RESUMEN
What was the educational challenge?The complexity and variability of cross-sectional imaging present a significant challenge in imparting knowledge of radiologic anatomy to medical students.What was the solution?Recent advancements in three-dimensional (3D) segmentation and augmented reality (AR) technology provide a promising solution. These advances allow for the creation of interactive, patient-specific 3D/AR models which incorporate multiple imaging modalities including MRI, CT, and 3D rotational angiography can help trainees understand cross-sectional imaging.How was the solution implemented?To create the model, DICOM files of patient scans with slice thicknesses of 1 mm or less are exported to a computer and imported to 3D Slicer for registration. Once registered, the files are segmented with Vitrea software utilizing thresholding, region growing, and edge detection. After the creation of the models, they are then imported to a web-based interactive viewing platform and/or AR application.What lessons were learned that are relevant to a wider global audience?Low-resource 3D/AR models offer an accessible and intuitive tool to teach radiologic anatomy and pathology. Our novel method of creating these models leverages recent advances in 3D/AR technology to create a better experience than traditional high and low-resource 3D/AR modeling techniques. This will allow trainees to better understand cross-sectional imaging.What are the next steps?The interactive and intuitive nature of 3D and AR models has the potential to significantly improve the teaching and presentation of radiologic anatomy and pathology to a medical student audience. We encourage educators to incorporate 3D segmentation models and AR in their teaching strategies.
Asunto(s)
Realidad Aumentada , Radiología , Humanos , Programas Informáticos , Radiografía , Radiología/educación , Aprendizaje , Modelos AnatómicosRESUMEN
Chyluria is characterized by chyle in the urinary tract and often presents as milky-white urine. We present a case of chyluria from a lymphatic malformation in a 13-year-old boy diagnosed using dynamic intranodal contrast-enhanced magnetic resonance (MR) lymphangiography. This report demonstrates the utility of intranodal lymphangiography and interstitial lymphatic embolization to treat a pediatric patient presenting with persistent chyluria. Glue migration into the urinary collecting system is a potential complication of this procedure that can be mitigated by adjusting the n-butyl cyanoacrylate dilution with Lipiodol.
Asunto(s)
Quilo , Embolización Terapéutica , Enfermedades Renales , Vasos Linfáticos , Adolescente , Niño , Humanos , Linfografía , Masculino , OrinaRESUMEN
BACKGROUND: Stroke is a feared complication of cardiac surgery. Modern clot-retrieval techniques provide effective treatment for large vessel occlusion (LVO) strokes. The purpose of this study was to 1) report the incidence of LVO stroke after cardiac surgery at a large academic center, and 2) describe outcomes of postoperative LVO strokes. METHODS: All patients experiencing stroke within 30 days after undergoing cardiac surgery at a single center in 2014-2018 were reviewed. LVOs were identified through review of imaging and medical records, and their characteristics and clinical courses were examined. RESULTS: Over the study period, 7,112 cardiac surgeries, including endovascular procedures, were performed. Acute ischemic stroke within 30 days after surgery was noted in 163 patients (2.3%). Among those with a stroke, 51/163 (31.3%) had a CTA or MRA, and 15/163 (9.2%) presented with LVO stroke. For all stroke patients, the median time from surgery to stroke was 2 days (interquartile range, IQR, 0-6 days), and for patients with LVO, the median time from surgery to stroke was 4 days (IQR 0-6 days). The overall rate of postoperative LVO was 0.2% (95% CI 0.1-0.4%), though only 6/15 received thrombectomy. LVO patients receiving thrombectomy were significantly more likely to return to independent living compared to those managed medically (n = 4/6, 66.6% for mechanical thrombectomy vs. n = 0/9, 0% for medical management, P = .01). Of the 9 patients who did not get thrombectomy, 6 may currently be candidates for thrombectomy given new expanded treatment windows. CONCLUSIONS: The rate of LVO after cardiac surgery is low, though substantially elevated above the general population, and the majority do not receive thrombectomy currently. Patients receiving thrombectomy had improved neurologic outcomes compared to patients managed medically. Optimized postoperative care may increase the rate of LVO recognition, and cardiac surgery patients and their caregivers should be aware of this effective therapy.