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Uterine artery embolization for management of placenta accreta, a single-center experience and literature review
Abdallah Noufaily, Raja Achou, Mitri Ashram, Miziana Mokbel, Emile Dabaj, Elie Snaifer, Abbas A Chamsuddin
January-June 2017, 1(1):37-42
“Morbidly adherent placenta” is a term that describes the continuum of placenta accreta, increta, and percreta. Placenta accreta is the least invasive form, whereas placenta percreta represents a complete penetration of the trophoblast through the uterus that reaches the serosal surface and potentially invades the bladder, rectal wall, and pelvic vessels. Leaving the placenta in situ in the setting of abnormally invasive placenta is now widely practiced. We herein present three cases of abnormal placental implantation diagnosed by antenatal ultrasound and magnetic resonance imaging, in which uterine artery embolization was performed to induce placental infarction and eventually rapid regression but most importantly to minimize peripartum and postpartum bleeding. As we do this, we sought to review the risks of placenta accreta, increta, and percreta and evaluate the role of endovascular therapy to improve maternal outcomes when abnormal placental implantation occurs.
  3,449 393 3
How i do it: Percutaneous image-guided peritoneal dialysis catheter insertion
Mohammad Arabi, Sultan Alammari, Shahbaz Qazi, Omar Bashir, Refaat Salman, Yousof Alzahrani, Elwaleed Elhassan, Mohammad Almoaiqel
July-December 2017, 1(2):49-54
Peritoneal Dialysis (PD) catheter insertion is traditionally performed using open surgical or laparoscopic techniques. The minimally invasive percutaneous PD catheter insertion techniques guided by fluoroscopy and ultrasound proved to provide comparable results in terms of catheter survival and dysfunction rates and lower incidence of catheter related peritonitis and leak. Percutaneous insertion by interventional radiologists offers more flexible scheduling and efficiency compared to surgical approaches that require operating room booking and general anesthesia. Here we report a step-by-step guide for percutaneous image-guided PD catheter insertion based on our institutional experience and previous best practice recommendations in the literature.
  2,916 377 -
How i do it: A practical database management system to assist clinical research teams with data collection, organization, and reporting
Amr Maged Elsaadany, Fida Hasan Alaeddin, Mohamed Farouk Badran, Hamad Saleh Alsuhaibani
January-June 2017, 1(1):10-14
With the growing amount of research projects in the field of interventional radiology, storing and organizing the patients' data and information effectively is becoming more difficult. Existing hospital electronic medical record and archiving systems store patient information in the form of reports which put the physicians and researchers in a situation where they have to use time-consuming manual search through reports for suitable patients for different clinical researches. Spreadsheet programs such as Microsoft Excel® (Microsoft, Washington, USA) are often used as a data storage, which has limitations in both organization and the quality of the data. Higher risk of incorrect data entry and introducing duplicates are associated with data input and analysis without a database system. Furthermore, selection, as well as calculation of data, is time-consuming. This article aims to provide interventionists with an efficient data collection tool optimized for interventional oncology clinical research. The implementation of the current database and interface allows a much faster and more detailed retrospective analysis of patient cohorts. The database management system with an interface is a very time-efficient and robust tool that provides a significant edge over the manual retrieval of patient records by filtering data and assisting statistical analysis in a study-relevant fashion.
  2,676 284 -
Percutaneous endovascular sapheno-femoral bypass for treatment of chronic iliac vein stent occlusion
Osman S Ahmed, Roberto Santos Loanzon, Bulent Arslan
January-June 2018, 2(1):20-23
We report a case of a 45-year-old female with a history of chronic iliac vein and inferior vena cava (IVC) occlusion, who presented with diffuse bilateral lower limb edema and pain secondary to severe postthrombotic syndrome. Computed tomography and digital subtraction angiography demonstrated reocclusion in the patient's previously placed iliofemoral and IVC stents. Recanalization was achieved with a percutaneous endovascular bypass approach after unsuccessful attempts using standard and other advanced endovascular techniques including sharp needle and radiofrequency wire recanalization.
  2,285 190 -
Treatment of massive systemic air embolism during lung biopsy
Abbas Chamsuddin, Raja Ashou
January-June 2017, 1(1):33-36
Percutaneous needle biopsy of lung lesions is commonly used and is usually regarded as a safe procedure with limited morbidity and extremely rare mortality. Most frequent complications are pneumothoax, pulmonary bleeding and hemoptysis. Other rare complications include systemic air embolus, tumor implantation and empyema. Systemic air emboli are extremely rare with a published incidence of 0.02' from a lung biopsy survey in the United Kingdom to 0.07' in the literature, but are serious and can be fatal. We present a case of massive air embolism occurring during lung biopsy and describe the technique used for immediate treatment.
