Heritability and genetic correlations of rumination time with milk-yield and milking traits in Holstein-Friesian cows using an automated milking system

Knowledge of the values of genetic parameters is a prerequisite for conducting a breeding program. This is especially important for rumination, which is considered an indicator of cow's health. Exploring the genetic relations between rumination time, milk yield, and milking traits could make it a valuable tool in dairy cattle breeding strategies. The objective of the research was to estimate heritability, repeatability, and genetic and phenotypic correlations of rumination time (RT), as well as traits associated with milk yield and milking of dairy cows of the Polish Holstein-Friesian breed kept in herds equipped with an automatic milking system. The research takes into consideration daily results for milking in the first lactation and second lactation, from 1 486 cows of the breed milked between 2013 and 2015 year. Cows were housed in 24 free-stall barns and fed a Partial Mixed Ration feed. The barns had an automated milking system (Astronaut A4 - Lely Industry). The cows received a varied dose of the concentrate, either in the milking robot or the feeding station, depending on the level of their milk yield. Our research has shown that RT was a low heritable trait (0.140 ± 0.039) and had a medium repeatability (0.572 ± 0.007). We detected a positive genetic correlation between RT and milk yield (0.341); however, a statistically significant negative relationship was identified between RT and urea content (-0.418) in milk. Estimations of genetic correlations suggest that selecting for higher RT may correspond to reduced urea content in milk. Investigating the genetics aspect of RT and the relationship with milk yield and milking traits may turn this into one of the useful criterion selections for dairy cattle breeding strategies, but should be used carefully. Further analyses on larger data sets and different populations are necessary.

Machine Learning Models in Prediction of Treatment Response After Chemoembolization with MRI Clinicoradiomics Features

PURPOSE

To evaluate machine learning models, created with radiomics and clinicoradiomics features, ability to predict local response after TACE.

MATERIALS AND METHODS

188 treatment-naïve patients (150 responders, 38 non-responders) with HCC who underwent TACE were included in this retrospective study. Laboratory, clinical and procedural information were recorded. Local response was evaluated by European Association for the Study of the Liver criteria at 3-months. Radiomics features were extracted from pretreatment pre-contrast enhanced T1 (T1WI) and late arterial-phase contrast-enhanced T1 (CE-T1) MRI images. After data augmentation, data were split into training and test sets (70/30). Intra-class correlations, Pearson's correlation coefficients were analyzed and followed by a sequential-feature-selection (SFS) algorithm for feature selection. Support-vector-machine (SVM) models were trained with radiomics and clinicoradiomics features of T1WI, CE-T1 and the combination of both datasets, respectively. Performance metrics were calculated with the test sets. Models' performances were compared with Delong's test.

RESULTS

1128 features were extracted. In feature selection, SFS algorithm selected 18, 12, 24 and 8 features in T1WI, CE-T1, combined datasets and clinical features, respectively. The SVM models area-under-curve was 0.86 and 0.88 in T1WI; 0.76, 0.71 in CE-T1 and 0.82, 0.91 in the combined dataset, with and without clinical features, respectively. The only significant change was observed after inclusion of clinical features in the combined dataset (p = 0.001). Higher WBC and neutrophil levels were significantly associated with lower treatment response in univariant analysis (p = 0.02, for both).

CONCLUSION

Machine learning models created with clinical and MRI radiomics features, may have promise in predicting local response after TACE.

LEVEL OF EVIDENCE

Level 4, Case-control study.

Machine Learning Insights: Predicting Hepatic Encephalopathy After TIPS Placement

PURPOSE

To develop and assess machine learning (ML) models' ability to predict post-procedural hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement.

MATERIALS AND METHODS

In this retrospective study, 327 patients who underwent TIPS for hepatic cirrhosis between 2005 and 2019 were analyzed. Thirty features (8 clinical, 10 laboratory, 12 procedural) were collected, and HE development regardless of severity was recorded one month follow-up. Univariate statistical analysis was performed with numeric and categoric data, as appropriate. Feature selection is used with a sequential feature selection model with fivefold cross-validation (CV). Three ML models were developed using support vector machine (SVM), logistic regression (LR) and CatBoost, algorithms. Performances were evaluated with nested fivefold-CV technique.

