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Purpose To evaluate the use of inframalleolar access for endovenous ablation when treating advanced venous disease with nonthermal nontumescent (NTNT) techniques. Methods This single-center retrospective study included 109 patients with advanced venous disease, treated using inframalleolar access between May 2018 and March 2020. NTNT techniques included ClariVein (Merit Medical Systems, South Jordan, Utah) and ScleroSafe (VVT Medical, Kefar Sava, Israel). Outcomes measured were postprocedure pain, leg edema, ulcer healing and recurrence rates, and venous insufficiency recurrence. Results Seventy-seven patients (70%) were treated with ClariVein and 32 (30%) with ScleroSafe. Postprocedure pain score (range, 0-10) after 1 week decreased from a preprocedure median of 5 (interquartile range, 3-6) to 1 ((interqartiel range, 0-2) (P = .0001). Complete wound healing was achieved in 38 patients (43.7%) after 30 days and in 71 patients (81.6%) after 90 days. One patient developed an ulcer recurrence and six developed venous insufficiency recurrence. There was no reported nerve or skin injuries. Conclusions NTNT ablation techniques using inframalleolar access are effective and safe without risk of nerve damage. Their use facilitates ulcer healing and limits pain in patients with advanced disease.

The purpose of this article is to assess the performance and safety of a novel, symmetric, side-hole–free tunneled cuffed catheter hypothesized to sustain adequate flow without the need for side holes. Between November 2016 and January 2019, Pristine hemodialysis catheters were placed de novo in 45 end-stage renal disease patients (27 males and 18 females) at a single investigational site. Forty-one catheters were placed in the right and four in the left internal jugular vein. There were no incidents of insertion failure. Patients had dialysis three times per week and were followed at four investigational sites. Nominal catheter flows, incidence of poor flow, and catheter-related infections were recorded at each dialysis session and analyzed. The average follow-up time was 161.69 days for a total of 7116 catheter days. Nine patients died from reasons unrelated to the catheter and one patient switched to fistula. Four patients had poor flows necessitating catheter replacement. Four patients had catheter-related bloodstream infections which resolved with antibiotics. These equate to 0.56 events per 1000 catheter days. Catheter survival was 100%, 97.6%, and 89.7% at 30, 90, and 180 days, respectively. The initial clinical assessment of the symmetric Pristine hemodialysis catheter featuring a Y-tip devoid of side holes revealed good catheter performance and survival and a low complication rate.

Background: Eighty percent of hemodialysis patients start their dialysis with a tunneled hemodialysis catheter. Catheter related bacteremia is the second most common cause of death in these patients. Side holes near the tips of the tunneled cuffed central venous catheters are associated with accumulation of thrombus, which can lead to catheter dysfunction and, possibly, also to catheter-related infection. To assess the hypothesis that a catheter without side holes would be associated with less bacterial growth, this study compared the susceptibility of a side-hole-free catheter to accumulation of pathogenic bacteria at the catheter tip with that of two catheters which have side holes. Methods: Eight tunneled cuffed double-lumen central venous catheters were inserted into both jugular veins of four sheep; one side-hole-free and one control catheter with side holes at the tip in each animal. Staphylococcus aureus bacteria were then infused intravenously to cause bacteremia. Six hours later, the catheters were removed, the clots that accumulated in their tips were collected and cultured, and the bacterial colonies were counted after additional 12 h of incubation. Results: Bacteria grew on culture plates seeded with the clot homogenate obtained from the tips of all catheters. The colony counts from the catheters with side holes at the tip exceeded the colony counts of bacteria accumulated in the tips of the side-hole-free hemodialysis catheters by one or more orders of magnitude, with a difference of at least two orders of magnitude observed in three of the four intra-animal comparisons. Conclusions: In paired intra-animal post-inoculation comparison made in this limited study, fewer colony forming units of pathogenic bacteria accumulated at the tip of the side-hole-free catheters than at the tips of the catheters which have side holes. This may translate to a decreased rate of catheter-related blood stream infections in the side-hole-free catheters.

