Techniques in Vascular and Interventional Radiology最新文献

{"title":"Acute RV Failure Management in Pulmonary Embolism","authors":"Naina Verma MD ,&nbsp;Vishaal Kondoor MBA ,&nbsp;Rajshree Singh MD ,&nbsp;Rakesh Ahuja MD","doi":"10.1016/j.tvir.2025.101039","DOIUrl":"10.1016/j.tvir.2025.101039","url":null,"abstract":"<div><div>Acute right ventricular (RV) failure significantly influences mortality rates in patients experiencing pulmonary embolism (PE). This condition arises from an abrupt increase in RV afterload triggered by clot burden, neurohormonal activation, and hypoxia-mediated feedback mechanisms. The ensuing pathological cascade results in RV dilation, decreased stroke volume, and compromised left ventricular (LV) filling due to interventricular dependence, which can lead to hemodynamic collapse. This paper elucidates management strategies focusing on preload optimization, early clot removal through thrombolytic therapy or thrombectomy, and the judicious use of vasopressors and inotropes to sustain systemic blood pressure, enhance coronary perfusion, and maintain RV-LV coupling. In cases of respiratory failure, mechanical ventilation must be utilized with caution. At the same time, advanced interventions such as extracorporeal membrane oxygenation (ECMO) or RV assist devices are reserved for more severe scenarios. A comprehensive understanding of RV physiology and the pathophysiology of PE is essential for devising early interventions aimed at averting the “RV death spiral” and enhancing patient outcomes. Timely recognition and aggressive management are foundational to treating acute RV failure in PE effectively. Acute right ventricular failure is a critical pathology observed in patients suffering from pulmonary embolism. The significance of understanding the underlying mechanisms of RV failure, particularly concerning PE, cannot be overstated, as it is a crucial determinant of morbidity and mortality. The development of acute RV failure is primarily precipitated by a sudden escalation in RV afterload, a consequence of the obstruction of pulmonary arteries by embolic material. This obstruction induces neurohormonal activation and triggers feedback mechanisms associated with hypoxia, leading to the aforementioned detrimental cascade. The resultant RV dilation and diminished stroke volume adversely affect LV filling due to the phenomenon of interventricular dependence, ultimately paving the way for hemodynamic instability. A nuanced understanding of RV physiology alongside the pathophysiological mechanisms underlying pulmonary embolism is imperative for developing and implementing timely interventions. Early recognition and an aggressive management approach are vital to prevent the “RV death spiral” and improve clinical outcomes for patients confronting acute RV failure in the context of pulmonary embolism.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101039"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECMO, VAD, Impella, and IABP: Primer on Mechanical Circulatory Support Devices","authors":"Jonas Kruse MD ,&nbsp;Mona Ranade MD","doi":"10.1016/j.tvir.2025.101042","DOIUrl":"10.1016/j.tvir.2025.101042","url":null,"abstract":"<div><div>Vascular and interventional physicians are routinely caring for some of the sickest patients in the hospital, including those with cardiopulmonary collapse. A foundational comprehension of mechanical circulatory devices is necessary in these situations. Within this article, we will review the indications, procedural steps, management, clinical follow up, and outcomes of 4 types of mechanical circulatory support devices: Extracorporeal membrane oxygenation (ECMO), ventricular assist devices (VAD), Impella, and intra-aortic balloon pumps (IABP). ECMO is a large-bore cannulation system serving patients in respiratory and/or combination of cardiorespiratory collapse. It requires constant monitoring and adjustment with a wide range of benefits in appropriately selected patients in the hospital. VADs are surgically-implanted devices for more long-term ventricular support, often extending the survival of end-stage heart failure or bridging to transplant. Impella and IABPs, by comparison, are smaller intravascular devices that aid in short-term ventricular off-loading and improve perfusion. They provide hemodynamic stabilization in the setting of acute cardiac insult or surgery, prior to either organ recovery or transition to more definitive therapy. All of these devices come with unique considerations and potential complications. This article will serve as a guide in evaluating patients for device candidacy, procedural placement, troubleshooting, management in the perioperative setting, complication surveillance, and clinical outcomes/follow-up.