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The Outpatient Endovascular & Interventional Society (OEIS)—The Voice of Advocacy for the OBL: Origins, Principles, and Historical Perspective 门诊病人血管内治疗和介入治疗协会(OEIS)的代言人:起源、原则和历史视角
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-03-01 DOI: 10.1016/j.tvir.2024.100946

The physician office offering imaging guided endovascular and minimally invasive interventional procedures is often referred to as an OBL (office based lab), OIS (office interventional suite), or OES (office endovascular suite). Initially, OBL's depended upon the national societies of interventional radiology (SIR), vascular surgery (SVS) and interventional cardiology (SCAI) to advocate for them. However, the OBL space needed a voice dedicated to advocating for the appropriate reimbursement of procedures in the OBL to allow the OBL to survive as a viable site of service and become integral to healthcare delivery in the US healthcare system. This need led to the formation of the Outpatient Endovascular & Interventional Society (OEIS). The society is multispecialty and ensures safety in outpatient care in all sites of service while maintaining a focus on the OBL. The mission of the OEIS is to advocate for patients to have the ability to choose their provider and be able to receive safe and effective healthcare in a more friendly and far less costly site of service for them.

提供成像引导的血管内介入和微创介入手术的医生诊室通常被称为 OBL(诊室实验室)、OIS(诊室介入治疗室)或 OES(诊室血管内治疗室)。最初,OBL 依靠介入放射学会(SIR)、血管外科学会(SVS)和介入心脏病学会(SCAI)的倡导。然而,OBL 领域需要有一个专门的声音来倡导对 OBL 中的手术进行适当的报销,以使 OBL 能够作为一个可行的服务场所生存下去,并成为美国医疗保健系统中医疗保健服务不可或缺的一部分。这一需求促成了门诊病人血管内介入学会(OEIS)的成立。该学会由多个专科组成,在确保所有服务场所的门诊护理安全的同时,始终将重点放在 OBL 上。OEIS 的使命是倡导患者有能力选择自己的医疗服务提供者,并能在更友好、成本更低的服务场所接受安全有效的医疗服务。
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引用次数: 0
Establishing a Critical Limb Ischemia Outpatient Center: Separating Facts from Myth 建立重症肢体缺血门诊中心:分清事实与神话
IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-03-01 DOI: 10.1016/j.tvir.2024.100953

Critical Limb Ischemia or chronic limb-threatening ischemia represents the end stage of peripheral artery disease where arterial flow is compromised to the lower extremities and risk of limb loss may become imminent. Revascularization of lower extremities is one of the cornerstones of limb salvage and amputation prevention. Establishing centers of high quality CLI therapy requires creating different foundational pillars in order to be successful. This article discusses critical limb ischemia center creation from the perspective of critical limb ischemia therapists working in an outpatient setting.

危重肢体缺血或慢性肢体缺血是外周动脉疾病的终末阶段,此时下肢动脉血流受到影响,肢体缺失的风险迫在眉睫。下肢血管重建是挽救肢体和预防截肢的基石之一。建立高质量的重症肢体缺血治疗中心需要建立不同的基础支柱,这样才能取得成功。本文从在门诊工作的重症肢体缺血治疗师的角度讨论了创建重症肢体缺血中心的问题。
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引用次数: 0
Interventional Radiology Approaches for Managing Postpancreatic Transplant Complications and Type 1 Diabetes Mellitus 治疗胰腺移植后并发症和 1 型糖尿病的介入放射学方法
IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-12-01 DOI: 10.1016/j.tvir.2023.100927
Talal Mourad MD , Wael Saad MD , Osman Ahmed MD

