Average Fluoroscopy Time Research Articles

Evaluation of the Modified Barium Swallow Study Conducted With and Without Radiologist Supervision: A Pre- and Post-Observational Study.

Assess quality metrics of modified barium swallow studies (MBSS) with and without a radiologist present during the procedure. Retrospective review of MBSS performed on adult inpatients at a tertiary care hospital 6-months pre- and post-institutional change from having to not having a radiologist present during the examination. fluoroscopy time; study duration; number of cine loops; number of images; efficiency of collimation (using a 5-point scoring system); time to final report; radiologist-speech language pathologist report disagreement; and recalls for inadequate studies. Statistical analysis was via Welch's t-test and a test of proportions for continuous and count data under the normal approximation. 106 and 119 MBSS were analyzed from the radiologist present and radiologist absent periods, respectively. No statistically significant differences were found for: average fluoroscopy time (116.1 s vs. 126.9 s; P = 0.161); study duration (400.4 s vs. 417.3 s; P = 0.453); number of cine loops (9.3 vs. 10.2; P = 0.075); number of images (620.5 vs. 581.1; P = 0.350); or report disagreement. There was improved performance without the radiologist present for collimation (1.92 vs. 1.43; P = 0.003) and fewer non-diagnostic images (6.5 vs. 4.5; P = 0.001). Time to final report was longer with the radiologist absent due to more reports with significant delays. There were no repeated studies because of inadequate technique in either group. MBSS performed by technologists without radiologist supervision is not inferior to those performed with radiologist supervision on multiple performance measures. This supports technologist operated MBSS without radiologist supervision, while acknowledging a need to further address radiologist report time delay.

Radiation exposure in fluoroscopy-guided anterior total hip arthroplasty: a systematic review.

To investigate the average fluoroscopy time, as well as the patient and surgical staff average radiation exposure in the context of intraoperative fluoroscopy use during anterior total hip arthroplasty (THA). PubMed, Cochrane, Embase, Web of Science and Scopus were systematically searched for studies pertaining to intraoperative anterior THA fluoroscopy (PROSPERO ID 258049). The comprehensive literary search was conducted using "THA," "fluoroscopy" and "radiation exposure" as the search criteria, which resulted in 187 total papers. Of these 187 papers, 11 studies were included in this systematic review as they involved anterior THA and specifically contained data regarding radiation exposure dose and/or time. Eleven studies were included, enrolling 1839 patients. The average fluoroscopy time was 21.4 (95% confidence interval [CI] 16.6-26.1) seconds, whereas the average patient radiation dose was 1.8 × 10-3 (95% CI 7.4 × 10-4-2.9 × 10-3) Gy. Although several studies fail to report fluoroscopy time and radiation dose in THA patients, fluoroscopy-guided THA has emerged as a safe procedure. Additional studies may analyze if radiation exposure during the surgeon's THA learning curve is significantly higher, as well as what protocols may potentially reduce radiation exposure even further.

Application of a targeted and quantificational foraminoplasty device in percutaneous transforaminal endoscopic discectomy for L5\u2013S1 disc herniation: preliminary clinical outcomes

ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disc herniation (LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5–S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term effects of PTED with ZESSYS at the L5–S1 level.MethodsBetween January and August of 2018, fifty-six patients with lumbar disc herniation at the single level of L5–S1 and who underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the transforaminal endoscopic surgical system (TESSYS) group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time, and fluoroscopy time were evaluated for operation efficiency. Clinical outcomes were assessed by the visual analog scale (VAS) score and Oswestry Disability Index (ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively.ResultsThe average puncture time (5.29 ± 2.05 min), foraminoplasty time (12.82 ± 2.52 min), and fluoroscopy time (26.29 ± 5.96 s) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07 ± 3.13 min, p < 0.01; foraminoplasty time, 17.18 ± 2.92 min, p < 0.01; fluoroscopy time, 34.73 ± 6.86 s; p < 0.01). No significant differences were observed between the 2 groups in the decompression time (p = 0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoperative, in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05).ConclusionThe targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disc herniation at the L5–S1 level.

