Clinical Efficacy, Safety, and Feasibility of Using Video Glasses during Interventional Radiologic Procedures: A Randomized Trial.

PURPOSE: To evaluate the clinical efficacy, safety, and feasibility of implementing video glasses in a variety of interventional radiologic (IR) procedures. MATERIALS AND METHODS: Between August 2012 and August 2013, 83 patients undergoing outpatient IR procedures were randomized to a control group (n = 44) or an experimental group outfitted with video glasses (n = 39). State-Trait Anxiety Inventory (STAI) scores, sedation and analgesia doses, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), pain scores, and procedure times were obtained. Complications and adverse events related to the use of video glasses were recorded. Postprocedural staff surveys and patient satisfaction surveys were completed. RESULTS: Women had greater preprocedural anxiety than men (P = .0056), and patients undergoing vascular interventions had greater preprocedural anxiety than those undergoing nonvascular interventions (P = .0396). When assessed after the procedure, patients who wore video glasses had significantly reduced levels of anxiety (-7.7 vs -4.4, respectively; P = .0335) and average MAP (-6.3 vs 2.1, respectively; P = .0486) compared with control patients. There was no significant difference in amount of sedation and analgesia, HR, RR, pain score, or procedure time between groups. No significant adverse events related to the use of video glasses were observed. Postprocedural surveys showed that video glasses were not distracting and did not interfere or pose a safety issue during procedures. Patients enjoyed using the video glasses and would use them again for a future procedure. CONCLUSIONS: Video glasses can be safely implemented during IR procedures to reduce anxiety and improve a patient's overall experience.

Assisted maturation of native fistula in two patients with a continuous flow left ventricular assist device.

Patients who receive a left ventricular assist device (LVAD) are prone to develop end-stage renal disease. Primary arteriovenous fistula (AVF) maturation in these patients may be unsuccessful secondary to the nonpulsatile flow with an LVAD. Two patients with LVADs are described in whom assisted maturation aided long-term AVF patency.

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.

Impact of Early Direct Patient Notification on Follow-Up Completion for Nonurgent Actionable Incidental Radiologic Findings.

PURPOSE: The aim of this study was to evaluate whether early direct patient notification in addition to an existing multistage recommendation-tracking system (Backstop) increases follow-up completion rates for actionable incidental findings (AIFs). Patient attitudes toward early notification were also assessed. METHODS: This prospective, randomized controlled trial recruited patients with AIFs requiring follow-up being enrolled into the Backstop system. Patients were randomized into four groups: those receiving additional early direct notification in a mailed letter (group 1, similar to Pennsylvania Act 112), by phone (group 2), or in an electronic portal message (group 3) and a control group (group 4) without additional notifications added to the existing Backstop system. Differences in follow-up completion rates among these groups were determined using χ2 tests. Patients were surveyed on binary yes/no and Likert-type scale questions, and descriptive statistics are reported. RESULTS: Data from 2,548 randomized patients were analyzed for the study, including 593 patients notified by letter, 637 notified by phone, 701 notified by portal, and 617 control patients. Group 3 demonstrated the lowest rate of follow-up completion within 1 month of the follow-up due date at 36.4%, compared with 58.7% for group 1, 60.4% for group 2, and 53.2% for group 4 (P < .0001 for all). Group 2 was the only group to have a significantly higher completion rate than group 4 (P = .014). Patients responded positively regarding early notification and preferred electronic portal communication. CONCLUSIONS: Early direct notification had a mixed impact on follow-up completion rates on the basis of communication modality but was positively received by patients and may have health care benefits when implemented within a recommendation-tracking system.

Transjugular intrahepatic portosystemic shunts in liver transplant recipients: technical analysis and clinical outcome.

