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Techniques in Vascular and Interventional Radiology

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https://www.readbyqxmd.com/read/28279413/a-primer-on-hemodialysis-from-an-interventional-radiology-perspective
#1
Rahul A Sheth, Anil U Sheth
Interventional radiologists play a central role in the care of patients with end-stage renal disease receiving renal replacement therapy. Ensuring that a patient׳s dialysis access remains suitable for high-quality dialysis is of paramount importance. However, although much has been spoken and written about endovascular techniques and outcomes based on angiographic criteria, little is generally known regarding the function and therefore the requirements of hemodialysis. In this article, we provide a heuristic overview of the mechanics of hemodialysis, with an emphasis on the "breaking points" in the extracorporeal circuit that trigger a patient׳s referral to Interventional Radiology...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279412/image-guided-approach-to-peritoneal-dialysis-catheter-placement
#2
Igor Latich, Randy L Luciano, Ali Mian
Peritoneal dialysis (PD) is a vastly underused form of renal replacement therapy that offers great flexibility to the patient, breaks the cycle of tri-weekly visits to a hemodialysis center, and is associated with fewer interventions to maintain functional dialysis access. PD catheter placement allows for urgent initiation of dialysis and minimizes the unnecessary use of temporary vascular access catheters. Image-guided placement of a PD catheter by interventional radiologists that combines ultrasound and fluoroscopy is an elegant, cost saving, safe, less invasive, and at least as effective an option when compared with traditional surgical placement...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279411/dialysis-catheter-placement-in-patients-with-exhausted-access
#3
Syed Rahman, Joshua D Kuban
Patients with end-stage renal disease undergo renal transplant, peritoneal dialysis, or intermittent hemodialysis for renal replacement therapy. For hemodialysis, native fistulas or grafts are preferred but hemodialysis catheters are often necessary. Per KDOQI, the right jugular vein is the preferred vessel of access for these catheters. However, in patients with long-standing end-stage renal disease vein thrombosis, stenosis and occlusion occurs. In these patients with end-stage vascular access, unconventional routes of placement of dialysis catheters are needed...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279410/complications-in-percutaneous-dialysis-interventions-how-to-avoid-them-and-how-to-treat-them-when-they-do-occur
#4
Tamir Friedman, Emilio E Lopez, Keith B Quencer
Because of the increasing prevalence of end-stage renal disease, more percutaneous interventions are being performed. They serve an important role, allowing for restoration of access function, which is achieved with high level of technical success. However, complications are inevitable during any types of procedure, and percutaneous dialysis interventions are no exception. To provide safe and effective care these patients need, anyone performing endovascular dialysis interventions needs to understand the possible complications, how they can be avoided, and how they can be addressed if they are to occur...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279409/central-venous-interventions
#5
Masahiro Horikawa, Keith B Quencer
Central venous stenosis or occlusion is a common and vexing problem in patients undergoing hemodialysis. Typical presenting symptoms include arm swelling and prolonged bleeding after hemodialysis. Despite multiple treatment approaches, these stenoses tend to recur and progress over time. A thorough preprocedure evaluation, methodical procedural approach and awareness of potential complications are all essential to try to preserve vascular access and improve patients' quality of life.
