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Purpose: To evaluate radiographic, laboratory, and clinical factors associated with conservative management (CM) failure in spontaneous rectus sheath hematoma (RSH).Materials and Methods: Retrospective review of 72 patients with spontaneous RSH between 2006 and 2017 was performed. Patients were initially managed conservatively and then divided into 2 groups based on decision to embolize. No differences were found between embolization (n = 32) and CM (n = 40) groups in age (67.5 vs 69.5 y; P = .79), sex (31% vs 38% male; P = .58), body mass index (27.7 vs 25.7 kg/m2; P = .20), or medical comorbidities. Univariate analyses compared initial hemoglobin level, change in hemoglobin level, coagulation parameters, transfusion requirements, hematoma volume, and active extravasation on computed tomographic (CT) angiography between groups. Multivariable logistic regression identified factors predictive of CM failure. A scoring system was then created to predict CM failure.Results: CM failed in 32 of 72 patients. Multivariable regression identified active extravasation on CT angiography (P = .02), hematoma volume (P = .01), and packed red blood cell (pRBC) transfusion of ≥ 4 U (P = .03) as predictors of embolization. A scoring system using these factors along with maximum rate of hemoglobin decrease yielded a sensitivity of 100% and specificity of 98% in determining need for embolization.Conclusions: CM for RSH was more likely to fail in patients with active extravasation on CT angiography, larger hematoma volume, pRBC transfusion of ≥ 4 U, and higher rate of hemoglobin decrease. Using these parameters, a scoring system was created that achieved high sensitivity and specificity in identifying patients who would require embolization. [ABSTRACT FROM AUTHOR]

Purpose To examine if the outcomes after endovascular treatment in hypertensive patients with renal artery fibromuscular dysplasia (FMD) and incidental atherosclerotic renal artery stenosis (ARAS) differ from the outcomes in patients with FMD alone. Materials and Methods All cases of patients with renal artery FMD undergoing percutaneous transluminal angioplasty during the period 2002–2012 were reviewed. The patients with complete data before and after the procedure were identified (N = 84). Based on the procedural reports, these patients were separated into two cohorts: patients with isolated FMD (n = 59) and patients with concomitant atherosclerotic renal artery stenosis and FMD (ARAS-FMD) (n = 25). The medical record of each patient was reviewed for baseline blood pressure, antihypertensive medication use, and renal function data and the same data after the procedure. Procedural details including the angiographic findings, the number of stents placed, the average number of revascularization procedures, and the number of patients requiring more than one revascularization procedure were noted. Results The study population included 68 patients (FMD, n = 46; ARAS-FMD, n = 22). Patients in the FMD and ARAS-FMD cohorts experienced comparable significant decreases in systolic and mean arterial pressures after endovascular intervention. There was no change in the number of antihypertensive medications after the procedure within or between groups. Patients in the ARAS-FMD cohort had lower baseline estimated glomerular filtration rates ( P = .007); however, renal function stabilized in both groups after endovascular therapy. Conclusions Patients with ARAS-FMD respond to endovascular therapy with outcomes similar to patients with isolated renal artery FMD. [ABSTRACT FROM AUTHOR]

The purpose of this work is to demonstrate the feasibility of lowering the dose per frame commonly used for digital subtraction angiography (DSA) imaging without noticeable loss in image quality. The results indicate that dose per frame for DSA may be reduced by 60% without measurable decreases in CNR and reduced by 73% without a drop in perceived image quality. [Extracted from the article]

Subintimal recanalization can be a useful procedure in selected patients with severe peripheral vascular disease with tissue loss or rest pain and limited surgical bypass options. Technical failure occurs in approximately 20% of patient who undergo percutaneous intentional extraluminal recanalization due to inability to reenter the distal true lumen. A technique to improve technical success when performing subintimal recanalization when there is failure to reenter the distal true lumen or possibly when there is a limited segment of patent distal target vessel for reentry is proposed. Further evaluation of this technique is necessary to confirm its safety and determine its technical and clinical success. [ABSTRACT FROM AUTHOR]

Intravascular stents play an increasingly important role in the treatment of iliac artery occlusive disease and their use has expanded the indications for percutaneous endoluminal therapies. The past several years have seen a sharp increase in the number of commercially available covered and uncovered stents. Knowledge of their design and mechanical properties is crucial for selecting the appropriate stent for a particular type of lesion. In this article, the indications for and results of iliac artery stent placement are reviewed and the various characteristics of the currently available stents that may influence operator choice for use in specific lesions are discussed [Copyright &y& Elsevier]

Digital subtraction angiography (DSA) is a valuable tool but can contribute a significant proportion of patient radiation doses. The purpose of this work is to demonstrate the feasibility of lowering the dose per frame commonly used for DSA imaging without noticeable loss in image quality using simulated lesions. For the six lesions, none of the mean reading scores dropped a full image quality level until the dose was at a 12% of the standard 3 Gy/fr, and two of the lesions did not drop their mean score one level until DSA dose was reduced to 6.7% and 4.7% of the standard dose. [Extracted from the article]