OBJECTIVE: The purpose of this study is to compare the technical success of transjugular intrahepatic portosystemic shunt (TIPS) in transplanted versus nontransplanted livers and to assess the clinical outcome of TIPS in liver transplant recipients. MATERIALS AND METHODS: A retrospective audit of patients receiving a TIPS was performed in two institutions during 1996-2009. The technical success of the TIPS was compared for transplanted versus nontransplanted livers. Clinical success was defined as graft survival longer than 1 month with improvement in symptoms. The cohort was divided into grafts that survived less than 3 months versus 3 months or more. The model for end-stage liver disease (MELD) scores and portosystemic gradients before and after TIPS creation were evaluated for predictive value for graft survival. The TIPS stent type, MELD scores and portosystemic gradients before and after TIPS creation, and causes of liver disease were evaluated for their predictive value for ascites response after TIPS creation. RESULTS: Thirty-nine TIPS in transplanted livers were found, representing 5.5% (39/715) of all TIPS procedures performed and 2.0% (39/1992) of all liver transplant recipients. Ninety percent of TIPS in transplanted livers had ascites. The median time from transplant to creation of the TIPS was 29 months (2-127 months). The median MELD score was 16 before and 22 after the TIPS procedure. The technical success rates for TIPS were 97% (38/39) in transplanted livers versus 97% (657/676) in nontransplanted livers (p = 1.00). Intent-to-treat clinical success rates were 36% for all indications versus 31% for ascites only. There were no predictors for ascites response. Six-, 12-, and 24-month graft survival rates were 43%, 32%, and 22%, respectively. One-year graft survival for a MELD score less than 17 versus a score of 17 or higher was 54% versus 8%, respectively (p < 0.05). CONCLUSION: Transplantation does not pose a technical challenge to TIPS creation. One third of patients have a favorable outcome. MELD score is the only predictor of graft survival.

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.

Effective photodynamic therapy against microbial populations in human deep tissue abscess aspirates.

BACKGROUND AND OBJECTIVE: The primary therapy for deep tissue abscesses is drainage accompanied by systemic antimicrobial treatment. However, the long antibiotic course required increases the probability of acquired resistance, and the high incidence of polymicrobial infections in abscesses complicates treatment choices. Photodynamic therapy (PDT) is effective against multiple classes of organisms, including those displaying drug resistance, and may serve as a useful adjunct to the standard of care by reduction of abscess microbial burden following drainage. STUDY DESIGN/MATERIALS AND METHODS: Aspirates were obtained from 32 patients who underwent image-guided percutaneous drainage of the abscess cavity. The majority of the specimens (24/32) were abdominal, with the remainder from liver and lung. Conventional microbiological techniques and nucleotide sequence analysis of rRNA gene fragments were used to characterize microbial populations from abscess aspirates. We evaluated the sensitivity of microorganisms to methylene blue-sensitized PDT in vitro both within the context of an abscess aspirate and as individual isolates. RESULTS: Most isolates were bacterial, with the fungus Candida tropicalis also isolated from two specimens. We examined the sensitivity of these microorganisms to methylene blue-PDT. Complete elimination of culturable microorganisms was achieved in three different aspirates, and significant killing (P < 0.0001) was observed in all individual microbial isolates tested compared to controls. CONCLUSIONS: These results and the technical feasibility of advancing optical fibers through catheters at the time of drainage motivate further work on including PDT as a therapeutic option during abscess treatment.

Prevalence, presentation, and endovascular management of hemodynamically or clinically significant arterio-portal fistulae in living and cadaveric donor liver transplant recipients.

PURPOSE: To compare the prevalence (cadaveric vs. living donor transplants), clinical features, and the effectiveness of endovascular management of significant arterio-portal fistulae (APF) in liver transplant recipients. METHODS: A retrospective audit of liver transplant recipients in two institutions was performed (1996-2009). Significant APF were included and were defined as symptomatic and/or hemodynamically significant (causing graft dysfunction and/or having abnormal Doppler findings in the portal vein). Patients with significant APF were evaluated for presenting symptoms, imaging features, size/branch order portal vein involvement, and effectiveness of the endovascular management (coil embolization). RESULTS: Four significant APF were found in 1992 (0.2%) liver transplants. Two were symptomatic and two were asymptomatic but were hemodynamically significant with liver function test abnormalities. All four APF were found in cadaveric donor graft recipients (0.23%, N = 4/1753) and none in 239 living donor graft recipients. However, there was no statistical difference between cadaveric and living donor graft recipients (p = 1.0, odds ratio = 1.23). Coil embolization was technically and clinically successful in all 4 without complications and causing normalization of the abnormal Doppler findings. CONCLUSION: Significant APF are a rare diagnosis (0.2% of transplants). Coil embolization is a safe and effective treatment option for APF in transplants.

Comparison of technical success and complications of percutaneous transhepatic cholangiography and biliary drainage between patients with and without transplanted liver.

