Fluoroscopically directed percutaneous placement of gastrostomy and gastrojejunostomy catheters with routine gastropexy is a safe procedure. Catheter revision was necessary in 13% of patients and was usually secondary to tube dislodgment, with tract disruption an unusual complication.

A 36-year-old patient underwent successful percutaneous fenestration of a type I aortic dissection which had caused occlusion of the right common iliac artery and ischemia of the right lower extremity. The patient is currently (6 months post-fenestration) ambulating without any signs of vascular compromise. The technique may be useful in patients who are at high risk for surgical procedures.

We imaged 75 hips in 40 patients using fat saturation technique before and after intravenous injection of contrast (0.1 mmol/kg gadolinium diethylene triamine penta-acetic acid, Gd-DTPA). Eighteen hips in 11 patients were determined to be osteonecrotic, either by pathologic or clinical examination. In the osteonecrotic hips, three distinct patterns of enhancement were found: (I) focal area outlined by brightly enhancing rim (7 hips); (II) diffuse enhancement in the femoral head and neck extending into the femoral shaft (3 hips); and (III) a combination of patterns I and II (8 hips). Our data support the hypothesis that early nontraumatic osteonecrosis is associated with hyperemia and/or an increase in capillary permeability rather than acute devascularization, and that diffuse marrow edema is the initial finding in early nontraumatic osteonecrosis.

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