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101042"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia and Analgesia for Interventional Radiology","authors":"Abram Feldman MD","doi":"10.1016/j.tvir.2025.101037","DOIUrl":"10.1016/j.tvir.2025.101037","url":null,"abstract":"<div><div>To perform procedures in the interventional radiology suite, patient comfort and tolerance must be ensured through appropriate anesthesia and analgesia. Various levels of anesthesia can be utilized to safely accomplish a procedure from local anesthesia and mild sedation to general anesthesia. Depending on patient and procedural factors, different anesthetic plans may be beneficial. Patient factors such as chronic pain, hemodynamic stability, and complex medical problems will likely benefit from anesthesiologist involvement in the procedure. Procedural factors such as specific positioning requirements, following instructions, or invasiveness of the procedure may dictate what level of anesthesia is required, as well. Various anesthetic agents are used for amnesia, anesthesia, analgesia, and muscle relaxation. Understanding patients’ needs and procedural requirements will aid a clinician in performing safe and effective interventional procedures and maintain safety – from preoperative evaluation and monitoring during the procedure to discharging from the recovery room.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101037"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and Initial Stabilization of Undifferentiated Shock","authors":"Bardia Nadim MD ,&nbsp;Alexandria Z. Byskosh MD ,&nbsp;Khanant M. Desai MD, RPVI","doi":"10.1016/j.tvir.2025.101038","DOIUrl":"10.1016/j.tvir.2025.101038","url":null,"abstract":"<div><div>Vascular Interventional Radiologists (VIRs) are increasingly involved in consultation and management of patients with circulatory shock. The ability to recognize the underlying pathophysiology of a patient’s shock and treat appropriately is therefore critical to VIR practice. Here, we discuss the initial evaluation and stabilization of undifferentiated shock. Shock is defined as tissue hypoperfusion from inadequate oxygen delivery and/or impaired tissue oxygen utilization. The etiologies of shock can be grouped into 3 main categories: distributive, hypovolemic, cardiogenic, and obstructive; each of which are associated with characteristic hemodynamic and metabolic derangements such as decreased preload or impaired cardiac contractility. Presentation typically involves 1) hypotension and tachycardia as indicators of impaired cardiac output, and 2) evidence of ongoing end-organ hypoperfusion such as oliguria, altered mental status, and lactic acidosis. Initial management includes control of airway and oxygenation/ventilation, identification of underlying hemodynamic and cardiovascular derangements, and support of cardiac output with intravenous fluid (IVF), blood products, diuresis, and/or vasopressors and inotropes. More detailed hemodynamic analysis can be performed with arterial catheters, blood gases, pulmonary artery catheters, and echocardiography to further tailor therapy. Finally, definitive evaluation for causative etiology should be initiated immediately with biochemical studies, cultures, imaging, and hemodynamic assessment so that etiology-specific treatment (e.g. antibiotics, blood products) can be initiated.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101038"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focused Cardiac Ultrasound for Rapid Hemodynamic Assessment: A Primer for Vascular and Interventional Radiologists","authors":"Khanant M. Desai MD, RPVI","doi":"10.1016/j.tvir.2025.101025","DOIUrl":"10.1016/j.tvir.2025.101025","url":null,"abstract":"<div><div>Interventional Radiology has evolved to encompass periprocedural and inpatient care of critically ill patients. Acute hypotension and shock can occur in IR patients due to various causes including hemorrhage, sepsis, myocardial infarction, and pulmonary embolism; therefore, the ability to accurately evaluate acutely deteriorating patients must become a part of the IR skillset. Goal-directed sonographic examination of the heart and inferior vena cava provides rapid bedside assessment of anatomic and functional parameters that can be used to determine the etiology underlying a patient's shock. Targets of evaluation include ventricular systolic function/size/thickness, presence of pericardial effusion and tamponade physiology, intravascular volume status, and existence of other structural pathology such as valvular disease and intracardiac masses. Presented is a primer on performing a systematic focused cardiac ultrasound examination for patients experiencing acute hypotension.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 1","pages":"Article 101025"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid Status Assessment and the Role of the Venous Excess Ultrasound (VExUS) Score","authors":"Andrew R. Ahn MD,&nbsp;Khanant M. Desai MD, RPVI","doi":"10.1016/j.tvir.2025.101026","DOIUrl":"10.1016/j.tvir.2025.101026","url":null,"abstract":"<div><div>Interventional radiologists frequently assume care of patients with high severity of acute and chronic illnesses, many of which can contribute to shock and organ failure in the inpatient setting. The ability to quickly assess the hemodynamic status of a decompensating patient at bedside is therefore a valuable skill for IRs to develop. Assessment of intravascular volume status is fundamental to this—shock and organ failure are commonly precipitated by hypovolemia resulting in decreased circulating blood volume and organ perfusion, but may also develop due to fluid overload resulting in heart failure and organ malperfusion due to venous congestion. The venous excess ultrasound (VExUS) protocol is a rapid point-of-care sonographic exam that scores severity of systemic venous congestion by integrating analysis of multiple venous beds. Here, we review traditional methods of estimating intravascular volume status, technical aspects of the VExUS examination, interpretation of VExUS results, and practical applications for VExUS.