OBJECTIVE: The purpose of this study is to compare technical success and complications of percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD) between patients with and without transplanted liver. MATERIALS AND METHODS: Between 2007 and 2011, 89 PTCs, including 34 PTBDs, in 87 patients with transplanted liver were attempted, and 131 PTCs, including 118 PTBDs, in 126 patients without transplanted liver were attempted. Technical success, diameters of the bile ducts, fluoroscopy time, and complications were statistically compared between the two groups. RESULTS: The technical success rate of PTC for transplanted liver was significantly lower than that for nontransplanted liver (88.8% vs 98.5%; p = 0.004). Consequently, the technical success rate of PTBD for transplanted liver was also significantly lower than that for nontransplanted liver (75.0% vs 95.8%; p < 0.001). The average diameters of the first branches and second branches of the bile ducts of transplanted liver were significantly smaller than those of nontransplanted liver (5.8 ± 3.4 mm vs 8.7 ± 3.9 mm for the first branches [p < 0.001]; and 3.7 ± 1.7 mm vs 5.8 ± 2.4 mm for the second branches [p < 0.001]). No significant difference of fluoroscopy time of unilateral successful PTBD was observed (21.8 ± 11.7 vs 19.3 ± 12.9 min; p = 0.372), and no significant difference of overall complication rates was observed (8.0% vs 8.7%; p = 1.000) between transplanted and nontransplanted liver. CONCLUSION: The technical success rates of PTC and PTBD for transplanted liver are slightly lower than those for nontransplanted liver because the bile ducts are smaller. There is no significant difference in complication rate.

The role of justice perceptions in formal and informal university technology transfer.

We extend organizational justice theory by investigating the justice perceptions of academic entrepreneurs regarding interactions with their universities. We assess how these justice perceptions influence the propensity of academic entrepreneurs to engage in different forms of commercialization, as well as the moderating role of entrepreneurial identity and prosocial motivation. We test our predictions using data from 1,329 academic entrepreneurs at 25 major U.S. research universities. Our results indicate that organizational justice is positively associated with intentions to engage in formal (i.e., sanctioned) technology transfer, and negatively associated with intentions to engage in informal (unsanctioned and noncompliant) technology transfer, which we characterize as a form of organizational deviance. Our findings also show that entrepreneurial identity and prosocial motivation (i.e., a focus on oneself vs. others) amplify and attenuate, respectively, the relationship between justice perceptions and technology transfer intentions. Finally, although intentions to engage in formal technology transfer predict subsequent behavior, intentions to engage in informal technology transfer do not. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Incidence of cholangitis and sepsis associated with percutaneous transhepatic biliary drain cholangiography and exchange: a comparison between liver transplant and native liver patients.

OBJECTIVE: The purpose of our study was to determine the rate of sepsis and cholangitis associated with percutaneous biliary drain cholangiography and subsequent drain exchanges and to compare the incidence of these complications between patients with liver transplants and those with native livers. MATERIALS AND METHODS: A retrospective review of 154 consecutive patients (100 with liver transplants and 54 with native livers) who underwent a total of 910 percutaneous biliary drain cholangiography examinations and exchanges (January 2005 to July 2008) was performed. Cholangitis was defined as fever (> 38.5°C) within 24 hours after the intervention, and sepsis included cholangitis in addition to hemodynamic instability. RESULTS: The overall incidence of cholangitis and sepsis after percutaneous biliary drain exchanges was 2.1% (n = 19/910 exchanges) and 0.4% (n = 4/910 exchanges), respectively. There was no statistically significant difference in complications between liver transplant patients versus nontransplant patients (p = 0.34 for cholangitis and p = 1.00 for sepsis). The mean hospital stay due to postprocedural complications was 2.4 days for observation and supportive treatment. None of these patients required an intensive care stay. Mean percutaneous biliary drain dwell time in liver transplant and nontransplant patients was 6.2 and 1.5 months, respectively. Transplant patients were significantly younger (54 versus 67 years; p << 0.05), male predominant (70% vs 52%, p = 0.035), and had more severe liver disease (12.2 vs 8.0 Model for End-Stage Liver Disease [MELD] scores; p << 0.05). CONCLUSION: Percutaneous biliary drain cholangiography and exchange is associated with a low rate of postprocedure cholangitis and sepsis. These complications require brief hospitalizations. Liver transplant patients do not have an increased risk of complications despite higher MELD scores and longer intubation periods.

Stent-grafts for transjugular intrahepatic portosystemic shunt creation: specialized TIPS stent-graft versus generic stent-graft/bare stent combination.

