Browsing by Author "Arepally, A."
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Item Open Access Evaluation of MR/Fluoroscopy–guided portosystemic shunt creation in a swine model(Elsevier Inc., 2006) Arepally, A.; Karmarkar, P. V.; Qian, D.; Barnett, B.; Atalar, ErginPURPOSE: To evaluate three different percutaneous portosystemic shunts created with magnetic resonance (MR) imaging and fluoroscopy guidance in a swine model. MATERIALS AND METHODS: In stage 1 of the experiment, an active MR intravascular needle system was created for needle tracking and extracaval punctures. Twenty inferior vena cava (IVC)/superior mesenteric vein (SMV)/portal vein (PV) punctures were performed in 10 swine (weight, 40-45 kg) in a 1.5-T short-bore interventional MR imager. With use of a real-time MR imaging sequence, the needle was guided through the IVC and into the SMV or PV (N = 20 punctures). After confirmation, a wire was advanced into the portal venous system under MR imaging guidance (N = 20). In stage 2, animals were transferred to the radiographic fluoroscopy suite for deployment of shunts. Three different shunts were evaluated in this study: (i) a commercial stent-graft, (ii) a prototype bridging stent, and (iii) a prototype nitinol vascular anastomotic device. Postprocedural necropsy was performed in all animals. RESULTS: Successful MR-guided IVC/SMV punctures were performed in all 20 procedures (100%). All three shunts were deployed. Stent-grafts had the poorest mechanism for securing a shunt. The vascular anastomotic device and the bridging stent had more secure anchoring mechanisms but also had higher technical failure rates (50% and 40%, respectively). When deployed successfully, the vascular anastomotic device resulted in no bleeding at the sites of punctures at necropsy. CONCLUSION: Percutaneous shunts and vascular anastomoses between the portal mesenteric venous system and IVC were successfully created with use of a combination of MR imaging and conventional fluoroscopy for guidance.Item Open Access Percutaneous MR imaging–guidedtransvascular access of mesenteric venous system: Study in Swine model(Radiological Society of North America, Inc., 2006) Arepally, A.; Karmarkar, P. V.; Weiss, C.; Atalar, ErginPurpose: To determine if, with use of magnetic resonance (MR) imaging guidance alone, transcaval puncture of the superior mesenteric vein (SMV) and/or portal vein is feasible with a percutaneous femoral vein approach. Materials and Methods: The Institutional Animal Care and Use Committee approved the animal studies. Ten inferior vena cava (IVC) SMV punctures were performed in six pigs. An active MR intravascular needle system was used for all transvascular punctures, and all procedures were performed with a 1.5-T MR unit. The needle was introduced via a 12-F femoral vein sheath and advanced into the IVC by using a real-time gradient-recalled-echo sequence (3.4/1.2 [repetition time msec/echo time msec], 45 flip angle, and six to eight frames per second). Fast transverse spoiled gradient-recalled acquisition in the steady state (SPGR) (6.0/1.5, 60 flip angle, one frame per second) was performed to confirm needle trajectory. The needle system was advanced under real-time MR imaging to puncture the SMV. The location of the needle tip was confirmed with a fast spin-echo sequence (1904/4.5, 36-cm field of view). A direct MR portogram was obtained after the administration of gadopentetate dimeglumine at a concentration of 25% with fast SPGR (6/1.3, 90 flip angle, no section selection, three frames per second). Success was defined as entry into the mesenteric venous system without traversal of any retroperitoneal organs or adjacent vasculature. Results: Successful MR imaging-guided IVC-SMV punctures were performed in all 10 procedures (100%). The needle was fully visualized as it traversed the retroperitoneum and entered the SMV. MR portograms were successfully obtained following all punctures through the needle. Conventional transverse MR imaging helped confirm that the needle did not traverse any retroperitoneal organs or vessels. Conclusion: With use of only MR imaging guidance and an active MR imaging intravascular needle system, the authors were able to successfully puncture the SMV from the IVC with direct visualization of the needle and all retroperitoneal structures.Item Open Access Tracking planar orientations of active MRI needles(John Wiley & Sons, Inc., 2007) Sathyanarayana, S.; Aksit P.; Arepally, A.; Karmarkar, P. V.; Solaiyappan, M.; Atalar, ErginPurpose: To determine and track the planar orientation of active interventional devices without using localizing RF microcoils. Materials and Methods: An image-based tracking method that determines a device's orientation using projection images was developed. An automated and a manual detection scheme were implemented. The method was demonstrated in an in vivo mesocaval puncture procedure in swine, which required accurate orientation of an active transvascular needle catheter. Results: The plane of the catheter was determined using two projection images. The scan plane was adjusted automatically to follow the catheter plane, and its orientation with respect to a previously acquired target plane was displayed. The algorithm facilitated navigation for a fast and accurate puncture. Conclusion: Using image-based techniques, with no mechanical design changes, the orientation of an active intravascular probe could be tracked.