To reduce inferior vena cava filter (IVCF) related complications, retrieval is recommended whenever possible. Nevertheless, IVCF retrieval rates remain lower than expected, likely due to insufficient ...follow-up after placement. We evaluated the value of a structured program designed to follow patients by the interventional radiology team up to 5 months after IVCF placement. We prospectively enrolled 366 consecutive patients (mean age 64 ± 17 years; 201 men and 165 women) who benefited from IVCF between March 2015 and February 2020. The program consisted of advising the patient and clinicians to consider IVCF retrieval as soon as possible (standard workflow) and systematically planning an additional follow-up visit at 5-month. Clinical and technical eligibility, as well as technical success for retrieval (TSR) were evaluated. At 5-months, 38 (10.4%) patients were lost to follow-up, and 47 (12.8%) had died. Among survivors, the overall retrieval rate was 58%. The retrieval rates were 83% and 97% for the clinically eligible and technically eligible patients for retrieval, respectively. The 5-month visit enabled 89 additional retrievals (47.8%) compared to the standard workflow. No significant difference was seen in TSR before and after 5 months (p = 0.95). Improved patient tracking with a dedicated IVCF program results in an effective process to identify suitable patients for retrieval and drastically improves retrieval rates in eligible patients. Involving interventionalists in the process improved IVCF patient management.
Background
The vast majority of superior vena cava (SVC) syndromes are of malignant causes, but with growing use of indwelling central catheters and implanted cardiac devices, benign SVC syndromes ...are becoming more frequent. The main objective of this study is to evaluate long term outcome in patients treated for benign SVC syndrome by endovascular techniques.
Methods
Forty-four patients, 26 men and 18 women, mean age 56, treated for benign SVC syndrome using endovascular techniques between 2002 and 2015 were included. Type of obstruction was classified according to the site of disease and degree of occlusion. Complications and recurrence of symptoms were analyzed.
Results
Technical and clinical success were achieved in all but one patient. Four patients (9 %) were treated by angioplasty alone and 40 (91 %) required stent implantation. Mean clinical follow-up was 1275 days. Nine patients had at least one episode of recurrence after a mean of 385 days. Four minor and two major complications were reported.
Conclusion
Percutaneous endovascular techniques to treat benign SVC syndrome are safe with good long term patency. Recurrence of symptoms can easily be addressed by repeat procedure.
Key Points
•
Malposition of indwelling central catheter can cause superior vena cava obstruction
.
•
Image
-
guided catheter placement helps prevent superior vena cava obstruction
.
•
Imaging and superior vena cava obstruction classification allows adequate procedure planning
.
•
Endovascular techniques are safe and effective for superior vena cava syndrome treatment
.
Objective
Peripherally inserted central catheter (PICC) use continues to increase, leading to the development of a blind bedside technique (BST) for placement. The aim of our study was to compare the ...BST with the fluoroscopically guided technique (FGT), with specific regard to catheter tip position (CTP).
Materials and methods
One hundred eighty patients were randomized to either the BST or the FGT. All procedures were done by the same interventional team and included postprocedural chest X-ray to assess CTP. Depending on the international guidelines for optimal CTP, patients were classified in three types: optimal, suboptimal not needing repositioning, and nonoptimal requiring additional repositioning procedures. Fisher’s test was used for comparisons.
Results
One hundred seventy-one PICCs were successful inserted. In the BST groups, 23.3% of placements were suboptimal and 30% nonoptimal, requiring repositioning. In the FGT group, 5.6% were suboptimal and 1.1% nonoptimal. Thus, suboptimal and nonoptimal CTP were significantly lower in the FGT group (
p
< 0.001).
Conclusion
Tip malposition rates are high when using blind BST, exposing the patient to an increased risk of deep venous thrombosis and catheter malfunction. Using the FGT or emerging technologies that could help tip positioning are recommended, especially for long-term indications.
Key points
•
Bedside and fluoroscopy guided techniques are commonly used for PICC placement.
•
Catheter malposition is the major technical issue with the bedside technique.
•
Catheter malposition occurred in 53% of patients with the bedside technique.
Endovascular interventions (EVI) are increasingly performed as minimally-invasive alternatives to surgery and have many advantages, including a decreased need for general anesthesia. However, EVI can ...be stressful for patients and often lead to anxiety and pain related to the procedure. The use of local anesthetics, anxiolytics, and analgesic drugs can help avoid general anesthesia. Nevertheless, these drugs have potential side effects. Alternative nonpharmacological therapies can improve patients' experience during conscious interventions and reduce the need for additional medications. The added value of virtually augmented self-hypnosis (VA-HYPO) and its potential to reduce pain and anxiety during peripheral and visceral arterial and venous EVI is unknown. This is a prospective two-arm trial designed to randomize 100 patients in two groups according to the use or not of VA-HYPO during peripheral EVI as a complementary nonpharmacological technique to improve patient comfort. The main objective is to compare per-procedural anxiety, and the secondary aim is to compare the rated per-procedural pain in both groups. The potential significance is that VA-HYPO may improve patients' experience during peripheral and visceral arterial and venous EVI and other minimally invasive interventions performed under local anesthesia. Trial registration: Our study is registered on clinicaltrials.gov, with trial registration number: NCT04561596.