Abstract No. 64 Analysis of complications and unsuccessful embolization of pulmonary arteriovenous malformations

Embolotherapy is the standard treatment for pulmonary arteriovenous malformation (pAVM). The purpose of this study is to explore the reasons for unsuccessful embolization and complications associated with embolotherapy. This retrospective chart review study was approved by the IRB. Data were collected for all the embolization procedures that were performed at our institution for pulmonary AVM treatment between January 2003 and January 2020. All ages of both genders were included in the analysis. The reason for unsuccessful embolization and complications were recorded. One hundred and eighty-seven patients had a total of 341 embolization procedures at our institutions for the treatment of PAVM. There were 240 (70%) women and 101 (30%) men included with a mean age of 49 ± 18 and 38 ± 20 years, respectively. The average fluoroscopic time was 34 minutes (range 3.4 to 120 minutes). Of 341, 47(14%) procedures were unsuccessful. The reason for unsuccessful embolization were (in order of frequency): no PAVM detected on catheter angiogram (n = 17, 36%), pAVM too small to treat (n = 12, 25%), tortuous feeding artery causing technical difficulty assessing the artery (n = 7, 15%), No evidence of reperfusion on follow up pulmonary angiogram (that were done to detect reperfusion) (n = 6, 13%), systemic arterial supply to the pAVM causing vein to vein shunting (n = 3, 6%), patient’s condition (increased respiratory motion and intraprocedural bradycardia) aborting the procedure (n = 2, 4%). There were a total of 9 (2%) intraprocedural complications with 2 major complications aborting the embolotherapy. Embolization of pulmonary arteriovenous malformation is a very successful procedure with minor complications. The main reasons of unsuccessful embolotherapy are no evidence of pAVM during catheter angiogram, very small feeding artery size, and tortuous feeding artery.

Abstract No. 101 Tibial-pedal artery access for uterine artery embolization

Purpose: To demonstrate the rationale for and feasibility of tibial-pedal (TP) access as an alternative to trans-radial (TR) or trans-femoral (TF) access for uterine artery embolization (UAE) Materials and Methods: 9 women ages 33-62 (mean 44) with a mean BMI of 32 (range 22.8-48.4) underwent UAE via TP access by a single operator in an academic center. 6 women had symptomatic fibroids, 2 women had hemorrhage from invasive uterine or cervical cancer, and 1 woman had post-partum hemorrhage from an arteriovenous malformation. Patencies of tibio-pedal arteries were documented pre-procedurally with palpation and/or ultrasound. With ultrasound guidance and micropuncture technique, a 5 French Glidesheath Slender (Terumo, USA) was placed and anti-spasmodic/anti-thrombotic medications were administered as previously reported for TR access. Hemostasis was achieved at embolization procedures’ end with a large TR band (Terumo, USA) reinforced with cloth tape. Proprietary catheters were used, though steam shaping of the base catheters was necessary for the initial cases. All 6 patients undergoing UAE for fibroids were discharged home the same day. Metrics evaluated were technical success, fluoroscopy time, clinical results and complications. Results: 8 of 9 UAEs were successfully performed via TP access;one patient required cross over to TF access for ipsilateral uterine artery catheterization. No clinically significant procedural complication occurred. Average fluoroscopy time was 38.3 minutes, though the last four cases performed with a proprietary cobra shaped catheter led to reduction of average fluoroscopy usage to 23.4 minutes. All patients with fibroids had either unchanged or palliated symptoms at short-term follow-up, and inpatients with acute bleeding were discharged shortly after the embolizations with cessation of hemorrhage. All patients expressed satisfaction with the vascular access, and access artery patency was objectively demonstrated from 5 hours post procedure to 6 weeks in clinic via either manual palpation or ultrasound in 6/8 patients;2 patients chose not to return to clinic during COVID-19 pandemic but were asymptomatic at phone follow-up;access arterial pulse could not be palpated in 2 asymptomatic patients at clinic follow-up (ultrasound was unavailable). Conclusions: The advantages of TP access mirror that of TR access, with few and mostly minor complications, and the risk of iatrogenic cerebral embolization is nil. Tibio-pedal arteries are a feasible alternative access for uterine artery embolization.

The radioprotective effect of the cathpax air cabin during interventional cardiology procedures

