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Techniques in Vascular and Interventional Radiology最新文献

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Image-guided peripheral nerve interventions- applications and techniques 图像引导下的周围神经干预--应用与技术
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100982
Junman Kim MD, Ricardo Martinez Garcia MD, MPH, John David Prologo MD
Interventional radiology continues to be at the forefront of acute and chronic pain management. Our unique imaging expertise and ability to target difficult to reach structures allows for the continuous development of new ways to treat a variety of pain generators. In addition, the advent of thermal ablation techniques and technologies has provided a unique opportunity to offer patients more durable and predictable options to treat their pain. This is particularly important during the opioid epidemic, as multiple local and international governmental bodies push for physicians to create ways to manage pain while reducing the need for long-term opioid dependence. This article aims to review various image-guided techniques and tools for the treatment of pain related to peripheral pain generators, with a focus on the extremities, lumbosacral and pelvic region, and the chest wall. For each target and pathology, we will discuss general etiology, anatomy, procedural approach, and briefly evaluate the supporting literature in each clinical situation.
介入放射学一直处于急性和慢性疼痛治疗的前沿。我们独特的成像技术和针对难以触及结构的能力,使我们能够不断开发出治疗各种疼痛发生器的新方法。此外,热消融技术的出现提供了一个独特的机会,为患者提供更持久、更可预测的疼痛治疗方案。在阿片类药物流行期间,这一点尤为重要,因为多个地方和国际政府机构都在推动医生想方设法控制疼痛,同时减少对阿片类药物的长期依赖。本文旨在综述用于治疗外周痛源相关疼痛的各种图像引导技术和工具,重点关注四肢、腰骶部和骨盆区域以及胸壁。针对每个目标和病理,我们将讨论一般病因学、解剖学、手术方法,并简要评估每种临床情况下的辅助文献。
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引用次数: 0
Extra axial bone ablation with augmentation 轴外骨消融与骨增量术
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100989
Anthony Tadros MD , Frank Chiarappa MD , James Flint MD , Susan Bukata MD , Sean Tutton MD
Pelvic bone metastases frequently result in severe pain and disability. Open surgical reconstruction is associated with a high complication and mortality rate. Percutaneous screw fixation is a minimally invasive treatment that is safe and effective for the management of periacetabular metastases. This article details our technique for pelvic screw fixation, including (1) perioperative care, (2) navigation and needle guidance, (3) access, (4) biopsy and ablation, (5) screw placement, and (6) cement augmentation.
骨盆骨转移经常导致严重疼痛和残疾。开放手术重建的并发症和死亡率都很高。经皮螺钉固定是一种微创治疗方法,对治疗髋臼周围转移瘤安全有效。本文详细介绍了我们的骨盆螺钉固定技术,包括(1) 围手术期护理、(2) 导航和针引导、(3) 入路、(4) 活检和消融、(5) 螺钉置入和(6) 骨水泥增强。
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引用次数: 0
Sacroiliac dysfunction and minimally invasive sacroiliac joint fusion 骶髂关节功能障碍和微创骶髂关节融合术
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100984
Jacob W. Fleming MD , Tommy Pan MD , Mohammed AbuBakar BS , Matthew Shonnard MD , Chris Radlicz DO , Douglas P. Beall MD
The sacroiliac joint (SIJ) is the largest diarthrodial joint in the human body and accounts for approximately 20% of all low back pain, which is commonly seen in patients with lumbosacral fusions. Despite this, SIJ dysfunction often poses a challenging diagnosis depending on clinical evaluation, imaging, and image-guided joint injection. SIJ fusion is an effective and safe method of treatment, with minimally invasive approaches fitting well within the armamentarium of interventional radiologists treating chronic pain and other musculoskeletal conditions. Contemporary technical approaches and clinical considerations are discussed.
骶髂关节(SIJ)是人体最大的二关节,约占所有腰痛的 20%,常见于腰骶部融合患者。尽管如此,SIJ 功能障碍的诊断往往具有挑战性,这取决于临床评估、影像学检查和图像引导下的关节注射。SIJ 融合术是一种有效而安全的治疗方法,微创方法非常适合介入放射科医生治疗慢性疼痛和其他肌肉骨骼疾病。本文讨论了当代的技术方法和临床注意事项。
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引用次数: 0
Percutaneous Sclerotherapy of Venous Malformations 静脉畸形的经皮硬化疗法
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1016/j.tvir.2024.100960
Kyung Rae Kim MD

