Extensive Iatrogenic Aortic Dissection During Renal Angioplasty: Successful Treatment with a Covered Stent-Graft

An extensive iatrogenic aortic type B dissection during percutaneous transluminal renal angioplasty (PTRA) for bilateral renal artery stenosis was treated with a covered stent placed in the right renal artery. Control angiography confirmed closure of the entry. Postprocedural CT demonstrated a thick intramural hematoma (IMH) up to the left subclavian artery. CT follow-up at 8 months showed an almost complete resorption of the IMH. While medical treatment is the standard therapy for type B dissections, closure of the intimal tear with a covered stent may be an additional option in extensive cases during PTR

Qualitätssicherung interdisziplinärer Polytraumaversorgung: Möglichkeiten und Grenzen retrospektiver Standarderfassung

Zusammenfassung: Hintergrund: Inwieweit kann die Auswertung standardmäßig erhobener Patienten- und Krankenhausdaten einen Behandlungsvergleich mit anderen Erhebungen gestatten? Material und Methoden: Es wurde eine retrospektive Analyse epidemiologischer und klinisch-technischer Parameter aller Mehrfachverletzten [Injury Severity Score (ISS)>15] einer Zentrumsklinik (n=172; Zeitraum: 01.01.1997-31.12.1999) bezüglich der Ablauforganisation und des Outcome (p74Jahre, Hypotension, initial verminderte Hämoglobin- und Quick-Werte, verminderte Glasgow Coma Scale (GCS) sowie Anzahl erhaltener Blutkonzentrate. Eine Gegenüberstellung der erhobenen Daten mit der zeitgleichen prospektiven Multizenterstudie der Deutschen Gesellschaft für Unfallchirurgie (DGU) bestätigte die Ergebnisse bezüglich des Ablaufs und des Outcome. Schlussfolgerung: Die interdisziplinäre retrospektive Datenauswertung ist unter Fokussierung auf prognoserelevante und routinemäßig erhobene Parameter eine praktikable sowie aussagefähige Alternative zu prospektiven Erfassungen und ermöglicht eine erste qualitative Standortbestimmun

Total-body contrast-enhanced MRA on a short, wide-bore 1.5-T system: intra-individual comparison of Gd-BOPTA and Gd-DOTA

Total-body contrast-enhanced MRA (CE-MRA) provides information of the entire vascular system according to a one-stop-shop approach. Short, wide-bore scanners have not yet been used for total-body CE-MRA, probably due to their restricted field of view in the z-direction. The purpose of this feasibility study is to introduce an image protocol for total-body MRA on a short, wide-bore system. The protocol includes five to six table-moving steps and two injection runs. Two pharmacologically different contrast materials (CM) were applied in ten healthy volunteers in view of possible CM-dependent influences on the protocol outcome (Gd-Bopta, Gd-Dota). Differences consisted of significantly higher CNR with Gd-Bopta with a mean of 73.8 ± 38.7 versus 69.1 ± 34.3 (p = 0.008), significantly better arterial visualization values with Gd-Dota with a mean of 1.26 ± 0.44 versus 1.53 ± 0.73 (p = 0.003) and a tendency to less venous overlay with Gd-Dota, mean 1.19 ± 0.44 and 1.34 ± 0.72, respectively (p = 0.065) (two-tailed Wilcoxon matched-pairs test). Overall 94% of the steps were valued as qualitatively excellent or good. The good results with both CM suggest a transfer to further patient evaluatio

Interdisziplinäres Schockraum-Management unfallchirurgischer Patienten aus der Sicht der Mitarbeitenden