  2,135 234 1
Pan Arab Interventional Radiology Society-PAIRS: A Milestone for Interventional Radiology in the Arab World - Reminiscences on the founding of the society
Aghiad Al-Kutoubi
January-June 2017, 1(1):2-4
  2,064 166 -
Robotics in interventional radiology: Past, present, and future
Maria Alejandra Rueda, Celia Theodoreli Riga, Mohamad S Hamady
July-December 2018, 2(2):56-63
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.
  1,860 285 -
Percutaneous removal of gallstones under fluoroscopy guidance in high-risk patients with acute cholecystitis
Ahmed Al Nammi, Ahsan Cheema, Mohanned Al Nammi, Ikram Chaudhry
January-June 2017, 1(1):30-32
We report our technique of percutaneous removal of gallstones in three elderly patients with acute calculus cholecystitis who were not surgical candidates due to multiple comorbidities. The procedure is performed under local anesthesia using fluoroscopic and choledochoscopic guidance. All patients had uneventful recovery and were discharged home in 3–4 days and fallow up at a low and high surveillance by ultrasound at 3 and 6 months interval.
  1,916 203 1
Catheter-directed treatment for pulmonary embolism in light of current evidence
Osman Ahmed, Alexandria Shadid
July-December 2018, 2(2):46-49
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.
  1,850 227 -
Demystifying Cyberknife stereotactic body radiation therapy for interventional radiologists
Azzam Khankan, Saif Althaqfi
July-December 2017, 1(2):55-63
Stereotactic body radiation therapy (SBRT) using CyberKnife system is a relatively new radiation therapy that has demonstrated feasibility, safety, and efficacy with a high local control of various extracranial unresectable primary cancer and oligometastasis. It involves accurate delivery of very high dose of radiation to the target or tumor volume with high precision and conformity, while minimizing the radiation exposure of nontargeted tissue. Radiopaque fiducial markers (FMs) implantation in and around the tumors is required to track the selected tumor during CyberKnife SBRT, especially in those organs moving with respiration. They act as internal radiographic landmarks that maintain a fixed relationship within the tumor and with each other. Although their implantation can be technically demanding, it can be performed using various techniques with varying success; however, percutaneous implantation under image guidance by interventional radiologists is the most common method. Close collaboration between interventional radiologists and radiation oncologists with understanding of the technical aspects of CyberKnife SBRT and FMs implantation has important implications for optimal delivery of therapy and direct impact on the interventional radiology practice in selected patients proposed for CyberKnife SBRT.
  1,852 188 -
Interventional oncology: A snapshot of expanding practice
Azzam Khankan
January-June 2017, 1(1):15-19
Interventional oncology (IO) was a minor part of interventional radiology. However, with the development of novel technologies and introduction of innovative therapeutics with dramatic transformations in the practice of oncology, IO is facing challenges in adopting and responding to these new changes to maintain its integral role and maximize its potentials in the efficient management of patients with cancer. In this snapshot, some of the novel therapeutic approach principles relevant to IO practice will be explained briefly.
  1,852 177 -
How i do it: Celiac and splanchnic plexus neurolysis
Aghiad Al-Kutoubi
January-June 2018, 2(1):4-7
Celiac block to alleviate pain in the upper abdomen was first described by Kappis in 1914. Since then the role of this procedure has been fairly established in the management of pain related to pancreatic disease and also in pain related to liver, gall bladder and gastric diseases. This article discusses the clinical indications and technical details of celiac and splanchnic neurolysis.
  1,742 259 -
Pharmacologic pain management in outpatient uterine fibroid embolization
Azzam A Khankan, Ibrahim A Al-Habli, Turki Alhazmi, Iyad Feteih, David A Valenti
July-December 2018, 2(2):50-55
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.