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Accidente Cerebrovascular Isquémico/terapia , Trombectomía , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Estado Funcional , Humanos , Incidencia , Vida Independiente , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/epidemiología , Accidente Cerebrovascular Isquémico/fisiopatología , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Trombectomía/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate endovascular treatment of head and neck arteriovenous malformations (AVMs) based on the Yakes AVM classification and correlate treatment approach with clinical and angiographic outcomes. MATERIALS AND METHODS: A retrospective single-center study was performed in patients who underwent endovascular treatment of head and neck AVMs between January 2005 and December 2017. Clinical and operative records, imaging, and postoperative courses of patients were reviewed. Clinical stage was determined according to the Schobinger classification. AVM architecture and treatment approaches were determined according to the Yakes classification. Primary outcomes were clinical and angiographic treatment success rates and complication rates, with analysis according to the Yakes classification. RESULTS: A total of 29 patients (15 females) were identified, with a mean age of 30.6 years. Downgrading of the Schobinger clinical classification was achieved in all patients. Lesions included 8 Yakes type IIa, 5 type IIb, 1 type IIIa and IIIb, and 14 type IV. Lesions were treated using an intra-arterial, nidal, or transvenous approach, using ethanol and liquid embolic agents. Arteriovenous shunt eradication of >90% was achieved in 22 of 28 patients (79%), including 9 of 13 (69%) of Yakes type IV lesions and 13 of 15 (87%) of the other types. There were 5 significant complications in 79 procedures (6%), including 4 of 50 (8%) in Yakes type IV lesions. CONCLUSIONS: Schobinger stage was downgraded in all patients. Arteriovenous shunt eradication of >90% was achieved in most patients. Yakes type IV lesions required more sessions, and shunt eradication was higher in the Yakes II and III groups.
Asunto(s)
Malformaciones Arteriovenosas/terapia , Embolización Terapéutica , Procedimientos Endovasculares , Etanol/administración & dosificación , Cabeza/irrigación sanguínea , Cuello/irrigación sanguínea , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Malformaciones Arteriovenosas/clasificación , Malformaciones Arteriovenosas/diagnóstico por imagen , Niño , Preescolar , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Etanol/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To characterize burnout, as defined by high emotional exhaustion (EE) or depersonalization (DP), among interventional radiologists using a validated assessment tool. MATERIALS AND METHODS: An anonymous 34-question survey was distributed to interventional radiologists. The survey consisted of demographic and practice environment questions and the 22-item Maslach Burnout Inventory-Human Services Survey (MBI). Interventional radiologists with high scores on EE (≥ 27) or DP (≥ 10) MBI subscales were considered to have a manifestation of career burnout. RESULTS: Beginning on January 7, 2019, 339 surveys were completed over 31 days. Of respondents, 263 (77.6%) identified as male, 75 (22.1%) identified as female, and 1 (0.3%) identified as trans-male. The respondents were interventional radiology attending physicians (298; 87.9%), fellows (20; 5.9%), and residents (21; 6.2%) practicing at academic (136; 40.1%), private (145; 42.8%), and hybrid (58; 17.1%) centers. Respondents worked < 40 hours (15; 4.4%), 40-60 hours (225; 66.4%), 60-80 hours (81; 23.9%), and > 80 hours (18; 5.3%) per week. Mean MBI scores for EE, DP, and personal achievement were 30.0 ± 13.0, 10.6 ± 6.9, and 39.6 ± 6.6. Burnout was present in 244 (71.9%) participants. Identifying as female (odds ratio 2.4; P = .009) and working > 80 hours per week (odds ratio 7.0; P = .030) were significantly associated with burnout. CONCLUSIONS: Burnout is prevalent among interventional radiologists. Identifying as female and working > 80 hours per week were strongly associated with burnout.
