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At least 1,423 records · Page 79

Cephalic Arch Stenosis in Autogenous Haemodialysis Fistulas: Treatment With the Viabahn Stent-Graft

Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS. Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up. The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482-0.977] at 6 months and 72.7 % (95 % CI 0.390-0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587-0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156-2,282). The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Embolization by Direct Puncture with a Transpedicular Approach Using an Isocenter Puncture (ISOP) Method in a Patient with a Type II Endoleak After Endovascular Aortic Repair (EVAR)

BackgroundEndovascular aortic repair (EVAR) requires further intervention in 20-30 % of cases, often due to type II endoleak (T2EL). Management options for T2EL include transarterial embolization, direct puncture (DP), or transcaval embolization. We report the case of an 80-year-old man with T2EL who successfully underwent DP embolization.MethodsEmbolization by DP was performed with a transpedicular approach using an isocenter puncture (ISOP) method. An isocenter marker (ICM) was placed at a site corresponding to the aneurysm sac on fluoroscopy in two directions (frontal and lateral views). A vertebroplasty needle was inserted tangentially to the ICM under fluoroscopy and advanced to the anterior wall of the vertebral body. A 20 cm-length, 20-G-PTCD needle was inserted through the outer needle of the 13-G needle and advanced to the ICM. Sac embolization using 25 % N-buty-2-cyanoacrylate diluted with Lipiodol was performed. After complete embolization, rotational DA confirmed good filling of the sac with Lipiodol. The outer cannula and 13-G needle were removed and the procedure was completed.ResultsThe patient was discharged the next day. Contrast-enhanced computed tomography 1 and 8 months later showed no Lipiodol washout in the aneurysm sac, no endoleak recurrence, and no expansion of the excluded aneurysm.ConclusionDP with a transpedicular approach using ISOP may be useful when translumbar and transabdominal approaches prove difficult.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Single Center Experience with the AngioVac Aspiration System

PurposeThe AngioVac catheter system is a mechanical suction device designed for removal of intravascular material using extracorporeal veno-venous bypass circuit. The purpose of this study is to present the outcomes in patients treated with the AngioVac aspiration system and to discuss its efficacy in different vascular beds.Materials and MethodsA retrospectively review was performed of seven patients treated with AngioVac between October 2013 and December 2014. In 6/7 cases, the AngioVac cannula was inserted percutaneously and the patient was placed on veno-venous bypass. In one of the cases, the cannula was inserted directly into the Fontan circuit after sternotomy and the patient was maintained on cardiopulmonary bypass. Thrombus location included iliocaval (2), SVC (1), pulmonary arteries (1), Fontan circuit and Glenn shunt with pulmonary artery extension (1), right atrium (1), and IVC with renal vein extension (1).ResultsThe majority of thrombus (50–95 %) was removed in 5/7 cases, and partial thrombus removal (<50 %) was confirmed in 2/7 cases. Mean follow-up was 205 days (range 64–403 days). All patients were alive at latest follow-up. Minor complications included three neck hematomas in two total patients. No major complications occurred.ConclusionAngioVac is a useful tool for acute thrombus removal in the large vessels. The setup and substantial cost may limit its application in straightforward cases. More studies are needed to establish the utility of AngioVac in treatment of intravascular and intracardiac material.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Percutaneous Biopsy and Radiofrequency Ablation of Osteoid Osteoma with Excess Reactive New Bone Formation and Cortical Thickening Using a Battery-Powered Drill for Access: A Technical Note

PurposeTo report our experience with the use of a battery-powered drill in biopsy and radiofrequency ablation of osteoid osteoma with excess reactive new bone formation. The battery-powered drill enables obtaining the sample while drilling.Materials and MethodsDuring the last 18 months, 14 patients suffering from painful osteoid osteoma with excess reactive new bone formation underwent CT-guided biopsy and radiofrequency ablation. In order to assess and sample the nidus of the osteoid osteoma, a battery-powered drill was used. Biopsy was performed in all cases. Then, coaxially, a radiofrequency electrode was inserted and ablation was performed with osteoid osteoma protocol. Procedure time (i.e., drilling including local anesthesia), amount of scans, technical and clinical success, and the results of biopsy are reported.ResultsAccess to the nidus through the excess reactive new bone formation was feasible in all cases. Median procedure time was 50.5 min. Histologic verification of osteoid osteoma was performed in all cases. Radiofrequency electrode was coaxially inserted within the nidus and ablation was successfully performed in all lesions. Median amount CT scans, performed to control correct positioning of the drill and precise electrode placement within the nidus was 11. There were no complications or material failure reported in our study.ConclusionsThe use of battery-powered drill facilitates access to the osteoid osteoma nidus in cases where excess reactive new bone formation is present. Biopsy needle can be used for channel creation during the access offering at the same time the possibility to extract bone samples.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Efficacy of a Self-expanding Tract Sealant Device in the Reduction of Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsy: A Matched Controlled Study Using Propensity Score Analysis

