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Purpose: To quantify eye lens dose in interventional radiology and assess whether neck dosimeter is a good surrogate to evaluate eye lens dosimetry. Methods: Radiation exposure was prospectively measured in 9 interventional radiologists between May and October 2017. Standard Hp(0,07) thermoluminescent dosimeters (TLDs) were worn at the neck outside the lead apron, and 2 dedicated eye lens Hp(3) TLDs were placed just above the eyes, one midline and another at the outer edge of the left eye. Correlations between eye lens and neck TLD doses were assessed with Pearson coefficient, and linear regression was used to predict eye lens dose from neck TLD values. Results: Eye lens dose without eye protection was 0.18 ± 0.11 (mean ± standard deviation; 0.08-0.41) mSv per workday and 35.3 ± 6.6 mSv (16.3-82.9) annually (200 workdays/year). Five (56%) radiologists exceeded the 20 mSv annual eye lens dose limit. Eye lens doses from left and central TLDs were 12.46 ± 3.02 and 9.29 ± 3.38 mSv, respectively ( P = .027). Mean eye lens (left and central) and neck TLD doses were 10.87 ± 2.67 and 16.56 ± 5.67 mSv, respectively ( P = .008). Pearson correlation coefficient between both eye lens TLD and between mean eye lens TLD and neck TLD doses were 0.91 and 0.92, respectively. Average of eye lens dose was 0.0179 + (0.5971 × neck dose). Conclusion: Full-time interventional radiologists are likely to suffer from deterministic radiation effects to the eye lens, especially on the left side. Neck TLD significantly overestimates eye lens dose. However, eye lens doses are highly correlated with neck doses and may be predicted from the neck TLD values.

Purpose To assess whether angioplasty of hemodialysis access (HA) stenosis with a drug-coated balloon (DCB) would prevent restenosis in comparison with plain-balloon percutaneous transluminal angioplasty (PTA). Materials and Methods This prospective randomized clinical trial enrolled 120 patients with dysfunctional arteriovenous fistulae (n = 109) and grafts (n = 11), due to a ≥50% stenosis between March 2014 and April 2018. All patients underwent high-pressure balloon angioplasty and were then randomized to either DCB (n = 60) or PTA (n = 60). Patients were followed-up for 1 year, and angiography was performed 6 months after angioplasty. The primary endpoint was the late lumen loss (LLL) at 6 months. Secondary endpoints included other angiographic parameters at 6 months and HA failures, adverse event, and mortality at 12 months. Continuous variables were compared with a Student t-test, and Kaplan-Meier curves were used for freedom from HA failure and for mortality. Results LLL in the DCB and in the PTA group were 0.64 mm ± 1.20 and 1.13 mm ± 1.51, respectively (P = .082, adjusted P = .0498). DCB was associated with lower percentage stenosis (54.2% ± 19.3 vs 61.7% ± 18.2; P = .047) and binary restenosis ≥50% (56.5% vs 81.1%; P = .009) than PTA. The number of HA failures after 12 months was lower for DCB than for PTA (45% vs 66.7%; P = .017). Mortality at 12 months was 10% and 8.3% in the DCB and PTA groups, respectively (P = .75). Conclusions Despite LLL improvement that failed to reach statistical significance, this study demonstrated decreased incidence and severity of restenosis with DCB compared with PTA to treat dysfunctional HA.

Arteriovenous malformations (AVMs) are fast flow malformations characterized by the presence of arteriovenous shunting. These congenital lesions can be evolutive, leading to serious complications such as bleeding, skin ulceration, and cardiac failure. The interventional radiologist plays an important role in the management of these patients. He should be involved in the clinical evaluation to make the proper diagnosis, evaluate the symptoms and potential indication for endovascular treatment. This evaluation should be done in a multidisciplinary clinic with access to plastic surgeons, internal medicine and dermatologist, as well as specific specialists that might need to be implicated (ENT surgeon in the face and neck area, for example). The Schobinger clinical classification is important to assess patient evolution and indicate intervention. We recommend to treat symptomatic or evolutive AVMs. Doppler ultrasound is the first imaging examination that should be performed. Then, MR angiography or computed tomography angiography (CTA) can be proposed depending on the anatomic area involved. Embolization is currently the first line of treatment for these patients. There is currently promising research in the identification of genetic markers and molecular target(s) but there is no recognized pharmacologic treatment for AVM available yet. Digital substraction angiography (DSA) is usually performed for guidance during the embolization session but is also essential to properly classify a specific lesion, according to its anatomy. The anatomic classifications proposed by Cho and Yakes are both useful to choose the best therapeutic approach: Endovascular, direct puncture, retrograde venous approach or a combination of these techniques. Ethanol is the most efficient agent but is at higher risk of skin necrosis and nerve injury and should therefore be used with caution in dangerous territories. Glue and Onyx are liquid agents that are also well suited to occlude the nidus; they can be used in association with ethanol. On the venous side, mechanical occlusion with coils or Amplatzer plugs is mostly used. Again, they can be used in association with a liquid agent (Ethanol, glue or Onyx) to reflux in the nidus. Surgery can be indicated to resect residual AVM following embolization if residual symptoms are present and the planned surgery is feasible, with relative safety.

Purpose This study evaluated the safety and efficacy of the JETi8 peripheral thrombectomy system in treating acute deep vein thrombosis (DVT). Materials and Methods A retrospective study was conducted in 18 consecutive patients (mean age, 41 years old [range, 15-74 years old]; 5 men and 13 women). There were 21 instances of DVTs (9 iliofemoral, 10 axillosubclavian, and 2 portal), which were treated using the JETi8 thrombectomy device between November 2016 and July 2018. Thrombus was laced with recombinant tissue plasminogen activator (r-TPA) (9.3 mg, on average; range, 2–12 mg) in 17 procedures (81%) prior to thrombectomy. Technical success was defined as restoration of antegrade flow using the JETi8 with or without additional treatment of an underlying obstructive lesion. Procedural success was defined as technical success with or without the addition of overnight catheter-directed thrombolysis (CDT) Results Mean procedure time was 83 minutes (range, 30–160 minutes), and mean thrombus reduction with the JETi8 alone was 92% (range, 60%–100%). Stent placement was required in 6 procedures (29%). Technical success using the JETi8 system alone was 76% (16 of 21 procedures), whereas 5 procedures (24%) required subsequent overnight CDT in the intensive care unit. Procedural success rate was 100% (20 of 20 procedures). Mean aspirated volume was 531 mL (range, 250–1,230 mL). The only adverse event was a subsegmental pulmonary embolism. Seven patients (33%) were discharged the same day. Recurrent thrombosis was observed in 5 patients (24%), of whom 3 were successfully treated with the JETi8 system. Conclusions The JETi8 system may be a safe and effective option for thrombectomy of acute DVT.

