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Techniques in Vascular and Interventional Radiology

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https://www.readbyqxmd.com/read/29029719/erratum-to-not-just-guess-work-tips-for-observation-brainstorming-and-prototyping-vasc-interv-radiol-20-2017-94-100
#1
Ryan Crone
No abstract text is available yet for this article.
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029718/the-future-of-catheter-directed-therapy-data-gaps-unmet-needs-and-future-trials
#2
Akhilesh K Sista, John M Moriarty
This article will focus on 3 avenues for future research: (1) addressing the lack of short- and long-term clinical outcome research on catheter-directed therapy; (2) determining the safety and efficacy of novel thrombus removal devices; and (3) translating our knowledge of the pathobiology and pathophysiology of pulmonary embolism into novel diagnostic and therapeutic strategies.
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029717/the-role-of-the-pulmonary-embolism-response-team-how-to-build-one-who-to-include-scenarios-organization-and-algorithms
#3
Andrew Galmer, Ido Weinberg, Jay Giri, Michael Jaff, Mitchell Weinberg
Pulmonary embolism response teams (PERTs) are multidisciplinary response teams aimed at delivering a range of diagnostic and therapeutic modalities to patients with pulmonary embolism. These teams have gained traction on a national scale. However, despite sharing a common goal, individual PERT programs are quite individualized-varying in their methods of operation, team structures, and practice patterns. The tendency of such response teams is to become intensely structured, algorithmic, and inflexible. However, in their current form, PERT programs are quite the opposite...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029716/balloon-pulmonary-angioplasty-in-chronic-thromboembolic-pulmonary-hypertension-new-horizons-in-the-interventional-management-of-pulmonary-embolism
#4
Michael D Rivers-Bowerman, Rebecca Zener, Arash Jaberi, Marc de Perrot, John Granton, John M Moriarty, Kong T Tan
Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed potential complication of acute or recurrent pulmonary thromboembolic disease. Multiple studies suggest that up to 5% of patients with acute pulmonary thromboembolic disease go on to develop CTEPH. The prognosis of untreated CTEPH is poor, but advances in medical and surgical treatments over the past few decades have improved patient outcomes. The gold standard and curative treatment for CTEPH is pulmonary endarterectomy; however, some patients are inoperable and others who have undergone pulmonary endarterectomy experience persistent or recurrent pulmonary hypertension despite medical therapy...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029715/the-role-of-inferior-vena-cava-filters-in-pulmonary-embolism
#5
Jonathan D Steinberger, Scott J Genshaft
Pulmonary embolism (PE) is a cause of significant morbidity and mortality, with an estimated 600,000 cases of clinically significant PE in the United States annually, and roughly 200,000 deaths per annum directly attributable to PE. By far the most frequent cause of PE is deep vein thrombosis originating in the lower extremities, which travels to the pulmonary vasculature. The mainstay of treatment is anticoagulation, but multiple additional treatments exist for patients in whom anticoagulation is inadequate or contraindicated...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029714/catheter-directed-therapy-for-acute-submassive-pulmonary-embolism-summary-of-current-evidence-and-protocols
#6
Andrew Kesselman, William T Kuo
Treatment of acute submassive pulmonary embolism (PE) with thrombolytic therapy remains an area of controversy. For patients who fail or who have contraindications to systemic thrombolysis, catheter-directed therapy (CDT) may be offered depending on the patient's condition and the available institutional resources to perform CDT. Although various CDT techniques and protocols exist, the most studied method is low-dose catheter-directed thrombolytic infusion without mechanical thrombectomy. This article reviews current protocols and data on the use of CDT for acute submassive pulmonary embolism...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029713/techniques-and-devices-for-catheter-directed-therapy-in-pulmonary-embolism
#7
Alok Bhatt, Ramsey Al-Hakim, James F Benenati
The clinical presentation of a patient with acute pulmonary embolism (PE) can be classified into 3 categories: low-risk, submassive (presence of right heart strain), and massive (hemodynamic compromise). Massive PE is associated with high morbidity or mortality and typically treated with systemic intravenous thrombolysis. Over the last 2 decades, however, catheter-directed techniques have become an increasingly popular treatment modality for patients with a contraindication to systemic thrombolysis or without clinical improvement after systemic thrombolysis...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029712/advanced-cardiopulmonary-support-for-pulmonary-embolism
#8
Oren Friedman, James M Horowitz, Danny Ramzy
