Percutaneous punctures

Crippa, F.G., Bruno, R., Brnnetti, E., Filice, C. Echinococcal liver cysts treatment with echo-guided percutaneous puncture PAIR for echinococcal liver cysts. Ital. J. Gastroenterol. 1999 31 884-892... 

Percutaneous puncture and pre-operative cyanoacrylate obliteration of a traumatic false aneurysm of an angular artery branch [see comment], Br J Radiol 76 746-749... 

Fig. 7.6a-d. A 48-year-old man with chronic pancreatitis developed further abdominal pain. CECT revealed a pseudoaneurysm in his lesser sac (a). Selective and super selective angiography failed to demonstrate any source for the pseudoaneurysm (b). It was therefore percutaneously punctured with a 21-Gauge needle (c) and thrombosed with 2000 units of autologous thrombin. CECT at 1 week demonstrated occlusion of the pseudoaneurysm (d)... 

Ozdoba C, Voigt K, Nusslin F (1991) New device for CT-tar-geted percutaneous punctures. Radiology 180 576-578 Palestrant AM (1990) Comprehensive approach to CT-guided procedures with a hand-held guidance device. Radiology... 

Cardiologists have used the Seldinger technique for percutaneous access for years, hi this technique, a large-bore needle ( 18 gauge) is used to percutaneously puncture the vascular structure. A guidewire is introduced through the needle into... 

Blind percutaneous puncture using surface landmarks... 

Venous access can be carried out by either cutdown or the percutaneous approach. If the initial electrode has been placed via cutdown, the isolation of a second vein for venous access will prove extremely difficult. In this case, percutaneous approach should be attempted. Conversely, if the initial electrode has been placed percutaneously, then a second percutaneous approach or a cut-down is always possible. The second percutaneous puncture is usually carried out just lateral to the initial venous entry site. The initial lead can be used as a marker of the venous anatomy. If any difficulty is encountered, fluoroscopy is used to guide the lead using the chronic ventricular lead for reference (85,86). There is potential risk of damaging the initial electrode and care should be taken to avoid its direct puncture. The use of radiographic materials can also help define the venous structure as well as its patency. 

Fig. 1.3a-c. Transhepatic internal/external biliary drainage of malignant distal common bile duct (CBD) stricture due to pancreatic cancer, a Opacification of the right peripheral duct by a percutaneous puncture shows irregular stricture of the distal CBD (arrow), b Using a combination of 0.038-in. guidewire and a 5-F catheter, the CBD stricture was negotiated, c An 8-F multi-sidehole internal/external biliary catheter was placed over the wire... 

Takes WF, Peosner PH, Reed MD et al. (1996) Serial embolizations of an extremity arteriovenous malformation with alcohol via direct percutaneous puncture. AJR 146 1038-1040... 

Doppman JL, Pevsner P (1983) Embolization of arteriovenous malformations by direct percutaneous puncture. AJR 140 773-778... 

Lukancic SP,NemcekAA Jr,Vogelzang RL (1991) Posttrau-matic intrahepatic arterial pseudoaneurysm treatment with direct percutaneous puncture. J Vase Interv Radiol... 

If the aneurysm is amenable to direct percutaneous puncture, another option includes direct thrombin injection or coiling via an 18-gauge needle. Simultaneous balloon occlusion of the aneurysm neck via arterial access can be performed to prevent nontarget embolization. 

Complex cysts may present anywhere in the abdomen and frequently bleed during or immediately after birth so that a fluid-sludge level or an evolving clot can be seen (Figs. 7.16,7.17). In some cases, percutaneous puncture of the cyst can be diagnostic in showing evidence of increased estradiol in the withdrawn fluid. 

Gunther SF, DiPasquale D, Martin R (1993) Struthers ligament and associated median nerve variations in a cadaveric specimen. Yale J Biol Med 66 203-208 Macon WL IV, Futrell JW (1973) Median-nerve neuropathy after percutaneous puncture of the brachial artery in patients receiving anticoagulants. N Engl J Med 288 1396... 

The atlanto-axial joints have been visualized radiologically recently by percutaneous puncture of the articular space (Dirkeimer 1977, Mellstrom et al. 1980). 

Percutaneous Denoting the passage of substances through unbroken skin for example, by needle puncture, including introduction of wire and catheters. 

