OBJECTIVE: To evaluate the efficacy of infra-inguinal, primary angioplasty as a method of limb salvage in patients with trophic lesions secondary to critical ischemia. MATERIALS AND METHODS: Thirty-six patients submitted to primary percutaneous transluminal angioplasty without stenting were evaluated. All of them presented critical limb ischemia with trophic lesion (Rutherford grade III, category 5). Eighty-four angioplasties were performed for 17 lesions in superficial femoral artery, 16 lesions in popliteal artery, and 51 lesions in below-knee arteries. Additionally, prevalence in relation to sex, age, limb involved and main comorbidities have been discussed, with technical considerations regarding procedures and materials utilized. RESULTS: Clinical success has been defined as complete healing of the trophic lesion or amputation level limited to toes or forefoot, not requiring bypass surgery, independently from time, drugs utilized and number of debridement procedures performed. CONCLUSION: Femoropopliteal and belowknee angioplasties present high technical success, low mortality and low complications rates and are highly effective in the treatment of patients with critical lower limb ischemia.

Keywords: Balloon angioplasty, Percutaneous transluminal angioplasty, Popliteal artery, Leg arteries, Limb salvage, Lower extremity

OBJECTIVE: To quantify neointimal hyperplasia in iliac arteries after stent implantation, correlating clinical, arterial factors and stent material. MATERIALS AND METHODS: In the period from June/2003 to August/ 2005, 60 patients were submitted to percutaneous transluminal angioplasty and stenting. Among these patients, 30 were followed-up with intravascular ultrasonography. Data were analyzed in a laboratory of quantitative analysis by means of a specific software. RESULTS: Sixteen (53.3%) patients were men, and 14 (46.7%), women, and the mean age was 60.3 years. Arterial hypertension was observed in 22 patients (73.3%), smoking in 18 (62.1%), hyperlipidemia in 20 (66.7%), and diabetes in 9 (30%). A total of 20 nitinol stents (66.7%) and 10 stainless steel stents (33.3%) were implanted. Four patients were classified as TASC A (13.3%), 15 TASC B (50%) and 11 TASC C (36.7%). The neointimal hyperplasia volume ranged from 49.02 mm³ to 112.87 mm³ (mean, 80.33 mm³). The rate of intrastent obstruction ranged from 18% to 47% (mean, 27.4%). The clinical outcomes achieved with stenting were sustained through the follow-up. CONCLUSION: Neointimal hyperplasia is a common finding after percutaneous transluminal angioplasty and stenting, but in the present study the stenosis rate was never higher than 50%. There was no statistically significant difference in intrastent stenosis rates in relation to stents materials, clinical and arterial risk factors.

Keywords: Stent, Iliac artery, Interventional ultrasonography, Hyperplasia

OBJECTIVE: To assess the hemodynamic changes considered normal after transjugular intrahepatic porto-systemic shunt (TIPS) placement and the efficacy of TIPS parameters suggestive of stenosis using Doppler sonography. MATERIALS AND METHODS: Sixteen patients were prospectively evaluated from December, 2001 to March, 2003 after TIPS placement. Evaluations were performed 24 to 48 hours after the procedure and then at intervals of 30 days, three months, six months and one year using B mode, color Doppler, power Doppler and spectral Doppler in different TIPS related sites. Angiography was performed only to confirm Doppler findings and treatment. RESULTS: To date the only statistically significant parameters for diagnosis of TIPS stenosis were continuous flow pattern in the proximal third of TIPS and the velocity gradient between the two sites (p < 0.001). Different non-statistically significant parameters were also observed. CONCLUSION: Doppler sonography is an efficient tool for the diagnosis of shunt patency and TIPS related complications such as stenosis. However, it is necessary to study a larger number of patients in order to determine a group of parameters that would help in the follow-up of these patients, thus using portal angiography only for indicated treatment.

Keywords: Portal hypertension, Transjugular intrahepatic portosystemic shunt, Ultrasound, Doppler ultrasound studies, Stents and prostheses

Objective: To report the feasibility and safety of percutaneous transluminal angioplasty with paclitaxel-eluting stents for management of vertebral artery stenosis in 14 patients, after two-year follow-up. Materials and Methods: Fourteen patients with a mean age of 67.2 years were submitted to endovascular treatment with placement of paclitaxel-eluting stents. The primary objective of the present study was to evaluate the safety of the procedure. The clinical effectiveness was evaluated according to the rates of restenosis and recurrence of ischemic events. Results: The initial stenosis degree ranged from 50% to 99% (mean, 73.3% ± 10.9%). The rate of technical success achieved 100%. Neither complications directly related to the procedure nor recurrence of symptoms were observed after 24-month follow-up. The rate of intra-stent restenosis was 7.1%, although asymptomatic in all the cases. Conclusion: The present study suggests that vertebral artery angioplasty with paclitaxel-eluting stents is a feasible and promising technique in terms of safety and effectiveness in the prevention of recurrent ischemia and restenosis.