Asunto(s)
Actitud del Personal de Salud , Agotamiento Profesional/etiología , Conocimientos, Actitudes y Práctica en Salud , Médicos Mujeres/psicología , Radiografía Intervencional , Radiólogos/psicología , Carga de Trabajo/psicología , Adulto , Agotamiento Profesional/diagnóstico , Agotamiento Profesional/psicología , Despersonalización/etiología , Despersonalización/psicología , Humanos , Persona de Mediana Edad , Distrés Psicológico , Factores de Riesgo , Factores Sexuales , Encuestas y Cuestionarios , Factores de TiempoAsunto(s)
Carcinoma Hepatocelular , Criocirugía , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugíaRESUMEN
PURPOSE: To determine if stent placement across the renal vein inflow affects kidney function and renal vein patency. METHODS: Between June 2008 and September 2016, 93 patients (mean age 39 years, range 15-70; 54 women) with iliocaval occlusion underwent venous stent placement and were retrospectively reviewed. For this analysis, the patients were separated into treatment and control groups: 51 (55%) patients had suprarenal and infrarenal iliocaval venous disease requiring inferior vena cava stent reconstruction across the renal vein inflow (treatment group) and 42 (45%) patients had iliac vein stenting sparing the renal veins (control group). Treatment group patients received Wallstents (n=15), Gianturco Z-stents (n=24), or suprarenal and infrarenal Wallstents such that the renal veins were bracketed with a "renal gap" (n=12). Stenting technical success, stent type, glomerular filtration rate (GFR), and creatinine before and after stent placement were recorded, along with renal vein patency and complications. RESULTS: All procedures were technically successful. In the 51-patient treatment group, 15 (29%) patients received Wallstents and 24 (47%) received Gianturco Z-stents across the renal veins, while 12 (24%) were given a "renal gap" with no stent placement directly across the renal vein inflow. In the control group, 42 patients received iliac vein Wallstents only. Mean prestent GFR was 59±1.8 mL/min/1.73 m2 and mean prestent creatinine was 0.8±0.2 mg/dL for the entire cohort. Mean prestent GFR and creatinine values in the Wallstent, Gianturco Z-stent, and "renal gap" subgroups did not differ from the iliac vein stent group. Mean poststent GFR and creatinine values were 59±3.3 mL/min/1.73 m2 and 0.8±0.3 mg/dL, respectively. There were no differences between mean pre- and poststent GFR (p=0.32) or creatinine (p=0.41) values when considering all patients or when comparing the treatment subgroups and the control group. There were no differences in the poststent mean GFR or creatinine values between the Wallstent (p=0.21 and p=0.34, respectively) and Gianturco Z-stent (p=0.43 and p=0.41, respectively) groups and the "renal gap" group. One patient with a Wallstent across the renal veins developed right renal vein thrombosis 7 days after the procedure. CONCLUSION: Stent placement across the renal vein inflow did not compromise renal function. A very small risk of renal vein thrombosis was seen.
Asunto(s)
Angioplastia de Balón/instrumentación , Venas Renales/fisiopatología , Stents , Enfermedades Vasculares/terapia , Grado de Desobstrucción Vascular , Adolescente , Adulto , Anciano , Angioplastia de Balón/efectos adversos , Biomarcadores/sangre , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Venas Renales/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/fisiopatología , Trombosis de la Vena/etiología , Adulto JovenRESUMEN
PURPOSE: To report types and outcomes of a small subset of malpractice lawsuits filed against physicians performing image-guided interventions in the United States. MATERIALS AND METHODS: In total, 1,312 cases involving common image-guided procedures were reviewed from the Westlaw and LexisNexis databases in the United States from 1963 to 2018. Social Security, disability, employment contract, product liability, criminal, and government employment claims were excluded. The final legal cohort comprised 184 (14.0%) cases. They were categorized into vascular (113/184; 61.4%), inferior vena cava filter (n = 22; 12.0%), neurointerventional (n = 13; 7.1%), gastrointestinal and genitourinary (n = 17; 9.2%), foreign body (n = 7; 3.8%), biopsy related (n = 9; 4.9%), and oncologic (n = 3; 1.6%) interventions. Claims were also organized by defendant type and by specialty, complication stage, verdict, and year. RESULTS: From 2001 to 2018, 58.7% of claims (n = 108) were reported. Procedural complications related to arteriography were most commonly litigated (63/113; 55.8%). Claims arising from intra-procedural and early post-procedural complications were common (84/184; 45.7%). Community hospitals were most often named as defendants (61/184; 33.2%). In reported outcomes, courts sided with defendants in 81.9% (104/127) of the cases, similar to national malpractice trends. Unreported outcomes comprised 31% (57/184) of the data. CONCLUSIONS: For the small subset of claims published within national legal databases, intra-procedural and early post-procedural complications after diagnostic arteriography were most commonly litigated. Most (81.9%) claims with reported outcomes sided with the defendant physician.
