Christopher S. Morris

Arterial Embolization in the Chest

Transcatheter therapy is an effective technique in the treatment of vascular abnormalities in the chest. Pulmonary arteriovenous malformations, associated with the clinical sequellae of dyspnea, stroke, brain abscess, and hemoptysis, can be treated by transcatheter embolization with metallic coils or occlusion balloons. The results of treatment are excellent, with improvement seen in symptoms and physiologic parameters. The bronchial arteries and systemic nonbronchial collateral arteries supplying the tracheobronchial tree are most frequently involved in massive hemoptysis, a serious disorder with associated high rates of morbidity and mortality. Transcatheter embolization of these arteries is both safe and effective, requiring a thorough understanding of the arterial anatomy and technique of embolization.

Radiofrequency Ablation of Renal Transitional Cell Carcinoma with Protective Cold Saline Infusion

Radiofrequency (RF) ablation is a feasible option for treatment of renal tumors when definitive tumor resection is not performed. Renal hilar and ureteral masses are generally more difficult than peripheral renal tumors to approach with RF ablation because of the higher associated risks of injury to the hilar vessels and the collecting system. This report presents a case of RF ablation of transitional cell carcinoma of the ureteropelvic junction, performed successfully for intractable hematuria. Significant injury to the uroepithelium was avoided by the concomitant use of a cold saline infusion into the collecting system of the kidney.

Transjugular intrahepatic portosystemic shunt for bleeding stomal varices associated with chronic portal vein occlusion: long-term angiographic, hemodynamic, and clinical follow-up

The efficacy of the transjugular intrahepatic portosystemic shunt procedure (TIPS) in controlling refractory hemorrhage from stomal varices at the mucocutaneous junction has been previously described, but the durability of this procedure for this indication is unknown. Conservative therapy may be unsuccessful in preventing recurrent hemorrhage. Some authors believe that portosystemic shunting is the treatment of choice for patients with bleeding stomal varices who are good surgical candidates, because of the low incidence of recurrent bleeding and the longest survival. We report the 39-month angiographic and hemodynamic follow-up, and the 48-month clinical follow-up of a patient with refractory hemorrhage from stomal varices and coexistent chronic portal vein occlusion successfully treated with a TIPS procedure.

A multidisciplinary quality improvement program increases the inferior vena cava filter retrieval rate

Published reports indicate low retrieval rates for retrievable inferior vena cava (IVC) filters. We performed a historic-controlled study of a 5-year intervention (March 2007 to February 2012) to improve IVC filter retrieval rates at a university medical center serving a rural area. All adults with a retrievable filter placed were included, except those with a life expectancy <6 months. The intervention included initial verbal counseling and printed educational materials, correspondence after discharge, and a hematology consultation. The control group included patients with retrievable filters placed in the 15 months preceding study initiation. In the control group, 116 filters were placed and 27 (23%) were removed, compared to 378 filters placed and 169 (45%) removed during the intervention. Adjusting for patient characteristics, the odds ratio of retrieval during the intervention was 3.03 (95% CI 1.85–4.27) compared to the control period. An intervention including patient education and hematology follow-up appeared to significantly improve IVC filter retrieval rates.

Update on uterine artery embolization for symptomatic fibroid disease (uterine artery embolization).

Transcatheter embolization of the uterine arteries for symptomatic fibroid disease has become an increasingly important alternative treatment. It is highly effective and well tolerated by most patients. Most notably, uterine artery embolization is associated with a short recovery period and is uterine sparing. To ensure the best chance for a safe and successful procedure, Interventional Radiologists should have familiarity with uterine artery anatomy, state of the art embolization techniques, and optimal patient selection and post procedure management.

Creation of a Ureterocystostomy in a Transplanted Cadaveric Kidney with the Use of a Radiofrequency Guide Wire

A duplicated collecting system (DCS) is a common anatomical variant of the kidney. As surgeons now perform more donor cadaveric transplants than in the past, the discovery of an occluded DCS may occur in the post-transplant setting. Over a dozen articles have reported on the use of DCS in the renal transplant setting. However, to our knowledge, this case report is the first to describe the creation of a ureterocystostomy with the use of a radiofrequency (RF) guide wire, involving a previously unidentified DCS in a transplanted kidney.

Role of Vascular and Interventional Radiology in the Diagnosis and Management of Acute Trauma Patients

Vascular and interventional radiology provides an important service in the diagnosis and management of the acute trauma patient. Historically angiography was used primarily as a diagnostic tool for both vascular and solid organ injuries. However, with technological advances, such as the advent of stents, stent grafts, newer embolization materials and sophisticated delivery devices, micro-catheters, and steerable guide wires, vascular and interventional radiology can now offer definitive treatment in selected cases. Transcatheter embolization can effectively treat acute hemorrhage and is useful in locations that are difficult to access surgically, or when surgical disruption of fascial planes, which may eliminate a tamponade effect, is less desirable. Stents and stent grafts have been used to preserve, rather than sacrifice, an injured blood vessel. In splenic, hepatic, and renal trauma, a trend in nonoperative management has been developed by traumatologists. Transcatheter embolization can increase the success rate of nonoperative management in selected injuries. In general, despite the injury grade, if evidence of ongoing hemorrhage is present, angiography and transcatheter embolization should be considered. Peripheral vascular injuries can be treated with transcatheter embolization or stents and stent grafts. Transcatheter embolization in trauma was first applied to bleeding associated with pelvic fractures and dislocations, and continues to be an important treatment option. Carotid and vertebral artery injuries can now be repaired using stents or stent grafts, although the experience of this treatment strategy is somewhat limited. Likewise, acute traumatic aortic injury has been successfully treated with stent grafts in small series. Conventional catheter thoracic aortography is now used as an adjunctive diagnostic test for indeterminate or questionable findings on noninvasive imaging studies, primarily computed tomography scans of the chest. In summary, vascular and interventional radiology maintains an important role in the diagnosis and management of acute vascular and solid organ injury. The following review illustrates its current status in acute trauma.