Journal of Vascular and Interventional Radiology

Pancreatic Islet Cell Transplantation: An Update for Interventional Radiologists

Ron C. Gaba, Raquel Garcia-Roca, Jose Oberholzer — 2012-03-13

Abstract: Pancreatic islet cell transplantation is a promising cellular-based therapy for type 1 diabetes mellitus. This procedure involves portal venous injection of islet cells and affords 1-year insulin independence in as many as 80% of recipients. Although transplant surgeons represent historical drivers of islet therapy, requirement for image guidance and transcatheter techniques has fostered collaboration with interventional radiologists, who are positioned to play a significant role in clinical performance of islet transplantation and in basic science research in this field. This review article aims to familiarize interventional radiologists with islet cell transplantation patient selection, procedure technique, clinical outcomes, and future clinical and research avenues.

CME Test Questions: May 2012

2012-05-01

Utero-ovarian Anastomoses and Their Influence on Uterine Fibroid Embolization

2012-03-22

Abstract: Purpose: To correlate clinical outcomes after uterine artery embolization (UAE) performed to treat uterine fibroids with the presence of varying types of utero-ovarian anastomoses (UOA). Materials and Methods: A retrospective analysis was performed of all uterine angiograms from 202 patients (mean age 42 y, range 28–54 y) who underwent UAE because of heavy menstrual bleeding, dysmenorrhea, or anemia or a combination of these symptoms. UOA were classified as absent or present, unilateral or bilateral. The effects of UOA on long-term outcomes (clinical endpoints such as control of bleeding and pain) and complications (amenorrhea) were assessed statistically using Kaplan-Meier curves and χ2 and log-rank tests. Results: Of the UOA in 104 women, 38 anastomoses were bilateral, and 66 were unilateral. Type III was the most common type of anastomosis (66 cases) followed by type Ia (22 cases) and type Ib (18 cases); there were no type II anastomoses. Amenorrhea was reported in 27 (14%) women at 5-year follow-up after UAE (only 3% in women < 45 y old). There were 10 cases of clinical failure with a median follow-up of > 4 years. Bilateral or unilateral presence of UOA had no statistically significant effect on outcomes or on complications. Conclusions: Recurrence rates, clinical failure, and amenorrhea after UAE do not seem to be influenced by the presence or absence of UOA. However, further studies are needed to confirm these findings.

What Do We Know about Uterine-Ovarian Anastomoses and Uterine Artery Embolization?

James B. Spies — 2012-05-01

The study by Lanciego et al () in the current issue of JVIR addresses a question that has undergone relatively little detailed study—that of the relationship of uterine-ovarian anastomoses and outcomes after uterine artery embolization (UAE). Basing their analysis on the study of Razavi and colleagues (), the authors () examined whether the varying types of uterine ovarian anastomoses result in a difference in outcomes after UAE.

Radiologically Placed Tunneled Hemodialysis Catheters: A Single Pediatric Institutional Experience of 120 Patients

2012-03-28

Abstract: Purpose: To report the outcome of tunneled dialysis catheter insertion in 120 patients. Materials and Methods: A retrospective review of the interventional radiology database and electronic medical records of 120 patients who had tunneled dialysis catheters inserted from April 1997 to July 2010 was performed with institutional review board approval. There were 61 female patients and 59 male patients, with a mean age of 13.3 years (range, 0.2–28.5 y). A total of 193 primary insertions and 330 salvage procedures were performed. Results: The technical success rate for primary catheter insertions was 100%. Immediate complications included self-limiting tract bleeding and air embolism in two of 193 insertions each (1.03%). Mean indwell duration for primary insertions was 66 catheter-days (range, 1–765 d), compared with a total mean of 159.4 catheter-days (range, 1–1,034 d). Rates of infection and mechanical complications were 0.21 and 0.9 per 100 total catheter-days, respectively. Mechanical and infections complications were increased in children younger than 9 years of age and weighing less than 20 kg. The catheter removal rates for infection and mechanical complications were 0.084 and 0.081 per 100 catheter-days, respectively. Medical salvage procedures, ie, intracatheter thrombolytic agent use or antibiotic therapy (52.1%) and interventional radiologic catheter salvage procedures (47.1%), increased catheter survival by an average of 54.8 days (range, 0–959 d). Conclusions: Radiologic placement of tunneled hemodialysis catheters is a safe and technically successful procedure in pediatric patients. However, there is a high rate of infectious and mechanical complications, particularly in younger and smaller patients.

