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Pathak P, Thampy R, Schat R, Bellin M, Beilman G, Hosseini N, Spilseth B. Transplantation for type 1 diabetes: radiologist's primer on islet, pancreas and pancreas-kidney transplantation imaging. Abdom Radiol (NY) 2024:10.1007/s00261-024-04368-8. [PMID: 38806704 DOI: 10.1007/s00261-024-04368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/30/2024]
Abstract
Whole-organ pancreas, pancreatic-kidney and islet transplantation are surgical therapeutic options for the treatment of type 1 diabetes. They can enable effective glycemic control, improve quality of life and delay/reduce the secondary complications of type 1 diabetes mellitus. Radiologists are integral members of the multidisciplinary transplantation team involved in these procedures, with multimodality imaging serving as the mainstay for early recognition and management of transplant related complications. This review highlights the transplantation procedures available for patients with type 1 Diabetes Mellitus with a focus on the imaging appearance of transplantation-related complications.
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Affiliation(s)
- Priya Pathak
- Department of Radiology, Body Imaging Division, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Rajesh Thampy
- Department of Radiology, Body Imaging Division, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Robben Schat
- Department of Radiology, Body Imaging Division, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Melena Bellin
- Department of Pediatric Endocrinology, and Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Greg Beilman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Benjamin Spilseth
- Department of Radiology, Body Imaging Division, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA
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2
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Betancur V, Zughul R, Ivanovic A, Madrazo BL, Castillo P, Casillas J, Alessandrino F. Ultrasound of pancreatic transplant complications: a primer for radiologists. Clin Radiol 2023; 78:861-871. [PMID: 37679209 DOI: 10.1016/j.crad.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/09/2023]
Abstract
Pancreatic transplantation is an established treatment for patients with type 1 diabetes patients and select type 2 diabetes patients, with excellent survival rates as graft health is evaluated through regular imaging and early detection of complications. Amongst the various imaging methods that may aid in diagnosis of pancreatic transplant complications, ultrasound is a widely available, quick, portable, and cost-effective technique, often used as the sole method to assess for pancreatic transplant complications. When assessing a patient with a pancreatic transplant, the radiologist should be methodical in assessing the vasculature, the pancreatic parenchyma, and the peripancreatic regions. Complications can be categorised based on time from transplant and type of complications, and include vascular, parenchymal, and enteric/anastomotic complications. Doppler has a major role in the diagnosis of vascular complications including arterial and venous thrombosis, arterial stenosis, pseudoaneurysms, and haematomas. Pancreatic complications include rejections and pancreatitis, and are often diagnosed through a combination of clinical, laboratory, and imaging findings, such as pancreatic heterogeneity or the presence of pancreatic pseudocysts. Enteric/anastomotic complications include leaks and bowel obstructions, and may require cross-sectional imaging in addition to ultrasound. This review covers the most common and high-impact vascular, parenchymal, and enteric/anastomotic complications that should be considered in every radiologist's search pattern when assessing a pancreatic graft, as well as their respective postoperative timeframes.
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Affiliation(s)
- V Betancur
- Leonard M. Miller School of Medicine, University of Miami, FL, USA
| | - R Zughul
- Department of Radiology, Jackson Memorial Hospital, Miami, FL, USA
| | - A Ivanovic
- Department of Diagnostic Imaging, Faculty of Medicine, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | - B L Madrazo
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - P Castillo
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - J Casillas
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - F Alessandrino
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA.
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3
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Mervak BM, Roseland ME, Wasnik AP. Pancreatic Transplantation: Surgical Anatomy and Complications. Radiol Clin North Am 2023; 61:821-831. [PMID: 37495290 DOI: 10.1016/j.rcl.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Pancreatic transplantation is a complex surgical procedure performed for patients with chronic severe diabetes, often performed in combination with renal transplantation. Vascular and exocrine drainage anatomy varies depending on the surgical technique. Radiology plays a critical role in the diagnosis of postoperative complications, requiring an understanding of grayscale/Doppler ultrasound as well as computed tomography and MR imaging. In this review, we detail usual surgical methods and normal postoperative imaging appearances. We then review the most common complications following pancreatic transplants, emphasizing diagnostic features of vascular (arterial/venous), surgical, and diffuse parenchymal pathologic conditions on multiple imaging modalities.
