331 COVID-19 Mortality After Vascular Procedures During the Initial UK Surge: Moving Forward with Elective Vascular Work

Aim Following the initial COVID-19 surge in the United Kingdom, there was a national incentive for elective vascular surgery to be restricted to clean sites in order to reduce perioperative cross infection and subsequent mortality. We assessed the risk of dying from perioperatively acquired COVID-19 during the peak of the London outbreak. Method 43 consecutive patients who had vascular (n = 48) procedures in March and April 2020 at a regional hub serving five London hospitals were analysed. The patients were screened for COVID-19 in the 30-day postoperative period and the main outcome measure was mortality from COVID-19. A comparison was then made with patients who underwent minimally invasive procedures from our integrated interventional radiology department. Median follow-up was 41 days (IQR 8- 58 days). Results Three patients (7%) in the vascular group (median age 61 years, all diabetic, two male) died from COVID-19, all of whom tested positive postoperatively. Two others became positive but recovered. In comparison, two patients (2%) in the interventional radiology group died from COVID-19, however one was positive prior to their procedure. Conclusions Only urgent vascular cases should be performed during a COVID-19 surge, with elective work delayed or continued at clean sites. However, with growing waiting lists for elective surgery currently, further restrictions may not be a viable long-term solution. Resumption of care at hot sites should be considered, if resources allow for it and if safety measures can be implemented. The advantages of minimally invasive surgery may inherently reduce risk as well.

O32 COVID-19 mortality after vascular procedures during the initial UK surge: moving forward with elective vascular work

Introduction Following the initial COVID-19 surge in the United Kingdom, there was a national incentive for elective vascular surgery to be restricted to clean sites in order to reduce perioperative cross infection and subsequent mortality. We assessed the risk of dying from perioperatively acquired COVID-19 during the peak of the London outbreak. Materials and Methods 43 consecutive patients who had vascular (n = 48) procedures in March and April 2020 at a regional hub serving five London hospitals were analysed. The patients were screened for COVID-19 in the 30-day postoperative period and the main outcome measure was mortality from COVID-19. A comparison was then made with patients who underwent minimally invasive procedures from our integrated interventional radiology department. Median follow-up was 41 days (IQR 8–58 days). Result Three patients (7%) in the vascular group (median age 61 years, all diabetic, two male) died from COVID-19, all of whom tested positive postoperatively. Two others became positive but recovered. In comparison, two patients (2%) in the interventional radiology group died from COVID-19, however one was positive prior to their procedure. Conclusion Only urgent vascular cases should be performed during a COVID-19 surge, with elective work delayed or continued at clean sites. However, with growing waiting lists for elective surgery currently, further restrictions may not be a viable long-term solution. Resumption of care at hot sites should be considered, if resources allow for it and if safety measures can be implemented. The advantages of minimally invasive surgery may inherently reduce risk as well. Take-home Message Only urgent vascular cases should be performed during a peak outbreak of COVID-19, however we cannot continue to postpone elective procedures indefinitely or restrict all cases to solely clean sites. The resumption of care at hot sites encompasses a fine balance of risks versus benefits.

Observational study on healthcare workers protection in the angiographic suite during the SARS-CoV-2 pandemic: before and during vax era

Background: Since the first case of Coronavirus Disease 2019 (COVID-19) in Italy, all the hospital facilities had to reform their daily activities. Amidst them, the Interventional Radiology Department in the “Azienda Ospedaliera Universitaria” of Novara (Italy) had to create a dedicated protocol for the patent’s management during the pandemic.Design and Methods: The time interval between February 2020 and March 2021 was divided into three different periods and we reported the evolution of our safety protocol, the changes in our daily activities and the rates of Sars-CoV-2 infection among the healthcare workers (HCW) of the Angiographic Suite. Personnel who had positive partners/family members or who had established close contacts of another nature outside the workplace were excluded from the study, in order to reduce any bias.Results: A total of 35 HCWs served in 355 patient procedures on Sars-CoV-2 positive patients from February 2020 to March 2021. During the year there was a reduction in the morbidity rate first from 7.9% to 1.4% and then currently reaching 0%.Conclusions: Dedicated routes, elevators, establishing Filter Areas and a clear demarcation between clean and contaminated areas, Dressing and undressing procedures, Cleaning procedures and the obligation to always wear a surgical mask during the working shift are essential to prevent in-hospital infection. The vaccines’ arrival seems to further reduce the risk for healthcare workers, but it is still necessary to take docile precautions in view of the new mutations of the virus.

Pericallosal berry aneurysm associated with azygous anterior cerebral artery – a case report

Introduction. Azygos anterior cerebral artery is a rare variant of the anterior segment of the circle of Willis caused by an unusual fusion of the normally paired A2 segments of the anterior cerebral artery (ACA). Despite its rare occurrence, it is associated with various vascular and structural cerebral abnormalities, particularly berry aneurysms. Aim. We aimed to present a case of a 41-year-old female patient who presented to our neurology department with complaints of headache. Description of the case. She had a positive paternal history of aneurysmal subarachnoid hemorrhage. Magnetic resonance angiography (MRA) of her brain revealed an azygos ACA (bifurcating into two pericallosal arteries) which was associated with a saccular aneurysm at its bifurcation point. She was referred to the interventional radiology department for preventive endovascular treatment. Conclusion. Azygos ACA carries a high risk of aneurysm development and its occlusion can potentially compromise blood supply to both cerebral hemispheres. It is therefore crucial for clinicians to be aware of its significance and to report its presence in angiographic studies.

