Seminars in Interventional Radiology最新文献

Endovascular creation of arteriovenous fistulas for hemodialysis access represents a promising alternative to surgical dialysis access provision. However, because the two available devices rely on the adequacy of the native vascular configuration, not all patients are candidates. Thus, a precise grasp of upper extremity vascular anatomy and the ability to apply that knowledge clinically are required. The purpose of this article is to provide an overview of endovascular arteriovenous creation, focusing on anatomic considerations, procedural steps, and outcomes.

Gastrostomy tube placement is a well-established technique for providing long-term feeding or decompression to patients with dysphagia or the need for gastric venting. However, direct transabdominal access to the stomach is not feasible in some patients, such as those without a safe percutaneous route to the stomach, with conditions that may inhibit tract healing, and/or at high risk of peritonitis. For these patients, percutaneous transesophageal gastrostomy (PTEG) is a safe and effective technique for providing gastric access for enteral feeding or decompression. PTEG placement involves ultrasound-guided percutaneous access to the cervical esophagus using a fluid-filled balloon as a target. Since the peritoneum is not breached during PTEG placement, the risks of peritoneal spillage of enteric contents and intra-abdominal hemorrhage are avoided. However, placement requires a safe esophagostomy window and has contraindications and complications distinct from direct transabdominal access. Here, we describe the approach to patient workup and PTEG placement, present a few special situations that can be encountered, and discuss existing data regarding patient outcomes.

The vascular system is an intricate system that develops during early periods of embryogenesis. Through a complex signaling pathway of vasculogenesis and angiogenesis, embryonic vessels grow and coalesce, which allows nutrient and waste management. Dysfunction in these endothelial cells gives rise to vascular variants. Throughout gestational development, vascular variants can form in different organ systems such as the thoracic cavity, hepatic, renal, and lower pelvis. It is clinically very important for physicians to recognize these variants, as these variants can predispose to certain illnesses and treatment of patients surgically. This article discusses the embryology and vascular variants of the arterial system with a focus on the thoracic cavity, hepatic, renal, and pelvic variations to help aid in minimizing technical complications during procedures.

Portosystemic collateral pathways are a significant concern in interventional radiology, frequently manifesting in patients with cirrhosis or portal vein thrombosis. These pathways can lead to severe clinical complications, including gastrointestinal bleeding, hepatic encephalopathy, and liver failure. A thorough understanding of the anatomy, hemodynamic alterations, and clinical implications of these shunts is crucial for interventional radiologists to provide effective treatment while minimizing risks. This article reviews the clinical presentations associated with portosystemic shunts, explores the anatomical variants and altered flow dynamics, and discusses the latest endovascular treatment strategies to optimize patient outcomes.

Nerve plexuses are complex networks of interwoven nerves in the peripheral nervous system. This article provides a comprehensive overview of the anatomy and function of the major nerve plexuses in the human body. The main spinal nerve plexuses-cervical, brachial, abdominal, lumbar, and sacral-are examined in detail, including their spinal origins, anatomical locations, and the areas they innervate. Understanding the intricate anatomy of nerve plexuses is essential for interventionalists, as it aids in the diagnosis and treatment of various neurological disorders affecting the peripheral nervous system.

Although bronchial artery embolization (BAE) initially emerged as a critical minimally invasive image-guided procedure to manage massive hemoptysis regardless of underlying etiologies, there has been a growing interest in BAE to treat pulmonary malignancies within recent years. This article provides an in-depth exploration of bronchial artery anatomy, pathologies, imaging modalities in guiding effective BAE, and procedural pearls for successful intervention. The complexity of bronchial artery anatomy, including its variations and potential complications during embolization, necessitates thorough understanding and precise procedural techniques to optimize patient outcomes and minimize risks.

Liver transplantation is becoming increasingly common in the United States, with very favorable 1- and 5-year survival rates. With increasing long-term survival rates, postprocedural vascular complications can occur with increased frequency. Familiarity with posttransplant vascular anatomy is essential for interventional radiologists dealing with this patient population. This article discusses the posttransplant venous, arterial, and biliary anatomy and the implications for minimally invasive interventions.

Gastrojejunostomy catheters are a common means of long-term enteral access in patients unable to meet their nutritional requirements through oral intake. The choice of gastrojejunostomy versus gastrostomy tubes in these patients depends largely on aspiration risk, which is a relative contraindication of gastrostomy placement. Initially a surgical procedure, gastrojejunostomy placement is now frequently performed endoscopically or with radiologic guidance. Additionally, in patients with prior gastrostomy placement who need more distal enteral access, gastrostomy to gastrojejunostomy conversion can easily be performed by an endoscopist or interventional radiologist. This article reviews common techniques for percutaneous radiologic gastrojejunostomy placement, conversion, and exchange, as well as indications and contraindications. Complications will be discussed and compared across the different methods for gastrojejunostomy placement.

Gastrostomy tube placement is a common medical procedure performed endoscopically, surgically, or with image guidance in interventional radiology. It is indicated for nutritional supplementation in those with inadequate oral intake and for gastric decompression in the setting of intestinal obstruction. For optimal outcomes, preprocedural clinical evaluation, imaging workup, meticulous technique during placement, and close clinical follow-up are essential. Complications are usually minor but not uncommon. They may occur during placement, in the immediate postoperative period, and throughout the time the tube is in place. This article will review the indications, contraindications, and complications of percutaneous gastrostomy tube placement. Major and minor complications will be illustrated along with tips and mitigation strategies employed to avoid and treat them.

Interventional radiology techniques using image guidance have revolutionized healthcare by enabling less invasive approaches for "difficult-to-treat" conditions. Complex gastrointestinal (GI) conditions such as bowel obstructions, enterocutaneous fistulas, and other enteric maladies are major causes of morbidity and mortality; are rising in incidence worldwide; and may benefit from the integration of interventional radiology techniques into current surgical/endoscopic management strategies, analogous to cardiovascular interventions of the past few decades. Conservative medical management of these intestinal conditions can fail or result in extended hospital admissions and poor quality of life, while current operative management can be fraught with complications and death, especially in high-risk patients with prior abdominal surgeries. The prevalence of GI conditions requiring intervention and the potential for complications and morbidity with current methods, including laparoscopy, suggests that this is a field ripe for innovation. This article outlines an innovative approach to managing complex GI problems that we are developing at our institution, combining interventional radiological techniques with advanced surgical/endoscopic methods. Specifically, we attempt to highlight the benefits of a multidisciplinary team using advanced imaging guidance to perform novel percutaneous, endoscopic, and surgical procedures for high-surgical risk patients with intestinal problems requiring intervention.