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 1","pages":"Article 101026"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to Image guided percutaneous robotic interventions for solid organs Techn Vasc Intervent Radiol (TVIR). 2024, 27: 101006","authors":"Govindarajan Narayanan MD ,&nbsp;Ripal T. Gandhi MD ,&nbsp;Matheus A. Dabus ,&nbsp;Bente A.T. van den Bemd MD","doi":"10.1016/j.tvir.2025.101019","DOIUrl":"10.1016/j.tvir.2025.101019","url":null,"abstract":"","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 1","pages":"Article 101019"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central Venous Recanalization and Right Atrial Thrombectomy Using IVUS","authors":"Rehan Syed Quadri MD","doi":"10.1016/j.tvir.2025.101024","DOIUrl":"10.1016/j.tvir.2025.101024","url":null,"abstract":"<div><div>Central venous occlusions (CVOs) of the systemic circulation are highly morbid, causing significant symptoms from venous congestion, venous thromboembolism (VTE) and impaired vascular access. Endovascular recanalization (EVR) has emerged as the treatment of choice for medically refractory nonthrombotic and thrombotic CVOs with Intravascular Ultrasound (IVUS) playing a pivotal role. Radial and side-firing IVUS catheters are used during central venous recanalization in the chest, abdomen and pelvis. The intraluminal ultrasonic view of a CVO shows dynamic details of pathology not obtained with conventional venography or cone-beam CT, allowing for a more accurate evaluation of clot burden, wall integrity, tumor invasion, occlusion length and luminal caliber. IVUS is also superb for guiding treatment of CVOs involving blunt and sharp recanalization, stenting, and mechanical thromboembolectomy (MTE) of VTE, especially high-risk free-floating thrombi (FFT) and clot in-transit (CIT) in the right atrium (RA). It most accurately assesses procedural endpoints, including successful intravascular traversal across an occlusion, adequate luminal gain after venoplasty and stenting, and complete clot extraction during thrombectomy. Moreover, this is all done without added contrast or radiation, which is paramount to reduce exposure during a challenging recanalization, especially in the aging hemodialysis population. Long-term data is now available that shows IVUS can enhance technical and clinical success and reduce complications during EVR. To achieve these benefits with IVUS interventionalists must be familiar with the available catheters and how to optimize and interpret the intraluminal images obtained. This paper will review the patient evaluation, indications, equipment, steps, challenges, complications, and outcomes for central venous recanalization (CVR) and RA thrombectomy with IVUS.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 1","pages":"Article 101024"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvenous biopsy of abdominal-pelvic lesions with no safe percutaneous access: How we do it","authors":"Akhilesh Pillai ,&nbsp;Achintya A. Patel MD ,&nbsp;Ankit Mehta MD ,&nbsp;Moaz M. Choudhary MD","doi":"10.1016/j.tvir.2025.101022","DOIUrl":"10.1016/j.tvir.2025.101022","url":null,"abstract":"<div><div>Recent developments in cancer genomics have allowed for comprehensive genomic profiling of tumors, thereby allowing oncologists to provide targeted therapies for patients with advanced cancers. This has made it even more important to obtain adequate core biopsies of lesions targeted for biopsies. While most lesions can be biopsied safely percutaneously using CT and ultrasound guidance, some lesions do not have a safe percutaneous window, thereby necessitating alternative biopsy techniques, such as transvenous biopsies, to aid in diagnosis and treatment. This review explores the use and technique of the transvenous approach for targeting small abdominal and pelvic masses using intravascular ultrasound guidance.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 1","pages":"Article 101022"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular Ultrasound: A Review of Radial and Side Firing IVUS","authors":"Aria Nazeri MD ,&nbsp;Alexander Ushinsky MD ,&nbsp;Sanjeeva P. Kalva MD ,&nbsp;Moaz M. Choudhary MD","doi":"10.1016/j.tvir.2025.101021","DOIUrl":"10.1016/j.tvir.2025.101021","url":null,"abstract":"<div><div>Intravascular ultrasound (IVUS) has become an essential tool for endovascular procedures, particularly during complex interventions. The benefits include improved visualization of vascular and extravascular anatomy, reduced complication rates, and enhanced accuracy during catheter-based interventions. In this review, we discuss the properties of side-firing (also commonly known as intracardiac echo ICE) and radial IVUS and explore their unique applications in endovascular procedures. The side-firing IVUS is advantageous for visualizing lesions and vascular structures in a plane parallel to the vessel wall, making it effective for guiding portal venous interventions, transvenous biopsies, and endoleak embolization, while the radial IVUS provides a 360-degree view of the vessel lumen, enabling detailed cross-sectional images of normal anatomy, pathologic processes requiring different endovascular therapy and their response to intervention(s).</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 1","pages":"Article 101021"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}