Seminars in Interventional Radiology最新文献

Genicular artery embolization (GAE) has emerged over the recent years as a minimally invasive alternative for patients with chronic knee pain due to osteoarthritis (OA). A growing body of evidence in the literature continues to support the safety and efficacy of GAE. As more interventional radiologists adopt this service line in their practice, it is imperative to understand the genicular anatomy to optimize technical success. This review aims to summarize the anatomical considerations critical to optimizing outcomes with GAE in patients with knee OA, highlighting its growing role in clinical practice.

Variant anatomy is relatively common in the lower extremity arteries and can play a role both in the incidence of peripheral arterial disease and the interventions performed to treat such disorders. Recognition of such anatomic variants prior to performing interventions on these patients is vital to be able to appropriately plan arterial approaches and in determining what intervention may be most appropriate for such patients. Interventional radiologists who perform lower extremity arterial interventions should be familiar with the most common anomalies affecting these vessels; this article discusses common lower extremity arterial anomalies and how these anomalies can affect interventional procedures in these vascular distributions.

Due to multiple medical advances over the past several years, angiographic investigation into arterial insufficiency as the cause of erectile dysfunction has decreased. Due to this, there is a general lack of familiarity with penile angiography technique and arterial anatomy, among current practicing interventional radiologists. Some potential indications for penile angiography include evaluation of penile trauma, high-flow priapism, further diagnostic evaluation of an abnormal penile Doppler ultrasound, or in the evaluation or treatment of erectile dysfunction with endovascular or surgical treatments. These indications, although relatively rare, still require practicing IRs to be familiar with angiographic anatomy of the penis. This article will briefly review angiographic technique in penile angiography with an emphasis on arterial anatomy.

A thorough understanding of normal biliary anatomy, common variants, and surgically altered anatomy is essential for the success of biliary interventions. Variations in biliary anatomy are seen in up to 40% of patients and frequently influence procedural planning and outcomes. This review highlights classical biliary anatomy, its common variations, and the challenges posed by surgical modifications, such as those encountered after cholecystectomy, liver resection, or biliary reconstructions. Case-based examples are used to explore the implications of these variations and modifications on interventional approaches, including the management of bile leaks, strictures, and complex obstructions. Strategies incorporating advanced imaging and procedural techniques, such as rendezvous interventions, are discussed to address complications and optimize outcomes. This article provides a practical framework for interventional radiologists to navigate challenging biliary cases with confidence and precision.

Enteral feeding plays a vital role for patients who are unable to meet their nutritional needs through oral intake, providing benefit to those with conditions such as inflammatory bowel disease, postsurgical recovery, chronic dysphagia, dysfunctional gastrointestinal tract, and critical illness. The role of interventional radiologists in enteral access is expanding, reflecting our pivotal role in nutritional support in clinical practice. This review explores the development, comparative benefits, and clinical outcomes associated with enteral nutrition (EN), highlighting its strengths and weaknesses as compared to parenteral nutrition (PN). EN supports gut mucosal health and immune function by stimulating gastrointestinal systems' native cellular programs, while reducing infection risks compared to PN. Modern advancements in EN formulations and delivery methods have enhanced patient care, demonstrating improved survival rates, reduced hospital stays, and improved quality of life.

Conventional management of thoracic aortic arch aneurysm and dissection with aneurysmal degeneration remains open surgical repair. However, multiple branched and fenestrated endograft systems offer promise for hybrid or total endovascular treatment of aortic arch pathology. Two zone 0 solutions involving an aortic arch with innominate branch and ascending aorta components are contemporarily in trial: the Gore thoracic branch endoprosthesis and ascending stent graft in the ARISE II Trial (W. L. Gore & Associates, Newark, Delaware) and the NEXUS Arch Stent Graft System (Endospan Ltd., Herzliya, Israel). Both device systems require a debranching procedure prior to endovascular treatment. Patients deemed appropriate for endovascular treatment with acute pathology or not qualifying for one of these trial devices may undergo homemade single or multiple fenestrated physician-modified endovascular grafts or in situ laser fenestration of aortic arch grafts with branch stenting to treat arch pathology. Ultimately, a durable total endovascular solution must achieve comparable or superior outcomes compared with open surgical repair, at significantly lower impact to patients. Branched and fenestrated endovascular treatments for aortic arch pathology require further investigation and follow-up to determine early, mid, and long-term outcomes including mortality, stroke, and endoleak requiring reintervention.