Seminars in Interventional Radiology最新文献

Endovascular aortic aneurysm repair (EVAR) has become the preferred treatment for abdominal aortic aneurysms, offering a minimally invasive alternative to open surgery. However, successful outcomes depend on meticulous patient selection. This review explores the key criteria for patient eligibility, including aneurysm size, morphology, and the quality of the proximal and distal aneurysm necks. Additionally, imaging assessment and various device variables, including anatomical suitability, are examined to emphasize their influence on procedural success. As EVAR technology evolves, understanding the nuances of patient selection remains crucial for maximizing technical success and clinical outcomes, while minimizing complications including endoleaks and migration, and extending the benefits of the procedure to a broader range of patients.

An in-depth understanding of portal venous anatomy, particularly its variants, is essential for interventional radiologists performing complex hepatobiliary procedures such as transjugular intrahepatic portosystemic shunt (TIPS) creation. Anatomical variations in the portal venous system occur in approximately 35% of the population, and failure to identify these variants can result in significant procedural complications including vascular injury and postprocedural liver failure. This article discusses the most common (types I-V) portal vein variants and the importance of their preprocedural identification, their potential impact on procedural outcomes, and the role of advanced imaging techniques in mitigating risks associated with these anatomical variations.

Percutaneous enteric tubes, including gastrostomy, gastrojejunostomy, and percutaneous transesophageal gastrostomy, are essential for patients who cannot maintain adequate oral nutrition or require gastric decompression due to conditions like malignant bowel obstruction. Proper care and maintenance are crucial to prevent complications and maintain function. Enteric tubes are inserted using various techniques at different locations based on patient needs and anatomical considerations. Enteric tubes play a vital role in patient care, and continued research and innovation are necessary to improve outcomes and reduce complications. Routine care involves regular flushing and site maintenance to prevent occlusion and infection. While complications are common, they can be effectively managed or avoided with proper care. This review outlines the care, maintenance protocols, and post-placement complication management for enteric tubes.

Gastrointestinal and hepatobiliary diseases are managed by various specialists, including gastroenterologists, surgeons, and interventional radiologists. Percutaneous cholangioscopy and endoscopy have immense potential within the field of interventional radiology (IR), especially given the unique ability to combine fluoroscopic guidance with direct visualization of internal structures. Transgastric endoscopy, in particular, is valuable for patients who already have established gastrostomy access or those unsuitable for surgery or traditional esophagogastroduodenoscopy. Cases of transgastric endoscopy have shown successful treatments for choledocolithiasis, duodenal collections, pancreatic leaks, and foreign body removal. As more research is conducted, percutaneous endoscopy could become an integrated part of various IR procedures, providing personalized treatment for patients who have exhausted conventional approaches.

New understanding of the lymphatic system as well as increasing recognition of its importance in various pathologies have increased the opportunity to perform lymphatic interventions. Advancement in our understanding of the lymphatic system anatomy, including variations, combined with improved imaging has renewed interest in both surgical and interventional management of a wide range of complex lymphatic pathologies. It is important for the proceduralist to recognize the anatomy, variability, and physiology of the lymphatic system, including lower extremity lymphatic drainage, cisterna chyli location, and thoracic duct drainage. The purpose of this study is to convey the practical aspects of performing lymphatic interventions in an effort to improve the speed and reliability of these procedures.

Direct percutaneous jejunostomy placement is an often underutilized procedure that can allow for supplemental enteral nutrition in a certain subset of patients, in which percutaneous gastrostomy is not technically feasible, or in patients who require post-pyloric feeding. Percutaneous jejunostomy catheter placement was first described in the 1980s; since that time there have been minimal case series on the procedural technique and outcomes. At our institution, we perform percutaneous jejunostomy placement as a planned two-stage procedure. During the initial stage, direct jejunostomy is performed under a combination of fluoroscopic and ultrasound guidance, after distending the jejunum through a nasojejunal tube. After confirming intraluminal access, at least one Cope suture anchor is deployed, and guidewire access is maintained. Subsequently, the track is serially dilated, and a 14-Fr pigtail catheter is placed into the jejunum. Approximately 4 to 6 weeks later, the patient returns for conversion of the pigtail drain into a formal jejunostomy catheter with retention balloon, under fluoroscopic guidance. Several of the prior larger studies on the technique have noted major complications to occur in 12% of patients and minor complications to occur in 9.8% of patients. While percutaneous jejunostomy placement is not a frequently performed procedure, technical success and complication rates are comparable to that of surgical jejunostomy.

The term "hemorrhoid" is commonly invoked to characterize the pathologic process of symptomatic hemorrhoidal disease instead of the normal anatomic structure. While often treated with conservative measures, rectal artery embolization offers a minimally invasive alternative for patients with persistent or severe symptoms. This technique involves blocking the blood supply to the hemorrhoids using embolic agents, reducing blood flow, and alleviating symptoms. This review explores the clinical evaluation, techniques, and outcomes associated with rectal artery embolization for the treatment of hemorrhoidal disease. A discussion of the pathophysiology of hemorrhoids, the anatomy of rectal arteries, and the embolization procedure is provided in detail. Additionally, the safety and efficacy of the technique, including potential complications and outcomes, are reviewed.

Percutaneous cecostomy catheters can be placed in the setting of either fecal incontinence or large bowel obstruction. While there are several etiologies for these disorders, the purpose of the cecostomy catheter is to provide ease of access for antegrade enemas in patients with fecal incontinence or relieve pain and discomfort in patients with a large bowel obstruction. Image-guided, percutaneous catheter placement into the cecum fits easily into the skillset of the interventional radiologist. Even though the literature consists of mostly single-center, retrospective case series, the procedure shows high rates of technical success, outstanding clinical outcomes, excellent patient satisfaction scores, and low rates of major adverse events. The purpose of this article is to review indications for cecostomy catheter placement, outline preprocedural patient evaluation, describe intraprocedural steps of catheter placement, detail postprocedural follow-up, and review both technical and clinical outcomes of cecostomy catheter placement.

In the appropriate patient population, endovascular aortic repair (EVAR) has become the standard of care for abdominal aortic aneurysms. While the initial success rates of EVAR are very high, reinterventions occur in a significant minority of patients, most of which consist of the repair of endoleaks. When indicated, such procedures are typically performed via endovascular or percutaneous approaches; however, in certain patients, these minimally invasive repairs fail. In these patients, surgical techniques can be used to treat the endoleaks. This article describes the open surgical techniques used in the repair of endoleaks where standard endovascular techniques fail.

Acute pancreatitis (AP) is a severe inflammatory condition of the pancreas with significant morbidity and mortality, particularly in its necrotizing form. This review explores the management of peripancreatic collections and in particular necrotizing pancreatitis, focusing on the evolution from traditional open surgical methods to contemporary minimally invasive image-guided techniques. AP can lead to various local complications, including pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Imaging plays a crucial role in diagnosing complications of AP, while treatment approaches have shifted toward a step-up strategy involving percutaneous, endoscopic, and minimally invasive methods. Percutaneous necrosectomy, combining mechanical and chemical debridement, has shown promising results. Mechanical necrosectomy uses devices like baskets and retrieval nets, while chemical necrosectomy adds agents like hydrogen peroxide and streptokinase. Current evidence suggests that the step-up approach, starting with percutaneous drainage or necrosectomy and escalating to endoscopic or surgical interventions, if necessary, improves patient outcomes. The review underscores the need for a multidisciplinary approach in managing complicated AP and highlights ongoing advancements in minimally invasive techniques.