Dinuke Warakaulle

Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology

Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition.

Superior vena caval stenting for SVC obstruction: Current status

Symptomatic obstruction of the superior vena cava is a debilitating and potentially life-threatening condition. Conventional surgery and radiation therapy have a historical role in the management of patients with malignant superior vena cava obstruction. Interventional radiologists can relieve these symptoms rapidly and safely in the vast majority of patients. The technical and clinical success rates are high and compare very favorably with currently available medical and surgical treatments. Although recurrent obstruction may occur, most patients can be treated by re-intervention.

An overview of vascular closure devices: What every radiologist should know

Haemostatic devices can be categorised according to their mechanism of action into three main types; namely pressure devices, topical haemostatic pads and vascular closure devices (VCD). Of these three categories, it is the development of VCDs that revolutionised management of endovascular procedures. Currently available VCDs fall into three major classes, those that use a collagen plug, those that use clips and those that perform suture closure at the arteriotomy site. This article provides a comprehensive review of the all three classes with examples of commercially available devices.

Vascular Closure Devices: A Comparative Overview

The use of closure devices is widespread and becoming more common. Radiologists performing arterial access procedures should be aware of when and how to use them, as well as the advantages and disadvantages of various devices, and any complications that may occur. This review intends to provide an overview of these devices, focusing on how they work, their efficacy in achieving hemostasis, any risks associated with their use, and our view as to which should be used for particular indications. There are three main categories of vascular closure devices: collagen based, suture based, and staples and clips. Newer generation devices use the same technique of closure and there are some that utilize newer techniques. Vascular closure devices have been demonstrated to reduce time to hemostasis, facilitate ambulation, and potentially decrease length of stay. The choice of a device would depend on the availability of that particular device, operator preference, anticipation of repeat arterial access, and size of the arteriotomy hole.

Modified Stent-Assisted Coil Embolization Technique to Treat an Internal Iliac Artery Aneurysm

Stent-assisted coil embolization is a well-described technique for the treatment of wide-necked intracranial aneurysms. We describe a modification of this technique used successfully to occlude a wide-necked internal iliac artery aneurysm.

Diagnostic Imaging of and Radiologic Intervention for Bovine Ureter Grafts Used as a Novel Conduit for Hemodialysis Fistulas

OBJECTIVE The objectives of our study were to review the appearances on diagnostic imaging and amenability to imaging-guided intervention of a novel bovine ureter graft (Syner-Graft 100 [SG 100]) for use as a conduit for hemodialysis fistulas. CONCLUSION The SG 100 shows initial promise as a conduit for hemodialysis fistulas in patients with difficult vascular access. The SG 100 has characteristic appearances on diagnostic imaging and is prone to similar pathologic processes that affect autogenous venous and synthetic grafts. These grafts are readily amenable to imaging-guided percutaneous intervention, which plays a major role in prolonging graft function.

A novel use of the AMPLATZER vascular plug: preventing bile leak following inadvertent subcapsular deployment of a biliary stent.

The AMPLATZER Vascular Plug (AVP; AGA Medical, USA) is designed to provide optimal embolization of peripheral veins and arteries through single-device occlusion. There are no reported cases of the AVP’s being used to prevent bile leak. We report the successful use of the AVP within the liver to prevent intraperitoneal bile leak following inadvertent subcapsular stent deployment.

The role of interventional radiology in obstetric and gynaecology practice

Interventional radiology is continuing to reshape current practice in many specialties of clinical care. It is a relatively new and innovative branch of medicine in which physicians treat diseases non-operatively through small catheters guided to the target by fluoroscopic and other imaging modalities. The aim is to provide image-guided, minimally invasive alternatives to traditional surgical and medical procedures in suitable cohorts of patients. Procedures which previously required major surgery can now be performed by interventional radiologists, sometimes on an outpatient basis, with little patient discomfort. In this review, we highlight the importance of interventional radiology in treating a comprehensive range of obstetric and gynaecological pathologies.

The CompressAR StrongArm 6000XL for Hemostasis in Day-case Peripheral Angioplasty Patients: Our Initial Experience

Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom Department of Radiology, Stoke Mandeville Hospital, Aylesbury, United Kingdom Department of Interventional Radiology, The Heartlands Teaching Hospital, Bordesely Green East, Birmingham, United Kingdom Department of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom Radiology Academy, Leeds General Infirmary, Cambridgeshire, United Kingdom

Use of a thrombin-gelatin matrix for hemostasis after failed device closure of femoral arterial access.

Access and closure continue to be a source of complications for all arterial endovascular procedures. Despite significant developments made in vascular closure devices (VCD), failure to achieve hemostasis in a small proportion of cases leads to continued bleeding, necessitating prolonged compression or surgical repair for larger punctures. We report on the use of a thrombin–gelatin matrix (Floseal, Baxter, Hayward, CA) to achieve hemostasis in two patients, in whom device closure failed to control arterial bleeding after femoral arterial access.