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Las malformaciones arteriovenosas pulmonares son anomalias poco frecuentes del pulmon, que entranan un riesgo considerable de complicaciones graves como la tromboembolia cerebral, el absceso cerebral y la hemorragia pulmonar. La embolizacion con coils o con balones desprendibles es el tratamiento de eleccion. Sin embargo, estos pueden migrar y producir embolia paradojica, especialmente en las malformaciones con comunicaciones arteriovenosas grandes. Presentamos un caso en el que utilizamos un nuevo dispositivo de oclusion vascular (Tapon Vascular Amplatzer) para ocluir una fistula arteriovenosa pulmonar en un paciente con sindrome de Rendu-Osler-Weber.

Our purpose was to study the effectiveness of thrombolytic therapy in treating acute, subacute, and chronic arterial occlusions in a multicenter retrospective study. Intraarterial urokinase infusion was performed in 235 patients for occluded native arteries. There were 70 (30%) with acute and 26 (5%) with subacute occlusions, and 141 (59%) with chronic symptoms for longer than 3 mo. Complete thrombolysis was achieved in 60 (86%) of the acute, 20 (77%) of the subacute, and 106 (75%) of the chronic occlusions. Adjunctive interventional procedures were performed as needed. Long-term follow-up revealed a primary patency of 87%, 85%, and 76% for the acute, subacute, and chronic occlusion groups, respectively. We conclude that the rate of complete thrombolysis of chronic occlusions proved slightly more efficient for acute and virtually the same for subacute occlusions. Long-term follow-up demonstrated a higher failure rate with chronic than with acute occlusions, probably due to worsened peripheral vascular runoff. Cathet. Cardiovasc. Diagn. 44:159–169, 1998. © 1998 Wiley-Liss, Inc.

SummaryTranscatheter embolization has proved to be an effective treatment for patients presenting with pelvic haemorrhage. Superselective catheterization with microcatheters facilitates the approach to the bleeding vessel and enables safer and more effective embolization. A 45-year-old man was admitted to hospital after blunt trauma to the left gluteal region. He complained of a painful enlarging mass in the left gluteal region. Radiography of the pelvis revealed absence of fracture. Selective angiography displayed significant extravasation from the left superior gluteal artery. Embolization was performed. The patient was discharged 2 days after admission with a resolving left gluteal haematoma.

To present our experience in the treatment of nasolacrimal occlusion by means of polyurethane stents.Forty polyurethane stents were placed under fluoroscopic guidance in 35 consecutive patients with epiphora due to total or partial obstruction of the nasolacrimal system. The set designed by Song was used in all patients. The procedure was performed by introducing a guidewire through the superior punctum into the canaliculus and advancing it across the obstruction into the inferior meatus of the nasal cavity. After pulling out the guidewire, the stent was advanced in retrograde fashion and released into the sac and the nasolacrimal duct.The technical success rate was 100%. The average time for the procedure was 25 min (range 10-60 min). Immediate complications were: mild pain (n = 5), severe pain (n = 1), minimal epistaxis (n = 7), and moderate epistaxis (n = 1). No major complications occurred. The last clinical control revealed complete resolution of epiphora in 35 eyes and partial resolution in four; one patient did not improve.This technique for treatment of obstruction of the nasolacrimal system is simple and safe, and may obviate the use of more invasive procedures.

To evaluate the results of primary stent placement without initial thrombolysis in the treatment of iliac occlusions.During a 3-year period, 61 iliac artery occlusions were treated in 59 patients. The mean length of the occluded segment was 10 cm (range, 4-25 cm). The occluded arteries were treated with primary placement of self-expandable metallic stents.Successful recanalization with primary stent placement was possible in 56 of 61 occlusions (92% technical success rate). Mean Doppler ankle/brachial index increased from 0.51 to 0.90 immediately after treatment and was 0.91 on the last follow-up (P.05). Primary patency rate at 24 months was 73%, and secondary patency rate was 88%. Procedural complications included distal embolization (n = 4) and an episode of massive intra-abdominal bleeding. Three patients developed a hematoma at the puncture site that did not require additional therapy. Late complications included stent occlusion (n = 9) and significant stenosis related to intimal hyperplasia (n = 1). Mean follow-up period was 29 months (range, 7-55 months).Primary stent placement is an effective therapeutic option for iliac artery occlusions.