Asunto(s)
Biopsia Guiada por Imagen/efectos adversos , Responsabilidad Legal , Mala Praxis/legislación & jurisprudencia , Seguridad del Paciente/legislación & jurisprudencia , Radiografía Intervencional/efectos adversos , Radiólogos/legislación & jurisprudencia , Bases de Datos Factuales , Humanos , Medición de Riesgo , Factores de RiesgoRESUMEN
The aim of this study was to report the technical success, adverse events, clinical outcomes, and long-term stent patency of iliocaval stent reconstruction for naïve, non-inferior vena cava (IVC) filter-related, chronic iliocaval thrombosis. A total of 69 patients, including 47 (68%) men, with a mean age of 36 years (range: 8-71 years), underwent first-time iliocaval stent reconstruction for non-IVC filter-associated iliocaval thrombosis. The mean number of prothrombotic risk factors was 2.2 (range: 0-5), including 30 (43%) patients with IVC atresia. Upon initial presentation, the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification was C3 in 55 (80%) patients, C4 in four (5.8%) patients, C5 in one (1.4%) patient, and C6 in seven (10%) patients. Technical aspects of stent reconstruction, technical success, adverse events, 2-week and 6, 12, and 24-month clinical response, and 6, 12, and 24-month primary, primary-assisted, and secondary stent patency rates were recorded. Technical success was defined as recanalization and stent deployment. Adverse events were reported according to the Society of Interventional Radiology classification system. Clinical success was defined as a 1-point decrease in CEAP classification and stent patency was defined by the Cardiovascular and Interventional Radiological Society guidelines. The technical success rate was 100%. There were 352 venous stents deployed during stent reconstructions. One (1.4%) severe, four (5.8%) moderate, and four (5.8%) minor adverse events occurred and median post-procedure hospitalization was 1 day (range: 1-45 days). Clinical success at 2 weeks and 6, 12, and 24 months was 76%, 85%, 87%, and 100%, respectively. The estimated 6, 12, and 24-month primary patency rates were 91%, 88%, and 62%, respectively. The estimated 6, 12, and 24-month primary-assisted patency rates were 98%, 95%, and 81%, respectively. The estimated 6, 12, and 24-month secondary-assisted patency rates were all 100%. In conclusion, iliocaval stent reconstruction is an effective treatment for non-IVC filter-associated chronic iliocaval thrombosis with high rates of technical success, clinical responses, and stent patency.
Asunto(s)
Angioplastia de Balón/instrumentación , Vena Ilíaca , Stents , Vena Cava Inferior , Trombosis de la Vena/terapia , Adolescente , Adulto , Anciano , Angioplastia de Balón/efectos adversos , Niño , Enfermedad Crónica , Angiografía por Tomografía Computarizada , Femenino , Humanos , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Masculino , Persona de Mediana Edad , Flebografía/métodos , Diseño de Prótesis , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Terapia Trombolítica , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/fisiopatología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/fisiopatología , Adulto JovenRESUMEN
Omental artery aneurysms are a unique subset of splanchnic artery aneurysms that are associated with intraperitoneal hemorrhage and high mortality rates. Detecting omental artery aneurysms prior to rupture is especially challenging; as such there are limited data surrounding unruptured aneurysms. Various methods of treating ruptured omental artery aneurysms have been previously described including omentectomy and transcatheter arterial embolization. Because of the mortality rate associated with ruptures, elective intervention in unruptured splanchnic artery aneurysms is recommended regardless of their size. This report details the successful embolization of an unruptured omental artery aneurysm utilizing a percutaneous approach.