Management of high-risk pulmonary embolism (PE) requires an understanding of the pathophysiology of PE, options for rapid clot reduction, critical care interventions, and advanced cardiopulmonary support. PE can lead to rapid respiratory and hemodynamic collapse via a complex sequence of events leading to acute right ventricular failure. Importantly, reduction in pulmonary vascular resistance must be accomplished either by systemic thrombolytics, catheter directed thrombolytics, endovascular clot extraction, or surgical embolectomy...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029711/surgical-embolectomy-for-massive-and-submassive-pulmonary-embolism-and-pulmonary-thromboendarterectomy-for-chronic-thromboembolic-pulmonary-hypertension
#9
Richard J Shemin
Surgical therapy for massive acute pulmonary embolism has improved with the use of rapid response teams and selective bedside extracorporeal membrane oxygenation initiation. The chronic consequence of unresolved pulmonary embolism is a treatable form of pulmonary hypertension. Pulmonary thromboendarterectomy is a curative operation in selected cases, operated upon in an experienced center with the multidisciplinary team including imaging, pulmonary medicine, and cardiothoracic surgery.
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029710/systemic-thrombolysis-for-pulmonary-embolism-who-and-how
#10
Victor F Tapson, Oren Friedman
Anticoagulation has been shown to improve mortality in acute pulmonary embolism (PE). Initiation of anticoagulation should be considered when PE is strongly suspected and the bleeding risk is perceived to be low, even if acute PE has not yet been proven. Low-risk patients with acute PE are simply continued on anticoagulation. Severely ill patients with high-risk (massive) PE require aggressive therapy, and if the bleeding risk is acceptable, systemic thrombolysis should be considered. However, despite clear evidence that parenteral thrombolytic therapy leads to more rapid clot resolution than anticoagulation alone, the risk of major bleeding including intracranial bleeding is significantly higher when systemic thrombolytic therapy is administered...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029709/medical-management-of-pulmonary-embolism-beyond-anticoagulation
#11
Nancy Hsu, Tisha Wang, Oren Friedman, Igor Barjaktarevic
Pulmonary embolism (PE) is a common medical condition that carries significant morbidity and mortality. Although diagnosis, anticoagulation, and interventional clot-burden reduction strategies represent the focus of clinical research and care in PE, appropriate risk stratification and supportive care are crucial to ensure good outcomes. In this chapter, we will discuss the medical management of PE from the time of presentation to discharge, focusing on the critical care of acute right ventricular failure, anticoagulation of special patient populations, and appropriate follow-up testing after acute PE...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029708/anticoagulation-in-pulmonary-embolism-update-in-the-age-of-direct-oral-anticoagulants
#12
Rachel Rosovsky, Geno Merli
The emergence of direct oral anticoagulants (DOACs) represents a major advancement and paradigm shift in the treatment of venous thromboembolism. Currently, dabigatran, rivaroxaban, apixiban, and edoxoban are approved and used routinely for the prevention and treatment of patients with venous thromboembolism. Because each of the DOACs has different doses and dosing regimens, clinicians need to become familiar with their use. This article focuses on the practical considerations of how and when to use the DOACs...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029707/epidemiology-pathophysiology-stratification-and-natural-history-of-pulmonary-embolism
#13
Nicholas J Giordano, Paul S Jansson, Michael N Young, Kaitlin A Hagan, Christopher Kabrhel
Pulmonary embolism (PE) is a common and potentially fatal form of venous thromboembolism that can be challenging to diagnose and manage. PE occurs when there is obstruction of the pulmonary vasculature and is a common cause of morbidity and mortality in the United States. A combination of acquired and inherited factors may contribute to the development of this disease and should be considered, since they have implications for both susceptibility to PE and treatment. Patients with suspected PE should be evaluated efficiently to diagnose and administer therapy as soon as possible, but the presentation of PE is variable and nonspecific so diagnosis is challenging...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029706/pulmonary-embolism-in-2017-how-we-got-here-and-where-are-we-going
#14
Geno J Merli
In the 1970s, both the Urokinase Pulmonary Embolism and Urokinase-Streptokinase Pulmonary Embolism trials began the quest to develop thrombolytic therapy for the treatment of acute massive and submassive pulmonary embolism (PE). The goals of these studies were the immediate reduction in clot burden, restoration of hemodynamic stability, and improved survival. Major bleeding became the major barrier for clinicians to employ these therapies. From 1980s to the present time, a number of studies using recombinant tissue-type plasminogen activator for achieving these same above outcomes were completed but major bleeding continued to remain an adoption barrier...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029705/introduction
#15
EDITORIAL
John M Moriarty, Akhilesh K Sista
No abstract text is available yet for this article.
