Utility of the Amplatzer Vascular Plug in Splenic Artery Embolization: A Comparison Study with Conventional Coil Technique

Purpose  

To retrospectively evaluate the role of the Amplatzer Vascular Plug (AVP) in proximal splenic artery embolization (SAE) compared with coils.     

Initial experiences with the Amplatzer Vascular Plug 4 for permanent occlusion of the internal carotid artery in the skull base in patients with head and neck tumors

Introduction  

As the first report in the literature, we present our initial experiences with the latest generation's Amplatzer Vascular Plug 4 (AVP4) as a device for permanent occlusion of the internal carotid artery in its course in the skull base.     

Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results

Purpose  

To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions.     

CIRSE Vascular Closure Device Registry

Purpose  

Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology.     

Early Experience with the AMPLATZER Vascular Plug IV for the Occlusion of Pulmonary Arteriovenous Malformations

The recent generation of AMPLATZER Vascular Plug (AVP; ie, the AVP IV) was used for the occlusion of eight pulmonary arteriovenous malformations (PAVMs) in five patients. A treatment was considered successful when there was a reduction or disappearance of the aneurysmal sac. At a mean follow-up of 20.1 months, no recanalization of PAVMs was observed on multidetector computed tomographic angiography. This shows the AVP IV to be safe and effective as an embolic device to occlude PAVMs.     

Percutaneous embolization of hemodialysis fistulas by AMPLATZER vascular plug with midterm follow-up

Purpose

To determine the midterm technical and clinical results of endovascular occlusion of native hemodialysis fistulas with the use of the AMPLATZER Vascular Plug (AVP) I and AVP II.

Materials and Methods

Data from 21 patients who underwent endovascular occlusion of their native fistulas between March 2008 and October 2009 were retrospectively evaluated. The reasons for closing the fistulas were hyperdynamic heart failure (n = 2), venous aneurysm with skin ulceration and nipple formation with impending rupture (n = 5), central venous occlusion that could not be recanalized by an endovascular approach (n = 7), dialysis-associated steal syndrome (n = 2), and critical hand ischemia with a nonhealing ulcer or necrosis (n = 5).

Results

All fistulas were embolized successfully by the end of the intervention. No procedure-related complications were observed after the intervention. The follow-up time ranged from 5 months to 24 months, with a mean of 13.5 months.

Conclusions

The results of this study suggest that the AVP is a safe and effective device for the endovascular occlusion of hemodialysis fistulas in selected cases.     

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures

Purpose  

To determine the value of a breast ultrasound (US) examination in addition to mammography in cases of American College of Radiology (ACR) tissue pattern III and IV in symptomatic women and women at risk.     

Endovascular repair of growing chronic type B aortic dissection with a vascular plug

We report the successful endovascular repair of a growing chronic type B aortic dissection using an Amplatzer Vascular Plug II. A 44-year-old man, with previous medical history of aortic surgery and stenting complained of vague back pain. An approximately 5-mm entry remained in the stented segment of the aorta on computed tomography (CT). Endovascular closure of the entry with a Vascular Plug was uneventful. A 3-month follow-up CT showed no leak, complete false lumen thrombosis in the thoracic segment, shrinkage of the false lumen, and a reduced diameter of thoracic aorta.     

Added value of contrast-enhanced CISS imaging in relation to conventional MR images for the evaluation of intracavernous cranial nerve lesions

Introduction  

The normal cranial nerves (CNs) of the cavernous sinus can be clearly demonstrated using contrast-enhanced constructive interference in steady-state (CISS) magnetic resonance imaging (MRI). This study used the method to evaluate pathological CNs III, IV, V₁, V₂, and VI in cavernous sinuses affected by inflammatory and neoplastic diseases.     

Inferior Mesenteric Artery Embolization Before Endovascular Aortic Aneurysm Repair Using Amplatzer Vascular Plug Type 4

Purpose

This study was designed to evaluate the efficacy and safety of Amplatzer Vascular Plug type 4 (AVP-4) for embolization of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) of the abdominal aorta to prevent endoleaks.