Asunto(s)
Aneurisma/terapia , Embolización Terapéutica/métodos , Arteria Gastroepiploica/diagnóstico por imagen , Aneurisma Ilíaco/terapia , Epiplón/irrigación sanguínea , Anciano , Aneurisma/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Cianoacrilatos , Fluoroscopía , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Masculino , PuncionesRESUMEN
Gastric varices are a common manifestation of portal hypertension and are associated with a high rate of mortality and rebleeding. Balloon-occluded retrograde transvenous obliteration (BRTO) is a commonly used method to sclerose gastric varices and has a high clinical success. Common complications following BRTO include portal or splenic vein thrombosis, systemic sclerosant extravasation, pulmonary emboli, and inferior vena cava thrombosis. This report describes a patient with vascular plug migration into the left pulmonary artery with subsequent endovascular retrieval.
Asunto(s)
Oclusión con Balón/efectos adversos , Remoción de Dispositivos/métodos , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares , Várices Esofágicas y Gástricas/cirugía , Migración de Cuerpo Extraño/cirugía , Hemorragia Gastrointestinal/terapia , Arteria Pulmonar/cirugía , Dispositivos de Cierre Vascular , Angiografía de Substracción Digital , Angiografía por Tomografía Computarizada , Várices Esofágicas y Gástricas/diagnóstico , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/fisiopatología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/fisiopatología , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico , Hipertensión Portal/fisiopatología , Masculino , Persona de Mediana Edad , Presión Portal , Arteria Pulmonar/diagnóstico por imagen , Resultado del TratamientoRESUMEN
The Angio-Seal vascular closure device is used to reduce time to hemostasis after femoral artery puncture. Although rare, complications associated with Angio-Seal are significant, including infection, pseudoaneurysm formation, symptomatic femoral artery stenosis, and separation and embolization, leading to limb-threatening ischemia. This report describes Angio-Seal polymer anchor embolization to the tibioperoneal trunk successfully retrieved using the 8-French Indigo Aspiration System.
Asunto(s)
Malformaciones Arteriovenosas/terapia , Cateterismo Periférico , Remoción de Dispositivos/métodos , Arteria Femoral , Migración de Cuerpo Extraño/terapia , Mano/irrigación sanguínea , Técnicas Hemostáticas/efectos adversos , Claudicación Intermitente/terapia , Isquemia/terapia , Trombectomía/métodos , Dispositivos de Cierre Vascular/efectos adversos , Cateterismo Periférico/efectos adversos , Femenino , Arteria Femoral/diagnóstico por imagen , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Técnicas Hemostáticas/instrumentación , Humanos , Claudicación Intermitente/diagnóstico por imagen , Claudicación Intermitente/etiología , Isquemia/diagnóstico por imagen , Isquemia/etiología , Punciones , Succión , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Endovascular stent reconstruction is the standard of care for chronic venous occlusive disease in adults, but it has not been reported in pediatric patients. OBJECTIVE: This study reports the technical success, complications, clinical outcomes, and stent patency of iliocaval stent reconstruction for chronic iliocaval thrombosis in pediatric patients. MATERIALS AND METHODS: Fourteen patients, 13 (93%) male with a mean age of 16.4 years (range: 8-20 years), underwent iliocaval stent reconstruction for chronic iliocaval thrombosis. The mean number of prothrombotic risk factors was 2.5 (range: 0-4), including 7 (50%) patients with inferior vena cava atresia. At initial presentation, the Clinical, Etiology, Anatomy, and Pathophysiology classification (CEAP) score was C3 in 2 (14%) patients, C4 in 11 (79%) patients, and C6 in 1 (7.1%) patient. Time course of presenting symptoms included chronic (>4 weeks) (n=7; 50%) and acute worsening of chronic symptoms (2-4 weeks) (n=7; 50%). Aspects of recanalization and reconstruction, stenting technical success, complications, clinical outcomes and stent patency were recorded. Clinical success was defined as a 1-point decrease in the CEAP. Primary, primary-assisted, and secondary patency were defined by Cardiovascular and Interventional Radiological Society of Europe guidelines. RESULTS: Most procedures employed three access sites (range: 2-4). Intravascular ultrasound was employed in 11 (79%) procedures. Blunt and sharp recanalization techniques were used in 12 (86%) and 2 (14%) patients, respectively. Stenting technical success was 100%. Two (14%) minor adverse events occurred and mean post-procedure hospitalization was 2.8 days (range: 1-8 days). Clinical success rates at 2 weeks, 6 months and 12 months were 85%, 82%, and 83%, respectively. At a mean final clinical follow-up of 88 months (range: 16-231 months), clinical success was 93%. Estimated 6- and 12-month primary stent patencies were 86% and 64%, respectively. Six- and 12-month primary-assisted and secondary stent patency rates were both 100%. CONCLUSION: Iliocaval stent reconstruction is an effective treatment for symptomatic chronic iliocaval thrombosis in pediatric patients with high rates of technical success, 6- and 12-month clinical success, and 6- and 12-month primary-assisted and secondary patency rates.
