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1.
Can Assoc Radiol J ; 71(1): 68-74, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32062990

RESUMO

PURPOSE: Cone-beam computed tomography (CBCT) in interventional radiology allows volumetric imaging with open patient access. This work aimed to assess radiation dose metrics of CBCT in simulated image-guided retrograde gastrostomy (IGRG) tube insertions in pediatric anthropomorphic phantoms and to compare them to measured radiation dose metrics obtained using fluoroscopy during clinical IGRG tube insertions in children. METHODS: Radiation dose indices obtained from radiation dose structured reports of fluoroscopic IGRG tube insertions were retrospectively evaluated in a consecutive cohort of 30 children. Dose indices were fractionated into 3 clinical stages for each procedure (planning, insertion, and confirmation). These 3 stages in 30 patients (3 × 30 = 90 patient stages) were compared to dose indices measured from 4 CBCT acquisition protocols acquired in pediatric phantoms. RESULTS: The mean proportion of radiation dose during planning, insertion, and confirmation was 35%, 38% and 27%, with mean reference-point air kerma (range) measured to be 1.0 (0.02-6.0) mGy, 0.9 (0.03-4.1) mGy, and 0.7 (0.04-3.7) mGy, respectively. Cone-beam computed tomography dose varied greatly depending on technical parameters and protocol selection, ranging from 0.7 to 39.3 mGy. In 19% of patient stages, the most dose-sparing CBCT protocol evaluated on phantoms delivered less radiation than the radiation dose indices recorded from patient's fluoroscopy. CONCLUSIONS: From a dosimetric perspective, radiation delivered in CBCT can vary widely, yet can be appreciably low. With appropriate CBCT protocol selection, the radiation dose delivered may be sufficiently low to warrant consideration for use, if clinically needed during difficult IGRG tube insertions, and satisfy the interventionalist's benefit-risk assessment.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Gastrostomia/métodos , Radiografia Intervencionista , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Fluoroscopia , Humanos , Lactente , Masculino , Imagens de Fantasmas , Doses de Radiação , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 99(1): e18627, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895821

RESUMO

To study the safety and efficacy of fluoroscopic removal of self-expandable metallic stent for airway stenosis.We conducted a retrospective analysis of 67 consecutive patients, 39 male and 28 female, who underwent fluoroscopic stent removal from March 2011 to April 2017. The patients ranged in age from 12 to 85 years. Seventy-six airway stents were implanted, 70 covered stents and 6 bare stents, including 9 stents for second stent implantation after removal. All patients underwent chest computed tomography scans with/without bronchoscopy before stent removal. The indication of stent removal and postinterventional complications were analyzed retrospectively.Seventy-four of 76 airway stents were successfully removed, only 2 stent showed retained struts after removal, for a technical success rate of 97.4%. Two patients died of complications (1 hemorrhage and 1 respiratory failure), resulting in a clinical success rate of 94.7%. Five stents showed strut fracture and the remaining 71 stents were removed in 1 piece. Indications for stent removal include planned removal (n = 40), excessive granulation tissue (n = 15), intolerance of stenting (n = 6), inadequate expansion and deformation (n = 5), stent migration (n = 5), replacement of bare stent (n = 4), and strut fracture (n = 1). There were 17 complications of stent removal: death from massive bleeding (n = 1), restenosis requires stenting (n = 9), strut fracture or residue (n = 5), dyspnea requires mechanical ventilation (n = 2). The survival rates were 83.8%, 82.1%, and 82.1% for 0.5, 3, and 6 years.Fluoroscopic removal of airway stent is technically feasible and effective. Stents are recommended for removal within 3 months for treating airway stenosis.