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279408/declotting-the-thrombosed-access
#6
Keith B Quencer, Tamir Friedman
Because a patent access is the lifeline for a dialysis patient, access declotting is extremely important. Before embarking on a declot, it is important to evaluate the patient for potential contraindications such as pulmonary hypertension, right-to-left shunts and access infection in order to be able to avoid potential complications such as symptomatic pulmonary embolism, stroke, and sepsis. Multiple methods to perform a percutaneous declot exist. Four common methods are described here. We also discuss how to avoid causing an arterial embolism and how to treat it if it does occur...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279407/nonmaturing-fistulae-epidemiology-possible-interventions-and-outcomes
#7
Rahul A Sheth, Robert Freed, Sidhartha Tavri, Tam T T Huynh, Zubin Irani
Autogenous arteriovenous fistulae are the best method for prolonged, successful dialysis access. However, a substantial limitation of dialysis fistulae is their high primary failure rate, estimated to be as high as 70% for radiocephalic fistulae. Fistula maturation is influenced by demographic risk factors as well as anatomical barriers, the latter of which can be readily identified by noninvasive ultrasound imaging and physical examination. These barriers can be categorized as inflow problems (native arterial disease, arteriovenous anastomotic stenosis, and juxta-anastomotic stenosis) or outflow problems (proximal venous stenosis or collateral veins)...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279406/preprocedure-evaluation-of-a-dysfunctional-dialysis-access
#8
Keith B Quencer, Jason Kidd, Thomas Kinney
Given the many different types of hemodialysis access and the various problems that can occur in each, a structured approach should be taken in the preprocedure evaluation of patients referred for hemodialysis access intervention. Abnormalities detected on surveillance or monitoring trigger referrals for evaluation and intervention in hopes of preventing thrombosis or underdialysis. Familiarity with surveillance and monitoring findings not only facilitates better communication with nephrologists but also helps the interventionalist surmise where the site of stenosis might be and which stenoses are clinically relevant...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279405/vascular-access-guidelines-summary-rationale-and-controversies
#9
Adrian Sequeira, Mihran Naljayan, Tushar J Vachharajani
Dialysis vascular access management in the United States changed significantly after National Kidney Foundation-Kidney Disease Outcome Quality Initiative (NKF-KDOQI) clinical practice guidelines were first published in 1997. The Centers for Medicare and Medicaid Service adopted these guidelines and in collaboration with the End-Stage Renal Disease Networks established the Fistula First Breakthrough Initiative (FFBI) in 2003 to improve the rate of arteriovenous fistula use over arteriovenous graft and central venous catheter in the dialysis population...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279404/strategies-for-hemodialysis-access-a-vascular-surgeon-s-perspective
#10
Larry A Scher, Saadat Shariff
Problems related to hemodialysis access are a significant cause of morbidity and mortality in patients with end-stage renal disease. Physicians of all specialties who are involved in the placement and maintenance of vascular access for hemodialysis must have a long-term strategy for sequential placement of autogenous fistulas, transpositions, and prosthetic grafts to preserve access sites and to avoid long-term use of tunneled dialysis catheters. The Fistula First and KDOQI initiatives have provided strategies and algorithms for access placement in patients with chronic kidney disease...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279403/introduction
#11
EDITORIAL
Keith B Quencer
No abstract text is available yet for this article.
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993327/percutaneous-treatment-of-lymphatic-malformations
#12
REVIEW
Michael Acord, Abhay S Srinivasan, Anne Marie Cahill
Lymphatic malformations are slow-flow vascular anomalies composed of dilated lymphatic channels and cysts of varying sizes. Percutaneous treatments, particularly sclerotherapy, play an important role in the treatment of these lesions, often obviating the need for surgical intervention. Owing to the complex nature of these lesions, a multidisciplinary approach should be used to guide diagnosis and management. This submission focuses on the workup and treatment of pediatric lymphatic malformations at our institution, with a focus on sclerotherapy...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993326/interventional-treatment-of-pulmonary-lymphatic-anomalies
#13
REVIEW
Maxim Itkin
Pulmonary lymphatic diseases have been recognized for many years and have been referred as pulmonary lymphangiectasia, pulmonary lymphangiomatosis, plastic bronchitis, and idiopathic chylothorax or chylopericardium. The lymphatic etiology of these conditions has been determined by detection of cystic lymphatic structures on biopsy or postmortem examination. Development of new imaging techniques such as dynamic contrast-enhanced magnetic resonance lymphangiography has allowed better understanding of pathophysiology of these conditions...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993325/percutaneous-treatment-of-chylous-ascites
#14
REVIEW
Jinoo Kim, Je Hwan Won