Asunto(s)
Procedimientos Endovasculares , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Stents , Trombosis de la Vena/cirugía , Adolescente , Angiografía de Substracción Digital , Niño , Angiografía por Tomografía Computarizada , Femenino , Humanos , Extremidad Inferior/diagnóstico por imagen , Masculino , Flebografía , Grado de Desobstrucción Vascular , Trombosis de la Vena/clasificación , Trombosis de la Vena/diagnóstico por imagen , Adulto JovenRESUMEN
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) placement has been extensively studied in adults. The experience with TIPS placement in pediatric patients, however, is limited. OBJECTIVE: The purpose of this study was to report technical success and clinical outcomes in pediatric patients undergoing TIPS placement. MATERIALS AND METHODS: Twenty-one children - 12 (57%) boys and 9 (43%) girls, mean age 12.1 years (range, 2-17 years) - underwent TIPS placement from January 1997 to January 2017. Etiologies of hepatic dysfunction included biliary atresia (n=5; 24%), cryptogenic cirrhosis (n=4; 19%), portal or hepatic vein thrombosis (n=4, 14%), autosomal-recessive polycystic kidney disease (n=3; 14%), primary sclerosing cholangitis (n=2; 10%) and others (n=3, 14%). Indications for TIPS placement included variceal hemorrhage (n=20; 95%) and refractory ascites (n=1; 5%). Technical success, manometry findings, stent type, hemodynamic success, complications, liver enzymes, and clinical outcomes were recorded. RESULTS: TIPS placement was technically successful in 20 of 21 (95%) children, with no immediate complications. Mean pre- and post-TIPS portosystemic gradient was 18.5±10.7 mmHg and 7.1±3.9 mmHg, respectively. Twenty-two total stents were successfully placed in 20 children. Stents used included: Viatorr (n=9; 41%), Wallstent (n=7; 32%), Express (n=5; 23%), and iCAST (n=1; 5%). All children had resolution of variceal bleeding or ascites. TIPS revision was required in 9 (45%) children, with a mean of 2.2 revisions. Hepatic encephalopathy developed in 10 children (48%), at a mean of 223.7 days following TIPS placement. During the study, 6 (29%) children underwent liver transplantation. CONCLUSION: TIPS placement in pediatric patients has high technical success with excellent resolution of variceal hemorrhage and ascites. TIPS revision was required in nearly half of the cohort, with hepatic encephalopathy common after shunt placement.
Asunto(s)
Derivación Portosistémica Intrahepática Transyugular , Radiografía Intervencional , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Embolización Terapéutica , Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Masculino , Humanos , Próstata/diagnóstico por imagen , Próstata/irrigación sanguínea , Hiperplasia Prostática/diagnóstico por imagen , Hiperplasia Prostática/terapia , Análisis Costo-Beneficio , Arterias , Resultado del Tratamiento , Síntomas del Sistema Urinario Inferior/terapiaRESUMEN
This report describes the use of laser ablation for treatment of chronic enterocutaneous fistulae (ECFs) after failure of conservative therapy. Three patients underwent laser ablation for treatment of 8 ECFs. Mean duration of fistula patency was 28 months with mean fistula output of 134 mL/day. The initial technical success was 100% with no major or minor complications. Three ECFs required repeat treatment. At mean follow-up of 53 days, 7 of the fistulae were occluded. One fistula showed a markedly reduced output of 10 mL/day.
