The authors report their experience with 15 cases of groin complications associated with the use of percutaneous closure devices following femoral arterial catheterization over a 2-year period. The complication rate was 1.7% for catheterizations in which a closure device was used. The 15 cases included 7 uncomplicated pseudoaneurysms (PSA), 3 infected pseudoaneurysms, 4 nonarterial groin infections (infected hematomas and/or abscesses), and 1 case of femoral artery occlusion. These complications presented at an average of 5 ±4 days postcatheterization. One patient with an infected PSA required a below-the-knee amputation. During the same time interval, there were no infectious complications in patients not receiving closure devices. We conclude that groin complications associated with such devices tend to present late and include a higher percentage of infections as opposed to complications occurring in patients not receiving closure devices. An aggressive surgical approach to these problems appears warranted.

No abstract

A retrospective review of 101 diabetics without aortoiliac disease was carried out to analyze the ability of various noninvasive tests to predict the level of significant (>50% stenosis) infrainguinal arterial disease. Patients were studied with anklebrachial indices (ABI), toebrachial indices (TBI), segmental pulse volume recordings (PVR), segmental pressures (SEGP), segmental Doppler waveforms (DWF), and arteriography. Results were classified as normal, disease at the femoropopliteal level, infrapopliteal level, or both levels (multilevel), or noninterpretable. Our findings for the entire study showed that, as a single test, DWF appears to have the best angiographic correlation, although the summed diagnosis of combined DWF and PVR data is superior in distinguishing multilevel disease from isolated tibial disease. SEGP are of very limited use in diabetics, even in multimodality testing, and we no longer include that test in our routine evaluation of diabetics.

A retrospective review of 101 diabetics without aortoiliac disease was carried out to analyze the ability of various noninvasive tests to predict the level of significant (>50% stenosis) infrainguinal arterial disease. Patients were studied with anklebrachial indices (ABI), toebrachial indices (TBI), segmental pulse volume recordings (PVR), segmental pressures (SEGP), segmental Doppler waveforms (DWF), and arteriography. Results were classified as normal, disease at the femoropopliteal level, infrapopliteal level, or both levels (multilevel), or noninterpretable. Our findings for the entire study showed that, as a single test, DWF appears to have the best angiographic correlation, although the summed diagnosis of combined DWF and PVR data is superior in distinguishing multilevel disease from isolated tibial disease. SEGP are of very limited use in diabetics, even in multimodality testing, and we no longer include that test in our routine evaluation of diabetics.

Biliary stents have become a common palliative measure in the treatment of unresectable obstructive pancreatic cancer. Survival after endoscopic stenting rivals that of surgical bypass. Complications involving stents are not uncommon and can be categorized as related to placement, obstruction, migration, or fracture. A case report and review of stent-related morbidity is presented. Overall complication rates range from 15 to 34%, often requiring stent replacement and occasionally requiring surgical intervention.