RESULTS

Post-procedural HE was observed in 105 (32%) patients. Patients with variceal bleeding (p = 0.008) and high post-porto-systemic pressure gradient (p = 0.004) had a significantly increased likelihood of developing HE. Also, patients having only one indication of bleeding or ascites were significantly unlikely to develop HE as well as Budd-Chiari disease (p = 0.03). The feature selection algorithm selected 7 features. Accuracy ratios for the SVM, LR and CatBoost, models were 74%, 75%, and 73%, with area under the curve (AUC) values of 0.82, 0.83, and 0.83, respectively.

CONCLUSION

ML models can aid identifying patients at risk of developing HE after TIPS placement, providing an additional tool for patient selection and management.

Prediction of carcinogenic human papillomavirus types in cervical cancer from multiparametric magnetic resonance images with machine learning-based radiomics models

PURPOSE

This study aimed to evaluate the potential of machine learning-based models for predicting carcinogenic human papillomavirus (HPV) oncogene types using radiomics features from magnetic resonance imaging (MRI).

METHODS

Pre-treatment MRI images of patients with cervical cancer were collected retrospectively. An HPV DNA oncogene analysis was performed based on cervical biopsy specimens. Radiomics features were extracted from contrast-enhanced T1-weighted images (CE-T1) and T2-weighted images (T2WI). A third feature subset was created as a combined group by concatenating the CE-T1 and T2WI subsets. Feature selection was performed using Pearson's correlation coefficient and wrapper- based sequential-feature selection. Two models were built with each feature subset, using support vector machine (SVM) and logistic regression (LR) classifiers. The models were validated using a five-fold cross-validation technique and compared using Wilcoxon's signed rank and Friedman's tests.

RESULTS

Forty-one patients were enrolled in the study (26 were positive for carcinogenic HPV oncogenes, and 15 were negative). A total of 851 features were extracted from each imaging sequence. After feature selection, 5, 17, and 20 features remained in the CE-T1, T2WI, and combined groups, respectively. The SVM models showed 83%, 95%, and 95% accuracy scores, and the LR models revealed 83%, 81%, and 92.5% accuracy scores in the CE-T1, T2WI, and combined groups, respectively. The SVM algorithm performed better than the LR algorithm in the T2WI feature subset (P = 0.005), and the feature sets in the T2WI and the combined group performed better than CE-T1 in the SVM model (P = 0.033 and 0.006, respectively). The combined group feature subset performed better than T2WI in the LR model (P = 0.023).

CONCLUSION

Machine learning-based radiomics models based on pre-treatment MRI can detect carcinogenic HPV status with discriminative accuracy.

Visceral to subcutaneous fat ratio predicts short-term mortality in patients with Covid 19. A multicenter study

OBJECTIVE

To evaluate the association of body composition parameters with outcomes in Covid-19.

METHODS

173 patients hospitalized for Covid-19 infection in 6 European centers were included in this retrospective study. Measurements were performed at L3-level and comprised skeletal muscle index (SMI), muscle density (MD), and adipose tissue measurements [visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular adipose tissue (IMAT), visceral-to-subcutaneous-adipose-tissue-area-ratio (VSR)]. The association with mortality, the need for intubation (MV), and the need for admission to ICU within 30 days were evaluated.

RESULTS

Higher SAT density was associated with a greater risk of MV (OR = 1.071, 95%CI=(1.034;1.110), p < 0.001). Higher VAT density was associated with admission to ICU (OR = 1.068, 95%CI=(1.029;1.109), p < 0.001). Higher MD was a protective factor for MV and ICU admission (OR = 0.914, 95%CI=(0.870;0.960), p < 0.001; OR = 0.882, 95%CI=(0.832;0.934), p = 0.028). Higher VSR was associated with mortality (OR = 2.147, 95%CI=(1.022;4.512), p = 0.044). Male sex showed the strongest influence on the risk of ICU admission and MV. SMI was not associated with either parameter.

