• Bedside and fluoroscopy guided techniques are commonly used for PICC placement. • Catheter malposition is the major technical issue with the bedside technique. • Catheter malposition occurred in 53% of patients with the bedside technique.
• Malposition of indwelling central catheter can cause superior vena cava obstruction. • Image-guided catheter placement helps prevent superior vena cava obstruction. • Imaging and superior vena cava obstruction classification allows adequate procedure planning. • Endovascular techniques are safe and effective for superior vena cava syndrome treatment.
• Intravascular filling-defect lesions are related to both benign conditions and malignant tumours. • Endovascular biopsy is indicated in case of doubt about intravascular lesion nature. • Percutaneous endovascular biopsy is a safe technique. • Endovascular biopsy provides tissue samples leading to correct histopathological analysis. • Percutaneous endovascular biopsy provides early diagnosis of malignant intravascular lesions.
Objectives: To report a new classification scheme for acute aortic dissection (AAD) that considers the aortic arch as a separate entity and integrates patterns of malperfusion syndrome (MPS). The proposed classification was evaluated retrospectively in a large population. Materials and Methods: We retrospectively reviewed pre-therapy CT angiograms of 226 consecutive patients (mean ± SD age: 64 ± 12 years) with AAD. AADs were reclassified with a new classification scheme that included three aortic dissection types (A, involving at least the ascending aorta; B, involving exclusively the descending aorta; and C, involving the aortic arch with/without the descending aorta) and four malperfusion grades (0: no MPS; 1: dynamic MPS; 2: static MPS; 3: static and dynamic MPS). AAD features were assessed and correlated to patient outcomes. Results: According to the new classification, we identified 152 type A dissections (92 A0, 11 A1, 38 A2, 11 A3); 50 type B (38 B0, 5 B1, 6 B2, 1 B3); and 24 type C (17 C0, 6 C2, 1 C3). Type C represented 11% of all AADs. MPS occurred in 39, 24, and 29% in type A, B, and C, respectively. Type C was treated with significantly more endovascular or hybrid interventions (37%) than in types A (3%) and B (20%) (p < 0.001). Conclusion: The new AAD classification was feasible, and type C was easily identified ("non-A, non-B"). Preliminary findings supported the usefulness of this classification for the decision-making process and subsequent treatments.
Computer-aided detection (CAD) systems, which automatically detect and indicate location of potential abnormalities in scan digital images, have the capacity to increase the accuracy of the radiologists' interpretations and finding. This paper presents an efficient new CAD .for automatic and accurate detection and quantification of Abdominal Aortic Aneurysm (AAA). The system first detects and extracts the lumen and then identifies the location of the abdominal aortic from the total lumen. The extracted abdominal aortic lumen is then used as an initial surface to segment the abdominal aorta which might contain aneurysm. The geometrical and morphological features of both lumen and aorta are examined for the presence of aneurysm based on predefined criteria set by incorporating prior understanding of the normal expected variation of aorta. The experimental result of the proposed system on 60 CTA datasets indicated a 98% success in detection (CAD) and a 95% in segmentation results (CAM).
To reduce inferior vena cava filter (IVCF) related complications, retrieval is recommended whenever possible. Nevertheless, IVCF retrieval rates remain lower than expected, likely due to insufficient follow-up after placement. We evaluated the value of a structured program designed to follow patients by the interventional radiology team up to 5 months after IVCF placement. We prospectively enrolled 366 consecutive patients (mean age 64 ± 17 years; 201 men and 165 women) who benefited from IVCF between March 2015 and February 2020. The program consisted of advising the patient and clinicians to consider IVCF retrieval as soon as possible (standard workflow) and systematically planning an additional follow-up visit at 5-month. Clinical and technical eligibility, as well as technical success for retrieval (TSR) were evaluated. At 5-months, 38 (10.4%) patients were lost to follow-up, and 47 (12.8%) had died. Among survivors, the overall retrieval rate was 58%. The retrieval rates were 83% and 97% for the clinically eligible and technically eligible patients for retrieval, respectively. The 5-month visit enabled 89 additional retrievals (47.8%) compared to the standard workflow. No significant difference was seen in TSR before and after 5 months (p = 0.95). Improved patient tracking with a dedicated IVCF program results in an effective process to identify suitable patients for retrieval and drastically improves retrieval rates in eligible patients. Involving interventionalists in the process improved IVCF patient management.
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