S.I. Iqbal

Intravascular Ultrasound-Guided Inferior Vena Cava Filter Placement Using a Single-Puncture Technique in 99 Patients

Purpose: To assess the feasibility and safety of intravascular ultrasound (IVUS) to guide inferior vena cava (IVC) filter placement using a single venous puncture technique. Materials and Methods: Medical records of all patients who had IVC filters placed under IVUS guidance between January 1, 2005 and December 31, 2011 were retrospectively reviewed for pertinent history, results, and complications. All filters were placed using a single venous puncture technique. Results: Filters were successfully placed within the IVC in 94% of the patients with 6 malpositioned filters (4 in the iliac veins and 2 in the suprarenal IVC). Complications included groin hematoma (4%), deep venous thrombosis at the site of vascular access (2%), and filter tilt >15° along the long axis of the IVC (2%). Conclusions: The IVUS-guided IVC filter placement using a single venous puncture technique is technically feasible and safe when compared to case series using a double venous puncture technique.

Preliminary experience with option inferior vena cava filter

Objectives: To evaluate the safety and efficacy of Option inferior vena cava (IVC) filter during placement and short-term follow-up. Methods: A total of 165 patients (mean age: 60-years) who received Option IVC filter from June 2009 to July 2011 were included. In all, 42 patients presented with deep vein thrombosis (DVT), 26 with pulmonary embolism (PE), and 17 with both. All outcomes were examined until April 30, 2012. Results: The filters were successfully deployed in 161patients. During follow-up (mean, 9.5 ± 0.68months), 10 patients were diagnosed with post-filter PE and 13 patients with DVT. There were no instances of fatal PE. Follow-up abdominal computed tomography was available in 60 patients and demonstrated filter-related problems in 8 patients (2: penetration of filter legs, 5: asymptomatic nonocclusive thrombus, and 1: caval occlusion). There were no instances of filter migration or fracture. In total, 27 filters were successfully retrieved after a mean of 5.27 ± 0.76 months. Conclusion: The Option filter was effective and safe during implantation and short-term follow-up and associated with high technical success at retrieval.

Expanding role of percutaneous cholecystostomy and interventional radiology for the management of acute cholecystitis: An analysis of 144 patients

PURPOSE To investigate the rates of interval cholecystectomy and recurrent cholecystitis after initial percutaneous cholecystostomy (PC) and identify predictors of patient outcome after PC. MATERIALS AND METHODS A total of 144 patients with acute cholecystitis who were treated with PC were included. There were 96 men and 48 women, with a mean age of 71±13 (SD) years (range: 25-100 years). Patient characteristics, diagnostic imaging studies and results of laboratory tests at initial presentation, clinical outcomes after the initial PC treatment were reviewed. RESULTS Among the 144 patients, 56 patients were referred for acute acalculous and 88 patients for calculus cholecystitis. Five procedure-related major complications (3.6%) were observed including bile peritonitis (n=3), hematoma (n=1) and abscess formation (n=1). Recurrent acute cholecystitis after initial clinical resolution and PC tube removal was observed in 8 patients (6.0%). The rate of interval cholecystectomy was 33.6% (47/140) with an average interval period of 100±482 (SD) days (range: 3-1017 days). PC was a definitive treatment in 85 patients (60.7%) whereas 39 patients (27.9%) had elective interval cholecystectomy without having recurrent cholecystitis. The clinical outcomes after PC did not significantly differ between patients with calculous cholecystitis and those with acalculous cholecystitis. Multiple prior abdominal operations were associated with higher rates of recurrent cholecystitis. CONCLUSION For both acute acalculous and calculous cholecystitis, PC is an effective and definitive treatment modality for more than two thirds of our study patients over 3.5-year study period with low rates of recurrent disease and interval cholecystectomy.

Fine-Needle Aspiration of Epithelial-Myoepithelial Carcinoma of the Parotid Gland With Prominent Adenoid Cystic Carcinoma-Like Cribriform Features: Avoiding a Diagnostic Pitfall.

