Seminars in Interventional Radiology最新文献

Uterine fibroids and adenomyosis are prevalent benign neoplasms that can lead to serious deleterious health effects including life-threatening anemia, prolonged menses, and pelvic pain; however, up to 40% of women remain undiagnosed. Traditional treatment options such as myomectomy or hysterectomy can effectively manage symptoms but may entail longer hospital stays and hinder future fertility. Endovascular treatment, such as uterine artery embolization (UAE), is a minimally invasive procedure that has emerged as a well-validated alternative to surgical options while preserving the uterus and offering shorter hospital stays. Careful patient selection and appropriate techniques are crucial to achieving optimal outcomes. There have been advancements in recent times that encompass pre- and postprocedural care aimed at enhancing results and alleviating discomfort prior to, during, and after UAE. Furthermore, success and reintervention rates may also depend on the size and location of the fibroids. This article reviews the current state of endovascular treatments of uterine fibroids and adenomyosis.

Chronic pelvic pain (CPP) is a challenging condition affecting an estimated 15% of females in the United States. Multiorgan system dysfunction results in the complex clinical pain presentation. Similar to other chronic pain syndromes, CPP is influenced by biopsychosocial factors and requires a multimodal approach for optimal pain management. This review summarizes the clinical evaluation and medical management of CPP with a comprehensive approach.

Medical complications often leave the responsible physicians with strong negative emotional responses. Through self-compassion, physicians can overcome these negative emotions and continue to improve.

Dialysis access steal syndrome (DASS) is a phenomenon known to occur following creation of an arteriovenous fistula or arteriovenous graft. The clinical presentation of DASS is characterized by symptoms of limb ischemia due to diversion of arterial flow from the distal extremity. Ischemic monomelic neuropathy (IMN) is a rare subtype of DASS classically described as an acute, isolated presentation of peripheral neuropathy following dialysis access creation. Although the underlying pathophysiology is not entirely understood, the clinical manifestation of IMN is often described as severe distal limb pain that progresses to motor and sensory defects. The onset of IMN may occur immediately following dialysis access creation or intervention. Here, we present a case of IMN following assisted maturation of an endovascular fistula.

A potential complication of complex endovascular procedures is retained foreign bodies such as fragmented catheters, wires, stents, or sheaths in the intravascular space. Different techniques are available for retrieval of intravascular foreign bodies including snares, forceps, baskets, tip-deflecting wires, and balloon catheters. The aim of this article is to describe our experience in which a lost large intravascular sheath was retrieved using balloon assistance. We also provide a review of different techniques used for intravascular large sheath retrieval and methods to avoid this complication during endovascular procedures such as complex inferior vena cava filter removal.

The addition of hepatic venous embolization to portal venous embolization to achieve ipsilateral liver venous deprivation before major hepatectomy has been suggested to increase the extent of hypertrophy of the future liver remnant. The presented case discusses a hepatic vein embolization procedure complicated by the unintended migration of a glue cast used to achieve hepatic venous occlusion and subsequent management with endovascular retrieval of the glue cast from the inferior vena cava. The emerging role of hepatic venous embolization and associated complications are also discussed.

We present a case of a 69-year-old male with profound Cushing's syndrome and hypercortisolemia secondary to a cortisol-secreting adrenocortical carcinoma. Patient was not a surgical candidate and subsequently underwent a successful posterior approach tumor cryoablation. The procedure was complicated by a T11 intercostal artery injury and hemothorax. The detection of the culprit injury was almost immediate and the quick response time, and treatment of the injury via an intercostal artery embolization was critical to limiting the patient's morbidity and mortality. This case discusses the technical challenges of a posterior-approach ablation, the pitfalls to avoid, and the importance of attaining rapid hemostasis.