  1,680 223 -
Endovascular management of arterial injuries related to venous access: A retrospective review of 10-year single-center experience
Mohammad Arabi, Abdullah Almutairi, Abdulaziz Abdullah Alangari, Mohammad Mari Alamri, Abdulaziz Alharbi, Abdulrahman Alvi, Qazi Shahbaz, Yousof Alzahrani, Omar Bashir, Azzam Khankan, Essam Dulaigan, Refaat Salman, Mohammad Almoaiqel
January-June 2018, 2(1):8-13
Purpose: Retrospective review of the pattern and management techniques of arterial injuries related to central venous access with long-term outcomes. Materials and Methods: Between January 2007 and November 2017, a total of 20 patients (13 females) were included with the mean age of 63 (28–89 years) and mean body mass index of 25.75 (13.3–36.5). Venous access procedures included central venous catheter (CVC) placement, dialysis line insertion, or endovascular venous procedures. The study excluded patients who had arterial injuries related to arterial access, such as postarterial line placement, postangiography, or percutaneous coronary interventions. Results: Iatrogenic arterial injuries occurred after attempted venous access procedures involving the common femoral vein (n = 18) and subclavian vein (n = 2). Injuries were related to CVC placement (n = 5), temporary dialysis catheter (n = 14), and inferior vena cava filter insertion (n = 1). Nine patients had transarterial venous catheter insertion complicated by active bleeding from pseudoaneurysm and arteriovenous fistula. Other injuries included isolated fistula (n = 3), isolated pseudoaneurysm (n = 4), isolated branch injury (n = 2), and intra-arterial insertion (n = 2). Endovascular management included stent–graft placement (n = 14), embolization of bleeding vessel (n = 2), and thrombin injection for pseudoaneurysm (n = 2). Conservative management with manual compression achieved hemostasis in two patients. Technical success was achieved in 100%. One patient required repeat angiography and embolization of bleeding branch vessel following stent–graft placement to control bleeding fistula and pseudoaneurysm. Clinical success was achieved in all patients. Procedure-related complications included puncture site hematoma (n = 1) and partially occlusive thrombus/spasm of deep femoral artery after stent–graft placement. Six patients (33%) died within 20 days after the procedure (3–20 days) due to other comorbidities. Three additional patients (16%) died during the same hospital admission at the time of the procedure (38–114 days). There were no reported complaints related to possible stent–graft stenosis or occlusion at mean follow-up time of 5 years (50 days–8.64 years) in all seven patients who survived after stent–graft placement procedure. Conclusion: Despite technically successful endovascular management of arterial injuries related to venous access in critically ill patients, the mortality rate remains high due to other comorbidities. Allowing for the small sample size, stent–graft placement for arterial injuries in this cohort of patients appears to be an effective option with high long-term patency rate.
  1,606 229 -
Transarterial embolization of intermediate hepatocellular carcinoma in elderly patients: Which technique should be first-line?
Azzam Khankan, Abdul Rahman Jazieh
January-June 2018, 2(1):1-3
  1,523 230 -
Interventional radiology practice in Saudi Arabia: Are we driving on soft sand?
Abdulkader Abdulmohsen Alkenawi
January-June 2017, 1(1):8-9
  1,503 192 1
MesoTIPS: Combined approach for the treatment of portal hypertension secondary to portal vein thrombosis – A brief report
Abbas Chamsuddin, Lama Nazzal, Thomas Heffron, Osama Gaber, Raja Achou, Louis G Martin
January-June 2017, 1(1):20-26
Introduction: We describe a technique we call “Meso-transjugular intrahepatic portosystemic shunt (MTIPS)” for relief of portal hypertension secondary to portal vein thrombosis (PVT) using combined surgical and endovascular technique. Materials and Methods: Nine adult patients with PVT underwent transjugular intrahepatic portosystemic shunt through a combined transjugular and mesenteric approach (MTIPS), in which a peripheral mesenteric vein was exposed through a minilaparotomy approach. The right hepatic vein was accessed through a transjugular approach. Mechanical thrombectomy, thrombolysis, and angioplasty were performed when feasible to clear PVT. Results: All patients had technically successful procedures. Patients were followed up for a mean time of 13.3 months (range: 8 days to 3 years). All patients are still alive and asymptomatic. Conclusion: We conclude that MTIPS is effective for the relief of portal hypertension secondary to PVT.
  1,508 168 -
Inadvertent migration of hepatic artery pseudoaneurysm coil during endoscopic retrograde cholangiopancreatography
Riad Alchanan, Rajdeep Chhina, Ghali Salahia, Dean Huang, Dylan lewis
July-December 2017, 1(2):68-71
We report a case of a 72-year-old male with a cascade of complications being diagnosed as an acute cholecystitis. The cascade includes iatrogenic pulling of coils, which were placed for treatment of right hepatic artery pseudoaneurysm, into the common bile duct (CBD) in an attempt for removal of the misplaced/migrated CBD plastic stent inserted by endoscopic retrograde cholangiopancreatography (ERCP). The case demonstrates a series of mishaps leading to a rare complication of iatrogenic migration of transarterial coil in the gastrointestinal tract. This could be the first case of coil migration as a complication of ERCP due to suboptimal stenting/removal techniques.
  1,497 161 -
Endovascular treatment of pulmonary arteriovenous malformations: How we do it
Xin Li, Leen Alkukhun, Sasan Partovi, Victor Kondray, Mohammed Al-Natour
July-December 2018, 2(2):64-70
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.
