The aim of our study was to assess our experience with the retrievable Gunther Tulip (GT) inferior vena cava (IVC) filter, with regard to its insertion, efficacy, ease of placement and retrieval, and associated complications. Between November 2001 and October 2005, 322 GT filters were placed in 317 patients. Insertion indications included the following: pulmonary embolus (PE) prophylaxis in trauma patients (n = 232), PE prophylaxis in perioperative patients (n = 27), PE prophylaxis in moribund intensive care unit patients (n = 22), recent PE (n = 48), extensive deep venous thrombosis (n = 66), contraindication to anticoagulation (n = 63), anticoagulation complication (n = 8) and deep venous thrombosis with failed anticoagulation (n = 8). Some patients had more than one indication for caval filter placement. Two hundred and five attempted retrievals have been carried out, with 15 failures. Our successful retrieval rate is 92%. Nineteen filters were originally inserted permanently. There have been three minor complications associated with insertion and five with retrieval. The mean time from filter insertion to attempted retrieval was 76.95 days. The ideal filter implantation time gives the patient the benefit of PE protection, while avoiding the long-term risks associated with caval filters. Although GT retrieval times have lengthened considerably, our data suggest that this is at the expense of successful retrieval rates.

Novel approaches to percutaneous gastrostomy have evolved because of catheter clogging and displacement, which is commonly seen with currently available gastrostomy catheters. Low-profile button gastrostomy catheters, designed to be inserted into mature tracts, have recently been inserted into fresh gastrostomy tracts. Catheter clogging rarely occurs with these low-profile devices. Catheter displacement remains a problem but new buttons can be inserted at the patient's bedside without the need for a return visit to the radiology department. A 90 to 100% success rate has been shown for placement of gastrostomy buttons. Pull-type endoscopic gastrostomy catheters can be placed radiologically using a standard puncture of the stomach and cannulation of the gastroesophageal junction. A guide wire is manipulated up the esophagus and out the mouth. The pull-type gastrostomy catheter is then attached and pulled down through the esophagus and out through the anterior abdominal wall. These catheters have very good retention devices and rarely become dislodged. Catheter clogging is also rarely seen, provided larger devices are used. Radiological placement of percutaneous endoscopic gastrostomy tubes has been termed the ''hybrid method'' and has been shown to be cheaper than endoscopic and other fluoroscopic methods of gastrostomy.

SummaryThe aim of this study was to evaluate our experience with the retrievable Cook Celect inferior vena cava (IVC) filter (William Cook, Europe) with regard to insertion, efficiency, ease of retrieval, and any associated complications. A retrospective review was performed of 115 patients (41 female, 74 male, mean age 47.97 years) who underwent Cook Celect IVC filter insertion between December 2005 and October 2007. Filter insertion was successful in all patients. Of the 115 filters inserted, 57 have been successfully retrieved (49.6%) to date. The successful retrieval rate from attempted retrieval was 93.4%. The mean dwell time of successfully retrieved filters was 114.9 days (range 14-267 days). Failed retrievals were due to a thrombosed vena cava (n = 1) and endothelialisation of the filter (n = 3). In the failed retrieval group the mean implantation time was 142 days (range 78-211 days). While this is the first retrospective clinical study on the Cook Celect filter, results to date are promising. We demonstrated an efficacious filter with a high successful retrieval rate of 93.4% and a low complication rate. The filter was assessed with extended dwell times (range 14-267 days). Failed retrieval secondary to hook endothelialisation continues to be an issue with this filter. We recognize that a limitation of our study was the lack of systematic followup for clinically silent complications. Further studies to evaluate longer term outcomes and effectiveness of this filter are warranted.

SUMMARYEstablishing and maintaining venous access forms an increasing proportion of the workload in interventional radiology. Several patient groups require medium-term to long-term venous catheters for a variety of purposes, including chemotherapy, long-term antimicrobials, parenteral nutrition, short-term access for haemodialysis or exhausted haemodialysis. Often, these catheters are required for treatment and frequent blood testing, which can quickly exhaust the peripheral veins. Long-term venous access devices minimize the discomfort of frequent cannulation while preserving the peripheral veins. Venous access devices include implantable catheters (ports), tunnelled catheters and peripherally inserted central catheters, which have different functions, advantages and limitations. Imagingguided placement is the preferred method of insertion in many institutions because of higher success rates and radiologists are well suited to address catheter complications.

To evaluate the safety and efficacy of percutaneous antegrade ureteric stent removal using a rigid alligator forceps. Twenty patients were included in our study. Indications for ureteric stent insertion included stone disease (n = 7), malignancy (n = 8) and transplant anastomotic strictures (n = 5). Stent retrieval was carried out for proximal stent placement/migration in seven patients and encrustation in the remaining 13. Twenty-two stents were successfully retrieved in 20 patients. There was one technical failure (5%). There were no major complications. We had four minor complications, which included nephrostomy site pain (n = 2), periprocedural sepsis (n = 1) and a small urinoma (n = 1). All patients settled with conservative management. Percutaneous radiologically guided antegrade ureteric stent removal with an alligator forceps is safe and effective, particularly when initial surgical removal has failed.