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Seminars in Interventional Radiology

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https://www.readbyqxmd.com/read/30087525/new-techniques-and-devices-in-transjugular-intrahepatic-portosystemic-shunt-placement
#1
REVIEW
Jamie RiChard, Bartley Thornburg
Recently, new techniques and devices in transjugular intrahepatic portosystemic shunt (TIPS) placement have emerged that can improve upon the standard procedure. Ultrasound guidance during TIPS with intracardiac echocardiography (ICE), placement of controlled expansion (CX) stents, and portal vein recanalization (PVR) via transsplenic access are three techniques with new data supporting their implementation. ICE guidance can improve the technical success of difficult cases, decrease procedure time, and decrease complications such as capsular puncture, hemobilia, and hepatic artery injury...
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087524/preoperative-transjugular-intrahepatic-portosystemic-shunt-placement-for-extrahepatic-abdominal-surgery
#2
REVIEW
Michelle Philip, Bartley Thornburg
Extrahepatic abdominal surgery in patients with portal hypertension is associated with a high rate of perioperative complications and death due to the increased risk of liver failure, perioperative bleeding, and ascites. One proposed method to facilitate surgery in these patients is with preoperative placement of a transjugular intrahepatic portosystemic shunt (TIPS). By decompressing the portal circulation, this presurgical measure would theoretically decrease the potential for bleeding and improve the ability to control ascites in the perioperative and postoperative period...
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087523/acute-portal-vein-thrombosis-current-trends-in-medical-and-endovascular-management
#3
REVIEW
Stephen M Seedial, Samdeep K Mouli, Kush R Desai
Acute portal vein thrombosis (PVT) is a relatively rare diagnosis with a nonspecific clinical presentation. Imaging plays an important role in establishing the diagnosis as well as the etiology and complications of acute PVT. Prompt diagnosis is essential to prevent catastrophic short-term complications including bowel infarction, sepsis, and possible death; missed diagnosis can also result in the long-term sequelae of portal hypertension. Differentiation of acute from chronic PVT is crucial as management strategies differ...
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087522/hepatorenal-syndrome-physiology-diagnosis-and-management
#4
REVIEW
Joseph Chmielewski, Robert J Lewandowski, Haripriya Maddur
Individuals with end-stage liver disease are susceptible to a myriad of highly morbid complications, including hepatorenal syndrome (HRS). This specific type of renal dysfunction in patients with underlying liver disease occurs in pathophysiologically normal kidneys and is a result of renal vasoconstriction secondary to diminished renal blood flow in the setting of worsening hepatic dysfunction. Liver transplantation is curative; shortage of available organs limits access to this beneficial therapy. Medical management of HRS has demonstrated increasing promise...
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087521/evolution-of-retrograde-transvenous-obliteration-techniques
#5
REVIEW
Mihir Patel, Christopher Molvar
Gastric variceal hemorrhage is a life-threatening complication of portal hypertension with a poorer prognosis compared with esophageal variceal hemorrhage. The presence of an infradiaphragmatic portosystemic shunt, often a gastrorenal shunt, allows for treatment with retrograde transvenous obliteration (RTO). RTO is an evolving treatment strategy, which includes balloon-assisted RTO, plug-assisted RTO, and coil-assisted RTO, for both gastric variceal hemorrhage and hepatic encephalopathy. RTO techniques are less invasive than transjugular intrahepatic portosystemic shunt creation, with the benefit of improved hepatic function, but at the expense of increased portal pressure...
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087520/endovascular-treatment-for-variceal-hemorrhage-tips-brto-and-combined-approaches
#6
REVIEW
Andrew J Lipnik, Mithil B Pandhi, Ramzy C Khabbaz, Ron C Gaba
Variceal hemorrhage is a feared complication of portal hypertension, with high rates of morbidity and mortality. Optimal management requires a thoughtful, multidisciplinary approach. In cases of refractory or recurrent esophageal hemorrhage, endovascular approaches such as transjugular intrahepatic portosystemic shunt (TIPS) have a well-defined role. For hemorrhage related to gastric varices, the optimal treatment remains to be established; however, there is increasing adoption of balloon-occluded retrograde transvenous obliteration (BRTO)...
