- Email: [email protected]
Ultrasound as a screening tool for the diagnosis of deep infiltrating endometriosis
S4
Abstract / Clinical Radiology 72 (2017) S1eS13
Conclusion: There is high interobserver agreement between medical and non-medical readers for C coding suggesting it is a precise method of classifying intra-colonic CTC findings. The much lower interobserver agreement for E coding may reflect greater difficulty in classifying the range of extra-colonic findings, but is also likely to be strongly confounded by the difference in skill set between radiologists and radiographers reading the study. Comparison in magnetic resonance imaging findings to endoscopy findings in patients with endometriosis involving the bowel Authors: Zain Habib, Rebecca Wiles Purpose: Endometriosis is common in women of reproductive age, potentially resulting in significant morbidity. Bowel involvement occurs in up to 37% of patients. Pretreatment diagnosis of bowel involvement is necessary to appropriately guide management. The authors aimed to correlate the findings on magnetic resonance imaging (MRI) and endoscopy in patients with suspected bowel endometriosis, and identify if endoscopy provided any additional important information. Methods and materials: Between September 2015 and November 2016, MRI scans from the regional endometriosis multidisciplinary team (MDT) were reviewed. Those that had an MRI reporting bowel involvement would go on to have an endoscopy. The MRI was retrospectively reviewed by a consultant radiologist blind to the endoscopy findings. The endoscopy findings were determined based on the endoscopy report. The findings were divided into four categories; normal, extrinsic/submucosal abnormality, extrinsic/submucosal and mucosal abnormality, and mucosal abnormality only. The findings were then compared. Results: 40 patients had both an MRI scan and an endoscopy during this period. Out of the 24 patients that had MRI findings of bowel involvement, only seven patients had abnormal endoscopy findings. Five of these patients had findings which correlated with each other. In only one patient mucosal abnormality was identified on endoscopy, when MRI was normal, but this proved to be normal bowel on histology. Conclusion: Endoscopy appears to add little additional information to MRI in diagnosing bowel endometriosis, mainly because it is typically an extrinsic process. As it is an invasive investigation which poses potential risks to the patient we suggest that endoscopy may not be needed when MRI has detected bowel involvement. The image quality of abdominal radiography revisited
There has been a significant improvement in overall adequacy of abdominal films (p<0.001) performed in June 2016 following the initial audit of January 2016 and intervention in the form of presentation of results to the department. Conclusion: In order to maximise clinical usefulness of abdominal radiographs certain landmarks must be exposed. Once intervention was implemented, re-audit after six months showed a statistically significant improvement in the number of adequate abdominal radiographs performed. Is the incidence of non-renal diagnoses and important incidental findings on CT KUB carried out for suspected renal tract calculi Authors: Stephen Sammut, Vincent Leung, Ravivarma Balasubramaniam, Nick Watson Purpose: Adult patients undergoing plain low-dose computed tomography (CT) of the renal tract (CT KUB) for loin-to-groin pain may have an alternative, non-renal tract-related, diagnosis underlying their clinical presentation. This study was conducted to determine whether alternative diagnoses were more common in older patients and whether a different imaging strategy should be considered. Methods and materials: We retrospectively identified all CT KUB examinations performed at our university teaching hospital over a six-month period (JanuaryeJune 2016). Patients were excluded if the CT KUB examination was not performed specifically for loin-to-groin pain. Scans were recorded as positive if there were obstructing calculi, ureteric calculi or reported as ‘recently passed calculus’. The presence of any alternative underlying pathology was recorded. Results: 706 examinations were included in the study. 240 (34%) of examinations were positive for a renal tract cause of the presenting symptoms. Alternative acute diagnoses or important incidental findings were detected in 16% of patients but the incidence of these findings was not significantly related to increasing patient age. Only eight patients required a full-dose CT to better characterise an equivocal finding. Three patients had a new diagnosis on repeat imaging for on-going persistent symptoms. Two of these 11 patients were aged less than 50 years. Conclusion: A proportion of CT KUB examinations detect alternate pathologies or reveal clinically important incidental findings. Few patients required repeat full-dose contrast-enhanced CT scans to identify or better characterise alternate pathology. This study demonstrates that the lowdose, non-contrast CT KUB remains an appropriate firstline examination for loin-to-groin pain regardless of the patient’s age.