Purpose This work describes the early experience with the Cragg Endopro System I. The safety and efficacy of this device in the treatment of atherosclerotic lesions of the femoral arteries are evaluated. Materials and Methods Eleven patients with complex femoral artery lesions were treated. Ten patients presented with femoral artery occlusion and one had a 90% stenosis. All patients had life-style limiting claudication. Associated comorbid states included smoking ( n = 10), hypertension ( n = 4), hyperlipidemia ( n = 5), coronary artery disease ( n = 3), and diabetes ( n = 1). The stents were dilated to the size of the native artery in the first three patients. The protocol was modified and stents were overdilated by 1 mm in the remaining eight patients. An anticoagulation regimen was used in the first three patients and modified per protocol requirements in the remaining eight. Prophylactic antibiotics were given before the procedure. Follow-up studies included Doppler ultrasound and intravenous and intraarterial digital subtraction angiography. Results An antegrade femoral approach was used. Stent placement was successful in all patients. The mean lesion length was 9.9 cm (4–18 cm). Mean ankle/brachial index before treatment was 0.65 and increased to 0.87 after treatment. Mean follow-up was 17.2 months, and one patient was lost to follow-up. Complications included sepsis ( n = 1), fever ( n = 2), severe pain ( n = 4), thrombosis ( n = 5), and hematoma ( n = 2). Stent patency was improved after protocol modifications. Overall primary patency rate was 45% and secondary patency was 56%. Conclusion This early experience with the Cragg Endopro System I shows that recanalization of long femoral occlusions and stent-graft placement is feasible. The primary and secondary patency rates are low and the complication rate is high. Improved patency rates are expected with a more aggressive anticoagulation regimen and stent overdilation.

CAS is a well-established therapy for the carotid artery disease with a very low rate of complications when performed by experimented operators.

Hemodynamic depression is a frequent complication related to carotid artery stenting with angioplasty. The aim of this study was to assess our results regarding hemodynamic depression, in patients who underwent carotid artery stenting without angioplasty.Between October 2002 and April 2010, 261 carotid stenosis (in 242 patients) were treated with the use of self-expanding stents without angioplasty. Inclusion criteria were symptomatic carotid stenosis50%, asymptomatic carotid stenosis70%, and stenosis ranging between 50-70% with evidence of high risk plaque morphology or micro-embolism. Outcomes during hospitalization and 30 days after procedure were registered. Hemodynamic depression was defined as hypotension (systolic blood pressure90 mm Hg) or bradycardia (heart rate60 beats/min).During the procedure 7 (2.9%) patients presented bradycardia and 3 (1.2%) hypotension. No patient required vasopressor drugs or ICU for hemodynamic monitoring. No patient developed asystole or other types of arrhythmia. During hospitalization, hemodynamic depression was not observed in any patients. During the first 30 days post-procedure, there were 11 TIAs (4.5%), 1 disabling stroke (0.4%), 1 non disabling stroke (0.4%), and 1 death (0.4%) (1 stent thrombosis at 11 days).The incidence of hemodynamic depression is low when carotid stenting procedure is performed without balloon angioplasty. The incidence of neurological complications post procedure was also low. This report highlights the need for performing randomized trials comparing both techniques.

How is it possible that when talking about technological developments in surgery and specifically in endovascular surgery no one thinks that without the other sciences: engineers, physicists, ITs etc, we wouldnt have the evolution we have now?

Our aim was to develop an easy-to-induce, reproducible, and low mortality clinically relevant closed-chest model of chronic myocardial infarction in swine using intracoronary ethanol and characterize its evolution using MRI and pathology. We injected 3-4 mL of 100% ethanol into the mid-LAD of anesthetized swine. Heart function and infarct size were assessed serially using MRI. Pigs were euthanized on days 7, 30, and 90 (n=5 at each timepoint). Postoperative MRI revealed compromised contractility and decreased ejection fraction, from 53.8% ± 6.32% to 43.79% ± 7.72% (P=0.001). These values remained lower than baseline thorough the followup (46.54% ± 11.12%, 44.48% ± 7.77%, and 40.48% ± 6.40%, resp., P<0.05). Progressive remodeling was seen in all animals. Infarcted myocardium decreased on the first 30 days (from 18.09% ± 7.26% to 9.9% ± 5.68%) and then stabilized (10.2% ± 4.21%). Pathology revealed increasing collagen content and fibrous organization over time, with a rim of preserved endocardial cells. In conclusion, intracoronary ethanol administration in swine consistently results in infarction. The sustained compromise in heart function and myocardial thinning over time indicate that the model may be useful for the preclinical evaluation of and training in therapeutic approaches to heart failure.

