Factors associated with outcome after successful radiological intervention in arteriovenous fistulas: A retrospective cohort.

INTRODUCTION: Arteriovenous fistulas are the best form of vascular access for haemodialysis. A radiological balloon angioplasty is the standard treatment for a clinically relevant stenosis, but the recurrence rate is high. Data on factors associated with recurrence are limited. METHODS: A single centre, retrospective analysis was performed for 124 consecutive patients who had successful interventions for dysfunctional arteriovenous fistulae, to examine factors associated with post-intervention patency. Follow-up was at least 1 year for all patients. Variables associated with primary and cumulative patency were pre-specified and assessed using both un-adjusted (univariate) and adjusted Cox proportional hazards models. Analysis was repeated for a subgroup of 80 patients with a single lesion only in order to examine the potential effects of stenotic lesion characteristics on patency. RESULTS: Factors found to have a significant association with poorer outcomes (less time to loss of patency) included thrombosis at the time of intervention and a history of previous intervention. Fistula age (log days) was significantly associated with better outcomes (greater time to loss of patency). Non-white ethnicity, lesion length, and patient age were also significantly associated with accelerated loss of patency. DISCUSSION: The factors we have identified as linked to poor outcome may help to identify patients in whom a balloon angioplasty is unlikely to provide a durable outcome. This may prompt exploring alternative treatment or dialysis options at an early stage.

Transcatheter Embolization of Type IA Endoleak after Nellix Endovascular Aortic Aneurysm Sealing with N-Butyl Cyanoacrylate: Technique in Three Patients.

The successful transcatheter treatment of a type IA endoleak after endovascular aortic aneurysm sealing with the Nellix EndoVascular Aneurysm Sealing system (Endologix Inc, Irvine, California) using proximal covered stent extension and transarterial N-butyl cyanoacrylate sac embolization is described. Three patients were treated using the same technique with a mean interval between the index procedure and reintervention of 9.3 months (range, 3-15 mo). No complications or endoleaks were seen on follow-up imaging. The mean follow-up time after reintervention was 10.3 months (range, 7-13 mo).

Tension pneumocephalus: the neurosurgical emergency equivalent of tension pneumothorax.

Tension pneumocephalus (TP) is the intracranial equivalent of tension pneumothorax. It is an unusual but life-threatening neurosurgical emergency, which has been described following head trauma, epidural injections or complicating neurological, spinal, craniofacial or sinus surgery. Unfortunately, the signs and symptoms of TP are non-specific and the diagnosis must be made by prompt recognition of the classic imaging signs of TP, allowing lifesaving emergency decompression. We present a trauma patient demonstrating the "Mount Fuji" sign on an unenhanced CT scan of the brain, which is reportedly specific for TP.

The role of interventional radiology in the management of deep vein thrombosis.

Deep venous thrombosis is a common life-threatening disorder with a significant mortality rate. The current standard anticoagulation therapy has proven inadequate in prevention of long-term post-thrombotic symptoms in patients with large clot burdens. Over the last two decades, advances in endovascular therapies have delivered a range of new treatment options including catheter-directed thrombolysis, percutaneous mechanical thrombectomy, venoplasty and stenting and inferior vena caval filter devices. Although there has been growing experience and guidelines in the treatment of deep vein thrombosis, there remains a wide variation in clinical practice nationally. This paper aims to raise the awareness of these emerging therapies and reviews the available evidence for their use.

The role of radiology in the diagnosis and treatment of mesenteric ischaemia.

Clinicians working in any acute medical/surgical unit need an understanding of mesenteric ischaemia. Acute mesenteric ischaemia is a life-threatening vascular emergency associated with high morbidity and mortality. However, prompt diagnosis with the use of contrast-enhanced CT, more specifically CT angiography, has replaced catheter angiography as the new standard and is readily available in many emergency departments. Similarly, new hybrid open surgery endovascular treatment can minimise the surgical insult to these often critically ill elderly patients. Together, these changes can change the previously grim prognosis associated with this condition. By contrast, chronic mesenteric ischaemia (CMI) is an insidious disease and often a diagnosis of exclusion. However, it can cause a significant reduction in a patient's quality of life, due to 'mesenteric angina' and food avoidance, yet can potentially be treated simply and effectively. Recognition of the typical clinical history and imaging findings is key to making the diagnosis in a timely fashion. Radiology plays a significant role in the diagnosis and increasingly in the treatment of mesenteric ischaemia. Other clinicians should have a basic understanding of what radiology can and cannot offer. The advantages and limitations of commonly used imaging modalities-plain films, CT, MRI and ultrasound, are examined. The significance of findings, such as pneumatosis coli and portal gas are explained. Finally, the different endovascular management of both acute and CMI is discussed, which have emerged as minimally invasive options to complement open revascularisation surgery.