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Purpose To test the feasibility of an online, simulator-based comprehensive interventional radiology (IR) training curriculum in times of COVID-19-induced travel restrictions. Materials and Methods A network of six VIST simulators (Mentice, Gothenburg, Sweden) was installed in six geographically different radiology departments. Two courses with six sessions each took place. 43 participants were recruited on a voluntary basis among local residents. The training sessions were conducted in real time with interconnected simulation devices and were led by experts in the field of IR on a rotational basis. The participants attitude toward various topics was quantified before and after training on a seven-point Likert scale (1 = “not at all”, 7 = “to the highest degree”). In addition, post-course surveys were conducted. Results The courses led to an improvement for all items compared with baseline: interest in IR (pre: 5.5, post: 6.1), knowledge of endovascular procedures (pre: 4.1, post: 4.6), likelihood of choosing IR as a subspecialty (pre: 5.7, post: 5.9). Experience with endovascular procedures (pre: 3.7, post: 4.6) improved significantly (p = 0.016). In the post-course surveys high satisfaction rates with the pedagogical approach (mean 6), the teaching content (mean 6.4), and the duration and frequency of the course (mean 6.1) were observed. Conclusion The implementation of a simultaneous endovascular online training curriculum in different geographic locations is feasible. The curriculum has the potential to meet the demand for training in IR in times of COVID-19-associated travel restrictions and can complement future training in the context of radiologic congresses. Key Points

With the increasing need for minimally invasive procedures based on lower complication rates, higher patient acceptance, and technical developments, there is a growing focus on the sound interventional training of young radiologists. This survey aimed to analyze the current situation in interventional radiology (IR) training in Germany to detect shortcomings and identify areas for improvement.From November 1-30, 2020, an online questionnaire was distributed to representative radiological associations and societies with the request to forward it to radiology residents and radiologists 40 years. The 44 questions covered six distinct areas from personal working conditions to the characterization of the IR department, training conditions, role of women in IR, and attendance at congresses/external training.A total of 330 participants completed the questionnaire. 77 % of participants expressed a high interest in IR, and 47 % could even imagine subspecializing in interventional radiology. Most institutions provided the necessary learning conditions and infrastructure. The rate of overall satisfaction with IR training conditions was 45 % (vs. a dissatisfaction rate of 39 %). However, females showed a lower satisfaction rate with their training environment than male participants (28 % vs. 51 %; P = 0.06). Positive correlations with work satisfaction were found for the presence and duration of the IR rotation, the number of partly independently/mentored performed interventions, and structured feedback. Moreover, the need for a structured training curriculum was expressed by 67 % of participants.Radiological residents and young radiologists expressed a high interest in interventional radiology, and they rate the infrastructure of German hospitals regarding IR as sufficient. However, they expressed the need for consistent IR rotations and better-structured resident and postgraduate education (curriculainterviews).Interest in interventional radiology among radiological residents and young radiologists in Germany is high, but satisfaction with interventional radiology training leaves room for improvement. The most frequently mentioned aspects that can improve IR training were · organized rotations of at least 6 months. · structured curriculums with face-to-face feedback. · structured guidance by senior interventionists during procedures. CITATION FORMAT: · Sieren M, Katoh M, Mahnken AH et al. Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology - A Nationwide Survey. Fortschr Röntgenstr 2022; 194: 1346 - 1357.Die fundierte interventionelle Ausbildung junger RadiologInnen gerät durch den zunehmenden Bedarf an minimal-invasiven Prozeduren immer mehr in den Fokus. Ziel dieser Umfrage war es, die aktuelle Situation der Ausbildung in der Interventionellen Radiologie (IR) in Deutschland zu analysieren, um Defizite aufzudecken und Verbesserungsmöglichkeiten zu identifizieren.Vom 1. bis 30. November 2020 wurde ein Online-Fragebogen an repräsentative radiologische Verbände und Gesellschaften versandt mit der Bitte, ihn an AssistenzärztInnen und RadiologInnen 40 Jahre weiterzuleiten. Die 44 Fragen deckten 6 verschiedene Bereiche ab, von den persönlichen Arbeitsbedingungen bis zur Charakterisierung der IR-Abteilung, den Ausbildungsbedingungen, der Rolle der Frauen in der IR und der Teilnahme an Kongressen/externen Fortbildungen.Insgesamt haben 330 TeilnehmerInnen den Fragebogen ausgefüllt. 77 % der TeilnehmerInnen bekundeten ein hohes Interesse an der IR und 47 % konnten sich sogar eine Subspezialisierung in der interventionellen Radiologie vorstellen. Die Mehrheit der Institutionen stellten die notwendigen Rahmenbedingungen und Infrastruktur bereit. Insgesamt lag die Zufriedenheit über die interventionsradiologische Weiterbildung bei 45 % (vs. 39 % Unzufriedenheit), wobei die Zufriedenheit mit den Ausbildungsbedingungen bei Teilnehmerinnen geringer ausfiel als bei den Teilnehmern (28 % vs. 51 %; P = 0,06). Positive Korrelationen mit der Arbeitszufriedenheit wurden für das Vorhandensein und die Dauer der IR-Rotation, die Anzahl der teilweise selbstständig/supervidiert durchgeführten Eingriffe und ein institutionalisiertes, strukturiertes Feedback festgestellt. Darüber hinaus äußerten 67 % der Teilnehmer den Wunsch nach einem strukturierten Ausbildungscurriculum.AssistenzärztInnen und junge RadiologInnen zeigen ein hohes Interesse an der Interventionellen Radiologie und bewerten die Infrastruktur deutscher Krankenhäuser im Bereich der IR als ausreichend. Sie äußerten jedoch den Bedarf an konsistenten IR-Rotationen und einer besser strukturierten grundlegenden und weiterführenden Ausbildung (CurriculaInterviews).Das Interesse an der Interventionellen Radiologie ist bei Assistenzärzten und jungen Radiologen in Deutschland hoch, die Zufriedenheit mit der Ausbildung in der Interventionellen Radiologie ist geringer. Die am häufigsten genannten Aspekte, die die IR-Ausbildung verbessern können, waren · organisierte Rotationen von mindestens 6 Monaten Dauer. · strukturierte Curricula mit persönlichem Feedback. · strukturierte Anleitung durch erfahrene Interventionisten während der Eingriffe.

