The use of totally implantable venous access devices in radiology may be associated with complications such as occlusion of the system (because of the high density of some contrast), infection (if the port is not handled in aseptic conditions, using proper barrier protections), and mechanical complications due to the high-pressure administration of contrast by automatic injectors (so-called power injector), including extravasation of contrast media into the soft tissues, subintimal venous or myocardial injection, or serious damage to the device itself (breakage of the external connections, dislocation of the non-coring needle, or breakage of the catheter). The last problem - i.e., the damage of the device from a power injection - is not an unjustified fear, but a reality. A warning by the US Food and Drug Administration of July 2004 reports around 250 complications of this kind, referring to both port and central venous catheters and peripherally inserted central catheter systems, which occurred over a period of several years; in all cases, the damage occurred during the injection of contrast material by means of power injectors for computed tomography or magnetic resonance imaging procedures. Though the risk associated with the use of ports in radiodiagnostics is thus clear, it has been suggested that administration of the contrast material via the port may have some advantage in terms of image quality, increased comfort for the patient, and maybe more accurate reproducibility of the patient's own follow-up exams. This contention needs to be supported by evidence. Also, since many cancer patients who need frequent computed tomography studies already have totally implantable systems, it would seem reasonable to try to define how and when such systems may safely be used. The purpose of this consensus statement is to define recommendations based on the best available evidence, for the safe use of implantable ports in radiodiagnostics.

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At the time of hemodialysis vascular access evaluation, many chronic kidney disease patients already have iatrogenic injury to their veins which impedes the surgical construction of an arteriovenous fistula (AVF). Achieving the important goal of a greater prevalence of arteriovenous fistulae in the US hemodialysis population will require identification of those patients prior to reaching end-stage renal disease and an educational and procedural system for preserving their veins.

To determine the efficacy of using stents and stent grafts for treatment of hemodialysis graft-related stenoses which have failed angioplasty. This retrospective study was composed of 51 patients with polytetrafluoroethylene hemodialysis grafts who underwent angioplasty of a graft-related stenosis but subsequently required insertion of a stent or stent graft. The study group included 40 patients with >30% residual stenosis and 11 patients with angioplasty-induced venous ruptures. The patient's medical records and radiology reports were reviewed. Patient demographics, indication for stent placement, and the type of stent were recorded. Stent patency was determined using Kaplan-Meier analysis. A total of 70 stents were used; most (57.7%) were deployed across the venous anastomosis. A variety of different types of stents and stent grafts were used including 26 SMART, 18 Viabahn, 13 aSpire, and 13 other stents. The technical success rate for insertion of the device was 100%. Following insertion of the device the primary patency of the vascular access was 81%, 70%, and 54% at 1, 3, and 6 months, respectively. The secondary patency of the vascular access was 89%, 82%, and 74% at 3, 6, and 12 months, respectively. The primary patency of the stent or stent graft was 96%, 93%, 87%, and 47% at 1, 3, 6, and 12 months, respectively. Stents and stent grafts are useful for salvaging failed angioplasty procedures and thereby maintaining patency of the hemodialysis graft. By inserting a stent, the resultant patency rates are similar to those following a successful angioplasty procedure. Importantly, the primary patency of the stent was substantially better than the primary patency of the entire vascular access.

Different types of complications may occur during a percutaneous vascular access procedure and the majority of these complications are caused by balloon angioplasty. These balloon angioplasty-induced complications include venous rupture, venous dissection, and the development of an acute pseudoaneurysm. Balloon tamponade is the traditional percutaneous technique for management of these complications. However, insertion of a stent or stent graft has become an increasingly popular method to quickly and effectively repair a venous injury. A stent or stent graft may provide a more effective and durable method to treat balloon angioplasty-induced complications. Unfortunately, there are few, if any, clinical studies to substantiate the advantages and cost-effectiveness of these devices and so their use remains controversial.

Purpose: To retrospectively determine the incidence and outcome of angioplasty-induced ruptures that occurred during treatment of hemodialysis graft-related stenoses. Materials and Methods: During a five year period 1222 patients with dysfunctional or thrombosed polytetrafluoroethylene (PTFE) hemodialysis grafts underwent angioplasty procedures at our institution. Angioplasty-induced vascular ruptures occurred in 24 (2.0%) patients. The locations of these ruptures were: basilic vein (10), venous anastomosis (7), cephalic vein (5), brachial vein (1) and intragraft (1). The mean length of the treated stenoses was 2.4 centimeters. Results: Manual compression was used to treat the vascular rupture in ten patients. One patient was treated with endovascular balloon tamponade and one patient underwent stenting of the rupture site. Despite the rupture, 15 patients had completion of the angioplasty procedure. In nine patients the procedure was abandoned due to persistent stenosis at the rupture site. There were no major complications as a result of these ruptures. Follow-up was available in ten of these patients. All ten underwent at least one successful hemodialysis treatment. In five of these patients the hemodialysis graft failed within 30 days after the rupture. The mean primary patency following rupture in the ten patients with follow-up was 87.5 days (range 5 - 225 days). Conclusion: The incidence of angioplasty-induced vascular rupture of hemodialysis-related stenoses is low and despite the injury, the majority (62%) of procedures can be completed. However, in our experience the long-term patency of the vascular access was suboptimal.