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Hepatocellular Carcinoma: Advances in Systemic Therapy Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-03-14 Insija Ilyas Selene, Merve Ozen, Reema A. Patel
Hepatocellular carcinoma (HCC) is a prevalent primary liver cancer, representing over 90% of cases globally and ranking as the third leading cause of cancer-related death. This article reviews the evolving landscape of systemic therapies for advanced HCC, emphasizing recent advancements and their impact on patient outcomes. The advent of molecular targeted therapies has transformed HCC management,
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Practical Considerations When Choosing Chemoembolization versus Radioembolization for Hepatocellular Carcinoma Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-03-14
Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are common liver-directed therapies (LDTs) for unresectable HCC. While both deliver intra-arterial treatment directly to the site of the tumor, they differ in mechanisms of action and side effects. Several studies have compared their side effect profile, time to progression, and overall survival data, but often these
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Chemoembolization Beyond Hepatocellular Carcinoma: What Tumors Can We Treat and When? Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-03-14
Liver metastases are the most common malignancy found in the liver and are 20 to 40 times more common than primary hepatic tumors, including hepatocellular carcinoma. Patients with liver metastases often present with advanced disease and are not eligible for curative-intent surgery or ablative techniques. The unique hepatic arterial blood supply of liver metastases allows interventional radiologists
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Immunoembolization for the Treatment of Uveal Melanoma Hepatic Metastases Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-03-14 Carin F. Gonsalves
Uveal melanoma is the most common primary intraocular tumor in adults. Approximately 50% of patients develop metastatic disease despite successful treatment of the primary eye tumor. The liver is the most common site of metastatic disease occurring in more than 90% of patients. Clinical prognosis is dependent on the ability to control the growth of liver tumors. Locoregional therapies play an important
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Techniques to Optimize Radioembolization Tumor Coverage Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-03-14 M. Kasim Fassia, Resmi Ann Charalel
Yttrium-90 (Y90) radioembolization has become a major locoregional treatment option for several primary and secondary liver cancers. Understanding the various factors that contribute to optimal tumor coverage including sphere count, embolization techniques, and catheter choice is important for all interventional radiologists while planning Y90 dosimetry and delivery. Here, we review these factors and
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Intra-arterial Peptide Receptor Radionuclide Therapy for the Treatment of Hepatic Neuroendocrine Tumor Metastases: Hope or Hype? Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-03-14
Peptide receptor radionuclide therapy (PRRT) confers significant progression-free survival advantage for patients with small bowel grade 1 and 2 well-differentiated neuroendocrine tumors (WD NET). PRRT may also be clinically beneficial for patients with NET of pancreatic, bronchial, and other sites of origin; patients with paragangliomas; as well as for patients with well-differentiated grade 3 NET
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SBRT for Liver Tumors: What the Interventional Radiologist Needs to Know Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-03-14 Michael J. Gutman, Lucas M. Serra, Matthew Koshy, Rohan R. Katipally
This review summarizes the clinical evidence supporting the utilization of stereotactic body radiotherapy (SBRT) for liver tumors, including hepatocellular carcinoma, liver metastases, and cholangiocarcinoma. Emerging prospective evidence has demonstrated the benefit and low rates of toxicity across a broad range of clinical contexts. We provide an introduction for the interventional radiologist, with
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A Review of Resection and Surgical Ablation for Primary and Secondary Liver Cancers Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-01-24 McKenzie J. White, Eric H. Jensen, David G. Brauer
The surgical management of primary and secondary liver tumors is constantly evolving. Patient selection, particularly with regard to determining resectability, is vital to the success of programs directed toward invasive treatments of liver tumors. Particular attention should be paid toward determining whether patients are best served with surgical resection or ablative therapies. A multidisciplinary
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Hepatocellular Carcinoma from a Hepatologist's Perspective Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-01-24 Giovanni A. Roldan, Jacquelin Blomker, Elizabeth S. Aby
Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, represents a growing health challenge worldwide. The incidence of HCC is rising, which, in turn, has led to a corresponding increase in the associated number of deaths. HCC will become the third leading cause of cancer-related deaths in the United States by 2030. HCC usually develops in the setting of chronic liver disease
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Liver-Directed Therapy Combined with Systemic Therapy: Current Status and Future Directions Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-01-24 Shamar Young, Jack Hannallah, Dan Goldberg, Mohammad Khreiss, Rachna Shroff, Junaid Arshad, Aaron Scott, Gregory Woodhead
In the past several decades, major advances in both systemic and locoregional therapies have been made for many cancer patients. This has led to modern cancer treatment algorithms frequently calling for active interventions by multiple subspecialists at the same time. One of the areas where this can be clearly seen is the concomitant use of locoregional and systemic therapies in patients with primary
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Ablation versus Radiation Segmentectomy for Small Liver Tumors Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-01-24
Hepatocellular carcinoma (HCC) is a liver malignancy that affects more than a million people worldwide with a complex multifactorial etiology. After the diagnosis of HCC is made, physicians establish management using the Barcelona Clinic Liver Cancer (BCLC) guidelines revolving around tumor stage, liver function, performance status, and patient preferences. According to recent updates to these guidelines
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Chemoembolization Plus Ablation: Current Status Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-01-24 Farnaz Dadrass, Pascal Acree, Edward Kim
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. The treatment landscape for HCC has evolved significantly over the past decade, with several modalities available to treat various stages of disease. The Barcelona Clinic Liver Cancer (BCLC) system provides a foundation for treatment guidance. However, given the complex nature of HCC, a more nuanced approach is often
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Non-Thermal Liver Ablation: Existing and New Technology Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-01-24 Tiffany Nakla, Jacqueline J. Chow, Kathleen Pham, Nadine Abi-Jaoudeh
Cancer has and continues to be a complex health crisis plaguing millions around the world. Alcohol ablation was one of the initial methods used for the treatment of liver lesions. It was surpassed by thermal ablation which has played a big role in the therapeutic arsenal for primary and metastatic liver tumors. However, thermal ablation has several shortcomings and limitations that prompted the development
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Thermal Ablation in the Liver: Heat versus Cold—What Is the Role of Cryoablation? Semin. Interv. Radiol. (IF 1.4) Pub Date : 2024-01-24 Donna L. D'Souza, Ranjan Ragulojan, Chunxiao Guo, Connie M. Dale, Christopher J. Jones, Reza Talaie
Cryoablation is commonly used in the kidney, lung, breast, and soft tissue, but is an uncommon choice in the liver where radiofrequency ablation (RFA) and microwave ablation (MWA) predominate. This is in part for historical reasons due to serious complications that occurred with open hepatic cryoablation using early technology. More current technology combined with image-guided percutaneous approaches
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Health Services Research: A Review for the Interventional Radiologist Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Katherine Marchak, Mira Malavia, Premal S. Trivedi
Health services research (HSR) is a multidisciplinary field which studies access to drivers of health care service utilization, the quality and cost of services, and their outcomes on groups of patients. Since its foundations in the 1960s, there has been a large focus on HSR and using large data sets to study real-world care. Because interventional radiology (IR) is a dynamic field with foundations
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Private Equity and Radiology: Productive Partnership or Inherently Misaligned? Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Elie Balesh, Hannah Hund, Eric J. Keller
Private equity acquisition of medical groups and health care organizations is becoming increasingly important in medicine and is a trend that is likely to continue for the foreseeable future. Some question the ethical implications of private equity acquisitions, since the clear goal of such organizations is maximizing profitability, which may or may not be in the best interests of either the patient
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Working with Hospital Administration: Strategies for Success Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Charles E. Ray Jr.