Background: The issue of side holes in the tips of the tunneled cuffed central venous catheters is complex and has been subject to longstanding debate. This study sought to compare the clotting potential of the side-hole-free Pristine hemodialysis catheter with that of a symmetric catheter with side holes. Methods: Both jugular veins of five goats were catheterized with the two different catheters. The catheters were left in place for 4 weeks and were flushed and locked with heparin thrice weekly. The aspirated intraluminal clot length was assessed visually prior to each flushing. In addition, the size and weight of the clot were recorded upon catheter extraction at the end of the 4-week follow-up Results: The mean intraluminal clot length observed during the entire study follow-up measured up to a mean of 0.66 cm in the GlidePath (95% CI, 0.14–1.18) and 0.19 cm in the Pristine hemodialysis catheter (95% CI, −0.33 to 0.71), the difference being statistically significant ( p = 0.026). On average, 0.01 g and 0.07 g of intraluminal clot were retrieved from the Pristine and GlidePath catheters, respectively ( p = 0.052). Conclusion: The Pristine hemodialysis catheter was largely superior to a standard side hole catheter in impeding clot formation, and, contrary to the side hole catheter, allowed for complete aspiration of the intraluminal clot.

The purpose of this study was to assess the feasibility of use of a novel uterine fibroid treatment device hypothesized to cause fibroid infarction by increasing intra-tumoral pressure. Between August 2019 and January 2020, 21 uterine fibroids were treated in 16 symptomatic pre-menopausal black women. Pelvic magnetic resonance imaging was performed before the procedure, a day after the procedure and at 1, 3, 6, and 12 months. The subjects were also followed for clinical outcomes and quality of life up to 12 months at a single investigational site. At 3 months, the mean reduction in the fibroid volume was 36.3% (P = .002). Incremental reduction in volume peaked at the end of the follow-up, at the 12-month mark (60.4%; P = .008). There were no procedures in which the users failed to perform laparoscopic pressure suturing of fibroids with the pressure-induced fibroid ischemia device. Improvement in the quality of life was evident in the Health-Related Quality of Life total, Energy/Mood, Control, and Sexual Function domains of the Uterine Fibroid Symptom and Quality of Life questionnaire at 3 months post-procedure. Unanticipated risks were not identified. Serious adverse events were not identified. The initial clinical assessment of the pressure-induced fibroid ischemia device supports feasibility of the approach and does not reveal serious safety concerns. Trial is currently being registered retrospectively (This was a feasibility study and therefore registration was not mandatory).

Background: Tunneled hemodialysis catheter-related bloodstream infection is a major cause of morbidity and mortality in end-stage renal disease patients. Side holes positioned near the tip of catheters have been linked to formation of thrombi, which, in turn, have been implicated in predisposition to infection. In addition, side holes allow spillage of catheter locking solution, including antibiotics, thereby minimizing the lock solution’s effect on the catheter tip. This study assessed the infection events that occurred in a series of hemodialysis patients using a non-side-hole catheter. Methods: Over a period of 2 years, a novel symmetric-tip non-side-hole catheter was placed in 60 patients. Hemodialysis was performed thrice weekly. Prescribed dialyzer flows were 300–350 mL/min. Catheters were routinely locked with heparin 5000 units/mL between treatments. Patients were followed up for any catheter related complications, specifically infection events. Results: Seven events of catheter-related bloodstream infection occurred for a rate of 0.76 events per 1000 catheter-days, with the first event occurring 9 weeks after insertion. These events were treated by locking the affected catheter with 2 g of clindamycin in 2 mL of heparin 1000 units/mL and administration of intravenous antibiotics, in most cases, for 7–14 days. Two catheters were removed due to infection. Conclusions: Catheter-related bloodstream infections with non-side-hole hemodialysis catheters do occur at a relatively low rate and in this initial preliminary study it seems that most of these infections can be successfully treated without removal of the affected catheters.

Purpose The VenaTrac™ is designed for exchange and primary placement of chronic tunneled hemodialysis catheters over a wire. It occludes both lumens of the catheter for the purpose of reducing the risk of air embolism and blood loss. The purpose of this paper is to report our experience with the use of this device. Methods A retrospective review of chronic hemodialysis dialysis catheters exchanges over a 30-month period was performed. Two hundred and ninety-seven over-the-wire catheter exchanges and 47 primary placements using the VenaTrac™ device were reviewed. In addition, 430 over-the-wire catheter exchanges without the use of the VenaTrac™ were reviewed. Results No insertional complications or air embolism occurred when using the VenaTrac™. Symptomatic air embolism was documented in 5 out of 430 catheter exchanges performed without the use of VenaTrac™ (1.2%). Conclusions VenaTrac™ over-the-wire insertion device demonstrated safe and reliable use with no incidence of air embolism.

