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   Table of Contents - Current issue
July-December 2018
Volume 2 | Issue 2
Page Nos. 41-96

Online since Tuesday, September 4, 2018

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PAIRS 2018 keynote lecture: The next decade in interventional radiology: Do we need more disruptive innovation or better integration? p. 41
John A Kaufman
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Catheter-directed treatment for pulmonary embolism in light of current evidence p. 46
Osman Ahmed, Alexandria Shadid
Pulmonary embolism (PE) is the leading cause of in-hospital morbidity and mortality and accounts for approximately 100,000 deaths in the United States and 300,000 deaths in Europe annually. Although societal guidelines for low- and high-risk PE are well established, the present management of submassive (intermediate)-risk PE is evolving. Catheter-directed thrombolysis (CDT) represents a viable treatment option for treatment of submassive PE given its ability to rapidly reduce right heart strain with an acceptably low rate of major hemorrhagic complication. The current review aims to discuss the existing guidelines and literature supporting CDT for PE and also to examine upcoming areas of future research to support its adoption in the algorithm for the management of submassive PE.
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Pharmacologic pain management in outpatient uterine fibroid embolization p. 50
Azzam A Khankan, Ibrahim A Al-Habli, Turki Alhazmi, Iyad Feteih, David A Valenti
The key for successful uterine fibroid embolization in outpatient setting is good management of pain and other postembolization symptoms. Although several different protocols with different medication regimens have been used successfully in multiple institutions, it is still a challenge for interventional radiologists who should be prepared to provide detailed follow-up plans, continuous staff availability, and an oral medication regimen sufficient to alleviate these symptoms. Moreover, the interventional radiologist should be able to educate the patient about this postprocedural pain and available treatments.
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Robotics in interventional radiology: Past, present, and future p. 56
Maria Alejandra Rueda, Celia Theodoreli Riga, Mohamad S Hamady
Robotic endovascular systems have been successfully used to treat a wide range of pathologies including endovascular aneurysm repairs, uterine artery embolizations, and cardiac electrophysiology ablations. Limited research suggests that the use of robotic systems may help to achieve a more accurate manipulation and increased steerability of the catheter during endovascular procedures. In addition, robotic systems have also been designed to enhance image-guided percutaneous procedures, demonstrating a potential to facilitate needle placements and guidance and diminish radiation exposure risk. There are still many limitations for the widespread of this emerging technology. More studies are needed to validate the use of robotic systems and to show meaningful clinical advantages over traditional methods as well as assessing cost-effectiveness.
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Endovascular treatment of pulmonary arteriovenous malformations: How we do it p. 64
Xin Li, Leen Alkukhun, Sasan Partovi, Victor Kondray, Mohammed Al-Natour
Pulmonary arteriovenous malformation (PAVM) is a rare disease disproportionally affecting patients with hereditary hemorrhagic telangiectasia and may be associated with other pulmonary or infectious etiologies. Respiratory symptoms are the most common, including dyspnea, hypoxemia, and hemoptysis. Due to the impairment of normal pulmonary filtration function, patients with PAVM are at risk for embolic events, ranging from ischemic strokes to brain abscesses. More importantly, PAVM can enlarge over time or with physiological changes, which may lead to catastrophic hemorrhages and increased embolization risks. From imaging perspective, echocardiography with contrast bubbles and computed tomography can both be used to diagnose PAVMs with high sensitivity and specificity. Treatment modalities have evolved from invasive surgeries to transluminal catheter-based interventions. In recent decades, the evolution of interventional techniques and equipment has resulted in a high technical success rate for the treatment of PAVMs. Here, we present the interventional PAVM treatment protocol at our institution.
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How effective is a departmental registry follow-up form for improving retrieval of inferior vena cava filters? A single-center experience p. 71
Esraa Y Arabi, Ghaida Almusallam, Abeer Alkhathlan, Razan Alfaiz, Yousof Alzarani, Mohammad Arabi
Purpose: This study evaluated the impact of a departmental registry follow-up form on the retrieval rate of retrievable inferior vena cava (IVC) filters. Materials and Methods: We performed a case–controlled retrospective study of all patients who had received such filters 2 years before and after the follow-up registry was implemented at the study center in June 2015. Patients were analyzed based on age, gender, indication, type of filter, date and location of filter insertion, date of retrieval, dwelling time, and previous attempts at retrieval. The two groups were compared in terms of filter type, rate of retrieval, and dwelling time, before and after the registry was implemented. Results: Between June 2013 and May 2017, 307 filters were inserted in 183 males and 124 females. Of these filters, 296 (96.42%) were placed below the renal veins and 11 (3.58%) were placed suprarenally. A total of 148 (48.21%) filters were inserted before implementing the follow-up form and 159 (51.79%) were inserted afterward. The retrieval rate was 35.81% before implementation of the registry form and 38.36% afterward. The mean dwelling time of retrieved filters prior to implementation was 32 days and 48 days during the 2 years after implementation, respectively. Filter retrieval was successful in 110 patients from the first attempt (96.49%) and four patients required more than one attempt (3.51%). Conclusion: The departmental vena cava filters' registry resulted in minimal improvement of retrievability rates. Younger age was associated with increased likelihood of retrieval. These data suggest that additional measures are required to further enhance retrieval rates.