Organizational structure has evolved over the past several decades, with physicians assuming more or fewer leadership positions over time. Regardless of the role of physicians in health care organizational leadership, constant meaningful communication with the hospital, radiology group, or greater physician group administrative leadership is vital for any group of IR physicians to be successful. Understanding
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How Medical Services Get Valued Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Katharine L. Krol
The mechanisms for Medicare payment to physicians are complicated and, in fee for service Medicare, the value of a procedure code explicitly determines the payment to the physician and the out-of-pocket cost to the beneficiary. These codes are created and then valued for payment through a complex but reproducible and transparent process that allows for physician and specialty society input. This article
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A Review of Healthcare Disparities Relevant to Interventional Radiology Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Katherine Marchak, Davinder Singh, Mira Malavia, Premal Trivedi
Racial, ethnic, and gender disparities have received focused attention recently, as they became more visible in the COVID era. We continue to learn more about how healthcare disparities manifest for our patients and, more broadly, the structural underpinnings that result in predictable outcomes gaps. This review summarizes what we know about disparities relevant to interventional radiologists. The
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Advancing IR in Underserved Regions: Interventional Radiology Simulation Near and Far Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02
Simulation facilitates learning by imitating real-world systems or processes utilizing educational tools and models. Various fields, including business, aviation, and education use simulation for training. In healthcare, simulation provides trainees opportunities to develop procedural skills in a safe environment, building their understanding through hands-on interactions and experiences rather than
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Medicare Payment Policy: The Basics Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Laura K. Findeiss
The mechanisms of payment for medical services are complicated and create predictable incentives. Physicians can benefit from understanding how hospitals, practices, employers, and payers understand payment, since this has a role in determining how certain patient care services are valued and prioritized. Type of hospital, location of service delivery, and a physician's relationship with the payer
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Endobronchial Migration of a POD Packing Coil Following Embolization of a Pulmonary Artery Pseudoaneurysm Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Joseph N. McLaughlin, Daniel Lamus, Siddhi Hegde, Sanjeeva P. Kalva
The authors report a case of endobronchial migration of a POD packing coil following embolization of a pulmonary artery pseudoaneurysm in a patient with cavitary tuberculosis and its successful management by bronchoscopy-assisted removal of the coil. Coil migration may be secondary to continued cough and persistence of a bronchial to pulmonary artery fistula from tuberculous infection and inflammation
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Demonstrating the Value of Interventional Radiology Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Mohammad-Kasim Fassia, Resmi Charalel, Adam D. Talenfeld
While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and
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Communicating with Your Department Chair: A Primer on How to Advocate for Your IR Section Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02
Many interventional radiologists express concern about communicating their practice needs to their radiology department chairs. As a result, they may have difficulty getting support for hiring of additional physicians and staff, capital investments in equipment, and marketing of IR services. Some perceive that chairs have a preference for diagnostic radiology initiatives over interventional and want
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Government Relations and Interventional Radiology Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02
Health care policy in the United States is made by nonphysician lawmakers and government employees. Through advocacy and lobbying, physicians have an opportunity to be involved in the process. Interventional radiologists (IRs) are the experts on issues related to IR. Government relation offers IRs the opportunity to engage with members of Congress, officials in Federal and State agencies, and State
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Transarterial Radioembolization: Overview of Radioembolic Devices. Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Muhamad Serhal,Andrew C Gordon,Daniel B Brown,Beau B Toskich,Robert J Lewandowski
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How I Do It: Endovascular Management of Acute Nonvariceal Gastrointestinal Bleeding. Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-11-02 Tushar Garg,Fereshteh Khorshidi,Peiman Habibollahi,Apurva Shrigiriwar,Adam Fang,Sasan Sakiani,Melike Harfouche,Jose J Diaz,Nariman Nezami
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Interventional Treatment of Labial Varices Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Victoria Risner, Yuko McColgan, Gloria Salazar
Labial varices are commonly seen in women with varicose veins of the pelvis. Initial management is conservative management since labial varies typically resolve, particularly in pregnant patients following delivery. Varices can be seen also in association with pelvic varices in the pelvic venous disease spectrum. Sclerotherapy is often the management. This article reviews the presentation and treatment
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Recanalization of Proximal Fallopian Tube Obstruction in the Treatment of Infertility Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Priya Mody, Gloria Salazar, Maureen P. Kohi
Infertility affects approximately 15% of patients worldwide, with up to 40% of cases attributed to tubal disease, and up to 25% of those being proximal fallopian tube obstruction (FTO). Evaluation of tubal patency can be performed via laparoscopic chromopertubation, hysterosalpingography, or hysterosalpingo-contrast-sonography (HyCoSy). In patients with proximal tubal obstruction, fallopian tube recanalization
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Evaluation and Medical Management of Chronic Pelvic Pain Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Erin T. Carey, Asha B. McClurg
Chronic pelvic pain (CPP) is a challenging condition affecting an estimated 15% of females in the United States. Multiorgan system dysfunction results in the complex clinical pain presentation. Similar to other chronic pain syndromes, CPP is influenced by biopsychosocial factors and requires a multimodal approach for optimal pain management. This review summarizes the clinical evaluation and medical
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Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Meghan R. Clark, Amy C. Taylor
Pelvic venous disorder (PeVD) is a term that encompasses all the interrelated causes of chronic pelvic pain (CPP) and perineal/lower extremity varicose veins of pelvic venous origin historically known as nutcracker syndrome, pelvic congestion syndrome, and May-Thurner syndrome, resulting in a more precise diagnosis that accounts for the underlying pathophysiology and anatomy. PeVD manifests as CPP
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Local Methotrexate Plus Uterine Artery Embolization for High-Risk Interstitial Ectopic Pregnancy Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Mark Mikhitarian, William Goodnight III, Nicole Keefe
Interstitial ectopic pregnancy involves the interstitial portion of the fallopian tube and is among the most hazardous of all ectopic pregnancies, with the highest risk of uterine rupture and maternal mortality. Unlike tubal ectopic pregnancy, management of interstitial pregnancy is not well standardized. Systemic methotrexate (MTX) and surgical resection are the primary treatment options; however
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Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Troy K. Sanders, Jessica K. Stewart
Placenta accreta spectrum is increasing in prevalence and poses significant risks to obstetric patients. This article defines characteristics, diagnosis, management, and outcomes of placenta accreta spectrum, highlighting interventional radiology's role in its management as part of a multidisciplinary approach.
