Alain T. Drooz

Quality Improvement Guidelines for Percutaneous Management of the Thrombosed or Dysfunctional Dialysis Access

John E. Aruny, MD, Curtis A. Lewis, MD, John F. Cardella, MD, Patricia E. Cole, PhD, MD, Andrew Davis, MD, Alain T. Drooz, MD, Clement J. Grassi, MD, Richard J. Gray, MD, James W. Husted, MD, Michael Todd Jones, MD, Timothy C. McCowan, MD, Steven G. Meranze, MD, A. Van Moore, MD, Calvin D. Neithamer, MD, Steven B. Oglevie, MD, Reed A. Omary, MD, Nilesh H. Patel, MD, Kenneth S. Rholl, MD, Anne C. Roberts, MD, David Sacks, MD, Orestes Sanchez, MD, Mark I. Silverstein, MD, Harjit Singh, MD, Timothy L. Swan, MD, Richard B. Towbin, MD, Scott O. Trerotola, MD, Curtis W. Bakal, MD, MPH, for the Society of Interventional Radiology Standards of Practice Committee

Quality Improvement Guidelines for Percutaneous Transhepatic Cholangiography and Biliary Drainage

PERCUTANEOUS transhepatic cholangiography is a safe and effective technique for evaluating biliary abnormalities. It reliably demonstrates the level of abnormalities and sometimes can help diagnose their etiologies. Percutaneous transhepatic biliary drainage is an effective method for the primary or palliative treatment of many biliary abnormalities demonstrated with cholangiography. Participation by the radiologist in patient follow-up is an integral part of percutaneous transhepatic biliary drainage and will increase the effectiveness of the procedure. Close follow-up, with monitoring and management of the patients’ drainage-related problems, is appropriate for the interventional radiologist. These guidelines are written to be used in quality improvement programs to assess percutaneous biliary procedures. The most important processes of care are (a) patient selection, (b) performing the procedure, and (c) monitoring the patient. The outcome measures or indicators for these processes are indications, success rates, and complication rates. Outcome measures are assigned threshold levels.

Quality improvement guidelines for transjugular intrahepatic portosystemic shunts.

Ziv J. Haskal, MD, Louis Martin, MD, John F. Cardella, MD, Patricia E. Cole, PhD, MD, Alain Drooz, MD,Clement J. Grassi, MD, Timothy C. McCowan, MD, Steven G. Meranze, MD, Calvin D. Neithamer, MD,Steven B. Oglevie, MD, Anne C. Roberts, MD, David Sacks, MD, Mark I. Silverstein, MD,Timothy L. Swan, MD, Richard B. Towbin, MD, and Curtis A. Lewis, MD, MBA, for the Society ofInterventional Radiology Standards of Practice Committee

Quality Improvement Guidelines for Percutaneous Transcatheter Embolization

Alain T. Drooz, MD, Curtis A. Lewis, MD, Timothy E. Allen, MD, Steven J. Citron, MD, Patricia E. Cole, PhD, MD, Neil J. Freeman, MD, James W. Husted, MD, Patrick C. Malloy, MD, Louis G. Martin, MD, A. Van Moore, MD, Calvin D. Neithamer, MD, Anne C. Roberts, MD, David Sacks, MD, Orestes Sanchez, MD, Anthony C. Venbrux, MD, Curtis W. Bakal, MD, MPH, for the Society of Interventional Radiology Standards of Practice Committee

Quality Improvement Guidelines for Image-guided Percutaneous Biopsy in Adults

PERCUTANEOUS biopsy has become established as a safe, effective procedure. Successful percutaneous needle biopsy has been applied in most organ systems with excellent results and few complications (1–19). The key to these procedures has been the use of imaging guidance, which allows for the safe passage of a needle into an organ or mass, to obtain tissue for cytologic or histologic examinations. Imageguided percutaneous biopsy is less invasive than open exploration to obtain these same tissues. Because of the lower morbidity and mortality of the noninvasive procedures, they can be applied to patients who are too ill to undergo surgery or who wish to avoid convalescence from large diagnostic laparotomy procedures. In most settings percutaneous biopsy is the first approach to diagnosis. Follow-up, with postprocedure monitoring and management of the patient, is appropriate for the radiologist and will increase the effectiveness of the procedure. These guidelines are written for use in a quality improvement program that monitors percutaneous biopsy procedures (20). The most important processes of care in this area are: (a) patient selection, (b) performing the procedure, and (c) monitoring the patient. The outcome measures or indicators for these processes are indications, success rates, and complication rate.

