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10 pages, 2330 KiB

Open AccessArticle

Practice Trends of Fibrinogen Monitoring in Thrombolysis

by Claire Kaufman, Thomas Kinney and Keith Quencer

J. Clin. Med. 2018, 7(5), 111; https://doi.org/10.3390/jcm7050111 - 10 May 2018

Cited by 15 | Viewed by 6469

Abstract

There is a lack of evidence or societal guidelines regarding the utility of fibrinogen monitoring during thrombolysis. The purpose of our study was to investigate the current use of monitoring fibrinogen levels during thrombolysis. A voluntary, anonymous online survey was sent to all [...] Read more.

There is a lack of evidence or societal guidelines regarding the utility of fibrinogen monitoring during thrombolysis. The purpose of our study was to investigate the current use of monitoring fibrinogen levels during thrombolysis. A voluntary, anonymous online survey was sent to all physician members of the Society of Interventional Radiology, consisting of 23 questions related to practitioner demographics, thrombolysis protocol, and fibrinogen monitoring. There were 455 physician responses; 82% of respondents monitored fibrinogen levels during thrombolysis, of which 97% decreased or stopped tissue plasminogen activator based on the level. Self-reported estimates of significant bleeding events during thrombolysis were 1.86% in those who monitored fibrinogen and 1.93% in those who did not. Only 34% of all respondents report, in their clinical experience, having found low fibrinogen level to be correlated with bleeding events. There was no significant difference in self-reported major bleeding rates between practitioners who monitor and those who do not monitor fibrinogen. This high variability of clinical use of fibrinogen monitoring during catheter-directed thrombolysis is secondary to the paucity of scientific studies demonstrating its utility; further scientific investigation is needed to define the true utility of fibrinogen monitoring. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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8 pages, 544 KiB

Open AccessArticle

Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome

by Patrick T. Hangge, Nikhil Gupta, Aditya Khurana, Keith B. Quencer, Hassan Albadawi, Sadeer J. Alzubaidi, M-Grace Knuttinen, Sailendra G. Naidu and Rahmi Oklu

J. Clin. Med. 2018, 7(5), 107; https://doi.org/10.3390/jcm7050107 - 08 May 2018

Cited by 23 | Viewed by 12522

Abstract

Nutcracker syndrome (NS) refers to symptomatic compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. No consensus diagnostic criteria exist to guide endovascular treatment. [...] Read more.

Nutcracker syndrome (NS) refers to symptomatic compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. No consensus diagnostic criteria exist to guide endovascular treatment. We aimed to evaluate the specificity of LRV compression to NS symptoms through a retrospective study including 33 NS and 103 control patients. The size of the patent lumen at point of compression and normal portions of the LRV were measured for all patients. Multiple logistic regression analyses (MLR) assessing impact of compression, body mass index (BMI), age, and gender on the likelihood of each symptom with NS were obtained. NS patients presented most commonly with abdominal pain (72.7%), followed by hematuria (57.6%), proteinuria (39.4%), and left flank pain (30.3%). These symptoms were more commonly seen than in the control group at 10.6, 11.7, 6.8, and 1.9%, respectively. The degree of LRV compression for NS was 74.5% and 25.2% for controls (p < 0.0001). Higher compression led to more hematuria (p < 0.0013), abdominal pain (p < 0.006), and more proteinuria (p < 0.002). Furthermore, the average BMI of NS patients was 21.4 and 27.2 for controls (p < 0.001) and a low BMI led to more abdominal pain (p < 0.005). These results demonstrate a strong correlation between the degree of LRV compression on imaging in diagnosing NS. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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11 pages, 682 KiB

Open AccessFeature PaperArticle

Developing Interventional Radiology Anticoagulation Guidelines: Process and Benefits ^†

by J. Scott Kriegshauser, Howard H. Osborn, Sailen G. Naidu, Eric A. Huettl and Maitray D. Patel

J. Clin. Med. 2018, 7(4), 85; https://doi.org/10.3390/jcm7040085 - 20 Apr 2018

Cited by 7 | Viewed by 4458

Abstract

We created, posted, and updated radiology department anticoagulation guidelines and identified various steps in the process, including triggering events, consensus building, legal analysis, education, and distribution of the guidelines to nurses and clinicians. Supporting data collected retrospectively, before and after implementation, included nursing [...] Read more.