Seventy-seven transjugular liver biopsies were performed with a coaxial, spring-loaded, 18-gauge cutting needle, the Biopty gun (Bard Biopsy System, Covington, GA, USA) on consecutive patients between July 1993 and February 1995. Fifty men and 27 women were included in the study; the mean age was 45 years (range 15-69 years). The average number of punctures per patient was 5.2, with a range of 2-9, yielding an average of 4.8 samples per patient (range 1-7). The length of the samples varied from 10 to 22 mm with a constant diameter of 1 mm. The mean time required to complete the procedure was 48 min (43-52 min). Histological diagnoses were obtained in 74 of 77 patients (96%), with non-diagnostic specimens attributed to excessive fragmentation (3 cases). Complications occurred in 10 patients (puncture site hematoma, carotid artery puncture, abdominal pain, vasovagal reaction, hepatic capsule perforation, and hemobilia). The latter two complications were self-limited. In our experience this transjugular hepatic biopsy method is promising for performing biopsies in patients with chronic liver disease, due to its high success rate and low morbidity rate.

To evaluate the usefulness of self-expandable metallic stents in the treatment of acute colonic obstruction secondary to colorectal neoplasm.Stents were placed in 12 patients with clinical and radiologic signs of acute colonic obstruction. After symptom improvement, patients underwent radiologic staging. Single-stage surgery was performed in patients without disseminated disease.Stent placement was successful in all patients. Signs and symptoms of intestinal obstruction resolved within 24 hours of stent placement in 10 patients (83%). In two patients with massive bowel dilation, improvement was evident 2 and 4 days after stent placement. Ten patients underwent elective single-stage surgery with partial colonic resection and creation of a primary end-to-end anastomosis without major complications. In two patients with disseminated neoplastic disease, stent placement was considered the primary palliative treatment.Metallic stent placement to relieve acute colonic obstruction secondary to colorectal carcinoma is a safe therapeutic alternative, allowing single-stage surgery in suitable cases. In patients who are not surgical candidates it is an adequate palliative option.

BACKGROUND & AIMS: Uncontrolled studies suggest that placement of a transjugular intrahepatic portosystemic shunt (TIPS) could be useful in the treatment of variceal bleeding. The aim of this study was to evaluate the efficacy and safety of TIPS in the elective treatment of hemorrhage from esophageal varices in a randomized controlled study that compared the effects of TIPS with those of endoscopic sclerotherapy (ES). METHODS: Sixty-three consecutive cirrhotic patients with hemorrhage from esophageal varices were included. Thirty-two patients were randomly allocated to ES and 31 to TIPS groups. RESULTS: One patient in each group died before the therapeutic procedure could be performed. During a mean follow-up period of 15 months, variceal rebleeding occurred in 51.6% of the patients in the ES group and 23% of those in the TIPS group. Uncontrolled rebleeding occurred in 10 of 31 patients in the ES group, whereas rebleeding did not occur in any patient of the TIPS group. Hepatic encephalopathy was more frequent in TIPS patients (33.3%) than in those treated by ES (13%). However, mortality was similar in both treatment groups. CONCLUSIONS: These preliminary results suggest that TIPS is more effective than ES in the prevention of variceal rebleeding in cirrhotic patients, even though no difference in survival was observed. (Gastroenterology 1996 Mar;110(3):832-9)

Aorta dissection is a serious vascular disease produced by a rupture of the tunica intima of the vessel wall that can be lethal to the patient. The related diagnosis is strongly based on images, where the multi-detector CT is the most generally used modality. We aim at developing a semi-automatic segmentation tool for aorta dissections, which will isolate the dissection (or flap) from the rest of the vascular structure. The proposed method is based on different stages, the first one being the semi-automatic extraction of the aorta centerline and its main branches, allowing an subsequent automatic segmentation of the outer wall of the aorta, based on a geodesic level set framework. This segmentation is then followed by an extraction the center of the dissected wall as a 3D mesh using an original algorithm based on the zero crossing of two vector fields. Our method has been applied to five datasets from three patients with chronic aortic dissection. The comparison with manually segmented dissections shows an average absolute distance value of about half a voxel. We believe that the proposed method, which tries to solve a problem that has attracted little attention to the medical image processing community, provides a new and interesting tool to isolate the intimal flap that can provide very useful information to the clinician.