CONCLUSION

In patients hospitalized for Covid-19 infection, higher VSR seems to be a strong prognostic factor of short-term mortality. Weak associations with clinical course were found for MD and adipose tissue measurements. Male sex was the strongest prognostic factor of adverse clinical course.

ADVANCES IN KNOWLEDGE

VSR is a prognostic biomarker for 30-day mortality in patients hospitalized for Covid-19 disease.

Prediction of Response of Hepatocellular Carcinoma to Radioembolization: Machine Learning Using Preprocedural Clinical Factors and MR Imaging Radiomics

PURPOSE

To create and evaluate the ability of machine learning-based models with clinicoradiomic features to predict radiologic response after transarterial radioembolization (TARE).

MATERIALS AND METHODS

82 treatment-naïve patients (65 responders and 17 nonresponders; median age: 65 years; interquartile range: 11) who underwent selective TARE were included. Treatment responses were evaluated using the European Association for the Study of the Liver criteria at 3-month follow-up. Laboratory, clinical, and procedural information were collected. Radiomic features were extracted from pretreatment contrast-enhanced T1-weighted magnetic resonance images obtained within 3 months before TARE. Feature selection consisted of intraclass correlation, followed by Pearson correlation analysis and finally, sequential feature selection algorithm. Support vector machine, logistic regression, random forest, and LightGBM models were created with both clinicoradiomic features and clinical features alone. Performance metrics were calculated with a nested 5-fold cross-validation technique. The performances of the models were compared by Wilcoxon signed-rank and Friedman tests.

RESULTS

In total, 1,128 features were extracted. The feature selection process resulted in 12 features (8 radiomic and 4 clinical features) being included in the final analysis. The area under the receiver operating characteristic curve values from the support vector machine, logistic regression, random forest, and LightGBM models were 0.94, 0.94, 0.88, and 0.92 with clinicoradiomic features and 0.82, 0.83, 0.82, and 0.83 with clinical features alone, respectively. All models exhibited significantly higher performances when radiomic features were included (P = .028, .028, .043, and .028, respectively).

CONCLUSIONS

Based on clinical and imaging-based information before treatment, machine learning-based clinicoradiomic models demonstrated potential to predict response to TARE.

Classification of retinoblastoma-1 gene mutation with machine learning-based models in bladder cancer

Purpose

This study aims to evaluate the potential of machine learning algorithms built with radiomics features from computed tomography urography (CTU) images that classify RB1 gene mutation status in bladder cancer.

Method

The study enrolled CTU images of 18 patients with and 54 without RB1 mutation from a public database. Image and data preprocessing were performed after data augmentation. Feature selection steps were consisted of filter and wrapper methods. Pearson’s correlation analysis was the filter, and a wrapper-based sequential feature selection algorithm was the wrapper. Models with XGBoost, Random Forest (RF), and k-Nearest Neighbors (kNN) algorithms were developed. Performance metrics of the models were calculated. Models’ performances were compared by using Friedman’s test.

Results

8 features were selected from 851 total extracted features. Accuracy, sensitivity, specificity, precision, recall, F1 measure and AUC were 84%, 80%, 88%, 86%, 80%, 0.83 and 0.84, for XGBoost; 72%, 80%, 65%, 67%, 80%, 0.73 and 0.72 for RF; 66%, 53%, 76%, 67%, 53%, 0.60 and 0.65 for kNN, respectively. XGBoost model had outperformed kNN model in Friedman’s test (p = 0.006).

Conclusions

Machine learning algorithms with radiomics features from CTU images show promising results in classifying bladder cancer by RB1 mutation status non-invasively.

Analysis of potential predatory journals in radiology

PURPOSE

The aim of this study is to determine the presence and evaluate the features of potential predatory journals in the radiology field.

METHODS

The presence of the keywords related to radiology listed in the name of journals was investigated in Beall's list. We have searched and recorded the features and the information of the included journals listed under the following headings: address and location, publishing features, editorial board, indexing features, submission, and peer-review processes.