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Puerta del Mar BACKGROUND The use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and the medical staff. Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has demonstrated to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real-world procedures. METHODS AND RESULTS In this non-randomized all-comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n = 59) and the non-RPC group (n = 60). No significant changes in patients and procedures characteristics, average contrast volume, air kerma (AK), dose area-product (PDA) and fluoroscopy time between both groups were apparent. In RPC group, the first operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures. CONCLUSIONS Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real-world setting. Table 3.Comparison of radiation exposureStructural (n = 12)Coronary (n = 107)pPrimary outcomesFirst operator relative exposure at chest*6.8 ± 33 ± 0.60.06First operator relative exposure at left wrist*19.3 ± 104 ± 1.50.01Secondary outcomesSecond operator relative exposure at chest*2.5 ± 1.21.2 ± 0.20.06First operator dose at chest (E in µSv)59.2 ± 4317.2 ± 50.08First operator dose at left wrist (E in µSv)134.1 ± 9623.4 ± 90.04Second operator dose at chest (E in µSv)19 ± 165.7 ± 20.1Patient exposure (DAP in mGy·cm2)62651 ± 2618059682 ± 142860.8Fluoroscopy time, min (±SD)24.2 ± 715.7 ± 40.2Abstract Figures 1 and 2

Second-generation laser balloon ablation for the treatment of atrial fibrillation assessed by continuous rhythm monitoring: the LIGHT-AF study.

Balloon-based technologies have been developed to simplify catheter ablation of atrial fibrillation (AF), to improve the clinical outcome of the procedure and to achieve durable pulmonary vein isolation (PVI). The objective of this study is to evaluate the safety and efficacy of second-generation laser balloon (LB2) ablation in the treatment of AF using a continuous cardiac rhythm monitoring strategy. Atrial tachyarrhythmias (ATas) recurrences were assessed with implantable cardiac monitors (ICMs) or devices. All patients underwent LB2 ablation procedure. The primary endpoint was the first recurrence of any, >5.5 and >24 h duration ATas after the blanking period (90 days). In-hospital visits were performed at 3, 6, and 12 months. Seventy-three patients (68% male, mean age 59.8 ± 11.3) were included in the study. The average procedure, fluoroscopy, and laser ablation times were 81.5 ± 30.1, 21.5 ± 12.4, and 33.8 ± 9.7, respectively. All PVs were isolated using the LB2 with no need of touch-up using focal catheters. No major complications occurred during or after the procedures. The one-year freedom from recurrences was 66.9% (95% CI: 57.0-76.7%), 81.0% (69.5-88.5%), and 86.8% (76.1-92.9%) considering any, 5.5-h and 24-h cut-off duration, respectively. At 3, 6, and 12 months, any ATas was recorded in 22%, 32%, and 25% of patients, with a ≥5% arrhythmic burden documented in 4%, 5%, and 3%, respectively. Few patients reported AF-related symptoms (7%, 8%, and 5%). LB2 ablation is a safe and effective procedure, showing a high freedom from recurrences and low arrhythmic burden as documented by a continuous rhythm monitoring strategy.

Procedural Safety Profile of Cardiomems Heart Failure Sensor Implantation in a Veterans Association Patient Population

<h3>Purpose</h3> Implantation of a wireless pulmonary artery pressure monitoring device [CardioMEMS] has been shown to reduce heart failure hospitalization but safety profile and peri-procedural complications have not been well described in real world practice in a Veterans Affairs (VA) patient population. <h3>Methods</h3> Electronic medical records of our single VA institution were retrospectively evaluated for device implantation procedure data and follow up clinic visits between 2017 and 2020. <h3>Results</h3> 63 patients with NYHA Class 3 heart failure were implanted with the device (Table 1A). Average procedure time was 48 minutes with average fluoroscopy time of 13 minutes. Average total volume of contrast used was 23 mL. Estimated blood loss was 10 mL. At device implantation, average right atrial mean pressures were 11 mmHg and pulmonary artery systolic, diastolic, and mean pressures were 51/24/34 mmHg. There were three peri-procedural complications. One patient developed an access related pseudoaneurysm successfully treated with surgical intervention. One patient developed a 2 cm hematoma at the access site managed conservatively. One patient developed proximal sensor migration following device deployment which was re-advanced using a Swan wedge balloon catheter and position was confirmed with chest radiograph and proper waveform analysis on device interrogation. All implants were successful and no patients were lost to follow up at clinic visits. There were no major adverse cardiovascular events (stroke, myocardial infarction and cardiovascular death) in hospital or at 30-day follow up. Procedural complications are summarized in Table 1B as compared to previously published data in the CHAMPION Trial. <h3>Conclusion</h3> This real world study demonstrates that the safety profile of pulmonary artery pressure monitoring device implantation in a single VA healthcare center serving a VA patient population is a feasible and safe management approach to patients with NYHA Class 3 heart failure.

Feasibility study of a novel portable digital radiography system modified for fluoroscopy in the neonatal intensive care unit.