Purpose To assess the accuracy of preoperative sonographic staging for prediction of limited axillary disease (LAD, one or two metastatic lymph nodes) and to identify factors associated with high prediction–pathology concordance in patients with early-stage breast cancer meeting the Z0011 criteria. Materials and Methods Patients treated between January 2015 and January 2020 were included in this retrospective, multicentric analysis of prospectively acquired service databases. The accuracy of LAD prediction was assessed separately for patients with one and two suspicious lymph nodes on preoperative sonography. Test validity outcomes for LAD prediction were calculated for both groups, and a multivariate model was used to identify factors associated with high accuracy of LAD prediction. Results Of 2059 enrolled patients, 1513 underwent sentinel node biopsy, 436 primary and 110 secondary axillary dissection. For LAD prediction in patients with one suspicious lymph node on preoperative ultrasound, sensitivity was 92% (95% CI 87–95%), negative predictive value (NPV) was 92% (95% CI 87–95%), and the false-negative rate (FNR) was 8% (95% CI 5–13%). For patients with two preoperatively suspicious nodes, the sensitivity, NPV, and FNR were 89% (95% CI 84–93%), 73% (62–83%), and 11% (95% CI 7–16%), respectively. On multivariate analysis, the number of suspicious lymph nodes was associated inversely with correct LAD prediction ([OR 0.01 (95% CI 0.01–0.93), p ≤ 0.01]. Conclusions Sonographic axillary staging in patients with one metastatic lymph node predicted by preoperative ultrasound showed high accuracy and a false-negative rate comparable to sentinel node biopsy for prediction of limited axillary disease.

Knowledge about anatomical details seems to facilitate the procedure and planning of prostatic artery embolization (PAE) in patients with symptomatic benign prostatic hyperplasia (BPS). The aim of our study was the pre-interventional visualization of the prostatic artery (PA) with MRA and the correlation of iliac elongation and bifurcation angles with technical success of PAE and technical parameters. MRA data of patients with PAE were analysed retrospectively regarding PA visibility, PA type, vessel elongation, and defined angles were correlated with intervention time, fluoroscopy time, dose area product (DAP), cumulative air kerma (CAK), contrast media (CM) dose and technical success of embolization. T-test, ANOVA, Pearson correlation, and Kruskal-Wallis test was applied for statistical analysis. MRA identified the PA origin in 126 of 147 cases (accuracy 86%). Vessel elongation affected time for catheterization of right PA (p = 0.02), fluoroscopy time (p = 0.05), and CM dose (p = 0.02) significantly. Moderate correlation was observed for iliac bifurcation angles with DAP (r = 0.30 left; r = 0.34 right; p = 0.01) and CAK (r = 0.32 left; r = 0.36 right; p = 0.01) on both sides. Comparing the first half and second half of patients, median intervention time (125 vs. 105 min.) and number of iliac CBCT could be reduced (p

(1) Background: Sympathetic overactivity is a major contributor to resistant hypertension (RH). According to animal studies, sympathetic overactivity increases immune responses, thereby aggravating hypertension and cardiovascular outcomes. Renal denervation (RDN) reduces sympathetic nerve activity in RH. Here, we investigate the effect of RDN on T-cell signatures in RH. (2) Methods: Systemic inflammation and T-cell subsets were analyzed in 17 healthy individuals and 30 patients with RH at baseline and 6 months after RDN. (3) Results: The patients with RH demonstrated higher levels of pro-inflammatory cytokines and higher frequencies of CD4+ effector memory (TEM), CD4+ effector memory residential (TEMRA) and CD8+ central memory (TCM) cells than the controls. After RDN, systolic automated office blood pressure (BP) decreased by −17.6 ± 18.9 mmHg. Greater BP reductions were associated with higher CD4+ TEM (r −0.421, p = 0.02) and CD8+ TCM (r −0.424, p = 0.02) frequencies at baseline. The RDN responders, that is, the patients with ≥10mmHg systolic BP reduction, showed reduced pro-inflammatory cytokine levels, whereas the non-responders had unchanged inflammatory activity and higher CD8+ TEMRA frequencies with increased cellular cytokine production. (4) Conclusions: The pro-inflammatory state of patients with RH is characterized by altered T-cell signatures, especially in non-responders. A detailed analysis of T cells might be useful in selecting patients for RDN.

Background Patient selection for transarterial chemoembolization (TACE) has remained challenging. Currently used markers mainly reflect liver function and turned out as less reliable in larger clinical trials. The patients´ body composition has been linked with patient outcome in different cancers. Now, we analyzed the function of different parameters of the patient’s body composition as prognostic and/ or predictive parameters in patients that received TACE. Methods CT scans were used to assess five parameters of the individual body composition (skeletal muscle index (SMI), median muscular attenuation (MMA), bone mineral density (BMD) as well as the visceral and subcutaneous fat area) in 89 patients undergoing TACE. Results were correlated with tumor response to TACE and outcome of patients. Results SMI and visceral fat area were significantly higher in male patients and among patients undergoing TACE for HCC compared to patients with liver metastases. While all parameters of the body composition did not predict response to TACE, patients with an SMI below the ideal cutoff value of 37.76 cm2/m2 had a significantly reduced long-term outcome with a median overall survival of 404 days compared to 1321 days for patients with a high SMI. Moreover, the pre-interventional SMI turned out as an independent prognostic factor in a multivariate Cox regression model including clinicopathological parameters and laboratory markers of organ dysfunction and systemic inflammation (HR: 0.899, 95% CI 0.827–0.979, p = 0.014). Conclusion The pre-interventional SMI represents an independent prognostic factor for overall survival following TACE. Assessment of the individual body composition using routine CT scan might help to identify the ideal patients for TACE.

Background Selective Internal Radiotherapy (SIRT) is a minimal invasive tumor therapy for hepatocellular carcinoma (HCC), biliary tract cancer (BTC), and liver metastasis of extrahepatic tumors. Comprehensive data on past and current trends of SIRT as well as outcome parameters such as in-hospital mortality and adverse events in Germany are missing. Methods We evaluated current clinical developments and outcomes of SIRT in Germany based on standardized hospital discharge data, provided by the German Federal Statistical Office from 2012 to 2019. Results A total of 11,014 SIRT procedures were included in the analysis. Reflecting the current guideline, the most common indication was hepatic metastases (54.3%; HCC: 39.7%; BTC: 6%) with a trend in favor of HCC and BTC over time. Most SIRTs were performed with yttrium-90 (99.6%) but the proportion of holmium-166 SIRTs increased in recent years. Mean length of hospital stay for ⁹⁰Y based SIRTs was 3.67 ± 2 days and for 166Ho based SIRTs 2.9 ± 1.3 days. Overall in-hospital mortality was 0.14%. The mean number of SIRTs/hospital was 22.9 (SD ± 30.4). The 20 highest case volume centers performed 25.6% of all SIRTs. Conclusion Our study gives a detailed insight into indications, patient-related factors, and the incidence of adverse events as well as the overall in-hospital mortality in a large SIRT collective in Germany. SIRT is a safe procedure with low overall in-hospital mortality and a well-definable spectrum of adverse events. We report differences in the regional distribution of performed SIRTs and changes in the indications and used radiopharmaceuticals over the years.

