Interventional Radiology Department Research Articles

Endovascular recanalization of symptomatic subacute and chronic occlusion of large intracranial artery: Initial clinical experience and technical considerations

Objective To investigate the feasibility, safety and efficacy of endovascular recanalization of symptomatic subacute and chronic occlusion of large intracranial artery. Methods During the period from October 2015 to September 2017, 11 patients with symptomatic subacute and chronic occlusion of large intracranial artery were treated with endovascular recanalization at Department of Interventional Radiology of Shanghai Tongji Hospital, Tongji University School of Medicine. We retrospectively analyzed the patients' clinical and imaging data to evaluate the rate of perioperative complications and follow-up results. Results Recanalization was successful in 10 of 11 patients and incomplete recanalization (2a based on Thrombolysis in Cerebral Infarction classification) was achieved in 1. Intraoperative complications occurred in 8 cases and included peripheral vascular embolism in 7 (1 symptomatic and 6 asymptomatic cases). One case was complicated with artery dissection and intracerebral hemorrhage associated with embolectomy occurred in another case. One patient was lost to follow-up and 10 patients received angiography and clinical follow-up for 3-12 months. The results of angiography follow-up showed that the stenosis artery segment of patient with incomplete recanalization was blocked again at 3 months. Of the 9 patients with complete recanalization, 1 patient developed in-stent restenosis at 12 months and suffered transient ischemic attack (TIA). The other 8 patients had no hemodynamic restenosis and no recurrence of TIA or stroke. The mRS (modified Rankin scale) score at 3-month follow-up was 0-1 in 9 patients and 4 in 1. Conclusions For patients with symptomatic subacute and chronic occlusion of large intracranial artery, on the premise of strict screening cases, mechanical recanalization is technically feasible and could improve the patient' symptoms in short term and reduce the recurrence rate of stroke. Its long-term effect, however, needs to be confirmed by longer follow-up. Key words: Arterial occlusive diseases; Cerebral angiography; Cerebral revascularization; Intraoperative complications

Quantification of the impact of interventional radiology in the management of acute pancreatitis

Interventional radiology plays a central role in the management of complicated acute pancreatitis, contributing to image-guided drainages, treating haemorrhagic complications and maintaining the patency of the biliary tree. In addition, many of these patients require long-term venous access for antibiotics or parenteral feeding. The aim of this study was to evaluate the role and level of involvement of the interventional radiology in this sub-group of patients. This was a single-centre retrospective review of all admissions for acute pancreatitis over a 5-year period. Each case was assessed to determine whether radiological intervention was utilised. Our review included 401 patients. A total of 18.7% (75/401) of patients required vascular access procedures and 18.4% (74/401) required image-guided drainage. A total of 1.2% (2/401) patients had embolisation procedures performed. The embolisation procedures were performed to treat a pseudoaneurysm that had formed. Overall, 20.9% (84/401) of patients were referred to the interventional radiology department for a procedure; a majority of these patients were referred for multiple procedures over the course of their admission. The patients in the 'severe pancreatitis' category had a total of 154 procedures performed, which was 65.5% of the total procedures. On average, the patients who underwent multiple interventional procedures tended to have a longer admission and more complex disease. The diagnosis and treatment of complicated acute pancreatitis is heavily dependent on the interventional radiology department. A substantial proportion of patients with pancreatitis required radiological intervention as part of their management, the proportion of which increased significantly in complex disease.

Percutaneous nephrostomy versus antegrade double-J stent placement in the treatment of malignant obstructive uropathy: a cost-effectiveness analysis from the perspective of the Brazilian public health care system.

