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Conventional Angiography (conventional + angiography)
Selected AbstractsReview article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2005P. L. Kozuch Summary Mesenteric ischaemia results from decreased blood flow to the bowel, causing cellular injury from lack of oxygen and nutrients. Acute mesenteric ischaemia (AMI) is an uncommon disorder with high morbidity and mortality, but outcomes are improved with prompt recognition and aggressive treatment. Five subgroups of AMI have been identified, with superior mesenteric artery embolism (SMAE) the most common. Older age and cardiovascular disease are common risk factors for AMI, excepting acute mesenteric venous thrombosis (AMVT), which affects younger patients with hypercoaguable states. AMI is characterized by sudden onset of abdominal pain; a benign abdominal exam may be observed prior to bowel infarction. Conventional angiography and more recently, computed tomography angiography, are the cornerstones of diagnosis. Correction of predisposing conditions, volume resuscitation and antibiotic treatment are standard treatments for AMI, and surgery is mandated in the setting of peritoneal signs. Intra-arterial vasodilators are used routinely in the treatment of non-occlusive mesenteric ischaemia (NOMI) and also are advocated in the treatment of occlusive AMI to decrease associated vasospasm. Thrombolytics have been used on a limited basis to treat occlusive AMI. A variety of agents have been studied in animal models to treat reperfusion injury, which sometimes can be more harmful than ischaemic injury. Chronic mesenteric ischaemia (CMI) usually is caused by severe obstructive atherosclerotic disease of two or more splanchnic vessels, presents with post-prandial pain and weight loss, and is treated by either surgical revascularization or percutaneous angioplasty and stenting. [source] Obstruction of cerebral venous sinus secondary to idiopathic intracranial hypertensionEUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2008A. Stienen Background:, Whether cerebral venous sinus obstruction is a cause or consequence of idiopathic intracranial hypertension (IIH) is uncertain. Methods and results:, Among the nine children with IIH, five showed stenosis (n = 5) and occlusion (n = 1) of cerebral venous sinus on cranial magnetic resonance imaging (n = 4) or conventional angiography (n = 1), respectively. Follow-up magnetic resonance imaging performed in four children showed complete regression of the venous pathology in one and partial regression in two of them. Conclusions:, Our data demonstrate that cerebral venous sinus obstruction is frequent and frequently transient in pediatric IIH and suggest that stenoses may result from elevated intracranial pressure. [source] Routine intraoperative Doppler sonography in the evaluation of complications after living-related donor liver transplantationJOURNAL OF CLINICAL ULTRASOUND, Issue 9 2007Jin-Young Choi MD Abstract Purpose To determine whether quantitative and qualitative analysis of intraoperative Doppler sonography data are predictive of vascular complications after living-related donor liver transplantation. Methods Intraoperative sonograms of 81 transplanted livers (right lobe in 61 patients, left lobe in 20 patients) were analyzed for the presence of blood flow, resistance index, systolic acceleration time (SAT), peak systolic velocity, and morphologic characteristics of spectral waveform of the hepatic artery. Peak velocity and spectral waveforms of portal and hepatic veins were also analyzed. Intraoperative sonography results were compared with information obtained with multidetector-row CT (MDCT) angiography or conventional angiography. The time interval between operation and angiography ranged from 1 to 23 days (mean, 8.5 days). Results Hepatic artery stenosis (HAS) was identified in 20 patients via MDCT angiography, conventional angiography, or both. The Doppler parameters found helpful for predicting HAS were tardus-parvus pattern and delayed SAT. The sensitivity, specificity, and negative predictive value (NPV) were 60.0%, 73.7%, and 84.9%, respectively, for tardus-parvus pattern and 40.0%, 83.6%, and 80.9%, respectively, for delayed SAT. Peak velocities of the portal and hepatic veins were not reliable indicators of vascular complication. Loss of triphasity of the hepatic vein had a 98.4% NPV for venous obstruction. Conclusions Delayed SAT of the hepatic artery and loss of triphasity of the hepatic vein had a >80% for specificity for predicting vascular complications. Tardus-parvus pattern, delayed SAT of the hepatic artery, and loss of triphasity of the hepatic vein showed an acceptable NPV for identifying vascular complications. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007 [source] Recovery of Reversed Basilar Artery Flow as Seen by Transcranial Sonography and MRA Source Images for Vertebral DissectionJOURNAL OF NEUROIMAGING, Issue 4 2008Sung Ik Lee MD ABSTRACT The dissection of the intracranial vertebral artery (VAD) is a common cause of young age brain stem stroke. VAD can be detected by conventional angiography, but there is yet no agreement on the most effective tool to use for the detection of VAD. Here, we report a patient with VAD, who was diagnosed with an intimal flap within the left vertebral artery by the magnetic resonance angiography (MRA) source images. Transcranial Doppler (TCD) showed a reversed flow in the basilar artery. After 4 months, TCD and transcranial color-coded Doppler (TCCD) confirmed a normal anterograde flow of the vertebro-basilar arteries. [source] Intravascular Ultrasound to Assess Extracranial Vertebral Artery Restenosis: Case ReportJOURNAL OF NEUROIMAGING, Issue 3 2008Rishi Gupta MD ABSTRACT We present a case report of a patient who developed restenosis 5 months after initial stent placement. computed tomography (CT) angiography revealed a 70% stenosis, while conventional angiography revealed a 40% stenosis. An