Assuntos
Broncopatias/terapia , Remoção de Dispositivo/métodos , Radiografia Intervencionista/mortalidade , Stents , Estenose Traqueal/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Remoção de Dispositivo/mortalidade , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Artigo em Japonês | MEDLINE | ID: mdl-31956188

RESUMO

PURPOSE: It is very important to manage the radiation dose of cardiovascular interventional (CVI) procedures. Overseas, the diagnostic reference levels for cardiac interventional procedures were established with the air kerma at the patient entrance reference point (Ka,r) and the air kerma-area product (PKA). Although the Japan DRLs 2015 was established by the Japan Network for Research and Information on Medical Exposure (J-RIME), the Japan DRL for CVIs were established by fluoroscopic dose rates of 20 mGy/min at the patient entrance reference point with 20 cm thickness polymethyl methacrylate (PMMA) phantom. In the present our study, we performed a questionnaire survey of indicated values of angiographic parameters in CVI procedures. METHODS: A nationwide questionnaire was sent by post to 765 facilities. Question focused on angiographic technology, exposure parameters and radiation doses as the displayed dosimetric parameters on the angiographic machine. RESULTS: The recovery rate was 22.8% at 175 out of 765 facilities. In total 1728 cases of the coronary angiography (CAG), 1703 cases of the percutaneous coronary intervention (PCI), 962 cases of the radiofrequency catheter ablation (RFCA) and 377 cases of pediatric CVI. The 75th percentile value of Ka,r, PKA, fluoroscopy time (FT) and number of cine images (CI) for CAG, PCI, RFCA and pediatric CVI were 702, 2042, 644, and 159 mGy, respectively, 59.3, 152, 81.3, and 14.9 Gy・cm2, respectively, 10.2, 35.6, 61.1, and 35.6 min, respectively and 1503, 2672, 722, and 2378 images, respectively. Our investigation showed that the angiographic parameters were different in several CVI procedures. CONCLUSIONS: The displayed dosimetric parameters on the angiographic machine in CVI procedures showed different values. We should classify the dosimetric parameters for each procedure.


Assuntos
Intervenção Coronária Percutânea , Doses de Radiação , Exposição à Radiação , Criança , Fluoroscopia , Humanos , Japão , Radiografia Intervencionista , Inquéritos e Questionários
4.
Vasc Endovascular Surg ; 54(3): 240-246, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31928203

RESUMO

PURPOSE: To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. METHODS: Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients' demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients' electronic medical records. RESULTS: The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. CONCLUSION: The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure.


Assuntos
Angiomiolipoma/terapia , Embolização Terapêutica/instrumentação , Doença Iatrogênica , Neoplasias Renais/terapia , Artéria Renal , Lesões do Sistema Vascular/terapia , Adulto , Angiomiolipoma/diagnóstico por imagem , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Artéria Renal/diagnóstico por imagem , Artéria Renal/lesões , Estudos Retrospectivos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Adulto Jovem
5.
Vasc Endovascular Surg ; 54(3): 233-239, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31957599

RESUMO

Industry has long fought the battle to design a vascular catheter that is less thrombogenic. Indwelling catheters provide long-term central venous access, but they develop fibrin sheaths as the vascular system recognizes them as foreign bodies. Peripheral catheters and central catheters can be changed over a guidewire when they form a fibrin sheath or otherwise malfunction. However, totally implantable venous access devices such as a port cannot be easily exchanged over a wire. Therefore, when a port malfunctions, thrombolytics are usually the only option attempted before the port is explanted and a new site is prepared for access. We present a minimally invasive technique demonstrating port salvage that does not require explant.


Assuntos
Obstrução do Cateter/etiologia , Cateterismo Periférico/métodos , Cateteres de Demora , Falha de Equipamento , Fibrina , Dispositivos de Acesso Vascular , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Resultado do Tratamento
6.
J Stroke Cerebrovasc Dis ; 29(2): 104495, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31806453

RESUMO

BACKGROUND AND AIM: Accurate anesthesia management is of great importance for the success of interventional neuroangiographic procedures (INPs). General anesthesia with endotracheal intubation is the most commonly preferred anesthetic method for these procedures. However, whether laryngeal mask airway (LMA) anesthesia is a suitable and safe option for such cases is unclear. The aims of this study were to report the outcomes of anesthetic management in patients who underwent INP, and to compare endotracheal intubation with LMA anesthesia in terms of anesthesia-related outcomes. METHODS: Data of patients who underwent INP under general anesthesia at interventional neuroangiography unit were retrospectively evaluated. RESULTS: A total of 105 patients with a mean age of 52.9 years were included in the study. All procedures were performed under general anesthesia with using endotracheal tube (n = 79, 75.2%) or laryngeal mask (n = 26, 24.8%). Anesthesia-related complications, including respiratory (laryngospasm,bronchospasm, and desaturation) and circulatory (disrhythmia, hypotension, hypertension), were observed in 20 (19.1%) patients. The 2 airway instruments were similar in age, gender, diagnosis, American Society of Anesthesiologist score, mallampati score, duration of procedure, and duration of anesthesia (P > .05). Anesthesia-related complications were more common in LMA group compared with patients who were intubated using endotracheal tube (P = .003). CONCLUSIONS: Anesthesia management in INPs carries many challenges for anesthesiologists, due to the need of exact immobility during the procedure and potential procedure-related risks such as vasculary perforation and bleeding. General anesthesia using endotracheal intubation seems to be more secure, in comparison to LMA anesthesia.