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Outcome of transjugular intrahepatic portosystemic shunt in Budd-Chiari syndrome: Long-term outcomes of 118 patients; A single-center experience p. 75
Mohamed Shaker, Mohammad Sakr, Hany Dabbous, Sara M Abdelhakam, Ahmed Samir, Hend Ebada, Amir M Farid, Mohamed El-Gharib, Ahmed Eldorry
Context: Budd–Chiari syndrome (BCS) is a heterogeneous group of clinical conditions ranging from acute liver failure to completely asymptomatic patient. Patients with BCS nonresponsive to medical treatment or who are not candidates for angioplasty/stenting are routinely treated with transjugular intrahepatic portosystemic shunt (TIPS) to improve portal venous outflow. Aims: This retrospective study aims at determining the short and long-term outcomes of TIPS in BCS patients. Subjects and Methods: This retrospective study included 118 patients with primary BCS who underwent TIPS from 2005 to 2011. They were classified according to Child-Pugh, model for end-stage liver disease (MELD), Rotterdam and BCS-TIPS scores. Short-term outcome of TIPS (<1 year) was determined and included immediate postprocedure complications, effect on clinical status, liver profile, and stent patency. Long-term outcome (1–5 years) was determined and included stent patency rate, time, and pattern of management of stent occlusion and survival rates at 1, 3, and 5 years. Statistical Analysis Used: SPSS statistical package version 16. Paired t-test was used to compare pre and post-TIPS MELD and Child-Pugh scores. Chi-square test and Kaplan–Meier survival curve were used to examine the association between short- and long-term occlusion, liver function and survival outcomes. P < 0.05 was considered statistically significant. Results: By the 1st year, there was a significant decline in the percentage of patients having ascites and abdominal pain, increase in mean serum albumin from 3.42–4.02 g/dl and reduction in bilirubin levels from 2.57–1.35 mg/dl (P < 0.001). The rate of stent occlusion by the 1st year was 27.4%. During long-term follow-up, there was a marked improvement in clinical status, liver profile, Child–Pugh, and MELD scores (P < 0.001). The 1- and 5-year shunt patency rates were 72.6% and 78.7%, respectively. The main management of post-TIPS occlusion was angioplasty without stenting. The 1-, 3-, and 5-year survival rates were 95.8%, 93.2%, and 91.5%, respectively. There was a significant relation between survival and post-TIPS MELD score (P = 0.009). Conclusions: TIPS is an effective treatment modality for BCS and has a long-term survival benefit with satisfactory shunt patency and patient survival.
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Percutaneous endoscopic gastrostomy large-bore tube application without the use of endoscope: Single-center experience on 86 neurologically compromised patients p. 82
Rana T. M. Khafagy, Karim A Abd El Tawab
Context: Percutaneous placement of gastrostomy tube has replaced surgical placement as the most accepted method of gastrostomy tube insertion. It can be done by an alternative nonendoscopic fluoroscopy-guided technique that combines the advantages of fluoroscopic guidance and the pull technique. Aims: This study aimed to describe a percutaneous fluoroscopy-guided technique for applying mushroom-retained large-bore gastrostomy advanced through the nose without endoscopy. Settings and Design: This retrospective study was conducted at the Interventional Radiology Unit, Ain Shams University Hospitals, Cairo, Egypt. Subjects and Methods: Between January 2015 and November 2017, 86 neurologically compromised patients underwent placement of 24F mushroom gastrostomy tubes. There were 55 males and 31 females, with the mean age of 61 years (58–87 years). Technical success and procedural complications were assessed. Follow-up data were collected retrospectively by reviewing the medical records at the neurology clinic to evaluate tube function and monitor complications. Results: Technical success rate was 100%. Procedure time varied between 10 and 13 min. No major procedure-related complications occurred. Twenty-two patients (25.5%) died during the study period with no procedure-related deaths. Nearly 34.8% of the patients (30/86 patients) could not be followed up due to loss of contact. Follow-up time ranged between 200 and 230 days in the remaining 34 patients with no evidence of tube dysfunction. Conclusions: Fluoroscopy-guided percutaneous placement of large-bore pull gastrostomy tubes inserted via nasal route showed a high rate of technical success and long-term patency with low risk of complications.
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Percutaneous salvage of a thrombosed immature arteriovenous fistula using a long segment stent graft across the juxta-anastomotic and outflow vein p. 87
Osman Ahmed, Patrick Tran, Youssef Hedroug, Ulku Cenk Turba
The role for stent grafting in the juxta-anastomotic segment for nonmaturing arteriovenous (AV) fistulas is not well understood. We report a case in which a long segment stent-graft of nearly the entire venous limb of a brachiocephalic AV fistula was stented to salvage an access that would likely otherwise have been abandoned. The patient went on to mature his fistula 3 months later and access it for hemodialysis through percutaneous puncture of the stent graft.
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Percutaneous ureteral embolization to manage fistulous bladder cancer p. 90
Almamoon I Justaniah, Motaz A Khairo, Amal Alfhmy, Noha H Guzaiz
An 85-year-old male who had an invasive urothelial carcinoma of the urinary bladder complicated by vesicocutaneous fistula, resulting in abscess formation. The patient was managed by percutaneous abscess drainage and ureteral embolization with permanent bilateral nephrostomy. Later, the abdominal drain was removed and the patient remained nephrostomy dependent for 5 months until he died.
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Arteriovenous fistula of the profunda femoris artery postdynamic hip screw fixation p. 93
Abdullah Bader Abohimed, Yousof Abdulrahman Al Zahrani, Essam Mohammed Al Dulagain, Mohammed Ibrahim Al Moaiqel
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Dialysis arteriovenous fistula access for arterial interventions: A forbidden or forgotten access p. 94
Naif Abdulaziz Alanazi, Mohammed Saeed Altolub, Nasser D AlHendi, Yousof A Al Zahrani, Mohammed Arabi
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Confronting the prevalence of limb amputation from peripheral artery disease in Nigeria p. 95
Anas Ismail, Abdulkadir Musa Tabari, Kabiru Isyaku, Nafiu Ahmed
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