RESULTS

A total of 66 radiology journals from 27 publishers were identified from the updated version of the original Beall's list. Regarding the publishers, 33 journals (50%) reported an address in the United States of America, while others were from United Kingdom, India, Hong Kong, Iran, and Canada. While 44 journals' (67%) website reported a contact address, no addresses were declared in the website of 21 journals (32%). The median time of publication activity was 3.5 years (interquartile range [IQR], 1-5 years; range, 0-16 years). Thirty-five journals (53%) indicated their publication ethics policy on the website. Forty-seven (71%) journals reported a regular editorial board (EB) list. The competency of the EB was considered as "inappropriate" in 27 (41%) journals. Only 18% of the total number of EB members had affiliations related to radiology (n=286/1566). Forty journals (61%) did not report any indexing and database coverage. We found 26 journals (39%) which had a DOI number in its latest 5 articles. Fifty-nine (89%) journals clearly reported article processing change (APC) on the webpage. The median APC value was 641.43 USD (IQR, 300-918.75 USD; range, 100-2588 USD). Considering the latest 5 articles, the number of journals with radiologic images in all of the articles was 8 (12%). Mean peer-review time was 63.5 days (IQR, 21.75-87.5 days; range, 1-237 days) for the journals which indicated the submission and acceptance dates clearly.

CONCLUSION

We demonstrated the several main characteristics of potential predatory journals in the radiology field such as reliability of the reported address, APC, publication frequencies, indexing features, features of published article and peer-review time which were all found to be similar to the characteristics of potential predatory journals in other biomedical fields.

Primary and Metastatic Liver Malignancy: Utility Low and High B Value (1600-2000) in 3 Tesla MRI

BACKGROUND/AIMS

To determine the utility of the quantitative apparent diffusion coefficient (ADC) values at various b values, in the differentiation of malignant hepatic masses on 3.0 Tesla (T) MRI.

METHODOLOGY

We evaluated 81 consecutive patients presenting with 529 malignant masses in the liver. Of those patients 27 had a primary hepatic malignancy while the other 54 patients had metastases in the liver. Quantitative ADC values of malignant hepatic masses was measured at four b values (b 400, b 800, b 1600, b 2000 mm2/s) on MR-DWI. We compared the primary and metastatic tumors within their groups and also with each other in terms of their ADC values.

RESULTS

In 4 various b value measurements, the mean ADC values of the primary and metastatic hepatic masses were 1. x 10(-3), 1.06 x 10(-3), 0.87 x 10(-3), and 0.736 x 10(-3)mm2/ seconds, 1.30 x 10(-3), 1.10 x 10(-3), 0.84 x 10(-3), and 0.715 x 10(-3) mm2/seconds respectively. There was no significant difference between mean ADC values of HCCs and metastases at b 400, 800, 1600 and 2000 gradients (P > 0.05).

CONCLUSIONS

The ADC values obtained at intermediate (400, 800) and high (b 1600, 2000) diffusion gradients are not helpful in differentiation between HCCs and liver metastases.

Sonographic findings of hepatobiliary fascioliasis accompanied by extrahepatic expansion and ectopic lesions

OBJECTIVES

The aim of the study was to describe the sonographic findings of hepatobiliary fascioliasis with extrahepatic expansion and ectopic lesions.

METHODS

The study included 45 patients with fascioliasis. All diagnoses were confirmed via serologic enzyme-linked immunosorbent assays. Sonographic findings in the hepatobiliary system, extrahepatic expansion, and ectopic lesions were defined.

RESULTS

The most common hepatic lesions were subcapsular localized, small, confluent, multiple hypoechoic nodules with poorly defined borders. We also detected ectopic lesion in 5 patients (11.1%) and live parasites in the gallbladder and bile duct in 11 (24.4%).

