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A case of an embolization of an Anthéor vena cava filter into the pulmonary artery with disastrous exit 9 days after placement is described. The possible reasons are discussed. [ABSTRACT FROM AUTHOR]

Background and Objective: The involvement of the cervical spine in rheumatoid arthritis can be essential regarding prognosis and mortality. The cervical myelopathy due to pannus formation and/or subluxation can be fatal. Aim of this study was to demonstrate the possible changes seen by MRI, and to establish a risk-profile for the individual patient., Patients and Method: Within a period of 24 months 214 patients with active RA were included. Clinical and laboratory data were obtained and plain radiographs of the cervical spine were taken. In patients with pathological findings on X-ray an MRI was performed (36 patients)., Results: Within the group of 214 patients 36 were identified to get an cervical spine MRI. In all cases the MRI showed significant changes: in 7 (19.5 %) pannus surrounded the dens, with additional erosions in one patient (2.7 %). In 25 (69.5 %) atlanto-axial-subluxation was present, 7 (19.5 %) showed a spondylodiscitis below C2. In 10 (27.8 %) a cervical myelopathy due to pannus or subluxation was present. There was no correlation of the MRI-results with symptoms and findings by examination. The patients with cervical spine disease were in all stages of RA. The majority was rheumatoid-factor positive. 5 out of 10 patients with cervical myelopathy showed neurological deficits: 3 patients died in consequence of neural compression, 2 patients underwent surgery successfully., Conclusion: The early detection of a cervical spine involvement in RA is essential to avoid possibly fatal complications. The only reliable method to achieve this goal has to include radiographic diagnostic including MRI of the cervical spine. Only this approach can answer the question of the right time-point for surgery. In daily clinical practice the cervical-spine involvement in RA is still underestimated.

Pseudoaneurysm following chronic pancreatitis is a severe complication that can lead to massive gastrointestinal bleeding. Surgical treatment means high risk for the patient. We report on two patients in whom the bleeding was managed by percutaneous transvascular embolization, a relatively non-invasive and successful method with low risk. The goal was either the definitive arrest of bleeding or stabilization of the patient to enable a surgical procedure. Embolization coils are the material most utilized for vessel occlusion. In patients with bleeding complication following pancreatitis, if sonography or computed tomography demonstrates a pseudoaneurysm, we recommend angiographic visualization and immediate subsequent embolization.

The main methods of interventional radiology are described under clinical aspects. Treatment in peripheral arterial occlusive diseases by angioplasty and special other methods (stents, thrombectomy), as well as in bleeding management by embolization or different diagnostic and therapeutic techniques associated with oncologic diseases are performed. Minimal-invasive procedures are one of the most important courses of the practical medicine in the future.

Recanalization of the vascular lumen by means of local fibrinolysis is of major importance in the treatment of peripheral arterial occlusive disease. While urokinase and streptokinase have been extensively used for local fibrinolysis, there have been few studies of infiltration thrombolysis with genetically engineered tissue plasminogen activator (rt-PA). The aim of the investigation reported here was to establish whether there is any difference between urokinase and rt-PA in the short- and long-term outcome of local fibrinolytic therapy. One-hundred twenty patients (70 men, 50 women) with acute or subacute femoral (n = 21), femoropopliteal (n = 33), popliteal (n = 13) or popliteocrural (n = 53) thrombotic occlusions were randomized to local lysis using urokinase or rt-PA, and 6 months later follow-up investigations took place. Recanalization of thrombotically occluded vessels, particularly in the lower leg, was found more frequently, and after treatment of shorter duration, with rt-PA. Large local haematomas occurred in 8% of cases in the urokinase group and 15% in the rt-PA group. No serious haemorrhages were encountered in either group. Six months after treatment, the rt-PA group showed lower rates of Fontaine stage III and IV disease and amputation than the urokinase group, with a higher number of patients in Fontaine stage IIb. This study shows that local lysis with rt-PA yields better results than urokinase, not only in the short term but also 6 months later.

The long-term results of 222 patients (pts) with transvenously implanted vena cava filters are critically reviewed. A total of 98 pts were given a Mobin-Uddin filter, 102 pts a Günther filter, and 16 pts a LGM filter. Among the serious complications observed during long-term follow-up were vena cava occlusions and increasing symptoms ranging from congestion of the deep leg veins, perforations into ureters, fractures and embolizations of the filters in up to 40% of the patients, if Günther filters were implanted.

It is reported on the practicability and the results of therapeutic embolizations in 7 patients with pulmonary av-malformations. The embolizations were carried out by detachable balloons. In all cases there were immediate and well-defined occlusions. In direct fistulas the embolization represents a curative procedure. However, in cases of angiomatous malformations with slow flow character, only a reduction of shunt or decreasing of size is obtained.

