Techniques in vascular and interventional radiology
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Acute mesenteric ischemia is a life-threatening condition that occurs when an abrupt decrease in blood flow results in inadequate supply to the intestines, leading to bowel infarction. Etiologies may include arterial embolus, arterial or venous thrombosis, and nonocclusive mesenteric ischemia. Other causes include vasculitis, traumatic injury, dissection of the aorta, cholesterol emboli, and intestinal obstruction. ⋯ However, endovascular approaches have been increasingly reported in multiple case series describing success with initial endovascular therapy followed by open surgical intervention in some cases. Acuity of presentation, presence of bowel infarction, etiology of the ischemia, and risk factors may influence a planned treatment approach. The key to successful treatment of acute mesenteric ischemia involves early clinical recognition based on a detailed history and physical examination along with assessment of contributory risk factors, rapid acquisition of appropriate diagnostics to confirm a diagnosis, and early intervention to correct the underlying abnormality.
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Ultrasound (US)-guided interventional procedures are routinely performed for lesions visualized on US and are the standard of care in the diagnosis and management of breast disease. When performed correctly, these procedures are safe, minimally invasive, and have a high diagnostic accuracy comparable to surgical biopsy. ⋯ This article reviews the indications and techniques for US-guided interventional procedures. Concordance of imaging and pathology results, potential challenges, and associated complications are also discussed.
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Image-guided ablation has evolved rapidly in the past decade into a competitive technique for treating focal solid malignancies. However, as they rely mainly on thermal energy, such as radiofrequency or microwave, many tumors close to sensitive organs, such as ducts, bowel, and nerves, still remain nonablatable owing to the risk of thermal injury. ⋯ However, practical limitations remain for irreversible electroporation, and its complete cancer and location-specific safety and efficacy profiles are still largely unknown. We therefore review what is known for this new ablation modality based on preclinical and preliminary clinical data, and discuss its emerging indications as well as technical challenges.
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Tech Vasc Interv Radiol · Dec 2013
Review"How we do it" - a practical approach to hepatic metastases ablation techniques.
Secondary liver malignancies are associated with significant mortality and morbidity if left untreated. Colorectal cancer is the most frequent origin of hepatic metastases. A multidisciplinary approach to the treatment of hepatic metastases includes medical, surgical, radiation and interventional oncology. ⋯ Recently, irreversible electroporation, a nonthermal modality, has also been used for liver tumor ablation. In the following section, we review the different liver ablation techniques, as well as indications for ablation, specific patient preparations, and different "tricks of the trade" that we use to achieve safe and effective liver tumor ablation. We also discuss appropriate imaging and clinical patient follow-up and potential complications of liver tumor ablation.
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Tumor ablation is a minimally invasive technique that is commonly used in the treatment of tumors of the liver, kidney, bone, and lung. During tumor ablation, thermal energy is used to heat or cool tissue to cytotoxic levels (less than -40°C or more than 60°C). ⋯ Each technique, although similar in purpose, has specific and optimal indications. This review serves to discuss general principles and technique, reviews each modality, and discusses modality selection.