Search

Introduction: Morel‐Lavallée lesions (MLL), also referred to as closed degloving injuries, result from traumatic shearing forces with separation of the subcutaneous fat from the underlying fascia. The aim of this study was to determine the incidence and treatment of MLLs at a level 1 trauma centre. Methods: Single‐centre retrospective cross‐sectional study of consecutive patients with an imaging diagnosis of a Morel‐Lavallee lesion from 1/1/2010–31/12/2019. Demographic data, mechanism of injury, volume of lesion, management and outcome data were collated. Results: Sixty‐six MLLs were identified in 63 patients (64% Male) with a median age of 49.5 years (19–94 years). Mechanism of injury were road traffic accidents in the majority (66%). Median injury severity score (ISS) was 17 (range 1–33). Patients on oral anti‐coagulants had significantly larger lesions (181.9 cc v 445.5 cc, P = 0.044). The most common lesion location was the thigh (60.5%). Patients that underwent imaging within 72 h of injury had significantly larger lesions than those imaged more than 72 h after the inciting trauma (65 cc v 167 cc, P < 0.05). Management data were documented in 59% of lesions (39/66) in which 66.6% (n = 26) had invasive treatment. In the 31 patients where follow‐up was available, 64.5% (n = 20) were persistent but decreasing in size. There was no significant difference in follow‐up size for those who had invasive compared to conservative treatment (P = 0.3). Conclusion: The diagnosis of MLL should be considered for soft‐tissue swelling in the context of shearing trauma. A variety of management options have been employed, with good overall outcomes. [ABSTRACT FROM AUTHOR]

Introduction: There are few female Interventional Radiologists worldwide and this is a significant issue for many countries. There is little known about the current status and attitudes to women in Interventional Radiology in Australia and New Zealand. The purpose of this study was to explore the gender balance, workforce challenges and perceptions towards women in Interventional Radiology in Australia and New Zealand. Methods: An anonymised voluntary survey exploring the current demographics of Interventional Radiologists and opinions on multiple gender issues in Interventional Radiology was conducted. The survey was sent to all members of the Interventional Radiology Society of Australasia. Statistical analysis was performed using independent samples t‐tests, the non‐parametric Mann–Whitney U testing and proportions of binary variables using logistic regression. Results: Seventy seven responses were received, 83% males and 17% females. The majority of participants worked full time (83%) and identified as an Interventional Radiologist with/without some sessions of diagnostic radiology per week (83%). There was general consensus in many issues; however, males tended to disagree more than females that female IRs are treated differently than male IRs (p < 0.037), and that male IRs are paid more than female IRs (P = 0.020). Females agreed it was harder for female IRs to gain academic or clinical promotion; however, males disagreed (P < 0.001). Conclusion: There is a clear gender imbalance in Interventional Radiology in Australia and New Zealand. Multiple issues should be investigated and addressed by the major stakeholders such as the Royal Australian and New Zealand College of Radiologists and the Interventional Radiology society of Australasia. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the efficacy of ultrasound and fluoroscopicguided aspiration and therapeutic injection of Baker’s cysts in the relief of pain and pressure symptoms. Methods A retrospective, observational, single-arm study of consecutive patients referred from the Orthopaedic service for image-guided aspiration followed by therapeutic injection of symptomatic Baker’s cysts was performed with institutional approval in the context of a Quality Improvement project. Patients’ pain was graded using a 10-point Likert scale. Under standard sterile conditions, a 10 cm 5 Fr Yueh centesis needle was advanced into the cyst under direct ultrasound guidance, septae disrupted as necessary, the contents of the cyst aspirated, and a sample sent for microbiological analysis. Bursography was performed in an attempt to identify the expected communication with the knee joint, the contrast was aspirated and 40 mg of DepoMedrone and 5 ml of Bupivacaine were injected. Results Thirteen patients were referred, nine of whom satisfied the inclusion criteria (all female, average age 63.8 years). Over a 35-month period, 11 procedures were performed (bilateral in 1, repeated in another) yielding an average volume of 20.1 ml (range 10 – 50 mls). In 2/11 procedures the communication with the knee joint was outlined. The average follow up post-procedure was 8.3 months. The average patient’s pain score reduced to zero from 5.7 for an average period of 5.96 months. After this period patients reported a gradual return of an ache, but none returned to the pre-procedure severity which, in some cases, had prevented them from sleeping. Conclusion Aspiration of symptomatic Baker’s cysts under Ultrasound and fluoroscopic guidance followed by therapeutic injection of DepoMedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients. [ABSTRACT FROM AUTHOR]

Introduction: Pseudoaneurysms are uncommon but potentially life‐threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound‐guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. Methods: Retrospective single‐centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010–2020). Results: There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm; 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound‐guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was <9 h for visceral artery pseudoaneurysms and 24 h for peripheral artery pseudoaneurysms. There was no change in survival outcomes with respect to time from diagnosis and intervention. Conclusion: In this study, pseudoaneurysms were treated with a high degree of success by observation or by using an endovascular approach, and those requiring endovascular intervention did not need to be treated immediately in an emergent setting. [ABSTRACT FROM AUTHOR]

