Paramjit S. Chopra

Radiofrequency Endovenous ClosureFAST versus Laser Ablation for the Treatment of Great Saphenous Reflux: A Multicenter, Single-blinded, Randomized Study (RECOVERY Study)

PURPOSE The present study was designed to address the hypothesis that radiofrequency (RF) thermal ablation, as represented by the ClosureFAST system, is associated with improved recovery and quality-of-life (QOL) parameters compared with 980-nm endovenous laser (EVL) thermal ablation of the great saphenous vein (GSV). MATERIALS AND METHODS Eighty-seven veins in 69 patients were randomized to ClosureFAST or 980-nm EVL treatment of the GSV. The study was prospective, randomized, single-blinded, and carried out at five American sites and one European site. Primary endpoints (postoperative pain, ecchymosis, tenderness, and adverse procedural sequelae) and secondary endpoints (venous clinical severity scores and QOL issues) were measured at 48 hours, 1 week, 2 weeks, and 1 month after treatment. RESULTS All scores referable to pain, ecchymosis, and tenderness were statistically lower in the ClosureFAST group at 48 hours, 1 week, and 2 weeks. Minor complications were more prevalent in the EVL group (P = .0210); there were no major complications. Venous clinical severity scores and QOL measures were statistically lower in the ClosureFAST group at 48 hours, 1 week, and 2 weeks. CONCLUSIONS RF thermal ablation was significantly superior to EVL as measured by a comprehensive array of postprocedural recovery and QOL parameters in a randomized prospective comparison between these two thermal ablation modalities for closure of the GSV.

Quality Improvement Guidelines for Adult Percutaneous Abscess and Fluid Drainage

Curtis W. Bakal, MD, MPH, Chairman, David Sacks, MD, Dana R. Burke, MD, John F. Cardella, MD, Paramjit S. Chopra, MD, Steven L. Dawson, MD, Alain T. Drooz, MD, Neil Freeman, MD, Steven G. Meranze, MD, A. Van Moore, Jr, MD, Aubrey M. Palestrant, MD, Anne C. Roberts, MD, James B. Spies, MD, Eric J. Stein, MD, Richard Towbin, MD, for the Society of Interventional Radiology Standards of Practice Committee

Prospective Double-Blinded Comparison of MR Imaging and Aortography in the Preoperative Evaluation of Abdominal Aortic Aneurysms

The authors conducted a prospective double-blind study comparing spin-echo axial and coronal magnetic resonance (MR) imaging with aortography in the preoperative evaluation of 20 patients with abdominal aortic aneurysms. Receiver-operating-characteristic (ROC) analysis was used to evaluate the performance of MR imaging versus aortography in assessing arterial stenotic disease. Both modalities were equivalent in demonstrating the upper extent of the abdominal aortic aneurysms with respect to the renal and visceral arteries. MR imaging was superior in demonstrating aneurysmal iliac arteries and intraluminal thrombus. Although aberrant venous anatomy, associated pathologic changes, and other concomitant lesions were demonstrated with MR imaging, it performed poorly in assessing arterial stenoses and occlusions. Thus, the authors caution against the routine substitution of spin-echo MR imaging for aortography in the evaluation of abdominal aortic aneurysms. Conventional angiography should continue to be performed in patients with suspected mesenteric ischemia, significant hypertension, and symptomatic iliofemoral atherosclerosis, at least until robust MR angiographic techniques have proved themselves under similar rigorous clinical evaluation.

Conjoined gastric and mediastinal benign cystic teratomas case report of a rare occurrence and review of literature

Teratomas are embryonal neoplasms which arise from totipotential cells and contain elements from all three germ layers (ectoderm, mesoderm, and the endoderm). Simultaneous occurrence of mediastinal and gastric teratomas in infants has not been reported, although gastric teratomas extending into the mediastinum have been reported twice in literature. We report here a case in which a gastric cystic teratoma was connected to its mediastinal counterpart with a pedicle. The pertinent literature is reviewed.

The Heparin-Induced Thrombocytopenia and Thrombosis Syndrome: Treatment with Intraarterial Urokinase and Systemic Platelet Aggregation Inhibitors

We report a case of the heparin-induced thrombocy-topenia and thrombosis syndrome presenting with acute ischemia of a lower limb. The patient was successfully treated by withdrawal of heparin products, intraarterial urokinase, and platelet anti-aggregation therapy consisting of Dextran and aspirin.

Improving the patient evaluation process in a cardiovascular and interventional radiology department.

Brigham & Womens Hospital (BWH) has adopted total quality management (TQM) to increase productivity and efficiency and to improve the quality of patient care services. This article reports on a quality improvement project in the department of radiology designed to improve the process of pre-procedure workup of patients referred for cardiovascular and interventional radiology (CVIR) procedures. The project was initiated, led, and conducted by a physician.

Endoluminal Thermal Occlusion of the Ureter with the Electromagnetic Field-Focusing Device☆

The authors attempted ureteral occlusion by means of heat application in nine ureters (24 sites) of New Zealand White rabbits with the electromagnetic field-focusing (EFF) device. The EFF device generates heat at the tip of a grounded probe by focusing eddy currents that have been induced within the tissues by an external radio-frequency field. The power settings were varied from 30 to 150 W. Heat was applied at multiple sites in each ureter. Immediate functional occlusion was seen in all nine ureters. Long-term complete occlusion was seen in six ureters at power settings ranging from 40 to 150 W, while long-term partial occlusion was seen in two ureters at 30-50 W. All sites at 30 W resulted in partial occlusions. Perforation of the ureter resulted in urinoma formation in one ureter at a site that was treated with 150 W. The EFF device can be used to endoluminally occlude the ureter by causing a fibrotic reaction to thermal injury. The effective power range for this application appears to be 40-100 W.

Superior Mesenteric Artery Angioplasty with the TEGwire: Usefulness and Technical Difficulties☆

The TEGwire percutaneous transluminal angioplasty balloon on a guide wire was used successfully for dilation of a proximal superior mesenteric arterial stenosis that was not well suited to dilation by conventional angioplasty catheters. After the stenosis was dilated, however, the balloon deflated only partially due to a kink in the TEGwire as it coursed over the acute angle between the aorta and the superior mesenteric artery. Several unsuccessful attempts to correct this problem were made; finally, the partially deflated balloon and the guide catheter had to be withdrawn. Although the TEGwire was used within the guidelines and recommendations of the product, this experience supports the manufacturers recommendation that the TEGwire system should not be used with narrow-radius vascular curves such as that formed between the superior mesenteric artery and the aorta.