Diagnostic Angiographic Procedures Research Articles

Radiation dose in radiologist from cerebral angiography using optically stimulated luminescence dosimeter

Background: The number of cerebral angiography procedures is increasing, resulting in higher X-ray radiation doses received by radiologists. Consequently, understanding the radiation doses received by radiologists and the accumulation of radiation in control rooms is crucial for guiding prevention strategies against radiation hazards. Objectives: This study aimed to measure and evaluate radiation doses to the hands, lenses of the eyes, and thyroids of radiologists performing cerebral angiography procedures, as well as to measure the accumulated radiation dose in the control room. Materials and methods: OSL dosimeters were placed on the eyeglass frames, thyroids, hands, and legs of radiologists performing 20 cerebral angiography procedures, as well as on the wall and window of the control room. Results: Radiologists’ average radiation doses were measured at specific body parts as follows: left eye (49 µSv), right eye (15 µSv), left hands (34 µSv), right hands (16 µSv), left legs (27 µSv), right legs (7 µSv), and thyroid glands (14 µSv). Notably, the received doses remained well within the maximum radiation dose limit established by the International Commission on Radiological Protection (ICRP). When calculating the maximum number of procedures that can be performed annually, we based it on the limit of the radiation dose that the eyes’ lenses should not exceed. Our findings revealed that the permissible number of procedures determined by the lens radiation dose limit, should not surpass 405 cases annually (equivalent to 34 cases per month). The radiation dose from therapeutic angiography procedures was discovered to be up to 5 times higher than that from diagnostic angiography procedures. The maximum accumulated radiation dose in the control room was 1.18 µSv/hr, which remained below the limit of the Department of Medical Sciences (< 3 µSv/hr). Conclusion: Radiologists receive less radiation from cerebral diagnostic angiography than therapeutic angiography. Organs on the left side were exposed to greater radiation levels than those on the right side. Wearing radiation protection devices during each procedure can reduce radiation exposure and mitigate long-term effects on radiologists. It is recommended to monitor and calculate the accumulated radiation dose of workers to ensure their exposure remains within safety limits.

Impact of monoplane to biplane angiography upgrade on diagnostic angiography procedures: A retrospective cross-sectional study

The radiation dose during digital subtraction angiography (DSA) examination is determined on the basis of many factors. The aim of this study was to evaluate the dose-area product, air kerma, and fluoroscopy time on monoplane and biplane DSA of the cerebral arteries. Our results show that biplane angiography offered lower DAP, cumulative air kerma at the reference point and fluoroscopy time despite comparable procedure time.. Further research in this area and personnel training warrant the improvement of the radiosafety of angiographic interventional procedures and further development of angiographic technology.

Warmed contrast media temperature loss in traditional manifold systems during angiographic procedures.

Extrinsic warming of contrast media (CM) to 37 °C before angiographic procedures is performed to improve bolus kinetics and avoid potential adverse effects. Extrinsically warmed CM readily loses temperature after removal from the warming cabinet, but the extent of its cooling has not been previously investigated. To assess temperature loss of extrinsically warmed CM in tubing of traditional angiographic manifolds during simulated angiography. In total, 35 scheduled diagnostic angiographic procedures were observed in a hospital setting. Relevant time points of CM use during the procedures were recorded. The shortest, median, and longest procedures were then simulated in the experimental laboratory to measure CM temperatures at specific times at three locations along the tubing system. The angiographic procedures lasted 7.0-26.6 min (median = 11.7 min), with the total duration dependent primarily on the time from contrast being removed from the warming cabinet to the commencement of imaging. During the simulated procedures, consistent patterns of temperature loss were observed. By the last simulated angiographic run, injected CM temperature decreased by 7.4-16.4 °C, depending on procedure length. Most of the heat loss occurred in the tubing between the CM bottle and coronary control syringe. During angiographic procedures, prewarmed CM loses its temperature rapidly with the duration of exposure to ambient room temperature. If no additional measures are employed to maintain its temperature outside of the warming cabinet, extrinsic warming has limited impact on injected CM temperature.