We created, posted, and updated radiology department anticoagulation guidelines and identified various steps in the process, including triggering events, consensus building, legal analysis, education, and distribution of the guidelines to nurses and clinicians. Supporting data collected retrospectively, before and after implementation, included nursing satisfaction survey results and the number of procedure cancellations. After the guidelines were developed and posted, significantly fewer procedures were cancelled, nursing satisfaction was higher, and radiologists performed procedures with less variability. Anecdotally, radiologists had fewer queries about anticoagulation. The development and dissemination of radiologic procedure anticoagulation guidelines should be considered as a departmental quality improvement project. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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11 pages, 3716 KiB

Open AccessArticle

Baseline Apparent Diffusion Coefficient as a Predictor of Response to Liver-Directed Therapies in Hepatocellular Carcinoma

by Andrew Niekamp, Reham Abdel-Wahab, Joshua Kuban, Bruno C. Odisio, Armeen Mahvash, Manal M. Hassan, Aliya Qayyum, Ahmed Kaseb and Rahul A. Sheth

J. Clin. Med. 2018, 7(4), 83; https://doi.org/10.3390/jcm7040083 - 14 Apr 2018

Cited by 10 | Viewed by 3434

Abstract

Predicting outcomes in patients with hepatocellular carcinoma (HCC) who undergo locoregional therapies remains a substantial clinical challenge. The purpose of this study was to investigate pre-procedure diffusion weighted magnetic resonance imaging (DW-MRI) as an imaging biomarker for tumoral response to therapy for patients [...] Read more.

Predicting outcomes in patients with hepatocellular carcinoma (HCC) who undergo locoregional therapies remains a substantial clinical challenge. The purpose of this study was to investigate pre-procedure diffusion weighted magnetic resonance imaging (DW-MRI) as an imaging biomarker for tumoral response to therapy for patients with HCC undergoing drug eluting embolic (DEE) chemoembolization and radioembolization. A retrospective review of HCC patients who underwent DEE chemoembolization or radioembolization was performed. Of the 58 patients who comprised the study population, 32 underwent DEE chemoembolization and 26 underwent radioembolization. There was no significant difference in median apparent diffusion coefficient (ADC) values across the two treatment groups (1.01 × 10⁻³ mm²/s, P = 0.25). The immediate objective response (OR) rate was 71% (40/56). Tumors with high ADC values were found to have a higher probability of OR within 90 days (odds ratio 4.4, P = 0.03). Moreover, index lesion specific progression free survival (PFS) was greater for high ADC tumors, independent of conventional predictors of treatment response (hazard ratio 0.44, P = 0.01). Low ADC was associated with poorer PFS (P = 0.02). Pre-procedure ADC < 1.01 × 10⁻³ mm²/s is an independent predictor of poorer immediate OR and index lesion specific PFS in patients with HCC undergoing DEE chemoembolization or radioembolization. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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Review

Jump to: Research

10 pages, 2115 KiB

Open AccessReview

Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER): A Review of the Available Literature and Brief Overview of Alternate Therapies in Dialysis Associated Steal Syndrome

by William W. Sheaffer, Patrick T. Hangge, Anthony H. Chau, Sadeer J. Alzubaidi, M-Grace Knuttinen, Sailendra G. Naidu, Suvranu Ganguli, Rahmi Oklu and Victor J. Davila

J. Clin. Med. 2018, 7(6), 128; https://doi.org/10.3390/jcm7060128 - 29 May 2018

Cited by 13 | Viewed by 9787

Abstract

Dialysis associated steal syndrome (DASS) is a relatively rare but debilitating complication of arteriovenous fistulas. While mild symptoms can be observed, if severe symptoms are left untreated, DASS can result in ulcerations and limb threatening ischemia. High-flow with resultant heart failure is another [...] Read more.