PURPOSE: To compare functional and anatomic outcomes of transjugular intrahepatic portosystemic shunts (TIPSs) created with the specialized Viatorr stent versus a Wallstent/Fluency stent combination. MATERIALS AND METHODS: Retrospective review of patients who underwent TIPS creation with stent-grafts was conducted over a 54-month period ending in June 2008. Patients were divided into three groups: Viatorr only, Fluency only, and combined Viatorr/Fluency, the latter of which was included in the overall evaluation but excluded from the comparative analysis between the Viatorr and Fluency groups. Patient demographics, Child-Pugh scores, and portosystemic gradient (PSG) reduction were compared. Patencies were calculated using the Kaplan-Meier method and compared. RESULTS: A total of 126 TIPSs created with stent-grafts were found: 28 with Fluency stents, 93 with Viatorr devices, and five combined. No significance in demographic factors or PSGs was found among groups (P > .05). Major encephalopathy rates were 3.6% and 4.3% in the Fluency and Viatorr groups, respectively (P = 1.000). Hemodynamic success rates were 93% and 98% in the Fluency and Viatorr groups, respectively (P = .099). The primary unassisted patency rates at 6, 9, and 12 months were 87%, 81%, and 81%, respectively, in the Fluency group and 95%, 93%, and 89%, respectively, in the Viatorr group (P = .03). Portal and hepatic end stenoses were the causes of TIPS narrowing in the Fluency and Viatorr groups, respectively. CONCLUSIONS: The Wallstent/Fluency stent combination is associated with a 1-year patency rate greater than 80%, with no significant difference versus the Viatorr stent regarding technical and hemodynamic success and encephalopathy rate. However, the Viatorr stent is associated with improved patency (89%) versus this bare stent/stent-graft combination.

Transjugular intrahepatic portosystemic shunts in liver transplant recipients for management of refractory ascites: clinical outcome.

PURPOSE: To determine the effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) creation in liver transplant recipients with recurrent portal hypertension presenting with refractory ascites. MATERIALS AND METHODS: A retrospective review of transplant recipients undergoing TIPS creation was performed over a 6-year period. Recipients were noted for age, sex, TIPS indication, Model for End-stage Liver Disease (MELD) score, cause of initial liver disease, and time between first transplantation and TIPS creation. Clinical success was defined as graft survival of longer than 1 month with improvement in ascites. New-onset or worsening encephalopathy was noted. Graft survival and patency were calculated according to the Kaplan-Meier method. MELD score and portosystemic gradient (PSG) before and after TIPS creation were evaluated for prediction of graft loss less than 3 months after TIPS creation. RESULTS: Nineteen liver transplant recipients underwent TIPS creation for ascites. Mean time from transplantation was 3.5 years (range, 3.7-112.2 months). Mean MELD score before TIPS creation was 17 (range, 7-24). The technical, hemodynamic, and clinical success rates were 100%, 95%, and 16%, respectively. Encephalopathy developed in five patients (26%). Thirty- and 90-day mortality rates were 16% (n = 3) and 21% (n = 4), respectively. Primary unassisted patency and graft survival rates at 1, 3, and 6 months were 100%, 90%, and 90% and 79%, 58%, and 47%, respectively. MELD score parameters were significant indicators (P < .05) for graft survival beyond 3 months, but PSG parameters were not. CONCLUSIONS: TIPS for the management of ascites in liver transplant recipients is not as clinically effective as it is in patients with native livers (16% vs 50%-80% in the literature). MELD score is a predictor of graft survival; PSG parameters are not.

Intravenous morphine for augmentation of postoperative T-tube cholangiograms in liver transplant recipients with choledocho-choledochal anastomoses.

