Background: Though vertebroplasty is a well-known and extremely effective procedure in experience... more 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.
Angiography is now a well-established modality for the diagnosis of acute lower gastrointestinal ... more Angiography is now a well-established modality for the diagnosis of acute lower gastrointestinal bleeding. Inferior mesenteric arteriography and selective superior hemorrhoidal artery embolizations for such bleeding have been well documented. However, to our knowledge the selective embolization of the middle hemorrhoidal artery has not been reported. We describe a patient with lifethreatening rectal bleeding that was successfully stopped by selective embolization of the middle hemorrhoidal or middle rectal artery (a branch of the anterior division of the internal iliac artery).
Journal of Vascular and Interventional Radiology, 2006
Percutaneous vertebroplasty and sacroplasty are becoming common modalities of treatment for verte... more 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. J Vasc Interv Radiol 2006; 17:909 -912
We report a rare complication of autopsy-proven fat and bone marrow embolization following percut... more We report a rare complication of autopsy-proven fat and bone marrow embolization following percutaneous vertebroplasty in a patient who had no evidence of cement leakage. Cement injection was done during one patient encounter, covering 3 vertebral levels by using a unipedicular approach. Patients may have complications even without polymethylmethacrylate leakage.
BACKGROUND AND PURPOSE: Refracture after percutaneous vertebroplasty in patients receiving oral g... more BACKGROUND AND PURPOSE: Refracture after percutaneous vertebroplasty in patients receiving oral glucocorticoid therapy has caused some patients and referring physicians to have negative perceptions concerning the efficacy of the initial vertebroplasty treatment. The purpose of this study was to analyze symptomatic refractures after vertebroplasty in patients on oral steroid therapy. We hypothesized that the higher refracture rate of patients on oral glucocorticoid therapy after percutaneous vertebroplasty is due not to an inadequacy of the procedure but rather to a naturally higher predisposition of these patients to refracture compared with patients with primary osteoporosis.
We present a case of vertebral osteomyelitis following vertebroplasty in a patient with acne of t... more 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.
To describe a new application of tissue plasminogen activator (t-PA) power-pulse spray rheolytic ... more 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. 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. We therefore present two unique cases of spontaneous and iatrogenic renal artery thromboses that were treated successfully with t-PA power-pulse spray rheolytic thrombectomy. t-PA Power-pulse spray rheolytic (pharmacomechanical) thrombectomy has the potential to be a useful means to restore perfusion and function in the setting of acute renal artery thrombosis.
Angiography is now a well-established modality for the diagnosis of acute lower gastrointestinal ... more Angiography is now a well-established modality for the diagnosis of acute lower gastrointestinal bleeding. Inferior mesenteric arteriography and selective superior hemorrhoidal artery embolizations for such bleeding have been well documented. However, to our knowledge the selective embolization of the middle hemorrhoidal artery has not been reported. We describe a patient with lifethreatening rectal bleeding that was successfully stopped by selective embolization of the middle hemorrhoidal or middle rectal artery (a branch of the anterior division of the internal iliac artery).
Journal of Vascular and Interventional Radiology, 2009
PURPOSE: Vertebroplasty is known for its high leakage rate compared to Kyphoplasty. High-viscosit... more PURPOSE: Vertebroplasty is known for its high leakage rate compared to Kyphoplasty. High-viscosity cements were shown to significantly enhance uniformity of cement filling and decrease incidence of leakage. New products for verte-Scientific Sessions SUNDAY S3
BACKGROUND AND PURPOSE: Percutaneous vertebroplasty has been performed in the United States in an... more 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. Occurrences of new symptomatic vertebral compression fractures were recorded for a year following initial vertebroplasty. RESULTS: Fifty-five patients (21.7%) of the 253 osteoporotic women with one or more initial fractures experienced a new symptomatic vertebral compression fracture within 1 year.
Subclavian stenting can be extremely difficult in a hostile type II aortic arch (with acute angul... more 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. This technique also avoids the use of a surgical cut down.
Purpose To describe a new technique to help localize life threatening colorectal bleeding during ... more 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. The marker was then used to guide superselective angiography and embolization. Results 5 cases of patients with colorectal bleeding were performed using this technique with cessation of bleeding in 4/5 initial attempts. 1 patient required a repeat angiogram that did demonstrate the bleeding on the second attempt allowing superselective angiography and embolization that resulted in cessation of bleeding. This patient with a rectal bleed required selection of additional vessels guided by the marker on the second attempt. Conclusion The dilemma of positive scintigraphic evidence of colonic bleeding with negative arteriography can be resolved with the use of a metal marker during the scintigram to guide superselective angiography. Although in our small series of patients this technique appears to be simple and effective, further clinical investigation is warranted with a larger patient population. This technique may offer a role in therapy in coordination with the colorectal surgeon for the high risk patient in an otherwise life threatening situation.
BACKGROUND AND PURPOSE: Adjacent fracture formation after percutaneous vertebroplasty has been re... more 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.
A patient initially presented with anginal symptoms and a positive stress thallium test. An arter... more 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. The patient had successful clinical, nuclear, and angiographic outcomes. (J Interven Cardiol 2003;16:347–350)
We present here an extremely rare case of celiac artery aneurysm treated by embolization coil occ... more We present here an extremely rare case of celiac artery aneurysm treated by embolization coil occlusion and review the literature on celiac artery aneurysm and its treatment. This case documents how celiac artery aneurysms can be successfully treated in a single setting with a good long-term outcome. In this unique case the technical and clinical details specific to this very complex and unusual aneurysm embolization are highlighted.
