A Multicenter Study of Needle Size and Safety for Splenic Biopsy.

Background Splenic biopsy is rarely performed because of the perceived risk of hemorrhagic complications. Purpose To evaluate the safety of large bore (≥18 gauge) image-guided splenic biopsy. Materials and Methods This retrospective study included consecutive adult patients who underwent US- or CT-guided splenic biopsy between March 2001 and March 2022 at eight academic institutions in the United States. Biopsies were performed with needles that were 18 gauge or larger, with a comparison group of biopsies with needles smaller than 18 gauge. The primary outcome was significant bleeding after the procedure, defined by the presence of bleeding at CT performed within 30 days or angiography and/or surgery performed to manage the bleeding. Categorical variables were compared using the χ2 test and medians were compared using the Mann-Whitney test. Results A total of 239 patients (median age, 63 years; IQR, 50-71 years; 116 of 239 [48.5%] female patients) underwent splenic biopsy with an 18-gauge or smaller needle and 139 patients (median age, 58 years [IQR, 49-69 years]; 66 of 139 [47.5%] female patients) underwent biopsy with a needle larger than 18 gauge. Bleeding was detected in 20 of 239 (8.4%) patients in the 18-gauge or smaller group and 11 of 139 (7.9%) in the larger than 18-gauge group. Bleeding was treated in five of 239 (2.1%) patients in the 18-gauge or smaller group and one of 139 (1%) in the larger than 18-gauge group. No deaths related to the biopsy procedure were recorded during the study period. Patients with bleeding after biopsy had smaller lesions compared with patients without bleeding (median, 2.1 cm [IQR, 1.6-5.4 cm] vs 3.5 cm [IQR, 2-6.8 cm], respectively; P = .03). Patients with a history of lymphoma or leukemia showed a lower incidence of bleeding than patients without this history (three of 90 [3%] vs 28 of 288 [9.7%], respectively; P = .05). Conclusion Bleeding after splenic biopsy with a needle 18 gauge or larger was similar to biopsy with a needle smaller than 18 gauge and seen in 8% of procedures overall, with 2% overall requiring treatment. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grant in this issue.

Caval pseudoaneurysms following complex inferior vena cava filter removal: Clinical significance and patient outcomes.

OBJECTIVES: To investigate the incidence and clinical significance of caval pseudoaneurysm and extravasation post-complex inferior vena cava filter retrieval. METHODS: A total of 83 patients (70% female, average age 56) underwent complex inferior vena cava filter retrieval between January 2015 and December 2019 utilizing either rigid endobronchial forceps (n = 69, 83%) and/or excimer laser (n = 20, 24%). Procedural variables were recorded. The incidence and size of caval pseudoaneurysms and extravasation along with treatment type and clinical outcomes were analyzed. RESULTS: Technical success in all cases was 96% (n = 80). Average fluoroscopy time was 23 min (median: 20.2, range: 0.9-129.5). Average filter dwell time was 85 months (range: 2-316 months). Caval pseudoaneurysm was detected on post-retrieval venography in 10 patients (12%) and frank extravasation occurred in 1 case (1%). Average pseudoaneurysm length and width was 20.4 mm (range: 5-45 mm) and 12.9 mm (range: 4-24 mm), respectively. Pseudoaneurysms occurred most frequently during the removal of Optease (n = 5) and Celect (n = 2) filters. The pseudoaneurysms completely resolved with prolonged (>5 min) balloon angioplasty in all but one instance where a small portion of the pseudoaneurysm persisted. This patient was admitted and observed overnight before being discharged without complication. The solitary case of significant extravasation was effectively managed with immediate stent placement and the patient remained hemodynamically stable. CONCLUSIONS: Radiographically detectable caval pseudoaneurysm and extravasation is not uncommon in complex inferior vena cava filter retrieval and, despite being considered a major complication by Society of Interventional Radiology guidelines, can often be managed without stenting or other invasive treatment.

Revascularization for failed carotid artery stenting in a patient with a rare vertebral artery anomaly.

There is a growing cohort of patients requiring complex revascularization for failed carotid artery stenting. This revascularization can be complex in patients with coexisting supra-aortic vascular anomalies. Aberrant origin of the vertebral artery (VA) is an example of such an anomaly. Although VA anomalies are rare, their occurrence is of significant importance in endovascular and open vascular procedures. We report a case of a 78-year-old man with rare VA anomaly, whose left internal carotid artery ostium was inadvertently covered during a carotid artery stenting procedure. We discuss the carotid artery revascularization in this patient as well as the relevant literature.

Retrieval of a permanent VenaTech LGM filter 18 years after implantation using a novel removal method.

The VenaTech LGM (B. Braun, Melsungen, Germany) inferior vena cava (IVC) filter was designed as a permanent IVC filter to prevent clot migration and pulmonary embolism. This filter has been discontinued, but thousands remain implanted within patients who incur the added long-term risks of an indwelling IVC filter. We present a case of successful removal of a permanent VenaTech LGM IVC filter using a novel technique in a patient in whom filter placement was no longer indicated. The conical portion of the filter was removed intact, and the vertical struts were intentionally left embedded extravascularly within the caval wall.