To analyze the quality of endovascular aortic aneurysm repair using the data of the DeGIR quality management system. Comparison of data between 2011 and 2019.A retrospective analysis of all data registered in the DeGIR quality management system of the year 2019 was performed regarding the treatment quality for endovascular aortic aneurysm repair. Registration of data was voluntary. As quality parameters indication, treatment process data and quality of results were examined. The latter was judged by treatment success, complication rates and radiation exposure.Out of 189 590 data sets overall 1639 cases of EVAR were registered; compared to 2011 this was an increase of 472 cases. 5.9 % of these cases encompassed emergency treatments. The most frequent indication was an abdominal aneurysm with 72 % of cases. In 54 % of cases, the aortic diameter ranged 50-70 mm. The rates for technical success, over all complications and major complications were 92.8 %, 6.7 % and 6.0 % respectively for all EVAR including emergency indications. In general, EVAR yielded a mortality rate of 1.2 % while emergency procedures had a mortality rate of 7.3 %. Median dose area product and fluoroscopy time were 10 503 cGy × cm2 and 20 minutes respectively at a mean procedure time of 114 minutes.Data analysis of the DeGIR quality management system persistently showed a very high technical success rate for endovascular aortic aneurysm repair performed by interventional radiologists accompanied by a low complication rate.· The voluntary DeGIR quality assurance-system has reached high acceptance among interventional radiologists.. · The database has nearly 200 000 submissions on record for 2019.. · EVAR by interventional radiologists has shown very high technical success as well as a low complication rate..· Frenzel F, Bücker A, Paprottka P et al. DeGIR Quality Report 2019: Report on the treatment quality of minimally invasive methods - Interventional therapy (EVAR) of abdominal aortic aneurysms. Fortschr Röntgenstr 2022; 194: 49 - 61.ZIEL: Analyse der Behandlungsqualität der endovaskulären Versorgung von Aortenaneurysmen anhand der Eingaben in das DeGIR-Qualitätssicherungssystem. Vergleich der Entwicklung der Daten aus dem Qualitätsreport von 2011 und 2019. Alle Registerdaten des Jahres 2019 zur Behandlungsqualität der endovaskulären Versorgung von Aortenaneurysmen (EVAR) des freiwilligen DeGIR-Qualitätssicherungssystems wurden retrospektiv ausgewertet. Als Qualitätskriterien dienten Indikation, Therapieprozess und Ergebnisqualität. Ergebnisparameter waren Therapieerfolg, Komplikationsraten und Strahlenexposition. Von insgesamt 189 590 im Jahre 2019 in das Register eingepflegten Datensätzen beschreiben 1639 die Behandlung eines Aortenaneurysmas; gegenüber 2011 erhöhte sich die absolute Zahl somit um 472 Fälle. Bei 5,9 % der Fälle handelte es sich um eine Notfallindikation. Die häufigste Indikation zur EVAR-Behandlung stellte mit 72 % das abdominelle Aneurysma dar. Der Aortendurchmesser lag in 54 % der Fälle zwischen 50 und 70 mm. Bezogen auf alle EVAR einschließlich der Notfallindikationen betrug der technische Erfolg 92,8 %, während die Raten für Komplikationen gesamt 6,7 % und für Major-Komplikationen 6,0 % betrugen. Die Letalitätsrate aller EVAR betrug 1,2 % und die der Notfallbehandlungen 7,3 %. Die Mediane des Dosisflächenprodukts und der Durchleuchtungszeit lagen bei 10 503 cGy×cm Die Datenauswertung des DeGIR-Qualitätssicherungssystems belegt eine konstant sehr hohe technische Erfolgsrate der durch interventionelle Radiologen durchgeführten EVAR-Prozeduren bei geringer Komplikationsrate. · Das freiwillige DeGIR-Qualitätssicherungssystem hat unter interventionell tätigen Radiologen eine hohe Akzeptanz gefunden.. · Die Datenbank umfasst knapp 200 000 Eingaben für 2019, davon 1639 endovaskuläre Aneurysmabehandlungen.. · Diese wurden mit einer hohen technischen Erfolgsrate bei gleichzeitig niedriger Komplikationsrate ausgeführt..· Frenzel F, Bücker A, Paprottka P et al. DeGIR Quality Report 2019: Report on the treatment quality of minimally invasive methods – Interventional therapy (EVAR) of abdominal aortic aneurysms. Fortschr Röntgenstr 2022; 194: 49 – 61.

Background For peripheral artery disease (PAD), MR angiography (MRA) is a well-established diagnostic modality providing morphologic and dynamic information comparable to digital subtraction angiography (DSA). However, relatively large amounts of contrast agents are necessary to achieve this. Purpose To evaluate the diagnostic accuracy of time-resolved 4D MR-angiography with interleaved stochastic trajectories (TWIST-MRA) by using maximum intensity projections (MIPs) of dynamic images acquired with reduced doses of contrast agent. Study type Retrospective. Population Forty adult PAD patients yielding 1088 artery segments. Field strength/sequence A 3.0 T, time-resolved 4D MR-angiography with TWIST-MRA and MIP of dynamic images. Assessment DSA was available in 14 patients (256 artery segments) and used as reference standard. Three-segmental MIP reconstructions of TWIST-images after administration of 3 mL of gadolinium-based contrast agent (Gadoteridol/Prohance®, 0.5 M) per anatomical level (pelvis, thighs, and lower legs) yielded 256 artery segments for correlation between MRA and DSA. Three independent observers rated image quality (scale: 1 [nondiagnostic] to 4 [excellent]) and the degree of venous overlay (scale: 0 [none] to 2 [significant]) for all segments. Diagnostic accuracy for the detection of >50% stenosis and artery occlusion was calculated for all observers. Statistical tests Binary classification test (sensitivity, specificity, positive/negative predictive values, diagnostic accuracy). Intraclass correlation coefficients (ICCs), logistic regression analysis with comparison of areas under the receiver-operating-characteristics (ROC) curves (AUCs) with the DeLong method. Bland-Altman-comparison. Results High diagnostic performance was achieved for the detection of >50% stenosis (sensitivity 92.9% [84.3-99.9% (95%-CI)] and specificity 98.5% [95.7-99.8% (95%-CI)]) and artery occlusion (sensitivity 93.1% [77.2-99.2% (95%-CI)] and specificity 99.1% [96.9-99.9% (95%-CI)]). Inter-reader agreement was excellent with ICC values ranging from 0.95 to 1.0 for >50% artery stenosis and occlusion. Image quality was good to excellent for both readers (3.41 ± 0.72, 3.33 ± 0.65, and 3.38 ± 0.61 [mean ± SD]) with good correlation between observer ratings (ICC 0.71-0.81). No significant venous overlay was observed (0.06 ± 0.24, 0.23 ± 0.43 and 0.11 ± 0.45 [mean ± SD]). Data conclusion MIPs of dynamic TWIST-MRA offer a promising diagnostic alternative necessitating only reduced amounts (50%) of gadolinium-based contrast agents for the entire runoff vasculature. Evidence level 3 TECHNICAL EFFICACY: Stage 2.

