- Email: [email protected]
Scientific Session 17 Cardiothoracic Interventions
and spliced vein). PTA was used in 76% of grafts, and the remaining 24% were treated surgically. Grafts were selected for PTA if they had a single stenosis smaller than 5 cm. Graft occlusion was the end point in determining the 5-year cumulative assisted patency (CAP). RESULTS: The 5-year CAP was 68% after PTA and 65%
after surgery. PTA of GSV had 72% 5-year CAP compared with 42% for AV (P = .0032). Surgical revision offered similar 5-year CAP for both GSV and AV (65%, 66%). Seventy-two percent of grafts were managed with PTA alone, and 58% were managed with a single PTA in 5 years. A second revision was needed in 38% of surgically revised grafts compared with 42% of grafts treated with PTA. CONCLUSIONS: With 5-year CAP and rate of reintervention comparable to surgery, PTA of appropriate (single, <5-cm lesion) stenotic vein grafts is an effective treatment. GSV grafts have significantly better 5-year patency than do AV grafts after PTA.
CONCLUSIONS: Interventional radiologists performed percutaneous lower extremity interventions with significantly greater efficacy and safety than was achieved by vascular surgeons.
Take Home Points: 1. A single-institution study showed significant treatment outcome differences for patients undergoing similar procedures performed by interventional radiologists and vascular surgeons.
2. Outcome differences cannot be attributed to differences in patient or vascular territory characteristics. 3. These differences may be related to training differences between the specialties.
Take Home Points: 1. Five-year cumulative assisted patency is comparable for PTA and surgical revision for appropriate stenotic vein grafts.
4. Further studies may be required to determine whether this difference exists in other institutions.
2. GSV grafts with stenoses larger than 5 cm are most appropriate for PTA.
Scientific Session 17 Cardiothoracic Interventions
3. AV grafts (cephalic, lesser saphenous, or spliced vein) have significantly worse 5-year patencies after PTA compared with GSV grafts.
Moderator: Albert Nemcek, MD, Chicago, IL
3:45 pm Differences in Outcomes of Percutaneous Endovascu1ar Lower Extremity Interventions: InterventiOl1a1 Radiology versus Vascular Surgery D.M. Ayoub, MD, Springfield, IL • CM. Muehle, MD PURPOSE: Evaluation of the outcomes of percutaneous endovascular therapy for peripheral vascular disease when performed by interventional radiologists and vascular surgeons. MATERIALS AND MElliODS: The medical records of pa-
tients who underwent thrombolytic (n = 74) and nonthrombolytic (n = 282) lower extremity procedures performed consecutively at a single institution under the direction of either interventional radiologists or vascular surgeons were reviewed retrospectively. Analysis was performed on an intent-to-treat basis. Assessment included technical and early clinical success rates. Procedure-related complications were noted. RESULTS: For thrombolysis, the success rate for radiolo-
214
ences in patient or vascular territory characteristics between the two groups. For nonthrombolytic procedures, technical and early clinical success was greater for procedures performed by radiologists than by surgeons (89.8% vs. 48.7%; P < .0005). Complications occurred more frequently during procedures performed by surgeons than by radiologists (13.5% vs. 5%; P < .025).