Deep femoral artery: A new point of view based on cadaveric study

IntroductionIn diagnostic angiographic procedures, the knowledge of arterial variations in the femoral artery (FA), deep femoral artery (DFA) and lateral and medial circumflex femoral arteries (LCFA, MCFA) has a great impact. Material and methodsThe frequency of branching patterns of these arteries was investigated in 111 thighs of body donors. Gender and side differences were analyzed statistically. ResultsThe median distance of separation of the DFA from the FA in relation to the inguinal ligament (IL) was 3.29 cm. High origins (1−2 cm below IL) and middle origins (3−5 cm below IL) of the DFA were found in an equal distribution of 39.3% and 41.1%, respectively. Low origins (6−10 cm below IL) were rare (19.6%) but showed a tendential significance toward expression in males (p = 0.096). The origin of the LCFA from the FA (19.8%) or DFA (70.2%) are in line with the findings of other groups. The origin of the MCFA from FA (14.4%) or DFA (74.7%) showed that circumflex femoral arteries arose mostly from DFA. A trifurcation of the FA into the DFA, LCFA and MCFA was only observed in 9.9% and, therefore, less frequently than reported by others. Branches of the femoral nerve (FN) passed mostly anterior (46.4%) or anterior and posterior (47.8%) to the LCFA. The rare constellation of branches of FN passing only posterior to the LCFA (5.8%) showed a tendential significance to left side expression (p = 0.084). ConclusionsTaken together, this is the first classification of the median distance of separation of the DFA from the FA in relation to the IL in three defined groups. The knowledge of DFA branching pattern is essential for recent therapy options of cardiac diseases using a femoral artery access: transcatheter aortic valve replacement, catheter-based miniaturized ventricular assist device and veno-arterial extracorporal membrane oxygenation. The variant topography of the branches of FN in relation to LCFA should be kept in mind when harvesting an anterolateral thigh flap.

Usefulness of a Nonsuture Closure Device in Patients Undergoing Diagnostic Coronary and Peripheral Angiography.

Vascular access site complications can follow diagnostic coronary and peripheral angiography. We compared the complication rates of the Catalyst vascular closure device, with the complication rates after manual compression in patients undergoing diagnostic angiographic procedures via femoral access. We studied 1,470 predominantly male patients undergoing diagnostic coronary and peripheral angiography. Catalyst closure devices were used in 436 (29.7%) patients and manual compression was used in 1,034 (70.3%) patients. The former were allowed to ambulate after 2 hours, while the latter were allowed to ambulate after 6 hours. Major complications occurred in 4 (0.9%) patients who had a Catalyst device and in 14 (1.4%) patients who had manual compression (odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.22-2.1, p = 0.49). Any complications occurred in 51 (11.7%) patients who had a Catalyst closure device and in 64 (6.2%) patients who had manual compression (OR: 2, CI: 1.4-3, p < 0.01). After adjustment for other variables and for a propensity score reflecting the probability to receive the closure device, the association of major complications with the use of the closure device remained not significant (OR: 0.54, 95% CI: 0.17-1.7, p = 0.29), while the association of any complications with the use of the Catalyst device remained significant (OR: 1.9, 95% CI: 1.3-2.9, p < 0.01). The Catalyst device was not associated with an increased risk of major groin complications but was associated with an increased risk of any complications compared with manual compression. Patients receiving the closure device ambulated sooner.

Thrombosis of pancreatic arteriovenous malformation induced by diagnostic angiography: case report

