James E. Silberzweig

Reporting Standards for Inferior Vena Caval Filter Placement and Patient Follow-up: Supplement for Temporary and Retrievable/Optional Filters

THIS Standards document is intended as a Supplement to the Recommended Reporting Standards for Vena Cava Filter Placement and Patient Followup, published in 1999 (1). Since 1999, there has been increased interest in non-permanent vena cava filters, with both increased research and clinical use of these devices. Several such devices are now approved for use in Europe, Canada, and the United States. The previous Standards did address several issues related specifically to non-permanent filters: this document contains additional issues that have arisen in the interval. Although there is a large number of publications regarding vena cava filters, the literature is generally limited, with few good prospective studies, and even fewer randomized controlled trials (2). A randomized trial published in 1998 (3) demonstrated the “initial efficacy of filters for the prevention of pulmonary embolism.” However, prevention of pulmonary embolism (PE) appeared to be shortlived, and was counterbalanced by an increased risk of recurrent deep-vein thrombosis (DVT) in the patients receiving filters (3). The data published in this trial, which was based on 2-year follow-up, resulted in increased interest in non-permanent filters. Of note, further follow-up data from the same trial showed continued filter protection against PE with no increase in post-thrombotic syndrome at 8 years (4).

Endovascular Repair of an Internal Iliac Artery Aneurysm with Use of a Stented Graft and Embolization Coils

O SCVIR, 1995 T H E high mortality associated with ruptured internal iliac artery aneurysms dictates early prophylactic repair. The traditional therapeutic options include surgical excision, ligation, or obliterative endoaneurysmorrhaphy (1-5). Although the origin of the aneurysm may be easily oversewn, the anterior and posterior divisions of the internal iliac artery usually arise deep in the pelvis and may be difficult or impossible to ligate or oversew from within. Without occlusion of these vessels, the aneurysm can remain patent by filling from contralateral pelvic collaterals and the potential for aneurysm rupture remains. Percutaneous repair of an internal iliac artery aneurysm has been performed, but i t has required complete iliac occlusion and extraanatomic bypass, as described by Hollis et a1 (6). This report describes a transfemoral endovascular approach that is effective in excluding internal iliac artery aneurysms and maintaining circulation through the ipsilateral external iliac artery.

State of Structured Reporting in Radiology, a Survey

RATIONALE AND OBJECTIVES To survey North American radiologists on current practices in structured reporting and language. MATERIALS AND METHODS An e-mail invitation was sent to the Association of University Radiologists membership (comprising 910 members) to participate in an online survey that addressed development, use, and experience of structured reporting, language, and imaging classification or reporting systems and personal dictation styles. RESULTS Of the 910 members e-mailed, 265 (29.1%) responded, 90.6% of whom were from academic teaching hospitals. There were no significant differences in responses based on group size or region of practice. Of all the respondents, 51.3% come from groups that developed structured reporting for at least half of their reports and only 10.9% for none. A significantly fewer 13% of respondents used rigid unmodifiable structures or checklists rather than adaptable outlines; 59.5% respondents report being satisfied or very satisfied with their structured reports, whereas a significantly fewer 13% report being dissatisfied or very dissatisfied. Structured reports were reportedly significantly more likely to be required, appreciated, and to decrease errors in departments using many structured reports compared to groups with less widespread use. CONCLUSIONS Most academic radiology departments are using or experimenting with structured reports. Although radiologist satisfaction with standardization is significant, there are strong opinions about their limitations and value. Our survey suggests that North American radiologists are invested in exploring structured reporting and will hopefully inform future study on how we define a standard report and how much we can centralize this process.

Cesarean section scar diverticulum: appearance on hysterosalpingography.

OBJECTIVE The purpose of this study was to characterize the frequency and appearance of hysterotomy defects on hysterosalpingography in patients with a history of cesarean section. MATERIALS AND METHODS We reviewed the hysterosalpingograms of 150 women with a history of cesarean section. The incidence, location, and appearance of defects at the expected location of a hysterotomy scar were evaluated. RESULTS Of the 148 patients with history of cesarean section and technically adequate hysterosalpingograms, 89 (60%) had defects that were in the expected location of a hysterotomy incision. Fifty-eight (65%) of the diverticula were focal outpouchings, and 31 (35%) were thin linear defects. Forty-eight (54%) of the diverticula were located at the lower uterine cavity, 32 (36%) at the uterine isthmus, and nine (10%) at the upper endocervical canal. CONCLUSION A diverticulum at the lower uterine cavity, uterine isthmus, or upper endocervical canal is a common finding on hysterosalpingography in patients with a history of cesarean section.

Radiation Protection in Interventional Radiology: Survey Results of Attitudes and Use

PURPOSE To assess attitudes of interventional radiologists toward personal radiation protection and the use of radiation protection devices. MATERIALS AND METHODS Invitations to an anonymous online survey that comprised eight questions focused on operator attitudes toward radiation protection devices were sent via e-mail to the active membership of the Society of Interventional Radiology (SIR): a total of 3,158 e-mail invitations. A single reminder e-mail was sent. RESULTS There were 504 survey responders (16% response rate). Reported radiation safety device use included lead apron (99%), thyroid shield (94%), leaded eyeglasses (54%), ceiling-suspended leaded shield (44%), rolling leaded shields (12%), ceiling-suspended/rolling lead-equivalent apron (4%), radiation-attenuating sterile surgical gloves (1%), and sterile lead-equivalent patient-mounted drape (4%). Reasons commonly cited for not using certain devices were comfort (eyewear), ease of use (mounted shields), and lack of availability (rolling/hanging shields and patient-mounted shields). CONCLUSIONS Interventionalists have an array of tools from which to choose for personal radiation protection; however, for a variety of reasons related to lack of availability or choice, these tools are not universally employed. Further study may be of value to clarify why comfort was cited most often as the primary barrier to the use of protective eyewear and difficulty of use was cited as the primary barrier to use of mounted shields (despite reporting that concern for radiation-induced injury to the eye is paramount). It may also be of interest to further study why certain devices with demonstrable protection effects are not readily available, such as rolling/hanging and patient-mounted shields.

