Eight patients (seven post partum, one post abortion) with massive pelvic hemorrhage related to pregnancy and one patient with uncontrollable bleeding following a cervical biopsy underwent angiography to facilitate the identification and treatment of bleeding sites. In all nine patients pelvic hemorrhage was successfully controlled with embolization under angiographic guidance. Angiographic embolization allowed preservation of the uterus in six patients referred prior to hysterectomy, and one patient subsequently became pregnant. When conservative measures and minor surgical repairs have failed, embolization should be the next step in the treatment of postpartum hemorrhage to avoid major surgery in an unstable patient and to maintain reproductive function.
Although percutaneous procedures have gained a degree of acceptance for treatment of lymphoceles, success rates for aspiration and drainage have been less than optimal. The authors investigated transcatheter sclerosis of pelvic lymphoceles with povidone-iodine as a method to increase the success rate of percutaneous management. Eight patients with a total of nine pelvic lymphoceles were treated with this method. Eight of the nine lymphoceles (89%) resolved without complications. Four patients had undergone lymphadenectomy and four, renal transplantation. The duration of catheter drainage ranged from 15 to 37 days. Four of the lymphoceles were found to be infected at initial drainage, but this did not alter the amount of time the catheter was left in place. One lymphocele failed to heal with sclerotherapy and required internal drainage. The early results with transcatheter povidone-iodine sclerosis of postoperative lymphoceles are encouraging and warrant further evaluation.
Four infants with congenital or acquired tracheobronchial stenosis were successfully treated with angioplasty balloon catheter dilation. The technical details and complications of these procedures are described. The authors believe balloon dilation therapy should be considered as the initial form of therapy for tracheal stenosis in infants, even in the presence of complex stenotic lesions.
This clinical report deals with a femoral venous aneurysm as a source of recurrent pulmonary embolism. The literature concerning venous aneurysms is reviewed with emphasis on those cases which were complicated by venous thrombosis and pulmonary embolism. This case demonstrates that lower leg venous aneurysms can occur in either sex and in different age groups. Venography was shown to be important in diagnosing these lesions. Surgical resection may be necessary to prevent potential thrombosis and life-threatening pulmonary embolism.
We review our experience with seven patients, (12 affected extremities) with popliteal artery entrapment. The classic angiographic finding of medial deviation of the popliteal artery was found in only three patients (four extremities). Four patients (eight extremities) had no medial deviation of their popliteal arteries and required a stress runoff examination to demonstrate arterial entrapment. Five patients had bilateral entrapment. This patient series underscores the need to consider possible arterial entrapment even when the popliteal arteries appear normal on the resting runoff examination as well as the importance of imaging both extremities since the incidence of bilateral entrapment may be higher than previously recognized.
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