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1.
J Vasc Interv Radiol ; 32(2): 220-225.e2, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33461874

RESUMO

PURPOSE: To evaluate the impact of a versatile flexible ceiling-mounted C-arm on active table and gantry repositioning during interventions and its effect on operator discomfort, system usability, and patient safety compared with a traditional ceiling-mounted system. MATERIALS AND METHODS: There were 100 IR procedures studied: 50 in a traditional IR system (standard group) and 50 with a novel multiaxis ceiling-mounted system (test group). FlexArm was capable of multiple gantry rotation points allowing increased access to the patient in addition to 236 cm of lateral x-ray detector travel. For each procedure, both the table and the gantry repositioning were measured. Patient safety, patient/equipment repositioning effort, and physical discomfort were evaluated through an operator survey. RESULTS: Table repositioning was reduced from 42 to 16 instances per procedure (P < .001) in the test group compared with the standard group. The operators perceived less table and gantry repositioning effort (P < .0001) and decreased risks of equipment collisions, displacement of vascular access, and dislodgment of tubes/lines with the test group (P < .0001). Operator discomfort was reduced for all body areas in the test group over the standard group (P < .0001). CONCLUSIONS: The FlexArm system geometry enhances operator ergonomics, as there was a decrease need to move the table, leading to a perceived decrease in patient risk and decrease operator physical discomfort when compared to a traditional imaging system.


Assuntos
Angiografia/instrumentação , Ergonomia , Radiografia Intervencionista/instrumentação , Radiologistas , Angiografia/efeitos adversos , Desenho de Equipamento , Humanos , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/prevenção & controle , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Saúde do Trabalhador , Posicionamento do Paciente , Segurança do Paciente , Estudos Prospectivos , Radiografia Intervencionista/efeitos adversos , Fluxo de Trabalho
2.
J Vasc Interv Radiol ; 32(2): 235-241, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33358387

RESUMO

Ergonomic research in the field of interventional radiology remains limited. Existing literature suggests that operators are at increased risk for work-related musculoskeletal disorders related to the use of lead garments and incomplete knowledge of ergonomic principles. Data from existing surgical literature suggest that musculoskeletal disorders may contribute to physician burnout and female operators are at a higher risk of developing musculoskeletal disorders. This review article aims to summarize the existing ergonomic challenges faced by interventional radiologists, reiterate existing solutions to these challenges, and highlight the need for further ergonomic research in multiple areas, including burnout and gender.


Assuntos
Esgotamento Profissional/prevenção & controle , Ergonomia , Doenças Musculoesqueléticas/prevenção & controle , Radiografia Intervencionista , Radiologistas , Esgotamento Profissional/epidemiologia , Feminino , Humanos , Masculino , Destreza Motora , Doenças Musculoesqueléticas/epidemiologia , Saúde do Trabalhador , Postura , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fluxo de Trabalho
3.
Tech Vasc Interv Radiol ; 23(3): 100693, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308525

RESUMO

Many interventions to treat men with benign prostatic hyperplasia (BPH) associated lower urinary tract symptoms (LUTS) are associated with sexual side effects or complications, such as hematospermia, erectile dysfunction, or ejaculatory dysfunction. As loss of sexual function can significantly impact quality of life, an optimal treatment for BPH associated LUTS would be one without any sexual dysfunction side effects. Prostatic artery embolization is a minimally invasive treatment for men with BPH associated LUTS. The aim of this paper is to review the effects of prostatic artery embolization on sexual function and compare the sexual side effect profile to the other available BPH procedures.


Assuntos
Embolização Terapêutica/efeitos adversos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/efeitos adversos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Medição de Risco , Fatores de Risco , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/psicologia , Resultado do Tratamento
4.
Tech Vasc Interv Radiol ; 23(3): 100696, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308526

RESUMO

There are active debates surrounding patient evaluation and procedural techniques of prostate artery embolization. This review evaluates the available evidence on the value of urodynamics, the effect of prostate gland size, the benefits of pre- and intraprocedural cross-sectional imaging, the utility of a balloon-occlusion microcatheter, the differences among embolic particle sizes and types, and the merits of radial versus femoral arterial access.