ObjectiveTo compare two percutaneous techniques used in the treatment of malignant obstructive uropathy-antegrade double-J stent placement (JJ stenting) and percutaneous nephrostomy-in terms of their cost-effectiveness, from the perspective of the Brazilian public health care system.Materials and MethodsIn this cost-effectiveness analysis, we employed decision-analytic modeling. We calculated material costs from 2017 factory prices listed by the Brazilian Pharmaceutical Market Regulatory Board (for medications) and published in the journal Revista Simpro (for medical devices). Procedure-related costs were evaluated, as were the rates of technical and clinical success. Those measures were then used as inputs for a cost-effectiveness analysis comparing the two procedures.ResultsThe sample comprised 41 patients, of whom 16 underwent antegrade JJ stenting (26 procedures) and 10 underwent percutaneous nephrostomy (15 procedures). Patient records, radiology reports, and expense reports of the interventional radiology department of the public hospital where the study was conducted were analyzed retrospectively. There were no significant complications: one patient had low back pain, and one had a transient retroperitoneal hematoma. The mean procedure time was 24 min, and clinical success (improvement in serum creatinine and resolution of hydronephrosis) was achieved in 97.5% of the cases. The average cost of JJ stenting was significantly lower than was that of percutaneous nephrostomy (US$164.10 vs. US$552.20).ConclusionIn the absence of any clinical contraindications, antegrade JJ stenting is a suitable alternative to both percutaneous nephrostomy and retrograde stenting in patients with dilated renal collecting systems secondary to malignant ureteral obstruction, providing significant cost savings and high success rates.

Decreasing Wait Times and Increasing Patient Satisfaction

Patient satisfaction scores in the vascular interventional radiology department were low, especially related to wait times in registration and for tests/treatments, with low scores for intentions to recommend. The purpose of our quality improvement project was to decrease wait times and improve patient satisfaction using Lean Six Sigma's define, measure, analyze, improve, and control (DMAIC) framework with a pre-/postintervention design. There was a statistically significant decrease in wait times (P < .0019) and an increase in patient satisfaction scores in 3 areas: registration wait times (from 17 to 99 percentiles), test/treatment (from 19 to 60 percentiles), and likelihood to recommend (from 6 to 97 percentiles). Lean Six Sigma was an effective framework for use in decreasing wait times and improving patient satisfaction.

Recent guidelined for the early endovascular management of patients with acute ischemic stroke and practical aspects of their implementation

Objective — to estimate safety and effectiveness of intra-arterial treatment for acute ischemic stroke in the interventional radiology department of multiprofile hospital. Materials and methods. Urgent endovascular treatment was applied at 15 patients with acute ischemic stroke in carotid circulation during 2015–2017. Mechanical intra-arterial therapy with thrombectomy by stent-retrievers and thromboaspiration was used at accordingly six and two recent cases (during 2017); in 7 cases intra-arterial thrombolysis was the treatment option (2015–2016). Results. The article consist brief review of literature about acute ischemic stroke treatment and discussion concerning results of treatment of selected patients. Mechanical thrombectomy or thromboaspiration were effective in 75.0 % of cases with good recanalization rate opposite to 42.9 % at 7 patients treated by either intra-arterial or bridging thrombolysis with rt-PA. Unexpected technical failures of mechanical thrombectomy regarding recent clinical guidelines for ischemic stroke management following are discussed on example of 2 clinical cases. Conclusions. Endovascular treatment of ischemic stroke has a high safety and well-known efficacy. It became evident at our patients that following current management guidelines for thrombectomy with stent-retrievers or thromboaspiration after thrombotic occlusions of extracranial and proximal segments of intracranial arteries allowed attaining in 2017 reperfusion rate 2b/3 Modified Treatment in Cerebral Ischaemia Scale in majority of cases. Intra-arterial thrombolysis contributed to the reperfusion rate 2b/3 on the Modified Treatment in Cerebral Ischaemia scale just in 42.9 % of cases, which indicates its lower effectiveness.

Clinical efficacy of absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation in children.

The aim of the present retrospective study was to investigate the clinical safety and efficacy of absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation. Sclerotherapy was performed in 121 children (52 males and 69 females; age range, 5 months to 16 years) with venous malformations under general anesthesia between April 2009 and October 2014 at the Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China. The patients with venous malformations were diagnosed and classified according to the diagnostic criteria of the International Society for the Study of Vascular Anomalies. According to the characteristics of intraoperative percutaneous angiography, 21 patient cases (9 males and 12 females; age range, 6 months to 14 years) were classified as advanced Puig's venous malformation. These 21 patients were treated with absolute ethanol combined with n-butyl cyanoacrylate. The patients were followed-up for 6–24 months (average, 15 months) after treatment. Following treatment with absolute ethanol combined with n-butyl cyanoacrylate, 15 cases were controlled and the total effective rate was 71% (15/21). However, 1 patient developed skin ulcerations, which was classed as a minor complication, 1 patient developed ectopic embolism caused by n-butyl cyanoacrylate reflux, and 1 patient developed transient pulmonary hypertension, the latter two complications were classified as major. Notably, the incidence rate of minor and major complications were 14.3%. To conclude, the present findings indicated that absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy was a safe and effective method with a low complication rate in the treatment of Puig's classified advanced venous malformation in patients.

