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2.
J Am Coll Radiol ; 12(5): 501-6, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25703699

RESUMEN

Given the changing climate of health care and the imperative to add value, radiologists must join forces with the rest of medicine to deliver better patient care in a more cost-effective, evidence-based manner. For several decades, interventional radiology has added value to the health care system through innovation and the provision of alternative and effective minimally invasive treatments, which have decreased morbidity, mortality, and overall cost. The clinical practice of interventional radiology embodies many of the features of Imaging 3.0, the program recently launched by the ACR. We provide a review of some of the major contributions made by interventional radiology and offer general principles from that experience, which are applicable to all radiologists.


Asunto(s)
Atención a la Salud/normas , Guías de Práctica Clínica como Asunto , Garantía de la Calidad de Atención de Salud/normas , Radiografía Intervencional/normas , Radiología Intervencionista/normas , Estados Unidos
3.
Semin Intervent Radiol ; 30(3): 223-4, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24436542
4.
Semin Intervent Radiol ; 30(3): 240-4, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24436545

RESUMEN

The basic neurologic history and exam for the interventional radiologist performing intracranial procedures need not be exhaustive and will not supplant that by neurologic specialist. It should include a pertinent history, focused neurologic exam, and a brief physical exam. The interventional radiologist should be familiar with the grading scales commonly used for patients with intracranial pathology to understand the severity and prognosis of various pathologies. The goal of the examination is to mitigate risk, direct the evaluation, aid in medical decision making, and allow the establishment of an appropriate physician-patient relationship.

5.
Semin Intervent Radiol ; 30(3): 249-62, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24436547

RESUMEN

A majority of the population will experience epistaxis at some time in their life. Most cases will be from an anterior source and can be treated with pressure, anterior nasal packing, or cautery. Intractable epistaxis is generally posterior in origin and may require endoscopic cautery, posterior packing, surgical ligation, or embolization. Embolization has been used to treat epistaxis for more than 30 years and success can be achieved in approximately 90% of patients, with major complications occurring in approximately 2%. These excellent results require thorough knowledge of the regional anatomy, familiarity with the equipment and various agents used to achieve this type of embolization, as well as attention to detail and meticulous technique. There remains debate on several aspects of embolization, including the agent of choice, preferred size of the embolic, and the number of vessels to embolize. Advances in endoscopic surgery have evolved to the point that similar success rates for embolization and modern surgical techniques in treating epistaxis may be expected. This detailed review of pertinent vascular anatomy, embolization technique, and surgical alternatives should allow practitioners to formulate treatment algorithms that result in optimal outcomes at their institutions.

6.
Semin Intervent Radiol ; 30(3): 263-77, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24436548

RESUMEN

Preoperative endovascular tumor embolization has been used for 40 years. Meningiomas are the most common benign intracranial tumor in which preoperative embolization has been most extensively described in the literature. Advocates of embolization report that it reduces operative blood-loss, and softens the tumor, thus making surgery safer and easier. Opponents suggest that it adds additional risk and cost for patients without controlled studies showing conclusive benefit. The literature suggests a 3 to 6% neurological complication rate related to embolization. The combined external and internal carotid artery blood supply and complex anastomoses of the meninges can make embolization challenging. Positive outcomes require thorough knowledge of the pertinent vascular anatomy, familiarity with the neurovascular equipment and embolics, and meticulous technique. There remains debate on several aspects of embolization, including tumors most appropriate for embolization, embolic agent of choice, ideal size of embolic, and the choice of vessel(s) to embolize. This detailed review of pertinent vascular anatomy, embolization technique, results, and complications should allow practitioners to maximize treatment outcomes in this setting.

7.
Semin Intervent Radiol ; 30(3): 282-7, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24436550

RESUMEN

Acute ischemic stroke is a leading cause of death and the leading cause of disability in the United States. Cerebral neuronal death begins within minutes after threshold values of blood oxygen saturation are crossed. Prompt restoration of oxygenated blood flow into ischemic tissue remains the common goal of reperfusion strategies. This article provides a brief overview of acute ischemic stroke, a summary of the major intra-arterial stroke therapy trials, and comments on current training requirements for the performance of intra-arterial therapies.

