BACKGROUND & AIMS:A 50% dysfunction rate at 1 year is one of the main drawbacks of the transjugular intrahepatic portosystemic shunt procedure. Preliminary experimental and clinical studies suggest that the use of stents covered with polytetrafluoroethylene could tremendously decrease this risk.METHODS:Eighty patients with cirrhosis and uncontrolled bleeding (n = 23), recurrent bleeding (n = 25), or refractory ascites (n = 32) were randomized to be treated by transjugular intrahepatic portosystemic shunts with either a polytetrafluoroethylene-covered stent (group 1; 39 patients) or a usual uncovered prosthesis (group 2; 41 patients). Follow-up Doppler ultrasound was scheduled at day 7, at 1 month, and then every 3 months for 2 years. Angiography and portosystemic pressure gradient measurements were performed 6, 12, and 24 months after the transjugular intrahepatic portosystemic shunt procedure and whenever dysfunction was suspected. Dysfunction was defined as a >50% reduction of the lumen of the shunt at angiography or a portosystemic pressure gradient >12 mm Hg.RESULTS:After a median follow-up of 300 days, 5 patients (13%) in group 1 and 18 (44%) in group 2 experienced shunt dysfunction (P < 0.001). Clinical relapse occurred in 3 patients (8%) in group 1 and 12 (29%) in group 2 (P < 0.05). Actuarial rates of encephalopathy were 21% in group 1 and 41% in group 2 at 1 year (not significant). Estimated probabilities of survival were 71% and 60% at 1 year and 65% and 41% at 2 years in groups 1 and 2, respectively (not significant).CONCLUSIONS:The use of polytetrafluoroethylene-covered prostheses improves transjugular intrahepatic portosystemic shunt patency and decreases the number of clinical relapses and reinterventions without increasing the risk of encephalopathy.

The screening, diagnosis and evaluation of diseases of the ureter depend almost entirely on radiological examinations. Only the definite diagnosis is obtained, in some cases by biopsy, endoscopic techniques and sometimes after surgical excision and pathological examination of the lesion.

Ureteral tumors are rare and usually of urothelial origin. Urothelial tumors are most frequently malignant, and their prognosis is variable, depending on their degree of differentiation (grading) and their extension through the ureteral wall (staging). Much rarer are tumors of connective tissue origin, which are most frequently benign (Table 6.1).

Whitaker has suggested a practical and useful defi - nition of urinary tract obstruction: “A narrowing of the urinary tract, such that the proximal pressure must be raised to transmit the usual fl ow through it” (Whitaker 1978b). The key factor of obstruction is blockade of urine fl ow, which leads to increased pressure in the collecting system.

The ureter responds to inflammation with some common abnormalities: loss of contraction and hypotonia, mural thickening by edema and cell infiltration, ulceration, pseudo-diverticula, cystic degeneration, and desmoplastic reaction leading to narrowing and obstruction (Wasserman 1996).

The main prerequisite to interventional uroradiologic procedures is the creation of an appropriate PCN tract. The reasons for and the potential complications of the intervention should be discussed with the patient. Familiarity with basic renal anatomy is necessary to select a safe route for renal entry. Posterior relationships with the 12th rib, pleural reflection line, colon, spleen, liver, and lobar vascular distribution are important points to take into account (Joffre et al. 1995).

Except in some particular circumstances, the lack of specificity of most clinical signs makes it necessary to carry out a first-line screening radiological examination that allows a fast and effective evaluation of the whole urinary tract.

PURPOSE:To evaluate the feasibility and middle term patency results, for endovascular treatment of peripheral aneurysms, using covered stents.MATERIALS AND METHODS:Between December 1993 and may 2000 25 peripheral aneurysms on 24 patients, mean age 67.8 years (42-81), were treated with covered stents (Cragg EndoPro system or passenger, hemobahn, Word Medical). Aneurysm locations were: 17 iliac, 4 popliteal, 1 femoral, 1 subclavian, 1 carotid. The follow-up range from 1 to 75 months (mean 30.1 months).RESULTS:Successful aneurysm exclusion was achieved in all patients, while maintaining good lower extremity perfusion. All but one stent remained patent during the early follow-up period. At one year 94.4% stents were patent, at two years 90.2.CONCLUSION:Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural and clinical success. At middle term follow-up patency is encouraging except with popliteal procedure, however long term follow-up and larger series is warranted to assess the place of this procedure as an alternative to the surgery.

Purpose : To evaluate the feasibility and middle term patency results,: for endovascular treatment of peripheral aneurysms, using covered stents. Materials and methods: Between December 1993 and may 2000 25 peripheral aneurysms on 24 patients, mean age 67.8 years (42-81), were treated with covered stents (Cragg EndoPro system or passager, hemobahn, Word Medical). Aneurysm locations were: 17 iliac, 4 popliteal, 1 femoral, 1 subclavian, 1 carotid. The follow-up range from 1 to 75 months (mean 30.1 months). Results : Successful aneurysm exclusion was achieved in all patients, while maintaining good lower extremity perfusion. All but one stent remained patent during the early follow-up period. At one year 94.4% stents were patent, at two years 90.2. Conclusion : Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural and clinical success, At middle term follow-up patency is encouraging except with popliteal procedure, however long term follow-up and larger series is warranted to assess the place of this procedure as an alternative to the surgery.