  1,374 198 -

Apr 2017, 1(3):1-18
  1,372 170 -
Safety and efficacy of cryoablation of renal tumors in a high-risk patient population at a community hospital
Martin Oselkin, Nathan Cornish, Peter Homel, Shaun Honig, David Silver, Sergei Sobolevsky
January-June 2018, 2(1):14-19
Purpose: The purpose of the study was to evaluate the safety and efficacy of percutaneous cryoablation for the treatment of renal masses in a high surgical risk population stratified by Charlson Comorbidity Index treated at a community hospital and to determine parameters associated with higher complication rates. Materials and Methods: A retrospective chart review of patients with renal masses treated with image-guided percutaneous cryoablation between 2007 and 2013 was performed. Results: A total of 121 tumors were ablated in 105 patients. The mean patient age was 70 years old. Comorbidities included morbid obesity, hypertension, diabetes mellitus, coronary artery disease, pulmonary disease, cigarette use, and renal insufficiency. Mean tumor size treated was 3.15 cm in largest diameter, ranging from 1.4 to 6.5 cm. Complications were observed in 16 cases. The most common complication was perinephric and/or pararenal hemorrhage. Procedures with >3.5 probes, hemoglobin >12.5 g/dl, tumor size >3.55 cm, and age >75 years were all associated with greater likelihood of complications. Conclusions: Our experience with percutaneous cryoablation of small renal masses offers similar results in efficacy to published data in patients with significant comorbidities. In addition, the results of our study show that percutaneous cryoablation is relatively safe in patients with renal cancer who are poor surgical candidates but warrants special consideration. Parameters associated with higher rates of complications have been established, which may be used by physicians as a guide.
  1,362 173 -
The future of IR: Ascending! keynote lecture at the Pairs Annual Scientific Meeting 2017, Dubai, UAE
Barry T Katzen
July-December 2017, 1(2):43-48
  1,276 203 -
Staged radiofrequency ablation and surgical resection for multiple lung metastases of germ cell tumors
Sebastian Tavolaro, Guilhem Roubaud, Nadine Houédé, Jacques Jougon, François H Cornelis
July-December 2017, 1(2):64-67
Purpose: To evaluate the morbidity and efficacy of percutaneous radiofrequency ablation (RFA) performed before surgical resection for multiple residual lung metastases of germ cell tumors with negative tumor markers. Materials and Methods: This Review Board-approved retrospective study was carried out on five consecutive patients (mean age: 31 years, range: 22–41) treated successively with percutaneous RFA and surgery for multiple lung metastases of germ cell tumors. Mean number of lung metastases before treatment was 9.4. Staged procedures were performed on an average of 7.2 months (range: 1–16) after the primitive tumor resection. Results: The median clinical and imaging follow-up was 26 months (range: 24–36). Percutaneous RFA was technically feasible in one session under general anesthesia and CT guidance in all cases. On average, 2.8 tumors were ablated per patient (range: 1–6), and three of five procedures were bilateral. Three patients developed pneumothorax requiring drainage, but no severe complications were reported. Mean time between RFA and surgical resection of residual tumors was 2.5 months (range: 1–5). No local recurrences were noted, but one patient died due to metastatic evolution. Conclusion: Staged percutaneous RFA and surgical resection could be efficient with low morbidity for the management of multiple lung metastases of germ cell tumors.
  1,279 131 -
Arab's research productivity and contribution to vascular and interventional radiology literature
Yousof Al Zahrani, Mohammad Arabi
January-June 2017, 1(1):27-29
Objective: Vascular and interventional radiology (VIR) is one of the most rapidly growing fields of medicine. In this report, we evaluate the contribution of Arab countries to VIR publications and literature. Materials and Methods: Using PubMed database, we reviewed the total number of VIR publications from all Arab countries. In addition, we evaluated the total number of IR articles from each individual country, number of publications in VIR specialty journals and the type of manuscripts. Results: Seventy-four articles from different Arab countries were published in different journals from 1988 to 2016. Only 11 (14.9') articles were published in interventional radiology journals. The majority of these publications were from Kingdom of Saudi Arabia 31 (41.9') articles, followed by 20 (27.02') articles from Egypt, 7 articles (9.5') from Jordan, 6 articles (8.1) from Kuwait, and 4 articles (5.4') from Morocco. There was one article (1.4') from Lebanon, United Arab Emirates, Oman, Tunis, and Qatar. Nine (12.2') articles from different Arab countries were published in the two highest impact specialty journals in VIR. Conclusion: This review demonstrated the limited number of publications and poor contribution of Arab countries to VIR literature. Collaborative efforts of researchers, governments, and funding bodies are needed to improve research output in this important field of medicine.
  1,238 169 -
A view for interventional radiology in the Arab region
Michael D Dake
January-June 2017, 1(1):5-7
  1,225 166 -