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A cirrhotic patient who had previously undergone both mesocaval shunting and transthoracic esophageal and gastric devascularization with splenectomy (Sugiura procedure) presented with recurring intractable variceal hemorrhage. Diagnostic visceral angiography demonstrated a large splenic arterial-venous fistula and gastroesophageal varices. Transarterial occlusion of the fistula and transheptic obliteration of the varices successfully done at one sitting prevented further bleeding. Follow-up angiography nine months later revealed persistent occlusion of the previous fistula and no evidence of esophageal varices. [ABSTRACT FROM AUTHOR]

The study is based on a German single-topic population survey on vaccination willingness against COVID-19 (VWC) by the authors (2020, n = 2014). The single-topic survey allowed us to test several competing explanations for VWC, as discussed in the literature. The VWC in the sample was 67.3%. Logistic regression was used to identify factors affecting VWC. Being at high risk from COVID-19 and having received flu vaccination have a positive impact on VWC. Perceived VWC of friends has a strong positive effect on respondents' VWC. Bivariate relationships of gender, age, and level of education with VWC were no longer significant in a multivariate analysis. Trust in alternative medicine and belief in conspiracy theories have a negative effect on VWC., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The project is funded by the Bavarian State Ministry of Science and the Arts as part of the Regensburg Center of Health Sciences and Technology (RCHST) at the Ostbayerische Technische Hochschule Regensburg (OTH Regensburg). Open Access publication is funded by OTH Regensburg. The sponsor was not involved in data collection, data analysis nor in any stage of the submission process., (© 2023 The Authors.)

Changes of the venous system in various pancreatic diseases were evaluated by retrograde pancreatic venographic studies done on 110 autopsy specimens of the pancreas. Fifty-one normal specimens exhibited well filled, regularly arranged veins. Postmortem autolysis (ten specimens) caused penetration of contrast medium into the parenchyma. Acute pancreatitis (six specimens) was associated with hypervascularity and venous irregularity. Chronic pancreatitis was associated with unevenly distributed venous deformities. Pseudocysts caused avascular foci which displaced adjacent vessels. Seven pancreatic cancers produced irregular encasement and occlusion of pancreatic and peripancreatic veins with thrombosis of major portal trunks-changes differing substantially from those caused by other diseases. Periancreatic cancer invading the pancreas caused encasement of superficial and occasionally deep pancreatic vessels. Acute leukemic infiltration demonstrated extreme deformity with complete structural disorder of intrapancreatic branches. Retrograde pancreatic venography, if used clinically, would enable radiographic diagnosis of the most common diseases of the pancrease.

The history of percutaneous transluminal angioplasty is briefly reviewed, from its initial, inadvertent use in 1963 to its current extensive applications. Transluminal angioplasty is equally as effective as surgery for stenotic lesions, and has the advantages of being safer and less expensive for the patient.

A pliable, easy to place, double pigtail, internal ureteral stent made of elastomeric polyurethane is described. The tapered distal pigtail end minimizes bladder irritation and the combination of a pusher and absorbable suture enables optimal placement of the proximal pigtail end in the renal pelvis. Ten stents used in eight patients remained functional without bladder irritation for a mean period of 8 months (range, 2-14 months).

To evaluate techniques for retrograde pancreatic venography similar to epinephrine renal venography, 35 dogs had transjugular portography before and after the infusion of various doses of vasopressin systemically or selectively into the superior mesenteric and celiac arteries, or after occlusion of the distal thoracic aorta. Increased filling of the peripheral portal branches resulted, but none of the techniques provided diagnostically useful enhanced pancreatic visualization.

During the past decade percutaneous therapeutic vascular occlusion was performed on 152 occasions in 124 patients. The primary indication for vasoocclusive therapy was acute or recurrent bleeding. Upper gastrointestinal bleeding from arterial sources was controlled in 92 percent of patients and acute variceal bleeding in 83 percent. Renal embolization was performed for palliation of severe pain and hematuria from unresectable renal primary or secondary malignancies, to decrease blood loss and facilitate surgery in operable renal tumors, and for ablation of renal function to control chronic protein loss or severe hypertension. Our encouraging experience convinces us that transcatheter embolization is a useful, safe and effective procedure in selected patients. It seems certain that the technique of therapeutic embolization will be improved, its indications extended and its application become commonplace whenever angiographic skills and facilities exist.