Introduction: Cataract formation is a tissue reaction effected by radiation exposure. The purpose of this study was to evaluate the occupational exposure to the lens of the eye of interventional radiologists (IR's) and interventional radiology staff, with and without lead glasses. Methods: Ethical approval was provided by the hospital research and ethics committee. A prospective cohort study was performed over 1 year, doses recorded, lifetime dose (estimated at working 5 days in angiography, for 30 years) was estimated and dose compared to current guidelines. Thermoluminescent dosimeters (TLDs; Landauer, Glenwood, USA) Hp(3) were placed on both the exterior and interior side of the personal lead glasses worn by three interventional radiologists and two radiographers. They were monitored during all procedures performed within 1 year. Lead glasses (AttenuTech® Microlite®, Florida, USA) with specifications were 0.75 mm lead equivalent front shield, and Side shield 0.3 mm Pb equivalent. A control TLD was placed in the storage location of the lead glasses when not in use. Yearly dose was measured and lifetime dose was calculated from the data obtained. Calculation of dose received per day(s) spent performing procedures for both annual and lifetime exposure was performed. In addition a record of occurrence of splashes on glasses was made after each case. Results: Eye doses without protection were double the recommended limits for both annual and lifetime dose. For interventional radiologists working between 3 and 4 or more days in the lab per week, annual dose thresholds would be exceeded (20 mSv/year averaged over 5 years, no more than 50 mSv in 1 year). If interventional radiologists worked between 3 and 4 or more days in the lab, lifetime dose thresholds would be exceeded (500 mSv lifetime dose). Lead glasses reduced radiation exposure by an average of 79%. If lead glasses were worn no interventional radiologists would exceed annual or lifetime dose thresholds to the eyes even if working 5 days per week as the primary operator. Radiographers would not exceed annual or lifetime dose thresholds even without lead glasses. Splash incidents occurred for all interventional radiologists and one radiographer. Conclusion: The use of lead glasses even in this small study resulted in a decreased dose of radiation to the lens of the eye. Regular use of radiation protection eyewear will reduce eye dose for primary proceduralists to well below yearly and lifetime thresholds. [ABSTRACT FROM AUTHOR]

We present a rare complication of the retraction and extensive twisting of a PICC line likely subsequent to interaction with the patient's right ventricular assist device (RVAD). Keywords: central venous access; PICC; RVAD EN central venous access PICC RVAD 799 801 3 09/08/22 20220901 NES 220901 Introduction PICC lines are a form of central venous access device.1 At our institution, when PICC lines are inserted without fluoroscopic guidance, a chest X-ray is routinely performed after insertion to confirm the position of the catheter. A left-sided pacemaker, intercostal catheter and the patients BI-VAD are also visible. gl This PICC line remained in use and functioning normally until day 37 postinsertion when it abruptly stopped flushing. [Extracted from the article]

We aimed to discuss and evaluate the technical success and efficacy of the ArtVentive endoluminal occlusion system (EOS) device for splenic embolization. A retrospective review was undertaken for all patients in whom the EOS device was deployed for the purpose of splenic embolization. Data was collected by a search of splenic artery embolization procedures in the hospital computer database. Data was reviewed for all patients in whom an EOS plug was deployed. Patient demographics, technical aspects of the procedure and follow-up at one month were reviewed. We review the technical success and efficacy of this occlusion device. Six patients underwent splenic embolization with the EOS plug. There were 5 male and 1 female patients; age range was 24-88 years. Five 8 mm and one 5 mm EOS plugs were deployed for the occlusion of the splenic artery. The technical success rate was 100% occurring in all 6 splenic arteries. One patient underwent a second angiogram and subsequent splenectomy for persistent splenic hemorrhage. One patient had a subsequent splenectomy for bacteremia with the spleen as the suspected source. This early data supports the efficacy of the EOS plug for the embolization of the proximal splenic artery. [ABSTRACT FROM AUTHOR]

Concerns have been raised in the literature, regarding the risk of venous thromboembolic events associated with the use of thermoregulatory catheters. Inferior vena cava (IVC) filters are commonly used to prevent venous thromboembolic events. We demonstrate the usefulness of IVC filter placement prior to the removal of thermoregulatory warming catheters. The management of thermoregulatory warming catheter associated venous thromboembolism is outlined through a retrospective case series of three patients. In one case IVC thrombus was incidentally detected at ultrasonography one-week post removal. The second case describes the occurrence of pulseless electrical activity arrest secondary to massive pulmonary embolism immediately post removal of the thermoregulatory catheter, and subsequent interventional radiology management including pulmonary thrombectomy and caval filter placement. The third case is of a patient in whom the removal of the warming catheter was performed in the angiography suite, with placement of IVC filter prior to removal. Venography displayed a large thrombus burden within the IVC filter. There is limited data in the literature regarding the use of IVC filters as prophylaxis in patients with thermoregulatory catheters, particularly warming catheters. We advocate the placement of an IVC filter prior to the removal of warming catheters. We raise awareness regarding the potential risks of venous thromboembolism in this population and the key role interventional radiology has in the management of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Uterine fibroids have the potential to cause morbidity, and there is a substantial cost to both the healthcare system and society. There is support for minimally invasive intervention, and uterine fibroid embolisation (UFE) is an established cost-effective option for women wishing for an alternative to surgery. There is a lack of local Australian costing data to compliment use in the public hospital system, and we offer a costing analysis of running a public hospital service.Methods: We reviewed the costs for 10 sequential uterine fibroid embolisation cases, by assessing the direct and indirect hospital costs.Results: The total cost of providing a uterine fibroid embolisation service using our model in a public hospital including initial outpatient assessment, procedure costs, overnight hospital ward stay and outpatient follow-up is $3995 per admission.Conclusion: Using our model, the overall cost to perform this procedure is low, and lower than prior estimates for surgical alternatives. We encourage government and regulatory bodies to support UFE through guidelines and remuneration models, and encourage more public Australian interventional radiology departments to offer this service. [ABSTRACT FROM AUTHOR]