Objective Difficulty to recognize or canulate the right adrenal vein is the most frequent cause of adrenal venous sampling (AVS) failure. We aimed to assess multinomial regression modeling (MRM) of peripheral and left adrenal vein samplings to detect lateralization of aldosterone secretion when the right AVS is missing. Methods Simultaneous bilateral AVS samplings were performed before (basal) and after intravenous cosyntropin injection in 188 consecutive patients between December 1989 and September 2015. Different reference standards for lateralization of aldosterone secretion were defined for basal and for postcosyntropin AVS and according to lateralization index cutoffs at least 2 and at least 4. MRMs were built to detect lateralization of aldosterone secretion according to these reference standards using only peripheral and left adrenal veins samplings (without the right AVS). Detection accuracy was assessed by the area under the receiver operating characteristic (AUROC) curves and detection sensitivities were reported for specificity at least 95%. Results For basal AVS with lateralization index at least 2, AUROC were respectively 0.931 [95% confidence interval (CI) 0.894-0.968] and 0.922 (95% CI 0.882-0.962) for right and left lateralization of aldosterone secretion detection and MRM could detect respectively 65.5 and 62.7% of the right and left lateralization of aldosterone secretion. For AVS after cosyntropin with lateralization index at least 4, AUROC were respectively 0.964 (95% CI: 0.940-0.987) and 0.955 (95% CI: 0.927-0.983) for right and left lateralization of aldosterone secretion, and MRM could detect respectively 77.2 and 72.9% of the right and left lateralization of aldosterone secretion. Conclusion MRM can detect lateralization of aldosterone secretion without the right AVS in most patients and could eliminate the need for repeat AVS when right adrenal vein canulation is nonselective or impossible.

Objective The objective of this study was to evaluate the safety and efficacy of external beam radiation (EBR) in preventing restenosis after superficial femoral artery (SFA) stenting in comparison with a control group treated with SFA stenting only. Methods In this Institutional Review Board-approved study, patients who provided written informed consent were randomly assigned to 0 Gy or 14 Gy of EBR to the stent site 24 hours after SFA stenting. The primary end point was the angiographic binary restenosis rate 2 years after stenting. Categorical and continuous end points were respectively analyzed using logistic regression models and Wilcoxon tests. End points expressed as time to event were analyzed using a log-rank test. Results The study included 155 patients, 46 women and 109 men (mean age, 66 years; range, 45-85 years). In the 0 and 14 Gy groups, binary restenosis was present, respectively, in 44% (34/77) and 68% (52/76; P = .003) 2 years after stenting. Stent thrombosis occurred in 13% (10/78) of the 0 Gy group and in 33% (25/77) of the 14 Gy group ( P = .003). Target lesion revascularization at 2 years was 26% (25/78) in the 0 Gy group and 30% (23/77) in the 14 Gy group ( P = .56). There were no significant differences in total walking distances change from baseline to 2 years (46 ± 100 and 26 ± 79 m, respectively, in the 0 Gy and 14 Gy group; P = .25). There were no procedure-related deaths and no major amputations. Conclusions A single 14 Gy dose of EBR to the SFA stenting site did not prevent in-stent restenosis.

The purpose of this study was to evaluate ultrasound elastography and echogenicity analysis to discriminate between carotid plaques in patients with symptomatic internal carotid artery (ICA) stenosis versus patients with asymptomatic stenosis.Patients with symptomatic and asymptomatic ICA stenosis of more than 50% were recruited for the study. After both carotid arteries were scanned, plaque translation and elastography and echogenicity features were assessed. Parameters of index stenosis (i.e., symptomatic or more severe stenosis) were compared between populations. For further validation, parameters of index stenosis were also compared with those of the contralateral artery for segments with plaque. Segments without plaque on the index side were also evaluated between populations. ROC curve analyses were performed using a cross-validation method with bootstrapping to calculate sensitivity and specificity.Sixty-six patients with symptomatic (n = 26) or asymptomatic (n = 40) carotid stenoses were included. The maximum axial strain (p0.001), maximum axial shear strain magnitude (p = 0.03), and percentage of low-intensity of gray level (p = 0.01) of the index ICA were lower for patients with symptoms than for those without symptoms. In both groups, the contralateral ICA had translation and elastography and echogenicity parameters similar to those of the index ICA in patients with asymptomatic stenosis. The ROC curve for the detection of vulnerable plaques in patients with symptomatic stenosis was higher when ultrasound elastography and ultrasound echogenicity were used in combination than when each method was used alone (p0.001); a sensitivity of 71.6% and a specificity of 79.3% were obtained.This pilot study establishes the usefulness of combining elastography with echogenicity analysis to discriminate plaques in patients with symptomatic ICA stenosis versus asymptomatic stenosis.

To assess the sensitivity and specificity for ratios of adrenal vein cortisol level (Ca) to peripheral vein cortisol level (Cp), adrenal vein aldosterone level (Aa) to peripheral vein aldosterone level (Ap), and combined cortisol and aldosterone levels ("combined ratio") for the detection of successful adrenal vein catheterization ("selectivity") in adrenal vein sampling (AVS) without adrenocorticotropic hormone (ACTH) injection at different cutoff values.This retrospective study was approved by the institutional review board, and informed consent was waived. AVS was performed in 160 consecutive patients (49 women and 111 men; mean age, 53.6 years) between December 1989 and January 2014. Cortisol and aldosterone levels were measured in samples from the adrenal veins and left iliac vein every 5 minutes, two times before (basal) and three times after intravenous cosyntropin (ACTH 1-24) injection. Selectivity was defined by Ca/Cp or Aa/Ap ratio of at least 5 in at least one sampling after ACTH administration. Sensitivity and specificity for the detection of selective adrenal vein catheterization were calculated for basal Ca/Cp ratio, Aa/Ap ratio, and combined ratios for three cutoff values reported in the literature. The McNemar test was used to assess differences in sensitivity and specificity to detect selective adrenal vein catheterization.The sensitivity and specificity for the cutoff values of at least 3, at least 2, and at least 1.1 for the detection of AVS selectivity were respectively 50.4% and 100%, 70.8% and 100%, and 98.5% and 76.9% for Ca/Cp ratio; 61.3% and 100%, 70.8% and 100%, and 94.2% and 53.8% for Aa/Ap ratio; and 75.2% and 100%, 88.3% and 100%, and 99.3% and 46.2% for combined ratios (sensitivity at the ≥2 cutoff value: P.0001 for combined ratio vs Ca/Cp ratio and for combined ratio vs Aa/Ap ratio).Basal combined ratio has the best sensitivity for the detection of AVS selectivity at all cutoff values, and for all ratios, the cutoff value of at least 2 has the best sensitivity for 100% specificity.