Venous malformation (VM) stands as the most prevalent form of vascular malformation, characterized by its diverse morphology. These lesions can manifest in any part of the body, affecting different tissue planes and giving rise to symptoms such as pain, swelling, or physical dysfunction. In the realm of treatment, direct puncture VM sclerotherapy holds its place as the primary approach. This technique involves the administration of a sclerosing agent into the VM channels during contrast phlebography while simultaneously managing the outflow veins through different methods. The process of VM sclerotherapy induces endothelial damage, thrombosis, and fibrosis, resulting in symptom relief through lesion shrinkage. It is crucial to exercise caution techniques and sclerosing agents during VM sclerotherapy to minimize procedural complications, enhance clinical outcomes, and ultimately improve the patient's overall quality of life.

静脉畸形(VM)是血管畸形中最常见的一种,其特点是形态多样。这些病变可出现在身体的任何部位,影响不同的组织平面,并引起疼痛、肿胀或身体功能障碍等症状。在治疗领域,直接穿刺 VM 硬化剂疗法是最主要的方法。这种技术包括在造影剂静脉造影时将硬化剂注入血管腔,同时通过不同方法处理流出的静脉。血管硬化剂治疗过程会诱发内皮损伤、血栓形成和纤维化,从而通过病变缩小来缓解症状。在进行虚拟微创硬化剂治疗时,必须采用谨慎的技术和硬化剂,以最大限度地减少手术并发症,提高临床疗效,最终改善患者的整体生活质量。
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引用次数: 0
Percutaneous Image-Guided Treatment of Pediatric Deep-Vein Occlusions 经皮图像引导治疗小儿深静脉闭塞症
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1016/j.tvir.2024.100963
Joseph Reis MD, Aaron Bogart MD, Giri M. Shivaram MD

Pediatric venous occlusions are a growing cause of morbidity and mortality, especially in hospitalized patients. Catheter-directed recanalization is a safe and effective treatment option in appropriately selected patients. Benefits of catheter directed therapies (CDTs) include the prevention of pulmonary embolism and end organ failure acutely as well as superior vena cava syndrome and post-thrombotic syndrome chronically. Timely diagnosis, recognition of underlying factors for thrombosis, and familiarity with the spectrum of tools and techniques for CDT are essential to optimizing outcomes in the acute setting. Recanalization of chronic venous occlusions can similarly provide symptomatic relief and achieve long term vessel patency. This review will detail the scope, techniques, and outcomes for CDT in the treatment of acquired systemic deep vein occlusions.

小儿静脉闭塞导致的发病率和死亡率越来越高,尤其是住院病人。对于经过适当选择的患者,导管引导再通术是一种安全有效的治疗方法。导管导向疗法(CDTs)的优点包括急性期预防肺栓塞和内脏衰竭,慢性期预防上腔静脉综合征和血栓后综合征。及时诊断、识别血栓形成的潜在因素以及熟悉 CDT 的各种工具和技术,对于优化急性期的治疗效果至关重要。慢性静脉闭塞的再通术同样可以缓解症状,实现血管的长期通畅。本综述将详细介绍 CDT 治疗获得性全身深静脉闭塞的范围、技术和效果。
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引用次数: 0
Anticoagulation in Pediatric Patients 儿科患者的抗凝治疗
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1016/j.tvir.2024.100958
Marilyn J. Manco-Johnson MD , Aparna Annam DO , Timothy Schardt PharmD

The use of antithrombotic agents is increasing in infants, children and adolescents. The more recent routine inclusion of children in FDA-monitored clinical trials has propelled the rapid accumulation of safety and efficacy data on these agents in pediatric patients. Antithrombotic agents in current use include indirect or antithrombin-dependent anticoagulants, intravenous direct thrombin inhibitors, direct oral anticoagulants (DOACs) targeting thrombin or factor Xa, antiplatelet agents and thrombolytic therapies. Each class of antithrombotic agent has distinct mechanisms of action, clearance routes, half-lives, safety and dosing. Anticoagulant efficacy is dependent upon the specific clinical indication and stability of the pediatric patient. Duration of anticoagulant course is also dependent upon the clinical indication as well as rate of thrombus resolution. This manuscript reviews the mechanism of action, route of administration, route of clearance and plasma half-life for the antithrombotic agents in current use in children. Use of anticoagulation in the context of thrombolytic therapy is discussed.

