- United States
Neil Halin
Tufts Medical Center, Interventional Radiology, Faculty Member
An abdominal pregnancy coexisting with an intrauterine pregnancy is a rare variant of heterotopic pregnancy. An abdominal heterotopic pregnancy was diagnosed at 22 weeks' gestation. Magnetic resonance imaging, magnetic resonance... more
An abdominal pregnancy coexisting with an intrauterine pregnancy is a rare variant of heterotopic pregnancy. An abdominal heterotopic pregnancy was diagnosed at 22 weeks' gestation. Magnetic resonance imaging, magnetic resonance angiography and sonography were performed to elucidate the anatomy. A multidisciplinary conference was held and management options were discussed. The patient elected to terminate the abdominal fetus. Selective embolization of the abdominal fetus was attempted but was unsuccessful. Intracardiac injection of potassium chloride was performed without incident. The intrauterine fetus was delivered at 36 weeks without complications. Abdominal heterotopic pregnancies pose unique management challenges, and close cooperation between obstetricians and radiologists is essential.
Research Interests: Obstetrics, Magnetic Resonance Imaging, Medicine, Pregnancy, Humans, and 15 moreFemale, Male, Diagnostic Imaging, Reproductive medicine, Newborn Infant, Gynecology, Adult, Patient Care Team, Cesarean Section, Fetus, Gestation, Nuclear Magnetic Resonance Imaging, Heterotopic Pregnancy, Paediatrics and reproductive medicine, and Abdominal Pregnancy
Previous clinical studies of autosomal dominant polycystic kidney disease (ADPKD) reported that loss of kidney function usually follows a steep and relentless course. A detailed examination of individual patterns of decline in estimated... more
Previous clinical studies of autosomal dominant polycystic kidney disease (ADPKD) reported that loss of kidney function usually follows a steep and relentless course. A detailed examination of individual patterns of decline in estimated glomerular filtration rate (eGFR) has not been performed. Longitudinal post hoc analysis of data collected during the Halt Progression of Polycystic Kidney Disease (HALT-PKD) trials. 494 HALT-PKD Study A participants (younger; preserved eGFR) and 435 Study B participants (older; reduced eGFR) who had more than 3 years of follow-up and 7 or more eGFR assessments. Longitudinal eGFR assessments using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation. Demographic, clinical, laboratory, and imaging features of participants. Probability of linear and nonlinear decline patterns or of stable eGFR calculated for each participant from a Bayesian model of individual eGFR trajectories. Most (62.5% in Study A and 81% in Study B) ...
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PURPOSE/AIM To discuss the indications, patient and tumor selection criteria, interventional techniques, and potential complications of renal cell carcinoma cryoablation, as well as the long term patient outcomes and imaging follow up for... more
PURPOSE/AIM To discuss the indications, patient and tumor selection criteria, interventional techniques, and potential complications of renal cell carcinoma cryoablation, as well as the long term patient outcomes and imaging follow up for the technique. CONTENT ORGANIZATION 1. Discuss which patients are suitable candidates for RCC cryoablation. 2. Desirable tumor characteristics for the technique. 3. How to safely perform the procedure, with a focus on critical anatomy and convective heat transfer. 4. Potential complications. 5. Long term patient outcomes, with a brief comparison to nephrectomy, as well as follow up imaging recommendations. SUMMARY By viewing this exhibit, the reader will: 1. Understand which patients and what tumor characteristics are desirable for RCC cryoablation. 2. Obtain a general understanding of how to safely perform the procedure, with a focus on critical anatomy and potential complications. 3. Learn about long term patient outcomes and follow up imaging re...
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To evaluate the diagnostic yield of complete lower extremity venous sonography for diagnosing deep venous thrombosis (DVT) in patients undergoing computed tomographic (CT) pulmonary angiography for suspected pulmonary embolism (PE). We... more
To evaluate the diagnostic yield of complete lower extremity venous sonography for diagnosing deep venous thrombosis (DVT) in patients undergoing computed tomographic (CT) pulmonary angiography for suspected pulmonary embolism (PE). We retrospectively reviewed all cases of lower extremity venous sonography and CT pulmonary angiography performed within 1 day of each other (n = 147) in a tertiary care center. Indications for the studies performed, angiographic findings, sonographic findings, age, sex, inpatient/outpatient status, lower extremity symptoms, and treatment status were recorded. Prevalence rates and patient characteristics were compared by χ(2) and Fisher exact probability tests where appropriate. Multivariable logistic regression with acute PE as the outcome was performed for age, sex, interval between angiography and sonography, indication for angiography, inpatient/outpatient status, and venous sonographic findings. The prevalence of PE (23.8%) was similar to the preval...
