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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Tech Vasc Interv Radiol · Mar 2015
ReviewIsolated stenosis of the inferior mesenteric artery: to treat or not to treat?
The indication for treatment of inferior mesenteric artery (IMA) is generally not clear. The IMA is frequently ignored owing to its size and the presence of alternate pathways within the mesenteric vasculature. However, IMA treatment may be indicated in certain clinical scenarios. In this article, we focus on the indications for IMA treatment and technical considerations when treatment is indicated.
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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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Tech Vasc Interv Radiol · Dec 2013
Review"How we do it" - a practical approach to hepatic metastases ablation techniques.
Secondary liver malignancies are associated with significant mortality and morbidity if left untreated. Colorectal cancer is the most frequent origin of hepatic metastases. A multidisciplinary approach to the treatment of hepatic metastases includes medical, surgical, radiation and interventional oncology. ⋯ Recently, irreversible electroporation, a nonthermal modality, has also been used for liver tumor ablation. In the following section, we review the different liver ablation techniques, as well as indications for ablation, specific patient preparations, and different "tricks of the trade" that we use to achieve safe and effective liver tumor ablation. We also discuss appropriate imaging and clinical patient follow-up and potential complications of liver tumor ablation.