PurposeTo evaluate the use of a self-expanding tract sealant device (BioSentry™) on the rates of pneumothorax and chest tube insertion after percutaneous lung biopsy.Materials and MethodsIn this retrospective study, we compared 318 patients who received BioSentry™ during percutaneous lung biopsy (treated group) with 1956 patients who did not (control group). Patient-, lesion-, and procedure-specific variables, and pneumothorax and chest tube insertion rates were recorded. To adjust for potential selection bias, patients in the treated group were matched 1:1 to patients in the control group using propensity score matching based on the above-mentioned variables. Patients were considered a match if the absolute difference in their propensity scores was ≤equal to 0.02.ResultsBefore matching, the pneumothorax and chest tube rates were 24.5 and 13.1% in the control group, and 21.1 and 8.5% in the treated group, respectively. Using propensity scores, a match was found for 317 patients in the treatment group. Chi-square contingency matched pair analysis showed the treated group had significantly lower pneumothorax (20.8 vs. 32.8%; p = 0.001) and chest tube (8.2 vs. 20.8%; p < 0.0001) rates compared to the control group. Sub-analysis including only faculty who had >30 cases of both treatment and control cases demonstrated similar findings: the treated group had significantly lower pneumothorax (17.6 vs. 30.2%; p = 0.002) and chest tube (7.2 vs. 18%; p = 0.001) rates.ConclusionsThe self-expanding tract sealant device significantly reduced the pneumothorax rate, and more importantly, the chest tube placement rate after percutaneous lung biopsy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Restoration of Dehiscent Pancreaticojejunostomy Causing a Major Postoperative Pancreatic Fistula by Reinsertion of a Pancreatic Duct Tube Using the Rendezvous Technique

Introduction: A postoperative clinically relevant pancreatic fistula can cause severe sequelae. We aimed to describe our minimally invasive procedure (rendezvous technique) for the treatment of a pancreatic fistula resulting from pancreaticojejunal anastomosis dehiscence involving a dislodged main pancreatic duct tube. Methods: In our rendezvous technique, a guidewire is advanced into the jejunal lumen from the access site of the drainage tube and is caught by a snare catheter, which is used to replace the dislodged main pancreatic duct tube. Then, the guidewire is passed from the access site of the drainage tube to the site of the dislodged main pancreatic duct tube. A sheath is inserted along the route of the dislodged main pancreatic duct tube and is placed across the pancreaticojejunal anastomosis over the guidewire. Another guidewire is advanced into the main pancreatic duct via the sheath, and a new main pancreatic duct tube is inserted into the main pancreatic duct over the second wire. This technique was performed in two patients with a pancreatic fistula. Results: Our rendezvous technique was successfully performed in a 73-year-old man with an intractable clinically relevant pancreatic fistula and large discharge from the drain and a 74-year-old woman with a pancreatic fistula and fluid collection between the elevated jejunum and remnant pancreas. Discharge from the drain and fluid collection decreased after the procedure. Conclusion: Our rendezvous technique is an effective minimally invasive approach for a pancreatic fistula resulting from pancreaticojejunal anastomosis dehiscence.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Inferior Vena Cava Filters in Hemodynamically Unstable Patients with Acute Pulmonary Embolism: How Often are They Used? Data from Multicenter Prospective Registries on Acute Pulmonary Embolism