This overview summarizes key points of complication management in vascular and non-vascular interventions, particularly focusing on complication prevention and practiced safety culture. Flowcharts for intervention planning and implementation are outlined, and recording systems and conferences are explained in the context of failure analysis. In addition, troubleshooting by interventionalists on patient cases is presented.The patient cases presented are derived from our institute. Literature was researched on PubMed.Checklists, structured intervention planning, standard operating procedures, and opportunities for error and complication discussion are important elements of complication management and essential for a practiced safety culture.A systematic troubleshooting and a practiced safety culture contribute significantly to patient safety. Primarily, a rational and thorough error analysis is important for quality improvement.· Establishing a safety culture is essential for high-quality interventions with few complications.. · A rational and careful troubleshooting is essential to increase quality of interventions.. · Checklists and SOPs can structure and optimize the procedure of interventions..· Weiss D, Wilms LM, Ivan VL et al. Complication Management and Prevention in Vascular and non-vascular Interventions. Fortschr Röntgenstr 2022; 194: 1140 - 1146.ZIEL: Diese Übersicht fasst zentrale Punkte des Komplikationsmanagements bei vaskulären und nicht vaskulären Interventionen mit Fokus auf die Komplikationsvermeidung und eine gelebte Sicherheitskultur zusammen. Ablaufpläne zur Interventionsplanung und -durchführung werden skizziert sowie Erfassungssysteme und Konferenzen im Rahmen der Fehleranalyse erläutert. Zudem wird das Vorgehen zur Fehlerbehebung durch die Interventionalisten an Patientenfällen dargestellt. Die präsentierten Patientenfälle stammen aus der eigenen Klinik. Zudem wurde eine PubMed-Literaturrecherche durchgeführt. Checklisten, eine strukturierte Interventionsplanung, Standardarbeitsanweisungen (SOP; standard-operating-procedure) sowie Möglichkeiten zur Fehler- und Komplikationsbesprechung sind wichtige Elemente des Komplikationsmanagements und für eine gelebte Sicherheitskultur unabdingbar. Eine systematische Fehleranalyse sowie eine gelebte Sicherheitskultur tragen maßgeblich zur Patientensicherheit bei. Darüber hinaus ist eine rationale und sorgfältige Fehleranalyse zur Qualitätssteigerung essenziell. · Die Etablierung einer Sicherheitskultur ist die Basis für hochwertige und komplikationsarme Interventionen.. · Eine rationale und sorgfältige Fehleranalyse ist zur Qualitätssteigerung essenziell.. · Checklisten und SOPs können das Prozedere einer Intervention strukturieren und optimieren..· Weiss D, Wilms LM, Ivan VL et al. Complication Management and Prevention in Vascular and Non-vascular Interventions. Fortschr Röntgenstr 2022; 194: 1140 – 1146.

The study described here systematically analyzed how specific artifacts in contrast-enhanced ultrasound (CEUS) can affect the detection of endoleaks during follow-up after endovascular aortic repair (EVAR). Patients undergoing EVAR of atherosclerotic or mycotic abdominal aortic aneurysms using various standard and branched stent-graft material for visceral and iliac preservation were enrolled over 5 y and followed up with computed tomography angiography (CTA) and CEUS simultaneously. CEUS artifacts were frequently identified after EVAR procedures (59% of examinations) and were caused mainly by contrast agent, different prosthesis or embolization material and postinterventional changes in the aneurysm sac. This article describes how to identify important artifacts and how to avoid false-negative or false-positive interpretations of endoleaks. Despite artifacts, CEUS had higher sensitivity for endoleak detection after EVAR than CTA. CEUS was superior to CTA in the identification of late endoleaks type II and in follow-up examinations after embolization procedures, where beam-hardening artifacts limited CTA.

Locoregional therapy options for CCA are used, in particular, for non-resectable tumors and aim to reduce tumor viability or delay tumor growth and ultimately prolong overall survival. In addition to local ablative procedures such as radiofrequency- or microwave-ablation, transarterial procedures such as transarterial embolization (TAE), transarterial chemoembolization (TACE), or selective internal radiotherapy (SIRT) play a major role. In particular, in combination with advances in molecular medicine and immunotherapy, there has been a further development in the therapy of primary malignant liver tumors in recent years. In this review, we analyze data from recent studies and examine the implications for therapy of CCA, particularly with regard to the combination of locoregional therapies with modern systemic therapies.

The aim of this study was to develop clinical preoperative, intraoperative, and postoperative scores for early identification of patients who are at risk of nonocclusive mesenteric ischemia (NOMI).A retrospective analysis.Single center.From January 2008 to December 2014, all patients from the Department of Thoracic and Cardiovascular Surgery were included on the basis of the hospital database.All mesenteric angiographically identified NOMI patients were compared with non-NOMI patients.The study population of 8,748 patients was randomized into a cohort for developing the scores (non-NOMI 4,214 and NOMI 235) and a cohort for control (non-NOMI 4,082 and NOMI 217). Risk factors were identified using forward and backward Wald test and were included in the predictive scores for the occurrence of NOMI. C statistic showed that the scores had a high discrimination for the prediction of NOMI preoperatively (C statistic 0.79; p0.001), intraoperatively (C statistic 0.68; p0.001), and postoperatively (C statistic 0.85; p0.001). A combination of the preoperative, intraoperative, and postoperative risk scores demonstrated the highest discrimination (C statistic 0.87; p0.001). The combined score included the following risk factors: renal insufficiency (preoperative); use of cardiopulmonary bypass and intra-aortic balloon pump support (intraoperative); and reexploration for bleeding, renal replacement therapy, and packed red blood cells ≥ 4 units (postoperative). The results were similar in the control group.These scores could be useful to identify patients at risk for NOMI and promote a rapid diagnosis and therapy.