Assuntos
Embolização Terapêutica/normas , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/normas , Tomada de Decisão Clínica , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Seleção de Pacientes , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Radiografia Intervencionista/efeitos adversos , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento , Urodinâmica
5.
Tech Vasc Interv Radiol ; 23(3): 100694, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308527

RESUMO

Hematuria of prostatic origin has multiple etiologies including benign prostatic hyperplasia (BPH), iatrogenic urological trauma, prostate cancer, and radiation therapy. Hematuria secondary to benign prostatic hyperplasia can occur because of the increased vascularity of the primary gland, itself, or because of the vascular re-growth following a transurethral resection of the prostate. Prostatic hematuria usually resolves with conservative measures; however, refractory hematuria of prostatic origin may require hospitalization with treatment with blood transfusions, repeated indwelling urinary catheterization, and continuous bladder irrigation. Prostate artery embolization is an emerging minimally invasive procedural therapy for men with BPH that was originally utilized for the treatment of refractory hematuria of prostatic origin . This article aims to summarize the currently available evidence around prostate artery embolization for the treatment of refractory hematuria of prostatic origin.


Assuntos
Embolização Terapêutica , Hematúria/terapia , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Embolização Terapêutica/efeitos adversos , Hematúria/diagnóstico por imagem , Hematúria/etiologia , Hematúria/fisiopatologia , Humanos , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
6.
Tech Vasc Interv Radiol ; 23(3): 100687, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308528

RESUMO

As prostatic artery embolization is assuming an increasingly important role in the management of benign prostatic hyperplasia, it is important for the practicing interventional radiologist to have a deep understanding of all aspects of the disease process and the available treatment options. This paper provides a comprehensive overview of the pathophysiology, diagnosis and management options for benign prostatic hyperplasia with an emphasis on the surgical and medical treatments.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Radiografia Intervencionista , Procedimentos Cirúrgicos Urológicos Masculinos , Agentes Urológicos/uso terapêutico , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/terapia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Agentes Urológicos/efeitos adversos
7.
Tech Vasc Interv Radiol ; 23(3): 100688, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308530

RESUMO

Prostate artery embolization (PAE) has been shown to be safe and effective at treating lower urinary tract symptoms (LUTS), urinary retention, and hematuria caused by benign prostatic hyperplasia (BPH). To distinguish from other causes of these symptoms, a multidisciplinary evaluation by a urologist and interventional radiologist should include a complete history to screen for any nonprostate causes of LUTS. The International Prostate Symptom Score is a useful objective measure to quantify the patient's urinary complaints. A physical exam should be performed to evaluate a patient's candidacy for angiography, and baseline laboratory evaluation should ensure that the patient's coagulation and kidney function are adequate. In certain situations, patients may benefit from cystoscopy and urodynamic evaluation to ensure their symptoms are related to BPH. A review of the patient's imagining can be the most important component of the evaluation of a patient prior to PAE, because a patient's gland size is often a primary driver of what procedural options available are to him. Men with small glands (≤30 mL) can be treated with several of the available minimally invasive transurethral procedures, but larger glands (≥80-120 mL) may be limited to holmium laser enucleation of prostate, thulium laser enucleation of prostate, surgical prostatectomy, or PAE, depending on institutional practice patterns. Secondary considerations include medical comorbidities, the risks for sexual side effects, the risk for bleeding, and the possible adverse events associated with the procedure, which are all low for PAE. Most patients suffering from symptomatic BPH resulting in LUTS, retention, or hematuria will benefit from PAE.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Tomada de Decisão Clínica , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Urodinâmica
8.
Tech Vasc Interv Radiol ; 23(3): 100695, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308532

RESUMO

Medically refractory benign prostatic hyperplasia induced lower urinary tract symptoms is an extremely prevalent issue in older men. The current gold standard therapy transurethral resection of the prostate does produce urologic improvements but is also associated with higher than desired morbidity. This has led to the need to develop new minimally invasive means to treat this disease; prostate artery embolization (PAE) has emerged as one minimally invasive treatment option for these patients. The body of evidence which supports the use of PAE has grown quickly and substantially over the last decade. The goal of this review is to introduce and summarize the published urologic outcomes for PAE when utilized to treat benign prostatic hyperplasia induced lower urinary tract symptoms as well as document the established complication profile. Finally, the paper reviews current societal recommendations as they relate to PAE.


