Techniques in Vascular and Interventional Radiology最新文献

{"title":"Noninvasive and Invasive Methods for the Diagnosis of Portal Hypertension.","authors":"Edwin Chou, Sameer Gadani, Xiaochen Liu","doi":"10.1016/j.tvir.2025.101054","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101054","url":null,"abstract":"<p><p>Portal hypertension is a complex and multifaceted condition that arises from increased resistance to portal blood flow, often secondary to prehepatic, intrahepatic, or post hepatic etiologies. The most common cause of portal hypertension in the United States is cirrhosis, which leads to structural and dynamic changes in the liver, exacerbating portal resistance and triggering a cascade of complications. Accurate diagnosis and management are critical to mitigating these risks and improving patient outcomes. Noninvasive imaging techniques, including ultrasound, CT, MRI, and elastography, have revolutionized the diagnosis and monitoring of portal hypertension. These modalities provide qualitative and quantitative measures of liver and spleen stiffness, portal vein flow, and morphological changes, enabling early risk stratification and intervention. Invasive techniques, such as hepatic venography with pressure measurement, remain the gold standard for diagnosing portal hypertension, particularly in for cases where in which noninvasive methods are inconclusive. Direct portal pressure measurement, although more invasive than these other techniques, is occasionally necessary in specific clinical scenarios. Liver biopsy, whether percutaneous, transjugular, or transfemoral, remains a crucial tool for histopathological diagnosis and guiding treatment strategy guidance, particularly in cases of chronic liver disease. Diagnosis of portal hypertension, which involves accurate measurement of portal pressure, is essential for early risk stratification and effective management. The available noninvasive and invasive techniques for the diagnosis of portal hypertension are reviewed here.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101054"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818208","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":"A Practical Guide to Portal Hypertension: The Basics of Diagnostics and Medical Management.","authors":"Nikhilesh R Mazumder","doi":"10.1016/j.tvir.2025.101052","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101052","url":null,"abstract":"<p><p>Portal hypertension is a hemodynamic consequence of altered mesenteric circulation. The chief drivers of portal hypertension are rising hepatic resistance and venous remodeling. A major challenge in treating patients with portal hypertension is early diagnosis because most patients progress through disease asymptomatically. Noninvasive tests such as serologic markers and elastography are the basis of determining if patients have clinically significant portal hypertension. If identified early, patients placed on carvedilol and who undergo etiologic cure may be able to delay or avert decompensation altogether. This paper reviews the pathophysiology, diagnosis, and medical management of portal hypertension.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101052"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818166","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":"Post-TIPS Encephalopathy: Clinical Presentation, Diagnosis, and Management.","authors":"Doo Hee Kim, Hassan Anbari, Sameer Gadani, Baljendra Kapoor","doi":"10.1016/j.tvir.2025.101063","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101063","url":null,"abstract":"<p><p>Management of portal hypertension commonly involves the creation of a transjugular intrahepatic portosystemic shunt (TIPS). Despite significant advancement in procedural techniques, hepatic encephalopathy (HE) continues to be one of the most consequential complications following TIPS creation. In this manuscript, we describe in detail several factors associated with the clinical condition of patients and TIPS creation that increase the likelihood of post TIPS development of hepatic encephalopathy. We also discuss the management of the post-TIPS encephalopathic patient.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101063"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818210","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":"Under Pressure: Treatment of Acute Severe Hypertension (Hypertensive Crisis)","authors":"Wilton Fidelis MD ,&nbsp;Basheir Salah MD ,&nbsp;Tarig Elhakim MD ,&nbsp;Dania Daye MD, PhD","doi":"10.1016/j.tvir.2025.101040","DOIUrl":"10.1016/j.tvir.2025.101040","url":null,"abstract":"<div><div>Acute severe hypertension encompasses a spectrum of severe blood pressure elevations that can progress to end organ damage if left unmanaged. Understanding the presentations of various acute hypertensive scenarios can help guide interventional radiologists in recognizing clinical symptoms, signs, and selecting effective management strategies. The timely administration of antihypertensive agents is critical to prevent the detrimental effects associated with hypertensive emergencies. The preferred approach to achieve optimal blood pressure control and the desired target blood pressure range may vary based on the hypertensive scenario and patient-specific factors.