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Uterine Vascular Anomalies: Management and Treatment Overview Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Monica M. Matsumoto, Theresa M. Caridi
Uterine vascular anomalies (UVAs), while rare, can result in severe, life-threatening hemorrhage. An understanding of the presentation and management options for UVAs is important for interventional radiologists to appropriately evaluate and care for these patients. The authors propose a standardized terminology for UVAs to avoid confusion and conflating congenital from acquired vascular lesions, which
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Updates on the Surgical Approach to Fibroids: The Importance of Radiofrequency Ablation Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Caroline S. Kwon, Noor Dasouki Abu-Alnadi
Uterine fibroids are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which can range from heavy menstrual bleeding and bulk-related symptoms such as pelvic pressure with bladder and bowel dysfunction to reproductive dysfunction
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Update on Endovascular Therapy for Fibroids and Adenomyosis Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Merve Ozen, Ronak Patel, Mark Hoffman, Driss Raissi
Uterine fibroids and adenomyosis are prevalent benign neoplasms that can lead to serious deleterious health effects including life-threatening anemia, prolonged menses, and pelvic pain; however, up to 40% of women remain undiagnosed. Traditional treatment options such as myomectomy or hysterectomy can effectively manage symptoms but may entail longer hospital stays and hinder future fertility. Endovascular
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Portal Hypertension in Patients with Hemophilia. Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-08-10 Dan F Laney Iv,Matthew Houle,Leigh Deshotels,Hector Ferral
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Hemorrhage from Adrenal Vein Rupture during Adrenal Vein Sampling Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Keith B. Quencer, Alan Massouh, Keshav Anand
We describe a case of right adrenal hemorrhage from adrenal vein sampling treated conservatively with overnight admission and pain control. We review the existing literature on rates of this complication, typical clinical outcomes, and practical tips to avoid its occurrence.
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New-Onset Paralysis following Biopsy of a Retroperitoneal Mass with Intraspinal Extension in a Pediatric Patient Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Michelle Wiese, Shankar Rajeswaran
Image-guided percutaneous biopsies are routine, safe procedures and complications are infrequent and usually directly related to the biopsy itself. This report describes a biopsy of a retroperitoneal mass with extension into the spinal canal, following which the patient developed paralysis unrelated to the biopsy itself but secondary to spinal cord ischemia during the procedure. Multiple factors contributed
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Malposition of a Femoral Tunneled Dialysis Catheter through a Patent Foramen Ovale Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Anthony Finnay Blackburn, Gina P. Landinez, Robert K. Kerlan, R. Peter Lokken
Patent foramen ovale (PFO) is a common congenital abnormality of high prevalence in adults. Its clinical significance is magnified in a right-to-left shunt, where paradoxical embolism can have catastrophic outcomes involving the brain, heart, mesenteric circulation, or extremities. Right-to-left shunting through a PFO is caused by increased right atrial pressure, as seen in the setting of pulmonary
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Balloon-Assisted Retrieval of a Retained Vascular Sheath during Complex Inferior Vena Cava Filter Removal Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Michael Samuel, Bashar Nahab, Seetharam Chadalavada
A potential complication of complex endovascular procedures is retained foreign bodies such as fragmented catheters, wires, stents, or sheaths in the intravascular space. Different techniques are available for retrieval of intravascular foreign bodies including snares, forceps, baskets, tip-deflecting wires, and balloon catheters. The aim of this article is to describe our experience in which a lost
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Acute Pancreatitis following Percutaneous Electrohydraulic Lithotripsy Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Asad Malik, Kent T. Sato, Ahsun Riaz
The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*. Some of these patients are still not surgical candidates after the acute cholecystitis episode has resolved.