Assuntos
Embolização Terapêutica/normas , Medicina Baseada em Evidências/normas , Sintomas do Trato Urinário Inferior/terapia , Guias de Prática Clínica como Assunto/normas , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/normas , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Radiografia Intervencionista/efeitos adversos , Recuperação de Função Fisiológica , Resultado do Tratamento , Urodinâmica
9.
Tech Vasc Interv Radiol ; 23(3): 100692, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308533

RESUMO

As prostate artery embolization (PAE) for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia becomes more commonly performed, operator knowledge of the adverse events is essential to inform patient selection, patient preparation, and postprocedural management. The aim of this article is to discuss the incidence, presentation, and management of adverse effects after PAE.


Assuntos
Embolização Terapêutica/efeitos adversos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Fatores de Risco , Resultado do Tratamento
10.
Tech Vasc Interv Radiol ; 23(3): 100691, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308534

RESUMO

In the last decade, prostatic artery embolization (PAE) established itself as a safe and effective treatment option for lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH), with reproducible results across multiple centers and endorsement by important international societies. However, PAE is also known to be a technically demanding procedure. Accompanying the prevalence of benign prostate hyperplasia, the procedure is usually performed in older patients, in whom atherosclerosis and comorbidities are common features. Also, prostatic vascular anatomy is described to be complex and variable, and pelvic structures are deeply interconnected by anastomosis. Thus, PAE demands a deep familiarization with materials and devices, intraprocedure imaging techniques, microcatetherization skills and with the pelvic vascular anatomy. Especially in the beginning of the learning curve, the procedure can be time-consuming and related to high radiation exposure for both medical team and the patient. In this article, the main points of technical concern during PAE are described and discussed, such as the equipment needed, the effect of different embolic materials, patient's preparation for the procedure, arterial access sites, identifying and catheterizing the prostatic arteries, the embolization techniques, among others. Finally, the most frequent technical challenges are presented, and the possible strategies to overcome them are exemplified and discussed.


Assuntos
Cateteres , Embolização Terapêutica/instrumentação , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/instrumentação , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
11.
Tech Vasc Interv Radiol ; 23(4): 100705, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308576

RESUMO

Neoplastic disease of the musculoskeletal system may result in serious morbidity and mortality secondary to cancer related bone pain, pathologic fracture, altered structural mechanics, and involvement of adjacent structures.1 Recent advances in cancer detection and treatment have allowed more patients to live longer. The prevalence of osseous metastatic disease has increased to 100,000 new patients developing bone metastases each year.2 These patients are seeing long-term exposure to chemotherapy and radiation leading to increased skeletal events, morbidity, and a negative impact on quality of life. Bone metastases in conjunction with poor bone quality often prevent surgical therapy. Utilization of thermal ablation in this patient population is supported by contemporary literature and offers a minimally invasive approach to pain palliation, local tumor control, and decreased morbidity with unique advantages compared to surgery or radiation.3 In addition to spine disease, interventional radiologists are able to meaningfully impact pelvic, shoulder girdle, and long bone metastases. Adding to ablation we have in our repertoire the ability to provide structural support utilizing cement and/or screw fixation as an adjunct for both pain palliation and mechanical stabilization.4-6 These novel therapies have allowed more patients with metastatic disease to be treated. The focus of this chapter is to highlight importance of patient selection, ablative modality selection, integration of cementoplasty (also described as osteoplasty) and osseous fixation, and procedural techniques/strategy in the pelvis and other common sites of bone metastases outside the spine.