BackgroundWe report on a case of pancreatic arteriovenous malformation (PAVM) that obliterated shortly after diagnostic angiography (DSA). PAVM is a rare anomaly that presents with upper abdominal pain, signs of acute pancreatitis and massive gastrointestinal bleeding. The management of PAVM is rather complex, with complete treatment usually accomplished only by a total extirpation of the affected organ or at least its involved portion. DSA prior to treatment decisions is helpful for characterizing symptomatic PAVM, since it can clearly depict the related vascular networks. In addition, interventional therapy can be performed immediately after diagnosis.Case presentationA 39-old male was admitted due to recurring upper abdominal pain that lasted several weeks. Initial examination revealed the absence of fever or jaundice, and the laboratory tests, including that for pancreatic enzymes, were unremarkable. An abdominal ultrasound (US) showed morphological and Doppler anomalies in the pancreas that were consistent with a vascular formation. A subsequent DSA depicted a medium-sized nidus, receiving blood supply from multiple origins but with no dominant artery. Coil embolization was not possible due to the small caliber of the feeding vessels. In addition, sclerotherapy was not performed so as to avoid an unnecessary wash out to the non-targeted duodenum. Consequently, the patient received no specific treatment for his symptomatic PAVM. A large increase in pancreatic enzymes was noticed shortly after the DSA procedure. Imaging follow-up by means of CT and MRI showed small amounts of peripancreatic fluid along with a limited area of intra-parenchymal necrosis, indicating necrotizing pancreatitis. In the post-angiography follow-up the patient was hemodynamically stable the entire time and was treated conservatively. The symptoms of pancreatitis improved over a few days, and the laboratory findings returned to normal ranges. Long-term follow-up by way of a contrast-enhanced CT revealed no recanalization of the thrombosed PAVM.ConclusionThe factors associated with the obliteration of PAVM during or after DSA are poorly understood. In our case it may be attributed to the low flow dynamics of PAVM, as well as to the local administration of a contrast agent. Asymptomatic PAVM, as diagnosed with non-invasive imaging techniques, should not be evaluated with DSA due to the potential risk of severe complications, such as acute pancreatitis.

Real-time eye lens dose monitoring during cerebral angiography procedures.

To develop a real-time dose-monitoring system to measure the patient's eye lens dose during neuro-interventional procedures. Radiation dose received at left outer canthus (LOC) and left eyelid (LE) were measured using Metal-Oxide-Semiconductor Field-Effect Transistor dosimeters on 35 patients who underwent diagnostic or cerebral embolization procedures. The radiation dose received at the LOC region was significantly higher than the dose received by the LE. The maximum eye lens dose of 1492 mGy was measured at LOC region for an AVM case, followed by 907 mGy for an aneurysm case and 665 mGy for a diagnostic angiography procedure. Strong correlations (shown as R(2)) were observed between kerma-area-product and measured eye doses (LOC: 0.78, LE: 0.68). Lateral and frontal air-kerma showed strong correlations with measured dose at LOC (AKL: 0.93, AKF: 0.78) and a weak correlation with measured dose at LE. A moderate correlation was observed between fluoroscopic time and dose measured at LE and LOC regions. The MOSkin dose-monitoring system represents a new tool enabling real-time monitoring of eye lens dose during neuro-interventional procedures. This system can provide interventionalists with information needed to adjust the clinical procedure to control the patient's dose. Real-time patient dose monitoring helps interventionalists to monitor doses. Strong correlation was observed between kerma-area-product and measured eye doses. Radiation dose at left outer canthus was higher than at left eyelid.

Nephrotoxicity of iodixanol versus iohexol inpatients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures

Background: The choice of radiographic contrast media for use in patients at increased risk of contrast-induced nephropathy is of ongoing interest. Materials and Methods: The current study is a prospective, randomized in which comparison of nonionic, isoosmolal agent, iodixanol, versus the nonionic, low-osmolal agent, iohexol, on the renal effects was carried out. A total of 526 subjects with impaired baseline renal functionand diabetes mellitus underwent diagnostic and/or therapeutic coronary angiographic procedures. The coprimary end points were the peak increase in serum creatinine and the incidence of contrast-induced nephropathy, that is, ≥0.5 mg/dl in serum creatinine from baseline within 72 h of receiving contrast media. Results: Of the 129 patients, 97 received iodixanol and 97 received iohexol randomly. The median peak increase in serum creatinine in the iodixanol arm was 0.10 mg/dl; whereas in the Iohexol arm, the median peak increase was 0.09 mg/dl (P = 0.13). The overall contrast-induced nephropathy incidence was 10.5% in the iodixanol arm and 9.8% in the iohexol arm (P = 0.7). The volume of contrast media, volume of saline administered, frequency of coronary interventional procedures, and severity of baseline kidney disease and of diabetes mellitus were similar between treatments. Conclusions: In the present study, the overall rate of contrast-induced nephropathy in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures was 10.5%. There was no significant difference between iodixanol and iohexol in either peak increase in serum creatinine or risk of contrast-induced nephropathy.