Purpose To compare automated measurements of maximal diameter (Dmax) of abdominal aortic aneurysm (AAA) orthogonal to luminal or outer wall envelope centerline for endovascular repair (EVAR) follow-up. Material and Methods Eighty-three consecutive patients with AAA treated by EVAR who had at least 1 computed tomography (CT) scan before and 2 CT scans after EVAR with at least 5 months’ interval were included. Three-dimensional reconstruction of the AAA was achieved with dedicated segmentation software. Performances of automated calculation algorithms of Dmax perpendicular to lumen or outer wall envelope centerlines were then compared to manual measurement of Dmax on double-oblique multiplanar reconstruction (gold standard). Accuracy of automated Dmax measurements at baseline, follow-up, and progression over time was evaluated by calculation of mean error, Bland-Altman plot, and regression models. Results Disagreement in Dmax measurements between outer wall envelope algorithm and manual method was insignificant (mean error: baseline, -0.07 ± 1.66 mm, P = .7; first follow-up, 0.24 ± 1.69 mm, P = .2; last follow-up, -0.41 ± 2.74 mm, P = .17); whereas significant discrepancies were found between the luminal algorithm and the manual method (mean error: baseline, -1.24 ± 2.01 mm, P Conclusions AAA outer wall envelope segmentation is recommended to enable automated calculation of Dmax perpendicular to its centerline during EVAR follow-up.

Many adrenal venous sampling (AVS) protocols require repeated samplings before and after adrenocorticotrophic hormone (ACTH) stimulation. Maintaining catheter selectivity in the adrenal vein over time is essential but can be challenging, especially in the short right adrenal vein, where the catheter is often in an unstable position. The aim of our study was to evaluate guide wire insertion into the right adrenal vein catheter to sustain AVS selectivity (adrenal/peripheral cortisol ratio [Ca/Cp]) over time.This retrospective investigation was approved by our institutional review board, and informed consent was obtained. A 0.014-inch guide wire was inserted in the right adrenal vein 5F catheter to secure its positioning and to facilitate blood sampling. Plasma cortisol levels from the left and right adrenal veins and left iliac vein were assessed in 117 consecutive patients undergoing bilateral, simultaneous sets of AVS at -5 and 0 min (baseline) and 5, 10, and 15 min after intravenous bolus of 250 μg ACTH (stimulated). Ca/Cp ratios of ≥2 for baseline and10 for stimulated AVS were considered selective.The first sampling, at time -5 min, was nonselective in 41 of 116 (35.3 %) right and 30 of 116 (25.9 %) left AVSs retained for analysis. In patients with a selective first sampling, 74 of 75 (98.7 %) right and 85 of 86 (98.8 %) left AVSs were selective in all post-ACTH samplings. Right and left selectivity rates were not statistically different (p0.87). No complications arose from guide wire insertion.Guide wire insertion into the right adrenal vein catheter is safe and effective to maintain AVS selectivity over time.

To evaluate venous malformation (VM) volume and contrast-enhancement analysis on magnetic resonance imaging (MRI) compared with diameter evaluation. Baseline MRI was undertaken in 44 patients, 20 of whom were followed by MRI after sclerotherapy. All patients underwent short-tau inversion recovery (STIR) acquisitions and dynamic contrast assessment. VM diameters in three orthogonal directions were measured to obtain the largest and mean diameters. Volumetric reconstruction of VM was generated from two orthogonal STIR sequences and fused with acquisitions after contrast medium injection. Reproducibility (interclass correlation coefficients [ICCs]) of diameter and volume measurements was estimated. VM size variations in diameter and volume after sclerotherapy and contrast enhancement before sclerotherapy were compared in patients with clinical success or failure. Inter-observer ICCs were similar for diameter and volume measurements at baseline and follow-up (range 0.87–0.99). Higher percentages of size reduction after sclerotherapy were observed with volume (32.6 ± 30.7 %) than with diameter measurements (14.4 ± 21.4 %; P = 0.037). Contrast enhancement values were estimated at 65.3 ± 27.5 % and 84 ± 13 % in patients with clinical failure and success respectively (P = 0.056). Venous malformation volume was as reproducible as diameter measurement and more sensitive in detecting therapeutic responses. Patients with better clinical outcome tend to have stronger malformation enhancement. • Magnetic resonance imaging readily demonstrates diameters and volumes of venous malformations • MRI diameter calculations are reproducible in estimating the size of venous malformations • But volumetric models of malformations are more sensitive in detecting therapeutic response • Dynamic enhancement is also better assessed with automated volumetric software • Volumetric analysis of malformations offers promise to guide therapy and assess response

To evaluate the efficacy and safety of sclerotherapy with sodium tetradecyl sulfate (STS) and bleomycin for treatment of venous malformations (VMs) of the oropharyngeal region.A retrospective study of 33 patients with 46 VMs of the buccal and pharyngolaryngeal cavity associated with impairment of eating, respiration, or elocution was performed. Individual lesions were divided based on their anterior or posterior location, using the base of the tongue as an anatomic landmark. Lesion size was estimated with the use of orthogonal measurements on magnetic resonance or ultrasound images before and after treatment to assess radiologic response. Sclerotherapy sessions were performed under ultrasound, fluoroscopic, and, if needed, endoscopic guidance. Clinical response was assessed with the use of the Manchester Orofacial Pain Disability Scale. Methods for airway management were also compiled.Following sclerotherapy, average VM diameter was reduced by 31.4% (P.0001) on a per-patient basis and by 30.8% (P.0001) on a per-lesion basis. The Manchester score improved by an average of 37.0% (P = .013). Four patients reported a worsening of symptoms, and 11 patients experienced symptomatic recurrence. Complications include pneumonia (5 patients) and urgent placement of a post-procedure tracheostomy (4 patients). Patients with posterior malformations experienced more complications (emergency tracheostomies in 4 and pneumonias in 4).Sclerotherapy using STS is an efficient treatment for venous malformations of the buccal and pharyngolaryngeal cavity but can lead to significant complication for posterior lesions. Careful assessment of the airway is needed before treatment, and prophylactic tracheotomy should be considered in patients with posterior lesions.

