Gail Egan Sansivero

The Interventional Radiology Clinic: Key Ingredients for Success

During the past two decades, the practice of interventional radiology has evolved into one that mandates longitudinal patient care taking place before, during, and after interventional procedures. This requires the establishment of relationships between physicians and patients that often must be fostered in an outpatient clinic setting. Recognition of this practice shift was formally made by the American College of Radiology with the publication of a document concerning the importance of clinical patient management within the practice of interventional radiology. This article will review the clinical patient management as it relates to the practice of interventional radiology, with a focus on the physician-patient relationship and the components of a successful outpatient clinic.

Early ambulation after diagnostic angiography using 4-f catheters and sheaths: a feasibility study.

Purpose: To assess the feasibility and safety of early ambulation in patients undergoing transfemoral diagnostic angiography using 4-F catheters or sheaths. Methods: In this prospective study approved by the institutional review board, patients undergoing diagnostic angiography were randomized to ambulate 3 or 6 hours after catheter or sheath removal. All patients were assessed for hematoma formation, pseudoaneurysm development, and other groin complications during the in-hospital recovery period and after 30 days. Patient satisfaction and comfort level were also assessed by survey. Results: Of 110 patients (66 men; mean age 64.9 ± 12.8 years) who participated in this study, 47 were randomized to the 6-hour (6-H) group and 63 to the 3-hour (3-H) group. In the 3-H and 6-H groups, respectively, a 4-F catheter was used in 45 (71%) and 35 (74%) patients and a 4-F sheath in 18 (29%) and 12 (26%). No clinically significant groin complications were encountered in either group. Moderate to severe discomfort was reported in 9 (16%) of the 56 patients responding to the discomfort survey in the 3-H group compared to 10 (26%) of the 38 in the 6-H survey respondents. Conclusions: It is feasible and safe to ambulate patients 3 hours after diagnostic angiography performed with a 4-F catheter with or without a 4-F sheath. Early ambulation of patients after angiography has the additional benefits of increasing patient satisfaction and resource utilization.

Use of a collagen plug device to seal a subclavian artery puncture secondary to intraarterial dialysis catheter placement.

O SCVIR, 1999 THE role of endovascular therapies for the treatment of traumatic arterial lesions has expanded in recent years. In the past, percutaneous treatment of such lesions was limited to arteries that could be embolized with coils, gelatin foam, or other agents. Traumatic pseudoaneurysms may be amenable to coil embolization or, more recently, in the common femoral artery region, to ultrasoundguided compressive occlusion. The advent of covered endovascular stent grafts has expanded the role of the interventional radiologist to treat arterial injuries, especially in locations that are more difficult to approach surgically. However, one of the limitations of this technique includes the occlusion of vital branch vessels by the covered stent. Recently, two collagen plug devices have been marketed to seal arterial puncture sites after arteriography and intervention (1,2). We report our experience in a patient with a dialysis catheter placed within the subclavian artery in which a collagen plug device was used to seal the arterial puncture site.

The role of the nurse practitioner in interventional radiology.

t U Interventional radiology (IR) has been expanded over the past decade to include an outpatient-based clinical practice as well as inpatient practice. This fundamental change in workload and the demands of longer term care and expanded clinical services has necessitated an examination of IR resources and practice strategies. Interventional radiologists have assumed a more pronounced and responsible role in managing the care of patients before, during, and after their procedures. Concurrently, the scope of interventions provided and performed by IR has expanded, with an increasing demand for these minimally invasive procedures. These two factors have challenged IR practices to manage the procedural workload while supporting the increasing demands of an outpatient or hospital-based clinical practice. This robust growth, coupled with difficulty in filling IR fellowship positions, has resulted in a shortage of properly trained IR physicians. The modern IR practice closely resembles a clinical practice, providing a full spectrum of care associated with minimally invasive procedures. Patients commonly are seen in an ambulatory care setting before procedures for a thorough evaluation to determine the most appropriate care for them. Similarly, IR is often consulted by other services to evaluate inpatients for services. Establishing and maintaining an outpatient practice and providing appropriate evaluation and management (E & M) services is an important component for IR practices and requires an infrastructure that is not inherent to radiology (1). In addition, the human

The interventional radiology clinic: what you need to know.

It is increasingly recognized that clinical management in interventional radiology is necessary. To effectively participate in such management requires patient management infrastructure. The cornerstone of this effort is the clinical office.