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087519/transjugular-intrahepatic-portosystemic-shunt-placement-for-refractory-ascites-review-and-update-of-the-literature
#7
REVIEW
Ana Cecilia Burgos, Bartley Thornburg
Ascites is the most common complication of cirrhosis, impairs quality of life, and carries a poor prognosis. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated therapy for refractory ascites and is superior at reducing the accumulation of fluid compared with paracentesis. More recent evidence has shown that TIPS also provides an improved transplant-free survival compared with paracentesis. To maximize the clinical efficacy and survival advantage, proper patient selection is crucial. While current guidelines recommend that elective TIPS for ascites should be performed only in patients with MELD ≤ 18, recent literature suggests that elective TIPS safely and effectively controls ascites and potentially provides a survival advantage in patients with higher MELD scores (≤ 24)...
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087518/management-of-portal-hypertension-in-the-pediatric-population-a-primer-for-the-interventional-radiologist
#8
REVIEW
Victoria Young, Shankar Rajeswaran
Interventional radiology's role in the management of portal hypertension in the pediatric population differs from the management of adult portal hypertension. In the pediatric population, portal hypertension is frequently secondary to thrombosis and cavernous transformation of the extrahepatic portion of the portal vein. Transjugular intrahepatic portosystemic shunt can be utilized to manage portal hypertension in children with intrinsic liver disease that results in cirrhosis and portal hypertension, and is often used as a bridge to transplant...
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087517/clinical-assessment-and-management-of-portal-hypertension
#9
REVIEW
Jacob Kibrit, Ruben Khan, Barbara H Jung, Sean Koppe
The development of portal hypertension in a patient with cirrhosis portends a poor prognosis. Untreated or progressive portal hypertension has serious clinical outcomes, which are often fatal. It is important to recognize portal hypertension early to delay progression and to treat complications of portal hypertension as they arise. This review will focus on the clinical assessment and management of portal hypertension.
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30087516/update-on-portal-hypertension
#10
EDITORIAL
Robert J Lewandowski
No abstract text is available yet for this article.
August 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/30026639/erratum-pediatric-portal-interventions
#11
Rajiv N Srinivasa, Jeffrey Forris Beecham Chick, Noah Chen, Joseph J Gemmete, Wael A Saad, Narasimham L Dasika, Ravi N Srinivasa
[This corrects the article DOI: 10.1055/s-0038-1642043.].
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872251/pediatric-portal-interventions
#12
REVIEW
Rajiv N Srinivasa, Jeffrey Forris Beecham Chick, Noah Chen, Joseph J Gemmete, Wael A Saad, Narasimham L Dasika, Ravi N Srinivasa
No abstract text is available yet for this article.
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872250/chronic-thromboembolic-pulmonary-hypertension
#13
REVIEW
Stuart Jamieson, G Victor Pretorius
Chronic thromboembolic pulmonary hypertension occurs when acute thromboemboli fail to dissolve completely. The resulting fibrotic scar tissue within the pulmonary arteries is obstructive and eventually leads to right heart failure. Medical therapy for this condition is supportive, but surgery with pulmonary artery endarterectomy is curative, and carries a low mortality at experienced centers.