A minimally invasive pericardial access and chronic catheterization may enhance the therapeutic effects of intrapericardial drug delivery. We aimed to evaluate the technical feasibility of percutaneous intrapericardial implantation of a drug port system for chronic local drug delivery.Under fluoroscopic guidance, a percutaneous subxiphoid access to the pericardial space was obtained with fine needle and micropuncture set in 6 Göttingen minipigs. A 6.4 Fr silicone tube and its drug port were implanted into the pericardial space and a subcutaneous pocket. One animal was euthanized immediately after procedure for acute macroscopic study. The other 5 animals were followed monthly for 2 months and then euthanized for chronic macroscopic study. Technical success was obtained in all animals. The mean procedure duration was 55.3 ± 9.6 minutes and the mean radiation exposure time was 7.9 ± 1.9 minutes. Acute macroscopic study showed no pericardial laceration at the entry site and no gross injury to the nearby epicardium. Follow-ups demonstrated that the pericardial space was intact and silicone catheters kept patent in all cases. No migration of the catheter tip out of the pericardial space or leakage of contrast was observed. All the catheters were easily removed at the end of study. Infection of the subcutaneous tunnel as a major complication was found in 1 pig. Small scattered adhesions of the pericardial space were observed in 2 pigs at chronic macroscopic study.Percutaneous intrapericardial catheterization for chronic local drug delivery is technically feasible and of potential for clinical trial.

A diabetic foot infection is usually the result of a pre-existing foot ulceration and is the leading cause of lower extremity amputation in patients with diabetes. It is widely accepted that diabetic foot infections may be challenging to treat for several reasons. The devastating effects of hyperglycemia on host defense, ischemia, multi-drug resistant bacteria and spreading of infection through the foot may complicate the course of diabetic foot infections. Understanding the ways in which infections spread through the diabetic foot is a pivotal factor in order to decide the best approach for the patient’s treatment. The ways in which infections spread can be explained by the anatomical division of the foot into compartments, the tendons included in the compartments, the initial location of the point of entry of the infection and the type of infection that the patient has. The aim of this paper is to further comment on the existed and proposed anatomical principles of the spread of infection through the foot in patients with diabetes.Keywords: diabetic foot; infection; osteomyelitis; anatomy; amputation(Published: 1 October 2012)Citation: Diabetic Foot & Ankle 2012, 3: 18693 - http://dx.doi.org/10.3402/dfa.v3i0.18693

Intractable and recurrent ureteral stricture presents a continuous challenge to the urologist. We report on 5 patients with severe ureteral stricture who were successfully treated with self-expanding metallic stents. Ureteral stricture occurred at ureteroileal anastomotic sites after neoplasm resection in 2 cases, multiple upper ureteral strictures were related to multiple surgical procedures for correction of bladder exstrophy in 1 and a ureteral kink developed in 1. Treatment with transluminal balloon dilation provided poor results but self-expanding metallic stents were used successfully with no major complications. In the last patient the stent and the overlying ureter were removed due to recurrent reflux; the gross and histological ureteral changes are discussed in detail. The technical approach is described, alternative therapeutic options are considered and pertinent literature is reviewed.

The clinical results of percutaneous transluminal angioplasty (PTA) were evaluated in patients with renovascular hypertension, and the effect of PTA on blood pressure and renal function was determined.Between February 1982 and December 1990, 93 hypertensive patients underwent 123 renal artery PTA procedures. Mean patient age was 43.4 years (range, 12-78 years). Average baseline blood pressure was 162/111 mm Hg (range, 140-230/95-150 mm Hg). The cause of renovascular hypertension, as determined with angiography, was atherosclerosis in 37 patients, fibromuscular dysplasia in 27, and mixed disease in one; 28 patients had renal transplant arterial stenosis.In patients with atherosclerotic renal vascular disease or fibromuscular renal artery stenosis, systolic and diastolic blood pressure decreased significantly (P.001) at 96 months after PTA. In patients with renal transplant arterial stenosis, blood pressure also decreased significantly (P.001) at 12 months after PTA. Technical success was achieved in 78% of patients with atherosclerosis, 92% of patients with fibromuscular dysplasia, and 76% of patients with renal transplants. Complications were seen in 4.8% and were related to renal failure and vessel dissection.PTA is the therapy of choice in patients with renovascular hypertension due to fibromuscular dysplasia. Patients with atherosclerotic renal artery stenosis or stenosis of a renal artery in a transplanted kidney should be selected according to the anatomy of the lesion and clinical patient characteristics.