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28673653/not-just-guess-work-tips-for-observation-brainstorming-and-prototyping
#16
Ryan Krone
Much has been written about brainstorming and prototyping in medical devices. These 2 topics are the crucial ingredients to innovation; which, if well seeded by organized and structured forays into each, will net much higher quality and more valuable results. Structure and process, although slightly counterintuitive as applied to brainstorming and prototyping, can greatly improve the value proposition of the innovation itself.
June 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28673652/innovation-best-practices-in-the-medical-device-industry
#17
Partha P Ray, Joseph F Amaral, Piet Hinoul
Advances in patient care often germinate from keen clinical insights and a needs-based approach to innovation. Although there is an important role for incremental improvements to existing solutions, transformational innovation is what truly drives real shifts in clinical outcomes and subsequently patient satisfaction, market access, and economic value. A good example of this is the evolution of the coronary stent market. The best innovation programs are focused on unmet needs rather than solutions, call for a careful articulation of the specific problems to be solved, involve a deep dive within a clinical area, and seek to prioritize research and development investments into areas where the greatest impact can be expected...
June 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28673651/needs-based-innovation-in-interventional-radiology-the-biodesign-process
#18
Jonathan D Steinberger, Lyn Denend, Dan E Azagury, Todd J Brinton, Josh Makower, Paul G Yock
There are many possible mechanisms for innovation and bringing new technology into the marketplace. The Stanford Biodesign innovation process is based in a deep understanding of clinical unmet needs as the basis for focused ideation and development. By identifying and vetting a compelling unmet need, the aspiring innovator can "derisk" a project and maximize chances for successful development in an increasingly challenging regulatory and economic environment. As a specialty founded by tinkerers, with a history of disruptive innovation that has yielded countless new ways of delivering care with minimal invasiveness, lower morbidity, and lower cost, interventional radiologists are uniquely well positioned to identify unmet needs and develop novel solutions free of dogmatic convention...
June 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28673650/innovation-in-interventional-radiology
#19
EDITORIAL
Jonathan D Steinberger
No abstract text is available yet for this article.
June 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28673649/if-you-build-it-they-will-come-how-to-establish-an-academic-innovation-enterprise
#20
Govindarajan Srimathveeravalli, Elie Balesh, Christopher P Cheng, David Chen
The rapid growth of minimally invasive, image-guided intervention has redefined the procedural management of multiple disease entities. The process of innovation which has characterized the growth of interventional radiology can be best described as "needs-based," whereby practicing interventionalists identify unmet clinical needs and subsequently invent solutions to achieve desired technical and clinical outcomes. Historically, catheters and other percutaneous devices were developed with rudimentary manufacturing techniques and subsequently translated to patients with relatively little regulatory oversight...
June 2017: Techniques in Vascular and Interventional Radiology
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