Feasibility of Ultrasound-guided Intranodal Lymphangiogram for Thoracic Duct Embolization

Gregory J. Nadolski, Maxim Itkin — 2012-03-22

Abstract: Purpose: To show the feasibility of opacifying the thoracic duct using ultrasound-guided intranodal lymphangiogram (IL) for thoracic duct embolization (TDE). Materials and Methods: Six patients (two women and four men, mean age, 59.2 y [range, 43–74 y]) underwent IL and TDE for chylothorax. Under ultrasound guidance, a needle was positioned in a groin lymph node, and lipiodol was injected. The thoracic duct was catheterized, and embolization was performed as indicated. Cumulative times from start of the procedure until initiation of the lymphangiogram, until identification of target lymphatic, until catheterization of the thoracic duct, and until completion of the procedure were collected. Times were compared with times of a control group of six patients (two women and four men, mean age, 66.7 y [range, 49–82 y]) who had undergone TDE using pedal lymphangiography (PL). Results: The procedure of opacification, catheterization, and embolization of the thoracic duct was successful in all cases. Cumulative times (mean ± standard deviation) in the IL and PL groups from start of the procedure until (i) initial lymphangiogram were 20.5 minutes ± 8.6 and 46.5 minutes ± 22.6, (ii) identification of a target lymphatic for catheterization were 60.5 minutes ± 18.2 and 110.5 minutes ± 31.6, (iii) catheterization of the thoracic duct were 79.0 minutes ± 28.9 and 128.2 minutes ± 37.0, and (iv) completion of procedure were 125.8 minutes ± 49.0 and 152.8 minutes ± 36.4. Conclusions: IL is a feasible technique to visualize the thoracic duct for embolization. Using IL, the thoracic duct may be more quickly visualized and catheterized for TDE than with PL.

Intranodal Lymphangiography: Coming Soon to a Hospital Near You

Robert K. Kerlan, Jeanne M. LaBerge — 2012-05-01

In 1998, a novel procedure, embolization of the thoracic duct via direct puncture of the cisterna chyli, was conceived by Constantin Cope (). As part of this procedure, the cisterna chyli is catheterized by means of fluoroscopically guiding a 21-gauge needle all the way through the abdomen (and its visceral contents) into this small saclike lymphatic structure. This structure resides in the retrocrural space adjacent to the aorta and is usually not even visible on computed tomography. The fact that this procedure can be done at all is a tribute to Dr. Cope and the field of interventional radiology. Thoracic duct embolization has been reported by Itkin et al () to clinically control chylothorax in as many as 90% of patients. Unfortunately, to catheterize the cisterna chyli, it must first be opacified by means of pedal lymphangiography.

Percutaneous Computed Tomography–guided High-Dose-Rate Brachytherapy Ablation of Breast Cancer Liver Metastases: Initial Experience with 80 Lesions

2012-05-01

Abstract: Purpose: To analyze initial experience with computed tomography–guided high-dose-rate brachytherapy (CT-HDRBT) ablation of breast cancer liver metastases (BCLM). Materials and Methods: Between January 2008 and December 2010, 37 consecutive women with 80 liver metastases were treated with CT-HDRBT in 56 sessions. Mean age was 58.6 years (range, 34–83 y). Treatment was performed by CT-guided applicator placement and high-dose-rate brachytherapy with an iridium-192 source. The mean radiation dose was 18.57 Gy (standard deviation 2.27). Tumor response was evaluated by gadoxetic acid–enhanced liver magnetic resonance (MR) imaging performed before treatment, 6 weeks after treatment, and every 3 months thereafter. Results: Two patients were lost to follow-up; the remaining 35 patients were available for MR imaging evaluation for a mean follow-up time of 11.6 months (range 3–32 mo). Mean tumor diameter was 25.5 mm (range 8–74 mm). Two (2.6%) local recurrences were observed after local tumor control for 10 months and 12 months. Both local progressions were successfully retreated. Distant tumor progression (new metastases or enlargement of nontreated metastases) occurred during the follow-up period in 11 (31.4%) patients. Seven (20%) patients died during the follow-up period. Overall survival ranged from 3–39 months (median 18 months). Conclusions: CT-HDRBT is a safe and effective ablative therapy, providing a high rate of local tumor control in patients with BCLM.

