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PURPOSE: Concerns have arisen regarding the use of retrievable inferior vena cava filters (rIVCFs) in trauma patients due to increasing reports of low retrieval rates. We hypothesized that complete follow-up with a dedicated trauma nurse practitioner would be associated with a higher rate of retrievability. This study was undertaken to determine the rate of retrievability of rIVCFs placed in a Canadian Lead Trauma Centre, and to compare the rate of retrievability in our trauma population to our non-trauma patients. METHODS: We performed a retrospective cohort study of all patients with rIVCF placed between Jan 1 2000 and June 30 2014. Data were collected on demographics, indication for filter placement, retrieval status, and reasons for non-retrieval. Comparison was made between trauma patients and non-trauma patients. RESULTS: A total of 374 rIVCFs were placed (61 in trauma patients and 313 in non-trauma patients) and follow-up was complete for the entire cohort. Filter retrieval was achieved in 86.9 % of trauma patients. Reasons for non-retrieval were technical in two patients, and death before retrieval in six patients. Retrieval was successful in 48.9 % of non-trauma patients. CONCLUSIONS: This study demonstrates that rIVCFs can be successfully retrieved amongst trauma patients. We demonstrated a higher rate of successful retrieval amongst trauma patients than non-trauma patients in our institution. Careful patient follow-up may play a role in successful retrieval of rIVCFs.

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The coexistence of an abdominal aortic aneurysm (AAA) and a pelvic renal allograft is a unique clinical situation. Because of the increased susceptibility of the transplant kidney to ischemic injury, various approaches have been developed to minimize allograft ischemia during open aneurysm repair. Endovascular techniques have the potential advantage in this situation of greatly diminishing renal ischemia time. To our knowledge, this approach has not been reported in this situation. We report a case of a 61-year-old male with a 7.0-cm AAA and a functioning right pelvic transplant kidney. There was an adequate aneurysm neck below the level of the superior mesenteric artery with occluded renal arteries. Successful endovascular repair of the aneurysm was achieved using a bifurcated graft and bilateral iliac extensions. Perfusion to the renal allograft was maintained throughout the procedure except for short periods when the graft was expanded with a balloon. Short-term follow-up reveals successful aneurysm exclusion and no deterioration in renal function. This exciting new approach to this challenging clinical problem is reviewed along with other methods of minimizing renal allograft ischemia.

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The endovascular repair of abdominal or thoracic aortic aneurysms is an alternative approach to conventional repair in the compromised patient. Although the long-term efficacy of these procedures has yet to be proved, there is growing interest among vascular surgeons and interventional radiologists throughout North America and Europe in the more frequent use of this technique. Starting an endovascular program necessitates extensive cooperation of the interdisciplinary vascular team. Decisions regarding patient selection, equipment, supplies, staff education, and the location of the procedure must be based on sound principles. This article demonstrates how a program can be planned, implemented, and evaluated by the use of a "decision tree." The experience of the London Health Sciences Centre will be used as a benchmark in the discussion of relative merits of branch points in program development. The article gives persons contemplating a program a structured process in decision making to avoid potential pitfalls.

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PURPOSE: The authors report their experience with the translumbar inferior vena cava (IVC) approach for central venous access during a 6-year period at three teaching hospital sites. PATIENTS AND METHODS: Twenty-nine percutaneous IVC central venous access catheters were inserted in 22 patients during a 6-year period in the radiology departments of three teaching hospital sites. All patients had undergone unsuccessful attempts at conventional central venous access. Information was gathered by retrospective radiologic and hospital chart review. RESULTS: All attempted placements were successful. Catheters were in place for a total of 3,510 catheter days. The average length of catheter placement was 121 days (range, 14-536 days). Life-table analysis predicted catheter function rates of 55% and 29% at 6 and 12 months, respectively. Three procedure-related complications occurred. A lower pole branch of the right renal artery was inadvertently entered with a 22-gauge needle during attempted IVC puncture in one patient without clinical sequelae. A second patient developed a small groin hematoma at the femoral venous puncture site, which resolved spontaneously. A third patient developed a moderate retroperitoneal hematoma, which resolved without specific intervention. The sepsis rate was 2.8 infections per 1,000 catheter days with an average time to infection of 127 days (range, 10-536 days). CONCLUSION: In the authors' experience of 29 translumbar central venous catheter insertions, all attempts were successful. Percutaneous central venous access via the IVC is a safe and effective option for patients in whom more conventional access is not possible.

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The observation of reversed diastolic flow during Doppler ultrasonography (US) of renal transplants has been described as sensitive but not specific in the diagnosis of renal vein thrombosis. To determine the diagnostic accuracy of reversed diastolic flow for renal vein obstruction in patients who underwent renal transplantation at a tertiary-care teaching hospital over a 3-year period, the authors identified all patients in whom reversed diastolic flow was observed during Doppler US (17 patients) and those in whom complete renal vein obstruction occurred, necessitating nephrectomy (16 patients). Three types of reversed diastolic flow were found; the wave-forms of two of these had a large reversed component. One of these two types was present in nine of the patients in whom complete venous obstruction occurred. The sensitivity, specificity and positive predictive value of reversed diastolic flow were 82%, 99% and 75% respectively. The authors conclude that a US finding of reversed diastolic flow with a large reversed component is a sensitive and specific sign of renal vein obstruction, usually renal vein thrombosis.

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