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Kim, Charles Yoon

Overview:

Minimally invasive treatments of solid tumors including thermal ablation, embolization, and radioembolization, endovascular strategies for treatment of central venous pathology, salvage therapy for failing hemodialysis access,  complex enteral access,  MR angiography, and bariatric embolization for obesity.

Positions:

Associate Professor of Radiology

Radiology, Interventional Radiology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2001

M.D. — Columbia University

Grants:

Percutaneous insertion of an extraluminal subcutaneous arterial bypass graft

Administered By
Radiology, Interventional Radiology
AwardedBy
Radiological Society of North America
Role
Principal Investigator
Start Date
July 01, 2015
End Date
June 30, 2018

Optimization of radiofrequency ablation with electrically conductive particles

Administered By
Radiology, Interventional Radiology
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
August 14, 2015
End Date
January 31, 2018

Investigation of mechanisms of thermal ablation zone enlargement

Administered By
Radiology, Interventional Radiology
AwardedBy
Radiological Society of North America
Role
Principal Investigator
Start Date
July 01, 2016
End Date
June 30, 2017

Investigation of mechanisms of thermal ablation zone enlargment

Administered By
Radiology, Interventional Radiology
AwardedBy
SIR Foundation
Role
Principal Investigator
Start Date
July 01, 2016
End Date
June 30, 2017

Cryoablation versus Radiofrequency Ablation of Collagenous Peri-Joint Structures in a Porcine Model

Administered By
Radiology, Interventional Radiology
AwardedBy
Galil Medical, Inc.
Role
Principal Investigator
Start Date
January 07, 2014
End Date
December 31, 2014

Bacteriophage Antimicrobial-Lock Technique for Staphylococcus Aureus Central Venous Parenteral Nutrition Catheter

Administered By
Radiology, Interventional Radiology
AwardedBy
Centers for Disease Control and Prevention
Role
Principal Investigator
Start Date
November 28, 2011
End Date
November 28, 2013
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Publications:

Pilot Evaluation of Angiogenesis Signaling Factor Response after Transcatheter Arterial Embolization for Hepatocellular Carcinoma.

Purpose To identify changes in a broad panel of circulating angiogenesis factors after bland transcatheter arterial embolization (TAE), a purely ischemic treatment for hepatocellular carcinoma (HCC). Materials and Methods This prospective HIPAA-compliant study was approved by the institutional review board. Informed written consent was obtained from all participants prior to entry into the study. Twenty-five patients (21 men; mean age, 61 years; range, 30-81 years) with Liver Imaging Reporting and Data System category 5 or biopsy-proven HCC and who were undergoing TAE were enrolled from October 15, 2014, through December 2, 2015. Nineteen plasma angiogenesis factors (angiopoietin 2; hepatocyte growth factor; platelet-derived growth factor AA and BB; placental growth factor; vascular endothelial growth factor A and D; vascular endothelial growth factor receptor 1, 2, and 3; osteopontin; transforming growth factor β1 and β2; thrombospondin 2; intercellular adhesion molecule 1; interleukin 6 [IL-6]; stromal cell-derived factor 1; tissue inhibitor of metalloproteinases 1; and vascular cell adhesion molecule 1 [VCAM-1]) were measured by using enzyme-linked immunosorbent assays at 1 day, 2 weeks, and 5 weeks after TAE and were compared with baseline levels by using paired Wilcoxon tests. Tumor response was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Angiogenesis factor levels were compared between responders and nonresponders by mRECIST criteria by using unpaired Wilcoxon tests. Results All procedures were technically successful with no complications. Fourteen angiogenesis factors showed statistically significant changes following TAE, but most changes were transient. IL-6 was upregulated only 1 day after the procedure, but showed the largest increases of any factor. Osteopontin and VCAM-1 demonstrated sustained upregulation at all time points following TAE. At 3-month follow-up imaging, 11 patients had responses to TAE (complete response, n = 6; partial response, n = 5) and 11 patients were nonresponders (stable disease, n = 9; progressive disease, n = 2). In nonresponders, the percent change in IL-6 on the day after TAE (P = .033) and the mean percent change in osteopontin after TAE (P = .024) were significantly greater compared with those of responders. Conclusion Multiple angiogenesis factors demonstrated significant upregulation after TAE. VCAM-1 and osteopontin demonstrated sustained upregulation, whereas the rest were transient. IL-6 and osteopontin correlated significantly with radiologic response after TAE. © RSNA, 2017.

Authors
Ronald, J; Nixon, AB; Marin, D; Gupta, RT; Janas, G; Chen, W; Suhocki, PV; Pabon-Ramos, W; Sopko, DR; Starr, MD; Brady, JC; Hurwitz, HI; Kim, CY
MLA Citation
Ronald, J, Nixon, AB, Marin, D, Gupta, RT, Janas, G, Chen, W, Suhocki, PV, Pabon-Ramos, W, Sopko, DR, Starr, MD, Brady, JC, Hurwitz, HI, and Kim, CY. "Pilot Evaluation of Angiogenesis Signaling Factor Response after Transcatheter Arterial Embolization for Hepatocellular Carcinoma." Radiology 285.1 (October 2017): 311-318.
PMID
28787261
Source
epmc
Published In
Radiology
Volume
285
Issue
1
Publish Date
2017
Start Page
311
End Page
318
DOI
10.1148/radiol.2017162555

Creation of an Extraluminal Arterial Bypass Graft Using a Commercially Available Self-Expanding Stent Graft: Feasibility Study in a Porcine Model.

The purpose of this study was to assess the technical feasibility of ultrasound-guided endovascular creation of a percutaneous extraluminal arterial bypass graft without a surgically created arterial anastomosis.Nine swine were utilized for this IACUC-approved study using a carotid bypass model in swine. Using sonographic guidance, percutaneous access was obtained to the proximal and distal common carotid artery. A self-expanding stent graft was advanced through the proximal carotid access site, tunneled subcutaneously, then advanced through the distal carotid access site, and deployed. The stent grafts were monitored weekly for patency using ultrasound. Angiography was performed at 4 weeks to evaluate for graft patency. Gross pathologic analysis was performed on the explanted stent grafts.In eight out of the nine swine (89%), percutaneous extraluminal bypass graft creation was technically successful, with brisk flow through the stent graft to the distal circulation, complete exclusion of the bypassed segment of carotid artery, and no extravasation. The technical failure was due to stent graft maldeployment. Of the six swine evaluated for patency, four grafts were patent at the 4-week end point. Both occluded stent grafts were due to extraluminal extrusion of one end, likely related to neck movement and growth in neck length.The percutaneous arterial bypass technique had a high technical success rate and a graft patency rate of 67% at 4 weeks, with early occlusions possibly related to limitations of the animal model.

Authors
Stewart, JK; Perkins, SS; Kim, CY
MLA Citation
Stewart, JK, Perkins, SS, and Kim, CY. "Creation of an Extraluminal Arterial Bypass Graft Using a Commercially Available Self-Expanding Stent Graft: Feasibility Study in a Porcine Model." Cardiovascular and interventional radiology 40.9 (September 2017): 1447-1453.
PMID
28474113
Source
epmc
Published In
CardioVascular and Interventional Radiology
Volume
40
Issue
9
Publish Date
2017
Start Page
1447
End Page
1453
DOI
10.1007/s00270-017-1672-7

Hemorrhage risk with transjugular intrahepatic portosystemic shunt (TIPS) insertion at the main portal vein bifurcation with stent grafts.

The purpose of this study was to assess the incidence of major hemorrhage after transjugular intrahepatic portosystemic shunt (TIPS) insertion using a stent graft at the main portal vein bifurcation.TIPS insertion using stent grafts was performed in 215 patients due to non-variceal hemorrhage indications. There were 137 men and 78 women, with a mean age of 57 years±10.6 (SD) (range: 19-90 years). Based on retrospective review of portal venograms, TIPS inserted within 5mm from the portal vein bifurcation were considered "bifurcation TIPS", while those inserted 2cm or greater from the bifurcation were considered intrahepatic. Suspicion for acute major periprocedural hemorrhage were categorized as low, moderate, and high, based on the number of signs of hemorrhage.Of 215 TIPS inserted for purposes other than hemorrhage, the TIPS was inserted at the portal bifurcation in 41 patients (29 men, 12 women; mean age, 55.9±11.7 (SD); range: 26-79 years) and intrahepatic in 62 patients (37 men, 25 women; mean age, 57.6±10.6 (SD), range: 34-82 years), whereas 112 were indeterminate in location. No active extravasations were identified on post-TIPS portal venograms. Suspicion for acute major hemorrhage was moderate or high in 3/41 (7%) of patients in the TIPS bifurcation group compared to 5/62 (8%) in the intrahepatic TIPS group (P>0.99). There were no significant differences in 30-day mortality rates (1/41 [2%] and 3/62 [5%] respectively; P> 0.99). No deaths or interventions were attributed to acute hemorrhage.TIPS insertion at the portal bifurcation with stent grafts did not incur an elevated risk of hemorrhagic complications.

Authors
Griffin, AS; Preece, SR; Ronald, J; Smith, TP; Suhocki, PV; Kim, CY
MLA Citation
Griffin, AS, Preece, SR, Ronald, J, Smith, TP, Suhocki, PV, and Kim, CY. "Hemorrhage risk with transjugular intrahepatic portosystemic shunt (TIPS) insertion at the main portal vein bifurcation with stent grafts." Diagnostic and interventional imaging (August 23, 2017).
PMID
28843589
Source
epmc
Published In
Diagnostic and Interventional Imaging
Publish Date
2017
DOI
10.1016/j.diii.2017.07.006

MR Venography of the Central Veins of the Thorax.

While imaging of the central venous system has traditionally been performed with conventional venography, MR venography (MRV) has emerged as an important modality as techniques and validation studies have evolved over time. While magnetic resonance angiography has a very robust representation in the literature, the proportion representing MRV is relatively sparse. The purpose of this article is to review the indications, techniques, and dedicated studies validating MRV of the central veins of the thorax.

Authors
Cline, B; Hurwitz, LM; Kim, CY
MLA Citation
Cline, B, Hurwitz, LM, and Kim, CY. "MR Venography of the Central Veins of the Thorax." Topics in magnetic resonance imaging : TMRI 26.4 (August 2017): 167-174. (Review)
PMID
28777165
Source
epmc
Published In
Topics in Magnetic Resonance Imaging
Volume
26
Issue
4
Publish Date
2017
Start Page
167
End Page
174
DOI
10.1097/rmr.0000000000000139

Clinical implications of acute pelvicaliceal hematoma formation during percutaneous catheter nephrostomy insertion.

To determine the clinical implications of acute pelvicaliceal hematoma formation during percutaneous catheter nephrostomy (PCN) insertion.Collecting system hematoma burden was retrospectively assessed for 694 PCN insertions in 502 patients.Pelvicaliceal hematoma formation occurred in 146 kidneys (21%) in 136 patients. Clinically significant blood loss occurred in 3 patients with hematomas within one week compared to 4 patients without hematomas (p=0.39). Twenty-four patients with hematomas underwent catheter exchange within one week, compared to 55 patients without hematomas (p=0.49).Pelvicaliceal hematoma formation after PCN insertion is not uncommon and is associated with very rare clinical sequelae.

Authors
Stewart, JK; Smith, TP; Kim, CY
MLA Citation
Stewart, JK, Smith, TP, and Kim, CY. "Clinical implications of acute pelvicaliceal hematoma formation during percutaneous catheter nephrostomy insertion." Clinical imaging 43 (May 2017): 180-183.
PMID
28342336
Source
epmc
Published In
Clinical Imaging
Volume
43
Publish Date
2017
Start Page
180
End Page
183
DOI
10.1016/j.clinimag.2017.02.009

Treatment of central venous in-stent restenosis with repeat stent deployment in hemodialysis patients.

To report patency rates for stent deployment for treatment of in-stent stenosis of the central veins of the chest in hemodialysis patients.A retrospective analysis was performed on 29 patients who underwent 35 secondary percutaneous transluminal stent (PTS) deployments for in-stent stenosis within the central veins that were refractory to angioplasty and ipsilateral to a functioning hemodialysis access (in-stent PTS group). For comparison, patency data were acquired for 47 patients who underwent 78 successful percutaneous transluminal angioplasty (PTA) procedures for in-stent stenosis (in-stent PTA group) and 55 patients who underwent 55 stent deployments within native central vein stenosis refractory to angioplasty (native vein PTS group).The 3-, 6-, and 12-month primary lesion patency for the in-stent PTS group was 73%, 57%, and 32%, respectively. The 3-, 6-, and 12-month primary patency for the in-stent PTA group was 70%, 38%, and 17% and for the native vein PTS group was 78%, 57%, and 26%, which were similar to the in-stent PTS group (p = 0.20 and 0.41, respectively). The 3-, 6-, and 12-month secondary access patency was 91%, 73%, and 65% for the in-stent PTS group. Sub-analysis of the in-stent PTS group revealed no difference in primary (p = 0.93) or secondary patency rates (p = 0.27) of bare metal stents (n = 23) compared with stent grafts (n = 12).Stent deployment for central vein in-stent stenosis refractory to angioplasty was associated with reasonable patency rates, which were similar to in-stent PTA and native vein PTS.

Authors
Ronald, J; Davis, B; Guevara, CJ; Pabon-Ramos, WM; Smith, TP; Kim, CY
MLA Citation
Ronald, J, Davis, B, Guevara, CJ, Pabon-Ramos, WM, Smith, TP, and Kim, CY. "Treatment of central venous in-stent restenosis with repeat stent deployment in hemodialysis patients." The journal of vascular access 18.3 (May 2017): 214-219.
PMID
28430317
Source
epmc
Published In
The journal of vascular access
Volume
18
Issue
3
Publish Date
2017
Start Page
214
End Page
219
DOI
10.5301/jva.5000705

Early infection risk with primary versus staged Hemodialysis Reliable Outflow (HeRO) graft implantation.

This study evaluated whether the use of a staged Hemodialysis Reliable Outflow (HeRO; Merit Medical, South Jordan, Utah) implantation strategy incurs increased early infection risk compared with conventional primary HeRO implantation.A retrospective review was performed of 192 hemodialysis patients who underwent HeRO graft implantation: 105 patients underwent primary HeRO implantation in the operating room, and 87 underwent a staged implantation where a previously inserted tunneled central venous catheter was used for guidewire access for the venous outflow component. Within the staged implantation group, 32 were performed via an existing tunneled hemodialysis catheter (incidentally staged), and 55 were performed via a tunneled catheter inserted across a central venous occlusion in an interventional radiology suite specifically for HeRO implantation (intentionally staged). Early infection was defined as episodes of bacteremia or HeRO infection requiring resection ≤30 days of HeRO implantation.For staged HeRO implantations, the median interval between tunneled catheter insertion and conversion to a HeRO graft was 42 days. The overall HeRO-related infection rate ≤30 days of implantation was 8.6% for primary HeRO implantation and 2.3% for staged implantations (P = .12). The rates of early bacteremia and HeRO resection requiring surgical resection were not significantly different between groups (P = .19 and P = .065, respectively), nor were age, gender, laterality, anastomosis to an existing arteriovenous access, human immunodeficiency virus status, diabetes, steroids, chemotherapy, body mass index, or graft location. None of the patient variables, techniques, or graft-related variables correlated significantly with the early infection rate.The staged HeRO implantation strategy did not result in an increased early infection risk compared with conventional primary implantation and is thus a reasonable strategy for HeRO insertion in hemodialysis patients with complex central venous disease.

Authors
Griffin, AS; Gage, SM; Lawson, JH; Kim, CY
MLA Citation
Griffin, AS, Gage, SM, Lawson, JH, and Kim, CY. "Early infection risk with primary versus staged Hemodialysis Reliable Outflow (HeRO) graft implantation." Journal of vascular surgery 65.1 (January 2017): 136-141.
PMID
27687322
Source
epmc
Published In
Journal of Vascular Surgery
Volume
65
Issue
1
Publish Date
2017
Start Page
136
End Page
141
DOI
10.1016/j.jvs.2016.07.114

Randomized Controlled Trial of Octyl Cyanoacrylate Skin Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous Port Placement.

To compare early outcomes of skin closure with octyl cyanoacrylate skin adhesive versus subcuticular suture closure.Over a 7-month period, 109 subjects (28 men and 81 women; mean age, 58.6 y) scheduled to undergo single-lumen implantable venous port insertion for chemotherapy were randomly assigned to skin closure with either octyl cyanoacrylate skin adhesive or absorbable subcuticular suture after suturing the deep dermal layer. Subjects were followed for episodes of infection or dehiscence within 3 months of port implantation. At 3 months, photographs of the healed incision were obtained and reviewed by a plastic surgeon in a blinded fashion who rated cosmetic scar appearance based on a validated 10-point cosmesis score.Of subjects, 54 were randomly assigned to skin adhesive, and 55 were randomly assigned to subcuticular suture. No subjects had incision dehiscence. Infection rates at 3 months were similar between groups (2.1% vs 4.0%; P = 1.0). The mean cosmesis scores were 4.40 for skin adhesive and 4.46 for subcuticular suture (P = .898). The superficial skin closure time was 8.6 minutes for suture versus 1.4 minutes for skin adhesive (P < .001).Scar cosmesis and patient outcomes did not significantly vary between skin adhesive versus subcuticular suture, although skin closure time was significantly less with skin adhesive.

Authors
Martin, JG; Hollenbeck, ST; Janas, G; Makar, RA; Pabon-Ramos, WM; Suhocki, PV; Miller, MJ; Sopko, DR; Smith, TP; Kim, CY
MLA Citation
Martin, JG, Hollenbeck, ST, Janas, G, Makar, RA, Pabon-Ramos, WM, Suhocki, PV, Miller, MJ, Sopko, DR, Smith, TP, and Kim, CY. "Randomized Controlled Trial of Octyl Cyanoacrylate Skin Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous Port Placement." Journal of vascular and interventional radiology : JVIR 28.1 (January 2017): 111-116.
PMID
27836404
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
28
Issue
1
Publish Date
2017
Start Page
111
End Page
116
DOI
10.1016/j.jvir.2016.08.009

Bariatric Embolization: Pilot Study on the Impact of Gastroprotective Agents and Arterial Distribution on Ulceration Risk and Efficacy in a Porcine Model.

To assess whether the number of fundal arteries embolized and use of gastroprotective agents have an impact on ghrelin suppression and gastric ulceration rates.Twenty-two healthy, growing swine (mean, 38.4 kg; range, 30.3-47.0 kg) were evaluated. Six control swine underwent a sham procedure. Gastric embolization was performed by the infusion of 40-µm microspheres selectively into some or all gastric arteries supplying the gastric fundus. In group 1, 6 swine underwent embolization of all 4 arteries to the gastric fundus. In group 2, 5 swine underwent embolization of 2 gastric fundal arteries. In group 3, 5 swine underwent embolization of 1 gastric fundal artery. Animals in groups 2 and 3 were treated with gastroprotective agents (sucralfate and omeprazole). Weight and fasting plasma ghrelin levels were analyzed at baseline and at week 4. Upon animal euthanasia, gross analysis was performed for identification of ulcers.Only group 1 animals exhibited changes in serum ghrelin levels that rendered them significantly lower than those in control animals (P = .049). Group 3 animals exhibited marked elevations in serum ghrelin levels compared with control animals (P = .001). Gross pathologic evaluation revealed 0 ulcers in the control animals, 3 ulcers (50%) in group 1, 2 ulcers (40%) in group 2, and 2 ulcers (40%) in group 3.Administration of gastroprotective agents and embolization of fewer arteries to the gastric fundus did not prevent gastric ulceration in treated animals. Only animals that underwent embolization of all gastric arteries exhibited significant decreases in serum ghrelin levels.

Authors
Paxton, BE; Arepally, A; Alley, CL; Kim, CY
MLA Citation
Paxton, BE, Arepally, A, Alley, CL, and Kim, CY. "Bariatric Embolization: Pilot Study on the Impact of Gastroprotective Agents and Arterial Distribution on Ulceration Risk and Efficacy in a Porcine Model." Journal of vascular and interventional radiology : JVIR 27.12 (December 2016): 1923-1928.
PMID
27717647
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
27
Issue
12
Publish Date
2016
Start Page
1923
End Page
1928
DOI
10.1016/j.jvir.2016.07.021

Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden.

Patients with metastatic disease of the liver can have hyperbilirubinemia due to a number of reasons, including biliary obstruction. The purpose of this study was to analyze patient outcomes after percutaneous biliary drainage (PBD) catheter insertion in patients with extensive hepatic metastatic tumor burden.Out of 746 PBD insertions, 44 patients (24 males, 20 females, mean age 57.4 years, range, 34-80 years) had metastatic malignancy with a hepatic tumor burden of greater than 20% parenchymal volume based on pre-procedure computed tomography (CT) or magnetic resonance imaging (MRI). Laboratory data before and after PBD insertion were compared. Survival and outcomes analysis performed. A subanalysis was performed on patients with CT-demonstrated catheter traversal of tumoral tissue.A PBD catheter was successfully inserted in all patients. The mean serum bilirubin level decreased significantly from 10.9±6.4 mg/dL immediately prior to PBD insertion to 7.1±5.6 mg/dL (P<0.001) within one month post PBD insertion. Four patients (11%) demonstrated normalization of bilirubin levels to less than 1.6 mg/dL. Of the 14 patients with a post-procedure CT or MRI, the PBD catheter traversed a tumor in 11 (79%). One of these patients required a transfusion after the procedure and one had recurrent catheter exchanges due to pericatheter leakage. The 30-day overall survival was 41% with a median survival of 19 days. The percentage decrease in serum bilirubin after PBD insertion and pre-procedure international normalized ratio (INR) were correlated with improved survival (OR =3.7, P=0.010 and OR =4.9, P=0.028 respectively). The PBD-associated major complication rate was 16%.In patients with hyperbilirubinemia and extensive hepatic metastatic disease burden, survival was dismal after PBD catheter insertion. Serum bilirubin level normalization occurred rarely.

