Purpose The presence of vascular calcifications helps to determine percutaneous access for interventional vascular procedures and has prognostic value for future cardiovascular events. Unlike CT, standard MRI techniques are insensitive to vascular calcifications. In this prospective study, we tested a proton density-weighted, in-phase (PDIP) 3D stack-of-stars gradient-echo pulse sequence with approximately 1 mm3 isotropic spatial resolution at 1.5 Tesla and 3 Tesla to detect ilio-femoral peripheral vascular calcifications and correlated MR-determined lesion volumes with CT angiography. Methods The study was approved by the Institutional Review Board. The prototype PDIP stack-of-stars pulse sequence was applied in 12 patients with ilio-femoral peripheral vascular calcifications who had undergone CT angiography. Results Vascular calcifications were well visualized in all subjects, excluding segments near prostheses or stents. The location, size and shape of the calcifications were similar to CTA. Quantitative analysis showed excellent correlation (r2 = 0.84, p<0.0001) between MR- and CT-based measures of calcification volume. In one subject in whom three pulse sequences were compared, PDIP stack-of-stars outperformed Cartesian 3D gradient-echo and PETRA. Conclusion In this pilot study, a PDIP 3D stack-of-stars gradient-echo pulse sequence with high spatial resolution provided excellent image quality and accurately depicted the location and volume of ilio-femoral vascular calcifications.

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Objectives: Endovascular aneurysm repair can be performed using multiple commercially available stent graft systems, each with their own unique design features and potential complications. This study evaluated the incidence, potential causative factors and outcomes of patients that developed an anaphylactic reaction following systemic exposure to the polyethylene glycol-based polymer used with the Ovation Abdominal Stent Graft System (Trivascular, Santa Rosa, Calif).Methods: We reviewed all reports related to polymer leak with the Ovation device received by the manufacturer. Patients that developed an anaphylactic or hypersensitivity reaction were evaluated for root cause. We independently analyzed the assembled data and outcomes.Results: Between September 2010 through August 2016, polymer leak was reported in 26 patients (mean age, 77 years; range, 61-100 years) among approximately 10,000 device implants (reported incidence, 0.26%). Symptoms occurred in 24 patients, with hypotension being the primary symptom. Treatment was in accordance with an anaphylactic reaction. There were three (11.5%) type 1 endoleaks. Of these, one patient underwent successful endovascular reintervention, one was converted to open surgical repair and one patient continues to be monitored. Factors that seem to contribute to the risk of polymer leak include manufacturing process, excessive graft manipulation, early ballooning before complete polymer cure, and lower body temperature, which can slow the polymer cure rate.Conclusions: Although polymer leak and anaphylaxis seems to be an infrequent event associated with use of the Ovation graft, awareness of this complication and prompt recognition can allow for timely treatment. Returning the patient to hemodynamic stability can allow for completion of the procedure and successful exclusion of the aneurysm sac.