PURPOSE: To determine the effectiveness of augmenting T-tube cholangiography by using intravenous morphine in orthotopic liver transplant recipients with choledocho-choledochostomies and poor filling of intrahepatic biliary ducts and to determine factors that may increase the likelihood of nonfilling of intrahepatic ducts. MATERIALS AND METHODS: A retrospective review of T-tube cholangiograms obtained in orthotopic liver transplant recipients was performed. Intravenous morphine had been given by two of five operators to augment T-tube cholangiograms with poor filling of bile ducts. Patients with malpositioned tubes and decompressive bile leaks were excluded from morphine diagnostic efficacy evaluation but were included in the overall cholangiogram diagnostic yield. Anastomotic narrowing, if present, was graded as follows: >50%, 20%-50%, and <20% diameter reduction. Patients with intrahepatic bile duct filling were compared to those without filling with regard to age, sex, time from transplantation, and clinically significant (>50%) stenoses. RESULTS: One hundred sixty-eight cholangiograms were obtained in 127 recipients. Twenty-three of the 168 cholangiograms (13.7%) had malpositioned/blocked T-tubes and five (3%) had decompressive leaks; 140 cholangiograms had well-positioned tubes and no leaks. Twenty-two of the 140 cholangiograms with well-positioned tubes and no leaks (15.7%) had nonfilling of peripheral bile ducts. Morphine (range, 2-6 mg; mean, 4 mg) had been used in 13 cases. Adequate filling after morphine was noted in 12 of the 13 cases (92%), and no complications occurred. Morphine improved adequate diagnostic examination of well-positioned patent T-tubes from 85% (123/145) to 93% (135/145). No parameters helped predict inadequate filling in well-positioned tubes (P > .05). CONCLUSIONS: In 92% of cases, intravenous morphine was successful in opacifying the biliary tract without complications. In well-positioned T-tubes, the use of morphine increased diagnostic yield from 85% to 93%. No predictors for inadequate filling were found.

Dual-tract transhepatic U-shaped hemodialysis inferior vena cava catheter: a feasibility study in a swine model.

PURPOSE: To evaluate the feasibility of establishing a U-shaped inferior vena cava (IVC) catheter entirely from a transhepatic approach and to determine the catheter caliber that would provide adequate flow for hemodialysis. MATERIALS AND METHODS: Three pigs (weight, 45-50 kg) were used. A peripheral right hepatic vein was accessed transhepatically by using a 22-gauge needle, and a 0.018-inch wire was passed into the hepatic veins and IVC. An accessory right hepatic vein was accessed from the IVC. A snare was deployed in the accessory vein and used as a target for a second transhepatic 22-gauge needle pass. A wire was snared through the second transhepatic tract, around into the IVC, and through the first transhepatic tract. The 0.018-inch wire was upsized to a 0.035-inch platform. Measurements where made to tailor a U-shaped catheter from simple 10.2- and 12-F tubes by cutting them longitudinally (single long side hole) along the length of the IVC segment. The U-shaped hemodialysis catheter was placed over the wire and positioned so that the catheter opening lay in the IVC. With use of a dialysis machine, pressures and flow tolerance at set flow rates (100, 200, 300, 350, and 400 mL/min) were tested. RESULTS: All pigs underwent and survived successful catheter placements. All 10.2- and 12-F catheters tolerated flow rates up to 350 and 400 mL/min, respectively. CONCLUSIONS: Establishing a U-shaped hemodialysis catheter with an entirely transhepatic approach is technically feasible. The 10.2-F U-shaped dialysis catheters provided a flow rate (>350 mL/min) that is appropriate for hemodialysis in human clinical settings.

Impact of chronic kidney disease on outcomes of superficial femoral artery endoluminal interventions.

While aggressive endoluminal therapy for superficial femoral artery (SFA) occlusive disease is commonplace, the implications of chronic kidney disease (CKD) on long-term outcomes in this population are unclear. We examined the consequences of endovascular treatment of the SFA in patients with and without varying stages of CKD. A database of patients undergoing endovascular treatment of the SFA between 1986 and 2007 was queried, and two groups were defined: estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 cm(2). Intention-to-treat analysis was performed. Results were standardized to TransAtlantic Inter-Society Consensus (TASC-II) and Society for Vascular Surgery criteria. Kaplan-Meier analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables. Data are presented as mean +/- standard deviation where appropriate. There were 525 limbs in 535 patients (68% male, average age 66 +/- 14 years) that underwent endovascular treatment for claudication or chronic critical limb ischemia (51%). Patients with eGFR 60. In patients with critical limb ischemia, there was no difference in patency between those with eGFR 60. Limb salvage was worse in patients with eGFR 60. With respect to limb salvage, six factors were significantly associated with a reduction in rates: presence of tissue loss at presentation (relative risk [RR] = 6.45, p = 0.003), 0 or 1 vessel tibial runoff (RR = 2.56, p < 0.01), progression of distal disease noted in follow-up (RR = 4.62, p < 0.01), embolization at the initial intervention (RR = 2.70, p < 0.05), diabetes mellitus (RR = 3.71, p < 0.01), and a history of congestive heart disease (RR = 2.42, p < 0.01). Notable factors that were not significantly associated included lesion calcification (p = 0.64), TASC C or D lesion categorization (p = 0.99), acute occlusion at initial intervention (p = 0.40), and adjuvant stenting (p = 0.67). CKD does not impact the patency of SFA interventions. Limb salvage in patients with critical ischemia is significantly worse when the eGFR is

Stent-graft placement for management of iatrogenic hepatic artery branch pseudoaneurysm after liver transplantation.

