The Seldinger Files

Dr. Sven-Ivar Seldinger (1921–1998),  a Swedish radiologist, introduced a novel way to access hollow organs in 1953. This technique is the backbone of all modern day interventional and endovascular procedures performed. In acknowledgement of his contribution to minimally invasive therapy, I have named this collection of patients I have treated and procedures I have performed after him.

ClaudicationCERAB Technique for AortoIliac Reconstruction

Severe aortoiliac occlusion with rest pain and short distance claudication treated with novel CERAB technique using covered stent grafts.

Critical Limb IschemiaChiba Needle Sharp Recanalization for CLI

Sharp recanailziation of a heavily calcified SFA occlusion

ClaudicationSharp Recanalization of Thrombosed Popliteal Artery Aneurysms for Claudication and Rest Pain

Short distance claudication and rest pain secondary to thrombosed popliteal artery aneurysm treated endovasculary.

Critical Limb IschemiaNon healing ulcer with normal skin perfusion pressures

Current physiologic testing for ulcer perfusion may fail to identify patients with ischemia

ClaudicationEndovascular therapy of external iliac and common femoral artery occlusion

Endovascular therapy of external iliac and common femoral artery occlusion with 31 month follow up

ClaudicationEndovascular Repair of an Aorto-Bifemoral Graft Limb Anastomotic Stenosis

Endovascular repair of an anastomic stenosis of a aortobifemoral bypass graft using JetStream atherectomy

ClaudicationDirectional atherectomy with external assistance

64 year old female with severe short distance claudication limiting the patients ability to work

ClaudicationClaudication and rest pain secondary to CFA occlusion

62 year old female with 2 months of short distance claudication and rest pain at night

Critical Limb IschemiaRest pain in a 104 year old female

104 year old female with worsening left foot rest pain

Venous InsufficiencyVenous ulceration secondary to venous outflow obstruction and incompetent superficial and deep veins

65 year old cyclist with extensive superficial and deep venous incompetence and venous ulceration

Leg & Foot UlcersPost thrombotic venous ulceration

38 year old female with severe post thrombotic syndrome and severe venous ulceration for 8 years

Critical Limb IschemiaPercutaneous bypass graft for severe critical limb ischemia

Percutaneous bypass graft for severe critical limb ischemia

Peripheral Arterial DiseaseSudden onset of calf pain

Unusual cause of extremity pain in a diabetic patients

Critical Limb IschemiaWire fragment retrieval from the dorsalis pedis artery

The tip of a hydrophilic wire was fractured and subsequently retrieved during the crossing of a distal anterior tibial artery near occlusion

Critical Limb IschemiaOccluded popliteal artery aneurysms with non healing ulcer

83 year old developed non healing ulcer left foot after occlusion of a known popliteal artery aneursym

Pelvic Venous IncompetencePelvic venous congestion secondary to iliac vein compression or May Thurner Syndrome

51 year old female with a long history of low back pain, pelvic aching and heaviness, urinary frequency and painful intercourse.

Pelvic Venous IncompetencePelvic Venous Congestion Secondary to Nutcracker Phenomena

62 year old female suffering for 30 years with pelvic venous congestion

Renal Vein CompressionPartial extratraction of a maldeployed renal vein stent

Renal vein stent placed for Nutracker Syndrome was placed too far into the IVC and causing pain. Stent was partially removed.

Arterial AneurysmEnlarging Internal Iliac Artery Aneurysm

Asymptomatic slowly enlarging internal iliac artery aneurysm

Pelvic Venous IncompetencePelvic Venous Congestion with Pelvic Heaviness and Urinary Frequency

36 year old with pelvic aching and heaviness, painful intercourse and urinary frequency treated with the "uncoil coil" technique

VaricoceleThe "Uncoil Coil" Technique for Gonadal Vein Embolization

A faster technique for embolization gonadal veins using large diameter coils

Iliac Vein CompressionVenous claudication post iliofemoral DVT

Active female with severe venous claudication 9 years after iliofemoral deep venous thrombosis.

ClaudicationShort distance claudication severely limiting daily living

87 year old with severe left leg claudication limiting ability to walk more than 100 feet

Peripheral Arterial DiseaseClinical evalulation of peripheral arterial disease

Review of the clinical findings and their usefulness in identifying patients with peripheral arterial disease

Leg & Foot UlcersNon healing wound after skin biopsy

55 year old female that underwent a skin biopsy with non healing of the biopsy site at 7 weeks.