Authors
Langman, EL; Suhocki, PV; Hurwitz, HI; Morse, MA; Burbridge, RA; Smith, TP; Kim, CY
MLA Citation
Langman, EL, Suhocki, PV, Hurwitz, HI, Morse, MA, Burbridge, RA, Smith, TP, and Kim, CY. "Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden." Journal of gastrointestinal oncology 7.6 (December 2016): 875-881.
PMID
28078111
Source
epmc
Published In
Journal of Gastrointestinal Oncology
Volume
7
Issue
6
Publish Date
2016
Start Page
875
End Page
881
DOI
10.21037/jgo.2016.06.13

Patient and tumor characteristics predictive of an elevated hepatopulmonary shunt fraction before radioembolization of hepatic tumors.

To determine whether any patient or hepatic tumor characteristics are predictive of hepatopulmonary shunt fraction when performed before radioembolization.A retrospective review was performed on 190 patients who underwent preradioembolization hepatic arteriography with calculation of hepatopulmonary shunt fraction using technetium-99m-labeled macroaggregated albumin perfusion scintigraphy. Patient and tumor characteristics including imaging features were reviewed for correlation with absolute shunt fraction, shunt fraction greater than 10%, and shunt fraction greater than 20%.Most tumor types showed some cases of elevated shunt fraction greater than 10%. Six patients had a shunt fraction greater than 20%: four were hepatocellular carcinoma and two were neuroendocrine tumor metastases. Univariate analysis showed that dominant tumor diameter, hepatic tumor burden, vascular invasion, hepatic venous invasion, and hypervascularity on angiography were associated with a shunt fraction greater than 10%. Only dominant tumor diameter and vascular invasion were associated with a shunt fraction greater than 20%. On multivariate analysis, only tumor diameter (odds ratio 1.2) and hepatic venous invasion (odds ratio 23.0) were associated independently with an increased shunt fraction greater than 10%.Multiple patient and tumor-related characteristics were significantly correlated with the hepatopulmonary shunt fraction on univariate analysis. However, on multivariate analysis, only the dominant tumor diameter and presence of hepatic venous invasion were associated independently with a greater than 10% shunt fraction.

Authors
Yerubandi, V; Ronald, J; Howard, BA; Suhocki, PV; James, OG; Wong, TZ; Kim, CY
MLA Citation
Yerubandi, V, Ronald, J, Howard, BA, Suhocki, PV, James, OG, Wong, TZ, and Kim, CY. "Patient and tumor characteristics predictive of an elevated hepatopulmonary shunt fraction before radioembolization of hepatic tumors." Nuclear medicine communications 37.9 (September 2016): 939-946.
PMID
27104280
Source
epmc
Published In
Nuclear Medicine Communications
Volume
37
Issue
9
Publish Date
2016
Start Page
939
End Page
946
DOI
10.1097/mnm.0000000000000528

Application of a Novel CT-Based Iliac Artery Calcification Scoring System for Predicting Renal Transplant Outcomes.

The objective of our study was to assess whether the degree and distribution of iliac artery calcifications as determined by a CT-based calcium scoring system correlates with outcomes after renal transplant.A retrospective review of renal transplant recipients who underwent CT of the pelvis within 2 years before surgery yielded 131 patients: 75 men and 56 women with a mean age of 52 years. Three radiologists assigned a separate semiquantitative score for calcification length, circumferential involvement, and morphology for the common iliac arteries and for the external iliac arteries. The operative and clinical notes were reviewed to determine which iliac arterial segment was used for anastomosis, the complexity of the operation, and whether delayed graft function (DGF) occurred. Renal allograft survival and patient survival were calculated using the Kaplan-Meier technique.Excellent interobserver agreement was noted for each calcification score category. The common iliac arteries showed significantly higher average calcification scores than the external iliac arteries for all categories. Advanced age and diabetes mellitus were independently predictive of higher scores in each category, whereas hypertension, cigarette smoking, hyperlipidemia, and sex were not. Based on multivariate analysis, only the calcification morphology score of the arterial segment used for anastomosis was independently predictive of a higher rate of surgical complexity and of DGF. None of the scores was predictive of graft or patient survival. However, patients with CT evidence of iliac arterial calcification had a lower 1-year survival after transplant than those who did not (92% vs 98%, respectively; p = 0.05).Only the calcification morphology score of the arterial segment used for anastomosis was significantly predictive of surgical complexity and of DGF. Routine pretransplant CT for calcification scoring in patients of advanced age or those with diabetes mellitus may enable selection of the optimal artery for anastomosis to optimize outcomes.

Authors
Davis, B; Marin, D; Hurwitz, LM; Ronald, J; Ellis, MJ; Ravindra, KV; Collins, BH; Kim, CY
MLA Citation
Davis, B, Marin, D, Hurwitz, LM, Ronald, J, Ellis, MJ, Ravindra, KV, Collins, BH, and Kim, CY. "Application of a Novel CT-Based Iliac Artery Calcification Scoring System for Predicting Renal Transplant Outcomes." AJR. American journal of roentgenology 206.2 (February 2016): 436-441.
PMID
26797375
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
206
Issue
2
Publish Date
2016
Start Page
436
End Page
441
DOI
10.2214/ajr.15.14794

Provocative angiography

© Springer International Publishing AG 2010, 2016. Diagnosis and treatment of obscure GI bleeding is challenging as the name suggests. In patient where conventional evaluations including upper, lower, and capsule endoscopy are unable to locate or treat the bleeding, especially from the small bowel, provocative angiography can be a useful. Pharmacologically assisted arteriography in the appropriate patient can identify the bleeding site, usually the small or large intestine with a diagnostic success rate ranging from 28 to over 70 %. A multidisciplinary approach to provocative angiography provides an effective and safe tool for evaluating and managing these patients.

Authors
Patel, MB; Kim, CY; Miller, MJ
MLA Citation
Patel, MB, Kim, CY, and Miller, MJ. "Provocative angiography." Gastrointestinal Bleeding: A Practical Approach to Diagnosis and Management, Second Edition. January 1, 2016. 203-210.
Source
scopus
Publish Date
2016
Start Page
203
End Page
210
DOI
10.1007/978-3-319-40646-6_18

Effectiveness of Transarterial Embolization of Hepatocellular Carcinoma as a Bridge to Transplantation.

To assess the effectiveness of bland transarterial embolization of hepatocellular carcinoma (HCC) as a "bridge" to transplantation.In this retrospective study, 117 patients with HCC that met Milan criteria underwent bland embolization as their initial and sole therapy for treatment of HCC (88 men and 29 women; mean age, 60.4 y; range, 35-88 y). Subsequent postembolization contrast-enhanced computed tomography or magnetic resonance imaging studies were reviewed to determine whether Milan criteria were met in an intent-to-transplant analysis. Freedom from progression beyond Milan criteria and survival were calculated by Kaplan-Meier technique. Predictors of progression and survival were also assessed.After embolization, 87% and 78% of patients' disease still met Milan criteria at 6 and 12 months, respectively. The median time until disease progression beyond Milan criteria was 22.6 months (95% confidence interval, 16.2-29 mo). α-Fetoprotein levels, number of lesions, United Network for Organ Sharing stage, Model for End-stage Liver Disease score, and cirrhosis etiology did not correlate significantly with stability within Milan criteria. A total of 34 patients (29%) underwent eventual liver transplantation at a median of 3.3 months (range, 0.5-20.9 mo). Liver transplantation was a significant independent predictor of longer survival (6.9 y vs 2.6 y; P < .001). The major complication rate within 30 days of embolization was 2.6%, including one mortality.Bland transarterial embolization as a bridging strategy to maintain HCC within Milan criteria was successful in 78% of patients at 1 year, which compares favorably with other locoregional embolotherapies.

Authors
Hodavance, MS; Vikingstad, EM; Griffin, AS; Pabon-Ramos, WM; Berg, CL; Suhocki, PV; Kim, CY
MLA Citation
Hodavance, MS, Vikingstad, EM, Griffin, AS, Pabon-Ramos, WM, Berg, CL, Suhocki, PV, and Kim, CY. "Effectiveness of Transarterial Embolization of Hepatocellular Carcinoma as a Bridge to Transplantation." Journal of vascular and interventional radiology : JVIR 27.1 (January 2016): 39-45.
PMID
26508449
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
27
Issue
1
Publish Date
2016
Start Page
39
End Page
45
DOI
10.1016/j.jvir.2015.08.032

Postintervention Patency Rates and Predictors of Patency after Percutaneous Interventions on Intragraft Stenoses within Failing Prosthetic Arteriovenous Grafts.

To determine postintervention patency rates after endovascular interventions on intragraft stenosis within failing prosthetic arteriovenous (AV) grafts, as well as predictors of patency.Retrospective review of percutaneous interventions on prosthetic AV grafts presenting with first-time intragraft stenoses over a 7-year period revealed 183 patients (81 male; mean age, 59.7 y). "Intragraft" was defined as 2 cm or more from the arterial or venous anastomosis. Procedural imaging was retrospectively reviewed. Patency rates were estimated by Kaplan-Meier test. Predictors of patency were calculated by Cox proportional-hazards model.Two-hundred twenty-nine intragraft stenoses were identified in 183 grafts. Intragraft stenoses were treated at a median of 20.7 months (interquartile range, 12.0-33.9 mo) after graft creation. Graft thrombosis was present in 62%. The anatomic success rate of angioplasty was 85%. Fifteen percent required stent or stent-graft deployment because of inadequate response to angioplasty. A concurrent nonintragraft stenosis within the access circuit was identified in 76% of grafts. At 3, 6, and 12 months, postintervention primary patency rates were 56%, 40%, and 23%, respectively. Secondary patency rates were 84%, 77%, and 67%, respectively. The lesion-specific patency rates were 89, 75%, and 63%, respectively. Graft thrombosis (hazard ratio [HR], 1.43; P = .048) and concurrent nonintragraft lesion (HR, 1.51; P = .047) were independent negative predictors of primary patency. Graft thrombosis (HR, 1.81; P = .029) was a negative predictor of lesion patency, and stent or stent-graft deployment (HR, 0.42; P = .045) was a positive predictor of lesion patency.Endovascular interventions on intragraft stenoses resulted in primary, secondary, and lesion-specific patency rates of 40%, 77%, and 75%, respectively, at 6 months. Stent or stent-graft deployment may prolong lesion patency.

Authors
Bautista, AB; Suhocki, PV; Pabon-Ramos, WM; Miller, MJ; Smith, TP; Kim, CY
MLA Citation
Bautista, AB, Suhocki, PV, Pabon-Ramos, WM, Miller, MJ, Smith, TP, and Kim, CY. "Postintervention Patency Rates and Predictors of Patency after Percutaneous Interventions on Intragraft Stenoses within Failing Prosthetic Arteriovenous Grafts." Journal of vascular and interventional radiology : JVIR 26.11 (November 2015): 1673-1679.
PMID
26403274
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
26
Issue
11
Publish Date
2015
Start Page
1673
End Page
1679
DOI
10.1016/j.jvir.2015.08.008

Percutaneous cryoablation of renal masses under CT fluoroscopy: radiation doses to the patient and interventionalist.

Computed tomographic (CT) fluoroscopy-guided percutaneous cryoablation is an effective therapeutic method used to treat focal renal masses. The purpose of this study is to quantify the radiation dose to the patient and interventional radiologist during percutaneous cryoablation of renal masses using CT fluoroscopic guidance.Over a 1-year period, the CT fluoroscopy time during percutaneous cryoablation of renal masses was recorded in 41 patients. The level of complexity of each procedure was designated as simple, intermediate, or complex. Patient organ radiation doses were estimated using an anthropomorphic model. Dose to the interventional radiologist was estimated using ion chamber survey meters.The average CT fluoroscopy time for technically simple cases was 47 s, 126 s for intermediate cases, and 264 s for complex cases. The relative risk of hematologic stomach and liver malignancy in patients undergoing this procedure was 1.003-1.074. The lifetime attributable risk of cancer ranged from 2 to 58, with the highest risk in younger patients for developing leukemia. The estimated radiation dose to the interventionalist without lead shielding was 390 mR (3.9 mGy) per year of cases.The radiation risk to the patient during CT fluoroscopy-guided percutaneous renal mass cryoablation is, as expected, related to procedure complexity. Quantification of patient organ radiation dose was estimated using an anthropomorphic model. This information, along with the associated relative risk of malignancy, may assist in evaluating risks of the procedure, particularly in younger patients. The radiation dose to the interventionist is low regardless of procedure complexity, but highlights the importance of lead shielding.

Authors
Stewart, JK; Looney, CB; Anderson-Evans, CD; Toncheva, GI; Sopko, DR; Kim, CY; Yoshizumi, TT; Nelson, RC
MLA Citation
Stewart, JK, Looney, CB, Anderson-Evans, CD, Toncheva, GI, Sopko, DR, Kim, CY, Yoshizumi, TT, and Nelson, RC. "Percutaneous cryoablation of renal masses under CT fluoroscopy: radiation doses to the patient and interventionalist." Abdominal imaging 40.7 (October 2015): 2606-2612.
PMID
25989931
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
7
Publish Date
2015
Start Page
2606
End Page
2612
DOI
10.1007/s00261-015-0456-2

Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT.

The purpose of this study is to determine the prevalence of left renal vein compression in patients with varicoceles.Abdominal and pelvis contrast-enhanced CT images from 100 male patients with varicoceles (mean age 50.6 years) and 100 matched control patients (mean age 49.8 years) were retrospectively reviewed. The diameter of the left renal vein was measured as it crosses between the aorta and superior mesenteric artery and was classified as compressed if there was greater than 50% narrowing. The diameter of the left gonadal vein was measured at the origin. Comparison of the prevalence of left renal vein compression was made via a Chi-squared test and the gonadal vein diameter via a t test.The distribution of varicoceles was 68 on the left, 24 bilateral, and 8 on the right. Compression of the left renal vein was significantly more common in the left varicocele (78%, 53/68) than in the bilateral varicocele (42%, 10/24, p = 0.002), right varicocele (13%, 1/8, p < 0.001), or control group (10%, 10/100, p < 0.001). In the subgroup analysis, the gonadal vein diameter was significantly greater in the left varicocele (mean 5.6 mm) than in the bilateral varicocele (mean 4.6 mm, p = 0.018), right varicocele (mean 3.2 mm, p < 0.001), and control group (mean 3.1 mm, p < 0.001).Left renal vein compression by the superior mesenteric artery is a major contributor to left-sided varicoceles.

Authors
Lewis, DS; Grimm, LJ; Kim, CY
MLA Citation
Lewis, DS, Grimm, LJ, and Kim, CY. "Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT." Abdominal imaging 40.8 (October 2015): 3147-3151.
PMID
26210372
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
8
Publish Date
2015
Start Page
3147
End Page
3151
DOI
10.1007/s00261-015-0512-y

Comparison of Acute Histologic and Biomechanical Effects of Radiofrequency Ablation and Cryoablation on Periarticular Structures in a Swine Model.

To compare the acute effects of radiofrequency (RF) ablation and cryoablation on the structural integrity of nontarget periarticular tissues that may be placed at risk during percutaneous bone ablation.RF ablation and cryoablation were separately performed on tendon, articular cartilage, and ligament in an ex vivo porcine model by using standard bone ablation protocols. Gross and histopathologic analysis was performed on cartilage and tendon (n = 6 for each treatment group, n = 5 controls). Tendon lengths were measured before and after ablation. Biomechanical tensile testing was performed on each ligament sample after ablation, with quantification of ultimate load at failure and linear stiffness (n = 7 ligaments in treatment and control groups).RF ablation and cryoablation injured chondrocytes within the ablation zones but caused minimal effects on gross and histologic cartilage architecture. Cryoablation resulted in minimal gross and histologic effects on tendon whereas RF ablation resulted in marked disruption of collagen fibers and significant longitudinal shortening (P = .002). Similarly, cryoablation did not alter ligament strength or stiffness compared with control, whereas RF ablation resulted in a significant decrease in tensile strength and stiffness compared with control and cryoablation samples (P < .001).Neither RF ablation nor cryoablation resulted in significant acute changes in cartilage architecture. However, RF ablation resulted in marked disruption of tendon architecture, tendon shortening, ligament weakening, and loss of ligament stiffness, whereas cryoablation had no significant effect on any of these parameters. These findings suggest that cryoablation may have fewer negative acute effects than RF ablation, although long-term outcomes are currently unknown.

Authors
Vikingstad, EM; de Ridder, GG; Glisson, RR; Cardona, DM; DiPalma, D; Eward, WC; Brigman, BE; Nelson, RC; Kim, CY
MLA Citation
Vikingstad, EM, de Ridder, GG, Glisson, RR, Cardona, DM, DiPalma, D, Eward, WC, Brigman, BE, Nelson, RC, and Kim, CY. "Comparison of Acute Histologic and Biomechanical Effects of Radiofrequency Ablation and Cryoablation on Periarticular Structures in a Swine Model." Journal of vascular and interventional radiology : JVIR 26.8 (August 2015): 1221-1228.e1.
PMID
26065927
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
26
Issue
8
Publish Date
2015
Start Page
1221
End Page
1228.e1
DOI
10.1016/j.jvir.2015.04.013

Management of Anticoagulant and Antiplatelet Medications in Adults Undergoing Percutaneous Interventions.

Many radiologists are unfamiliar with the new antithrombogenic medications and how to modify patient management before nonvascular percutaneous procedures performed in a radiology department. In this article, we review the indications for use, mechanism of action, pharmacokinetics, dosing, and recommendations for periprocedural management of patients using these medications.To improve patient safety, radiologists involved in percutaneous procedures should have knowledge of the antithrombotics that will be encountered routinely in clinical practice.

Authors
Jaffe, TA; Raiff, D; Ho, LM; Kim, CY
MLA Citation
Jaffe, TA, Raiff, D, Ho, LM, and Kim, CY. "Management of Anticoagulant and Antiplatelet Medications in Adults Undergoing Percutaneous Interventions." AJR. American journal of roentgenology 205.2 (August 2015): 421-428. (Review)
PMID
26204296
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
205
Issue
2
Publish Date
2015
Start Page
421
End Page
428
DOI
10.2214/ajr.14.13342

Haskal ZJ. JVIR editor’s awards: 2014 top papers. (J Vasc Interv Radiol 2015; 26:372–373)

MLA Citation
"Haskal ZJ. JVIR editor’s awards: 2014 top papers. (J Vasc Interv Radiol 2015; 26:372–373)." Journal of Vascular and Interventional Radiology 26.8 (August 2015): 1253-1253.
Source
crossref
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
26
Issue
8
Publish Date
2015
Start Page
1253
End Page
1253
DOI
10.1016/j.jvir.2015.05.026

Prevention and management of infectious complications of percutaneous interventions.

Infectious complications following interventional radiology (IR) procedures can cause significant patient morbidity and, potentially, mortality. As the number and breadth of IR procedures grow, it becomes increasingly evident that interventional radiologists must possess a thorough understanding of these potential infectious complications. Furthermore, given the increasing incidence of antibiotic-resistant bacteria, emphasis on cost containment, and attention to quality of care, it is critical to have infection control strategies to maximize patient safety. This article reviews infectious complications associated with percutaneous ablation of liver tumors, transarterial embolization of liver tumors, uterine fibroid embolization, percutaneous nephrostomy, percutaneous biliary interventions, central venous catheters, and intravascular stents. Emphasis is placed on incidence, risk factors, prevention, and management. With the use of these strategies, IR procedures can be performed with reduced risk of infectious complications.

Authors
Huang, SY; Philip, A; Richter, MD; Gupta, S; Lessne, ML; Kim, CY
MLA Citation
Huang, SY, Philip, A, Richter, MD, Gupta, S, Lessne, ML, and Kim, CY. "Prevention and management of infectious complications of percutaneous interventions." Seminars in interventional radiology 32.2 (June 2015): 78-88. (Review)
PMID
26038616
Source
epmc
Published In
Seminars in Interventional Radiology
Volume
32
Issue
2
Publish Date
2015
Start Page
78
End Page
88
DOI
10.1055/s-0035-1549372

Diagnosis and management of hemorrhagic complications of interventional radiology procedures.

Image-guided interventions have allowed for minimally invasive treatment of many common diseases, obviating the need for open surgery. While percutaneous interventions usually represent a safer approach than traditional surgical alternatives, complications do arise nonetheless. Inadvertent injury to blood vessels represents one of the most common types of complications, and its affect can range from inconsequential to catastrophic. The interventional radiologist must be prepared to manage hemorrhagic risks from percutaneous interventions. This manuscript discusses this type of iatrogenic injury, as well as preventative measures and treatments for postintervention bleeding.

Authors
Lessne, ML; Holly, B; Huang, SY; Kim, CY
MLA Citation
Lessne, ML, Holly, B, Huang, SY, and Kim, CY. "Diagnosis and management of hemorrhagic complications of interventional radiology procedures." Seminars in interventional radiology 32.2 (June 2015): 89-97. (Review)
PMID
26038617
Source
epmc
Published In
Seminars in Interventional Radiology
Volume
32
Issue
2
Publish Date
2015
Start Page
89
End Page
97
DOI
10.1055/s-0035-1549373

Transjugular intrahepatic portosystemic shunt complications: prevention and management.

Transjugular intrahepatic portosystemic shunt (TIPS) insertion has been well established as an effective treatment in the management of sequelae of portal hypertension. There are a wide variety of complications that can be encountered, such as hemorrhage, encephalopathy, TIPS dysfunction, and liver failure. This review article summarizes various approaches to preventing and managing these complications.

