The Ash Split catheter allows increased rates of blood flow during hemodialysis but this increase was not significant at the beginning (p = 0.21) or end (p = 0.27) of the first six hemodialysis sessions. The Ash Split catheter is more prone to minor complications, particularly dislodgment, than the PermCath catheter.

More than 50% of respondents are unhappy with their policies for obtaining informed consent. Interventional societies have a role to play in advocating formal consent guidelines.

Background. Recently, interventional radiologists have adopted an increasingly prominent role in the placement and management of hemodialysis catheters, as well as in the research and development of new and better catheters. The purpose of this study was to evaluate the viability and hemodialysis efficiency of the AshSplit catheter and the Permcath catheter. Methods. 204 consecutive patients requiring radiological insertion of hemodialysis catheters were followed, retrospectively, over a 42-month period. Both hemodialysis catheters were placed using a combination of ultrasonic and fluoroscopic guidance and tunneled appropriately. Information collected included catheter insertion sites, insertion complications, catheter duration, and final outcome. Results. Over the study period of two years, 269 catheters were placed into 204 patients with end stage renal failure. Patients received either an AshSplit (101 patients, 127 catheters) or a Permcath (103 patients, 142 catheters). Vascular access route of choice was the right internal jugular vein (67% AshSplit, 71% Permcath). Insertion complications occurred in 18 patients overall (6.6%), with only 1 requiring further intervention (hemopneumothorax). Flow rates averaged 259 mls/min for AshSplits and 248 mls/min for Permcaths (p < 0.001). Follow-up of catheter viability for 42 months yielded a mean AshSplit catheter duration of 246 days (range 6-932) and 239 days (range 1-1,278) for Permcath (p = 0.46). Reasons for catheter failure and elective catheter removal were similar in both groups; however, Permcaths required significantly more thrombolysis than AshSplits, p < 0.001. Conclusion. The AshSplit provides significantly better flow rates and less thrombolysis compared to the Permcath, with similar catheter dwell times.

Our data using MR imaging suggests that fat pad elevation in the presence of recent trauma is frequently associated with a fracture. The size of the effusion, anterior/posterior fat pad elevation, or a combination of both does not correspond to the likelihood of an underlying fracture. MR imaging reveals a broad spectrum of bone and soft tissue injury beyond that recognizable on plain radiographs as demonstrated by all patients in this study.

Bouveret's syndrome is obstruction of the stomach or the duodenum from a gallstone that has migrated through a biliogastric or bilioduodenal fistula. This rare syndrome has been described in a number of case reports.