Planning Ultrasound for Percutaneous Radiofrequency Ablation to Treat Small (≤ 3 cm) Hepatocellular Carcinomas Detected on Computed Tomography or Magnetic Resonance Imaging: A Multicenter Prospective Study to Assess Factors Affecting Ultrasound Visibility

2012-03-02

Abstract: Purpose: To assess factors affecting tumor visibility on planning ultrasound (US) for percutaneous radiofrequency (RF) ablation to treat small hepatocellular carcinomas (HCCs) primarily detected on computed tomography (CT) or magnetic resonance (MR) imaging. Materials and Methods: Patients referred for planning US for percutaneous RF ablation between September 2008 and June 2009 were prospectively enrolled from nine institutions in Korea. The first small (≤ 3 cm) single HCC or new single HCC after treatment was included. The study enrolled 898 patients (684 men and 214 women, age range 32–86 years). HCCs that were invisible on planning US were compared with visible HCCs with respect to tumor size, distance between the tumor and the diaphragm, subcapsular location, etiology of liver disease, liver cirrhosis, macronodular cirrhosis on US, ascites, Child-Pugh class, serum alpha fetoprotein (AFP) level, body mass index (BMI), previous treatments for HCC, previous chemoembolization treatments for HCC, institutions, and experience of radiologists. Results: Among 898 HCCs, 671 (74.7%) were visible on the planning US. In multivariate analysis, tumor size, distance between the tumor and the diaphragm, liver cirrhosis, and macronodular cirrhosis were statistically significant factors affecting US detection (each P < .05). Conclusions: Smaller tumors, subphrenic location of the tumor, liver cirrhosis, and macronodular cirrhosis were independent predictors of invisible tumors on planning US.

Radiofrequency Ablation of Liver Metastasis in Patients with Locally Controlled Pancreatic Ductal Adenocarcinoma

2012-05-01

Abstract: Purpose: To evaluate retrospectively the role of radiofrequency (RF) ablation for liver metastases arising from pancreatic ductal adenocarcinoma simultaneously with pancreatic resection or after curative resection in patient survival. Materials and Methods: RF ablation of liver metastases was performed on 34 patients with pancreatic ductal adenocarcinoma postoperatively after pancreatectomy or intraoperatively at pancreatectomy between December 2002 and June 2009. Criteria for RF ablation were liver metastasis ≤ 3 cm diameter in size, five or fewer lesions, and no definite suspicious lesion other than liver metastasis. Patient survival was assessed by the Kaplan-Meier method, and prognostic factors were analyzed. Results: Of the patients receiving RF ablation treatment (n = 34), 18 underwent one session of RF ablation, and 16 underwent more than one session. In each session, all the targeted lesions were successfully ablated by ultrasound-guided RF ablation. Median duration of follow-up was 15 months (range, 3–65 mo). The interval between pancreatic resection and liver metastasis was 3 months (range, 0–33 mo). Median survival time after liver metastasis was 14 months. Univariate analysis of factors affecting survival showed that better patient survival after RF ablation was associated with a single, < 2 cm diameter liver metastasis (P = .007) and well or moderate differentiation (P = .032). In multivariate analysis, a single < 2 cm diameter liver metastasis and good or moderate differentiation were independent predictors for longer patient survival (P = .027, P = .016). Conclusions: RF ablation in liver metastasis occurring after locally controlled pancreatic ductal adenocarcinoma can be a safe and feasible strategy for extending survival in selected patients.