Authors
Suhocki, PV; Lungren, MP; Kapoor, B; Kim, CY
MLA Citation
Suhocki, PV, Lungren, MP, Kapoor, B, and Kim, CY. "Transjugular intrahepatic portosystemic shunt complications: prevention and management." Seminars in interventional radiology 32.2 (June 2015): 123-132. (Review)
PMID
26038620
Source
epmc
Published In
Seminars in Interventional Radiology
Volume
32
Issue
2
Publish Date
2015
Start Page
123
End Page
132
DOI
10.1055/s-0035-1549376

Management of dysfunctional catheters and tubes inserted by interventional radiology.

Minimally invasive percutaneous interventions are often used for enteral nutrition, biliary and urinary diversion, intra-abdominal fluid collection drainage, and central venous access. In most cases, radiologic and endoscopic placement of catheters and tubes has replaced the comparable surgical alternative. As experience with catheters and tubes grows, it becomes increasingly evident that the interventional radiologist needs to be an expert not only on device placement but also on device management. Tube dysfunction represents the most common complication requiring repeat intervention, which can be distressing for patients and other health care professionals. This manuscript addresses the etiologies and solutions to leaking and obstructed feeding tubes, percutaneous biliary drains, percutaneous catheter nephrostomies, and drainage catheters, including abscess drains. In addition, we will address the obstructed central venous catheter.

Authors
Huang, SY; Engstrom, BI; Lungren, MP; Kim, CY
MLA Citation
Huang, SY, Engstrom, BI, Lungren, MP, and Kim, CY. "Management of dysfunctional catheters and tubes inserted by interventional radiology." Seminars in interventional radiology 32.2 (June 2015): 67-77. (Review)
PMID
26038615
Source
epmc
Published In
Seminars in Interventional Radiology
Volume
32
Issue
2
Publish Date
2015
Start Page
67
End Page
77
DOI
10.1055/s-0035-1549371

Accessory veins in nonmaturing autogenous arteriovenous fistulae: analysis of anatomic features and impact on fistula maturation.

The appropriate management of nonmaturing arteriovenous (AV) fistulae continues to be a controversial issue. While coil embolization of accessory side-branch veins can be performed to encourage maturation of nonmaturing AV fistulae, the true efficacy and optimal patient population are not well understood. Fistulagrams performed on nonmaturing AV fistulae were retrospectively reviewed in 145 patients (86 males, median age 63 years) for the presence of accessory veins. Fistula and accessory vein measurements were obtained, as were rates of eventual fistula maturation after accessory vein coil embolization. Of 145 nonmaturing fistulae, 49 (34%) had a stenosis without any accessory veins, 76 (52%) had a stenosis and one or more accessory veins, and 20 (14%) had an accessory vein without concurrent stenosis. Eighteen AV fistulae had one or more accessory veins without coexisting stenosis. Nine fistulae had a caliber decrease immediately downstream from the accessory vein. Coil embolization of dominant accessory veins with a caliber decrease immediately downstream (n = 6) resulted in a 100% eventual fistula maturation rate versus 67% for fistulae without this configuration (n = 6, p = 0.15). Accessory vein size was not correlated with maturation rates (p = 0.51). The majority of nonmaturing fistulae with accessory veins had a coexisting stenosis. Higher maturation rates may result with selected anatomic parameters, although additional studies with more robust sample sizes are needed prior to definitive conclusions.

Authors
Engstrom, BI; Grimm, LJ; Ronald, J; Smith, TP; Kim, CY
MLA Citation
Engstrom, BI, Grimm, LJ, Ronald, J, Smith, TP, and Kim, CY. "Accessory veins in nonmaturing autogenous arteriovenous fistulae: analysis of anatomic features and impact on fistula maturation." Seminars in dialysis 28.3 (May 2015): E30-E34.
PMID
25482275
Source
epmc
Published In
Seminars in Dialysis
Volume
28
Issue
3
Publish Date
2015
Start Page
E30
End Page
E34
DOI
10.1111/sdi.12333

Bariatric embolization of the gastric arteries for the treatment of obesity.

Obesity is a public health epidemic in the United States that results in significant morbidity, mortality, and cost to the health care system. Despite advancements in therapeutic options for patients receiving bariatric procedures, the number of overweight and obese individuals continues to increase. Therefore, complementary or alternative treatments to lifestyle changes and surgery are urgently needed. Embolization of the left gastric artery, or bariatric arterial embolization (BAE), has been shown to modulate body weight in animal models and early clinical studies. If successful, BAE represents a potential minimally invasive approach offered by interventional radiologists to treat obesity. The purpose of the present review is to introduce the interventional radiologist to BAE by presenting its physiologic and anatomic bases, reviewing the preclinical and clinical data, and discussing current and future investigations.

Authors
Weiss, CR; Gunn, AJ; Kim, CY; Paxton, BE; Kraitchman, DL; Arepally, A
MLA Citation
Weiss, CR, Gunn, AJ, Kim, CY, Paxton, BE, Kraitchman, DL, and Arepally, A. "Bariatric embolization of the gastric arteries for the treatment of obesity." Journal of vascular and interventional radiology : JVIR 26.5 (May 2015): 613-624. (Review)
PMID
25777177
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
26
Issue
5
Publish Date
2015
Start Page
613
End Page
624
DOI
10.1016/j.jvir.2015.01.017

Effects of model-based iterative reconstruction on image quality for low-dose computed tomographic angiography of the thoracic aorta in a Swine model.

PURPOSE: The aim of the study was to assess the image quality of multi-detector-row computed tomography (CT) angiographic images of the thoracic aorta reconstructed with filtered back projection (FBP), adaptive statistical iterative reconstruction, and model-based iterative reconstruction (MBIR) at different kVp and mA settings. METHODS: A healthy 56.1-kg Yorkshire pig underwent sequential arterial CT angiograms on a 64-slice multi-detector-row CT scanner (Discovery CT 750HD; GE Healthcare Inc, Milwaukee, Wis) at progressively lower kVp and mA settings. At 120-, 100-, and 80-kVp levels, the pig was scanned at 700, 400, 200, 100, and 50 mA at, for a total of 15 scans. Each scan was reconstructed with FBP, adaptive statistical iterative reconstruction (50% blend), and MBIR. Relative noise and contrast-to-noise ratio (CNR) were calculated from regions of interest over the aorta and paraspinous muscle. In addition, selected axial and oblique sagittal images were scored subjectively for both aortic wall visibility and for overall image quality. RESULTS: Averaged across all kVp and mA variations, MBIR reduced relative noise by 73.9% and improved CNR by 227% compared with FBP; MBIR reduced relative noise by 63.4% and improved CNR by 107% compared with ASIR. The effects were more pronounced in lower tube output settings. At 100 kVp/700 mA, MBIR reduced noise by 57% compared with FBP and 40% compared with ASIR. At 100 kVp/50 mA, MBIR reduced noise by 82% compared with FBP and 75% compared with ASIR. Subjective improvements in image quality were noted only in higher noise settings. CONCLUSIONS: Model-based iterative reconstruction reduces relative noise and improves CNR compared with ASIR and FBP at all kVp and mA settings, which were significantly greater at lower mA settings.

Authors
Caywood, D; Paxton, B; Boll, D; Nelson, R; Kim, C; Lowry, C; Seaman, D; Roos, JE; Hurwitz, LM
MLA Citation
Caywood, D, Paxton, B, Boll, D, Nelson, R, Kim, C, Lowry, C, Seaman, D, Roos, JE, and Hurwitz, LM. "Effects of model-based iterative reconstruction on image quality for low-dose computed tomographic angiography of the thoracic aorta in a Swine model." Journal of computer assisted tomography 39.2 (March 2015): 196-201.
PMID
25474144
Source
epmc
Published In
Journal of Computer Assisted Tomography
Volume
39
Issue
2
Publish Date
2015
Start Page
196
End Page
201
DOI
10.1097/rct.0000000000000180

Respiratory-gated noncontrast SPACE MR angiography sequence at 3T for evaluation of the central veins of the chest: A feasibility study

© 2013 Wiley Periodicals, Inc. 125. Purpose: To evaluate the feasibility of a respiratorygated noncontrast magnetic resonance angiography (MRA) sequence for imaging the central veins of the chest. Materials and Methods: Eleven healthy subjects underwent MRA of the central veins of the chest with a respiratory-gated noncontrast (SPACE) sequence. Qualitative visualization and signal homogeneity of each central venous segment were scored by two radiologists on a scale of 1-4. Signal-to-noise and contrast-to-noise ratios (SNR and CNR) were also calculated. Retrospective review of our imaging database revealed 13 patients with suspected pathology of the central veins who underwent a clinical MRA examination using the SPACE sequence as well as reference standard central venous imaging with contrast-enhanced MRA or conventional venography. Results: In healthy subjects, all central venous segments demonstrated good to excellent venous visualization and homogeneity scores with the noncontrast SPACE sequence. The mean SNR and CNR of the central venous system were 192.7 and 175.0, respectively. In the 13 clinical examinations, the sensitivity and specificity for detection of stenosis or occlusions was 100% and 100% for reader 1 and 95% and 91% for reader 2, respectively. Conclusion: The respiratory-gated noncontrast SPACE sequence provided excellent imaging characteristics of the central veins in healthy subjects with promising diagnostic accuracy in patients with central venous pathology.

Authors
Kim, CY; Bashir, MR; Heye, T; Dale, BM; Nichols, HL; Merkle, EM
MLA Citation
Kim, CY, Bashir, MR, Heye, T, Dale, BM, Nichols, HL, and Merkle, EM. "Respiratory-gated noncontrast SPACE MR angiography sequence at 3T for evaluation of the central veins of the chest: A feasibility study." Journal of Magnetic Resonance Imaging 41.1 (January 1, 2015): 67-73. (Review)
Source
scopus
Published In
Journal of Magnetic Resonance Imaging
Volume
41
Issue
1
Publish Date
2015
Start Page
67
End Page
73
DOI
10.1002/jmri.24540

Effects of model-based iterative reconstruction on image quality for low-dose computed tomographic angiography of the thoracic aorta in a swine model

© 2015 Wolters Kluwer Health, Inc. Purpose: The aim of the study was to assess the image quality of multi-detector-row computed tomography (CT) angiographic images of the thoracic aorta reconstructed with filtered back projection (FBP), adaptive statistical iterative reconstruction, and model-based iterative reconstruction (MBIR) at different kVp and mA settings. Methods: A healthy 56.1-kg Yorkshire pig underwent sequential arterial CT angiograms on a 64-slice multi-detector-row CT scanner (Discovery CT 750HD; GE Healthcare Inc, Milwaukee, Wis) at progressively lower kVp and mA settings. At 120-, 100-, and 80-kVp levels, the pig was scanned at 700, 400, 200, 100, and 50 mA at, for a total of 15 scans. Each scan was reconstructed with FBP, adaptive statistical iterative reconstruction (50% blend), and MBIR. Relative noise and contrast-to-noise ratio (CNR) were calculated from regions of interest over the aorta and paraspinous muscle. In addition, selected axial and oblique sagittal images were scored subjectively for both aortic wall visibility and for overall image quality. Results: Averaged across all kVp and mAvariations, MBIR reduced relative noise by 73.9% and improved CNR by 227% compared with FBP; MBIR reduced relative noise by 63.4% and improved CNR by 107% compared with ASIR. The effects were more pronounced in lower tube output settings. At 100 kVp/700 mA, MBIR reduced noise by 57% compared with FBP and 40% compared with ASIR. At 100 kVp/50 mA, MBIR reduced noise by 82% compared with FBP and 75% compared with ASIR. Subjective improvements in image quality were noted only in higher noise settings. Conclusions:Model-based iterative reconstruction reduces relative noise and improves CNR compared with ASIR and FBP at all kVp and mA settings, which were significantly greater at lower mA settings.

Authors
Caywood, D; Paxton, B; Boll, D; Nelson, R; Kim, C; Lowry, C; Seaman, D; Roos, JE; Hurwitz, LM
MLA Citation
Caywood, D, Paxton, B, Boll, D, Nelson, R, Kim, C, Lowry, C, Seaman, D, Roos, JE, and Hurwitz, LM. "Effects of model-based iterative reconstruction on image quality for low-dose computed tomographic angiography of the thoracic aorta in a swine model." Journal of Computer Assisted Tomography 39.2 (January 1, 2015): 196-201.
Source
scopus
Published In
Journal of Computer Assisted Tomography
Volume
39
Issue
2
Publish Date
2015
Start Page
196
End Page
201
DOI
10.1097/RCT.0000000000000180

Accessory Veins in Nonmaturing Autogenous Arteriovenous Fistulae: Analysis of Anatomic Features and Impact on Fistula Maturation

© 2014 Wiley Periodicals, Inc. The appropriate management of nonmaturing arteriovenous (AV) fistulae continues to be a controversial issue. While coil embolization of accessory side-branch veins can be performed to encourage maturation of nonmaturing AV fistulae, the true efficacy and optimal patient population are not well understood. Fistulagrams performed on nonmaturing AV fistulae were retrospectively reviewed in 145 patients (86 males, median age 63 years) for the presence of accessory veins. Fistula and accessory vein measurements were obtained, as were rates of eventual fistula maturation after accessory vein coil embolization. Of 145 nonmaturing fistulae, 49 (34%) had a stenosis without any accessory veins, 76 (52%) had a stenosis and one or more accessory veins, and 20 (14%) had an accessory vein without concurrent stenosis. Eighteen AV fistulae had one or more accessory veins without coexisting stenosis. Nine fistulae had a caliber decrease immediately downstream from the accessory vein. Coil embolization of dominant accessory veins with a caliber decrease immediately downstream (n = 6) resulted in a 100% eventual fistula maturation rate versus 67% for fistulae without this configuration (n = 6, p = 0.15). Accessory vein size was not correlated with maturation rates (p = 0.51). The majority of nonmaturing fistulae with accessory veins had a coexisting stenosis. Higher maturation rates may result with selected anatomic parameters, although additional studies with more robust sample sizes are needed prior to definitive conclusions.

Authors
Engstrom, BI; Grimm, LJ; Ronald, J; Smith, TP; Kim, CY
MLA Citation
Engstrom, BI, Grimm, LJ, Ronald, J, Smith, TP, and Kim, CY. "Accessory Veins in Nonmaturing Autogenous Arteriovenous Fistulae: Analysis of Anatomic Features and Impact on Fistula Maturation." Seminars in Dialysis 28.3 (January 1, 2015): E30-E34.
Source
scopus
Published In
Seminars in Dialysis
Volume
28
Issue
3
Publish Date
2015
Start Page
E30
End Page
E34
DOI
10.1111/sdi.12333

Bariatric embolization of the gastric arteries for the treatment of obesity

© 2015 SIR. Obesity is a public health epidemic in the United States that results in significant morbidity, mortality, and cost to the health care system. Despite advancements in therapeutic options for patients receiving bariatric procedures, the number of overweight and obese individuals continues to increase. Therefore, complementary or alternative treatments to lifestyle changes and surgery are urgently needed. Embolization of the left gastric artery, or bariatric arterial embolization (BAE), has been shown to modulate body weight in animal models and early clinical studies. If successful, BAE represents a potential minimally invasive approach offered by interventional radiologists to treat obesity. The purpose of the present review is to introduce the interventional radiologist to BAE by presenting its physiologic and anatomic bases, reviewing the preclinical and clinical data, and discussing current and future investigations.

Authors
Weiss, CR; Gunn, AJ; Kim, CY; Paxton, BE; Kraitchman, DL; Arepally, A
MLA Citation
Weiss, CR, Gunn, AJ, Kim, CY, Paxton, BE, Kraitchman, DL, and Arepally, A. "Bariatric embolization of the gastric arteries for the treatment of obesity." Journal of Vascular and Interventional Radiology 26.5 (January 1, 2015): 613-624. (Review)
Source
scopus
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
26
Issue
5
Publish Date
2015
Start Page
613
End Page
624
DOI
10.1016/j.jvir.2015.01.017

Respiratory-gated noncontrast SPACE MR angiography sequence at 3T for evaluation of the central veins of the chest: a feasibility study.

PURPOSE: To evaluate the feasibility of a respiratory-gated noncontrast magnetic resonance angiography (MRA) sequence for imaging the central veins of the chest. MATERIALS AND METHODS: Eleven healthy subjects underwent MRA of the central veins of the chest with a respiratory-gated noncontrast (SPACE) sequence. Qualitative visualization and signal homogeneity of each central venous segment were scored by two radiologists on a scale of 1-4. Signal-to-noise and contrast-to-noise ratios (SNR and CNR) were also calculated. Retrospective review of our imaging database revealed 13 patients with suspected pathology of the central veins who underwent a clinical MRA examination using the SPACE sequence as well as reference standard central venous imaging with contrast-enhanced MRA or conventional venography. RESULTS: In healthy subjects, all central venous segments demonstrated good to excellent venous visualization and homogeneity scores with the noncontrast SPACE sequence. The mean SNR and CNR of the central venous system were 192.7 and 175.0, respectively. In the 13 clinical examinations, the sensitivity and specificity for detection of stenosis or occlusions was 100% and 100% for reader 1 and 95% and 91% for reader 2, respectively. CONCLUSION: The respiratory-gated noncontrast SPACE sequence provided excellent imaging characteristics of the central veins in healthy subjects with promising diagnostic accuracy in patients with central venous pathology.

Authors
Kim, CY; Bashir, MR; Heye, T; Dale, BM; Nichols, HL; Merkle, EM
MLA Citation
Kim, CY, Bashir, MR, Heye, T, Dale, BM, Nichols, HL, and Merkle, EM. "Respiratory-gated noncontrast SPACE MR angiography sequence at 3T for evaluation of the central veins of the chest: a feasibility study." Journal of magnetic resonance imaging : JMRI 41.1 (January 2015): 67-73.
PMID
24343858
Source
epmc
Published In
Journal of Magnetic Resonance Imaging
Volume
41
Issue
1
Publish Date
2015
Start Page
67
End Page
73
DOI
10.1002/jmri.24540

Bacteriophage K antimicrobial-lock technique for treatment of Staphylococcus aureus central venous catheter-related infection: a leporine model efficacy analysis.

To determine whether a bacteriophage antimicrobial-lock technique can reduce bacterial colonization and biofilm formation on indwelling central venous catheters in a rabbit model.Cuffed central venous catheters were inserted into the jugular vein of female New Zealand White rabbits under image guidance. Catheters were inoculated for 24 hours with broth culture of methicillin-sensitive Staphylococcus aureus. The inoculum was aspirated, and rabbits were randomly assigned to two equal groups for 24 hours: (i) untreated controls (heparinized saline lock), (ii) bacteriophage antimicrobial-lock (staphylococcal bacteriophage K, propagated titer > 10(8)/mL). Blood cultures were obtained via peripheral veins, and the catheters were removed for quantitative culture and scanning electron microscopy.Mean colony-forming units (CFU) per cm(2) of the distal catheter segment, as a measure of biofilm, were significantly decreased in experimental animals compared with controls (control, 1.2 × 10(5) CFU/cm(2); experimental, 7.6 × 10(3); P = .016). Scanning electron microscopy demonstrated that biofilms were present on the surface of five of five control catheters but only one of five treated catheters (P = .048). Blood culture results were not significantly different between the groups.In a rabbit model, treatment of infected central venous catheters with a bacteriophage antimicrobial-lock technique significantly reduced bacterial colonization and biofilm presence. Our data represent a preliminary step toward use of bacteriophage therapy for prevention and treatment of central venous catheter-associated infection.

Authors
Lungren, MP; Donlan, RM; Kankotia, R; Paxton, BE; Falk, I; Christensen, D; Kim, CY
MLA Citation
Lungren, MP, Donlan, RM, Kankotia, R, Paxton, BE, Falk, I, Christensen, D, and Kim, CY. "Bacteriophage K antimicrobial-lock technique for treatment of Staphylococcus aureus central venous catheter-related infection: a leporine model efficacy analysis." Journal of vascular and interventional radiology : JVIR 25.10 (October 2014): 1627-1632.
PMID
25088065
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
10
Publish Date
2014
Start Page
1627
End Page
1632
DOI
10.1016/j.jvir.2014.06.009

T-fastener migration after percutaneous gastropexy for transgastric enteral tube insertion.

BACKGROUND/AIMS: To determine the prevalence and time-course of t-fastener migration after gastropexy deployment. METHODS: We reviewed our procedural database for all percutaneous gastrostomy and gastrojejunostomy tube insertions performed over a 14-month period using a widely accepted t-fastener kit for gastropexy (Kimberly-Clark). Of 201 patients, 71 (41 males, 30 females; mean age, 56 years) underwent subsequent abdominal computed tomography (CT) imaging. The location and associated findings of each t-fastener were retrospectively recorded for each CT scan performed after the tube insertion. RESULTS: A total of 153 t-fasteners were deployed during 71 procedures with subsequent CT follow-up. In the short term (within 4 weeks after deployment), 5.1% of the t-fasteners had detached and were no longer present; 59.5% were intraluminal or within the gastric wall; and 35.5% were within the anterior abdominal wall musculature or subcutaneous. In the long term (>3 months), 48.6% of the t-fasteners had detached and were no longer present, 25.0% were intraluminal or within the gastric wall, and 26.4% were within the anterior abdominal wall musculature or subcutaneous. No t-fastener-related complications, such as abscesses, fluid collections, or fistulae, were identified. CONCLUSIONS: Following gastropexy for percutaneous transgastric feeding tube placement, t-fastener migration into the abdominal wall frequently occurred soon after the tube insertion. Therefore, recent t-fastener deployment does not guarantee an intact gastropexy.

Authors
Sydnor, RH; Schriber, SM; Kim, CY
MLA Citation
Sydnor, RH, Schriber, SM, and Kim, CY. "T-fastener migration after percutaneous gastropexy for transgastric enteral tube insertion." Gut and liver 8.5 (September 2014): 495-499.
PMID
25228973
Source
epmc
Published In
Gut and Liver
Volume
8
Issue
5
Publish Date
2014
Start Page
495
End Page
499
DOI
10.5009/gnl13204

Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases.