CONCLUSIONS

The large spectrum of entities in the differential diagnosis of hepatobiliary fascioliasis may lead to misdiagnosis and incorrect treatment. However, the diagnosis can be made when the characteristic sonographic features are seen, such as heterogeneity of the liver with multiple poorly defined hypoechoic-isoechoic lesions and multiple echogenic nonshadowing particles in the gallbladder or common bile ducts. Nonetheless, the differential diagnosis of fascioliasis versus other hepatic lesions may still be difficult. In these situations, pathologic confirmation should be performed to exclude the possibility of malignancy.

Endovascular treatment of surgically implanted arterial graft thrombosis by using manual aspiration thrombectomy

The purpose of this study was to present our experience with guiding catheters in manual aspiration thrombectomy of occluded infra-aortic bypass grafts. This material was designed as a guiding catheter but was also used for thrombus aspiration. Six consecutive patients (all male; mean age, 61.0±5.7 years; range, 54-68 years) who underwent manual aspiration thrombectomy at the discretion of the operator for infra-aortic bypass graft thrombosis between 2002 and 2010 were retrospectively reviewed. The angiographic success described as either stenosis or residual thrombus less than 30% was 67%. Primary patency was 50%, and secondary patency was 66.7%. Additional stents were needed in four lesions of three patients. Manual aspiration thrombectomy is intended to remove both soft acute blood clots and hard organized embolic and thrombotic obstructions. Manual aspiration thrombectomy appears to be a safe and effective method for treating delayed graft thrombosis. This method provides an alternative to surgical thrombectomy, especially for patients who are not good candidates for the surgery.

US-guided retrograde tibial artery puncture for recanalization of complex infrainguinal arterial occlusions

PURPOSE

We aimed to describe the technical aspects and outcomes of the retrograde tibial approach and balloon predilation for recanalization of complex infrainguinal arterial occlusions and determine the efficacy of this approach in minimizing failure rates.

MATERIALS AND METHODS

Between September 2006 and April 2011, antegrade revascularization failed in 22 limbs with complex total occlusions within the infrainguinal arterial territory. For each of these antegrade failure cases in 22 patients, a retrograde tibial puncture had been attempted. Percutaneous recanalization and predilation were initially performed through tibial access, and final balloon dilatation or stent placement was performed from antegrade femoral access. The patients were followed up for functionality and wound healing.

RESULTS

Access from the tibial artery was successfully obtained for all patients (100%). Successful recanalization was obtained in 18 patients (82%). Retrograde access was performed from the anterior tibial/dorsalis pedis artery in 12 patients and posterior tibial artery in 10 patients. One major and one minor complications were documented.

CONCLUSION

Retrograde tibial recanalization technique in the infrainguinal complex arterial occlusion safely increases the success rates of percutaneous recanalization in the failed traditional approach and is a feasible endovascular option to avoid more invasive, time-consuming, and high-risk procedures.

Radiation-free percutaneous nephrostomy performed on neonates, infants, and preschool-age children

AIM

The aim of this study was to evaluate the effectiveness and safety of high-frequency linear probe ultrasonographic (US) guidance percutaneous nephrostomy (PN) in terms of diagnostic and therapeutic approach in preschool-age children with urological problems.

MATERIALS AND METHODS

PN was performed on 40 kidneys in 33 patients (13 girls, 20 boys) aged 3 days - 7 years (mean 4.1 years). All procedures were performed with US guidance utilizing a Shimadzu SDU 2200 Xplus 5-10 mHz probe. Complete blood count, urinalysis, bladder urine culture, blood urea, and creatinine values were obtained before PN placement on the same day. Urine cultures were obtained by nephrostomy tube and compared to bladder urine culture.

RESULTS

PN procedures were technically successful in 39 kidney units (97.5%). Two major complications were macroscopic hematuria requiring blood transfusions (1 case) and sepsis (1 case). Minor complications were displacement of the catheter (4), urinary tract infection (4), urine extravasation (1), early dislocation of the catheter (1). In three cases, the catheter was replaced. Analysis of bladder urine showed that 13 patients (39.4%) had positive cultures, but analysis of PN urine showed that 25 patients (78.1%) had positive cultures.