Assuntos
Anestesia Geral/instrumentação , Transtornos Cerebrovasculares/terapia , Tubos Torácicos , Procedimentos Endovasculares , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Radiografia Intervencionista , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Transtornos Cerebrovasculares/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
7.
Radiol Med ; 125(1): 24-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31531810

RESUMO

PURPOSE: The increasing number of computed tomography (CT) performed allows the more frequent identification of small, solid pulmonary nodules or ground-glass opacities. Video-assisted thoracic surgery (VATS) represents the standard in most lung resections. However, since VATS limit is the digital palpation of the lung parenchyma, many techniques of nodule localization were developed. The aim of this study was to determine the feasibility and safety of CT-guided microcoil insertion followed by uniportal VATS wedge resection (WR). MATERIALS AND METHODS: Retrospective study in a single institution, including patients undergone CT-guided microcoil insertion prior to uniportal VATS resection between May 2015 and December 2018. The lesion was identified using fluoroscopy. RESULTS: Forty-six consecutive patients were enrolled (22 male and 24 female). On CT: 5 cases of GGO, 2 cases of semisolid nodules, 39 cases of solid nodules. The median pathologic tumor size was 1.21 cm. Neither conversion to thoracotomy nor microcoil dislodgement was recorded. All patients underwent uniportal VATS WR (9/46 underwent completion lobectomy after frozen section). WR median time was 105 min (range 50-150 min). No patients required intraoperative re-resection for positive margins. After radiological procedure, 1 case of hematoma and 2 cases of pneumothorax were recorded. Four complications occurred in the postoperative period. The mean duration of chest drain and length of stay were 2.9 and 4.6 days, respectively. CONCLUSIONS: CT-guided microcoil insertion followed by uniportal VATS resection was a safe and feasible procedure having a minimal associated complications rate and offering surgeons the ease of localization of small intrapulmonary nodules.


Assuntos
Marcadores Fiduciais , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/cirurgia , Radiografia Intervencionista/métodos , Cirurgia Torácica Vídeoassistida , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Duração da Cirurgia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adulto Jovem
8.
World Neurosurg ; 133: e443-e447, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526885

RESUMO

BACKGROUND: S1 transforaminal epidural steroid injection (S1-TFESI) results in positive clinical outcomes for the treatment of pain associated with the S1 nerve root. S1-TFESI via the transforaminal approach is commonly performed under fluoroscopic guidance. Ultrasound guidance is an alternative to mitigate radiation exposure. However, performing spinal procedures under ultrasound guidance has some limitations in confirming the position of the needle tip and vascular uptake. New techniques are therefore needed to make ultrasound and fluoroscopy complementary. Our objective was to describe a novel technique for S1-TFESI and confirm its reproducibility. METHODS: Records of patients with S1 radiculopathy were reviewed retrospectively; those treated using the new S1-TFESI technique were selected. Initially, ultrasound was used to distinguish anatomy of the sacral foramen and guide initial placement of the needle entry point. Fluoroscopy was subsequently used to confirm needle tip position and vascular injection. The number of times the needle required reinsertion was recorded, and ultrasound and C-arm images were stored. RESULTS: Sixty-seven S1-TFESIs were performed in 56 patients. All injections exhibited epidural spread of contrast media, not only to the S1 nerve. The cephalad angle was 16.25 ± 6.75° (range, 5-27°), the oblique angle was 2.48 ± 2.62° (range, 0-7°), and the mean number of attempts was 1.24 ± 1.25. CONCLUSIONS: The new technique, involving the use of ultrasound to guide initial placement of the needle entry point, followed by confirmatory imaging and any needed adjustment with the use of fluoroscopy, can be a technique to complement the shortcomings of using ultrasound or fluoroscopy alone.