gists was significantly higher than for surgeons (81.1% vs. 45.9%; P < .005). Complications occurred in 29.7% of the surgeons' cases and in 8.1% of radiologists' examinations (P < .05). Two procedure-related deaths were identified in the surgeons' group (5.6%), and no deaths were attributed to radiologists. There were no differ-
2:30 pm A New Device for Percutaneous Transvenous Closure of Atrial Septal Defects D. Pavcnik, MD, PhD, Portland, OR PURPOSE: To evaluate in vivo a new device for percu-
taneous transvenous closure of atrial septal defects (ASD) in dogs. MATERIALS AND MElliODS.: ASDs of 10, 14, and 17 mm
were created using a percutaneous transeptal technique from the right femoral vein in eight dogs. After ASD creation, the 9.5-FR Teflon sheath was advanced across the defect into left atrium. Dacron-covered Monodisks 20, 30, or 40 rom in diameter attached to the pusher catheter were loaded into the sheath and pushed into the left atrium. The devices resumed their oval shape after extrusion from the guiding catheter, allowing a simple, one-step closure procedure. Five of eight dogs underwent follow-up studies at 3 and 6 months. RESULTS: The devices were easily and successfully
placed in all dogs. Dogs were followed radiographically with no shunting of contrast media in all cases. Pathohistologic evaluation showed that the device was well incorporated in the atrial septum and covered with a layer of endothelium in all animals. CONCLUSION An animal model with large ASDs can be successfully created percutaneously and treated simply and efficiently using the Monoclisk.
Take Home Points: Possible clinical applications include repair of ASDs, some ventral septal defects, large and short patent ductus arteriosus, and aortopulmonary window. 2:45 pm Amplatz Patent Ductus Arteriosus Occluder: Evaluation in a Canine Model Mj. Sharajuddin, MD, Minneapolis, MN • X. Gu, MD • Ii. Titus, MD • M. Urness • K. Amplatz, MD PURPOSE: To evaluate a new self-expanding patent duc-
tus arteriosus occlusion device. MATERIALS AND METHODS: Percutaneous closure of
surgically placed aortopulmonary conduits was attempted in 19 dogs. The occluder consisted of a woven nitinol wire frame with a flat retention disc (13 nonfilled frame and six polyester-filled frames). A 6-F introducing sheath was advanced across the conduit into the descending aorta. The collapsed device was pushed with an attached delivery cable and allowed to reform in the descending aorta before being retracted and firmly lodged into the conduit. RESULTS: Subtotal misplacement of one device occurred
into the descending aorta (95% technical success rate). One animal died before the I-week follow-up evaluation. Shunt closure on angiography occurred in seven of 17 animals (41%) at 30 minutes, in 12 of 17 animals (71%) at 1 week, in 14 of 17 animals (82%) at 1 month, and in 11 of 12 animals (92%) at 3 months. Significantly higher 30-minute closure rates were noted with polyesteraugmented occluders compared with nonfilled occluders (five of five [100%] vs. two of 12 [17%]; P = .002). Persistent shunt at 3 months occurred in only one nonfilled device (6%). In the remaining 16 cases, both shunt orifices were completely or nearly completely covered by neoendothelium. CONCLUSION: The device appears capable of safe and effective percutaneous patent ductus arteriosus closure.
Take Home Points: 1. The occluder combines the advantages of a small delivery system and easy placement with the ability to self-center and reposition itself. 2. Immediate closure occurs reliably with the polyesterfilled prototype. 3. Small introducer size and low profile may allow percutaneous closure in small children. 3:00 pm
Percutaneous Transthoracic Needle Biopsy of the Lung: Review of 628 Lesions F. Castaneda, MD, Peoria, IL • I Patel, MD • R. Li, MD • K. w: Fraser, MD • T.M. Brady, MD • R. Bertino, MD
PURPOSE: The results of 628 consecutive percutaneous
biopsies were analyzed for diagnostic accuracy, compli-
cation rate, specificity and sensitivity, number of passes required, and accuracy of repeated procedures. MATERIALS AND METHODS: From January 1990 to De-
cember 1995, 628 consecutive lung biopsies were performed in 600 patients with Franceen needles of 18-22 gauge. RESULTS: Fifty-seven percent of the patients were men
and 43% were women. Nineteen percent of patients had a previous history of malignancy. Correct diagnoses were made in 96.7% of the biopsies, indeterminate diagnoses were made in 2.8%, and incorrect diagnoses were made in 0.48%. Pneumothorax occurred in 27.5% of patients and 9.6% required chest tubes. Hemoptysis was seen in 3.2% and perinodular interstitial hemorrhage in 7.5% of patients. There was no significance difference in specificity and sensitivity related to needle size. There was also no significant difference in pneumothorax rate and need for chest tube placement when comparing needle size or number of passes. CONCLUSIONS: This study, one of the longest ever published, contradicts established perceptions that the complication rate will diminish if thinner needles are used and the number of passes is minimized. In addition, larger needles will not necessarily obtain better diagnostic samples. This study shows that the procedure is simple and has a high degree of sensitivity and specificity and a low incidence of complications, thus making it the preferred procedure.