CONCLUSIONS

PN is an easy, safe and efficient diagnostic and therapeutic procedure with few complications even in preschool-age children. The antibiotic regimen should be revised in order to avoid sepsis and urinary tract infection.

Variations of the celiac trunk and hepatic arteries: a study with 64-detector computed tomographic angiography

OBJECTIVES

The aim of the present study was to evaluate variations in celiac trunk and hepatic artery with multi-detector computed tomography (MDCT).

PATIENTS AND METHODS

Totally 820 patients who underwent angiography of the abdominal aorta were evaluated. Anatomical findings were grouped according to the Michels classification.

RESULTS

Several variations and/or anomalies were noted in 33.2% of the patients (n=272). The most common abnormality was Michels type III (10.1%), followed by type V (7.3%), type II (4.7%) and others. Type X was not observed in our series. We have noted additional, previously unclassified variations in 12 cases (1.5%).

CONCLUSIONS

Preoperative knowledge of variant anatomy may assist in the selection of treatment options and surgical planning, which in turn facilitates surgical dissection and helps avoiding iatrogenic injury. MDCT angiography allows detailed visualization of the vascular anatomy.

Investigation of the retrorenal colon frequency using computed tomography in patients with advanced scoliosis

PURPOSE

The aim of this study is to investigate the frequency of retrorenal colon in patients with advanced scoliosis.

MATERIALS AND METHODS

The existence of retrorenal colon was retrospectively investigated in 550 patients with vertebral scoliosis who had undergone abdominal CT scans at our institution between January 2008 and March 2012. The investigation was also carried out on a control group of 200 patients without scoliosis.

RESULTS

Among the 550 patients with scoliosis, 100 patients had advanced scoliosis necessitating treatment. Among these 100 patients with advanced scoliosis, retrorenal colon was detected in a total of 25 patients (25 %). The variation was observed on the right side in eight patients (two males, six females) (8 %), on the left side in 15 patients (five males, ten females) (15 %), and bilaterally in two patients (both females) (2 %). In the control group consisting of 200 individuals, retrorenal colon was detected in seven subjects (3.5 %), among which six were on the left and one was on the right. The difference between the incidence of retrorenal colon observed in the patients with advanced scoliosis and those without scoliosis was found to be statistically significant (p < 0.001).

CONCLUSION

Since the frequency of retrorenal colon in patients with advanced scoliosis is significantly higher than the control group without scoliosis, the risk of experiencing complications during renal interventions including renal biopsy is also higher. Therefore, these patients should undergo a detailed CT examination before these procedures, and renal interventions should be planned according to findings.

Endovascular treatment of infrarenal abdominal aortic lesions with or without common iliac artery involvement

PURPOSE

To evaluate the results of stent placement for obstructive atherosclerotic aortic disease with or without involvement of the common iliac artery.

MATERIALS AND METHODS

Forty patients had self-expanding stents primarily or after balloon dilatation in the abdominal aorta between January 2005 and May 2011. All patients had trouble walking. Follow-up examinations were performed with clinical visits; these included color Doppler ultrasonography and computed tomographic angiography.

RESULTS

Technical, clinical, and hemodynamic success was achieved in all patients. None of the patients underwent reintervention during the follow-up period, which ranged from 3 months to 6 years (median 24 months). Nine complications occurred in six patients. Of the nine complications, four were distal thromboembolisms, which were successfully treated with catheter-directed thrombolysis or anticoagulation therapy.

CONCLUSION

Endovascular treatment of the obstructive aortic disease using self-expanding stents was safe and effective, with high technical success and long-term patency. Thromboembolic complications were high even though direct stenting was considered protective for thromboembolism formation. Particularly for infrarenal aortic stenosis, it can be recommended as the first-line treatment option for patients with obstructive atherosclerotic aortic disease.