Assuntos
Corticosteroides/administração & dosagem , Fluoroscopia/métodos , Injeções Epidurais/métodos , Bloqueio Nervoso/métodos , Radiculopatia/tratamento farmacológico , Radiografia Intervencionista/métodos , Ultrassonografia de Intervenção/métodos , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Meios de Contraste , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sacro , Adulto Jovem
9.
World Neurosurg ; 133: e197-e204, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31491572

RESUMO

OBJECTIVE: To evaluate the functional connectivity (FC) and resting-state networks (RSNs) in patients under anesthesia operated for resection of intracerebral lesions. METHODS: We performed intraoperative resting-state functional magnetic resonance imaging (irs-fMRI) in 24 patients under anesthesia before and after lesion resection. Correlation matrices were established for each session (a total 48 of sessions). We analyzed the changes in overall FC and in FC of the healthy and operated hemispheres between the first and second sessions. We tested the correlation between changes in FC and clinical outcomes and the duration, rate, and total dosage of anesthesia. We also performed a group analysis to detect topographic changes in RSNs in patients under anesthesia. A single-subject analysis was performed to detect clinically relevant RSNs in each patient. RESULTS: FC decreased significantly in the second session, as did interhemispheric connectivity. The decrease in the pathological hemisphere was significant and significantly greater than the decrease in the intrahemispheric connectivity of the healthy hemisphere. The change in FC was not correlated with clinical outcome or with the duration, rate, or dosage of anesthesia. Group analysis showed topographic changes in RSNs, especially in high-level networks such as default mode and salience networks. Identification of clinically relevant networks was also possible. CONCLUSIONS: FC and RSNs could be identified under anesthesia and used for extended brain mapping. Further studies are needed to optimize the depth of hypnosis to stabilize FC between sessions.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Conectoma/métodos , Glioma/diagnóstico por imagem , Hemangioma Cavernoso/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neuronavegação/métodos , Radiografia Intervencionista/métodos , Cirurgia Assistida por Computador , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/cirurgia , Pré-Escolar , Feminino , Glioma/cirurgia , Hemangioma Cavernoso/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Eur Radiol ; 30(1): 588-599, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31418086

RESUMO

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the diagnostic outcomes and complication rates and to identify potential covariates that could influence these results for computed tomography (CT)-guided core needle biopsy (CNB) of mediastinal masses. METHODS: A computerized search of the PubMed and EMBASE databases was performed to identify original articles on the use of CT-guided CNB for mediastinal mass. The pooled proportions of the diagnostic yield and accuracy were assessed using random effects modeling. We assessed the pooled proportion of complication rates using random effects or fixed effects modeling. Multivariate meta-regression analyses were performed to evaluate the potential sources of heterogeneity. RESULTS: Eighteen eligible studies (1310 patients with 1345 CT-guided CNBs) were included. The pooled proportions of the diagnostic yield and accuracy of CT-guided CNB for mediastinal masses were 92% (18 studies, 1345 procedures) and 94% (15 studies, 803 procedures), respectively. In the subgroup analysis, the pooled proportions of the total complication rate and major complication rate were 13% and 2%, respectively. In the meta-regression analyses, the number of tissue samplings (odds ratio [OR], 3.3; p = 0.03), real-time fluoroscopy-guided (OR, 2.1; p = 0.02), and percentage of lymphoma (OR, 2.2; p < 0.001) for diagnostic yield, number of tissue samplings (OR = 2.0, p = 0.02) for diagnostic accuracy, and biopsy needle diameter (OR, 2.5; p = 0.002) for total complication rate were all sources of heterogeneity. CONCLUSIONS: CT-guided CNB for mediastinal mass demonstrates high diagnostic outcomes and low complication rates. The use of 20-gauge biopsy needles and obtaining ≥ 3 samples may be recommended to improve diagnostic outcomes and decrease complication rates. KEY POINTS: • The pooled estimates of diagnostic yield and accuracy of computed tomography (CT)-guided core needle biopsy (CNB) for mediastinal masses are 92% and 94%, respectively. • The pooled estimates of the total complication rate and major complication rate were 13% and 2%, respectively. • The use of a 20-gauge needle and ≥ 3 tissue samplings are recommended for CT-guided mediastinal CNB to achieve high diagnostic outcomes and lower complication rates.


