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Aspirex thrombectomy procedures in occluded renal dialysis access fistulae
Abstract / Clinical Radiology 72 (2017) S1eS13
Conclusion: Transvaginal ultrasound is an increasingly recognised screening modality for patients with suspected DIE. It is being explored at Luton and Dunstable as a tool for triaging patients who need MRI for characterisation. Unfortunately it remains an operator dependent technique and increasing sonographer experience will improve uptake and clinical confidence. Adequacy and safety of thyroid core needle biopsy (CNB)
S5
diagnostic skills. Despite a consultant radiologist formally reporting all OM views, there maybe a significant delay and not all OM views are evaluated by a head and neck radiologist. This can delay operative management and in some cases patients require surgical intervention without imaging information being available. CBCT is advised in patients with a high clinical suspicion of a fracture. Clinicians frequently take OM scans and are unable to confidently make a diagnosis, requiring patients to be reviewed in maxillofacial clinics, often unnecessarily. Thus, there are numerous OM radiographs that can be avoided to prevent harmful radiation doses.
Author: Prashant Gupta Purpose: To assess diagnostic adequacy and safety of CNB in thyroid nodules. Methods and materials: - Retrospective study, patient radiology notes and discharge notes reviewed: - Data items collected: - Departmental database interrogated to collect a breakdown of all thyroid biopsies performed over time period of past eight months. - Reviewed patient discharge notes e review details of consent, clotting documentation, procedural details including number of passes, needle type and throw, operator, right/ left lobe/isthmus, details of postprocedural complications and final histology report. Results: - All biopsies were done with an 18 G 6 cm needle with an adjustable variable notch size. - Twenty-six biopsies done from 20 nodules. Nodule size ranging from 14e55 mm. - Twenty-four (92.3%) of the 26 samples were adequate to provide a histological diagnosis. Two samples (7.7%) were inadequate/nondiagnostic. - Of the 24 samples, 19 (79.2%) were benign, three (12.5%) were malignant, two (8.3%) showed follicular neoplasm, one of which was operated and confirmed follicular carcinoma. - No major complications were observed; one patient had a focal hematoma (0.05%), managed conservatively. - Of the 20 patients, nine (45%) had at least one previous inadequate fine needle aspiration (FNA), three (15%) had no prior FNA done and eight (40%) had a positive prior FNA. Conclusion: - Thyroid CNB is a safe and rapid method to evaluate thyroid nodules. - It is especially useful for nodules with prior non-diagnostic FNA and for patients with benign nodules who want to avoid a diagnostic hemithyroidectomy. - Although its safety is well documented, no guidelines exist for thyroid CNB as a firstline in diagnosis. A review of the diagnostic yield of occipitomental radiographs compared to cone beam CT imaging in assessing facial trauma Authors: Shilen Patel, Jimmy Makdissi, Virjen Patel, Ravikiran Pawar Purpose: To evaluate if occipitomental (OM) radiograph views offer any diagnostic advantage to a cone beam computed tomography scan (CBCT) alone and to evaluate the role of OM radiographs in the assessment of facial trauma in a major UK trauma centre. Methods and materials: A retrospective review of all maxillofacial trauma patients presenting to a busy UK trauma centre within 2016, undergoing both an OM view and CBCT scan was undertaken to assess the appropriateness of the OM view. Secondary outcomes included the duration of CBCT scan reporting and whether reports were available to assist in surgical planning. Results: 42 patients were identified to have both OM and CBCT scans. The mean age of the group was 34. Of the 42 patients, 20 had orbital floor fractures. Interestingly, 31.7% of fractures were visualised and reported on the CBCT scans but not seen on the OM views. Conclusion: Prior to this retrospective review, an audit collecting three months of data revealed 71% of fractures diagnosed with the assistance of OM views. Another UK trauma centre has shown a much lower diagnostic rate of 50%, with an astonishing 60% of doctors feeling unsure with their