A new practical model of testes shield: the effectiveness during abdominopelvic computed tomography

The goal of our prospective study was to measure the effect of a new standard model male gonad shield on the testicular radiation exposure during routine abdominopelvic computed tomography (CT). Two hundred male patients who underwent upper abdominal and pelvic CT examinations were included in our study. To prepare the testes shield (TS), 2 No. 8 fluoroscopy radiation-protection gloves made of bismuth (0.35 mm lead equivalent) were used. These gloves were invaginated into one another and their fingers were turned inside out. Scrotums of all patients were pushed into these lead-containing gloves. Upper abdominal CT (n = 6), pelvic CT (n = 9), and abdominopelvic scanning (n = 185) were performed. Immediately after the CT examinations and at postprocedural day 1, the scrotal examinations were repeated. None of the patients exhibited scrotal laceration, edema, eruption, erythema, tenderness, or pain. During the CT examinations, 22 patients (11%) felt unrest because of their exposed genital regions, without any adverse effect on the procedure. Dosimetric measurements of radioactivity inside the TS (dosimeter I) and outside it (dosimeter II) were 6.8 and 69.00 mSv, respectively. Accordingly, the TS we used in our study reduced the radiation exposure of the testes by 90.2% (10.1 times). We think that the use of this radioprotective TS during radiological diagnostic and therapeutic procedures is an appropriate approach from both a medical and legal perspective. Therefore, we recommend this userfriendly, practical, low-cost, and effective TS for all radiologic procedures.

US-guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

PURPOSE

This study retrospectively evaluated ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of postcatheterization femoral and brachial artery pseudoaneurysms.

MATERIALS AND METHODS

Fifty-five patients with postcatheterization femoral artery (n = 53) or brachial artery (n = 2) pseudoaneurysms were treated using US-guided human thrombin (500 IU/mL) injection. Pseudoaneurysm size, thrombin dose, therapy outcome, and complications were documented. Follow-up color Doppler US was performed 7 and 30 days after treatment. Short-duration supplemental compression was applied to six patients at the first week follow-up examination after a reinjection of thrombin had failed.

RESULTS

Mean pseudoaneurysm volume was 20.3 ± 18.7 cm(3). The mean injected thrombin dose was 478 ± 238 IU. Thirty-eight (69.1%) of the 55 pseudoaneurysms were thrombosed with a single injection, and 11 of 17 pseudoaneurysms were thrombosed after a second injection. All (100%) of the 41 pseudoaneurysms that were diagnosed within the first two weeks of postcatheterization were successfully treated. The overall primary success rate was 89.1% (49 of 55 pseudoaneurysms). Supplemental compression promoted thrombosis in four of the six patients who had treatment failure with thrombin injection. The secondary success rate was 96.4% (53 of 55 pseudoaneurysms). There were no complications.

CONCLUSION

US-guided thrombin injection was most successful within the first two weeks, and the supplemental compression might aid in the closure of partially thrombosed pseudoaneurysms.

Successful treatment of delayed aortobifemoral graft thrombosis with manual aspiration thrombectomy

We present a 67-year-old man who had undergone aortobifemoral synthetic graft surgery one year earlier. The patient experienced thrombosis of the graft nine months after the operation, and thrombectomy of the graft was planned. However, the patient refused to undergo repeat surgery for thrombus removal and was referred to our center for possible endovascular treatment. We treated the patient with percutaneous aspiration thrombectomy. The thrombi were chronic in nature but could be removed with minimal residue in any part of the graft by using repeated aspiration thrombectomy with 7 F guiding catheters. Underlying stenosis of both distal graft anastomoses was treated with percutaneous balloon angioplasty, and a self-expanding stent was deployed on the right distal anastomosis. A small fragment of thrombus embolized to the right popliteal artery and was removed with aspiration thrombectomy through a second antegrade puncture on the right side. We believe this is the first report of aspiration thrombectomy for an aortobifemoral graft thrombosis. The method was successful despite the chronic nature of the thrombi. Manual aspiration thrombectomy with largebore guiding catheters can be used as an effective recanalization method for delayed aortobifemoral graft occlusion and could be regarded as a good alternative technique to surgical thrombectomy in selected patients.