U Teichgräber

Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems.

ObjectivesIn this retrospective study the success and complication rates after radiologically guided port catheter implantation were evaluated.MethodsBetween 2000 and 2008, 3,160 port catheter systems were implanted in our interventional suite. All interventions were imaging guided. The puncture of the preferably right internal jugular vein (IJV) was ultrasound-assisted and the catheter tip position was controlled with fluoroscopy. Catheter indwelling time and rates of periprocedural, early and late complications were evaluated.Results922,599 catheter days (mean, 292xa0days; range, 0–2,704xa0days) were documented. The implantation was successful in 3,153 (99.8%) cases. A total of 374 (11.8%; 0.41/1,000 catheter days) adverse events were recorded. Of these, 42 (1.33%) were periprocedural complications. 86 (3.3%; 0.09/1,000 catheter days) early and 246 (9.4%; 0.27/1,000 catheter days) late onset complications occurred after port implantation. The most common complications were blood stream infection (nu2009=u2009134; 5.1%; 0.15/1,000 catheter days), catheter-induced venous thrombosis (nu2009=u200997; 3.7%; 0.11/1,000 catheter days) and catheter migration (nu2009=u200934; 1.3%; 0.04/1,000 catheter days). A total of 193 (6.1%) port explantations were required.ConclusionUltrasound guided port implantation via the IJV results in low periprocedural complication rates

Central Venous Access Catheters: Radiological Management of Complications

AbstractA great variety of central venous access devicesnsuch as tunneled and non-tunneled central venous catheters (CVC) asnwell as port systems are implanted by interventional radiologists at annincreasing rate. There are some possible immediate, early, and latencomplications related to the implantation technique, care, andnmaintenance of CVCs. This review will illustrate possible complicationsnof CVCs and will discuss risk factors. Different strategies will benshown regarding the prevention and treatment of complications.

A Comparison of Clinical Outcomes with Regular- and Low-Profile Totally Implanted Central Venous Port Systems

The purpose of this study was to evaluate whether low-profile totally implanted central venous port systems can reduce the late complication of skin perforation. Forty patients (age, 57xa0±xa013xa0years; 22 females, 18 males) were randomized for the implantation of a low-profile port system, and another 40 patients (age, 61xa0±xa014xa0years; 24 females, 16 males) received a regular port system as control group. Indications for port catheter implantation were malignant disease requiring chemotherapy. All port implantations were performed in the angiography suite using sonographically guided central venous puncture and fluoroscopic guidance of the catheter placement. Procedure time, number of complications (procedure-related immediate, early, and late complications), and number of explantations were assessed. Follow-up was performed for 6xa0months. All port implantations were successfully completed in both study groups. There were two incidents of skin perforation observed in the control group. One skin perforation occurred 13xa0weeks and the other 16xa0weeks after port implantation (incidence, 5%) in patients with regular-profile port systems. Two infections were observed, one port infection in each study group. Both infections were characterized as catheter-related infections (infection rate: 0.15 catheter-related infections per 1000 catheter days). In conclusion, low-profile port systems can be placed as safely as traditional chest ports and reduce the risk of developing skin perforations, which occurs when the port system is too tight within the port pocket.

Satisfaction and quality of life: a survey-based assessment in patients with a totally implantable venous port system

The purpose was to assess the satisfaction and quality of life in patients with a totally implantable central venous port system using a questionnaire-based survey. A self-designed questionnaire to assess patient satisfaction and the impact of the port on daily life was dispatched 180 days after implantation. The questionnaire was combined with the commonly used short form (SF)-12 Health Survey quality of life questionnaire. Of the 98 patients who received a port system, 75 were contacted, and 42 (56%) returned the questionnaire. Most of the responding patients reported high overall satisfaction. The impact of the system on daily life was widely perceived not to be negative. The physical component summary (PCS) and the mental component summary (MCS) scores from the SF-12 were 35.5 and 45.23 respectively (general German population: PCS = 49.6, MCS = 52.3). The multiple stepwise regression showed that the cosmetic result was a predictor of overall satisfaction; the cosmetic result and a painful port together were predictors of the MCS. Overall, it was found that the cosmetic result of the implantation procedure was a predictor of satisfaction and quality of life and should thus not be underestimated.

Osteochondral Lesions of the Talus: Retrograde Drilling with High-Field-Strength MR Guidance

The institutional review board approved the use of cadaveric specimens, and informed consent was obtained from all volunteers. The authors performed and assessed a magnetic resonance (MR)-assisted navigation method for minimally invasive retrograde drilling of talar osteochondral lesions. For this method, a single imaging plane is sufficient for navigation during intervention. To accomplish this objective, a passive MR navigation device was used to evaluate 16 cadaveric ankle joints. Use of this interactive MR-assisted navigation method in combination with a passive aiming device allowed precise and rapid retrograde drilling of talar osteochondral lesions.

