Mohammad Arabi

Practice of teleradiology in crisis zones: the unique case of Syria

Medical Imaging Department, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia (MAr); Imaging Institute, Cleveland Clinic, Cleveland, OH, USA (IM); Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA (AM); Internal Medicine Department, Southeast Alabama Medical Center, AL, USA (MAl); and Eastern Ghouta medical point, Syria (NH) Practice of teleradiology in crisis zones: the unique case of Syria

The Arab Journal of Interventional Radiology: Launching into the Future

© 2017 The Arab Journal of Interventional Radiology | Published by Wolters Kluwer Medknow Vascular interventional radiology (VIR), driven by its minimally invasive innovative therapies and improved technology, has played an integral role in the practice of medicine over the past few decades. Despite all the challenges and gravity pull that faced the subspecialty worldwide, VIR in the Middle East and Arab World lifted off successfully setting the sky as the limit. The high prevalence of diabetes, peripheral arterial disease, end-stage renal disease, cirrhosis, and hepatocellular carcinoma in the region translates into high demand on interventional radiologists. VIR as a radiology subspecialty was incorporated in fellowship training programs in several countries in the Arab World.

How i do it: Percutaneous image-guided peritoneal dialysis catheter insertion

Peritoneal Dialysis (PD) catheter insertion is traditionally performed using open surgical or laparoscopic techniques. The minimally invasive percutaneous PD catheter insertion techniques guided by fluoroscopy and ultrasound proved to provide comparable results in terms of catheter survival and dysfunction rates and lower incidence of catheter related peritonitis and leak. Percutaneous insertion by interventional radiologists offers more flexible scheduling and efficiency compared to surgical approaches that require operating room booking and general anesthesia. Here we report a step-by-step guide for percutaneous image-guided PD catheter insertion based on our institutional experience and previous best practice recommendations in the literature.

Pharmacomechanical Thrombectomy of Superficial Venous Thrombosis in Sturge-Weber and Klippel-Trénaunay Overlap Syndrome

through an anterograde approach. A retrograde loop approach from the SMA to the CA was the only strategy applicable to achieve a secure access at the same time for CA stenting and PDA aneurysm embolization. In cases of PDA aneurysms associated with SMA tight stenosis, a similar technique consisting of a CA-to-SMA retrograde loop with pull-through technique and anterograde stenting of the SMA with subsequent coil embolization of the PDA aneurysm has been described (4). In this case, the stenosis was located at the CA, so the loop was inverted. Although great technical skill is required, this technique can help to overcome difficulties related to access. PDA aneurysms may recur after surgical treatment of MALS if CA stenosis persists. In such cases, endovascular treatment with SMA-to-CA loop pull-through technique, CA stenting, and PDA aneurysm coil embolization can be considered a safe, effective, and less invasive approach to reduce the risk of aneurysm-related bleeding.

Congenital Extrahepatic Portosystemic Shunt Embolization with the Use of a Duct Occluder in a Neonate with Liver Dysfunction and Hyperammonemia

The ostium of the accessory inferior left renal artery was purposely covered by the aortic stent graft. Completion angiography showed complete exclusion of the aneurysm, patency of the target vessels, and no endoleak. An expected infarction of the inferior pole of the left kidney was observed, secondary to the sacrifice of the accessory inferior left renal artery. Operative time was 180 minutes, with a fluoroscopic time of 45 minutes. A 60-mL dose of the contrast agent iodixanol (Visipaque 270 mg Iodine/mL; GE Healthcare, Wauwatosa, Wisconsin) was administered. Cumulative radiation exposure was 261,047 mGy

Transarterial therapy: An evolving treatment modality of hepatocellular carcinoma

cm. Intravenous remifentanil 146 μg was administered following the episode of discomfort. The patient was satisfied with his overall experience and confirmed that his trance remained positive during the entire procedure. He recalled the episode of discomfort but did not express it as a “bad memory.” On postoperative day 4, the patient experienced acute respiratory distress secondary to pulmonary infection, which was successfully treated by intravenous antibiotics. CT angiography performed 1 month later confirmed complete exclusion of the aneurysm without endoleak and patency of the renal arteries with stents (Fig d, e). At 3-year follow-up, the patient was asymptomatic and resumed supplemental oxygen therapy at 1 L/min. Hypnosis offers a potentially less risky alternative to general anesthesia, eliminating the need for intubation and mechanical ventilation, decreasing the amount of sedative administration, and enabling a quick recovery after the procedure. The state of trance induced by hypnosis modifies pain sensation, allowing pain management often with complementary analgesia. The trance state alsomaintains immobility and allows communication during the procedure, enabling the use of image fusion techniques. Hypnosis can be achieved only in cooperative patients. This requires a clear explanation and preparation by the anesthesiologist as well as a full understanding of the process by the patient. Therefore, patients with psychotic disorders or cognitive impairment are not eligible for hypnosis. An obstacle to expansion of use of hypnosis is the lack of training for medical personnel. Awareness of hypnosis as an alternative to general anesthesia and resources to provide training and experience to care providers are necessary for its development. Hypnosis is currently accepted as a means of sedation and has shown benefits when used for relief of pain or anxiety (4). Patients undergoing painful endovascular and percutaneous procedures, such as gastrostomy, embolization, or biliary drainage, may also benefit from hypnosis. Additionally, use of hypnosis may reduce procedure time in interventional radiology cases (5). Hypnosis was possible for this complex case and may be considered for other procedures in high-risk patients.

Endovascular management of arterial injuries related to venous access: A retrospective review of 10-year single-center experience

Liver cancer is the fifth most common cancer in men, the seventh most common in women, and the third most common cause of death from cancer worldwide. Only 30-40% of liver cancer patients present early enough to undergo curative treatments such as surgery or liver transplantation. Local treatment with radiofrequency ablation or ethanol injection is often reserved for non-surgical candidates with early stages of disease. Transarterial embolization has become a widely accepted treatment for asymptomatic patients with unresectable lesions. This review discusses in details the three major forms of transarterial therapies: Bland embolization, chemoembolization, and radioembolization.