Hungarian Radiology

[Prevention of thrombotic complications in vascular interventional procedures]


JUNE 10, 2005

Hungarian Radiology - 2005;79(03)

[Procedures of vascular interventional radiology is linked inevitably a certain amount of risk of thrombotic complications, like intimal and vascular wall injuries, increased thrombotic risk caused by the catheter itself, etc. The first approach of thrombotic prevention was achieved by acetyl salicylic acid in case of peripheral arteries, this treatment was later replaced by long-term anticoagulation. Opportunities were provided by the recognition of risky blood characteristics in relation to thrombotic complications. Consequently, a well performed preparation and premedication of the patients could reasonably decrease the risk. The most important steps are the cessation of smoking, normalization of hemoconcentration and antithrombotic premedication. Better understanding of the nature of atherosclerotic progression led to the introduction of long-term fibrinolytic inhibition therapy. In the past decades beside patients with vascular stenosis, the oncology patients are also treated by different radiological interventions, like intraarterial chemotherapy and chemoembolization. The use of several-day-long infusion represent a new challenge, the treated vessels, the lumen and the surface of the catheter must be prevented of thrombosis. For this purpose a few suitable drugs can be applied with mild anticoagulant and fibrinolytic stimulating effect. We use the sodium pentosan polysulphate.]



Further articles in this publication

Hungarian Radiology

[Entertainment ultrasound]


Hungarian Radiology

[13th French-Hungarian Radiologic Symposium and 5th Eastern-Central European Francophone Congress of Radiology]

- va -

Hungarian Radiology

[Comparison of the results of lung helical CT and lung scintigraphy in pulmonary embolism]

WENINGER Csaba, BODROGI Gabriella, BOROS Szilvia, SCHMIDT Erzsébet, UDVAROS Eszter, ZÁMBÓ Katalin

[INTRODUCTION - The frequency of the pulmonary embolism is high and the underdiagnosis or delayed recognition of the disease occurs. Recently the helical CT is used to detect pulmonary embolism. The authors compare the results of single-slice spiral thoracic CT and lung scan. PATIENTS AND METHODS - During one year period chest CT examination was performed in 49 patients due to the suspicion of pulmonary embolism, in 30 of them lung scan was also performed. RESULTS - The results of the two diagnostic methods were the same in 21 cases out 30 (in 13/21 cases both methods demonstrated embolism and 8/21 cases the findings were normal). In the remaining nine cases the findings were different. CONCLUSIONS - The lung CT examination is a rapid, non-invasive method to depict the central pulmonary embolism and small infarcts in non fresh cases. The negative result of perfusion lung scan can exclude the pulmonary embolism. If the lung scan demonstrates perfusion defect(s), it is necessary to perform another diagnostic tests (e.g. chest X-ray, ventillation scan). While the lung scan is a cheap, simple method with low radiation dose, it can play important role in the screening.]

Hungarian Radiology

[Medal of commemoration Mihály Erdélyi 2005]

BOHÁR László

Hungarian Radiology

[Interventional radiology of multiple biliary stenoses]


[INTRODUCTION - In palliative treatment of malignant bile duct obstruction the endoscopic and the percutaneous methods are the possible options. In multiple lesions the percutaneous method must be preferable. Decrease of the bilirubin level to normal gives an opportunity for further treatment of the oncology patients. CASE REPORT - Authors report three patients’ case history, when following an unsuccessful endoscopic retrograde cholangiopancreatography, percutaneous cholangiography revealed multiple biliary stenoses. In all cases successful stent implantations were performed (three stents in one patient, two stents in two patients). The bilirubin levels decreased rapidly and the quality of life improved in all cases. Following the stent implantation selective cytostatic treatment (one patient) and systemic cytostatic treatment (one patient) were performed. The mean survival time was 300 days. CONCLUSION - In the case of multiple biliary stenoses the percutaneous stent implantation is an acceptable palliative method, which permit the possibilities of further interventional radiological or oncological treatments.]

All articles in the issue

Related contents

Hungarian Radiology

[The radiohygienic aspects of the interventional radiology]

PELLET Sándor, GICZI Ferenc, GÁSPÁRDY Géza, TEMESI Alfréda

[Interventional radiology is a relatively new and very rapidly developing cost-effective branch of radiology. Its aim to help or to replace surgical procedures and interventions in many cases are life saving, which are performed by imaging modality control (most commonly angiography or fluoroscopy). During interventional radiological procedures the exposure of staff and patients is usually higher, than in conventional radiography or fluoroscopy. Deterministic effects may also occur. The dosimetry can be carried out by film dosimetry, thermoluminescent dosimetry, DAP meters, semiconductor detectors and personal electronic dosimeter. The basis of reduction of radiation exposure is the radiation protection training. An important rule is that reduction of patient exposure is connected with reduction of staff exposure. With the use of appropriate tools and training the most injuries are avoidable.]

