Atypical presentation of subclavian steal syndrome with left sided sensorineural deafness.

We present a rare manifestation of a common pathology: left sided sensorineural hearing loss secondary to subclavian steal syndrome after thoracic endovascular aortic repair for complicated acute aortic dissection. We describe the vascular physiology that can result in unilateral hearing loss and provide a brief review of subclavian steal syndrome. This case report highlights the importance of avid clinical recognition of an atypical presentation of a common vascular disease.

Endovascular Management of Chronic Type B Aortic Dissection.

Acute uncomplicated type B aortic dissection (aTBAD) is often treated non operatively, with medical management primarily focused on blood pressure and heart rate control. After a 3 month period following the initial diagnosis, the dissection is considered chronic. Frequent clinical and imaging follow-up is performed to evaluate for dissection stability, aneurysmal degeneration, and visceral malperfusion, which would represent indication for surgical or endovascular repair.

Hybrid repair for acute aortic occlusion using aortobifemoral bypass and AngioVac thrombectomy.

Aortic thrombus with multilevel acute ischemia is rare. We report the use of vacuum-assisted thrombectomy of an aortic mural thrombus with superior mesenteric artery involvement causing bilateral lower extremity ischemia and acute mesenteric ischemia, in conjunction with embolectomy and fasciotomy. We describe the novel use of the AngioVac device (AngioDynamics, Latham, NY) for reperfusion in the systemic arterial circulation.

Recent Trends in Clinical Setting and Provider Specialty for Endovascular Peripheral Artery Disease Interventions for the Medicare Population.

Purpose: To describe national trends in peripheral endovascular interventions by physician specialty, anatomic segment of disease, and clinical location of service.

Materials And Methods: Current Procedural Terminology codes were used to identify claims for peripheral vascular interventions (PVIs) in 2011-2017 Physician Supplier Procedure Summary master files, which contain 100% Part B Medicare billing. Market share was defined as enrollment-adjusted proportion of billed PVI services for each specialty.

Sex-dependent outcomes following elective endovascular aortic repair.

Background: Evidence has shown that women derive less benefit from endovascular aortic repair (EVAR) in large part due to more challenging aortoiliac anatomy. This study sought to examine whether sex-dependent outcomes exist following elective EVAR cases.

Methods: An institutional retrospective review was performed on patients who underwent elective EVAR procedures between 2008 and 2014.

Disseminated Mycotic Aneurysms following Intravesical Bacillus Calmette-Guérin Therapy for Bladder Cancer: Case Discussion and Systematic Treatment Algorithm.

Numerous case reports have highlighted the relationship between bacillus Calmette-Guérin (BCG) therapy and development of systemic mycotic aneurysms but none have established a management algorithm in patients with suspected vascular dissemination of Mycobacterium bovis. Delay in diagnosis of this disease process will lead to delays in initiation of antimycobacterium treatment to prevent dissemination into other arterial beds and potentially complicate effective surgical treatment leading to aneurysmal rupture and other devastating vascular consequences. Given the increasing number of reported cases in the literature and the ongoing, standard of care utilization of BCG for bladder cancer, we believe that a systematic approach to the management of patients with suspected BCG-related mycotic aneurysms should be set in place to prevent misdiagnosis and delays in treatment.

Lumbar Sympathetic Neurolysis: How to and When to Use?

Lumbar sympathectomy was historically a mainstay of treatment for arterial occlusive disease and other vasospastic disorders, before the development of contemporary arterial reconstructive procedures either by surgical or endovascular means. Today, percutaneous methods of sympathetic blockade are possible using chemical neurolytic or ablative modalities. Lumbar sympathetic neurolysis is generally reserved for those patients with ischemic rest pain in the setting of nonreconstructable arterial occlusive disease, although patients with complex regional pain syndrome, peripheral neuralgia, vasospastic disorders, and various other disease states such as plantar hyperhydrosis may also benefit.

Evaluation of catheter infection rates in converted dialysis catheters versus de novo placement in the setting of chlorhexidine use.

Purpose: Prior studies have reported infection rates of converting non-tunneled dialysis catheters (NTDCs) to tunneled dialysis catheters (TDCs) versus de novo placement of TDCs using povidone-iodine. Chlorhexidine, per the Center of Disease Control guidelines, has been exclusively used in our institution since 2005. Therefore, our study aims to determine whether there is a difference in infection rates between conversion and de novo placement when utilizing chlorhexidine.

Current Status of Percutaneous Endografting.

