The Effect of Immediate Versus Delayed Port Access on 30-Day Infection Rate.

This study compared the 30-day infection risk of chest ports accessed on the same day as placement and chest ports with delayed initial access. The aim was to evaluate a larger data set that provided evidence for the development of port access guidelines. A retrospective chart review of 3322 chest port placement procedures performed between October 15, 2003, and June 10, 2015, was conducted at the interventional radiology department of a single institution. Procedure notes and health records were reviewed to determine time of initial port access, evidence of infection within a 30-day window of port placement, and causal organism(s) of infection. The results demonstrated that 64 ports (1.93%) met infection criteria within 30 days of placement, including 30 of the 945 ports immediately accessed and 34 of the 2377 ports not immediately accessed (3.17% vs 1.43%; P < .005). Dual lumen devices had a statistically significant higher rate of infection compared with single lumen devices (P = .006). This study concluded that there is a statistically significant higher rate of infection if a port is accessed immediately versus when access is deferred to later than 24 hours after placement.

Fractured Bard Recovery, G2, and G2 express inferior vena cava filters: incidence, clinical consequences, and outcomes of removal attempts.

PURPOSE: To increase the understanding of risks of inferior vena cava (IVC) filter fracture and embolization and the safety of removing fractured filters via retrospective review of a prospectively collected database of fractured IVC filters. MATERIALS AND METHODS: A total of 63 fractured IVC filters were discovered among 548 patients presenting for retrievable filter removal between April 2004 and November 2010 at a single institution. Device type, duration of implantation, component fracture, and embolization events were recorded. Success rates and techniques for removal of components were recorded. RESULTS: A total of 63 fractured Recovery, G2, and G2 Express IVC filters were identified, for an overall fracture rate of 12%. Excluding foot process fractures, the fracture rate for only filter arms and/or legs was 6%. The incidence of fracture increased with longer filter dwell times. Success rates for removal of the nonfractured component (ie, main body) and fractured components (ie, arm or leg) were 98.4% and 53.4%, respectively. The distal embolization rate of fractured filter components was 13%. There were no immediate clinically significant complications associated with fracture component embolization or filter removal. A single patient was encountered with symptoms related to their fractured filter. CONCLUSIONS: IVC filter fracture rates increase with longer dwell times; however, removal of fractured filters and fractured components (ie, arms and legs) can be achieved safely and effectively. Clinically significant complications of IVC filter fracture are rare, and there were no immediate clinical sequelae related to embolization of fracture components.

Optional vena cava filter use in the elderly population.

PURPOSE: To review utility, safety, and efficacy of optional inferior vena cava (IVC) filters in patients 65 years or older at a single institution over a 6-year period. MATERIALS AND METHODS: Retrospective review of permanent and optional IVC filters placed in elderly patients was performed. Older and younger groups were compared based on technical success of filter placement and clinical success measured by recurrent pulmonary embolism (PE) or thrombotic complications. The rate of successful filter removal was compared with that in the cohort of patients of all ages who received optional filters. RESULTS: Fifty-three patients received an optional filter and 445 received a permanent filter. Technical success rates for filter placement in the permanent and optional filter groups were 99.8% (447 of 448) and 98.1% (53 of 54), respectively (P = .51). Rates of PE after filter placement were 0% and 1.4% (five of 359) in the optional and permanent filter groups, respectively (P = .87). Incidences of deep vein thrombosis were 12% (six of 50) and 4.5% (16 of 359) in optional and permanent filter recipients, respectively (P = .06). Filter retrieval was attempted in 55.6% of optional filter recipients (30 of 54), similar to that seen in patients of any age with optional filters. Retrieval was unsuccessful in one patient in whom a suprarenal IVC filter was placed. CONCLUSIONS: Optional filters are safe and effective in patients aged 65 years or older. Age alone is a poor predictor of a clinical opportunity to remove a filter. With appropriate patient selection and aggressive follow-up, retrieval rates comparable with those in younger populations can be achieved.

Comparison of the recovery and G2 filter as retrievable inferior vena cava filters.