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101040"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570021","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":"Sepsis and Common Infections in Interventional Radiology","authors":"David-Dimitris Chlorogiannis MD,&nbsp;Yan Epelboym MD, MPH","doi":"10.1016/j.tvir.2025.101041","DOIUrl":"10.1016/j.tvir.2025.101041","url":null,"abstract":"<div><div>Sepsis is a clinical syndrome encompassing physiologic and biologic abnormalities caused by a dysregulated host response to infection. If sepsis progresses into septic shock it is associated with a high mortality, therefore early identification and treatment is critical. Interventional radiologists often perform treatments which may cause or temporarily exacerbate sepsis. Therefore, it is important for the interventional radiologist to recognize early signs of sepsis and understand sepsis treatment protocols. These protocols include source control of infections, administration of systemic broad-spectrum antibiotics, as well as fluid and cardiopulmonary support. The present manuscript provides an overview of sepsis, common infections encountered in interventional radiology, and sepsis management.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101041"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569732","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":"Acute RV Failure Management in Pulmonary Embolism","authors":"Naina Verma MD ,&nbsp;Vishaal Kondoor MBA ,&nbsp;Rajshree Singh MD ,&nbsp;Rakesh Ahuja MD","doi":"10.1016/j.tvir.2025.101039","DOIUrl":"10.1016/j.tvir.2025.101039","url":null,"abstract":"<div><div>Acute right ventricular (RV) failure significantly influences mortality rates in patients experiencing pulmonary embolism (PE). This condition arises from an abrupt increase in RV afterload triggered by clot burden, neurohormonal activation, and hypoxia-mediated feedback mechanisms. The ensuing pathological cascade results in RV dilation, decreased stroke volume, and compromised left ventricular (LV) filling due to interventricular dependence, which can lead to hemodynamic collapse. This paper elucidates management strategies focusing on preload optimization, early clot removal through thrombolytic therapy or thrombectomy, and the judicious use of vasopressors and inotropes to sustain systemic blood pressure, enhance coronary perfusion, and maintain RV-LV coupling. In cases of respiratory failure, mechanical ventilation must be utilized with caution. At the same time, advanced interventions such as extracorporeal membrane oxygenation (ECMO) or RV assist devices are reserved for more severe scenarios. A comprehensive understanding of RV physiology and the pathophysiology of PE is essential for devising early interventions aimed at averting the “RV death spiral” and enhancing patient outcomes. Timely recognition and aggressive management are foundational to treating acute RV failure in PE effectively. Acute right ventricular failure is a critical pathology observed in patients suffering from pulmonary embolism. The significance of understanding the underlying mechanisms of RV failure, particularly concerning PE, cannot be overstated, as it is a crucial determinant of morbidity and mortality. The development of acute RV failure is primarily precipitated by a sudden escalation in RV afterload, a consequence of the obstruction of pulmonary arteries by embolic material. This obstruction induces neurohormonal activation and triggers feedback mechanisms associated with hypoxia, leading to the aforementioned detrimental cascade. The resultant RV dilation and diminished stroke volume adversely affect LV filling due to the phenomenon of interventricular dependence, ultimately paving the way for hemodynamic instability. A nuanced understanding of RV physiology alongside the pathophysiological mechanisms underlying pulmonary embolism is imperative for developing and implementing timely interventions. Early recognition and an aggressive management approach are vital to prevent the “RV death spiral” and improve clinical outcomes for patients confronting acute RV failure in the context of pulmonary embolism.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101039"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570020","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":"ECMO, VAD, Impella, and IABP: Primer on Mechanical Circulatory Support Devices","authors":"Jonas Kruse MD ,&nbsp;Mona Ranade MD","doi":"10.1016/j.tvir.2025.101042","DOIUrl":"10.1016/j.tvir.2025.101042","url":null,"abstract":"<div><div>Vascular and interventional physicians are routinely caring for some of the sickest patients in the hospital, including those with cardiopulmonary collapse. A foundational comprehension of mechanical circulatory devices is necessary in these situations. Within this article, we will review the indications, procedural steps, management, clinical follow up, and outcomes of 4 types of mechanical circulatory support devices: Extracorporeal membrane oxygenation (ECMO), ventricular assist devices (VAD), Impella, and intra-aortic balloon pumps (IABP). ECMO is a large-bore cannulation system serving patients in respiratory and/or combination of cardiorespiratory collapse. It requires constant monitoring and adjustment with a wide range of benefits in appropriately selected patients in the hospital. VADs are surgically-implanted devices for more long-term ventricular support, often extending the survival of end-stage heart failure or bridging to transplant. Impella and IABPs, by comparison, are smaller intravascular devices that aid in short-term ventricular off-loading and improve perfusion. They provide hemodynamic stabilization in the setting of acute cardiac insult or surgery, prior to either organ recovery or transition to more definitive therapy. All of these devices come with unique considerations and potential complications. This article will serve as a guide in evaluating patients for device candidacy, procedural placement, troubleshooting, management in the perioperative setting, complication surveillance, and clinical outcomes/follow-up.