To determine the clinical outcome and the success of stent application for high-grade lesions of the infrapopliteal arteries compared with treatment with percutaneous transluminal angioplasty (PTA) in critical limb ischemia (CLI).In this ethics board-approved randomized prospective study, PTA or stent application was performed on 131 lesions in 88 patients with CLI. The primary end points were clinical improvement after endovascular treatment and limb salvage rate. Secondary end points were defined by the minimal lumen diameter (MLD) before and after the revascularization procedure, percentage of residual diameter stenosis (DS), binary restenosis rate (50% DS and70% DS), and incidence of target lesion revascularization at 9-month follow-up.At 3 months, the clinical status in the PTA group was less improved than that in the stent group (P = .008). At 9 months, there had been five minor and two major amputations in the PTA group and five major and five minor amputations in the stent group. MLD was significantly larger and the percentage of DS was significantly less in the stent group at completion angiography. At 9 months, the angiographic control showed better trends for the stent group in comparison to the PTA group despite that no significant differences were detected (MLD, 1.19 mm ± 0.92 vs 1.02 mm ± 1.02; DS, 38.68% ± 25.47 vs 43.31% ± 28.37).Infrapopliteal stent application is an effective treatment modality in CLI. The PTA and stent groups were essentially equal at 3 and 9 months except for the difference in clinical improvement in the stent group at 3 months.

Summary Objectives The aim of this study was to evaluate the effects of excessive intake at weekends, on different parameters in young university students. Study design Cross sectional, descriptive study. Methods A group of 180 subjects were selected (young males between 18 and 22 years old) and were classified into three groups by their alcohol consumption habits: The control group of non-drinkers (ND; n = 60), the group of one day/weekend drinkers (1D/W, n = 60) and the group of two day/weekend drinkers (2D/W, n = 60). An evaluation of the body composition, a spirometry test (FVC, PEF and MVV), a maximal cycle ergometer test (Heart rate, blood pressure, VO2 max, total watts and time test until exhaustion), a blood sample (GOT, Triglycerides, Total Cholesterol, HDL cholesterol, LDL cholesterol and Glucose) were performed. Results It was observed that 2D/W group presented significantly higher levels than ND in the following parameters: total cholesterol [185.66 (16.06) compared to 154.28 (25.53) mg/dl]; triglycerides [113.66 (22.47) compared to 45.75 (12.76) mg/dl]; systolic blood pressure [130 (9.50) compared to 115 (5.77) mmHg] and waist to hip ratio [0.92 (0.08) compared to 0.84 (0.05)], and 1D/W group also showed significantly higher levels of triglycerides [71.04 (24.31) compared to 45.75 (12.76) mg/dl] than ND. Moreover, it was confirmed that the accumulation of triglycerides in weekend drinkers is influenced by smoking and the lack of physical activity, and that the relationship between alcohol drinking and systolic blood pressure could be modified by smoking. Conclusions Young people's abusive intake of alcohol at weekends can cause negative changes in various health parameters, similar to those observed in alcoholics that drink regularly during the week.

This report describes the use of transcollateral retrograde revascularization in two patients after failed recanalization of the tibioperoneal trunk in one and superficial femoral artery occlusion in the other. Retrograde recanalization was successfully achieved via a distal branch of the profunda femoris artery in the first case and a medial genicular branch in the second. After successful retrograde recanalization, the guide wire was snared in both cases and angioplasty/stent placement was performed in an antegrade fashion.

Cadmium (Cd), tungsten (W), tellurium (Te), beryllium (Be), and lead (Pb), are non-essential metals pervasive in the human environment. Studies on athletes during training periods compared to non-training control subjects, indicate increased loss of minerals through sweat and urine. The aim of this study was to compare the level of these trace elements, determined by inductively coupled plasma mass spectrometry (ICP-MS) in urine samples, between athletes and age-matched sedentary subjects living in the same geographical area, although anthropometric and cardiovascular measurements showed that athletes have significantly (P ≤ 0.001) lower BMI, body fat and heart rate, whereas the muscle and bone percentage was significantly (P ≤ 0.001) higher than in sedentary subjects. The validity of the methodology was checked by the biological certified reference material. Trace element analysis concentrations, expressed in μg/mg creatinine, of five toxic elements in urine from athletes (n = 21) versus sedentary subjects, (n = 26) were as follows: Cd (0.123 ± 0.075 vs. 0.069 ± 0.041, P ≤ 0.05); W (0.082 ± 0.053 vs.