intravascular ultrasound (IVUS) was used to assess the degree of narrowing along with the mechanism causing the stenosis. IVUS can be utilized to resolve discrepancies between imaging modalities for degree of stenosis and also aid in determining the mechanism of restenosis after stent placement in the extracranial vertebral arteries. [source] Moyamoya-disease-related ischemic stroke in the postpartum periodJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2009Kei Miyakoshi Abstract Stroke during pregnancy or the puerperium is an extremely rare yet serious cause of perinatal morbidity and mortality. Moyamoya disease, a cerebrovascular occlusive pathology with a female predominance, may become symptomatic for the first time in association with pregnancy. A 36-year-old woman with postpartum pre-eclampsia suddenly developed hemiparesis in the left arm with dysarthria after the initiation of antihypertensive measures. Cranial magnetic resonance imaging and angiography revealed acute ischemic lesions in the right hemisphere along with the steno-occlusive lesions of bilateral terminal portions of the internal carotid artery, indicating Moyamoya disease. With anti-platelet medication, the patient recovered gradually and was diagnosed as having Moyamoya disease using conventional angiography 3 months postpartum. In this case, the fluctuations in blood pressure in association with pre-eclampsia appear to have exacerbated the clinical symptoms of Moyamoya disease. As such, Moyamoya disease should be considered as an underlying disease of ischemic stroke associated with pregnancy. [source] Does peak systolic velocity correlate with renal artery stenosis in a pediatric renal transplant population?PEDIATRIC TRANSPLANTATION, Issue 5 2006Anthony Cook Abstract:, PSV of renal transplant vessels, calculated during allograft ultrasonography, has previously been shown to correlate with TRAS. Controversy exists regarding the threshold PSV value (adult range: 1.5,3.0 ms), which should prompt further, more invasive investigations to confirm the diagnosis of TRAS. Furthermore, there is a paucity of literature regarding PSV values in the pediatric renal transplant population. In a group of pediatric renal transplant patients, we correlated post-operative renal transplant PSV values with BP, renal function (serum creatinine) and TRAS. All patients who underwent cadaveric or living-related renal transplantation at the HSC between 2001 and 2004 with at least 6 months of follow-up were reviewed through the HSC multi-organ transplant database. Post-operative allograft Doppler ultrasonography was performed during routine follow-up. PSV values obtained were correlated with BP and serum creatinine performed concomitantly. Finally, we correlated PSV in those patients who underwent more intensive investigations, including magnetic resonance and conventional angiography. Fifty-three patients underwent transplantation during the study period. Complete data available for 50/53 demonstrated a mean PSV of 2.13 m/s (range: 0.9,6.1 m/s) for all patients. Of six patients who underwent MRA for suspicion of TRAS, two (with mean PSV values of 1.93 m/s) were found to have clinically significant stenoses. Four of six without angiographic evidence of TRAS had mean PSV values of 2.22 m/s. Patients suspected of having TRAS demonstrated elevated median serum creatinine values compared with those without clinical suspicion of TRAS. However, both mean PSV and BP were not found to be statistically different in both patient subgroups. Furthermore, there was no correlation identified between PSV and serum creatinine and BP in these patient populations. Despite the utility of PSV for monitoring adult renal transplant patients, we did not find that PSV correlated with BP, nadir creatinine or identify those patients who, through subsequent investigations, were found to have TRAS in this pediatric population. Maintaining cognizance in conjunction with close clinical follow-up may identify patients at risk for this rare but potentially morbid complication of transplantation. [source] Living related small bowel transplantation in children: 3-dimensional computed tomography donor evaluationPEDIATRIC TRANSPLANTATION, Issue 1 2004Fabrizio Panaro Abstract:, The evaluation of the small bowel vascular anatomy of living small bowel donors (LSBD) is usually performed with conventional angiography (CA). Recently, angio computed tomography (CT) has become a valid study of the vascular anatomy for kidney and liver living donors. We studied the applicability of angio CT with 3-D reconstruction (3-D-ACT) in the evaluation of LSBD. Potential LSBDs for pediatric transplant underwent both CA and 3-D-ACT to evaluate the anatomy of the distal branches of the superior mesenteric artery and vein. Angio-CT was performed with General Electric Lightspeed Scanner. The 3-D reconstruction was performed on the TeraRecon workstation. Adverse reactions, contrast dosage, test duration, invasiveness, hospital-stay, patient discomforts and accuracy were evaluated. Four potential donors (four female; mean age: 30.5 yr; mean BMI: 28.4) underwent both tests. Adverse reactions correlated to contrast agent used (90 mL CA, 150 mL 3-D-ACT) were not reported. CA required a hospitalization of 6 h as opposed to immediate discharge after the 3-D-ACT. The CA required the placement of transfemoral catheter and therefore greater patient discomfort than with 3-D-ACT. The 3-D-ACT arterial images were rated as equivalent to CA, however, 3-D-ACT venous images were rated better than the CA in all cases. CT-angiography with 3-D reconstruction is an acceptable method for vascular evaluation. When compared with routine angiography, it is less invasive, better tolerated and faster, but does require a significantly greater volume of venous contrast. 3-D-ACT also offers a better evaluation of the venous phase, and thus may become the test of choice to evaluate the vascular anatomies of LSBD candidates. [source] | ||||||||||