8.
Semin Intervent Radiol ; 30(3): 307-17, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24436553

RESUMEN

Chronic low back pain is a common clinical condition. Percutaneous fluoroscopic-guided interventions are safe and effective procedures for the management of chronic low back pain, which can be performed in an outpatient setting. Interventional radiologists already possess the technical skills necessary to perform these interventions effectively so that they may be incorporated into a busy outpatient practice. This article provides a basic approach to the evaluation of patients with low back pain, as well as a review of techniques used to perform the most common interventions using fluoroscopic guidance.

10.
Tech Vasc Interv Radiol ; 15(2): 144-9, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22640503

RESUMEN

Chronic cerebrospinal venous insufficiency (CCSVI) has recently been implicated as a potential causal factor in the development of multiple sclerosis (MS). The treatment of jugular and azygous vein stenoses, characteristic of CCSVI, has been proposed as a potential component of therapy for MS. In the few short years since Dr. Paulo Zamboni published "A Prospective Open label Study of Endovascular Treatment of Chronic Cerebrospinal Venous Insufficiency", there has been tremendous patient-driven demand for treatment. Concurrently, there have been numerous publications since 2009 addressing CCSVI and its association with MS. The purpose of this article is to present a brief review of CCSVI and its association with MS and to review the available literature to date with a focus on outcomes data.


Asunto(s)
Venas Cerebrales/cirugía , Procedimientos Endovasculares/mortalidad , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Médula Espinal/irrigación sanguínea , Insuficiencia Venosa/mortalidad , Insuficiencia Venosa/cirugía , Enfermedad Crónica , Humanos , Prevalencia , Medición de Riesgo , Médula Espinal/cirugía , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del Tratamiento
11.
J Am Coll Radiol ; 8(5): 318-24, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21531307

RESUMEN

Interventional radiology (IR) is a vital component of diagnostic imaging (DI). The Society of Interventional Radiology has long held that the practice of IR should be clinical in nature, with dedicated clinical time, space, and infrastructure. The ACR has recognized the necessity of the clinical practice of IR. The cost to DI groups and hospitals of providing clinical IR is substantial. A willingness to invest in the creation or maintenance of a clinical IR service should be based on the value such an investment may provide. The author presents a 2-fold assessment of the value of IR. A review of the intangible value of IR to DI groups and facilities follows the presentation of an algorithm that ascribes a tangible, financial value to the provision of clinical IR services. The author provides an example of this algorithm applied to a mature, clinical IR practice. The author's assertion is that this value is compelling justification to warrant support of clinical IR. Additionally, the author's hope is that the utilization of this algorithm may allow DI groups to determine the financial value of clinical IR in their own settings.


Asunto(s)
Algoritmos , Costos de la Atención en Salud/estadística & datos numéricos , Modelos Económicos , Radiografía Intervencional/economía , Simulación por Computador , Análisis Costo-Beneficio , Estados Unidos
12.
Cardiovasc Intervent Radiol ; 34(3): 536-41, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20556384

RESUMEN

The design of laser fibers used for endovenous laser ablation (EVLA) in the management of lower-extremity varicose vein disease may affect treatment success. The purpose of this investigation is to report our experience using the gold-tip NeverTouch VenaCure laser fiber (AngioDynamics, Queensbury, NY) and to compare that to our experience with standard bare-tip fibers. A retrospective chart review of 363 consecutive EVLA treatments using the gold-tip laser fiber was performed. Demographic data including patient age, sex, history of previous varicose vein stripping, vein identity, laterality, treatment length, total applied energy in joules (J), use of adjuvant sclerotherapy and ambulatory phlebectomy, treatment-related complications, and treatment failure, which was defined as recanalization of any portion of the treated vein during follow-up as assessed by duplex ultrasound examination-were entered into a spreadsheet. These data were compared with a control group of 471 EVLA treatments performed with a standard bare-tip laser fiber. Data were analyzed using independent-samples Student's t test, chi-square test, and multivariate analysis. Demographic data were similar between the two groups. Treatments with the gold-tip fiber had a failure rate of 11.1%, whereas treatment with a bare-tip fiber had a failure rate of 2.3% during a similar follow-up period. This difference was highly statistically significant (p<0.0001). Multivariate analysis showed fiber type as the most significant factor associated with treatment failure. We conclude that laser fiber design has a significant effect on treatment success in the performance of EVLA.


