CardioVascular and Interventional Radiology (CVIR) acknowledges and appreciates all of our contributing reviewers for another successful year. In 2011, more than 500 reviewers provided substantial scientific analysis of manuscripts submitted for publication in CVIR. Several reviewers have emerged as this year’s ‘‘Distinguished Reviewers.’’ These individuals have submitted six or more reviews in the past year (maximum: 29 reviews), and have averaged 10 days or less for review turnaround time (minimum: \24 h). Special recognition is presented to the following individuals. Thank you all, and congratulations for a job very well done!

PurposeUterine artery embolization (UAE) for symptomatic fibroid disease is associated with postembolization pain. This peaks several hours after UAE and decreases over the next 24 hours. Postprocedural pain control is a major issue after UAE and traditionally treated with epidural catheter injection, intrathecal injection and/or IV patient controlled narcotic medication (PCNM). Alternative is to selectively block afferent pain fibers to the uterus. This study investigates the use of superior hypogastric nerve block (SHB) for pain management after UAE.Materials and MethodsTwelve consecutive patients (age 33–54) were treated prospectively with SHB during UAE. This included image-guided, anterior percutaneous access to the superior hypogastric plexus with injection of 15–20 cc of 0.25% bupivicaine with 1:200000 epinephrine. All patients received hydromorphone PCNM and were observed for 16–22 hours. Visual analog pain scale (VAPS) was charted every 4 hours. The PCNM use was recorded during observation. Comparison is made to a historical control (29 patient age-matched with similar preprocedural symptom score).ResultsTechnical success for SHB was 100%. The mean time to complete SHB was 3.6 minutes. All patients receiving SHB had significantly lower mean VAPS scores (2.96 vs. 6.92) and mean PCNM use (3.8mg vs. 8.9mg) compared to the control. Patients with SHB had less nausea. No inadvertent complication in the SHB group occurred.ConclusionImproved pain control for patients after UAE with SHB is demonstrated in this prospective, nonrandomized study. Low complication rate and ease of SHB procedure will lend itself to add SHB to the post UAE pain management. PurposeUterine artery embolization (UAE) for symptomatic fibroid disease is associated with postembolization pain. This peaks several hours after UAE and decreases over the next 24 hours. Postprocedural pain control is a major issue after UAE and traditionally treated with epidural catheter injection, intrathecal injection and/or IV patient controlled narcotic medication (PCNM). Alternative is to selectively block afferent pain fibers to the uterus. This study investigates the use of superior hypogastric nerve block (SHB) for pain management after UAE. Uterine artery embolization (UAE) for symptomatic fibroid disease is associated with postembolization pain. This peaks several hours after UAE and decreases over the next 24 hours. Postprocedural pain control is a major issue after UAE and traditionally treated with epidural catheter injection, intrathecal injection and/or IV patient controlled narcotic medication (PCNM). Alternative is to selectively block afferent pain fibers to the uterus. This study investigates the use of superior hypogastric nerve block (SHB) for pain management after UAE. Materials and MethodsTwelve consecutive patients (age 33–54) were treated prospectively with SHB during UAE. This included image-guided, anterior percutaneous access to the superior hypogastric plexus with injection of 15–20 cc of 0.25% bupivicaine with 1:200000 epinephrine. All patients received hydromorphone PCNM and were observed for 16–22 hours. Visual analog pain scale (VAPS) was charted every 4 hours. The PCNM use was recorded during observation. Comparison is made to a historical control (29 patient age-matched with similar preprocedural symptom score). Twelve consecutive patients (age 33–54) were treated prospectively with SHB during UAE. This included image-guided, anterior percutaneous access to the superior hypogastric plexus with injection of 15–20 cc of 0.25% bupivicaine with 1:200000 epinephrine. All patients received hydromorphone PCNM and were observed for 16–22 hours. Visual analog pain scale (VAPS) was charted every 4 hours. The PCNM use was recorded during observation. Comparison is made to a historical control (29 patient age-matched with similar preprocedural symptom score). ResultsTechnical success for SHB was 100%. The mean time to complete SHB was 3.6 minutes. All patients receiving SHB had significantly lower mean VAPS scores (2.96 vs. 6.92) and mean PCNM use (3.8mg vs. 8.9mg) compared to the control. Patients with SHB had less nausea. No inadvertent complication in the SHB group occurred. Technical success for SHB was 100%. The mean time to complete SHB was 3.6 minutes. All patients receiving SHB had significantly lower mean VAPS scores (2.96 vs. 6.92) and mean PCNM use (3.8mg vs. 8.9mg) compared to the control. Patients with SHB had less nausea. No inadvertent complication in the SHB group occurred. ConclusionImproved pain control for patients after UAE with SHB is demonstrated in this prospective, nonrandomized study. Low complication rate and ease of SHB procedure will lend itself to add SHB to the post UAE pain management. Improved pain control for patients after UAE with SHB is demonstrated in this prospective, nonrandomized study. Low complication rate and ease of SHB procedure will lend itself to add SHB to the post UAE pain management.