Take Home Points: 1. Needle size and number or passes does not correlate with the complication rate. 2. Diagnostic accuracy is independent of needle size. 3. This approach remains the best procedure for investigating pulmonary nodules.
3:15 pm TracheobroncWal Stents: Bridging the Bronchial Ostium and Its Effects on the Lung Segment H. Bjarnason, MD, Minneapolis, MN • B. Cahill, MD
• M.e. Urness • G.K. Nazarian, MD • e.A. Dietz, MD • D. w: Hunter, MD PURPOSE: To evaluate the effect of a metal stent placed
across the ostium of a bronchus on the involved lung segment and bronchus. MATERIALS AND METHODS: Nine pigs were used for the
study. Noncovered Palmaz® stents were placed in three pigs, Wallstent® (Schneider Inc., Minneapolis, MN) in three, and Gianturco® in three. The stents were placed in the trachea across the right upper lobe bronchial ostium as it comes off separately from the trachea. Bronchoscopy was performed initially and then at 1 and 3 months; chest radiographs were obtained at the same intervals. The animals were killed at 3 months and the lung specimens were evaluated histologically.
215
RESULTS: Opacification frequently developed in the right upper lobe. The bronchial ostium stayed open in all cases. In some cases, development of granulation tissue in the region of the stent was noted. In a few cases, there also seemed to be more accumulation of secretions in the stented areas. One of the Palmaz stents was crushed during the study.
Take Home Points: Both benign and malignant tracheobronchial obstructions respond well to stenting. In most patients, symptoms improve dramatically. Stenting of chronic lobar collapse is ineffective because it does not restore functional patency.
CONCLUSIONS: Stents can be placed across the ostium of bronchi without causing obstruction. The stents cause an increase in granulation tissue, and secretions may not be as effectively cleared.
Percutaneous Transthoracic Duct Catheterization to the Neck and Esophagus: A Feasibility Study
Take Home Points: 1. Stents may be placed across the bronchial ostium. 2. Granulation tissue will form at the stent site. 3. Secretions may not clear as effectively and cause atelectases. 4. The stents differ in their applicability for the tracheobronchial tree.
3:30 pm Clinical Experience with Expandable Metallic Stents to Treat Tracheobronchial Obstructions B.M. Hoppenfeld, MD, Newark, NJ Shoenfeld, MD • A. Novick, MD
• H. Mast,
MD • R.
PURPOSE: To study the efficacy of tracheobronchial stents to treat central airway obstructions. MATERIALS AND METHODS: Twenty-two patients with airway obstruction received a total of 45 tracheobronchial stents (39 Wallstents® [Schneider Inc., Minneapolis, MN], three elastomer-covered Wallstents®, and three Gianturco Z-stents). Indications included symptomatic malignant airway obstruction (n = 15), postintubation tracheal stenosis (n = 3), post-transplant anastomotic bronchial stenosis (n = 1), exclusion of a dehisced pneumonectomy stump (n = 1), transbronchial drainage of a postobstructive lung abscess (n = 1), and prophylaxis of impending airway closure before radiotherapy (n = 1).
3:45 pm
e.
