Techniques in Vascular and Interventional Radiology最新文献

{"title":"Practical Suture Techniques for Drain Securement: A Comparative Overview","authors":"Manisha Naganatanahalli BS,&nbsp;Annabelle Kwok,&nbsp;Edwin Chou MD,&nbsp;Gray Lyons MD,&nbsp;Charles Martin MD,&nbsp;Abraham Levitin MD,&nbsp;Justin Guan MD","doi":"10.1016/j.tvir.2026.101134","DOIUrl":"10.1016/j.tvir.2026.101134","url":null,"abstract":"<div><div>Effective drain fixation is a crucial step of drainage procedures, directly impacting both patient safety and postoperative outcomes. This manuscript reviews commonly-employed suture techniques for drain securement, emphasizing comparative advantages in terms of time, security, and tissue response. We detail suture material selection, including common types such as silk, nylon, and prolene, and outline the execution and clinical considerations of 6 core techniques: the air knot, Roman Sandle, Reverse Stitch, Bumper Stitch, Purse String, and Double D stitches. Based on the authors’ institutional experience, the reverse and bumper stitches demonstrate superior resistance to dislodgement.</div></div><div>Effective drain fixation is a crucial step of drainage procedures, directly impacting both patient safety and postoperative outcomes. This manuscript reviews commonly-employed suture techniques for drain securement, emphasizing comparative advantages in terms of time, security, and tissue response. We detail suture material selection, including common types such as silk, nylon, and prolene, and outline the execution and clinical considerations of 6 core techniques: the air knot, Roman Sandle, Reverse Stitch, Bumper Stitch, Purse String, and Double D stitches. Based on the authors’ institutional experience, the reverse and bumper stitches demonstrate superior resistance to dislodgement.</div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101134"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Stone Removal","authors":"Adam Cohen MD,&nbsp;Smita De MD, PhD","doi":"10.1016/j.tvir.2026.101133","DOIUrl":"10.1016/j.tvir.2026.101133","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Endoscopic stone management consists of ureteroscopy and percutaneous nephrolithotomy, 2 robustly developed techniques in which the surgeon directly visualizes kidney stones to facilitate removal. Ureteroscopy is performed in retrograde fashion and can be used to clear smaller stones from the ureter and renal collecting system. Percutaneous nephrolithotomy involves percutaneous renal access, guided by either ultrasound or fluoroscopy, to identify, fragment, and remove large renal stones. A key aspect to performance of these 2 procedures is careful preoperative work-up, including urine culture, with positive cultures mandating treatment prior to definitive stone removal. Deciding which procedure to perform requires accounting for several factors including stone burden (based on preoperative imaging), anatomy, comorbidities, and patient preference. Many intra-operative techniques, such as wire use and coaxial advancement of sheaths and endoscopes, are analogous to those used in interventional radiology and vascular surgery. Stone ablation relies on the use of laser technology, though percutaneous nephrolithotomy for larger stones may also employ mechanical lithotripters. Postoperatively, a temporary ureteral stent or nephrostomy tube is often left in place to prevent acute obstruction from ureteral edema. It is recommended to obtain routine postoperative imaging following endoscopic stone management as renal obstruction due to residual stone fragments or ureteral stricture can be asymptomatic and result in significant loss of renal function. Overall, however, endoscopic stone management is safe, effective, and performed extensively worldwide.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Endoscopic stone management consists of ureteroscopy and percutaneous nephrolithotomy, 2 robustly developed techniques in which the surgeon directly visualizes kidney stones to facilitate removal. Ureteroscopy is performed in retrograde fashion and can be used to clear smaller stones from the ureter and renal collecting system. Percutaneous nephrolithotomy involves percutaneous renal access, guided by either ultrasound or fluoroscopy, to identify, fragment, and remove large renal stones. A key aspect to performance of these 2 procedures is careful preoperative work-up, including urine culture, with positive cultures mandating treatment prior to definitive stone removal. Deciding which procedure to perform requires accounting for several factors including stone burden (based on preoperative imaging), anatomy, comorbidities, and patient preference. Many intra-operative techniques, such as wire use and coaxial advancement of sheaths and endoscopes, are analogous to those used in interventional radiology and vascular surgery. Stone ablation relies on the use of laser technology, though percutaneous nephrolithotomy for larger stones may also employ mechanical lithotripters. Postoperatively, a temporary ureteral stent or nephrostomy tube is often left in place to prevent acute