PURPOSE: To compare abdominopelvic and lower extremity venous enhancement in contrast-enhanced magnetic resonance venography (ceMRV), using iron-based ferumoxytol and gadolinium-based gadofosveset. MATERIALS AND METHODS: This was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. Thirty-four patients were identified who had undergone ceMRV using either ferumoxtyol (Group A, all with chronic renal insufficiency) or gadofosveset (Group B). Two radiologists rated confidence for evaluation of the major abdominopelvic and lower extremity veins from 4 (excellent confidence) to 1 (nondiagnostic). A third radiologist measured signal intensity ratios (SIRs) of venous segments compared with adjacent muscles. Scores were compared using repeated-measures analysis of variance (ANOVA). The medical record was searched for contemporaneous imaging to confirm the ceMRV findings. RESULTS: In Group A, 14/225 venous segments were thrombosed, compared with 18/282 in Group B. There was no statistically significant difference between confidence scores (3.79 ± 0.44 vs. 3.85 ± 0.44, P = 0.34) or SIRs (2.40 ± 0.73 vs. 2.38 ± 0.51, P = 0.51) for patent segments in the two groups, nor were confidences scores (3.89 ± 0.29 vs. 3.72 ± 0.46, P = 0.31) or SIRs (0.90 ± 0.12 vs. 0.84 ± 0.19, P = 0.31) significantly different for thrombosed segments. Contemporaneous imaging confirmed ceMRV findings in 227 segments. CONCLUSION: ceMRV can be performed with ferumoxytol, yielding similar image quality to a blood pool gadolinium-based contrast agent.

Authors
Bashir, MR; Mody, R; Neville, A; Javan, R; Seaman, D; Kim, CY; Gupta, RT; Jaffe, TA
MLA Citation
Bashir, MR, Mody, R, Neville, A, Javan, R, Seaman, D, Kim, CY, Gupta, RT, and Jaffe, TA. "Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases." J Magn Reson Imaging 40.1 (July 2014): 113-118.
PMID
24130008
Source
pubmed
Published In
Journal of Magnetic Resonance Imaging
Volume
40
Issue
1
Publish Date
2014
Start Page
113
End Page
118
DOI
10.1002/jmri.24330

Venous filling defects on portal venous phase CT of the abdomen and pelvis: clinical implications and positive predictive value for diagnosing deep venous thrombosis.

PURPOSE: To determine the prevalence, resulting clinical decisions, and the positive predictive value (PPV) of venous filling defects detected on portal venous phase (PVP) CT. METHODS: Over a 3-year period, 42412 consecutive patients underwent a PVP abdominopelvic CT; of these, 348 reports mentioned a filling defect concerning for deep venous thrombosis (DVT) in the IVC, iliac, or common femoral veins. Ninety-three patients underwent a reference standard venous imaging study. RESULTS: The prevalence of venous filling defects in CT reports was 0.82% (n = 348). Reports worded with higher degrees of certainty were statistically more likely to result in treatment, while lower certainty was correlated with additional confirmatory imaging. The PPV for detection of DVT was 77%. The presence of peri-vascular stranding or vessel expansion increased the PPV of PVP CT to 95% and 100%, respectively. CONCLUSION: While the PPV for filling defects on PVP CT was modest, it was substantially improved if peri-venous stranding or vessel expansion was present.

Authors
Horvath, JJ; Looney, CB; Nelson, RC; Kim, CY
MLA Citation
Horvath, JJ, Looney, CB, Nelson, RC, and Kim, CY. "Venous filling defects on portal venous phase CT of the abdomen and pelvis: clinical implications and positive predictive value for diagnosing deep venous thrombosis." Abdominal imaging 39.3 (June 2014): 554-561.
PMID
24441580
Source
epmc
Published In
Abdominal Imaging
Volume
39
Issue
3
Publish Date
2014
Start Page
554
End Page
561
DOI
10.1007/s00261-014-0077-1

Coil embolization of the splenic artery: impact on splenic volume.

PURPOSE: To determine the impact of coil embolization of the splenic artery on splenic volume based on computed tomography (CT) imaging. MATERIALS AND METHODS: Splenic artery embolization (SAE) was performed in 148 consecutive patients over an 8-year period in an institutional review board-approved retrospective study. Of these, 60 patients (36 men; mean age, 49 y) had undergone contrast-enhanced CT before and after SAE with a mean time interval of 355 days. Pre- and postembolization splenic volumes were calculated with volume-rendering software. Presence of Howell-Jolly bodies was ascertained on laboratory tests. A trauma control group consisted of 39 patients with splenic laceration and follow-up CT but no splenic intervention. RESULTS: SAE in trauma patients resulted in an insignificant decrease in mean spleen size from 224 cm(3) to 190 cm(3) (P = .222). However, postembolization splenic volume was significantly smaller than follow-up volume in the trauma control group (353 cm(3); P < .001). In nontrauma patients, the mean splenic volume decreased from 474 cm(3) to 399 cm(3) after SAE (P = .068). Multivariable analysis revealed that coil pack location was the only factor significantly affecting resultant splenic volume (P = .016). For trauma and nontrauma patients, distal embolization resulted in significant splenic volume loss (P = .034 and P = .013), whereas proximal embolization did not. No patients had persistent circulating Howell-Jolly bodies after SAE. No patients required repeat embolization or splenectomy. CONCLUSIONS: Coil embolization of the splenic artery resulted in a modest but significant decrease in splenic volume when performed distally; proximal embolization resulted in an insignificant volume change.

Authors
Preece, SR; Schriber, SM; Choudhury, KR; Suhocki, PV; Smith, TP; Kim, CY
MLA Citation
Preece, SR, Schriber, SM, Choudhury, KR, Suhocki, PV, Smith, TP, and Kim, CY. "Coil embolization of the splenic artery: impact on splenic volume." Journal of vascular and interventional radiology : JVIR 25.6 (June 2014): 859-865.
PMID
24534094
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
6
Publish Date
2014
Start Page
859
End Page
865
DOI
10.1016/j.jvir.2013.12.564

Vascular artifact mimicking thrombosis on MR imaging using ferumoxytol as a contrast agent in abdominal vascular assessment.

PURPOSE: To describe an artifact that mimics thrombosis when assessing abdominal vasculature on magnetic resonance (MR) imaging using ferumoxytol in patients with contraindications to gadolinium-based contrast agents and to evaluate factors that may contribute to this artifact. MATERIALS AND METHODS: Three radiologists in consensus retrospectively evaluated 61 abdominal MR imaging examinations using ferumoxytol as an intravenous contrast agent for the presence of an observed artifact that can mimic thrombosis. Patient demographics and contrast agent bolus concentrations were compared with an unpaired Wilcoxon signed rank test. RESULTS: An artifact mimicking thrombosis was observed in 30 of 61 examinations, all on the arterial phase sequences. In examinations with this artifact, the average concentration of administered ferumoxytol was greater than in examinations where the artifact was not observed (P < .01). Several additional vascular findings were observed, including portal vein thrombosis (n = 2) and aneurysm (n = 1), renal vein thrombosis (n = 2), abdominal aortic aneurysm (n = 1), abdominal and iliac artery dissection (n = 3), and sequelae of portal hypertension (n = 8). CONCLUSIONS: Although MR imaging using ferumoxytol as an intravenous contrast agent can be useful in detecting abdominal vascular abnormalities, an artifact mimicking vascular thrombosis was observed in nearly half of the examinations.

Authors
Fananapazir, G; Marin, D; Suhocki, PV; Kim, CY; Bashir, MR
MLA Citation
Fananapazir, G, Marin, D, Suhocki, PV, Kim, CY, and Bashir, MR. "Vascular artifact mimicking thrombosis on MR imaging using ferumoxytol as a contrast agent in abdominal vascular assessment." Journal of vascular and interventional radiology : JVIR 25.6 (June 2014): 969-976.
PMID
24630749
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
6
Publish Date
2014
Start Page
969
End Page
976
DOI
10.1016/j.jvir.2013.12.019

Safety of an intercostal approach for imaging-guided percutaneous drainage of subdiaphragmatic abscesses.

OBJECTIVE: The objective of our study was to test the hypothesis that an intercostal approach to imaging-guided percutaneous subdiaphragmatic abscess drainage is as safe as a subcostal approach. MATERIALS AND METHODS: A cohort of 258 consecutive patients with one or more subdiaphragmatic abscesses referred for imaging-guided (CT or ultrasound) percutaneous drainage was identified. Demographic characteristics and clinical outcomes were compared between patients who underwent drainage catheter placement via an intercostal approach versus those who underwent drainage catheter placement via a subcostal approach. RESULTS: Percutaneous drainage was performed for 441 abscesses in 258 patients in 409 separate procedures (214 via an intercostal approach, 186 by a subcostal approach, and nine by a combined approach). The total number of pleural complications was significantly higher in the intercostal group (56/214 [26.2%]) than the subcostal group (15/186 [8.1%]; p < 0.001). These complications included a significantly higher pneumothorax rate in the intercostal group than the subcostal group (15/214 [7.0%] vs 0/186 [0%], respectively; p < 0.01) and a higher incidence of new or increased pleural effusions (38/214 [17.8%] vs 14/186 [7.5%]; p < 0.01). The incidence of empyema was low and similar between the two groups (intercostal vs subcostal, 3/214 [1.4%] vs 1/186 [0.5%]; p = 0.63). A few of the complications in the patients who underwent an intercostal-approach drainage were clinically significant. Four of the 15 pneumothoraces required thoracostomy tubes and eight of 38 (21.1%) pleural effusions required thoracentesis, none of which was considered infected. CONCLUSION: An intercostal approach for imaging-guided percutaneous drainage is associated with a higher risk of pleural complications; however, most of these complications are minor and should not preclude use of the intercostal approach.

Authors
Preece, SR; Nelson, RC; Bashir, MR; Jaffe, TA; Kim, CY; Haystead, CM
MLA Citation
Preece, SR, Nelson, RC, Bashir, MR, Jaffe, TA, Kim, CY, and Haystead, CM. "Safety of an intercostal approach for imaging-guided percutaneous drainage of subdiaphragmatic abscesses." AJR. American journal of roentgenology 202.6 (June 2014): 1349-1354.
PMID
24848834
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
202
Issue
6
Publish Date
2014
Start Page
1349
End Page
1354
DOI
10.2214/ajr.13.10712

Small renal mass biopsy--how, what and when: report from an international consensus panel.

To discuss the use of renal mass biopsy (RMB) for small renal masses (SRMs), formulate technical aspects, outline potential pitfalls and provide recommendations for the practicing clinician. The meeting was conducted as an informal consensus process and no scoring system was used to measure the levels of agreement on the different topics. A moderated general discussion was used as the basis for consensus and arising issues were resolved at this point. A consensus was established and lack of agreement to topics or specific items was noted at this point. Recommended biopsy technique: at least two cores, sampling different tumour regions with ultrasonography being the preferred method of image guidance. Pathological interpretation: 'non-diagnostic samples' should refer to insufficient material, inconclusive and normal renal parenchyma. For non-diagnostic samples, a repeat biopsy is recommended. Fine-needle aspiration may provide additional information but cannot substitute for core biopsy. Indications for RMB: biopsy is recommended in most cases except in patients with imaging or clinical characteristics indicative of pathology (syndromes, imaging characteristics) and cases whereby conservative management is not contemplated. RMB is recommended for active surveillance but not for watchful-waiting candidates. We report the results of an international consensus meeting on the use of RMB for SRMs, defining the technique, pathological interpretation and indications.

Authors
Tsivian, M; Rampersaud, EN; del Pilar Laguna Pes, M; Joniau, S; Leveillee, RJ; Shingleton, WB; Aron, M; Kim, CY; DeMarzo, AM; Desai, MM; Meler, JD; Donovan, JF; Klingler, HC; Sopko, DR; Madden, JF; Marberger, M; Ferrandino, MN; Polascik, TJ
MLA Citation
Tsivian, M, Rampersaud, EN, del Pilar Laguna Pes, M, Joniau, S, Leveillee, RJ, Shingleton, WB, Aron, M, Kim, CY, DeMarzo, AM, Desai, MM, Meler, JD, Donovan, JF, Klingler, HC, Sopko, DR, Madden, JF, Marberger, M, Ferrandino, MN, and Polascik, TJ. "Small renal mass biopsy--how, what and when: report from an international consensus panel." BJU Int 113.6 (June 2014): 854-863. (Review)
PMID
24119037
Source
pubmed
Published In
Bju International
Volume
113
Issue
6
Publish Date
2014
Start Page
854
End Page
863
DOI
10.1111/bju.12470

Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model.

To evaluate the histopathologic sequelae of bariatric embolization on the gastric mucosa and to correlate with immunohistochemical evaluation of the gastric fundus, antrum, and duodenum.This study was performed on 12 swine stomach and duodenum specimens after necropsy. Of the 12 swine, 6 had previously undergone bariatric embolization of the gastric fundus, and the 6 control swine had undergone a sham procedure with saline. Gross pathologic, histopathologic, and immunohistochemical examinations of the stomach and duodenum were performed. Specifically, mucosal integrity, fibrosis, ghrelin-expressing cells, and gastrin-expressing cells were assessed.Gross and histopathologic evaluation of treatment animals showed healing or healed mucosal ulcers in 50% of animals, with gastritis in 100% of treatment animals and in five of six control animals. The ghrelin-immunoreactive mean cell density was significantly lower in the gastric fundus in the treated animals compared with control animals (15.3 vs 22.0, P < .01) but similar in the gastric antrum (9.3 vs 14.3, P = .08) and duodenum (8.5 vs 8.6, P = .89). The gastrin-expressing cell density was significantly lower in the antrum of treated animals compared with control animals (82.2 vs 126.4, P = .03). A trend toward increased fibrosis was suggested in the gastric fundus of treated animals compared with controls (P = .07).Bariatric embolization resulted in a significant reduction in ghrelin-expressing cells in the gastric fundus without evidence of upregulation of ghrelin-expressing cells in the duodenum. Healing ulcerations in half of treated animals underscores the need for additional refinement of this procedure.

Authors
Paxton, BE; Alley, CL; Crow, JH; Burchette, J; Weiss, CR; Kraitchman, DL; Arepally, A; Kim, CY
MLA Citation
Paxton, BE, Alley, CL, Crow, JH, Burchette, J, Weiss, CR, Kraitchman, DL, Arepally, A, and Kim, CY. "Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model." Journal of vascular and interventional radiology : JVIR 25.3 (March 2014): 455-461.
PMID
24462005
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
3
Publish Date
2014
Start Page
455
End Page
461
DOI
10.1016/j.jvir.2013.09.016

Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model

Purpose To evaluate the histopathologic sequelae of bariatric embolization on the gastric mucosa and to correlate with immunohistochemical evaluation of the gastric fundus, antrum, and duodenum. Materials and Methods This study was performed on 12 swine stomach and duodenum specimens after necropsy. Of the 12 swine, 6 had previously undergone bariatric embolization of the gastric fundus, and the 6 control swine had undergone a sham procedure with saline. Gross pathologic, histopathologic, and immunohistochemical examinations of the stomach and duodenum were performed. Specifically, mucosal integrity, fibrosis, ghrelin-expressing cells, and gastrin-expressing cells were assessed. Results Gross and histopathologic evaluation of treatment animals showed healing or healed mucosal ulcers in 50% of animals, with gastritis in 100% of treatment animals and in five of six control animals. The ghrelin-immunoreactive mean cell density was significantly lower in the gastric fundus in the treated animals compared with control animals (15.3 vs 22.0, P < .01) but similar in the gastric antrum (9.3 vs 14.3, P =.08) and duodenum (8.5 vs 8.6, P =.89). The gastrin-expressing cell density was significantly lower in the antrum of treated animals compared with control animals (82.2 vs 126.4, P =.03). A trend toward increased fibrosis was suggested in the gastric fundus of treated animals compared with controls (P =.07). Conclusions Bariatric embolization resulted in a significant reduction in ghrelin-expressing cells in the gastric fundus without evidence of upregulation of ghrelin-expressing cells in the duodenum. Healing ulcerations in half of treated animals underscores the need for additional refinement of this procedure. © 2014 SIR.

Authors
Paxton, BE; Alley, CL; Crow, JH; Burchette, J; Weiss, CR; Kraitchman, DL; Arepally, A; Kim, CY
MLA Citation
Paxton, BE, Alley, CL, Crow, JH, Burchette, J, Weiss, CR, Kraitchman, DL, Arepally, A, and Kim, CY. "Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model." Journal of Vascular and Interventional Radiology 25.3 (January 22, 2014): 455-461.
Source
scopus
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
3
Publish Date
2014
Start Page
455
End Page
461
DOI
10.1016/j.jvir.2013.09.016

Small renal mass biopsy - How, what and when: Report from an international consensus panel

To discuss the use of renal mass biopsy (RMB) for small renal masses (SRMs), formulate technical aspects, outline potential pitfalls and provide recommendations for the practicing clinician. The meeting was conducted as an informal consensus process and no scoring system was used to measure the levels of agreement on the different topics. A moderated general discussion was used as the basis for consensus and arising issues were resolved at this point. A consensus was established and lack of agreement to topics or specific items was noted at this point. Recommended biopsy technique: at least two cores, sampling different tumour regions with ultrasonography being the preferred method of image guidance. Pathological interpretation: 'non-diagnostic samples' should refer to insufficient material, inconclusive and normal renal parenchyma. For non-diagnostic samples, a repeat biopsy is recommended. Fine-needle aspiration may provide additional information but cannot substitute for core biopsy. Indications for RMB: biopsy is recommended in most cases except in patients with imaging or clinical characteristics indicative of pathology (syndromes, imaging characteristics) and cases whereby conservative management is not contemplated. RMB is recommended for active surveillance but not for watchful-waiting candidates. We report the results of an international consensus meeting on the use of RMB for SRMs, defining the technique, pathological interpretation and indications. © 2013 The Authors. BJU International © 2013 BJU International.

Authors
Tsivian, M; Rampersaud, EN; Del Pilar Laguna Pes, M; Joniau, S; Leveillee, RJ; Shingleton, WB; Aron, M; Kim, CY; Demarzo, AM; Desai, MM; Meler, JD; Donovan, JF; Klingler, HC; Sopko, DR; Madden, JF; Marberger, M; Ferrandino, MN; Polascik, TJ
MLA Citation
Tsivian, M, Rampersaud, EN, Del Pilar Laguna Pes, M, Joniau, S, Leveillee, RJ, Shingleton, WB, Aron, M, Kim, CY, Demarzo, AM, Desai, MM, Meler, JD, Donovan, JF, Klingler, HC, Sopko, DR, Madden, JF, Marberger, M, Ferrandino, MN, and Polascik, TJ. "Small renal mass biopsy - How, what and when: Report from an international consensus panel." BJU International 113.6 (January 1, 2014): 854-863. (Review)
Source
scopus
Published In
Bju International
Volume
113
Issue
6
Publish Date
2014
Start Page
854
End Page
863
DOI
10.1111/bju.12470

Vascular artifact mimicking thrombosis on mr imaging using ferumoxytol as a contrast agent in abdominal vascular assessment

Purpose To describe an artifact that mimics thrombosis when assessing abdominal vasculature on magnetic resonance (MR) imaging using ferumoxytol in patients with contraindications to gadolinium-based contrast agents and to evaluate factors that may contribute to this artifact. Materials and Methods Three radiologists in consensus retrospectively evaluated 61 abdominal MR imaging examinations using ferumoxytol as an intravenous contrast agent for the presence of an observed artifact that can mimic thrombosis. Patient demographics and contrast agent bolus concentrations were compared with an unpaired Wilcoxon signed rank test. Results An artifact mimicking thrombosis was observed in 30 of 61 examinations, all on the arterial phase sequences. In examinations with this artifact, the average concentration of administered ferumoxytol was greater than in examinations where the artifact was not observed (P < .01). Several additional vascular findings were observed, including portal vein thrombosis (n = 2) and aneurysm (n = 1), renal vein thrombosis (n = 2), abdominal aortic aneurysm (n = 1), abdominal and iliac artery dissection (n = 3), and sequelae of portal hypertension (n = 8). Conclusions Although MR imaging using ferumoxytol as an intravenous contrast agent can be useful in detecting abdominal vascular abnormalities, an artifact mimicking vascular thrombosis was observed in nearly half of the examinations. © 2014 SIR.

Authors
Fananapazir, G; Marin, D; Suhocki, PV; Kim, CY; Bashir, MR
MLA Citation
Fananapazir, G, Marin, D, Suhocki, PV, Kim, CY, and Bashir, MR. "Vascular artifact mimicking thrombosis on mr imaging using ferumoxytol as a contrast agent in abdominal vascular assessment." Journal of Vascular and Interventional Radiology 25.6 (January 1, 2014): 969-976.
Source
scopus
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
6
Publish Date
2014
Start Page
969
End Page
976
DOI
10.1016/j.jvir.2013.12.019

Coil embolization of the splenic artery: Impact on splenic volume

Purpose To determine the impact of coil embolization of the splenic artery on splenic volume based on computed tomography (CT) imaging. Materials and Methods Splenic artery embolization (SAE) was performed in 148 consecutive patients over an 8-year period in an institutional review board-approved retrospective study. Of these, 60 patients (36 men; mean age, 49 y) had undergone contrast-enhanced CT before and after SAE with a mean time interval of 355 days. Pre- and postembolization splenic volumes were calculated with volume-rendering software. Presence of Howell-Jolly bodies was ascertained on laboratory tests. A trauma control group consisted of 39 patients with splenic laceration and follow-up CT but no splenic intervention. Results SAE in trauma patients resulted in an insignificant decrease in mean spleen size from 224 cm 3 to 190 cm 3 (P =.222). However, postembolization splenic volume was significantly smaller than follow-up volume in the trauma control group (353 cm 3 ; P < .001). In nontrauma patients, the mean splenic volume decreased from 474 cm 3 to 399 cm 3 after SAE (P =.068). Multivariable analysis revealed that coil pack location was the only factor significantly affecting resultant splenic volume (P =.016). For trauma and nontrauma patients, distal embolization resulted in significant splenic volume loss (P =.034 and P =.013), whereas proximal embolization did not. No patients had persistent circulating Howell-Jolly bodies after SAE. No patients required repeat embolization or splenectomy. Conclusions Coil embolization of the splenic artery resulted in a modest but significant decrease in splenic volume when performed distally; proximal embolization resulted in an insignificant volume change. © 2014 SIR.