Late complications after surgical repair of aortic coarctation are not uncommon. Among these complications pseudoaneurysms are the most frequent complications, occurring between 3 and 38%. Reoperation in these patients is associated with high morbidity and mortality. In the last decade, endovascular techniques emerged as an alternative to conventional surgery with excellent results. We report the case of two patients who presented with pseudoaneurysms after surgical correction for aortic coarctation, which were treated by endovascular means.

[Figure][1] A 46-year-old female patient was admitted with signs of lower limb ischemia. Her examination demonstrated a nonpalpable distal pulse. Computed tomography angiography revealed an anomalous origin of both renal arteries (A, B) and severe aortic narrowing between the renal arteries

The conventional elective open procedures for abdominal aortic aneurysm repair are reliable and yield durable results. The aortoaortic tube graft has the lowest morbidity incidence when compared with different techniques. Albeit infrequent, thrombosis can be present in the first 30 days. Its treatment consists in thrombectomy and anastomosis evaluation, but with an increase in morbidity, especially in patients with urgent reintervention. This is a case report of a patient with aortoaortic tube graft, who present critical left limb ischemia immediately after surgical procedure. Angiography showed complete occlusion of left common iliac artery, affecting the distal graft anastomosis. The occlusion was resolved with endovascular treatment, and a noncovered, self-expanding, nitinol stent was deployed (primary stenting) covering the distal bypass anastomosis, with no complications and complete lower limb perfusion recovery. One month later, the patient was still asymptomatic, with distal pulse palpable and ankle-brachial index 1.

Mycotic aneurysms are uncommon, especially those located in visceral arteries. We present a case of a patient with two visceral mycotic aneurysms due to bacterial endocarditis, one located in right upper pole renal artery and the second in the splenic artery. Both aneurysms were treated as endovascular embolization using microcoils. In the aneurysm located at the renal artery, the technique of stent-assisted coils embolization was preferred to avoid coils migration due to its wide neck. The stent used was the Solitaire AB, which was designed for the treatment of intracranial aneurysms and was used recently in acute stroke as a mechanical thrombectomy device. Complete embolization of the aneurysm was achieved, preserving all the arterial branches without nephrogram defects in the final angiogram.

Revascularization of infrainguinal vessels is still a challenge. Complications such as flow-limiting dissections or perforation are responsible for a limited success rate. Failed revascularization attempt leads to amputation in a significant number of patients and increases mortality. We report the use of a novel percutaneous device using the CROSSER catheter system in two patients with peripheral vascular disease. In case # 1 anterior tibial artery patency was restored in a diabetic foot and in case # 2 a chronic traumatic occlusion of the superficial femoral artery was revascularized. In both cases the lesion was recanalized in a short time without any procedure-related complications. The CROSSER catheter system can overcome technical problems and make reentry devices and retrograde distal accesses less relevant. It opens new horizons for the treatment of complex below-the-knee lesions.

Despite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies.The aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model.Six male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17beta-estradiol and 5alpha-androstene 3alpha 17beta-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates.All animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia.The administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study..

We have studied the rate of lower extremity amputations (LEAs) in the south of Gran Canaria. The incidence rate was 319.7 per 100,000 (95% CI, 258.6–380.8) per year in the diabetic subjects. The incidence of both diabetic and non-diabetic LEAs is the highest reported in Spain.

Objective: To demonstrate the technical success and clinical follow-up after endovascular treatment of femoropopliteal segment TASC II C and D lesions. Methods: From July 2002 to February 2007, 234 limbs in 190 patients with femoropopliteal segment TASC II C (n = 112) and D (n = 122) lesions were treated. Endovascular treatment consisted of PTA, fibrinolysis and PTA, subintimal recanalization and PTA, and finally stent graft. Patients were clinically evaluated at 30 days, 3, 6 month, and at 1 year in the outpatient setting with clinical examination and ankle-brachial indices (ABI). In the case of stent placement, additional ultrasound evaluation was performed at 12, 24, and 48 month. Results: 49.5% of procedures were performed on patients with lifestyle-limiting claudication (IC) and 50.5% were performed for critical limb ischemia (CLI). Technical success, defined as successful recanalization and treatment of the occluded vessel, was achieved in 97% of cases. Periprocedural mortality was 3.15% and all deaths occurred in the CLI group. A follow-up 13 ± 6 months and was achieved in 76%. During the follow-up, clinical outcome for IC group and clinical CLI group was asymptomatic 72% vs. 29.8%, symptomatic with clinical improvement 22% vs. 33.7%, and major amputation 3% vs. 23.3%. Conclusion: The majority of claudicating patients with femoropopliteal TASC II C and D lesions will benefit from the endovascular treatment. Patient presenting CLI have a worse outcome, nevertheless the endovascular treatment can delay amputation, preserving the native vessel and does not impede surgical bypass if needed. For this reason, we consider that endovascular treatment may be the first choice treatment even in femoropopliteal TASC II C and D lesions. © 2009 Wiley-Liss, Inc.