Dialysis associated steal syndrome (DASS) is a relatively rare but debilitating complication of arteriovenous fistulas. While mild symptoms can be observed, if severe symptoms are left untreated, DASS can result in ulcerations and limb threatening ischemia. High-flow with resultant heart failure is another documented complication following dialysis access procedures. Historically, open surgical procedures have been the mainstay of therapy for both DASS as well as high-flow. These procedures included ligation, open surgical banding, distal revascularization-interval ligation, revascularization using distal inflow, and proximal invasion of arterial inflow. While effective, open surgical procedures and general anesthesia are preferably avoided in this high-risk population. Minimally invasive limited ligation endoluminal-assisted revision (MILLER) offers both a precise as well as a minimally invasive approach to treating both dialysis associated steal syndrome as well as high-flow with resultant heart failure. MILLER is not ideal for all DASS patients, particularly those with low-flow fistulas. We aim to briefly describe the open surgical therapies as well as review both the technical aspects of the MILLER procedure and the available literature. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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9 pages, 1265 KiB

Open AccessReview

Social Medicine: Twitter in Healthcare

by Yash Pershad, Patrick T. Hangge, Hassan Albadawi and Rahmi Oklu

J. Clin. Med. 2018, 7(6), 121; https://doi.org/10.3390/jcm7060121 - 28 May 2018

Cited by 194 | Viewed by 19419

Abstract

Social media enables the public sharing of information. With the recent emphasis on transparency and the open sharing of information between doctors and patients, the intersection of social media and healthcare is of particular interest. Twitter is currently the most popular form of [...] Read more.

Social media enables the public sharing of information. With the recent emphasis on transparency and the open sharing of information between doctors and patients, the intersection of social media and healthcare is of particular interest. Twitter is currently the most popular form of social media used for healthcare communication; here, we examine the use of Twitter in medicine and specifically explore in what capacity using Twitter to share information on treatments and research has the potential to improve care. The sharing of information on Twitter can create a communicative and collaborative atmosphere for patients, physicians, and researchers and even improve quality of care. However, risks involved with using Twitter for healthcare discourse include high rates of misinformation, difficulties in verifying the credibility of sources, overwhelmingly high volumes of information available on Twitter, concerns about professionalism, and the opportunity cost of using physician time. Ultimately, the use of Twitter in healthcare can allow patients, healthcare professionals, and researchers to be more informed, but specific guidelines for appropriate use are necessary. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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15 pages, 1271 KiB

Open AccessReview

Role of Venous Sampling in the Diagnosis of Endocrine Disorders

by Ryan W. England, Eliza B. Geer and Amy R. Deipolyi

J. Clin. Med. 2018, 7(5), 114; https://doi.org/10.3390/jcm7050114 - 14 May 2018

Cited by 10 | Viewed by 5951

Abstract

Venous sampling is the gold standard for localizing abnormal hormone secretion in several endocrine disorders. The most common indication for venous sampling is in the workup of primary aldosteronism, adrenocorticotropic hormone-dependent Cushing’s syndrome, and hyperparathyroidism. In experienced hands, venous sampling is safe and [...] Read more.

