Francois H. Cornelis MD, PhD , Stephen B. Solomon MD , Muneeb Ahmed MD
{"title":"Expanding the Horizons of Interventional Radiology With Advanced Image Guidance and Robotics","authors":"Francois H. Cornelis MD, PhD , Stephen B. Solomon MD , Muneeb Ahmed MD","doi":"10.1016/j.tvir.2023.100910","DOIUrl":"10.1016/j.tvir.2023.100910","url":null,"abstract":"","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136127359","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}
Mari Tanaka MD , Rui Dai MD, PhD , Animan Randhawa MD , Sara Smolinski-Zhao MD , Vincent Wu MD , T. Gregory Walker MD , Dania Daye MD, PhD
{"title":"Catheter Directed Thrombectomy and Other Deep Venous Interventions in Cancer Patients","authors":"Mari Tanaka MD , Rui Dai MD, PhD , Animan Randhawa MD , Sara Smolinski-Zhao MD , Vincent Wu MD , T. Gregory Walker MD , Dania Daye MD, PhD","doi":"10.1016/j.tvir.2023.100900","DOIUrl":"10.1016/j.tvir.2023.100900","url":null,"abstract":"<div><p><span>Treating cancer patients with deep venous thrombosis/venous thromboembolism (DVT/VTE) can be challenging as patients are frequently unable to receive the standard therapy of anticoagulation<span> due to the increased risk of bleeding complications seen in this population. Similarly, the hesitation of interventionalists to use thrombolytic agents due to bleeding risks limits </span></span>percutaneous intervention<span><span> options as well. Further, outcome data and guidelines do not exist for oncologic patients and often treatment is tailored to patient-specific factors after multidisciplinary discussion. This article reviews specific factors to consider when planning percutaneous </span>treatment of cancer patients with DVT/VTE, focusing on the iliocaval system.</span></p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684870","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":"How to Evaluate and Choose the Proper Treatments for Patients with Lower Extremity Venous Disease","authors":"Suman M. Wasan MD, MS","doi":"10.1016/j.tvir.2023.100895","DOIUrl":"10.1016/j.tvir.2023.100895","url":null,"abstract":"<div><p><span><span>With an increasing number of interventional and noninterventional treatment options available for </span>venous disorders, it is important that patients undergo a thorough and systematic evaluation. </span>Clinical evaluation<span><span><span><span> should include a personal and family history of venous thromboembolism<span> (VTE), varicose veins, and thrombophilia as these factors affect response and recurrence of disease. Patient should undergo diagnostic and </span></span>quality of life assessment using validated tools to monitor response to treatment. Duplex ultrasound, both deep and </span>superficial veins<span><span>, documenting both obstruction and reflux is initial imaging with CT and MRI indicated to document pelvic, iliac vein, and IVC patency and pathology. Conservative therapy including compression, healthy lifestyle with diet, and exercise. New and novel </span>interventional therapies are available for patients with venous disease with recent </span></span>randomized controlled trials<span> and multisocietal guidelines providing evidence-based recommendations for patients with superficial and deep venous disease. Since the use of anticoagulant<span> and antiplatelet<span> therapies post venous intervention is not well studied nor standardized, patients should routinely undergo evaluation for ongoing risk of recurrent thrombosis and stent occlusion. Finally, patients should be counseled that superficial and deep venous disease is a chronic and often progressive disease, and follow-up at least annually is recommended.</span></span></span></span></p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684872","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}
George Rahmani FFR (RCSI), Gerard J. O'Sullivan FRCR, FRCPI, F-CIRSE, F-SIR
{"title":"Lessons Learned With Venous Stenting: In-flow, Outflow, and Beyond","authors":"George Rahmani FFR (RCSI), Gerard J. O'Sullivan FRCR, FRCPI, F-CIRSE, F-SIR","doi":"10.1016/j.tvir.2023.100897","DOIUrl":"10.1016/j.tvir.2023.100897","url":null,"abstract":"<div><p>Venous stents are being used with increasing frequency, with a multitude of dedicated venous stents now well established or emerging onto the market. This review explores the multifaceted aspects of venous stenting. We discuss the history of venous stents, indications for their use, the imaging required before, during and after stenting, as well as some technical tips and tricks which we have found to be helpful in our own daily practice with a particular focus on iliofemoral venous stenting. Ultimately, this article seeks to enhance the understanding of venous stenting, offering insights into what we feel are best practices, challenges, and prospects for improved patient outcomes.