PURPOSE: To determine the effects of primary chemoembolization on the health-related quality of life (HRQOL) of patients with hepatocellular carcinoma (HCC).MATERIALS AND METHODS: Single-center prospective data collection with longitudinal analysis of HRQOL scores obtained via the Short Form-36 (SF-36) assessment tool was performed before and during serial chemoembolization procedures in 73 patients with HCC. Baseline HRQOL scores were evaluated for significant (P < .05) change within the total patient population during 4, 8, and 12 months of treatment, and separately within a subset of 23 patients who underwent three or more chemoembolization procedures.RESULTS: Patients had decreased pretreatment baseline scores within all eight scales of the SF-36 compared with healthy age-adjusted norms. Within the total population, mental health scores improved after 4 months of chemoembolization (rate of change, 5.6; P = .05; n = 48), but no significant change was present at 8 or 12 months. Subset patients experienced improvements of mental health scores after the first (score change, 13; P = .008; n = 21) and second procedures (score change, 12.2; P = .002; n = 23) and improvements of bodily pain scores (score change, 9.9; P = .047; n = 21) after the initial procedure. Vitality scores worsened (score change, -7.8; P = .044; n = 21) in the subset after the first chemoembolization.CONCLUSIONS: Patients with HCC are likely to perceive improved mental health during the first 4 months of primary treatment with chemoembolization. In addition, if patients ultimately undergo more than two procedures, they are likely to perceive improved mental health during the first two sessions, with decreased bodily pain during the initial session. Patient-perceived vitality will likely worsen after the initial procedure.

THE membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from both the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such they represent a valid broad expert constituency of the subject matter under consideration for standards production.

OBJECTIVE. The goal of this study was to assess the safety and efficacy of combination therapy consisting of the third-generation plasminogen activator reteplase and the glycoproteins IIb and IIIa platelet receptor antagonist abciximab for thrombolysis in peripheral artery occlusive disease. This two-center experience focused on immediate thrombolytic success, thrombolysis time, complication rate, and 30-day patency rate.SUBJECTS AND METHODS. Fifty patients with arterial occlusive disease (age range, 40-96 years; mean age, 69 years) were prospectively enrolled at two centers. Eighteen patients (36%) had native artery thromboses, and 32 patients (64%) had graft thromboses. Catheter-directed intraarterial thrombolytic infusion of reteplase (average dose, 0.51 U/hr; range, 0.25-1 U/hr) was combined with IV infusion of abciximab (bolus, 0.25 mg/kg of body weight; 12-hr infusion, 0.125 mug/kg of body weight per minute). Nontherapeutic heparin (100-400 U/hr) was given intraarterially during the thrombolytic infusion.RESULTS. Complete thrombolysis was achieved in 89% of the patients with native artery occlusions and 94% of the patients with graft occlusions for an overall rate of 92%. The average thrombolysis time was 20.7 hr (range, 4-41 hr) with a mean reteplase dose of 12.1 U (range, 2-23 U). Major hematoma occurred in 12% of the patients, with an average blood transfusion of 3.1 U of packed RBC (range, 1-11 U), and correlated to increased thrombolysis time and dose. No intracranial hemorrhage occurred. The 30-day primary patency rate was 92%. Two patients (4%) underwent amputation, including one major amputation (2%), within 30 days of thrombolysis.CONCLUSION. The combination of reteplase and abciximab in catheter-directed arterial thrombolysis is feasible and effective. Results of this combination therapy suggest acceptable thrombolysis times and doses with tolerable complication rates. Which patient group might benefit the most from combination therapy and the long-term results of combination therapy still need to be determined.

