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Arterial stent-related infections: Society of cardiovascular and interventional radiology (SCVIR) membership survey results
biopsy results and complicalions Ibllowing TNB were reviewed retrospectively. Results: Sixty-six CT-guided core hiopsy procedures of the lung were performed. The overall diagnostic yield was 73%. The post-biopsy p n e u m o t h o r a x rate was 35%. Following detection of a pnemnothotax, 17% required placement of a small-bore thoracostomy tube. Hemoptysis occurred in 2% of procedures. C o n c l u s i o n : CT-guided core biopsy can yield a definitive diagnosis in the majority of pulmonary parenchymal lesions. The rate of pneum o t h o r a x complicating CT-guided core biopsy of the lung is similar to reported rates following title needle aspiration biopsy of the lung. L e a r n i n g O b j e c t i v e s : l . CT guided core biopsy of pulmonary parenchymal lesions yields a diagnosis in 73% of cases. 2. The rate of pneum o t h o r a x complicating CT guided core biopsy of the lung is n o t higher than reported rates following fine needle aspiration.
7-54 Arterial Stent-Related Infections: Society of Cardiov a s c u l a r and Interventional Radiology (SCVIR) Membership Survey Results Steven W. Falen, MD, Phi), Wake Forest University School of Medicine, Winston-Salem, NC, William D. Routh, MD P u r p o s e : To determine the frequency of arterial stent-related infections encountered by Society of Cardiovascular and Interventional Radiology (SCVIR) m e m b e r s and survey m e m b e r s about their use of prophylactic antibiotics for arterial stent placement. M a t e r i a l s a n d M e t h o d s : A one-page self-addressed questionnaire concerning arterial stent-related infection was submitted to the SCVIR for approval. U p o n approval, surveys were mailed to all SCVIR members. R e s u l t s : Of 2,700 surveys sent:, 534 responses were received. Each year, the 534 individual respondents or their practices perform one to m o r e than 400 (mean, 38.6: SD, -+47.5) arterial stent placement procedures, for an annual total of m o r e than 19,000 procedures. Of 498 respondents w h o place arterial stents, 80.7% never administer prophylactic antibiotics, 12.5% do so routinely, and 6.8% do so seleclively. Of respondents w h o used prophylactic antibiotics, 90.2% used cefazolin. Twenty arterial stem-related infections were reported. In 19 cases, no prophylactic antibiotics were used; in the remaining case, the respondent did not indicate w h e t h e r prophylactic antibiotics were used. The most c o m m o n hlfectious organisms were S. aureus mad S. epidermidis. C o n c l u s i o n : Arterial stent-related infections are infrequent. Alt h o u g h benefits of prophylactic antibiotics were not objectively assessed in this study, arterial stent-related infections generally occurred in patients w h o did not receive prophylactic antibiotics.
7-55 Image-Guided P l a c e m e n t of t h e Schon C a t h e t e r Syst e m for Hemodialysis: Results of a Prospective Study William N. Paik, MD, St Luke's~Roosevelt Hospital Center, New York, NY, Rajesh I, Patel, MD, W e n Y. Wang, MD, Stanley G. Cooper, MD, Sanjaya Viswamitra, MD, Patricia H. Choi, MD P u r p o s e : To evaluate the results of radiologic placement of the Sehon catheter system. M a t e r i a l s a n d M e t h o d s : The Schon catheter system (Angiodynamics, Queensbury, NY), a single lumen, dual catheter hemo-access device, was placed for hemodialysis using interventional radiologic techniques. V e n t - p u n c t u r e was performed using real-time ultrasound guidance and catheters were inserted u n d e r fluoroscopic control. Outcomes including infection, catheter dysfunction and flow rates were followed prospectively. Results: Forty-eight Schon catheters were placed in 45 patients during a 35 w e e k period. 24 catheters were placed for hemodialysis while awaiting maturation of surgical accesses; the remainder were intended as the patient's p e r m a n e n t access. The technical success of
catheter insertion was 100%. There were no clinically significant procedure-related complications. The m e a n time interval that Schon catheters were in place was 81 days with a range of 11 to 229 days. The catheter hlfection rate was O. 11 p e r 100 catheter days. The rate of catheter dysfunction or perforation was 0.26 p e r 100 catheter days. Two w e e k s following insertion, m e a n catheter blood flow was 336 ml/min. C o n c l u s i o n : Radiologic placement of the Schon catheter is safe and provides an effective catheter access w h o s e infection and malfunction rates are similar to those reported for dual lumen, single catheter systems. L e a r n i n g Objectives: 1. Image-guided placement of the Schon catheter for hemodialysis is safe. 2. Catheter malfunction and infection rates are similar to those reported for tunnelled, single catheters.