Assuntos
Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Mediastino/diagnóstico por imagem , Mediastino/patologia , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos
13.
Br J Radiol ; 93(1108): 20190866, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860329

RESUMO

OBJECTIVE: This systematic review and meta-analysis investigated risk factors for pneumothorax following CT-guided percutaneous transthoracic lung biopsy. METHODS: A systematic search of nine literature databases between inception to September 2019 for eligible studies was performed. RESULTS: 36 articles were included with 23,104 patients. The overall pooled incidence for pneumothorax was 25.9% and chest drain insertion was 6.9%. Pneumothorax risk was significantly reduced in the lateral decubitus position where the biopsied lung was dependent compared to a prone or supine position [odds ratio (OR):3.15]. In contrast, pneumothorax rates were significantly increased in the lateral decubitus position where the biopsied lung was non-dependent compared to supine (OR:2.28) or prone position (OR:3.20). Other risk factors for pneumothorax included puncture site up compared to down through a purpose-built biopsy window in the CT table (OR:4.79), larger calibre guide/needles (≤18G vs >18G: OR 1.55), fissure crossed (OR:3.75), bulla crossed (OR:6.13), multiple pleural punctures (>1 vs 1: OR:2.43), multiple non-coaxial tissue sample (>1 vs 1: OR 1.99), emphysematous lungs (OR:3.33), smaller lesions (<4 cm vs 4 cm: OR:2.09), lesions without pleural contact (OR:1.73) and deeper lesions (≥3 cm vs <3cm: OR:2.38). CONCLUSION: This meta-analysis quantifies factors that alter pneumothorax rates, particularly with patient positioning, when planning and performing a CT-guided lung biopsy to reduce pneumothorax rates. ADVANCES IN KNOWLEDGE: Positioning patients in lateral decubitus with the biopsied lung dependent, puncture site down with a biopsy window in the CT table, using smaller calibre needles and using coaxial technique if multiple samples are needed are associated with a reduced incidence of pneumothorax.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pulmão/patologia , Pneumotórax/etiologia , Tomografia Computadorizada por Raios X , Humanos , Incidência , Agulhas/efeitos adversos , Posicionamento do Paciente/métodos , Punções/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco
14.
Vasc Endovascular Surg ; 54(3): 220-224, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31884881

RESUMO

PURPOSE: For transradial interventions, most published studies report an initial Terumo Radial (TR) band placement time of 60 minutes, with gradual deflation over 30 to 90 minutes. We aimed to determine, retrospectively, whether TR band removal time could be expedited to 45 to 60 minutes, without adverse effects via an expedited single-step deflation protocol. METHODS: A total of 115 consecutive noncoronary visceral interventions that utilized TR band from September 2017 till February 2019 were retrospectively reviewed. Alternative single-step deflation protocol was utilized where the nursing staff was instructed to deflate the TR band in 1 step between 45 and 60 minutes; 79 patients (43 men, 36 women, mean age of 55.3 ± 13.6 years) underwent 115 transradial interventions. Mean procedure time was 49.8 ± 22.1 minutes, and mean fluoroscopy time was 18.5 ± 10.6 minutes. Data collected included patient demographics, procedure details, and nursing notes on complications including bleeding and reinflation of the TR band. Univariate and Multivariate analyses of independent variables were performed using a binary logistic regression model. All patients were followed up postoperatively before discharge and in clinic upon follow-up. RESULTS: The TR band was deflated at 51.3 ± 14.5 minutes, with successful removal achieved on the first attempt in 103 cases (90.3% primary technical success rate). In 12 cases, bleeding was noted upon initial deflation, secondary technical success was achieved when the band was reinflated for an additional mean time of 37.0 ± 19.1 minutes. There was 1 incidence of radial artery occlusion (0.8%) and 1 incidence of a grade 1 hematoma (0.8%). The only variable predictive of technical outcome upon initial band deflation on univariate binomial logistic regression was initial TR band removal time (P = .019). CONCLUSIONS: A single-step deflation protocol for TR band placement may be safe for nonocclusive patent hemostasis and may translate to even further shorten postprocedural hospital times for patients and cost savings for hospitals.