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

Clinical results of transarterial embolization to control postoperative vascular complications after partial nephrectomy

PurposeTo evaluate the safety and clinical efficacy of transarterial embolization for vascular complications after partial nephrectomy. Materials and MethodsThis retrospective study included 1187 patients who underwent partial nephrectomy between January 2006 and December 2017. In total, 36 patients were referred to the interventional radiology department for vascular complications after partial nephrectomy. Data on demographics, clinical manifestations, angiographic findings, embolization procedure, perioperative details, and the technical and clinical success rates were analyzed. Further, renal functions at diagnosis, after embolization, and at the last follow-up were recorded. ResultsA diagnosis of hemorrhage was made at a median of 5 (range, 0–89) days after surgery. The incidence of the requirement of embolization owing to hemorrhage after laparoscopic surgery (5.9%, 17/289) was higher than that after open surgery (1.8%, 8/440; p = 0.003) and robot-assisted surgery (2.4%, 11/458; p = 0.014). The technical and clinical success rates were 100% (36/36) and 94.4% (34/36), with 2 patients requiring additional embolization using n-butyl-2-cyanoacrylate glue. The estimated glomerular filtration rates at diagnosis, post-embolization, and the last follow-up were 81.0 ± 21.6, 83.7 ± 21.0, and 84.9 ± 15.8mL/min/1.73 m2, respectively (p = 0.345). No major complication was observed during follow-up. ConclusionsTransarterial embolization is safe and effective in the management of vascular complications after partial nephrectomy. Moreover, renal functions were well-preserved with superselective TAE.

Central venous access in oncology patients: A pragmatic approach to minimizing complications following port insertion.

267 Background: Subcutaneous venous access devices, specifically implantable ports, are vital in the care of oncology patients. Despite routine use, complications remain prevalent. This retrospective single-institutional review was performed to identify rates of complications following port placement and target areas to improve patient outcomes. Methods: Retrospective analysis of 539 cancer patients who underwent port insertion in a one-year span at University of Florida was conducted. Data examining 18 potentially predictive factors was collected, and multivariate analysis was conducted using logistic regression and odds ratios with standard errors to determine predictive factors. Results: Of 539 patients, 100 (19%) experienced a complication, and 12 (2%) experienced 2 or more complications. An overall lower rate of complications was seen in patients on therapeutic anticoagulation (OR 0.17, p &lt; 0.001) or on antiplatelet agents (OR 0.47, p = 0.02). No patients on therapeutic anticoagulation developed VTE (0%). Right-sided port insertion was associated with decreased rates of infection (OR 0.44, p = 0.04). Insertion as inpatient was associated with increased risk for mechanical failure (OR 4.60, p &lt; 0.01) and catheter migration (OR 4.33, p &lt; 0.01). Conclusions: This analysis identified multiple predictive factors that can potentially put patients at higher risk of complication following port insertion. A thorough risk assessment for VTE should be done prior to port insertion, and high-risk patients (i.e. prior VTE, Khorana score &gt; 3) should be considered for prophylactic anticoagulation. Further analysis on optimal port insertion site (right/left) and location (inpatient/outpatient) are also targets that can potentially decrease complication rates. As ports inserted while inpatient had increased risk of both mechanical failure and catheter migration, and as ports inserted on the left side had increased risk of infectious complications, a prospective quality improvement initiative coordinated between Oncology and Interventional Radiology departments as to whether insertion of right-sided ports on an outpatient basis may improve outcomes is the next step in our investigation.

Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access \u2013 prospective audit at a single interventional radiology centre

BackgroundFemoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the influence of sheath size on overall complication rates and morbidity following femoral arterial access is not well described. This prospective single centre study reports our experience of vascular sheath size, patient and procedural factors in influencing complication rates following femoral arterial access. From April 2010 to May 2013, data was collected prospectively for all femoral arterial access procedures performed in the Interventional Radiology department of a tertiary hospital. For vascular sheath size <6-Fr, haemostasis was achieved by manual compression. For 6-Fr sheath size, a closure device was used in the absence of any contraindication.ResultsOf the 320 femoral access cases with eligible inclusion criteria, 52.5% had 4-Fr whilst 47.5% had 6-Fr vascular sheaths inserted. Overall post procedure complications rates were significantly higher following 6-Fr sheath (17/152 (11.2%)) versus 4-Fr systems (3/168 (1.8%)) (p=0.0007) mostly comprising self-limiting hematoma. There was no significant difference in major complications that required escalation of treatment.ConclusionNo significant difference has been demonstrated between the use of either sheath systems for major complications. The practical limitations of a smaller system, combined with existing body of evidence, may not justify the routine use of 4-Fr sheath systems as the primary sheath size for all endovascular procedures.

OA219] Eye lens dose monitoring in interventional radiology

Purpose The new limit established for the eye lens has increased the interest for lens dose monitoring. This work aims to: • Estimate the lens doses for the staff of the Interventional Radiology department at Vicenza Hospital; • Establish relationships between the eye lens dose and the dose measured with personal dosimeters; • Verify the feasibility of using commercial Hp(3) dosimeters; • Investigate a possible relationships between the lens dose and the air Kerma–Area product (KAP). Methods Measurements have been carried out both in vivo (4 radiologists and 5 nurses) during 87 different abdominal procedures performed with a Multistar (Siemens, Germany), and in anthropomorphic-phantom using a single 180° projection at 59 kV and 125 kV. The evaluations included: Hp(10) and Hp(0.07) measurements performed at the chest level over the apron (Hp,chest); Hp(0.07) measurements performed on the external and inferior sides of the left eye using Hp(0.07) detectors specifically modified for this purpose (Hp,eye); Hp(3) performed with dedicated dosimeters positioned over the left arm of the protective glasses (Hp,glasses). Additional Hp(0.07) measurement were performed directly at the phantom eye lens level (Hp,lens). Transmission factors of the lead glasses were also estimated. Results The main results are: • Hp,eye/Hp,chest: 0.6 ± 0.6 (in vivo); 0.4 ± 0.2 (in phantom) • Hp,eye/Hp,glasses: 1.1 ± 1.2 (in vivo); 0.5 ± 0.5 (in phantom) • Hp,chest/KAP: 2.5 ± 3.6 μSv Gy−1 cm−2 (in vivo); 5.8 ± 2.0 μSv Gy−1 cm−2 (in phantom) In vivo and phantom results are consistent within the large uncertainties due to low dose levels and irradiations variability. Therefore phantom measurements allowed estimating Hp,lens/Hp,eye in 0.20 when glasses are used. Using this factor, the projected annual eye lens dose, considering the workload, resulted 4 mSv for the personnel using lead glasses and 15 mSv for the others. The ratio between eye lens dose with and without glasses is higher than expected based on transmission factors. Conclusions According to our results, traditional monitoring methods with proper corrections could be used to estimate lens dose in place of expensive Hp(3) dosimeters. Missing glasses-skin contact could explain eye doses higher than expected.

Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access.

Aim: The purpose of this paper was to evaluate the efficacy of ultrasound-guided percutaneous thrombin injection as a treatment method for arterial access site pseudoaneurysm. Materials and methods: A total of 148 patients with iatrogenic arterial access site pseudoaneurysms were treated in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Of those, 142 pseudoaneurysms were located in the common femoral artery, 3 in the brachial artery and the remaining 3 in the radial artery. The study included 77 woman and 71 men (mean age 64.5 ± 14 years). Patients were qualified for percutaneous thrombin injection after Doppler examination during which pseudoaneurysm size and morphology were assessed as well as the presence of arteriovenous fistula was excluded. Results: In the reported study, 94.8% (128/135) of patients were successfully treated during the initial thrombin injection. Additional 400 IU dose of thrombin after 24 hours was effective in 5 out of 7 patients with recanalization during the follow-up. A total of 98.5% (133/135) of patients were successfully treated with a percutaneous ultrasound-guided thrombin injection. Conclusions: The 10-year experience presented in this study as well as literature reports prove that percutaneous ultrasound-guided thrombin injection is an effective and safe treatment method for iatrogenic arterial access site pseudoaneurysm.