A portable radiographic system capable of fluoroscopic imaging in the neonatal intensive care unit (NICU) potentially benefits critically ill neonates by eliminating the need to transport them to a fluoroscopy suite. To evaluate whether a portable bedside fluoroscopy system in the NICU can deliver comparable image quality at a similar dose rate to a standard system in a fluoroscopy suite. In phase A, 20 patients <3years of age and scheduled to undergo upper gastrointestinal series (upper GI) or voiding cystourethrograms (VCUG) in the radiology fluoroscopy suite were recruited to evaluate a portable fluoroscopic unit. A modified portable radiographic system with a cassette-sized detector and an in-room fluoroscopy system were sequentially used in the same examination. Four radiologists compared the image quality of 20 images from each system using the Radlex score (1-4) for five image quality attributes. The radiation dose rates for the portable and in-suite systems were collected. In phase B, fluoroscopy studies were performed in 5 neonates in the NICU and compared to the 20 previous neonatal studies performed in the department. Clinical workflow, examination time, fluoroscopy time, scattered radiation dose and patient radiation dose were evaluated. In phase A, average dose rates for in-room and portable systems were equivalent, (0.322mGy/min and 0.320mGy/min, respectively). Reader-averaged Radlex scores for in-room and portable systems were statistically significantly greater (P<0.05) for all attributes on the portable system except for image contrast. In phase B, scattered radiation from the average fluoroscopy time (26s) was equivalent to the scattered radiation of 2.6 portable neonatal chest radiographs. Procedure time and diagnostic quality were deemed equivalent. The average dose rate in the NICU with the portable system was 0.21mGy/min compared to 0.29mGy/min for the in-room system. The portable fluoroscopy unit is capable of providing comparable image quality at equivalent dose levels to an in-room system for neonates with minimal risks to the staff and other patients in the NICU.

Osteoporotic Intertrochanteric Fractures in the Elderly Managed with Proximal Femoral Nail Antirotation-The Functional Outcome

Introduction: Despite recent evolution in the operating techniques and surgical implants, debate continues around the choice of implant for the management of intertrochanteric fractures of femur bone. There is a paucity of clinical data on the results with Proximal Femoral Nail Antirotation (PFNA). Aim: To evaluate the functional and radiological outcome of reduction and fixation of these fractures with PFNA. Materials and Methods: This prospective interventional study was conducted from december 2015 to november 2018. A total of 62 patients of more than 50 years of age with intertrochanteric fracture were managed with internal fixation using PFNA. All the pateints were evaluated with respect to the mean operative time, blood loss. Fluoroscopy exposure, time to union and development of any complication. The statistical analysis involved calculation of the mean and Standard Deviations (SD) of above parameters which was done using the Microsoft excel chart sheet. Functional evaluation was done using the Harris Hip Score (HHS). Results: A total of 62 patients with age ranging from 54 to 94 years (mean 78.2, SD 09.11) were evaluated. The mean duration of follow-up was 14.3 months. The average operative time, the mean blood loss and the average fluoroscopy time were 61.4 (range 45-90 minutes, SD 11.6) minutes, 103.9 (range 60-200 mL, SD 36.4) mL and 74.0 (range 41 to 98, SD 13.5) seconds respectively. About 100% union rate with the average time to union being 16.1 (SD 3.3) weeks and ranging from 12 weeks to 24 weeks was reported. Varus collapse and limb shortening &gt;1 cm were observed in 3 patients. The average HHS at the end of study showed a mean value of 82.8 (SD 8.6) and ranged from 65 to 94 with 46 (74.2%) patients having excellent to good outcome. Conclusion: Owing to easy insertion, reduced operative time and blood loss, stable fixation, less complications and good functional and radiological outcome, PFNA can prove to be an implant of choice for the management of intertrochantric fractures of the femur.

Interventional Radiology in C&amp;#244;te d’Ivoire: Analysis and Assessment of the Radiological Risk of the Surgical Team

Ionizing radiation is widely used in medical practice for both diagnostic and therapeutic purposes. However, they are not devoid of adverse health effects on exposed operators. Therefore, we propose to assess the radiological risk of the interventional radiology team of the International Polyclinic of Indénié of Abidjan during the procedures of Embolization of uterine fibromyomas. The effective and equivalent doses to the extremities and crystals were estimated by TLD dosimeters positioned at different body areas selected on the basis of a radiological analysis of the exposure of personnel during five procedures. The analysis of fluoroscopic and record times showed variability in or an average fluoroscopy time of 32.37 min with extremes of 25.14 to 56.32 min; average record time of 0.52 min with extremes of 0.12 min to 1 min. The annual effective doses were respectively, 4.04 mSv, 3.42 mSv, 2.84 mSv; 2.28 mSv, in the Radiologist (R), Operator Assistant (O2); Anesthesiologist (A2), Manipulator (M2). The annual equivalent doses to the radiologist’s predominant extremities and lenses were left index and left lens with values of 37.07 mSv and 9.46 mSv. The estimated doses in our study are reassuring from a regulatory point of view of dose limits. The results of our work have shown no significant short-term danger to the health of personnel.