The use of inferior vena cava (IVC) filters is recommended in patients with acute pulmonary embolism (PE) who have absolute contraindications to anticoagulant drugs and/or in those subjects with recurrent PE despite treated with an adequate anticoagulant regimen. During the last 2 decades, some investigations have demonstrated that the use of IVC filters in high-risk PE patients, treated or not with systemic thrombolysis, was able to reduce the short-term mortality rate if inserted early after the acute event. The aim of the present review is to analyze the use of IVC filters in high-risk PE patients enrolled in prospective multicenter registries between 1990 and 2018. After screening 3542 article in PubMed, Scopus, Cochrane library and Goggle Scholar databases, we identified four registry studies meeting the inclusion criteria. In a prospective cohort of 39,056 patients, 1387 (3.5%) were hemodynamically unstable at admission. Among them, IVC filters were used only in 2.7% of cases. Conversely, IVC filters were inserted in 3.8% of hemodynamically stable patients. Over the years, a fluctuating trend in the use of IVC filters was observed. In the absence of randomized controlled trial on this issue, which would be difficult, if not impossible to realize, data obtained from the medical literature seem to suggest that IVC filters could represent a valid adjunctive therapy in hemodynamically unstable PE patients, able to prevent further hemodynamic deterioration. Further and larger subgroup analyses, obtained both by prospective and retrospective studies, are necessary to clarify this therapeutic approach.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

The Randomized Freeway Stent Study: Drug-Eluting Balloons Outperform Standard Balloon Angioplasty for Postdilatation of Nitinol Stents in the SFA and PI Segment

Purpose: The prospective randomized multicenter Freeway study evaluated the possible hemodynamic and clinical benefits of primary stent insertion followed by percutaneous transluminal angioplasty (PTA) with drug-eluting balloons (DEB) over post-stent insertion PTA with standard balloons in the treatment of symptomatic femoropopliteal arteriosclerotic lesions. Methods: In total, 204 patients in 13 centers in Germany and Austria were enrolled and randomized to primary stenting followed by either FREEWAY™ drug-eluting balloon or standard PTA balloon angioplasty. The primary endpoint was the rate of clinically driven target lesion revascularization (TLR) at 6 months; the secondary endpoints include TLR rate at 12 months and primary patency, shift in Rutherford classification, ankle–brachial index (ABI) and major adverse events (MAE) at 6 and 12 months. Lesion characteristics and vessel patency were analyzed by an independent and blinded corelab. Results: At 6-month and 12-month follow-up, TLR rate was lower in the DEB arm compared to standard PTA but did not reach statistical significance (4.1% vs. 9.0% p = 0.234 and 7.9% vs. 17.7% p = 0.064, respectively). Primary patency was significantly better for patients treated with the DEB at 6 months (90.3% vs. 69.8% p = 0.001) and 12 months (77.4% vs. 61.0% p = 0.027). Improvement in Rutherford classifications was likewise significantly better for patients in the DEB group at 6 (94.9% vs. 84.3% p = 0.027) and 12 months (95.5% vs. 79.9% p = 0.003). The percentage of patients with an improved ABI of 1.0–1.2 was significantly higher in the DEB group compared to the PTA group at 6 months (55.3% vs. 35.3%; p = 0.015) but without significant difference at 12 months (48.2% vs. 32.9%; p = 0.055). At 6 months, rate of major adverse events (MAE) was 1% in both arms, and at 12 months 2.2% for the DEB and 3.8% for the PTA group. Conclusion: The Freeway Stent Study shows that the usage of DEB as a restenosis prophylaxis seems to be safe and feasible. The 12-month follow-up results give a clear sign in favor of the DEB group.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A Fast Algorithm for Computing Zigzag Representatives

Zigzag filtrations of simplicial complexes generalize the usual filtrations by allowing simplex deletions in addition to simplex insertions. The barcodes computed from zigzag filtrations encode the evolution of homological features. Although one can locate a particular feature at any index in the filtration using existing algorithms, the resulting representatives may not be compatible with the zigzag: a representative cycle at one index may not map into a representative cycle at its neighbor. For this, one needs to compute compatible representative cycles along each bar in the barcode. It is known that the barcode for a zigzag filtration with m insertions and deletions can be computed $O(m^ω)$ in time, where $ω < 2.373$ is the matrix multiplication exponent. However, it is not known how to compute the compatible representatives so efficiently. For a non-zigzag filtration, the classical matrix-based algorithm provides representatives in $O(m^3)$ time, which can be improved to $O(m^ω)$. However, no known algorithm for zigzag filtrations computes the representatives with the $O(m^3)$ time bound. We present an $O(m^3 n)$ time algorithm for this problem, where $n ≤ m$ is the size of the largest complex in the filtration.

