Vertebral augmentation-related osteomyelitis.

We present a case of vertebral osteomyelitis following multiple vertebral augmentations in a patient with an insidious presentation. Vertebral augmentation (kyphoplasty and/or vertebroplasty) is a minimally invasive procedure that has become a fairly common and highly effective method in treating compression fractures. A large majority of patients that undergo this procedure suffer from osteoporosis.

t-PA power-pulse spray with rheolytic mechanical thrombectomy using cross-sectional image-guided portal vein access for single setting treatment of subacute superior mesenteric vein thrombosis.

Background: Isolated superior mesenteric vein (SMV) thrombosis is a rare but potentially fatal condition if untreated. Current treatments include transjugular or transhepatic approaches for rheolytic mechanical thrombectomy and subsequent infusions of thrombolytics. Tissue plasminogen activator (t-PA) power-pulse spray can provide benefit in a single setting without thrombolytic infusions.

Gastric Artery Embolization Trial for the Lessening of Appetite Nonsurgically (GET LEAN): Six-Month Preliminary Data.

Purpose: To report 6-month safety and efficacy results of a pilot study of left gastric artery (LGA) embolization for the treatment of morbid obesity (ie, body mass index [BMI] > 40 kg/m(2)).

Materials And Methods: Four white patients (three women; average age, 41 y [range, 30-54 y]; mean weight, 259.3 lbs [range, 199-296 lbs]; mean BMI, 42.

Does age of fracture affect the outcome of vertebroplasty? Results from data from a prospective multicenter FDA IDE study.

Purpose: To evaluate whether the age of a fracture is a variable that can identify patients for whom vertebroplasty would be most beneficial.

Materials And Methods: Data from 256 patients with painful osteoporotic vertebral compression fractures (VCFs) who underwent vertebroplasty were examined to assess the effect of fracture age on outcomes. Patients ranged in age from 34-76 years, and the age of fractures ranged from 6 weeks or less (n = 117) to more than 52 weeks (n = 3).

Transjugular intrahepatic porto-systemic shunt in the elderly: Palliation for complications of portal hypertension.

Aim: To present a dedicated series of transjugular intrahepatic porto-systemic shunts (TIPS) in the elderly since data is sparse on this population group.

Methods: A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010. Twenty-five patients were referred for TIPS.

Subclavian stenting in a hostile aortic arch facilitated by a low-profile brachial artery through-and-through access.

Subclavian stenting can be extremely difficult in a hostile type II aortic arch (with acute angulation of the subclavian artery origin) or type III aortic arch. This case illustrates use of a low-profile system to gain through-and-through (flossing) access through the brachial artery to facilitate stenting via the femoral approach. This approach can be useful in patients with small brachial arteries where the risk of complication may be high if a standard vascular sheath was placed for stenting via the brachial approach.

Percutaneous superficial temporal artery access for carotid artery stenting in patients with a hostile aortic arch.

Purpose: To describe an entirely percutaneous treatment for carotid artery stenting in a type IIa aortic arch via the superficial temporal artery (STA) for through-and-through guidewire access.

Technique: The technique is demonstrated in an 83-year-old man status post left carotid endarterectomy 3 months prior who presented with 2.5 hours of confusion and dysphasia following diagnostic carotid arteriography.

Renal vein stenting via the right internal jugular approach with a provocative Valsalva maneuver to reduce the risk of stent migration.

An adult male with nutcracker syndrome was treated successfully by placement of a self-expanding stent in the left renal vein via a right internal jugular vein approach with a provocative Valsalva maneuver. Previous case reports have described renal vein stenting for this condition via common femoral vein approach. However, this study proposes the right internal jugular vein approach as a safer method for the treatment of nutcracker syndrome since the stent can be easily captured along the guidewire if undersized.

Acute renal artery thrombosis treated with t-PA power-pulse spray rheolytic thrombectomy.

Purpose: To describe a new application of tissue plasminogen activator (t-PA) power-pulse spray rheolytic (pharmacomechanical) thrombectomy in the treatment of acute renal artery thrombosis.

Case Report: Acute renal artery thrombosis is a relatively rare, but serious condition in which it is imperative to restore perfusion as quickly as possible. Percutaneous pharmacomechanical thrombectomy technique was utilized to provide an effective means of restoring renal flow and function.

Vertebral osteomyelitis following vertebroplasty: is acne a potential contraindication and are prophylactic antibiotics mandatory prior to vertebroplasty?

We present a case of vertebral osteomyelitis following vertebroplasty in a patient with acne of the back. Vertebral biopsy revealed Corynebacterium species and blood cultures were positive for Propionibacterium species. The patient did not respond to long-term intravenous antibiotics and required vertebral corpectomy and debridement with instrumentation.

Accurate localization of life threatening colonic hemorrhage during nuclear medicine bleeding scan as an aid to selective angiography.

Purpose: To describe a new technique to help localize life threatening colorectal bleeding during nuclear medicine bleeding scan to aid in selective angiography.

Methods: During the gastrointestinal bleeding scan, a simple metallic marker (paper clip) was used to localize the bleeding site on the patient body. Angiography was then performed within 2 hours.

Vertebroplasty: a systematic approach.

Background: Though vertebroplasty is a well-known and extremely effective procedure in experienced hands, it is a much more difficult procedure to learn than standard spinal pain injection procedures. We therefore present a simplified, methodical approach to vertebroplasty that can be adopted by trained interventionalists. Many practitioners who attend hands-on cadaver workshops lack confidence to apply this technique in live patients.

Catheter-directed middle hemorrhoidal artery embolization for life-threatening rectal bleeding.

Over the past 10 years, arteriography has become a well-established technique for the diagnosis of acute lower gastrointestinal bleeding, but not particularly for rectal bleeding. However, to the authors' knowledge, the technique of middle hemorrhoidal artery embolization has rarely been reported in the literature. In the present report, three patients with life-threatening rectal bleeding are presented, which was controlled by superselective embolization of the middle hemorrhoidal artery or selective embolization of the internal iliac artery as a last resort.

Coccygeoplasty: treatment for fractures of the coccyx.

Percutaneous vertebroplasty and sacroplasty are becoming common modalities of treatment for vertebral body compression fractures and sacral insufficiency fractures, respectively. The present report describes a case of a coccygeal fracture treated with injection of polymethylmethacrylate cement, which resulted in immediate relief of symptoms. It is suggested that this procedure be called coccygeoplasty.

Intradiskal extravasation with low-volume cement filling in percutaneous vertebroplasty.

Background And Purpose: Adjacent fracture formation after percutaneous vertebroplasty has been reported in literature. The purpose of this study was to determine whether intervertebral disk extravasation is related to adjacent fracture formation in low-volume cement-filling vertebroplasty.

Methods: A retrospective analysis of 308 patients having vertebroplasty was undertaken.

New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women.

Background And Purpose: Percutaneous vertebroplasty has been performed in the United States in an increasing volume since the mid-1990s. The purpose of this study is to analyze the risk of a new symptomatic vertebral compression fractures within 1 year of having an acute/subacute fracture treated with vertebroplasty.

Methods: A retrospective analysis was performed in which 253 female patients were found to have acute/subacute vertebral compression fractures secondary to osteoporosis treated with percutaneous vertebroplasty.

Microcoil embolization for treatment of a right coronary arteriovenous fistula.

A patient initially presented with anginal symptoms and a positive stress thallium test. An arteriovenous malformation in the right coronary artery causing a suspected coronary "steal syndrome" was subsequently discovered. This was treated with a microcoil embolization technique in lieu of the traditional surgical approach and this technique is described in detail.