To compare safety and effectiveness of splenic artery embolization (SAE) techniques following blunt traumatic injury. Proximal embolization resulted in significantly less skin entry dose (SED) to the patient (median: 677 mGy vs. 1441 mGy, P <0.01). [Extracted from the article]

To determine the clinical outcomes of patients with underlying acquired or congenital thrombophilia who underwent lower extremity venous catheter-directed thrombolysis (CDT) for treatment of deep vein thrombosis. In patients with thrombophilia, the median total infusion dose of tPA was 21.0 mg and the median duration of tPA infusion was 25.1 hours, compared to 20.0 mg and 23.7 hours in those without thrombophilia. There may be utility in pursuing hypercoagulability workup in patients undergoing CDT without established diagnosis of an underlying thrombophilia as these patients have a lower chance of thrombolytic success, and are at increased risk for re-thrombosis and re-intervention. [Extracted from the article]

Clinical success (CS) rate was defined as sac size stability on latest available follow-up imaging. TL endoleak treatment had a TS of 83.3% (n = 25), CS of 66.7% (n = 20) and ACS of 86.7% (n = 9). Even though the TS of the TL approach over TA approach is superior (P = 0.001), the overall CS and ACS rates are comparable (P = 0.79 and P = 0.82 respectively). [Extracted from the article]

To report outcomes of patients with type Ia endoleak treated with embolization of the excluded sac rather than conventional endovascular methods such as cuff extension, balloon dilation, or balloon-expandable stent placement. A retrospective review was performed of patients with type Ia endoleak of thoracic and abdominal aortic endografts treated with embolization, including coils, plugs, N-butyl cyanoacrylate (NBCA), and/or ethylene vinyl alcohol co-polymer (EVOH) between January 2005 and April 2019. [Extracted from the article]

Local anesthesia (LA) administration provokes pain responses that can be the worst part of a patient's experience in interventional radiology (IR). Pain of LA (mean 1.1 vs. 3.3 on a 0-10 scale, P <0.001), number of times a painful stick was felt (mean, 0.8 times vs. 1.9 times, P <0.001), and pain during the procedure (mean, 1.5 vs. 3.4 on 0-10 scale, P <0.001) were significantly less using the standardized versus random techniques. [Extracted from the article]

Purpose Distal embolization (DE) of plaque or thrombus is a well-recognized cause of iatrogenic injury during percutaneous peripheral interventions. Several devices are available to help mitigate this and prevent potential distal ischemia. This study evaluated the incidence of DE during percutaneous intervention with the use of the Emboshield NAV-6 embolic protection system (Abbott Vascular, Abbott Park, Illinois). The relative incidence of DE during chemical thrombolysis (intra-arterial TPA), atherectomy, and treatment of in-stent restenosis (ISR) was analyzed. Material and Methods The NAV-6 was used over a 46-month period in 69 patients undergoing lower extremity arterial intervention. A database was generated through utilization of the Hi-IQ inventory management system. A retrospective analysis of this database was performed reviewing both the intervention notes stored in the EMR and the case images stored in PACS. The relative incidence of DE during chemical thrombolysis (intra-arterial TPA), atherectomy, and treatment of ISR was analyzed and compared to DE rates during procedures not involving one of the above categories. Retrieved DE was determined through identification of visible contents within the NAV-6 basket either upon visual inspection following capture and removal or inferred from identification of filling defects during DSA with the device deployed. Results Interventions were performed in 34 native vessels, 6 bypass grafts, and 29 vessels that had been stented previously. NAV-6 devices were placed immediately distal to the arterial lesion in all cases. Twenty-four were treated with intra-arterial TPA either prior to the case during overnight thrombolysis or during the case via pulse-spray thrombolysis. Of the 24 patients treated with TPA, 12 had DE retrieved through the NAV-6 (50%). Twenty patients were being treated with atherectomy (including laser, directional, and rotational) with 10 having DE retrieved through the NAV-6 (50%). Nineteen patients were being treated for ISR with or without complete thrombosis with 9 having DE retrieved through the NAV-6 (47%). Twenty-one patients had treatment not involving TPA, ISR, or atherectomy. Of those 21 patients, DE was retrieved through the NAV-6 in 4 patients (19%). 8 patients had DE despite NAV-6 use (12%) with 6 of the 8 being secondary to an over-filled filter basket. There were no cases of hemodynamically significant arterial spasm or dissection with the use of NAV-6. There was 1 device malfunction where the NAV-6 fractured during retrieval. All but 1 patient had preserved or improved runoff at the end of the case. Conclusions The overall incidence of DE during lower extremity arterial intervention was 30%. Treatment of ISR, treatment with atherectomy, or use of intra-arterial TPA was associated with an increased incidence of DE (47%, 50%, and 50%, respectively) when compared with treatment not involving one of these techniques (19%). The incidence of DE despite use of NAV-6 was 12%. These findings validate the continued use of NAV-6 during lower extremity arterial interventions particularly in the settings of ISR, atherectomy, or use of intra-arterial TPA. [ABSTRACT FROM AUTHOR]