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04-20 Contrast-enhanced ultrasound angiography of carotid arteries in human subjects
04-18 Creation of a Community-Wide Database for Dialysis Access Wael E. Saad, MD, University of Rochester Medical Center, Rochester, NY, David L. Waldman, MD, PhD, David Lee, MD, Rodolfo Queiroz, MD Purpose: To create a point-of-service community-wide dialysis access database. Materials and Methods: Microsoft Access was used to write a dialysis-specific database. The database is housed on the Department of Radiology server. The database operates over the University of Rochester intranet and is accessible from the interventional, dialysis, and transplant clinics and offices. The information collected includes current and historical data on all dialysis fistulae, grafts, and catheters. Information on function, interventions (surgical and radiological), and complications is also collected. Results: The database went on-line 45 days prior to this writing. There are 250 patients in the university dialysis system. There are currently 112 patients entered into the system. Complete patient accrual should occur within 3 months. Conclusion: An interdisciplinary approach to thalysis access can be achieved and may be necessary to deliver adequate patient care. Commitment from the involved services to collate historical and current data of access creation, function, and intervention should allow the implementation of sensible clinical pathways. 04-19 Prophylactic Antibiotic Use Prior to Biliary Tract Procedure in Liver Transplant Patient Kenny S. Yoo, MD, University of Rochester Medical Center, Rochester, NY, David L. Waldman, MD, PhD, David Lee. MD, Rodolfo Queiroz, MD, Wael E. Saad, MD Purpose: To evaluate prophylactic antibiotic administered in our liver transplant population prior to bdiary interventional procedures. Materials and Methods: Retrospective analysis was performed on 51 bile cultures obtained from liver transplant recipients from November 1994 through August 1999. Data were collected from the patient chart and transplant chart and through the computerized hospital database. Results: 51 separate bile cultures were performed in 36 liver transplant patients. More than one microorganism was cultured in 33 (65%) of the bile samples. 47 samples (92%) showed positive growth of 106 organisms. The most common organism which grew out from the bile culture was Enterococcus sp (19). Conclusion: Enterococcus is the most common organism seen in the biliary tree of our transplant population. The current practice of using cephalosporin prior to a biliary tract procedure is not appropriate for our immunocompromised liver transplant patients. As a result of this study, ampicillin sodium and sulbactam were chosen in consultation with the transplant pharmacist. Further study is needed to look at the differences in the complication rate. 04-20 Contrast-enhanced Ultrasound Angiography of Carotid Arteries in Human Subjects Scan Pinnell, MD, UCSD Medical Center, San Diego, CA, Yuko Kono, MD, Claude B. Sirlin, MD, Wade H. Wong, DO, Robert F. Mattrey, MD Purpose: Preclinical studies have shown the benefit of utilizing ultrasound (US) contrast-enhanced B mode to more accurately define the arterial lumen by delineating intimal thickening, plaque ulceration, and degree of stenosis. This study evaluates the use of contrast-enhanced US angiography in human subjects with carotid artery stenosis.
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Materials and Methods: The carotid arteries of 15 patients were scanned using B-mode US wideband harmonic imaging (Siemens Ultrasound). US contrast, Optison (Mallinckrodt Inc.. St Louis, MO), was used under a physician-sponsored IND in multiple doses of 1 to 3 ml. US angiograms and duplex sonograms were compared to x-ray angiograms done within one week. In 2 specimens, high-resolution ex vivo MRI was performed. Results: The percent stenosis measured on US and x-ray angiograms correlated strongly (r = 0.993). When patients were grouped by stenoses greater or lesser than 70% on x-ray angiography, US angiography was 100% sensitive and 93% specific, and duplex US was 82% sensitive and 87% specific. While duplex US only estimated the category of stenosis, US angiography also detected unsuspected wall irregularities, ulceration, and dissection. Conclusion: Contrast US angiography was comparable to x-ray angiography and superior to duplex US in assessing stenoses. It delineated plaque surface ulceration and identified a dissection that was missed using duplex sonography alone. 