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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.
  7,926 514 -
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.
  6,757 698 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.
  6,030 667 -
Arteriovenous fistula of the profunda femoris artery postdynamic hip screw fixation
Abdullah Bader Abohimed, Yousof Abdulrahman Al Zahrani, Essam Mohammed Al Dulagain, Mohammed Ibrahim Al Moaiqel
July-December 2018, 2(2):93-93
  5,165 244 -
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.
  4,768 541 -
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.
  4,743 452 -
Bariatric Arterial Embolization: Position Statement by the Pan Arab Interventional Radiology and the Saudi Interventional Radiology Societies
Mohammad Arabi, Karim A Abd El Tawab, Mohammad Almoaiqe, Abbas Chamsuddin, Majed Ashour, Andrew J Gunn, Ali Alzahrani
January-June 2020, 4(1):4-10
  4,526 276 1
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.
  4,165 510 -
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.
  4,089 344 1
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.
  3,971 396 1
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.
  3,964 361 1
Adrenal vein sampling: How i do it
Karim Valji
July-December 2019, 3(2):44-49
Adrenal vein sampling (AVS) is an uncommonly performed interventional procedure. However, it is essential in the management of patients with primary aldosteronism and several other rare hormonal disorders. AVS can be technically challenging, largely from difficulty with right adrenal vein catheterization. Recently described technical modifications have improved the likelihood of successful sampling in every case. This paper highlights the author's approach to patient selection and step-by-step details of his technique.
  3,747 466 -
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.
  3,737 414 -
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.
  3,511 406 -
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.
  3,492 401 -
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.
  3,376 330 -
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
  3,331 309 1
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.
  3,299 326 -
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.
  3,176 304 -

August 2018, 2(3):1-33
  3,104 332 -

February 2019, 3(3):1-44
  3,209 173 -
Interventional radiology practice in Saudi Arabia: Are we driving on soft sand?
Abdulkader Abdulmohsen Alkenawi
January-June 2017, 1(1):8-9
  2,983 339 1

Apr 2017, 1(3):1-18
  2,862 400 -
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.
  2,971 282 -
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
  2,824 355 -