Daniele Wiseman

Fibrinogen Level and Bleeding Risk During Catheter-Directed Thrombolysis Using Tissue Plasminogen Activator.

Purpose: The purpose of this study was to determine whether low fibrinogen levels (fibrinogen level <1.5 g/L) during catheter-directed thrombolysis are associated with an increased bleeding risk. Methods: A retrospective review was performed on patients undergoing extremity arterial or venous thrombolysis between 2005 and 2013. Results: Patients in the low fibrinogen group were younger (P = .006) and had a higher number of venous occlusive events (P = .004). The low fibrinogen group received a larger dose of tissue plasminogen activator (tPA; P = .009) and had a longer duration of thrombolysis (P = .010). The rates of major bleeding were not significantly different (P = .139). Univariate analysis showed that larger total dose and longer duration of tPA infusion were associated with increased bleeding complications (P < .01 and P = .03). Conclusion: A fibrinogen level <1.5 g/L during thrombolysis was not associated with an increased bleeding risk. However, larger dose and longer duration of thrombolysis were associated with increased bleeding risk.

Informed Consent for Radiation in Interventional Radiology Procedures

Purpose To explore the patient perception on radiation-related cancer risk from interventional radiology (IR) procedures and whether informed radiation consent is warranted. Methods A multiple-choice survey was prospectively administered to 68 adults undergoing a body or neuro-IR procedure with ionizing radiation exposure. Subgroup analysis with chi-square or Fisher exact test was performed based on patient past IR history (P < .05). Results A total of 81% of patients wanted to be informed if there was a radiation-related 3% increased cancer risk over 5 years. Although 55% considered 3% a small risk, 28% wanted to further discuss the risks and alternate options, and 15% would have only proceeded if it were a life-saving procedure: 89%, 80%, and 67% of patients wanted to be informed with exposure risks of 1 in 100, 1 in 1000, and 1 in 10,000, respectively. Only 53% were aware they were going to be exposed to radiation, irrespective of past IR history (P = .15). Most patients believed radiation consent should include radiation-related cancer risks (85%). No past IR history was significantly associated with wanting consent to include cancer-related risk (100% vs 76%; P = .01) and deterministic risks (70% vs 41%; P = .04). A majority (69%) believed both the referring physician and the interventional radiologist were responsible for obtaining radiation consent, and 65% of patients wanted verbal consent followed by signed written consent, regardless of past IR history. Conclusions Many patients want to discuss cancer-related radiation risks with both radiologists and physicians. Informed radiation consent should be considered for procedures with high anticipated radiation doses.

Accessory Right Hepatic Artery Arising from Splenic Artery Supplying Hepatocellular Carcinoma Identified by Computed Tomography Scan and Conventional Angiography: A Rare Anatomic Variant

Accessory right hepatic artery (ARHA) is a common anatomic variant. This variant has been frequently described in the literature. Here, we report a rare case of ARHA arising from splenic artery depicted during imaging work-up and transarterial hepatic chemoembolization of a 74-year-old gentleman with hepatocellular carcinoma. This patients tumor was exclusively supplied by this variant artery. Splenic artery origin of the ARHA is extremely rare. This has been previously reported once in the literature on a cadaveric organ donor during dissection. To the best of our knowledge, our report is the first radiologically detected case of ARHA originating from splenic artery.

Spontaneous rupture of a rare adrenal artery aneurysm mimicking a ruptured abdominal aortic aneurysm.

Spontaneous adrenal artery aneurysm rupture is an exceedingly rare but life-threatening condition that requires emergent treatment. We report on an 80-year-old male who underwent an emergent exploratory laparotomy and repair of a ruptured adrenal artery aneurysm and highlight the role of both vascular surgery and interventional radiology in the management of this scenario.

Staging Computed Tomography in Patients With Noncurative Laparotomy for Periampullary Cancer: Does Nonstructured Reporting Adequately Communicate Resectability?

Periampullary cancer (PC) is a term encompassing malignancies that originate near the ampulla of Vater. It includes cancers of the head and neck of the pancreas, distal common bile duct, second part of the duodenum, and the ampulla itself. Differentiating between these entities, evenwith biopsy, is often not possible. Therefore, PC ismanaged identically to pancreatic adenocarcinoma, the fourth leading cause of cancer death in the United States despite representing only 3.1% of new cancer diagnoses [1]. Surgical resection by pancreaticoduodenectomy is the only potentially curative measure [2]. Unfortunately, as PC frequently presents at an advanced stage (particularly pancreatic adenocarcinoma), it is often inoperable at the time of diagnosis [3]. The 2016 National Comprehensive Cancer Network (NCCN) Guidelines for Pancreatic Adenocarcinoma define criteria to determine resectability [2]. Nonetheless, a subset of patients undergo noncurative laparotomy (NCL) either because the resection is 1) margin positive (termed an R1 resection) [4,5] or 2) the disease is found to be unresectable due to local invasion or unexpected metastases [6,7]. Although it is not the preferred outcome, NCL can benefit patients via definitive staging in borderline resectable cases, surgical bypass of obstructed bowel or bile ducts, placement of fiducial markers for radiation therapy, and tumour debulking.

The use of endo-vascular balloon tamponade technique for the removal of a misplaced nephrostomy tube in the inferior vena cava: A case report

Highlights • Inadvertent placement of nephrostomy tube in the IVC is rare.• This tube misplacement usually occurs during percutaneous nephrolithotomy.• A non- operative extrication method is by minimally invasive interventional radiology.• We used intravenous balloon tamponade to remove the misplaced tube in an elderly co- morbid patient.