Assuntos
Cateterismo Periférico , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Artéria Radial , Adulto , Idoso , Cateterismo Periférico/efeitos adversos , Desenho de Equipamento , Feminino , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Artéria Radial/diagnóstico por imagem , Radiografia Intervencionista , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Radiol Med ; 125(3): 296-305, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845091

RESUMO

The advances in technology have led to a growing trend in population exposure to radiation emerging from the invention of high-dose procedures. It is, for example, estimated that annually 1.2% of cancers are induced by radiological scans in Norway. This study aims to investigate and discuss the frequency and dose trends of radiological examinations in Europe. European Commission (EC) launched projects to gain information for medical exposures in 2004 and 2011. In this study, the European Commission Radiation Protection (RP) reports No. 154 and 180 have been reviewed. The RP 154 countries' data were extracted from both reports, and the average variation trend of the number of examinations and effective doses were studied. According to the results, plain radiography and fluoroscopy witnessed a reduction in the frequency and effective dose per examination. Nevertheless, European collective dose encountered an average increase of 23%, which resulted from a growing tendency for implementation of high-dose procedures such as CT scans and interventional examinations. It is worth noting that most of the CT procedures have undergone an increase in effective dose per examination. Although demand and dose per examination in some radiological procedures (such as intravenous urography (IVU) have been reduced, population collective dose is still rising due to the increasing demand for CT scan procedures. Even though the individual risks are not considerable, it can, in a large scale, threaten the health of the people at the present time. Due to this fact, better justification should be addressed so as to reduce population exposure.


Assuntos
Exposição à Radiação/estatística & dados numéricos , Radiografia Intervencionista/tendências , Radiografia/tendências , Tomografia Computadorizada por Raios X/tendências , Europa (Continente)/epidemiologia , Fluoroscopia/estatística & dados numéricos , Fluoroscopia/tendências , Humanos , Neoplasias Induzidas por Radiação/epidemiologia , Noruega/epidemiologia , Doses de Radiação , Proteção Radiológica , Radiografia/estatística & dados numéricos , Radiografia Intervencionista/estatística & dados numéricos , Radiologia/tendências , Tomografia Computadorizada por Raios X/estatística & dados numéricos
18.
Tech Vasc Interv Radiol ; 22(4): 100634, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864529

RESUMO

Klippel-Trenaunay syndrome or KTS is a complex vascular syndrome associated with overgrowth occurring as a result of somatic mutations in the PIK3CA gene. Patients are diagnosed on the basis of physical findings, sometimes with supportive imaging, of commonly a segmental anomaly with a cutaneous port-wine stain, lymphatic and venous malformations and overgrowth. The severity of the component vascular malformations and the degree of overgrowth varies from patient to patient which demands care given by a multi-professional team with regular follow-up in a specialist clinic. Some patients may present with acute life-threatening problems, often as a result of veno-thromboembolic events (VTEs) especially following surgical and invasive radiological procedures. Awareness of such problems is vital and prophylactic measures to reduce such risks are paramount. The interventional radiologist is vital to the care team as he/she can undertake procedures including endovascular closure of significant venous anomalies which predispose to such VTEs. Although these procedures can be lengthy and complex, they can now provide a minimally invasive means to reduce the risk from life-threatening and sometimes fatal VTEs. The results however from such interventions will require long-term studies which to date are unavailable.


Assuntos
Malformações Arteriovenosas/terapia , Procedimentos Endovasculares , Síndrome de Klippel-Trenaunay-Weber/terapia , Tromboembolia Venosa/prevenção & controle , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/genética , Malformações Arteriovenosas/mortalidade , Classe I de Fosfatidilinositol 3-Quinases/genética , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Predisposição Genética para Doença , Hemangioma/diagnóstico , Hemangioma/genética , Hemangioma/terapia , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Síndrome de Klippel-Trenaunay-Weber/genética , Síndrome de Klippel-Trenaunay-Weber/mortalidade , Mutação , Fenótipo , Radiografia Intervencionista , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/genética , Tromboembolia Venosa/mortalidade
19.
Tech Vasc Interv Radiol ; 22(4): 100633, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864530

