Prophylactic oral administration of the antioxidant acetylcysteine, along with hydration, prevents the reduction in renal function induced by contrast agents in patients with chronic renal insufficiency.
Purpose: The aim of this study was to identify factors predisposing to lung infarction in patients with pulmonary embolism (PE).
Materials and Methods: We performed a retrospective analysis on 154 patients with the final diagnosis of PE being examined between January 2009 and December 2012 by means of a Toshiba Aquilion 64 CT scanner. The severity of clinical symptoms was defined by means of a clinical index with 4 classes. The pulmonary clot load was quantified using a modified severity index of PE as proposed by Miller. We correlated several potential predictors of pulmonary infarction such as demographic data, pulmonary clot burden, distance of total vascular obstruction and pleura, the presence of cardiac congestion, signs of chronic bronchitis or emphysema with the occurrence of pulmonary infarction.
Results: Computed tomography revealed 78 areas of pulmonary infarction in 45/154 (29.2?%) patients. The presence of infarction was significantly higher in the right lung than in the left lung (p?0.001). We found no correlation between pulmonary infarction and the presence of accompanying malignant diseases (r?=??0.069), signs of chronic bronchitis (r?=??0.109), cardiac congestion (r?=??0.076), the quantified clot burden score (r?=?0.176), and the severity of symptoms (r?=??0.024). Only a very weak negative correlation between the presence of infarction and age (r?=??0.199) was seen. However, we could demonstrate a moderate negative correlation between the distance of total vascular occlusion and the occurrence of infarction (r?=??0.504).
Conclusion: Neither cardiac congestion nor the degree of pulmonary vascular obstruction are main factors predisposing to pulmonary infarction in patients with PE. It seems that a peripheral total vascular obstruction more often results in infarction than even massive central clot burden.
Key points:
??A peripheral location of vascular occlusion is the main factor predisposing to pulmonary infarction.
Citation Format:
??Kirchner J, Obermann A, St?ckradt S et?al. Lung Infarction Following Pulmonary Embolism: A Comparative Study on Clinical Conditions and CT Findings to Identify Predisposing Factors. Fortschr R?ntgenstr 2015; 187: 440???444
Two hundred patients were treated with tantalum stents, 2 in the aortoiliac bifurcation, 114 in the iliac, and 84 in the femoropopliteal arteries. The indications for stenting were technically unsuccessful percutaneous transluminal angioplasty (PTA) due to arterial recoil, dissection (156 patients), or acute occlusions (15 patients). Long iliac artery occlusions (29 patients) were indications for primary stenting. Life-table analysis revealed a 3-year patency rate of 95% for stented iliac arteries, and a 1-year patency rate of 80% for stented femoropopliteal arteries. Restenosis of the stented femoropopliteal lumen was particularly frequent in stents placed for restenosis following prior PTA (7 of 12 patients), in stents placed into the distal superficial femoral and popliteal arteries (14 of 24 patients), and in stents positioned over a longer than 4-cm artery segment (9 of 16 patients). For the aortic bifurcation and iliac arteries, arterial stenting has proved to be a valuable adjunct to PTA; for femoropopliteal arteries, stenting should be restricted to acute arterial occlusions or severe residual stenosis following PTA.
The balloon-expandable vascular prosthesis consists of a flexible, knitted tantalum wire mesh tube. To demonstrate its pliability, this prosthesis was tested experimentally in 10 mongrel dogs by implanting it into the proximal femoral arteries. The maximum follow-up time was 1 year. On the basis of the experimental results, in which there was no relevant stenosis, occlusion, or migration of the vascular prosthesis, nine patients were treated: one with iliac artery occlusive disease and eight with superficial femoral artery (SFA) occlusive disease (four reocclusions after angioplasty and four unsatisfactory primary angioplasty results). One SFA lesion was treated with the crossover method from the contralateral side. All implants remained patent without hemodynamically significant stenoses, with the longest observation time being 6 months. Flexible, expandable vascular prostheses are promising adjuncts to angioplasty.
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