Hemodialysis catheters are a considered a necessary evil. They provide an immediate and reliable access for hemodialysis patients, and therefore their use is steadily increasing. This important role of chronic hemodialysis catheters has lead to the development of many generations of dialysis catheters. Some aspects of novel designs have shown potential to reduce complications, while others provide options for physician insertion preference. This paper reviews current hemodialysis catheters and how they attempt to address some of the more common complications associated with hemodialysis catheters.

OBJECTIVE: Comparison of recurrence of magnetic resonance imaging (MRI) enhancement of uterine fibroids treated with uterine artery embolization (UAE) among embolic agents: polyvinyl alcohol (PVA), spherical PVA (SPVA), and tris-acryl gelatin microspheres (GM). METHODS: Pre/post-UAE gadolinium-enhanced MRIs were evaluated for residual enhancement of fibroids after UAE. Data were analyzed using 2-tail Fisher exact test to determine the likelihood of recurrence of enhancement post-UAE among embolic agents. RESULTS: One hundred one women underwent UAE. A total of 24 (41%) of 59 embolized with PVA, 18 (75%) of 24 with SPVA, and 4 (22%) of 18 with GM showed residual enhancement in some or all fibroids. Statistically significant differences in presence of residual enhancement on follow-up were found between SPVA and PVA (P = 0.0072), and SPVA and GM (P = 0.0015), but not between PVA and GM (P = 0.1756). CONCLUSIONS: Patients embolized with SPVA have a higher risk of having residual enhancement on follow-up MRI than those embolized with PVA or GM.

When evaluating a new biologic agent, especially ones thought to predispose to thromboembolic events, a reliable means for identifying those events in vivo is much needed. Assessing thromboembolic events in primates has traditionally required that the animal be euthanized for detailed postmortem analysis. This approach means that early thromboembolic events may be missed. For instance, an animal euthanised months after the experimental agent was administered may have allowed for a vessel occluded from a prior clot to have recanalized. In clinical practice, pulmonary angiography is the safe, “gold standard” for the diagnosis of pulmonary emboli (1). The aim of this study was to assess feasibility of this procedure in non-human primates. We successfully performed a percutaneous pulmonary angiography upon 11 rhesus macaques and now describe both the pulmonary angiography procedure and our findings in the 11 animals. Our laboratory is interested in studying ways to promote immunologic tolerance. Monoclonal antibodies (e.g., anti-CD154 and anti-CD40) and receptor-based fusion proteins (e.g., CTLA4-Ig) represent promising agents in the quest for immunologic tolerance toward a health restoring allograft or against a tissue or organ undergoing autoimmune attack (2). Although these agents have appeared safe and effective in animal models, some (e.g., anti-CD154) have been associated with a high frequency of thromboembolic events in early clinical trials (3,4). The thromboembolic complications reported after the initial use of many antibodies largely disappeared when more highly purified antibody preparations were administered (3). Non-human primates are highly relevant for the study of such novel therapeutic agents because of their close phylogenetic relationship to humans (5,6) and because many of the newer immunomodulatory agents (antibodies and receptor fusion proteins) are specific for human epitopes that will cross-react with the corresponding primate epitopes (7,8). We have therefore adapted pulmonary angiography for use in the non-human primate.