Authors
Preece, SR; Schriber, SM; Choudhury, KR; Suhocki, PV; Smith, TP; Kim, CY
MLA Citation
Preece, SR, Schriber, SM, Choudhury, KR, Suhocki, PV, Smith, TP, and Kim, CY. "Coil embolization of the splenic artery: Impact on splenic volume." Journal of Vascular and Interventional Radiology 25.6 (January 1, 2014): 859-865.
Source
scopus
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
6
Publish Date
2014
Start Page
859
End Page
865
DOI
10.1016/j.jvir.2013.12.564

Venous filling defects on portal venous phase CT of the abdomen and pelvis: Clinical implications and positive predictive value for diagnosing deep venous thrombosis

Purpose: To determine the prevalence, resulting clinical decisions, and the positive predictive value (PPV) of venous filling defects detected on portal venous phase (PVP) CT. Methods: Over a 3-year period, 42412 consecutive patients underwent a PVP abdominopelvic CT; of these, 348 reports mentioned a filling defect concerning for deep venous thrombosis (DVT) in the IVC, iliac, or common femoral veins. Ninety-three patients underwent a reference standard venous imaging study. Results: The prevalence of venous filling defects in CT reports was 0.82% (n = 348). Reports worded with higher degrees of certainty were statistically more likely to result in treatment, while lower certainty was correlated with additional confirmatory imaging. The PPV for detection of DVT was 77%. The presence of peri-vascular stranding or vessel expansion increased the PPV of PVP CT to 95% and 100%, respectively. Conclusion: While the PPV for filling defects on PVP CT was modest, it was substantially improved if peri-venous stranding or vessel expansion was present. © 2014 Springer Science+Business Media.

Authors
Horvath, JJ; Looney, CB; Nelson, RC; Kim, CY
MLA Citation
Horvath, JJ, Looney, CB, Nelson, RC, and Kim, CY. "Venous filling defects on portal venous phase CT of the abdomen and pelvis: Clinical implications and positive predictive value for diagnosing deep venous thrombosis." Abdominal Imaging 39.3 (January 1, 2014): 554-561.
Source
scopus
Published In
Abdominal Imaging
Volume
39
Issue
3
Publish Date
2014
Start Page
554
End Page
561
DOI
10.1007/s00261-014-0077-1

Bacteriophage K antimicrobial-lock technique for treatment of staphylococcus aureus central venous catheter-related infection: A leporine model efficacy analysis

© 2014 SIR. Purpose To determine whether a bacteriophage antimicrobial-lock technique can reduce bacterial colonization and biofilm formation on indwelling central venous catheters in a rabbit model. Materials and Methods Cuffed central venous catheters were inserted into the jugular vein of female New Zealand White rabbits under image guidance. Catheters were inoculated for 24 hours with broth culture of methicillin-sensitive Staphylococcus aureus. The inoculum was aspirated, and rabbits were randomly assigned to two equal groups for 24 hours: (i) untreated controls (heparinized saline lock), (ii) bacteriophage antimicrobial-lock (staphylococcal bacteriophage K, propagated titer > 10 8 /mL). Blood cultures were obtained via peripheral veins, and the catheters were removed for quantitative culture and scanning electron microscopy. Results Mean colony-forming units (CFU) per cm 2 of the distal catheter segment, as a measure of biofilm, were significantly decreased in experimental animals compared with controls (control, 1.2 × 10 5 CFU/cm 2 ; experimental, 7.6 × 10 3 ; P =.016). Scanning electron microscopy demonstrated that biofilms were present on the surface of five of five control catheters but only one of five treated catheters (P =.048). Blood culture results were not significantly different between the groups. Conclusions In a rabbit model, treatment of infected central venous catheters with a bacteriophage antimicrobial-lock technique significantly reduced bacterial colonization and biofilm presence. Our data represent a preliminary step toward use of bacteriophage therapy for prevention and treatment of central venous catheter-associated infection.

Authors
Lungren, MP; Donlan, RM; Kankotia, R; Paxton, BE; Falk, I; Christensen, D; Kim, CY
MLA Citation
Lungren, MP, Donlan, RM, Kankotia, R, Paxton, BE, Falk, I, Christensen, D, and Kim, CY. "Bacteriophage K antimicrobial-lock technique for treatment of staphylococcus aureus central venous catheter-related infection: A leporine model efficacy analysis." Journal of Vascular and Interventional Radiology 25.10 (January 1, 2014): 1627-1632.
Source
scopus
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
10
Publish Date
2014
Start Page
1627
End Page
1632
DOI
10.1016/j.jvir.2014.06.009

Conventional and cross-sectional venography

© Springer International Publishing Switzerland 2014. Conventional venography has long been considered the gold standard for evaluation of the venous system. This exam is performed in an angiography suite using real-time X-ray imaging (fluoroscopy) to visualize intravenously injected iodinated contrast media. Digital subtraction angiography (DSA) is a technique that allows depiction of only the venous structures of interest by “subtracting” out the nonvascular structures, such as bone. This greatly improves visualization of intravascular contrast material. Cross-sectional venography, comprised of CT venography and MR venography, has the unique advantage of allowing visualization of any obstructing masses or other extrinsic structures that impact the venous system. The entire central venous system can be evaluated by injection through a central venous catheter or a single peripheral IV at any site using indirect imaging. MRV is the preferred method for evaluation of the central veins because the excellent signal intensity generated by gadolinium agents allows excellent visualization with indirect injection. With time-resolved MRA, the contrast bolus can be visualized passing through the vasculature in real-time manner, which allows excellent evaluation of collateral veins and routes of preferential blood flow. High-spatial resolution imaging can also be performed, allowing accurate characterization of lesions. This chapter discusses conventional and cross-sectional venography with a focus on particular disease processes.

Authors
Kim, CY; Guevara, CJ
MLA Citation
Kim, CY, and Guevara, CJ. "Conventional and cross-sectional venography." Phlebology, Vein Surgery and Ultrasonography: Diagnosis and Management of Venous Disease. January 1, 2014. 115-132.
Source
scopus
Publish Date
2014
Start Page
115
End Page
132
DOI
10.1007/978-3-319-01812-6_9

Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model

Authors
Paxton, BE; Alley, CL; Crow, JH; Burchette, J; Weiss, CR; Kraitchman, DL; Arepally, A; Kim, CY
MLA Citation
Paxton, BE, Alley, CL, Crow, JH, Burchette, J, Weiss, CR, Kraitchman, DL, Arepally, A, and Kim, CY. "Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model." Journal of Vascular and Interventional Radiology 25.3 (2014): 455-461.
Source
scopus
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
25
Issue
3
Publish Date
2014
Start Page
455
End Page
461

Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases

Purpose To compare abdominopelvic and lower extremity venous enhancement in contrast-enhanced magnetic resonance venography (ceMRV), using iron-based ferumoxytol and gadolinium-based gadofosveset. Materials and Methods This was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. Thirty-four patients were identified who had undergone ceMRV using either ferumoxtyol (Group A, all with chronic renal insufficiency) or gadofosveset (Group B). Two radiologists rated confidence for evaluation of the major abdominopelvic and lower extremity veins from 4 (excellent confidence) to 1 (nondiagnostic). A third radiologist measured signal intensity ratios (SIRs) of venous segments compared with adjacent muscles. Scores were compared using repeated-measures analysis of variance (ANOVA). The medical record was searched for contemporaneous imaging to confirm the ceMRV findings. Results In Group A, 14/225 venous segments were thrombosed, compared with 18/282 in Group B. There was no statistically significant difference between confidence scores (3.79 ± 0.44 vs. 3.85 ± 0.44, P = 0.34) or SIRs (2.40 ± 0.73 vs. 2.38 ± 0.51, P = 0.51) for patent segments in the two groups, nor were confidences scores (3.89 ± 0.29 vs. 3.72 ± 0.46, P = 0.31) or SIRs (0.90 ± 0.12 vs. 0.84 ± 0.19, P = 0.31) significantly different for thrombosed segments. Contemporaneous imaging confirmed ceMRV findings in 227 segments. Conclusion ceMRV can be performed with ferumoxytol, yielding similar image quality to a blood pool gadolinium-based contrast agent. © 2013 Wiley Periodicals, Inc. © 2013 Wiley Periodicals, Inc.

Authors
Bashir, MR; Mody, R; Neville, A; Javan, R; Seaman, D; Kim, CY; Gupta, RT; Jaffe, TA
MLA Citation
Bashir, MR, Mody, R, Neville, A, Javan, R, Seaman, D, Kim, CY, Gupta, RT, and Jaffe, TA. "Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases." Journal of Magnetic Resonance Imaging 40.1 (2014): 113-118.
Source
scival
Published In
Journal of Magnetic Resonance Imaging
Volume
40
Issue
1
Publish Date
2014
Start Page
113
End Page
118
DOI
10.1002/jmri.24330

Comparison of primary jejunostomy tubes versus gastrojejunostomy tubes for percutaneous enteral nutrition

Purpose To evaluate technical success and long-term outcomes of percutaneous primary jejunostomy tubes for postpyloric enteral feeding compared with percutaneous gastrojejunostomy (GJ) tubes. Materials and Methods Over a 25-month interval, 41 consecutive patients (26 male; mean age, 55.9 y) underwent attempted fluoroscopy-guided direct percutaneous jejunostomy tube insertion. Insertions at previous jejunostomy tube sites were excluded. The comparison group consisted of all primary GJ tube insertions performed over a 12-month interval concomitant with the jejunostomy tube interval (N = 169; 105 male; mean age, 59.4 y). Procedural, radiologic, and clinical data were retrospectively reviewed. Intervention rates were expressed as events per 100 catheter-days. Results The technical success rate for percutaneous jejunostomy tube insertion was 96%, versus 93% for GJ tubes (P =.47). Mean fluoroscopy times were similar for jejunostomy and GJ tubes (9.8 vs 10.0 min, respectively; P value not significant). Jejunostomy tubes exhibited a lower rate of catheter dysfunction than GJ tubes, with catheter exchange rates of 0.24 versus 0.93, respectively, per 100 catheter-days (P =.045). GJ tube tip retraction into the stomach occurred in 9.5% of cases, at a rate of 0.21 per 100 catheter-days. Intervention rates related to leakage were 0.19 and 0.03 for jejunostomy and GJ tubes, respectively (P < .01). Jejunostomy and GJ tubes exhibited similar rates of catheter exchange for occlusion and replacement as a result of inadvertent removal. No major complications were encountered in either group. Conclusions Percutaneous insertion of primary jejunostomy tubes demonstrated technical success and complication rates similar to those of GJ tubes. Jejunostomy tubes exhibited a lower dysfunction rate but a higher leakage rate compared with GJ tubes. © 2013 SIR.

Authors
Kim, CY; Engstrom, BI; Horvath, JJ; Lungren, MP; Suhocki, PV; Smith, TP
MLA Citation
Kim, CY, Engstrom, BI, Horvath, JJ, Lungren, MP, Suhocki, PV, and Smith, TP. "Comparison of primary jejunostomy tubes versus gastrojejunostomy tubes for percutaneous enteral nutrition." Journal of Vascular and Interventional Radiology 24.12 (December 1, 2013): 1845-1852.
Source
scopus
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
24
Issue
12
Publish Date
2013
Start Page
1845
End Page
1852
DOI
10.1016/j.jvir.2013.08.012

Comparison of primary jejunostomy tubes versus gastrojejunostomy tubes for percutaneous enteral nutrition.

PURPOSE: To evaluate technical success and long-term outcomes of percutaneous primary jejunostomy tubes for postpyloric enteral feeding compared with percutaneous gastrojejunostomy (GJ) tubes. MATERIALS AND METHODS: Over a 25-month interval, 41 consecutive patients (26 male; mean age, 55.9 y) underwent attempted fluoroscopy-guided direct percutaneous jejunostomy tube insertion. Insertions at previous jejunostomy tube sites were excluded. The comparison group consisted of all primary GJ tube insertions performed over a 12-month interval concomitant with the jejunostomy tube interval (N = 169; 105 male; mean age, 59.4 y). Procedural, radiologic, and clinical data were retrospectively reviewed. Intervention rates were expressed as events per 100 catheter-days. RESULTS: The technical success rate for percutaneous jejunostomy tube insertion was 96%, versus 93% for GJ tubes (P = .47). Mean fluoroscopy times were similar for jejunostomy and GJ tubes (9.8 vs 10.0 min, respectively; P value not significant). Jejunostomy tubes exhibited a lower rate of catheter dysfunction than GJ tubes, with catheter exchange rates of 0.24 versus 0.93, respectively, per 100 catheter-days (P = .045). GJ tube tip retraction into the stomach occurred in 9.5% of cases, at a rate of 0.21 per 100 catheter-days. Intervention rates related to leakage were 0.19 and 0.03 for jejunostomy and GJ tubes, respectively (P < .01). Jejunostomy and GJ tubes exhibited similar rates of catheter exchange for occlusion and replacement as a result of inadvertent removal. No major complications were encountered in either group. CONCLUSIONS: Percutaneous insertion of primary jejunostomy tubes demonstrated technical success and complication rates similar to those of GJ tubes. Jejunostomy tubes exhibited a lower dysfunction rate but a higher leakage rate compared with GJ tubes.

Authors
Kim, CY; Engstrom, BI; Horvath, JJ; Lungren, MP; Suhocki, PV; Smith, TP
MLA Citation
Kim, CY, Engstrom, BI, Horvath, JJ, Lungren, MP, Suhocki, PV, and Smith, TP. "Comparison of primary jejunostomy tubes versus gastrojejunostomy tubes for percutaneous enteral nutrition." J Vasc Interv Radiol 24.12 (December 2013): 1845-1852.
PMID
24094674
Source
pubmed
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
24
Issue
12
Publish Date
2013
Start Page
1845
End Page
1852
DOI
10.1016/j.jvir.2013.08.012

Bacteriophage K for reduction of Staphylococcus aureusbiofilm on central venous catheter material.

The purpose of this project was to determine whether bacteriophage can reduce bacterial colonization and biofilm formation on central venous catheter material. Twenty silicone discs were inoculated for 24 h with broth culture of Methicillin sensitive staphylococcus aureus (0.5 McFarland standard). The inoculate was aspirated and discs placed into two equal groups for 24 h: (1) untreated controls; (2) bacteriophage treatment (staphylococcal bacteriophage K, propagated titer > 10(8)). At the completion of the experiment discs were processed for quantitative culture. Statistical testing was performed using the rank sum test. Mean colony forming units (CFU) were significantly decreased in experimental compared with controls (control 6.3 × 10(5) CFU, experimental 6.7 × 10(1), P ≤ 0.0001). Application of bacteriophage to biofilm infected central venous catheter material significantly reduced bacterial colonization and biofilm presence. Our data suggests that bacteriophage treatment may be a feasible strategy for addressing central venous catheter staph aureus biofilm infections.

Authors
Lungren, MP; Christensen, D; Kankotia, R; Falk, I; Paxton, BE; Kim, CY
MLA Citation
Lungren, MP, Christensen, D, Kankotia, R, Falk, I, Paxton, BE, and Kim, CY. "Bacteriophage K for reduction of Staphylococcus aureusbiofilm on central venous catheter material." Bacteriophage 3.4 (October 1, 2013): e26825-.
PMID
24265979
Source
pubmed
Published In
Bacteriophage
Volume
3
Issue
4
Publish Date
2013
Start Page
e26825
DOI
10.4161/bact.26825

Impact of phase of respiration on central venous catheter tip position.

PURPOSE: To determine the impact of the phase of respiration on CVC tip position using cross-sectional imaging. METHODS: We retrospectively analyzed the CT scans of 24 consecutive patients (eight men and 16 women, mean age 56.3 years, range 18-79) who underwent a CT scan protocol that includes both imaging of the thorax in inspiration and expiration. Only patients with a central venous catheter and absence of any substantial pulmonary pathology that might affect lung volumes were included. Measurements of the catheter tip location and central venous structures were obtained from inspiratory and expiratory phase images in each patient and compared using the paired t test. RESULTS: The length of the SVC and superior mediastinum were significantly longer during inspiration compared to expiration (9 mm and 7 mm respectively, P<0.001 for both). The distance between the superior and inferior cavo-atrial junction did not change significantly with respiration. The catheter tip location moved on average 9 mm (range 0-25 mm) cephalad during inspiration compared to expiration (P=0.001) in relation to the superior cavoatrial junction. The amount of catheter tip movement correlated significantly with the degree of diaphragmatic excursion with respiration (R=0.58). During inspiration, the cavo-atrial junction was on average 11 mm inferior to the right cardiomediastinal angle observed on radiography, but was nearly identical during expiration (R=0.78, P<0.001). CONCLUSIONS: The central catheter tip position varied significantly with respiratory motion, with a mean excursion of 9 mm. The right cardiomediastinal border demonstrated a strong correlation with the actual location of the superior cavo-atrial junction in expiration, but not in inspiration.

Authors
Pan, PP; Engstrom, BI; Lungren, MP; Seaman, DM; Lessne, ML; Kim, CY
MLA Citation
Pan, PP, Engstrom, BI, Lungren, MP, Seaman, DM, Lessne, ML, and Kim, CY. "Impact of phase of respiration on central venous catheter tip position." J Vasc Access 14.4 (October 2013): 383-387.
PMID
23599138
Source
pubmed
Published In
The journal of vascular access
Volume
14
Issue
4
Publish Date
2013
Start Page
383
End Page
387
DOI
10.5301/jva.5000135

Radiation exposure associated with dedicated renal mass computed tomography protocol: impact of patient characteristics.

BACKGROUND AND PURPOSE: Renal mass protocol CT (RMP-CT) using multiphase abdomen and pelvis CT imaging is the mainstay for diagnosis, characterization, and follow-up for renal masses; however, it is associated with ionizing radiation to the patient. We sought to quantify the effective dose associated with RMP-CT and to determine how patient factors affect radiation exposure. MATERIAL AND METHODS: We retrospectively reviewed the records of 247 patients undergoing management of a small renal mass (cT1a) between 2005 and 2011 at our institution. Body mass index (BMI) was categorized as normal weight, overweight, obese, and morbidly obese (≤25, 25.1-30, 30.1-35 and >35, respectively). Effective dose of RMP-CT was calculated through the dose-length-product multiplied by a factor coefficient (0.015). Effective doses in milliSieverts (mSv) were correlated to patient characteristics. RESULTS: Patients' median age was 61 years, and median BMI was 28.7 kg/m(2); 72% were Caucasian and 56% were male. Median effective dose was 26.1 mSv (interquartile range 20.6-35.3). When stratified by BMI, the median effective doses were 18.9, 25.2, 27.7, and 36.2mSv for normal weight, overweight, obese, and morbidly obese patients, respectively. On multivariable analyses, BMI and male sex were significantly associated with increased radiation dose. CONCLUSIONS: In this series, the median effective dose for RMP-CT was 26.1 mSv. Obesity was independently associated with markedly increased radiation exposure, with morbidly obese patients being exposed to almost twice the amount of radiation compared with normal weight persons. These findings should be considered when devising management strategies in patients with a renal mass and strategies should be developed to reduce medical ionizing radiation exposure.

Authors
Tsivian, M; Abern, MR; Yoo, JJ; Evans, P; Qi, P; Kim, CY; Lipkin, ME; Polascik, TJ; Ferrandino, MN
MLA Citation
Tsivian, M, Abern, MR, Yoo, JJ, Evans, P, Qi, P, Kim, CY, Lipkin, ME, Polascik, TJ, and Ferrandino, MN. "Radiation exposure associated with dedicated renal mass computed tomography protocol: impact of patient characteristics." J Endourol 27.9 (September 2013): 1102-1106.
PMID
23682980
Source
pubmed
Published In
Journal of Endourology
Volume
27
Issue
9
Publish Date
2013
Start Page
1102
End Page
1106
DOI
10.1089/end.2013.0111

Tunneled peritoneal drainage catheter placement for refractory ascites: single-center experience in 188 patients.

PURPOSE: To assess the success and safety of tunneled peritoneal drainage catheters for the management of ascites refractory to medical management. MATERIALS AND METHODS: A total of 188 consecutive patients (83 male, 105 female; average age 59 y) with refractory ascites were treated with tunneled peritoneal drainage catheters from January 1, 2006, to August 10, 2012. A combination of fluoroscopic and ultrasound guidance was used to insert all catheters. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data (malignancy, renal disease, chemotherapy, neutropenia, albumin levels) were compared with respect to patency and complication rates with the use of odds ratios. Catheter survival curves were generated with the Kaplan-Meier method and life-table analysis for the cumulative and infection-free survival of primary and secondary catheters. RESULTS: A total of 193 catheter placements or interventions were performed in 188 patients with refractory ascites: 170 catheters (93%) were placed for malignant etiologies and 13 (7%) for nonmalignant etiologies. The most common malignancies were ovarian (22%), pancreatic (12%), and breast (11%). The most common nonmalignant etiologies were end-stage liver disease (n = 7) and heart failure (n = 6). There was a 100% technical success rate for catheter insertion; no procedure-related deaths or major placement complications were identified. Catheter survival ranged from 0 to 796 days (mean, 60 d), with a total of 11,936 cumulative catheter-days. Fourteen postplacement complications were identified: five patients experienced catheter malfunction, four had leakage of ascites at the incisional site requiring suture placement, three had cellulitis of the tunnel tract, and two developed peritonitis. The annual complication event rate was 0.43 events per year (ie, 0.12 events per 100 catheter-days). Pancreatic malignancy was associated with a significantly increased rate of catheter malfunction (ie, occlusion). CONCLUSIONS: Radiologic insertion of tunneled peritoneal drainage catheters demonstrated a 100% technical success rate for insertion and an acceptable complication rate for the management of refractory ascites.