</p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684874","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":"Back To Basics: Theory of Thrombus Formation and Potential Implications for Therapies?","authors":"M. Silena Mosquera MD , Jose A. Diaz MD, FAHA","doi":"10.1016/j.tvir.2023.100894","DOIUrl":"10.1016/j.tvir.2023.100894","url":null,"abstract":"<div><p><span><span>Venous thromboembolism (VTE), including </span>deep vein thrombosis<span><span> (DVT) and pulmonary embolism (PE), is a common and potentially fatal condition. Despite existing </span>treatments<span>, recurrence rates and complications remain high. Understanding the pathophysiology of </span></span></span>thrombus formation is crucial for developing effective therapies. This narrative review provides an overview of the critical elements of acute and chronic DVT, presents a theoretical framework for understanding thrombus formation, and discusses potential implications for therapeutic interventions. In addition, a hypothesis of thrombus formation is formulated, encompassing all elements described in this work.</p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684869","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":"Venous Thromboembolism Management in Pregnant Patients","authors":"Linzi A. Webster MD, Vivian Bishay MD","doi":"10.1016/j.tvir.2023.100901","DOIUrl":"10.1016/j.tvir.2023.100901","url":null,"abstract":"<div><p><span>Pulmonary embolism<span><span><span> (PE) in pregnancy accounts for 10% of maternal deaths in the United States. As maternal morbidity and mortality continue to increase, it is imperative for all specialties interfacing with pregnant patients to understand the current research and guidelines surrounding </span>risk stratification<span>, diagnosis, and treatments of PE in pregnancy. Given the complexity of high-risk pregnancy-associated PE (PA-PE), that is, which is associated with </span></span>hemodynamic<span> instability or collapse, and the rising popularity of new technologies to treat high-risk PA-PE in the nonpregnant population, this review aims to emphasize the differences in diagnosis, risk stratification, and management of the pregnant and nonpregnant PE patients. Furthermore, this review will cover treatment paradigms that include anticoagulation versus advanced therapies such as systemic </span></span></span>thrombolysis<span><span>, surgical embolectomy, </span>extracorporeal membrane oxygenation<span>, and inferior vena cava disruption as well as the more novel therapies which fall under the umbrella term of catheter-based treatments. Finally, this review will include a case-based review of 2 patients with PA-PE requiring catheter-based therapies and their ultimate clinical outcomes.</span></span></p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684878","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":"Combined Management of Wound Ulcers With Focus on Interventional Techniques","authors":"Teodora Bochnakova MD, Claire Kaufman MD","doi":"10.1016/j.tvir.2023.100896","DOIUrl":"10.1016/j.tvir.2023.100896","url":null,"abstract":"<div><p>This review provides a summary of current practice patterns in managing venous ulcers<span><span>. The authors will describe the workup for venous ulcers, including differentiation of symptoms, physical examination, and imaging to guide the most effective treatment<span> course for each patient. An overview of conservative management and minimally invasive treatment options for venous ulcers will be provided with a specific focus on periulcer foam </span></span>sclerotherapy<span> to aid in preventing ulcer recurrence and promoting healing. We will give interventional troubleshooting techniques for challenging patient presentations.</span></span></p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684871","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}
Mario Dervishi MD , Mohamed Al-Natour MD , Jones P. Thomas MD , Karem Harth MD, MHS
