Seminars in Interventional Radiology最新文献

Pediatric renovascular hypertension (RVH) is a significant cause of secondary hypertension in children, often resulting from renal artery stenosis (RAS) due to nonatherosclerotic etiologies such as fibromuscular dysplasia (FMD), mid aortic syndrome (MAS), and syndromic conditions like neurofibromatosis type 1 (NF-1). Early diagnosis is critical to prevent long-term complications, including renal dysfunction and cardiovascular disease. Diagnostic evaluation begins with ultrasound, which, despite its limitations, remains the first-line modality. Advanced imaging techniques such as CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA) provide detailed vascular assessment, with DSA considered the gold standard. Adjunctive tools like intravascular pressure measurements, intravascular imaging, and renal vein renin sampling supplement DSA. Management should have multidisciplinary consensus and is tailored to the individual patient. Pharmacological therapy is seldom sufficient and percutaneous transluminal angioplasty is effective in many cases. Stent placement and surgical interventions are reserved for refractory or complex cases. Chemical ablation in select cases and emerging therapies such as renal denervation offer additional options. This review outlines the current diagnostic and therapeutic approaches to pediatric RVH, emphasizing the importance of personalized care and the role of specialist pediatric centers, with experience in managing RVH, in optimizing outcomes.

Central venous access device (CVAD) placement is a common procedure for outpatient and inpatient pediatric interventional radiology practices. The principles of CVAD placement in pediatrics are similar to those in adults; however, certain clinical parameters must be considered when choosing the optimal type of line, size of catheter, and location for pediatric patients. The vessel lumen to catheter ratio is of utmost importance, and unique techniques may be necessary to facilitate bedside procedures. As in adults, all CVAD placements confer some level of risk. This review article discusses vascular anatomy, CVAD procedural techniques, and complications specifically concerning venous access in children.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a critical adjunct in the management of trauma-related shock, serving as a temporizing measure to preserve vital organ perfusion and allow time to achieve definitive hemorrhagic control. However, the increasing adoption of REBOA into clinical practice is associated with a spectrum of potential complications that significantly increase morbidity and mortality in the setting of acute traumatic injury. There is little existing research to guide clinical decision-making and monitoring for these feared complications, especially iatrogenic vascular injuries. This paper synthesizes the current evidence on the classification, frequency, and management of vascular complications following REBOA insertion in the setting of trauma in addition to our observations and experiences as a level I trauma center.

Restoring venous patency and flow is crucial for pediatric patients with superior vena cava (SVC), IVC, and iliac vein occlusion, and advancements in venous recanalization and stent reconstruction have proven safe and efficacious in the adult population, with techniques from adult patients adapted to manage these conditions in younger individuals. Endovascular therapy has advanced significantly, improving device and stent technologies, imaging modalities, and procedural techniques. This study reviews indications, technical considerations, and outcomes for venous stenting in pediatric patients, focusing on SVC syndrome, IVC atresia, and iliac vein compression. This guide is a reference for interventional radiologists to optimize outcomes through precise stent selection and procedure execution.

Trauma remains a leading cause of death and disability worldwide, responsible for over 4.4 million deaths annually. Advances in imaging and technology have shifted modern trauma care toward the increased use of nonoperative management. This review explores the evolving collaboration between trauma surgery and interventional radiology (IR), presenting the trauma surgeon's perspective of this multidisciplinary collaboration. IR offers minimally invasive, organ-preserving interventions, which reduce the morbidity associated with open surgery and improve patient outcomes. The article reviews standardized trauma assessment protocols, the utility of imaging modalities such as FAST and CT, and the role of efficient multidisciplinary collaboration. It emphasizes the importance of institutional protocols to streamline communication, reduce time to intervention, and ensure timely IR activation. Key IR procedures, such as transarterial embolism (TAE), balloon occlusion, and stent or stent-graft placement, are explored in the context of managing solid organ injuries (spleen, liver, kidney), pelvic fractures, and vascular and extremity trauma. Despite these advances, challenges persist, including resource availability and inconsistent protocol adherence. Future efforts must focus on enhancing training, improving communication, and data-driven protocol refinement to guide nonoperative management. Strengthening this interdisciplinary collaboration is critical to optimizing patient outcomes and advancing evidence-based, nonsurgical trauma care.

Management of solid organ arterial pseudoaneurysms following both blunt and penetrating trauma has become a point of increased emphasis in recent years. At present, consensus guidelines for management of post-traumatic solid organ arterial pseudoaneurysms do not exist. There is a trend in recent literature towards recommending short interval repeat imaging of solid organ trauma patients to screen for arterial pseudoaneurysm formation facilitating prompt intervention in order to mitigate the risk of delayed hemorrhage. This viewpoint, however, is not shared by all in the trauma surgery and interventional radiology communities. Nonetheless, implementation of institutional protocols based upon current literature and local expertise is a practical step in managing patients at risk for pseudoaneurysm development until consensus guidelines are developed.

Pediatric venous thromboembolism (VTE) has seen a significant rise in prevalence coinciding with the increasing availability of complex and invasive treatments in children. While anticoagulation remains the cornerstone of VTE treatment, increasing evidence supports interventional approaches for select cases, particularly in life- or limb-threatening scenarios. Treatment strategies must be individualized, considering age-related differences in hemostasis and the higher bleeding risk associated with interventions. This remains challenging due to a dearth of pediatric-specific studies. This manuscript explores pathophysiology, risk factors, and management strategies for pediatric VTE, emphasizing both pharmacologic and interventional treatments and providing updated recommendations regarding available anticoagulant agents and VTE management paradigms in children. It highlights the potential of interventional techniques in special conditions, namely Paget-Schroetter syndrome, superior vena cava syndrome, inferior vena cava atresia, pulmonary emboli, and May-Thurner syndrome. In the absence of rigorous clinical trial data, continued multidisciplinary collaboration and standardized approaches will remain imperative for ensuring careful use of interventional procedures to achieve optimal outcomes in these young patients.

Pediatric cancer, though rare compared with adult malignancy, remains a significant cause of morbidity and mortality, with approximately 15,000 new diagnoses and over 1,500 deaths annually in the United States. Advances in multimodal therapy and cooperative group clinical trials have improved overall survival rates to over 80% in developed nations. Pediatric interventional oncology, a subset of pediatric interventional radiology (IR), has expanded beyond its role in biopsy and vascular access to include tumor-targeted and supportive care interventions. However, challenges in the field remain, including less pediatric-specific data and limited access to pediatric-trained interventional radiologists. Multidisciplinary collaboration is important for the integration of pediatric interventional oncology as a key component of pediatric cancer treatment.