Distal transradial artery access for vascular access intervention.

Vascular access intervention is a useful treatment method for maintaining arteriovenous fistula (AVF) in dialysis patients. The outflow vein is commonly used as the access site for vascular access intervention. In cases where it is difficult to puncture veins due to multiple lesions or poor AVF development, vascular access intervention is performed using the radial artery. However, it is difficult to perform a vascular access intervention with radial artery access to the AVF in the distal forearm. We reported the efficacy and safety of vascular access intervention with distal transradial artery access (dTRA). We have been conducting vascular access intervention with dTRA access since January 2019. We evaluated complications and procedure time for 12 cases of vascular access intervention with dTRA access performed from January to December 2019.The success rate of the procedure was 100% and no puncture hemorrhagic complication was observed in 12 cases performed at our institution. No radial artery occlusion was observed in 12 cases. The average fluoroscopy time was 11.5 min and the average contrast volume was 41 ml. dTRA for vascular access intervention has advantages over conventional radial artery access in terms of safety of the procedure and ease of hemostasis.

Usefulness of a Simple Preoperative Planning Technique using Plain X-rays for Direct Anterior Approach for Total Hip Arthroplasty.

ObjectiveTo examine the accuracy, reliability, and reproducibility of a simple preoperative planning technique using plain X‐rays.MethodsA retrospective analysis of 96 consecutive cases of primary direct anterior approach (DAA)‐total hip arthroplasty (THA) from July 2015 to December 2018 was performed. The 96 patients included 24 males and 72 females, with an average age of 70 years. The standard AP pelvis radiographs with the patients' hips extended and internally rotated were obtained pre‐ and postoperatively. The preoperative planning was also completed on the standardized AP pelvic radiographs. The prearranged cup positioning was radiologically measured intraoperatively using fluoroscopy. The correct leg length was assessed intraoperatively, which was compared with the preoperative planning. The component positioning was measured by three independent researchers. Two of the researchers completed the measurements three times, and intra‐observer and inter‐observer reliability were calculated. All patients received at least 6 months follow‐up (6 months–4 years).ResultsIn all cases, the median leg length discrepancy (LLD) was 4.4 mm (range 1.6–15.9 mm), and 84 patients had an LLD smaller than 10 mm, of which 58 patients had an LLD of less than 5 mm. None of the patients had a critical LLD of 2 cm or larger. The multivariable logistic regression for LLD (safe range: yes/no) with the co‐variables including gender, ASA classification, type of cup, the surgeon's experience level, and the presence of a total hip arthroplasty (THA) on the contralateral side did not present statistical significance. The median angle of the inclination of the acetabular component (IA) was 42.3° (range: 28.7°–52.2°). Ninety‐one patients were within the defined safe range. The hit ratio for the cup to be within the safe zone was significantly higher for the Pinnacle cups than that for the Continuum cups (P < 0.05). However, there was no significant difference in gender, ASA classification, the surgeon's experience level, and the presence of a total hip arthroplasty (THA) on the contralateral side. The median of its anteversion (AA) was 20.6° (range: 10.6°–40.1°). Only 41 patients were within the defined safe range. None of the co‐variables presented a statistical significance affecting the AA of the cup positioning. Meanwhile, the average fluoroscopy time for the cup positioning (n = 86, missing data in 10 cases) was 4 seconds (range: 1–74), with most of the patients (97.9%) having a fluoroscopy time of fewer than 20 seconds.ConclusionsThe combination of correct preoperative planning and standardized intraoperative measurements can reestablish right leg length and assure the correct cup positioning.

Improved Fluoroscopy and Time Efficiency with Radial Access for Diagnostic Cerebral Angiography.