{"title":"Multidisciplinary Approach to Venous Disease: Enhancing Patient Care and Trainee Education Through Collaboration","authors":"Mario Dervishi MD , Mohamed Al-Natour MD , Jones P. Thomas MD , Karem Harth MD, MHS","doi":"10.1016/j.tvir.2023.100902","DOIUrl":"10.1016/j.tvir.2023.100902","url":null,"abstract":"<div><p><span><span><span>The full spectrum of venous disease poses a significant burden on individuals and health-care systems globally. Venous disease can lead to a wide range of symptoms based on the level of disease and underlying pathology. In general, underlying pathologies are due to nonthrombotic (reflux/obstructive) and thrombotic causes. Most conditions are a </span>sequela<span><span> of the long-term effects of chronic venous insufficiency, </span>deep vein thrombosis<span> (DVT), or nonthrombotic deep vein obstruction. The prevalence of venous disease is substantial, impacting the </span></span></span>quality of life of a considerable proportion of the adult population. Untreated and progressive lower extremity venous disease can lead to venous </span>ulceration<span> and other complications. Additionally, poorly recognized and poorly understood venous conditions of the abdomen and pelvis leave many patients “orphaned” in health-care systems that lack expertise in complex venous conditions. Addressing the burden and breadth of venous disease requires comprehensive management approaches, early diagnosis, appropriate treatment interventions, and provider and patient education. Multidisciplinary collaborations and further research are essential to enhance our understanding, develop innovative therapies, and improve patient outcomes in the field of venous disease. In this paper, we highlight the importance of multidisciplinary collaboration and our journey to building an institutional venous team, as well as lessons learned.</span></p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684875","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":"Utilization of Intravascular Ultrasound in the Management of Venous Disease","authors":"Baxter Williams MD, Nicole A. Keefe MD","doi":"10.1016/j.tvir.2023.100898","DOIUrl":"10.1016/j.tvir.2023.100898","url":null,"abstract":"<div><p>As the field of Vascular and Interventional Radiology<span><span> continues to grow, the variety of pathology treated, the approaches to treating various disease processes, and the vast options of equipment and devices continue to grow as well. Numerous venous disease<span><span> processes have now become commonplace within the treatment realm of interventional radiologists and knowing how to approach each disease process is critical to successful management of these complex patients. A few of the most encountered venous disease processes include pelvic venous disorders, </span>vena cava<span> tumor involvement, venous thrombosis<span>, and inferior vena cava filter placement; an understanding of the management of these processes is integral to the practice of today's interventional radiologists. </span></span></span></span>Intravascular ultrasound (IVUS) has become increasingly important both in the diagnosis and in guiding treatment for venous disease. This article will describe in detail the multiple ways that IVUS can be used in the treatment of complex venous disorders.</span></p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684877","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":"Techniques for Embolization of the Ovarian Vein and Pelvic Reservoir","authors":"Kimberly L. Scherer DO, Ronald S. Winokur MD","doi":"10.1016/j.tvir.2023.100899","DOIUrl":"10.1016/j.tvir.2023.100899","url":null,"abstract":"<div><p><span><span>Pelvic venous disorders are a common and under diagnosed cause of chronic pelvic pain in women, presenting with chronic, noncyclical pelvic pain for greater than 6 months and the presence of pelvic varicosities. Pelvic varices and </span>ovarian vein<span><span><span> reflux are a strong indicator of venous origin chronic pelvic and may benefit from embolization. This most commonly occurs in multiparous, </span>premenopausal women with symptoms of gravity dependent pelvic pain and postcoital pain. Additional causes of pelvic venous disorders include </span>iliac vein compression, internal iliac vein reflux, and </span></span>renal vein compression<span><span>, however for the purposes of this article we will focus on ovarian vein insufficiency. The mainstay of treatment for pelvic </span>venous insufficiency is Ovarian Vein Embolization and embolization of the pelvic venous reservoir. This article will focus on the patient presentation and workup, followed by a detailed summary of how to perform this procedure, current research to support treatment, possible technical challenges and complications, and finally future research priorities.</span></p></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684876","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}