Objective Many investigators believe that basal adrenal venous sampling (AVS) should be done simultaneously, whereas others opt for sequential AVS for simplicity and reduced cost. This study aimed to evaluate the concordance of sequential and simultaneous AVS methods. Design and methods Between 1989 and 2015, bilateral simultaneous sets of basal AVS were obtained twice within 5 min, in 188 consecutive patients (59 women and 129 men; mean age: 53.4 years). Selectivity was defined by adrenal-to-peripheral cortisol ratio ≥2, and lateralization was defined as an adrenal aldosterone-to-cortisol ratio ≥2, the contralateral side. Sequential AVS was simulated using right sampling at −5 min (t = −5) and left sampling at 0 min (t = 0). Results There was no significant difference in mean selectivity ratio (P = 0.12 and P = 0.42 for the right and left sides respectively) and in mean lateralization ratio (P = 0.93) between t = −5 and t = 0. Kappa for selectivity between 2 simultaneous AVS was 0.71 (95% CI: 0.60–0.82), whereas it was 0.84 (95% CI: 0.76–0.92) and 0.85 (95% CI: 0.77–0.93) between sequential and simultaneous AVS at respectively −5 min and at 0 min. Kappa for lateralization between 2 simultaneous AVS was 0.84 (95% CI: 0.75–0.93), whereas it was 0.86 (95% CI: 0.78–0.94) and 0.80 (95% CI: 0.71–0.90) between sequential AVS and simultaneous AVS at respectively −5 min at 0 min. Conclusions Concordance between simultaneous and sequential AVS was not different than that between 2 repeated simultaneous AVS in the same patient. Therefore, a better diagnostic performance is not a good argument to select the AVS method.

To validate the reproducibility and accuracy of a software dedicated to measure abdominal aortic aneurysm (AAA) diameter, volume and growth over time.A software enabling AAA segmentation, diameter and volume measurement on computed tomography angiography (CTA) was tested. Validation was conducted in 28 patients with an AAA having 2 consecutive CTA examinations. The segmentation was performed twice by a senior radiologist and once by 3 medical students on all 56 CTAs. Intra and inter-observer reproducibility of D-max and volumes values were calculated by intraclass correlation coefficient (ICC). Systematic errors were evaluated by Bland-Altman analysis. Differences in D-max and volume growth were compared with paired Student's t-tests.Mean D-max and volume were 49.6±6.2mm and 117.2±36.2ml for baseline and 53.6±7.9mm and 139.6±56.3ml for follow-up studies. Volume growth (17.3%) was higher than D-max progression (8.0%) between baseline and follow-up examinations (p.0001). For the senior radiologist, intra-observer ICC of D-max and volume measurements were respectively estimated at 0.997 (≥0.991) and 1.000 (≥0.999). Overall inter-observer ICC of D-max and volume measurements were respectively estimated at 0.995 (0.990-0.997) and 0.999 (0.999). Bland-Altman analysis showed excellent inter-reader agreement with a repeatability coefficient3mm for D-max,7% for relative D-max growth,6ml for volume and6% for relative volume growth.Software AAA volume measurements were more sensitive than AAA D-max to detect AAA growth while providing an equivalent and high reproducibility.

Purpose To evaluate the efficacy and safety of percutaneous renal artery embolization (RAE) of iatrogenic vascular kidney injuries and the effects of RAE on renal function and arterial blood pressure (BP). Materials and Methods Over a 12-year period, 50 consecutive patients with severe hemorrhage after iatrogenic arterial kidney injuries underwent RAE. Technical success was defined as occlusion of the bleeding site, and clinical success was defined as complete bleeding cessation. The effects on renal function and arterial BP were assessed by comparing the estimated glomerular filtration rate (eGFR), renal function stage (National Kidney Foundation scale), systolic BP, and BP stage (European Society of Hypertension classification) before and after RAE. Results RAE was technically successful in 49 patients (98%). Two patients were lost to follow-up after RAE. Clinical success was obtained in 40 (83%), 45 (94%), and 47 patients (98%), respectively, at 24, 48, and 96 hours after RAE. Three patients (6%) had minor complications, and one patient (2%) died within 30 days after RAE. Follow-up renal function data (mean, 4 mo) were available for 33 patients (66%). No statistically significant differences in eGFR ( P = .186) or renal function stage ( P = .183) were apparent after RAE. Follow-up BP data (mean, 3 mo) were available for 28 patients (56%). There were no significant differences in systolic BP ( P = .233) or BP stage ( P = .745) after RAE. Conclusions Embolization of iatrogenic renal artery injuries is safe and associated with high technical and clinical success rates. It is not associated with a significant worsening of renal function or increase in BP.

This study was designed to evaluate the feasibility of using ethylene vinyl alcohol copolymer (EVAC) for bronchial artery embolization (BAE) in patients with life-threatening hemoptysis and to compare the visualization and transarterial penetration of EVAC under fluoroscopy and computed tomography (CT).Fifteen patients (mean age, 62.9 (range, 24-82) years) who were referred for life-threatening hemoptysis (27 month period) underwent BAE using EVAC. All patients had thoracic CT examination before and after BAE. Technical and clinical results were evaluated. Visibility and extent of cast penetration (graded 1-4) on fluoroscopy and postprocedure CT were assessed and compared.BAE was feasible in all but one artery (due to spasm; n=27; 96.4%). No procedure-related complications or deaths were detected. Two patients had recurrent bleeding in the following day (13.3%). Immediate clinical success was achieved in 14 cases (93.3%) after reembolization of pulmonary artery pseudoaneurysm in one patient (mean follow-up, 43.5 (range, 14-148) days). Visibility of the cast was possible in 73.3% of patients (n=11) under fluoroscopy (mean cast penetration 1.66) and in all patients under CT (mean cast penetration 2.06). The postinjection fluoroscopic visibility in 6 of 15 (40%) patients was inferior to CT (P0.02).BAE with EVAC seems to be feasible and safe with immediate control of hemoptysis in most patients. The postinjection fluoroscopic visibility of EVAC under fluoroscopy was inferior to CT.