Radial artery catheterization has been newly incorporated into the field of endovascular surgical neuroradiology as a safer and more efficient method for Cerebral angiography as opposed to the femoral artery approach. The objective is to understand the relationship between cerebral angiography procedure times after an operator has converted to a radial first approach. A retrospective analysis was conducted from January to August of 2019 to compare procedural times for femoral and radial artery approaches. This was conducted by comparing different procedural specifications, such as total procedural time, fluoroscopy time, and amount of contrast used. The average age of the 434 patients in the analysis was 63.9 years with a range of 19 and 96 years. One hundred eighty-three patients (mean fluoroscopy time 7.55, 95% confidence interval 7.03-8.08) underwent successful diagnostic cerebral angiographies through the radial artery and, 251 patients through the femoral approach. The first 2 months of the radial approach saw an average fluoroscopy time of 11.23 minutes. In the last 2 months of the study, the fluoroscopy time plateaued to an average of 6.73 minutes after 55 cases. Radial artery average procedural time was reduced from 33 to 21 minutes. Angiography utilizing the femoral approach averaged 16 minutes throughout the study period. Transradial procedural time and fluoroscopy time continued to improve until about 55 cases, but did not reach the peak efficiency of the femoral approach. Further advances in catheter technology are needed to continue to improve radial artery diagnostic cerebral angiography.

Analysis of percutaneous kyphoplasty under different types of anesthesia for the treatment of multiple osteoporotic vertebral fractures

BackgroundSurgeons recognize that using percutaneous kyphoplasty (PKP) under local anesthesia to treat osteoporotic vertebral fracture (OVF) prevents interference with the general situation of elderly patients suffering from multiple organ dysfunction. Surgeons can directly assess whether nerve injury occurs while the patient is awake. However, when patients with multiple osteoporotic vertebral fractures (m-OVFs) receive local anesthesia, fluoroscopy time often has to be increased, the operative time has to be extended, or the operation has to be terminated because of discomfort related to body posture. No relevant study has thus far been conducted on the type of anesthesia to administer to patients undergoing PKP for m-OVFs. This study aimed to determine which of the two types of anesthesia is more suitable for PKP for m-OVFs.MethodsA retrospective study was conducted involving 159 patients who underwent PKP for m-OVFs from January 2016 to January 2020; 81 patients underwent PKP under general anesthesia (Group G), and 78 patients underwent PKP under local anesthesia (Group L). Clinical and adverse events were compared between the two groups.ResultsThe intraoperative mean arterial pressure, average heart rate, average fluoroscopy times of each vertebral body, and operative time were less in Group G than in Group L. The visual analog scale (VAS) score was significantly lower after than before the operation. The anterior vertebral height (AVH), middle vertebral height (MVH), and kyphotic angle (KA) were significantly improved in both groups postoperatively. The improvement in VAS score, AVH, MVH, and KA in Group G were higher than those in Group L. No significant difference in the incidence of complications was observed between the two groups.ConclusionPKP under either general anesthesia or local anesthesia was reliable. Compared with PKP under local anesthesia, PKP under general anesthesia could more reliably maintain the stability of vital signs, alleviate preoperative pain in patients, and attain a better orthopedic effect. Moreover, the latter does not increase the complications of patients with m-OVFs. However, the high medical expense of PKP under general anesthesia is a factor to consider when choosing the type of anesthesia.

Cross sectional analytic study of the relationship between age and the distance from His bundle to slow pathway in atrioventricular nodal reentrant tachycardia (AVNRT) patients using 3D mapping

Abstract Background and objective The incidence of atrioventricular nodal reentrant tachycardia (AVNRT) in elderly patients has increased due to an increased in life expectancy of the general population. Slow pathway (SPs) ablation is considered the treatment of choice for patients with AVNRT. This study is interested in the relationship of the distance from SPs to His bundle electrogram (HBEs) in various age groups because understanding of anatomy clearly could guide treatment patients by using radiofrequency ablation to be easier and safer. Design and methods A cross-sectional study was analyzed in patients diagnosed with AVNRT and underwent SPs ablation using EnSite NavX mapping system guided therapy. The distance from SPs to the lowest HBEs recorded was measured. Relationship between distance from SPs to HBEs and age was analyzed by Pearson correlation. Results A total 68 adults diagnosed with AVNRT (27.9% males, mean age 52.43 years old) were included. The mean distance from SPs to HBEs is shorter in the group older than or equal to 60 years old (n=24, mean age 70.70 years old) compared to the group younger than 60 years old (n=44, mean age 42.45 years old) (13.77 vs. 17.73 millimeter, p=0.024). Average fluoroscopy time was greater in the older group compared to the younger group (24.43 vs. 16.52 minutes, p=0.002) while the procedure time in both groups was not different (105.1 vs. 85.48 minutes, p=0.09). The distance from SPs to HBEs was negative correlation with age with the coefficient of −0.392 (p&amp;lt;0.001). When dividing the age group into three age groups, the group that younger than 40 years old (n=15, mean age 29.73 years old), 40 to 60 years old (n=29, mean age 49.03) and older than 60 years old (n=24, mean 70.70 age), the average distance from SPs to HBEs was 20.77, 16.15 and 13.77 millimeter respectively. The mean distance from SPs to HBEs in the group younger than 40 years old is significant statistically different to the group that is older than 60 years old (p=0.006). Slow pathway ablation was successful in all patients in this study except for one patient who was 72 years old because frequent transient atrioventricular block occurred during ablation. Conclusion Distance from SPs to HBEs was negative correlation with age by measuring with 3-dimentional mapping. Distance from SPs to HBEs in each groups Funding Acknowledgement Type of funding source: None

