Practicing interventional radiologists (IRs) are routinely faced with challenging decisions that pertain to the management of patients with acute deep vein thrombosis (DVT). In this article, we describe five questions that are commonly posed by interventionalists and discuss both the indirect published evidence as well as our own experience in dealing with these issues. Our aim is to address procedural and, perhaps more importantly, nonprocedural-related knowledge domains with which the IR physician is less familiar and are often not directly addressed by published data or evidence-based clinical practice guidelines. This discussion is meant to facilitate a stronger understanding of the published literature as it pertains to the justifiable indications for endovascular thrombolytic therapy, the optimal use of anticoagulant therapy, and the reasonable use of adjuncts such as inferior vena cava filters and elastic compression stockings. Our goal is to provide a framework for practicing IRs to help them make the best clinical decisions for their individual patients and, ultimately, achieve optimal DVT treatment outcomes. Semin intervent Radiol 2012; 29(01): 023-028 DOI: 10.1055/s-0032-1302448. Copyright © 2012 by Thieme Medical Publishers, Inc.
Radiofrequency ablation is the most commonly used percutaneous ablation technique and well-documented in the literature on focal therapies. It has become the image-guided ablation method of choice because of its efficacy, safety, and ease of use. Radiofrequency ablation has shown promise in treating selected solid tumors, particularly those involving the liver, kidneys, lungs, and the musculoskeletal system. It is a minimally invasive technique often used in inoperable patients with other comorbidities. Radiofrequency ablation requires a minimal hospital stay or can be performed on an outpatient basis. The aim of this article is to review radiofrequency ablation techniques and their clinical applications. Diagn Interv Radiol 2012; 18:508–516. Copyright © Turkish Society of Radiology 2012
Local-regional treatments play a key role in the management of hepatocellular carcinoma (HCC). Image-guided tumor ablation is recommended in patients with early-stage HCC when surgical options are precluded and can replace resection in selected patients. Radiofrequency (RF) ablation has shown superior anticancer effects and greater survival benefit with respect to the seminal percutaneous technique, ethanol injection, in meta-analyses of randomized controlled trials and is currently established as the standard method for local tumor treatment. Novel thermal and nonthermal techniques for tumor ablation, including microwave ablation and irreversible electroporation, seem to have potential to overcome the limitations of RF ablation and warrant further clinical investigation. Transcatheter arterial chemoembolization (TACE) is the standard of care for patients with asymptomatic noninvasive multinodular tumors in intermediate-stage disease. Embolic microspheres that have the ability to release a drug in a controlled and sustained fashion have been shown to substantially increase the safety and efficacy of TACE in comparison to conventional ethiodized oil–based regimens. The available data for radioembolization with yttrium 90 suggest that this is a potential new option for patients with HCC, and future studies should be devoted to assessments of the role of radioembolization in the treatment algorithm for HCC. January 2012 Radiology, 262, 43-58. Copyright © RSNA, 2012
Purpose: To determine the efficacy and tolerance of ultrasonography (US)–guided percutaneous radiofrequency (RF) ablation with endocrine therapy in elderly patients with breast cancer who decline or are not candidates for surgery. Published online before print June 12, 2012, doi: 10.1148/radiol.12111303 August 2012 Radiology, 264, 597-605. Copyright © RSNA, 2012
Hepatocellular carcinoma (HCC) is a malignancy that is increasing in incidence in the United States (4.9 per 100,000) with mortality rates that remain close to 50% at 1 year, despite improvement in programs aimed at the prevention of cirrhosis and early detection of liver cancer in high-risk patients. Liver cancer is now the third cause of cancer-related death. Diagnosis at an advanced stage excludes >85% of patients from curative surgical therapies. Medical therapy remains of limited benefit for nonsurgical patients. Sorafenib has shown the most promising results for palliative therapy in HCC patients, imparting a 10-week survival benefit in patients with advanced disease. Semin intervent Radiol 2012; 29(01): 064-068 DOI: 10.1055/s-0032-1302454. Copyright © 2012 by Thieme Medical Publishers, Inc.