Difference in Dose Area Product between Analog Image Intensifier and Digital Flat Panel Detector in Peripheral Angiography and the Effect of BMI

Comparison of dose area products (DAP) in diagnostic angiography procedures between an image intensifier (II) and a flat panel detector (FPD) angiography system and the evaluation of DAP/body mass index (BMI) dependency. An image intensifier system or a flat panel detector system was used to perform 571 diagnostic angiographies (n = 328 and n = 243, respectively) of 5 different types: peripheral arterial, venous, single leg, abdominal and upper extremity. The results were retrospectively analyzed. The DAP, fluoroscopy time (t) and the number of series of the respective interventions as calculated by the respective machines was compared for all interventions and for the respective subtypes and machines. The BMI dependency was calculated separately for both machines for all interventions by subdividing the patients into 6 BMI classes defined by the WHO. The average DAP for all diagnostic interventions was 1958.9 cGy×cm2 (t = 384.6 s, n = 7.85 series) for the II and 2927.4 cGy×cm2 (t = 267.4 s, n = 7.02 series) for the FPD. Group-dependent differences ranged between + 21 and + 252 % when using the FPD system. After time standardization, the respective increases were found to be 120 % for the FPD system. The DAPs increased considerably in patients with higher BMIs (766.7 cGy × cm2 - 6892.6 cGy × cm2, II machine, 950.5 cGy × cm2 - 12 487.7 cGy × cm2, FPD machine) with a greater DAP gain seen for the FPD. The average duration of the interventions was higher using the II machine. The use of an FPD system led to higher DAP values compared to the II system in diagnostic angiographic procedures. In addition, increased BMI values led to higher DAPs, especially for the FPD machine. However, the average fluoroscopy times were shorter.

Clinical outcomes and quality of life assessment of patients with diabetes mellitus undergoing surgical ablation of atrial fibrillation

Background: Vascular access site complications can follow diagnostic coronary and peripheral angiography and can be associated with significant morbidity. Vascular closure devices improve hemostasis at the access site and potentially reduce complications rates. We compared the complication rates of the Boomerang closure device, which closes the arteriotomy site using vascular elastic recoil and thrombosis, with the complication rates after manual compression in patients undergoing diagnostic angiographic procedures. Methods and results: We studied 710 predominantly male patients undergoing diagnostic coronary and peripheral angiography at a Veterans' Administration Medical Center. The mean age was 63.6 years. Boomerang closure devices were used in 203 (28.6%) patients, and manual compression was used in 507 (71.4%) patients. Significant groin complications such as arteriovenous fistula, pseudoaneurysm or hematoma greater than 5 cm occurred in 3 (1.5%) patients who had a Boomerang closure device and in 12 (2.4%) patients who had manual compression used for hemostasis [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.17–2.22, P=.44]. Other complications such as minor bleeding complications requiring additional manual compression, bruising, pain and swelling occurred in 24 (11.8%) patients who had a Boomerang closure device and 30 (5.9%) patients who had manual compression (OR 2.10, 95% CI 1.19–3.74, P=.0126). After adjustment for other comorbid factors such as age, gender, peripheral vascular disease and chronic kidney disease, the association of significant complications with the use of the Boomerang closure device remained not significant (OR 0.63, 95% CI 0.19–2.20, P=.48), while the association of minor complications with the use of the Boomerang device remained significant (OR 2.28, 95% CI 1.24–4.69, P=.0048). Conclusion: In this cohort of predominantly male patients, the use of the Boomerang closure device was not associated with a decreased risk of major groin complications and was associated with an increased risk of minor complications compared to manual compression.

The diagnostic and interventional procedures performed in Angiography Laboratory of Pediatric Cardiology Section