Methods

A single-center retrospective review of 31 patients who underwent IMA embolizations before EVAR using the AVP-4 was performed. We analyzed the insertion and detachment procedure, the technical success, and the final position of the plug. Technical success was defined as complete occlusion of the IMA. To compare the incidence of IMA-related type II endoleaks in patients with and without preoperative IMA embolization, we additionally reviewed the course of 43 patients with a preoperatively patent IMA who underwent no IMA embolization.

Results

Plugs with a diameter of 5, 6, and 8 mm were used in 5 (16.1 %), 21 (67.7 %), and 5 (16.1 %) patients, respectively (50–100 % oversizing). In 29 of 31 patients (93.5 %), we observed complete occlusion of the IMA within 10 min (mean 5.1 min). Precise placement of the plug in the proximal segment of the IMA without occlusion of the first IMA branches was achievable in all patients. The distance between the AVP-4 and the first branches was on average 12 (range 2–57) mm. Preoperative IMA embolization with AVP-4 significantly reduced the incidence of complex IMA-lumbar type II endoleaks after EVAR (0/31 vs. 11/43; p = 0.002).

Conclusions

The AVP-4 is a safe, feasible, and technically effective embolization device for IMA embolization before EVAR.     

Intravenous flat-detector CT angiography in acute ischemic stroke management

Introduction  

In the settings of stroke, a non-invasive high-resolution imaging modality to visualize the arterial intracranial circulation in the interventional lab is a helpful mean to plan the endovascular recanalization procedure. We report our initial experience with intravenously enhanced flat-detector CT (IV FDCT) technology in the detection of obstructed intracranial arteries.     

Pineal parenchymal tumor of intermediate differentiation: imaging spectrum of an unusual tumor in 11 cases

Introduction  

Pineal parenchymal tumor of intermediate differentiation (PPTID) was recognized in the 2007 World Health Organization (WHO) classification as a new pineal parenchymal neoplasm, intermediate in malignancy (WHO grade II or III) between pineocytoma (grade I) and pineoblastoma (grade IV). The imaging spectrum of this new tumor has not been previously delineated. We describe the imaging spectrum in 11 pathologically proven PPTIDs and identify findings that may suggest the preoperative diagnosis of this newly recognized entity.     

The AMPLATZER Vascular Plug 4: Preliminary Experience

The purpose of this communication is to describe our preliminary experience with the AMPLATZER Vascular Plug 4 (AVP 4) in peripheral vascular embolization. The AVP 4 was used for peripheral vascular embolization in five patients with renal pseudoaneurysm (n = 2), postsurgical peritoneal bleeding (n = 1), posttraumatic gluteal hemorrhage (n = 1), and intercostal pseudoaneurysm (n = 1). Occlusion time was recorded. Patients were followed up clinically and by imaging for 1 month after the procedure. All treated vessels or vascular abnormalities were successfully occluded within 3 min for low-flow circulation and over 8 min for high-flow circulation. At 1-month follow-up, all patients were symptom-free. All deployed devices remained in the original locations and desirable configurations. In conclusion, the AVP 4 seems to be safe and effective for occluding peripheral vessels and vascular abnormalities. Because of its compatibility with 0.038–in. catheters, it can be deployed through a diagnostic catheter following angiography without exchanging a sheath or guiding catheter. Compared with the previous generation of vascular plugs, the AVP 4 allows for faster procedure times and decreased exposure to radiation.     

Application of the AMPLATZER Vascular Plug in Endovascular Occlusion of Dialysis Accesses

The purpose of this study was to share our initial experience with the AMPLATZER Vascular Plug (AVP) in occluding dialysis accesses. Between January 2007 and October 2008, five patients with autogenous and one patient with prosthetic accesses were referred for endovascular occlusion owing to central venous obstruction (n = 4) and dialysis-associated steal syndrome (n = 2) leading to disabling complications. We used a single AVP in two patients, double AVPs in two patients, and double AVPs and n-butyl 2-cyanoacrylate in one patient with an autogenous access. Two coils were deployed between two AVPs to occlude the prosthetic graft. Immediate success was achieved in all patients, with no complications. Mean follow-up time was 13 months (range, 1–21 months) and none of the patients had experienced symptom recurrence as of the time of writing. The AVP allows simple, precise, and reliable dialysis access occlusion without significant complications when surgical ligation is not preferred. It can be used with other embolizing agents to provide occlusion in the case of failure.     