Cope, MD, Philadelphia, PA
PURPOSE: To assess the feasibility of inserting a drain catheter percutaneously from the cysterna chyli (CC) through the thoracic duct (TD) wall to the neck or esophagus for potential long-term T-cell sampling and drainage. MA ThlUALS AND METHODS: Percutaneous transabdominal catheterization of the TD from the CC was performed in three animals to insert a 60-cm 21-gauge needle over a micro guide wire. In one dog, the distal TD was perforated into the neck to insert a TD drain to an access port. In acute experiments on two swine, the esophagus was accessed by puncturing the mid-TD to insert a catheter into the distal esophagus. RESULTS: Transmediastinal TD-to-neck catheterization was well tolerated during 1 week of observation except for a skin infection that developed over the port. The technique for TD-to-esophagus catheterization in swine was feasible with no acute complications. CONCLUSIONS: Percutaneous inside-out transmural catheterization of the TD to reach the neck or the esophagus is feasible and may have clinical applications for immunosuppression by T-cell depletion.
Take Home Points: Transabdominal percutaneous transmural thoracic duct catheterization for lymph drainage to the neck or esophagus is feasible in animals.
Scientific Session 18 Central Venous Access Moderator: John Cardella, MD, Hershey, PA
216
RESULTS: Symptoms, which included chronic lobar collapse, prophylactic stenting, tumor mass mistaken for collapse, and left upper lobe collapse after stenting of the left lower lobe (our only complication), were not improved in four of 22 patients. Six patients became asymptomatic. Three others had tissue ingrowth through the stent that required restenting (two with covered stents). Patient survival ranged from 1.5 weeks to 1.5 years. Thirteen patients are still alive. Three died of comorbid conditions and six died of progression of extrapulmonary disease or progressive respiratory compromise.
].G. Caridi, MD, Gainesville, FL • I.P. Hawkins, Jr. MD • BN. Wiechmann, MD .].e. Tonkin, MD • DJ. Pevarski, MD
CONCLUSION: Tracheobronchial stenting effectively relieves benign and malignant symptomatic airway obstructions.
MA7ERIALS AND METHODS: Eighty sequential patients having central venous access procedures were evaluated with hand-held ultrasound to determine the size, pa-
2:30 pm Ultrasound Guidance of the Internal Jugular Vein for Central Venous Access
PURPOSE: To prospectively demonstrate the safety and accuracy of right internal jugular (RIJ) vein cannulation for central venous access when guided by hand-held ultrasound.
after surgery. PTA of GSV had 72% 5-year CAP compared with 42% for AV (P = .0032). Surgical revision offered similar 5-year CAP for both GSV and AV (65%, 66%). Seventy-two percent of grafts were managed with PTA alone, and 58% were managed with a single PTA in 5 years. A second revision was needed in 38% of surgically revised grafts compared with 42% of grafts treated with PTA. CONCLUSIONS: With 5-year CAP and rate of reintervention comparable to surgery, PTA of appropriate (single, <5-cm lesion) stenotic vein grafts is an effective treatment. GSV grafts have significantly better 5-year patency than do AV grafts after PTA.
CONCLUSIONS: Interventional radiologists performed percutaneous lower extremity interventions with significantly greater efficacy and safety than was achieved by vascular surgeons.
Take Home Points: 1. A single-institution study showed significant treatment outcome differences for patients undergoing similar procedures performed by interventional radiologists and vascular surgeons.
2. Outcome differences cannot be attributed to differences in patient or vascular territory characteristics. 3. These differences may be related to training differences between the specialties.
Take Home Points: 1. Five-year cumulative assisted patency is comparable for PTA and surgical revision for appropriate stenotic vein grafts.
4. Further studies may be required to determine whether this difference exists in other institutions.
2. GSV grafts with stenoses larger than 5 cm are most appropriate for PTA.
Scientific Session 17 Cardiothoracic Interventions
3. AV grafts (cephalic, lesser saphenous, or spliced vein) have significantly worse 5-year patencies after PTA compared with GSV grafts.