Lege Artis Medicinae

[Tumour therapy with the tools of interventional radiology]


[The author reviews the interventional radiological methods applicable in tumour therapy. The therapy of non-resectable primary and secondary liver tumours is discussed based on literature data and own experience. The possibilities of percutaneous tumour ablation are limited by the size and number of the tumours. Intra-arterial chemotherapy, chemoembolisation and feeding artery occlusion can be successful resulting in longer life and better quality of life in cases with advanced tumours. The results are better if these methods are combined with systemic chemotherapy.]

Hungarian Radiology

[Balloon dilatation and metallic stent placement in inferior vena cava stenosis complicating liver transplantation]

DOROS Attila, NÉMETH Andrea, HARTMANN Erika, DEÁK Pál Ákos, FEHÉRVÁRI Imre, TÓTH Szabolcs, NEMES Balázs, KÓBORI László

[INTRODUCTION - The only successful therapy for end stage liver cirrhosis is liver transplantation. The anastomotic stenosis of the inferior vena cava is rare but serious complication. In these cases surgery is a high risk procedure; therefore interventional radiological methods are recommended. PATIENTS AND METHODS - Eleven patients developed 12 caval stenosis from 365 liver transplant recipients in Budapest. One of the patients had caval stenosis again after retransplantation. Dilatation was performed with 10- 25 mm large balloon catheters in 6 cases and 6 metallic stents (12-24 mm in diameter) were implanted. All the procedures were performed via the common femoral vein. RESULTS - The success of the intervention was measured by the morphological results, clinical signs and by the changes of superior-inferior vena cava pressure gradients. Before the intervention 14 Hgmm mean pressure gradient was measured, which decreased to 8 Hgmm post intervention. Eleven patients developed renal insufficiency before treatment; this was reversible in 6 cases. One patient had impaired renal function before treatment, and later on again, after retransplantation. Three of 4 patients with renal insufficiency died in the post operative period. One stent migration was noticed prompting surgical fixation of the stent. CONCLUSION - Inferior vena cava stenosis represents a serious complication after liver transplantation, causing ascites, hydrothorax and venous congestion in the kidneys and the liver. In the critical post operative period surgery is not recommended, risking the viability of the liver and the life of the patient. Interventional radiology with balloon dilatation and stent implantation is the method of choice in these cases, primary stenting with large self expanding metallic stents is necessary in elastic stenosis caused by torsion of the anastomosis.]

Hungarian Radiology

[The possibilities of invasive radiological therapy of deep venous thrombosis and in vitro experimental examination of therapeutic factors affecting the treatment]


[INTRODUCTION - The first part of this paper is an overview on the possibilities of invasive radiology treatment of deep venous thrombosis. In the next part an in vitro experiment is described demonstrating the basics of mechanical and pharmaco-mechanical catheters applied in deep venous thrombosis. MATERIALS AND METHODS - The in vitro haemodinamic model of the iliocaval veins contained a thermostat and an engine responsable for pulsing circulation according to the venous system. We tested the chance of driftage of thrombus in different age according to the state of the collateral system. Thrombectomy was made by mechanical (Simpson-catheter) and pharmaco-mechanical (Pulsespray catheter) ways. The weight of the non-drifted thrombi was measured. RESULTS - All the 16 thrombus were flown while collateral system was closed and none of them were flown while the collateral system was open but the rate of their solubility was different. The efficacy of the thrombus-removal by Simpson catheter was better than by Pulse-spray catheter and fresh thrombus-fragments were more soluble than older ones. CONCLUSION - By this in vitro experiment we opened the way for using mechanical and pharmaco-mechanical catheters in deep venous thrombosis.]

Clinical Neuroscience

[Initial clinical experience with radio-frequency assisted percutaneous vertebral augmentation in the treatment of vertebral compression fractures]


[Purpose - Percutaenous Vertebroplasty (PVP) is effective in alleviating pain and facilitating early mobilization following vertebral compression fractures. The relatively high risk of extravertebral leakage due to uncontrolled delivery of low viscosity bone cement is an inherent limitation of the technique. The aim of this research is to investigate the ability of controlled cement delivery in decreasing the rate of such complications by applying radiofrequency heating to regulate cement viscosity. Method and material - Thirty two vetebrae were treated in 28 patients as part of an Ethics Committee approved multicenter clinical trial using RadioFreqency assisted Percutaenous Vertebral Augmentation (RF-PVA) technique. This technique is injecting low viscosity polymethylmethacrylate (PMMA) bone cement using a pressure controlled hydraulic pump and applying radiofrequency heating to increase cement viscosity prior to entering the vertebral body. All patients were screened for any cement leakage by X-ray and CT scan. The intensity of pain was recorded on a Visual Analog Scale (VAS) and the level of physical activiy on the Oswestry Disability Index (ODI) prior to, one day, one month and three months following procedure. Results - All procedures were technically successful. There were no clinical complication, intraspinal or intraforaminal cement leakage. In nine cases (29%) a small amount of PMMA entered the intervertebral space through the broken end plate. Intensity of pain by VAS was reduced from a mean of 7.0 to 2.5 and physical inactivity dropped on the ODI from 52% to 23% three months following treatment. Conclusion - In this small series controlled cement injection using RF-PVA was capable of preventing clinically hazardous extravertebral cement leakage while achieving outcomes similar to that of conventional vertebroplasty.]