Multipolar mapping for catheter ablation of premature ventricular complexes originating from papillary muscles in the structurally normal heart: a case series

BackgroundPrevious studies on radiofrequency catheter ablation of premature ventricular complexes (PVCs) arising from the left ventricle (LV) papillary muscles (PM) show a modest procedural success rate with higher recurrence rate. Our study sought to explore the utility of using a multipolar mapping with a steerable linear duodecapolar catheter for ablating the PM PVCs.MethodsDetailed endocardial multipolar mapping was performed using a steerable linear duodecapolar catheter in 6 consecutive PM PVCs patients with structurally normal heart. The clinical features and procedural data as well as success rate were analysed.ResultsLV endocardial electroanatomic mapping was performed in all patients via a retrograde aortic approach using a duodecapolar mapping catheter. All patients displayed a PVC burden with 16.2 ± 5.4%. Duodecapolar catheter mapping demonstrated highly efficiency with an average procedure time (95.8 ± 7.4 min) and fluoroscopy time (14.2 ± 1.5 min). The mean number of ablation applications points was 6.8 ± 1.9 with an average overall ablation duration of 6.1 ± 3.0 min. The values of earliest activation time during mapping using duodecapolar catheter were 37.8 ± 7.2 ms. All patients demonstrated acute successful ablation, and the PVC burden in all patients after an average follow-up of 8.5 ± 2.0 months was only 0.7%. There were no complications during the procedures and after follow-up.ConclusionsMapping and ablation of PM PVCs using a duodecapolar catheter facilitated the identification of earliest activation potentials and pace mapping, and demonstrated a high success rate during follow-up.

Initial implantation experience and short-term follow-up results of implanting leadless intracardiac transcatheter pacing system

Objective: To explore the utility and safety of leadless intracardiac transcatheter pacing system. Methods: The study was a prospective observational study. Patients underwent Micra transcatheter pacing system in Beijing Anzhen hospital from December 2019 to January 2020 were enrolled. The baseline characteristics, platelet count, hemoglobin, anticoagulation and/or antiplatelet therapy, mean procedural time, average fluoroscopy time, number of deployment and electrical parameters (threshold, R-wave amplitude, impedance) were recorded. Ultrasonography of bilateral femoral and iliac veins was performed in all patients. Patients were followed including access site complication, adverse event and device evaluation at implant, hospital discharge, 1 and 3 months post-implant. R-wave≥5 mV, impedance between 400 and 1 500 Ω and threshold increase≤1.5 V than implant is considered a stable parameter. Femoral access site complications included hematoma, hemorrhage, pseudoaneurysm, and arteriovenous fistula. Adverse events included dislodgement, cardiac effusion/perforation and infection. Left ventricular end diastolic diameter and ejection fraction before and at 1 month after implant were reported. Results: Five patients were enrolled and pacemaker implantation was successful in all 5 patients. Patients were all males and the average age was (78.4±8.4) years. 2 patients received aspirin and clopidogrel therapy, 1 patient suffered from anemia and thrombocytopenia occurred in 1 patient. No stenosis, occlusion and vascular malformation of bilateral femoral and iliac veins was observed. The mean implant time was (39.6±1.7) minutes. The average fluoroscopy time was (9.2±1.3) minutes and the number of deployment was (1.40±0.55). Electrical parameters(threshold, R-Wave amplitude and impedance) were as follows: (0.40±0.10) V/0.24 ms, (10.80±3.72) mV and (822.00±162.23) Ω at implant; (0.45±0.07) V/0.24 ms, (13.04±2.41) mV, and (748.0±91.5) Ω at discharge, (0.40±0.06) V/0.24 ms, (14.26±4.11) mV, and (700.0±91.7) Ω at 1 month post-implant and (0.39±0.05) V/0.24 ms, 14.40±3.97 mV, and (682.0±96.0) Ω at 3 months post-implant, respectively. Threshold increase was ≤1.5 V compared to that during implantation, electrical parameters were acceptable and stable. There was no difference in LVEDD [(44.00±5.24) mm vs. (44.00±5.34) mm,P=1.000] and EF [(62.00±3.39)% vs. (62.20±3.56)%, P=0.861] before and 1 month post-implant. No incidence of access site complications, cardiac effusion/perforation, dislodgment or infections occurred during the 3 months. Conclusions: The leadless transcatheter pacemaker implantation performed in our study archived a high implant success rate and favorable safety profile as well as associated with low and stable pacing thresholds. The long-term safety and benefit of leadless pacemaker need to be evaluated in future clinical studies.

