Percutaneous Orthotopic IVC Construction in a Pediatric Patient with Symptomatic IVC Agenesis.

Inferior vena cava agenesis is an uncommon condition usually attributed to embryologic dysgenesis. When symptomatic, unprovoked deep venous thrombosis and/or lower extremity venous congestion are the most frequent manifestations. Its rarity has precluded consensus regarding appropriate management.

Atherosclerotic renal artery stenosis in the post-CORAL era part 2: new directions in Transcatheter Nephron Salvage following flawed revascularization trials.

Unlike endovascular therapeutic studies for atherosclerosis in many other vascular beds, major trials regarding endovascular renovascular revascularization have resulted in a stagnating equipoise. However, every major trial completed for this topic thus far has suffered from major methodological flaws that limit the validity and external generalizability of their results. Furthermore, certain patient populations who are known to benefit from renovascular revascularization may never be studied because they cannot be ethically withheld from life-saving treatment.

Transjugular liver access cannula as a guiding instrument for the recanalization of chronic venous occlusions.

Background: Chronic venous occlusions can result in debilitating symptoms and can be refractory to standard methods of venous recanalization because of the formation of dense fibrous tissue. A transjugular liver access cannula can be incorporated into recanalization efforts to treat such refractory cases. This report describes our experience using the transjugular liver access cannula technique in nine patients.

Atherosclerotic renal artery stenosis in the post-CORAL era part 1: the renal penumbra concept and next-generation functional diagnostic imaging.

After three neutral trials in which renal artery stenting failed to improve renal function or reduce cardiovascular and renal events, the controversy surrounding diagnosis and treatment of atherosclerotic renal artery stenosis and renovascular hypertension has led to paradigm shifts in the diagnostic algorithm. Noninvasive determination of earlier events (cortex hypoxia and renal artery hemodynamic changes) will supersede late sequelae (calcific stenosis, renal cortical thinning). Therefore, this review proposes the concept of renal penumbra in defining at-risk ischemic renal parenchyma.

Brachial Artery Access.

Low brachial artery access is a safe alternative approach for the interventionalist when the femoral artery approach is not feasible or desirable. One important advantage of upper extremity access is the favorable route of entry from above into the caudally oriented visceral arteries. Although the risk of complications is low for experienced operators, meticulous attention to technique and knowledge of local anatomy are imperative to safely use brachial artery access.

Renal artery stenosis: imaging options, pitfalls, and concerns.

Renal artery stenosis can be diagnosed with multiple imaging modalities, each one having different risk vs accuracy tradeoffs. Catheter angiography with pressure gradient measurements is the definitive gold standard but also the most invasive and thus reserved primarily for imaging at the time of renal revascularization. Ultrasonography is the safest and least expensive but also the least accurate and most operator-dependent.

Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators.

Purpose: To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials.

Methods: Diagnostic management recommendations were formulated based on results of the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) and outcome studies.

Results: The PIOPED II investigators recommend stratification of all patients with suspected pulmonary embolism according to an objective clinical probability assessment.

Multidetector computed tomography for acute pulmonary embolism.

Background: The accuracy of multidetector computed tomographic angiography (CTA) for the diagnosis of acute pulmonary embolism has not been determined conclusively.

Methods: The Prospective Investigation of Pulmonary Embolism Diagnosis II trial was a prospective, multicenter investigation of the accuracy of multidetector CTA alone and combined with venous-phase imaging (CTA-CTV) for the diagnosis of acute pulmonary embolism. We used a composite reference test to confirm or rule out the diagnosis of pulmonary embolism.

Three-dimensional MR angiography in imaging platinum alloy stents.

Purpose: To evaluate visualization inside platinum stents with three-dimensional contrast-enhanced magnetic resonance angiography (CE-MRA).

Materials And Methods: Breath-hold three-dimensional gadolinium (Gd) MRA was performed on 18 patients with 22 platinum stents in the renal (n = 18), celiac (n = 1), superior mesenteric (n = 1), and iliac (n = 2) arteries. Electronic calibers were used to measure the lumen diameter within the stent and just distal to the stent to calculate percent stenosis.