抗血栓药物在婴儿、儿童和青少年中的使用越来越多。最近,美国食品及药物管理局(FDA)监控的临床试验开始常规纳入儿童,这推动了这些药物在儿童患者中安全性和有效性数据的快速积累。目前使用的抗血栓药物包括间接或抗凝血酶依赖型抗凝剂、静脉注射直接凝血酶抑制剂、针对凝血酶或 Xa 因子的直接口服抗凝剂 (DOAC)、抗血小板药物和溶栓疗法。每一类抗血栓药物都有不同的作用机制、清除途径、半衰期、安全性和剂量。抗凝剂的疗效取决于特定的临床适应症和儿科患者的稳定性。抗凝疗程的持续时间也取决于临床适应症和血栓清除率。本手稿回顾了目前用于儿童的抗血栓药物的作用机制、给药途径、清除途径和血浆半衰期。还讨论了在溶栓治疗中使用抗凝剂的问题。
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引用次数: 0
Venous Anomalies in Overgrowth Syndromes 过度生长综合征中的静脉异常
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1016/j.tvir.2024.100962

Overgrowth syndromes, particularly within the PIK3CA-related overgrowth syndrome (PROS) spectrum, are commonly associated with venous anomalies. The anomalies include spongiform venous malformations and persistent embryonic veins, such as the lateral marginal vein (of Servelle). The anomalous veins pose a significant risk of thromboembolic disease and should be occluded, preferably earlier in life. A thorough understanding of the conditions, anatomy, and interdisciplinary treatment of these complex anomalies is essential for optimal management. This review explores the clinical and imaging diagnosis of overgrowth syndromes and techniques for assessing and treating associated venous anomalies, particularly the endovenous closure of anomalous veins.

过度生长综合征,尤其是 PIK3CA 相关过度生长综合征(PROS)谱系中的过度生长综合征,通常与静脉异常有关。这些异常包括海绵状静脉畸形和顽固的胚胎静脉,如侧缘静脉(Servelle)。异常静脉会带来血栓栓塞性疾病的巨大风险,因此应予以闭塞,最好在生命早期就进行闭塞。透彻了解这些复杂异常的病症、解剖结构和跨学科治疗对于优化治疗至关重要。这篇综述探讨了过度生长综合征的临床和影像诊断,以及评估和治疗相关静脉异常的技术,尤其是异常静脉的腔内闭合。
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引用次数: 0
Interventional Treatment of Pediatric Venous Thromboembolic Disease 小儿静脉血栓栓塞性疾病的介入治疗
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1016/j.tvir.2024.100957

This review explores the clinical presentation of lower extremity DVT and pulmonary embolism (PE), treatment strategies, and outcomes for venous thromboembolism (VTE) in the pediatric population. Traditional therapy for pediatric VTE was anticoagulation alone with thrombolysis and surgery reserved only in life or limb-threatening cases. Catheter-directed thrombolysis (CDT), pharmacomechanical thrombectomy (PMT) and mechanical thrombectomy (MT) have emerged as effective and safe treatment options for VTE management. Although most data are from adult studies, early pediatric studies suggest that these interventional procedures can be effective in children. The significant clinical impact of post-thrombotic syndrome (PTS) is also discussed, as PTS can lead to lifelong physical symptoms and psychosocial damage.

