Following blunt trauma, contrast extravasation (CE) from the spleen on computed tomography (CT) imaging is associated with increased morbidity and mortality. The current study sought to determine the relationship of CE on CT with active arterial bleeding on splenic angiography and associated clinical outcomes. Single-center retrospective review from January 6, 2012, to September 13, 2023, of 196 consecutive patients who underwent splenic angiography secondary to blunt trauma at a level 1 trauma center. Contrast-enhanced CT was performed prior to angiography in all patients. Clinical, imaging, and procedural data were recorded. American Association for the Surgery of Trauma (AAST) splenic injury grade was determined by two independent readers. Of the 196 patients, 56% (110/196) had CE on CT. Of those with CE on CT, 27% (30/110) had CE on subsequent angiography. CE on CT was associated with a 5-fold increase in the odds of CE on angiography (OR: 5, 95% CI: 2.0-12.4; p < 0.001). There was no statistically significant association between AAST grade and CE on angiography. The sensitivity, specificity, positive predictive value, and negative predictive value of CE on CT for CE on angiography was 83%, 50%, 27%, and 93% respectively. The sensitivity, specificity, PPV, and NPV of an AAST grade of 4 or 5 for CE on angiography was 83%, 14%, 18%, and 79% respectively. Patients with CE on splenic angiography were older in age (52.9 ± 20.4 versus 44.1 ± 19.2 years, p = 0.01). Time from CT to angiography was increased in patients without CE on angiography (235.7 ± 132.3 versus 172.5 ± 84.4 minutes, p = 0.01). All patients with CE on CT underwent splenic artery embolization. There was no difference in need for post-procedural blood transfusion, repeat angiography, or splenectomy between those with and without CE on angiography. However, patients with CE on angiography had significantly higher 30-day mortality versus those without CE (5/36, 13.9% versus 2/160, 1.25%, p = 0.003). AAST grade was not associated with 30-day mortality or need for post-procedural blood transfusion. CE on CT has a low positive predictive value for CE on angiography but performs better than AAST grade. After a positive CT, the time to angiography predicts the likelihood of a positive angiogram. There was an increased 30-day mortality rate in patients with active CE on angiography.

This study aims to analyze the correlation between quantitative improvement in blood flow to the foot, calculated using catheter-directed foot computed tomography (CT) perfusion studies before and after angioplasty, and clinical success in 6 months for patients with critical limb-threatening ischemia (CLTI). The institutional review board approved this study. 18 patients with CLTI who received a catheter-directed foot perfusion CT before and after peripheral artery intervention using an Angio-CT scanner. Blood flow (BFD mL/100g/min), blood volume (BVD mL/100g), and mean transit time (MMTD seconds) were calculated in regions of interest (ROIs). Four ROIs were placed on the skin using the angiosome concept (medial plantar, lateral plantar, dorsal pedis, and heel areas) to assess skin perfusion. These four perfusion areas were classified into direct or indirect perfusion areas based on wound location in the angiosome. Additionally, the average value of all four areas was calculated as the value of whole foot perfusion. The percent change in these values between pre- and post-angioplasty was calculated as pre-post ratios, and it was compared with clinical success using the Mann–Whitney U test. Clinical success was defined as wound healing or improvement of ischemic pain without above-ankle amputation or major surgical intervention within 6 months. Clinical success was seen in 12 of 18. Significant differences were observed in the pre-post ratios of BFD and BVD in the indirect and whole foot areas between patients with and without clinical success. Comparison of pre-post ratios for patients with clinical success versus those without: BFD 84.62 vs. 2.82 (p = 0.007) and BVD 131.00 vs. 3.23 (p = 0.007) in the indirect areas; BFD 95.85 vs. 20.20 (p = 0.031) and BVD 98.41 vs. 15.34 (p = 0.015) in the whole foot area. Although an increase in BFD and BVD following angioplasty was observed in the direct areas, no significant association of increase in these ratios with clinical success was demonstrated. Significant differences were found in the increase ratio of BFD and BVD in the indirect and whole foot areas between patients with and without clinical success. There appears to be less immediate change in perfusion in the areas of wounds.

Catheter-directed thrombolysis (CDT) is a common treatment for acute lower extremity arterial occlusions. The Rutherford classification scheme is a well-known tool for risk-stratifying and guiding treatment in patients with acute limb ischemia (ALI). In this study, we examine the relationship between Rutherford classification and outcomes of CDT.