Okuda, K., Musha, H., Nakajima, Y., Takayasu, K., Suzuki, Y., Morita, M., Yamasaki, T. Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver. Gastroenterology 1978 74 1204-1207... 

Percutaneous splenoportography has lost its importance. Should a direct procedure be indicated, laparoscopic splenoportography is a possible alternative. Recently, a new technique has been described. (134) The percutaneous splenic puncture is performed using a thin needle under screen control, with the needle directed at the splenic hilus. The pressure of the splenic pulp can be measured directly in order to estimate the portal vein pressure. Contrast medium is injected manually or by a special device. From this depot in the red pulp, the splenic vein, the portal vein and the intrahepatic branches of the portal vein are contrasted within a few seconds, (s. fig. 8.12) Complications resulting from percutaneous splenoportography include afterbleeding from the spleen, bilateral rupture of the spleen, arterial aneurysms and a.v. shunts — these complications are serious in nature, but rare. Contraindications for the procedure should be carefully observed, (s. tab. 8.6)... 

Percutaneous transhepatic hepatophlebography involves a typical puncture of the liver with a needle from the right midaxillary line to enter a hepatic vein. Pressure measurement and CM injection ensure that the position of the needle or the catheter is correct. Thrombosis of the portal vein is an absolute contraindication, which is why indirect splenoportography must be carried out prior to percutaneous hepatophlebography. Serious complications occur in 1.5-4.0% of cases. 

The method of percutaneous transhepatic cholangiography (PTC) was first described by H. Burckhardt et af in 1921 and by P. Huard et af in 1937, and revived by R.F. Carter et af in 1952. Routine use was recommended by F. Glenn et af in 1962. After the development of a thin and flexible puncture needle (Y. Tsuchiya, 1969) and the Okuda technique using a Chiba needle (K. Okuda et af, 1974), PTC became a widely used clinical method. (174)... 

Filice, C., Brunetti, E., Bruno, R., Crippa, F.G Percutaneous drainage of echinococcal cysts (PAIR-puncture, aspiration, injection, reaspiration) results of a worldwide survey for assessment of its safety and efficacy. Gut 2000 47 156-157... 

Salama, H., Abdel-Wahab, M.F., Strickland, G.T. Diagnosis and treatment of hepatic hydatid cysts with the aid of echo-guided percutaneous cyst puncture. Clin. Infect. Dis. 1995 21 1372-1376... 

In an extremely large abscess, percutaneous aspiration of the focus with evacuation of the pus is carried out as an initial measure. Generally, several punctures have to be performed with respective aspiration of the focal contents until the abscess cavity is gradually obliterated under the impact of specific antibiotics. The outcome of... 

The results of contact dissolution of gallstones using infusions of methyl-tert-butylether by percutaneous trans-hepatic gallbladder puncture have been assessed in 803 patients (3). Stones were dissolved in 724 of 761 patients in whom gallbladder puncture was successful. The 30-day mortality was 0.4%. Common comphcations were biliary leak, fever, leukocytosis, abdominal pain, and mild increases in transaminases. Toxic effects due to ether were not reported. 

The intrathecal route is more invasive than i.v, i.m. or s.c routes. Both percutaneously implanted catheters and subcutaneously implantable pumps have heen used to reduce the risk of infection on repeated puncture. 

The direct puncture percutaneous approach to pancreatic aneurysm embolization was first described... 

The author has used percutaneous CT guided thrombin injection in six patients where pancreatitis associated aneurysms could not be seen at selective angiography. The technique is relatively simple, the aneurysm being punctured with a 21-Gauge saline flushed needle under CT guidance... 

There has been increased use of percutaneous closure devices for closing the femoral artery puncture site. These devices are particularly helpful in patients that are being anticoagulated. There are a number of types of hemostatic devices hemostatic patches, collagen-mediated devices, and suture... 

The PAKY system, a robot for percutaneous needle puncture, incorporates a 1-DOF PAKY (percutaneous access of the kidney) radiolucent needle driver, a2-DOF RCM (remote center of motion) module capable of needle orientation, a 3-DOF XYZ Cartesian stage for translational positioning of the needle tip, and a passive 7-DOF positioning arm (S-arm) (Fichtinger et al. 2002 Su et al. 2002). The lower joints are positioned and locked manually, while the upper stages are motorized (Fig. 28.5). 

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