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disorder characterized by the destruction of insulin-secreting beta cells in the pancreas, resulting in metabolic disturbances and long-term complications. While subcutaneous insulin remains the primary approach for achieving normoglycemia, pancreatic transplantation has emerged as an effective intervention for long-standing T1DM, providing insulin independence and normalized glycosylated hemoglobin levels. However, complications associated with pancreatic transplantation are frequent, necessitating thorough evaluation using diverse imaging modalities. This manuscript presents an overview of complications encountered with pancreatic transplantation, including vascular complications such as arterial and venous graft thrombosis, vessel stenosis, pseudoaneurysm, arterio-enteric fistula, and arteriovenous malformations. Additionally, the manuscript discusses other associated complications such as pancreatitis, pseudocyst formation, fistulas, pseudo-thrombosis of the iliac vein, post-transplantation lymphoproliferative disorder, and fluid collections. The integration of various imaging modalities plays a crucial role in diagnosing and managing these complications, with interventional radiologists assuming a vital role in employing image-guided procedures. Moreover, the manuscript explores pancreatic islet cell transplantation as a promising cellular-based therapy for T1DM, offering stable long-term glycemic control and decreased reliance on exogenous insulin in a significant proportion of recipients. This minimally invasive procedure involves the image-guided transcatheter infusion of islet cells obtained from deceased donors into the recipient's liver. The importance of interventional radiologists in managing complications related to pancreatic transplantation is underscored, with endovascular or image-guided approaches being utilized to address the diverse spectrum of encountered complications. Furthermore, the potential of islet cell transplantation as a minimally invasive alternative to traditional pancreatic transplantation is emphasized, as it offers the prospect of preventing many associated complications.

1 型糖尿病(T1DM)是一种慢性自身免疫性疾病,其特点是胰腺中分泌胰岛素的 beta 细胞遭到破坏,导致代谢紊乱和长期并发症。虽然皮下注射胰岛素仍是实现正常血糖的主要方法,但胰腺移植已成为治疗久治不愈的 T1DM 的有效干预措施,它能使患者独立使用胰岛素,并使糖化血红蛋白水平恢复正常。然而,胰腺移植相关并发症屡见不鲜,需要使用各种影像学模式进行全面评估。本手稿概述了胰腺移植遇到的并发症,包括血管并发症,如动静脉移植物血栓、血管狭窄、假性动脉瘤、动静脉瘘和动静脉畸形。此外,手稿还讨论了其他相关并发症,如胰腺炎、假性囊肿形成、瘘管、髂静脉假性血栓形成、移植后淋巴增生性疾病和积液。各种成像模式的整合在诊断和处理这些并发症方面起着至关重要的作用,介入放射科医生在采用图像引导程序方面发挥着重要作用。此外,手稿还探讨了胰岛细胞移植作为一种治疗 T1DM 的前景广阔的细胞疗法,它能提供长期稳定的血糖控制,并减少相当一部分受者对外源性胰岛素的依赖。这种微创手术是在图像引导下,将从已故捐赠者处获得的胰岛细胞经导管输注到受者的肝脏中。介入放射科医生在处理胰腺移植相关并发症方面的重要性得到了强调,他们利用血管内或图像引导的方法来处理遇到的各种并发症。此外,还强调了胰岛细胞移植作为传统胰腺移植微创替代方法的潜力,因为它有望预防许多相关并发症。
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引用次数: 0
Endovascular Treatment of Venous Outflow and Portal Venous Complications After Liver Transplantation 肝移植术后静脉流出和门静脉并发症的血管内治疗
IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-12-01 DOI: 10.1016/j.tvir.2023.100924
Michael T. Aaberg MD , Carlos E. Marroquin MD , Nima Kokabi MD , Anant D. Bhave MD , Joseph T. Shields MD , Bill S. Majdalany MD, FSIR

Liver transplantation continues to rapidly evolve, and in 2020, 8906 orthotopic liver transplants were performed in the United States. As a technically complex surgery with multiple vascular anastomoses, stenosis and thrombosis of the venous anastomoses are among the recognized vascular complications. While rare, venous complications may be challenging to manage and can threaten the graft and the patient. In the last 20 years, endovascular approaches have been increasingly utilized to treat post-transplant venous complications. Herein, the evaluation and interventional treatment of post-transplant venous outflow complications, portal vein stenosis, portal vein thrombosis, and recurrent portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS) are reviewed.

肝移植继续快速发展,到2020年,美国共进行了8906例正位肝移植手术。作为一种技术复杂、多血管吻合的手术,静脉吻合口狭窄和血栓形成是公认的血管并发症之一。静脉并发症虽然罕见,但处理起来具有挑战性,可能会威胁到移植物和患者。在过去的 20 年中,越来越多地采用血管内方法治疗移植后静脉并发症。在此,我们将回顾移植后静脉流出并发症、门静脉狭窄、门静脉血栓形成以及经颈静脉肝内门体分流术(TIPS)复发性门静脉高压症的评估和介入治疗。
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引用次数: 0
Pediatric Transplant Interventions 小儿移植干预
IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-12-01 DOI: 10.1016/j.tvir.2023.100930
Pareena Sharma , Ritu Shah , Vaz Zavaletta MD, PhD , Frederic Bertino MD , Tina Sankhla , Jun Man Kim , Michael Leshen , Jay Shah