PURPOSE: To compare the technical success of the Recovery and G2 filters as retrievable inferior vena cava (IVC) filters. MATERIALS AND METHODS: Recovery (n = 128) and G2 (n = 113) filters were placed in the IVCs of 241 patients with the intent of retrieval. The referring physician and/or patient were contacted at 6-month intervals to ensure filter retrieval when indicated. The Recovery and G2 filter groups were compared regarding technical success of filter placement, technical success of attempted retrieval, filter tilt, filter migration, filter fracture, and filter efficacy. RESULTS: Filter placement was technically successful in 95% of Recovery filters (n = 122) and 100% of G2 filters (n = 113). Recovery filter retrieval was attempted in 55% of patients (n = 71) at a mean of 228 days (range, 0-838 d) after filter placement. G2 filter retrieval was attempted in 55% of patients (n = 62) at a mean of 230 days (range, 7-617 d) after filter placement. Technical success rates of filter retrieval were 94% (n = 67) and 97% (n = 60) in the Recovery and G2 filter groups, respectively. The G2 filter group had significantly fewer cases of (i) filter tilt at placement, (ii) filter tilt at attempted retrieval, and (iii) filter fracture than the Recovery filter group. In the G2 filter group, there was a significantly higher technical success rate of filter placement and there were more cases of caudal filter migration than in the Recovery filter group. CONCLUSIONS: Compared with the Recovery filter, the G2 filter is associated with significantly less filter fracture and tilt, greater technical success of filter placement, and more caudal filter migration.

Percutaneous removal of a metallic foreign body from the wall of the thoracic aorta.

This report details the percutaneous removal of a metallic foreign body from the wall of the thoracic aorta. The foreign body was presumably swallowed and migrated from the esophagus into the aortic lumen progressively during a period of 10 months. The patient had no adverse consequences from the procedure immediately or in the subsequent 18 months of follow-up.

Complications and controversies associated with peripherally inserted central catheters.

The placement of peripherally inserted central catheters has grown into one of the most common forms of intravenous access. Although complications associated with peripherally inserted central catheters are low, most healthcare providers will encounter them on a frequent basis. Awareness of these complications will help the clinician manage these issues appropriately.

C(6)-Ceramide-Coated Catheters Promote Re-Endothelialization of Stretch-Injured Arteries.

OBJECTIVE: Drug eluting stents have recently been associated with the increased risk of adverse thrombogenic events and/or late luminal loss, which is highly associated with incomplete re-endothelialization. The increased risks behoove the design of alternative delivery modalities and/or drugs that do not compromise the re-endotheliaization process. The objective of the present study is to elucidate the biological mechanism(s) by which non-stent-based delivery modalities for the anti-proliferative lipid metabolite, C(6)-ceramide, could lead to a reduction in arterial injury after angioplasty. RESULTS: Immunohistochemical studies in rabbit and porcine models suggest that C(6)-ceramide-coated balloon catheters limit arterial stenosis without inhibiting endothelial wound healing responses. Specifically, C(6)-ceramide-coated balloon catheters reduce internal elastica injury with a corresponding reduction in medial fracture length in a 28-day porcine coronary artery stretch model. In addition, C(6)-ceramide decreases the formation of the fibrin matrix to possibly augment the subsequent wound healing response. We hypothesized that differential metabolism of exogenous ceramide by coronary endothelial and smooth muscle cells could explain the apparent discrepancy between the anti-proliferative actions of ceramide and the pro-wound healing responses of ceramide. Human coronary artery endothelial cells (HCAEC), in contrast to human coronary artery smooth muscle cells (HCASMC), preferentially express ceramide kinase and form ceramide-1-phosphate, which promotes endothelial cell survival. CONCLUSION: Differential metabolism of ceramide between HCASMC and HCAEC offers a mechanism by which ceramide preferentially limits smooth muscle cell growth, in the presence of active wound healing. The combinatorial ability of ceramide to limit vascular smooth muscle proliferation and promote re-endothelialization, offers the potential for C(6)-ceramide-coated catheters to serve as adjuncts to stent-based modalities or as a stand-alone treatment.