Accreditation: RPVI, RVT, IAC Accreditation, and ACR Accreditation.

Personnel and department accreditation are means by which institutions can evaluate, demonstrate, and maintain the highest level of patient care. In this article, we will discuss the certification and the resources for physicians (RPVI) and technologists (RVT) who provide care to patients in the vascular lab (VL) as well as information about certification by the two accrediting bodies - the Intersocietal Accreditation Commission (IAC) and the American College of Radiology (ACR) - that accredit VLs. Noninvasive vascular testing provides timely delivered valuable information to healthcare providers.

Anti-Restenotic Technologies in the SFA: Balloons and Stents.

Peripheral arterial disease (PAD) is a common condition, which significantly impacts the quality and length of life. In recent years, drug-eluting devices have demonstrated improved clinical effectiveness for treating peripheral arterial disease in the femoropopliteal arteries compared to traditional stents and angioplasty balloons. However, recent controversial studies have called the safety of this technology into question, leading to confusion as to if, when, and how these devices should be used.

"Catch, Flip, and Remove" Technique for Retrieval of a Hypermobile Detached Leadless Pacemaker: A Case Report and Literature Review.

Leadless pacemaker (LP) detachment is a rare but life-threatening complication that may occur during implantation. While different snaring techniques have been described to remove partially or completely detached LPs, there are currently no reports of snaring a hypermobile LP that travels between different cardiac chambers. This report describes a technique to successfully snare a hypermobile detached LP by first "catching" onto the tines for stabilization with the help of a multi-loop snare, followed by using a second snare for the proximal retrieval feature.

Imaging of Patellofemoral Instability.

Patellar instability is a broad term that encompasses patellar dislocation, patellar subluxation, and patellar instability. Although both functional and anatomic considerations contribute to symptoms of patellar instability, the most important are thought to be patella alta, trochlear dysplasia, and lateralization of the tibial tubercle. In patients with a history suspicious for prior patellar dislocation, careful evaluation of MRI and radiographic studies can reveal characteristic findings.

Computational Prediction of All Lanthanide Aqua Ion Acidity Constants.

The protonation state of lanthanide-ligand complexes, or lanthanide-containing porous materials, with many Brønsted acid sites can change due to proton loss/gain reactions with water or other heteroatom-containing compounds. Consequently, variations in the protonation state of lanthanide-containing species affect their molecular structure and desired properties. Lanthanide(III) aqua ions undergo hydrolysis and form hydroxides; they are the best characterized lanthanide-containing species with multiple Brønsted acid sites.

Retrieval of Bard Simon Nitinol inferior vena cava filters: Approaches, technical successes, complications, and clinical outcomes.

Objective: The Simon Nitinol filter is a bi-level filtration device designed for permanent implantation that is no longer commercially available, but may result in similar complications to current commercially available long term indwelling temporary or permanent filters. Complications related to indwelling inferior vena cava filters include inferior vena cava thrombosis, inferior vena cava penetration, filter migration, and filter fracture. There is a paucity of reports describing the technical aspects related to retrieval of Simon Nitinol filters.

Nicotine Induces IL-8 Secretion from Pancreatic Cancer Stroma and Worsens Cancer-Induced Cachexia.

Smoking is highly associated with pancreatic cancer. Nicotine, the addictive component of tobacco, is involved in pancreatic cancer tumorigenesis, metastasis, and chemoresistance. This work aimed to describe the role of nicotine within the pancreatic cancer tumor microenvironment.

Step-by-Step Approach to Management of Type II Endoleaks.

Seventy-five percent of abdominal aortic aneurysms are now treated by endovascular aneurysm repair (EVAR) rather than open repair, given the decreased periprocedural mortality, complications, and length of hospital stay for EVAR compared to the surgical counterpart. An endoleak is a potential complication after EVAR, characterized by continued perfusion of the aneurysm sac after stent graft placement. Type II endoleak is the most common endoleak, and often has a benign course with spontaneous resolution, occurring in the first 6 months after repair.

Endovascular Management of Acute Traumatic Aortic Injury.

Acute traumatic injury of the thoracic aorta is a highly lethal condition, with many afflicted patients expiring before hospital arrival. While previously these conditions were managed with open surgery, endovascular repair has rapidly evolved and is now considered the standard of care for certain patterns of aortic injury at centers with appropriate expertise. The development of newer branched devices has allowed these techniques to be utilized further and further proximally into the aorta.

Transvenous Biopsy in the Diagnosis of Intravascular or Perivascular Neoplasm: A Single-Center Retrospective Analysis of 36 Patients.

Between September 2008 and August 2017, 36 patients (mean age 56 y; range, 30-89 y) underwent transvenous biopsy of suspected tumor thrombus or perivascular tumor. Intravascular biopsy was pursued because of inaccessible percutaneous access in 9 patients (25%) and as part of a planned revascularization procedure in 27 patients (75%). Histopathologic results showed malignancy in 26 patients (72%) and benign etiologies in 10 patients (28%).

Endobronchial Forceps-Assisted Removal of Gianturco Z-Stents from the Right Atrium.

Endovascular treatment of malignant intrahepatic inferior vena cava stenosis involves venoplasty and stenting. Intravascular migration is a complication associated with stents. This technical report describes the retrieval of migrated intracardiac Gianturco Z-stents using rigid endobronchial forceps.

Removal of T-Fasteners Immediately After Percutaneous Gastrostomy Tube Placement: Experience in 488 Patients.