Additive value of PET-CT in detecting primary site of unknown primary in head and neck squamous cell cancer (CUP-HNSCC) with cervical nodal metastases Authors: Seung-Jin Choi, Jenny Walsh, Helen Cliffe, Shishir Karthik, Sriram Vaidyanathan Purpose: To estimate the detection rate of primary cancer by positron emission tomography-computed tomography (PET-CT) in cancer of unknown in primary in head and neck cancer (CUP-HNSCC) in cervical node metastases in a tertiary head and neck centre and compare this with published detection rates. Methods and materials: Patients with proven SCC in cervical nodes, with a primary not detected by prior magnetic resonance imaging (MRI)/ computed tomography (CT) and clinical examination +/- examination under anesthesia (EUA), who had a PET-CT from 2010 to 2016 were included. A true positive case was defined as concordance between the primary site detected by the PET-CT and histology. Results: Of 66 patients (male 83%), nine (14%) had a definite primary proven by histology and treated accordingly. In ten (15%), PET-CT raised potential primary sites in the head and neck region, needing further evaluation. One of these was deemed erroneous later due to lack of adequate clinical information. The other nine cases had further evaluation and examination with sampling and subsequently treated as unknown primaries. In two cases, primary was found within the lung on PET-CT. Conclusion: In our experience, the overall yield of PET-CT in detecting a primary in CUP-HNSCC is 14% which is significantly less than published literature (range 37e44%). There is a false positive rate of 14% in patients where a primary is suggested, but not found on further evaluation. Despite the low yield, use of PET-CT is quite useful in CUP-HNSCC where primary is identified and confirmed as appropriate targeted treatment can be delivered. Aspirex thrombectomy procedures in occluded renal dialysis access fistulae Authors: Simon Lambracos, Kashif Andrew Keane, Nalin Khosla
Burney, Ravindran
Karthigan,
Purpose: Mechanical thrombectomy procedures have become an increasingly popular method for treating occluded renal dialysis access fistulae. This retrospective study assessed the success rate and associated complications of the Aspirex device in such patients. Methods and materials: Data from the renal and radiology units has been compiled for patients that have been treated with thrombectomy procedures between 2014 and 2017. A keyword search on the CV5 renal database was performed to identify the patients. Only patients who were treated with the Aspirex device were included in the study. Results: A total of 47 procedures were analysed for 43 patients (28 men, median age 72). 31 of these were autologous arterio-venous fistulae and 16 synthetic arterio-venous grafts. Primary patency rates were 67%, 53% and 17% after 30, 90 and 365 days respectively. Surgical/radiological re-interventions were necessary in 34% of salvaged fistulae. Initial major complications were noted in seven procedures (15%). These included axillary vein tears, brachial venous rupture, distal embolisation, broken wire, fistula rupture and a mechanical fault. Conclusion: The high complication and re-intervention rates, along with the significant financial burden, associated with Aspirex thrombectomy procedures cast considerable doubt over its reliability and effectiveness and make this a potentially unsustainable service in the long term.
Conclusion: Transvaginal ultrasound is an increasingly recognised screening modality for patients with suspected DIE. It is being explored at Luton and Dunstable as a tool for triaging patients who need MRI for characterisation. Unfortunately it remains an operator dependent technique and increasing sonographer experience will improve uptake and clinical confidence. Adequacy and safety of thyroid core needle biopsy (CNB)
S5
diagnostic skills. Despite a consultant radiologist formally reporting all OM views, there maybe a significant delay and not all OM views are evaluated by a head and neck radiologist. This can delay operative management and in some cases patients require surgical intervention without imaging information being available. CBCT is advised in patients with a high clinical suspicion of a fracture. Clinicians frequently take OM scans and are unable to confidently make a diagnosis, requiring patients to be reviewed in maxillofacial clinics, often unnecessarily. Thus, there are numerous OM radiographs that can be avoided to prevent harmful radiation doses.
