RESUMO
PURPOSE: To evaluate the use of retrievable filters placed in bilateral common iliac veins in high-risk surgical patients. MATERIALS AND METHODS: During the 4-year study period, 10 patients received bilateral common iliac vein placement of retrievable filters for pulmonary embolism (PE) prophylaxis. These patients were at risk for venous thromboembolism (VTE) but had no evidence of VTE at the time of filter placement. In nine patients undergoing bariatric surgery, placement of a filter in the inferior vena cava (IVC) was impossible because of megacava (defined as caval diameter ≥ 3.0 cm). In one patient who had planned dissection of an extensive retroperitoneal tumor, there was concern that IVC location of the filter would be prone to complications secondary to intraoperative manipulation. Filter placement and retrieval were evaluated. All patients were followed clinically until 4-6 weeks after filter retrieval. RESULTS: There were 20 filters placed in 10 attempts, 18 (nine patients) through the right internal jugular vein and 2 (one patient) through bilateral femoral veins. The mean (± standard deviation) dwell time of the filters was 40 days ± 10 (range 30-71 days). All filters were successfully removed. There were no procedural complications. No clinically evident PE was noted. CONCLUSIONS: Use of retrievable filters in the bilateral common iliac veins was found to be feasible and effective in preventing PE in patients with contraindications to filter placement in the IVC.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Dispositivos de Proteção Embólica , Veia Ilíaca , Obesidade Mórbida/cirurgia , Embolia Pulmonar/prevenção & controle , Neoplasias Retroperitoneais/cirurgia , Filtros de Veia Cava , Tromboembolia Venosa/prevenção & controle , Adulto , Índice de Massa Corporal , Chicago , Contraindicações , Remoção de Dispositivo , Estudos de Viabilidade , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico por imagem , Flebografia , Embolia Pulmonar/etiologia , Neoplasias Retroperitoneais/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Tromboembolia Venosa/etiologiaRESUMO
PURPOSE: To retrospectively review experience with difficult retrievals of Günther Tulip filters (GTFs) in which various techniques were used. MATERIALS AND METHODS: From December 2004 to December 2006, 32 patients were referred to a single radiology department for GTF retrieval (25 women and seven men; mean age, 40 years; range, 21-60 y). All patients were evaluated, and 22 of these patients had undergone unsuccessful filter retrieval attempts elsewhere. In the remaining patients, significant tilt of the filter (n = 8) or difficult internal jugular vein access (n = 2) discouraged retrieval attempts. There were a total of 38 filters. Twenty-five patients had a filter in the infrarenal inferior vena cava (IVC). Among the remaining seven patients, six had bilateral iliac filters and one had a left iliac filter. Retrievals were performed via conventional technique-ie, by snaring the hook of the filter without additional maneuvers-or other techniques. RESULTS: Thirty-seven of 38 filters were successfully removed, for a success rate of 97%. Successful retrievals were performed with conventional (n = 4), catheter twist (n = 3), modified snare (n = 15), loop snare (n = 14), and balloon dilation (n = 1) techniques. The average dwell time for filters successfully removed was 58 days (range, 22-258 d). One failure occurred in a patient who had undergone unsuccessful retrieval previously. The hook of the filter and a displaced secondary strut, which had migrated superiorly, were incorporated into the IVC wall in this case. CONCLUSIONS: Additional maneuvers were useful in these difficult retrievals of GTFs that might not otherwise be retrievable with the conventional method.
Assuntos
Cateterismo Venoso Central , Remoção de Dispositivo/métodos , Radiografia Intervencionista , Filtros de Veia Cava , Veia Cava Inferior/diagnóstico por imagem , Adulto , Cateterismo , Cateterismo Venoso Central/efeitos adversos , Remoção de Dispositivo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The optimal care of patients with end stage renal disease on hemodialysis involves a multidisciplinary approach involving nephrologists, vascular surgeons, transplant surgeons and interventional radiologists. A collaborative effort by these groups of physicians was used to create the KDOQI guidelines and the Fistula First program, which have served as the template for the management of dialysis patients. This article will briefly review the recent updates for vascular access in the KDOQI guidelines and summarize the highlights of the Fistula First program.
RESUMO
Dialysis-associated steal syndrome is a clinically significant complication associated with the creation of dialysis grafts or fistulae. The distal revascularization and interval ligation (DRIL) procedure is a surgical procedure, which has been used to treat patients with hand ischemia secondary to arterial "steal" from dialysis accesses. This article will review the dialysis-associated steal syndrome and the history, anatomy, and clinical results of the DRIL procedure.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Artéria Renal/lesões , Angiografia , Meios de Contraste , Diagnóstico Diferencial , Embolização Terapêutica , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Emergent percutaneous nephrostomy is a potentially lifesaving procedure with a high technical success rate, minimal morbidity, and long safety record that is often used in the setting of an obstructed and infected renal collecting system (i.e., pyonephrosis). This article discusses all aspects of the emergent placement of nephrostomy catheters including indications, techniques, results, and complications. Differences between emergent and nonemergent placement of percutaneous nephrostomy catheters are also addressed.
RESUMO
When patients with end-stage renal disease have exhausted both conventional and unconventional venous access options, creative solutions must be sought for hemodialysis catheter placement in order to ensure survival. This case describes a patient in urgent need of a dialysis catheter despite total occlusion of the jugular, subclavian, and femoral veins. Occlusion of the inferior vena cava (IVC) and right renal vein resulted in failed attempts at translumbar catheter placement. A gooseneck snare was temporarily advanced through the liver to the IVC for use as a fluoroscopic target to facilitate successful single-puncture, translumbar catheterization.
Assuntos
Cateterismo Venoso Central/métodos , Cateteres de Demora , Falência Renal Crônica/terapia , Diálise Renal/métodos , Veia Cava Inferior , Idoso , Feminino , Humanos , Radiografia Intervencionista , Ultrassonografia de IntervençãoRESUMO
Wound closure issues are not as common in the field of interventional radiology when compared with other surgical fields, such as plastic surgery or dermatology. A common exception to this rule involves the placement and removal of chest wall vascular ports. This article reviews newer wound closure devices such as skin adhesives and closure film.
RESUMO
The primary indication for the urgent percutaneous nephrostomy is to relieve an obstructed and infected renal collecting system (pyonephrosis). Percutaneous nephrostomy catheter placement is a safe procedure with a high technical success rate. This article will discuss all aspects regarding the emergent placement of nephrostomy catheters, including the indications, techniques, results, and complications. Differences between emergent and nonemergent placement of percutaneous nephrostomy catheters will also be addressed.