Purpose To evaluate the safety and effectiveness of Amplatzer vascular plugs (AVPs) for percutaneous closure of arteries feeding pulmonary arteriovenous malformations (PAVMs). Materials and Methods Over a 45-month period, 24 consecutive patients with at least one PAVM treated with an AVP were selected from a database on patients with a PAVM who received embolotherapy. Immediate technical success was defined as the complete absence of flow through the PAVM after embolization without the need for additional embolization material. Success on follow-up imaging was defined as a reduction in size of at least 70% of the aneurysm or draining vein on follow-up computed tomography or the absence of flow through the PAVM on a subsequent pulmonary angiogram. Results Thirty-seven AVPs were used to close 36 feeding arteries in 35 PAVMs in seven male and 17 female patients aged 11–86 years (mean age, 50 y). Technical success was achieved in 35 feeding arteries (97%). One feeding artery required two AVPs for closure. There were no immediate procedure-related complications. At a mean clinical follow-up of 322 days (range, 1–1,126 d), all patients were alive without new PAVM-related complications. Imaging follow-up was available for 29 embolized vessels (81%) with a mean follow-up of 418 days (range, 40–937 d), and recanalization occurred in two treated vessels (7%). Conclusions AVPs are safe and effective for closure of PAVMs feeding vessels that can be reached with a guiding catheter, with an acceptable rate of recanalization.

The purpose of this study was to evaluate the usefulness of renal length, volume, and resistive index measurements at Doppler ultrasound and MR angiography in predicting improvement after renal angioplasty.Fifty-one patients underwent Doppler ultrasound examinations and MR angiography before percutaneous transluminal renal angioplasty. Renal length, total and cortical volumes, and resistive index were calculated. Combinations of length, volume, and resistive index measurements were correlated with improvement in blood pressure and renal function after percutaneous transluminal renal angioplasty. Thresholds for improving patient selection were chosen after analysis of receiver operating characteristics curves.Lower total and cortical volumes on MR angiograms and shorter kidney length on Doppler ultrasound images were found among patients with successful blood pressure control (p = 0.042, p = 0.035, and p = 0.016, respectively). Renal length measured with Doppler ultrasound and cortical volume measured with MR angiography weighted by resistive index were the best predictive factors (p = 0.004, p = 0.006). Using a threshold of renal length-resistive index product less than 7 cm, therapeutic response was predicted with a sensitivity of 87% and specificity of 50%, whereas with a threshold value of 52 mL/m(2) for cortical renal volume-resistive index product divided by body surface area, sensitivity of 86% and specificity of 50% were obtained.Renal length and volume combined with resistive index measurements appear to be predictive of therapeutic response after percutaneous transluminal renal angioplasty.

To compare the outcome of patients treated with balloon dilation and stent placement in the management of bronchial strictures after lung transplantation.Forty-one lung recipients were treated with balloon dilation or stent placement between January 1997 and July 2005. Stent placement was reserved for cases of bronchoplasty technical failure or restenosis. Clinical files and results of pulmonary function tests and bronchoscopic evaluation were reviewed. Dyspnea and cough were defined according to the Breathlessness, Cough, and Sputum Scale. Patient survival and bronchial patency after bronchial intervention were estimated with the Kaplan-Meier method and Cox proportional hazards regression with analysis of stent implantation as a cofactor.Twenty-three of the 41 patients (56%) received a stent because of balloon dilation failure or stenosis recurrence. A total of 243 procedures were performed in 106 strictures (205 bronchoplasties and 38 stent insertions). At the first session, primary patency was higher in patients treated with stents (71%) than in those who underwent bronchoplasty (19%) (P = .037). Mean survival in patients with stents was longer than that in those who underwent bronchoplasty (82 vs 22 months, respectively), and stent insertion was associated with a 66% reduction in the risk of death (P.02). Primary patency was 40 months for stented strictures versus 10 months for strictures treated with bronchoplasty (P.02). Dyspnea and cough were improved after intervention (P.001), and the forced expiratory volume in 1 second (FEV(1)) was ameliorated by 17% (P.00003) at last follow-up.Clinical outcome and FEV(1) were improved after bronchoplasty and stent placement. Longer patient survival and bronchial patency were observed after stent insertion.

Background: Noninvasive vascular ultrasoundelastography (NIVE) was recently introduced to assess mechanical properties (strain or elasticity) of peripheral vessel walls. The goal of this study was to determine strain values in subjects with normal carotid arteries and the reproducibility of these measurements. Methods: Sixteen individuals without previous history of carotid atherosclerosis were recruited in four age categories [40–49], [50–59], [60–69], and [70–79] years old. The left and right common and internal carotids (LCC, LIC, RCC, and RIC, respectively) were independently scanned by two radiologists (RAD-A and RAD-B). The axial strain elastograms were computed with the Lagrangian speckle model estimator. Results: Supported by Bland–Altman analyses, strain values between LCC and RCC were found similar with a Pearson correlation coefficient ( r ) of 0.83 ( p 0.0001 ) . Equivalently, a good correlation was found between RAD-A and RAD-B for common carotids with r = 0.80 ( p 0.0001 ) . Lower strain values ( p 0.001 ) were measured for male common carotids ( 1.62 ± 0.32 % ) than females ( 2.21 ± 0.76 % ) . Regarding the internal carotid strain measurements, the correlation was lower between RAD-A and RAD-B with r = 0.52 ( p = 0.01 ) , but drastically decreased between LIC and RIC ( r = 0.16 , nonsignificant). Male internal carotid strain estimates ( p = 0.03 ) were lower ( 1.48 ± 0.44 % ) than in females ( 1.84 ± 0.64 % ) . Additionally, male common and internal carotid mean elastic moduli varied from 33–106 kPa, whereas it covered a range of 25–67 kPa for females. Female carotids were more elastic ( 44 ± 17 kPa ) than males ( 58 ± 17 kPa , p 0.001 ) . Conclusion: Strain measurements in common carotids were found reproducible. However, less consistency was observed for the deeper internal carotids. The NIVE imaging method still remains to be validated with pathological cases, but it might provide a unique approach for stroke prevention and characterization of vascular stiffness.

IN 2003, the Canadian Interventional Radiology Association (CIRA), the national body that represents interventional radiology (IR) in Canada, applied to the Royal College of Physicians and Surgeons of Canada (RCPSC) for subspecialty recognition under the broader specialty of diagnostic radiology. The application was widely supported by stakeholder specialty societies and involved a twostep process. Step 1 was approved on March 22, 2004. Step 2 was rejected by the Committee of Specialties on May 4, 2006, on the grounds that IR did not meet the criteria of a subspecialty. The RCPSC also stated that the entry routes into IR were too restrictive, the extra training beyond that of diagnostic radiology did not meet the expectations for a subspecialty, and the advancement of an area focused on ‘additional technical competence’ did

Only a minority of patients with carotid arterial disease have warning symptoms, because the majority of strokes are caused by previously asymptomatic lesions. Because morbidity and mortality after acute stroke are high, patients should be diagnosed and treated before symptoms develop. The hypothesis of this study is that vascular elasticity maps (or elastograms) of carotids are of predictive value for plaque characterization. The strain tensor from either cross-sectional or longitudinal ultrasound radiofrequency data were assessed by a new implementation of the Lagrangian speckle model estimator (LSME), which considers local echogenicity variations. A 26-year-old healthy male (HS1), a 40-year-old (HS2) normal female subject and two 75-year-old asymptomatic patients with severe carotid stenoses were scanned. Reproducible elastograms were obtained as a function of time over five to seven cardiac cycles. Stress-strain modulus elastograms were computed for normal subjects. Stiffening of healthy carotid walls was estimated to be 148 +/- 7 kPa and 163 +/- 30 kPa at peak-systole for HS1 and HS2, respectively. For patients with heterogeneous plaques, strain and shear elastograms revealed interesting information about plaque size, tissue composition and mechanical interaction between structures. In conclusion, the LSME provides a promising approach for strain and shear estimates to characterize vulnerable plaque.

