There is a significant re-stenosis rate with percutaneous treatment of stenoses of the infrarenal abdominal aorta with balloon angioplasty. Since 1990 the authors have primarily treated local infrarenal aortic stenoses with metallic endoluminal stents. The authors' experience with 12 consecutive patients (nine women and three men, aged from 30 to 72 years (mean age = 57 years)) is presented. Follow-up is available in 11 cases over 7-78 months (mean 32 months). The procedure was technically successful in all patients. Of the 11 patients with follow-up available, claudication was cured (n = 7) or significantly improved (n = 4). Those with persisting claudication had concurrent distal arterial disease. Periprocedural complications occurred in five cases, with two significant complications. One case required iliac angioplasty for embolized aortic atherosclerotic plaque, and one case required surgical thrombectomy and vein patch for iliac thrombosis complicating iliac dissection, without long-term sequelae in either case. One patient has had recurrent symptomatic aortic stenosis occurring 6 years after initial stenting, which responded to further stent insertion. Primary patency of 91% and secondary assisted patency of 100% has been achieved. Primary treatment of infrarenal aortic stenosis with endoluminal stenting results in high patency rates, with low morbidity and relatively low complication rates.
Intracranial epidermoids can closely mimic cerebrospinal fluid (CSF) on MRI and CT. Therefore epidermoids can be difficult to detect, or distinguish from CSF. Three cases of intracranial epidermoid are presented, one of which closely mimicked an arachnoid cyst on CT and routine MRI sequences. Diffusion-weighted magnetic resonance imaging (DWI) was performed. All three epidermoids demonstrated marked restriction of diffusion relative to CSF, clearly defining the extent of each lesion, and allowing differentiation from an arachnoid cyst or an enlarged CSF space.
Expandable metallic stents have been used with considerable success for the palliation of malignant vena caval obstruction. The role of stenting in vena caval obstruction of benign aetiology is less well defined. A review of 11 patients stented for vena caval obstruction and a review of recent series in the literature is presented. Of the 11 patients, seven patients had involvement of the superior vena cava (SVC), and four patients had inferior vena caval (IVC) obstruction. Seven cases had malignant vena caval obstruction, with a benign aetiology (SVC n = 3; IVC n = 1) in the other four cases. All seven patients treated with SVC stents experienced complete resolution or significant improvement in symptoms with no recurrence over the duration of available follow-up, over an average of 4.3 months (range: 1 week-12 months). Only one of four IVC lesions stented resulted in a good clinical response. All four patients with vena caval obstruction of benign aetiology had a good outcome. One patient experienced a small pulmonary embolus following SVC stent insertion without further sequelae. No other serious complications were encountered. Stenting can provide prompt relief of vena caval obstruction with low morbidity, and high patency rates in both benign and malignant vena caval lesions.
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