Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Sep 2019
ReviewBiliary Endoscopy for Benign and Malignant Biliary Strictures.
Percutaneous endoscopy operated by interventional radiologists has the potential to become an effective tool to both help diagnose and treat benign and malignant biliary strictures. This is particularly true in cases where endoscopic retrograde cholangiopancreatography fails or is not feasible due to surgically-altered anatomy. Both preoperative clinical and technical procedural factors must be taken into consideration when pursuing percutaneous endoscopy. In this article, clinical evaluation, perioperative management, and procedural techniques for biliary endoscopy for benign and malignant strictures are reviewed.
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Intraductal biliary stones can result in significant acute and long-term complications. When patients' anatomy precludes more traditional management, the interventional radiologist may be called upon to provide well-established techniques for percutaneous biliary drainage and stone removal. ⋯ Direct percutaneous visualization of the biliary tree can also diagnose and provide symptomatic relief for stone-mimicking pathologic conditions such as biliary tumors. This article will review the role, technique, and considerations for percutaneous biliary endoscopy and adjunct interventions in patients with isolated and complex, biliary stone disease and stone-mimicking pathologies.
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Tech Vasc Interv Radiol · Sep 2019
ReviewPercutaneous Interventional Radiology-Operated Endoscopy for Foreign Body Removal.
Image-guided retrieval of endovascular devices such as inferior vena cava filters, guidewires, and stents is well reported, though there is a paucity of published reports on biliary, genitourinary, or gastrointestinal foreign body retrieval utilizing percutaneous endoscopy, particularly when it is performed solely by interventional radiologists. In cases of failed traditional endoscopic techniques or to evade more invasive surgical options, percutaneous endoscopy can be an adjunctive tool employed by interventional radiologists to extract foreign bodies. In this article, clinical evaluation, perioperative management, and procedural techniques for biliary, genitourinary, and gastrointestinal endoscopy for foreign body retrieval are reviewed.
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The morbidity and mortality of cholecystectomy can increase to 10% in high surgical risk patients. The technique for percutaneous cholecystolithotomy consists of 3 steps: (1) percutaneous cholecystostomy, (2) tract dilation and cholecystolithotomy, and (3) tract evaluation and catheter removal. Cholecystoscopy is critical in guiding the lithotripsy probe for fragmentation of large stones and is useful for locating small stone fragments not seen in cholangiography. ⋯ The most common complication is bile leak during the procedure or after catheter removal. Although recurrence rate of gallstones has been reported up to 40%, the symptom recurrence rate is much lower. Therefore, percutaneous cholecystolithotomy using cholecystoscopy can be an alternative to cholecystectomy in high surgical risk patients with symptomatic gallstones.
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Tech Vasc Interv Radiol · Jun 2018
ReviewCatheter-Directed Thrombolysis for Pulmonary Embolism: The State of Practice.
Acute pulmonary embolism (PE) is a major public health problem. It is the third most common cause of death in hospitalized patients. In the United States, there are up to 600,000 cases diagnosed per year with 100,000-180,000 acute PE-related deaths. ⋯ Massive, submassive, and low-risk acute PE have mortality rates of 25%-65%, 3%, and <1%, respectively. Current PE management includes the use of anticoagulation alone, systemic thrombolysis, catheter-directed thrombolysis, and surgical embolectomy. This article will describe the current state of practice for catheter-directed thrombolysis and its role in the management of acute PE.