Techniques in Vascular and Interventional Radiology最新文献

The advantages of the vascular lab (VL) are a specialized knowledgeable team and a dedicated equipment which is transferrable to the procedure room to facilitate the procedure and gather information about the procedure endpoints. In this article, Registered Vascular Technologists (RVT) from various institutions discuss the basic and the complex ways the VL can be used inside a procedure room. The advantages of the vascular lab (VL) are a specialized knowledgeable team and dedicated equipment which is transferrable to the procedure room to facilitate the procedure and gather information about procedure endpoints. Such expertise may improve imaging guided access, enable complicated lesion crossing, and provide information about the success of the procedure. Below are the reports from practicing registered vascular technologists at the forefront of patient vascular care within institutions that have adopted the mobile intraprocedural VL idea in basic and complex real-world ways.

A vascular lab procedure culminates in a diagnostic report that is a combination of the data generated on the vascular lab equipment, physician interpretations, and recommendations. The transcription process can be error prone and inefficient. Computerized capture of data from the equipment and transmission into a reporting system is the definition of “automation” in this article. In this article, we describe an organized approach to collecting data generated on vascular lab equipment and delivering to reporting systems to decrease error and improve efficiency.

The vascular lab (VL) is a powerful tool in diagnosing arterial disease, including peripheral and aortic disease, which is cornerstone of many VLs. This article discusses the indications, protocol, and diagnostic criteria of noninvasive testing for peripheral arterial disease and contrast enhanced ultrasound after endovascular repair of aortic aneurysm.

The vascular lab (VL) provides unequalled information regarding venous disease especially in the depiction and characterization of venous waveforms. This article provides the indications, protocol, and diagnostic criteria for peripheral and central venous disease and venous mapping. Venous evaluation is one of the most common studies performed at vascular labs (VL). Patient may present with swelling for evaluation of thrombosis, central obstruction, or venous insufficiency, or may need preoperative planning prior to a bypass or dialysis access creation. It is my hope that the added value a VL brings to the sonographic evaluation of veins, beyond the compressibility of the veins, is the utmost respect and attention to the depiction and characterization of the venous waveform.

The vascular lab is an essential tool in diagnosing intracranial and extracranial disease including vasospasm from subarachnoid hemorrhage and carotid artery stenosis in the setting of stroke or transient ischemic attack. This article discusses the indications, protocol, and diagnostic criteria for transcranial doppler (TCD) and carotid artery duplex ultrasound. Intracranial and extracranial arterial testing by way of TCD and carotid imaging carries enormous implications and can provide life or death information. The learning curve for these techniques is steep but can be mastered with repetition and precise technique.

The vascular lab (VL) provides vital information for dialysis access to guide management. This article discusses the indication, protocol, and diagnostic criteria for the evaluation of arteriovenous fistulas and grafts. An arteriovenous (AV) dialysis access is made by creating a connection between an artery and vein (AV fistula [AVF]) or by interposing a conduit between an artery and a vein (AV graft [AVG]) to provide high flow circuit for hemodialysis. A normal mature AV dialysis access has a thrill or vibration from turbulent flow in the graft or vein. The nomenclatures at our institution for an AVF and AVG are in the Figure 1 A and B diagrams.

Setting up a vascular lab (VL) requires initial substantial capital, personnel, real-estate, and time commitment and requires support from leadership and champions. There are certain tangible building blocks for a successful VL. The more time and effort that are leant to these foundational components, the better the VL will operate. This article will discuss the preliminary measures that need to be in place for a successful VL. This article describes space, equipment, policy and procedure, structured reporting, and personnel – the tangible building blocks for a successful VL that needs advanced planning and implementation.

Patient evaluation is critical to identify and quantitate patient's disease. Aside from the patient's history and physical examination, imaging can help confirm and determine the extent of disease. Imaging can aid in treatment planning once the decision to proceed to intervention has been made. This chapter will discuss the role of imaging before and after peripheral arterial interventions and how it may improve intervention outcomes. It will discuss the value of the arterial noninvasive examinations (ankle-brachial index, toe-brachial index, pulse volume recordings, and arterial duplex ultrasound), computed tomographic angiograms, magnetic resonance angiogram, and intravascular ultrasound.

Peripheral arterial disease (PAD) is a common condition, which significantly impacts the quality and length of life. In recent years, drug-eluting devices have demonstrated improved clinical effectiveness for treating peripheral arterial disease in the femoropopliteal arteries compared to traditional stents and angioplasty balloons. However, recent controversial studies have called the safety of this technology into question, leading to confusion as to if, when, and how these devices should be used. This article focuses on the underlying pathophysiology and pharmacology, the clinical benefits and potential harms, as well as expected future developments affecting the use of these drug-eluting technologies in treating peripheral arterial disease of the superficial femoral arteries.