Unsuspected iatrogenic vertebral artery cannulation with a dialysis catheter.

Internal jugular vein cannulation is a common clinical procedure but not without risks including inadvertent artery puncture. The incidence of vertebral artery puncture during internal jugular vein cannulation is unclear but is thought to be much less than carotid artery involvement. Here, we describe an unsuspected case of vertebral artery cannulation with a Vas Cath dialysis catheter which was used for hemofiltration before the inadvertent artery cannulation was discovered later during open surgical retrieval.

Ankle brachial pressure index (ABPI): An update for practitioners.

Peripheral vascular disease affects some 12%-14% of the general population, and the majority of people with the disease are asymptomatic. The ankle brachial pressure index (ABPI) test is widely used by a diverse range of practitioners (in the community and hospital setting) in order to screen asymptomatic patients, diagnose patients with clinical symptoms, and to monitor patients who have had radiological or surgical intervention. This paper explains the theoretical basis of the ABPI test, as well as the relevance of the common modifications of the test. It explores the background to the quoted normal ranges for the ABPI test. It reviews the large body of literature that has developed on the association between ABPI and cardiovascular risk, as well as ABPI as a predictor for cardiovascular morbidity and mortality, highlighting the evidence that can inform practice. The review looks critically at the limitations of the ABPI test, providing practitioners with an evidence-based update on the importance and challenges of standardizing ABPI methodology. This paper highlights the influence of the key technical aspects of the ABPI test that all practitioners need to consider in order to be able to make more reliable and informed management decisions based on ABPI findings.

Interstudy reproducibility of three-dimensional volume-selective fast spin echo magnetic resonance for quantifying carotid artery wall volume.

PURPOSE: To assess the interstudy reproducibility of a three-dimensional volume-selective, fast spin echo (FSE) magnetic resonance technique for the assessment of carotid artery wall volume, which is a marker for total carotid plaque volume. MATERIALS AND METHODS: Interstudy reproducibility was evaluated in 10 subjects with evidence of carotid artery atherosclerotic disease on carotid Doppler ultrasonography. Subjects were scanned twice with an interscan time of one hour to four days. The carotid artery was imaged in cross-section, and the total carotid arterial wall volume (TWV) was calculated by subtraction of the total carotid lumen volume from the total outer carotid vessel volume. RESULTS: The mean carotid TWV for the scans was 741 and 734 mm3, respectively, with no significant difference (mean difference 7 mm3; P = 0.5). The time for each study was approximately 20 minutes. The standard deviation of the differences between the measurements was 33 mm3, yielding an interstudy coefficient of variation of 4.4%. Sample size calculations showed that 16 patients would enable this difference in plaque volume over time to be detected with 80% power at a P value of 0.05. CONCLUSION: Volumetric analysis with CMR of carotid artery plaques using a three-dimensional volume-selective FSE is efficient with good interstudy reproducibility, and is well suited for longitudinal studies of progression of carotid atheroma with reasonable sample sizes.