[Quality report 2011 of the German Society of Interventional Radiology (DeGIR)--part 2. Endovascular treatment of aortic aneurysms (EVAR)]. / Qualitätsreport 2011: Bericht über die Behandlungsqualität minimalinvasiver Methoden--Teil 2. Interventionelle Therapie (EVAR) von Aortenaneurysmen.

PURPOSE: To analyze the quality of treatment for endovascular aortic aneurysm repair using the data of the DeGIR quality management system. MATERIALS AND METHODS: A retrospective analysis of all data registered in the DeGIR quality management system of the year 2011 was performed regarding the treatment quality for endovascular aortic aneurysm repair. Registry of data within this system was voluntary. Quality aims of correct indication, treatment strategy and results were examined. Special interest was directed towards treatment success, complication rates and radiation exposure. RESULTS: Out of 82,881 data sets from the year 2011 overall 1167 cases of EVAR were registered. 12.4% of these cases encompassed emergency treatments. The most frequent indication was an abdominal aneurysm with 85% of cases. The median aortic diameter was 56.5 mm. 253 cases showed an aortic diameter between 50 and 55 mm. Technical success was achieved in 94.6% of all cases including emergency indications for aortic rupture. The overall complication rate of all cases was 4% with 2.5% major complications. Examining only the elective cases a mortality rate of 0.34% was found. EVAR of ruptured aneurysms yielded a mortality rate of 12%. Median dose area product and fluoroscopy time were 10,676.5 cGy × cm2 und 17.32 min respectively. CONCLUSION: Data analysis of the DeGIR quality management system proved a very high technical success rate for the registered cases of endovascular aortic aneurysm repair accompanied by a low complication rate. Improvement of data quality will need further mandatory fields within the software to be implemented. KEY POINTS: The voluntary DeGIR quality management system has reached a high acceptance among radiologists. Endovascular aortic aneurysm repair by radiologists has shown a very high technical success rate and a very low complication rate.

Improved peripheral MRA using multi-velocity-encoding phase contrast-enhanced MRA techniques.

Phase contrast MR angiography (PC-MRA) depends on phase shifts caused by blood flow. Generally, PC sequences employ one VENC (velocity-encoding) value for each encoded spatial direction to optimize the signal in major vessels during peak systolic flow. We compared a mono-(30) with a multi-(20/30/45) VENC-PC-MRA technique in 10 patients with peripheral arterial occlusive disease. In all patients, the multi-VENC-PC sequence enhanced the vascular signal in vessels with very different flow velocities in one measurement. Large fields-of-view can be measured in a relatively short examination time to obtain an overview of the peripheral arterial system of the patient when contrast-enhanced MRA is not possible.

Culture of type II pneumocytes on a type II cell-derived fibronectin-rich matrix.

Recent evidence suggests that during primary culture, type II pneumocytes synthesize and deposit components of an extracellular matrix. The present study investigated the response of freshly isolated type II cells to a preformed, fibronectin-rich matrix synthesized by type II cells over a 6-day interval of primary culture on a plastic surface. Type II cells on 6-day matrix (M6) degraded the preformed matrix and deposited newly synthesized fibronectin more rapidly than cells on plastic, suggesting that M6 itself stimulated type II cell-mediated matrix turnover. In type II cells on plastic, incorporation of radiolabeled thymidine into DNA increased 620 and 1,880% after 2 and 3 days in culture, respectively, as the cells assumed a more flattened phenotype. Although cells on M6 did not divide, both basal rates of thymidine labeling and sensitivity to serum modulators of DNA synthesis were enhanced by the M6 surface, as compared with plastic. Culture of type II cells on surfaces of purified fibronectin enhanced the rate of DNA synthesis in a manner similar to that observed on M6; this effect was blocked by antifibronectin. The data suggest that more rapid fibronectin synthesis and deposition are important components of the response of type II cells to primary culture. Extracellular matrix produced by type II cells appears to be similar to the basement membrane onto which these cells proliferate in vivo after lung injury. A fibronectin-rich surface in itself may thus induce additional extracellular matrix synthesis and further direct cellular differentiation and proliferation.