Rationale and Objectives To determine optimum spatial resolution when imaging peripheral arteries with magnetic resonance angiography (MRA). Materials and Methods Eight vessel diameters ranging from 1.0 to 8.0 mm were simulated in a vascular phantom. A total of 40 three-dimensional flash MRA sequences were acquired with incremental variations of fields of view, matrix size, and slice thickness. The accurately known eight diameters were combined pairwise to generate 22 "exact" degrees of stenosis ranging from 42% to 87%. Then, the diameters were measured in the MRA images by three independent observers and with quantitative angiography (QA) software and used to compute the degrees of stenosis corresponding to the 22 "exact" ones. The accuracy and reproducibility of vessel diameter measurements and stenosis calculations were assessed for vessel size ranging from 6 to 8 mm (iliac artery), 4 to 5 mm (femoro-popliteal arteries), and 1 to 3 mm (infrapopliteal arteries). Maximum pixel dimension and slice thickness to obtain a mean error in stenosis evaluation of less than 10% were determined by linear regression analysis. Results Mean errors on stenosis quantification were 8.8% ± 6.3% for 6- to 8-mm vessels, 15.5% ± 8.2% for 4- to 5-mm vessels, and 18.9% ± 7.5% for 1- to 3-mm vessels. Mean errors on stenosis calculation were 12.3% ± 8.2% for observers and 11.4% ± 15.1% for QA software ( P = .0342). To evaluate stenosis with a mean error of less than 10%, maximum pixel surface, the pixel size in the phase direction, and the slice thickness should be less than 1.56 mm 2 , 1.34 mm, 1.70 mm, respectively (voxel size 2.65 mm 3 ) for 6- to 8-mm vessels; 1.31 mm 2 , 1.10 mm, 1.34 mm (voxel size 1.76 mm 3 ), for 4- to 5-mm vessels; and 1.17 mm 2 , 0.90 mm, 0.9 mm (voxel size 1.05 mm 3 ) for 1- to 3-mm vessels. Conclusion Higher spatial resolution than currently used should be selected for imaging peripheral vessels.

To evaluate the sensitivity and specificity of non-enhanced chest CT to detect reperfusion after pulmonary arteriovenous malformation (PAVM) embolization.The Institutional Review Board approved this retrospective HIPAA-compliant study and waived the need for patient consent. All consecutive patients who underwent PAVM embolization between January 2000 and April 2011 were included. Complex PAVMs and patients without available pre- and/or post-embolization CT were excluded. PAVM artery, aneurysm and vein diameters were measured on non-enhanced chest CT before and after PAVM embolization. Pulmonary angiography (PA) was the reference standard to assess PAVM reperfusion. Reperfusion detection was analyzed with receiver operating characteristic (ROC) curves according to percentage of diameter reduction cut-off. Inter-observer concordance was ascertained with intra-class correlation coefficients (ICCs).Out of 68 patients with PAVM embolizations, 42 (62%) had 108 PAVMs that met inclusion/exclusion criteria. Areas under the ROC curves for PAVM reperfusion detection were 0.84, 0.87, and 0.78, respectively, for PAVM artery, aneurysm and vein (p0.05). Sensitivity varied between 51% and 56%, and specificity between 86% and 98% for the30% diameter reduction cut-off. Sensitivity was between 98% and 100%, and specificity, between 20% and 47% for the70% diameter reduction cut-off. ICCs for inter-observer concordance were 0.58, 0.88 and 0.68 for percentage reduction of PAVM artery, aneurysm and vein, respectively.PAVM diameter reduction cut-offs of30% and70%, to detect PAVM reperfusion on non-enhanced CT reported in the literature, would respectively result in low sensitivity and specificity.

PURPOSE To evaluate the safety and efficacy of endovascular treatment of symptomatic arteriovenous (AV) fistulas associated with femoropopliteal in situ venous bypass grafts MATERIALS AND METHODS Twenty-one patients underwent embolization of symptomatic AV fistulas associated with lower-limb bypass with use of the saphenous vein ( n = 16) or femoral vein ( n = 5). The procedures were performed with microcatheters and metallic coils. Indications for embolization were venous congestion ( n = 15) and arterial insufficiency ( n = 6). Eight patients had persistent lower-limb edema, seven had painful inflammatory skin thickening, three had intermittent claudication, and three had nonhealing ulcers RESULTS Forty-four AV fistulas were embolized. Symptoms of venous congestion regressed completely in 12 of 15 patients (80%). Partial symptom improvement was achieved in three other patients (20%), two of whom had persistent lower-limb edema and bypass with use of the femoral vein. Five of six patients with ischemic symptoms (83%) had complete symptom relief. One patient (17%) whose ischemic ulcer did not recover despite successful embolization of AV fistulas required an amputation 4 months later. Overall, 17 of 21 patients (81%) showed complete recovery of clinical symptoms. There was no bypass occlusion during follow-up (mean, 17.5 months; range, 1–45 months) CONCLUSIONS Embolization of symptomatic AV fistulas secondary to lower-limb in situ venous bypass is a safe and efficient alternative to surgical ligature. Complete regression of clinical symptoms is less likely when the bypass is performed with use of the femoral vein