Objective The use of foam and liquid sclerotherapy for the treatment of varicose veins and underlying venous reflux is widespread. A novel device, the ClariVein Occlusion Catheter (Vascular Insights LLC, Madison, Conn), has been the subject of several clinical trials in humans. We report the initial histologic results obtained with use of the device in a caprine vein model. Methods A total of 11 male goats (12 veins) underwent minimally invasive procedures. Unilateral mechanochemical ablation of the lateral saphenous vein by the ClariVein Occlusion Catheter with an E-140° tip was performed under fluoroscopic guidance in five veins with 5 mL of 1.5% sodium tetradecyl sulfate (STS) and in one vein with 5 mL of 0.9% saline. The remaining six received injection sclerotherapy with 5 mL of 1.5% STS or 0.9% saline. All subjects were assessed with ultrasound before the procedure and intermittently afterward during a period of 12 weeks. Subsequent termination was immediately followed by necropsy and histologic examination of the treated veins. Results Complete occlusion of the lateral saphenous vein was observed in all subjects treated with ClariVein and STS, whereas complete patency was noted in all other treatment modalities. Histologic staining with hematoxylin and eosin and Masson trichrome stain revealed total fibrotic sealing with extensive collagen production in all ClariVein/STS veins. A statistical significance was observed in the difference in the number of occluded veins between subjects treated with ClariVein/STS and those treated by injection sclerotherapy (Fisher exact test, P Conclusions The ClariVein Occlusion Catheter with 1.5% STS can be used to achieve complete mechanochemical ablation of the lateral saphenous vein in a caprine model. The evidence in this report can be used to justify the device's use for the treatment of the great saphenous vein in subsequent human clinical trials.

This report describes a 67-year-old trauma victim in whom a retrievable Günther Tulip (Cook, Bloomington, IN) inferior vena cava filter was placed. The filter migrated to the right atrium immediately after placement. Initial attempts to retrieve the filter with Amplatz Goose Neck snares (Microvena, White Bear Lake, MN) were unsuccessful. A second attempt performed a week later with the addition of the new EnSnare (MDTech, Gainesville, FL) was successful. Possible causes of the migration are discussed and the difficulties encountered while removing this retrievable filter are described.

Purpose End-stage renal disease patients with hemodialysis catheters in need of contrast enhanced imaging studies often have limited peripheral venous access. In this study we aimed to determine pressures generated in hemodialysis catheters during power injection of computed tomography (CT) contrast media. Methods Three different chronic hemodialysis catheters and two acute hemodialysis catheters were included in this study. All catheters were evaluated in vitro. A total volume of 120 cc of CT contrast material was injected at rate of 10 cc/s using a power injector. The catheters were connected to the power injector using a standard connecting tubing. Pressures were simultaneously measured in the power injector as well as in the hemodialysis catheters. Results The maximal measured pressures during injection in the power injector averaged 338 PSI (SD ± 8.7 PSI). The maximal measured pressure in the dialysis catheters ranged between 9.17 and 21.2 PSI. Pressures averaged 14.02 PSI (SD ± 3.34 PSI). The average pressure in the power injector was over 23 times higher than the pressure recorded at the hemodialysis catheter. None of the catheters ruptured or deformed during testing. Conclusions Pressures measured in hemodialysis catheters during power injection are lower than currently believed and markedly lower than the pressures recorded in the power injector. Standard hemodialysis catheters are likely to be amenable to power contrast injection in hemodialysis patients who have limited venous access. In vivo studies are necessary to confirm these findings.

To compare the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath with percutaneous transluminal angioplasty balloons and those who underwent over-the-wire catheter exchange. This study is a retrospective review of 209 percutaneous transluminal angioplasty balloon disruption and 1304 over-the-wire catheter exchange procedures performed in 753 patients. Approval from the Human Investigations Committee was obtained for this study. Up to 10-year follow-up was performed. A χ(2) test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A t-test was used to compare time to central venous stenosis development. Of the 753 patients in the study, 127 patients underwent balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18 (14.2%) of 127 patients subsequently developed central venous stenosis, compared with 44 (7.0%) of 626 in the catheter exchange group (P 0.01, χ(2) test). Time to central venous stenosis development was approximately 3 years in both groups and not significantly different (1371 and 1010 days, P = 0.20). A total of 25.2% of patients in the balloon disruption group had four or more subsequent catheter exchanges, versus 12.6% in the catheter exchange group (P 0.01, χ(2) test). In conclusions, there is a possible association between percutaneous transluminal angioplasty balloon disruption of fibrin sheath and late-onset central venous stenosis. Because venography was not routinely performed in catheter exchange patients, future randomized studies are necessary to confirm these findings.

