Female medical student impression of interventional radiology: what can we do to improve this?

PURPOSE: The number of female medical students has increased significantly in the last decade due to increased gender diversity. However, the number of female doctors going into interventional radiology (IR) does not reflect this trend on an international scale. METHODS: A standardized set of questions was created looking into medical students' demographics, awareness of IR, their general opinion, and whether they would consider IR as a potential career path. One-hundred female medical students from the United Kingdom, Germany, Poland, Spain, and New Zealand were approached either directly or via an online survey platform. The students ranged from first to final year study of Medicine and were between 18 and 30 years of age. RESULTS: The majority of medical students (68%) were unaware of what IR is and 98% denied having teaching about IR in their university. Influential factors to choosing IR were more exposure to IR in medical school (15%), more options to allow family life (15%), direct training pathway to IR rather than via diagnostic radiology (13%), options of private practice (13%), and understanding more about radiation protection during pregnancy (12%). CONCLUSION: A lack of awareness about what IR is and misconceptions, particularly regarding radiation exposure during pregnancy, play an important role in discouraging entry into IR. Additionally, some of the concerns raised were directed at IR training pathway. Female IR consultants should also take leadership initiative to act as role models. More lectures and direct clinical exposure are paramount to their understanding of IR.

Aortoenteric fistula after endovascular mycotic aortic aneurysm exclusion: lessons learned during the COVID-19 era.

We report a case of aortoenteric fistula 2 years following endovascular aortic aneurysm repair (EVAR) for mycotic aneurysm presenting as upper gastrointestinal bleeding. Initial CT angiogram did not reveal the bleeding or connection to bowel, but endoscopy was suspicious of endograft in the duodenum. Management required a multidisciplinary approach. To stabilise the patient and to control bleeding, a 'bridging' endograft extension was performed. This was followed by open surgical removal of the EVAR endograft and lower limb in situ revascularisation. During postoperative recovery, the patient developed atypical, staged multisystemic symptoms (cardiac, pulmonary and neurological). With increasing awareness of the COVID-19 pandemic, the patient was found SARS-CoV-2-positive, which explained the progression of his symptoms. This was also reflected on other case reports in literature later.

Technical success and outcomes using a flexible bifurcated stent graft (AorfixTM) in abdominal aortic aneurysms: a systematic review.

Introduction: The Aorfix aortic stent graft is a modular device with greater compliance and flexibility. This systematic review aims to assess the evidence regarding the technical success and outcomes of the AorfixTM stent graft.Methods: Electronic bibliographic databases were searched. We conducted our review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards.Results: This review of the 442 documented cases of AorfixTM EVAR demonstrates assisted technical success to be achieved in 97.7% of cases. The need for unplanned adjunct maneuvers was low at 9.8% and was most commonly required for resolving an intra-operative type I endoleak. The need for secondary intervention in the 1-year follow up period was even lower, at 1.3% in the same eight studies, while Malas et al reports a re-intervention rate of 7.8% at 1-year.Conclusion: The AorfixTM device has been used in AAA with highly angulated proximal necks with success, with acceptable short- and midterm results. But larger multi-center comparative studies, and registry data is needed to be to compare the safety of different stent grafts and for optimal graft selection. This will increase the likely number of patients considered suitable for EVAR.

Retroperitoneal fibrosis-the long and winding path.

Retroperitoneal fibrosis (RPF) is a rare systemic disease. Two-third of the cases are idiopathic but assumed to have autoimmune process related to IgG-4. It is often a diagnosis of exclusion due to its non-specific clinical presentation. Early manifestation commonly causes back pain, raised erythrocyte sedimentation rate level and renal impairment. Investigations of choice are MRI and contrast-enhanced CT but biopsy should be performed for diagnostic confirmation. This case report describes a delay in diagnosing RPF in a 57-year-old female who initially presented to primary care with back pain, mild anaemia, raised erythrocyte sedimentation rate and progressive renal function decline. She was seen urgently in haematology clinic who arranged bone scan to rule out osteoblastic metastases, finding demonstrated possible pelviureteric junction dysfunction. The investigation was followed by a MAG3 renogram 4 weeks later instead of an abdominal CT leading to diagnostic delay. She then presented acutely 1 day after renogram with life-threatening hyperkalaemia and AKI 3. RPF was then suspected. Renal ultrasound scan and CT scan consecutively showed bilateral gross hydronephrosis and retroperitoneal mass around the aorta. The pelviureteric junction dysfunction was due to ureters getting embedded into the dense retroperitoneal fibrous tissue. She subsequently underwent bilateral ureteric stent placement and was commenced on steroid therapy, with satisfactory outcome on follow-up. Laparoscopic retroperitoneal biopsy later confirmed the diagnosis. This case not only highlighted important learning points on the presenting features and radiographic findings of RPF, but also the clinician's cognitive biases leading to diagnostic delay of a rare but life-threatening disease.