Mark Reddick

Ureteroarterial Fistula: Diagnosis and Management

OBJECTIVE Ureteroarterial fistula (UAF) is an uncommon condition with only approximately 150 cases reported in the literature. Patients typically present with hematuria in the setting of prolonged ureteral stenting, prior pelvic surgery, malignancy, or radiation. Presentation can vary from intermittent hematuria to life-threatening hemorrhagic shock. CONCLUSION Recognizing this condition in a prototypical patient is essential for accurate diagnosis and management. Angiography yields the highest diagnostic benefit, and arterial stent-graft placement is the treatment of choice.

Noninvasive Physiologic Vascular Studies: A Guide to Diagnosing Peripheral Arterial Disease

Noninvasive physiologic vascular studies play an important role in the diagnosis and characterization in peripheral arterial disease (PAD) of the lower extremity. These studies evaluate the physiologic parameters of blood flow through segmental arterial pressures, Doppler waveforms, and pulse volume recordings. Collectively, they comprise a powerful toolset for defining the functionality of the arterial system, localizing the site of disease, and providing prognostic data. This technology has been widely adopted by diverse medical specialty practitioners, including radiologists, surgeons, cardiologists, and primary care providers. The use of these studies increased substantially between 2000 and 2010. Although they do not employ imaging, they remain a critical component for a comprehensive radiologic vascular laboratory. A strong presence of radiology in the diagnosis of PAD adds value in that radiologists have shifted to noninvasive alternatives to diagnostic catheter angiography (DCA), such as computed tomography (CT) and magnetic resonance (MR) angiography, which provide a more efficient, less-expensive, and lower-risk alternative. Other specialties have increased the use of DCA during the same period. The authors provide a review of the relevant anatomy and physiology of PAD as well as the associated clinical implications. In addition, guidelines for interpreting the ankle-brachial index, segmental pressures, Doppler waveforms, and pulse volume recordings are reviewed as well as potential limitations of these studies. Noninvasive physiologic vascular studies are provided here for review with associated correlating angiographic, CT, and/or MR findings covering the segmental distribution of PAD as well as select nonatherosclerotic diagnoses. ©RSNA, 2016.

Catheter-Directed Pharmacologic Thrombolysis for Acute Pulmonary Embolism Immediately Following Lung Transplantation

device. The StarClose device is another valid option to close femoral artery defects up to 12-F (3). In each case, the combination of PSA neck catheterization via the contralateral CFA and foreign body retrieval techniques allowed flossing wire placement through the original arteriotomy and subsequent treatment using a closure device. This inside-out technique avoided the perceived risk of thrombin and offers another possible method of sealing damage after catheterization without surgery.

Diagnosis and interventions of vascular complications in lung transplant

Though rare, pulmonary vascular complications after lung transplantation carry high morbidity and mortality. Knowledge of the normal and abnormal appearance of lung transplant vasculature is essential for timely and appropriate diagnosis and management of complications. Appropriate selection of surgical and endovascular treatments depend on the availability of expertise and requires a multidisciplinary approach to ensure the best outcomes.

Safety and Effectiveness of the Denali Inferior Vena Cava Filter Intermediate Follow-Up Results

Purpose: The purpose of the study is to evaluate the clinical safety and effectiveness of the Denali (Bard, Tempe, Arizona) retrievable inferior vena cava (IVC) filter. Materials and Methods: In this retrospective study, authors reviewed the data of Denali IVC filters placed at their institution between 2013 and 2015. The clinical presentation, indications, and procedure-related complications during placement and retrieval were evaluated. The frequency of post filter pulmonary embolism (PE) and filter-related complications was assessed. Results: Denali filters were placed in 87 patients (47 males; mean age: 56 years). Twenty patients presented with PE, 45 with deep vein thrombosis (DVT), and 21 with both PE and DVT, 1 filter was placed prophylactically before surgery. Indications for filter placement included contraindications to anticoagulation (AC; n = 80), failure of AC (n = 4), and complications of AC (n = 3). No patients had PE on follow-up imaging after filter placement. Retrieval was attempted in 31 patients after a mean period of 125 days (range: 34-324 days). The filter was successfully removed in 31 (100%) patients. Follow-up imaging, available in 71 (82%) patients (range: 2-538 days), demonstrated penetration of 15 legs in 5 patients, caval thrombus in 3, 1 resulting in caval occlusion, <15° filter tilt in 5, and no leg fractures or crossed legs. Conclusion: The Denali filter is safe during deployment and readily retrievable. The overall safety following deployment is similar to those reported in the literature, and the incidence of filter fractures and migration appears to be less than the previous generation of Bard devices.

Hemodialysis Access: Imaging Diagnosis

A well functioning dialysis access is the lifeline for patients with end stage renal disease (ESRD) on hemodialysis. Dialysis access circuits include both arterio-venous fistulas (AVF) and arterio-venous grafts (AVG). An AV fistula is created by connecting a vein to an artery, resulting in one anastomosis. An AV graft is created when a biologically acceptable tube is connected to an artery at one end and to a vein at the other end, resulting in two anastomoses. The upper extremities are preferred over the lower extremities for dialysis access creation and fistulas have been shown to out-perform grafts in terms of durability and infection rates [1]. Maintaining a given dialysis access requires early detection of access dysfunction. The goal is to keep the dialysis access functioning such that adequate dialysis is achieved, as well as to prevent thrombosis of the access. Once dialysis access thromboses, its lifespan declines dramatically [1–3].