PURPOSE To evaluate the success, safety, and efficacy of the retrieval of the OptEase Permanent/Retrievable Vena Cava Filter (Cordis, Warren, NJ), when implanted for temporary protection against venous thromboembolism. MATERIALS AND METHODS This prospective, multicenter, non-randomized study enrolled 27 patients who needed temporary protection against pulmonary embolism in whom the intent at the time of filter insertion was retrieval of the OptEase filter. Patients presented with deep venous thrombosis ( n = 17), pulmonary embolism (PE) ( n = 6), and high risk for PE without thromboembolic disease ( n = 4). Assessments included duplex sonography of the access site performed within 24 hours of device implantation and retrieval. All patients underwent cavography before and after filter placement and filter retrieval. Contrast-enhanced computed tomography (CT) of the abdomen and clinical follow-up was performed at 1 month after device retrieval. RESULTS Of the 27 enrolled patients, 21 patients (77.8%) met the criteria for retrieval and all 21 patients (100%) had filters successfully retrieved with no associated adverse events. Retrieval was not attempted in six patients as a result of ongoing contraindication to anticoagulation ( n = 3), large trapped thrombi within the filter ( n = 2), and poor patient prognosis ( n = 1). Time to retrieval ranged from 5 to 14 days with a mean implantation time of 11.1 days ± 1.82. No symptomatic pulmonary embolism, vena cava wall injury, vena cava stenosis, significant bleeding, filter fracture, or filter migration was observed. Nineteen of the 21 patients (90.5%) were followed for 1-month post-retrieval with no device-related adverse events or symptomatic PE. Caval patency was documented in 18 of these 19 patients with CT. Two patients were lost to follow-up, and one patient refused to undergo CT examination. CONCLUSION The OptEase permanent/retrievable vena cava filter can be safely and successfully retrieved up to 14 days in patients who no longer require inferior vena cava filter protection against pulmonary embolism.

PURPOSE To compare functional autonomy, quality of life (QOL), and pain control after endovascular and open repair (OR) of abdominal aortic aneurysms. MATERIALS AND METHODS Forty patients with a low surgical risk profile and anatomic compatibility for stent-graft therapy were randomized to receive OR or endovascular aneurysm repair (EVAR). Technical and clinical success as well as mortality were assessed in both groups and compared by Kaplan-Meier analysis. Functional autonomy and QOL were assessed by Karnofsky score and Short Form 36 (SF-36) questionnaire. Pain control was assessed by a numeric rating scale and Brief Pain Inventory questionnaire. QOL outcomes by means of the SF-36 and pain questionnaires were compared with use of mixed-effects models for repeated-measures analysis. RESULTS All procedures were technically successful in both groups. Three late clinical failures requiring surgical conversion or repeated intervention were observed in the EVAR group and one was observed in the OR group. There was no significant difference between groups in terms of functional autonomy or QOL. No difference in pain level was evident during the early postoperative period, whereas the pain level was lower in the OR group after 1 month. Opioid analgesic drug consumption was significantly greater in the OR group during the postoperative period. Mean hospitalization duration was shorter in the EVAR group than in the OR group (4.5 days ± 2.4 vs 11.5 days ± 8.1; P = .001). CONCLUSION EVAR has no advantage over OR in patients at low risk in terms of functional autonomy, QOL, and pain control. However, EVAR was associated with shorter hospitalization durations compared with OR.

We sought to evaluate and compare the relative cost-benefit of Doppler sonography, MR angiography, and captopril-enhanced renal scintigraphy as techniques for predicting a patient's clinical response to renal angioplasty.Estimations of positive and negative predictive values of baseline and captopril-enhanced renal scintigraphy and Doppler sonography examinations for predicting a favorable outcome after renal angioplasty were based on a previously published prospective study involving 74 patients who underwent this treatment. For gadolinium-enhanced MR angiography, predictive values were calculated from a subpopulation of 57 of these 74 subjects. The value of different combined strategies with these techniques for predicting clinical success after angioplasty was evaluated in this population. The costs of investigation and treatment per improved patient were calculated for each imaging technique and for combined strategies in a hypothetic 1,000-patient population with a 30% prevalence of renal artery stenosis, relying on the diagnostic performance reported in the literature for each technique in detecting renal artery stenosis.The costs for each improved patient were $12,579 for patients selected on the basis of a positive finding on Doppler sonography (false-negative results = 12/1,000) and $10,149 for patients selected with criteria combining a positive finding on Doppler sonography with a bilateral resistive index of less than 0.75 (false-negative results = 32/1,000). Patient selection based on a positive finding on MR angiography cost $18,119 (false-negative results = 0), whereas the cost of patient selection based on a positive finding on renal scintigraphy was $12,939 (false-negative results = 29/1,000).Doppler sonography is more cost-efficient but less sensitive than MR angiography for identifying patients with renovascular hypertension. MR angiography should be favored in hypertensive patients who are resistant to medical therapy to avoid false-negative examinations.

The recent development of aortic stent-grafts has brought the management of thoracic aortic diseases into the realm of interventional radiology. Stent-graft placement is now an alternative to surgery for the treatment of descending thoracic aortic aneurysms, ulcers, and fistulas and is sometimes indicated in cases of mycotic aneurysm, posttraumatic aortic rupture, or thoracic descending aortic dissection. Pretreatment imaging is crucial for evaluating patient eligibility, selecting the appropriate stent-graft, and planning the intervention. Stent-graft treatment of long atherosclerotic aneurysms, lesions close to aortic branch vessels, and aortic dissections is subject to technical pitfalls, and adverse events such as endoleaks, stent migration or misplacement, aortic perforation, and vascular trauma will require specific interventions, although they occur in only a minority of patients. Thoracic stent-graft placement in good surgical candidates remains controversial because long-term results are unknown. However, short-term morbidity and mortality rates from endovascular treatment compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases and is already the best option in many affected patients who are poor surgical candidates.

PURPOSE To evaluate imaging characteristics and artifacts of a nitinol stent with distal tantalum markers with computed tomography (CT) angiography and magnetic resonance (MR) angiography. MATERIALS AND METHODS A vascular phantom was built to simulate in-stent restenosis. A nitinol stent with tantalum markers (Luminexx stent) was evaluated with CT angiography in different orientations relative to the z-axis and with MR angiography in different positions relative to both B0 and the readout gradient. Stenosis measurements were compared with conventional digital subtraction angiography for both modalities. In-stent signal intensity obtained with different flip angles was assessed in two nitinol stents with distal markers (Luminexx stent and SMART stent) and one without markers (Memotherm-FLEXX stent). RESULTS Stenosis detection was not possible with CT angiography when the stent was perpendicular to the z-axis because of streak-like artifacts induced by tantalum markers. Stenosis evaluation with multiplanar reformation was accurate when the stent was in parallel and oblique orientations relative to the table axis. With MR angiography, metallic artifacts were mostly related to the stent orientation with B0, whereas orientation of the readout gradient had little influence. The mean error (overestimation) for stenosis measurements varied between 0.1% and 7.4% for CT imaging in parallel and oblique positions and 3.6% and 9.5% for MR imaging. Higher flip angles did not improve signal intensity inside the three stents tested. CONCLUSIONS CT and MR angiography can be used for evaluating the patency of stents with distal markers that are parallel or oblique relative to the table axis (iliac, carotid, or femoral stents). MR angiography is preferred if the stent is perpendicular to the table axis (renal stent).

