Techniques in vascular and interventional radiology
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Endovascular management and treatment of chronic mesenteric ischemia has taken on an increasing role in recent years. The safety, efficacy, and cost-effectiveness have been validated in several studies. The procedure is best performed by an operator with a complete understanding of the pertinent imaging findings; a thorough knowledge of the risks, benefits, limitations, and technical challenges of the procedure; and understanding of the importance and necessity of long-term clinical management. This article outlines a general approach to endovascular management of chronic mesenteric ischemia and discusses indications, potential complications, and technical aspects of the procedure.
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Mesenteric vasculitis is a rare diagnosis, but it comprises a group of disorders that may have devastating manifestations. It is often difficult to diagnose using clinical symptoms and biomarkers. Vascular imaging often provides the best opportunity for the noninvasive diagnosis of vasculitis and obviates the need for performing a biopsy. ⋯ Operative management remains the mainstay of therapy for focal occlusive or aneurysms, but the treatment options for multifocal disease remain challenging. Endovascular treatment is increasingly being used as a first line of treatment for symptomatic vasculitis. Interventionalists should be familiar with the indications and outcomes associated with the various therapeutic options for mesenteric vasculitis-associated occlusive disease and aneurysms.
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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.