obstruction f","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101133"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Tools for the Interventional Radiologist","authors":"Joshua Cornman-Homonoff MD,&nbsp;Matteo Conte MD,&nbsp;Stacey Bass MD, PhD","doi":"10.1016/j.tvir.2026.101141","DOIUrl":"10.1016/j.tvir.2026.101141","url":null,"abstract":"<div><div>Many of the instruments used in interventional radiology originated in surgical practice and have been adapted for minimally invasive procedures. Formal training in the design, handling, and optimal use of these instruments is not typically included in interventional radiology education. The purpose of this article is to provide a basic overview of these tools, including their names, variants, uses, and other potentially valuable details, using a pictorial approach. Included are scalpels, pickups, scissors, needle drivers, clamps, retractors, electrocautery, and sutures.</div></div><div>Many of the instruments used in interventional radiology originated in surgical practice and have been adapted for minimally invasive procedures. Formal training in the design, handling, and optimal use of these instruments is not typically included in interventional radiology education. The purpose of this article is to provide a basic overview of these tools, including their names, variants, uses, and other potentially valuable details, using a pictorial approach. Included are scalpels, pickups, scissors, needle drivers, clamps, retractors, electrocautery, and sutures.</div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101141"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Considerations for Wound Closure: A Plastic Surgery Perspective Part I","authors":"Cleo Rowntree MBBS, BSc,&nbsp;Khong Yik Chew MBBS, MMed, MRCSEd, FAMS","doi":"10.1016/j.tvir.2026.101130","DOIUrl":"10.1016/j.tvir.2026.101130","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Although most interventional radiology (IR) access wounds are small, they frequently occur in physiologically high-risk patients—including those who are anticoagulated, vasculopathic, diabetic, immunosuppressed, or previously irradiated. Even minor wound breakdown in this population can lead to hematoma, infection tracking to grafts or devices, pseudoaneurysm exposure, and reintervention. This invited review discusses reconstructive surgery principles and delves into a practical IR workflow to reduce wound complications. We focus on actionable strategies: hemostasis-first closure, preservation of marginal perfusion, tension offloading, shear mitigation, and dead space control. A rapid preclosure assessment framework evaluates patient physiology, wound edge viability, contamination, mechanical stress, and hematoma potential before committing to closure. Primary closure techniques are discussed with an emphasis on layered repair, suture selection, fragile skin management, and site-specific considerations for high-risk regions such as the groin and upper limb. Indications for delayed primary closure and incisional negative pressure wound therapy (NPWT) are highlighted. Common failure modes—including hematoma, edge necrosis, and infection threatening vascular grafts or devices—are addressed with corresponding reconstructive responses. A range of common and useful wound dressings and their indications are also discussed. Integrating microvascular principles and biomechanical awareness into routine IR wound closure may reduce complication rates, improve access site durability, and minimize the need for reintervention in high-risk cohorts.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Although most interventional radiology (IR) access wounds are small, they frequently occur in physiologically high-risk patients—including those who are anticoagulated, vasculopathic, diabetic, immunosuppressed, or previously irradiated. Even minor wound breakdown in this population can lead to hematoma, infection tracking to grafts or devices, pseudoaneurysm exposure, and reintervention. This invited review discusses reconstructive surgery principles and delves into a practical IR workflow to reduce wound complications. We focus on actionable strategies: hemostasis-first closure, preservation of marginal perfusion, tension offloading, shear mitigation, and dead space control. A rapid preclosure assessment framework evaluates patient physiology, wound edge viability, contamination, mechanical stress, and hematoma potential before committing to closure. Primary closure techniques are discussed with an emphasis on layered repair, suture selection, fragile skin management, and site-specific considerations for high-risk regions such as the groin and upper limb. Indications for delayed primary closure and incisional negative pressure wound therapy (NPWT) are highlighted. Common failure modes—including hematoma, edge necrosis, and infection threatening vascular grafts or devices—are addressed with ","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101130"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making the most of the surgical internship: Optimizing preliminary