Chylous ascites occurs as a result of lymphatic leakage, which contains high concentration of triglycerides. The leakage is caused by various benign or malignant etiologies ranging from congenital lymphatic abnormality to trauma. Lymphangiography has been shown to be effective in the diagnosis of lymphatic leakage and has also been reported to have therapeutic outcome. The development of intranodal technique for lymphangiography has recently made the procedure more widespread. As an adjunctive procedure, percutaneous embolization may be performed which involves use of embolic agents such as N-butyl cyanoacrylate and coil to occlude the leak...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993324/nontraumatic-chylothorax-diagnostic-algorithm-and-treatment-options
#15
REVIEW
Gregory Nadolski
Nontraumatic chylothorax is a relatively rare condition in which the intestinal lymph (chyle) leaks into the pleural cavity. Nontraumatic chylothorax is more difficult to treat than the more common traumatic chylothorax because the site of chylous leak may occur in less predictable locations. In the past, patients with nontraumatic chylothoraces were offered traditional fluoroscopically guided lymphangiography and thoracic duct embolization similar to traumatic chylothorax. However, the observation that thoracic duct embolization outcomes for nontraumatic chylothorax differed based on the imaging findings during lymphangiography has led to the development of a treatment algorithm, which incorporates noninvasive diagnostic studies, such as magnetic resonance lymphangiography...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993323/lymphangiography-for-thoracic-duct-interventions
#16
REVIEW
Michael S Stecker, Chieh-Min Fan
Lymph leaks resulting in chylous pleural effusions can be life-threatening. Minimally invasive thoracic duct embolization and disruption have been gaining acceptance as first-line treatment for these leaks. This review discusses the techniques for both pedal and intranodal lymphangiography in detail. It also discusses the use of lymphangiography as a means of targeting a retroperitoneal lymphatic to facilitate thoracic duct interventions for chyle leaks. Finally, outcomes and adverse events pertaining to these thoracic duct interventions are discussed...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993322/lymphoscintigraphy-for-imaging-of-the-lymphatic-flow-disorders
#17
REVIEW
Rie Yagi Yoshida, Shuji Kariya, Sangkil Ha-Kawa, Noboru Tanigawa
Lymphoscintigraphy has introduced with the great advantage for diagnostic imaging of the lymphatic flow disorders. Lymphoscintigraphy can be performed in patients of any age, including neonates, and even in patient in critical conditions. The procedure is quite simple, and it needs only subcutaneous injection of small amounts of radiotracers. From subcutaneous tissue the radiotracer is taken by the lymphatic vessels and gives off energy in the form of gamma radiation detected by a gamma camera. Radiotracers rarely cause the allergic reaction and can be administered to the patients with allergy to iodine contrast media...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993321/peripheral-magnetic-resonance-lymphangiography-techniques-and-applications
#18
REVIEW
Lee M Mitsumori, Elizabeth S McDonald, Peter C Neligan, Jeffrey H Maki
Peripheral lymphedema is a chronic progressive and debilitating disorder that results from abnormal lymphatic drainage. Advances in microsurgical techniques have led to the development of new treatment options for lymphedema that benefit from preoperative imaging to select the most appropriate surgical repair. Magnetic resonance (MR) lymphangiography is a noninvasive imaging modality capable of providing high-resolution 3D images of the lower extremities to define the severity and extent of lymphedema and depict individual lymphatic channels...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993320/novel-lymphatic-imaging-techniques
#19
REVIEW
Yoav Dori
The lymphatic system plays an important role in immune regulation, transport of metabolites, and fluid balance. The key circulatory role of the lymphatic system is to transport fluid from tissue back into the venous system via lymphovenous connections. Despite the centuries-old recognition of this key role, there has been poor understanding of lymphatic flow pathophysiology because of a lack of a simple reliable noninvasive clinical lymphatic imaging method. This lack of clinical imaging has limited the treatment options for patients with lymphatic flow disorders...
December 2016: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/27993319/lymphatic-anatomy
#20
REVIEW
Michael C Hsu, Maxim Itkin
Recent development of new lymphatic imaging and intervention techniques, such as intranodal lymphangiogram, dynamic contrast enhanced magnetic resonance lymphangiography and lymphatic embolization, have resulted in the resurgence of interest in the lymphatic anatomy. The lymphatic system is a continuous maze of interlacing vessels and lymph nodes and is extremely complex and variable. This presents a significant challenge for interpretation of imaging and performance of interventions on this system. There is an embryological reason for this complexity and variability; the lymphatic system sprouts off of primordia from several locations in the body, which later fuse together at different stages of development of the embryo...
December 2016: Techniques in Vascular and Interventional Radiology
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