Venous sampling is the gold standard for localizing abnormal hormone secretion in several endocrine disorders. The most common indication for venous sampling is in the workup of primary aldosteronism, adrenocorticotropic hormone-dependent Cushing’s syndrome, and hyperparathyroidism. In experienced hands, venous sampling is safe and accurate. This review discusses the role of venous sampling in the workup of endocrine disease, describing the underlying anatomy and pathophysiology, as an understanding of these concepts is essential for technical and clinical success. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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17 pages, 5170 KiB

Open AccessReview

The Use of Transarterial Approaches in Peripheral Arteriovenous Malformations (AVMs)

by Aditya Khurana, Patrick T. Hangge, Hassan Albadawi, M-Grace Knuttinen, Sadeer J. Alzubaidi, Sailendra G. Naidu, J. Scott Kriegshauser, Rahmi Oklu and Brian W. Chong

J. Clin. Med. 2018, 7(5), 109; https://doi.org/10.3390/jcm7050109 - 09 May 2018

Cited by 14 | Viewed by 5343

Abstract

Arteriovenous malformations (AVMs) are a subset of congenital vascular malformations (CVMs). They comprise abnormal connections between arterial and venous circulation; treatment approaches are dependent on the angioarchitecture of the AVM, specifically the number and arrangement of the feeder arteries and outflow veins. Various [...] Read more.

Arteriovenous malformations (AVMs) are a subset of congenital vascular malformations (CVMs). They comprise abnormal connections between arterial and venous circulation; treatment approaches are dependent on the angioarchitecture of the AVM, specifically the number and arrangement of the feeder arteries and outflow veins. Various imaging modalities can be used to diagnose and plan treatment. Here we will review the use of transarterial approaches to treat AVMs. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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20 pages, 18488 KiB

Open AccessReview

Gastrodoudenal Embolization: Indications, Technical Pearls, and Outcomes

by Gokhan Kuyumcu, Igor Latich, Rulon L. Hardman, Gabriel C. Fine, Rahmi Oklu and Keith B. Quencer

J. Clin. Med. 2018, 7(5), 101; https://doi.org/10.3390/jcm7050101 - 02 May 2018

Cited by 11 | Viewed by 6904

Abstract

The gastroduodenal artery (GDA) is frequently embolized in cases of upper GI bleed that has failed endoscopic therapy. Additionally, it may be done for GDA pseudoaneurysms or as an adjunctive procedure prior to Yttrim-90 (Y90) treatment of hepatic tumors. This clinical review will [...] Read more.

The gastroduodenal artery (GDA) is frequently embolized in cases of upper GI bleed that has failed endoscopic therapy. Additionally, it may be done for GDA pseudoaneurysms or as an adjunctive procedure prior to Yttrim-90 (Y90) treatment of hepatic tumors. This clinical review will summarize anatomy and embryology of the GDA, indications, outcomes and complications of GDA embolization. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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17 pages, 5816 KiB

Open AccessReview

Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments

by Keith B. Quencer, Anthony S. Tadros, Keyan B. Marashi, Ziga Cizman, Eric Reiner, Ryan O’Hara and Rahmi Oklu

J. Clin. Med. 2018, 7(5), 94; https://doi.org/10.3390/jcm7050094 - 01 May 2018

Cited by 25 | Viewed by 9713

Abstract

Of all procedures in interventional radiology, percutaneous transhepatic biliary drainage (PTBD) is amongst the most technically challenging. Successful placement requires a high level of assorted skills. While this procedure can be life-saving, it can also lead to significant iatrogenic harm, often manifesting as [...] Read more.

Of all procedures in interventional radiology, percutaneous transhepatic biliary drainage (PTBD) is amongst the most technically challenging. Successful placement requires a high level of assorted skills. While this procedure can be life-saving, it can also lead to significant iatrogenic harm, often manifesting as bleeding. Readers of this article will come to understand the pathophysiology and anatomy underlying post-PTBD bleeding, its incidence, its varied clinical manifestations and its initial management. Additionally, a structured approach to its treatment emphasizing endovascular and percutaneous methods is given. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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9 pages, 19199 KiB

Open AccessFeature PaperReview

Endovascular Interventions for the Morbidly Adherent Placenta

by Claire Kaufman and Anthony Tadros

J. Clin. Med. 2018, 7(5), 92; https://doi.org/10.3390/jcm7050092 - 01 May 2018

Cited by 12 | Viewed by 5037

Abstract

Morbidly adherent placentas are a spectrum of abnormalities ranging from placental invasion of the myometrium to invasion past the myometrium and muscular layers into adjacent structures. This entity is becoming more prevalent recently with increased number of cesarean deliveries. Given the high risk [...] Read more.