Authors
Lungren, MP; Kim, CY; Stewart, JK; Smith, TP; Miller, MJ
MLA Citation
Lungren, MP, Kim, CY, Stewart, JK, Smith, TP, and Miller, MJ. "Tunneled peritoneal drainage catheter placement for refractory ascites: single-center experience in 188 patients." Journal of vascular and interventional radiology : JVIR 24.9 (September 2013): 1303-1308.
PMID
23876552
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
24
Issue
9
Publish Date
2013
Start Page
1303
End Page
1308
DOI
10.1016/j.jvir.2013.05.042

Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates.

PURPOSE: To determine rates of dysfunction and infection for tunneled internal jugular vein hemodialysis catheters based on laterality of insertion and catheter tip position. MATERIALS AND METHODS: Retrospective review of a procedural database for tunneled internal jugular vein hemodialysis catheter placements between January 2008 and December 2009 revealed 532 catheter insertions in 409 patients (234 male; mean age, 54.9 y). Of these, 398 catheters were placed on the right and 134 on the left. The catheter tip location was categorized as superior vena cava (SVC), pericavoatrial junction, or mid- to deep right atrium based on review of the final intraprocedural radiograph. The rates of catheter dysfunction and catheter-related infection (reported as events per 100 catheter-days) were analyzed. RESULTS: Catheters terminating in the SVC or pericavoatrial junction inserted from the left showed significantly higher rates of infection (0.50 vs 0.27; P = .005) and dysfunction (0.25 vs 0.11; P = .036) compared with those inserted from the right. No difference was identified based on laterality for catheter tip position in the mid- to deep right atrium. Left-sided catheters terminating in the SVC or pericavoatrial junction had significantly more episodes of catheter dysfunction or infection than catheters terminating in the mid- to deep right atrium (0.84 vs 0.35; P = .006), whereas no significant difference was identified for right-sided catheters based on tip position. CONCLUSIONS: When inserted from the left internal jugular vein, catheter tip position demonstrated a significant impact on catheter-related dysfunction and infection; this relationship was not demonstrated for right-sided catheters.

Authors
Engstrom, BI; Horvath, JJ; Stewart, JK; Sydnor, RH; Miller, MJ; Smith, TP; Kim, CY
MLA Citation
Engstrom, BI, Horvath, JJ, Stewart, JK, Sydnor, RH, Miller, MJ, Smith, TP, and Kim, CY. "Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates." J Vasc Interv Radiol 24.9 (September 2013): 1295-1302.
PMID
23891045
Source
pubmed
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
24
Issue
9
Publish Date
2013
Start Page
1295
End Page
1302
DOI
10.1016/j.jvir.2013.05.035

Gadofosveset-enhanced magnetic resonance angiography of the thoracic vasculature in the equilibrium phase: feasibility and impact of dose.

OBJECTIVE: The objectives of this study were to evaluate the feasibility of gadofosveset-enhanced magnetic resonance angiography (MRA) of the thoracic vasculature in the equilibrium phase and to determine the impact of gadofosveset dose on imaging quality. METHODS: Thirty healthy volunteers were randomized to receive a dose of 0.03, 0.02, or 0.01 mmol/kg of gadofosveset for MRA at 3 T in the equilibrium phase. Two radiologists assessed the central veins, the pulmonary arteries, and the thoracic aorta. Quantitative assessments were also performed. RESULTS: At 0.03 and 0.02 mmol/kg, all vessel segments were rated as adequate. At a dose of 0.01 mmol/kg, less than 10% of vascular segments were collectively rated as inadequate. The signal-to-noise ratio and contrast-to-noise ratio were significantly lower in all segments at 0.01 mmol/kg compared with higher doses. CONCLUSIONS: Gadofosveset-enhanced MRA of the thoracic vessels in the equilibrium phase in healthy volunteers resulted in adequate vessel visualization, even when dose reduction was performed.This trial was registered with clinicaltrials.gov, identifier NCT01431300.

Authors
Kim, CY; Heye, T; Bashir, MR; Gebhard, TA; Merkle, EM
MLA Citation
Kim, CY, Heye, T, Bashir, MR, Gebhard, TA, and Merkle, EM. "Gadofosveset-enhanced magnetic resonance angiography of the thoracic vasculature in the equilibrium phase: feasibility and impact of dose." J Comput Assist Tomogr 37.5 (September 2013): 732-736.
PMID
24045249
Source
pubmed
Published In
Journal of Computer Assisted Tomography
Volume
37
Issue
5
Publish Date
2013
Start Page
732
End Page
736
DOI
10.1097/RCT.0b013e318299dde9

Abdominopelvic and lower extremity deep venous thrombosis: evaluation with contrast-enhanced MR venography with a blood-pool agent.

OBJECTIVE: The purpose of this article is to evaluate contrast-enhanced (CE) MR venography (MRV) with a blood-pool agent for detection of abdominopelvic and lower extremity deep venous thrombosis (DVT) compared with a conventional unenhanced gradient-recalled echo (GRE) MRV technique. MATERIALS AND METHODS: This retrospective study was performed on 30 patients (mean age, 52.7 years; 15 men and 15 women) referred for MRV between March 2010 and November 2010 for evaluation of lower extremity or abdominopelvic DVT. All patients underwent a GRE sequence followed by a CE T1-weighted sequence with gadofosveset, a blood-pool agent. The abdominopelvic and lower extremity venous system was divided into 13 segments. The presence of acute or chronic DVT was assessed by six radiologists, as well as qualitative and quantitative assessments of each venous segment. Image acquisition and interpretation times were also tabulated. RESULTS: The sensitivity and specificity for acute DVT were 91.0% and 99.8%, respectively, on CE MRV compared with 80.8% and 95.8%, respectively, on GRE MRV (p = 0.077 and p < 0.001). The sensitivity and specificity for chronic DVT were 84.4% and 98.4%, respectively, on CE MRV and 64.5% and 95.6%, respectively, on GRE MRV (p < 0.001 for both). Subjective ratings of vein visualization, signal homogeneity, and confidence pertaining to DVT diagnosis were significantly higher with the CE images (p < 0.001). The contrast-to-noise ratio for CE images was similar or significantly higher for all venous segments. Image acquisition and radiologist interpretation times on the CE studies were decreased (p < 0.001). CONCLUSION: Gadofosveset-enhanced MRV had equal or higher sensitivity and specificity for detection of DVT than did GRE MRV, with decreased time for image acquisition and interpretation.

Authors
Huang, SY; Kim, CY; Miller, MJ; Gupta, RT; Lessne, ML; Horvath, JJ; Boll, DT; Evans, PD; Befera, NT; Krishnan, P; Chan, JL; Merkle, EM
MLA Citation
Huang, SY, Kim, CY, Miller, MJ, Gupta, RT, Lessne, ML, Horvath, JJ, Boll, DT, Evans, PD, Befera, NT, Krishnan, P, Chan, JL, and Merkle, EM. "Abdominopelvic and lower extremity deep venous thrombosis: evaluation with contrast-enhanced MR venography with a blood-pool agent." AJR Am J Roentgenol 201.1 (July 2013): 208-214.
PMID
23789677
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
201
Issue
1
Publish Date
2013
Start Page
208
End Page
214
DOI
10.2214/AJR.12.9611

Incidental detection of nutcracker phenomenon on multidetector CT in an asymptomatic population: prevalence and associated findings.

OBJECTIVE: To determine the prevalence of nutcracker phenomenon (left renal vein compression by the superior mesenteric artery) and secondary anatomic findings using multidetector computed tomographic (CT) angiography in an asymptomatic population. METHODS: Ninety-nine consecutive CT angiograms for potential renal transplant donors (mean age, 39.0 years; 42 males) without variant renal vein anatomy were reviewed retrospectively. The diameters of the maximal left renal vein, left renal vein between the aorta and superior mesenteric artery, and draining gonadal and lumbar veins were measured. Sex, age, hematuria, proteinuria, and abdominal or flank pain were recorded. RESULTS: Twenty-three patients had 50% to 70% stenosis, and 4 patients had greater than 70% stenosis of the left renal vein. Dilated gonadal and lumbar veins were found in 16 and 28 patients, respectively. Four patients had hematuria. These findings were not significantly associated with left renal vein compression. CONCLUSIONS: Nutcracker phenomenon and dilated veins originating from the left renal vein are common incidental CT findings and nonspecific for the diagnosis of nutcracker syndrome.

Authors
Grimm, LJ; Engstrom, BI; Nelson, RC; Kim, CY
MLA Citation
Grimm, LJ, Engstrom, BI, Nelson, RC, and Kim, CY. "Incidental detection of nutcracker phenomenon on multidetector CT in an asymptomatic population: prevalence and associated findings." J Comput Assist Tomogr 37.3 (May 2013): 415-418.
PMID
23674014
Source
pubmed
Published In
Journal of Computer Assisted Tomography
Volume
37
Issue
3
Publish Date
2013
Start Page
415
End Page
418
DOI
10.1097/RCT.0b013e3182873235

Covered transjugular intrahepatic portosystemic shunts: accuracy of ultrasound in detecting shunt malfunction.

OBJECTIVE: The purpose of this study was to determine the accuracy of ultrasound for detecting transjugular intrahepatic portosystemic shunt (TIPS) malfunction in covered stents in comparison with bare metal stents. MATERIALS AND METHODS: During a 6-year period, 126 TIPS angiography examinations were performed in 78 patients who had undergone a recent TIPS ultrasound examination. Radiology reports and images were retrospectively reviewed, and the sensitivity and specificity of sonographic parameters for detecting TIPS dysfunction were calculated using TIPS angiography and portosystemic gradient as the reference standards. RESULTS: Of 126 paired studies, 43 were in bare metal TIPS and 83 were in covered TIPS. Peak shunt velocity of covered and bare metal TIPS measured by ultrasound showed comparable sensitivities for detection of shunt dysfunction, using both depressed (< 90 cm/s) and elevated (> 200 cm/s) peak shunt velocity criteria. However, a depressed velocity was more specific in covered TIPS (0.939 vs 0.550, p < 0.001) whereas elevated velocity was more specific in bare TIPS (0.485 vs 0.800, p = 0.041). An interval change in peak TIPS velocity greater than 25% was significantly more sensitive in detection of dysfunction in covered TIPS (0.815 vs 0.400, p = 0.015) whereas detection based on main portal vein velocities (≤ 30 cm/s) was not statistically different in the two groups. CONCLUSION: Our data suggest that the accuracy of ultrasound for detection of TIPS shunt malfunction is at least as high in covered stents as in bare metal stents. Diagnostic performance for several sonographic parameters varied significantly between bare and covered stents, suggesting the need for optimization of sonographic criteria for covered stents.

Authors
Engstrom, BI; Horvath, JJ; Suhocki, PV; Smith, AD; Hertzberg, BS; Smith, TP; Kim, CY
MLA Citation
Engstrom, BI, Horvath, JJ, Suhocki, PV, Smith, AD, Hertzberg, BS, Smith, TP, and Kim, CY. "Covered transjugular intrahepatic portosystemic shunts: accuracy of ultrasound in detecting shunt malfunction." AJR Am J Roentgenol 200.4 (April 2013): 904-908.
PMID
23521468
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
200
Issue
4
Publish Date
2013
Start Page
904
End Page
908
DOI
10.2214/AJR.12.8761

Percutaneous interventions on the hemodialysis reliable outflow vascular access device.

PURPOSE: To determine the outcomes of percutaneous interventions for prolonging the patency of the Hemodialysis Reliable Outflow (HeRO) device. MATERIALS AND METHODS: Between January 2007 and August 2011, 73 percutaneous interventions were performed on 26 HeRO devices in 25 patients. The graft was implanted in the upper arm with the outflow catheter tip in the superior vena cava or right atrium. Procedural reports, angiographic images, and clinical notes were retrospectively reviewed. The primary and secondary patency rates after intervention were calculated using the Kaplan-Meier method. RESULTS: The mean time from HeRO implantation to initial dysfunction or thrombosis was 171 days. In 60 (82%) procedures, the HeRO device was thrombosed. An intragraft stenosis was the most common lesion identified (59%; n = 43) followed by an arterial anastomosis stenosis identified in 18% (n = 13). In 22% (n = 16) of procedures in which the HeRO device was thrombosed, an underlying cause was not identified after thrombectomy. The 3-, 6-, and 12-month primary patency rates after intervention were 47%, 37%, and 26% for first-time interventions. The secondary patency rates were 80%, 70%, and 64%. The only complication was pulmonary embolism resulting in death 2 days after HeRO thrombectomy. CONCLUSIONS: Percutaneous interventions on thrombosed and failing HeRO devices yielded acceptable primary and secondary patency rates after intervention in these patients with few, if any, alternatives for hemodialysis access.

Authors
Gebhard, TA; Bryant, JA; Adam Grezaffi, J; Pabon-Ramos, WM; Gage, SM; Miller, MJ; Husum, KW; Suhocki, PV; Sopko, DR; Lawson, JH; Smith, TP; Kim, CY
MLA Citation
Gebhard, TA, Bryant, JA, Adam Grezaffi, J, Pabon-Ramos, WM, Gage, SM, Miller, MJ, Husum, KW, Suhocki, PV, Sopko, DR, Lawson, JH, Smith, TP, and Kim, CY. "Percutaneous interventions on the hemodialysis reliable outflow vascular access device." J Vasc Interv Radiol 24.4 (April 2013): 543-549.
PMID
23462067
Source
pubmed
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
24
Issue
4
Publish Date
2013
Start Page
543
End Page
549
DOI
10.1016/j.jvir.2012.12.027

Tunneled peritoneal drainage catheter placement for refractory ascites: Single-center experience in 188 patients

Purpose To assess the success and safety of tunneled peritoneal drainage catheters for the management of ascites refractory to medical management. Materials and Methods A total of 188 consecutive patients (83 male, 105 female; average age 59 y) with refractory ascites were treated with tunneled peritoneal drainage catheters from January 1, 2006, to August 10, 2012. A combination of fluoroscopic and ultrasound guidance was used to insert all catheters. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data (malignancy, renal disease, chemotherapy, neutropenia, albumin levels) were compared with respect to patency and complication rates with the use of odds ratios. Catheter survival curves were generated with the Kaplan-Meier method and life-table analysis for the cumulative and infection-free survival of primary and secondary catheters. Results A total of 193 catheter placements or interventions were performed in 188 patients with refractory ascites: 170 catheters (93%) were placed for malignant etiologies and 13 (7%) for nonmalignant etiologies. The most common malignancies were ovarian (22%), pancreatic (12%), and breast (11%). The most common nonmalignant etiologies were end-stage liver disease (n = 7) and heart failure (n = 6). There was a 100% technical success rate for catheter insertion; no procedure-related deaths or major placement complications were identified. Catheter survival ranged from 0 to 796 days (mean, 60 d), with a total of 11,936 cumulative catheter-days. Fourteen postplacement complications were identified: five patients experienced catheter malfunction, four had leakage of ascites at the incisional site requiring suture placement, three had cellulitis of the tunnel tract, and two developed peritonitis. The annual complication event rate was 0.43 events per year (ie, 0.12 events per 100 catheter-days). Pancreatic malignancy was associated with a significantly increased rate of catheter malfunction (ie, occlusion). Conclusions Radiologic insertion of tunneled peritoneal drainage catheters demonstrated a 100% technical success rate for insertion and an acceptable complication rate for the management of refractory ascites. © 2013 SIR.

Authors
Lungren, MP; Kim, CY; Stewart, JK; Smith, TP; Miller, MJ
MLA Citation
Lungren, MP, Kim, CY, Stewart, JK, Smith, TP, and Miller, MJ. "Tunneled peritoneal drainage catheter placement for refractory ascites: Single-center experience in 188 patients." Journal of Vascular and Interventional Radiology 24.9 (2013): 1303-1308.
Source
scival
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
24
Issue
9
Publish Date
2013
Start Page
1303
End Page
1308
DOI
10.1016/j.jvir.2013.05.042

Tunneled internal jugular hemodialysis catheters: Impact of laterality and tip position on catheter dysfunction and infection rates

Purpose To determine rates of dysfunction and infection for tunneled internal jugular vein hemodialysis catheters based on laterality of insertion and catheter tip position. Materials and Methods Retrospective review of a procedural database for tunneled internal jugular vein hemodialysis catheter placements between January 2008 and December 2009 revealed 532 catheter insertions in 409 patients (234 male; mean age, 54.9 y). Of these, 398 catheters were placed on the right and 134 on the left. The catheter tip location was categorized as superior vena cava (SVC), pericavoatrial junction, or mid- to deep right atrium based on review of the final intraprocedural radiograph. The rates of catheter dysfunction and catheter-related infection (reported as events per 100 catheter-days) were analyzed. Results Catheters terminating in the SVC or pericavoatrial junction inserted from the left showed significantly higher rates of infection (0.50 vs 0.27; P =.005) and dysfunction (0.25 vs 0.11; P =.036) compared with those inserted from the right. No difference was identified based on laterality for catheter tip position in the mid- to deep right atrium. Left-sided catheters terminating in the SVC or pericavoatrial junction had significantly more episodes of catheter dysfunction or infection than catheters terminating in the mid- to deep right atrium (0.84 vs 0.35; P =.006), whereas no significant difference was identified for right-sided catheters based on tip position. Conclusions When inserted from the left internal jugular vein, catheter tip position demonstrated a significant impact on catheter-related dysfunction and infection; this relationship was not demonstrated for right-sided catheters. © 2013 SIR.

Authors
Engstrom, BI; Horvath, JJ; Stewart, JK; Sydnor, RH; Miller, MJ; Smith, TP; Kim, CY
MLA Citation
Engstrom, BI, Horvath, JJ, Stewart, JK, Sydnor, RH, Miller, MJ, Smith, TP, and Kim, CY. "Tunneled internal jugular hemodialysis catheters: Impact of laterality and tip position on catheter dysfunction and infection rates." Journal of Vascular and Interventional Radiology 24.9 (2013): 1295-1302.
Source
scival
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
24
Issue
9
Publish Date
2013
Start Page
1295
End Page
1302
DOI
10.1016/j.jvir.2013.05.035

Bariatric Embolization for Suppression of the Hunger Hormone Ghrelin in a Porcine Model.

Purpose:To prospectively test in a porcine model the hypothesis that bariatric embolization with commercially available calibrated microspheres can result in substantial suppression of systemic ghrelin levels and affect weight gain over an 8-week period.Materials and Methods:The institutional animal care and use committee approved this study. Twelve healthy growing swine (mean weight, 38.4 kg; weight range, 30.3-47.0 kg) were evaluated. Bariatric embolization was performed by infusion of 40-μm calibrated microspheres selectively into the gastric arteries that supply the fundus. Six swine underwent bariatric embolization, while six control animals underwent a sham procedure with saline. Weight and fasting plasma ghrelin and glucose levels were obtained in animals at baseline and at weeks 1-8. Statistical testing for differences in serum ghrelin levels and weight at each time point was performed with the Wilcoxon signed rank test for intragroup differences and the Wilcoxon rank sum test for intergroup differences.Results:The pattern of change in ghrelin levels over time was significantly different between control and experimental animals. Weekly ghrelin levels were measured in control and experimental animals as a change from baseline ghrelin values. Average postprocedure ghrelin values increased by 328.9 pg/dL ± 129.0 (standard deviation) in control animals and decreased by 537.9 pg/dL ± 209.6 in experimental animals (P = .004). The pattern of change in weight over time was significantly different between control and experimental animals. The average postprocedure weight gain in experimental animals was significantly lower than that in control animals (3.6 kg ± 3.8 vs 9.4 kg ± 2.8, respectively; P = .025).Conclusion:Bariatric embolization can significantly suppress ghrelin and significantly affect weight gain. Further study is warranted before this technique can be used routinely in humans.© RSNA, 2012.

Authors
Paxton, BE; Kim, CY; Alley, CL; Crow, JH; Balmadrid, B; Keith, CG; Kankotia, RJ; Stinnett, S; Arepally, A
MLA Citation
Paxton, BE, Kim, CY, Alley, CL, Crow, JH, Balmadrid, B, Keith, CG, Kankotia, RJ, Stinnett, S, and Arepally, A. "Bariatric Embolization for Suppression of the Hunger Hormone Ghrelin in a Porcine Model." Radiology (November 2012). (Academic Article)
PMID
23204538
Source
manual
Published In
Radiology
Publish Date
2012
DOI
10.1148/radiol.12120242

Early outcomes of empiric embolization of tumor-related gastrointestinal hemorrhage in patients with advanced malignancy.