Purpose: To determine the safety, efficacy, and long-term results of percutaneous biliary balloon dilation (PBBD) of benign hepaticojejunostomy strictures and evaluate the necessity of repeated PBBD in this setting. Journal of Vascular and Interventional Radiology Volume 23, Issue 10 , Pages 1347-1355, October 2012. Copyright © SIR, 2012
Transluminal ablation of renal artery sympathetic nerves has been shown to provide a significant and durable reduction in blood pressure with very low complication rates. Additional publications have documented improvement in insulin sensitivity, obstructive sleep apnea indices, and frequency and severity of congestive heart failure in subgroups undergoing the procedure. This technology may provide effective management of other diseases in which there is autonomic imbalance. Available data are reviewed with the intent to provoke interest within the interventional radiology community in this novel technology, which may allow minimally invasive treatment of many important chronic medical conditions. Journal of Vascular and Interventional Radiology Volume 23, Issue 9 , Pages 1125-1134, September 2012. Copyright © SIR, 2012
Various adjunctive techniques have been reported for challenging inferior vena cava (IVC) filter retrievals (1–4). One particularly challenging obstacle to successful IVC filter retrieval is the formation of a radiolucent fibrin cap over the embedded apex of the IVC filter. This obstacle is a result of filter tilting that creates turbulent blood flow, which promotes fibrin cap formation. The aim of this brief report is to depict a novel technique for IVC filter retrieval: guide wire–manipulated disruption of the fibrin cap. Journal of Vascular and Interventional Radiology Volume 23, Issue 9 , Pages 1233-1235, September 2012. Copyright © SIR, 2012
Purpose: To describe the computed tomographic (CT) appearance of lung tumors treated with cryoablation to establish a reliable reference profile. Journal of Vascular and Interventional Radiology Volume 23, Issue 8 , Pages 1043-1052, August 2012. Copyright © SIR, 2012
Purpose: To evaluate the treatment efficacy of unilateral versus bilateral transarterial chemoembolization for hepatocellular carcinoma (HCC) based on whether the tumor is located across the Cantlie line within the watershed zone of the liver. Journal of Vascular and Interventional Radiology Volume 23, Issue 8 , Pages 1036-1042, August 2012. Copyright © SIR, 2012
Purpose: To retrospectively evaluate the presence and distribution patterns of contrast agent retention in the liver on noncontrast computed tomography (CT) immediately following chemoembolization with drug-eluting beads (DEBs). Journal of Vascular and Interventional Radiology Volume 23, Issue 8 , Pages 1031-1035, August 2012. Copyright © SIR, 2012
Which Response Criteria Best Help Predict Survival of Patients with Hepatocellular Carcinoma Following Chemoembolization? A Validation Study of Old and New Models. Published online before print December 20, 2011, doi: 10.1148/radiol.11110282 February 2012 Radiology, 262, 708-718. Copyright © RSNA, 2012
Venous thromboembolism (VTE) remains a serious problem, and treatments surrounding this potentially life-threatening disease continue to evolve. Evidence-based guidelines purport the need for minimally invasive catheter-based procedures as part of the armamentarium to prevent and treat VTE. When the appropriate clinical scenarios arise, intravascular ultrasound (IVUS) becomes a necessary part of those procedures to provide alternative imaging that complements traditional venography. IVUS of the major axial veins provides a 360-degree two-dimensional gray scale ultrasound image of lumen and vessel wall structures. IVUS remains the criterion standard for venous imaging when contemplating catheter-based procedures from the common femoral vein to the inferior vena cava. Not only can precise location and size of these veins be determined by the IVUS probe from key landmarks and venous branches, but other important abnormalities can be visualized. These include external compression, acute and chronic thrombus, fibrosis, mural wall thickening, spurs, and trabeculations. Specific procedures that use IVUS include the treatment of venous obstruction and the placement of vena cava filters at the bedside. IVUS remains a vital part of accurately imaging the major axial veins when contemplating catheter-based procedures to prevent or treat VTE-related disorders. Semin intervent Radiol 2012; 29(01): 010-015 DOI: 10.1055/s-0032-1302446. Copyright © 2012 by Thieme Medical Publishers, Inc.
In prior decades, splenic arterial embolization (SAE) was used increasingly in the setting of nonoperative management of blunt splenic trauma. Recently, however, multiple studies have questioned the efficacy of SAE in the blunt trauma population; at the very least, the clinical indications for SAE appear to be changing.[1] At many institutions, however, including ours, SAE remains a mainstay in the treatment of patients suffering blunt trauma to the spleen. Although there is evidence that in certain patient populations SAE improves outcome, the superiority of a specific technique (proximal embolization, distal embolization, or a combination of both) is still debated. This article briefly reviews indications, general techniques, and complications of SAE; specific attention is paid to our preferred technique for SAE, with an emphasis on the distinction between proximal and distal embolization. Semin intervent Radiol 2012; 29(02): 147-149 DOI: 10.1055/s-0032-1312577. Copyright © 2012 by Thieme Medical Publishers, Inc.
To present our clinical experience and to suggest different strategies in the management of dysfunctioning plastic biliary stents in patients with malignant biliary obstruction. Diagn Interv Radiol 2012; 18:503–507. Copyright © Turkish Society of Radiology 2012
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