Videoscopic phantom-based angiographic simulation: effect of brief angiographic simulator practice on vessel cannulation times.

PURPOSE: This study was performed to determine the effectiveness of videoscopic phantom-based angiographic simulation (VPAS) in providing effective endovascular procedural training for medical student and resident populations. MATERIALS AND METHODS: Medical students and radiology residents were separated equally into experimental and control groups (n = 20 each). The primary objective was to evaluate the efficiency of cannulating vessels with the use of the VPAS apparatus. The experimental group received 30 minutes of didactic training on angiography techniques and 30 minutes of untutored hands-on practice with the VPAS. The control group received a 60-minute didactic session without subsequent practice on the VPAS. After 1 hour of total training for each group, every participant was asked to cannulate the following four simulator vessels under fluoroscopic guidance: the right renal artery (RRA), left renal artery (LRA), superior mesenteric artery (SMA), and right internal carotid artery. The primary endpoint was time to successful cannulation. RESULTS: Participants in the experimental group performed better overall, which was reflected by a significantly higher mean efficiency rating (all P values < .05). The experimental group also demonstrated significantly higher rates of successful cannulation (in the LRA and RRA) and successful wire entry (in the LRA, RRA, and SMA). The experimental cohort also had significantly shorter times to cannulation (in the RRA and LRA) and wire entry (in the RRA and SMA). CONCLUSIONS: Study participants who underwent hands-on angiographic practice with VPAS performed significantly better on evaluation under fluoroscopic angiographic conditions than those who did not receive hands-on practice with VPAS.

Saphenous venous ablation with hot contrast in a canine model.

PURPOSE: To determine the feasibility, efficacy, and safety of thermal ablation of the saphenous vein with hot contrast medium. METHODS: Twelve saphenous veins of 6 dogs were percutaneously ablated with hot contrast medium. In all animals, ablation was performed in the vein of one leg, followed by ablation in the contralateral side 1 month later. An occlusion balloon catheter was placed in the infragenicular segment of the saphenous vein via a jugular access to prevent unwanted thermal effects on the non-target segment of the saphenous vein. After inflation of the balloon, 10 ml of hot contrast medium was injected under fluoroscopic control through a sheath placed in the saphenous vein above the ankle. A second 10 ml injection of hot contrast medium was made after 5 min in each vessel. Venographic follow-up of the ablated veins was performed at 1 month (n = 12) and 2 months (n = 6). RESULTS: Follow-up venograms showed that all ablated venous segments were occluded at 1 month. In 6 veins which were followed up to 2 months, 4 (66%) remained occluded, 1 (16%) was partially patent, and the remaining vein (16%) was completely patent. In these latter 2 cases, an inadequate amount of hot contrast was delivered to the lumen due to a closed balloon catheter downstream which did not allow contrast to displace blood within the vessel. DISCUSSION: Hot contrast medium thermal ablation of the saphenous vein appears feasible, safe, and effective in the canine model, provided an adequate amount of embolization agent is used.