Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Jun 2002
ReviewFibrin sheaths and central venous catheter occlusions: diagnosis and management.
Central venous catheter malfunction diagnosis and treatment is a growing component of the field of interventional radiology. A thorough understanding of the causes of catheter malfunction and the technical skills needed to treat these problems are necessities to appropriate management. ⋯ Differentiating a sheath from thrombus is imperative to appropriate therapy. The purpose of this article is to provide an understanding of the causes of fibrin sheaths and how to treat them.
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Catheter-induced venous thrombosis remains a significant problem in current clinical practice. A high level of biocompatibility of the materials used to manufacture the existing venous access devices has not eliminated catheter-induced venous thrombosis. ⋯ The focus of this article is on discussion of the various factors that influence formation of catheter-induced venous thrombosis. Also discussed is the management of this clinical problem, and a useful algorithm is outlined.
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Venous access is commonly thought of as the bread and butter of interventional radiologic procedures. However, in those patients who have undergone multiple previous central venous catheter placements, venous access can be a technical challenge for even the most seasoned interventional radiologist. Conventional access sites include the internal jugular veins (IJV) and subclavian veins (SCV). ⋯ Only after surgical hemodialysis access is no longer an option in the upper extremity should cannulation of the SCV be entertained. Once these usual access sites are no longer available, it may necessary to use an unconventional access method, including catheterization of the common femoral vein, catheterization of enlarged collateral vessels, recanalization of occluded veins, translumbar inferior vena cava (IVC) catheter placement, and transhepatic catheter placement. This chapter serves as a review of these techniques.
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Tech Vasc Interv Radiol · Sep 2001
ReviewPercutaneous endoscopy for biliary radiologic interventions.
Biliary endoscopy is an adjunct to percutaneous biliary interventions. Although there are technical and cost considerations, the interventional radiologist may apply this useful tool to patients with a wide range of biliary diseases (eg, patients with retained intrahepatic stones, patients with suspected lesions requiring biopsy, etc). ⋯ The procedure is generally performed on an outpatient basis under conscious sedation. Given access to a choledochofiberscope and familiarity with its use, percutaneous endoscopy for biliary radiologic interventions is a valuable technique and may be used to manage patients with complex biliary disease.
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Tech Vasc Interv Radiol · Jun 2001
Review Practice Guideline GuidelineAlteplase and tenecteplase: applications in the peripheral circulation.
Alteplase (t-PA), a recombinant analogue of human tissue plasminogen activator, became the first genetically engineered thrombolytic approved by the Food and Drug Administration in 1987 for acute myocardial infarction (AMI). In addition to AMI, alteplase is currently approved for the treatment of acute ischemic stroke and pulmonary embolism, and we anticipate approval for catheter clearance in late 2001 in a 2-mg vial configuration. With the withdrawal of human neonatal kidney cell-derived urokinase, alteplase has become an alternative agent in peripheral vascular applications. ⋯ Because of its enhanced safety profile, TNK may be a desirable agent for peripheral vascular applications. Initial clinical studies with TNK in acute arterial and venous disease are ongoing. This article outlines the Advisory Panel guidelines for using alteplase and highlights features of tenecteplase.