Morbidly adherent placentas are a spectrum of abnormalities ranging from placental invasion of the myometrium to invasion past the myometrium and muscular layers into adjacent structures. This entity is becoming more prevalent recently with increased number of cesarean deliveries. Given the high risk of morbidity and mortality, this was traditionally treated with pre-term planned cesarean hysterectomy. However, recently, uterine preservation techniques have been implemented for those women wishing to preserve future fertility or their uterus. Early identification is crucial as studies have shown better outcomes for women treated at tertiary care facilities by a dedicated multidisciplinary team. Interventional radiologists are frequently included in the care of these patients as there are several different endovascular techniques which can be implemented to decrease morbidity in these patients both in conjunction with cesarean hysterectomy and in the setting of uterine preservation. This article will review the spectrum of morbidly adherent placentas, imaging, as well as the surgical and endovascular interventions implemented in the care of these complex patients. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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13 pages, 6477 KiB

Open AccessReview

Multi-Detector Computed Tomography Imaging Techniques in Arterial Injuries

by Cameron Adler, Patrick T. Hangge, Hassan Albadawi, M-Grace Knuttinen, Sadeer J. Alzubaidi, Sailendra G. Naidu and Rahmi Oklu

J. Clin. Med. 2018, 7(5), 88; https://doi.org/10.3390/jcm7050088 - 24 Apr 2018

Cited by 4 | Viewed by 5094

Abstract

Cross-sectional imaging has become a critical aspect in the evaluation of arterial injuries. In particular, angiography using computed tomography (CT) is the imaging of choice. A variety of techniques and options are available when evaluating for arterial injuries. Techniques involve contrast bolus, various [...] Read more.

Cross-sectional imaging has become a critical aspect in the evaluation of arterial injuries. In particular, angiography using computed tomography (CT) is the imaging of choice. A variety of techniques and options are available when evaluating for arterial injuries. Techniques involve contrast bolus, various phases of contrast enhancement, multiplanar reconstruction, volume rendering, and maximum intensity projection. After the images are rendered, a variety of features may be seen that diagnose the injury. This article provides a general overview of the techniques, important findings, and pitfalls in cross sectional imaging of arterial imaging, particularly in relation to computed tomography. In addition, the future directions of computed tomography, including a few techniques in the process of development, is also discussed. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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13 pages, 3524 KiB

Open AccessReview

Colorectal-Vaginal Fistulas: Imaging and Novel Interventional Treatment Modalities

by M-Grace Knuttinen, Johnny Yi, Paul Magtibay, Christina T. Miller, Sadeer Alzubaidi, Sailendra Naidu, Rahmi Oklu, J. Scott Kriegshauser and Winnie A. Mar

J. Clin. Med. 2018, 7(4), 87; https://doi.org/10.3390/jcm7040087 - 22 Apr 2018

Cited by 7 | Viewed by 11531

Abstract

Colovaginal and/or rectovaginal fistulas cause significant and distressing symptoms, including vaginitis, passage of flatus/feces through the vagina, and painful skin excoriation. These fistulas can be a challenging condition to treat. Although most fistulas can be treated with surgical repair, for those patients who [...] Read more.