Keywords: Vertebral artery; Angioplasty; Stents.

The authors report the case of mixed approach for endovascular treatment of occlusive disease of the anterior tibial artery by retrograde pedal artery access where the traditional antegrade approach failed to overcome a segmental occlusion. The technique seems to offer an option for endovascular procedures aimed at treating occlusion of the anterior tibial artery in cases where the conventional antegrade approach demonstrates to be inappropriate.

Keywords: Angioplasty; Arterial occlusive disease; Percutaneous transluminal angioplasty; Tibial arteries; Endovascular procedures.

OBJECTIVE: This study aimed to compare two self-expanding stents, a nitinol stent and an elgiloy stent, both placed percutaneously, in terms of their efficacy in palliating inoperable malignant biliary obstruction. MATERIALS AND METHODS: We retrospectively investigated 99 patients with unresectable malignant biliary obstruction treated with percutaneous placement of a self-expanding metallic stent at our institution between May 2007 and January 2010. Serum bilirubin and liver enzyme levels were measured before and 30 days after stenting. For all procedures using elgiloy or nitinol stents, stent occlusion and patient survival rates were calculated using Kaplan-Meyer analysis. RESULTS: All of the patients showed clinical improvement after stent placement, with no difference between the two groups. In both groups, the occlusion-free survival rate was 67% at 30 days, 37% at 90 days, 25% at 180 days, and 10% at 360 days, with no significant difference in relation to the type of stent. CONCLUSION: The two stents evaluated showed comparable efficacy for the percutaneous treatment of unresectable biliary malignancy, with good clinical results.

Keywords: Radiology, interventional; Drainage; Stents; Biliary tract/pathology; Oncology.

OBJECTIVE: To evaluate the frequency and types of upper cervical spine injuries in asymptomatic elderly patients undergoing computed tomography (CT) for the investigation of minor head trauma. MATERIALS AND METHODS: This was a prospective study of 2613 asymptomatic elderly patients with minor head trauma seen between January 2015 and December 2016. We adopted a dedicated head CT protocol that included the C1–C2 region. RESULTS: Of the 2613 patients analyzed, 33 (1.26%) had upper cervical spine injuries, corresponding to 8.37% of the 394 patients with trauma-related findings. Of those 33 patients, 6 had C1 fractures and 27 had C2 fractures. The use of 16- and 128-slice scanners increased the CT dose by 25.0% and 23.7%, respectively. CONCLUSION: Inclusion of the C1–C2 region in head CT scans allowed us to identify upper cervical spine injuries in 1.26% of asymptomatic elderly patients with minor head trauma. The protocol evaluated helps detect potentially life-threatening injuries and could be adopted for routine use in elderly individuals with minor head trauma.

Keywords: Craniocerebral trauma; Aged; Aged, 80 and over; Spinal injuries/diagnosis; Cervical vertebrae/injuries; Tomography, X-ray computed.

OBJECTIVE: To compare two percutaneous techniques used in the treatment of malignant obstructive uropathy—antegrade double-J stent placement (JJ stenting) and percutaneous nephrostomy—in terms of their cost-effectiveness, from the perspective of the Brazilian public health care system. MATERIALS AND METHODS: In this cost-effectiveness analysis, we employed decision-analytic modeling. We calculated material costs from 2017 factory prices listed by the Brazilian Pharmaceutical Market Regulatory Board (for medications) and published in the journal Revista Simpro (for medical devices). Procedure-related costs were evaluated, as were the rates of technical and clinical success. Those measures were then used as inputs for a cost-effectiveness analysis comparing the two procedures. RESULTS: The sample comprised 41 patients, of whom 16 underwent antegrade JJ stenting (26 procedures) and 10 underwent percutaneous nephrostomy (15 procedures). Patient records, radiology reports, and expense reports of the interventional radiology department of the public hospital where the study was conducted were analyzed retrospectively. There were no significant complications: one patient had low back pain, and one had a transient retroperitoneal hematoma. The mean procedure time was 24 min, and clinical success (improvement in serum creatinine and resolution of hydronephrosis) was achieved in 97.5% of the cases. The average cost of JJ stenting was significantly lower than was that of percutaneous nephrostomy (US$164.10 vs. US$552.20). CONCLUSION: In the absence of any clinical contraindications, antegrade JJ stenting is a suitable alternative to both percutaneous nephrostomy and retrograde stenting in patients with dilated renal collecting systems secondary to malignant ureteral obstruction, providing significant cost savings and high success rates.