04-21 Uterine Fibroid Embolization: The Kansas University Experience and a Review of the Literature A. James Beyer III, MD, University of Kansas Medical Center, Kansas City, KS, Tim G. Raveill, MD, Julia A. Chapman, MD, Edward L. Siegel, MD Purpose: We reviewed our experience with as well as the available literature concerning fibroid embolization to determine the indications, results, and complications of this procedure. Materials and Methods: We reviewed the Kansas University Medical Center's Interventional Radiology Database to find all patients undergoing fibroid embolization at KUMC. The medical records of these patients, as well as the pertinent medical literature, were reviewed to determine the indications, complications, and short-term and longterm results of fibroid embolization. Results: Thirty-nine women underwent fibroid embolization at KUMC between January of 1997 and December of 1999. Our results and those in the literature suggest that bleeding and pelvic pain are the most common indication for the procedure. The procedure is technically successful in over 95% of patients. Complications include bleeding and infection at the arterial puncture site, contrast reaction, and postprocedural pain. Patients leave the hospital within 24 hours of the procedure's completion. Symptomatic relief of pelvic pain is achieved in 85-90% of patients. Follow-up with sonography and magnetic resonance imaging demonstrates an average reduction m fibroid size of 72%. Conclusion: Embolization provides a cost-effective, minimally invasive treatment for uterine fibroids. 04-22 Transjugular Intrahepatic Portosystemic Shunts: The Kansas University Experience and a Review of the Literature A. James Beyer HI, MD, University of Kansas Medical Center, Kansas City, KS, Tim G. Raveill, MD, Philip L. Johnson, MD, Edward L. Siegel, MD Purpose: We examined our experience with TIPS, as well as the available literature, to determine the indications for and the results and complications of TIPS placement. Materials and Methods: Kansas University Medical Center's Interventional Radiology Database was searched to produce a list of all patients undergoing TIPS at KUMC. The medical records for all of these patients were reviewed, as well as the pertinent medical literature, to determine the indications for TIPS, as well as the short-term and longterm results of the procedure and the expected complications.
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Materials and Methods: The carotid arteries of 15 patients were scanned using B-mode US wideband harmonic imaging (Siemens Ultrasound). US contrast, Optison (Mallinckrodt Inc.. St Louis, MO), was used under a physician-sponsored IND in multiple doses of 1 to 3 ml. US angiograms and duplex sonograms were compared to x-ray angiograms done within one week. In 2 specimens, high-resolution ex vivo MRI was performed. Results: The percent stenosis measured on US and x-ray angiograms correlated strongly (r = 0.993). When patients were grouped by stenoses greater or lesser than 70% on x-ray angiography, US angiography was 100% sensitive and 93% specific, and duplex US was 82% sensitive and 87% specific. While duplex US only estimated the category of stenosis, US angiography also detected unsuspected wall irregularities, ulceration, and dissection. Conclusion: Contrast US angiography was comparable to x-ray angiography and superior to duplex US in assessing stenoses. It delineated plaque surface ulceration and identified a dissection that was missed using duplex sonography alone. 04-21 Uterine Fibroid Embolization: The Kansas University Experience and a Review of the Literature A. James Beyer III, MD, University of Kansas Medical Center, Kansas City, KS, Tim G. Raveill, MD, Julia A. Chapman, MD, Edward L. Siegel, MD Purpose: We reviewed our experience with as well as the available literature concerning fibroid embolization to determine the indications, results, and complications of this procedure. Materials and Methods: We reviewed the Kansas University Medical Center's Interventional Radiology Database to find all patients undergoing fibroid embolization at KUMC. The medical records of these patients, as well as the pertinent medical literature, were reviewed to determine the indications, complications, and short-term and longterm results of fibroid embolization. Results: Thirty-nine women underwent fibroid embolization at KUMC between January of 1997 and December of 1999. Our results and those in the literature suggest that bleeding and pelvic pain are the most common indication for the procedure. The procedure is technically successful in over 95% of patients. Complications include bleeding and infection at the arterial puncture site, contrast reaction, and postprocedural pain. Patients leave the hospital within 24 hours of the procedure's completion. Symptomatic relief of pelvic pain is achieved in 85-90% of patients. Follow-up with sonography and magnetic resonance imaging demonstrates an average reduction m fibroid size of 72%. Conclusion: Embolization provides a cost-effective, minimally invasive treatment for uterine fibroids. 04-22 Transjugular Intrahepatic Portosystemic Shunts: The Kansas University Experience and a Review of the Literature A. James Beyer HI, MD, University of Kansas Medical Center, Kansas City, KS, Tim G. Raveill, MD, Philip L. Johnson, MD, Edward L. Siegel, MD Purpose: We examined our experience with TIPS, as well as the available literature, to determine the indications for and the results and complications of TIPS placement. Materials and Methods: Kansas University Medical Center's Interventional Radiology Database was searched to produce a list of all patients undergoing TIPS at KUMC. The medical records for all of these patients were reviewed, as well as the pertinent medical literature, to determine the indications for TIPS, as well as the short-term and longterm results of the procedure and the expected complications.