RESUMO

Arteriovenous malformations (AVMs) are fast flow malformations characterized by the presence of arteriovenous shunting. These congenital lesions can be evolutive, leading to serious complications such as bleeding, skin ulceration, and cardiac failure. The interventional radiologist plays an important role in the management of these patients. He should be involved in the clinical evaluation to make the proper diagnosis, evaluate the symptoms and potential indication for endovascular treatment. This evaluation should be done in a multidisciplinary clinic with access to plastic surgeons, internal medicine and dermatologist, as well as specific specialists that might need to be implicated (ENT surgeon in the face and neck area, for example). The Schobinger clinical classification is important to assess patient evolution and indicate intervention. We recommend to treat symptomatic or evolutive AVMs. Doppler ultrasound is the first imaging examination that should be performed. Then, MR angiography or computed tomography angiography (CTA) can be proposed depending on the anatomic area involved. Embolization is currently the first line of treatment for these patients. There is currently promising research in the identification of genetic markers and molecular target(s) but there is no recognized pharmacologic treatment for AVM available yet. Digital substraction angiography (DSA) is usually performed for guidance during the embolization session but is also essential to properly classify a specific lesion, according to its anatomy. The anatomic classifications proposed by Cho and Yakes are both useful to choose the best therapeutic approach: Endovascular, direct puncture, retrograde venous approach or a combination of these techniques. Ethanol is the most efficient agent but is at higher risk of skin necrosis and nerve injury and should therefore be used with caution in dangerous territories. Glue and Onyx are liquid agents that are also well suited to occlude the nidus; they can be used in association with ethanol. On the venous side, mechanical occlusion with coils or Amplatzer plugs is mostly used. Again, they can be used in association with a liquid agent (Ethanol, glue or Onyx) to reflux in the nidus. Surgery can be indicated to resect residual AVM following embolization if residual symptoms are present and the planned surgery is feasible, with relative safety.


Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Angiografia Digital , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/fisiopatologia , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Radiografia Intervencionista/métodos , Resultado do Tratamento
20.
J Comput Assist Tomogr ; 43(6): 892-897, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738212

RESUMO

OBJECTIVE: The objective of this study was to assess the impact of preprocedural time-out on workflow and patient safety in computed tomography (CT)-guided procedures. METHODS: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study, preprocedure time-out was assessed by an independent observer in CT-guided procedures performed from January 16, 2018, to May 15, 2018. Anonymous survey of 302 radiology team members involved in image-guided procedures about preprocedure time-out was performed using REDCap. RESULTS: Preprocedure time-out for 100 CT-guided procedures (biopsies, drainages, ablations) was observed. Procedures were recruited per observer availability and thus were nonconsecutive and nonrandom. Preprocedure time-out was performed in 100 procedures (100%). Median duration was 60 seconds (interquartile range, 60-71 seconds). Scripted checklist was followed in 52 cases (52/100, 52%). Omissions from the preprocedure time-out were identified in 40 cases (40/100, 40%) and were much more frequent when scripted checklist was not used (30/48 [63%] vs 10/52 [19%], P < 0.005). One case (1/100, 1%) was postponed due to abnormal coagulation parameters discovered during the time-out. Three cases (3/100, 3%) were delayed by 3 minutes to address other safety issues. In additional 14 cases (14/100, 14%), safety issues were raised during the time-out, which were resolved in less than 30 seconds.A total of 137 (45%) of 302 survey responses from 54 radiologists (39%), 55 technologists (40%), and 28 nurses (20%) were received. Forty-eight respondents (48/137, 35%) encountered a procedure that was cancelled or delayed as a result of information identified during time-out. Ninety-six percent (131/137) of respondents stated that time-out improves teamwork, 98% (134/137) stated that it enhances communication between the team members, and 93% (127/137) stated that it identifies and resolves problems and ambiguities. CONCLUSIONS: Scripted preprocedure time-out for CT-guided procedures takes approximately 1 minute to execute and detects safety issues in 18% of cases.


Assuntos
Lista de Checagem/métodos , Radiografia Intervencionista/métodos , Feminino , Humanos , Masculino , Segurança do Paciente , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Tomografia Computadorizada por Raios X , Fluxo de Trabalho
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