The Amplatzer Vascular Plug (AVP) is an established embolic device that can be an excellent alternative to coils or detachable balloons to embolize medium to large vessels with high flow. The device is easy to use and can be precisely deployed in the target vessel with high resistance to migration and a low recanalization rate. The technical success of this device is high, indications for use are expanding, and no absolute contraindications have been reported. Since its introduction, the AVP has grown from a single device to a group of 4 models (AVP, AVP II, AVP III, and AVP 4). Each model has a unique design and features that fit different vascular anatomies, hemodynamic situations, and clinical scenarios. Therefore, the new models cannot simply be treated as replacements for older ones. Unpredictable occlusion time remains a major shortcoming for the new models of the AVP. Large vessel size, high flow status, and coagulopathy can prolong the occlusion time, which can offset the cost benefit, reduced procedure time, and reduced radiation dose typically seen with use of the AVP alone. Coils or multiple AVPs can be used to expedite the occlusion process, and large Gelfoam particles also can be used as an adjunct to achieve rapid and reliable occlusion with minimal cost.

Background Despite improvements in cancer management, most pancreatic cancers are still diagnosed at an advanced stage. We have recently identified promoter DNA methylation of the genes ADAMTS1 and BNC1 as potential blood biomarkers of pancreas cancer. In this study, we validate this biomarker panel in peripheral cell-free tumor DNA of patients with pancreatic cancer. Results Sensitivity and specificity for each gene are as follows: ADAMTS1 87.2% and 95.8% (AUC = 0.91; 95% CI 0.71–0.86) and BNC1 64.1% and 93.7% (AUC = 0.79; 95% CI 0.63–0.78). When using methylation of either gene as a combination panel, sensitivity increases to 97.3% and specificity to 91.6% (AUC = 0.95; 95% CI 0.77–0.90). Adding pre-operative CA 19-9 values to the combined two-gene methylation panel did not improve sensitivity. Methylation of ADAMTS1 was found to be positive in 87.5% (7/8) of stage I, 77.8% (7/9) of stage IIA, and 90% (18/20) of stage IIB disease. Similarly, BNC1 was positive in 62.5% (5/8) of stage I patients, 55.6% (5/9) of stage IIA, and 65% (13/20) of patients with stage IIB disease. The two-gene panel ( ADAMTS1 and/or BNC1 ) was positive in 100% (8/8) of stage I, 88.9% (8/9) of stage IIA, and 100% (20/20) of stage IIB disease. The sensitivity and specificity of the two-gene panel for localized pancreatic cancer (stages I and II), where the cancer is eligible for surgical resection with curative potential, was 94.8% and 91.6% respectively. Additionally, the two-gene panel exhibited an AUC of 0.95 (95% CI 0.90–0.98) compared to 57.1% for CA 19-9 alone. Conclusion The methylation status of ADAMTS1 and BNC1 in cfDNA shows promise for detecting pancreatic cancer during the early stages when curative resection of the tumor is still possible. This minimally invasive blood-based biomarker panel could be used as a promising tool for diagnosis and screening in a select subset of high-risk populations. Electronic supplementary material The online version of this article (10.1186/s13148-019-0650-0) contains supplementary material, which is available to authorized users.

There is insufficient evidence to show that these resources have a true place for replacing traditional methods in teaching anatomy. Further research should be conducted to determine how to use these resources in conjunction with current teaching methods or how their use can be integrated into the current anatomy curriculum.

Rapid prototyping of aortic aneurysms is feasible and can aid decision making and device delivery. Further work is required to test the value of 3D replicas in planning procedures and their impact on procedure time, radiation dose, and procedure cost.

A 6 year old girl presented with a large osteochondroma arising from the scapula. Radiographs, CT and MRI were performed to assess the lesion and to determine whether the lesion could be safely resected. A model of the scapula was created by post-processing the DICOM file and using a 3-D printer. The CT images were segmented and the images were then manually edited using a graphics tablet, and then an STL-file was generated and a 3-D plaster model printed. The model allowed better anatomical understanding of the lesion and helped plan surgical management.

AVP with additional embolic agents is a useful alternative for proximal SAE because of precise deployment, resistance to migration, and radiation reduction. AVP use may be limited by vessel tortuosity. The occlusion time, procedure time, and cost were reduced but this was not statistically significant due to the need for additional embolic material.

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Background-Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters. Methods and Results-The MEDLINE database was searched for all studies showed evidence of organ/structure involvement. Among patients with penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%, 108 of 140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement or embolization (n=11), endovascular retrieval of the permanent filter (n=4), and percutaneous nephrostomy or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% of patients (127 of 146) underwent premature filter retrieval or interventions for underlying symptoms or penetration-related complications. Conclusions-Caval penetration is a frequent but clinically underrecognized complication of IVC filter placement.Symptomatic patients accounted for nearly 1/10th of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic patients.