poplausky M. Iliofemoral venous thrombolysis after failed surgical thrombectomy. J Vasc Interv Radiol 1998; 9:852-3. [PMID: 9756081 DOI: 10.1016/s1051-0443(98)70408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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17
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Rundback JH, Gray RJ, Rozenblit G, Poplausky MR, Babu S, Shah P, Butt K, Tomasula J, Garrick R, Goodman A, Dolmatch B, Horton K. Renal artery stent placement for the management of ischemic nephropathy. J Vasc Interv Radiol 1998; 9:413-20. [PMID: 9618099 DOI: 10.1016/s1051-0443(98)70292-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the angiographic and clinical results of percutaneously implanted renal artery endoprostheses (stents) for the treatment of patients with ischemic nephropathy. MATERIALS AND METHODS During a 52-month period, 45 patients with azotemia (serum creatinine > or = 1.5 mg/dL) and atheromatous renal artery stenosis untreatable by, or recurrent after, balloon angioplasty were treated by percutaneous placement of Palmaz stents. Stent implantation was unilateral in 32 cases and bilateral in 11 cases. Clinical results were determined by measurements of serum creatinine and follow-up angiography. Clinical benefit was defined as stabilization or improvement in serum creatinine level. Angiographic patency was defined as less than 50% diameter recurrent arterial stenosis. RESULTS Stent placement was technically successful in 51 of 54 (94%) renal arteries. Technical failures were stent misdeployment requiring percutaneous stent retrieval (n = 2) and inadvertent placement distal to the desired position (n = 1). Complications included acute stent thrombosis (n = 1) and early initiation of hemodialysis (within 30 days; n = 1). There were two periprocedural deaths. With use of life-table analysis, clinical benefit was seen in 78% of patients at 6 months (n = 36), 72% at 1 year (n = 24), 62% at 2 years (n = 12), and 54% at 3 years (n = 3). In patients with clinical benefit, average creatinine level was reduced from 2.21 mg/dL +/- 0.91 before treatment to 2.05 mg/dL +/- 1.05 after treatment (P = .018). Lower initial serum creatinine level was associated with a better chance of clinical benefit (P = .05). No other variables affected outcome, including patient age, sex, diabetes, implanted stent diameter, unilateral versus bilateral stent placement, or ostial versus nonostial stent positioning. Conventional catheter angiography or spiral computed tomographic (CT) angiography performed in 19 patients (28 stents) at a mean interval of 12.5 months demonstrated primary patency in 75%. Maintained stent patency appeared to correlate with renal functional benefit. CONCLUSIONS Percutaneous renal artery stent placement for angioplasty failures or restenoses provides clinical benefit in most patients with ischemic nephropathy.
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Affiliation(s)
- J H Rundback
- Department of Radiology, New York Medical College, Westchester Medical Center, Valhalla 10595, USA
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18
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Poplausky MR, Rozenbilt G, Pavlis M, Rundback JH. Balloon angioplasty for an unusual aortic coarctation. Cathet Cardiovasc Diagn 1998; 43:77-80. [PMID: 9473198 DOI: 10.1002/(sici)1097-0304(199801)43:1<77::aid-ccd23>3.0.co;2-p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Percutaneous balloon angioplasty is an alternative therapy for the treatment of the typical type of coarctation. Its associated morbidity and mortality compares favorably when compared to the standard treatment surgery. While atypical coarctations are rare, the described cases have been treated surgically. We present a case of unusually located aortic coarctation successfully treated with percutaneous balloon angioplasty.