Focal Hepatic Lesions: Contrast-Enhancement Patterns at Pulse-Inversion Harmonic US using a Microbubble Contrast Agent

Objective

To analyze the contrast-enhancement patterns obtained at pulse-inversion harmonic imaging (PIHI) of focal hepatic lesions, and to thus determine tumor vascularity and the acoustic emission effect.

Materials and Methods

We reviewed pulse-inversion images in 90 consecutive patients with focal hepatic lesions, namely hepatocellular carcinoma (HCC) (n=43), metastases (n=30), and hemangioma (n=17). Vascular and delayed phase images were obtained immediately and five minutes following the injection of a microbubble contrast agent. Tumoral vascularity at vascular phase imaging and the acoustic emission effect at delayed phase imaging were each classified as one of four patterns.

Results

Vascular phase images depicted internal vessels in 93% of HCCs, marginal vessels in 83% of metastases, and peripheral nodular enhancement in 71% of hemangiomas. Delayed phase images showed inhomogeneous enhancement in 86% of HCCs; hypoechoic, decreased enhancement in 93% of metastases; and hypoechoic and reversed echogenicity in 65% of hemangiomas. Vascular and delayed phase enhancement patterns were associated with a specificity of 91% or greater, and 92% or greater, respectively, and with positive predictive values of 71% or greater, and 85% or greater, respectively.

Conclusion

Contrast-enhancement patterns depicting tumoral vascularity and the acoustic emission effect at PIHI can help differentiate focal hepatic lesions.     

Carotid artery stenosis: performance of advanced vessel analysis software in evaluating CTA

Objectives

The aim of this study was to evaluate time efficiency and diagnostic reproducibility of an advanced vessel analysis software for diagnosis of carotid artery stenosis.

Material and methods

40 patients with suspected carotid artery stenosis received head and neck DE-CTA as part of their pre-interventional workup. Acquired data were evaluated by 2 independent radiologists. Stenosis grading was performed by MPR eyeballing with freely adjustable MPRs and with a preliminary prototype of the meanwhile available client-server and advanced visualization software syngo.via CT Vascular (Siemens Healthcare, Erlangen, Germany). Stenoses were graded according to the following 5 categories: I: 0%, II: 1–50%, III: 51–69%, IV: 70–99% and V: total occlusion. Furthermore, time to diagnosis for each carotid artery was recorded.

Results

Both readers achieved very good specificity values and good respectively very good sensitivity values without significant differences between both reading methods. Furthermore, there was a very good correlation between both readers for both reading methods without significant differences (kappa value: standard image interpretation k = 0.809; advanced vessel analysis software k = 0.863). Using advanced vessel analysis software resulted in a significant time saving (p < 0.0001) for both readers. Time to diagnosis could be decreased by approximately 55%.

Conclusions

Advanced vessel analysis application CT Vascular of the new imaging software syngo.via (Siemens Healthcare, Forchheim, Germany) provides a high rate of reproducibility in assessment of carotid artery stenosis. Furthermore a significant time saving in comparison to standard image interpretation is achievable.     

Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization

Purpose

To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up.

Materials and Methods

Sixty-one patients (39 men; mean ± standard deviation age 66.1 ± 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 ± 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III).

Results

Among the 48 patients, 26 (54 %; 17 men, aged 64.3 ± 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 ± 9.5 months (range 12–42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved.

Conclusion

Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.     