Percutaneous, nonsurgical interventions using angiographic catheter techniques and radiologic guidance were used in the management of seven cases of various lesions of the chest and lungs. Successful catheter therapy included the embolization of a large, acquired, postinflammatory vascular malformation causing massive hemoptysis and a cavernous hemangioma of the chest wall. Sixteen pulmonary arteriovenous fistulas (one patient), an iatrogenic internal mammary artery-to-innominate vein fistula, and a persistent, postbiopsy bronchopleural fistula were successfully closed. Percutaneous drainage of a pyogenic lung abscess and the nonoperative retrieval of an intravascular foreign body that had embolized to the left pulmonary artery were also successfully achieved. Performed under local anesthesia with minimal morbidity, stress, and risk, interventional catheter therapy is remarkably cost-effective. Primary chest physicians are encouraged to consider this mode of therapy whenever applicable.

Routine postprocedural administration of protamine sulfate has been advocated to offset the anticoagulant effect of prophylactic heparin given during transfemoral catheter angiography. The value of protamine is shown in a double-blind, randomized, placebo controlled series of 257 cases.

To explore the feasibility of retrograde pancreatic venography, transhepatic portal catherization via jugular and hepatic veins was performed in 10 dogs. Coaxially introduced catheters were then used to enter individual pancreatic veins for retrograde venography. Appropriate injection technique led to detailed visualization of the pancreatic venous system without anatomically evident injury to the pancreas. The (readily avoidable) injection of contrast agent through catheters wedged into pancreatic veins caused parenchymal extravasation and hemorrhagic pancreatitis. The detection of pancreatic cancer in patients not approachable by arteriography and the intensified search for small islet cell tumors are possible indications for pancreatic venography when the safety of this method is further demonstrated.

Gelfoam (gelatin foam) powder was used for embolization therapy of massive gastric bleeding from small vessels in 14 patients with severe underlying medical problems. Bleeding was controlled in 10 patients with lesions localized in areas supplied by the embolized left gastric artery. In four patients with concurrent lesions in other portions of the stomach, bleeding decreased only (3 patients) or did not respond to embolization (1 patient). Complications developed in 2 patients with compromised vascular supply of the stomach: superficial ischemic ulcers that healed, and a large ulcer that perforated and required surgery. Microscopic studies demonstrated Gelfoam powder penetration mostly into vessels 100 to 200 microns in diameter and only occasionally into smaller vessels 50 to 60 microns, with occlusion of approximately 10 to 15% of the vasculature. It is concluded that Gelfoam fragments are the primary embolic material to be used for occlusion of the left gastric artery. Use of Gelfoam powder should be limited to occasional patients who have only little chance of responding to Gelfoam fragment embolization. Potential candidates for Gelfoam powder embolization include patients with major coagulopathies and/or uremia who massively hemorrhage from small-vessel lesions localized in upper portions of the stomach, exhibit significant mucosal hypervascularity, and do not respond to selective vasopressin treatment. An uncompromised vascular supply of the stomach is a precondition of a safe left gastric artery embolization.

Reflux cholangiography is an extension of hypotonic duodenography. In patients with abnormal enterobiliary communications, it is a rapid, effective method for demonstrating not only biliary and occasionally pancreatic ducts, but also fistulas, the duodenum, and the papilla of Vater. It is especially useful for preoperative evaluation of strictures for it enhances both the value and success of endoscopic cholangiopancreatography.

A double-blind, randomized study was performed to compare discomfort and pain associated with the use of iopamidol and Hypaque (diatrizoate sodium and diatrizoate meglumine) during iliofemoral runoff arteriography in 33 patients. Iopamidol caused substantially less discomfort and pain. The evaluation was helped by audiotaping the study and comparing patients' vocal responses to injections of these materials.