Radiofrequency Ablation in the Management of Unresectable Intrahepatic Cholangiocarcinoma

Ying Fu, Wei Yang, Wei Wu, Kun Yan, Bao Cai Xing, Min Hua Chen — 2012-05-01

Abstract: Purpose: To evaluate the efficacy of radiofrequency (RF) ablation for treatment of unresectable intrahepatic cholangiocarcinoma (ICC) and to explore the impact of prognostic variables on outcomes. Materials and Methods: From 2000–2010, 17 patients with 26 ICCs underwent RF ablation at a single institution. None of the patients were surgery candidates. Seven patients had 15 primary ICCs, and 10 patients had 11 recurrent ICCs. The median largest diameter was 4.4 cm (range 2.1–6.8 cm). A percutaneous approach was used in 15 patients, and an open approach was used in 2 patients. Early tumor necrosis, recurrence-free survival, and overall survival were analyzed. Univariate analysis was performed to evaluate 12 clinicopathologic and treatment-related variables associated with recurrence-free survival and overall survival. Results: Early tumor necrosis was 96.2% (25 of 26 tumors). The median follow-up period after RF ablation was 29 months. The median recurrence-free survival and overall survival were 17 months and 33 months. The 1-year, 3-year, and 5-year survival rates were 84.6%, 43.3%, and 28.9%, with an overall complication rate of 3.6% (1 of 28 sessions). Three variables were found to be closely associated with recurrence-free survival: lymph node metastases (P = .023), tumor differentiation (P = .034), and tumor number (P = .035). The only variable significantly associated with overall survival was tumor differentiation (P = .033). Conclusions: Preliminary results showed that RF ablation may be an effective treatment for ICC because it achieved an acceptable survival rate in a small population. Prognostic factors might allow better patient selection and outcomes.

Simultaneous Combined Balloon-occluded Retrograde Transvenous Obliteration and Partial Splenic Embolization for Portosystemic Shunts

2012-03-28

Abstract: Purpose: To evaluate the efficacy and safety of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE) for gastric varices and/or hepatic encephalopathy. Materials and Methods: B-RTO was performed in 19 consecutive patients with gastric varices and/or hepatic encephalopathy, of whom 10 received simultaneous combined B-RTO and PSE (group 1) and nine received B-RTO monotherapy (group 2). To evaluate the safety of these techniques, we analyzed 20 patients who received PSE monotherapy during the same period as a control group (group 3). Outcomes were retrospectively assessed. Results: No significant differences were observed in baseline characteristics among the three groups except for significantly lower platelet counts and larger spleen volumes in group 3. In all cases in groups 1 and 2, gastric varices disappeared and hepatic encephalopathy improved after treatment. Procedure times were not significantly different between groups 1 and 2 (P = .7435). In group 1, the volume of sclerosing agent required for B-RTO was significantly lower (P = .0355) and exacerbation of esophageal varices was significantly less frequent (P = .0146) than in group 2. Few serious complications occurred in patients who received combined therapy. Conclusions: This study indicates that concomitant PSE may help diminish the increase in portal venous pressure after B-RTO for portosystemic shunts, and may allow a reduction in the volume of hazardous sclerosing agent used. It is worth evaluating the efficacy of simultaneous B-RTO and PSE in a prospective study.

Transscapular Microcoil Lung Nodule Localization

Bippan S. Sangha, Erik D. Skarsgard, Manraj K.S. Heran — 2012-02-16

A 12-year-old boy with a history of Hodgkin disease was receiving antifungals and developed multiple lung nodules. It was unclear if these lesions represented resistant infection or relapse. Computed tomography (CT)–guided microcoil localization was requested before thoracoscopic resection ().

Radiation Emission from Patients Treated with Selective Hepatic Radioembolization Using Yttrium-90 Microspheres: Are Contact Restrictions Necessary?

2012-03-22

Abstract: Purpose: To estimate the possible radiation dose to other individuals from patients treated with yttrium-90 (90Y). Materials and Methods: Dosimetry data were analyzed after 143 consecutive administrations of 90Y (124 resin, 19 glass) in 86 patients. External radiation exposure levels from patients were measured immediately after infusion. Total effective dose equivalent (TEDE) to maximally exposed individuals was calculated based on total body residence time and measured dose rate. These values were compared to Nuclear Regulatory Commission (NRC) regulations (maximum, 1 mSv) and other potential guidelines for caregivers, extensive caregivers, or pregnant contacts. Results: Mean administered activity for resin microspheres was 0.71 GBq ± 0.35 (range, 0.07–1.6GBq). Mean TEDE dose to the maximally exposed contact was 0.03 mSv (range, 0.0005–0.16 mSv). For glass microspheres, mean administered activity was 2.8 GBq ± 1.5 (range, 0.37–5.14 GBq). Mean TEDE dose to the maximally exposed contact was 0.06 mSv (range, 0.0023–0.23 mSv). All 90Y treatments were within current NRC regulations for release without instructions. One, three, and one infusion were beyond potential thresholds for caregivers, extensive caregivers, or pregnant contacts, respectively. For any contact scenario, release without instruction was appropriate when administered activity was less than 3 GBq. Conclusions: All patients treated with 90Y hepatic radioembolization to a maximum administered activity of 5.14 GBq and maximum dose rate of 10 uSv/h were releasable without contact restrictions according to the NRC contact scenario. Patients who receive more than 3 GBq during infusion may require dose rate measurement if more restrictive contact scenarios are considered.