Imaging sequences for intraoperative MR-guided laparoscopic liver resection in 1.0-T high field open MRI

The aim of this study was to identify suitable interactive (dynamic) magnetic resonance (MR) sequences for real-time MR-guided liver dissection in a 1.0-T high field open MRI system. Four dynamic sequences encompassing balanced steady state free precession (bSSFP), T1W gradient echo (GRE), T2W GRE and T2W fast spin echo (FSE) were analysed regarding the image quality, artefact susceptibility and the performance of SNR and CNR. The T2W FSE sequence (1.5xa0s/image) was considered superior because of an intraoperative SNR of 6.9 (±0.7) and CNR (vessel to parenchyma) of 5.6 (±1.7) in the interventional setting. As a proof of concept, MR-guided laparoscopic liver resection was performed in two healthy domestic pigs by using the T2W FSE sequence. The additional MR images offered simultaneous multiplanar real-time visualisation of the liver vessels during the intervention and thereby increased the anatomical orientation of the surgeon.

Advancements in Orthopedic Intervention: Retrograde Drilling and Bone Grafting of Osteochondral Lesions of the Knee Using Magnetic Resonance Imaging Guidance

Computer-assisted surgery is currently a novel challenge for surgeons and interventional radiologists. Magnetic resonance imaging (MRI)-guided procedures are still evolving. In this experimental study, we describe and assess an innovative passive-navigation method for MRI-guided treatment of osteochondritis dissecans of the knee. A navigation principle using a passive-navigation device was evaluated in six cadaveric knee joint specimens for potential applicability in retrograde drilling and bone grafting of osteochondral lesions using MRI guidance. Feasibility and accuracy were evaluated in an open MRI scanner (1.0 T Philips Panorama HFO MRI System). Interactive MRI navigation allowed precise drilling and bone grafting of osteochondral lesions of the knee. All lesions were hit with an accuracy of 1.86xa0mm in the coronal plane and 1.4xa0mm the sagittal plane. Targeting of all lesions was possible with a single drilling. MRI allowed excellent assessment of correct positioning of the cancellous bone cylinder during bone grafting. The navigation device and anatomic structures could be clearly identified and distinguished throughout the entire drilling procedure. MRI-assisted navigation method using a passive navigation device is feasible for the treatment of osteochondral lesions of the knee under MRI guidance and allows precise and safe drilling without exposure to ionizing radiation. This method may be a viable alternative to other navigation principles, especially for pediatric and adolescent patients. This MRI-navigated method is also potentially applicable in many other MRI-guided interventions.

Intradiscal temperature monitoring using double gradient-echo pulse sequences at 1.0T.

To validate an unspoiled gradient‐recalled echo pulse sequence with dual echo acquisition as a means to increase temperature sensitivity while monitoring intradiscal laser ablation therapy.

Digital Ischemia and Consecutive Amputation After Emergency Transradial Cardiac Catheter Examination

The vascular anatomy of the hand is complex and challenging and has gained increasing importance as a vascular access site with improvements in interventional endovascular techniques [1]. Gaining knowledge of the hand’s vascular diameters, variations, and perfusion patterns is crucial for preventing adverse events, such as perfusion loss, and has been the subject of many studies [2–7]. Before cannulation of the radial artery, sufficient collateral circulation via the ulnar artery should always be evaluated [8]. The Allen test can be used as a screening method of hand circulation [9]. It is widely adopted in preoperative assessment, can be performed quickly and easily, but remains susceptible to error [2]. The sole presence of a palpable radial pulse may not be a reliable estimate of artery patency [10]. Several assistive technologies, including Doppler ultrasound, pulse monitor, and pulse oximeter [11], are available to further reduce the risk of perfusion loss.

Evaluation of radiologically implanted central venous port systems explanted due to complications.

Purpose The aim of this study was to evaluate explantations of central venous port systems that were implanted by interventional radiologists in cases where complications demanded the removal of the port device. Methods In this retrospective single-center study, explantation rates of central venous port catheter systems (CVPS) associated with complications were investigated over a 10-year period. All CVPS were implanted and explanted in our radiology departments interventional suite. Port catheter dysfunctions were divided into early and late complications, as well as into nonthrombotic and thrombotic events. Indications for implantation and explantation as well as clinical demographics were considered. Results One hundred and ninety-three CVPS were removed from 182 patients, due to complications. The total indwelling time of all CVPS was 55,132 catheter-days (mean 285.7; range 1–2,704). The most common diagnoses were gastrointestinal cancers 77 (39.9%) and hematological malignancies 32 (16.6%). Bloodstream infections 134 (69.4%) were the most common indication for the explantation procedure. These were followed by catheter-related thrombosis 28 (14.5%), nonthrombotic CVPS dysfunction 18 (9.3%), port pocket infections 9 (4.7%), and others 4 (2.1%). The highest percentages of explantations related to bloodstream infections were observed in patients with malabsorption (81.8%) and hematological malignancies (81.3%). Conclusion Bloodstream infections were the most common cause for port explantation, followed by catheter-related thrombosis. Complication-related explantations were mainly for late-onset complications. Prevention and management strategies should be applied regarding care and usage of port systems to reduce the rate of complication-related explantations.