The field of pediatric organ transplantation has grown significantly in recent decades, with interventional radiology (IR) playing an essential role in managing pre and post-transplant complications. Pediatric transplant patients face unique challenges compared to adults, including donor-recipient size mismatch, and complications of a growing child with changing physiology. Interventional radiologists play a major role in pediatric renal and liver transplant. IR interventions begin early in the child's pretransplant journey, with diagnostic procedures such as biopsies, angiograms, and cholangiograms. These procedures are essential for understanding the etiology of organ failure and identifying potential transplant candidates. Minimally invasive therapeutic procedures may serve as bridges to transplant and may include vascular access optimization for hemodialysis, transjugular intrahepatic portosystemic shunts (TIPS) creation, and tumor embolization or ablation. After transplant, image-guided biopsies for the surveillance of graft rejection and treatment of vascular or luminal stenoses, pseudoaneurysms, and anastomotic leaks can maintain the function and longevity of the transplant organ. Careful consideration must be given to patient size and evolving anatomy, radiation exposure, and the need for deeper sedation for pediatric patients. Despite these challenges, the integration of IR in pediatric transplant care has proven beneficial, offering minimally invasive alternatives to surgery, faster recovery times, and improved outcomes.

近几十年来,儿科器官移植领域取得了长足发展,介入放射学(IR)在处理移植前后并发症方面发挥了重要作用。与成人相比,儿科移植患者面临着独特的挑战,包括供体与受体大小不匹配,以及因儿童生长发育和生理变化而产生的并发症。介入放射科医生在小儿肾脏和肝脏移植中发挥着重要作用。介入放射治疗在儿童移植前的早期就已开始,包括活组织检查、血管造影和胆管造影等诊断程序。这些程序对于了解器官衰竭的病因和确定潜在的移植候选者至关重要。微创治疗程序可作为通往移植的桥梁,包括优化血液透析的血管通路、创建经颈静脉肝内门体分流术(TIPS)以及肿瘤栓塞或消融术。移植后,通过图像引导活检监测移植排斥反应,治疗血管或管腔狭窄、假性动脉瘤和吻合口漏,可以保持移植器官的功能和寿命。必须慎重考虑患者的体型和不断变化的解剖结构、辐射暴露以及对儿童患者进行深度镇静的必要性。尽管存在这些挑战,但事实证明,将红外技术整合到儿科移植护理中是有益的,它提供了手术的微创替代方案,缩短了恢复时间,改善了治疗效果。
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引用次数: 0
Disparities in Transplant Interventions 移植干预中的差异
IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-12-01 DOI: 10.1016/j.tvir.2023.100921
Kaesha Thomas MD, Owosela Babajide BS, Judy Gichoya MD, MS, Janice Newsome MD, FSIR
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引用次数: 0
Special Considerations and Techniques of Interventions in Lung Transplant Recipients 肺移植受者的特殊考虑因素和干预技术
IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-12-01 DOI: 10.1016/j.tvir.2023.100926
Daniel H. Kim, Shenise Gilyard, Robert Suh

Lung transplant remains an important treatment option for patients with end-stage lung diseases providing improvement in survival rates and quality of life. Specialized considerations should be applied with interventions of lung transplant recipients as they host specific anatomic variations and high risk towards certain complications. In this article, we highlight the role of interventional radiology for lung transplant recipients along with discussion of interventional techniques. Specific emphasis is placed on describing and explaining the techniques pertained to the points of anastomosis, diagnosis and treatment of malignancies, and management of complications in lung transplant recipients.

肺移植仍然是终末期肺病患者的重要治疗选择,可提高生存率和生活质量。由于肺移植受者存在特殊的解剖变异和某些并发症的高风险,因此在对他们进行介入治疗时应特别注意。在本文中,我们将强调介入放射学在肺移植受者中的作用,并讨论介入技术。重点描述和解释了与肺移植受者吻合点、恶性肿瘤的诊断和治疗以及并发症的处理有关的技术。
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引用次数: 0
Interventional Radiological Treatment of Orthotopic Heart Transplant Complications 正位心脏移植并发症的介入放射治疗
IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-12-01 DOI: 10.1016/j.tvir.2023.100928
Jonathan Charles BS , Monique Girgis BS , Nariman Nezami MD , Kamal Massis MD , Cliff Davis MD , Glenn Hoots MD , Jamil Shaikh MD