Radiation Pneumonitis Following Yttrium-90 Radioembolization: Case Report and Literature Review

2012-05-01

Abstract: Radiation-induced pneumonitis (RP) is a rare complication of radioembolization with yttrium-90 (90Y) microspheres. The present report describes a case of RP in a patient with liver metastases from a gastrointestinal stromal tumor after radioembolization with 90Y glass microspheres. This patient developed clinical, functional, and radiographic findings consistent with RP, with near-complete pulmonary parenchymal recovery and no clinical evidence of relapse or progressive decline in pulmonary function over a 9-month period. As clinical use of radioembolization expands, rare adverse events such as RP may become more frequent. It is essential that interventional radiologists, radiation/medical oncologists, and nuclear medicine physicians recognize this potential complication.

Safe and Effective Treatment of Colorectal Anastomotic Stricture Using a Well-defined Balloon Dilation Protocol

2012-02-23

Abstract: Purpose: To present a well-defined protocol for balloon dilation for colorectal anastomotic strictures and evaluate clinical efficacy of the dilation in 42 patients. Materials and Methods: From October 1999 to June 2010, 42 patients (32 males and 10 females with mean age 52.1 years ± 16.3) with surgical colorectal anastomotic strictures who received transanal balloon dilation using a well-defined protocol were retrospectively investigated. After the procedure, a water-soluble contrast media study was performed to detect possible complications. Stricture diameter was measured 1 month after balloon dilation. Clinical outcomes and recurrence were evaluated with a median follow-up period of 63.7 months. Results: There were 47 dilation sessions performed in 42 patients. Technical success and clinical success were achieved in all patients. At long-term follow-up, 36 (85.7%) patients had complete improvement. No complications were observed in any patients. Stricture diameter 1 month after the procedure was 8.85 cm ± 3.23, which was a significant increase over stricture diameter before the procedure of 5.89 cm ± 2.64 (P < .001), showing increase in diameter by 50.3%. Four (9.5%) patients experienced symptomatic recurrence. Stricture diameter of the patients with recurrence was considerably larger than stricture diameter of other patients (P = .036). Conclusions: Fluoroscopically guided balloon dilation using the protocol described is safe and clinically effective for treatment of colorectal anastomotic stricture.

Fatal Reperfusion Injury after Thrombolysis for Phlegmasia Cerulea Dolens

Mark L. Lessne, Jawad Bajwa, Kelvin Hong — 2012-05-01

Abstract: Reperfusion injury after venous thrombolysis for phlegmasia cerulea dolens (PCD), despite its potentially rapid, fatal course, has not been well described in the literature. Two cases of fatal reperfusion injury after venous thrombolysis are reported, and the clinical manifestations and treatment strategies of PCD and the aspects of reperfusion injury relevant to the interventionalist are reviewed.

Modified Loop Snare Technique for the Removal of Bard Recovery, G2, G2 Express, and Eclipse Inferior Vena Cava Filters

Frank C. Lynch — 2012-05-01

Abstract: The present work describes the preliminary results of the use of a novel technique for the removal of tilted and apex-embedded Recovery, G2, G2 Express, and Eclipse inferior vena cava filters. A retrospective review was performed of 33 filters removed in 32 patients by using the described modified loop snare technique. All filters were successfully removed with the use of the technique. The average duration of filter implantation for the devices removed with the technique was 556 days (range, 11-2,437 d; median, 268 d). No filter fractures occurred related to the removal technique. No procedure-related complications occurred.