Totally percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) using suture-mediated closure devices (SMCDs) has several well-established advantages over standard open femoral exposure as a direct consequence of being less invasive and having shorter times to hemostasis and procedure completion. The first multicenter randomized controlled trial designed to assess the safety and efficacy of PEVAR and to compare percutaneous access with standard open femoral exposure was recently published (the PEVAR trial). The PEVAR trial demonstrated that percutaneous endografting is safe, effective, and noninferior to standard open femoral exposure among trained operators.

Safety and efficacy of transarterial chemoembolization in patients with transjugular intrahepatic portosystemic shunts.

Background: Transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) is an important option as the majority of patients present with advanced disease. Data regarding treatment outcomes in patients who have undergone transjugular intrahepatic portosystemic shunts (TIPS) are limited. The present study seeks to evaluate the safety and efficacy of TACE in HCC patients with a TIPS.

A single-center experience in capturing inpatient evaluation and management for an IR practice.

Purpose: To demonstrate that interventional radiologists can capture work relative value units (wRVUs) for the work that is already being performed providing evaluation and management (E&M) clinical services.

Materials And Methods: A team approach was implemented to optimize revenue capture for inpatient E&M. Structured templates were created for inpatient documentation to ensure that maximum wRVUs were captured.

Endovascular management of acute aortic syndromes.

The term "acute aortic syndrome" (AAS) refers to a spectrum of life-threatening thoracic aortic pathologies including intramural hematoma, penetrating atherosclerotic ulcer, and aortic dissection. Clinically, patients often present with characteristic aortic pain. AAS often leads to aortic rupture.

Longitudinal quality of life assessment of patients with hepatocellular carcinoma after primary transarterial chemoembolization.

Purpose: To determine the effects of primary chemoembolization on the health-related quality of life (HRQOL) of patients with hepatocellular carcinoma (HCC).

Materials And Methods: Single-center prospective data collection with longitudinal analysis of HRQOL scores obtained via the Short Form-36 (SF-36) assessment tool was performed before and during serial chemoembolization procedures in 73 patients with HCC. Baseline HRQOL scores were evaluated for significant (P < .

Percutaneous revascularization of chronic total occlusions.

Many patients with severe intermittent claudication (IC) or critical limb ischemia (CLI) have chronic total occlusions (CTO) in their lower extremity vascular bed. The successful treatment of these lesions is becoming increasingly more important as the population ages and the prevalence of diseases such as diabetes mellitus and its consequences increases. Many of these patients have significant comorbidities and may benefit from less invasive treatment options.

Resonance metallic ureteral stents do not successfully treat ureteroenteric strictures.

Purpose: To report the outcomes of patients with ureteroenteric strictures after ileal conduit urinary diversion that were managed with Resonance metallic ureteral stents.

Patients And Methods: Ten ureteroenteric strictures in patients with ileal conduits that were managed with metallic ureteral stenting were retrospectively identified. Charts were examined for patient age, anastomosis type, stricture cause, stricture laterality, complications, and follow-up.

Safety and effectiveness of repeat arterial closure using the AngioSeal device in patients with hepatic malignancy.

Purpose: To retrospectively evaluate the safety and effectiveness of the use of the AngioSeal device for repeat arterial closure in patients with hepatic malignancy.

Materials And Methods: A retrospective analysis of patients with hepatic malignancy who had undergone repeated arterial closure with the AngioSeal device was performed. All charts for patients undergoing transarterial chemoembolization or TheraSphere radioembolization were reviewed for the method of hemostasis and the number of arterial closures.

The extent of lower extremity occlusive disease predicts short- and long-term patency following endovascular infrainguinal arterial intervention.

Background: Endovascular revascularization of the femoral-politeal arterial segment has gained acceptance despite lower patency than surgical bypass due to lower morbidity. Choosing patients that are ideal candidates for endovascular therapy remains controversial. We have assessed hemodynamic factors that might predict longer primary patency after endovascular therapy.

Asymptomatic lumbar vertebral erosion from inferior vena cava filter perforation.

In 2002, a 24-year-old female trauma patient underwent prophylactic inferior vena cava filter placement. Recurrent bouts of renal stones prompted serial CT imaging in 2004. In this brief report, we describe erosion and ossification of the L3 vertebral body by a Greenfield filter strut.

Chemoembolization in patients at high risk: results and complications.

Purpose: Transarterial chemoembolization (TACE) has become a standard treatment option for unresectable hepatocellular carcinoma (HCC) and is often used to palliate hepatic metastases. Many patients who are candidates for TACE present with poor hepatic reserve, advanced tumor stage with major portal vein (PV) invasion or thrombosis, and/or biliary dilation. These factors have been associated with a poor prognosis and increased complications after chemoembolization.