Accidental central venous catheter cannulation into aberrant arterial anatomy requiring endovascular intervention.

Central venous catheter placement continues to be an extremely common procedure throughout hospital systems. Although ultrasound guidance can mitigate some placement risks, misplacement of lines into neighboring structures, such as arteries, remains an unfortunate complication. In this report, we will discuss an 83-year-old female with aberrant left subclavian artery and right sided arch, which provided for successful stent graft coverage of arterial injury secondary to accidental subclavian artery cannulation with a central venous catheter with preservation of the right common carotid artery and avoidance of a potentially morbid sternotomy.

External Validation of the Percutaneous Renal Ablation Complexity Scoring System in Patients Undergoing Percutaneous Cryoablation or Microwave Ablation of Renal Tumors.

PURPOSE: To assess the ability of the Percutaneous Renal Ablation Complexity (P-RAC) scoring system to predict procedural complexity or adverse events (AEs) in adult patients undergoing percutaneous thermal ablation of renal tumors. MATERIALS AND METHODS: A retrospective review of 240 consecutive adult patients who underwent percutaneous thermal renal ablation from 2004 to 2018 was conducted. The P-RAC score was calculated for each renal tumor and procedural complexity recorded. A correlation coefficient was calculated for the P-RAC score and both the number of probes used and procedural duration. Receiver operating characteristic curves assessed the score's ability to predict the use of adjunctive techniques and/or major AEs, classified according to the Society of Interventional Radiology guidelines. RESULTS: For the entire cohort, there was a weak correlation between P-RAC scores and both the number of probes used (r = 0.31; P < .001) and procedural duration (r = 0.18; P = .03). When evaluating only patients treated with microwave ablation (MWA), no correlation between P-RAC scores and either the number of probes (P = .7) used or procedural duration (P = .4) was found. The area under the curve (AUC) for the P-RAC score to predict the use of adjunctive techniques was 0.55 and 0.53 for the entire cohort and MWA group, respectively. The AUC for the P-RAC score to predict major AEs was 0.70, 0.71, and 0.73 for the entire cohort, MWA group, and cryoablation group, respectively. CONCLUSIONS: The P-RAC scoring system is limited in its ability to predict percutaneous thermal renal tumor ablation procedural complexity, especially in patients treated with MWA. The scoring system may have a role in identifying patients at risk of major AEs.

Dialysis access-associated steal syndrome with percutaneous endovascular arteriovenous fistula creation.

BACKGROUND: Dialysis access-associated steal syndrome (DASS) is an infrequent complication after hemodialysis access creation. Clinical symptoms depend on the degree of steal. Percutaneous arteriovenous fistula creation offers a minimally invasive alternative to surgical creation, though complications have been reported. The following presents the first described case of DASS after percutaneous endovascular arteriovenous fistula creation, and discusses risk factors and management. CASE PRESENTATION: Our case is that of a 27-year-old male with end stage renal disease due to congenital renal dysplasia, who underwent left percutaneous arteriovenous fistula creation for initiation of dialysis. Two months after the procedure the patient complained of coldness, pain, tingling, and numbness in the left arm during dialysis, concerning for steal syndrome. The patient subsequently underwent brachial artery angiogram, which showed minimal antegrade flow through the ulnar and interosseous arteries towards the hand, and a focal, severe stenosis in the distal ulnar artery. Angioplasty of the stenosis was performed, though steal symptoms continued. CONCLUSIONS: DASS, though rare, can be seen with percutaneous arteriovenous fistula creation. Identification of the risk factors prior to creation can help avoid this complication. Management is largely guided by clinical presentation. As long as there is adequate collateral supply to the extremity, single vessel occlusion is not a contraindication to percutaneous arteriovenous fistula creation with the use of WavelinQ technology. Careful patient selection with pre-creation angiogram may reduce the risk of symptomatic steal.

External Validation of the Renal Ablation-Specific (MC)2 Risk Scoring System in Predicting Complications from Percutaneous Renal Cryoablation.

PURPOSE: The (MC)2 score is a renal ablation-specific risk scoring system to predict major complications from percutaneous renal cryoablation (PRCA). However, it is untested in an external population of patients. The purpose of this study is to validate the ability of the (MC)2 score to predict major complications after PRCA in an external population. MATERIALS AND METHODS: Retrospective review of patients who underwent PRCA from 2004 to 2019. Patient demographics, medical histories, and tumor characteristics were collected. The (MC)2 score was calculated and patients were assigned to low risk (< 5), moderate risk (5-8) and high-risk (> 8) groups. Complications were recorded. Major complications were classified according to CIRSE guidelines. RESULTS: Two hundred and one patients [M = 116; F = 85; median age = 65 (range 27-90)] met inclusion criteria. Eleven patients (5.5%) developed major complications and 50 patients (24.9%) developed minor complications. Of patients with major complications, mean tumor diameter was 39 mm (± 10.4), seven patients (63.6%) had a central tumor, four patients (36.4%) had complicated diabetes, and one patient (9.1%) had a prior MI. Major complication rates were 2.1%, 14%, and 14.3% in the (MC)2 low risk, moderate risk, and high risk groups, respectively. The mean (MC)2 score for patients with major complications [6.2 (± 2.4)] was higher than the mean score for patients with minor complications [4.7 (± 2.4) (p = 0.07)] and no complications [3.9 (± 1.9) (p < 0.01)]. The area under the ROC curve to predict major complications was 0.78. CONCLUSION: The (MC)2 risk scoring system appropriately identifies patients at risk for major complications from PRCA in this external patient population.

Percutaneous Cryoablation of Stage T1b Renal Cell Carcinoma: Safety, Technical Results, and Clinical Outcomes.

PURPOSE: The use of percutaneous cryoablation for T1b (4.1-7.0 cm) renal cell carcinoma, has not yet been widely adopted. The purpose of this study was to describe our experience in the cryoablation of stage T1b tumors with an emphasis on safety, technical results, and clinical outcomes. MATERIALS AND METHODS: A retrospective review of hospital records identified 37 patients who underwent cryoablation for T1b lesions from 2008 to 2018. Patient demographics, comorbidities, tumor characteristics, technical parameters, and outcomes were recorded and analyzed. Recurrence-free, overall, and cancer-specific survival rates were estimated using the Kaplan-Meier method. RESULTS: Thirty-seven patients (22 males, 15 females; mean age 66.5 ± 11.3) with 37 T1b tumors (mean diameter 47.3 ± 6.3 mm) were included. A median of 3 probes were used (range: 1-7). Angio-embolization was used in 3/37 (8.1%) and 2/37 patients (5.4%) required hydrodissection. The mean number of total cryoablation procedures for each patient was 1.5 (median 1; range: 1-4). Technical success was achieved in 88.2% of patients. Recurrence-free survival was 96.5%, 86.1%, and 62.6% at 1, 2, and 3 years respectively. Cancer-specific survival was 100% at 1, 2, and 3 years respectively. Overall survival was 96.7%, 91.8%, and 77.6% at 1, 2, and 3 years respectively. Complications classified as CIRSE grade 2 or higher occurred in 6/37 (16.2%) patients. CONCLUSION: T1b cryoablation is associated with high rates of technical success, excellent cancer-specific survival, and an acceptable safety profile. LEVEL OF EVIDENCE: Level 4, Case Series.