Resumen Introduccion A pesar de exhibir diferencias histologicas con el proceso en humanos, la hiperplasia benigna de prostata (HBP) inducida por hormonas en perros representa el modelo mas utilizado actualmente para la evaluacion de tratamientos. Objetivos El objetivo del presente estudio es determinar el momento optimo para la realizacion de un ensayo terapeutico en este modelo. Material y metodos En el estudio se utilizaron 6 perros beagle, machos mayores de un ano, a los que se administro una combinacion de hormonas, 17β-estradiol y 5α-androsteno 3α 17β-diol, en dias alternos durante 3 (grupo 1, n = 3) o 5 meses (grupo 2, n = 3). Se realizaron seguimientos ultrasonograficos mensuales, con determinacion del tamano prostatico. A los 5 meses se procedio al sacrificio de todos los animales y el estudio histologico de las glandulas prostaticas. Resultados Todos los animales desarrollaron una HBP, con un volumen prostatico que aumentaba con el tiempo de administracion hormonal (r = 0,910), evidenciandose en todos los estudios ecograficos hasta el tercer mes un aumento significativo de tamano frente al estudio anterior. El tamano prostatico disminuyo considerablemente en el grupo 1 al retirar la hormonoterapia, al tiempo que en el grupo 2 continuo aumentando. Los animales del grupo 1 apenas evidenciaron signos histologicos de HBP, frente a los del grupo 2, que presentaron una clara hiperplasia del epitelio glandular. Conclusiones La administracion de una combinacion de hormonas esteroides es efectiva para inducir hiperplasia de prostata en perro, si bien esta desaparece en el momento que se retira la hormonoterapia. Para utilizar este modelo en estudios experimentales, se deben administrar hormonas al menos durante 3 meses antes de la actuacion terapeutica, y continuar durante todo el ensayo.

Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the case of a female patient with traumatic aortic injury, treated with endograft, who developed a type II endoleak through the left subclavian and vertebral arteries. Both arteries originated independently from the aortic arch, and were managed with coil embolization of each vessel. We also report our experience with treating the left vertebral artery by placing a microcatheter through the right vertebral one.

Gianturco self-expandable stents were used successfully in the management of 5 patients with tracheobronchial pathology. Placement was performed under endoscopic and fluoroscopic guidance. None of the patients has experienced complications secondary to the stent placement, and in all of them the clinical problems resolved satisfactorily. Longer follow-up is required to determine the place of tracheobronchial stenting in patients with respiratory compromise.

BACKGROUND AND PURPOSE: A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices. MATERIALS AND METHODS: Eighty-seven consecutive patients with 100 carotid stenoses compose this series. Ninety four of the 100 hundred stented carotid arteries were either symptomatic (58 [58%]) or had a greater than 70% stenosis (36 [36%]). Six percent of them were asymptomatic and had stenosis between 50% and 70%. Patients underwent neurologic evaluation before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Carotid sonography and plain films of the neck were performed immediately after the procedure and then at the same time intervals. RESULTS: Primary stent placement was successful in 98 of 100 case subjects. In 2 case subjects, predilation was necessary before stent deployment. Neurologic periprocedural complications included 1 nondisabling and 1 disabling stroke and 5 transient ischemic attacks. The mean duration of follow-up was 23 months (range: 10–36 months). During the follow-up period, there were 5 deaths, all unrelated to the carotid disease, and no major stroke. The degree of stenosis decreased from a mean of 78.85% before the procedure to a mean of 21.23% immediately after. CONCLUSIONS: In this series, carotid stent placement without the use of either balloon angioplasty or distal protection devices was safe and effective with a low incidence of periprocedural complications.

Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery.

Pulmonary arteriovenous malformations are rare anomalies that carry a considerable risk of serious complications such as cerebral thromboembolism or abscess and pulmonary hemorrhage. The first-line treatment of such malformations is detachable coil or balloon embolotherapy. However, coils and balloons may migrate and cause paradoxical embolism especially in malformations with large arteriovenous shunts. We report a case in which we used a new vascular occlusion device (amplatzer vascular plug), to occlude a pulmonary arteriovenous fistula in a patient with Rendu-Osler-Weber syndrome.