Persistent homology↗

Preparation of Bimetal Objects by Lost Foam Casting

The possibility of obtaining bimetallic steel castings by the lost foam casting method is demonstrated, in which an insert of special steel is placed in an expanded polystyrene mold. Bottom casting is used. With the optimum choice of the casting temperature, fusion of the steels is guaranteed and there is no warping of flat inserts. Stages of bimetallic casting formation are considered and the parameters affecting filling of the mold and ensuring the production of a finished casting are determined. It is shown that the heat treatment of objects with air cooling provides hardness of 20–46 HRC for steel of 20X13 with different tempering conditions. The technology is recommended for parts of the locking assembly of pipeline fittings and other products where a combination of local special properties and workability is required.

36 MATERIALS SCIENCE↗

Finite deformation cohesive polygonal finite elements for modeling pervasive fracture

In this work, we introduce a framework for modeling dynamic fracture problems using cohesive polygonal finite elements. Random polygonal meshes provide a robust, efficient method for generating an unbiased network of fracture surfaces. Further, these meshes have more facets per element than standard triangle or quadrilateral meshes, providing more possible facets per element to insert cohesive surfaces. This property of polygonal meshes is advantageous for the modeling of pervasive fracture. We use both Wachspress and maximum entropy shape functions to form a finite element basis over the polygons. Fracture surfaces are captured through dynamically inserted cohesive zone elements at facets between the polygons in the mesh. Contact is enforced through a penalty method that is applied to both closed cohesive surfaces and general interpenetration of two polygonal elements. Finally, several numerical examples are presented that illustrate the capabilities of the method and demonstrate convergence of solutions.

97 MATHEMATICS AND COMPUTING↗

IR Thermographic Analysis of 3D Printed CFRP Reference Samples with Back-Drilled and Embedded Defects

Carbon-fiber composite structures may demonstrate a defective behavior due to manufacturing induced anomalies (delamination, dis-bonds) or service related defectives (impact damage, water ingress). Thus, there is a need for a relatively fast and low cost non-intrusive testing schemes such as infrared thermography (IRT). Still, thermography testing requires calibrated samples and coupons to yield best results. The presented research demonstrates the novel use of 3D printing technology to generate IRT calibration samples. In this text, two carbon fiber reinforced polymer samples are 3D printed; the first mimics a 'back-drilled holes' type coupons, while the other is designed to embed air pockets similar to Teflon inserts. The generated samples are then tested using two IRT modalities; namely pulse thermography and lock-in thermography. Furthermore, the resulted thermograms are processed using a principle component analysis, to help highlight the variance of defectives in a consistent manner among the samples. This research findings offer insights on the variation of detectability between embedded and back-printed samples, which might be due to the inserts thickness.

36 MATERIALS SCIENCE↗

Structural and Magnetic Behavior of BaAl{sub x}Cr{sub y}Fe{sub 11}O{sub 19} (x + y = 1) Hexagonal Ferrites

The present study aims to analyze barium hexagonal ferrite and its derivation behavior using sol-gel auto-combustion co-doped with Al{sup 3+}/Cr{sup 3+}ions. Also, the effects of dopants on structural and magnetic properties of prepared samples were investigated. To this purpose, the finest powders were preheated at 500 °C for 1 h and calcinated at 900 °C about 2 h. Then, the magnetic powders were characterized by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), field emission scanning electron microscope (FESEM), and vibrating sample magnetometer (VSM). The XRD patterns show the magnetoplumbite phase. According to the Scherrer equation applied, inserting ions led to a decrease in lattice parameters (a and c) and crystallite size. The morphology of synthesized samples was observed by FESEM and proved the hexagonal shapes of the prepared samples. The nanoparticles sizes were recorded between 59 and 79 nm. Moreover, the magnetic properties of prepared samples were specified by VSM. The saturation magnetization (M{sub s}) and remnant magnetization (M{sub r}) of the synthesized magnetic powders were decreased by inserting Al{sup 3+}/Cr{sup 3+} ions, while coercivity (H{sub c}) increased from 5215 to 7178 Oe. .