Objective: The purpose of this article is to evaluate the safety of T-fastener removal immediately after percutaneous gastrostomy tube placement by assessing difference in complication rates between early and delayed gastropexy removal.

Materials And Methods: A retrospective review was performed of the electronic medical records of all patients who underwent percutaneous gastrostomy at our institution from January 2015 to June 2017. A total of 722 patients successfully underwent gastrostomy tube insertion during this period.

Type II endoleaks: diagnosis and treatment algorithm.

Elective abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm, symptomatic, or rapidly expanding more than 0.5 cm in 6 months.

Endovascular management of acute aortic dissection.

Acute dissection of the thoracic aorta is a potentially life-threatening condition which requires collaborative treatment from multiple specialties for optimal patient outcomes. Dissections involving the ascending aorta and aortic arch have traditionally been managed entirely by surgery, while dissections beyond the arch vessels have most commonly been relegated to medical management. This algorithm has been undergoing a paradigm shift over the past two decades due to improvements in stent graft technology, better understanding of the hemodynamic interactions of the true and false lumen and their influence on organ and limb perfusion, and improvements in medical management and long term surveillance for dissection-related complications.

Endovascular Iliocaval Reconstruction for Chronic Iliocaval Thrombosis: The Data, Where We Are, and How It is Done.

Iliocaval thrombosis, or thrombosis of the inferior vena cava and iliac veins, is associated with significant morbidity in the form of limb-threatening compromise from phlegmasia cerulean dolens, development of post-thrombotic syndrome, and death secondary to pulmonary embolism. Endovascular iliocaval reconstruction is an effective treatment for iliocaval thrombosis with high levels of technical success, favorable clinical outcomes and stent patency rates, and few complications. It is often able to relieve the debilitating symptoms experienced by affected patients and is a viable option for patients who fail conservative management.

ACR Appropriateness Criteria Lower Extremity Arterial Revascularization-Post-Therapy Imaging.

Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or occlusion of previously treated vessels remains a pervasive issue in the postoperative setting.

Total Endovascular Iliocaval Reconstruction Using Polytetrafluoroethylene Stent-Graft Placement for the Treatment of Inferior Vena Cava Resection.

Resection of the inferior vena cava (IVC) is a rare surgical technique that is occasionally combined with nephrectomy in the setting of renal malignancy with intravascular tumor extension. While this may be fairly well tolerated in some patients due to extensive collateralization in the venous system, there is a clear potential for lower extremity venous insufficiency and deep vein thrombosis (DVT). This report describes a patient who underwent right nephrectomy and segmental IVC resection from the subhepatic space to the iliac confluence, which was complicated by profoundly symptomatic lower extremity DVT and gastrointestinal hemorrhage due to system-to-portal shunting.

Interventional Radiology-Operated Endoscopy as an Adjunct to Image-Guided Interventions.

Purpose: Interventional radiology-operated endoscopy is an underused technique, which may have a significant impact on the ability to treat patients with a variety of conditions. The purpose of this article is to discuss the setup, equipment, and potential clinical uses of interventional radiology-operated endoscopy.

Methods: A number of new and innovative interventions may be performed in the biliary, genitourinary, and gastrointestinal systems through percutaneous access that interventional radiologists already create.

Interventional radiology-operated endoscopy-assisted retrograde transnasal placement of a retrievable transhepatic covered biliary stent.

Biliary stent placement is an adjunct for complex biliary intervention. Patients with benign biliary strictures or aversion to external drainage may benefit from placement of retrievable biliary stents. This report describes a patient with a working diagnosis of benign biliary stricture who underwent interventional radiology-operated endoscopy-guided transnasal placement of a fully covered retrievable biliary stent.

Transgastric jejunal snare technique facilitates primary jejunostomy placement.

Placement of percutaneous jejunostomy tubes using fluoroscopy may be technically challenging because of the peristaltic motion of small bowel loops within the peritoneum. Furthermore, fluoroscopic jejunostomy placement has an inherent risk of complications, including peritonitis and death. A transnasal snare technique to facilitate direct jejunostomy in patients with a surgically altered gastric anatomy has been previously reported.

Endovascular iliocaval reconstruction for the treatment of iliocaval thrombosis: From imaging to intervention.

Thrombosis of the inferior vena cava and iliac veins, known as iliocaval thrombosis, is a common cause of significant morbidity. Patients with chronic iliocaval obstruction often present with life-limiting occlusive symptoms secondary to recurrent lower extremity deep venous thrombosis, swelling, pain, venous stasis ulcers, or phlegmasia. Endovascular iliocaval reconstruction is a technically successful procedure that results in favorable clinical outcomes and stent patency rates with few complications and is often able to relieve debilitating symptoms in affected patients.

Single-session total endovascular iliocaval reconstruction with stent grafting for the treatment of inferior vena cava agenesis and concurrent iliac venous aneurysm rupture.

Iliac venous aneurysms are rare vascular abnormalities that may be manifested by abdominal masses, pelvic tenderness, or hypovolemia and may lead to rupture, thrombosis, pulmonary embolism, paradoxical embolism, or death. Inferior vena cava agenesis, like venous aneurysm, is an uncommon condition that may present with deep venous thrombosis. This report describes a patient with inferior vena cava agenesis and iliac venous aneurysm rupture treated with emergent iliocaval reconstruction and endovascular stent graft placement.