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A Case of Ischemic Monomelic Neuropathy following Endovascular Arteriovenous Fistula Creation and Assisted Maturation Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Kyle Sonnabend, Simon Park, Ketan Shah, Andrew J. Lipnik, Matthew M. Niemeyer
Dialysis access steal syndrome (DASS) is a phenomenon known to occur following creation of an arteriovenous fistula or arteriovenous graft. The clinical presentation of DASS is characterized by symptoms of limb ischemia due to diversion of arterial flow from the distal extremity. Ischemic monomelic neuropathy (IMN) is a rare subtype of DASS classically described as an acute, isolated presentation of
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Intercostal Artery Laceration after Adrenal Mass Cryoablation Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Shantanu Warhadpande, Amber Liles, Daniel Kirkpatrick
We present a case of a 69-year-old male with profound Cushing's syndrome and hypercortisolemia secondary to a cortisol-secreting adrenocortical carcinoma. Patient was not a surgical candidate and subsequently underwent a successful posterior approach tumor cryoablation. The procedure was complicated by a T11 intercostal artery injury and hemothorax. The detection of the culprit injury was almost immediate
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Persistent Bleeding after Coil Embolization of a Pancreatic Transplant Pseudoaneurysm: Should Covered Stents Be the Primary Management? Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Keshav Anand, Ziga Cizman, Tyler Smith, David Strain, Suraj Patel, Jeffrey Campsen, Talia Baker, Wael Saad
Life-threatening arterial complications after pancreatic transplantation can be dire. Pseudoaneurysms can be challenging to treat. There are multiple strategies to treat such complications. We present a case of pancreatic pseudoaneurysm which was initially treated by coiling followed by subsequent covered stent placement for a more durable outcome. We advocate for a “stent first” approach to these
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Transplant Hepatic Artery Rupture Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Keith B. Quencer
A case of transplant hepatic artery thrombosis treated with thrombolysis and vascular stenting is presented. Stenting was complicated by hepatic artery rupture necessitating emergent stent graft placement. Hepatic artery occlusion in a liver transplant often leads to biliary complications such as ischemic cholangiopathy, biliary necrosis, cholangitis, biloma formation, intrahepatic abscesses, and liver
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Massive Hemoperitoneum after Paracentesis in a Patient with Budd-Chiari Syndrome: Treated with a TIPS after Negative Arteriogram Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Dylan J. Assael, Steven C. Sauk
Paracenteses are considered safe procedures; however, in patients with portal hypertension, the rapid shifts in intraabdominal pressure can prompt hemorrhage from an ectopic varix. Little literature exists on the appropriate management in this clinical setting. Here, we describe a patient with portal hypertension secondary to Budd-Chiari syndrome, presenting with massive hemoperitoneum following paracentesis
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Viatorr Stent Migration and Retrieval during Transjugular Intrahepatic Portosystemic Shunt Revision Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Stephanie H. Kim, Michael Samuel, Abouelmagd Makramalla
Transjugular intrahepatic portosystemic shunt (TIPS) is an important interventional option for the treatment of complications related to cirrhosis and portal hypertension. Emergent TIPS placement can be a life-saving measure in patients with uncontrolled variceal hemorrhage. After TIPS placement, patients may benefit from additional interventions for clinical optimization including stent dilation,
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Hepatic Encephalopathy following Transjugular Intrahepatic Portosystemic Shunt Placement Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Bartley Thornburg
Hepatic encephalopathy (HE) is a complex condition that arises as a complication of chronic liver disease and portosystemic shunting. Its pathophysiology involves several factors, including impaired ammonia metabolism, portosystemic shunting, sarcopenia, and systemic inflammation. The symptoms of HE can vary significantly, with manifestations ranging from subclinical signs to a comatose state. The
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Diaphragmatic Injury with Empyema Development after Microwave Ablation of a Liver Dome Lesion Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Ran Jing, Travis Merritt, Joseph J. Gemmete
Percutaneous microwave ablation (MWA) of the liver is a minimally invasive procedure that utilizes high frequency electromagnetic waves to generate heat and induce tumor necrosis. MWA has been proven to be a safe and effective treatment option for primary and metastatic liver tumors. The treatment of liver dome lesions can present a technical challenge due to the proximity of the hepatic dome to the
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A Sticky Situation: Glue Migration during Hepatic Vein Embolization Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Koustav Pal, Joshua D. Kuban, Ravi Murthy, Bruno C. Odisio, Zeyad A. Metwalli
The addition of hepatic venous embolization to portal venous embolization to achieve ipsilateral liver venous deprivation before major hepatectomy has been suggested to increase the extent of hypertrophy of the future liver remnant. The presented case discusses a hepatic vein embolization procedure complicated by the unintended migration of a glue cast used to achieve hepatic venous occlusion and subsequent
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Dealing with Complications: First Address the Emotional Response Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Mikin V. Patel
Medical complications often leave the responsible physicians with strong negative emotional responses. Through self-compassion, physicians can overcome these negative emotions and continue to improve.