Catheter-related infections (CRIs) are a significant source of morbidity and mortality in hemodialysis patients. The identification of novel, modifiable risk factors for CRIs may lead to improved outcomes in this population. Peripherally inserted central catheters (PICCs) have been hypothesized to compromise vascular access due to vascular damage and venous thrombosis, whereas venous thrombosis has been linked to the development of CRIs. Here we examine the association between PICC placement and CRIs. A retrospective review was performed of all chronic hemodialysis catheter placements and exchanges performed at a large university hospital from September 2003 to September 2008. History of PICC line use was determined by examining hospital radiologic records from December 1993 to September 2008. Catheter-related complications were assessed and correlated with PICC line history. One hundred eighty-five patients with 713 chronic tunneled hemodialysis catheter placements were identified. Thirty-eight of those patients (20.5%) had a history of PICC placement; these patients were more likely to have CRIs (odds ratio = 2.46, 95% confidence interval = 1.71–3.53, p

In this paper we wish to report our clinical experience with a new heparin-coated dialysis catheter with a symmetric tip. Over a 16-month period, 60 heparin-coated Tal Palindrome catheters were placed in 57 patients. Catheter patency, catheter-related complications, and reasons for catheter removal were recorded. The patient's initial cause of end-stage renal disease, underlying diseases, and site of access were recorded as well. Patients were specifically followed for development of heparin-induced thrombocytopenia. Patient ages were 34-91 (average 66). Fifty-four percent of patients had a history of diabetes. Sixty catheters were placed for a total of 5353 catheter-days. The average catheter indwell time was 107 days (range of 2-381 days). Catheter-related infection occurred in 6 patients over the study period, with a rate of 1.12/1000 catheter-days. Bacteremia occurred in 3 patients with a rate of 0.56/1000 catheter-days. Six catheters were removed or exchanged due to malfunction. There was no incidence of heparin-induced thrombocytopenia. Initial clinical experience with the heparin-coated Tal Palindrome hemodialysis catheter demonstrated safe, reliable use, and low infection rates.

Hyperglycemia is a key factor in both beta cell death and dysfunction as well as in development of microvascular disease. The hypothesis described in this paper suggests that pancreatic microvascular endothelial dysfunction and subsequent microvascular disease of the pancreas causes islet ischemia. This subtle ischemia is the cause of initial dysfunction and subsequent apoptosis of B cells which is preceding development of type 2 diabetes. Moreover, the subtle beta cell ischemia will continue to diminish the beta cells' ability to secrete the increasing amount of insulin needed as the insulin resistant state progresses into type 2 diabetes. This vicious cycle might perpetuate type 2 diabetes.

To test the hypothesis that not all embolic materials are equivalent by using postprocedural magnetic resonance (MR) imaging enhancement of uterine fibroids in patients treated with uterine artery embolization (UAE).Approval and a waiver of consent from the institutional human investigations committee was received for this study. The study was HIPAA compliant. A total of 84 women who underwent 6-month MR imaging follow-up constituted this retrospective study. Within this group, 25 women were treated with Contour polyvinyl alcohol (PVA) particles, 23 were treated with Contour SE particles, 19 were treated with Embosphere microspheres, and 17 were treated with Bead Block microspheres. Pre- and postprocedural MR imaging results were analyzed for the total number of fibroids present in the uterus of each patient and for the percentage of individual fibroid enhancement. Enhancement of individual fibroids was measured with quartile intervals. Greater than 25% residual enhancement of a fibroid after embolization was considered an incomplete infarction. The overall percentage change in enhancement was calculated for each patient. Bivariate analysis by using generalized linear modeling and one-way analysis of variance was used to assess differences in infarction with different embolic materials.Among patients treated with Contour and Embosphere, there was a mean reduction in enhancement by 76.60% and 83.07%, respectively, compared with a mean reduction of 52.53% and 49.78% in patients treated with Bead Block and Contour SE, respectively. There was a significant difference in postembolization enhancement between Bead Block and Embosphere, Bead Block and Contour, Contour SE and Embosphere, and Contour SE and Contour.Patients treated with Bead Block or Contour SE demonstrated a reduced degree of infarction at follow-up MR imaging compared with patients treated with Contour or Embosphere.

Hemodialysis catheters are a necessary evil. They provide an immediate and effective lifeline for hemodialysis patients, and their use is steadily increasing. This increasingly important role has lead to the development of many generations of dialysis catheters. Some aspects of novel designs have shown potential to reduce complications, while others provide options for physician insertion preference. The two major biomaterials for catheter construction are currently polyurethane and silicone, while copolymers such as carbothane are becoming more widespread. Catheter coatings such as heparin, antibiotics, and silver ion are designed to minimize thrombosis and infection. Finally, many lumen and tip designs are also available. These new features were designed to address common problems, including maintenance of adequate flow rate and prevention of thrombosis, fibrin sheath, and catheter-related infection. However, reliable data directly comparing these different designs and coatings are currently lacking. This communication reviews current hemodialysis catheters, including materials, design, and advanced features.