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Affiliation(s)
- M R Poplausky
- Department of Radiology, New York Medical College, Valhalla, USA
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19
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Rundback JH, Shah PM, Wong J, Babu SC, Rozenblit G, Poplausky MR. Livedo reticularis, rhabdomyolysis, massive intestinal infarction, and death after carbon dioxide arteriography. J Vasc Surg 1997; 26:337-40. [PMID: 9279324 DOI: 10.1016/s0741-5214(97)70198-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In patients with renal insufficiency or hypersensitivity to iodinated contrast material, carbon dioxide gas (CO2) is generally considered a safe alternative contrast media for digital subtraction angiography. However, we herein report a previously undescribed fatal complication of CO2 angiography in a patient with acute renal dysfunction and congestive heart failure. The possible pathogenetic mechanisms of this complication are discussed.
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Affiliation(s)
- J H Rundback
- Department of Radiology, Westchester County Medical Center, Valhalla, NY 10595, USA
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20
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Abstract
To evaluate the efficacy of balloon-expandable (Palmaz) stents in the treatment of atheromatous renal artery stenosis, prospective placement of stents in 24 arteries in 20 patients was performed over an 18-month period. Indications were hypertension in 18 patients and renal insufficiency (serum creatinine > 1.5 mg/dL) in 11, and all lesions failed conventional transluminal angioplasty. Technical success was achieved in 96% of cases. Hypertension benefit was noted in 77% of patients followed for 6 months (n = 13) and 67% of patients at 1 year (n = 8). Improvement in serum creatinine was seen in 71% (n = 7) and 100% (n = 3) of azotemic patients evaluated at 6 and 12 months, respectively. Six-month angiographic patency was identified in 13 of 16 treated sites. Renal artery stent placement resulted in one asymptomatic segmental branch occlusion; there were no other procedural complications. In conclusion, renal artery stent placement is a technically and clinically effective treatment for hypertension and azotemia due to renal artery stenosis.
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Affiliation(s)
- J H Rundback
- Department of Radiology, Muhlenberg Hospital Center, Bethlehem, PA, USA
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21
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Rozenblit G, DelGuercio LR, Savino JA, Rundback JH, Cerabona TD, Policastro AJ, Artuso DP. Transmesenteric-transfemoral method of intrahepatic portosystemic shunt placement with minilaparotomy. J Vasc Interv Radiol 1996; 7:499-506. [PMID: 8855525 DOI: 10.1016/s1051-0443(96)70790-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To determine whether the transmesenteric-transfemoral method of intrahepatic portosystemic shunt (IPS) placement is safer and more efficient than the transjugular method. PATIENTS AND METHODS Sixty-six consecutive patients with cirrhosis and bleeding varices underwent 67 IPS procedures. Sixty-one of these procedures were performed using a combination of transfemoral access to the hepatic vein with transmesenteric access to the portal system provided by means of minilaparotomy. Follow-up days were collected periodically by means of clinical evaluation and duplex sonography of the shunt. Angiographic evaluation was performed when necessary. RESULTS No technical failures or periprocedural deaths occurred. The radiologic and surgical portions of the procedure were accomplished within 45 and 55 minutes, respectively. In cases without portal thrombosis, maximum fluoroscopy time was 12 minutes. During follow-up (mean, 16 months), eight shunt revisions including one additional shunt placement were necessary. CONCLUSION Transmesenteric-transfemoral IPS placement requires surgical participation but may offer improved efficiency and safety compared with regular transjugular IPS placement.
