The approval of the new certificate in interventional radiology (IR) and diagnostic radiology (DR) by the American Board of Medical Specialties was a notable event for two reasons: The basic training schematic in IR was changed from a 1-4-1 pattern (years of internship-years of DR-years of IR) to a 1-3-2 pattern, and IR was recognized as a primary specialty of the American Board of Radiology.
The evolution of modern interventional radiology began over half century ago. Use of the same diagnostic imaging tools that had revolutionized the practice of medicine became a possibility in guiding real-time treatment of disease. This concept led to rapid treatment advances in every organ system of the body. It became clear that by utilizing imaging some patients could undergo targeted minimally invasive procedures, thus avoiding major surgery, while others could undergo procedures for previously unsolvable problems. The breadth of these changes now encompasses all of medicine and has forever changed the way we think about disease. In this brief review article, we will describe the major technologic advances in the field, as chronicled in the pages of Radiology. We will also explore the 50-year journey of interventional radiologists, from diagnostic imagers to practicing clinicians.
Purpose: To determine the functional discrepancy between the two liver lobes using technetium 99m (99mTc) diethylenetriamine–pentaacetic acid–galactosyl human serum albumin (GSA) single photon emission computed tomography (SPECT)/computed tomography (CT) fusion imaging following preoperative biliary drainage and portal vein embolization (PVE) in patients with jaundice who have bile duct cancer (BDC).
Purpose: To determine whether semiquantitative perfusion magnetic resonance (MR) imaging parameters are associated with therapeutic effectiveness of MR imaging–guided high-intensity focused ultrasound (HIFU) ablation of uterine fibroids and which semiquantitative perfusion parameters are significant with regard to treatment efficiency.
The recently published JETSTREAM Calcium Study was a prospective, single-arm, multicenter study to evaluate the effect of the JETSTREAM™ Atherectomy System (Boston Scientific Corporation) when treating severely calcified peripheral arterial lesions in the common femoral, superficial femoral, or popliteal arteries causing claudication. The main question was whether the JETSTREAM Atherectomy System was effective in removing calcification. This was evaluated using both quantitative and qualitative intravascular ultrasound (IVUS), by comparing preintervention and postatherectomy IVUS images. The two major findings were as follows: The JETSTREAM Atherectomy System removed and modified moderate to severe superficial calcium to achieve significant lumen gain as standalone therapy; and adjunctive balloon angioplasty after calcium modification with the JETSTREAM Atherectomy System showed further lumen increase without major complications. In this study, the JETSTREAM 2.1/3.0 mm device was used for all procedures without distal protection. There were no major adverse events up to 30 days postprocedure.
Peripheral artery disease (PAD) is a major cause of morbidity and mortality in the United States, affecting 8 to 12 million people. The incidence of PAD increases in the presence of well-defined atherosclerotic risk factors, including cigarette smoking, diabetes mellitus, hypertension, hyperlipidemia, and advanced age, and is estimated to affect > 20% of adults aged 55 years and older. When symptomatic, PAD may adversely have an impact on functional capacity, ability to work, and quality of life. Furthermore, PAD is associated with significant social and economic costs and increases the risk of future cardiovascular events.
Dr. Lawrence A. Garcia shares his thoughts on what is needed most from future trials and reflects on his key learnings in this space.
With a 5-year head start using DCBs before US physicians, Prof. Jos van den Berg shares his take on best practices with this tool, as well as the available data.
Endovascular Today sat down with a multidisciplinary panel of esteemed interventionists to discuss their current practice paradigms for atherectomy, including the hot topic of Vessel Prep prior to drug-coated balloons and other adjunctive therapies.
Minimally invasive treatment of abdominal aortic aneurysms (AAAs) was first introduced by Volodos and colleagues in the 1980s and then became popularized by Parodi in the early 1990s. Until recently, most stent grafts with rather large delivery system profiles required bilateral open surgical cutdown of the common femoral artery (CFA). Newer delivery systems with lower profiles, such as the INCRAFT® AAA Stent Graft System (Cordis Corporation), enable safe and effective percutaneous treatment of patients with AAAs on a much larger scale. Prof. Do and Dr. Makaloski discuss their firsthand experience with the INCRAFT® System and present a case that demonstrates use of the device in percutaneous endovascular aneurysm repair (PEVAR).
If one includes the entire spectrum of venous disease, from telangiectasias and reticular veins to open leg ulcerations, there are approximately 25 million people in the United States who are affected. More than 500,000 patients have active venous ulcers, with approximately 1% of all adults estimated to develop a leg ulcer at some point in their lives (Figure 1). This level of disease prevalence is associated with a significant economic burden on the health care system, which is thought to be between $1.5 to $3 billion annually for ulcer care alone. Particularly with the advent of less-invasive percutaneous methods for the treatment of venous insufficiency, the number of procedures performed has skyrocketed and has become a focus of concern for both payers and the public.
Hospitals have become large, integrated systems, as required for the complex infrastructure and teams of people necessary to care for patients with acute, life-threatening vascular disorders. However, for the treatment of patients with chronic vascular conditions, hospital care is bloated and expensive. The physician’s office, or office-based lab (OBL), offers a lower-cost alternative for the delivery of streamlined outpatient vascular care. Catheter-based platforms for vascular interventions have created an opportunity for physicians to open comprehensive outpatient vascular centers. Patients with venous conditions present with a broad range of disease severity, as captured in the Clinical Etiology Anatomy Pathophysiology (CEAP) classification: spider telangiectasia (C1), varicose veins (C2), edema (C3), skin changes (C4a, b), or venous ulcers (C5–6). It is then reasonable that the procedures to treat these conditions are also broad, ranging from small injections to complex vascular reconstructions.
The new VQI Varicose Vein Registry is establishing ties with electronic medical record companies to support office-based venous procedures.
Office-based endovascular labs offer advanced techniques for limb revascularization. Initially, when these labs opened, the primary purpose was to manage and improve the patency of dialysis access. Over the years, these labs have developed to take the lead in managing lower extremity ischemia, including claudication and critical limb ischemia. As favorable results of endovascular intervention in lower extremity arterial occlusive disease are published, patients are increasingly treated with these techniques. The rate of surgical bypass continues to fall. With the increasing focus on patient outcomes and safety, the traditional approaches to arterial access need to be reviewed. Two approaches that are gaining favor are the retrograde tibial/pedal approach and radial artery entry.
Several years ago, our team at Bay Area Vein and Vascular Center decided to open an office-based laboratory (OBL) to deliver better patient care, reduce bureaucracy, and increase access to innovative technology. I was exhausted from the ever-changing hospital schedule leading to unproductive time and defaulting to the same big-name products under contract at the hospital. I wanted freedom of choice and improved efficiency.
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