To investigate the relationship between MRI-determined uterine fibroid size and their location, and fibroid-related symptoms, including quality of life and sexual function, in women with symptomatic fibroids before uterine artery embolization (UAE).Forty-six women underwent pelvic MRI within four weeks prior to UAE. The MRIs were analyzed and fibroid size and fibroid location were recorded. Women also completed a comprehensive self-report questionnaire within the four weeks prior to the procedure. The questionnaire (Short Form-36 (SF-36) and Female Sexual Function Index (FSFI), respectively, investigated the frequency of fibroid-related symptoms, as well as quality of life and sexual function. Pearson product moment correlation coefficients were used to examine relationships among variables, and ANOVAs were used to determine between-group difference.At baseline, women with symptomatic fibroids had worse quality of life and sexual function scores than healthy controls (p.05). No fibroid-related symptoms, or aspects of quality of life or sexual function, were significantly correlated with either total uterine volume or largest fibroid volume. No significant differences with respect to fibroid-related symptoms were found between patients with or without subserosal or submucosal fibroids.Women with symptomatic fibroids pre-UAE had impaired quality of life and sexual function, but size and location of fibroids as determined by MRI were not related to fibroid-related symptoms, health-related quality of life, or sexual function.

Purpose To report the authors' clinical experience with the Tal Palindrome chronic dialysis catheter with a symmetric tip. Materials and Methods During a 39-month period, 126 Palindrome catheters were placed consecutively in 85 patients. Follow-up was available for 115 catheters. Insertion complications, patency, catheter-related bacteremia, exit site infections, and reasons for catheter removal were recorded. The patient's initial cause of end-stage renal disease, underlying diseases, and site of access were recorded as well. Results Patient ranged in age from 35 to 91 years (median, 69 years). Fifty percent of patients had diabetes. One hundred twenty-six Palindrome catheters were placed for a total of 12,046 catheter-days. The technical success rate of catheter placement was 100%. The average catheter indwell time was 105 days (range, 1–673 days). Catheters were inserted via the right ( n = 107) or left ( n = 19) jugular vein in all patients without insertional complication. Catheter-related infections occurred in 16 of the 115 catheters (13.9%) during the study period and culture-proved bacteremia occurred in four (3.5%). Seven exit site infections were recorded, and 10 catheters (8.7%) developed fibrin sheaths that necessitated catheter exchanges. Conclusions Clinical experience with the Tal Palindrome hemodialysis catheter demonstrated safe and reliable use with low infection rates.

A 39-year-old gravida 2 para 2 woman presented to our Hospital's Emergency Department with complaints of difficulty voiding. She had an enlarged leiomyomatous uterus, for which she was not receiving any current treatment. A Foley catheter placed yielded 1,500 cc of clear yellow urine; however, the patient remained Foley-dependent for 2 weeks until she underwent uterine artery embolization (UAE). Twenty-four hours afterwards, the Foley catheter was removed and the patient spontaneously voided with negligible post-void residual. There was no recurrence of urinary retention or development of any other urinary symptoms during the outpatient follow-up period. Repeat pelvic magnetic resonance imaging (MRI) 1 week after UAE showed negligible reduction in the size of the fibroids and uterus in comparison with a pre-procedure MRI. The Vascular Steal Theory, first presented in this paper, discusses this improvement in symptoms without significant change in size.

