A. Herr

Review of Venous Anatomy for Venographic Interpretation in Chronic Cerebrospinal Venous Insufficiency

Chronic cerebrospinal venous insufficiency (CCSVI) represents a recently described condition that may potentially contribute to the symptoms experienced by patients with multiple sclerosis. The evaluation of a prospective patient for CCSVI often involves an invasive evaluation with venography of the internal jugular and azygos veins. The purpose of this article is to review the normal anatomy of the internal jugular, vertebral, and azygos veins, as an understanding of these veins is necessary for appropriate interpretation of the venograms obtained to evaluate patients for CCSVI.

Internet-Based Social Networking and Its Role in the Evolution of Chronic Cerebrospinal Venous Insufficiency

The Internet is being seen as a growing resource for health-related information for a large number of patients. It is undeniable that its widespread presence has led to the growth of awareness that chronic cerebrospinal venous insufficiency (CCSVI) as an entity that may contribute to the symptoms experienced by patients with multiple sclerosis (MS). Social networking and file-sharing Web sites have brought patients with MS together from all over the world and have facilitated the distribution of personal experiences and information derived from medical research as it relates to CCSVI. As a result, there has been an accelerated growth in the number of patients seeking treatment for this syndrome in light of the possibility that it may improve their present condition. This article will review this phenomenon, the Internet-based resources available to MS patients seeking information about CCSVI, and the responsibilities of physicians as they participate in these online discussions.

Use of a collagen plug device to seal a subclavian artery puncture secondary to intraarterial dialysis catheter placement.

O SCVIR, 1999 THE role of endovascular therapies for the treatment of traumatic arterial lesions has expanded in recent years. In the past, percutaneous treatment of such lesions was limited to arteries that could be embolized with coils, gelatin foam, or other agents. Traumatic pseudoaneurysms may be amenable to coil embolization or, more recently, in the common femoral artery region, to ultrasoundguided compressive occlusion. The advent of covered endovascular stent grafts has expanded the role of the interventional radiologist to treat arterial injuries, especially in locations that are more difficult to approach surgically. However, one of the limitations of this technique includes the occlusion of vital branch vessels by the covered stent. Recently, two collagen plug devices have been marketed to seal arterial puncture sites after arteriography and intervention (1,2). We report our experience in a patient with a dialysis catheter placed within the subclavian artery in which a collagen plug device was used to seal the arterial puncture site.

Safety of Limited Supplemental Iodinated Contrast Administration in Azotemic Patients Undergoing CO2 Angiography

Purpose: To determine if limited doses of iodinated contrast significantly worsen the underlying renal insufficiency that had warranted the use of CO2 for diagnostic angiography. Methods: The records of 122 consecutive patients who had undergone CO2 angiography for peripheral vascular disease at our institution over a 5-year period were reviewed. The volume and type of iodinated contrast and the volume of CO2 administered were recorded. Serum creatinine measurements obtained before angiography and from 2 to 3 days after angiography were recorded. Results: One hundred patients had pre-angiography and post-angiography creatinine levels available for analysis (51 CO2 only, 49 CO2 with iodinated contrast). The average pre-treatment creatinine level was 2.8±1.5 mg/dL (range 1.8–6.6) for the CO2 only group and 3.0±1.4 mg/dL (range 1.8–8.2) for the CO2 plus iodinated contrast group (p=0.46). After angiography, the mean change in creatinine was +0.17±0.87 mg/dL for the CO2 only group and +0.03±0.98 mg/dL in the CO2 plus contrast group (p=0.27). Complications included 1 patient with a failing renal transplant who received iodinated contrast and ultimately required return to hemodialysis. A second patient had a transient 1-mg/dL rise of creatinine but did not require dialysis. Conclusions: This study supports the relative safety of CO2 angiography with the limited used of iodinated contrast supplementation for diagnostic studies or interventions in azotemic patients with peripheral vascular disease.

The ABCs of the FDA: A Primer on the Role of the United States Food and Drug Administration in Medical Device Approvals and IR Research

The role of the US Food and Drug Administration (FDA) in medical device regulation is important to device-driven specialties such as interventional radiology. Whether it is through industry-sponsored trials during the approval process for new devices or investigator-initiated research prospectively evaluating the role of existing devices for new or established procedures, interaction with the FDA is an integral part of performing significant research in interventional radiology. This article reviews the potential areas of interface between the FDA and interventional radiology, as understanding these areas is necessary to continue the innovation that is the hallmark of this specialty.

Management of Failing Prosthetic Bypass Grafts with Metallic Stent Placement

AbstractPurpose: To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts. Methods: Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n=3), rest pain (n=9), and minor or major tissue loss (n=3). Lesions were at the proximal anastomosis (n=6), the distal anastomosis (n=3), or within the graft (n=6). Results: Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement (at a mean of 10.8 months). Three late deaths occurred during follow-up. Conclusion: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.