Adrenal Vein Sampling Results and Surgical Outcomes in Patients with Nonsuppressed Plasma Renin Activity.

Purpose: To determine adrenal vein sampling (AVS) and postadrenalectomy outcomes in patients with a nonsuppressed plasma renin activity (PRA) and elevated aldosterone-to-renin ratio (ARR).

Materials And Methods: The study sample included 23 patients with an ARR of >20 and PRA of >1 ng/mL/h (nonsuppressed group) and 69 patients with an ARR of >20 and PRA of <0.6 ng/mL/h (suppressed group) who underwent AVS from 2006 to 2023.

Percutaneous Management of Dialysis Access Steal Syndrome: Interventions and Outcomes from a Single Institution's 20-Year Experience.

Purpose: To determine safety and effectiveness of percutaneous interventions performed by interventional radiologists at a single institution over 2 decades in patients with dialysis access steal syndrome (DASS).

Materials And Methods: A retrospective review of fistulograms from 2001 to 2021 (N = 11,658) was performed. In total, 286 fistulograms in 212 patients with surgically created dialysis accesses met inclusion criterion of fistulography for suspected DASS.

Supply Costs in Complex and Routine Inferior Vena Cava Filter Retrieval: 10 Years' Data from a Single Center.

Purpose: To characterize the medical supply costs associated with inferior vena cava filter retrieval (IVCFR) using endobronchial forceps (EFs), a snare, or Recovery Cone (RC).

Materials And Methods: In total, 594 of 845 IVCFRs attempted at a tertiary referral hospital between October 1, 2012, and June 20, 2022 were categorized by intended retrieval strategy informed by, rotational cavography as follows: (a) EF (n = 312) for tilted or tip-embedded/strut-embedded filters and for long-dwelling closed-cell filters and (b) a snare (n = 255) or (c) RC (n = 27) for other well-positioned filters with or mostly without hooks, respectively. List prices of relevant supplies at time of retrieval were obtained or, rarely, estimated using a standard procedure.

Quality Improvement Report: Design and Implementation of a Radiology E-Consult Service.

Electronic consultations (e-consults) mediated through an electronic health record system or web-based platform allow synchronous or asynchronous physician-to-physician communication. E-consults have been explored in various clinical specialties, but relatively few instances in the literature describe e-consults to connect health care providers directly with radiologists.The authors outline how a radiology department can implement an e-consult service and review the development of such a service in a large academic health system.

A Practical Guide for Left Adrenal Vein Sampling in Patients with Left Renal Vein Variants.

Background: The presence of left renal vein (LRV) variants can increase the complexity of adrenal vein sampling (AVS), an already technically demanding procedure. While AVS literature often focuses on the right adrenal vein, an understanding of common LRV variants, their relationship with the left adrenal vein, and principles for successful catheterization can facilitate AVS. This guide provides practical, technical tips for AVS for duplicated (Du), circumaortic (Ca), and retroaortic (Ra) LRVs.

Outcomes following Exchange and Upsizing of Malfunctioning Small-Caliber Double-J Ureteral Stents.

Purpose: To determine the effectiveness of exchange and upsizing of malfunctioning small-caliber double-J (JJ) ureteral stents.

Materials And Methods: Thirty-one patients with malfunctioning cystoscopically placed small-caliber (6 or 7 F) JJ stents underwent transurethral (n = 28) or transrenal (n = 3) exchange and upsizing to a large-caliber (10 F) JJ stent from 2013 to 2022. Ureteral obstruction was malignant in 20 patients (65%) and benign in 11 (35%).

Dialysis Access-Associated Steal Syndrome and Management.

Dialysis-associated steal syndrome (DASS) occurs in 1-8% of hemodialysis patients with arteriovenous (AV) access. Major risk factors include use of the brachial artery for access creation, female sex, diabetes, and age > 60 years. DASS carries severe patient morbidity including tissue or limb loss if not recognized and managed promptly, as well as increased mortality.

Comparison of Fibered versus Nonfibered Coils for Venous Embolization in an Ovine Model.

Purpose: To compare nylon fibered (F) with nonfibered (NF) coils for embolization in an ovine venous model.

Materials And Methods: Four- to 8-mm-diameter, 0.035-inch F and NF coils were deployed in 24 veins in 6 sheep.

Tricks of the trade: Techniques for preoperative localization in reoperative parathyroidectomy.

Background: Reoperative parathyroidectomy for recurrent/persistent primary hyperparathyroidism (PHPT) has high rates of failure. The goal of this study was to analyze our experience with imaging and parathyroid vein sampling (PAVS) for recurrent/persistent PHPT.

Methods: We performed a retrospective cohort study (2002-2018) of patients with recurrent/persistent PHPT undergoing reoperative parathyroidectomy.

Choosing the right treatment for the right lesion, Part II: a narrative review of drug-coated balloon angioplasty and its evolving role in dialysis access maintenance.

