Cardiovascular and interventional radiology
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Cardiovasc Intervent Radiol · Apr 2011
Randomized Controlled Trial Multicenter Study Comparative StudyPercutaneous palliation of pancreatic head cancer: randomized comparison of ePTFE/FEP-covered versus uncovered nitinol biliary stents.
The purpose of this study was to compare the clinical effectiveness of expanded polytetrafluoroethylene/fluorinated-ethylene-propylene (ePTFE/FEP)-covered stents with that of uncovered nitinol stents for the palliation of malignant jaundice caused by inoperable pancreatic head cancer. Eighty patients were enrolled in a prospective randomized study. Bare nitinol stents were used in half of the patients, and ePTFE/FEP-covered stents were used in the remaining patients. ⋯ Complications and mean cost were similar in both groups. Regarding primary patency and ingrowth rate, ePTFE/FEP-covered stents have shown to be significantly superior to bare nitinol stents for the palliation of malignant jaundice caused by inoperable pancreatic head cancer and pose comparable cost and complications. Use of a covered stent does not significantly influence overall survival rate; nevertheless, the covered endoprosthesis seems to offer result in fewer reinterventions and better quality of patient life.
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Cardiovasc Intervent Radiol · Feb 2011
Case ReportsComputed tomography-guided access to the cisterna chyli: introduction of a technique for direct lymphangiography to evaluate and treat chylothorax.
The purpose of this report is to introduce a technique of direct lymphangiography to enable chylothorax treatment. Using a hybrid computed tomography (CT) and fluoroscopy imaging system, a 21-gauge needle was placed under CT guidance into the cisterna chyli to allow contrast lymphangiography and CT lymphangiography in two patients with presumed postoperative chylothorax. Water-soluble contrast media injection demonstrated the thoracic duct anatomy in both patients. Further successful needle disruption of the cisterna chyli was performed in one patient to interrupt lymph flow and stop the chylous leak, with subsequent resolution of the chylothorax.
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Cardiovasc Intervent Radiol · Feb 2011
Case ReportsDiaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma.
We describe a 71-year-old woman with a hepatocellular carcinoma who underwent percutaneous radiofrequency ablation (RF) with a single internally cooled electrode under computed tomography (CT) fluoroscopic guidance. Nine months after the procedure, CT images showed herniation of the large intestine into the right pleural cavity. To our knowledge this complication of RF performed with a single internally cooled electrode under CT guidance has not been previously reported.
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Cardiovasc Intervent Radiol · Feb 2011
Letter Case ReportsIntramural dissection of the renal collecting system during percutaneous nephrostomy: computed tomography findings of a rare complication.
Intramural dissection of the renal collecting system during percutaneous nephrostomy (PCN) is a rare complication that can be challenging to diagnose. In this report, we describe the computed tomography (CT) and fluoroscopic findings of urothelial dissection during CT-guided PCN in a 65-year old patient with an obstructed congenital solitary left kidney due to an urinary bladder carcinoma. To our knowledge, CT findings of urothelial dissection have not yet been described.
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Cardiovasc Intervent Radiol · Feb 2011
Case ReportsDelayed development of brain abscesses following stent-graft placement in a head and neck cancer patient presenting with carotid blowout syndrome.
We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. ⋯ CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.