TIPS psoas muscle attenuation was also observed (3.1 ± 8.5 HU, P ¼ 0.022). In multivariate analysis, increases in psoas (HR ¼ 0.14, P ¼ 0.016), paraspinal (HR ¼ 0.15, P ¼ 0.016), abdominal (HR ¼ 0.05, P ¼ 0.005), core (HR ¼ 0.06, P ¼ 0.001) and total (HR ¼ 0.05, P ¼ 0.003) muscle areas after TIPS creation predicted significantly increased survival rates compared to those with no change. Changes in core muscle area following TIPS creation were not predicted by patient demographics, comorbidities, or pre-and post-TIPS liver function studies. Conclusions: Cross-sectional area of truncal muscles significantly increased after TIPS creation and correlated with improved survival. These parameters can complement other determinants in the assessment of prognosis after TIPS creation. Future research will elucidate the prognostic impact of sarcopenia for TIPS creation, and will increase understanding of potential metabolic changes induced after portosystemic shunting.
To evaluate the occurrence of spontaneous and assisted recanalization of hemodialysis accesses following failed percutaneous mechanical thrombectomy and abandonment of the access Materials and Methods: A retrospective review was performed of a prospectively managed quality assurance database of all hemodialysis (HD) access interventions performed between March 2001 and September 2020. Of 11,266 hemodialysis access interventions, 3,137 thrombectomy procedures were performed. Successful thrombectomy procedures were performed in 2,891 cases for an overall success rate of 92.2%. A total of 246 failed thrombectomy procedures were identified. An access was considered abandoned if no further attempts at thrombectomy were planned. Cases in which thrombectomy was recorded as failure due to other issues such as procedure complication but not considered abandoned, with planned subsequent return for repeat attempt, were excluded from analysis. Retrospective review of all failed thrombectomy procedures was performed to evaluate for a subset of accesses deemed abandoned that demonstrated spontaneous or assisted recanalization. Results: Of the 246 failed mechanical thrombectomy procedures, access types included 99 native fistulas, 120 grafts, 9 hybrid access, and 18 without documented access details. There were 14 accesses (5.7% of failures) that demonstrated recanalization enabling subsequent salvage of the access after failed thrombectomy and access abandonment; all accesses exhibited trace flow beyond the (arterial) anastomosis at the time of failed thrombectomy. Of these salvaged accesses, 9 occurred in fistulas, 4 in grafts, and 1 in a hybrid access. Secondary procedures were performed in 7 patients including repeat thrombectomy with angioplasty (n ¼ 3), thrombectomy with stent (n ¼ 1), angioplasty (n ¼ 1) and stent (n ¼ 1) to maintain access function. Seven of the cases demonstrated spontaneous recanalization with no required additional intervention. All 14 salvaged accesses were successfully used for hemodialysis within 30 days post spontaneous or assisted recanalization. Conclusions: Spontaneous recanalization of clotted hemodialysis accesses considered abandoned after failed mechanical thrombectomy can occur. Further characterization of this phenomenon is needed to determine whether an observation period of catheter HD is warranted in the subset of patients with trace flow beyond the anastomosis following failed thrombectomy.
Purpose: Tapered (4 -7 mm) hemodialysis grafts are used to prevent access-related steal syndrome. During treatment of dysfunction or thrombosis, detapering the inflow segment of such grafts by angioplasty may improve flow, albeit with a theoretical risk of development of steal. We report the immediate flow response and incidence of steal syndrome following detapering of dialysis grafts. Materials: Retrospective review of a prospectively collected quality assurance database of all hemodialysis access interventions performed between 2005 and 2017 was carried out. The inclusion criteria were detapering coupled with intravascular direct flow measurement (Transonic). Those undergoing detapering without flow measurement were excluded (n¼65). Fourteen patients (mean age: 59.7 years) with 15 dialysis grafts met inclusion criteria. A paired samples t-test was used to compare preand post-detaper flows. Distal ischemic symptoms collected by chart review included pain, pallor, diminished pulse, and ischemic skin changes. Results: Mean duration of follow-up was 28.1 months. Mean balloon taper size was 6.1 mm. Pre-and post-detaper flows (mean±SD) were 565.7±323.8 and 924.3±363.7 mL/min, respectively (p<0.0001). The mean ratio of post-to pre-detaper flows was 1.6 (range 1.1 -10.2). Although 5/65 excluded patients exhibited symptomatic steal post-detaper, no patients meeting the above criteria developed steal syndrome postdetaper. Conclusions: Detapering dialysis grafts resulted in nearly a twofold improvement in access flow, a key predictor of access function. Although a small subset of patients may develop steal postdetaper, detapering was not associated with development of steal syndrome using the defined criteria within this retrospective study.
Purpose: The Society of Interventional Radiology (SIR) has placed an emphasis on promoting diversity and inclusion, particularly of gender and race. To increase gender diversity amongst speakers at the Annual Scientific Meetings (ASM), the Annual Meeting Committees (AMC) for the meetings held in 2017 and 2018 strongly promoted inclusion of female speakers by directly inviting speakers, while allowing substitutions offered by the coordinators. This study investigates the impact of the AMC's initiative by reporting the gender trends for invited faculty at the 2017 and 2018 ASMs. Materials: Faculty rosters for the 2017 and 2018 SIR ASM were stratified by gender to quantify female representation at the plenary sessions, categorical courses, symposia, self-assessment modules and "meet-the-expert" sessions, collectively called "podium sessions." Keynote events and award ceremonies were excluded. Results: 2017 and 2018 saw a significant increase in female representation at podium sessions with 89 of 684 (15%) and 83 of 595 (16%) presentations delivered by women (vs. 9% in 2016, p¼0.01). Despite the new structure of invitations, the proportion of female speakers differed by the gender of coordinators leading the session. Of the 103 podium sessions at the 2018 meeting, 86 (83%) were led by all-male coordinators and 17 (17%) were led by mixed or all-female coordinators. Having at least one female coordinator correlated with significantly higher proportion of female speakers (46 of 124, 37%) compared to that for only male coordinators (37 of 471, 8%; p<0.0001). Similar results were observed for the 2017 meeting, where the presence of a female coordinator resulted in a significantly higher proportion of female speakers (40% vs. 8%, p<0.0001). Conclusions: Our study supports the work done by the current and past AMCs to increase diversity at the SIR Annual Scientific Meeting. The inclusion of more women as coordinators will further increase gender diversity at the podium.
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