Selecting patients for embolization of varicoceles based on ultrasonography.

Aim: The aim of the study was to assess patient selection for embolization of varicoceles based on ultrasonography. An additional objective of the work was to evaluate the results of endovascular treatment. Material and methods: From January 2015 till August 2017, 53 patients with varicoceles diagnosed in an ultrasound examination underwent endovascular treatment in the Department of Interventional Radiology and Neuroradiology in Lublin, Poland. Each ultrasound examination was performed using the Logiq 7 GE Medical System with a linear probe at 6–12 MHz using the B-mode and Doppler functions. The study was performed in both the supine and standing position of the patient. The morphological structures of the scrotum and the width of the pampiniform venous plexus were assessed. Based on clinical signs and symptoms as well as ultrasound findings, the patients were selected for endovascular treatment. This procedure involved the implantation of coils in the distal and proximal parts of the testicular vein and administration of a sclerosing agent between the coils. Results: Varicoceles were confirmed in all patients during a color Doppler scan. Diagnostic venography confirmed venous stasis or retrograde flow in the testicular vein and widened vessels of the pampiniform venous plexus over 2 mm in diameter in all patients undergoing endovascular treatment. The diagnostic efficacy of ultrasound was 100%. The technical success of the procedure was 89%. One patient had a recurrence of varicose veins (2.2%). There were no complications in any of the patients. Conclusions: Ultrasound is the preferred method in the diagnosis of varicoceles and selection for their treatment. Testicular vein embolization is a minimally invasive procedure characterized by high efficacy and safety.

Correlations of serum VEGF and MMP-2 levels with CLM in CRC patients and effects of TACE on their expressions.

To investigate the correlations of serum vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP-2) levels with colorectal liver metastasis (CLM) in patients with colorectal cancer (CRC), and determine the effects of transhepatic arterial chemoembolization (TACE) on their expressions. A total of 110 CRC patients treated in the department of interventional radiology of our hospital from May 2013 to May 2016 were randomly enrolled. All patients received treatment of TACE after surgery. During surgery, 10 mL venous blood was taken, and the protein levels of VEGF and MMP-2 in serum were detected via enzyme-linked immunosorbent assay (ELISA). The correlations of VEGF and MMP-2 levels with clinicopathological features of patients were analyzed. The values of VEGF and MMP-2 in predicting CLM were analyzed using the receiver operating characteristic (ROC) curve. Moreover, changes in serum VEGF and MMP-2 levels in CRC patients were analyzed before TACE, and at 1 and 6 months after TACE. The median VEGF and MMP-2 levels in serum of CRC patients were 64.8 ng/mL and 114.4 ng/mL, respectively, which were significantly higher than those in healthy control group (5.3 ng/mL and 6.8 ng/mL) (p<0.05). The expressions of VEGF and MMP-2 in serum of CRC patients were correlated with the depth of tumor infiltration, Dukes' staging, CLM and lymph node metastasis (p<0.05). Logistic regression analyses showed that the expression levels of VEGF and MMP-2 were positively correlated with CLM (p<0.05). The ROC curve revealed that the sensitivity, specificity and accuracy of serum VEGF in the diagnosis of CLM were 62.2%, 78.5% and 80.2%, respectively. The sensitivity, specificity and accuracy of serum MMP-2 in the diagnosis of CLM were 68.9%, 85.5% and 82.2%, respectively. The serum VEGF levels in CRC patients before TACE, and at 1 and 6 months after TACE were (64.8±58.8) ng/mL, (43.1±27.3) ng/mL and (24.8±12.3) ng/mL, respectively, showing a downward trend (p<0.05). The serum MMP-2 levels in CRC patients before TACE, and at 1 and 6 months after TACE were (114.4±136.2) ng/mL, (73.4±58.5) ng/mL and (39.6±30.4) ng/mL, respectively, also indicating a reducing trend (p<0.05). The levels of VEGF and MMP-2 in portal vein serum of CRC patients can be used as effective indexes for judging the prognosis of CRC and predicting CLM. Patients with high expression of VEGF and MMP-2 should be actively treated with TACE after surgery to improve the survival rate.