Zusammenfassung: Einleitung: Wir untersuchten, ob die Mitarbeiterbefragung in der Qualitätskontrolle des Schockraum-Managements von Nutzen sein kann. Methode: Konsekutive anonyme schriftliche Befragung (15Fragen, Likert-Skala 1-5) der klinisch Mitarbeitenden aller Schockraumeinsätze mit Verdacht auf Mehrfachverletzung von Juli 2002 bis Dezember 2003 (Anova; p<0,05). Ergebnisse: Bei 171 unfallchirurgischen Einsätzen retournierten 884Beteiligte den Antwortbogen. Die Beobachtungen der Mitarbeitenden hingen signifikant von der jeweiligen Schockraumsituation ab. Am meisten kritisiert wurden das Zeitmanagement und die eigene Ausbildung (Likert-Skala <4). Leitende- und Oberärzte bewerteten ihren Ausbildungsstand besser als Assistenzärzte und hatten häufiger einen ATLS®-Kurs absolviert (p<0,001). Es fanden sich signifikante systematische Unterschiede in den Beurteilungen, z.B. je nach Fachdisziplin der Antwortenden. Schlussfolgerung: Unser Fragebogen erwies sich als gut diskriminierendes Instrument und kann somit die Erfassung klinischer Parameter im Qualitätsmanagement der Schockraumphase sinnvoll ergänzen. Vor einer breiteren Anwendung werden allerdings zusätzliche Validierungs- und Korrelationsuntersuchungen benötig

Fluoroscopic Contrast-Enhanced MR Angiography with a Magnetization-Prepared Steady-State Free Precession Technique in Peripheral Arterial Occlusive Disease

OBJECTIVE. The objective of our study was to evaluate the feasibility of intraarterial (IA) near-real-time contrast-enhanced MR angiography (CE-MRA) with a frame rate of 1.3 frames per second in seven patients with lower extremity peripheral arterial occlusive disease (PAOD). For optimized background suppression, a modified 2D steady-state free precession (SSFP) technique with magnetization preparation and mask subtraction was developed. The femoropopliteal and infrapopliteal arteries were covered in two separate steps. Acceptable contrast-to-noise ratios were obtained, and road maps were reconstructed from the same data set. CONCLUSION. Mastering IA near-real-time CE-MRA, including road map reconstruction, with an SSFP technique in the lower extremity of patients with PAOD is an important building block toward successfully performing endovascular catheter MR-guided interventions

MR-guided endovascular interventions: a comprehensive review on techniques and applications

The magnetic resonance (MR) guidance of endovascular interventions is probably one of the greatest challenges of clinical MR research. MR angiography is not only an imaging tool for the vasculature but can also simultaneously depict high tissue contrast, including the differentiation of the vascular wall and perivascular tissues, as well as vascular function. Several hurdles had to be overcome to allow MR guidance for endovascular interventions. MR hardware and sequence design had to be developed to achieve acceptable patient access and to allow real-time or near real-time imaging. The development of interventional devices, both applicable and safe for MR imaging (MRI), was also mandatory. The subject of this review is to summarize the latest developments in real-time MRI hardware, MRI, visualization tools, interventional devices, endovascular tracking techniques, actual applications and safety issues

Total-body contrast-enhanced MRA on a short, wide-bore 1.5-T system: intra-individual comparison of Gd-BOPTA and Gd-DOTA

Total-body contrast-enhanced MRA (CE-MRA) provides information of the entire vascular system according to a odne-stop-shop approach. Short, wide-bore scanners have not yet been used for total-body CE-MRA, probably due to their restricted field of view in the z-direction. The purpose of this feasibility study is to introduce an image protocol for total-body MRA on a short, wide-bore system. The protocol includes five to six table-moving steps and two injection runs. Two pharmacologically different contrast materials (CM) were applied in ten healthy volunteers in view of possible CM-dependent influences on the protocol outcome (Gd-Bopta, Gd-Dota). Differences consisted of significantly higher CNR with Gd-Bopta with a mean of 73.8+/-38.7 versus 69.1+/-34.3 (p=0.008), significantly better arterial visualization values with Gd-Dota with a mean of 1.26+/-0.44 versus 1.53+/-0.73 (p=0.003) and a tendency to less venous overlay with Gd-Dota, mean 1.19+/-0.44 and 1.34+/-0.72, respectively (p=0.065) (two-tailed Wilcoxon matched-pairs test). Overall 94% of the steps were valued as qualitatively excellent or good. The good results with both CM suggest a transfer to further patient evaluation