PURPOSE: To report the efficacy of catheter-directed thrombolysis with a combination of a thrombolytic agent (reteplase) and a glycoprotein (GP) IIb/IIIa platelet receptor antagonist (abciximab) in peripheral arterial occlusive disease.MATERIALS AND METHODS: Fifteen patients with lower extremity arterial thromboses (age range, 40-96 y; mean, 73 y) were prospectively enrolled in a protocol approved by the Institutional Review Committee. Nine patients had native arterial occlusions, three (33%) of whom had subacute symptoms (>14 d) and one of whom had chronic symptoms (>3 mo). Four patients had acute arterial graft thromboses. Two patients with lower extremity bypass grafts presented with subacute limb ischemia. All patients received catheter-directed infusion of reteplase (0.5 U/h) in combination with intravenous administration of abciximab (0.25-mg/kg bolus followed by 0.125 mug/kg/min infusion) for 12 hours without systemic heparinization. The thrombolytic success was studied by Doppler ultrasonography (US) and angiography.RESULTS: Complete thrombolysis and clinical success was achieved in 14 of the 15 patients (93%). One patient with unsuccessful thrombolysis underwent major amputation. The mean thrombolysis time per Doppler US procedure was 6.8 hours (range, 2-30 h). Angiographic patency was achieved at a mean of 17.5 hours (range, 4-36 h) corresponding to a mean dose of reteplase of 8.8 U. The mean increase in ankle-brachial index was 0.52 (range, 0-0.9). No major hemorrhagic complications occurred. The 30-day primary patency rate was 93%.CONCLUSION: The combination of reteplase and abciximab in catheter-directed arterial thrombolysis is feasible and effective. This combination therapy pilot study suggests short thrombolysis times and minimal adverse effects in catheter-directed thrombolytic therapy for peripheral arterial occlusive disease.

Magnetic resonance (MR) angiography is a widely used, noninvasive tool for evaluating the aorta and its branches. It is particularly useful in renal transplant recipients because it provides anatomic detail of the transplant artery without nephrotoxic effects. Volume rendering is underutilized in MR angiography, but this technique affords high-quality three-dimensional MR angiograms, especially in cases of tortuous or complex vascular anatomy. An imaging protocol was developed that includes gadolinium-enhanced MR angiography of the transplant renal artery with volume rendering and multiplanar reformation postprocessing techniques. Axial T2-weighted and contrast material-enhanced T1-weighted MR images are also obtained to examine the renal parenchyma itself and to evaluate for hydronephrosis or peritransplant fluid collections. This imaging protocol allows rapid global assessment of the renal transplant arterial system, renal parenchyma, and peritransplant region. It can also help detect or exclude many of the various causes of renal transplant dysfunction (eg, stenosis or occlusion of a transplant vessel, peritransplant fluid collections, ureteral obstruction). Conventional angiography can thus be avoided in patients with normal findings and reserved for those with MR angiographic evidence of stenosis.