PURPOSE: To report short-term results of empiric transcatheter embolization for patients with advanced malignancy and gastrointestinal (GI) hemorrhage directly from a tumor invading the GI tract wall. MATERIALS AND METHODS: Between 2005 and 2011, 37 mesenteric angiograms were obtained in 26 patients with advanced malignancy (20 men, six women; mean age, 56.2 y) with endoscopically confirmed symptomatic GI hemorrhage from a tumor invading the GI tract wall. Angiographic findings and clinical outcomes were retrospectively evaluated. Clinical success was defined as absence of signs and symptoms of hemorrhage for at least 30 day following embolization. RESULTS: Active extravasation was demonstrated in three cases. Angiographic abnormalities related to a GI tract tumor were identified on 35 of 37 angiograms, including tumor neovascularity (n = 21), tumor enhancement (n = 24), and luminal irregularity (n = 5). In the absence of active extravasation, empiric embolization with particles and/or coils was performed in 25 procedures. Cessation of hemorrhage (ie, clinical success) occurred more frequently when empiric embolization was performed (17 of 25 procedures; 68%) than when embolization was not performed (two of nine; 22%; P = .03). Empiric embolization resulted in clinical success in 10 of 11 patients with acute GI bleeding (91%), compared with seven of 14 patients (50%) with chronic GI bleeding (P = .04). No ischemic complications were encountered. CONCLUSIONS: In patients with advanced malignancy, in the absence of active extravasation, empiric transcatheter arterial embolization for treatment of GI hemorrhage from a direct tumor source demonstrated a 68% short-term success rate, without any ischemic complications.

Authors
Tandberg, DJ; Smith, TP; Suhocki, PV; Pabon-Ramos, W; Nelson, RC; Desai, S; Branch, S; Kim, CY
MLA Citation
Tandberg, DJ, Smith, TP, Suhocki, PV, Pabon-Ramos, W, Nelson, RC, Desai, S, Branch, S, and Kim, CY. "Early outcomes of empiric embolization of tumor-related gastrointestinal hemorrhage in patients with advanced malignancy." J Vasc Interv Radiol 23.11 (November 2012): 1445-1452.
PMID
23101916
Source
pubmed
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
23
Issue
11
Publish Date
2012
Start Page
1445
End Page
1452
DOI
10.1016/j.jvir.2012.08.011

Assessment of vascular contrast and depiction of stenoses in abdominopelvic and lower extremity vasculature: comparison of dual-energy MDCT with digital subtraction angiography.

RATIONALE AND OBJECTIVES: To assess whether dual-energy computed tomography (DECT) multidetector computed tomography (MDCT) angiography improves vascular contrast beyond MDCT angiography and digital subtraction angiography (DSA) while preserving the ability to precisely characterize stenoses, using DSA as reference standard. MATERIALS AND METHODS: This prospective, Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study was performed on 25 patients referred for lower extremity DECT angiography and subsequent DSA. Spectral data were postprocessed to create single-energy 120 kVp (MDCT series) and iodine-only (DECT series) datasets. The arterial tree was subdivided into 11 anatomical levels. Contrast-to-noise ratios (CNR) and corresponding coefficient -of variation (CV) of patent vessel segments were evaluated for DECT, MDCT, and DSA using analysis of variance comparisons. Degree of stenoses was determined for DECT, MDCT, and DSA and correlated with t-test, bivariate Pearson comparisons, and Bland-Altman plots. RESULTS: Patent vasculature comprised 230 vessel segments. From infrarenal aorta to distal femoral arteries, DECT showed higher CNR compared to DSA and MDCT (P < .05); distal to the popliteal arteries, DSA achieved higher CNR (P < .05). Analyses of contrast homogeneity showed minimal CV above the knee for MDCT (≤9%) and for DSA below the knee (≤7%). Stenotic vasculature comprised 33 segments. Significant correlations of stenosis severity were found comparing DECT and MDCT with DSA as reference standard showing a 0.04-fold mean underestimation of stenoses on MDCT and no detectable mean variation on DECT compared with DSA. CONCLUSION: DECT angiography improved contrast in vascular abdominopelvic and thigh distributions beyond MDCT angiography and DSA while preserving the ability to precisely assess severity of stenoses, using DSA as an accepted reference standard.

Authors
Huang, SY; Nelson, RC; Miller, MJ; Kim, CY; Lawson, JH; Husarik, DB; Boll, DT
MLA Citation
Huang, SY, Nelson, RC, Miller, MJ, Kim, CY, Lawson, JH, Husarik, DB, and Boll, DT. "Assessment of vascular contrast and depiction of stenoses in abdominopelvic and lower extremity vasculature: comparison of dual-energy MDCT with digital subtraction angiography." Acad Radiol 19.9 (September 2012): 1149-1157.
PMID
22743115
Source
pubmed
Published In
Academic Radiology
Volume
19
Issue
9
Publish Date
2012
Start Page
1149
End Page
1157
DOI
10.1016/j.acra.2012.04.014

Outcomes of prosthetic hemodialysis grafts after deployment of bare metal versus covered stents at the venous anastomosis.

PURPOSE: To compare postintervention patency rates after deployment of bare metal versus covered stents across the venous anastomosis of prosthetic arteriovenous (AV) grafts. METHODS: Review of our procedural database over a 6 year period revealed 377 procedures involving stent deployment in an AV access circuit. After applying strict inclusion criteria, our study group consisted of 61 stent deployments in 58 patients (median age 58 years, 25 men, 33 women) across the venous anastomosis of an upper extremity AV graft circuit that had never been previously stented. Both patent and thrombosed AV access circuits were retrospectively analyzed. Within the bare metal stent group, 20 of 32 AV grafts were thrombosed at initial presentation compared to 18 of 29 AV grafts in the covered stent group. RESULTS: Thirty-two bare metal stents and 29 covered stents were deployed across the venous anastomosis. The 3, 6, and 12 months primary access patency rates for bare metal stents were not significantly different than for covered stents: 50, 41, and 22 % compared to 59, 52, and 29 %, respectively (p = 0.21). The secondary patency rates were also not significantly different: 78, 78, and 68 % for bare metal stents compared to 76, 69, and 61 % for covered stents, respectively (p = 0.85). However, covered stents demonstrated a higher primary stent patency rate than bare metal stents: 100, 85, and 70 % compared to 75, 67, and 49 % at 3, 6, and 12 months (p < 0.01). CONCLUSION: The primary and secondary access patency rates after deployment of bare metal versus covered stents at the venous anastomosis were not significantly different. However, bare metal stents developed in-stent stenoses significantly sooner.

Authors
Kim, CY; Tandberg, DJ; Rosenberg, MD; Miller, MJ; Suhocki, PV; Smith, TP
MLA Citation
Kim, CY, Tandberg, DJ, Rosenberg, MD, Miller, MJ, Suhocki, PV, and Smith, TP. "Outcomes of prosthetic hemodialysis grafts after deployment of bare metal versus covered stents at the venous anastomosis." Cardiovasc Intervent Radiol 35.4 (August 2012): 832-838.
PMID
22584754
Source
pubmed
Published In
CardioVascular and Interventional Radiology
Volume
35
Issue
4
Publish Date
2012
Start Page
832
End Page
838
DOI
10.1007/s00270-012-0413-1

A 6-year experience treating vascular malformations with foam sclerotherapy.

In this study, the authors present an analysis of the outcomes of 105 low-flow vascular malformation patients treated over a 6-year period and report specific lesion characteristics that correlate with those vascular malformations that will benefit from sodium tetradecyl sulfate foam sclerotherapy (STS FS) versus surgical resection as well as morphological characteristics of vascular malformations that are associated with a poor response to FS treatment. Improvement in symptoms was documented in 92.9% of patients treated with STS FS. There were no complications. Low-flow vascular malformations that were morphologically characterized by microcystic, septated vessels did not respond to FS, and these vascular malformations are best treated with surgical resection. Primary surgical resection is also the treatment of choice for localized, microcystic, and superficial low-flow vascular malformations. Symptomatic, diffuse, extensive, macrocystic malformations that involve multiple tissue planes and vital structures are best treated with FS.

Authors
Markovic, JN; Kim, CY; Lidsky, ME; Shortell, CK
MLA Citation
Markovic, JN, Kim, CY, Lidsky, ME, and Shortell, CK. "A 6-year experience treating vascular malformations with foam sclerotherapy." Perspect Vasc Surg Endovasc Ther 24.2 (June 2012): 70-79.
PMID
22918935
Source
pubmed
Published In
Perspectives in Vascular Surgery and Endovascular Therapy
Volume
24
Issue
2
Publish Date
2012
Start Page
70
End Page
79
DOI
10.1177/1531003512457205

Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure?

BACKGROUND AND PURPOSE: Renal cryoablation has gained popularity as a treatment option for localized renal masses. Treatment success is typically defined by the absence of contrast enhancement on follow-up imaging. We investigate the evolution of lesions that demonstrate contrast enhancement on CT after renal cryoablation. PATIENTS AND METHODS: Retrospective review of records of laparoscopic and percutaneous cryoablation (LCA and PCA) was performed, identifying records with postoperative radiographic enhancement. Imaging studies were reviewed and radiographic (pre- and post-contrast Hounsfield units, pattern and location of enhancement) and clinical data including follow up were collected. RESULTS: One hundred and seventy-two cryoablation procedures were analyzed. Of these, 30 (17.4%) showed enhancement on follow-up CT. In 28 cases, contrast enhancement was demonstrated on the first postoperative study. Seven patients underwent salvage treatments. Spontaneous resolution of enhancement was noted in 17 (56.7%) cases. No association was found between enhancement pattern (diffuse/nodular/rim) and resolution. Of lesions enhancing >35 HU, only 14.3% resolved spontaneously. Delayed enhancement (after negative imaging studies) occurred in two patients; both underwent salvage treatments. CONCLUSIONS: Most of the time, contrast-enhancements after cryoablation are evident on the first follow-up imaging study. More than 50% of these resolve spontaneously, and only one of four patients need salvage treatment. Delayed appearance of enhancement after previously negative imaging and highly enhancing lesions (>35 HU) are unlikely to resolve and should be considered suspicious for local recurrence or incomplete ablation. Further investigation is warranted to reach a consensus on a radiographic definition of local recurrence after renal cryoablation.

Authors
Tsivian, M; Kim, CY; Caso, JR; Rosenberg, MD; Nelson, RC; Polascik, TJ
MLA Citation
Tsivian, M, Kim, CY, Caso, JR, Rosenberg, MD, Nelson, RC, and Polascik, TJ. "Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure?." J Endourol 26.4 (April 2012): 330-335.
PMID
22070179
Source
pubmed
Published In
Journal of Endourology
Volume
26
Issue
4
Publish Date
2012
Start Page
330
End Page
335
DOI
10.1089/end.2011.0337

Hepatic venous pressure measurements: comparison of end-hole and balloon catheter methods.

PURPOSE: To determine the difference in hepatic venous pressures measured with the use of an end-hole diagnostic catheter versus a balloon catheter. MATERIALS AND METHODS: A total of 92 patients underwent transjugular hepatic venous pressure measurements with a 5-F diagnostic end-hole catheter and a balloon catheter, with the catheter type used initially determined randomly. With both catheters, free and wedged systolic, diastolic, and mean pressures were collected. Hepatic venous pressure gradients were calculated from each pressure set. Eighty-five patients (92%) also underwent concurrent transjugular biopsy after pressures were recorded. Demographic, histologic, and specific procedural information were also collected. RESULTS: The study included 47 men and 45 women, with a mean age of 52.7 years (range, 19-84 y). For the entire population, there were statistically significant differences in mean measurements between the two catheters in wedged systolic (P = .004), diastolic (P = .021), and mean (P = .036) pressures. However, the differences between the means were only 0.783, 0.609, and 0.207 mm Hg, respectively. A subanalysis based on histologic stage revealed no difference between catheter types for normal or cirrhotic livers, but a significant (P = .017) difference in systolic wedged pressure (absolute difference of 0.67 mm Hg) in patients with mild to moderate fibrosis (stages 1-3). In all differences, the balloon catheter had the greater pressure reading. CONCLUSIONS: There was a significant difference in wedged pressure measurements between the two catheter systems in the overall population and among patients with a histologic grade indicating fibrosis. However, the absolute value differences between the two systems were comparatively small (< 1 mm Hg).

Authors
Smith, TP; Kim, CY; Smith, AD; Janas, G; Miller, MJ; Sopko, DR; Suhocki, PV
MLA Citation
Smith, TP, Kim, CY, Smith, AD, Janas, G, Miller, MJ, Sopko, DR, and Suhocki, PV. "Hepatic venous pressure measurements: comparison of end-hole and balloon catheter methods." J Vasc Interv Radiol 23.2 (February 2012): 219-26.e6.
PMID
22209265
Source
pubmed
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
23
Issue
2
Publish Date
2012
Start Page
219
End Page
26.e6
DOI
10.1016/j.jvir.2011.09.025

Vascular radiology: Case 17

Authors
Hayes, MA; Kim, CY
MLA Citation
Hayes, MA, and Kim, CY. "Vascular radiology: Case 17." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 414-415.
Source
scopus
Publish Date
2012
Start Page
414
End Page
415

Vascular radiology: Case 8

Authors
Smith, TP; Kim, CY
MLA Citation
Smith, TP, and Kim, CY. "Vascular radiology: Case 8." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 396-397.
Source
scopus
Publish Date
2012
Start Page
396
End Page
397

Vascular radiology: Case 4

Authors
Suhocki, PV; Kim, CY
MLA Citation
Suhocki, PV, and Kim, CY. "Vascular radiology: Case 4." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 388-389.
Source
scopus
Publish Date
2012
Start Page
388
End Page
389

Vascular radiology: Case 1

Authors
Newman, GE; Kim, CY
MLA Citation
Newman, GE, and Kim, CY. "Vascular radiology: Case 1." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 382-383.
Source
scopus
Publish Date
2012
Start Page
382
End Page
383

Vascular radiology: Case 3

Authors
Stackhouse, DJ; Kim, CY
MLA Citation
Stackhouse, DJ, and Kim, CY. "Vascular radiology: Case 3." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 386-387.
Source
scopus
Publish Date
2012
Start Page
386
End Page
387

Vascular radiology: Case 14

Authors
Payne, CS; Kim, CY
MLA Citation
Payne, CS, and Kim, CY. "Vascular radiology: Case 14." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 408-410.
Source
scopus
Publish Date
2012
Start Page
408
End Page
410

Vascular radiology: Case 9

Authors
Newman, GE; Kim, CY
MLA Citation
Newman, GE, and Kim, CY. "Vascular radiology: Case 9." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 398-399.
Source
scopus
Publish Date
2012
Start Page
398
End Page
399

Vascular radiology

Authors
Kim, CY; Newman, GE; Smith, TP; Stackhouse, DJ; Suhocki, PV; Payne, CS; Husum, K; Bryant, JA; Hayes, MA; Engstrom, B; Toomayan, GA; Amrhein, TJ; Duncan, SM
MLA Citation
Kim, CY, Newman, GE, Smith, TP, Stackhouse, DJ, Suhocki, PV, Payne, CS, Husum, K, Bryant, JA, Hayes, MA, Engstrom, B, Toomayan, GA, Amrhein, TJ, and Duncan, SM. "Vascular radiology." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 381-.
Source
scopus
Publish Date
2012
Start Page
381

Vascular radiology: Case 20

Authors
Amrhein, TJ; Kim, CY
MLA Citation
Amrhein, TJ, and Kim, CY. "Vascular radiology: Case 20." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 420-421.
Source
scopus
Publish Date
2012
Start Page
420
End Page
421

Vascular radiology: Case 5

Authors
Payne, CS; Kim, CY
MLA Citation
Payne, CS, and Kim, CY. "Vascular radiology: Case 5." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 390-391.
Source
scopus
Publish Date
2012
Start Page
390
End Page
391

Vascular radiology: Case 15

Authors
Smith, TP; Kim, CY
MLA Citation
Smith, TP, and Kim, CY. "Vascular radiology: Case 15." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 410-411.
Source
scopus
Publish Date
2012
Start Page
410
End Page
411

Vascular radiology: Case 7

Authors
Newman, GE; Kim, CY
MLA Citation
Newman, GE, and Kim, CY. "Vascular radiology: Case 7." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 394-395.
Source
scopus
Publish Date
2012
Start Page
394
End Page
395

Analysis of infection risk following covered stent exclusion of pseudoaneurysms in prosthetic arteriovenous hemodialysis access grafts.

PURPOSE: To determine whether exclusion of pseudoaneurysms with the use of a covered stent in prosthetic arteriovenous (AV) hemodialysis access grafts impacts the incidence of eventual AV graft infection. MATERIALS AND METHODS: Review of an interventional radiology database for prosthetic AV graft interventions involving stent deployment anywhere within the AV graft circuit revealed 235 interventions in 174 patients between November 2004 and December 2008. Incidence of AV graft infection was analyzed based on stent type (bare metal vs covered), location, and indication for stent deployment on a per-stent, per-procedure, and per-graft basis. RESULTS: A total of 16.3% of the stent-implanted AV grafts were eventually surgically excised as a result of graft infection. Covered stents used to treat an intragraft pseudoaneurysm were more commonly associated with subsequent graft infection compared with bare or covered stents deployed within the graft for other reasons: 42.1% versus 18.2% (P = .011). Stents deployed in an intragraft location were also associated with a higher incidence of graft infection compared with those deployed at the venous anastomosis or outflow vein: 26.9% versus 6.9% (P < .001). No significant difference was identified in infection rates between bare and covered stents. CONCLUSIONS: Covered stent exclusion of intragraft pseudoaneurysms demonstrated a significant correlation with eventual prosthetic AV graft infection.

Authors
Kim, CY; Guevara, CJ; Engstrom, BI; Gage, SM; O'Brien, PJ; Miller, MJ; Suhocki, PV; Lawson, JH; Smith, TP
MLA Citation
Kim, CY, Guevara, CJ, Engstrom, BI, Gage, SM, O'Brien, PJ, Miller, MJ, Suhocki, PV, Lawson, JH, and Smith, TP. "Analysis of infection risk following covered stent exclusion of pseudoaneurysms in prosthetic arteriovenous hemodialysis access grafts." J Vasc Interv Radiol 23.1 (January 2012): 69-74.
PMID
22019181
Source
pubmed
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
23
Issue
1
Publish Date
2012
Start Page
69
End Page
74
DOI
10.1016/j.jvir.2011.09.003

Expanded Use of the Hemodialysis Reliable Outflow (HeRO) Vascular Access Device for Permanent Dialysis Access in Patients with Total Central Venous Occlusion

Authors
O'Brien, PJ; Kim, CY; Gage, SM; Lawson, JH
MLA Citation
O'Brien, PJ, Kim, CY, Gage, SM, and Lawson, JH. "Expanded Use of the Hemodialysis Reliable Outflow (HeRO) Vascular Access Device for Permanent Dialysis Access in Patients with Total Central Venous Occlusion." June 2011.
Source
wos-lite
Published In
Journal of Vascular Surgery
Volume
53
Publish Date
2011
Start Page
76S
End Page
76S

Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications.

OBJECTIVE: The purpose of this study was to determine the incidence of collecting system and hemorrhagic complications resulting from CT-guided percutaneous cryoablation of renal tumors in which the radiographic ice ball abuts or involves the renal sinus. MATERIALS AND METHODS: From November 2005 through July 2009 at our institution, we performed 129 CT-guided percutaneous cryoablation procedures on 107 patients (mean age, 64 years) with renal masses suspicious of being renal cell carcinoma. Radiographic ice balls that abutted or overlapped the renal sinus were classified as central; the other lesions were classified as noncentral. Medical records and follow-up images were retrospectively reviewed for hemorrhage requiring intervention and for evidence of collecting system injury. The mean follow-up period was 9.3 months. RESULTS: The radiographic ice ball was classified as central in 67 cases. In these central ablations, the mean sinus involvement was 6.2 mm (range, 0-19 mm), 41 ice balls overlapping the renal sinus by 6 mm or more (mean, 9.4 mm). No cases of collecting system injury were identified for any ablation. Overall, there was only one hemorrhagic complication requiring intervention, and it occurred in a noncentral ablation. CONCLUSION: CT-guided percutaneous cryoablation of renal masses with ice ball overlap of the renal sinus resulted in no cases of collecting system injury or serious hemorrhagic complications in our series.

Authors
Rosenberg, MD; Kim, CY; Tsivian, M; Suberlak, MN; Sopko, DR; Polascik, TJ; Nelson, RC
MLA Citation
Rosenberg, MD, Kim, CY, Tsivian, M, Suberlak, MN, Sopko, DR, Polascik, TJ, and Nelson, RC. "Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications." AJR Am J Roentgenol 196.4 (April 2011): 935-939.
PMID
21427348
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
196
Issue
4
Publish Date
2011
Start Page
935
End Page
939
DOI
10.2214/AJR.10.5182

Bronchial artery arising from the left vertebral artery: case report and review of the literature.

Knowledge of bronchial artery anatomy, including the possible locations of anomalous origin, is essential for complete catheter directed embolization for massive hemoptysis. Undetected anomalous bronchial arteries can be a source of failed bronchial artery embolization. We report a case of a common trunk bronchial artery arising from the left vertebral artery and review standard and variant bronchial artery anatomy.

Authors
Amrhein, TJ; Kim, C; Smith, TP; Washington, L
MLA Citation
Amrhein, TJ, Kim, C, Smith, TP, and Washington, L. "Bronchial artery arising from the left vertebral artery: case report and review of the literature." Journal of clinical imaging science 1 (January 2011): 62-.
PMID
22267997
Source
epmc
Published In
Journal of Clinical Imaging Science
Volume
1
Publish Date
2011
Start Page
62
DOI
10.4103/2156-7514.91135

Successful endovascular management of a transected horseshoe kidney

Overview: The horseshoe kidney is more prone to blunt abdominal trauma because of its low position and the presence of the isthmus across the midline. This is a rare case of complete transection of a horseshoe kidney at the isthmus due to blunt abdominal trauma with two sites of active extravasation on initial CT imaging. This extravasation was successfully treated by embolization with coils. Superselective embolization may be used for eff ective, minimally invasive control of active extravasation due to blunt renal trauma, even in kidneys with congenital malformations such as the horseshoe kidney.