Our aim was to compare the diagnostic and interventional procedures performed in our clinic and evaluate the increase in number and diversity of interventional procedures. Between July 2003 and May 2011 medical records of 1989 patients on whom diagnostic and interventional procedures had been performed was examined. 1036 of the patients (52%) were female and 953 of the patients (48%) were male. Diagnostic procedures were performed in 998 (50.2%) patients, while interventional procedures were performed in 991 (49.8%) patients. The interventional procedures are coil occlusion for patent ductus arteriosus, trans-catheter closure of atrial septal defect, pulmonary balloon valvuloplasty for pulmonary stenosis, aortic coarctation angioplasty, pericardiocentesis for pericardial effusion, aort balloon valvuloplasty for valvular aortic stenosis, permanent and temporary pacemaker insertion for acquired or congenital third degree atrioventricular block and /or sinus node disfunction in 321 (16.1%), 210 (10.6%), 146 (7.3%), 50 (2.5%), 45 (2.3%), 42 (2.1%), 40 (2%) and 33 (1.6%) patients; retrospectively. Interventional procedures were performed in 2,4 and 35 patients in 2003, 2004, and 2005; respectively. Following Angiography Laboratory of Pediatric Cardiology Section set up, interventional procedures were performed in 234 and 439 patients in 2009 and 2010; respectively. Number and variety of interventional procedures have been increased over the years after increased experience of Angiography Laboratory of Pediatric Cardiology Section. Diagnostic angiography procedures have been decreasing over the years by increase in development of new devices and progress of use of interventional treatment techniques. Therefore, interventional procedures have been replaced by diagnostic procedures.

The Effect of the Introduction of MR and CT Angiography on the Utilization of Catheter Angiography for Peripheral Arterial Disease

To determine whether the utilization rate of diagnostic catheter angiography (DCA) for peripheral arterial disease (PAD) has been affected by the utilization in recent years of magnetic resonance angiography (MRA) and computed tomographic angiography (CTA). Medicare Part B data sets for 2000 to 2004 were reviewed to study utilization trends in the Current Procedural Terminology, 4th ed., codes for DCA, MRA, and CTA of peripheral arteries. The Medicare physician specialty codes were used to indicate procedures performed by radiologists, cardiologists, surgeons, and other physicians. Utilization rates per 100,000 Medicare beneficiaries were calculated. Between 2000 and 2004, the total utilization rate of all 3 types of angiographic procedures for PAD rose from 789 to 969 per 100,000 (+23%). The rate for DCA dropped slightly, from 767 to 761 per 100,000, whereas the rate for MRA and CTA together increased from 23 to 208 per 100,000. Almost all MRA and CTA were performed by radiologists. Among radiologists, the DCA utilization rate dropped from 486 to 334 per 100,000 (-31%); among cardiologists and surgeons together, the DCA rate increased from 228 to 387 per 100,000 (+70%). The total utilization rate of all diagnostic angiographic procedures for PAD among radiologists increased by 3%, compared with much higher rate increases among cardiologist and surgeons. Among radiologists, a substitution effect occurred, in that noninvasive procedures such as MRA and CTA progressively replaced an invasive procedure, DCA. However, the rapid increase in DCA utilization among cardiologists and surgeons led to an increase in the overall utilization rate of angiographic procedures for diagnosing PAD. Increasing self-referral for an invasive procedure such as DCA among these two specialties is of concern at a time when less expensive, noninvasive alternatives are readily available.

The Case for Outpatient Coronary Intervention

Over the past 30 years, dramatic improvements have been achieved in the safety of percutaneous coronary intervention (PCI) procedures, despite the increasing complexity of clinical and anatomic conditions treated. The need for emergent bypass surgery has declined from 8% in 1990 to far less than 1% in the current era, and the rate of vascular complications has declined dramatically as techniques have improved and procedural experience has increased. Given the remarkable current periprocedural safety profile of elective coronary intervention, has the time come for us to consider whether outpatient PCI can be safely performed? In this issue of Circulation , investigators from the Academic Medical Center of the University of Amsterdam investigated this question as part of the Elective PCI in Outpatient Study (EPOS).1 Article p 2299 The study by Heyde and colleagues randomly assigned 800 consecutive, elective, outpatient, planned PCI patients to a strategy of either same-day discharge or routine care that included an overnight observation in the hospital. The patients and providers were blinded to the assignment until after evaluation according to predefined criteria for those patients who required additional observation or treatment. All patients eligible for same-day discharge, regardless of assignment, were then strictly observed for 4 hours and then underwent a rigorous triage evaluation to determine if same-day discharge would be appropriate. At that time, those patients who were randomized to the same-day discharge group were discharged, whereas the patients randomized to the overnight hospitalization group were kept in-hospital for observation. The investigators found that 20% of patients in both disposition arms developed one of the predefined exclusions for same-day discharge. Of the ≈80% of patients suitable for same-day discharge, none suffered a cardiac event within 24 hours after PCI, and only 3 patients suffered a vascular complication, with no differences observed in the 2 …

Heavy Metal Pad Shielding during Fluoroscopic Interventions

Significant direct and scatter radiation doses to patient and physician may result from routine interventional radiology practice. A lead-free disposable tungsten antimony shielding pad was tested in phantom patients during simulated diagnostic angiography procedures. Although the exact risk of low doses of ionizing radiation is unknown, dramatic dose reductions can be seen with routine use of this simple, sterile pad made from lightweight tungsten antimony material.

