Seminars in Interventional Radiology最新文献

Pain is a complex interplay of psychological, immunological, and sensory experiential factors that leads to discomfort and physical suffering unique to each person. Uncontrolled pain greatly affects quality of life, a person's ability to function in society, and often results in increased healthcare costs. In order to appropriately treat a patient, knowledge of the different types of pain and various combinations of therapies is imperative. Cryoneurolysis is an important adjunctive therapy in pain management. When used in the appropriate clinical setting, it can decrease a patient's pain, opioid consumption, and improve quality of life. This article reviews common targets for cryoneurolysis based on patient pathology and discusses anatomic considerations to ensure the most efficacious and safe patient outcomes.

Prostatic artery embolization (PAE) is a minimally invasive treatment for patients with moderate to severe lower urinary tract symptoms and/or urinary retention due to benign prostatic hyperplasia (BPH), as well as hematuria secondary to prostatic bleeding. PAE achieves its therapeutic effect by inducing ischemic necrosis and reducing prostatic volume, while also decreasing neuromuscular tone. This dual mechanism addresses both the static and dynamic components of bladder outflow obstruction associated with BPH. PAE is technically challenging and necessitates in-depth knowledge of the complex and variable anatomy of the pelvic vasculature. Successful outcomes depend on precise identification of the prostatic artery and recognition of anastomoses to surrounding structures to minimize the risk of nontarget embolization and associated complications. This article reviews the prostatic arterial anatomy and explores the role of advanced imaging techniques for preprocedural planning and intraprocedural guidance to optimize procedural safety and efficacy.

Percutaneous radiologic gastrostomy is indicated for patients who require enteral access for nutritional support, medication administration, and/or decompression. Some patients have comorbidities that increase procedural risk and may require deviation from the conventional approach, such as upper gastrointestinal tract obstruction, ascites, and postsurgical anatomy. In such cases, technical modifications and/or changes to the standard approach may be needed. This review describes several specific scenarios that require special consideration, focusing on clinical management options, risk mitigation techniques, and supportive evidence.

Trauma, particularly pelvic trauma, is a leading cause of morbidity and mortality in the United States, with hemorrhage being the primary cause of death in these trauma patients. In particular, pelvic fractures often result in substantial vascular injuries, requiring rapid diagnosis, and intervention to prevent fatal outcomes. Multiphase computed tomography angiography (CTA) has emerged as the gold standard for assessing pelvic trauma, facilitating early identification of vascular injuries and active hemorrhage. Interventional radiology (IR) plays a key role in managing these injuries through angiography and embolization, effectively stabilizing hemodynamics and preventing long-term complications such as necrosis or claudication. The complex vascular anatomy of the pelvis, including variants like the corona mortis and aberrant obturator arteries, necessitates careful planning during angiography. Techniques such as nonselective embolization, selective embolization with temporary embolic, and coil embolization are critical in achieving hemostasis. While effective, these procedures carry risks, including rebleeding and complications such as neuropathy and gluteal necrosis. Early activation of the angiography suite and multiphase CTA are essential to improving patient outcomes. This review outlines the anatomy, evaluation, and management strategies for pelvic trauma, emphasizing the importance of rapid intervention and the integral role of IR in controlling hemorrhage and ensuring patient survival.

Gastrostomy tubes are a common procedure for interventional radiologists. Several techniques are available to obtain gastric access radiologically, including the antegrade, retrograde, and balloon-assisted techniques. The choice of technique can depend on the patient's clinical presentation and the available services at each institution. Indications, preprocedural workup, technique, and postprocedural care help guide the choice of approach. Three common methods will be reviewed in this article: antegrade, retrograde, and balloon assisted. The antegrade technique is comparable to percutaneous endoscopic gastrostomy placement with a decreased incidence of tube dislodgement compared to the retrograde technique, but it requires reliable oral and esophageal access. The retrograde technique reduces the risk of postprocedural infection, has shorter procedure times, and reduces radiation exposure. The balloon-assisted technique reduces procedure time even more than the antegrade or retrograde technique, with comparable outcomes. Understanding the most common techniques available and how they compare is essential to providing patient-centered care.

Transarterial embolization of external carotid artery (ECA) branches is increasingly performed for the management of epistaxis, preoperative embolization of head and neck tumors, treatment of dural arteriovenous fistulas, and, more recently, for the treatment of chronic subdural hematoma. As new indications for ECA embolization in the management of conditions like chronic subdural hematoma continue to be identified, it is imperative that interventionalists understand the presence of intricate anastomoses between the extracranial and intracranial arterial systems, which confer significant procedural risks. Failure to account for these connections can result in devastating complications such as stroke, blindness, or cranial nerve injury due to nontarget embolization. This review examines the key anatomical territories of ECA-internal carotid artery anastomoses: the orbital region, petrous-cavernous region, and upper cervical region. These areas, often involving embryological remnants or collateral channels that enlarge in response to pathology, represent potential conduits for inadvertent embolization. We discuss the importance of preprocedural angiography to document anastomosis locations, embolic material selection, special considerations in the context of pathology, and techniques to mitigate risks. Specific considerations for each anatomical region are discussed, with a focus on critical anastomoses, embolization risks, and prevention strategies.

The Trauma Radiology Service (TRS) at Kings County Hospital was founded in 1976 and immediately integrated into its trauma surgical service (TSS), one of the earliest trauma centers in the United States. For more than 35 years, the TRS introduced surgeons to many applications of advanced diagnostic imaging and interventional procedures that can be used in the care of the injured. Some of these are now standards of practice throughout the world. Arterial embolizations of critical vessels to the brain and viscera, the peripheral and central vasculature, and nonvascular procedures for complications of trauma were described, and indications and techniques were shared through key publications. An understanding of Dr. Ludwik Fleck's epistemology, with thought collectives, thought styles, and collective moods, helps explain the successful integration of interventional radiology in the trauma center.

Ruptured abdominal aortic aneurysm are a critical vascular emergency. A coordinated, multidisciplinary management pathway can aid in timely diagnosis, triage, and coordination of best care. We present our institutional care algorithm for rAAA with an accompanying case example.