Authors
Paxton, BE; Kim, CY; Miller, MJ; Gupta, RT
MLA Citation
Paxton, BE, Kim, CY, Miller, MJ, and Gupta, RT. "Successful endovascular management of a transected horseshoe kidney." Journal of Surgical Radiology 2.1 (2011): 80-85.
Source
scival
Published In
Journal of Surgical Radiology
Volume
2
Issue
1
Publish Date
2011
Start Page
80
End Page
85

May-Thurner syndrome

Authors
Kim, CY
MLA Citation
Kim, CY. "May-Thurner syndrome." Journal of Surgical Radiology 2.1 (2011): 108-109.
Source
scival
Published In
Journal of Surgical Radiology
Volume
2
Issue
1
Publish Date
2011
Start Page
108
End Page
109

Provocative angiography

Determination of the site and etiology of lower gastrointestinal (GI) bleeding may lead to frustration for internists, gastroenterologists, surgeons, diagnostic, and interventional radiologists. The intermittent nature, variable severity, and changes in patient hemodynamic status can result in multiple rounds of diagnostic imaging without an answer. This is especially true in the setting of negative upper endoscopy and limited lower endoscopy due to the amount of blood within the colon. Despite significant blood loss, traditional diagnostic examinations such as tagged red cell scans may be negative or positive without definitive localization of the responsible site. Mesenteric angiography is the definitive imaging tool for localization of the bleeding site. This can, however, lend to confusion when multiple vascular lesions are identified without visible bleeding. With the addition of super-selective microcatheter embolization, angiography has become both diagnostic and therapeutic, and in many institutions, the first-line intervention for the management of lower GI bleeding. The main limitations of angiographic detection are the temporal relation of the arteriogram to the intermittent nature of the bleed, as well as the volume of bleeding. To help improve the sensitivity of angiography, practices have combined catheter-based delivery of pharmacologic agents with intermittent angiography in hopes of increasing the yield of angiography without compromising safety or efficacy. Now, known as provocative angiography, this technique has been applied to assess fore-, mid-, and hindgut bleeding that is refractory to traditional diagnostic and therapeutic modalities. © 2010 Springer-Verlag New York.

Authors
Patel, MB; Kim, CY; Miller, MJ
MLA Citation
Patel, MB, Kim, CY, and Miller, MJ. "Provocative angiography." (December 1, 2010): 195-202. (Chapter)
Source
scopus
Publish Date
2010
Start Page
195
End Page
202
DOI
10.1007/978-1-4419-1693-8_18

CONTRAST ENHANCEMENT AFTER RENAL CRYOABLATION: AN EVIDENCE OF TREATMENT FAILURE?

Authors
Tsivian, M; Kim, CY; Caso, JR; Rosenberg, M; Mouraviev, V; Albala, DM; Nelson, R; Polascik, TJ
MLA Citation
Tsivian, M, Kim, CY, Caso, JR, Rosenberg, M, Mouraviev, V, Albala, DM, Nelson, R, and Polascik, TJ. "CONTRAST ENHANCEMENT AFTER RENAL CRYOABLATION: AN EVIDENCE OF TREATMENT FAILURE?." September 2010.
Source
wos-lite
Published In
Journal of Endourology
Volume
24
Publish Date
2010
Start Page
A236
End Page
A237

Complications of laparoscopic and percutaneous renal cryoablation in a single tertiary referral center.

BACKGROUND: Laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) of small renal masses have gained popularity, but only limited data exist on the complication rates. OBJECTIVES: In this study, we report on postoperative complications associated with LCA and PCA in a single tertiary center experience. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective review of electronic medical records for patients undergoing LCA or PCA between 2001 and 2008 at our institution. INTERVENTIONS: All patients underwent LCA or PCA. MEASUREMENTS: Demographics, radiographic variables, and complication rates were compared between the two groups. Complications were classified according to the modified Clavien system. RESULTS AND LIMITATIONS: Of a total of 195 patients included in this study, 72 underwent LCA and 123 underwent PCA. There were no differences in demographics between the groups. We observed complications in 10 LCA procedures (13.9%) and 26 PCA procedures (21.1%) (p=0.253). The distribution of the complications differed significantly between the groups with mild complications (grades 1 and 2) more common in the PCA group (20.3% vs 5.6%, respectively; p=0.001), whereas severe events (grades 3 and 4) were more frequent in the LCA group (8.3% vs 0.8%, respectively; p=0.011). On multivariate analysis, age and body mass index were inversely associated with complications, whereas female gender, multiple tumors, and preexisting comorbidities showed a trend toward increased risk. CONCLUSIONS: LCA and PCA, although minimally invasive, are not void of complications. Most of the complications encountered are mild; however, severe (grade 3 or 4) events may occur in up to 3.6% of patients. PCA may be associated with a higher rate of complications, although most of these are mild and transient. However, on multivariate analysis, the chosen ablative approach (laparoscopic or percutaneous) is not associated with the risk of complications.

Authors
Tsivian, M; Chen, VH; Kim, CY; Zilberman, DE; Mouraviev, V; Nelson, RC; Albala, DM; Polascik, TJ
MLA Citation
Tsivian, M, Chen, VH, Kim, CY, Zilberman, DE, Mouraviev, V, Nelson, RC, Albala, DM, and Polascik, TJ. "Complications of laparoscopic and percutaneous renal cryoablation in a single tertiary referral center." Eur Urol 58.1 (July 2010): 142-147.
PMID
20363550
Source
pubmed
Published In
European Urology
Volume
58
Issue
1
Publish Date
2010
Start Page
142
End Page
147
DOI
10.1016/j.eururo.2010.03.035

Gastrostomy-to-gastrojejunostomy tube conversion: impact of the method of original gastrostomy tube placement.

PURPOSE: To determine the outcome of gastrostomy tube-to-gastrojejunostomy tube conversion on the basis of the method of original gastrostomy tube placement. MATERIALS AND METHODS: One hundred twenty-four patients (age range, 13-87 years; 72 male and 52 female patients) underwent conversion of a primarily placed gastrostomy tube to a gastrojejunostomy tube at the authors' institution between January 2000 and December 2008. The method of original gastrostomy tube placement was radiologic (n = 27), endoscopic (n = 75), laparoscopic (n = 2), or open surgery (n = 20). The method of placement was correlated with the success rates of gastrostomy-to-gastrojejunostomy tube conversion. Medical records and radiologic images were reviewed to determine the frequency of proximal migration of the jejunostomy tube into the stomach. Follow-up data were available for an average of 136 days after gastrostomy-to-gastrojejunostomy tube conversion (median, 63 days; range, 1-1,300 days). RESULTS: Of 124 gastrostomy tube-to-gastrojejunostomy tube conversions, 109 (87.9%) were successfully performed. Procedural conversion failure occurred in one of the 27 radiologically inserted gastrostomy tubes (3.7%) compared to 14 of the 97 (14%) nonradiologically inserted gastrostomy tubes (P = .19), of which 12 were inserted endoscopically and two were inserted surgically. Of the 109 patients with successful tube conversion, jejunal tip malposition occurred at follow-up in 18 (16.5%). Of these, four patients developed aspiration pneumonia (22%), which contributed to patient death in two. The frequency of jejunal tip malposition was 3.8% (one of 26 patients) for radiologically placed gastrostomy tubes and 20% (17 of 83 patients) for nonradiologically placed gastrostomy tubes (P = .07). Combined, 32% of gastrostomy tubes placed nonradiologically resulted in either procedural failure or eventual jejunal tip malposition, compared to 7.4% of radiologically placed gastrostomy tubes (P = .01). CONCLUSIONS: The frequency of procedural failure or eventual jejunal tip malposition with conversion of radiologically placed gastrostomy tubes to gastrojejunostomy tubes is significantly lower with radiologically placed gastrostomy tubes than with nonradiologically inserted gastrostomy tubes.

Authors
Kim, CY; Patel, MB; Miller, MJ; Suhocki, PV; Balius, A; Smith, TP
MLA Citation
Kim, CY, Patel, MB, Miller, MJ, Suhocki, PV, Balius, A, and Smith, TP. "Gastrostomy-to-gastrojejunostomy tube conversion: impact of the method of original gastrostomy tube placement." J Vasc Interv Radiol 21.7 (July 2010): 1031-1037.
PMID
20538477
Source
pubmed
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
21
Issue
7
Publish Date
2010
Start Page
1031
End Page
1037
DOI
10.1016/j.jvir.2010.04.003

Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study.

PURPOSE: To determine the diagnostic capability, complication rate, and potential predictors of success for provocative mesenteric angiography in patients with obscure and recurrent lower gastrointestinal (GI) hemorrhage. MATERIALS AND METHODS: Thirty-four patients (age, 7-92 years; 22 men) underwent 36 provocative mesenteric angiograms between January 2002 and December 2008. Provocative mesenteric angiography consisted of systemic anticoagulation with heparin followed by selective transcatheter injection of vasodilator and tissue plasminogen activator into the arterial distribution of highest suspicion. Medications were administered incrementally until active extravasation was visualized or until the operator deemed the outcome negative. The pertinent clinical, radiologic, surgical, laboratory, and pathologic notes were retrospectively reviewed. RESULTS: Among 36 provocative mesenteric angiograms, 11 resulted in angiographically visible extravasation (31%) and an additional procedure resulted in angiographic visualization of an undiagnosed hypervascular mass, resulting in the identification of a source of a hemorrhage in 33% overall. In 10 of the 11 cases with visualized extravasation, transcatheter embolization successfully controlled recurrent hemorrhage, while the hypervascular mass without extravasation was successfully resected. Therefore, a total of 11 of 36 studies (31%) resulted in successful definitive treatment of recurrent hemorrhage. One embolization-related complication occurred, resulting in surgical resection of perforated ischemic bowel. No hemorrhagic complications were identified. Patients with melena and patients admitted for reasons other than acute lower GI hemorrhage were significantly less likely to benefit from provocative mesenteric angiography. CONCLUSIONS: In this series, provocative mesenteric angiography was safe and effective for eliciting the source of occult lower GI hemorrhage, leading to definitive therapy in about one third of patients.

Authors
Kim, CY; Suhocki, PV; Miller, MJ; Khan, M; Janus, G; Smith, TP
MLA Citation
Kim, CY, Suhocki, PV, Miller, MJ, Khan, M, Janus, G, and Smith, TP. "Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study." J Vasc Interv Radiol 21.4 (April 2010): 477-483.
PMID
20171902
Source
pubmed
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
21
Issue
4
Publish Date
2010
Start Page
477
End Page
483
DOI
10.1016/j.jvir.2009.11.021

Time-resolved MR angiography as a useful sequence for assessment of ovarian vein reflux.

OBJECTIVE: The purpose of this retrospective study was to assess the imaging characteristics of ovarian vein reflux using time-resolved MR angiography (TR-MRA). One hundred consecutive female patients underwent TR-MRA of the pelvis to evaluate suspected or known pelvic pathology. Findings of ovarian vein reflux, ovarian vein dilation, and periuterine varices were analyzed and correlated with symptoms of pelvic pain. CONCLUSION: Overall, TR-MRA is a useful sequence for the assessment of ovarian vein reflux, which may aid the evaluation of pelvic congestion syndrome.

Authors
Kim, CY; Miller, MJ; Merkle, EM
MLA Citation
Kim, CY, Miller, MJ, and Merkle, EM. "Time-resolved MR angiography as a useful sequence for assessment of ovarian vein reflux." AJR Am J Roentgenol 193.5 (November 2009): W458-W463.
PMID
19843728
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
193
Issue
5
Publish Date
2009
Start Page
W458
End Page
W463
DOI
10.2214/AJR.09.2557

Time-resolved MR angiography of the central veins of the chest.

OBJECTIVE: The purpose of our study was to show the usefulness and limitations of contrast-enhanced time-resolved MR angiography (MRA) for imaging the central veins of the chest. CONCLUSION: Time-resolved MRA is highly sensitive for the detection of abnormalities and is particularly useful in conjunction with static high-spatial-resolution MRA. However, several intrinsic limitations must be kept in mind.

Authors
Kim, CY; Merkle, EM
MLA Citation
Kim, CY, and Merkle, EM. "Time-resolved MR angiography of the central veins of the chest." AJR Am J Roentgenol 191.5 (November 2008): 1581-1588.
PMID
18941105
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
191
Issue
5
Publish Date
2008
Start Page
1581
End Page
1588
DOI
10.2214/AJR.08.1027

Central veins of the chest: evaluation with time-resolved MR angiography.

PURPOSE: To retrospectively assess the diagnostic performance of time-resolved magnetic resonance (MR) angiography in the detection of stenoses and occlusions in the central veins of the chest, with angiographic and surgical findings and consensus readings serving as the reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained, and the informed consent requirement was waived for this HIPAA-compliant study. Retrospective analysis was performed with 27 consecutive patients (12 male, 15 female; age range, 16-67 years) who underwent MR venography of the central veins. Six radiologists with varying levels of experience interpreted the studies. For each study, the readers were presented with time-resolved maximum intensity projection (MIP) images only, high-spatial-resolution images only, or both. Sensitivity and specificity were calculated for detection of stenoses and occlusions, as well as for confidence levels, study interpretation time, and determination of the side of the body on which upper extremity contrast material injection was performed. RESULTS: The addition of time-resolved angiographic images to the high-spatial-resolution images resulted in improved specificity in the detection of venous occlusions (0.99 vs 0.96, P = .03), in reader confidence (P < .001), and in the ability to infer the side of injection (83% correct compared with 32% correct, P < .001), without increasing the average time required for study interpretation. Use of time-resolved angiographic data sets as a stand-alone technique had high sensitivity (0.95) but only moderate specificity (0.56) in the detection of venous stenoses or occlusions. CONCLUSION: Time-resolved angiographic images are a useful adjunct to high-spatial-resolution images in the evaluation of central venous stenoses and occlusions.

Authors
Kim, CY; Mirza, RA; Bryant, JA; Whiting, ED; Delong, DM; Spritzer, CE; Merkle, EM
MLA Citation
Kim, CY, Mirza, RA, Bryant, JA, Whiting, ED, Delong, DM, Spritzer, CE, and Merkle, EM. "Central veins of the chest: evaluation with time-resolved MR angiography." Radiology 247.2 (May 2008): 558-566.
PMID
18349313
Source
pubmed
Published In
Radiology
Volume
247
Issue
2
Publish Date
2008
Start Page
558
End Page
566
DOI
10.1148/radiol.2472070790

Qa-1, a nonclassical MHC molecule with immunomodulatory functions, is ubiquitously expressed in the immune-privileged anterior chamber of the eye.

PURPOSE: To determine whether the MHC class Ib gene, Qa-1, is expressed in the tissues that surround the immune-privileged anterior chamber (AC) of the murine eye. METHODS: Transcription of Qa-1 mRNA in BALB/c ocular tissues was analyzed by reverse transcription-polymerase chain reaction. Expression of Qa-1 protein was assessed on ocular frozen tissue sections by immunohistochemistry, and within aqueous humor by western blotting. RESULTS: Transcription of Qa-1 was found in all tissues surrounding the AC of the eye. Immunohistological staining revealed Qa-1 expression on corneal endothelium, corneal epithelium, and lens epithelium. No soluble Qa-1 was detected in aqueous humor. CONCLUSIONS: Qa-1, unlike other MHC class I molecules, is ubiquitously expressed in tissues surrounding the AC of the eye, raising the possibility that Qa-1 plays a role in creating and maintaining ocular immune privilege.

Authors
Kim, CY; Masli, S; Streilein, JW
MLA Citation
Kim, CY, Masli, S, and Streilein, JW. "Qa-1, a nonclassical MHC molecule with immunomodulatory functions, is ubiquitously expressed in the immune-privileged anterior chamber of the eye." Ocul Immunol Inflamm 13.4 (July 2005): 271-277.
PMID
16159717
Source
pubmed
Published In
Ocular Immunology and Inflammation (Informa)
Volume
13
Issue
4
Publish Date
2005
Start Page
271
End Page
277
DOI
10.1080/09273940590951052

Evaluation of an antimicrobial-impregnated continuous ambulatory peritoneal dialysis catheter for infection control in rats.

Infection is the most serious complication arising in long-term continuous ambulatory peritoneal dialysis (CAPD), specifically peritonitis and exit-site infection. The initial weeks after implantation is the crucial period during which bacterial colonization of the catheter results in maximal morbidity, with Staphylococcus aureus being the most virulent organism. We developed an antimicrobial-impregnated CAPD catheter by impregnating the cuff and tubing with chlorhexidine, silver sulfadiazine, and triclosan in a polymer matrix. The antimicrobial spectrum and duration were shown by measuring zones of inhibition to various bacteria and fungi over the course of 5 to 10 days. Activity also was assessed subsequent to soaking in trypticase soy broth containing 20% bovine serum over the course of 1, 3, and 7 days. Significant antimicrobial activity was shown against all organisms tested for, with particular efficacy against gram-positive bacteria. Catheters were implanted in rats followed by inoculation of the exit site with S aureus. Seven days postimplantation, 0% of the impregnated catheters were colonized intraperitoneally compared with 100% of the control catheters. Similarly, 12.5% of the impregnated catheters were colonized at the exit site, whereas 100% of the controls were colonized. Histologic analysis showed that this combination and concentration of antimicrobials did not retard healing or cause increased inflammation compared with control catheters after 3, 10, and 24 days postimplantation in noninoculated rats.

Authors
Kim, CY; Kumar, A; Sampath, L; Sokol, K; Modak, S
MLA Citation
Kim, CY, Kumar, A, Sampath, L, Sokol, K, and Modak, S. "Evaluation of an antimicrobial-impregnated continuous ambulatory peritoneal dialysis catheter for infection control in rats." Am J Kidney Dis 39.1 (January 2002): 165-173.
PMID
11774116
Source
pubmed
Published In
American Journal of Kidney Diseases
Volume
39
Issue
1
Publish Date
2002
Start Page
165
End Page
173
DOI
10.1053/ajkd.2002.29911

Molecular analysis of HLA-B35 alleles and their relationship to HLA-B15 alleles.

The HLA-B35 serotype is one of the largest allelic groups of HLA class I molecules and includes four isotypes. Of the four, the B35 variant isoform is relatively rare and is the most acidic form. DNA sequencing of the rare isoforms revealed three alleles, B*1522, B*3511, and B*3517. A phylogenetic tree of HLA-B15- and HLA-B35-related alleles for the exon 2 and 3 nucleotide sequences showed that exon 2 of B*1522 clusters with B35 alleles whereas exon 3 clusters with B15 alleles. Branches of the tree suggest that the serodeterminants of B35, B62, B63, and B70 may reside in the alpha 1 domain, encoded by exon 2. The B*1520 and B*1522 genes, which type as B62 and B35, respectively, are hybrid molecules alternatively using exon 2 and exon 3 sequences of B*3501 and B*1501. A comparison of intron 2 sequences for B*3501, B*1501 and B*1522 suggests that the recombination site may have been in the region at the 3' end of intron 2. Despite being flanked by two highly polymorphic exons (exons 2 and 3), intron 2 is relatively well conserved in the B-locus, and it is characterized by seven to eight tandem repeats of the CGGGG pentanucleotide. A high degree of sequence homology and repetitive sequences are essential for a significant frequency of recombination. In this report, we reveal more about the complex evolutionary history of the HLA-B alleles.

Authors
Cereb, N; Kim, C; Hughes, AL; Yang, SY
MLA Citation
Cereb, N, Kim, C, Hughes, AL, and Yang, SY. "Molecular analysis of HLA-B35 alleles and their relationship to HLA-B15 alleles." Tissue Antigens 49.4 (April 1997): 389-396.
PMID
9151391
Source
pubmed
Published In
Tissue Antigens
Volume
49
Issue
4
Publish Date
1997
Start Page
389
End Page
396
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Research Areas:

  • Abdomen
  • Angiography
  • Angiography, Digital Subtraction
  • Angioplasty, Balloon
  • Animals
  • Arterial Occlusive Diseases
  • Arteries
  • Arteriovenous Shunt, Surgical
  • Artifacts
  • Ascites
  • Biopsy
  • Biopsy, Needle
  • Case-Control Studies
  • Catheter-Related Infections
  • Catheterization, Central Venous
  • Catheterization, Peripheral
  • Catheters, Indwelling
  • Central Venous Catheters
  • Cryosurgery
  • Drainage
  • Embolization, Therapeutic
  • Endovascular Procedures
  • Enteral Nutrition
  • Equipment Design
  • Feasibility Studies
  • Female
  • Ferumoxytol
  • Fibrinolytic Agents
  • Foreign-Body Migration
  • Gadolinium
  • Gastrointestinal Hemorrhage
  • Gastrointestinal Neoplasms
  • Gastrointestinal Tract
  • Gastropexy
  • Gastrostomy
  • Ghrelin
  • Graft Occlusion, Vascular
  • Hemorrhage
  • Image Processing, Computer-Assisted
  • Intubation, Gastrointestinal
  • Iron Compounds
  • Kidney
  • Kidney Diseases
  • Kidney Transplantation
  • Leg
  • Lower Extremity
  • Lower Gastrointestinal Tract
  • Magnetic Resonance Angiography
  • Male
  • Microspheres
  • Movement
  • Multidetector Computed Tomography
  • Obesity
  • Observer Variation
  • Pelvis
  • Peripheral Vascular Diseases
  • Pneumothorax
  • Postoperative Complications
  • Prospective Studies
  • Prosthesis-Related Infections
  • Radiation Dosage
  • Radiographic Image Interpretation, Computer-Assisted
  • Radiography, Interventional
  • Renal Dialysis
  • Renal Nutcracker Syndrome
  • Retrospective Studies
  • Space
  • Spleen
  • Splenectomy
  • Stents
  • Stomach
  • Surgery, Computer-Assisted
  • Surgical Fixation Devices
  • Swine
  • Thrombectomy
  • Thrombolytic Therapy
  • Tissue Distribution
  • Tissue Plasminogen Activator
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Upper Extremity
  • Upper Extremity Deep Vein Thrombosis
  • Varicose Veins
  • Vascular Diseases
  • Vascular Patency
  • Veins
  • Venous Thrombosis