Possibilities and indications for reconstruction of the femoro-popliteal and femoro-crural region are dealth with. Autogenous veins still are the favoured graft material for the femoro-popliteal/crural bypass. If an autogenous vein is not available bovine arterial grafts, Gore-Tex-PTFE prostheses or modified human umbilical cord vein are alternative materials.

The results of varicocele treatment by balloon occlusion of the testicular vein in 22 children and 29 adults are compared with the results after operative ligation of the testicular vein in 95 patients. In 6 out of 22 children (27%) the varicocele persisted after balloon occlusion, compared with 3 out of 29 adult patients (10%). These results in adults are comparable to the results after operative ligation of the testicular vein, whereas the complication rate was significantly lower after balloon occlusion in comparison with operative treatment.

30 patients underwent implantation of the Mobin-Uppin filter for recurrent life threatening pulmonary embolism. 20 patients could be followed by phlebography. In 11 cases obstruction of the inferior vena cava was observed. Due to the collaterals having developed in the intermediate time there were no significant clinical symptoms below the obstruction.

In 53 external patients with extensive malignant renal tumours before nephrectomy the renal artery was closed centrally by radioopaque ivalonchips. 46 arteries were completely obturated, in 7 cases the embolization was incomplete. This method of embolization is indicated preoperatively because there are some advantages concerning technique of operation. In or ivalon-material there was only one complication without clinical symptoms. The occurring ischemic pain was controllable by medicaments and eased off within some hours. Directly after transcatheter occlusion the patients can be transported back under first aid conditions in hospital where will be nephrectomy carried out.

Report on the application of a new (valve equipped) detachable balloon for percutaneous transvasal embolization therapy in 372 patients with (noncerebral) curative preoperative and palliative indications.

In a retrospective study of 303 patients with renal cell carcinomas the prognostic influence of the percutaneous transvasal embolization of the renal artery was demonstrated. In form of the life-table-method we compared statistically the survival rates of preoperatively or palliatively embolized patients with such ones who were only nephrectomized or treated only symptomatically. In the tumour stages T2 and T3 the preoperative percutaneous transvasal embolization leads to a clearly higher survival rate; in stage T2 statistically significant. After palliative embolization the improvement of the prognosis is evident compared with the inoperable patients who were treated only symptomatically. The prognosis after palliative preoperative percutaneous transvasal embolization and retarded nephrectomy is not worse than after preoperative percutaneous transvasal embolization and immediate nephrectomy. The effect of the preoperative and palliative embolization improving the prognosis should incite all partners who up to now objected to this therapeutic method to reconsider their therapy concept.

In 16 patients suffering from occlusions of the pelvic and/or femoral arteries a combined treatment was performed: percutaneous transluminal angioplasty (PTA) and surgical reconstructive measures. Indications for this procedure are: 1. Stenoses of the pelvic arteries and occlusion of the ipsilateral superficial femoral artery with PTA for the iliac artery and endarterectomy for the femoral artery. 2. Occlusion of the iliac and the femoral arteries with a decreased run-off: PTA and lumbar sympathectomy. 3. Endarterectomy on one side and PTA contralaterally.

Report on 12 women with acute massive or chronic tumor hemorrhage, treated with embolisation. There were 7 women with cervical cancer T3/T4, 3 women with adenocarcinoma (2mal primary progressive, one with metastases in lymph-nodes), one woman with progressive malignant mesenchymale tumor in vagina and one with local persistent ovarian cancer. In 10/12 cases hemorrhage stopped immediately after embolisation. In 3 cases, after one-sided embolization, repeated procedure of the contralateral vessel was necessary. In 2/12 cases side-effects like fever and subileus, and, in one case, complications like skin necrosis and bladder-vagina-fistula were seen. In all patients temporary improvement of life-quality were found. Low risk and good tolerance of this palliative therapy are emphasized.

Aortography and subsequent angiography of the A. carotis communis (Seldinger technique) was carried out in a 51-year-old man suffering from cerebrovascular insufficiency (transitory hemiparesis, disturbances in word finding). Complete interna occlusion from the carotid fork, no formation of collaterals in the ophthalmic artery region. After the last administration of the contrast medium loss of sight on the side of the carotid angiography (right side). Reappearing of retinal circulation only on the following day. Treatment with Radecol, Prednisolut, amyl nitrite. No return of slight, --Discussion of the two releasing possibilities; washing-in of embolic material and arterial spasms. A survey in the form of tables is given of nine similar complications which were found in the literature. Comprehensive bibliography.