Assuntos
Técnicas de Ablação , Neoplasias Ósseas/terapia , Manejo da Dor , Dor/prevenção & controle , Radiografia Intervencionista , Técnicas de Ablação/efeitos adversos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Tomada de Decisão Clínica , Humanos , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/efeitos adversos , Seleção de Pacientes , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
13.
Tech Vasc Interv Radiol ; 23(4): 100699, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308579

RESUMO

This article provides a step-by-step guide for minimally invasive percutaneous image-guided thermal ablation for treatment of vertebral metastases. Such interventions have proved safe and effective in management of selected patients with spinal metastases primarily to achieve pain palliation and local tumor control. Particular attention to patient selection guidelines, details of procedure techniques, thermal protection, adequacy of treatment, recognition and management of potential complications, and post-ablation imaging are essential for improved patient outcomes.


Assuntos
Dor nas Costas/cirurgia , Criocirurgia , Metastasectomia , Micro-Ondas/uso terapêutico , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Neoplasias da Coluna Vertebral/cirurgia , Dor nas Costas/diagnóstico , Criocirurgia/efeitos adversos , Humanos , Metastasectomia/efeitos adversos , Micro-Ondas/efeitos adversos , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
14.
Tech Vasc Interv Radiol ; 23(4): 100701, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308580

RESUMO

Vertebral compression fractures (VCFs) result from either trauma or a pathologic process that weakens the bone by conditions such as osteoporosis or tumor. The incidence of VCFs has been rising over the last few decades in accordance with the aging population. These fractures can result in severe pain, physical limitation and disability, as well as increased morbidity and mortality. Patients with VCFs are optimally treated by accurate and early diagnosis and treatment. An effective method to treat these fractures is percutaneous vertebral augmentation, which is a set of minimally invasive procedures that stabilizes osseous fractures, provides immediate pain relief, and improves quality of life. Vertebral augmentation procedures include vertebroplasty, kyphoplasty, and vertebral augmentation with implants. Each of these techniques is described in general terms in this article. The ideal candidate for vertebral augmentation is a patient with a symptomatic fracture seen on cross-sectional imaging in which nonsurgical management has failed and has positive signs on physical examination with no absolute contraindication. This procedure should be done with the appropriate equipment and personnel in a facility designed for this purpose. After the procedure, the patient should undergo the appropriate follow-up to ensure optimal recovery. Additionally, it is essential that the patient receives appropriate therapy for the underlying disorder that predisposed them to the vertebral fracture.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia , Radiografia Intervencionista , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Tomada de Decisão Clínica , Protocolos Clínicos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/fisiopatologia , Humanos , Cifoplastia/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Vertebroplastia/efeitos adversos
15.
Tech Vasc Interv Radiol ; 23(4): 100698, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308581

RESUMO

The application of advanced imaging guidance and the interventional radiology skill set has expanded the breadth of nerve and nerve plexus targets in the body for potential cryoneurolysis. Advancement of the basic science supporting cryoneurolysis has further solidified proceduralists' confidence and ability to select and manage patients clinically. As these procedures continue to evolve, a structured approach to the wide variety of indications is necessary.


Assuntos
Criocirurgia , Manejo da Dor , Dor Intratável/cirurgia , Nervos Periféricos/cirurgia , Radiografia Intervencionista , Criocirurgia/efeitos adversos , Humanos , Manejo da Dor/efeitos adversos , Dor Intratável/diagnóstico , Dor Intratável/fisiopatologia , Nervos Periféricos/diagnóstico por imagem , Nervos Periféricos/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento
16.
Tech Vasc Interv Radiol ; 23(4): 100706, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308582

RESUMO

Knee osteoarthritis, a chronic degenerative condition, can be a debilitating and limiting process with affected patients presenting with symptoms such as pain, restrictive range of motion, and swelling. This condition commonly afflicts millions of people with a higher incidence among the elderly that results from chronic mechanical repetitive loading. The treatment of pain generating conditions such as arthritis in large joints is complex requiring interventions of varying focuses such as weight loss, anti-inflammatory medications, corticosteroid, hyaluronic and viscosupplementation injections, and prescription opioids. A gap in the treatment options of this ailment currently exists between short term pain solutions and surgical approaches such as total knee arthroplasty that may offer longer pain relief. Cooled radiofrequency ablation is an emerging technique that offers a minimally invasive alternative for treating knee pain with a clinical relevance in patients who are not surgical candidates due to coexistent medical comorbidities or those who are undesiring of surgery. This procedure uses radiofrequency ablation that blocks genicular nerves from transmitting knee pain signals to the brain. Further research will allow the application of this technique to treat other sensory nerves in large joints such as the hip and shoulder.