Purpose To define the three-dimensional anatomy of the left central veins and the implication for left-sided dialysis catheter placement. Materials and Methods Images from 30 consecutive patients undergoing computed tomography (CT) pulmonary angiography were reconstructed to depict the central venous anatomy. The reconstructed images were analyzed for parameters that could influence dialysis catheter placement. In particular, the cross-sectional diameters of the left brachiocephalic vein were measured, as well as the angulation between the left internal jugular vein and brachiocephalic vein, the angulation between left brachiocephalic vein and superior vena cava, and the angulation of the left brachiocephalic vein in the axial plane as it crosses the mediastinum. Results The cross-sectional diameters of the left brachiocephalic vein did not change significantly as it traversed the mediastinum. The mean cross-sectional diameters were 11 (±5.2) × 12 (±5.1) mm for the peripheral, 13 (±5.0) × 13 (±4.8) mm for the mid, and 13 (±4.6) × 14 (±4.5) mm for the central left brachiocephalic vein. The angulation between the left internal jugular and brachiocephalic vein measured 117 degrees (±11), the angulation between the left brachiocephalic vein and the superior vena cava measured 116 degrees (±7), and the angulation of the left brachiocephalic vein as it traverses the aorta and left brachiocephalic artery measured 106 degrees (±9). Conclusions A sharp angulation of the left brachiocephalic vein as it drapes over the aorta or arch vessels is a common anatomic finding. This angulation is not apparent on frontal projection radiographs or venograms. A hemodialysis catheter torqued over this angulation could contact the vessel wall and lead to endothelial irritation. Further study may help define whether this contributes to the higher complication rates associated with left-sided catheters.

INTRODUCTION: We aimed to compare VeraCept a novel low-profile nitinol intrauterine contraceptive with 175 mm of copper surface area with a commercially available copper T380S. METHODS: We performed a randomized subject-blinded comparison of VeraCept and a copper T380S in a two-to-one fashion. The primary outcome was total continuation. We also examined pain on insertion ease of placement expulsion satisfaction tolerability and pregnancy. Satisfaction ratings were on a 5-point Likert scale. We report data from insertion through 9-month follow-up. RESULTS: We enrolled women in a single clinic with 199 allocated to VeraCept and 101 to the T380S. Insertion was successful in 198 women for VeraCept and 100 for the T380S (P>.2). Mean age was 25 years and median parity was two (range 1-4) with 39% having only had cesarean deliveries. No women developed clinical infection or reported serious adverse events. In the VeraCept and T380S groups mean pain at insertion was 1.4 and 2.4 respectively (P

Current literature suggests that side holes may be detrimental to dialysis catheter performance. Today, these catheters are primarily available with side holes. The purpose of this study was to compare flow rates, infection rate, and survival of side hole vs. non side hole hemodialysis catheters. Over a 16-month period patients were arbitrarily assigned to either a 14.5 F MAHURKAR MAXID cuffed dual lumen tunneled catheter with side holes or a 14.5 F MAHURKAR MAXID cuffed dual lumen tunneled catheter without side holes ("non side hole catheters"). We performed a retrospective analysis of catheter flow rates, patency, catheter survival, and catheter-related infections. Information was gathered for the life of the catheter or up to 28 weeks. A total of 54 patients were enrolled in the study. Thirty-seven of 54 (68%) patients received a catheter with side holes for a total of 3,930 catheter days and 17/54 (32%) received a similar catheter without side holes for a total of 2,188 catheter days. Catheter infection necessitating removal of the catheter occurred in 10/37 catheters with side holes and 1/17 without side holes. Infection rates per 1,000 catheter days were 2.545 with side holes and 0.254 without side holes (p

PURPOSE The purpose of this study was to evaluate in vivo recirculation of a new bi-directional dialysis catheter with a symmetric tip design and compare it to currently marketed staggered and split tip catheters. MATERIALS AND METHODS Twelve catheters were placed in three 70-kg male swine. The catheters were connected to a roller type peristaltic pump. Blood flow and recirculation rates were measured with ultrasound (US) dilution. Recirculation was measured in blood flow rates of 300 mL/min, 400 mL/min, and 500 mL/min. The dialysis lines were then reversed and recirculation was measured in flow rate of 400 mL/min. Measurements were conducted with the catheter tip in the right atrium (RA) and repeated with the catheter tip in the superior vena cava (SVC). RESULTS Recirculation rates measured with the Palindrome catheter tip (Tyco Healthcare Group LP, Mansfield, MA) in the SVC and in the RA were 0%. When the dialysis lines were reversed, the Palindrome catheter average recirculation was 0% with the tip in the SVC and 1% (0%–3%) with the tip in the RA. The average recirculation rates measured with the split tip catheter were 1% (0%–10%) in the SVC and 0% when the catheter tip was in the RA. When the dialysis lines were reversed split tip catheter recirculation was 11% (9%–16%) with the tip in the SVC and 13% (7%–18%) with the tip in the RA. With the staggered tip catheter, 1% (0%–5%) recirculation was measured. When the dialysis lines were reversed, the average recirculation in the staggered tip catheter measured 23% (18%–30%). Recirculation rate with reversal of dialysis lines was significantly lower with the Palindrome catheter when compared to the split tip and staggered tip designs ( P CONCLUSIONS Preliminary results in vivo indicate that the Palindrome catheter demonstrates minimal recirculation with reversal of the dialysis lines compared to currently marketed split tip and staggered tip catheters.