Research Interests: Causality, Medicine, Comorbidity, Humans, Ultrasonography, and 15 moreFemale, Pulmonary Embolism, Male, Risk factors, Boston, Clinical Sciences, Angiography, Prevalence, Middle Aged, Prognosis, Reproducibility of Results, Risk Factors, Sensitivity and Specificity, Lower Extremity, and Venous Thrombosis
The purpose of this study is to evaluate the safety and efficacy of using a radiofrequency wire (RF) for central venous occlusion (CVO) recanalization after failure using conventional techniques. A retrospective analysis of all central... more
The purpose of this study is to evaluate the safety and efficacy of using a radiofrequency wire (RF) for central venous occlusion (CVO) recanalization after failure using conventional techniques. A retrospective analysis of all central venous recanalization procedures using an RF wire from January 2007 to December 2012 was performed. This comprised 13 consecutive procedures in 12 patients. The electronic medical record and radiologic imaging studies were reviewed to obtain information regarding patient demographics, indication for revascularization, duration of vascular occlusion, procedure outcome, and complications. Technical success was achieved in nine of 13 (69%) occluded vessels in nine of 12 (75%) patients. Lengths of successfully crossed lesions (mean 29.8 ± 29.3 mm) were significantly less than those of unsuccessfully crossed lesions (mean 90 ± 73.7 mm), p = 0.039. Of the nine patients with technically successful procedures, three died with patent stents of causes unrelated...
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Lower x-ray exposures are commonly used in radiographic exams to reduce the patient radiation dose. An unwanted side effect is that the noise level increases as the exposure level is reduced. Image enhancement techniques increasing image... more
Lower x-ray exposures are commonly used in radiographic exams to reduce the patient radiation dose. An unwanted side effect is that the noise level increases as the exposure level is reduced. Image enhancement techniques increasing image contrast, such as sharpening and dynamic range compression tend to increase the appearance of noise. A Gaussian filter-based noise suppression algorithm using an adaptive
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Arteriovenous hemodialysis fistulas (AVFs) serve as a lifeline for many individuals with end-stage renal failure. A common cause of AVF failure is cephalic arch stenosis. Its high prevalence compounded with its resistance to treatment... more
Arteriovenous hemodialysis fistulas (AVFs) serve as a lifeline for many individuals with end-stage renal failure. A common cause of AVF failure is cephalic arch stenosis. Its high prevalence compounded with its resistance to treatment makes cephalic arch stenosis important to understand. Proposed etiologies include altered flow in a fistulized cephalic vein, external compression by fascia, the unique morphology of the cephalic arch, large number of valves in the cephalic outflow tract and biochemical changes that accompany renal failure. Management options are also in debate and include angioplasty, cutting balloon angioplasty, bare metal stents, stent grafts and surgical techniques including flow reduction with minimally invasive banding as well as more invasive venovenostomy with transposition surgeries for refractory cases. In this review, the evidence for the clinical relevance of cephalic arch stenosis, its etiology and management are summarized.