Moderator: Albert Nemcek, MD, Chicago, IL
3:45 pm Differences in Outcomes of Percutaneous Endovascu1ar Lower Extremity Interventions: InterventiOl1a1 Radiology versus Vascular Surgery D.M. Ayoub, MD, Springfield, IL • CM. Muehle, MD PURPOSE: Evaluation of the outcomes of percutaneous endovascular therapy for peripheral vascular disease when performed by interventional radiologists and vascular surgeons. MATERIALS AND MElliODS: The medical records of pa-
tients who underwent thrombolytic (n = 74) and nonthrombolytic (n = 282) lower extremity procedures performed consecutively at a single institution under the direction of either interventional radiologists or vascular surgeons were reviewed retrospectively. Analysis was performed on an intent-to-treat basis. Assessment included technical and early clinical success rates. Procedure-related complications were noted. RESULTS: For thrombolysis, the success rate for radiolo-
214
ences in patient or vascular territory characteristics between the two groups. For nonthrombolytic procedures, technical and early clinical success was greater for procedures performed by radiologists than by surgeons (89.8% vs. 48.7%; P < .0005). Complications occurred more frequently during procedures performed by surgeons than by radiologists (13.5% vs. 5%; P < .025).
gists was significantly higher than for surgeons (81.1% vs. 45.9%; P < .005). Complications occurred in 29.7% of the surgeons' cases and in 8.1% of radiologists' examinations (P < .05). Two procedure-related deaths were identified in the surgeons' group (5.6%), and no deaths were attributed to radiologists. There were no differ-
2:30 pm A New Device for Percutaneous Transvenous Closure of Atrial Septal Defects D. Pavcnik, MD, PhD, Portland, OR PURPOSE: To evaluate in vivo a new device for percu-
taneous transvenous closure of atrial septal defects (ASD) in dogs. MATERIALS AND MElliODS.: ASDs of 10, 14, and 17 mm
were created using a percutaneous transeptal technique from the right femoral vein in eight dogs. After ASD creation, the 9.5-FR Teflon sheath was advanced across the defect into left atrium. Dacron-covered Monodisks 20, 30, or 40 rom in diameter attached to the pusher catheter were loaded into the sheath and pushed into the left atrium. The devices resumed their oval shape after extrusion from the guiding catheter, allowing a simple, one-step closure procedure. Five of eight dogs underwent follow-up studies at 3 and 6 months. RESULTS: The devices were easily and successfully
placed in all dogs. Dogs were followed radiographically with no shunting of contrast media in all cases. Pathohistologic evaluation showed that the device was well incorporated in the atrial septum and covered with a layer of endothelium in all animals. CONCLUSION An animal model with large ASDs can be successfully created percutaneously and treated simply and efficiently using the Monoclisk.
Take Home Points: Possible clinical applications include repair of ASDs, some ventral septal defects, large and short patent ductus arteriosus, and aortopulmonary window. 2:45 pm Amplatz Patent Ductus Arteriosus Occluder: Evaluation in a Canine Model Mj. Sharajuddin, MD, Minneapolis, MN • X. Gu, MD • Ii. Titus, MD • M. Urness • K. Amplatz, MD PURPOSE: To evaluate a new self-expanding patent duc-
tus arteriosus occlusion device. MATERIALS AND METHODS: Percutaneous closure of
surgically placed aortopulmonary conduits was attempted in 19 dogs. The occluder consisted of a woven nitinol wire frame with a flat retention disc (13 nonfilled frame and six polyester-filled frames). A 6-F introducing sheath was advanced across the conduit into the descending aorta. The collapsed device was pushed with an attached delivery cable and allowed to reform in the descending aorta before being retracted and firmly lodged into the conduit. RESULTS: Subtotal misplacement of one device occurred
into the descending aorta (95% technical success rate). One animal died before the I-week follow-up evaluation. Shunt closure on angiography occurred in seven of 17 animals (41%) at 30 minutes, in 12 of 17 animals (71%) at 1 week, in 14 of 17 animals (82%) at 1 month, and in 11 of 12 animals (92%) at 3 months. Significantly higher 30-minute closure rates were noted with polyesteraugmented occluders compared with nonfilled occluders (five of five [100%] vs. two of 12 [17%]; P = .002). Persistent shunt at 3 months occurred in only one nonfilled device (6%). In the remaining 16 cases, both shunt orifices were completely or nearly completely covered by neoendothelium. CONCLUSION: The device appears capable of safe and effective percutaneous patent ductus arteriosus closure.
