Gregory Guy

Complications of Celect, Günther Tulip, and Greenfield Inferior Vena Cava Filters on CT Follow-up: A Single-Institution Experience

PURPOSE To evaluate and compare the rates of complications on follow-up computed tomography (CT) studies of patients with Celect, Günther Tulip, and Greenfield inferior vena cava (IVC) filters. MATERIALS AND METHODS Retrospective review of CT studies obtained 0-1,987 days after infrarenal placement of an IVC filter identified 255 Celect, 160 Tulip, and 50 Greenfield filters. Follow-up CT studies were independently evaluated by two observers for IVC perforation, contact with adjacent organs, and filter fracture. Multivariate analysis was performed to identify factors associated with higher rates of IVC perforation, including age, IVC diameter, sex, and history of malignancy. RESULTS IVC perforation was observed in 126 of 255 Celect filters (49%) with a mean follow-up of 277 days, 69 of 160 Tulip filters (43%) with a mean follow-up of 437 days, and one of 50 Greenfield filters (2%) with a mean follow-up of 286 days. A significantly higher IVC perforation rate was observed in women (45.5%) compared with men (30.8%; P = .002) and in patients with a history of malignancy (43.7%) compared with patients with no history of malignancy (29.9%; P < .001). Filter fracture was rare, observed in two of 255 Celect filters (0.8%), one of 160 Tulip filters (0.6%), and none of 50 Greenfield filters. CONCLUSIONS No significant difference was observed in IVC perforation rate between Celect and Tulip filters. Greenfield filters had a significantly lower rate of IVC perforation than Celect and Tulip filters. Higher IVC perforation rates were observed in women and patients with a history of malignancy.

Celect Inferior Vena Cava Wall Strut Perforation Begets Additional Strut Perforation

PURPOSE To identify risk factors for strut perforation following Celect inferior vena cava (IVC) filter (IVCF) placement and to use finite element modeling to predict the mechanical impact of long-dwelling filters. MATERIALS AND METHODS Ninety-one patients with three computed tomography (CT) studies were evaluated following Celect IVCF placement (2007-2013). Three-dimensional finite element models of the Celect IVCF were developed to simulate mechanical deformation of the IVCF encountered in vivo. Simulated forces applied by the primary struts on the IVC wall were measured as a function of luminal area and tilt angle. RESULTS Although 33 patients (36%) showed primary strut perforation on initial follow-up CT, 60 patients (66%) showed progressive perforation over time (P < .0001), with 72 patients (79%) showing primary strut perforation on the final CT (average, 554 d). Female patients (P = .004) and those with malignancy history (P = .01) had significantly higher perforation rates at a given time. Caval area also decreased after primary filter strut perforation, and we therefore proposed that this was the mechanism for progressive perforation. Consistent with this mechanism, three-dimensional finite element modeling demonstrated increasing strut force with decreasing IVC diameter. CONCLUSIONS Celect IVCF primary strut perforation is progressive over time and is more common in female patients and those with a history of malignancy. In addition, this progressive perforation may be predicted by three-dimensional finite element modeling. These patient populations may require closer follow-up after IVCF placement to prevent or reduce the risk for filter complication or worsening perforation.

Best radiological response to trans‐arterial chemoembolization for hepatocellular carcinoma does not imply better outcomes

INTRODUCTION Regional therapy with trans-arterial chemoembolization (TACE) is a common treatment for unresectable hepatocellular carcinoma (HCC). Outcomes were examined in patients with the best radiological response (BR) after the initial TACE. METHODS This was a retrospective cohort study of patients who underwent TACE as the initial treatment for HCC between the years 2000 and 2010. BR was defined as complete disappearance of the tumour or no enhancement with contrast on the first cross-sectional imaging study after the initial TACE. RESULTS Seventy-eight out of 104 total consecutive patients were identified with the potential for a BR to TACE therapy for unresectable HCC, and 24 met the criteria for BR. Patients with BR had a median survival of 12.8 months (2.2-54.9) compared with 18.9 months(1.3-56.7) for the entire cohort (P= 0.313). The median time to progression was 10.6 months (1.2-24.3) in the BR group and 3.2 months (0.7-49.2) in the patients without a BR (P= 0.003). DISCUSSION BR to initial TACE for unresectable HCC is associated with comparable survival to those without BR in spite of a longer time to cancer progression. It may be reasonable to consider further therapy such as repeat TACE or biological/systemic therapy in patients with HCC even when the radiological response to the initial TACE is favourable.

Institutional Interventional Radiology Symposium Increases Medical Student Interest and Identifies Target Recruitment Candidates

OBJECTIVES To assess and raise medical student interest in interventional radiology (IR); and to evaluate student response across gender, level of training, and surgical vs nonsurgical specialty interest. MATERIALS AND METHODS All Ohio medical students were invited to an IR Symposium held by a large academic medical center in central Ohio. The program encompassed didactic lectures, hands-on simulation models, and a networking luncheon with faculty, trainees, and industry partners. All attendees completed an anonymous, 5-point Likert scaled survey preattending and postattending the event to assess their awareness of IR as a specialty, understanding of the current training pathways, and level of interest. RESULTS A total of 46 participants (M:F 60%:40%, MS1-53%, MS2-36%, and MS3-11%) attended the symposium. The cohort demonstrated increased interest in pursuing a career in IR following the symposium (4.12 vs 3.70, P < 0.001). Students with an interest in a nonsurgical specialty showed an increased interest in IR (4.20 vs 3.68, P < 0.001), whereas surgically oriented students did not demonstrate a significant increase (4.00 vs 3.71, P = 0.375). No statistically significant differences were noted across gender or level of training. The symposium experience significantly increased understanding of the IR training pathways (4.51 vs 2.94, P < 0.001). Students rated lectures (57%) and endovascular simulators (41%) as the most useful experiences. CONCLUSIONS This study demonstrated the role of symposia in improving medical student awareness of IR and training pathways. Findings were validated across gender and training level, and identified the subset of students with nonsurgical interests as most responsive to such intervention and potential recruitment.

Percutaneous Methods of Common Bile Duct Stone Retrieval

Percutaneous transhepatic stone removal, most commonly by expulsion into the duodenum through the papilla, is an effective and safe alternative to surgery particularly when endoscopic stone extraction has failed or is not possible. In specific patient populations, such as following Billroth II gastrectomy or laparoscopic Roux-en-Y gastric bypass, percutaneous approaches may be the best option for patients with symptomatic choledocholithiasis. With the increase in global obesity, the need for bariatric surgery will continue to incline in the future. Given the association of gallstones in bariatric patients following surgery, an increasing number of patients with surgically altered anatomy will require management for symptomatic stones. Therefore, an understanding of transhepatic percutaneous approaches is important to provide optimal care for these patients and those that are not candidates for ERCP.

Unique case of pinch-off syndrome in a patient presenting with acute stroke.

None of the authors have identified a conflict of interest. 2. Uflacker R, Kaemmerer A, Picon PD, et al. Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results. Radiology 1985; 157:637–644. 3. Giron J, Poey C, Fajadet P, et al. CT-guided percutaneous treatment of inoperable pulmonary aspergillomas: a study of 40 cases. Eur J Radiol 1998; 28:235–242. 4. Baisi A, Raveglia F, De Simone M, Cioffi U. Palliative role of percutaneous radiofrequency ablation for severe hemoptysis in an elderly patient with inoperable lung cancer. J Thorac Cardiovasc Surg 2010; 140: 1196–1197.