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872249/percutaneous-pulmonary-embolism-thrombectomy-and-thrombolysis-technical-tips-and-tricks
#14
REVIEW
Zlatko Devcic, William T Kuo
Catheter-directed therapy (CDT) is now acknowledged as a treatment option for select patients with acute massive or submassive pulmonary embolism (PE), and more patients are being considered for CDT if there is available expertise. Therefore, interventionalists should be aware of the variety of catheter-based treatment options, specific pitfalls to avoid during therapy, and the appropriate treatment endpoints. This article reviews currently available techniques and protocols for treating acute massive and submassive PE, with tips to safely and successfully perform percutaneous PE interventions...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872248/catheter-directed-thrombolysis-for-submassive-pulmonary-embolism
#15
REVIEW
Matthew A Chiarello, Akhilesh K Sista
Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality in the United States. PE associated with right ventricular strain, termed submassive or intermediate-risk PE, is associated with an increased rate of clinical deterioration and short-term mortality. Trials have demonstrated systemic thrombolytics may improve patient outcomes, but they carry a risk of major hemorrhage. Catheter-directed thrombolysis (CDT) may offer similar efficacy to and a lower risk of catastrophic hemorrhage than systemic thrombolysis...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872247/patient-assessment-clinical-presentation-imaging-diagnosis-risk-stratification-and-the-role-of-pulmonary-embolism-response-team
#16
REVIEW
Tamir Friedman, Ronald S Winokur, Keith B Quencer, David C Madoff
Pulmonary embolism (PE) is currently the third leading cause of death and moreover is likely underdiagnosed. PE remains the most common preventable cause of hospital deaths in the United States, which may be attributable to its diagnostic challenges. Although difficult to diagnose, patient mortality rates are time-dependent, and thus, the suspicion and diagnosis of PE in a timely manner is imperative. Diagnosis based on several criteria which may dictate imaging workup as well as laboratory tests and clinical parameters are discussed...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872246/intervention-in-massive-pulmonary-embolus-catheter-thrombectomy-thromboaspiration-versus-systemic-lysis-versus-surgical-thrombectomy
#17
REVIEW
John M Moriarty, Martin Edwards, Adam N Plotnik
Massive pulmonary embolus (PE), defined as hemodynamic shock from acute PE, is a life-threatening condition. Deaths from massive PE, especially when unsuspected, occur within minutes to hours of onset and as such prompt intervention can be lifesaving. Acute massive PE patients have traditionally been candidates for treatment with intravenous systemic thrombolysis to improve pulmonary artery pressure, arteriovenous oxygenation, and pulmonary perfusion in an effort to reduce mortality. However, patients with contraindications to systemic thrombolysis or those who have failed thrombolysis may benefit from other techniques including endovascular and surgical embolectomy...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872245/inferior-vena-cava-filters-and-prevention-of-recurrent-pulmonary-embolism
#18
REVIEW
Anuj Malhotra, Sirish Kishore, David Trost, David C Madoff, Ronald S Winokur
Although inferior vena cava (IVC) filters have a clear role in preventing recurrent pulmonary embolism (PE) in patients with venous thromboembolism who cannot be anticoagulated, the role of filters in patients who are candidates for anticoagulation is controversial. With limited and conflicting data, practitioners often have to make an educated patient-specific decision when encountering this scenario. This article reviews the available data on the efficacy and risks associated with adjunctive IVC filter use to prevent recurrent PE...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872244/hypercoagulable-states-and-thrombophilias-risks-relating-to-recurrent-venous-thromboembolism
#19
REVIEW
Marissa D Rybstein, Maria T DeSancho
Inherited and acquired thrombophilias and hypercoagulable states, such as active cancer, estrogen-induced, autoimmune disorders, major surgery, hospitalization, and trauma, are well-known risk factors for venous thromboembolism (VTE). The effect of these on recurrent VTE is different for each specific risk factor. The major risk factors affecting VTE recurrence include the presence of active cancer and an unprovoked first VTE. In addition, the use of combined female hormones in a woman with a previous history of estrogen-related VTE is a major risk factor for VTE recurrence...
June 2018: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29872243/epidemiology-pathophysiology-and-natural-history-of-pulmonary-embolism
#20
REVIEW
Meredith Turetz, Andrew T Sideris, Oren A Friedman, Nidhi Triphathi, James M Horowitz
Pulmonary embolism (PE) is a common and potentially deadly form of venous thromboembolic disease. It is the third most common cause of cardiovascular death and is associated with multiple inherited and acquired risk factors as well as advanced age. The prognosis from PE depends on the degree of obstruction and hemodynamic effects of PE and understanding the pathophysiology helps in risk-stratifying patients and determining treatment. Though the natural history of thrombus is resolution, a subset of patients have chronic residual thrombus, contributing to the post-PE syndrome...
June 2018: Seminars in Interventional Radiology
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