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Affiliation(s)
- G Rozenblit
- Department of Radiology, New York Medical College, Westchester County Medical Center, Valhalla 10595, USA
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22
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Gray RJ, Horton KM, Dolmatch BL, Rundback JH, Anaise D, Aquino AO, Currier CB, Light JA, Sasaki TM. Use of Wallstents for hemodialysis access-related venous stenoses and occlusions untreatable with balloon angioplasty. Radiology 1995; 195:479-84. [PMID: 7724770 DOI: 10.1148/radiology.195.2.7724770] [Citation(s) in RCA: 140] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine whether the Wallstent endoluminal prosthesis can be used to maintain patency of venous stenoses and occlusions related to hemodialysis access. MATERIALS AND METHODS Wallstents were placed in 52 patients with 56 lesions. Thirty-two lesions were in central veins and 24 were in peripheral veins. Stents were placed immediately after failed angioplasty in 39 patients, because of early restenosis after angioplasty in four, and for treatment of a lesion unsuitable for angioplasty in eight. The remaining five lesions were treated at the operator's discretion after predilation. RESULTS The procedural success rate was 96%. The cumulative primary patency rate was 46% at 6 months and 20% at 12 months; however, with repeat treatment, the cumulative assisted patency rate was 76% at 6 months and 33% at 12 months. Known causes of recurrence included intimal hyperplasia in or near the stent, stent slippage, and remote stenoses. Complications included two stent migrations due to central line placement and one stent-related pseudoaneurysm. CONCLUSION Wallstents are safe to deploy for dialysis access. Wallstents are useful for treating lesions that fail angioplasty and catheter-related central venous occlusions.
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Affiliation(s)
- R J Gray
- Department of Radiology, Washington Hospital Center, Washington, DC 20010, USA
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23
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Dolmatch BL, Gray RJ, Horton KM, Rundback JH, Kline ME. Treatment of anastomotic bypass graft stenosis with directional atherectomy: short-term and intermediate-term results. J Vasc Interv Radiol 1995; 6:105-13. [PMID: 7703574 DOI: 10.1016/s1051-0443(95)71071-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Areas of anastomotic stenosis in lower-extremity bypass grafts (BPGs) were treated by means of directional atherectomy (DA) in hopes of achieving better patency rates than have been reported with percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS During a 4-year period, 17 patients (11 men and six women) with 23 areas of anastomotic stenosis in 18 lower-extremity BPGs were selected for treatment with DA. Urokinase thrombolysis was initially performed in eight BPGs that were thrombosed at the time of presentation. Adjunctive preatherectomy PTA was performed in six lesions, and postatherectomy PTA was performed in three lesions. RESULTS The technical success rate for DA was 92% (23 of 25 sites). There was less than 50% restenosis at 74% of the areas of stenosis (14 of 19 sites), with a mean follow-up time for the sites of 13 months. The graft patency rate was 88% (14 of 16 grafts), with a mean follow-up time for the grafts of 14 months. Areas of stenosis treated with DA alone had the same patency rates as those treated with DA and PTA. CONCLUSIONS DA is an effective treatment method for anastomotic peripheral arterial BPG stenosis. The intermediate-term patency rates following DA are superior to those reported for PTA and similar to those reported for surgical revision.
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Affiliation(s)
- B L Dolmatch
- Department of Radiology, Washington Hospital Center, Washington, DC, USA
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24
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Gray RJ, Rundback JH, Dolmatch BL, Horton KM. Ergonomic vascular access needle with blood-containment capability: clinical evaluation during arterial access procedures. J Vasc Interv Radiol 1995; 6:115-8. [PMID: 7703575 DOI: 10.1016/s1051-0443(95)71073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate the performance of the ergonomic vascular access needle (EVAN), which is designed to contain blood while allowing for observation of pulsations before passage of a guide wire, in arterial catheterization. MATERIALS AND METHODS EVANs were used for initial puncture in 118 arterial access procedures. Visualization of pulsatile blood motion and containment of blood were prospectively evaluated. Results from 82 separate procedures performed with standard access needles were used as a control. Success or failure of guide-wire passage through the needle, number of attempts, guide-wire type, findings on the access vessel arteriogram, and complications were recorded for both groups. RESULTS In the EVAN group, 92% of procedures were successfully completed, usually within two attempts (82%). Success was independent of guide-wire type (P = .4) and was not significantly different from that of the control group (96%) (P = .37). In 89% of the EVAN procedures, contained pulsatile blood motion was observed before attempted guide-wire passage. Uncontrolled spraying of pulsatile blood did not occur unless the hemostasis valve was removed. In 16%, slow oozing of blood occurred through the needle hub, mainly during guide-wire passage. Oozing was common with floppy-tipped guide wires (46%) but was uncommon with stiffer-tipped wires (6%). There were no needle-related complications. CONCLUSION The EVAN provides protection from blood spray while allowing for successful guide-wire passage into the arterial system as often as standard access needles. However, slow periwire leakage occurs frequently with floppy-tipped guide wires.