Occupational radiation protection of pregnant or potentially pregnant workers in IR: A joint guideline of the society of interventional radiology and the cardiovascular and interventional radiological society of europe

Lawrence T. Dauer, PhD, Donald L. Miller, MD, Beth Schueler, PhD, James Silberzweig, MD, Stephen Balter, PhD, Gabriel Bartal, MD, Charles Chambers, MD, Jeremy D. Collins, MD, John Damilakis, PhD, Robert G. Dixon, MD, M. Victoria Marx, MD, Michael S. Stecker, MD, Eliseo Vano, PhD, Aradhana M. Venkatesan, MD, and Boris Nikolic, MD, MBA, for the Society of Interventional Radiology Safety and Health Committee and the Cardiovascular and Interventional Radiological Society of Europe Standards of Practice Committee

Central venous catheter tip malposition

Central venous catheters are commonly utilised to gain vascular access for varied clinical indications. Successful central venous catheter placement requires not only technical expertise, but also awareness of the potential complications. This article reviews the major procedural and post‐procedural complications resulting from central venous catheter tip malposition.

Outcomes of Rejected Journal of Vascular and Interventional Radiology Manuscripts

PURPOSE To track the publication fate of rejected Journal of Vascular and Interventional Radiology (JVIR) manuscript submissions. MATERIALS AND METHODS All manuscripts submitted to JVIR for consideration in 2004, but subsequently rejected, were retrospectively evaluated. The PubMed database was searched for subsequent manuscript publication. Manuscript type, journal type and title, publication delay, journal publication volume, journal circulation volume, and journal impact factor were evaluated. RESULTS Two hundred thirteen of the 366 rejected JVIR submissions (58%) were subsequently published in 72 different journals as of December 15, 2007. Fifty-five of the published manuscripts (26%) were revised resubmissions to JVIR and 45 (21%) were published in Cardiovascular and Interventional Radiology, with 113 manuscripts published in other journals. The mean time from manuscript rejection to subsequent publication was 15.5 months. Half of the 366 rejected manuscripts were ultimately published within 25 months. CONCLUSIONS A majority of rejected JVIR mauscripts were ultimately published. Rejection of a manuscript by JVIR does not preclude publication.

Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques

Uterine fibroids occur in approximately 50% of women over the age of 40 years, and an estimated 50% of those are symptomatic. Menorrhagia is the most common symptom and the primary indication for treatment, although bulk symptoms often occur and can be treated. Pharmacotherapy is typically inadequate unless it can be expected to successfully bridge to menopause or allow for a less-invasive intervention. However, hormonal therapies have risks. Hysterectomy is still the most commonly performed procedure for symptomatic fibroids and has the lowest rate of reintervention (compared with myomectomy or uterine artery embolization [UAE]), but rates of more serious complications are higher and patient satisfaction and ability to return to normal activities may also be less favorable. Myomectomy is not necessarily less morbid than hysterectomy and may have a greater failure rate than UAE. Techniques and devices vary with little standardization, and operator experience is crucial to success. The largest studies of UAE show very low rates of serious complications and rapid recovery. UAE significantly improves symptoms related to uterine fibroids in 85%-90% of patients. Herein, this article will discuss the nature of fibroids and their diagnosis, pharmacotherapy, surgical treatment, and nonsurgical interventional treatment, including UAE and magnetic resonance-guided focused ultrasound. (©) RSNA, 2016.

Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization for Acute Hemorrhage: A Systematic Review of Peripheral Applications

PURPOSE To evaluate the endovascular use of ethylene vinyl alcohol (EVOH) copolymer (Onyx; ev3 Endovascular, Inc, Plymouth, Minnesota) for the treatment of acute peripheral nonneurologic hemorrhage. MATERIALS AND METHODS MEDLINE and PubMed databases were searched for articles published in English from 1946 to August 2014 describing patients treated for hemorrhage with EVOH copolymer outside of its usual neurovascular applications. Additional cases were collected from the bibliographies of relevant articles. Full-text articles were obtained. Demographic data, clinical presentation, underlying etiology, culprit vessel, endovascular treatment, outcomes, and follow-up times were obtained. RESULTS The literature search yielded 19 relevant articles. Cases of 131 patients (87 men, 44 women; mean age, 61 y ± 19.2) describing the treatment of 151 lesions were reviewed. The most common categories of arterial lesions were gastrointestinal (n = 53) and bronchial (n = 40) in origin. In 14 cases, EVOH copolymer was employed after failure or rebleeding following the use of a different embolic agent. Average follow-up time was 12.0 months. EVOH copolymer was the sole embolic agent used in 105 patients. Rebleeding after treatment with EVOH copolymer occurred in 10 patients. There were 2 technical failures. One patient died of multiorgan failure in the setting of persistent hemoptysis. Complications included 2 nerve injuries and 2 minor strokes. CONCLUSIONS Embolization of acute hemorrhage in the peripheral vasculature was safe and effective with EVOH copolymer.