7-56 T r a n s c a t h e t e r Embolization of T r a u m a t i c H e m o r r h a g e from t h e Inferior Epigastric Artery a n d its B r a n c h e s Brian I. Yuh, MD, University of Michigan Hospital, Ann Arbor, MI David M. Williams, MD, James A. Goulet, MD, Paul A. Taheri, MD, M. Victoria Marx, MD, Sahira N. Kazanjian, MD P u r p o s e : To describe angiographic evaluation and transcatheter embolization (TCE) of hemorrhage from branches of the inferior epigastric artery (IEA). M a t e r i a l s a n d M e t h o d s : Eleven patients (6 men, 5 w o m e n , ages 3287 years) were treated for traumatic hemorrhage from branches of the IEA b e t w e e n December 1990 and November 1997. All had suffered blunt trauma and had pubic ramus fractures. Bleeding sites were embolized with Gelfoam, coils, polyvinyl alcohol particles or thrombin. Results: All patients had ipsilateral pubic rami fractures. Six patients had bleeding from an obturator artery replaced to IEA. Two IEA branch hemorrhages, one from an anomalous obturator artery, were missed on initial angiography but discovered on repeat arteriograms for persistent hemorrhage. Five patients died despite successful TCE. The remaining six were discharged alive following TCE. C o n c l u s i o n s : Angiographic evaluation of pelvic trauma includes selective internal iliac arteriography. The IEA and its branches can represent significant bleeding sites in this setting. Exclusion of arterial bleeding m a y require selective external iliac arteriography. Obturator artery arising from IEA, a normal variant, can be a source of bleeding in patients with pubic ramus fracture. TCE is effective in controlling hemorrhage. L e a r n i n g O b j e c t i v e s : l . To s h o w that injury to branches of the inferior epigastric artery can cause significant bleeding in patients with pelvic blunt trauma. 2. To describe the anomalous origin of the obturator artery from the inferior epigastric and s h o w that this can be a source of u n s u s p e c t e d hemorrhage. 3. To s h o w that transcatheter embolization is effective in controlling hemorrhage from branches of the inferior epigastric artery.
7-57 Angiography and Endovascular Embolization in Pelvic T r a u m a : O u t c o m e with Aggressive Use of Superselective Techniques Richard J. Woodcock, Jr, MD, University of Virginia HSC, Charlottesville, VA, J o h n F. Angle, MD, Alan H. Matsmlloto, MD, David J. Spinosa, MD, Klaus D. Hagspiel, MD P u r p o s e : Pelvic trauma is associated with a high mortality rate. The purpose of this study is to evaluate the benefits of aggressive use of superselective embolization in patients with pelvic trauma. M a t e r i a l s a n d M e t h o d s : Between July, 1993 and March, 1997, 183 patients with pelvic trauma were evaluated at one center. After clinical evaluation by the trauma team, 30 patients were referred for angiography. Twenty-eight of the 30 patients (92%) were hemodynamically unstable. Any pelvic arteries demonstrating extravasation or abnormal morphology were selectively catheterized and embolized.
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7-54 Arterial Stent-Related Infections: Society of Cardiov a s c u l a r and Interventional Radiology (SCVIR) Membership Survey Results Steven W. Falen, MD, Phi), Wake Forest University School of Medicine, Winston-Salem, NC, William D. Routh, MD P u r p o s e : To determine the frequency of arterial stent-related infections encountered by Society of Cardiovascular and Interventional Radiology (SCVIR) m e m b e r s and survey m e m b e r s about their use of prophylactic antibiotics for arterial stent placement. M a t e r i a l s a n d M e t h o d s : A one-page self-addressed questionnaire concerning arterial stent-related infection was submitted to the SCVIR for approval. U p o n approval, surveys were mailed to all SCVIR members. R e s u l t s : Of 2,700 surveys sent:, 534 responses were received. Each year, the 534 individual respondents or their practices perform one to m o r e than 400 (mean, 38.6: SD, -+47.5) arterial stent placement procedures, for an annual total of m o r e than 19,000 procedures. Of 498 respondents w h o place arterial stents, 80.7% never administer prophylactic antibiotics, 12.5% do so routinely, and 6.8% do so seleclively. Of respondents w h o used prophylactic antibiotics, 90.2% used cefazolin. Twenty arterial stem-related infections were reported. In 19 cases, no prophylactic antibiotics were used; in the remaining case, the respondent did not indicate w h e t h e r prophylactic antibiotics were used. The most c o m m o n hlfectious organisms were S. aureus mad S. epidermidis. C o n c l u s i o n : Arterial stent-related infections are infrequent. Alt h o u g h benefits of prophylactic antibiotics were not objectively assessed in this study, arterial stent-related infections generally occurred in patients w h o did not receive prophylactic antibiotics.