Purpose
Hypnosis is useful for diminishing distress during medical procedures. This study investigated the efficacy of virtually augmented self-hypnosis as an adjunctive non-pharmacological method ...for procedural pain and anxiety relief during endovascular interventions (EVI).
Methods
We compared an immersive distraction experience (clinicaltrials.gov identifier NCT04561596) featuring virtual reality (VR) using a head-mounted display versus treatment as usual (TAU). Patients followed the “Aqua” module (Oncomfort™) consisting of a scuba dive and breathing exercises. They experienced a self-induced dissociative state similar to clinical hypnosis without direct intervention of a professional. Enrollment followed a 1:1 randomized open study (VR or TAU). Patients’ feelings were evaluated just before and after the procedure, and 3 months following intervention. Anxiety was evaluated using the State Trait Anxiety Inventory (STAI) and pain (sensory, emotional, and memory) with a visual analogue scale (VAS).
Results
This study included 100 patients. Mean anxiety (pre-post) was significantly reduced within groups and between groups (difference of 4.2 points,
p
= 0.016). The percentage of responders to anxiety lowering were 76 and 46% for VR and TAU, respectively (
p
= 0.004). The two groups did not significantly differ in mean sensory-intensity and affective emotional pain (pre-post) using VAS, in negative memories concerning remembered pain at 3 months (difference > 1 from immediate post-procedural reported pain intensity), mean procedural time, or the need for analgesic or sedative drugs.
Conclusions
VR self-hypnosis has the potential to improve the management of patients’ distress during radiological procedures. It is safe and effective for reducing anxiety during EVI.
Purpose
To evaluate the efficacy and safety of percutaneous endovascular biopsy (PEB) in intravascular filling-defect lesions (IVLs) of the great vessels.
Material and methods
We retrospectively ...reviewed 19 patients (age 65 ± 12 years), 11 men and eight women, who underwent PEB for IVLs, between March 2004 and November 2014. All PEBs were performed for early diagnosis and/or characterization of the IVL, or in case of reasonable doubt about the IVL nature. Pre-intervention imaging work-up included CT, MRI and/or PET-CT. PEBs were obtained with a 7F biopsy forceps device. Clinical profile, procedure technical success and safety, and clinical success were evaluated.
Results
PEB was technically successful in all patients (mean of two samples per IVL). No intra- or post-procedural complications were reported. Histopathological analysis provided a diagnosis in all PEBs with a clinical success of 100%. Of the 19 IVLs, 14 were malignant (74%). The most frequent malignant lesion observed was leiomyosarcoma (29%). Benign lesions (26%) included three thrombi (pulmonary artery) and two myxomas.
Conclusion
PEB is a safe and efficient procedure providing the most effective technique to obtain a tissue sample of high diagnostic quality, which serves to establish early diagnosis in patients with suspected malignant lesions.
Key Points
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Intravascular filling-defect lesions are related to both benign conditions and malignant tumours.
•
Endovascular biopsy is indicated in case of doubt about intravascular lesion nature.
•
Percutaneous endovascular biopsy is a safe technique.
•
Endovascular biopsy provides tissue samples leading to correct histopathological analysis.
•
Percutaneous endovascular biopsy provides early diagnosis of malignant intravascular lesions.
Purpose
To report our experience using a multilevel patient management algorithm to direct transarterial embolization (TAE) in managing spontaneous intramuscular hematoma (SIMH).
Materials and ...Methods
From May 2006 to January 2014, twenty-seven patients with SIMH had been referred for TAE to our Radiology department. Clinical status and coagulation characteristics of the patients are analyzed. An algorithm integrating CT findings is suggested to manage SIMH. Patients were classified into three groups: Type I, SIMH with no active bleeding (AB); Type II, SIMH with AB and no muscular fascia rupture (MFR); and Type III, SIMH with MFR and AB. Type II is furthermore subcategorized as IIa, IIb and IIc. Types IIb, IIc and III were considered for TAE. The method of embolization as well as the material been used are described. Continuous variables are presented as mean ± SD. Categorical variables are reported as percentages. Technical success, clinical success, complications and 30-day mortality (d30 M) were analyzed.
Results
Two patients (7.5%) had Type IIb, four (15%) Type IIc and 21 (77.5%) presented Type III. The detailed CT and CTA findings, embolization procedure and materials used are described. Technical success was 96% with a complication rate of 4%. Clinical success was 88%. The bleeding-related thirty-day mortality was 15% (all with Type III).
