Vessel Wall Penetration Research Articles

Intravascular ultrasound to aid in the diagnosis and revision of an intra-aortic pedicle screw: illustrative case.

Pedicle screw impingement on vessel walls has the potential for complications due to pulsatile effects and wall erosion. Artifacts from spinal instrumentation create difficulty in accurately evaluating this interface. The authors present the first case of intravascular ultrasound (IVUS) used to characterize a pedicle screw breach into the aortic lumen. A 21-year-old female with surgically corrected scoliosis underwent computed tomography angiography (CTA) 3 years postoperatively, which revealed a pedicle screw within the thoracic aorta lumen. Metal artifact distorted the CTA images, which prompted the decision to use intraoperative IVUS. The IVUS confirmed the noninvasive imaging findings and guided final decisions regarding aortic endograft size and location during spine hardware revision. For asymptomatic patients presenting with pedicle screws malpositioned in or near the aorta, treatment decisions revolve around the extent of vessel wall penetration. Intraluminal depth can be obscured by artifact on computed tomography or magnetic resonance imaging or inadequately evaluated by a transesophageal echocardiogram. In our intraoperative experience, IVUS confirmed the depth of vessel lumen violation by a single pedicle screw and no wall penetration by two additional screws of concern. This was useful in deciding on thoracic endovascular aortic repair graft size and landing zone and facilitated safe spinal instrumentation removal and revision.

Abstract No. 294 - Positional changes of retrievable inferior vena cava (IVC) filters at the time of removal: a comparative study of different filter types

Retrospective study of positional changes of retrievable IVC filters between insertion and removal. The following parameters were recorded: changes in tilt angle, filter position and strut penetration. Retrospective review of the PACS at an academic medical center, was performed for IVC filter retrieval attempts from Jan 1 2010 to Dec 30 2012 identified 337 cases. Demographic information, insertion and retrieval parameters, and filters types were documented. Images were reviewed and the tilt and migration of the filters were measured from venograms performed post insertion and pre removal. Penetration of struts through the vessel wall was measured. Patients in which imaging was inadequate were excluded, leaving 262 patients in the final study group. 262 filter retrievals were identified. 5 filter types were recorded: Cook Celect filter (187), Bard Recovery family (33), ALN (27), Cordis Optease (8), Cook Tulip (7)Comparative average values of filter tilt relative to IVC long axis, migration, and vessel wall penetration for the different brands are presented in the table. For the parameters measured, all filter types demonstrated similar changes in filter tilt, migration and penetration at the time of removal. To our knowledge this is the largest dataset of IVC filter retrieval comparing multiple filter types. We have measured IVC filter tilt, migration and strut penetration changes that occured between insertion and removal parameters that may influence the overall success of the retrieval procedure. Although no filter type is clearly superior to the others, each type has its own characteristics that should be taken into account at the time of insertion. This comparative data does not allow a determination of the superiority of any one filter.

Aortoiliac Vascular Injuries After Misplacement of Fixation Screws

To report our experience with the diagnosis and treatment of aortoiliac vascular injuries caused by misplaced orthopedic fixation screws. Six patients (age range, 35-60 years; mean, 52 years) were diagnosed with seven arterial injuries related to misplacement of fixation screws. The location of the injuries were thoracic aorta (n = 4) and common iliac arteries (n = 3). There was vessel wall penetration in five injuries resulting in active bleeding in two patients, contained penetrations in two patients, and vessel occlusion in one patient. One patient had associated inferior vena cava injury and pulmonary embolism. Two patients had asymptomatic impingement of the aortic wall by the screws. Vascular injuries resulted in death in one patient and limb amputation in another patient. Three patients were treated with placement of stent grafts and screw removal. Screw replacement was performed in one patient. Conservative observation was done in one patient. Vascular injuries related to misplacement of fixation screws are relatively infrequent but potential life and limb-threatening complications that require early recognition with prompt repair of vascular lesions and screw reposition.

Posterior vessel wall penetration by needles during internal jugular vein central catheter placement using ultrasound guidance: Is that a real danger?

Posterior vessel wall penetration by needles during internal jugular vein central catheter placement using ultrasound guidance: Is that a real danger?

Posterior vessel wall penetration by needles during internal jugular vein central catheter placement using ultrasound guidance: Is that a real danger?

Posterior vessel wall penetration by needles during internal jugular vein central catheter placement using ultrasound guidance: Is that a real danger?

An Unseen Danger: Frequency of Posterior Vessel Wall Penetration by Needles During Attempt to Place Internal Jugular Vein Central Catheters Using Ultrasound Guidance: Blaiva M, Adhikari S. Crit Care Med 2009;37:2345–9

This prospective, single-blinded study evaluated for posterior vessel wall penetration during ultrasound-guided internal jugular (IJ) catheter placement. It was conducted at an urban Level I trauma center with emergency medicine residents. The 25 residents that participated in the study had more than 2 years experience in ultrasound, performed more than 100 ultrasound-guided vascular-access procedures before the study, and participated in a 2-day ultrasound-training course. Each resident was asked to place an IJ catheter using ultrasound guidance in the short access view on life-sized torso models.

