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1.
J Am Coll Radiol ; 16(5S): S214-S226, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31054748

RESUMO

Venous thromboembolism (VTE)-deep vein thrombosis and pulmonary embolism-is a common cause of morbidity and mortality. The mainstay of VTE prophylaxis and therapy is anticoagulation. In select patients with VTE, inferior vena cava (IVC) filters are used to prevent pulmonary embolism by trapping emboli as they pass from the lower extremity venous system through the IVC. These guidelines review the indications for placement of IVC filters in acute and chronic VTE, as well as the indications for retrieval of implanted IVC filters. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

2.
J Endourol Case Rep ; 4(1): 108-110, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30065957

RESUMO

This retrospective study presents three consecutive patients who underwent bilateral ureteral occlusion using the Amplatzer vascular plugs and N-butyl cyanoacrylate glue sandwich method. The patients were 63- and 65-year-old males and a 79-year-old female. Indications for the procedure included severe cystitis and complex vesicular fistulas unresponsive to urinary diversion. All three patients had immediate resolution of urinary leakage, resulting in symptom relief throughout the follow-up period. There were no procedure-related complications or side effects.

3.
J Am Coll Radiol ; 14(11S): S506-S529, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29101989

RESUMO

Obtaining central venous access is one of the most commonly performed procedures in hospital settings. Multiple devices such as peripherally inserted central venous catheters, tunneled central venous catheters (eg, Hohn catheter, Hickman catheter, C. R. Bard, Inc, Salt Lake City UT), and implantable ports are available for this purpose. The device selected for central venous access depends on the clinical indication, duration of the treatment, and associated comorbidities. It is important for health care providers to familiarize themselves with the types of central venous catheters available, including information about their indications, contraindications, and potential complications, especially the management of catheters in the setting of catheter-related bloodstream infections. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Radiografia Intervencionista/métodos , Medicina Baseada em Evidências , Humanos , Sociedades Médicas , Estados Unidos
4.
J Am Coll Radiol ; 14(11S): S530-S539, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29101990

RESUMO

Iliac artery occlusive disease can present as a sudden-onset acute thrombotic or thromboembolic event or as a chronic progressive atherosclerotic process that presents as claudication progressing to rest pain. Depending on the clinical presentation, the diagnosis is usually confirmed through Doppler vascular ultrasound, CT angiography, or MR angiography; the choice of imaging is usually based on modality availability and the presence of patient comorbidities such as chronic kidney disease. The Trans-Atlantic Inter-Society Consensus II classification system is commonly used to describe the extent of the peripheral vascular disease. Depending on the pathophysiology, clinical presentation, and radiologic extent of the disease process, therapeutic options for acute thrombotic cases can include supportive care, anticoagulation, thrombolytic therapy, surgical or catheter-directed mechanical thrombectomy, and surgical bypass. Therapeutic options for atherosclerotic disease include supportive measures such as behavior modification, a supervised exercise program, adjunctive treatment with anticoagulation and antiplatelet medications, angioplasty, stent placement, stent-graft placement, surgical or catheter-directed endarterectomy or plaque excision, and surgical bypass. This document describes the appropriateness of imaging in this patient population, treatment procedures for specific clinical scenarios, and the likely prognosis for these patients. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Artéria Ilíaca , Medicina Baseada em Evidências , Humanos , Prognóstico , Sociedades Médicas , Estados Unidos
5.
J Vasc Interv Radiol ; 28(10): 1432-1437.e3, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28757285

RESUMO

PURPOSE: To develop a new adverse event (AE) classification for the interventional radiology (IR) procedures and evaluate its clinical, research, and educational value compared with the existing Society of Interventional Radiology (SIR) classification via an SIR member survey. MATERIALS AND METHODS: A new AE classification was developed by members of the Standards of Practice Committee of the SIR. Subsequently, a survey was created by a group of 18 members from the SIR Standards of Practice Committee and Service Lines. Twelve clinical AE case scenarios were generated that encompassed a broad spectrum of IR procedures and potential AEs. Survey questions were designed to evaluate the following domains: educational and research values, accountability for intraprocedural challenges, consistency of AE reporting, unambiguity, and potential for incorporation into existing quality-assurance framework. For each AE scenario, the survey participants were instructed to answer questions about the proposed and existing SIR classifications. SIR members were invited via online survey links, and 68 members participated among 140 surveyed. Answers on new and existing classifications were evaluated and compared statistically. Overall comparison between the two surveys was performed by generalized linear modeling. RESULTS: The proposed AE classification received superior evaluations in terms of consistency of reporting (P < .05) and potential for incorporation into existing quality-assurance framework (P < .05). Respondents gave a higher overall rating to the educational and research value of the new compared with the existing classification (P < .05). CONCLUSIONS: This study proposed an AE classification system that outperformed the existing SIR classification in the studied domains.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde/normas , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/normas , Radiologia Intervencionista/normas , Humanos , Sociedades Médicas
11.
Urology ; 71(2): 181-4, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18308078

RESUMO

OBJECTIVES: To assess SAPE as an alternative treatment option in patients with refractory hematuria of prostatic origin. METHODS: A retrospective analysis of charts from 10 patients. Two patients were excluded from the analysis because of severe atherosclerotic disease that prevented selective angiography of the pelvic vasculature. Therefore, 8 patients, mean age of 78.3 +/- 7.1 years with a history of refractory hematuria of prostatic origin were analyzed. All patients failed conventional therapy. The selective embolization procedures were performed between 2000 and 2006. Success was monitored with postembolization angiography and cessation of hematuria clinically. RESULTS: Of the 8 patients, 6 had a history of adenocarcinoma of the prostate (mean Gleason Grade 7, range 5 to 9); 4 were previously treated with external beam radiation. The remaining patient's histories were consistent with benign prostatic hypertrophy. SAPE was technically successful in all 8 patients and resulted in immediate cessation of gross hematuria. Mean follow-up postembolization was 20.0 months (range 1.5 to 86.3 months). One patient had gross hematuria develop 14 months after embolization that was attributed to a bladder tumor recurrence. One patient with T4 prostate cancer had a rectovesical fistula develop 1 month after embolization. CONCLUSIONS: SAPE results in cessation of refractory gross hematuria in patients with benign prostate hyperplasia and patients with prostate cancer previously treated with radiotherapy. SAPE may be considered an effective treatment for gross hematuria in patients with refractory hematuria regardless of the cause (radiation, cancer and/or hyperplasia).


Assuntos
Adenocarcinoma/complicações , Embolização Terapêutica/métodos , Hematúria/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/complicações , Neoplasias da Próstata/complicações , Idoso , Artérias , Hematúria/etiologia , Humanos , Masculino , Estudos Retrospectivos
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