Background: Though vertebroplasty is a well-known and extremely effective procedure in experience... more 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.
Angiography is now a well-established modality for the diagnosis of acute lower gastrointestinal ... more Angiography is now a well-established modality for the diagnosis of acute lower gastrointestinal bleeding. Inferior mesenteric arteriography and selective superior hemorrhoidal artery embolizations for such bleeding have been well documented. However, to our knowledge the selective embolization of the middle hemorrhoidal artery has not been reported. We describe a patient with lifethreatening rectal bleeding that was successfully stopped by selective embolization of the middle hemorrhoidal or middle rectal artery (a branch of the anterior division of the internal iliac artery).
Journal of Vascular and Interventional Radiology, 2006
Percutaneous vertebroplasty and sacroplasty are becoming common modalities of treatment for verte... more 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. J Vasc Interv Radiol 2006; 17:909 -912
We report a rare complication of autopsy-proven fat and bone marrow embolization following percut... more We report a rare complication of autopsy-proven fat and bone marrow embolization following percutaneous vertebroplasty in a patient who had no evidence of cement leakage. Cement injection was done during one patient encounter, covering 3 vertebral levels by using a unipedicular approach. Patients may have complications even without polymethylmethacrylate leakage.
BACKGROUND AND PURPOSE: Refracture after percutaneous vertebroplasty in patients receiving oral g... more BACKGROUND AND PURPOSE: Refracture after percutaneous vertebroplasty in patients receiving oral glucocorticoid therapy has caused some patients and referring physicians to have negative perceptions concerning the efficacy of the initial vertebroplasty treatment. The purpose of this study was to analyze symptomatic refractures after vertebroplasty in patients on oral steroid therapy. We hypothesized that the higher refracture rate of patients on oral glucocorticoid therapy after percutaneous vertebroplasty is due not to an inadequacy of the procedure but rather to a naturally higher predisposition of these patients to refracture compared with patients with primary osteoporosis.
We present a case of vertebral osteomyelitis following vertebroplasty in a patient with acne of t... more 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.
To describe a new application of tissue plasminogen activator (t-PA) power-pulse spray rheolytic ... more 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. 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. We therefore present two unique cases of spontaneous and iatrogenic renal artery thromboses that were treated successfully with t-PA power-pulse spray rheolytic thrombectomy. t-PA Power-pulse spray rheolytic (pharmacomechanical) thrombectomy has the potential to be a useful means to restore perfusion and function in the setting of acute renal artery thrombosis.
Angiography is now a well-established modality for the diagnosis of acute lower gastrointestinal ... more Angiography is now a well-established modality for the diagnosis of acute lower gastrointestinal bleeding. Inferior mesenteric arteriography and selective superior hemorrhoidal artery embolizations for such bleeding have been well documented. However, to our knowledge the selective embolization of the middle hemorrhoidal artery has not been reported. We describe a patient with lifethreatening rectal bleeding that was successfully stopped by selective embolization of the middle hemorrhoidal or middle rectal artery (a branch of the anterior division of the internal iliac artery).
Journal of Vascular and Interventional Radiology, 2009
PURPOSE: Vertebroplasty is known for its high leakage rate compared to Kyphoplasty. High-viscosit... more PURPOSE: Vertebroplasty is known for its high leakage rate compared to Kyphoplasty. High-viscosity cements were shown to significantly enhance uniformity of cement filling and decrease incidence of leakage. New products for verte-Scientific Sessions SUNDAY S3
BACKGROUND AND PURPOSE: Percutaneous vertebroplasty has been performed in the United States in an... more 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. Occurrences of new symptomatic vertebral compression fractures were recorded for a year following initial vertebroplasty. RESULTS: Fifty-five patients (21.7%) of the 253 osteoporotic women with one or more initial fractures experienced a new symptomatic vertebral compression fracture within 1 year.
Subclavian stenting can be extremely difficult in a hostile type II aortic arch (with acute angul... more 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. This technique also avoids the use of a surgical cut down.
Purpose To describe a new technique to help localize life threatening colorectal bleeding during ... more 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. The marker was then used to guide superselective angiography and embolization. Results 5 cases of patients with colorectal bleeding were performed using this technique with cessation of bleeding in 4/5 initial attempts. 1 patient required a repeat angiogram that did demonstrate the bleeding on the second attempt allowing superselective angiography and embolization that resulted in cessation of bleeding. This patient with a rectal bleed required selection of additional vessels guided by the marker on the second attempt. Conclusion The dilemma of positive scintigraphic evidence of colonic bleeding with negative arteriography can be resolved with the use of a metal marker during the scintigram to guide superselective angiography. Although in our small series of patients this technique appears to be simple and effective, further clinical investigation is warranted with a larger patient population. This technique may offer a role in therapy in coordination with the colorectal surgeon for the high risk patient in an otherwise life threatening situation.
BACKGROUND AND PURPOSE: Adjacent fracture formation after percutaneous vertebroplasty has been re... more 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.
A patient initially presented with anginal symptoms and a positive stress thallium test. An arter... more 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. The patient had successful clinical, nuclear, and angiographic outcomes. (J Interven Cardiol 2003;16:347–350)
We present here an extremely rare case of celiac artery aneurysm treated by embolization coil occ... more We present here an extremely rare case of celiac artery aneurysm treated by embolization coil occlusion and review the literature on celiac artery aneurysm and its treatment. This case documents how celiac artery aneurysms can be successfully treated in a single setting with a good long-term outcome. In this unique case the technical and clinical details specific to this very complex and unusual aneurysm embolization are highlighted.
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Papers by Azim Shaikh