year for future vascular and interventional radiologists","authors":"Zaeem Billah MD,&nbsp;Anthony Monaco MD,&nbsp;Austin Shinagawa MD,&nbsp;Dishan Abeydeera MD,&nbsp;Ahmed Farag MD,&nbsp;Rakesh Ahuja MD,&nbsp;Justin J Guan MD","doi":"10.1016/j.tvir.2026.101137","DOIUrl":"10.1016/j.tvir.2026.101137","url":null,"abstract":"<div><div>The surgical internship represents a unique opportunity over that of transitional years or internal medicine preliminary years because it allows trainees to develop procedural confidence, clinical judgment, and patient-care habits that directly translate to vascular and interventional radiology (VIR) practice. Although the internship year is often viewed as a prerequisite before radiology residency, available evidence suggests that surgical preliminary training may offer advantages in procedural exposure and perceived preparedness for trainees pursuing VIR. As VIR continues to evolve into a clinical specialty centered on image-guided therapy and longitudinal disease management, the internship year assumes increasing importance in shaping future vascular and interventional radiologists. This review examines the rationale for surgical internship training, compares available internship pathways, and provides practical recommendations for maximizing the educational value of the surgical year. When approached deliberately, the surgical internship serves not merely as a prerequisite to radiology residency, but as an early foundation for the clinical and procedural responsibilities of contemporary vascular and interventional radiology practice.</div></div><div>The surgical internship represents a unique opportunity over that of transitional years or internal medicine preliminary years because it allows trainees to develop procedural confidence, clinical judgment, and patient-care habits that directly translate to vascular and interventional radiology (VIR) practice. Although the internship year is often viewed as a prerequisite before radiology residency, available evidence suggests that surgical preliminary training may offer advantages in procedural exposure and perceived preparedness for trainees pursuing VIR. As VIR continues to evolve into a clinical specialty centered on image-guided therapy and longitudinal disease management, the internship year assumes increasing importance in shaping future vascular and interventional radiologists. This review examines the rationale for surgical internship training, compares available internship pathways, and provides practical recommendations for maximizing the educational value of the surgical year. When approached deliberately, the surgical internship serves not merely as a prerequisite to radiology residency, but as an early foundation for the clinical and procedural responsibilities of contemporary vascular and interventional radiology practice.</div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101137"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fundamental Surgical Principles for Interventional Radiology and Vascular Practice","authors":"Callum Ward MBBS Student,&nbsp;Bella Hausen MD","doi":"10.1016/j.tvir.2026.101139","DOIUrl":"10.1016/j.tvir.2026.101139","url":null,"abstract":"<div><div>Interventional radiology (IR) and vascular procedures are minimally invasive in approach, yet complications such as bleeding, infection, pseudoaneurysm formation, and delayed wound healing remain closely linked to fundamental surgical principles. Despite increasing procedural complexity, structured training in tissue handling, suturing, and infection prevention remains variable across IR practice. This narrative review synthesises established surgical literature, IR guidance, and procedural evidence to present a practical, principle-based framework applicable to routine IR and vascular interventions. By optimising tissue handling, closure technique, infection prevention, and data-driven audit, procedural safety and reproducibility can be maximized and the best possible outcomes achieved.</div></div><div>Interventional radiology (IR) and vascular procedures are minimally invasive in approach, yet complications such as bleeding, infection, pseudoaneurysm formation, and delayed wound healing remain closely linked to fundamental surgical principles. Despite increasing procedural complexity, structured training in tissue handling, suturing, and infection prevention remains variable across IR practice. This narrative review synthesises established surgical literature, IR guidance, and procedural evidence to present a practical, principle-based framework applicable to routine IR and vascular interventions. By optimising tissue handling, closure technique, infection prevention, and data-driven audit, procedural safety and reproducibility can be maximized and the best possible outcomes achieved.