Background And Objective: Drug-coated balloons (DCBs) seek to inhibit restenosis in treated hemodialysis access lesions by delivering an anti-proliferative agent (paclitaxel) into the vessel wall. While DCBs have proven effective in the coronary and peripheral arterial vasculature, the evidence for their use in arteriovenous (AV) access has been less robust. In part two of this review, a comprehensive overview of DCB mechanisms, implementation, and design is provided, followed by an examination of the evidence basis for their use in AV access stenosis.

Choosing the right treatment for the right lesion, part I: a narrative review of the role of plain balloon angioplasty in dialysis access maintenance.

Background And Objective: The majority of patients with end-stage renal disease (ESRD) requiring hemodialysis (HD) do so via an arteriovenous fistula (AVF) or graft. Both of these accesses are complicated by dysfunction related to neointimal hyperplasia (NIH) and subsequent stenosis. Percutaneous balloon angioplasty using plain balloons is the first line treatment for clinically-significant stenosis, with excellent initial response rates, however, with poor long-term patency and need for frequent reintervention.

Surgical Referral for Hemodialysis Access Maintenance.

Hemodialysis access is the lifeline for end-stage renal disease patients. However, dialysis access is associated with a host of complications, including thrombosis, recurrent stenosis, infection, aneurysmal changes and bleeding. Although endovascular therapy remains the first-line treatment owing to its less invasive nature, there are certain situations where surgical referral is recommended or even necessary.

Endobronchial Forceps Retrieval of Embedded Inferior Vena Cava Filters: Retrieval of 535 Filters at a Single Center.

Purpose: To report results of 16 years of using the endobronchial forceps technique to remove embedded inferior vena cava (IVC) filters.

Materials And Methods: Between January 2005 and June 2021, 534 patients (310 women and 224 men) with a mean age of 52 years (standard deviation [SD] ± 16 years) presented for complex filter retrieval of 535 tip- or strut-embedded IVC filters. Tip-embedded filters were diagnosed on rotational venography.

Grasp-and-Fold Technique for Complex Inferior Vena Cava Filter Retrieval.

This study evaluated the use of the grasp-and-fold technique for complex forceps retrieval of inferior vena cava (IVC) filters. A retrospective study of 14 patients (12 women and 2 men) who had either deeply tip-embedded or severely distorted IVC filters was performed at a single institution over 10 years. In this technique, endobronchial forceps were used to fold the filter in half to remove it through the sheath because the filter tip could not be accessed by dissection.

Adrenal Vein Sampling Results and Surgical Outcomes in Patients with a Normal Plasma Aldosterone Concentration.

Purpose: To determine the utility of adrenal vein sampling (AVS) and outcomes after adrenalectomy in patients with normal plasma aldosterone concentration (PAC) and elevated aldosterone-to-renin ratio (ARR).

Materials And Methods: The study sample included 106 patients with ARR greater than 20 and PAC between 5 and 15 ng/dL (normal PAC group) who underwent AVS from 2005 to 2021. These patients were compared with a cohort of 106 patients with ARR >20 and PAC >15 ng/dL (high PAC group) who underwent AVS during the same period.

Iatrogenic Renal Artery Injury in 90 Cases: Arteriographic Findings and Outcomes after Embolization for Bleeding.

Purpose: To evaluate differences in arteriographic findings and outcomes after embolization among patients with a suspected iatrogenic renal arterial injury (IRAI).

Materials And Methods: Patients at the authors' institution who underwent renal arteriography for suspected IRAIs after partial nephrectomy, biopsy, or percutaneous access over a 20-year period were included. Records, imaging, and outcomes were reviewed.

Local Anesthesia in Interventional Radiology.

Interventional radiology is an evolving field that treats a variety of diseases. Local anesthetics is an important component of pain management during interventional radiologic procedures. It is highly effective and generally safe for routine procedures.

Techniques in adrenal vein sampling: Multipurpose catheter shape facilitates sampling of cranially oriented right adrenal veins.

Adrenal vein sampling (AVS) failure is often attributed to difficulty sampling the right adrenal vein (RAV). Normally, the RAV is caudally oriented, however, cranial orientation of the RAV is not uncommon. In such cases, use of a multipurpose (MPA) catheter shape may facilitate sampling.

Stability of Retained Inferior Vena Cava Filter Fragments after Filter Removal.

Purpose: To assess the stability and outcome of fractured inferior vena cava (IVC) filter fragments that are retained in patients after IVC filter removal.

Materials And Methods: A retrospective analysis was conducted on all patients at a single tertiary referral center between May 2005 and June 2020 with fractured IVC filters where fragment(s) were retained after removal of the main filter body. IVC filter fragment stability was assessed by a clinician review of computed tomography images, chosen from available radiologic studies, to best visualize the fragments.