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Affiliation(s)
- Benjamin M Mervak
- Division of Abdominal Radiology, Department of Radiology, University of Michigan-Michigan Medicine, University Hospital, B1D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Molly E Roseland
- Division of Abdominal Radiology, Department of Radiology, University of Michigan-Michigan Medicine, University Hospital, B1D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Division of Nuclear Medicine, Department of Radiology, University of Michigan-Michigan Medicine, University Hospital, B1D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ashish P Wasnik
- Division of Abdominal Radiology, Department of Radiology, University of Michigan-Michigan Medicine, University Hospital, B1D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Doherty DT, Khambalia HA, van Dellen D, Jennings RE, Piper Hanley K. Unlocking the post-transplant microenvironment for successful islet function and survival. Front Endocrinol (Lausanne) 2023; 14:1250126. [PMID: 37711891 PMCID: PMC10497759 DOI: 10.3389/fendo.2023.1250126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023] Open
Abstract
Islet transplantation (IT) offers the potential to restore euglycemia for patients with type 1 diabetes mellitus (T1DM). Despite improvements in islet isolation techniques and immunosuppressive regimes, outcomes remain suboptimal with UK five-year graft survivals (5YGS) of 55% and most patients still requiring exogenous insulin after multiple islet infusions. Native islets have a significant non-endocrine component with dense extra-cellular matrix (ECM), important for islet development, cell survival and function. Collagenase isolation necessarily disrupts this complex islet microenvironment, leaving islets devoid of a supporting framework and increasing vulnerability of transplanted islets. Following portal venous transplantation, a liver injury response is potentially induced, which typically results in inflammation and ECM deposition from liver specific myofibroblasts. The impact of this response may have important impact on islet survival and function. A fibroblast response and ECM deposition at the kidney capsule and eye chamber alongside other implantation sites have been shown to be beneficial for survival and function. Investigating the implantation site microenvironment and the interactions of transplanted islets with ECM proteins may reveal therapeutic interventions to improve IT and stem-cell derived beta-cell therapy.
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Affiliation(s)
- Daniel T. Doherty
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Department of Renal & Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Hussein A. Khambalia
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Department of Renal & Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David van Dellen
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Department of Renal & Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel E. Jennings
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Department of Endocrinology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Karen Piper Hanley
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
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Doherty D, Khambalia H, Summers A, Moinuddin Z, Yiannoullou P, Krishnan A, Augustine T, Naish J, van Dellen D. Future imaging modalities for the assessment of pancreas allografts a scan of the horizon. Transplant Rev (Orlando) 2022; 36:100692. [DOI: 10.1016/j.trre.2022.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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de Oliveira Leite TF, Pazinato LV, Nunes TF, da Motta Leal Filho JM. Endovascular management of giant common iliac artery pseudoaneurysm after complications in simultaneous pancreas-kidney transplant: a case report. J Med Case Rep 2021; 15:329. [PMID: 34187552 PMCID: PMC8243608 DOI: 10.1186/s13256-021-02944-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pancreatic transplantation is a definitive treatment for selected patients with insulin-dependent diabetes. It is a technically challenging surgery, and vascular complications are the most common cause of pancreatic graft failure. Although rare, pancreas transplants present higher rates of pseudoaneurysms at the vascular anastomosis than other visceral transplants. We present a case of a simultaneous pancreas–kidney transplant complicated with graft failure and common iliac artery pseudoaneurysm that was successfully treated through endovascular techniques. Case presentation A 34-year-old White woman presented with abdominal pain and a history of type 1 diabetes mellitus, end-stage renal disease, and two previous pancreas transplantation failures. The first was a simultaneous pancreas–kidney transplantation performed 7 months prior that was complicated by pancreas graft thrombosis within 1 month and required graft resection. Five months later, she underwent a second pancreas transplantation with another pancreatic graft thrombosis requiring graft resection. Abdominal angiotomography revealed a pseudoaneurysm in the right common iliac artery at the point of the previous graft anastomosis. The patient was successfully treated endovascularly with a covered stent in the common iliac artery. Conclusion Stent graft implantation for the treatment of common iliac artery pseudoaneurysm as a complication of simultaneous pancreas–kidney transplantation is a safe and feasible procedure.