</div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101139"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General and Surgical Considerations for Enteral Access","authors":"Brianna Tischner MD,&nbsp;Andrew J. Sinnamon MD, MS","doi":"10.1016/j.tvir.2026.101128","DOIUrl":"10.1016/j.tvir.2026.101128","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Durable enteral access with feeding tube placement is critical for patients expected to require enteral nutrition for an extended period. There are different options for enteral access, including gastrostomy tube and jejunostomy tube. Gastrostomy tubes are often preferred for feeding access when possible, as they are generally more physiologic and because the stomach is distensible and can accommodate a large volume, making intermittent bolus feeding possible, which is generally much easier for patient and provider management. Gastrostomy tubes may not be preferred in patients at risk of aspiration. Radiographic gastrostomy tube placement may not be feasible due to gastroesophageal obstruction precluding nasogastric tube placement and insufflation or due to body habitus. In these situations, endoscopic or surgical placement is preferred and a basic understanding of these techniques is helpful. Jejunostomy tubes are generally used when gastrostomy feeding is not possible and typically require surgical placement. Gastrostomy tubes may also serve a palliative role as venting tubes to relieve symptoms of malignant or recurrent bowel obstruction, while jejunostomy tubes are poor choices for palliative venting. Jejunostomy tubes require continuous feeding, are at higher risk of tube impaction, and carry risk of bowel obstruction due to tethering to the abdominal wall. Regardless of indication, diligent tube care is essential to reduce complications such as dislodgement, clogging, malposition, leakage, and peristomal infection. Routine flushing, appropriate medication administration, and proper site care help maintain function and minimize morbidity. Ultimately, a clear understanding the intent of tube placement—nutritional support vs palliative venting—as well as considering patient goals and comorbidities is fundamental to appropriate enteral access selection and method of placement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Durable enteral access with feeding tube placement is critical for patients expected to require enteral nutrition for an extended period. There are different options for enteral access, including gastrostomy tube and jejunostomy tube. Gastrostomy tubes are often preferred for feeding access when possible, as they are generally more physiologic and because the stomach is distensible and can accommodate a large volume, making intermittent bolus feeding possible, which is generally much easier for patient and provider management. Gastrostomy tubes may not be preferred in patients at risk of aspiration. Radiographic gastrostomy tube placement may not be feasible due to gastroesophageal obstruction precluding nasogastric tube placement and insufflation or due to body habitus. In these situations, endoscopic or surgical placement is preferred and a basic understanding of these techniques is helpful. Jejunostomy tubes are generally used when gastrostomy feeding is not possible and typically require surgical placement. Gastrostomy tubes may also serve a ","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101128"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of acute pulmonary embolism","authors":"Matteo Conte MD,&nbsp;Hamid Mojibian MD,&nbsp;Prashanth Vallabhajosyula MD, MS,&nbsp;Joshua Cornman-Homonoff MD","doi":"10.1016/j.tvir.2026.101140","DOIUrl":"10.1016/j.tvir.2026.101140","url":null,"abstract":"<div><div>Pulmonary embolism (PE) is a complex clinical entity affecting multiple organ systems with varying severity and for which numerous therapeutic options are available. Surgical embolectomy is one such treatment that is essential to any center providing comprehensive care to patients with PE. This review discusses the role of surgical embolectomy in contemporary PE management, approaches to surgical intervention, options for cardiopulmonary support, and outcomes compared to alternative treatment modalities. In the current multidisciplinary era, surgical management is best understood as a complementary tool to systemic and catheter-based interventions, with careful patient selection necessary to optimize outcomes.</div></div><div>Pulmonary embolism (PE) is a complex clinical entity affecting multiple organ systems with varying severity and for which numerous therapeutic options are available. Surgical embolectomy is one such treatment that is essential to any center providing comprehensive care to patients with PE. This review discusses the role of surgical embolectomy in contemporary PE management, approaches to surgical intervention, options for cardiopulmonary support, and outcomes compared to alternative treatment modalities. In the current multidisciplinary era, surgical management is best understood as a complementary tool to systemic and catheter-based interventions, with careful patient selection necessary to optimize outcomes.