Context: Previous studies have examined the associations of individual clinical risk factors with risk of peripheral artery disease (PAD), but the combined effects of these risk factors are largely unknown.
Previously considered uncommon, visceral artery aneurysms (VAAs) are now more often diagnosed due to the increased use of cross-sectional imaging and an aging population. The reported incidence is approximately 0.01% to 2% in autopsy and angiographic studies. The splenic artery is the most common site of VAA (60%) followed by the hepatic artery (20%), gastroduodenal and pancreaticoduodenal arteries (6%), superior mesenteric artery (SMA; 5.5%), and celiac artery (4%).1-4
Introduction: Magnetic resonance (MR) imaging–guided high-intensity focused ultrasound ablation (also known as MR-guided focused ultrasound surgery) is used to treat symptomatic uterine fibroids. Since the approval of the technique by the U.S. Food and Drug Administration in 2004, thousands of clinical treatments have been performed worldwide. This modality has become a major nonsurgical therapeutic option for uterine fibroid treatment, not only because of its noninvasiveness but also as a result of its excellent therapeutic efficacy for relieving fibroid-related symptoms (1–3).
OBJECTIVE. The introduction of dual-energy CT (DECT) has ushered in the ability of material differentiation and tissue characterization beyond the traditional CT attenuation scale. This quality has been exploited for visualizing and quantifying the specific tissue content using radiographic contrast agents, such as iodine-based contrast media or inhaled xenon gas. Applications of this paradigm in the thorax include characterization of the pulmonary blood pool in the setting of acute or chronic pulmonary embolism (PE) and characterization of diseases of the lung parenchyma. Selective xenon detection is being explored for imaging of lung ventilation. In addition, the usefulness of DECT-based selective iodine uptake measurements has been described for the diagnosis and surveillance of thoracic malignancies. This article reviews the current applications of DECT-based imaging techniques in the chest with an emphasis on the diagnosis and characterization of pulmonary thromboembolic disorders.
PURPOSE To evaluate accurate diagnosis and complication rates of percutaneous core needle biopsy (PCNB) with an automated gun for small lung nodules that are 10 mm or less in diameter.
Purpose: To find a significant predictive factor for the efficacy of endovascular treatment of peripheral arteriovenous malformations (AVMs).
ABSTRACK: Life-threatening hemorrhage rarely occurs from the portal vein following blunt hepatic trauma. Traditionally, severe portal bleeding in this setting has been controlled by surgical techniques such as packing, ligation, and venorrhaphy. The presence of portal hypertension could potentially increase the amount of hemorrhage in the setting of blunt portal vein trauma making it more difficult to control. This case series describes the use of indirect carbon dioxide portography to identify portal hemorrhage. Furthermore, these cases illustrate attempted endovascular treatment utilizing a transjugular intrahepatic portosystemic shunt in one scenario and transmesocaval shunt coiling of a jejunal varix in the other.
Research evidence is necessary but insufficient for making patient care decisions. An effective but toxic chemotherapeutic regimen is the treatment one patient with cancer can and will take, another patient can take but will not, and yet another patient could not take even if wanted. Careful attention to the biopsychosocial context of patients and to their informed preferences when crafting treatments requires expertise and practical wisdom. This represents the optimal practice of evidence-based medicine.
The treatment of peripheral vascular disease has changed dramatically during the last decade, and a shift toward endovascular therapy can be observed. For the treatment of vascular injuries, life-threatening hemorrhage, and potentially lethal aneurysmal disease, several minimally invasive therapies are available. This article gives an overview of the currently available covered stents (excluding stent grafts used for aortic aneurysms) and provides guidelines for the choice of the type of covered stent. Four representative cases will be presented.
OBJECTIVE. In this article, we focus on the arterial anatomy of the upper extremities, the technical aspects of upper extremity CT angiography (CTA), and CTA use in trauma patients.
OBJECTIVE. CT angiography using modern MDCT scanners has evolved into a highly accurate noninvasive diagnostic tool for the evaluation of patients with pathologic abnormalities of the upper extremity arterial system.
Clinical services in interventional radiology (IR) have multidimensional aspects that are unique in the radiology specialty. To ensure patient safety and quality of services, it is paramount to establish an accurate auditing system with the use of a focused and inclusive clinical protocol that should be in compliance with the Standards of Practice of the Society of Interventional Radiology (SIR). Establishing a program that includes continuous assessment of clinical outcomes, allowing identification of problems within our field and areas to be improved, is desirable to minimize risks and maintain a low incidence of complications. In spite of the variation and heterogeneity of procedures performed in IR, there are several safety practices that can substantially reduce errors and medical complications and provide an optimal standard of care to patients. This review of the process of quality and assurance in IR focuses on implementation, review of complication thresholds, and description of clinical improvement practices.
OBJECTIVE. The purpose of this article is to evaluate MRI-guided therapies and to investigate their feasibility for focal therapy in prostate cancer patients. Relevant articles were retrieved using the PubMed online search engine.
OBJECTIVE. The purpose of this article is to describe the evaluation of transjugular intrahepatic portosystemic shunts (TIPS) and the management of dysfunctional shunts.
Acute variceal hemorrhage, a life-threatening condition that requires a multidisciplinary approach for effective therapy, is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy, the presence of large esophageal varices with recent stigmata of bleeding, or fresh blood visible in the stomach with no other source of bleeding identified. Transfusion of blood products, pharmacological treatments and early endoscopic therapy are often effective; however, if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs, transjugular intrahepatic portosystemic shunt (TIPS) is recommended as rescue treatment. The TIPS represents a major advance in the treatment of complications of portal hypertension. Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS, which has a 90% to 100% success rate. However, TIPS is associated with a mortality of 30% to 50% in such a setting. Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure, before the clinical condition worsens. Furthermore, admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively. This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage, particularly as a rescue therapy following failure of endoscopic approaches.
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