James S. Newman’s research while affiliated with Vascular and Interventional Radiology and other places

A pregnant patient presenting to interventional radiology (IR) has a different set of needs from any other patient requiring a procedure. Often, the patient's care can be in direct conflict with the growth and development of the fetus, whether it be optimal fluoroscopic imaging, adequate sedation of the mother, or the timing of the needed procedure. Despite the additional risks and complexities associated with pregnancy, IR procedures can be performed safely for the pregnant patient with knowledge of the special and general needs of the pregnant patient, use of acceptable medications and procedures likely to be encountered during pregnancy, in addition to strategies to protect the patient and her fetus from the hazards of radiation.

To evaluate the retrievability and safety of the G2 filter. A retrospective study of all G2 filter retrievals at a single institution was conducted. Hospital records and imaging studies were reviewed for complications, and factors affecting retrieval were analyzed. From 2005 to 2009, a total of 139 patients presented for retrieval of their G2 filter, and 131 pairs of pre- and post-placement cavagrams and 39 computed tomography scans were available for analysis. The following findings were recorded: limb penetration (n = 33), tilt greater than 15° (n = 22), local migration greater than 2 cm (n = 17), retained thrombus within the filter (n = 16), deformity (n = 10), inferior vena cava (IVC) occlusion (n = 3), fracture (n = 2), and pulmonary embolism breakthrough (n = 2). A total of 118 filters were removed, with a mean indwelling time of 131.8 days (range, 3-602 d). Indwell time (< 90, 90-180, or > 180 d) did not affect retrieval (P = .4). There were 21 filters (15.1%) left in situ as a result of severe tilt (n = 9), significant thrombus in the filter (n = 5), IVC occlusion (n = 3), filter incorporation into the caval wall (n = 3), or lack of central venous access (n = 1). There was a strong relationship between penetration and caudal migration (P < .0001). Severe tilt was associated with prolonged fluoroscopic times for retrieval (P = .003). The majority of G2 filters can be removed without difficulty. The most common factor affecting retrieval was severe tilting. The indwelling time had no impact on retrieval. G2 filter-related complications were frequent but most, including fractures, were clinically insignificant.

To determine whether the effectiveness of arterial embolization in patients with acute upper gastrointestinal hemorrhage is related to the visualization of contrast medium extravasation at angiography. Transcatheter embolization was performed in 108 patients who experienced acute upper gastrointestinal hemorrhage during a 5-year period. Patient charts were retrospectively reviewed. Thirty-six patients who underwent embolization after angiography demonstrated active contrast medium extravasation from an involved artery. Seventy-two patients underwent embolization in the absence of contrast medium extravasation into a bowel lumen. Embolization technique, requirement for further blood products, need for further surgery, and 30-day mortality were recorded. The gastroduodenal artery (GDA) was embolized in 26 of the 36 patients (72%) with extravasation, and the left gastric artery was embolized in 10 (28%). The GDA was embolized in 64 of the 72 patients (89%) without extravasation, and the left gastric artery was embolized in 13 (18%). After embolization, 23 of the 36 patients (64%) with extravasation and 44 of the 72 (61%) without extravasation required additional blood product transfusions. Seven of the 36 patients (19%) with extravasation and 16 of the 72 (22%) without extravasation required subsequent surgery secondary to bleeding. Thirty-day hemorrhage-related mortality was 17% (six of 36 patients) in the positive extravasation group and 22% (16 of 72 patients) in the negative extravasation group. The treatment success rate was 44% (16 of 36 patients) in the positive extravasation group and 44% (32 of 72 patients) in the negative extravasation group. In patients with acute upper gastrointestinal hemorrhage, arterial embolization is equally effective in patients who demonstrate active contrast medium extravasation at angiography as in those who do not show contrast extravasation.

To determine the incidence and risk factors for surgical intervention after uterine artery embolization for symptomatic uterine fibroids. Electronic medical records of all patients who underwent uterine artery embolization for symptomatic uterine leiomyomata were reviewed. Logistic regression was used to identify independent risk factors for any surgical intervention and for hysterectomy alone after uterine artery embolization. Uterine artery embolization was performed in 454 patients during the study period, with a median follow-up time (range) of 14 (0-128) months. Overall, 99 patients (22%) underwent any surgical intervention after uterine artery embolization in the operating room. Risk factors for any surgical intervention included younger age (P < .003), bleeding as an indication for uterine artery embolization (P < .01), presence of significant collateral ovarian vessel contribution to the uterus (P < .01), or use of 355-500 mum particles (P < .008). Patients undergoing uterine artery embolization have a 22% risk for requiring additional surgical intervention, but overall uterine artery embolization is an effective minimally invasive option.

In patients with acute lower gastrointestinal bleeding, colonoscopy is the initial test of choice. But when colonoscopy gives indeterminate results or cannot be performed, either radionuclide imaging or angiography is indicated.

To assess the feasibility of peritoneal ports for management of patients with cirrhotic refractory ascites, 10 ports were placed in nine patients for frequent outpatient paracentesis. Retrospective review and telephone interviews were used to assess port performance. Kaplan-Meier analysis revealed a median duration of port patency of 255 days. In 1,557 port days, four access problems prompted further interventional evaluation. Three cases of bacterial peritonitis and one catheter obstruction developed. The use of subcutaneous venous access ports to allow control of ascites by nursing personnel is a promising alternative for management of patients with refractory ascites. Additional studies are needed to determine long-term effectiveness and safety.

Uterine leiomyomata are a frequent finding in a gynecologist’s practice. Until recently, options for management have been limited. A relatively new procedure is gaining popularity as another option for a select group of patients. The treatment of choice for definitive management remains hysterectomy. However, uterine artery embolization (UAE) can be considered in certain women. We discuss the indications, benefits, risks, and potential complications of UAE. We review recent literature including results and complication rates. A proposed protocol is introduced for patient selection, preoperative assessment, and postprocedural follow-up. A coordinated effort is recommended, including incorporating a multiteam approach with the interventional radiologist, pain management service, and gynecologist. A brief technical review of the procedure is included. (Primary Care Update Ob/Gyns 2001;8:232–239

MAINTAINING reliable access sites for hemodialysis is an essential aspect of the care of patients with chronic renal failure. Many of these individuals have had numerous surgical and percutaneously acquired vascular access sites fail and become unusable because of stenosis, thrombosis, and vessel compromise. The inferior vena cava (IVC), however, affords reliable dialysis with the advantage of access reacquisition in patients who have had previous catheter failure. From July 17, 1996, to January 23, 1997, five Tesio twin silicone, 10-F catheters (Medicomp, Harleysville, PA) were inserted into the IVC of four patients. All patients had chronic renal failure and all other access sites for hemodialysis had been exhausted.