Transcollateral Approach for Percutaneous Revascularization of Complex Superficial Femoral Artery and Tibioperoneal Trunk Occlusions

Tobias Zander, Gabriela Gonzalez, Luis De Alba, Oscar Rivero, Manuel Maynar — 2012-05-01

Abstract: This report describes the use of transcollateral retrograde revascularization in two patients after failed recanalization of the tibioperoneal trunk in one and superficial femoral artery occlusion in the other. Retrograde recanalization was successfully achieved via a distal branch of the profunda femoris artery in the first case and a medial genicular branch in the second. After successful retrograde recanalization, the guide wire was snared in both cases and angioplasty/stent placement was performed in an antegrade fashion.

Retention of an Autologous Endothelial Layer on a Bioprosthetic Valve for the Treatment of Chronic Deep Venous Insufficiency

Casey M. Jones, Monica T. Hinds, Dusan Pavcnik — 2012-03-12

Abstract: Purpose: Percutaneous transcatheter implantation of porcine small intestinal submucosa (SIS) bioprosthetic valves has been reported as a treatment for chronic deep venous insufficiency (CDVI). Endothelial progenitor outgrowth cells (EOCs), isolated from whole ovine blood, were evaluated as a source of in vitro autologous seeding for SIS endothelialization. Retention of the EOC monolayer was evaluated to test the feasibility of delivering an endothelialized SIS valve. Materials and Methods: Twenty bioprosthetic venous valves were constructed from SIS sutured onto collapsible square stent frames and were seeded with ovine EOCs in vitro. Retention of the endothelial monolayer through valve loading and delivery (three valves), in vitro flow (three valves), and ex vivo flow (four valves) was evaluated with immunofluorescent staining and histologic analysis compared with paired unmanipulated control valves. In the ex vivo shunt loop, venous blood was pulled from an implanted dialysis catheter, through the valve, and returned to the sheep. Results: Immunofluorescent staining of EOCs on the valves after in vitro seeding revealed a confluent monolayer (95.6% ± 2.3% confluent) on each side of the valve. When examined by immunofluorescent staining, the endothelial monolayer remained intact after loading and delivery (97.1% ± 1.7%) and when subjected to flow in the in vitro loop (96.0% ± 3.0%). Histologic analysis of the valves subjected to the ex vivo shunt loop revealed retention of the endothelial monolayer. Conclusions: Endothelial monolayers seeded on SIS were retained under loading and delivery, in vitro flow, and ex vivo flow. EOCs are a promising cell source for autologous endothelialization of bioprosthetic valves for the treatment of CDVI.

Intratumoral versus Intravenous Gene Therapy Using a Transcriptionally Targeted Viral Vector in an Orthotopic Hepatocellular Carcinoma Rat Model

2012-03-02

Abstract: Purpose: To evaluate the feasibility of intratumoral delivery of adenoviral vector carrying a bidirectional two-step transcriptional amplification (TSTA) system to amplify transcriptional strength of cancer-specific Survivin promoter in a hepatocellular carcinoma model. Materials and Methods: MCA-RH7777 cells were implanted in rat liver, and tumor formation was confirmed with [18F]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET). The adenoviral vector studied had Survivin promoter driving a therapeutic gene (tumor necrosis factor-α–related apoptosis-inducing ligand [TRAIL]) and a reporter gene (firefly luciferase [FL]; Ad-pSurvivin-TSTA-TRAIL-FL). Tumor-bearing rats were administered Ad-pSurvivin-TSTA-TRAIL-FL intravenously (n = 7) or intratumorally (n = 8). For control groups, adenovirus FL under cytomegalovirus (CMV) promoter (Ad-pCMV-FL) was administered intravenously (n = 3) or intratumorally (n = 3). One day after delivery, bioluminescence imaging was performed to evaluate transduction. At 4 and 7 days after delivery, 18F-FDG-PET was performed to evaluate therapeutic efficacy. Results: With intravenous delivery, Ad-pSurvivin-TSTA-TRAIL-FL showed no measurable liver tumor FL signal on day 1 after delivery, but showed better therapeutic efficacy than Ad-pCMV-FL on day 7 (PET tumor/liver ratio, 3.5 ± 0.58 vs 6.0 ± 0.71; P = .02). With intratumoral delivery, Ad-pSurvivin-TSTA-TRAIL-FL showed positive FL signal from all tumors and better therapeutic efficacy than Ad-pCMV-FL on day 7 (2.4 ± 0.50 vs 5.4 ± 0.78; P = .01). In addition, intratumoral delivery of Ad-pSurvivin-TSTA-TRAIL-FL demonstrated significant decrease in tumoral viability compared with intravenous delivery (2.4 ± 0.50 vs 3.5 ± 0.58; P = .03). Conclusions: Intratumoral delivery of a transcriptionally targeted therapeutic vector for amplifying tumor-specific effect demonstrated better transduction efficiency and therapeutic efficacy for liver cancer than systemic delivery, and may lead to improved therapeutic outcome for future clinical practice.