77 NANOSCIENCE AND NANOTECHNOLOGY↗

Ultra-compact low loss electro-optical nanobeam cavity modulator embedded photonic crystal

In this paper, a hybrid electro-optical modulator based on a one-dimensional photonic crystal nanobeam cavity is proposed. The main component of the cavity builder is the indium–tin–oxide that is a transparent conductive oxide. The proposed structure is used to minimize optical losses and also to have a high-quality factor with a tunability from the distributed feedback system. The proposed modulator has a wide range of resonant tunable in a footprint of 1.892 μm{sup 2}. This structure has the ability to shift the wavelength of 1.55 μm using a very small voltage 0.1 V. Simulation results show that the proposed structure has an insertion loss of 0.027 dB, extension ratio 3.484 dB, 119.89 GHz modulation speed, and 0.59 aJ/bit modulation energy. By comparing the proposed method parameters and other modulators based on the one-dimensional photonic crystal nanobeam cavity, a significant improvement in modulation voltage, insertion losses, energy consumption, and footprint have been observed.

77 NANOSCIENCE AND NANOTECHNOLOGY↗

Complexes of dichlorosilylene with allyl chloride and allyl bromide: matrix IR spectroscopy and quantum chemical studies

Formation of donor-acceptor complexes between dichlorosilylene, SiCl{sub 2}, and allyl halides, AllHal(Hal= Cl, Br) was detected in Ar matrixes using matrix IR spectroscopy. In agreement with the predictions of the performed quantum chemical calculations, only broad unstructured absorption bands contributed by different conformers of the 1 : 1 complexes between SiCl{sub 2} and AllHal were observed in IR spectra of matrixes after deposition in the regions of characteristic vibrations of starting reactants. Annealing of matrixes resulted in strong narrowing the bands due to conversions of different conformers into the most stable structures. The predominantly formed conformers in both the reaction systems were those of complexes with SiCl{sub 2} coordinated to the Hal atoms of AllHal in the gauche conformations. At the same time, according to the calculations, the complexes with SiCl{sub 2} coordination to the double bonds of AllHal can be only slightly less stable than the complexes with coordination to the Hal atoms, and all these basic centers can be considered as comparable in their activity in the complexation. The only products revealed upon photolysis of complexes were the products of silylene insertion into the C–Hal bonds, viz., AllSiCl{sub 3} and AllSiCl{sub 2}Br. Theoretical study of thermal transformations in the SiCl{sub 2} + AllHal systems showed that formal insertion of SiCl{sub 2} in the C–Hal bonds and its addition to the double bonds of AllHal have low activation barriers of 3–8 kcal mol{sup –1}. However, these barriers are too high for these reactions to occur under the matrix isolation conditions.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Increasing Efficiency of Energy Output to an Electron Diode by Means of Auxiliary Discharge Generated by Prepulse

This paper examines the source of submicrosecond electron beam with an explosive emission cathode, where the main voltage pulse is preceded by an additional pulse (prepulse). Prepulse with an amplitude of 60 kV and duration of 100 ns is formed by a separate capacitive storage unit, the energy storage of which constitutes 4% of energy storage of the capacitive storage unit of the main discharge circuit. Prepulse allowed reducing the diode resistance on the pulse front to single Ohm units, improving diode matching with the generator and increasing the efficiency of energy output from the low-resistance capacitive storage unit to electron beam by 17%. When amplitude of accelerating voltage pulse is 100 kV, around 65% of energy is inserted into the diode at voltage of over 50 kV. For comparison, when working without a prepulse the share of inserted energy at voltage of over 50 kV does not exceed 35% of the full energy dissipated in the diode. A distinctive feature of the source circuit is absence of the system of additional auxiliary discharge electrodes that is typical for most circuits of diodes with preliminary plasma filling.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗

On Reproducibility of Collective Acceleration of Protons in a Plasma-Anode Diode System

The article deals with the investigation of the conditions of reproducibility of the results of collective acceleration of protons in a high-current relativistic electron beam of nanosecond duration passing through a plasma bunch. A quantitative criterion of reproducibility in the system of an anode with a dielectric insert and a cylindrical cathode was the neutron yield in a nuclear reaction with the threshold about 2 MeV, which was measured by a silver-activated detector after each operation of the accelerator. Generation of an azimuthally-homogeneous electron beam and plasma in the area of the dielectric insert on the anode and the use of lenses in the region of electron beam drift resulted in the stabilization of the accelerating process. After optimization, the neutron yield scatter in a series of 30 pulses was at the level ±5% of the average value, which corresponded to the accelerated proton energy scatter ±3%. The conditions of best reproducibility coincided with those where the main group of protons reached their maximum values.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