Urinary Excretion of Vasoactive Factors following Contrast Media Exposure in Humans

Background: Radiographic contrast media (CM) induce renal vasoconstriction and may initiate induced nephropathy. Endothelin (ET), a vasoconstrictor, and nitric oxide (NO), a vasodilator, which are synthesized in the kidney by the vascular endothelium as well as by tubular epithelial and glomerular mesangial cells, are key modulators of renal circulation after CM administration. Intravascular CM, in addition, induces pronounced diuresis and natriuresis. The aim of the present study was to evaluate and compare changes in endogenous vasoactive mediators and contrast-induced natriuresis after CM administration. Methods: Diagnostic angiographic procedures were performed in 14 patients (9 males and 5 females) using the non-ionic CM Iopamidol. Before and immediately after angiography, venous blood and urine samples were obtained. The urinary excretion of ET-1 and nitrates/nitrites (NOx), and the fractional excretion of sodium (FENa) were measured and analyzed. Results: The urinary excretion of both ET-1 and NOx increased significantly (p < 0.05) after angiography, and urinary ET-1 and NOx excretion was correlated with an increase in FENa (p < 0.05). Conclusion: Exposure to CM in humans is associated with an increase in urinary ET and NOx. The excretion of sodium following CM administration is associated with an increase in urinary ET and NOx. ET and NO might be important in the renal change in humans after CM administration.

The Evolving Role of Interventional Radiology in Trauma Care

Although the traditional role of radiology in trauma care has been diagnostic, therapeutic interventional radiology (IR) techniques have now become essential in the management of many injuries. We hypothesized that IR has evolved at our institution over the last decade from a largely diagnostic to a more therapeutic role in the care of the injured patient. Demographic information, computed tomographic scans of the chest and abdomen, and angiographic procedures (APs) performed within 48 hours of admission were reviewed in all patients evaluated at a Level I trauma center for the periods 1993 to 1995 and 2000 to 2002. All APs performed with the intent to embolize, stent, or insert a device into a vessel were designated as therapeutic. Analysis by means of chi provided between-group comparisons for questions of interest and the Student's t test was used for comparison of means. A total of 4,750 patients were reviewed, 1,677 from the time period 1993 to 1995 and 3,073 from the period 2000 to 2002. Overall injury severity as measured by the Injury Severity Score (ISS) was similar in both groups (9.6 vs. 9.9, p = not significant). The number of angiograms obtained decreased significantly from 7.1% to 4.0% of all patients (p < 0.01). Concurrently, the fraction of all angiograms that were considered therapeutic rose from 10% to 22% (p < 0.05). The overall number of aortic arch angiograms decreased over time (from 3.6% to 0.9%, p < 0.01), and the percentage of positive examinations increased from 5.0% to 21.4%. In comparison, the number of computed tomographic scans of the chest increased from 1.6% of all patients to 10.8% (p < 0.01). Axial imaging studies are being used more frequently to screen trauma patients for injury. Concurrently, diagnostic APs are less frequently performed but are more frequently positive. In addition, IR studies are increasingly focused on therapeutic intervention. IR program development and support is an integral aspect of modern trauma care. These findings have prompted our institution to equip the IR suite to function as an active resuscitation area similar to the trauma bay and intensive care unit.

IRM des cardiopathies congénitales

The incidence of congenital heart disease in live births is low; nevertheless, its early diagnosis and the establishment of appropriate presurgical management are critical. The significant progress in surgical treatment realized over the last two decades has resulted in the survival of many patients who would previously have died from their congenital malformation. Recently, a trend toward the use of new techniques such as magnetic resonance imaging (MRI) has been observed, in an attempt to obviate the need for more invasive or ionizing means. MRI has the potential of providing three-dimensional detailed anatomic and functional information on the cardiovascular system. It is not limited by intervening gas or bones, and provides a large view. Thus MRI clearly emerged as an excellent imaging modality complementary to sonography both during the preoperative and during the postoperative management. MRI bridges the gap between echocardiography and angiography, and consequently diagnostic angiographic procedures have become unnecessary. Indeed angiography has drawbacks; it is risky and invasive, exposes to radiation hazards and requires deeper sedation which is deleterious especially in evaluating a pediatric population.