Assuntos
Artralgia/cirurgia , Denervação , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Artralgia/diagnóstico por imagem , Artralgia/fisiopatologia , Denervação/efeitos adversos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
17.
Tech Vasc Interv Radiol ; 23(4): 100700, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308584

RESUMO

Degenerative lumbar spine disorder (DLSD) is a ubiquitously occurring event that may be induced or accelerated by multiple factors such as from overuse, trauma, genetic predisposition, nutrition deficiency, and others. While our understanding of this degenerative disorder is limited, in terms of prevention, the symptoms from DLSD can be significant and may lead to the reduction in the patient's quality of life and loss of work time. In the Global Burden of Disease Study, low back pain was ranked the highest of 291 different conditions, due to the number of years lost to disability, amounting to 83 million disability-adjusted life years lost in 2010. DLSD contains conditions involving disc degeneration, lumbar spinal stenosis, and spondylolisthesis, including symptoms ranging from low back pain to lower extremity radicular pain and weakness. In this issue, we will be discussing treatments for patients suffering with chronic low back pain from endplate disruption, utilizing basivertebral nerve radiofrequency ablation, also known as the INTRACEPT procedure. This issue will also cover minimally invasive lumbar decompression from lumbar spinal stenosis, due to contributory ligamentum flavum hypertrophy, utilizing the percutaneous image-guided lumbar decompression technique known as the MILD procedure.


Assuntos
Dor Crônica/cirurgia , Descompressão Cirúrgica , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Doenças da Coluna Vertebral/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Manejo da Dor/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/fisiopatologia , Resultado do Tratamento
18.
J Vasc Interv Radiol ; 31(11): 1772-1783, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32981819

RESUMO

PURPOSE: To evaluate safety and efficacy of CT hepatic arteriography compared with conventional CT fluoroscopy guidance in percutaneous radiofrequency (RF) and microwave (MW) ablation to treat colorectal liver metastases (CRLM). MATERIALS AND METHODS: This single-center comparative, retrospective study analyzed data of 108 patients treated with 156 percutaneous ablation procedures (42 CT fluoroscopy guidance [25 RF ablation, 17 MW ablation]; 114 CT hepatic arteriography guidance [18 RF ablation, 96 MW ablation]) for 260 CRLM between January 2009 and May 2019. Local tumor progression-free survival (LTPFS) was assessed using univariate and multivariate Cox proportional hazard regression analyses. LTPFS and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: There were no complications related to the transarterial catheter procedure. CT hepatic arteriography proved superior to CT fluoroscopy regarding 2-year LTPFS (18/202 [8.9%] vs 19/58 [32.8%]; P < .001, respectively). CT hepatic arteriography versus CT fluoroscopy (hazard ratio = 0.28; 95% confidence interval, 0.15-0.54; P < .001) and MW ablation versus RF ablation (hazard ratio = 0.52; 95% confidence interval, 0.24-1.12; P = .094) were positive predictors for longer LTPFS. Multivariate analysis revealed that CT hepatic arteriography versus CT fluoroscopy (hazard ratio = 0.41; 95% confidence interval, 0.19-0.90; P = .025) was associated with a significantly superior LTPFS. OS was similar between the 2 cohorts (P = .3). CONCLUSIONS: While adding procedure time and marginal patient burden, transcatheter CT hepatic arteriography-guided ablation was associated with increased local disease control and superior LTPFS compared with conventional CT fluoroscopy. CT hepatic arteriography represents a safe and valid alternative to CT fluoroscopy, as it reduces the number of repeat ablations required without adding risk or detrimental effect on survival.