Utilizing a Sedation Decision Aid in Ambulatory Venous Access Device Placement: Effects on Patient Choice, Workup, and Recovery Time

This study was undertaken to determine the influence of using a sedation decision aid when selecting a sedation option for totally implantable vascular access device placement on patient choice, workup, and recovery time. An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study of 76 patients (aged 23-89 years, 58% female) presenting to a vascular interventional radiology department between January 2, 2017, and May 5, 2017. Patients were given a decision aid that inquired about personal values and goals, and provided information about expectations; benefits; and risks of the options, including undergoing the procedure with no sedation (local anesthetic), minimal sedation (anxiolysis with a benzodiazepine), or moderate sedation (benzodiazepine and opiate). No sedation was selected by 15 out of 76 patients (19.7%), minimal sedation was selected by 26 out of 76 patients (34.2%), and moderate sedation was selected by 34 out of 76 patients (44.7%). Postprocedure recovery time differences were significant (P < .001) with a mean of 17.4 minutes for no sedation, 49.3 minutes for minimal sedation, and 70.8 minutes for moderate sedation. The use of a decision aid did not slow down the process because workup times were not significantly different: 15.9 minutes for no sedation, 22.1 minutes for minimal sedation, and 18.4 minutes for moderate sedation. Patient sedation preference for totally implantable vascular access device is variable, signifying there is a role for utilizing a decision aid because it empowers a patient to select the option most aligned with his or her goals. Influence on departmental flow is notable because this does not slow down the workup and a majority of patients choose no or minimal sedation, resulting in a decreased postprocedure recovery time burden.

Use of active personal dosimeters in hospitals: EURADOS survey

Considering that occupational exposure in medicine is a matter of growing concern, active personal dosimeters (APDs) are also increasingly being used in different fields of application of ionising radiation in medicine. An extensive survey to collect relevant information regarding the use of APDs in medical imaging applications of ionising radiation was organised by the EURADOS (European Radiation Dosimetry Group) Working Group 12. The objective was to collect data about the use of APDs and to identify the basic problems in the use of APDs in hospitals. APDs are most frequently used in interventional radiology and cardiology departments (54%), in nuclear medicine (29%), and in radiotherapy (12%). Most types of APDs use silicon diodes as the detector; however, in many cases their calibration is not given proper attention, as radiation beam qualities in which they are calibrated differ significantly from those in which they are actually used. The survey revealed problems related to the use of APDs, including their reliability in pulsed x-ray fields that are widely used in hospitals. Guidance from regulatory authorities and professional organisations on the testing and calibration of APDs used in hospital would likely improve the situation.

PMD112 - Interventional Radiology to Bedside Peripherally Inserted Central Catheter Placement: A U.S. Hospital Cost Analysis

Estimate the health economic impact associated with nurse-based (RN) increased use of Sherlock 3CG® Tip Confirmation System (TCS) for intensive care unit (ICU) and non-ICU bedside peripherally inserted central catheter (PICC) placements compared to current physician-based interventional radiology (IR) department PICC placement (e.g., confirmatory chest x-ray) and physician-based centrally inserted central catheters (CICC) insertion procedures. A model was developed to estimate health economic outcomes over a three-year time horizon. For the current mix, it was assumed that all non-ICU patients received IR PICC placement and the majority of ICU patients received CICC placement. The future mix assumed that all eligible patients receiving IR PICC placement (~93%) switched to Sherlock 3CG® TCS. Tray, kit, and operational costs were assessed. Differences in staff time were also estimated. Inputs were derived from published literature where available. Sensitivity analyses, such as varying unit costs and utilization inputs were conducted to test a range of assumptions. Increased use of Sherlock 3CG® TCS was predicted to result in procedural cost savings when compared with current conventional PICC placements in the IR. In the base case, for an estimated population size of 1,325 annual patients, the cumulative three-year cost-savings were predicted to be $734,328. In addition, increased use of bedside PICC placement with Sherlock 3CG® TCS was predicted to reduce resource use (e.g., physician or IR staff time) when compared with conventional PICC placement in the IR. Finally, Sherlock 3CG® TCS was predicted to be cost-saving in the majority of sensitivity analyses. These analyses suggest that increased use of RN-based Sherlock 3CG® TCS may reduce the clinical, resource, and economic limitations associated with physician-based IR PICC placement methods. These analyses were not based upon head-to-head clinical comparisons and therefore additional data would help to further elucidate these findings.