OBJECTIVES Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland malignancy associated with an overall good prognosis. Fine-needle aspiration (FNA) typically shows a dual population of myoepithelial and ductal cells. Rarely, acellular matrix globules are present, raising a differential diagnosis of adenoid cystic carcinoma (AdCC), a more aggressive salivary gland malignancy associated with a poor long-term prognosis. We report an FNA case of EMC containing a predominant pattern of AdCC-like spherical globules. METHODS We compare features of an unusual case of EMC with those of cribriform AdCC to arrive at morphologic clues to the correct diagnosis. RESULTS Distinguishing features of EMC on FNA include (1) a prominent population of myoepithelial cells vs the predominance of basaloid cells in AdCC and (2) cohesive matrix globules with a peripheral rim of pale-staining basement membrane material compared with the dyscohesive matrix globules of AdCC. Immunochemical markers (S100, CD117, and MyB) are also useful. CONCLUSIONS Although EMC and AdCC can both contain spherical matrix globules, close evaluation of the cytomorphology of the globules and their relationship to surrounding cells provides a clue to distinguish the two neoplasms.

Purposeful Creation of a Pneumothorax and Chest Tube Placement to Facilitate CT-Guided Coil Localization of Lung Nodules before Video-Assisted Thoracoscopic Surgical Wedge Resection

PURPOSE To evaluate the feasibility and efficacy of pneumothorax creation and chest tube insertion before computed tomography (CT)-guided coil localization of small peripheral lung nodules for video-assisted thoracoscopic surgical (VATS) wedge resection. MATERIALS AND METHODS From May 2011 to October 2013, 21 consecutive patients (seven men; mean age, 62 y; range, 42-76 y) scheduled for VATS wedge resection required CT-guided coil localization for small, likely nonpalpable peripheral lung lesions at a single institution. Outcomes were evaluated retrospectively for technical success and complications. RESULTS There were 12 nodules and nine ground-glass opacities. Mean lesion distance from the pleural surface was 15 mm (range, 5-35 mm), and average size was 13 mm (range, 7-30 mm). A pneumothorax was successfully created in all patients with a Veress needle, and a chest tube was inserted. All target lesions were marked successfully, leaving one end of the coil within/beyond the lesion and the other end of the coil in the pleural space. The inserted chest tube was used to insufflate air to widen the pleural space during coil positioning and to aspirate any residual air before transfer of the patient to the operating room holding area. Intraparenchymal hemorrhages smaller than 7 cm in diameter developed in two patients during coil placement. All lesions were successfully resected with VATS. Histologic examinaiton revealed 13 primary adenocarcinomas, four metastases, and four benign lesions. CONCLUSIONS Pneumothorax creation and chest tube placement before CT-guided coil localization of peripheral lung nodules for VATS wedge resection facilitates the deployment of the peripheral end of the coil in the pleural space and provides effective management of procedure-related pneumothorax until surgery.

Interventional Radiology and Angioinfarction: Transcatheter Embolization of Renal Tumors

The embolization of the renal vasculature to treat kidney cancer has been introduced nearly 40 years ago and has now evolved to a standard procedure in interventional radiology (Dotter CT, Goldman ML, Rosch J. Instant selective arterial occlusion with isobutyl 2-cyanoacrylate. Radiology. 1975; 114:227–30; Loffroy R, Abualsaud B, Delgal A, et al. Role of percutaneous arterial embolization in renal pathology. Prog Urol. 2010; 20:161–71; Fechner G, Hauser S, Flacke S, Gerhard T, Muller SC. The role of superselective transcatheter arterial embolisation in management of complications after kidney surgery. Aktuelle Urol. 2008; 39:229–33). To date, the majority of embolization procedures use a superselective approach targeting a portion of the kidney, a small tumor, or a focal vascular problem (Fechner G, Hauser S, Flacke S, Gerhard T, Muller SC. The role of superselective transcatheter arterial embolisation in management of complications after kidney surgery. Aktuelle Urol. 2008; 39:229–33). The embolization of the entire kidney also known as angioinfarction is usually limited to selected cases of advanced renal cancer involving the renal vein and vena cava prior to complex surgery (Klimberg I, Hunter P, Hawkins IF, Drylie DM, Wajsman Z. Preoperative angioinfarction of localized renal cell carcinoma using absolute ethanol. J Urol. 1985; 133:21–4.). Preprocedural imaging using modern cross-sectional imaging techniques such as MDCT or MRI and Doppler ultrasound provides the necessary structural and functional information to plan the intended procedure. Arteriography is used less often in the planning phase, but it precedes every endovascular procedure and confirms imaging findings of the noninvasive imaging studies.