S.X. Chan

Severe Bleeding after Percutaneous Transhepatic Drainage of the Biliary System

We thank Dr Nyman for his comments about our study (1). The James formula (2) is commonly used for calculating the contrast material dose for CT (3–5). It is also incorporated into many modern positron emission tomography/CT systems to calculate the standardized uptake value based on the LBW (6). We fully agree with Dr Nyman that the James formula is not necessarily appropriate in patients with a high BMI and that the Boer formula is more appropriate in such patients. In our study, the mean BMI for women and men was 22.2 kg/m2 (range, 13.2–36.7 kg/m2) and 22.4 kg/m2 (range, 12.1–42.0 kg/m2), respectively. In this population, there is a very strong linear correlation between the estimated LBW calculated with the James formula and the estimated LBW obtained with the Boer formula. The correlation coefficient was 0.981 (95% confidence interval: 0.979, 0.983), and the mean difference in the estimated LBW calculated with the two methods was 0.127 kg (range, −6.88 to 4.65 kg). Therefore, almost the same results are obtained with the Boer and the James formula. The Janmahasatian formula (7) is another formula for estimating the LBW; it can be applied in patients with a high BMI. As it involves an increasing function of weight and plateaus at large weight values, it can be applied in a wide range of body weights. Studies are needed to assess whether the Boer or the Janmahasatian formula is better for estimating the LBW for the determination of the appropriate contrast material dose.

Hemodialysis Arteriovenous Fistula and Graft Stenoses: Randomized Trial Comparing Drug-eluting Balloon Angioplasty with Conventional Angioplasty

Purpose To compare lesion primary patency and restenosis rates between drug-eluting balloon (DEB) percutaneous transluminal angioplasty (PTA) and conventional balloon PTA (cPTA) in the treatment of arteriovenous fistula (AVF) and arteriovenous graft (AVG) stenosis. Materials and Methods In this prospective study, 119 participants (mean age, 59.2 years; 79 men, 40 women) with failing AVFs (n = 98) or AVGs (n = 21) were randomly assigned to undergo either DEB PTA (n = 59) or cPTA (n = 60) from January 2012 to May 2013. Primary end points were lesion primary patency and restenosis rates at 6 months; secondary outcomes were anatomic and clinical success after PTA, circuit primary patency at 6 months and 1 year, and lesion primary patency at 1 year. Statistical analysis was performed by using the Kaplan-Meier product limit estimator, and hazard ratio was calculated by using Cox proportional hazards regression. Complication rates were assessed in both groups. Results Estimated lesion primary patency in the DEB PTA and cPTA arms was 0.81 and 0.61, respectively, at 6 months (P = .03) and 0.51 and 0.34, respectively, at 1 year (P = .04). Estimated circuit primary patency in the DEB PTA and cPTA arms was 0.76 and 0.56, respectively, at 6 months (P = .048) and 0.45 and 0.32, respectively, at 1 year (P = .16). Restenosis rate was 34.0% (16 of 47) for DEB PTA and 62.9% (22 of 35) for cPTA at 6 months (P = .01). No major complications were noted. Conclusion Drug-eluting balloon angioplasty was effective in prolonging lesion primary patency of dialysis access stenoses at 6 months and 1 year.

Complications of 90Y Transarterial Radioembolization of Hepatic Tumors: Primer for Interventional Radiology Residents and Fellows RadioGraphics Fundamentals | Online Presentation

This presentation provides a pictorial review of known complications related to transarterial radioembolization, focusing on their imaging appearances and prevention and management strategies.

Mind Your Back

Spinal fractures can be potentially unstable and they may result in significant morbidity. Appropriate and prompt imaging plays an important role in the management of these patients by delineating the anatomy, extent of injury and associated complications. We present a simple case of a vertebral burst fracture to illustrate the role of imaging.