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Affiliation(s)
- Túlio Fabiano de Oliveira Leite
- Interventional Radiologist, Radiology Department, Heart Institute (InCor), University of São Paulo, Rua Rafael Rinaldi, 365 apto 601, São Paulo, Uberlândia, 38400-384, Brazil.
| | - Lucas Vatanabe Pazinato
- Interventional Radiologist Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Thiago Franchi Nunes
- Interventional Radiologist, Hospital Universitário Maria Aparecida Pedrossian (HUMAP), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Joaquim Mauricio da Motta Leal Filho
- Interventional Radiologist, Radiology Department, Heart Institute (InCor), University of São Paulo, Rua Rafael Rinaldi, 365 apto 601, São Paulo, Uberlândia, 38400-384, Brazil.,Interventional Radiologist Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, SP, Brazil
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7
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Yadav K, Stern J, Cholyway R. Pseudocyst of Pancreas Transplant Allograft: A Case Report. Transplant Proc 2020; 52:2831-2834. [PMID: 32859403 DOI: 10.1016/j.transproceed.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/18/2020] [Accepted: 08/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pancreatic pseudocysts are rarely reported complications of pancreas transplant. CASE We present a case of a patient with simultaneous pancreas and kidney transplant with bladder exocrine drainage who developed reflux pancreatitis and symptomatic pancreatic pseudocyst as a result of neuropathic bladder, 15 years after the original transplant. He was initially managed with percutaneous aspiration and drainage along with Foley catheter placement to help with bladder emptying. But the pseudocyst recurred after drains and Foley were removed. Eventually, he underwent an enteric conversion of the pancreas allograft with resolution of his symptoms and the pseudocyst. CONCLUSIONS Enteric conversion should be considered in cases of bladder-drained pancreas transplants with recurrent reflux pancreatitis and/or pseudocyst formation.
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Affiliation(s)
- Kunal Yadav
- Division of Transplantation, Department of Surgery, University Hospitals, Cleveland, OH, United States.
| | - Jeffrey Stern
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Renee Cholyway
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
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Tovmassian D, Tang L, Hameed AM, Yao J, Yoon PD, Lee T, Laurence JM, Yuen LPK, Allen RDM, Lau H, Pleass HCC. Beware the band adhesion: an unexpected cause of double obstruction following intraperitoneal kidney transplantation. J Surg Case Rep 2020; 2020:rjaa239. [PMID: 32821370 PMCID: PMC7427041 DOI: 10.1093/jscr/rjaa239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 01/11/2023] Open
Abstract
Small bowel obstruction (SBO) following intraperitoneal renal transplantation, either solitary or due to simultaneous pancreas-kidney transplantation, is a known complication. While SBO is most commonly due to adhesions, there have been documented cases of internal herniation following simultaneous pancreas-kidney transplantation with enteric drainage due to the formation of a mesenteric defect. We present a unique complication in which the transplant ureter has caused strangulation and necrosis of a length of small intestine. The transplant ureter was mistaken for a band adhesion and divided. Post-operative anuria signalled this difficult diagnosis. Subsequent re-look laparotomy and ureteric reimplantation with Boari flap were required. Therefore, it is important to consider the ureter as a cause of internal herniation in kidney transplant patients and recognize that a band adhesion within the pelvis may in fact be the transplant ureter, obstructing a loop of small intestine beneath its course.
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Affiliation(s)
- David Tovmassian
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
- Correspondence address: Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead 2145, Australia. Tel: 02 8890 5555; E-mail:
| | - Linda Tang
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
| | - Ahmer M Hameed
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
| | - Jinna Yao
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
| | - Peter Daechul Yoon
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
| | - Taina Lee
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
| | - Jerome M Laurence
- Liver and Renal Transplant Unit, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Lawrence P K Yuen
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
| | - Richard D M Allen
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
| | - Howard Lau
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
| | - Henry C C Pleass
- Pancreas and Renal Transplant Unit, Westmead Hospital, Westmead, Australia
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9
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Pancreatic transplantation with duodenoduodenostomy drainage: technique, normal radiological appearance and complications. Abdom Radiol (NY) 2020; 45:479-490. [PMID: 31616962 DOI: 10.1007/s00261-019-02267-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pancreas transplantation is considered the curative treatment for severe type 1 diabetes mellitus in selected cases. Since the first procedure in 1966, surgical techniques have been improved. The current trend among most medical centers, as well as at our Institution, is enteric drainage and systemic venous or portal anastomosis. The aim of this pictorial essay is to describe the main imaging features of pancreatic transplantation with duodenoduodenostomy drainage.