Detection of Extracellular Genomic DNA Scaffold in Human Thrombus: Implications for the Use of Deoxyribonuclease Enzymes in Thrombolysis

2012-05-01

Abstract: Purpose: Mechanisms underlying transition of a thrombus susceptible to tissue plasminogen activator (TPA) fibrinolysis to one that is resistant is unclear. Demonstration of a new possible thrombus scaffold may open new avenues of research in thrombolysis and may provide mechanistic insight into thrombus remodeling. Materials and Methods: Ten human thrombus samples were collected during cases of thrombectomy and open surgical repair of abdominal aortic aneurysms (five samples < 3 d old and five samples > 1 y old). Additionally, an acute murine hindlimb ischemia model was created to evaluate thrombus samples in mice. Human sections were immunostained for the H2A/H2B/DNA complex, myeloperoxidase, fibrinogen, and von Willebrand factor. Mouse sections were immunostained with the H2A antibody. All samples were further evaluated after hematoxylin and eosin and Masson trichrome staining. Results: An extensive network of extracellular histone/DNA complex was demonstrated in the matrix of human ex vivo thrombus. This network is present throughout the highly cellular acute thrombus. However, in chronic thrombi, detection of the histone/DNA network was predominantly in regions of low collagen content and high cell density, which were mostly near the lumen. These regions of high cell density contained neutrophils and monocytes. Similarly, sections from the acute murine hindlimb ischemia model also exhibited extensive immunoreactivity to the histone antibody in the extracellular space within murine thrombi. Conclusions: Extensive detection of genomic DNA associated with histones in the extracellular matrix of human and mouse thrombi suggest the presence of a new thrombus-associated scaffold.

Intracardiac Methylmethacrylate Embolism Resulting in Right Atrial Wall Perforation and Pericarditis following Percutaneous Vertebroplasty

Tod Mattis, Michael Knox, Leena Mammen — 2012-05-01

A 71-year-old man presented to the emergency department describing gradually worsening epigastric and chest pain, diaphoresis, and syncope 4 days after an L2 vertebral body methylmethacrylate (MMA) percutaneous vertebroplasty (PV). The procedure was complicated only by a 5-cm length of MMA extending into an anterior paravertebral vein at the level of L2 but without central embolization (). Medical history was significant for a previous thoracic (T7) MMA PV 5 years before admission and a lumbar (L1) MMA PV 2 months earlier. All three PVs were performed for osteoporotic compression fractures and resulted in good pain relief. The present report was reviewed by the appropriate institutional review board and determined to be exempt.

Nasogastric Tube Found in the Right Atrium

2012-05-01

The placement of a nasogastric tube (NGT) is a very common procedure, although it is not without risks. A wide spectrum of known complications can occur, including malposition, aspiration pneumonia, epistaxis, or esophageal perforation (). More infrequently, severe complications have been reported, such as the inadvertent insertion of an NGT into the brainstem and spinal cord (after endoscopic skull base surgery) or into the vascular system (). We present an example of the infrequent case of NGT malpositioning in which the tube entered the vascular system.

Symptomatic Ascites Caused by a Longstanding Posttraumatic Mesenteric Arteriovenous Fistula

Heiko Uthoff, Constantino Peña, Francisco Contreras, Barry T. Katzen — 2012-05-01

Posttraumatic mesenteric arteriovenous fistulas (AVFs) are very rare. Patients with this type of fistula often remain asymptomatic but may present with unspecific symptoms years after the causal insult (). We report the successful endovascular treatment of a complex mesenteric AVF leading to delayed symptomatic portal hypertension 30 years after an abdominal trauma.