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Affiliation(s)
- R J Gray
- Department of Radiology, Washington Hospital Center, Washington, DC 20010, USA
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25
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Rundback JH, Gray RJ, Buck DR, Dolmatch BL, Haffner GH, Horton KM, Jelinek JS, Maxwell DD, Steves MA, Sugarbaker PH. Fluoroscopically guided peritoneal catheter placement for intraperitoneal chemotherapy. J Vasc Interv Radiol 1994; 5:161-5. [PMID: 8136597 DOI: 10.1016/s1051-0443(94)71476-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Surgical placement of intraperitoneal catheters for intraperitoneal chemotherapy is associated with bowel perforation, peritonitis, and catheter occlusion. The authors evaluated the safety and efficacy of fluoroscopically guided placement of temporary intraperitoneal catheters for chemotherapy. PATIENTS AND METHODS Two hundred one intraperitoneal catheter placements were attempted in 88 patients with peritoneal carcinomatosis or sarcomatosis. The peritoneum was punctured with 22-gauge needles and exchange was made with use of Seldinger technique and liberal injections of contrast material at each step for 8.3- or 8.5-F multiple-side-hole catheters. Placement sites included all four quadrants and the midline. Computed tomographic (CT) peritoneography was performed prior to chemotherapy. RESULTS One hundred ninety (94.5%) of 201 attempted catheter insertions were technically successful. Results of CT peritoneography were available in 175 cases and showed free distribution of peritoneal contrast material in 39% (n = 69), partial loculation in 38% (n = 67), and extensive loculation in 22% (n = 39). Catheters remained in place for a median of 5 days (range, 2-6 days). Significant complications occurred in 11 procedures (5.5%). There were seven unintended bowel intubations; all were treated conservatively except one that required surgical repair. One other patient developed necrotizing fasciitis requiring surgical débridement. Three other patients (1.5%) developed mild peritonitis responsive to antibiotics. Technical success, complications, and peritoneal distribution of contrast material did not correlate with the site of catheter placement. CONCLUSION Percutaneous catheter placement with use of small-gauge needles for initial puncture is safe and efficacious in patients requiring short-term peritoneal access for chemotherapy.
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Affiliation(s)
- J H Rundback
- Department of Radiology, Washington Hospital Center, Washington, DC 20010
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Abstract
Radiographs were reviewed in a group of nine patients with classical seropositive rheumatoid arthritis who on tissue typing were found to express the class I HLA-B27 allele. Radiographs were analyzed with regard to whether or not they demonstrated radiographic features of (1) classical rheumatoid arthritis, (2) seronegative arthritis, or (3) mixed features of rheumatoid and seronegative arthritis. Five patients (55%) displayed radiographic features consistent with a diagnosis of rheumatoid arthritis, two patients (22%) showed radiographic features of seronegative disorder (periostitis and sacroiliitis), and two patients (22%) showed a mixed picture with evidence of both rheumatoid arthritis and a seronegative disorder. Thus, the HLA-B27 allele contributed to the radiographic features in 44% of patients with rheumatoid arthritis and associated HLA-B27. Thus, the wide range of findings in our population indicates that the radiographic attributes are not specific enough to constitute a unique subpopulation of patients with rheumatoid arthritis.
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Affiliation(s)
- J H Rundback
- Department of Radiology, Beth Israel Medical Center, New York, New York
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Abstract
Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis.
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Affiliation(s)
- J H Rundback
- Beth Israel Medical Center, Department of Diagnostic Radiology, New York, New York 10003
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