A comparison between two types of indwelling pleural catheters for management of malignant pleural effusions

Malignant pleural effusion (MPE) is a common cause of quality of life deterioration in patients with advanced cancer. Management options include chemical pleurodesis with a sclerosing agent such as doxycycline or talc powder, surgery, and also the placement of tunneled indwelling pleural catheters (IPCs). Two different IPC types are mostly used in the USA. We conducted a single-center retrospective study with the objective to compare the efficacy and safety profiles of two IPC systems. Patients with a diagnosis of malignancy, who received IPCs by the interventional radiology department of our hospital from January 2013 to March 2015, were identified in the local database and a chart review was performed to record characteristics and outcomes. Patients without a diagnosis of malignancy or with pleural effusions of cardiac origin were excluded from the study. We identified 27 patients with a median age of 59.0 years. Eighty patients received Aspira catheter while nine patients received PleurX catheter, and seven patients achieved spontaneous pleurodesis. The median length of stay (LOS) was 9 days for the Aspira group (AG), as compared to 13 days for the PleurX group (PG) (overall median LOS was 10 days; range, 2-62 days). The rate of catheter-related complications (pain, obstruction, loculations, infection, hemorrhage) was 39% (seven patients) for the AG and 33% (three patients) for the PG (overall ten patients, 37%). In our study, outcomes and safety were similar for patients receiving either type of IPC, Aspira or PleurX.

Radiation Protection Knowledge, Attitude, and Practice (KAP) in Interventional Radiology.

Due to increasing cardiac disease and its mortality rate, the frequency of cardiac imaging has grown and, as a result, interventional cardiologists potentially receive high radiation doses in cardiac examinations. This study aimed to assess the knowledge, attitude, and practice (KAP) level of radiation protection (RP) among interventional radiology staff in Iranian health care centers across the country. We used a validated questionnaire survey consisting of 30 multiple-choice questions to perform a cross-sectional study. Participants were healthcare personnel working professionally with radiation at different levels (i.e., secretary, radiology technologists, nurse, and physician). The questionnaire was divided into three sections to assess KAP regarding RP. Significant differences exist in RP KAP mean scores based on educational age (p < 0.050). There was no significant difference in RP KAP mean scores when looking at sex, practice age, and hospital type (p > 0.050). We found a significant difference between RP KAP mean scores and different regions (p < 0.050). Educational and practice age, sex, type of hospital, and geographical region affect he KAP of interventional radiology staff regarding RP. Since many of the subjective radiation harms for both medical team and patients, this can be easily controlled and prevented; a checkup for personnel of interventional radiology departments, considering samples from different parts of the country with different levels of education, continuous training, and practical courses may help map the status of KAP. The results of this study may also help authorized health physics officers design strategic plans to enhance the quality of such services in radiation departments.

Percutaneous treatment of orofacial vascular malformations

The aim of this study was to evaluate the efficacy of fluoroscopy-guided percutaneous injection of bleomycin as the primary treatment for low-flow vascular malformations. A total of 34 patients (mean (range) age 24 (8–51) years) with orofacial vascular lesions were treated in the Department of Interventional Radiology and Maxillofacial Surgery. There were 20 low-flow venous malformations, 11 lymphatic malformations, and three of mixed type. All patients were treated by fluoroscopy-guided percutaneous injection of a mixture of bleomycin (mean (range) 15 (5–15)mg) and a radio-opaque agent (Ultravist® (iopromide), Bayer)/session. The number of sessions ranged from one to six. The clinical response was complete in 21 patients, obvious in nine, and of clinical benefit in four. Patients were reviewed within the first week, third week, and at three-month periods until 24 months. There were no serious complications such as pulmonary fibrosis. Fluoroscopy-guided intralesional injection of bleomycin should be considered as the first-line treatment for lymphatic malformations because it is effective and reliable with few complications.