To develop and assess a technique for induction of C peptide-negative diabetes in adult nonhuman primates in preparation for preclinical investigation of type 1 diabetes treatments.First, temporary embolization of the hepatic and gastric arteries was performed in 14 adult nonhuman primates (six cynomolgus, five rhesus, and three pigtail macaques). After embolization was confirmed with angiography, streptozotocin was injected at a dose of 50-70 mg/kg into the celiac artery and branches supplying the pancreas. The macaques then were given intravenous injections of arginine and glucose, and blood levels of insulin and C peptide were measured with an enzyme-linked immunosorbent assay to determine whether diabetes had been induced.All but one of the macaques developed persistent long-term C peptide-negative diabetes after the streptozotocin injection. One macaque did not develop diabetes after the initial injection and was given a second dose of streoptozotocin, which did induce diabetes. None of the macaques showed any symptoms of hepatic or renal injury, and only one died (of gastric dilatation 5 days after the procedure).Streptozotocin injection after temporary embolization of the hepatic and gastric arteries is a safe and reproducible method for inducing C peptide-negative diabetes in adult nonhuman primates in preparation for preclinical investigation of type 1 diabetes treatments.

Objective To determine the long-term sequelae of pelvic embolization for postpartum hemorrhage and to study the effect on fertility and menses. Methods Twenty-eight consecutive patients who underwent pelvic embolization for postpartum hemorrhage between the years 1977 and 2002 were included in the study. Chart review and telephone interviews were conducted to gather data regarding the type of delivery, causative factors of the bleeding, preembolization treatments, total blood loss, length of time between delivery and embolization, complications, long-term side effects, and subsequent pregnancies. Results The average (± standard deviation) time to follow-up was 11.7 ± 6.9 years. The most common causes of hemorrhage were vaginal/cervical laceration, placenta accreta, and placenta previa. In only one case was the embolization unsuccessful, during which there was an accidental perforation of an internal iliac artery resulting in a retroperitoneal hematoma and subsequent total abdominal hysterectomy. All of the interviewed patients that desired to get pregnant after embolization were able to do so. Six patients reported a total of six uncomplicated pregnancies and deliveries in the years after their embolization. Of the remaining patients interviewed, none made subsequent attempts to get pregnant. The most commonly reported long-term side effects were transient buttock numbness (n = 2) and urinary frequency (n = 2). In no patients were the side effects severe enough to seek further medical attention. Conclusion Pelvic arterial embolization is a safe and effective procedure and offers patients a fertility-preserving alternative to hysterectomy for treatment of intractable postpartum hemorrhage.

This study's purpose was to survey patients' perceptions of gynecologists' opinions of uterine artery embolization (UAE) for fibroids. Twenty-one women who underwent UAE between July 2000 and April 2002 and 21 women who underwent UAE between September 1998 and July 2000 completed questionnaires. Each woman was asked what her gynecologist's initial opinion was toward UAE, what treatment options were offered, who initiated discussion of UAE, and whether she returned to the same gynecologist after UAE. As of 2002, more gynecologists had a favorable opinion of UAE and were offering UAE versus in the year 2000. The majority of patients whose gynecologists initially opposed UAE did not return to the same gynecologists, reflecting a similar trend noted 2 years earlier.

In seven of 255 consecutive patients (2.7%) who underwent pulmonary arteriovenous malformation (PAVM) embolization at our center between July 1, 1996, and July 1, 2000, the feeding artery was considered too short for safe occlusion with use of standard stainless-steel coils or detachable balloons. These patients were successfully treated with use of a modified vein of Galen technique similar to the one used for managing intracranial vein of Galen aneurysms. In this article, the authors report their experience with this technique in safely occluding the aneurysmal sacs of PAVMs in patients with short (