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101042"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569733","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":"Anesthesia and Analgesia for Interventional Radiology","authors":"Abram Feldman MD","doi":"10.1016/j.tvir.2025.101037","DOIUrl":"10.1016/j.tvir.2025.101037","url":null,"abstract":"<div><div>To perform procedures in the interventional radiology suite, patient comfort and tolerance must be ensured through appropriate anesthesia and analgesia. Various levels of anesthesia can be utilized to safely accomplish a procedure from local anesthesia and mild sedation to general anesthesia. Depending on patient and procedural factors, different anesthetic plans may be beneficial. Patient factors such as chronic pain, hemodynamic stability, and complex medical problems will likely benefit from anesthesiologist involvement in the procedure. Procedural factors such as specific positioning requirements, following instructions, or invasiveness of the procedure may dictate what level of anesthesia is required, as well. Various anesthetic agents are used for amnesia, anesthesia, analgesia, and muscle relaxation. Understanding patients’ needs and procedural requirements will aid a clinician in performing safe and effective interventional procedures and maintain safety – from preoperative evaluation and monitoring during the procedure to discharging from the recovery room.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101037"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569786","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":"Evaluation and Initial Stabilization of Undifferentiated Shock","authors":"Bardia Nadim MD ,&nbsp;Alexandria Z. Byskosh MD ,&nbsp;Khanant M. Desai MD, RPVI","doi":"10.1016/j.tvir.2025.101038","DOIUrl":"10.1016/j.tvir.2025.101038","url":null,"abstract":"<div><div>Vascular Interventional Radiologists (VIRs) are increasingly involved in consultation and management of patients with circulatory shock. The ability to recognize the underlying pathophysiology of a patient’s shock and treat appropriately is therefore critical to VIR practice. Here, we discuss the initial evaluation and stabilization of undifferentiated shock. Shock is defined as tissue hypoperfusion from inadequate oxygen delivery and/or impaired tissue oxygen utilization. The etiologies of shock can be grouped into 3 main categories: distributive, hypovolemic, cardiogenic, and obstructive; each of which are associated with characteristic hemodynamic and metabolic derangements such as decreased preload or impaired cardiac contractility. Presentation typically involves 1) hypotension and tachycardia as indicators of impaired cardiac output, and 2) evidence of ongoing end-organ hypoperfusion such as oliguria, altered mental status, and lactic acidosis. Initial management includes control of airway and oxygenation/ventilation, identification of underlying hemodynamic and cardiovascular derangements, and support of cardiac output with intravenous fluid (IVF), blood products, diuresis, and/or vasopressors and inotropes. More detailed hemodynamic analysis can be performed with arterial catheters, blood gases, pulmonary artery catheters, and echocardiography to further tailor therapy. Finally, definitive evaluation for causative etiology should be initiated immediately with biochemical studies, cultures, imaging, and hemodynamic assessment so that etiology-specific treatment (e.g. antibiotics, blood products) can be initiated.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 2","pages":"Article 101038"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569787","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":"Focused Cardiac Ultrasound for Rapid Hemodynamic Assessment: A Primer for Vascular and Interventional Radiologists","authors":"Khanant M. Desai MD, RPVI","doi":"10.1016/j.tvir.2025.101025","DOIUrl":"10.1016/j.tvir.2025.101025","url":null,"abstract":"<div><div>Interventional Radiology has evolved to encompass periprocedural and inpatient care of critically ill patients. Acute hypotension and shock can occur in IR patients due to various causes including hemorrhage, sepsis, myocardial infarction, and pulmonary embolism; therefore, the ability to accurately evaluate acutely deteriorating patients must become a part of the IR skillset. Goal-directed sonographic examination of the heart and inferior vena cava provides rapid bedside assessment of anatomic and functional parameters that can be used to determine the etiology underlying a patient's shock. Targets of evaluation include ventricular systolic function/size/thickness, presence of pericardial effusion and tamponade physiology, intravascular volume status, and existence of other structural pathology such as valvular disease and intracardiac masses. Presented is a primer on performing a systematic focused cardiac ultrasound examination for patients experiencing acute hypotension.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 1","pages":"Article 101025"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870865","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}