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Recent reports document the efficacy of transjugular intrahepatic portocaval shunts (TIPS) for the prevention of portal hypertensive bleeding and have advocated its use as a bridge to liver transplantation. There are no reports, however,... more
Recent reports document the efficacy of transjugular intrahepatic portocaval shunts (TIPS) for the prevention of portal hypertensive bleeding and have advocated its use as a bridge to liver transplantation. There are no reports, however, analyzing liver transplant results for patients with indwelling TIPS. We reviewed the records of all adult primary recipients with a history of portal hypertensive bleeding or unmanageable ascites transplanted since the TIPS procedure became available in our institution in July 1991. Seven of 20 recipients underwent TIPS before transplant. There were no significant differences between patients with or without TIPS in age, United Network for Organ Sharing status, Child-Pugh score, preoperative prothrombin time, operative time, operative blood product requirement, overall length of stay, and 6-month patient survival after transplant. We noted a trend toward less operative red cell (26.0 +/- 26.2 vs. 31.8 +/- 38.1 U, mean +/- SD) and autologous blood (4,762 +/- 3,335 vs. 13,355 [corrected] +/- 20,460 ml) transfusion and improved patient survival for those with a TIPS. Patients with a TIPS in place waited significantly longer for their transplant (282 +/- 113 vs. 149 +/- 113 days, P = 0.014). There were 2 technical complications related to the TIPS, 1 in a patient who died after rupture of the suprahepatic vena caval anastomosis where the device had traversed the caval/hepatic vein junction and weakened the tissues, and the other in a survivor in whom the device extended into the right atrium and was extracted during the transplant procedure. Three patients with TIPS in place died of sepsis while waiting for a donor organ. We conclude that while the TIPS offers benefits for the liver transplant recipient, placement of the device in small shrunken cirrhotic livers must be precise. Immediate benefits for the transplant candidate may be offset by increased waiting time and technical complications at the transplant operation.
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Research Interests: Liver diseases, Humans, Kidney, Hypertension, Blood Pressure, and 15 moreFemale, Disease Severity, Clinical Sciences, Adult, Cross Section, Combination drug therapy, Chi Square Distribution, Disease Progression, Chronic Renal Disease, Chronic Kidney Failure, Angiotensin Converting Enzyme Inhibitors, Glomerular Filtration Rate, Autosomal Dominant Polycystic Kidney Disease, Antihypertensive agents, and BODY SURFACE AREA
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ABSTRACT Purpose Evaluate the safety and efficacy of radiofrequency wire (RF wire) recanalization of chronic central venous occlusion after failure using conventional techniques. Materials and Methods Retrospective analysis of 13... more
ABSTRACT Purpose Evaluate the safety and efficacy of radiofrequency wire (RF wire) recanalization of chronic central venous occlusion after failure using conventional techniques. Materials and Methods Retrospective analysis of 13 consecutive venous recanalization procedures from 1/2007 to 12/2012 using a RF wire was performed. After the presence of central vein occlusion was confirmed with venography, antegrade passage of the occlusion was attempted with various angiographic catheters and hydrophilic guidewires. If these methods failed, a radiofrequency wire was used. Technical success rate and complication rates were evaluated. Results Technical success was achieved in 9/13 occluded vessels in 9/12 patients. Two patients (16.7%) experienced minor complications and 1 patient (8.3%) experienced a major complication. The minor complications were contrast extravasations demonstrated on angiography not requiring further treatment. The major complication was tracheal perforation requiring bronchoscopy and advanced care. Conclusion Use of a radiofrequency wire to recanalize central vein occlusion refractory to a traditional procedure is a viable option in patients without other potential access sites. Currently available data suggests that the device is 100% efficacious without reported major complications. In our experience, the technique was less than perfect with a technical success of 69% and potential for major complications (8.3%).
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... Radiology 176:531534 3. Cekirge S, Foster RG, Weiss JP, McLean GK (1993) Percutaneous removal of an embolized Wallstent during a TIPS ... AP, Pochaczevsky R, Levowitz BS, Feraru F (1971) Fo-garty balloon catheter for removal of... more
... Radiology 176:531534 3. Cekirge S, Foster RG, Weiss JP, McLean GK (1993) Percutaneous removal of an embolized Wallstent during a TIPS ... AP, Pochaczevsky R, Levowitz BS, Feraru F (1971) Fo-garty balloon catheter for removal of catheter fragment in subcla-vian vein. ...
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Endograft treatment of aortic aneurysms has become a common procedure in many centers. However, not all patients are candidates for this new technology, because of their vascular anatomy and device limitations. One common problem is... more
Endograft treatment of aortic aneurysms has become a common procedure in many centers. However, not all patients are candidates for this new technology, because of their vascular anatomy and device limitations. One common problem is iliofemoral occlusive disease, which ...