For peripheral artery disease (PAD), MR angiography (MRA) is a well-established diagnostic modality providing morphologic and dynamic information comparable to digital subtraction angiography (DSA). However, relatively large amounts of contrast agents are necessary to achieve this.To evaluate the diagnostic accuracy of time-resolved 4D MR-angiography with interleaved stochastic trajectories (TWIST-MRA) by using maximum intensity projections (MIPs) of dynamic images acquired with reduced doses of contrast agent.Retrospective.Forty adult PAD patients yielding 1088 artery segments.A 3.0 T, time-resolved 4D MR-angiography with TWIST-MRA and MIP of dynamic images.DSA was available in 14 patients (256 artery segments) and used as reference standard. Three-segmental MIP reconstructions of TWIST-images after administration of 3 mL of gadolinium-based contrast agent (Gadoteridol/Prohance®, 0.5 M) per anatomical level (pelvis, thighs, and lower legs) yielded 256 artery segments for correlation between MRA and DSA. Three independent observers rated image quality (scale: 1 [nondiagnostic] to 4 [excellent]) and the degree of venous overlay (scale: 0 [none] to 2 [significant]) for all segments. Diagnostic accuracy for the detection of50% stenosis and artery occlusion was calculated for all observers.Binary classification test (sensitivity, specificity, positive/negative predictive values, diagnostic accuracy). Intraclass correlation coefficients (ICCs), logistic regression analysis with comparison of areas under the receiver-operating-characteristics (ROC) curves (AUCs) with the DeLong method. Bland-Altman-comparison.High diagnostic performance was achieved for the detection of50% stenosis (sensitivity 92.9% [84.3-99.9% (95%-CI)] and specificity 98.5% [95.7-99.8% (95%-CI)]) and artery occlusion (sensitivity 93.1% [77.2-99.2% (95%-CI)] and specificity 99.1% [96.9-99.9% (95%-CI)]). Inter-reader agreement was excellent with ICC values ranging from 0.95 to 1.0 for50% artery stenosis and occlusion. Image quality was good to excellent for both readers (3.41 ± 0.72, 3.33 ± 0.65, and 3.38 ± 0.61 [mean ± SD]) with good correlation between observer ratings (ICC 0.71-0.81). No significant venous overlay was observed (0.06 ± 0.24, 0.23 ± 0.43 and 0.11 ± 0.45 [mean ± SD]).MIPs of dynamic TWIST-MRA offer a promising diagnostic alternative necessitating only reduced amounts (50%) of gadolinium-based contrast agents for the entire runoff vasculature.3 TECHNICAL EFFICACY: Stage 2.

OBJECTIVE. The purpose of this study was to evaluate radiation dose, effective dose, and image quality of different low-dose abdominal CT protocols in a swine model and an anthropomorphic phantom u...

To prospectively evaluate the relationship of established inflammatory markers and presepsin on nonocclusive mesenteric ischemia and to correlate presepsin levels to the occurrence and severity of nonocclusive mesenteric ischemia.Patients were prospectively enrolled and blood samples taken, followed by a retrospective evaluation of laboratory values and angiographic findings. The study was ethics committee approved.Patients with clinical suspicion of nonocclusive mesenteric ischemia underwent catheter angiography of the superior mesenteric artery. Images were assessed by two experienced radiologists on consensus basis using a previously published standardized reporting system (Homburg-Nonocclusive Mesenteric Ischemia-Score). Two groups were formed according to the severity of nonocclusive mesenteric ischemia, mild and severe, patients without clinical signs of nonocclusive mesenteric ischemia formed the reference group. These data were correlated to inflammatory blood markers assessed pre- and postoperatively: C-reactive protein, leucocytes, procalcitonin, and presepsin as well as outcome data.Between January 2010 and March 2011, a total of 839 patients undergoing cardiovascular surgery participated in this study.Mild nonocclusive mesenteric ischemia was diagnosed in 4.5%, and severe nonocclusive mesenteric ischemia in 3.2%. Median postoperative presepsin concentrations were significantly greater in mild and severe nonocclusive mesenteric ischemia than in non-nonocclusive mesenteric ischemia. Statistics showed that postoperative presepsin better discriminated mild and severe nonocclusive mesenteric ischemia than any other tested biomarker.Elevated postoperative plasma presepsin concentrations are an independent predictor of mild and severe nonocclusive mesenteric ischemia. The established inflammatory blood markers significantly correlate with the development and severity of nonocclusive mesenteric ischemia.

Different techniques are available for carpal tunnel release such as classical surgical operations or minimally invasive procedures. A minimally invasive approach and the relevant regional anatomy are reported in this pilot study which was conducted with bodies from a body donation program. The method described here uses a hook knife to cut through the transverse carpal ligament or flexor retinaculum under ultrasound guidance. The results are documented by means of magnetic resonance and ultrasound imaging as well as by anatomical dissection.

Vasopressin is used as an adjunct to norepinephrine to support blood pressure in vasodilatory shock after cardiopulmonary bypass (CPB). In this study, we report our observation of vasopressin treatment in 11 patients with nonocclusive mesenteric ischemia (NOMI).In an observational cohort study, 78 patients were studied after having been treated for NOMI with intraarterial iloprost infusion after elective cardiac operation. All patients received norepinephrine as vasopressor for marked vasodilation. In 11 patients mean arterial pressure could not be maintained with norepinephrine alone (≤0.4 μg · kg(-1) · min(-1)), and vasopressin was given in addition to norepinephrine as a rescue therapy. The 11 patients (Vaso) and the remaining 67 patients (Nor) were analyzed for clinical improvement after initiation of NOMI treatment, on the following days 1 and 2, and for hospital survival. Intestinal perfusion was controlled by mesenteric angiography.Before initiation of NOMI treatment Vaso patients had significantly higher doses of norepinephrine than the Nor patients (Vaso, 0.65 ± 0.20 μg · kg(-1) · min(-1); Nor, 0.20 ± 0.13 μg · kg(-1) · min(-1); p0.001), and their diagnostic score of the angiography was higher (Vaso, 5.4 ± 1.1 points; Nor, 3.5 ± 2.1 points; p = 0.004). After 2 days of NOMI treatment, Vaso patients had improved intestinal perfusion in the control angiography (Vaso, 3.8 ± 1.5 points) and significantly lower doses of norepinephrine than the Nor patients (Vaso, 0.28 ± 0.12 μg · kg(-1) · min(-1); Nor, 0.53 ± 0.34 μg · kg(-1) · min(-1); p = 0.002). All patients survived in the Vaso group; in the Nor group, 17 of 67 patients died in the hospital.Vasopressin administration during NOMI treatment after CPB seems to improve small intestine perfusion and appears be to associated with improved hospital survival.