Authors: Deborah Carlyle, Douglas Black, Iain Cameron, Ellen Anderson Purpose: The clinical usefulness of abdominal radiographs can be limited by the quality of the radiograph, often due to inability to cover the appropriate anatomical landmarks. The standard abdominal radiograph should include the area from the diaphragm cranially to the pubic symphysis caudally with the inclusion of both flanks. This audit was performed to review the performance of the department in producing abdominal radiographs of adequate quality. Methods and materials: Retrospective sequential analysis of 219 adult abdominal plain radiograph films in January 2016 via the picture archiving and communication system (PACS). All abdominal radiographs were examined according to the standard; to include pubic symphysis and both hemi-diaphragms, and extend sufficiently laterally to ensure that all bowel is included. The target was for 95% of films to meet this standard. Following analysis of audit results, intervention in the form of presentation of audit results to both radiographers and radiologists within the department was conducted. Follow-up retrospective analysis in June 2016 of 220 patients via PACS was completed and data from both cycles compared. Results: Overall outcome: Cycle 1: - Adequate 33.79% - Inadequate 66.21% Cycle 2: - Adequate 56.0% - Inadequate 44.0%
Ultrasound as a screening tool for the diagnosis of deep infiltrating endometriosis Authors: Rachana Shukla, Marlin Mubarak, Firras Younis Purpose: To assess the efficacy of ultrasound as a screening investigation in patients with suspected deep infiltrating endometriosis. Methods and materials: This was a two part study. We first established the concordance of magnetic resonance (MR) reporting with respect to surgical findings using the ENZIAN system. We then standardised our transvaginal ultrasound (TVUS) reporting to include endometriosis assessment in patients with unexplained pelvic pain. Patients with suspected deep infiltrating endometriosis (DIE) who had TVUS as part of their screening for pelvic pain were then reviewed at the local gynaecology and endometriosis multidisciplinary teams (MDTs) by a dedicated gynae radiologist between January 2015 and 2017. Patients were classified as 1) normal ultrasound 2) DIE 3) indeterminate ultrasound. All patients with clinically or sonographically suspected DIE underwent an MRI. Results: All patients with positive or indeterminate ultrasound had a positive MRI. A small proportion of patients with negative ultrasound had a positive MRI. We found a progressively higher concordance between MRI and ultrasound as our ultrasound experience built from 2015 to 2017.
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.
Abstract / Clinical Radiology 72 (2017) S1eS13
Conclusion: There is high interobserver agreement between medical and non-medical readers for C coding suggesting it is a precise method of classifying intra-colonic CTC findings. The much lower interobserver agreement for E coding may reflect greater difficulty in classifying the range of extra-colonic findings, but is also likely to be strongly confounded by the difference in skill set between radiologists and radiographers reading the study. Comparison in magnetic resonance imaging findings to endoscopy findings in patients with endometriosis involving the bowel Authors: Zain Habib, Rebecca Wiles Purpose: Endometriosis is common in women of reproductive age, potentially resulting in significant morbidity. Bowel involvement occurs in up to 37% of patients. Pretreatment diagnosis of bowel involvement is necessary to appropriately guide management. The authors aimed to correlate the findings on magnetic resonance imaging (MRI) and endoscopy in patients with suspected bowel endometriosis, and identify if endoscopy provided any additional important information. Methods and materials: Between September 2015 and November 2016, MRI scans from the regional endometriosis multidisciplinary team (MDT) were reviewed. Those that had an MRI reporting bowel involvement would go on to have an endoscopy. The MRI was retrospectively reviewed by a consultant radiologist blind to the endoscopy findings. The endoscopy findings were determined based on the endoscopy report. The findings were divided into four categories; normal, extrinsic/submucosal abnormality, extrinsic/submucosal and mucosal abnormality, and mucosal abnormality only. The findings were then compared. Results: 40 patients had both an MRI scan and an endoscopy during this period. Out of the 24 patients that had MRI findings of bowel involvement, only seven patients had abnormal endoscopy findings. Five of these patients had findings which correlated with each other. In only one patient mucosal abnormality was identified on endoscopy, when MRI was normal, but this proved to be normal bowel on histology. Conclusion: Endoscopy appears to add little additional information to MRI in diagnosing bowel endometriosis, mainly because it is typically an extrinsic process. As it is an invasive investigation which poses potential risks to the patient we suggest that endoscopy may not be needed when MRI has detected bowel involvement. The image quality of abdominal radiography revisited