Conclusion
TAE is a safe and efficient technique to control bleeding that should be considered in selected SIMH as soon as possible. The proposed algorithm integrating CT features provides a comprehensive chart to select patients for TAE.
Level of Evidence
4.
Objectives
Recanalization of peripheral chronic total occlusions (CTO) is technically challenging especially in cases of in-stent and/or pre-stent and heavily calcified lesions. A high-frequency ...vibrational device (HFVD) was first used as a secondary-intention device in CTO recanalizations when they were refractory to a guidewire. The aim of this study was to assess the safety and efficacy of the HFVD as a first-line treatment for challenging CTOs and thus to define the percutaneous intentional intraluminal-assisted recanalization (PILAR) technique.
Methods
Fifty-two patients were treated with the HFVD. Only challenging CTOs were included: 7 pre-stent, 7 in-stent, and 38 highly calcified CTOs. Technical success was defined as the ability to cross the CTO using the HFVD. Secondary outcome was defined as successful intraluminal crossing. Safety endpoints were procedure-related thromboembolism or perforation. Patients were followed up at 3 months and 1 year.
Results
The technical success rate for recanalization was 90%, of which 83% were intraluminal. The mean recanalized length was 91 ± 44 mm. One thromboembolic complication occurred, which was subsequently treated with thromboaspiration. Three-month and 1-year primary patency rates were 92% and 79%, respectively.
Conclusions
HFVD-based PILAR is a safe and effective technique for in-stent or pre-stent CTO recanalization of long and calcified lesions.
Key Points
•
Intraluminal recanalization is the preferred procedure in heavily calcified or pre-/in-stent CTO
.
•
First-line use of assisted intraluminal recanalization for CTO defines the PILAR technique
.
•
HFVD-based PILAR is safe and provides a high success rate for challenging CTO recanalization
.
Background: Coronary CT angiography (CCTA) is increasingly used as a non-invasive tool to assess coronary artery disease (CAD). However, CCTA is subject to motion artifacts, potentially limiting its ...clinical utility. Despite faster (0.35 and 0.28 s/rot) gantry rotation times, low (60–65 bpm) heartbeat is recommended, and the use of β-blockers is often needed. Technological advancements have resulted in the development of faster rotation speeds (0.23 s/rot). However, their added value in patients not premedicated with β-blockers remains unclear. This prospective single-center, two-arm, randomized, controlled trial aims to assess the influence of fast rotation on coronary motion artifacts, diagnostic accuracy of CCTA for CAD, and patient safety. Methods: We will randomize a total of 142 patients aged ≥ 50 scheduled for an aortic stenosis work-up to receive CCTA with either a fast (0.23) or standard (0.28 s/rot) gantry speed. Primary outcome: rate of CCTAs with coronary motion artifacts hindering interpretation. Secondary outcomes: assessable coronary segments rate, diagnostic accuracy against invasive coronary angiography (ICA), motion artifact magnitude per segment, contrast-to-noise ratio (CNR), and patient ionizing radiation dose. The local ethics committee has approved the protocol. Potential significance: FAST-CCT may improve motion artifact reduction and diagnosis quality, thus eliminating the need for rate control and β-blocker administration. Clinicaltrials.gov identifier: NCT05709652.
To determine inter-session and intra/inter-individual variations of the attenuations of aortic blood/myocardium with MDCT in the context of calcium scoring. To evaluate whether these variations are ...dependent on patients' characteristics.
Fifty-four volunteers were evaluated with calcium scoring non-enhanced CT. We measured attenuations (inter-individual variation) and standard deviations (SD, intra-individual variation) of the blood in the ascending aorta and of the myocardium of left ventricle. Every volunteer was examined twice to study the inter-session variation. The fat pad thickness at the sternum and noise (SD of air) were measured too. These values were correlated with the measured aortic/ventricular attenuations and their SDs (Pearson). Historically fixed thresholds (90 and 130 HU) were tested against different models based on attenuations of blood/ventricle.
The mean attenuation was 46 HU (range, 17-84 HU) with mean SD 23 HU for the blood, and 39 HU (10-82 HU) with mean SD 18 HU for the myocardium. The attenuation/SD of the blood were significantly higher than those of the myocardium (p < 0.01). The inter-session variation was not significant. There was a poor correlation between SD of aortic blood/ventricle with fat thickness/noise. Based on existing models, 90 HU threshold offers a confidence interval of approximately 95% and 130 HU more than 99%.
Historical thresholds offer high confidence intervals for exclusion of aortic blood/myocardium and by the way for detecting calcifications. Nevertheless, considering the large variations of blood/myocardium CT values and the influence of patient's characteristics, a better approach might be an adaptive threshold.
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