Venous stenoses and fibrin sheath formation are common causes of hemodialysis (HD) catheter failure. Catheter exchange is an effective treatment of a poorly functioning HD catheter. The current study evaluates the use of intravascular ultrasound (IVUS) to augment detection of these chronic complicating features and to facilitate catheter positioning when compared to venography alone. A single-center prospective study (enrolled from 9/2019 to 6/2020), supported by Philips (Cambridge, MA), was performed in end stage renal disease (ESRD) patients undergoing chronic catheter-based hemodialysis. Inclusion criteria were adults presenting with a malfunctioning HD catheter placed greater than 14 days prior. Patients with active infection were excluded. IVUS and venography through the catheter were performed in all patients to evaluate for the cause of malfunction. Specifically, the presence and extent of a fibrin sheath, right atrial morphology, and presence of chronic stenoses were prospectively evaluated by both modalities. The impact of IVUS on diagnosis and procedural plan was also recorded. A paired sample t-test was used to compare anatomic distances calculated on IVUS vs. venography. A total of 26 patients (18 female), with mean age of 62 years (32-81) were enrolled. The presence of a fibrin sheath was identified in 61.5% (16/26) of venograms, compared to 100% (26/26) with IVUS (p < 0.01). Anatomic measurement of the distance from carina to caudal extent of the fibrin sheath (by IVUS and venography) was available in 15/26 cases and the caudal extent of the fibrin sheath was significantly underestimated by venography (19.1 ± 28.5 mm on venography vs. 33.2 ± 14.0 mm on IVUS, p = 0.03). There was no significant difference in calculated distance from carina to the right atrial floor on venogram vs. IVUS. In 62% (16/26) of cases, operators reported a change in procedural plan after IVUS compared to venographic imaging alone. In 85% (21/26) of cases, operators reported the replaced catheter tip to be free of the fibrin sheath due to IVUS imaging compared to venography alone. There was a significant difference in the length of replaced catheters (replaced: 23.2 ± 3.4 cm vs 24.3 ± 2.6 cm, p = 0.01). IVUS helped better identify the caudal extent of catheter related fibrin sheaths when compared to venography alone. IVUS aided in more optimal positioning of catheters and may play an adjunctive role in hemodialysis catheter exchange in the appropriate patient.

The purpose of this study is to analyze the correlation between quantitative improvement in blood flow to the foot calculated using a catheter-directed foot computed tomography (CT) perfusion study and pulse volume recording (PVR) tests before and after angioplasty in patients with critical limb-threatening ischemia (CLTI). The institutional review board approved this study. Fourteen patients with CLTI who received a catheter-directed foot perfusion CT before and after peripheral artery intervention (angioplasty and stenting) using an Angio-CT scanner were evaluated. Three regions of interest (ROI) were placed on plantar muscles (abductor hallucis, flexor digitorum brevis, and abductor digiti minimi) to calculate muscular perfusion, and four ROIs were placed on skin using the angiosome concept (medial plantar, lateral plantar, dorsal pedis and heal areas) to assess skin perfusion. Blood flow (BFD mL/100 g/min), blood volume (BVD mL/100 g), and mean transit time (MMTD seconds) were calculated with deconvolution. The pre-and post-angioplasty PVR test results, including the amplitude of the waveform, ankle-brachial index (ABI), and toe-brachial index (TBI) were collected from the medical records. Pre- and post-angioplasty PVR, ABI, and TBI were collectible in 11, 7, and 8 patients, respectively. There were significant correlations between the improvement of skin BFD and the amplitude on PVR of the ankle (Correlation coefficient 0.655, P = 0.029), and between the improvement of muscle BFD and the amplitude on PVR of the ankle (correlation coefficient 0.636, P = 0.031). There were no significant associations between the improvement of blood flow to the foot and ABI and TBI. There was significant correlation between the improvement of skin and muscular blood flow on a catheter-directed foot perfusion CT and the amplitude on PVR of the ankle.

