Raman Uberoi

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.

Short- and long-term retrievability of the Celect vena cava filter: Results from a multi-institutional registry

PURPOSE To evaluate retrievability of the Celect vena cava filter over time and to assess the safety of the retrieval procedure in a prospective multicenter registry. MATERIALS AND METHODS Between October 2005 and March 2008, Celect filters were placed in 95 patients (61 men; mean age, 51 years +/- 18.5) with a temporary need for an inferior vena cava (IVC) filter. All patients satisfied requirements for filter placement; the primary indications for placement were pulmonary embolism (PE) with a contraindication to or failure of anticoagulation (n = 40), high risk for further PE (n = 29), trauma (n = 23), or massive PE with residual deep vein thrombosis and risk for further PE (n = 3). Filter orientation, vena cava injury, and other device-related incidents were evaluated at implantation and retrieval. The degree of difficulty associated with retrieval was also assessed. RESULTS Filter retrieval was attempted in 58 patients (mean indwell time of 179 days; median, 168.5 d; range, 5-466 d). Fifty-six filters (96.6%) were successfully retrieved. Unsuccessful retrieval attempts were attributed to filter tilt (n = 1) or excessive tissue growth with the hook embedded in the endothelium (n = 1). No adverse events were associated with the inability to retrieve these filters. A Kaplan-Meier product-limit survival estimate revealed that the probability of successful filter retrieval remained at 100% at 50 weeks and at more than 74% at 55 weeks after implantation. No adverse events were related to the retrieval procedures. CONCLUSIONS Retrieval of the Celect filter was performed safely as long as 466 days after implantation.

Quality Assurance Guidelines for Superior Vena Cava Stenting in Malignant Disease

Superior vena cava stenting for the treatment of malignant superior vena cava obstruction is now well established. It offers simple, rapid, and safe palliation of a distressing and potentially fatal complication of mediastinal malignant disease and compares very favorably with standard therapies such as chemotherapy and radiotherapy. The following are quality assurance guidelines for superior vena cava stenting.

Central Venous Access

Central venous access plays an important role in the management of an ever-increasing population of patients ranging from those that are critically ill to patients with difficult clinical access. Interventional radiologists are key in delivering this service and should be familiar with the wide range of techniques and catheters now available to them. A comprehensive description of these catheters with regard to indications, technical aspects of catheterization, success rates, and associated early and late complications, as well as a review of various published guidelines on central venous catheter insertion are given in this article.

Standard of Practice for the Interventional Management of Isolated Iliac Artery Aneurysms

Isolated iliac artery aneurysms are uncommon, comprising less than 2% of all abdominal aneurysmal disease. Although they have a fairly innocuous natural history, when they have attained a large size they carry a significant risk of rupture. Rupture is associated with significant morbidity and mortality. Therefore, an early diagnosis and treatment are crucial. Over the last decade, interventional treatment options have become established alternatives to open surgical repair. These guidelines aim to review the pathogenesis, natural history, and presentation of isolated iliac artery aneurysms including a description of imaging and interventional treatment strategies.

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.

Endovascular treatment options in the management of lower limb deep venous thrombosis.

Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

The accuracy of ultrasound in the diagnosis of clinically occult groin hernias in adults

This prospective study examined the accuracy of ultrasound in diagnosing occult groin hernias in adults. The study included 52 consecutive patients reviewed in the surgical out-patient clinic with a history suggestive of groin hernia but with a normal or inconclusive clinical examination. Each patient underwent a preliminary ultrasound examination by an experienced consultant radiologist who was aware that the patient had a history suggestive of a hernia but was blinded to the side of the symptoms. The patient then proceeded to herniography, and some patients also had surgical exploration. The results of the ultrasound were assessed in relation to the herniography, and the patients who proceeded to surgical exploration had further correlation with surgery. Ultrasound had a sensitivity of 29% and specificity of 90% compared with the herniography. Correlation with surgical findings showed ultrasound to have a sensitivity of 33% and a specificity of 100%. The sensitivity of ultrasound in detecting clinically occult hernias in a non-acute presentation is poor, and patients with normal ultrasound should be considered for further investigation.

Retrograde vs. Antegrade Puncture for Infra-Inguinal Angioplasty

AbstractThis study was done to compare antegrade punctures with a retrograde puncture technique for infrainguinal angioplasty. A group of 100 consecutive patients (71 men, 29 women) were randomized for antegrade puncture or retrograde puncture of the common femoral artery. Following retrograde puncture the guidewire was ‘turned’ and placed into the superficial femoral artery. The time for gaining access, screening time, radiation dose, patient height, weight and complications were recorded. All patients were reviewed the day after the procedure and within 3 months. Data from 46 patients (34 males and 12 females) in the retrograde group and 44 (28 males and 16 females) in the antegrade group were available for analysis. Mean procedure time, screening time, radiation dose, height and weight were 8.3 minutes (range 3–22), 2.1 minutes (0.3–6.5), 7950 mGy cm−2 (820–71250), 169 cm (149–204) and 79 kg (32–108) for retrograde puncture and 8 min (2–60), 0.7 min (0.0–3.2), 1069 mGy cm−2 (0–15400), 169 cm (152–186) and 75 kg (39–125) for antegrade punctures, respectively. An average of 1.2 (1–2) punctures was required for retrograde and 1.75 (1–8) for antegrade. Seven small hematomas occurred with antegrade and three for retrograde puncture. Retrograde puncture is technically easier with a tendency to fewer complications but results in a higher radiation dose. This technique should be used in difficult patients at high risk of haematoma formation.

StarClose Vascular Closure Device: Prospective Study on 222 Deployments in an Interventional Radiology Practice

The StarClose device (Abbott Vascular Devices; Abbott Laboratories, Redwood City, CA) utilizes an externally placed Nitinol clip to achieve arterial closure following femoral artery puncture. The objectives of this study were to assess the efficacy and complications of the StarClose device in patients undergoing interventional radiological procedures. Preprocedural clotting status, pulse and blood pressure, severity of vessel calcification, sheath size, and time to deployment were recorded. Postdeployment complications immediately postprocedure, at 1 h, at 2 h, and at 1 week were recorded. A duplex scan was performed in the first 10 patients to assess any immediate vascular complications. Deployments were successful in 96% achieving immediate hemostasis. Mean deployment time was 48 s. There were no major complications. The StarClose device was found to have a high technical and clinical efficacy.