Assuntos
Técnicas de Ablação , Neoplasias Colorretais/patologia , Angiografia por Tomografia Computadorizada , Neoplasias Hepáticas/cirurgia , Radiografia Intervencionista , Técnicas de Ablação/efeitos adversos , Técnicas de Ablação/mortalidade , Idoso , Neoplasias Colorretais/mortalidade , Angiografia por Tomografia Computadorizada/efeitos adversos , Angiografia por Tomografia Computadorizada/mortalidade , Feminino , Fluoroscopia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Países Baixos , Duração da Cirurgia , Intervalo Livre de Progressão , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/mortalidade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
19.
Medicine (Baltimore) ; 99(31): e21424, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756146

RESUMO

BACKGROUND: Spine interventionists frequently employ fluoroscopy to guide injection procedures. The increase in fluoroscopically guided procedures in recent years has led to a growing concern about radiation exposure. A new method of covering the C-arm tube with a lead apron has been suggested to reduce radiation exposure. This study aimed to compare the radiation exposure when performing lumbar transforaminal epidural steroid injections (TFESIs) using this new method to a control group. METHODS: A total of 200 patients who underwent lumbar TFESIs by a single physician were recruited. Patients were divided into 2 groups, the new method group (group A) and the control group (group C), and the amount of radiation exposure was compared. The dosimetry badge locations were marked as outside of apron, inside of apron, outside of thyroid collar, inside of thyroid collar, ring, and glasses. RESULTS: The cumulative dose equivalents of all the measurement sites were reduced in group A compared with group C, and the most reduced site was inside the thyroid collar. CONCLUSIONS: Covering the C-arm tube with a lead apron can be effective in reducing the cumulative radiation exposure when performing fluoroscopically guided TFESIs.


Assuntos
Fluoroscopia/efeitos adversos , Injeções Epidurais , Exposição Ocupacional/prevenção & controle , Médicos , Roupa de Proteção , Exposição à Radiação/prevenção & controle , Corticosteroides/administração & dosagem , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/efeitos adversos
20.
PLoS One ; 15(8): e0238107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834016

RESUMO

BACKGROUND: In CT-guided transthoracic lung biopsy (CTLB), pneumothorax can occur as a late complication (delayed pneumothorax). The incidence, risk factors, and clinical significance of delayed pneumothorax are not well known. OBJECTIVES: To compare the risk factors for immediate and delayed pneumothorax after CTLB and to know their clinical significance. METHODS: Images and medical records of 536 consecutive patients who underwent CTLB were reviewed. All biopsies were performed as inpatient procedures. Follow-up chest radiographs were obtained at least twice at 4 h after procedure and before discharge. Risk factors for immediate and delayed pneumothorax were assessed based on patient-, lesion-, and procedure-related variables. Rates of chest tube insertion were also compared. RESULTS: Pneumothorax developed in 161 patients (30.0%) including 135 (25.2%) immediate and 26 (4.9%) delayed cases. Lesion size was an independent risk factor for both immediate and delayed pneumothorax (OR = 0.813; CI = 0.717-0.922 and OR = 0.610; CI = 0.441-0.844, respectively). While emphysema, lower lobe location, and long intrapulmonary biopsy track were risk factors (OR = 1.981; CI = 1.172-3.344, OR = 3.505; CI = 2.718-5.650, and OR = 1.330; CI = 1.132-1.563, respectively) for immediate pneumothorax, upper lobe location and increased number of pleural punctures were independent risk factors (OR = 5.756; CI = 1.634-20.274 and OR = 3.738; CI = 1.860-7.511, respectively) for delayed pneumothorax. The rate of chest tube insertion was significantly (p < 0.001) higher in delayed pneumothorax. CONCLUSION: Pneumothorax tends to occur immediately after CTLB in patients with emphysema, lower lobe lesion, and long intrapulmonary biopsy track. Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of delayed development of pneumothorax and higher requirement for chest tube drainage.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pneumotórax/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Tubos Torácicos , Enfisema/patologia , Feminino , Humanos , Incidência , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Paracentese/efeitos adversos , Enfisema Pulmonar/patologia , Punções/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Tórax , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/métodos
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