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Aref A, Zayan T, Pararajasingam R, Sharma A, Halawa A. Pancreatic transplantation: Brief review of the current evidence. World J Transplant 2019; 9:81-93. [PMID: 31523630 PMCID: PMC6715578 DOI: 10.5500/wjt.v9.i4.81] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 02/05/2023] Open
Abstract
Kidney transplantation is the treatment of choice for management of end-stage renal disease. However, in diabetic patients, the underlying metabolic disturbance will persist and even may get worse after isolated kidney transplantation. Pancreatic transplantation in humans was first introduced in 1966. The initial outcome was disappointing. However, this was changed after the improvement of surgical techniques together with better patient selection and the availability of potent and better-tolerated immune-suppression like cyclosporine and induction antibodies. Combined kidney and pancreas transplantation will not only solve the problem of organ failure, but it will also stabilise or even reverse the metabolic complications of diabetes. Combined kidney and pancreas transplantation have the best long term outcome in diabetic cases with renal failure. Nevertheless, at the cost of an initial increase in morbidity and risk of mortality. Other transplantation options include pancreas after kidney transplantation and islet cell transplantation. We aim by this work to explore various options which can be offered to a diabetic patient with advanced chronic kidney disease. Our work will provide a simplified, yet up-to-date information regarding the different management options for those diabetic chronic kidney failure patients.
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Affiliation(s)
- Ahmed Aref
- Department of Nephrology, Sur Hospital, Sur 411, Oman
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Tariq Zayan
- Department of Nephrology, Sur Hospital, Sur 411, Oman
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Ravi Pararajasingam
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
- Department of Transplantation, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
| | - Ajay Sharma
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
- Renal Medicine, Royal Liverpool University Hospitals, Liverpool L7 8XP, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
- Department of Transplantation Surgery, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
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11
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Gallego Ferrero P, Crespo Del Pozo J. Imaging in pancreas transplantation complications: Temporal classification. J Med Imaging Radiat Oncol 2018; 62:504-511. [PMID: 29808575 DOI: 10.1111/1754-9485.12750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/19/2018] [Indexed: 12/14/2022]
Abstract
Pancreatic transplantation is a therapeutic option for both poorly controlled cases of diabetes mellitus and patients with advanced diabetic nephropathy. It is important for radiologists to know the different surgical techniques as well as the typical radiological appearance after pancreatic transplantation, in order to accurately identify the complications. These complications can be classified according to the period of time after the transplantation in which they typically occur: immediate (first 24 hours), early (24-72 hours), intermediate (72 hours to weeks) and late (months). An accurate and early diagnosis of pancreas transplantation complications is essential to start the adequate treatment and increase the chances of graft survival.
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Affiliation(s)
- Paula Gallego Ferrero
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Juan Crespo Del Pozo
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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12
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O'Malley RB, Moshiri M, Osman S, Menias CO, Katz DS. Imaging of Pancreas Transplantation and Its Complications. Radiol Clin North Am 2016; 54:251-66. [PMID: 26896223 DOI: 10.1016/j.rcl.2015.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Whole pancreas transplantation is an effective treatment for obtaining euglycemic status in patients with insulin-dependent diabetes mellitus, and is usually performed concurrent with renal transplantation in the affected patient. This article discusses complex surgical anatomical details of pancreas transplantation including surgical options for endocrine and exocrine drainage pathways. It then describes several possible complications related to surgical factors in the immediate post operative period followed by other complications related to systemic issues, vasculature, and the pancreatic parenchyma.
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Affiliation(s)
- Ryan B O'Malley
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA.
| | - Sherif Osman
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | | | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, USA
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Abdel-Aal AK, Elsayed A, Saddekni S, Hamed MF, Young C. Endovascular Treatment of Pancreatic Allograft Transplant Arteriovenous Fistula Using Amplatzer Vascular Plug 2. Cardiovasc Intervent Radiol 2013; 37:819-24. [DOI: 10.1007/s00270-013-0682-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 05/25/2013] [Indexed: 12/28/2022]
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