To conduct a meta-analysis to assess the efficacy of intravascular ultrasound (IVUS) during transjugular intrahepatic portosystemic shunt (TIPS) creation. MEDLINE and Embase databases were queried until July 2022 for comparative studies reporting procedure metrics for TIPS creation with or without IVUS guidance. Meta-analysis was performed with random-effects modeling for total procedural time, time to portal venous access, fluoroscopy time, iodinated contrast volume use, air kerma, dose area product, and number of needle passes. Intraoperative procedure-related complications were also reviewed. Of 95 unique records initially identified, 6 were eligible for inclusion. A total of 194 and 240 patients underwent TIPS with and without IVUS guidance. Pooled analyses indicated that IVUS guidance was associated with reduced total procedure time (SMD -0.76 [95% CI -1.02, -0.50] P < 0.001), time to portal venous access (SMD -0.41 [95% CI -0.67, -0.15] P = 0.002), fluoroscopy time (SMD, -0.54 [95% CI -1.02, -0.07]; P = 0.002), contrast volume use (SMD, -0.89 [95% CI -1.16, -0.63]; P < 0.001), air kerma (SMD, -0.75 [95% CI -1.11, -0.38]; P < 0.001) and dose area product (SMD, -0.98 [95% CI -1.77, -0.20]; P = 0.013). 4.2 and 7.8 needle passes were required in the IVUS and non-IVUS group, respectively (SMD, -0.60 [95% CI -1.42, 0.21]; P = 0.134), whereas pooled complication rates were 15.2% (12/79), and 21.4% (28/131), respectively. IVUS guidance during TIPS creation improves procedural metrics including procedural time, contrast usage, and radiation exposure.

Despite the relatively low-risk and routine nature of interventional radiology procedures, procedure-visit duration is variable, complicating room utilization and staffing. The purpose of the study was to assess the impact of pre-visit choices on the duration of pre-procedure, intra-procedure, post-procedure, and total visit duration for patients undergoing interventional radiology procedures. At a single institution, between June 6 and July 20, 2022, nurses recorded relevant visit timestamps using a combination of handwritten forms and the Hi-IQ scheduling software. Variables including inpatient versus outpatient, completed pre-arrival consent (routinely obtained for patients that had a prior office visit), the need to obtain same-day bloodwork, the type of pain management, procedure type, and operator type (physician assistant (PA) versus resident) were extracted from each case’s electronic medical record. Times were analyzed by way of linear mixed models. Completed time durations were collected for 498 visits. For all visits, preparation time averaged 80.7 minutes (SD = 52.6), procedure time averaged 77.2 minutes (SD = 52.8) and recovery time averaged 42.7 minutes (SD = 59.3). For preparation time, outpatient status (+46 minutes [95% CI: 37.9, 54.2], P< 0.001), completed pre-arrival consent (-34 minutes [95% CI: 23.8, 44.3], P< 0.001) and the use of anesthesia (+24 minutes [95% CI: 10.11, 38.7], P< 0.001) made a significant difference, while the need for bloodwork did not (P = 0.955). For procedure time, the use of anesthesia (24.4 minutes [95% CI: 10.11, 38.68], P< 0.001), sedation compared with only local anesthetic (+37 minutes [95% CI: 28.9, 45.0], P< 0.001) and the type of procedure (e.g., mean 20.0 minutes for a upper extremity venogram to 186.3 minutes for a runoff with atherectomy or stent (P< 0.001)) were significant. For PICC and tunneled line placements, Pas provided a shorter procedure time than residents (PICC, -13.5 minutes [95% CI: -19.16, -7.91], P< 0.001; tunneled line placement, -11.31 minutes [95% CI: -19.1, -3.53], P = 0.005) but no difference in total visit time (P = 0.853 and P = 0.857); they had similar procedure (P = 0.365) and total visit times (P = 0.885) for port placements. Differences in the availability of a pre-procedure consent, the choice of pain management, procedure type, and the selective application of Pas significantly impact pre-procedure and procedure time. Among these variables, the completion of pre-procedure consent prior to patient arrival appears the most easily modifiable.

In treating great saphenous insufficiency (GSI), there is common understanding that a higher rate of deep vein thrombosis (DVT) occur with greater saphenous vein (GSV) ablations extending within close proximity to the sapheno-femoral junction (SFJ). However, the precise association between this distance and post-ablation complication rate is unknown1. A surrogate for how close the ablation was to the SFJ is the length of residual GSV stump on follow-up imaging. The purpose of this study was to identify the association between post-ablation GSV stump length and complication rate.

The purpose of this study is to describe a preliminary experience of a catheter-directed foot computed tomography (CT) perfusion study for critical limb ischemia (CLI) patients and compare the findings between pre and post angioplasty.