这篇综述探讨了儿童下肢深静脉血栓和肺栓塞(PE)的临床表现、治疗策略以及静脉血栓栓塞症(VTE)的治疗效果。小儿静脉血栓栓塞症的传统治疗方法是单纯抗凝,只有在危及生命或肢体的情况下才进行溶栓和手术。导管引导溶栓(CDT)、药物机械血栓切除术(PMT)和机械血栓切除术(MT)已成为治疗 VTE 的有效而安全的治疗方案。虽然大多数数据来自成人研究,但早期的儿科研究表明,这些介入治疗方法对儿童也有效。此外,还讨论了血栓后综合征(PTS)的重大临床影响,因为 PTS 可导致终身的身体症状和社会心理伤害。
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引用次数: 0
Fibroadipose Vascular Anomaly: Diagnosis and Treatment 纤维脂肪血管异常:诊断与治疗
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1016/j.tvir.2024.100961
Raja Shaikh MD

Fibro-Adipose Vascular Anomaly (FAVA) is a recently identified type of vascular malformation predominantly affecting adolescent females. Comprising abnormal adipose and vascular components, FAVA is frequently misdiagnosed as other vascular anomalies. It primarily manifests with pain, functional impairment, and musculoskeletal symptoms, particularly in the lower extremities. Accurate diagnosis requires a combination of clinical, radiologic, and histopathologic evaluation, with MRI and ultrasound being the primary imaging tools. Management of FAVA is multidisciplinary and tailored to individual patients. Interventional radiology procedures, such as percutaneous cryoablation, sclerotherapy, and embolization, are effective in long term control of symptoms. Cryoablation is particularly successful in alleviating pain and improving function. Surgical resection is reserved for specific cases with extensive lesions involving joints or when there is severe muscle or joint dysfunction. Additionally, sirolimus, an mTOR inhibitor, has shown promise in symptom relief, although further research is needed to confirm its long-term efficacy. Early diagnosis and treatment are essential for improving the quality of life in FAVA patients. Advances in imaging and treatment strategies have enhanced the ability to manage this complex and rare condition effectively.

纤维脂肪血管畸形(Fibro-Adipose Vascular Anomaly,FVA)是最近发现的一种血管畸形,主要影响青少年女性。纤维脂肪血管畸形由异常的脂肪和血管组成,经常被误诊为其他血管畸形。它主要表现为疼痛、功能障碍和肌肉骨骼症状,尤其是下肢。准确诊断需要结合临床、放射学和组织病理学评估,其中核磁共振成像和超声波是主要的成像工具。FAVA 的治疗是多学科的,并根据患者的具体情况量身定制。经皮冷冻消融术、硬化剂注射和栓塞术等介入放射学手术对长期控制症状非常有效。冷冻消融术在减轻疼痛和改善功能方面尤为成功。手术切除只适用于病变广泛累及关节或出现严重肌肉或关节功能障碍的特殊病例。此外,mTOR 抑制剂西罗莫司(sirolimus)有望缓解症状,但其长期疗效尚需进一步研究证实。早期诊断和治疗对于提高 FAVA 患者的生活质量至关重要。成像和治疗策略的进步提高了有效控制这种复杂而罕见疾病的能力。
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引用次数: 0
Portal Venous Disease 门静脉疾病
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-06-01 DOI: 10.1016/j.tvir.2024.100959

Portal interventions in pediatric patients present unique difficulties when compared to adult procedures. In addition, children who need a portal intervention require a different workup and clinical management. Based on these elements, the clinical decisions for the study and treatment of these pathologies are different. This review is intended to present a summary of the interventional radiologist's role in treating pediatric portal venous diseases. Focus is placed on the technical elements, patient management and procedural indications while discussing different interventions involving the portal vein, providing some recommendations supported by recent research and the authors' experience.

与成人手术相比,对儿童患者进行门静脉介入治疗存在独特的困难。此外,需要门静脉介入治疗的儿童需要不同的检查和临床管理。基于这些因素,研究和治疗这些病症的临床决策也有所不同。本综述旨在总结介入放射医师在治疗小儿门静脉疾病中的作用。重点放在技术要素、患者管理和手术适应症上,同时讨论涉及门静脉的不同介入治疗,并根据最新研究和作者的经验提出一些建议。
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引用次数: 0
期刊
Techniques in Vascular and Interventional Radiology
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