Sequential ascending venographic studies were used to assess the healing of deep venous thrombosis in 50 patients randomly assigned to streptokinase or heparin therapy. Various degrees of thrombolysis and/or recanalization were demonstrated by venograms performed on the fourth and tenth days of treatment. Late follow-up studies (mean, 7 months after treatment) showed three basic patterns of resolution: (1) return to normal, (2) complete recanalization, and (3) incomplete recanalization and/or collateralization. Loss of valves or their function was associated with recanalization. The character, speed, and outcome of healing reflected the nature and extent of thrombosis, prior thrombotic disease in the extremity, and the type and timing of treatment. Streptokinase was highly effective and preferable to heparin in patients with deep vein thrombosis when therapy was begun within 4 days of onset of symptoms. In later stages of acute or recurrent deep vein thrombosis, the effectiveness of both drugs was significantly reduced.

A method is described for the percutaneous catheter placement of expandable nitinol coil stents for the nonoperative restoration and maintenance of patency in internal flow pathways, especially the lumina of blood vessels and biliary ducts.

A new device for the removal of ureteral stents by the percutaneous nephrostomy route is presented. We used this device successfully in a 4-month-old male child. Its advantages in the removal of unwanted intracorporeal wanderers such as lost catheters are discussed.

A new small intestinal biopsy technique was developed and evaluated: it involves the rapid replacement of a simple duodenal tube using a controllable spring guide and fluoroscopy. A suction biopsy catheter was then passed coaxially through the tube as often as needed for sampling, after which other diagnostic studies were done with the same intubation. In clinical trials totaling 31 biopsies in 15 adult patients, the method proved safe and effective. Currently, the time required to intubate the ligament of Treitz and obtain two biopsies is usually less than 15 minutes.

Randomly assigned streptokinase or heparin therapy was studied in 50 patients with deep vein thrombosis of less than 2 weeks' duration. Venography was performed prior to therapy, after 3 days, and after 10 days. Two radiologists who were unaware of the patient's therapy compiled a single average lytic score for each patient at each time interval. Lysis of venous thrombi was significantly greater with streptokinase than with heparin after 3 days, but not after 10 days of treatment. Lytic scores achieved with streptokinase were significantly better than those achieved with heparin therapy (P less than .01) in male patients who were symptomatic for 3 days or less. In females, regardless of the duration of symptoms, thrombolytic results obtained with streptokinase were not significantly different than results obtained with heparin.

Of 402 United States owners of side-viewing duodenoscopes surveyed, 222 (55%) responded, reporting 10,435 endoscopic retrograde cholangiopancreatograms. Procedure failed occurred in 30%, complications in 3%, and death in 0.2%. Complications included pancreatitis, cholangitis, pancreatic sepsis, instrumental injury to the gastrointestinal tract, and drug reactions. Pancreatitis was associated with injection into the pancreatic duct, sepsis with injection into an obstructed duct or pseudocyst, and injury with abnormal gastroduodenal anatomy. Experienced workers had a 15% incidence of complications, whereas inexperience gave 4 times the failures (62%) and twice the complications (7%). The causes of complications and their prevention are discussed.

Experimental catheter obstruction of the left gastric (coronary) vein was explored in 10 dogs. Using a transjugular approach, the liver was punctured and the portal vein catheterized. Coaxially introduced catheters were then used to catheterize selectively and produce an intravascular obstruction (tamponade) of the gastric coronary vein. Ballon catheters were used for a temporary occlusion. Injection of a tissue adhesive, isobutyl 2-cyanoacrylate, was used for a definitive obliteration. The achieved results show the anatomical feasibility of this approach and give good perspective for development of a clinical method for percutaneous intravascular tamponade of the bleeding gastroesophageal varices in cirrhotics.