Author: Prashant Gupta Purpose: To assess diagnostic adequacy and safety of CNB in thyroid nodules. Methods and materials: - Retrospective study, patient radiology notes and discharge notes reviewed: - Data items collected: - Departmental database interrogated to collect a breakdown of all thyroid biopsies performed over time period of past eight months. - Reviewed patient discharge notes e review details of consent, clotting documentation, procedural details including number of passes, needle type and throw, operator, right/ left lobe/isthmus, details of postprocedural complications and final histology report. Results: - All biopsies were done with an 18 G 6 cm needle with an adjustable variable notch size. - Twenty-six biopsies done from 20 nodules. Nodule size ranging from 14e55 mm. - Twenty-four (92.3%) of the 26 samples were adequate to provide a histological diagnosis. Two samples (7.7%) were inadequate/nondiagnostic. - Of the 24 samples, 19 (79.2%) were benign, three (12.5%) were malignant, two (8.3%) showed follicular neoplasm, one of which was operated and confirmed follicular carcinoma. - No major complications were observed; one patient had a focal hematoma (0.05%), managed conservatively. - Of the 20 patients, nine (45%) had at least one previous inadequate fine needle aspiration (FNA), three (15%) had no prior FNA done and eight (40%) had a positive prior FNA. Conclusion: - Thyroid CNB is a safe and rapid method to evaluate thyroid nodules. - It is especially useful for nodules with prior non-diagnostic FNA and for patients with benign nodules who want to avoid a diagnostic hemithyroidectomy. - Although its safety is well documented, no guidelines exist for thyroid CNB as a firstline in diagnosis. A review of the diagnostic yield of occipitomental radiographs compared to cone beam CT imaging in assessing facial trauma Authors: Shilen Patel, Jimmy Makdissi, Virjen Patel, Ravikiran Pawar Purpose: To evaluate if occipitomental (OM) radiograph views offer any diagnostic advantage to a cone beam computed tomography scan (CBCT) alone and to evaluate the role of OM radiographs in the assessment of facial trauma in a major UK trauma centre. Methods and materials: A retrospective review of all maxillofacial trauma patients presenting to a busy UK trauma centre within 2016, undergoing both an OM view and CBCT scan was undertaken to assess the appropriateness of the OM view. Secondary outcomes included the duration of CBCT scan reporting and whether reports were available to assist in surgical planning. Results: 42 patients were identified to have both OM and CBCT scans. The mean age of the group was 34. Of the 42 patients, 20 had orbital floor fractures. Interestingly, 31.7% of fractures were visualised and reported on the CBCT scans but not seen on the OM views. Conclusion: Prior to this retrospective review, an audit collecting three months of data revealed 71% of fractures diagnosed with the assistance of OM views. Another UK trauma centre has shown a much lower diagnostic rate of 50%, with an astonishing 60% of doctors feeling unsure with their
Additive value of PET-CT in detecting primary site of unknown primary in head and neck squamous cell cancer (CUP-HNSCC) with cervical nodal metastases Authors: Seung-Jin Choi, Jenny Walsh, Helen Cliffe, Shishir Karthik, Sriram Vaidyanathan Purpose: To estimate the detection rate of primary cancer by positron emission tomography-computed tomography (PET-CT) in cancer of unknown in primary in head and neck cancer (CUP-HNSCC) in cervical node metastases in a tertiary head and neck centre and compare this with published detection rates. Methods and materials: Patients with proven SCC in cervical nodes, with a primary not detected by prior magnetic resonance imaging (MRI)/ computed tomography (CT) and clinical examination +/- examination under anesthesia (EUA), who had a PET-CT from 2010 to 2016 were included. A true positive case was defined as concordance between the primary site detected by the PET-CT and histology. Results: Of 66 patients (male 83%), nine (14%) had a definite primary proven by histology and treated accordingly. In ten (15%), PET-CT raised potential primary sites in the head and neck region, needing further evaluation. One of these was deemed erroneous later due to lack of adequate clinical information. The other nine cases had further evaluation and examination with sampling and subsequently treated as unknown primaries. In two cases, primary was found within the lung on PET-CT. Conclusion: In our experience, the overall yield of PET-CT in detecting a primary in CUP-HNSCC is 14% which is significantly less than published literature (range 37e44%). There is a false positive rate of 14% in patients where a primary is suggested, but not found on further evaluation. Despite the low yield, use of PET-CT is quite useful in CUP-HNSCC where primary is identified and confirmed as appropriate targeted treatment can be delivered. Aspirex thrombectomy procedures in occluded renal dialysis access fistulae Authors: Simon Lambracos, Kashif Andrew Keane, Nalin Khosla
Burney, Ravindran
Karthigan,
Purpose: Mechanical thrombectomy procedures have become an increasingly popular method for treating occluded renal dialysis access fistulae. This retrospective study assessed the success rate and associated complications of the Aspirex device in such patients. Methods and materials: Data from the renal and radiology units has been compiled for patients that have been treated with thrombectomy procedures between 2014 and 2017. A keyword search on the CV5 renal database was performed to identify the patients. Only patients who were treated with the Aspirex device were included in the study. Results: A total of 47 procedures were analysed for 43 patients (28 men, median age 72). 31 of these were autologous arterio-venous fistulae and 16 synthetic arterio-venous grafts. Primary patency rates were 67%, 53% and 17% after 30, 90 and 365 days respectively. Surgical/radiological re-interventions were necessary in 34% of salvaged fistulae. Initial major complications were noted in seven procedures (15%). These included axillary vein tears, brachial venous rupture, distal embolisation, broken wire, fistula rupture and a mechanical fault. Conclusion: The high complication and re-intervention rates, along with the significant financial burden, associated with Aspirex thrombectomy procedures cast considerable doubt over its reliability and effectiveness and make this a potentially unsustainable service in the long term.