Asunto(s)
Terapia por Láser/instrumentación , Pierna/irrigación sanguínea , Vena Safena , Várices/terapia , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Diseño de Equipo , Femenino , Humanos , Terapia por Láser/efectos adversos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Estudios Retrospectivos , Escleroterapia , Insuficiencia del Tratamiento , Resultado del Tratamiento
13.
Med Health R I ; 92(12): 394-7, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20066826

RESUMEN

DVT and PE contribute to at least 100,000 deaths each year. In addition, 4% of patients with PE will progress to CTEPH and PTS will affect nearly 30%. Anticoagulation alone appears inadequate to prevent PTS in many patients. Newer treatment strategies, including PCDT, appear to offer the possibility of reducing the pain, suffering and expense of PTS especially in the most severe cases. The NIH/NHLBI sponsored the ATTRACT trial, which will compare PCDT plus standard anticoagulation versus standard anticoagulation alone in patients with proximal DVT. The ATTRACT trial will enroll patients at both Miriam and RI Hospitals and is expected to add significantly to the research in this area. When successfully completed, results from the trial may guide therapy in the years ahead.


Asunto(s)
Angioplastia de Balón , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Trombosis de la Vena/terapia , Anticoagulantes/uso terapéutico , Humanos , Embolia Pulmonar/epidemiología , Factores de Riesgo , Terapia Trombolítica/instrumentación , Estados Unidos/epidemiología , Trombosis de la Vena/epidemiología
16.
J Vasc Interv Radiol ; 19(10): 1449-53, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18760628

RESUMEN

PURPOSE: To assess the relationship between energy density and the success of endovenous laser ablation (EVLA) treatment. MATERIALS AND METHODS: A total of 586 EVLAs were performed in a period of 35 months. Retrospective chart review was performed, and data collected included the patients' age, sex, and history of venous stripping procedures, as well as the name, laterality, and length of the treated vein segment(s) and the total energy delivered. Energy density was calculated by dividing total energy delivered (in J) by the length of vein (in cm). Energy density selection was based on the treating interventionalist's preference. Ablated segments were grouped into those treated with less than 60 J/cm, 60-80 J/cm, 81-100 J/cm, and more than 100 J/cm. Failure of EVLA was defined by recanalization of any portion of the treated vein during follow-up as assessed by duplex Doppler ultrasound examination. Failure rates were compared with the chi(2) test and Wilcoxon rank-sum test. RESULTS: A total of 471 segments were included in the analysis with an average follow-up period of 5 months (range, 0.2-28.7 months). Overall, 11 failures were encountered, including four in the group treated with less than 60 J/cm (n = 109; 4%), two in the 60-80-J/cm group (n = 77; 3%), four in the 81-100-J/cm group (n = 169; 3%), and one in the group treated with more than 100 J/cm (n = 116; 1%). There was no statistically significant difference in failure rates among energy density ranges. CONCLUSION: EVLA has a low failure rate that is not affected by energy density.