Take Home Points: 1. The occluder combines the advantages of a small delivery system and easy placement with the ability to self-center and reposition itself. 2. Immediate closure occurs reliably with the polyesterfilled prototype. 3. Small introducer size and low profile may allow percutaneous closure in small children. 3:00 pm
Percutaneous Transthoracic Needle Biopsy of the Lung: Review of 628 Lesions F. Castaneda, MD, Peoria, IL • I Patel, MD • R. Li, MD • K. w: Fraser, MD • T.M. Brady, MD • R. Bertino, MD
PURPOSE: The results of 628 consecutive percutaneous
biopsies were analyzed for diagnostic accuracy, compli-
cation rate, specificity and sensitivity, number of passes required, and accuracy of repeated procedures. MATERIALS AND METHODS: From January 1990 to De-
cember 1995, 628 consecutive lung biopsies were performed in 600 patients with Franceen needles of 18-22 gauge. RESULTS: Fifty-seven percent of the patients were men
and 43% were women. Nineteen percent of patients had a previous history of malignancy. Correct diagnoses were made in 96.7% of the biopsies, indeterminate diagnoses were made in 2.8%, and incorrect diagnoses were made in 0.48%. Pneumothorax occurred in 27.5% of patients and 9.6% required chest tubes. Hemoptysis was seen in 3.2% and perinodular interstitial hemorrhage in 7.5% of patients. There was no significance difference in specificity and sensitivity related to needle size. There was also no significant difference in pneumothorax rate and need for chest tube placement when comparing needle size or number of passes. CONCLUSIONS: This study, one of the longest ever published, contradicts established perceptions that the complication rate will diminish if thinner needles are used and the number of passes is minimized. In addition, larger needles will not necessarily obtain better diagnostic samples. This study shows that the procedure is simple and has a high degree of sensitivity and specificity and a low incidence of complications, thus making it the preferred procedure.
Take Home Points: 1. Needle size and number or passes does not correlate with the complication rate. 2. Diagnostic accuracy is independent of needle size. 3. This approach remains the best procedure for investigating pulmonary nodules.
3:15 pm TracheobroncWal Stents: Bridging the Bronchial Ostium and Its Effects on the Lung Segment H. Bjarnason, MD, Minneapolis, MN • B. Cahill, MD
• M.e. Urness • G.K. Nazarian, MD • e.A. Dietz, MD • D. w: Hunter, MD PURPOSE: To evaluate the effect of a metal stent placed
across the ostium of a bronchus on the involved lung segment and bronchus. MATERIALS AND METHODS: Nine pigs were used for the
study. Noncovered Palmaz® stents were placed in three pigs, Wallstent® (Schneider Inc., Minneapolis, MN) in three, and Gianturco® in three. The stents were placed in the trachea across the right upper lobe bronchial ostium as it comes off separately from the trachea. Bronchoscopy was performed initially and then at 1 and 3 months; chest radiographs were obtained at the same intervals. The animals were killed at 3 months and the lung specimens were evaluated histologically.
215
RESULTS: Opacification frequently developed in the right upper lobe. The bronchial ostium stayed open in all cases. In some cases, development of granulation tissue in the region of the stent was noted. In a few cases, there also seemed to be more accumulation of secretions in the stented areas. One of the Palmaz stents was crushed during the study.
Take Home Points: Both benign and malignant tracheobronchial obstructions respond well to stenting. In most patients, symptoms improve dramatically. Stenting of chronic lobar collapse is ineffective because it does not restore functional patency.