7-55 Image-Guided P l a c e m e n t of t h e Schon C a t h e t e r Syst e m for Hemodialysis: Results of a Prospective Study William N. Paik, MD, St Luke's~Roosevelt Hospital Center, New York, NY, Rajesh I, Patel, MD, W e n Y. Wang, MD, Stanley G. Cooper, MD, Sanjaya Viswamitra, MD, Patricia H. Choi, MD P u r p o s e : To evaluate the results of radiologic placement of the Sehon catheter system. M a t e r i a l s a n d M e t h o d s : The Schon catheter system (Angiodynamics, Queensbury, NY), a single lumen, dual catheter hemo-access device, was placed for hemodialysis using interventional radiologic techniques. V e n t - p u n c t u r e was performed using real-time ultrasound guidance and catheters were inserted u n d e r fluoroscopic control. Outcomes including infection, catheter dysfunction and flow rates were followed prospectively. Results: Forty-eight Schon catheters were placed in 45 patients during a 35 w e e k period. 24 catheters were placed for hemodialysis while awaiting maturation of surgical accesses; the remainder were intended as the patient's p e r m a n e n t access. The technical success of
catheter insertion was 100%. There were no clinically significant procedure-related complications. The m e a n time interval that Schon catheters were in place was 81 days with a range of 11 to 229 days. The catheter hlfection rate was O. 11 p e r 100 catheter days. The rate of catheter dysfunction or perforation was 0.26 p e r 100 catheter days. Two w e e k s following insertion, m e a n catheter blood flow was 336 ml/min. C o n c l u s i o n : Radiologic placement of the Schon catheter is safe and provides an effective catheter access w h o s e infection and malfunction rates are similar to those reported for dual lumen, single catheter systems. L e a r n i n g Objectives: 1. Image-guided placement of the Schon catheter for hemodialysis is safe. 2. Catheter malfunction and infection rates are similar to those reported for tunnelled, single catheters.
7-56 T r a n s c a t h e t e r Embolization of T r a u m a t i c H e m o r r h a g e from t h e Inferior Epigastric Artery a n d its B r a n c h e s Brian I. Yuh, MD, University of Michigan Hospital, Ann Arbor, MI David M. Williams, MD, James A. Goulet, MD, Paul A. Taheri, MD, M. Victoria Marx, MD, Sahira N. Kazanjian, MD P u r p o s e : To describe angiographic evaluation and transcatheter embolization (TCE) of hemorrhage from branches of the inferior epigastric artery (IEA). M a t e r i a l s a n d M e t h o d s : Eleven patients (6 men, 5 w o m e n , ages 3287 years) were treated for traumatic hemorrhage from branches of the IEA b e t w e e n December 1990 and November 1997. All had suffered blunt trauma and had pubic ramus fractures. Bleeding sites were embolized with Gelfoam, coils, polyvinyl alcohol particles or thrombin. Results: All patients had ipsilateral pubic rami fractures. Six patients had bleeding from an obturator artery replaced to IEA. Two IEA branch hemorrhages, one from an anomalous obturator artery, were missed on initial angiography but discovered on repeat arteriograms for persistent hemorrhage. Five patients died despite successful TCE. The remaining six were discharged alive following TCE. C o n c l u s i o n s : Angiographic evaluation of pelvic trauma includes selective internal iliac arteriography. The IEA and its branches can represent significant bleeding sites in this setting. Exclusion of arterial bleeding m a y require selective external iliac arteriography. Obturator artery arising from IEA, a normal variant, can be a source of bleeding in patients with pubic ramus fracture. TCE is effective in controlling hemorrhage. L e a r n i n g O b j e c t i v e s : l . To s h o w that injury to branches of the inferior epigastric artery can cause significant bleeding in patients with pelvic blunt trauma. 2. To describe the anomalous origin of the obturator artery from the inferior epigastric and s h o w that this can be a source of u n s u s p e c t e d hemorrhage. 3. To s h o w that transcatheter embolization is effective in controlling hemorrhage from branches of the inferior epigastric artery.
7-57 Angiography and Endovascular Embolization in Pelvic T r a u m a : O u t c o m e with Aggressive Use of Superselective Techniques Richard J. Woodcock, Jr, MD, University of Virginia HSC, Charlottesville, VA, J o h n F. Angle, MD, Alan H. Matsmlloto, MD, David J. Spinosa, MD, Klaus D. Hagspiel, MD P u r p o s e : Pelvic trauma is associated with a high mortality rate. The purpose of this study is to evaluate the benefits of aggressive use of superselective embolization in patients with pelvic trauma. M a t e r i a l s a n d M e t h o d s : Between July, 1993 and March, 1997, 183 patients with pelvic trauma were evaluated at one center. After clinical evaluation by the trauma team, 30 patients were referred for angiography. Twenty-eight of the 30 patients (92%) were hemodynamically unstable. Any pelvic arteries demonstrating extravasation or abnormal morphology were selectively catheterized and embolized.
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