Reliability and accuracy of simple visual estimation in assessment of peripheral arterial stenosis.

PURPOSE: To evaluate reliability, accuracy, and agreement of simple visual estimation (SVE) in determining the degree of peripheral arterial stenosis compared with calibrated measurements. MATERIALS AND METHODS: In 2 sessions, 23 interventionists with a wide range of experience and subspecialty training reviewed 42 angiographic images of lower extremity and carotid arteries (21 iliofemoral arteries and 21 carotid arteries). An independent physician measured all lesions using manual calipers. Intrarater and interrater reliability were assessed by intraclass correlation. A ± 5% error was considered the threshold for accuracy, and weighted κ statistics were computed to assess agreement with respect to the degree of stenosis (< 50%, nonsignificant; 50%-80%, significant; > 80%, severe). RESULTS: Intrarater reliability of SVE was 0.99, and interrater reliability was 0.83. Accuracy varied from 52.8% for images of severe stenosis to 26.5% and 18.1% for significant and nonsignificant stenosis, respectively (P < .001). Agreement between SVE and caliper with regard to degree of stenosis was good (weighted κ 0.56) overall with correct classification ranging from 92.6% for severe stenosis to 53.4% and 68.2% for significant and nonsignificant stenosis, respectively (P < .001). Misclassification of nonsignificant and significant stenosis was more frequent for carotid arteries than for lower extremities. CONCLUSIONS: Despite high reliability, SVE of peripheral arterial stenosis has limited accuracy in determining the exact degree of stenosis. Although severe stenosis is readily identified by SVE, arterial stenosis of < 80% is frequently overestimated, especially for carotid arteries, and should be confirmed by caliper assessment.

Lightweight bilayer barium sulfate-bismuth oxide composite thyroid collars for superior radiation protection in fluoroscopy-guided interventions: a prospective randomized controlled trial.

PURPOSE: To test whether newer bilayer barium sulfate-bismuth oxide composite (XPF) thyroid collars (TCs) provide superior radiation protection and comfort during fluoroscopy-guided interventions compared with standard 0.5-mm lead-equivalent TCs. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained for this HIPAA-compliant study, and 144 fluoroscopy-guided vascular interventions were included at one center between October 2011 and July 2012, with up to two operators randomly assigned to wear XPF (n = 135) or standard 0.5-mm lead-equivalent (n = 121) TCs. Radiation doses were measured by using dosimeters placed outside and underneath the TCs. Wearing comfort was assessed at the end of each procedure on a visual analog scale (0-100, with 100 indicating optimal comfort). Adjusted differences in comfort and radiation dose reductions were calculated by using a mixed logistic regression model and the common method of inverse variance weighting, respectively. RESULTS: Patient (height, weight, and body mass index) and procedure (type and duration of intervention, operator, fluoroscopy time, dose-area product, and air kerma) data did not differ between the XPF and standard groups. Comfort was assessed in all 256 measurements. On average, the XPF TCs were 47.6% lighter than the standard TCs (mean weight ± standard deviation, 133 g ± 14 vs 254 g ± 44; P < .001) and had a significantly higher likelihood of a high level of comfort (visual analog scale >90; odds ratio, 7.6; 95% confidence interval: 3.0, 19.2; P < .001). Radiation dose reduction provided by the TCs was analyzed in 117 data sets (60 in the XPF group, 57 in the standard group). The mean radiation dose reductions (ie, radiation protection) provided by XPF and standard TCs were 90.7% and 72.4%, with an adjusted mean difference of 17.9% (95% confidence interval: 7.7%, 28.1%; P < .001) favoring XPF. CONCLUSION: XPF TCs are a lightweight alternative to standard 0.5-mm lead-equivalent TCs and provide superior radiation protection during fluoroscopy-guided interventions.

Endovascular treatment of visceral and renal artery aneurysms.

PURPOSE: To analyze early and midterm results of endovascular treatment of visceral aneurysms regarding technical considerations, technical success rate, aneurysm rupture, and end-organ ischemia. MATERIALS AND METHODS: Endovascular treatment of 41 visceral and renal artery aneurysms (VAAs) in 40 consecutive patients (25 women; mean age, 59.4 y ± 16.2) was retrospectively reviewed. The series included 30 true aneurysms and 11 pseudoaneurysms in renal (n = 17), splenic (n = 13), hepatic (n = 4), celiac (n = 4), gastroduodenal (n = 2), and middle colic (n = 1) arteries. Demographic, clinical, procedural, and follow-up data were analyzed. RESULTS: Forty-one aneurysms underwent endovascular treatment. Hypertension (73%) and hyperlipidemia (32%) were the most common associated comorbidities. Nineteen patients presented with symptoms of pain (15%) or rupture (32%) in 10 pseudoaneurysms (91%) and nine true aneurysms (30%; P = .0007). The most commonly used technique (93%) was coil embolization with (15%) or without (78%) other endovascular agents. The rate of technical success (cessation of hemorrhage or blood flow into aneurysm sac) was 98%. There was no periprocedural mortality. Mean hospital stays were 1 and 2 days for asymptomatic and symptomatic patients, respectively. Mean clinical follow-up was 44.5 months; mean imaging follow-up was 11.7 months. The only complication was an intraprocedural thromboembolic event in one case (3%). Follow-up imaging evidence of end-organ partial infarct was detected in six patients (21%), with no clinical evidence of organ insufficiency. CONCLUSIONS: Endovascular treatment of VAAs is a safe and highly successful procedure. Associated side effects such as distal embolization and end-organ infarcts were not found to be clinically significant.