La retirada percutanea de cuerpos extranos intravasculares es un procedimiento ampliamente utilizado en los ultimos anos que puede evitar la cirugia mayor. Cuando el cuerpo extrano se aloja en las cavidades cardiacas su rescate se ve dificultado por la posibilidad de arritmias. Presentamos un caso en el que un fragmento de un introductor quedo alojado en el ventriculo derecho, atrapado entre las cuerdas tendinosas. No fue posible extraerlo del ventriculo derecho, por lo que fue necesario desplazarlo hacia la arteria pulmonar izquierda desde donde fue retirado sin dificultad.

SummaryWe report the endoluminal treatment of a para-anastomotic aneurysm with an endovascular stent-graft. A straight stent graft was inserted through the femoral artery into the abdominal aorta. The angiogram performed after the procedure showed total exclusion of the aneurysm. The patient has been asymptomatic for a 2 year follow-up period. We consider that this is a feasible technique in patients with high-risk for surgery, but more experience is required to evaluate the efficacy of the procedure.

We report our experience with the use of a self-expanding stent in the treatment of a severe innominate artery stenosis resulting in right upper limb ischemia. A 45-year-old woman was admitted for right upper limb ischemia, asymmetry of the carotid pulse and the lack of pulse in the right upper extremity. The patient had a history of chain smoking, hypertension, hypercholesterolemia, and acute myocardial infarction one year ago. She was diagnosed of the innominate artery stenosis by angiography one year ago at another hospital. At the time of admission her blood pressure was normal in the left arm and absent in the right upper limb. Arteriography showed a severe stenosis subocclusion of the innominate artery with an inverse flow of the ipsilateral vertebral artery. As the patient was not considered to be a surgical candidate due to instable angina, stent placement was indicated. After placement through an axillary approach an angiogram showed a patent right subclavian artery without residual stenosis. Angiographic follow-up showed a patent innominate arterial lumen two years after the procedure. The patient continued to be asymptomatic during six years follow-up. Blood pressure remained normal in both upper extremities, without any ischemic signs. Our experience indicates that placement of an endovascular stent is an effective therapeutic option in selected patients with symptomatic stenosis in the innominate artery when a surgical treatment is contraindicated.

Endoluminal occlusion has been performed since the early beginning of interventional radiology. Over recent decades, major technological advances have improved the techniques used and different devices have been developed for changing conditions. Most of these occlusion devices have been implemented in the vascular territory. Early embolization materials included glass particles, hot contrast, paraffin, fibrin, and tissue fragments such as muscle fibers and blood clots; today, occlusion materials include metallic devices, particles, and liquid materials, which can be indicated for proximal or distal occlusion, high-flow and low-flow situations, and in large-caliber and small-caliber vessels, based on need. Technological progress has led to a decreased size of delivery catheters, and an increase in safety due to release systems that permit the withdrawing and replacement of embolization material. Furthermore, bioactive embolization materials have been developed to increase the efficacy of embolization or the biological effect of medication. Finally, materials have been modified for changing indications. Intravascular stents were initially developed to keep an artery open; however, by adding a covering membrane, these stents can be used to occlude the wall of a vessel or other endoluminal structures. This article gives an overview of the devices most utilized for occlusion of endoluminal structures, as well as their major purpose in the endovascular territory.

This study was performed with approval from the ethics committee for animal research of the local government. The purpose of the study was to evaluate the technical feasibility of a technique for subxiphoid access to the normal pericardial space with a micropuncture set in 10 large white pigs. With fluoroscopic guidance, a fine needle was inserted through a subxiphoid approach into the anterior mediastinal space to puncture the pericardium, and a micropuncture set was placed in the pericardial space successfully in all animals without complications. Necropsy at 24 hours did not reveal hemomediastinum, hemopericardium, or laceration of the pericardium. Results of the experiments in animals indicated that the technique was feasible and safe. © RSNA, 2005

Tracheal collapse in dogs is a common respiratory disorder, typically presenting with a history of chronic cough, increasing respiratory difficulties, and episodes of dyspnoea. Medical treatment is the therapy of choice and surgical repair is considered when patients do not respond well. Minimally invasive endotracheal stenting is a promising new therapy under investigation, but there remain significant challenges to overcome potential complications. The purpose of this article is to provide a comparative overview of intra-luminal stenting of the trachea in human and veterinary medicine. The currently available stents and their potential clinical application to the veterinary patient will be discussed.