Asunto(s)
Terapia por Láser/métodos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Insuficiencia Venosa/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Persona de Mediana Edad , Dosis de Radiación , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
17.
Surg Oncol Clin N Am ; 17(4): 957-85, xii, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18722928

RESUMEN

Selective internal radiation therapy involves the intra-arterial delivery of radioactive beads to the tumor while minimizing dosing to the adjacent organ. Because this technique invariably results in some degree of embolization, it has also been termed radioembolization. More than 8000 patients have been treated worldwide, with a large body of experience with primary hepatocellular carcinoma (HCC) and metastatic colorectal carcinoma (MCRC) and growing experience with other tumors (metastatic neuroendocrine, breast carcinoma, cholangiocarcinoma). Response rates by FDG-PET are 80% to 90%. Complications are uncommon and most often consist of self-limited malaise. More significant complications, including radiation-induced liver disease, ischemic cholecystitis, and gastrointestinal ulceration may be seen in up to 10% of patients. This underscores the critical importance of patient selection and meticulous technique. Median survival times in patients who have HCC and MCRC are significantly improved compared with historic controls. Further study is required to determine the appropriate role of radioembolization in the context of state-of-the-art chemotherapy and other liver-directed therapies.


Asunto(s)
Quimioembolización Terapéutica/métodos , Quimioterapia del Cáncer por Perfusión Regional/métodos , Neoplasias/radioterapia , Radiofármacos/administración & dosificación , Radioterapia/métodos , Ensayos Clínicos como Asunto , Humanos , Radioisótopos de Itrio/administración & dosificación
18.
J Vasc Interv Radiol ; 19(5): 639-44, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18440449

RESUMEN

PURPOSE: Traditionally, surgeons have served as primary consultants for patients with peripheral vascular disease for whom revascularization is considered. An important component of care for patients with peripheral artery disease (PAD) is risk factor management. The present study was undertaken to determine current management practices of interventional radiologists for patients with PAD and compare them to published data for vascular surgeons. If PAD patient management practices are similar, this would support direct referral of PAD patients who are considered for revascularization from primary care doctors to interventional radiologists. MATERIALS AND METHODS: An online survey was administered to full members of the Society of Interventional Radiology with e-mail addresses on file. Filtering was done to examine and compare interactions among several responses. The margin of error for the survey was +/-2%, based on 95% CIs for the entire surveyed population (N=2,371). RESULTS: Seventy-five percent of respondents see PAD patients in ambulatory office settings. Only eight percent see themselves as the physician responsible for risk factor management, similar to reported results of vascular surgeons (10%). Other variables examined, such as frequency of inquiring about Framingham risk factors, indicate similar practices to those previously reported for vascular surgeons. CONCLUSIONS: For interventional radiologists who accept direct referrals for medical management of patients with PAD, disease management by interventional radiologists is similar to that previously reported for vascular surgeons. This supports the role of interventional radiologists who accept direct referrals of patients with PAD as primary consultants to primary care doctors.


Asunto(s)
Enfermedades Vasculares Periféricas/terapia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Radiografía Intervencional , Atención Ambulatoria/estadística & datos numéricos , Humanos , Enfermedades Vasculares Periféricas/cirugía , Derivación y Consulta/estadística & datos numéricos , Gestión de Riesgos , Encuestas y Cuestionarios , Estados Unidos
20.
J Vasc Interv Radiol ; 18(1 Pt 1): 127-31, 2007 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17296713

RESUMEN

Uncontrolled acute menorrhagia resulting in hemodynamic instability in the adolescent is uncommon. We report a case of life-threatening menorrhagia upon first menses in a 12-year-old girl who was successfully treated with uterine artery embolization after failure of standard gynecologic and medical measures. Testing eventually revealed a coagulopathy that resulted from decreased plasminogen activator inhibitor-1 activity in combination with an immature hypothalamic-pituitary-ovarian axis. Coagulation disorders are more common in patients presenting with severe menorrhagia upon menarche. Interventional radiologists should be aware of such coagulation abnormalities and the differences between adults and adolescents when contemplating uterine artery embolization for adolescent patients.


Asunto(s)
Trastornos de la Coagulación Sanguínea/diagnóstico , Embolización Terapéutica , Menorragia/terapia , Hemorragia Uterina/terapia , Útero/irrigación sanguínea , Trastornos de la Coagulación Sanguínea/complicaciones , Niño , Diagnóstico Diferencial , Femenino , Humanos , Menarquia , Menorragia/etiología , Inhibidor 1 de Activador Plasminogénico/deficiencia , Ultrasonografía , Útero/diagnóstico por imagen , Útero/patología
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