Placement of a transjugular intrahepatic portosystemic shunt in addition to recanalization of acute and chronic portomesenteric vein occlusions – a retrospective evaluation

Background Portomesenteric vein thrombosis may be life-threatening due to bowel ischemia caused by venous stasis, or variceal bleeding caused by portal hypertension. Purpose To evaluate the effectiveness and safety of recanalization combined with transjugular intrahepatic portosystemic shunt in acute and chronic portomesenteric vein thrombosis in patients with and without liver cirrhosis. Material and Methods 21 consecutive patients (5 women, 16 men; mean 48 years) with portomesenteric vein thrombosis (8 acute, 13 chronic) treated at the Interventional Radiology department between March 2014 and September 2018 were retrospectively reviewed. The main portal vein was completely obliterated and the portomesenteric vein thrombosis extended into the superior mesenteric vein in all patients. The portomesenteric vein thromboses were recanalized transhepatically, a transjugular intrahepatic portosystemic shunt was inserted, thrombectomy was performed in acute portomesenteric vein thrombosis, and angioplasty with or without additional stenting was performed in chronic portomesenteric vein thrombosis. Results Recanalization was successful in 8/8 patients (100%) with acute portomesenteric vein thrombosis, and in 11/13 patients (85%) with chronic portomesenteric vein thrombosis. In 12 patients, blood flow was restored in one session. Several sessions were more frequently needed in patients with acute portomesenteric vein thrombosis compared to those with chronic portomesenteric vein thrombosis ( p = 0.003). Re-occlusion occurred and was recanalized in 10/19 patients and was more frequent in patients with chronic ( n = 8/11) than on those with acute ( n = 2/8) portomesenteric vein thrombosis ( p = 0.04). Adverse events occurred in five patients. There was no 30-day mortality. Conclusion Recanalization and insertion of a transjugular intrahepatic portosystemic shunt is safe and effective in patients with acute and chronic portomesenteric vein thrombosis with or without cirrhosis. Recanalization was more likely to stay patent in acute compared with chronic portomesenteric vein thrombosis.

Audit of electronic operative documentation in interventional radiology: the value of standardised proformas

Background On the background of the interventional radiology department of a tertiary hospital converting its periprocedural documentation from paper-based to electronic using a standardised proforma, a study was performed to ascertain the effects of this change on the standard of clinical documentation for radiologically-guided angiographic procedures. Using a retrospective approach, perioperative records were analysed in reverse chronological order for inclusion in the study. The standard for this audit was developed in the form of minimum criteria that all clinical documentation of angiographic procedures were expected to meet. Results The audit was performed at three equally spaced intervals of 6 months, yielding a total of 99 records. The baseline audit of paper-based records concluded > 80% completeness for 8 out of the 14 of parameters measured, with only two of parameters meeting the target of 100% completeness. The second audit cycle performed on electronic records found 7 out of 14 parameters demonstrating absolute improvement in completeness, when compared to paper-based, but with the number of parameters exceeding 80% completeness falling to only 4 out of 14. Again, 100% completeness was observed in only 2 of the parameters. In the final audit cycle, after the introduction of a standardised electronic proforma, performance improved in every dimension with 6 out of 14 parameters reaching completeness of 100% and the 80% completeness threshold met by 12 out of 14 parameters. Conclusion The construction of a procedure-specific perioperative electronic proforma can save clinicians valuable time and encourage safe and effective clinical documentation.

Antegrade insertion of a double J catheter in the treatment of malignant ureteral obstruction: a retrospective analysis of the results obtained with a modified technique at a university hospital

Objective: To analyze the results obtained with a modified antegrade double J catheter insertion (JJ stenting) technique in patients with urinary tract obstruction due to malignancy. Materials and Methods: This was a retrospective analysis of data collected from patients undergoing antegrade JJ stenting for malignant ureteral obstruction in the interventional radiology department of our institution between March 1, 2017 and May 31, 2019. Results: Antegrade JJ stenting was performed in 32 patients (20 women and 12 men). The mean age was 66.2 years among the females and 61.5 years among the males. A total of 53 antegrade JJ stenting procedures were performed. The procedure was successful in 50 cases and failed in 3 (due to migration of the double J catheter in 2 and due to technical failure in 1). Complications occurred in 3 patients (low back pain, in 1, subcapsular hematoma, in 1, and pyelonephritis, in 1). The procedure time ranged from 14 min to 55 min. Conclusion: In patients with ureteral obstruction due to malignancy, antegrade JJ stenting is safe and effective. The technique selected in our study is easily reproduced and can be performed by a trained professional.

Two-Year Experience of 14 French Pigtail Catheters Placed by Procedure-Focused Hospitalists

BACKGROUND: Recent studies show small-bore chest tubes, commonly 14 French pigtail catheters (PCs), are noninferior to large-bore chest tubes for treating various conditions, and they are associated with better patient comfort. The Medical College of Wisconsin implemented a bedside procedure service (BPS) that has been trained in the placement of PCs as an adjunct to its interventional radiology department. METHODS: The data regarding consults for PC placement was collected by the BPS over a 2-year period. Primary outcomes reviewed were insertion-related complications (IRCs), unsuccessful attempts (UAs), and adverse outcomes (AOs) because the authors believe these represent the safety and effectiveness of the group. It was determined which services consulted the BPS for PC placement, the indications for consults, and a brief review of declined PC consults. RESULTS: Of the 124 accepted consults, the service had 3 IRCs (2.4%), 2 UAs (1.6%), and 3 AOs (2.4%). A total of 18 consults were declined. The BPS was consulted by 12 services with 8 primary reasons for PC placement. CONCLUSIONS: At high-volume, tertiary care centers, and with the support of cardiothoracic surgical and interventional radiology services, procedure-focused hospitalists can safely serve as an adjunct service for PC placement in selected hospitalized patients.