CONCLUSIONS: Stents can be placed across the ostium of bronchi without causing obstruction. The stents cause an increase in granulation tissue, and secretions may not be as effectively cleared.
Percutaneous Transthoracic Duct Catheterization to the Neck and Esophagus: A Feasibility Study
Take Home Points: 1. Stents may be placed across the bronchial ostium. 2. Granulation tissue will form at the stent site. 3. Secretions may not clear as effectively and cause atelectases. 4. The stents differ in their applicability for the tracheobronchial tree.
3:30 pm Clinical Experience with Expandable Metallic Stents to Treat Tracheobronchial Obstructions B.M. Hoppenfeld, MD, Newark, NJ Shoenfeld, MD • A. Novick, MD
• H. Mast,
MD • R.
PURPOSE: To study the efficacy of tracheobronchial stents to treat central airway obstructions. MATERIALS AND METHODS: Twenty-two patients with airway obstruction received a total of 45 tracheobronchial stents (39 Wallstents® [Schneider Inc., Minneapolis, MN], three elastomer-covered Wallstents®, and three Gianturco Z-stents). Indications included symptomatic malignant airway obstruction (n = 15), postintubation tracheal stenosis (n = 3), post-transplant anastomotic bronchial stenosis (n = 1), exclusion of a dehisced pneumonectomy stump (n = 1), transbronchial drainage of a postobstructive lung abscess (n = 1), and prophylaxis of impending airway closure before radiotherapy (n = 1).
3:45 pm
e.
Cope, MD, Philadelphia, PA
PURPOSE: To assess the feasibility of inserting a drain catheter percutaneously from the cysterna chyli (CC) through the thoracic duct (TD) wall to the neck or esophagus for potential long-term T-cell sampling and drainage. MA ThlUALS AND METHODS: Percutaneous transabdominal catheterization of the TD from the CC was performed in three animals to insert a 60-cm 21-gauge needle over a micro guide wire. In one dog, the distal TD was perforated into the neck to insert a TD drain to an access port. In acute experiments on two swine, the esophagus was accessed by puncturing the mid-TD to insert a catheter into the distal esophagus. RESULTS: Transmediastinal TD-to-neck catheterization was well tolerated during 1 week of observation except for a skin infection that developed over the port. The technique for TD-to-esophagus catheterization in swine was feasible with no acute complications. CONCLUSIONS: Percutaneous inside-out transmural catheterization of the TD to reach the neck or the esophagus is feasible and may have clinical applications for immunosuppression by T-cell depletion.
Take Home Points: Transabdominal percutaneous transmural thoracic duct catheterization for lymph drainage to the neck or esophagus is feasible in animals.
Scientific Session 18 Central Venous Access Moderator: John Cardella, MD, Hershey, PA
216
RESULTS: Symptoms, which included chronic lobar collapse, prophylactic stenting, tumor mass mistaken for collapse, and left upper lobe collapse after stenting of the left lower lobe (our only complication), were not improved in four of 22 patients. Six patients became asymptomatic. Three others had tissue ingrowth through the stent that required restenting (two with covered stents). Patient survival ranged from 1.5 weeks to 1.5 years. Thirteen patients are still alive. Three died of comorbid conditions and six died of progression of extrapulmonary disease or progressive respiratory compromise.
].G. Caridi, MD, Gainesville, FL • I.P. Hawkins, Jr. MD • BN. Wiechmann, MD .].e. Tonkin, MD • DJ. Pevarski, MD
CONCLUSION: Tracheobronchial stenting effectively relieves benign and malignant symptomatic airway obstructions.
MA7ERIALS AND METHODS: Eighty sequential patients having central venous access procedures were evaluated with hand-held ultrasound to determine the size, pa-
2:30 pm Ultrasound Guidance of the Internal Jugular Vein for Central Venous Access
PURPOSE: To prospectively demonstrate the safety and accuracy of right internal jugular (RIJ) vein cannulation for central venous access when guided by hand-held ultrasound.