</div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101140"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Building in Vascular Interventional Radiology: A Comprehensive Guide","authors":"Merve Ozen MD,&nbsp;Berk Mizrak MD,&nbsp;Justin J. Guan MD","doi":"10.1016/j.tvir.2026.101138","DOIUrl":"10.1016/j.tvir.2026.101138","url":null,"abstract":"<div><div>Vascular Interventional radiology (VIR) has evolved from a predominantly procedure-based specialty into a clinically-driven discipline centered on longitudinal patient care, multidisciplinary collaboration, and innovation in minimally invasive therapies. As such, building a successful VIR practice requires a deliberate transition from a procedure-focused model to a comprehensive clinical service. This review provides a practical framework for building and sustaining a modern VIR practice while highlighting three example high-growth service-lines in VIR: fibroid embolization, spine pain management and prostate artery embolization.</div></div><div>Vascular Interventional radiology (VIR) has evolved from a predominantly procedure-based specialty into a clinically-driven discipline centered on longitudinal patient care, multidisciplinary collaboration, and innovation in minimally invasive therapies. As such, building a successful VIR practice requires a deliberate transition from a procedure-focused model to a comprehensive clinical service. This review provides a practical framework for building and sustaining a modern VIR practice while highlighting three example high-growth service-lines in VIR: fibroid embolization, spine pain management and prostate artery embolization.</div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101138"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonoperating Room Anesthesia and Procedural Sedation in Interventional Radiology: A Collaborative Framework for Safe Growth","authors":"Avneep Aggarwal MD, FASA, FCCM,&nbsp;Beth Ann Traylor MD,&nbsp;Matthew Sharobeem DO,&nbsp;Charles Martin III MD,&nbsp;Basem B. Abdelmalak MD, FASA, SAMBA-F","doi":"10.1016/j.tvir.2026.101132","DOIUrl":"10.1016/j.tvir.2026.101132","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Interventional radiology (IR) has become one of the fastest expanding areas of procedural care, with increasing demand for image-guided diagnostic, vascular, oncologic, and emergency interventions. This growth has created parallel demands for both procedural sedation (PS) and anesthesiology services, the so-called nonoperating room anesthesia (NORA) within the IR suite. These services should not be viewed as competing models, but as different points on a continuum in which the level of sedation or anesthesia is matched to the patient, procedure, location, level of care, clinicians’ qualifications and rescue resources. The 2023 American Society of Anesthesiologists (ASA) Statement on Nonoperating Room Anesthesia Services emphasizes that NORA locations require operating room-level leadership, equipment, staffing, scheduling, quality oversight, emergency preparedness, and information-system support. In parallel, implementation of anesthesiology oversight for PS can standardize education, credentialing, monitoring, recovery criteria, reporting, regulatory survey readiness, and quality improvement across procedural areas. This article proposes a triage framework to distinguish PS from NORA in IR and an operational model for safely expanding both services. A brief PS vignette and 2 detailed NORA examples, pulmonary artery mechanical thrombectomy and transthoracic lung cancer cryoablation, demonstrate how physiology, procedural complexity, airway access, positioning, and rescue planning determine the safest model of care. When IR and anesthesiology operate as a coordinated system, patients receive the proper and safest level of care, procedural services expand safely, and health systems are better positioned for rising demand.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Interventional radiology (IR) has become one of the fastest expanding areas of procedural care, with increasing demand for image-guided diagnostic, vascular, oncologic, and emergency interventions. This growth has created parallel demands for both procedural sedation (PS) and anesthesiology services, the so-called nonoperating room anesthesia (NORA) within the IR suite. These services should not be viewed as competing models, but as different points on a continuum in which the level of sedation or anesthesia is matched to the patient, procedure, location, level of care, clinicians’ qualifications and rescue resources. The 2023 American Society of Anesthesiologists (ASA) Statement on Nonoperating Room Anesthesia Services emphasizes that NORA locations require operating room-level leadership, equipment, staffing, scheduling, quality oversight, emergency preparedness, and information-system support. In parallel, implementation of anesthesiology oversight for PS can standardize education, credentialing, monitoring, recovery criteria, reporting, regulatory survey readiness, and quality improvement across procedural areas. This article proposes a triage framework to distinguish PS from NORA in IR and an operati","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"29 3","pages":"Article 101132"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}