Rauch D, Bohnemann L, Kurtz C, et al. Vascular response to gadolinium-containing contrast media in an ex vivo rabbit arterial model. Invest Radiol 2001;36:589–596. rationale and objectives. To assess the influence of gadolinium-containing magnetic resonance contrast agents on contractility of the arterial vessel wall. methods.Bilateral segments of rabbit carotid arteries were mounted in flow chambers, surrounded by aerated (95% O2, 5% CO2) Krebs’ solution, and perfused at a constant rate by separated and aerated Krebs’ solution. Therefore, changes in pressure of the circulating Krebs’ solution indicated alterations of vessel wall contractility. Viability of the artery was tested by 124 mmol/L KCl, 3 × 10−5 mol/L phenylephrine, and 10−5 mol/L acetylcholine. After a washout phase, gadopentate (n = 10) or gadoteridol (n = 10) was added to the perfusate of one carotid artery in increments of 0.1, 0.3, and 0.6 mmol/L. Concentrations up to 0.9 mmol/L and 1.2 mmol/L were tested, respectively. The contralateral artery served as a control. To assess potential relaxing effects of the media, vessels were brought into a contracted status with 3 × 10−5 mol/L phenylephrine and then received gadolinium chelates. results.Potassium chloride and phenylephrine increased and acetylcholine decreased the pressure, indicating vasoconstriction and vasodilatation, respectively. After gadopentate and gadoteridol infusion, no statistically significant pressure changes could be detected, ruling out any vasoconstrictor or vasodilator effect. conclusions.Gadopentetate and gadoteridol in doses of up to 1.2 mmol/L did not alter vessel wall tone. The impact of contrast media on blood pressure, as has been shown in some clinical trials, probably is not due to direct changes in arterial wall tone.

Atherosclerotic disease of the vertebral artery can pose a significant clinical problem. The treatment of that disease is not uniformly accepted. We report two cases of patients with vertebral basilar insufficiency due to stenosis of the vertebral artery origins and contralateral occlusions that were treated percutaneously with coronary stent placement. Cathet Cardiovasc Intervent 2001;52:373–377. © 2001 Wiley‐Liss, Inc.

Rationale and Objectives. The authors' purpose was to investigate the role of histamine release causing renal vasoconstriction induced by application of contrast media, an important element in contrast medium-induced nephrotoxicity.Materials and Methods. Isometric contractions in rabbit segmental renal arteries stimulated with KCl and increasing concentrations of the ionic contrast medium diatrizoate and the nonionic agents iomeprol and iodixanol were studied both with and without increasing concentrations of the histamine H-1 and H-2 blockers diphenhydramine and cimetidine. Histamine concentrations after contrast medium application were determined.Results. Contrast-induced, dose-dependent, reversible renal artery contractions of 27%, 4.5%, and 5% of the control KCl contraction were found for diatrizoate, iodixanol, and iomeprol respectively. Those induced by the ionic contrast medium were statistically significantly higher (P < .01). Contractions were partially inhibited by diphenhydramine (49%) but not by cimetidine. Significant elevation of histamine concentrations (P < .05) was detected only after stimulation with diatrizoate but not with nonionic agents.Conclusion. Ionic contrast medium induces histamine release leading to renal vasoconstriction, which can be partly blocked by H-1 blockers. Histamine has no effect on renal vasospasm induced by nonionic contrast media.