This report enumerates and analyzes the complications of percutaneous transaxillary catheterization encountered in 200 consecutive patients undergoing diagnostic arteriography, and 20 consecutive patients who had catheter placement for selective chemotherapy. Diagnostic arteriography led to minor complications in eleven percent and major complications in two percent. Risk correlated with the type of procedure, number of catheter exchanges and particularly, the presence of arteriographic risk factors, such as hypertension, bleeding tendencies, and advanced atherosclerosis. Therapeutic catheter placements had a 15 percent incidence of minor and a 20 percent incidence of major complications. Here, also, complications were more likely in the presence of the arteriographic risk factors. Suggested means for decreasing the hazards of the transaxillary catheterization include: exclusion of high risk patients, use of a proper puncture site, careful catheter manipulation, the fewest possible catheter exchanges, correct manual hemostatis following catheter withdrawal, and close observation of the patient after the procedure. Early surgical intervention is indicated in the presence of a progressively developing neural defect.

A percutaneous transhepatic cholangiogram tract was used to visualize a large stone in the common duct; following the tract's dilation, the stone was crushed and partially removed. Fragments were flushed and also passed spontaneously into the duodenum. The approach described offers a feasible alternative to surgery.

A patient with severe nephrotic syndrome who was too debilitated to undergo surgical nephrectomies, underwent therapeutic bilateral renal artery occlusion by the selective injection of isobutyl 2-cyanoacrylate into the renal arteries. The therapy resulted in dramatic cessation of urine flow and elimination of proteinuria.

Fifty consecutive chemotherapeutic infusions for cancer via precutaneously introduced arterial catheters were reviewed to determine the frequency of angiographic and clinical complications related to the indwelling catheter. Fibrin cloaking along the catheter was found in 20 patients studied by pull-out arteriography and was unassociated with clinical symptoms. Major thrombus formation occurred around the catheter tip in 28% of the infused vessels, all within the hepatic artery. Clinical symptoms developed in only three patients where thrombosis of the hepatic artery had propagated into the celiac axis. Systemic heparinization did not reduce the incidence of thrombus formation but did increase the incidence of mild gastrointestinal bleeding. Several factors may reduce the incidence of complications, such as puncture of a large artery, use of soft, pliable, and small diameter catheters, proper free position of the catheter in the infused vessel, regular angiographic checkups for catheters position, and early evidence of thrombus formation.

Two cases of angiographically demonstrated chemodectomas of uncommon locations and behavior are reported: one located retroperitoneally and one with multi-centric sites including both carotid bodies and the upper mediastinum, with late distant bone metastases. Based on this experience and that reported by others, the angiographic appearance of chemodectomas is described and the value of angiography in the diagnosis and therapy of chemodectomas is discussed.

Simple techniques for percutaneous intravenous biopsy were used in 3 patients to obtain histopathologic diagnoses of thrombosis of the inferior vena cava and tumors invading renal veins. Techniques, risks and diagnostic sensitivity of percutaneous intravenous-biopsy are discussed.

Isobutyl 2-cyanoacrylate (IBC) delivered selectively in small doses produced immediate occlusion of the injected arteries in dogs without significant undesired sequelae. In one patient, pelvic hemorrhage was promptly stopped by a similar technique. In another patient, who was on chronic renal dialysis and judged too ill for nephrectomy, IBC occluded both renal arteries and terminated a life-threatening renal protein loss.

Absolute ethanol was evaluated as a vaso-obliterative agent in 15 patients with bleeding of gastroesophageal varices. Initial control of hemorrhaging was obtained in 13 (87%). Two patients died from unrelated causes within 48 hours of the procedure. Variceal bleeding recurred in seven of the 11 remaining patients (64%) from one week to 13 months after embolization. Four patients did not rebleed; two of them died (4 weeks and 6 months after the procedure), and two are alive (14 and 16 months after the procedure). Significant disadvantages of ethanol for obliteration of gastroesophageal varices (marked prolongation of procedure time and lack of radio-opacity) probably contributed to the high incidence of portal vein thrombosis (3 patients [20%]).