Factors Influencing Clinical Success Following Endovascular Treatment of Type II Endoleaks.

PURPOSE: To compare long-term outcomes of transarterial (TA) and translumbar (TL) embolization of type II endoleaks (T2E) following EVAR, as well as factors that predict clinical success. METHODS: 129 (mean age, 71.4y; range, 53-95) with T2E referred for embolization from August-2003 to December-2017 were retrospectively reviewed. One-hundred-eighty procedures were performed via TA (n = 139) and TL (n = 41) approaches, with 37 patients undergoing 51 reinterventions. Clinical success was defined as absence of endoleak and/or absence of aneurysm sac enlargement on follow-up imaging. Medical comorbidities, procedural data, embolic agents used, presence of successful sac embolization, and 30-day morbidity and mortality data were collected. RESULTS: TL approaches had higher technical success (41/41 vs.122/139, p = .014). Clinical success rates were 52% (N = 58/111) and 62% (N = 23/37) for TA and TL procedures respectively (p = .34). Looking at all procedures, sac embolization using n-butyl cyanoacrylate glue had higher clinical success compared to other embolic agents (p = .017-.037). Successful sac access was a strong predictor of success for TA procedures (46/78 vs.12/33, p = .0379). 30-day complication rates were similar between TA (5.8%) and TL (4.9%) approaches. There was 1 death secondary to graft infection following TA embolization. CONCLUSIONS: Overall clinical success of TA and TL embolization when considering re-interventions is high. n-butyl cyanoacrylate glue had significantly higher success than other embolic agents (p = .017-.037). Successful sac access was associated with success for TA procedures.

Technical Considerations and Clinical Outcomes in the Endovascular Management of Celiac Arterial Aneurysms.

This retrospective case series details a single-center experience of 8 patients (mean age, 54.4 years) with celiac artery aneurysms (CAAs) who underwent 1 parent vessel-sparing, 5 partial parent vessel-sparing, and 2 non-parent vessel-sparing procedures. Technical success was achieved in 6 of 8 (75%) patients. Both technical failures arose from type II endoleaks, which spontaneously resolved, resulting in clinical success of all cases. In-stent restenosis requiring reintervention complicated 3 of 5 (60%) partial parent vessel-sparing techniques, with 2 of 3 developing complete thrombosis. Two Society of Interventional Radiology grade C complications were recorded, none of which resulted in permanent sequelae. The endovascular management of CAAs is safe and amenable to various techniques.

MR venography using time-resolved imaging in interventional management of pelvic venous insufficiency.

PURPOSE OF REVIEW: To evaluate the utility of magnetic resonance venography with time-resolved imaging (MRV TRI) in the diagnosis of pelvic vein insufficiency (PVI). RECENT FINDINGS: A retrospective single-center review of N = 17 consecutive patients who underwent pelvic MRI for the assessment of PVI was performed. N = 8/17 (47%) studies were positive for PVI. TRI imaging demonstrated N = 6/8 patients with Grade 0-3 PVI and N = 2/8 patients with May-Thurner Syndrome. N = 4/8 patients underwent elective endovascular management, all of which were technically successful. In the assessment of PVI, MRV TRI provides a dynamic assessment of venous insufficiency, serving as an adjunct to the imaging diagnosis of this pathology.

Intra-Arterial and Intravenous Contrast-Enhanced Ultrasonography in Prostate Artery Embolization: A Case Series.

This retrospective case series details early experience with intra-arterial (IA) and intravenous (IV) contrast-enhanced ultrasound (CEUS) in 8 patients (mean age, 70.4 years) who underwent prostatic arterial embolizations from July 2014 to March 2017. Technical success was achieved in 7 of the 8 patients. IA CEUS demonstrated ipsilateral prostatic perfusion in 15 out of 20 interrogated prostatic arteries (PAs), confirming proper catheter placement. Four of the 20 interrogated PAs demonstrated extraprostatic perfusion. One PA was not successfully interrogated owing to a localized wire perforation. IV CEUS, performed on 4 of the 8 patients, demonstrated decreased enhancement after embolization in all 4 patients, confirming the procedural end point.

Case report: Diffuse hyperplastic perilobar nephroblastomatosis complicated by a unilateral Wilms tumour: diagnosis, treatment and follow-up.

BACKGROUND: Nephroblastomatosis is an uncommon pathologic process characterized by the presence of persistent embryonic nephrogenic rests. Progression to Wilms tumour occurs in an estimated 35% of patients. Cure rates are based on histologic findings and disease stage and have improved from 10% in the 1920s to over 90% today. CASE PRESENTATION: We report a case of a 9-month-old female presenting with a 2-month history of abdominal distension. Ultrasonographic and computed tomographic assessments demonstrated features consistent with bilateral, diffuse, hyperplastic perilobar nephroblastomatosis (DHPLNB) for which she underwent chemotherapy. Magnetic resonance imaging 6 weeks following commencement of chemotherapy revealed a mass concerning for unilateral Wilms tumor for which she underwent partial nephrectomy. Pathology confirmed DHPLNB with a unilateral Wilms tumor. CONCLUSION: 3.5 year radiographic follow up demonstrates complete recovery. To our knowledge, there are no similar cases with imaging depiction recently published. With potential for malignant transformation into Wilms tumour and low survival rate for late diagnosed Wilms tumors, it is important to recognize nephroblastomatosis early, both clinically and radiographically to improve overall patient prognosis.

A digital peer-to-peer learning platform for clinical skills development.

BACKGROUND: Due to constraints in time and resources, medical curricula may not provide adequate opportunities for pre-clerkship students to practice clinical skills. To address this, medical students at the University of Alberta developed a digital peer-to-peer learning initiative. The initiative assessed if students can learn clinical skills from their peers in co-curricular practice objective structured clinical exams (OSCEs). METHODS: A total of 144 first-year medical students participated. Students wrote case scenarios that were reviewed by physicians. Students enacted the cases in practice OSCEs, acting as the patient, physician, and evaluator. Verbal and electronic evaluations were completed. A digital platform was used to automate the process. Surveys were disseminated to assess student perceptions of their experience. RESULTS: Seventy-five percent of participants said they needed opportunities to practice patient histories and physical exams in addition to those provided in the medical school curriculum. All participants agreed that the co-curricular practice OSCEs met this need. The majority of participants also agreed that the digital platform was efficient and easy to use. CONCLUSION: Students found the practice OSCEs and digital platform effective for learning clinical skills. Thus, peer-to-peer learning and computer automation can be useful adjuncts to traditional medical curricula.