An unseen danger: Frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance

Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts

An unseen danger: Frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance

Critical Care Medicine: January 2010 - Volume 38 - Issue 1 - p 346-347 doi: 10.1097/CCM.0b013e3181c0d9bb

An unseen danger: Frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance*

To evaluate the frequency of unsuspected posterior vessel wall penetration of the internal jugular vein during ultrasound-guided needle cannulation. Prospective, single-blinded observational study. Urban level I emergency department with an annual census of 80,000. Residents who had previously completed a 2-day ultrasound course including a 3-hr didactic and hands-on session on ultrasound-guided central venous cannulation. Residents were asked to place an ultrasound-guided catheter on a human torso mannequin. Residents used a short-axis approach for ultrasound guidance. During the procedure, an 8-4 MHz convex (endocavity) transducer was used to observe the path of the resident's needle without interference with the placement procedure. Unknown to residents, researchers tracked the frequency of posterior wall penetration and the final needle location when the resident felt that optimal needle placement was achieved in the lumen of the internal jugular. Residents were also asked to rate their confidence regarding appropriate final needle position on a 10-point Likert scale. Statistical analysis consisted of descriptive statistics and Spearman correlation analysis. A total of 25 residents participated. All had placed at least one ultrasound-guided central catheter previously. The median number of previous ultrasound-guided cannulations was 8.0. Sixteen (64%) residents accidentally penetrated the posterior wall of the internal jugular vein during cannulation. The median number of posterior wall penetrations was 1.0 for all residents. In six cases the final location of the needle was through the posterior wall and deep to the venous lumen. In five of these cases the carotid artery was actually mistakenly penetrated. Median confidence by residents regarding appropriate needle placement was 8.0 out of 10. More training and more ultrasound-guided catheters placed were associated with fewer posterior wall penetrations (p = .04). In this study, residents accidentally penetrated the posterior vessel wall of the internal jugular in a lifelike vascular access mannequin in the majority of cases. These results suggest that care must be taken even with ultrasound-guided central catheter placement and that alternative ultrasound guidance techniques, such as visualization of the vein and needle in longitudinal axis, should be considered.

Endoluminal Repair of Peripheral Arterial Aneurysms: 4-Year Experience with the Cragg EndoPro System I

To assess the efficiency and long-term patency of the Cragg EndoPro System I in patients with peripheral arterial aneurysms. In 10 patients, 13 stent-grafts were used to treat 15 arterial aneurysms. Aneurysms were located in the common iliac (n = 4), superficial femoral (n = 4), popliteal (n = 3), and subclavian arteries (n = 2), and in a femoropopliteal bypass-graft (n = 2). Follow-up ranged between 2 and 46 months (mean, 36 months). Examination included clinical status, color-coded duplex sonography, computed tomography angiography, and intra-arterial digital subtraction angiography (DSA). Technical success was achieved in all patients. Primary patency was four of four in iliac vessels and three of nine in non-iliac vessels; secondary patency in noniliac vessels was four of nine. Repairs included one local lysis, four percutaneous transluminal angioplasties, one surgical thrombectomy, and one bypass surgery. Stent wire disintegration was detected in one of four iliac stent-grafts and in seven of nine noniliac stent-grafts. In noniliac grafts, significant stenoses occurred in three of nine; occlusion occurred in five of nine. One complication at the iliac level was a vessel wall penetration at the proximal stent edge, with development of a new aneurysmal formation. No late endoleaks were found. Exclusion of peripheral arterial aneurysms with stent-grafts is feasible. Long-term results are excellent in iliac vessels. Mechanical weakness of the stent assembly and frequent re-stenoses or occlusions are significant drawbacks in noniliac vessels with low patency rates.

Anatomy of the endophyte of Viscum album L. (Loranthaceae)

Anatomy of the endophyte of Viscum album L. (Loranthaceae). An anatomical investigation into the nature of the host-parasite interaction of V. album and several of its phanerogamic hosts using SEM and light microscopy was conducted. Three kinds of parasite cell (haustorial parenchyma cells, cells resembling transfer cells and haustorial tracheids) were identified at the host-parasite interface. The terms haustorial parenchyma and haustorial tracheid are defined. Haustorial tracheids were seen to have penetrated the walls of host vessel elements and it is suggested that V. album is able to establish on a wide range of hosts because of the anatomically plastic nature of its haustorium. The development of the haustorium depends to a large extent on the nature of the surrounding host tissues. Parasite-induced host abnormalities including hypertrophy, distorted xylem elements, vessel-wall penetration and tylosis-occluded vessels were observed. The macroanatomical features observed are discussed and interpreted by-proposing a new theory for the ontogenesis of the V. album haustorium. Cortical strands with ‘chisel’ and ‘pencil’ shaped apices were both found to be present at the same time on one plant and thus were not seasonally separated.