The objective of this study was to compare the capability of two algorithms for metal artifact reduction and virtual monoenergetic imaging (VME), a metal artifact reduction application for dual-source CT.A bovine vertebra phantom with 16 artificial osteolyses and two 20 × 4.5 mm stainless steel screws was scanned on two single-source CT scanner and one dual-source CT scanner at a dose identical to the single-source acquisitions. Datasets were reconstructed with a metal artifact reduction algorithm for orthopedic implants (O-MAR, Philips Healthcare), an iterative metal artifact reduction algorithm (iMAR, Siemens Healthineers), and VME. Blinded to the method used for artifact reduction, three independent observers evaluated datasets regarding the extent of metal artifacts using a 4-point scale. Depicted osteolyses were counted and screw diameters measured for each reconstruction. Interobserver variability was evaluated using the Kendall coefficient of concordance for ordinal variables and the intraclass correlation coefficient for continuous data.VME showed the best metal artifact reduction capability among evaluated methods; overall artifacts were rated 1.08 ± 0.29 for VME, 3.33 ± 0.65 for iMAR, and 3.91 ± 0.29 for O-MAR (p0.01). VME resulted in better representation of the cortical bone, trabecular structure, and soft tissue compared with the other two algorithms. VME provided the most realistic reconstruction of screw diameter. However, VME missed osteolyses. Good to almost perfect agreement was achieved for nearly all evaluated attributes.In our vertebral phantom, VME led to the most detailed representation of the osteosynthesis screw, caused the lowest amount of artifact, and represented the adjacent tissue best. Thus, VME should be considered as an alternative method to evaluate implants when other algorithms fail.

Background: Patients with a forced expiratory volume in 1 s (FEV1) below 20% of the predicted normal values (pred.) and either homogeneous emphysema or low diffusing capacity for carbon monoxide (DLCO) have a high risk for adverse events including death when undergoing surgical lung volume reduction. Objectives: We hypothesized that selected patients can benefit from endoscopic lung volume reduction (eLVR) despite a very low FEV1. Methods: This study is a retrospective analysis of consecutive patients with severe airflow obstruction, an FEV1 ≤20% of pred., and low DLCO who were treated by eLVR with endobronchial valves (EBV) between June 2012 and January 2015. Pre- and postinterventional lung function parameters, the 6-min walking test (6-MWT) distance, adverse events, and follow-up were recorded. Results: In 20 patients, there was an overall improvement in lung function with an increase in FEV1 (16.97-21.03% of pred.) and a decrease in residual volume (322-270% of pred.) and total lung capacity (144-129.06% of pred.). The 6-MWT distance improved (from 239 ± 77 to 267± 97 m overall, and from 184 ± 50 to 237 ± 101 m if patients developed an atelectasis of the target lobe). Pneumothorax occurred in 5 of the 20 patients (25%). 30-day mortality was 0%, and all patients survived to discharge. Conclusions: The patients benefitted moderately from EBV treatment despite an initially low FEV1. Some patients improved remarkably. EBV treatment in patients with an FEV1 ≤20% of pred. is generally feasible and safe. The greatest risk is pneumothorax with prolonged chest tube duration.

Vascular malformations and hemangiomas of the thyroid gland are rare disorders. The first case of a patient with recurrent high-flow arterio-venous malformation of the right thyroid gland involving the right endolarynx is presented.In June 2013, a 42-year-old female patient presented to the surgical department with recurrent hoarseness and a soft, vibrating mass on the right side of her neck. In 1993, she underwent right subtotal hemithyroidectomy with embolization on the day before surgery for a high-flow arterio-venous malformation of the thyroid gland. Diagnostic work-up in 2013 demonstrated a complex recurrent high-flow arterio-venous malformation on the right side of her neck involving the endolarynx. Full function of the right vocal fold could not be ascertained. The lesion was embolized again and excised the following day. Intraoperative gross bleeding and scar tissue prevented visualization and monitoring of the recurrent laryngeal nerve. Gross bleeding was also noted on hemithyroidectomy after embolization in 1993. No therapy was needed for the endolaryngeal part of the lesion. Histology showed large arterio-venous malformations with thyroid tissue. She remains well without signs of recurrence 18 month later but with a definitive voice handicap.This is the first report of a recurrent high-flow arterio-venous malformation originally developing from the right thyroid gland involving the right endolarynx. Counseling, diagnostic, and therapeutic work-up of the patient was possible only with an interdisciplinary team. The endolaryngeal part of the hemangioma dried out after embolization and completion hemithyroidectomy. Her hoarseness has greatly improved but a definitive voice handicap remains.High-flow arterio-venous malformations of the thyroid gland are a rare disease, and recurrent lesions have not been reported. Interdisciplinary management of these patients is mandatory due to the complex nature of the underlying pathology. Recurrence might develop after long free intervals.

Background Nonocclusive mesenteric ischemia (NOMI) can occur after cardiac surgery, commonly in conjunction with use of cardiopulmonary bypass. Some evidence suggests that serum procalcitonin (PCT) levels are increased in patients with mesenteric ischemia; however, an association between PCT and NOMI has not yet been studied. The current study investigates whether elevated serum PCT levels are found in patients exhibiting NOMI. Methods In an observational cohort study of 865 patients undergoing elective cardiac surgery, 78 experienced NOMI. Preoperative and postoperative PCT levels were determined by means of enzyme-linked immunosorbent assay. Odds ratios and 95% confidence intervals were calculated by logistic regression analyses to predict accuracy of PCT in identifying patients with NOMI. Additional models were calculated, adjusting for potential confounders. Results Patients with NOMI had higher postoperative PCT levels than control patients (20.8 ± 3.2 ng/mL versus 2.3 ± 1.1 ng/mL; p Conclusions Postoperative measurement of PCT seems useful to improve the clinical and noninvasive identification of patients with NOMI after cardiac surgery.

Purpose To compare abdominal imaging dose from 3D imaging in radiology (standard/low-dose/dual-energy CT) and radiotherapy (planning CT, kV cone-beam CT (CBCT)). Methods Dose was measured by thermoluminescent dosimeters (TLD’s) placed at 86 positions in an anthropomorphic phantom. Point, organ and effective dose were assessed, and secondary cancer risk from imaging was estimated. Results Overall dose and mean organ dose comparisons yield significantly lower dose for the optimized radiology protocols (dual-source and care kV), with an average dose of 0.34±0.01 mGy and 0.54±0.01 mGy (average ± standard deviation), respectively. Standard abdominal CT and planning CT involve considerably higher dose (13.58 ± 0.18 mGy and 18.78±0.27 mGy, respectively). The CBCT dose show a dose fall-off near the field edges. On average, dose is reduced as compared with the planning or standard CT (3.79 ± 0.21 mGy for 220° rotation and 7.76 ± 0.37 mGy for 360°), unless the high-quality setting is chosen (20.30 ± 0.96 mGy). The mean organ doses show a similar behavior, which translates to the estimated secondary cancer risk. The modelled risk is in the range between 0.4 cases per million patient years (PY) for the radiological scans dual-energy and care kV, and 300 cases per million PY for the high-quality CBCT setting. Conclusions Modern radiotherapy imaging techniques (while much lower in dose than radiotherapy), involve considerably more dose to the patient than modern radiology techniques. Given the frequency of radiotherapy imaging, a further reduction in radiotherapy imaging dose appears to be both desirable and technically feasible.

To investigate the 3-year outcome of patients with peripheral arterial disease (PAD) and heavily calcified stenotic lesions of the superficial femoral artery after directional atherectomy. Fifty-three patients (mean age 67 ± 10 years; 18 females, 35 males, TASC B and C, mean lesion length 7.9 ± 3.5 cm) with PAD (Rutherford 2–6) were enrolled into this prospective monocentric study. In total, 59 calcified lesions of the superficial femoral artery were treated with the Silverhawk atherectomy device (Covidien, Plymouth, MN, USA). Patients were followed-up for 36 months with a 6-month interval to perform clinical re-evaluation, including measurement of maximum walking distance and ankle–brachial index (ABI) as well as duplex-sonography. The primary success rate of the procedure was 92 %. In five cases (8 %), additional balloon-PTA and/or stent-PTA was necessary. Procedure-related embolization occurred in seven cases (12 %), which were all successfully treated by aspiration. The primary patency rate after 3 years was 55 %. Median Rutherford score decreased significantly from 5 to 0 after 36 months (p

Objective Nonocclusive mesenteric ischemia (NOMI) may occur after cardiopulmonary bypass. It is crucial to early identify patients who are at risk of developing this complication. The aim of this prospective study was to evaluate perioperative risk factors in a large cohort of patients undergoing elective cardiac surgery. Methods From January 1, 2010, to March 31, 2011, all patients scheduled for elective cardiac surgery were screened for participation in this trial. If NOMI was suspected, arterial angiography was performed. NOMI and non-NOMI patients were compared with respect to all variables assessed in this study. Additionally, odds ratios were calculated. Linear discriminant analyses as well as logistic regression analyses were performed to develop a model that identifies patients at risk for developing NOMI. Results Eight hundred sixty-five patients were included in the study, of whom 78 developed NOMI. Among preoperative parameters, renal insufficiency, diuretic therapy, and age >70 years showed the highest odds ratios for postoperative NOMI. The highest odds ratios for development of NOMI were observed with postoperative variables. In particular, the need for intra-aortic balloon pump support and serum lactate concentrations >5 mmol/L proved to be serious risk factors. Using a linear discriminant analysis with 7 variables, 92.3% of patients were correctly classified (sensitivity 76.9%, specificity 93.8%). Conclusions A high index of suspicion for NOMI in patients with the above-mentioned risk factors may decrease the diagnostic and therapeutic delay. To identify at-risk patients the developed risk equation is a useful tool with a high specificity.

Reducing hyperinflated areas in chronic obstructive pulmonary disease, either surgically or endoscopically, leads to improvement of functional parameters. It is unclear if bilateral treatment with endobronchial valves (EBV) aiming at total lobar occlusion is beneficial. The aim of this study was to assess the results after staged bilateral endoscopic treatment with EBV. This is a retrospective analysis of patients with severe airflow obstruction, who were treated bilaterally with EBV in two stages, aiming at subsequent atelectasis. Pre- and postintervention lung function parameters, the 6-minute walk test (6-MWT), complications, and follow-up were recorded. Sixteen patients were treated bilaterally in two stages. There was an overall improvement in lung function from baseline to second-treatment follow-up with an increase in FEV1 (23.57-29.21% of predicted) and a decrease in residual volume (299.21-240.10% of predicted) and total lung capacity (140.78-128.71% of predicted). The 6-MWT improved up to 54 m. After each procedure, 9 of 16 patients (56.25%) developed an atelectasis of the target lobe. Overall, pneumothorax occurred in 8 of 32 procedures (25%). No patient died. Patients benefitted from the first EBV treatment. The second treatment did not lead to marked improvements compared to the first treatment. Bilateral lung volume reduction with valves is possible; however, the current results seem not to justify bilateral valve treatment as a routine approach.

Purpose: To establish a standardized scoring system for angiographic findings in patients with non-occlusive mesenteric ischemia (NOMI). Materials and Methods: In 36 patients (mean age: 72 years), 53 angiographies of the superior mesenteric artery (SMA) were performed for suspected NOMI after cardiac or major aortic surgery. All examinations were performed using a standardized DSA technique. Two experienced radiologists performed a consensus reading blinded to the clinical information, on two occasions with an interval of two weeks. In order to investigate the reproducibility of the criteria, the images were assessed once by an intensivist and a medical student. Image analysis was performed with respect to vessel morphology, reflux of contrast medium into the aorta, small bowel parenchymal contrast enhancement and distension and the delay between arterial injection and portal vein filling. Results: Almost perfect intra-observer correlation was obtained for the assessment of the contrast medium reflux (κ = 0.82) and substantial correlation for the time of portal vein filling (κ = 0.66). Moderate correlations were obtained for the vessel morphology (κ = 0.51), small bowel enhancement (κ = 0.63) and distension (κ = 0.53). Contrast medium reflux into the aorta (κ = 0.77 and 0.63) and the time of portal vein filling (κ = 0.42 and 0.58) resulted in the highest inter-observer correlations between the radiologists and the intensivist as well as the radiologists and the student. Conclusion: In patients with suspected NOMI, using our scoring system yields high intra- and inter-observer correlations, allowing a standardized evaluation of angiographic findings.

Ziel: Evaluation des Nutzens eines Reentry-Katheters bei der subintimalen Revaskularisation von chronischen Verschlussen der Beckengefase. Material und Methoden: Bei 5 Patienten (Durchschnittsalter 67 ± 12; 3 Frauen, 2 Manner) mit einem Verschluss der A. iliaca com. bzw. ext. (TASC B bis D) wurde ein Revaskulariationsversuch vorgenommen. Bei allen Patienten konnte der Verschluss subintimal passiert werden. Der Wiederanschluss an das Gefaslumen konnte jedoch erst nach Einsatz eines Reentry-Katheters erreicht werden. Die Patienten wurden nach 6, 12, 18 und 24 Monaten nachuntersucht, wobei der Knochel-Arm-Index (KAI) und das Rutherfordstadium bestimmt wurden. Zudem wurde eine Duplex-Sonografie zur Evaluierung der Offenheitsrate durchgefuhrt. Ergebnisse: Die technische Erfolgsrate betrug 100 %. Bei allen Patienten wurde zur Etablierung des Rekanalisationstrakts zusatzlich zur Ballon-Angioplastie eine Stent-Implantation durchgefuhrt. Das mittlere Rutherford-Stadium sank von initial 3,6 ± 0,9 auf 0,33 ± 0,57 und der KAI stieg von 0,67 ± 0,06 auf 1,2 ± 0 nach 24 Monaten. Die Duplex-Sonografie ergab bei allen Patienten kein Hinweis auf eine Restenose. Schlussfolgerung: Der Reentry-Katheter erlaubt bei der subintimalen Rekanalisation von chronisch verschlossenen Beckengefasen einen sicheren Anschluss an das wahre Lumen. Nach der subintimalen Rekanalisation konnte zudem eine signifikante Reduktion des Rutherford-Stadiums, eine Steigerung des KAI und eine gute Offenheitsrate im Verlauf von 2 Jahren beobachtet werden. Purpose: To demonstrate the value of a Reentry-Catheter for true lumen access after subintimal revascularization of chronic iliac artery occlusions. Materials and Methods: Subintimal revascularization was performed in 5 patients (mean age: 67 ± 12 years; female: 3, male: 2) with total iliac artery occlusion (TASC B to D), but without gaining access to the true lumen distal to the occlusion. Subsequently, a Reentry-Catheter was used to establish reentry and a new subintimal tract. Patients were followed up after 6, 12 and 24 months for clinical re-evaluation to determine the Rutherford score and the ankle brachial index (ABI). In addition, duplex ultrasound was performed to evaluate vessel patency. Results: The primary technical success rate was 100 %. In all cases angioplasty was followed by stent placement to establish the subintimal tract. The mean Rutherford score decreased from 3.6 ± 0.9 to 0.33 ± 0.57 after 24 months, while the ABI increased from 0.67 ± 0.06 to 1.2 ± 0. Vessel patency was observed in all patients available for follow-up examinations. Conclusion: The Reentry-Catheter reliably allowed access to the true lumen after subintimal revascularization of occluded iliac arteries. Results in this small patient cohort showed a significant reduction in the Rutherford score, increase in the ABI, and a good patency rate after two years.

The purpose of this study was to prospectively compare the effect of inspiration and resting expiratory position on contrast enhancement in pulmonary CT angiography (CTA) in a randomized clinical trial.In accordance with a power analysis performed before the study, we included 28 consecutive patients referred for evaluation of suspected pulmonary embolism in this prospective study. Patients were randomly assigned to perform either inspiration (n = 14; six men, eight women; mean age [SD], 38.1 ± 9.8 years) or resting expiratory position (n = 14; six men, eight women; mean age: 42.1 ± 9.2 years). All patients were scanned in a standardized supine position and scanning parameters were kept constant. Contrast medium was injected automatically with bolus tracking. Objective pulmonary vessel attenuation was quantified with digital measurement. Results were analyzed by using the unpaired t test and chi-square test.Patients in the resting expiratory position showed significantly higher contrast attenuation than those who performed inspiration (302.9 ± 11.9 HU vs 221.5 ± 20.9 HU; p0.01). There were no significant differences in applied total volume of contrast agent (76.8 ± 1.9 mL vs 75.7 ± 1.6 mL; p = 0.6765), total volume including normal saline bolus (116.8 mL ± 2.8 mL vs 121.8 mL ± 2.3 mL; p = 0.1724) or flow rate (3.1 mL/s ± 0.1 mL/s vs 3.2 mL/s ± 0.1 mL/s).Pulmonary CTA should be performed in the resting expiratory position, and patients should be instructed to avoid inspiration to achieve the highest possible attenuation in the pulmonary arteries.

Patients with a forced expiratory volume in 1 s (FEV1) below 20% of the predicted normal values (pred.) and either homogeneous emphysema or low diffusing capacity for carbon monoxide (DLCO) have a high risk for adverse events including death when undergoing surgical lung volume reduction.We hypothesized that selected patients can benefit from endoscopic lung volume reduction (eLVR) despite a very low FEV1.This study is a retrospective analysis of consecutive patients with severe airflow obstruction, an FEV1 ≤20% of pred., and low DLCO who were treated by eLVR with endobronchial valves (EBV) between June 2012 and January 2015. Pre- and postinterventional lung function parameters, the 6-min walking test (6-MWT) distance, adverse events, and follow-up were recorded.In 20 patients, there was an overall improvement in lung function with an increase in FEV1 (16.97-21.03% of pred.) and a decrease in residual volume (322-270% of pred.) and total lung capacity (144-129.06% of pred.). The 6-MWT distance improved (from 239 ± 77 to 267± 97 m overall, and from 184 ± 50 to 237 ± 101 m if patients developed an atelectasis of the target lobe). Pneumothorax occurred in 5 of the 20 patients (25%). 30-day mortality was 0%, and all patients survived to discharge.The patients benefitted moderately from EBV treatment despite an initially low FEV1. Some patients improved remarkably. EBV treatment in patients with an FEV1 ≤20% of pred. is generally feasible and safe. The greatest risk is pneumothorax with prolonged chest tube duration.

Purpose: To report a retrospective observational analysis of standard balloon angioplasty (BA) vs. paclitaxel-coated balloon angioplasty (PCBA) for symptomatic central vein restenoses in patients with impaired native hemodialysis fistulas. Methods: A retrospective review was conducted of 27 consecutive patients (15 men; mean age 66±13.8 years, range 39–90) with 32 central vein stenoses (CVS; 6 axillary, 11 subclavian, 12 brachiocephalic, and/or 3 superior caval veins) treated successfully using BA. Freedom from reintervention after BA of de novo lesions was 7.4±7.9 months (range 1–24). Twenty-five (92.6%) patients developed symptomatic restenoses and were treated one or more times by BA (n=32) or PCBA (n=20) using custom-made paclitaxel-coated balloons (diameter 6–14 mm). Results: Technical (50% of patients were event-free during the observation period (mean freedom from TLR 10 months). Restenosis intervals were prolonged by PCBA (median 9 months) vs. BA (median 4 months; p=0.023). Conclusion: Paclitaxel-coated balloon angioplasty of central vein restenosis in patients with hemodialysis shunts yields a statistically significant longer freedom from TLR compared to standard balloon angioplasty.