Comparative analysis of operation time and intraoperative fluoroscopy time in intramedullary and extramedullary fixation of trochanteric fractures

Background/Aim. Cephalomedullary and extramedullary methods are used for the internal fixation of trochanteric fractures. The usage of the third generation Gamma Nail (GN) is a gold standard in this kind of treatments. Self-dynamisable Internal Fixator (SIF) is an extramedullary implant for trochanteric fractures? treatment. The aim of this study was to compare these two methods regarding operation time and intraoperative fluoroscopy time. Methods. A total of 89 patients with a surgical treatment of a trochanteric fracture were included in this study. There were two groups of patients ? GN group (43 patients) and SIF group (46 patients). Results. Average operation times were 67.5 min (GN group) and 56.0 min (SIF group). Average intraoperative fluoroscopy times were 84.8 s (GN group) and 36.7 s (SIF group). The difference between the groups was statistically significant for both of the given parameters (p &lt; 0.05). The correlation between operation time and intraoperative fluoroscopy time was confirmed in the SIF group (p &lt; 0.05; r = 0.405), while it was not confirmed in the GN group (p &gt; 0.05). There was a higher variability in the GN method than in the SIF method regarding the duration and type of repeated surgical maneuvers followed by X-ray checks. Conclusion. The number of planned surgical interventions per day could depend on the type of trochanteric fracture internal fixation (intramedullary or extramedullary). Certain additional analyses including radiation dose assessment are desirable to clarify if shorter intraoperative fluoroscopy time in the SIF method can have the influence regarding intraoperative X-ray protection clothing. If there is the need to activate dynamization in long femoral axis after initial static fixation in that axis, the SIF method provides its spontaneous activation several weeks after the surgery without the need neither for additional surgery nor for additional intraoperative fluoroscopy

Caval pseudoaneurysms following complex inferior vena cava filter removal: Clinical significance and patient outcomes.

To investigate the incidence and clinical significance of caval pseudoaneurysm and extravasation post-complex inferior vena cava filter retrieval. A total of 83 patients (70% female, average age 56) underwent complex inferior vena cava filter retrieval between January 2015 and December 2019 utilizing either rigid endobronchial forceps (n = 69, 83%) and/or excimer laser (n = 20, 24%). Procedural variables were recorded. The incidence and size of caval pseudoaneurysms and extravasation along with treatment type and clinical outcomes were analyzed. Technical success in all cases was 96% (n = 80). Average fluoroscopy time was 23 min (median: 20.2, range: 0.9-129.5). Average filter dwell time was 85 months (range: 2-316 months). Caval pseudoaneurysm was detected on post-retrieval venography in 10 patients (12%) and frank extravasation occurred in 1 case (1%). Average pseudoaneurysm length and width was 20.4 mm (range: 5-45 mm) and 12.9 mm (range: 4-24 mm), respectively. Pseudoaneurysms occurred most frequently during the removal of Optease (n = 5) and Celect (n = 2) filters. The pseudoaneurysms completely resolved with prolonged (>5 min) balloon angioplasty in all but one instance where a small portion of the pseudoaneurysm persisted. This patient was admitted and observed overnight before being discharged without complication. The solitary case of significant extravasation was effectively managed with immediate stent placement and the patient remained hemodynamically stable. Radiographically detectable caval pseudoaneurysm and extravasation is not uncommon in complex inferior vena cava filter retrieval and, despite being considered a major complication by Society of Interventional Radiology guidelines, can often be managed without stenting or other invasive treatment.