Intraoperative Portal Vein Stent Placement in Pediatric Living Donor Liver Transplantation

2012-05-01

The use of intraoperative portal venography to detect spontaneous portosystemic collateral vessels and evaluate the portal vein (PV) anastomosis has been described in adult living donor liver transplantation (). However, the use of intraoperative venography to address portal venous issues has not been widely described. We report two cases in which this procedure was used to guide intraoperative PV stent placement through an inferior mesenteric vein approach () with use of the stump of the segment 4 PV () in pediatric living donor liver transplant recipients. The use of stents to correct size mismatches or acute angulation at the anastomosis may prove as—or more—effective in treating small-sized native PVs and may carry less risk of warm ischemia to the graft than surgical revision of the anastomosis.

Editorial Board

2012-05-01

Subscription Information Page

2012-05-01

Contents in Brief

2012-05-01

Forthcoming Articles: June 2012

2012-05-01

Journal of Vascular and Interventional Radiology

Pancreatic Islet Cell Transplantation: An Update for Interventional Radiologists

CME Test Questions: May 2012

Utero-ovarian Anastomoses and Their Influence on Uterine Fibroid Embolization

What Do We Know about Uterine-Ovarian Anastomoses and Uterine Artery Embolization?

Radiologically Placed Tunneled Hemodialysis Catheters: A Single Pediatric Institutional Experience of 120 Patients

Feasibility of Ultrasound-guided Intranodal Lymphangiogram for Thoracic Duct Embolization

Intranodal Lymphangiography: Coming Soon to a Hospital Near You

Percutaneous Computed Tomography–guided High-Dose-Rate Brachytherapy Ablation of Breast Cancer Liver Metastases: Initial Experience with 80 Lesions

Planning Ultrasound for Percutaneous Radiofrequency Ablation to Treat Small (≤ 3 cm) Hepatocellular Carcinomas Detected on Computed Tomography or Magnetic Resonance Imaging: A Multicenter Prospective Study to Assess Factors Affecting Ultrasound Visibility

Radiofrequency Ablation of Liver Metastasis in Patients with Locally Controlled Pancreatic Ductal Adenocarcinoma

Radiofrequency Ablation in the Management of Unresectable Intrahepatic Cholangiocarcinoma

Simultaneous Combined Balloon-occluded Retrograde Transvenous Obliteration and Partial Splenic Embolization for Portosystemic Shunts

Transscapular Microcoil Lung Nodule Localization

Radiation Emission from Patients Treated with Selective Hepatic Radioembolization Using Yttrium-90 Microspheres: Are Contact Restrictions Necessary?

Radiation Pneumonitis Following Yttrium-90 Radioembolization: Case Report and Literature Review

Safe and Effective Treatment of Colorectal Anastomotic Stricture Using a Well-defined Balloon Dilation Protocol

Fatal Reperfusion Injury after Thrombolysis for Phlegmasia Cerulea Dolens

Modified Loop Snare Technique for the Removal of Bard Recovery, G2, G2 Express, and Eclipse Inferior Vena Cava Filters

Transcollateral Approach for Percutaneous Revascularization of Complex Superficial Femoral Artery and Tibioperoneal Trunk Occlusions

Retention of an Autologous Endothelial Layer on a Bioprosthetic Valve for the Treatment of Chronic Deep Venous Insufficiency

Intratumoral versus Intravenous Gene Therapy Using a Transcriptionally Targeted Viral Vector in an Orthotopic Hepatocellular Carcinoma Rat Model

Detection of Extracellular Genomic DNA Scaffold in Human Thrombus: Implications for the Use of Deoxyribonuclease Enzymes in Thrombolysis

Intracardiac Methylmethacrylate Embolism Resulting in Right Atrial Wall Perforation and Pericarditis following Percutaneous Vertebroplasty

Nasogastric Tube Found in the Right Atrium

Symptomatic Ascites Caused by a Longstanding Posttraumatic Mesenteric Arteriovenous Fistula

Intraoperative Portal Vein Stent Placement in Pediatric Living Donor Liver Transplantation

Editorial Board

Subscription Information Page

Contents in Brief

Table of Contents

Forthcoming Articles: June 2012