Seminars in Interventional Radiology最新文献

New catheter-based technologies in the treatment of thrombolysis of venous thromboembolism have changed the landscape of the treatment of that disease spectrum. Traditional catheter-directed thrombolysis (CDT) typically involved placement of a lysis catheter and infusion of thrombolytic medications in the ICU setting for many hours, requiring frequent monitoring of fibrinogen, and titration of the thrombolytic agent based on patient-reported symptom improvement and standard vital signs. However, new devices and studies have shown effectiveness with significantly shorter infusion times and medication use, and have introduced features that may help to personalize therapy and help to preserve resources such as ICU bed allocation. This review examines the most recent advances in thrombolysis technology focusing on innovative devices and their clinical implications.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive condition characterized by persistent thromboembolic disease in the pulmonary arteries, leading to increased pulmonary vascular resistance and right heart failure. Medical therapy offers symptomatic relief but is not curative. Pulmonary thromboendarterectomy (PTE) remains the gold standard treatment; however, patients are often ineligible for surgery due to unfavorable anatomy, comorbidities, or preferences. Balloon pulmonary angioplasty (BPA) has emerged as a minimally invasive alternative, particularly for patients with inoperable CTEPH or post-PTE patients who remain symptomatic. Balloon catheters are used to dilate stenotic pulmonary arteries and to disrupt intraluminal webs and synechia, improving hemodynamics and leading to better quality of life. Careful patient selection for BPA is crucial, requiring a multidisciplinary approach to identify suitable candidates. Although BPA has demonstrated favorable outcomes, challenges remain in optimizing procedural techniques, reducing complication rates, and establishing standardized treatment protocols. This work aims to review BPA and its role in treating CTEPH, from patient selection to expected outcomes, as well as potential areas of future research, which includes the need for increased awareness and accessibility to specialized CTEPH centers, advancements in imaging technology, procedural standardization, and investigation of combination therapies to further support BPA efficacy and improve patient outcomes.

Upper extremity deep venous thrombosis (UEDVT) represents 4 to 11% of all deep vein thrombosis (DVT) and can result in persistent pain, swelling, and disability if inadequately treated. The range of presentations varies, from acute pain and swelling in the young overhead athlete to the asymptomatic cancer patient with chronic catheter-associated thrombus. Given the range of presentations, it is important to be familiar with the multimodal therapeutic options for UEDVT to appropriately select patients who will benefit from intervention. This is vitally important as use of central venous access devices and imaging increases, resulting in increased incidence and detection of UEDVT.

The postthrombotic syndrome (PTS) is a common complication of lower extremity deep vein thrombosis (DVT) that impairs patients' health-related quality of life despite the use of standard therapy. Prevention of PTS is an important goal of quality DVT care, and includes prevention of recurrent DVT with anticoagulation, use of compression therapy, mitigation of functional contributors to limb edema, use of endovascular therapy to prevent venous obstruction and valvular reflux, and reduction of inflammation within the involved veins and limb. This study reviews best practices in clinical PTS prevention, clinical trial evidence on endovascular therapy outcomes, and mechanistic observations about PTS with the goal of preparing the interventional radiology physician to deliver outstanding patient care and to lead local and national multi-specialty initiatives that are aimed at PTS prevention.

Despite the well-defined role of interventional radiology (IR) in the management of adult patients with hepatocellular carcinoma (HCC), the role of IR for pediatric liver tumors is still being established. This is, in part, due to the rarity and heterogeneity of pediatric liver tumors as well as the limited literature supporting liver-directed therapies for children. In addition, hepatoblastoma, the most common primary pediatric liver tumor, carries a good prognosis with current surgical and systemic treatment options directed by well-established clinical trials. Still, a subset of patients will not be amenable to operative treatment, and other pediatric liver tumors, such as HCC, portend a dismal prognosis. These settings offer opportunities for growth of pediatric IR and to provide services that improve the lives of children. The purpose of this article is to review the role of IR in pediatric liver cancer, including biopsy recommendations set forth by current clinical trials, transarterial chemoembolization and radioembolization, and percutaneous ablation.

This study aims to review current practices in thrombolysis and thrombectomy for managing deep venous thrombosis (DVT) and associated complications in the pediatric population. Pediatric thrombosis care has a rich history of evolution, from the early days of anticoagulation to the current era of endovascular therapies. This evolution has been driven by the need for a nuanced, multidisciplinary approach that includes interventional radiology (IR) and hematology. While anticoagulation remains the standard of care, endovascular therapies are increasingly utilized in cases of extensive, occlusive, or limb-threatening DVT, particularly to prevent pulmonary embolism and postthrombotic syndrome (PTS) and to preserve venous patency. This review outlines the indications, contraindications, and procedural techniques for catheter-directed thrombolysis, pharmaco-mechanical thrombectomy (PMT), mechanical thrombectomy, and venous stenting in children. It emphasizes the crucial role of a multidisciplinary team, including pediatric hematologists, interventional radiologists, and other medical professionals, in managing pediatric DVT. This collaboration is essential for considering pediatric-specific factors such as patient size, sedation requirements, radiation, contrast dosing, and anticoagulation. Also highlighted are postprocedural care, anticoagulation strategies, and imaging follow-up. Multidisciplinary collaboration is critical to improving outcomes for children with thrombotic disease.

Traumatic vascular injuries are a major cause of death and disability, especially in those under 45. Vascular and interventional radiology (VIR) has transformed management, offering minimally invasive options. This paper examines the implementation of a Code Angio protocol at a level I trauma center to expedite response times for such injuries by VIR. Initiated in August 2014 at University Hospital in San Antonio, Code Angio uses automated alerts to simultaneously notify a multidisciplinary team-including VIR, trauma surgery, anesthesia, and operating room staff-when trauma patients meet vascular injury criteria. After implementation, Code Angio response times decreased, and the need for urgent laparotomies for hemorrhage control was reduced. From 2019 to 2024, 1,447 cases were recorded, with Code Angio facilitating rapid VIR team activation, mostly within 60 minutes. The survival rate for Code Angio patients was higher than with surgery alone. Subgroup analysis showed Code Angio's routine use in specific injuries, helping reduce invasive surgeries and optimizing resource use. Rapid response VIR protocols like Code Angio improve patient outcomes, resource use, and healthcare efficiency. Future efforts will focus on better integration with trauma guidelines, identifying workflow delays, and continuous protocol refinement for seamless coordination.

Nonoperative management is becoming more common for hemodynamically stable patients with hemorrhagic traumatic injuries. N-butyl 2-cyanoacrylate (NBCA) glue is a safe and effective embolic agent in cases of solid organ traumatic injury, hemorrhage associated with pelvic fractures, as well as deep and superficial trauma. Although glue can be effectively used off-label in these cases (either alone or in combination with other embolization methods, such as microcoils), operators should first understand the mechanism of action, advantages and disadvantages, common applications, and proper preparation and injection techniques to reduce risk of complications such as nontarget embolization, proximal occlusion preventing distal embolization, and microcatheter occlusion.