Quality Improvement Guidelines for Adult Percutaneous Abscess and Fluid Drainage

Curtis W. Bakal, MD, MPH, Chairman, David Sacks, MD, Dana R. Burke, MD, John F. Cardella, MD, Paramjit S. Chopra, MD, Steven L. Dawson, MD, Alain T. Drooz, MD, Neil Freeman, MD, Steven G. Meranze, MD, A. Van Moore, Jr, MD, Aubrey M. Palestrant, MD, Anne C. Roberts, MD, James B. Spies, MD, Eric J. Stein, MD, Richard Towbin, MD, for the Society of Interventional Radiology Standards of Practice Committee

Technical Success and Safety of Retrieval of the G2 Filter in a Prospective, Multicenter Study

PURPOSE To assess the technical success and safety for retrieval of the G2 filter. MATERIALS AND METHODS The authors performed a prospective, multicenter study of 100 patients with temporary indication for caval interruption. Patients were enrolled consecutively between December 2005 and July 2006. There were 67 men and 33 women with a mean age of 52.1 years (range, 19-82 years). Indications for filter placement were trauma (n = 56), perioperative risk (n = 16), and medical indications (n = 28). Forty-two patients had venous thromboembolism at filter placement. Fifty-eight filters were placed prophylactically. RESULTS Retrieval was attempted in 61 patients. Fifty-eight of the 61 filters (95%) were successfully retrieved after a mean dwell time of 140 days (range, 5-300 days). In all failed retrievals, the filter tip was against the caval wall. There was no difference in dwell times between successful and unsuccessful retrievals. Although there were no cases of cranial migration, caudal migrations were observed in 12% of cases (10 of 85 patients with a complete data set). Other device-related complications included filter fracture (1/85, 1.2%), filter tilt of more than 15 degrees (15/85, 18%), and leg penetration (16/61, 26%). The recurrent pulmonary embolism (PE) rate was 2%, with no PE in the 30-day period after filter retrieval. CONCLUSIONS Retrieval of the Recovery G2 filter was safe and successful in most patients. Caudal migration was observed as an unexpected phenomenon.

Multidisciplinary Management of Hepatocellular Carcinoma

Hepatocellular carcinoma is a challenging disease to treat because of its association with cirrhosis, variable biologic behavior, and variable morphology and because of the variations in local expertise and resources available. The expertise of multiple specialties is required for optimal treatment, which must be individualized. Multidisciplinary and multimodality approaches can be successful for converting patients with unresectable disease into surgical candidates and can stabilize disease as patients await liver transplantation. Regional and local ablation treatment strategies provide effective palliation and possibly prolong survival in nonsurgical candidates, with novel combinations of therapies showing promising results. Interventional radiologists can and should play a lead role in the multidisciplinary management of this disease and in the development of future treatment strategies.

Angioplasty Standard of Practice

Society of Interventional Radiology Standards of Practice Committee: James B. Spies, MD, Chairman, Curtis W.Bakal, MD, Dana R. Burke, MD, John F. Cardella, MD, Alain Drooz, MD, Michael E. Edwards, MD, James W.Husted, MD, Aubrey M. Palestrant, MD, Michael J. Pentecost, MD, Anne C. Roberts, MD, William F. Rogers,MD, Millard C. Spencer, MD, Phillip J. Weyman, MD

Quality Improvement Guidelines for Image-guided Percutaneous Biopsy in Adults: Society of Cardiovascular & Interventional Radiology Standards of Practice Committee

PERCUTANEOUS biopsy has become established as a safe, effective procedure. Successful percutaneous needle biopsy has been applied in most organ systems with excellent results and few complications (1–19). The key to these procedures has been the use of imaging guidance, which allows for the safe passage of a needle into an organ or mass, to obtain tissue for cytologic or histologic examinations. Imageguided percutaneous biopsy is less invasive than open exploration to obtain these same tissues. Because of the lower morbidity and mortality of the noninvasive procedures, they can be applied to patients who are too ill to undergo surgery or who wish to avoid convalescence from large diagnostic laparotomy procedures. In most settings percutaneous biopsy is the first approach to diagnosis. Follow-up, with postprocedure monitoring and management of the patient, is appropriate for the radiologist and will increase the effectiveness of the procedure. These guidelines are written for use in a quality improvement program that monitors percutaneous biopsy procedures (20). The most important processes of care in this area are: (a) patient selection, (b) performing the procedure, and (c) monitoring the patient. The outcome measures or indicators for these processes are indications, success rates, and complication rate.