Arterial AneurysmPulsatile groin mass 15 years after an aorto bifemoral bypass graft

87 year old male with a right groin pseudoaneurysm due to the dehisences of the fabric of an aorto bifemoral bypass graft

Venous ThrombosisRecurrent Left Leg Deep Venous Thrombosis

Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.

VaricoceleRecurrent varicocele after inadequate embolization

Recurrent left testicular pain after inadequate embolization of the proximal left testicular vein

Leg & Foot UlcersAnkle ulcer for 6 years

86 year old male with a recurring painful left ankle ulcer

VaricoceleVaricocele Embolization in a High School Athlete

Painful varicoceles interfering with high school athletics

Iliac Vein CompressionLeg Swelling Post Lymph Node Dissection

Robotic lymph node dissection for prostrate cancer staging with severe leg swelling after

Pelvic Venous IncompetencePelvic Venous Congestion Secondary to Nutcracker Sydrome

Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.

Pelvic Venous IncompetencePelvic Venous Congestion Secondary to Iliac Vein Compression

Iliac vein compression may cause pelvic venous congestion.

Venous InsufficiencyIncompetent (Abnormal) Venous Valve

Ultrasound of Incompetent SaphenoFemoral Junction Valve

Venous InsufficiencyCharring Cross CX Vascular Foam Phlebectomy 2015

Presentation at Charring Cross Meeting London 2015

ClaudicationFlank Claudication

Exertional flank pain secondary to claudication.

Venous InsufficiencyFoam Phlebectomy: Technique & Outcomes

Presentation at Charring Cross Meeting London 2015

ClaudicationShort distance claudication treated with atherectomy

59 year old male with short distance exercise induced left leg pain. Pain was severe and was interfering with the patients actively living.

Critical Limb IschemiaPain misdiagnosed as in grown toe nail

101 year old female, admitted to the hospital with foot and toe pain. Patient had a cool pulseless foot.

Critical Limb IschemiaAnte/retrograde recanalization occluded ATA for CLI

79 year old female with non healing ulcers. Occlusion of all three arteries in the calf.

Critical Limb IschemiaPedal Loop Reconstruction

46 year old male, type 1 diabetes, with ulcers on several toes. Patient had palpable pulses at the ankle.

AtheroembolismPurple Toe from Ulcerated Popliteal Artery Plaque

59 year old male, smoker, sudden onset of pain and discoloration of the right 3rd toe.

Critical Limb IschemiaNeuroischemic ulcer from distal PTA and LPA stenosis

61 year old male, diabetic, developed a lateral right foot ulcer after a pedicure. The posterior tibial artery pulse was palpable.

Critical Limb IschemiaCritical limb ischemia, failed bypass graft

64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.

Critical Limb IschemiaPlantar arch angioplasty to prevent toe amputation

67 year old male, type1 diabetic, with painful ulceration at the tip of the second toe. Patient did not toe amputation.

Critical Limb IschemiaHeel ulcer during rehabilitation after fracture of the femur

82 year old male, heavy smoker, developed right heel ulcer during rehab after a femur fracture.

Leg & Foot Ulcers Gangrene right foot after failed open and endovascular procedures

83 year old male, Type I Diabetes, end stage renal disease, living independently who was told he needed a below knee amputation.

Critical Limb IschemiaPainful lateral malleorar ulcer

86 year old female with a several month history of a painful non-healing ulcer over the lateral malleolus.

Critical Limb IschemiaCritical limb ischemia misdiagnosed as gout

94 year old female, worsening right toe and foot pain. Seen by primary care and diagnosed as having gout.

Iliac Vein CompressionLeg pain and swelling after road trip

30 year old female, on oral contraceptives, with severe left leg swelling after a long car ride. Ultrasound showed left iliofemoral DVT.

Iliac Vein CompressionYoung male with severe post thrombotic syndrome

22 year old with severe post thrombotic syndrome 6 months after left leg deep venous thrombosis (DVT).

Critical Limb IschemiaSFA Recanalization and viabhaun stenting after failed bypass graft

71 year old female with a non healing ulcer on the left foot.