Search

PURPOSE: We aimed to investigate the safety and functionality of tunneled transhepatic hemodialysis catheters in chronic hemodialysis patients. METHODS Thirty-eight patients (20 women aged 56±10 years and 18 men aged 61±11 years) with transhepatic tunneled hemodialysis catheters were evaluated. The date of the first transhepatic catheterization, indications, procedure details, functional time periods of catheters, reasons for the removal or revision of catheters, catheter-related complications, and current conditions of patients were retrospectively analyzed. RESULTS A total of 69 catheters were properly placed in all patients (100% technical success) under imaging guidance during the 91-month follow-up period. The functionality of 35 catheters could not be evaluated: five catheters were removed because of noncomplication related reasons (surgical fistulas were opened in two cases [2/35, 5.7%], transplantation was performed in three cases [3/35, 8.6%]), 18 patients died while their catheters were functional (18/35, 51.4%), and 12 catheters were still functional at the time of the study (12/35, 34.3%). The functionality of catheters was evaluated the remaining 34 catheters that necessitated revision because of complications. Furthermore, only half of the catheters were functional on day 136 when evaluated using Kaplan- Meier analysis. The four main complications were thrombosis (16/34, 47%; complication rate of 0.37 days in 100 catheters), infection (8/34, 23.5%; 0.18 days in 100 catheters), migration (8/34, 23.5%; 0.18 days in 100 catheters), and kinking (2/34, 6%; 0.04 days in 100 catheters). CONCLUSION Transhepatic venous catheterization is a safe and functional alternative route in chronic hemodialysis patients without an accessible central venou route. The procedure can be performed with high technical success and low complication rates under imaging guidance. © Turkish Society of Radiology 2016.

Ufuk, Furkan/0000-0002-8614-5387; Ufuk, Furkan/0000-0002-8614-5387 WOS:000459432000025 PubMed: 30629460 Objective: We aimed to determine the diagnostic performance of the contrast-enhanced and unenhanced combined pulmonary arterial MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism (VTE). Methods: 44 patients who underwent CT pulmonary angiography (CTPA) for suspected PE constituted the study population. Patients underwent combined pulmonary and lower extremity MRI, and Doppler ultrasonography within 72 h after CTPA. Combined MRI included two sequences: unenhanced steady-state free precession (SSFP) and contrast-enhanced three-dimensional (3D) gradient echo (GRE). The presence of emboli in pulmonary arteries and thrombi in lower extremity veins on 3D-GRE and SSFP sequences was recorded. Results: CTPA showed a total of 244 emboli in 33 (75%) patients whereas contrast-enhanced 3D-GRE MRI showed deep vein thrombosis (DVT) in 34 (77%) subjects. Sensitivities for SSFP vs 3D-GRE MRI respectively in PE detection were 87.9 vs 100% on a per-patient basis, and 53.7 vs 73% on a per-embolus basis. Of 34 patients with established DVT, 31 (91%) were detected by Doppler ultrasound and 29 (85%) were detected by SSFP technique respectively. Conclusion: Both contrast-enhanced and unenhanced combined MRI of acute PE and DVT are feasible one-stop-shopping techniques in patients with suspected thromboembolism. Advances in knowledge: Pulmonary VTE is a common disease with high mortality. Non-invasive techniques withhigh accuracy are required for the assessment of VTE. CT-related radiation and contrast material risks cause concerns. MRI is a radiation-free technique evaluating the vessels with and without contrast. Combined contrast enhancedor unenhanced pulmonary and lower extremity MRI is feasible in patients with suspected thromboembolism.

Not Available

Sir, I read with great interest the paper by Drs Schaefer-Prokop and Prokop [1] in the December 2008 issue of European Radiology, highlighting the protocols to optimize the image quality of CT pulmonary angiography (CTPA) in pregnant individuals. I appreciate the authors’ editorial work, which comprehensively overviewed the limitations of CTPA related to physiological changes during pregnancy and summarized the options to overcome them. In an attempt to shed further light on the effect of altered caval blood flow deteriorating the quality of CTPA, I would like to draw attention to a recent paper by Kuzo et al. [2], who quantitatively measured caval blood flow in healthy subjects by velocity-encoded cine MRI. They found that caval blood flow significantly increases during continuous inspiration and decreases during the Valsalva manoeuvre compared with free breathing. When the ratio of inferior vena cava to superior vena cava blood flow was taken into consideration, it increases during continuous inspiration (2.37), and decreases during breath-hold at end inspiration (1.90), breath-hold at end expiration (1.94), and at Valsalva manoeuvre (1.51) compared with free breathing (2.04). They concluded that CTPA should be performed with only a small inspiration or no inspiration before acquiring CT data. It has also been demonstrated by a Doppler study that hepatic venous pulsatility is decreased during pregnancy, being completely flat with increasing gestational age, which is attributed to increased cardiac output and the pressure effects of the enlarged gravid uterus [3]. Similarly, the compliance of the inferior vena cava is likely to be decreased during pregnancy by the same mechanism, leading to continuous forward flow of unopacified blood into the right atrium. Knowledge of physiological changes taking place during pregnancy will enable us to modify our acquisition protocols accordingly.

