Basics of Guidewire Technology and Peripheral Artery Disease.

Guidewire technology has advanced significantly over the last several decades. As more components are incorporated providing valuable features, deciding which guidewire to use during peripheral artery disease (PAD) interventions has become more complex. The challenge for both the beginner and expert is not only understanding which components offer the best characteristics in a guidewire but choosing the optimal wire for an intervention. Manufacturers have attempted to optimize components to provide physicians with routinely available guidewires needed in everyday practice. Yet selecting the best guidewire for a particular situation during an intervention is still challenging. This article provides a basic overview of guidewire components and what benefits they offer during PAD interventions.

Advanced limb salvage: Pedal artery interventions.

Chronic limb-threatening ischemia (CLTI) is on the rise due to the increasing prevalence of diabetes, which is a significant cause of morbidity and mortality worldwide. Due to diabetes, many patients with CLTI present with a predominance of tibial and pedal artery disease. Despite best care, limb amputation cannot always be prevented. Surgical bypass has always been the mainstay in distal revascularization and limb salvage; however, many patients with CLTI have comorbidities, insufficient vein, and anatomic abnormalities that prevent them from undergoing surgery. As a result, endovascular therapies have increased over the last 2 decades and are providing revascularization options in these patients. Although most of the current endovascular literature has focused on above-ankle arterial interventions, recent studies have highlighted the feasibility, safety, and clinical importance of pedal artery interventions. These endovascular techniques hold promise in relieving ischemic pain, healing foot ulcers, reducing rates and extent of amputation, and improving patient functionality and quality of life. This review aims to comprehensively detail pedal artery interventions in terms of anatomy, technique, intraprocedural imaging, and outcomes. In addition, suggestions of when to perform pedal artery interventions and post-intervention surveillance options will be discussed.

Prostate Arterial Anatomy: A Primer for Interventional Radiologists.

Identification of the prostatic arteries (PAs) is one of the most challenging aspects of prostate artery embolization for treatment of benign prostatic hyperplasia-associated lower urinary tract symptoms. Operators require a detailed understanding of the prostate arterial anatomy to ensure technical and clinical success with minimal complications. Due to substantial variability in internal iliac artery branch patterns and specifically the origin of the PA, we focus on 3 clinically relevant classification systems used to categorize the pelvic vasculature. These include classification systems to understand the internal iliac artery branching pattern, PA origin variation, and intraprostatic branching.

Infrapopliteal Artery Occlusive Disease: An Overview of Vessel Preparation and Treatment Options.

Critical limb ischemia (CLI) is defined as chronic rest pain and/or the presence of tissue loss (ulcers or gangrene) in the lower extremities secondary to ischemia. CLI is a limb and potentially life-threatening disease associated with a poor prognosis with only 50% of patients being able to preserve both limbs within 12 months of diagnosis. CLI related to diabetes is often more extensive with multi-level long segmental arterial disease resulting in a 5-30-fold increased rate of amputation. As the incidence and prevalence of diabetes mellitus increases within our aging society, the rate of infrapopliteal artery occlusive disease (IPOD) and the need for intervention rises with it. The aim of this manuscript is to provide the reader with an overview of the various devices available for vessel preparation (VP) and treatment of IPOD in order to optimize patency rates, symptom resolution, healing of wounds, and minimize complications.

Three-Dimensional Printing for Procedure Rehearsal/Simulation/Planning in Interventional Radiology.

With the advances in affordable three-dimensional (3D) printing technology, 3D reconstruction and patient-specific 3D printed models are establishing a crucial role in the field of medicine for both educational purposes and procedural planning. 3D printed models provide physicians with increased 3D perception and tactile feedback, and enable a team-based approach to operational planning. However, performing an effective 3D reconstruction requires an in-depth understanding of the software features to accurately segment and reconstruct the human anatomy of interest from preacquired image data from multiple modalities such as computer tomography, 3D angiography and magnetic resonance imaging, and the different 3D printers/materials available in the market today. Increased understanding of this technology may benefit radiologists by developing techniques and tricks specific to interventional radiology and establishing a criterion to determine when to use these. Thus, the purpose of this manuscript is to provide physicians with an update on currently available 3D reconstruction software as well as printers and materials. Our initial experience using this technology is introduced based on a specific case of developing a 3D printed aorta for a patient with severe stenosis of the abdominal aorta.

Clinical Assessment of Peripheral Arterial Disease in the Office: What Do the Guidelines Say?

Lower extremity peripheral arterial disease (PAD) is the manifestation of atherosclerotic disease within the lower extremities. The presentation of PAD is diverse ranging from asymptomatic disease to claudication or to debilitating rest pain, nonhealing ulcers, and gangrene. PAD is associated with significant morbidity, mortality, and healthcare costs. Proper diagnosis and management of PAD is important so as to maintain quality of life and reduce the risk of cardiovascular disease and adverse limb events such as amputation. This document provides a comprehensive outpatient approach to the clinical assessment of PAD that includes risk factors, diagnosis, treatment, and follow-up options.

Robotic en bloc first-rib resection for Paget-Schroetter disease, a form of thoracic outlet syndrome: technique and initial results.

OBJECTIVE: First-rib resection is a key component of the treatment of Paget-Schroetter disease. There are many controversies regarding the management of this disease. We report a safe, effective, minimally invasive robotic transthoracic approach for resection of the first rib. METHODS: Over an 8-month period, five patients underwent robotic first-rib resection. Preoperative assessment included physical examination and bilateral venous angiography. On a thoracoscopic platform using three 2-cm incisions and one 1-cm incision, the robot was used to dissect the first rib and divide the scalene muscles. Success of the first-rib resection was assessed by postoperative venous angiography. RESULTS: There were four men and one woman. Mean age was 34.6 ± 10 years. Mean operative time was 195 ± 24.6 minutes. There were no complications and no mortality. All patients had a patent subclavian vein on the postoperative venogram and were anticoagulated with warfarin for 3 months. At a median follow-up of 12 months, all patients had an open subclavian vein for a patency rate of 100%. CONCLUSIONS: Robotic thoracoscopic first-rib resection represents a feasible minimally invasive approach to en bloc resection of the first rib. This technique minimizes the risk of neurovascular complications that are associated with conventional techniques.