Does virtual reality training make sense in interventional radiology? Training skill-, rule- and knowledge-based behavior.

To be able to meet the fast-growing demands of interventional radiology and endovascular therapy, many more interventional radiologists have to be trained in procedures that are becoming more complex. Until recently, fellows obtained their first basic skills training during diagnostic angiography procedures. This traditional method of training is disappearing because other diagnostic methods became available which raises the question “How can our future interventional radiologists be trained?” Training on animals, bench models (skill boxes) and virtual reality (VR) training has been suggested as a solution for this problem [1–5]. In many countries, animal experiments have been confronted with a growing resistance because animals are too expensive to be used as a full-scale training tool. With the use of bench models, objective assessment of performance is difficult to obtain. Training on simulators does not have these problems and seems therefore to be a good alternative. However, the effectiveness and efficiency of VR trainers in interventional radiology (IR) have not yet been addressed. In aviation, human behavior models have been implemented to develop and to evaluate new training methods [6, 7]. These models are useful for specifying the objectives, needs and means of training methods [8–10]. This paper introduces Rasmussen’s model of human behavior and applies it to IR. This model will be used to discuss the capabilities and limitations of current VR for IR training in relation to the training needs.

Complications of a Percutaneous Suture-mediated Closure Device versus Manual Compression for Arteriotomy Closure: A Case-controlled Study

To evaluate the incidence and types of complications encountered with use of a percutaneous suture-mediated closure device versus manual compression for arteriotomy closure in a retrospective case-controlled study. The authors identified 100 consecutive patients, 15 men and 85 women 21-85 years of age (mean, 50 years), between December 2000 and July 2001 in whom the Closer percutaneous suture-mediated closure device was used during 65 uterine artery embolization (UAE) procedures, 11 hepatic chemoembolization procedures, nine diagnostic angiography procedures, seven peripheral vascular interventions, six visceral arterial interventions, and two thrombolysis procedures. An age-, sex-, and procedure-matched control population was identified in which manual compression was performed. Procedure reports and clinical charts were reviewed for the presence of puncture-site complications, as categorized according to Society of Interventional Radiology reporting standards, and for risk factors and comorbid conditions (hypertension, diabetes, stroke, smoking, and coronary artery disease). Follow-up visits and imaging studies were reviewed for patients with complications. In the Closer group, there were seven device failures, four minor complications, and three major complications. Minor complications included two groin hematomas and two cases of persistent pain at the arteriotomy site. Three major complications consisted of two cases of external iliac artery dissection, one with distal embolization, and one case of common femoral artery (CFA) occlusion and distal embolization. All major complications occurred in women undergoing UAE. One patient required thromboendarterectomy and patch angioplasty to repair the CFA occlusion, as well as amputation of a gangrenous toe. In the manual-compression group, there was one minor complication (a groin hematoma) and no major complications. There were significantly more complications in the Closer group than in the manual compression group (P =.02). Significantly more complications were associated with use of a percutaneous suture-mediated closure device than with manual compression for arteriotomy-site hemostasis. Major complications and associated morbidity may be seen with use of percutaneous suture-mediated closure devices. In particular, an unexpectedly high frequency of device-related complications was demonstrated in young women undergoing UAE.

Immediate ambulation following diagnostic angiography procedures utilizing a femoral closure device (Perclose) Henry H. Ting, Christopher Crocker, Tamara Brevik, Robert J. Houlihan, Kevin T. Cragun, Farris K. Timimi, Steven J. Melby, Kirk N. Garratt, David R. Holmes. Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN

Immediate ambulation following diagnostic angiography procedures utilizing a femoral closure device (Perclose) Henry H. Ting, Christopher Crocker, Tamara Brevik, Robert J. Houlihan, Kevin T. Cragun, Farris K. Timimi, Steven J. Melby, Kirk N. Garratt, David R. Holmes. Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN