Clinical outcomes of inferior vena cava filter placement in patients with renal vein anomalies.

BACKGROUND: To investigate the clinical outcomes in patients with renal vein anomalies who undergo inferior vena cava (IVC) filter placement. METHODS: Contrast-enhanced computed tomography images of 410 patients who underwent IVC filter placement were retrospectively reviewed to detect renal vein anomalies. Clinical outcomes involving de novo pulmonary embolism and worsening of renal function were compared between patients with the location of filters placed in relation to the anomalous renal veins versus not in relation to any renal veins. RESULTS: A total of 97 (23.7%) renal vein anomalies were identified: 62 (15.1%) multiple right renal veins, 23 (5.6%) circumaortic left renal veins, 10 (2.4%) retroaortic left renal veins, and 2 (0.5%) accessory left renal veins. Frequency of de novo pulmonary embolism in patients with circumaortic left renal veins who had filters placed at or in between the 2 left renal veins was not significantly different from patients who underwent infra- or suprarenal filter placement (5.9% [1/17] vs. 3.1% [12/387]; P = 0.433). The frequency of patients who had a >25% decrease in estimated glomerular filtration rate after IVC filter placement was not significantly different whether the filter was placed in an infrarenal location or at or above the level of the anomalous renal veins (11.0% [37/335] vs. 17.6% [6/34]; P = 0.261). CONCLUSIONS: Clinical outcomes involving the frequency of de novo pulmonary embolism and worsening of renal function are not dependent on location of IVC filter placement in patients with renal vein anomalies.

Incidence and complications of accidental cannulation of retroperitoneal veins during venography for inferior vena cava filter placement.

BACKGROUND: The purpose of this study was to evaluate the incidence and complications of accidental cannulation of retroperitoneal veins during venography for inferior vena cava (IVC) filter placement. METHODS: In total, 641 patients who underwent IVC filter placement were retrospectively reviewed. Incidence of accidental cannulation of retroperitoneal veins during venography (using 633 sheaths and 18 catheters, including 11 pigtail type and 7 end-hole-type catheters), along with the associated complications, were evaluated. RESULTS: The overall frequency of accidental cannulation of retroperitoneal veins was 5.4% (35 of 651) via venous approaches: 5.8% (24 of 411) via a right femoral approach, 3.9% (5 of 129) via a left femoral approach, and 5.4% (6 of 111) via a jugular approach. The most frequent veins cannulated were the ascending lumbar veins (4.6%, 25 of 540) via a femoral approach, and the median sacral vein (3.6%, 4 of 111) via a jugular approach. No significant difference in the frequency of accidental cannulation was observed between venography through sheaths and catheters (5.4% [n = 34] vs. 5.6% [n = 1; using an end-hole-type catheter]; P = 1.000). Injuries to 5 veins (0.8%), including 3 ascending lumbar veins, were observed. Inadvertent filter placement within the right ascending lumbar vein was observed in 1 patient (0.2%). CONCLUSIONS: Accidental cannulation of retroperitoneal veins during venography for IVC filter placement is an infrequent occurrence, and in this patient series did not result in negative clinical outcomes. However, operators should be aware of the risk of accidental cannulation to prevent avoidable complications such as venous injury or filter misplacement.

Acute complete splenic infarction secondary to COVID-19 infection.

Splenic infarction in COVID-19 patients is a rare entity with few documented cases. We report a case of symptomatic complete splenic infarction and discuss COVID-19 related thrombosis, splenic infarction, diagnostic imaging for splenic infarction, and the management. Thrombotic events related to COVID-19 have been reported in unusual locations, and our case highlights an example of one such location, the splenic artery. Contrast enhanced Computed Tomography (CT) is the standard diagnostic modality and will typically reveal foci of hypo-enhancement, peripheral and wedge-shaped. CT angiography can be performed to evaluate the arteries and diagnose thrombosis. The primary treatment is aimed at addressing the underlying cause and includes supportive care. It is important that physicians consider splenic infarction as an explanation for abdominal pain in COVID-19 patients.

Characterizing the Online Presence of Interventional Radiologists: A Potential Marketing Opportunity.

Purpose Patients increasingly utilize online resources to access healthcare information. Over the years, there has been an increasing trend of websites that allow patients to review their physicians. In many instances, the information found on these websites can be inaccurate or obsolete. This can affect patients' ability to make informed decisions about their provider choices. The need for interventional radiologists (IRs) is expected to rise due to an increasing demand for minimally invasive procedures. However, there is a lack of research regarding their online presence. Therefore, this study aims to characterize the online presence of IRs in the United States. Materials The Physicians Compare National Downloadable File (PCNDF) from the Center for Medicare Services was used to identify a sample of IRs in the United States. Then, a Google Custom Search Engine was created to parse the first ten search results for each physician using a set of search parameters. A coded script analyzed the URL contents of each link and placed the search results into one of the following categories: health or hospital system, third-party, social media, academic journal, or other. Results A total of 1,666 IRs were included for analysis. The results are as follows: 26.94% were from hospital or health systems, 66.93% were from third-party websites, 5.48% were from social media sites, 0.02% were from academic journals, and 0.64% were from other. Conclusion The online presence of IRs is primarily controlled by third-party websites, many of which do not allow physicians to manage their content. As the field of interventional radiology continues to grow; a great opportunity exists for physicians to expand their digital presence to more accurately reflect their practice.

Optimizing the Interventional Approach for Embolization of Pulmonary Arteriovenous Malformations in Patients With Osler-Weber-Rendu Syndrome.

Techniques in vascular and interventional radiology are adapted to the ever-evolving clinical challenges that interventional operators face. In the case of rare diseases, supporting literature that guides an operator's plan for intervention is limited. As a result, published case reports and series can be utilized to direct future intervention and potentially help others tasked with similar clinical scenarios. The proceeding case offers an interventional solution to a clinical manifestation of an otherwise rare disease, Osler-Weber-Rendu (OWR) syndrome. The supporting literature for techniques in embolization of pulmonary arteriovenous malformations (AVMs) in OWR syndrome is limited due to disease rarity. Therefore, the objective of the following case is to offer clinical insights on how to perform this procedure successfully and critique methods previously utilized.

Becoming the Standard: Expanding the Conventional Use of Interventional Embolization for Ruptured Pulmonary Artery Aneurysms.

Behcet's disease is inflammatory vasculitis that has a high incidence of mortality in patients with pulmonary artery aneurysm (PAA) formation. Traditionally, patients with Behcet's disease and PAA rupture undergo invasive surgical management. Surgical intervention; however, has been shown to have high complication, failure, and mortality rates. It has become a more contemporary practice to utilize the interventional embolization of pulmonary artery aneurysms (PAAs) in patients with Behcet's disease and other various etiologies because of its inherent minimally invasive nature and decreased risk for complications. The management paradigm for treating PAAs has shifted toward endovascular embolization even in severe or emergent cases where surgical management was once thought to be the standard. The following case is a testimony to the practicality of interventional embolization in the setting of a symptomatic patient presenting with PAAs.