Colovaginal and/or rectovaginal fistulas cause significant and distressing symptoms, including vaginitis, passage of flatus/feces through the vagina, and painful skin excoriation. These fistulas can be a challenging condition to treat. Although most fistulas can be treated with surgical repair, for those patients who are not operative candidates, limited options remain. As minimally-invasive interventional techniques have evolved, the possibility of fistula occlusion has enriched the therapeutic armamentarium for the treatment of these complex patients. In order to offer optimal treatment options to these patients, it is important to understand the imaging and anatomical features which may appropriately guide the surgeon and/or interventional radiologist during pre-procedural planning. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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8 pages, 1273 KiB

Open AccessReview

Quadrilateral Space Syndrome: Diagnosis and Clinical Management

by Patrick T. Hangge, Ilana Breen, Hassan Albadawi, M. Grace Knuttinen, Sailendra G. Naidu and Rahmi Oklu

J. Clin. Med. 2018, 7(4), 86; https://doi.org/10.3390/jcm7040086 - 21 Apr 2018

Cited by 21 | Viewed by 17892

Abstract

Quadrilateral space syndrome (QSS) is a rare disorder characterized by axillary nerve and posterior humeral circumflex artery (PHCA) compression within the quadrilateral space. Impingement is most frequently due to trauma, fibrous bands, or hypertrophy of one of the muscular borders. Diagnosis can be [...] Read more.

Quadrilateral space syndrome (QSS) is a rare disorder characterized by axillary nerve and posterior humeral circumflex artery (PHCA) compression within the quadrilateral space. Impingement is most frequently due to trauma, fibrous bands, or hypertrophy of one of the muscular borders. Diagnosis can be complicated by the presence of concurrent traumatic injuries, particularly in athletes. Since many other conditions can mimic QSS, it is often a diagnosis of exclusion. Conservative treatment is often first trialed, including physical exercise modification, physical therapy, and therapeutic massage. In patients unrelieved by conservative measures, surgical decompression of the quadrilateral space may be indicated. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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15 pages, 218 KiB

Open AccessReview

A Practical Review of the Emerging Direct Anticoagulants, Laboratory Monitoring, and Reversal Agents

by Stephanie A. Joppa, Justin Salciccioli, Jill Adamski, Salma Patel, Waldemar Wysokinski, Robert McBane, Farah Al-Saffar, Heidi Esser and Fadi Shamoun

J. Clin. Med. 2018, 7(2), 29; https://doi.org/10.3390/jcm7020029 - 11 Feb 2018

Cited by 31 | Viewed by 8627

Abstract

Millions of patients in the United States use anticoagulation for a variety of indications, such as the prevention of stroke in those with atrial fibrillation (AF) and the treatment and prevention of venous thrombosis. For over six decades warfarin was the only available [...] Read more.

Millions of patients in the United States use anticoagulation for a variety of indications, such as the prevention of stroke in those with atrial fibrillation (AF) and the treatment and prevention of venous thrombosis. For over six decades warfarin was the only available oral anticoagulant, but now several DOACs are available and their use has become more prevalent in recent years. In spite of this increased use, many physicians remain reluctant to prescribe DOACs due to concerns about bleeding and reversibility. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

10 pages, 1992 KiB

Open AccessReview

The Evolving Treatment of Peripheral Arterial Disease through Guideline-Directed Recommendations

by Ramez Morcos, Boshra Louka, Andrew Tseng, Sanjay Misra, Robert McBane, Heidi Esser and Fadi Shamoun

J. Clin. Med. 2018, 7(1), 9; https://doi.org/10.3390/jcm7010009 - 09 Jan 2018

Cited by 18 | Viewed by 5739

Abstract

Peripheral arterial disease (PAD) refers to partial or complete occlusion of one or more non-coronary arteries that leads to compromised blood flow and ischemia. Numerous processes are involved in arterial stenosis, however, atherosclerosis remains the most common etiology. PAD constitutes a major health [...] Read more.

Peripheral arterial disease (PAD) refers to partial or complete occlusion of one or more non-coronary arteries that leads to compromised blood flow and ischemia. Numerous processes are involved in arterial stenosis, however, atherosclerosis remains the most common etiology. PAD constitutes a major health economic problem, and it is estimated that over 200 million people around the world suffer from PAD, with at least 20% having some degree of claudication. The purpose of this review is to compare and contrast the guidelines on PAD published in 2005, 2011 and 2016 in terms of new recommendations and level of evidence for practicing clinicians. Full article

(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)

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