Orthotopic heart transplantation is a life-saving procedure that has substantially improved the lives of countless patients since its inception. However, there are several procedure-related complications that require prompt management. Interventional radiology, with its ever expanding toolkit, is a cornerstone of the multidisciplinary team following post-cardiac transplant patients. Percutaneous, endovascular therapy provides minimally invasive, safe, and effective treatments for immediate and delayed cardiac transplant complications and this paper serves to highlight the various management options interventional radiology can provide for orthotopic heart transplantation complications.

异位心脏移植是一种挽救生命的手术,自诞生以来已大大改善了无数患者的生活。然而,有几种与手术相关的并发症需要及时处理。介入放射学的工具包不断扩大,是多学科团队为心脏移植术后患者提供治疗的基石。经皮、血管内治疗可为即时和延迟的心脏移植并发症提供微创、安全和有效的治疗,本文将重点介绍介入放射学可为正位心脏移植并发症提供的各种治疗方案。
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引用次数: 0
Transplant Renal Interventions 移植肾干预
IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-12-01 DOI: 10.1016/j.tvir.2023.100925
Hamed Jalaeian MD, RPVI, MSc , David H. Field MD, MS , Emil I. Cohen MD, FSIR

Renal transplantation is the most commonly performed solid-organ allograft surgery; in 2021, 25487 kidneys were transplanted in the United States, and nearly 42,000 adult patients were listed for transplant. As the treatment of choice for patients with end-stage renal disease, transplantation is performed at more than 250 centers. Despite a high rate of success, renal transplantation is not without complication, and the interventional radiologist plays a crucial role in the management of the postoperative patient. Knowledge of postsurgical anatomy, imaging findings, and technical challenges unique to these patients is important for the safe and effective treatment of transplant-related conditions. We offer a guide to the most common interventions in the renal transplant population, including biopsy, vascular interventions, and the management of urinary obstruction.

肾移植是最常见的实体器官异体移植手术;2021 年,美国共移植了 25487 个肾脏,近 42000 名成年患者被列入移植名单。作为终末期肾病患者的首选治疗方法,移植手术在 250 多个中心进行。尽管成功率很高,但肾移植并非没有并发症,介入放射科医生在术后病人的管理中发挥着至关重要的作用。了解手术后的解剖结构、成像结果以及这些患者特有的技术难题,对于安全有效地治疗移植相关疾病非常重要。我们将为您提供肾移植患者最常见的介入治疗指南,包括活组织检查、血管介入治疗和尿路梗阻治疗。
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引用次数: 0
Surgical Versus Image-Guided Interventions in the Management of Complications After Liver Transplantation 肝移植术后并发症处理中的手术与图像引导干预
IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-12-01 DOI: 10.1016/j.tvir.2023.100922
Denise J. Lo MD , Joseph F. Magliocca MD

Liver transplantation is a technically demanding surgical procedure with known complications, and the optimal approach to addressing vascular and biliary complications requires a coordinated effort between surgical and interventional radiology teams. Vascular complications involving the hepatic artery, portal vein, or hepatic veins can be characterized by their mechanism, chronicity, and timing of presentation. These factors help determine whether the optimal therapeutic approach is surgical or endovascular. Very early presentation in the perioperative period favors surgical revision, while later presentation is best addressed endovascularly. Biliary complications can be categorized as leaks or strictures, and coordinated surgical, endoscopic, and percutaneous management is needed to address these types of complications. Through advances in technique and the management of complications, outcomes after liver transplantation continue to improve.

肝脏移植是一种技术要求很高的外科手术,并发症众所周知,而解决血管和胆道并发症的最佳方法需要外科和介入放射学团队的共同努力。涉及肝动脉、门静脉或肝静脉的血管并发症可根据其发病机制、慢性程度和发病时间来确定。这些因素有助于确定最佳治疗方法是手术还是血管内治疗。围手术期的早期并发症更适合手术治疗,而晚期并发症则最好采用血管内治疗。胆道并发症可分为胆漏和胆道狭窄,需要协调手术、内镜和经皮治疗来解决这类并发症。通过技术的进步和并发症的处理,肝移植术后的疗效不断提高。
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引用次数: 0
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Techniques in Vascular and Interventional Radiology
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