Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Mar 2012
ReviewIntra-arterial thrombolysis: tissue plasminogen activator and other thrombolytic agents.
Recanalization rates with the administration of intravenous tissue plasminogen activator in acute ischemic stroke are low. Adjuvant endovascular techniques that achieve recanalization by direct intra-arterial (IA) delivery of thrombolytics, mechanical clot retrieval, clot aspiration, and stenting may complement intravenous pharmacotherapy. IA thrombolytics can be administered within 6 hours of symptom onset in anterior circulation strokes and within 24 hours in posterior circulation strokes. This review describes the indications, patient selection, and technique for IA administration of thrombolytics.
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Non-tunneled central venous access has become an important tool in the management of the sick patient, particularly in the intensive care unit. Image guidance allows more precise placement of lines with overall lower complication rates compared with guidance by physical landmarks. The use of image guidance has brought a procedure traditionally performed by surgeons into the realm of the interventional radiologist. Techniques for placement of non-tunneled central venous catheters, hemodialysis catheters, and peripherally inserted central catheter lines will be discussed.
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Tech Vasc Interv Radiol · Dec 2011
ReviewEvaluation and management of central venous access complications.
Venous access is 1 of the most common interventional procedures in the USA. Using image guidance in the last 2 decades, obtaining venous access has become increasingly routine, and the complications commonly associated with the procedure have significantly decreased. ⋯ This article discusses the most common and some unusual complications seen with the placement of these devices. We also briefly discuss the management of these complications.
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Atherosclerotic renal artery stenosis (ARAS) is the most common cause of renal artery stenosis in the adult population. ARAS may result in progressive renal impairment, renovascular hypertension, and/or cardiac disturbance syndromes. ⋯ When performed correctly, renal artery stenting has been shown to stabilize or improve renal function and/or renovascular hypertension in 65-70% of carefully selected patients with ARAS. Therefore, percutaneous renal artery stenting should be considered the primary treatment for patients with symptomatic ARAS.
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Massive hemoptysis is a life-threatening emergency. Chest radiograph, computed tomography, and bronchoscopy play a complementary role in diagnosing the underlying cause of hemorrhage and localizing the bleeding site. ⋯ Immediate cessation of bleeding occurs in more than 75% of patients; however, long-term recurrences are common in patients with progressive lung disease. Complications are infrequent except for a rare occurrence of spinal cord ischemia.