Embolization of the Internal Iliac Artery: Cost-Effectiveness of Two Different Techniques

The purpose of this study was to compare the cost-effectiveness of coils versus the Amplatzer Vascular Plug (AVP) for occlusion of the internal iliac artery (IAA). Between 2002 and January 2006, 13 patients (mean age 73 ± 13 years) were referred for stent-grafting of abdominal aortic aneurysm (n = 6); type I distal endoleak (n = 3), isolated iliac aneurysm (n = 3), or rupture of a common iliac aneurysm (n = 1). In all patients, extension of the stent-graft was needed because the distal neck was absent. Two different techniques were used to occlude the IIA: AVP in seven patients (group A) and coil embolization in six patients (group C). Immediate results and direct material costs were assessed retrospectively. Immediate success was achieved in all patients, and simultaneous stent-grafting was successfully performed in two of six patients in group C versus five of seven patients in group A. In all group A patients, a single AVP was sufficient to achieve occlusion of the IIA, accounting for a mean cost of 485 €, whereas in group C patients, an average of 7 ± 3 coils were used, accounting for a mean cost of 1,745 €. Mean average cost savings using the AVP was 1,239 €. When IIA occlusion is needed, the AVP allows a single-step procedure at significant cost savings.     

No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts

Purpose

To investigate the pre-soaking of hamstring grafts in topical vancomycin, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction to reduce the incidence of post-operative infection, and to describe an evidence-based diagnostic and treatment algorithm to facilitate early diagnosis and appropriate management of possible knee sepsis post-operatively after ACL reconstruction.

Methods

This study is a controlled observational series comprising of 1585 individuals who underwent ACL reconstruction over a 13-year period. All surgeries were performed by a single surgeon at the same hospital. Group 1 consisted of 285 patients who received pre-operative IV antibiotics without topical graft pre-soaking. Group 2 consisted of 1300 individuals who received IV antibiotics and graft pre-soaking in a vancomycin solution of 5 mg/mL.

Results

In group 1, a total of four patients suffered a post-operative joint infection (1.4 %). Three out of the four were culture positive for Staphylococcus species. The fourth was culture negative but was managed as an acute infection. Group 2 suffered no post-operative infections (0 %). Statistical analysis of the vancomycin pre-soak with IV antibiotics group, compared with IV antibiotics-alone group, revealed a significantly reduced post-operative infection rate using a Fisher’s exact test (P = 0.0011) and Chi-square test with Yates’ correction (P = 0.0003).

Conclusions

Pre-soaking of hamstrings grafts with topical vancomycin reduced the rate of post-operative infection when compared to IV antibiotics alone. This technique should be utilised by surgeons to reduce the overall incidence of knee sepsis post-ACL reconstruction.

Level of evidence

III.

     

Differentiation of grade II/III and grade IV glioma by combining “T1 contrast-enhanced brain perfusion imaging” and susceptibility-weighted quantitative imaging

Purpose

MRI is a useful method for discriminating low- and high-grade glioma using perfusion MRI and susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of T1-perfusion MRI and SWI in discriminating among grade II, III, and IV gliomas.

Methods

T1-perfusion MRI was used to measure relative cerebral blood volume (rCBV) in 129 patients with glioma (70 grade IV, 33 grade III, and 26 grade II tumors). SWI was also used to measure the intratumoral susceptibility signal intensity (ITSS) scores for each tumor in these patients. rCBV and ITSS values were compared to seek differences between grade II vs. grade III, grade III vs. grade IV, and grade III+II vs. grade IV tumors.

Results

Significant differences in rCBV values of the three grades of the tumors were noted and pairwise comparisons showed significantly higher rCBV values in grade IV tumors as compared to grade III tumors, and similarly increased rCBV was seen in the grade III tumors as compared to grade II tumors (p < 0.001). Grade IV gliomas showed significantly higher ITSS scores on SWI as compared to grade III tumors (p < 0.001) whereas insignificant difference was seen on comparing ITSS scores of grade III with grade II tumors. Combining the rCBV and ITSS resulted in significant improvement in the discrimination of grade III from grade IV tumors.

Conclusion

The combination of rCBV values derived from T1-perfusion MRI and SWI derived ITSS scores improves the diagnostic accuracy for discrimination of grade III from grade IV gliomas.