Asunto(s)
Fístula Intestinal/cirugía , Terapia por Láser/métodos , Enfermedad Crónica , Femenino , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Masculino , Persona de Mediana Edad , Reoperación , Resultado del TratamientoRESUMEN
PURPOSE: To characterize the interventional radiology Twitter network by analyzing tweets bearing the #IRad hashtag. MATERIALS AND METHODS: A total of 61,055 consecutive tweets bearing the hashtag #IRad composed by 5,704 Twitter users from January 8, 2015 to October 13, 2017 were analyzed. Twitter analytics, including activity metrics, content analysis, user characteristics, engagement, and network analysis, were obtained with the use of Symplur Signals, a health care social media analytics platform. RESULTS: The number of tweets bearing the #IRad hashtag, the number of users, and the number of impressions increased by 124%, 76%, and 102%, respectively, over the past year. Regarding tweet content, 4,571 tweets (7.5%) reported new or innovative topics and 4,040 tweets (6.6%) pertained to patients; 19,409 (31.8%) tweets contained at least 1 image and 15,245 tweets (25.0%) included links to websites or journals. Embolization, ablation, and stent placement were commonly discussed topics. Endoscopy, transarterial chemoembolization, uterine artery embolization, and prostate artery embolization discussions were trending more commonly. As for engagement, there were 39,953 retweets (65.4%), 50,452 mentions (82.6%), and 1,704 replies (2.8%). Physicians and patients authored 29,182 (47.8%) and 127 (0.8%) tweets, respectively. Network analysis demonstrated advocate, provider, and media organizations, and physicians as the most active participants using the #IRad hashtag on Twitter. CONCLUSIONS: The use of the #IRad hashtag by interventional radiologists is growing rapidly, with the majority of discussions involving medical professionals and medical-related organizations.
Asunto(s)
Radiología Intervencionista , Medios de Comunicación Sociales , HumanosRESUMEN
OBJECTIVE: The objective of our study was to report the technique, complications, and clinical outcomes of interventional radiology-operated cholecystoscopy with stone removal for the management of symptomatic cholelithiasis. MATERIALS AND METHODS: Ten (77%) men and three (23%) women (mean age, 65 years) with symptomatic cholelithiasis underwent cholecystostomy followed by interventional radiology-operated cholecystoscopy with stone removal. Major comorbidities precluding cholecystectomy included prior cardiac, pulmonary, or abdominal surgery; cirrhosis; sepsis with hyponatremia; seizure disorder; developmental delay; and cholecystoduodenal fistula. Cholecystostomy access, time between cholecystostomy and cholecystoscopy, endoscopic and fragmentation devices used, technical success, procedure time, fluoroscopy time, complications, length of hospital stay, time between cholecystoscopy and cholecystostomy removal, follow-up, and acute cholecystitis recurrence were recorded. RESULTS: Eleven (85%) patients underwent transhepatic cholecystostomy, and two (15%) patients underwent transperitoneal cholecystostomy. The mean time from cholecystostomy to cholecystoscopy was 151 days. Flexible endoscopy was used in eight (62%) patients, rigid endoscopy in three (23%), and both flexible and rigid in two (15%). Electrohydraulic lithotripsy was used in eight procedures, nitinol baskets in seven, ultrasonic lithotripsy in two, and percutaneous thrombectomy devices in one. Primary technical success was achieved in 11 (85%) patients, and secondary technical success was achieved in 13 (100%) patients. The mean procedure time was 164 minutes, and the mean number of procedures required to clear all gallstones was 1. One (8%) patient developed acute pancreatitis, and one (8%) patient died of gastrointestinal hemorrhage. The median hospital length of stay after cholecystoscopy was 1 day for postoperative monitoring. The mean time between cholecystoscopy and cholecystostomy removal was 39 days. One (8%) patient developed recurrent acute cholecystitis 1095 days after cholecystoscopy. CONCLUSION: Interventional radiology-operated cholecystoscopy may serve as an effective method for percutaneous gallstone removal in patients with multiple comorbidities precluding cholecystectomy.
