Techniques in vascular and interventional radiology
-
Tech Vasc Interv Radiol · Dec 2017
Review Case ReportsBronchial Artery Embolization for the Treatment of Acute Hemoptysis.
Massive hemoptysis is a life-threatening condition often defined as coughing up 300-600mL of blood in 24 hours in an adult, or >8mL/kg in 24 hours in a child. Although the definition is controversial, one should view massive hemoptysis as any volume of expectorated blood that can cause respiratory failure. This is because mortality in the setting of hemoptysis is usually associated with asphyxiation, rather than exsanguination. ⋯ Treatment begins with resuscitation and airway protection, followed by minimally invasive bronchoscopic and endovascular techniques. Surgical interventions are considered last line therapy due to mortality rates of 37%-43% in the setting of massive hemoptysis. Bronchial artery embolization is now considered the treatment of choice for massive hemoptysis.
-
Tech Vasc Interv Radiol · Dec 2017
Review Case ReportsEvaluation and Management of Blunt Solid Organ Trauma.
Trauma is a leading cause of death in patients under the age of 45 and generally associated with a high kinetic energy event such as a motor vehicle accident or fall from extreme elevations. Blunt trauma can affect every organ system and major vascular structure with potentially devastating effect. When we consider abdominal solid organ injury from blunt trauma, we usually think of the liver, spleen, and kidneys. ⋯ Renal injuries are less common, and evidence of arterial injury such as active extravasation or pseudoaneurysm is warranted before endovascular therapy. Pancreatic trauma is uncommon and usually secondary to steering wheel/handlebar mechanism injuries. Adrenal injuries are rare in the absence of megatrauma or underlying adrenal abnormality.
-
Tech Vasc Interv Radiol · Dec 2017
Review Case ReportsEvaluation and Treatment of Blunt Pelvic Trauma.
Trauma is a significant contributor to mortality, especially in the young. Pelvic trauma with pelvic ring fractures may result in associated arterial injury, necessitating endovascular intervention. ⋯ Management is determined by the acuity of the patient's clinical status, radiographs, ultrasound, and the results of computed tomography imaging when available. Numerous embolic agents are available for treatment of arterial hemorrhage.
-
Tech Vasc Interv Radiol · Dec 2017
Review Case ReportsEmergent Endovascular Treatment of Penetrating Trauma: Solid Organ and Extremity.
Penetrating injuries can result in acute or subacute arterial injuries of the solid organs or extremities. Although most penetrating injuries are managed conservatively, some patients require endovascular or surgical treatment. Often, the best method for management is controversial and the level of urgency for clinical decision-making is high. ⋯ Not unfrequently, these decisions are made during the course of the procedure. There are numerous embolization agents, each of which serves a very specific purpose, depending on the clinical scenario. Within this article, we will review endovascular treatment indications, contraindications, and endovascular techniques for the treatment of penetrating trauma of the solid organs or extremities.
-
Tech Vasc Interv Radiol · Sep 2017
ReviewSystemic Thrombolysis for Pulmonary Embolism: Who and How.
Anticoagulation has been shown to improve mortality in acute pulmonary embolism (PE). Initiation of anticoagulation should be considered when PE is strongly suspected and the bleeding risk is perceived to be low, even if acute PE has not yet been proven. Low-risk patients with acute PE are simply continued on anticoagulation. ⋯ Standard-dose thrombolysis, low-dose systemic thrombolysis, and catheter-based therapy which includes a number of devices and techniques, with or without low-dose thrombolytic therapy, have offered potential solutions and this area has continued to evolve. On the basis of heterogeneity within the category of intermediate-risk as well as within the high-risk group of patients, we will focus on the use of systemic thrombolysis in carefully selected high- and intermediate-risk patients. In certain circumstances when the need for aggressive therapy is urgent and the bleeding risk is acceptable, this is an appropriate approach, and often the best one.