PURPOSE: A new inferior vena cava filter was evaluated in vivo to determine the percutaneous retrievability after an implantation period of up to 18 days. MATERIALS AND METHODS: The inferior venae cavae of six goats were percutaneously implanted with three filters, and one animal received two filters. To assess filter stability, a plain radiograph was obtained after 7-9 days and on the day of retrieval. After cavography, filter retrieval with an endovascular snare and retrieval catheter was performed in three animals after 12 days and in three others after 14 days. In one animal, retrieval of one filter was performed after 18 days, and one filter was intended to be permanent. Twenty-eight days after filter retrieval, cavography was performed before inferior vena cava removal for gross and histologic examination. RESULTS: All filters (N = 20) were implanted without complications. There was no migration during the implantation period. Preretrieval cavography demonstrated all filters to be patent and centered. Filters intended for retrieval (n = 19) were all successfully extracted at 12 (nine filters), 14 (nine filters), and 18 days (one filter). For the animal with the filter extracted at 18 days, one filter remained in situ intentionally. Postretrieval cavography showed no visible signs of vessel wall anomalies. There were no complications during the 28 days of follow-up after retrieval. Presacrifice cavography showed no evidence of caval wall abnormalities. In all animals, gross examination of the inner wall of the explanted vena cava showed only minimal macroscopic changes. The struts of the filter in situ for 46 days (18 days with 28 days of follow-up) were overgrown with neointima. Histological study of the 19 filter retrieval sites revealed no to moderate intima proliferation, minimal residual signs of hemorrhages, and no or only occasional slight inflammatory reaction. CONCLUSIONS: In this animal model, the new vena cava filter demonstrated event-free retrieval, without postretrieval complications, up to 18 days postimplantation. After implantation of 46 days, the filter showed neointima overgrowth of the struts.

PURPOSE: A new inferior vena cava filter was evaluated in vivo to determine the percutaneous retrievability after an implantation period of up to 18 days. MATERIALS AND METHODS: The inferior venae cavae of six goats were percutaneously implanted with three filters, and one animal received two filters. To assess filter stability, a plain radiograph was obtained after 7-9 days and on the day of retrieval. After cavography, filter retrieval with an endovascular snare and retrieval catheter was performed in three animals after 12 days and in three others after 14 days. In one animal, retrieval of one filter was performed after 18 days, and one filter was intended to be permanent. Twenty-eight days after filter retrieval, cavography was performed before inferior vena cava removal for gross and histologic examination. RESULTS: All filters (N = 20) were implanted without complications. There was no migration during the implantation period. Preretrieval cavography demonstrated all filters to be patent and centered. Filters intended for retrieval (n = 19) were all successfully extracted at 12 (nine filters), 14 (nine filters), and 18 days (one filter). For the animal with the filter extracted at 18 days, one filter remained in situ intentionally. Postretrieval cavography showed no visible signs of vessel wall anomalies. There were no complications during the 28 days of follow-up after retrieval. Presacrifice cavography showed no evidence of caval wall abnormalities. In all animals, gross examination of the inner wall of the explanted vena cava showed only minimal macroscopic changes. The struts of the filter in situ for 46 days (18 days with 28 days of follow-up) were overgrown with neointima. Histological study of the 19 filter retrieval sites revealed no to moderate intima proliferation, minimal residual signs of hemorrhages, and no or only occasional slight inflammatory reaction. CONCLUSIONS: In this animal model, the new vena cava filter demonstrated event-free retrieval, without postretrieval complications, up to 18 days postimplantation. After implantation of 46 days, the filter showed neointima overgrowth of the struts.

Coronary artery fistulas are the second most frequently seen coronary anomaly following abnormalities of coronary artery origin and distribution. A coronary fistula is defined as a direct communication between a coronary artery and any cardiac chamber or vessel. Treatment options include percutaneous embolization and surgical intervention. Herein, we present a case of a giant coronary artery fistula and right atrial tachycardia that was induced during a diagnostic electrophysiologic study but was not inducible after the successful treatment of the fistula. This is the first case indicating this association. Resumo: As fístulas coronárias são a segunda anomalia mais frequente das artérias coronárias a seguir às anomalias coronárias da câmara de saída. A fístula define-se como uma comunicação direta entre as artérias coronárias e uma cavidade cardíaca ou estrutura vascular. As opções terapêuticas incluem a embolização percutânea e o tratamento cirúrgico. Apresentamos aqui um caso de uma fistula coronária gigante e taquicardia auricular direita induzida durante um estudo electrofisiológico diagnóstico e que não foi possível induzir após o tratamento bem sucedido da fístula. Este é o primeiro caso que reporta esta associação. Keywords: Coronary artery fistula, Atrial tachycardia, Coil embolization, Palavras-chave: Fistula arterial coronária, Taquicardia auricular, Embolização com coil