Pseudoaneurysm of the hepatic arteries is uncommon following liver transplantation and is usually iatrogenic. We describe a case of balloon angioplasty of a left hepatic artery stenosis complicated by an iatrogenic pseudoaneurysm. Resolution of the stenosis and the pseudoaneurysm was achieved through a combination of a bare stent and a balloon-expandable covered stent. The completion angiogram demonstrated excellent appearance of the patent hepatic arteries with exclusion of the pseudoaneurysm. No surgery was required. The graft and the patient did well for the following 6 months. Doppler ultrasound examination at 2 and 6 months postintervention revealed patent hepatic arteries and no evidence of the pseudoaneurysm.

Digital radiography reject analysis: data collection methodology, results, and recommendations from an in-depth investigation at two hospitals.

Reject analysis was performed on 288,000 computed radiography (CR) image records collected from a university hospital (UH) and a large community hospital (CH). Each record contains image information, such as body part and view position, exposure level, technologist identifier, and--if the image was rejected--the reason for rejection. Extensive database filtering was required to ensure the integrity of the reject-rate calculations. The reject rate for CR across all departments and across all exam types was 4.4% at UH and 4.9% at CH. The most frequently occurring exam types with reject rates of 8% or greater were found to be common to both institutions (skull/facial bones, shoulder, hip, spines, in-department chest, pelvis). Positioning errors and anatomy cutoff were the most frequently occurring reasons for rejection, accounting for 45% of rejects at CH and 56% at UH. Improper exposure was the next most frequently occurring reject reason (14% of rejects at CH and 13% at UH), followed by patient motion (11% of rejects at CH and 7% at UH). Chest exams were the most frequently performed exam at both institutions (26% at UH and 45% at CH) with half captured in-department and half captured using portable x-ray equipment. A ninefold greater reject rate was found for in-department (9%) versus portable chest exams (1%). Problems identified with the integrity of the data used for reject analysis can be mitigated in the future by objectifying quality assurance (QA) procedures and by standardizing the nomenclature and definitions for QA deficiencies.

Outcomes of endoluminal therapy for ostial disease of the major branches of the aortic arch.

While aggressive endoluminal therapy for occlusive disease of the major branches of the arch of the aorta (brachiocephalic [BCA], left common carotid [LCCA], and left subclavian [LSCA] arteries) is commonplace, long-term outcomes in this population are unclear. We examined the long-term outcomes of endoluminal therapy for ostial aortic arch disease at a single tertiary referral academic medical center. A prospective database of patients undergoing endovascular treatment of aortic arch vessel atherosclerotic occlusive disease between 1990 and 2004 was maintained and retrospectively analyzed. Patients with stenotic ostial lesions of the major thoracic aorta branches were selected. Angiograms were reviewed in all cases to assess lesion characteristics. Patency was assessed by routine clinical and, in the LCCA and LSCA, duplex ultrasound follow-up at 1, 6, and 12 months postintervention and every 12 months thereafter. Results were standardized to current Trans-Atlantic Inter-Society Consensus and Society for Vascular Surgery criteria. Kaplan-Meier analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables. Data are presented as mean +/- SEM. Forty-four patients (average age 64 +/- 2 years, 59% male) underwent 26 LSCA, 11 LCCA, and eight BCA interventions for primary indications of arm ischemia (29%), prevention or treatment of coronary steal syndrome (29%), or cerebrovascular signs/symptoms (42%). The technical success rate was 98%, with a 90-day mortality rate of 0% and a major adverse event rate of 2%. There were no strokes and no upper extremity embolic events. Cumulative patency was 88 +/- 8% at 3 years, with a reintervention rate of 7%. The overall symptom recurrence rate was 4%. No local or systemic factors were associated with poor outcomes. Endoluminal stenting for ostial disease of the branches of the aortic arch provides excellent and long-term patency rates with low morbidity, mortality, and secondary intervention rates. With an overall technical success of 98%, our results parallel those for lesions located more distally in the arch branches and support the continued use of percutaneous therapy for atherosclerotic disease throughout the arch branches.