There has been a significant improvement in overall adequacy of abdominal films (p<0.001) performed in June 2016 following the initial audit of January 2016 and intervention in the form of presentation of results to the department. Conclusion: In order to maximise clinical usefulness of abdominal radiographs certain landmarks must be exposed. Once intervention was implemented, re-audit after six months showed a statistically significant improvement in the number of adequate abdominal radiographs performed. Is the incidence of non-renal diagnoses and important incidental findings on CT KUB carried out for suspected renal tract calculi Authors: Stephen Sammut, Vincent Leung, Ravivarma Balasubramaniam, Nick Watson Purpose: Adult patients undergoing plain low-dose computed tomography (CT) of the renal tract (CT KUB) for loin-to-groin pain may have an alternative, non-renal tract-related, diagnosis underlying their clinical presentation. This study was conducted to determine whether alternative diagnoses were more common in older patients and whether a different imaging strategy should be considered. Methods and materials: We retrospectively identified all CT KUB examinations performed at our university teaching hospital over a six-month period (JanuaryeJune 2016). Patients were excluded if the CT KUB examination was not performed specifically for loin-to-groin pain. Scans were recorded as positive if there were obstructing calculi, ureteric calculi or reported as ‘recently passed calculus’. The presence of any alternative underlying pathology was recorded. Results: 706 examinations were included in the study. 240 (34%) of examinations were positive for a renal tract cause of the presenting symptoms. Alternative acute diagnoses or important incidental findings were detected in 16% of patients but the incidence of these findings was not significantly related to increasing patient age. Only eight patients required a full-dose CT to better characterise an equivocal finding. Three patients had a new diagnosis on repeat imaging for on-going persistent symptoms. Two of these 11 patients were aged less than 50 years. Conclusion: A proportion of CT KUB examinations detect alternate pathologies or reveal clinically important incidental findings. Few patients required repeat full-dose contrast-enhanced CT scans to identify or better characterise alternate pathology. This study demonstrates that the lowdose, non-contrast CT KUB remains an appropriate firstline examination for loin-to-groin pain regardless of the patient’s age.
Authors: Deborah Carlyle, Douglas Black, Iain Cameron, Ellen Anderson Purpose: The clinical usefulness of abdominal radiographs can be limited by the quality of the radiograph, often due to inability to cover the appropriate anatomical landmarks. The standard abdominal radiograph should include the area from the diaphragm cranially to the pubic symphysis caudally with the inclusion of both flanks. This audit was performed to review the performance of the department in producing abdominal radiographs of adequate quality. Methods and materials: Retrospective sequential analysis of 219 adult abdominal plain radiograph films in January 2016 via the picture archiving and communication system (PACS). All abdominal radiographs were examined according to the standard; to include pubic symphysis and both hemi-diaphragms, and extend sufficiently laterally to ensure that all bowel is included. The target was for 95% of films to meet this standard. Following analysis of audit results, intervention in the form of presentation of audit results to both radiographers and radiologists within the department was conducted. Follow-up retrospective analysis in June 2016 of 220 patients via PACS was completed and data from both cycles compared. Results: Overall outcome: Cycle 1: - Adequate 33.79% - Inadequate 66.21% Cycle 2: - Adequate 56.0% - Inadequate 44.0%
Ultrasound as a screening tool for the diagnosis of deep infiltrating endometriosis Authors: Rachana Shukla, Marlin Mubarak, Firras Younis Purpose: To assess the efficacy of ultrasound as a screening investigation in patients with suspected deep infiltrating endometriosis. Methods and materials: This was a two part study. We first established the concordance of magnetic resonance (MR) reporting with respect to surgical findings using the ENZIAN system. We then standardised our transvaginal ultrasound (TVUS) reporting to include endometriosis assessment in patients with unexplained pelvic pain. Patients with suspected deep infiltrating endometriosis (DIE) who had TVUS as part of their screening for pelvic pain were then reviewed at the local gynaecology and endometriosis multidisciplinary teams (MDTs) by a dedicated gynae radiologist between January 2015 and 2017. Patients were classified as 1) normal ultrasound 2) DIE 3) indeterminate ultrasound. All patients with clinically or sonographically suspected DIE underwent an MRI. Results: All patients with positive or indeterminate ultrasound had a positive MRI. A small proportion of patients with negative ultrasound had a positive MRI. We found a progressively higher concordance between MRI and ultrasound as our ultrasound experience built from 2015 to 2017.
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.