RATIONALE AND OBJECTIVES. This study investigated the involvement of cyclic adenosine monophosphate (cAMP) in contrast medium-induced renal vasomotor effects and the efficacy of selective phosphodiesterase (PDE) inhibitors influencing cAMP in preventing contrast medium-induced renal vasospasm. METHODS. Isometric contractions of rabbit renal artery rings were subjected to increasing concentrations of the ionic contrast medium sodium/meglumine diatrizoate (DIA) and the nonionic contrast media iopamidol (IOP) and iodixanol (IOD) and compared with a potassium chloride control. Subsequently increasing concentrations of the nonselective phosphodiesterase inhibitors theophylline and papaverine and the following selective phosphodiesterase inhibitors were applied: vinpocetine, trequinsin, zardaverine, rolipram, and dipyridamole (subtypes I-V) before restimulation of the arterial tissue with contrast medium. RESULTS. Diatrizoate, iopamidol, and iodixanol induced contractions up to 30%, 15%, and 3.5% of the potassium chloride control, respectively. All phosphodiesterase inhibitors markedly inhibited the contrast medium-induced contractions in a dose-dependent manner. The selective phosphodiesterase inhibitors rolipram and trequinsin attenuated these contractions significantly more (92% and 94%) than did zardaverine, dipyridamole, and vinpocetine, with an inhibitory potency of 37%, 41%, and 62%, respectively. CONCLUSIONS. Nonionic contrast media induced renal vasoconstriction less potently than ionic contrast media. Significant differences in the ability to prevent contrast medium-induced vasoconstriction were observed among the various phosphodiesterase subtypes studied. selective phosphodiesterase inhibition with inhibitor subtypes II and IV showed the most promising results in specifically preventing contrast medium-induced renal vasospasm.

OBJECTIVE:In human erectile tissue smooth muscle contraction and detumescence are highly dependent on an increase in cytosolic [Ca2+]. The Ca2+ influx can be derived from the extracellular space or from intracellular sarcoplasmic stores. The role of both pathways was evaluated in an organ bath study on human cavernosal strips.PATIENTS AND METHODS:The tissue was obtained from 12 patients with chronic erectile dysfunction. The effects of Ca2+-free solution, ryanodine, caffeine and of nifedipine on electrically and adrenergically induced contractions were evaluated.RESULTS:Following an incubation period of 10 min in Ca2+-free solution the electrically induced contraction was reduced to 20%, whereas the contraction induced by phenylephrine (PE) was only reduced to 64 +/- 6% (mean +/- SEM). Ryanodine inhibited the PE-contraction to 30 +/- 6% and the additional application of caffeine or nifedipine further reduced the contraction to 11% and 8%.CONCLUSION:The results give evidence for a role of intracellular Ca2+-stores in human cavernosal tissue. Whether the more marked effect of ryanodine in tissue from patients with erectile failure in comparison with similar experiments in rabbit cavernosal tissue might be a sign of an increased cavernosal contractility in these patients remains to be shown in future experiments with normal erectile tissue.

LettersFebruary 1998Contrast medium-induced nephrotoxicity.Authors: P Drescher and P O MadsenAuthor Info & AffiliationsVolume 170, Issue 2https://doi.org/10.2214/ajr.170.2.9456977 METRICS

Contractility of smooth muscle within mammalian urogenital organ systems has an established role in physiological/pathophysiological functioning of the component structures. Our aim was to examine the direct effect of epidermal growth factor (EGF) on smooth muscle tone as well as its indirect effects in regulatingα1-adrenoceptor-mediated contraction of the prostate, the vas deferens and renal arteries. Tissues were mounted isometrically, under controlled conditions, and changes in tension in response to treatment with phenylephrine (PE) with or without pretreatment with EGF were recorded on a physiological recorder via force transducers. In the rabbit prostate, EGF potentiated the magnitude of contraction to PE. The potentiation appeared to be dependent on cyclo-oxygenase products. In the human prostate, EGF potentiated the contractile response to PE. EGF had no effect on the PE-induced contraction of the rabbit renal artery and vas deferens. EGF alone did not alter smooth muscle tone in any of the above-mentioned tissues. The main finding of this study is the difference in the regulation by EGF of theα1-adrenoceptor-mediated response in smooth muscle of the prostate, from that by the vas deferens and renal artery. The reasons for this difference in response remain to be elucidated. This study may form the basis for further investigation into receptor transregulation and its relevance to symptomatic benign prostatic hyperplasia (BPH).