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Ethical Considerations for Artificial Intelligence in Interventional Radiology: Balancing Innovation and Patient Care. Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-07-20 Helena D Rockwell,Eric D Cyphers,Mina S Makary,Eric J Keller
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Peripheral Arterial Disease Treatment in the Non-Hospital Setting Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-06-16 Bret N. Wiechmann
Treatment of peripheral artery disease (PAD) has undergone a progressive shift toward less invasive, endovascular options within the last three decades. For PAD patients, the benefits of this shift are numerous and include less periprocedural pain, decreased blood loss, shorter recovery times, and fewer missed workdays. Commonly, patient-reported outcomes are very positive with this “endovascular first”
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Deep Venous Arterialization: Background, Patient Selection, Technique, Outcomes and Follow-up, and Future Implementation Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-06-16 Naveed Zaman, John Rundback
Critical limb-threatening ischemia (CLTI) is a severe manifestation of peripheral arterial disease with a highly increased risk for morbidity and mortality that has limited and suboptimal opportunities for treatment, ultimately resulting in major amputation for patients. Deep venous arterialization (DVA) provides a suitable limb salvage option for “no-option” patients facing amputation by introducing
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Techniques Providing Endpoints for Revascularization in Chronic Limb-Threatening Ischemia Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-06-16 Oleksandra Kutsenko, Jill Sommerset, Venita Chandra, Yolanda Bryce
It is frequently difficult to estimate the revascularization endpoint in patients with chronic limb-threatening ischemia where there may be extensive multifocal multiarterial disease. There have been attempts to identify an endpoint for revascularization procedures, but none has become the standard of care. An ideal indicator of an endpoint can objectively quantify tissue perfusion, predict wound healing
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How to Approach Below-the-Ankle Arterial Interventions Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-06-16 Bulent Arslan, Sreekumar Madassery
Critical limb ischemia, also referred to as chronic limb-threatening ischemia, is a major medical problem leading to limb amputations if not managed properly with a multispecialty team. Establishment of sufficient arterial flow to the foot is an integral part of this care. During the past two to three decades, arterial revascularization has become primarily endovascular with open surgical approaches
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Below-the-Knee Stents and Scaffolds: A Comprehensive Review Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-06-16 Farnaz Dadrass, Sahitya C. Raja, Robert Lookstein
Below-the-knee intervention of chronic limb-threatening ischemia is an area of increasing interest. Due to lower morbidity and possibly better clinical outcomes, endovascular techniques have become increasingly important in this patient population many of who have limited surgical options. This article serves as a review of existing stent and scaffolding devices utilized for infrapopliteal disease
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Drug-Coated Balloon versus Drug-Eluting Stent: The Debate of Leave Nothing Behind Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-06-16 Nicole Keefe, Trevor Shull, Lev Botea, Katharine McGinigle
Endovascular techniques for peripheral artery disease have changed significantly in the past 10 years with advances in technology and data. Treatment of superficial femoral disease is complex secondary to the length, degree of calcification, high rate of chronic total occlusion, and areas of flexion within this vessel. Use of drug-coated devices has increased the interventionalist's toolbox with the
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Surgical, Endovascular, and Multimodal Approaches to the Management of Atherosclerotic Common Femoral Artery Disease Semin. Interv. Radiol. (IF 1.4) Pub Date : 2023-06-16 Nathan W. Kugler
Common femoral artery disease is at the heart of nearly all treatment algorithms and decisions for patients with symptomatic peripheral arterial disease. Surgical endarterectomy has been the mainstay of common femoral treatment with a wealth of data supporting its safety, efficacy, and durability. Advances in endovascular technology and techniques for the management of iliac and superficial femoral