Keywords: Cost-benefit analysis; Radiology, interventional; Nephrostomy, percutaneous; Stents.

Objective: To analyze the results obtained with a modified antegrade double J catheter insertion (JJ stenting) technique in patients with urinary tract obstruction due to malignancy. Materials and Methods: This was a retrospective analysis of data collected from patients undergoing antegrade JJ stenting for malignant ureteral obstruction in the interventional radiology department of our institution between March 1, 2017 and May 31, 2019. Results: Antegrade JJ stenting was performed in 32 patients (20 women and 12 men). The mean age was 66.2 years among the females and 61.5 years among the males. A total of 53 antegrade JJ stenting procedures were performed. The procedure was successful in 50 cases and failed in 3 (due to migration of the double J catheter in 2 and due to technical failure in 1). Complications occurred in 3 patients (low back pain, in 1, subcapsular hematoma, in 1, and pyelonephritis, in 1). The procedure time ranged from 14 min to 55 min. Conclusion: In patients with ureteral obstruction due to malignancy, antegrade JJ stenting is safe and effective. The technique selected in our study is easily reproduced and can be performed by a trained professional.

Keywords: Urinary catheterization/instrumentation; Stents; Ureteral obstruction; Radiology, interventional; Urologic neoplasms.

Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.

Keywords: Radiology, interventional; Stents; Cholestasis/therapy.

OBJECTIVE: To present our clinical experience with percutaneous antegrade ureteral stenting. MATERIALS AND METHODS: This was a single-center retrospective study in which we reviewed the electronic medical records of patients who underwent percutaneous image-guided antegrade ureteral stenting between January 2016 and August 2020. We evaluated 90 patients (48 men). The mean age was 61.4 ± 15 years (range, 30–94 years). Patients were divided into two main groups: those with malignant neoplasms; and those with non-neoplastic disease. Technical and clinical success of the procedure were defined, respectively, as maintenance of the patency of the urinary tract, with a reduction in the degree of hydronephrosis, and as a reduction in the level of nitrogenous waste. Postprocedural complications were categorized as major or minor according to the CIRSE classification. RESULTS: The study sample comprised 150 antegrade stenting procedures performed in 90 patients, most of whom had previously undergone retrograde stenting that was unsuccessful. The stenting was bilateral in 60 patients and unilateral in 30. Technical success was achieved in 143 (95.3%) of the procedures, whereas seven procedures (4.6%) were unsuccessful. Failed procedures were characterized by inability to place a stent or migration of a stent after its placement. Complications occurred in 12 (8.0%) of the procedures. Of those 12 complications, two were classified as major (bleeding) and 10 were classified as minor (lumbar pain or infection). The most common techniques used were the over-the-wire technique and the modified technique (in 58.0% and 42.0% of the cases, respectively). In seven cases (4.7%), a nephrostomy tube was inserted. CONCLUSION: Percutaneous antegrade ureteral stenting is a safe, effective method for the management of ureteral injuries and obstructions, due to malignant or benign causes, when the retrograde approach has failed.

Keywords: Urinary catheterization/instrumentation; Stents; Ureteral obstruction; Radiology, interventional; Urologic neoplasms.

OBJECTIVE: To promote advanced research using magnetic resonance imaging (MRI) in the diagnosis of and screening for osteoporosis by looking for correlations among the T-scores measured by dual-energy X-ray absorptiometry (DEXA), the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI), and the T1-weighted signal intensity values. MATERIALS AND METHODS: This was a prospective study of postmenopausal women with no contraindications to MRI and no history of cancer who underwent DEXA within 30 days before or after the MRI examination. A 3.0-T scanner was used in order to acquire sagittal sequences targeting the lumbar spine. RESULTS: Thirteen women underwent DEXA and MRI. In two cases, the MRI was discontinued early. Therefore, the final sample comprised 11 patients. The ADC values and T1-weighted signal intensity were found to be higher in patients with osteoporosis. However, among the patients > 60 years of age with osteoporosis, ADC values were lower and T1-weighted signal intensity was even higher. CONCLUSION: It is unlikely that MRI will soon replace DEXA for the diagnostic workup of osteoporosis. Although DWI and ADC mapping are useful for understanding the pathophysiology of osteoporosis, we believe that T1-weighted sequences are more sensitive than is DWI as a means of performing a qualitative analysis of vertebral alterations.

Keywords: Osteoporosis; Postmenopause; Vertebral body/pathology; Multiparametric magnetic resonance imaging/methods; Bone marrow/pathology.