Asunto(s)
Colecistitis Aguda/cirugía , Colecistostomía/métodos , Endoscopía del Sistema Digestivo , Radiografía Intervencional , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Recurrencia , Resultado del TratamientoRESUMEN
BACKGROUND: To report approach, technical success, safety, and short-term outcomes of thoracic duct stent-graft reconstruction for the treatment of chylothorax. METHODS: Two patients, 1 (50%) male and 1 (50%) female, with mean age of 38 years (range: 16-59 years) underwent endolymphatic thoracic duct stent-graft reconstruction between September 2016 and July 2017. Patients had radiographic left-sided chylothoraces (n = 2) from idiopathic causes (n = 1) and heart transplantation (n = 1). In both (100%) patients, antegrade lymphatic access was used to opacify the thoracic duct after which retrograde access was used for thoracic duct stent-graft placement. Pelvic lymphangiography technical success, antegrade cisterna chyli cannulation technical success, thoracic duct opacification technical success, retrograde thoracic duct access technical success, thoracic duct stent-graft reconstruction technical success, ethiodized oil volume, contrast volume, estimated blood loss, procedure time, fluoroscopy time, radiation dose, clinical success, complications, deaths, and follow-up were recorded. RESULTS: Pelvic lymphangiography, antegrade cisterna chyli cannulation, thoracic duct opacification, retrograde thoracic duct access, and thoracic duct stent-graft reconstruction were technically successful in both (100%) patients. Mean ethiodized oil volume was 8 mL (range: 5-10 mL). Mean contrast volume was 13 mL (range: 5-20 mL). Mean estimated blood loss was 13 mL (range: 10-15 mL). Mean fluoroscopy time was 50.4 min (range: 31.2-69.7 min). Mean dose area product and reference air kerma were 954.4 µGmy2 (range: 701-1,208 µGmy2) and 83.5 mGy (range: 59-108 mGy), respectively. Chylothorax resolved in both (100%) patients. There were no minor or major complications directly related to the procedure. CONCLUSIONS: Thoracic duct stent-graft reconstruction may be a technically successful and safe alternative to thoracic duct embolization, disruption, and surgical ligation for the treatment of chylothorax. Additional studies are warranted.
Asunto(s)
Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Quilotórax/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Stents , Conducto Torácico/cirugía , Adolescente , Quilotórax/diagnóstico por imagen , Quilotórax/fisiopatología , Angiografía por Tomografía Computarizada , Femenino , Humanos , Linfografía/métodos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Conducto Torácico/diagnóstico por imagen , Conducto Torácico/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization. METHODS: Two (66%) men and 1 (33%) woman with mean age of 52 years (range: 14-79 years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017. Patients presented with chylous ascites (n = 3) and with renal cell carcinoma after left nephrectomy and lymph node dissection (n = 1), metastatic Merkel cell carcinoma after left nephrectomy and adrenalectomy (n = 1), and heart transplantation after failed Fontan procedure (n = 1). Pelvic lymphangiography technical successes, complications, radiation dose, contrast volume, clinical response, and follow-up were recorded. RESULTS: Pelvic lymphangiography and BORAL were technically successful in 3 (100%) patients. BORALE was attempted in 2 (66%) patients and was technically successful in both patients (100%). No minor or major complications occurred. Mean radiation dose was 1,037 mGy (range: 391-2,264 mGy). Mean contrast was 83 mL (range: 25-150 mL). Mean blood loss was 15 mL (range: 5-30 mL). Chylous ascites resolved in all 3 (100%) patients. CONCLUSIONS: BORAL and BORALE provide a rational and effective approach for the diagnosis and treatment of patients with chylous ascites and previously unidentifiable leakage site or failed lymphatic embolization.