Cardiovascular and interventional radiology
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Cardiovasc Intervent Radiol · Aug 2010
ReviewHave recent vertebroplasty trials changed the indications for vertebroplasty?
Two different investigators in the New England Journal of Medicine recently published two randomized controlled trials (RCTs) regarding the efficacy of vertebroplasty for painful osteoporotic vertebral compression fractures. In their results, both investigators concluded that there was no significant difference in pain relief between the vertebroplasty group and control group 1 month after treatment. The trials described a different patient cohort from the one we treat with vertebroplasty. ⋯ Randomization in both RCTs took >4 years for completion. We advise that vertebroplasty be offered to patients with recent fractures <8 weeks old who have uncontrolled pain as well as patients progressing to osteonecrosis and the intravertebral vacuum phenomenon (Kummels disease). The availability of recent MRI scanning is also critical to proper patient selection.
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Cardiovasc Intervent Radiol · Apr 2010
ReviewRadiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization.
Hemoptysis can be a life-threatening respiratory emergency and indicates potentially serious underlying intrathoracic disease. Large-volume hemoptysis carries significant mortality and warrants urgent investigation and intervention. Initial assessment by chest radiography, bronchoscopy, and computed tomography (CT) is useful in localizing the bleeding site and identifying the underlying cause. ⋯ Recurrent bleeding is not uncommon, especially if there is progression of the underlying disease process. Prompt repeat embolization is advised in patients with recurrent hemoptysis in order to identify nonbronchial systemic and pulmonary arterial sources of bleeding. This article reviews the pathophysiology and causes of hemoptysis, diagnostic imaging and therapeutic options, and technique and outcomes of BAE.
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Cardiovasc Intervent Radiol · May 2009
Review Case ReportsEndovascular stent graft placement in the treatment of ruptured tuberculous pseudoaneurysm of the descending thoracic aorta: case report and review of the literature.
We report a successful repair of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta by endovascular stent graft placement. This procedure is starting to be accepted as an alternative method to surgery, and we review similar cases in the literature.
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Cardiovasc Intervent Radiol · Sep 2007
ReviewLong-term retrievability of IVC filters: should we abandon permanent devices?
Thromboembolic disease produces a considerable disease burden, with death from pulmonary embolism in the UK alone estimated at 30,000-40,000 per year. Whilst it is unproven whether filters actually improve longevity, the morbidity and mortality associated with thromboembolic disease in the presence of contraindications to anticoagulation is high. Thus complications associated with filter insertion, and whilst they remain in situ, must be balanced against the alternatives. ⋯ Follow-up (preferably prospective) is necessary for all retrievable filters, whether or not they are retrieved. Until these data become available we should restrict ourselves to the present indications of permanent and retrievable filters. If long-term follow-up data on larger numbers of cases confirm the initial data that retrievable filters are as safe and effective as permanent filters, the use of the retrievable filters is likely to expand.
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Central venous access plays an important role in the management of an ever-increasing population of patients ranging from those that are critically ill to patients with difficult clinical access. Interventional radiologists are key in delivering this service and should be familiar with the wide range of techniques and catheters now available to them. A comprehensive description of these catheters with regard to indications, technical aspects of catheterization, success rates, and associated early and late complications, as well as a review of various published guidelines on central venous catheter insertion are given in this article.