The goal of our study was to compare Doppler sonography and renal scintigraphy as tools for predicting the therapeutic response in patients after undergoing renal angioplasty. SUBJECTS AND METHODS. Seventy-four hypertensive patients underwent clinical examination, Doppler sonography, and renal scintigraphy before and after receiving captopril in preparation for renal revascularization. The patients were evaluated for the status of hypertension 3 months after the procedure. The predictive values of the findings of clinical examination, Doppler sonography, renal scintigraphy, and angiography were assessed.For prediction of a favorable therapeutic outcome, abnormal results from renal scintigraphy before and after captopril administration had a sensitivity of 58% and specificity of 57%. Findings of Doppler sonography had a sensitivity of 68% and specificity of 50% before captopril administration and a sensitivity of 81% and specificity of 32% after captopril administration. Significant predictors of a cure or reduction of hypertension after revascularization were low unilateral (p = 0.014) and bilateral resistive (p = 0.016) indexes on Doppler sonography before (p = 0.009) and after (p = 0.028) captopril administration. On multivariate analysis, the best predictors were a unilateral resistive index of less than 0.65 (odds ratio [OR] = 3.7) after captopril administration and a kidney longer than 93 mm (OR = 7.8). The two best combined criteria to predict the favorable therapeutic outcome were a bilateral resistive index of less than 0.75 before captopril administration combined with a unilateral resistive index of less than 0.70 after captopril administration (sensitivity, 76%; specificity, 58%) or a bilateral resistive index of less than 0.75 before captopril administration and a kidney measuring longer than 90 mm (sensitivity, 81%; specificity, 50%).Measurements of kidney length and unilateral and bilateral resistive indexes before and after captopril administration were useful in predicting the outcome after renal angioplasty. Renal scintigraphy had no significant predictive value.

PURPOSE To identify predictors of clinical outcome after percutaneous revascularization of the renal arteries. MATERIALS AND METHODS In 63 patients, the therapeutic response was retrospectively assessed after percutaneous revascularization of the renal arteries indicated for hypertension (41.3%), renal failure (4.8%), or both (53.9%). All patients underwent percutaneous transluminal renal angioplasty, complemented by stent insertion in 30 patients. The authors analyzed the role of clinical and imaging factors, including scintigraphy, Doppler sonography, and angiography for predicting clinical success. RESULTS In the hypertensive population, there were three cures (5.6%), 26 improvements (48.1%), and 25 failures (46.3%). Among patients with renal insufficiency, 12 were improved (37.5%), 11 were stabilized (34.4%), and nine deteriorated (28.1%). Predictors of favorable outcome for hypertension were shorter duration of hypertension, higher diastolic blood pressure, fibromuscular dysplasia, abnormal Doppler study, higher percentage of angiographic stenosis, and lower grade of aortic atheromatous disease. Predictors of favorable outcome for renal failure were nondiabetic status, abnormal Doppler study, and higher percentage of angiographic stenosis. Abnormal Doppler and scintigraphic examinations predicted successful treatment of hypertension in 60% and 53.8% of cases, respectively, and renal insufficiency in 85% and 60% of cases, respectively. CONCLUSION Clinical and angiographic variables were the best predictors of therapeutic success for hypertension. Doppler sonography was useful in patients with renal failure.

Purpose To compare the diagnostic value of carbon dioxide to that of iodinated contrast material for digital subtraction angiography of the abdominal aorta and lower extremities. Materials and Methods Thirty-five patients underwent comparative CO 2 and iodinated contrast material arteriography of the abdominal aorta and lower extremities. For each contrast study, three independent observers evaluated the degree of opacification and percentage of stenosis of each vessel, the degree of certainty of their observations, and the overall quality of the study. Data of CO 2 and iodinated studies were compared using analysis of variance for repeated measures. Interobserver and intertechnique agreements were estimated with Cohen's kappa and intraclass correlation coefficient. Results Iodine-based vascular opacification was superior to that with CO 2 in the central and distal arteries ( P =.02). The degree of certainty and overall quality score were higher for iodine than for CO 2 -based contrast studies ( P =.00001). The interobserver agreement for categorizing stenoses was higher for iodine as compared to CO 2 -based angiography. No significant difference was observed between the mean stenosis values obtained with CO 2 and iodine-based angiography in any segment. Intraclass correlation coefficient demonstrated a high degree of convergence of the two techniques for assessing the percentage of stenosis. Conclusion CO 2 can be used as an alternative to iodinated contrast material for obtaining arteriograms of the abdominal aorta and lower extremities for investigating atherosclerotic disease.

This case discusses when and how to treat a post-angioplasty arterial dissection. The merits of balloon expanding and self-expanding stents are also discussed.

This case illustrates an example of iliac artery rupture, management measures to deal with this, and steps which can be taken to facilitate treatment to reduce risk to the patient should this happen.

This case describes the development and treatment of an abscess following embolization of a neuroendrocrine tumor metastasis within the liver. The features of abscess formation and post-embolization syndrome are discussed along with treatment strategies.

This case illustrates management of a thrombosed dialysis fistula. During this process an angioplasty balloon ruptured circumferentially leaving part of the balloon within the fistula. Successful retrieval of the balloon fragment is outlined.

This case illustrates management of a proximal type 1 endoleak post EVAR with a proximal cuff. Management of the resulting compromise to a renal artery is also illustrated.

This case reviews the management of an occluded renal artery by the fabric of an aortic stent graft during an EVAR procedure.

This case discusses the management of a misplaced central venous line including the diagnostic difficulties this may present in determining the exact location of a line which is not in its intended location.

This case illustrates the treatment of a type 2 endoleak following fenestrated EVAR by coil embolization of the IMA.

This case describes hemorrhage following transjugular liver biopsy in a cirrhotic patient. Various tips are given with respect to technical approach and steps which can be taken to minimize the risk of such a complication.

This case discusses the complication of distal embolization following angioplasty. Management of distal embolization from thromboaspiration to thrombolysis is also reviewed.

This case illustrates the basic technique of retrieval of a displaced embolization coil. Catheter selection to avoid such a complication is discussed.

This case discusses the management options for hemorrhage occurring post-nephrostomy insertion with an example from a nephrostomy insertion in an acutely obstructed, septic patient.

This case illustrates a method of managing the complication of deploying the contralateral limb outside the main body during an EVAR procedure.