Interventional Radiology Department Research Articles

Uterine Arteries Embolization—A Rescue Tool for Acute Vaginal Bleeding in Late Stages of Gynecologic Malignancies

Background: Uterine arteries embolization (UAE) is a minimally invasive procedure with good results when it is used as interventional treatment for patients diagnosed with benign or malignant uterine tumors. The main gynecological malignancies that are complicated by hemorrhages and would benefit from UAE are cervical cancer and endometrial cancer in late inoperable stages or following surgery. Methods: During five years, in the Bucharest University Emergency Hospital’s Obstetrics and Gynecology Department, from 605 patients to whom trans-catheter embolization of the uterine arteries was performed, 33 (5.45%) were diagnosed with cervical cancer (n = 31) and endometrial cancer (n = 2) in the advanced stage addressed for heavy acute vaginal bleeding and secondary anemia. Results: For those patients, UAE was used as palliative treatment. The average age of the patients in the evaluated group was 48.7 ± 8.3 years, and the average number of days of hospitalization was 4.72 ± 2.97 (range 1–11). The benefits of UAE include cessation of bleeding in up to 100% of cases and expanding the window of opportunity for secondary anemia correction. The most common side effects (pain, nausea) could be managed with mild analgesics and easily-accessible antiemetics. Conclusions: Considering these patients’ fragile advanced oncological status, surgical ligation should be adopted only in centers where UAE is not available. The article strengthens the need for interventional radiology departments in all regional emergency centers.

Abstract No. 527 Audit of the consent process in interventional radiology and patient perspectives

The current guidance on pre-procedural consent from the General Medical Council (GMC) recommends a two-stage process (1). In many interventional radiology (IR) departments in the UK, patients are consented on the same day of their procedure, often immediately prior to their procedure, in breach of GMC guidance. The aim of this two-cycle audit was to evaluate patients’ perspectives on consenting processes in an IR department.

Abstract No. 532 Interventional radiology workflow and hospital occupancy in the pandemic era: areas for improvement

Throughout the COVID-19 pandemic, an increasing hospital occupancy rate has been an ongoing issue, with several hospitals operating at or near full capacity. Emphasis has been placed to improve discharge strategies to maintain bed space and decrease hospital occupancy rate. The interventional radiology (IR) department can play a pivotal role in the discharge process by providing timely interventions that are essential prior to a patient’s discharge. This project aims to define the time intervals between the date of priority request for an IR procedure (in preparation to discharge), date of IR procedure, and date of patient’s actual discharge.

Assessment of role of MRI in the evaluation of spinal trauma

A total of 100 patients were analysed. Complete demographic and clinical details of all the patients were obtained. The source of data for this study was patients referred to Department of Radio diagnosis, Imaging and Interventional radiology from OPD. After obtaining clinical history relevant clinical examination was done.ASIA grading was done for neurological injury. MRI examinations were done. Every patient lay in supine position with quiet breathing. No movement was allowed during examination. In 71 percent of the patients, compression fracture of the vertebral body was present. Cord oedema of >3cm was seen in 55 percent of the patients. Sensory loss and motor loss was seen in 26 percent and 21 percent of the patients respectively. MRI findings in acute spinal cord injury correlate well with the initial clinical findings and can be helpful to clinician in predicting the outcome and extent of recovery in patients of spinal cord injury.

Comparison of Sonographic-Based TI-RADS Classification and Cytological-Based Bethesda Scoring: 6-Month Experience in Somalia

The aim of this study is to investigate the agreement between ‎the thyroid image reporting and data systems (TI-RADS) ‎classification and the Bethesda scoring in adults with thyroid ‎nodules and to evaluate the effectiveness of our clinic in the ‎management of thyroid nodules. In this prospective study, in ‎which the analyzes of the patients who applied to the ‎Interventional Radiology Department of our hospital for fine ‎needle aspiration biopsy due to thyroid nodule were analyzed, ‎‎59 patients were included between January 1, 2020 and June ‎‎1, 2020. Sonographic features (composition, echogenicity, ‎shape, margin, and echogenic foci) of all nodules were recorded ‎for TI-RADS scoring before biopsy and TI-RADS scoring was ‎performed by the radiologist. It was then the results compared ‎with the Bethesda scoring, which is the cytological ‎classification. A total of 59 patients (n=43; 72.9% female and, ‎n=16; 27.1% male) were analyzed. Of the biopsied nodules, 31 ‎‎(52.5%) were localized in the right lobe and 28 (47.5%) in the ‎left lobe. The mean longest diameter of the nodules was ‎‎35.9±13.9 mm (range, 13-70 mm). The TI-RADS category was ‎also significantly higher in those with larger nodule diameters ‎‎(p=0.026). There was moderate agreement between both ‎scorings (kappa value=0.406 and p<0.001). There were 7 ‎‎(11.9%) patients with TI-RADS ≥ 4 and 10 (16.9%) patients ‎classified as Bethesda ≥ 4. Thyroid nodules reported as highly ‎suspected of malignancy (TIRADS ≥ 4) had good agreement ‎with Bethesda scoring (Kappa value= 0.658 and p<0.001). ‎According to the findings of our study, there is a moderate ‎agreement between TI-RADS scoring and Bethesda. However, ‎the rate of compliance was increasing in nodules classified as ‎malignant nodules (TI-RADS ≥4).‎

Lumbar Disc Degenerative Disorder among Patients Undergoing Magnetic Resonance Imaging in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Magnetic resonance imaging is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast, and precise localization of intervertebral discs changes. The aim of the study is to find out the prevalence of lumbar disc degenerative disorder among patients undergoing magnetic resonance imaging in a tertiary care hospital. A descriptive cross-sectional study was conducted in the Department of Radiodiagnosis and Interventional Radiology of a tertiary care centre among patients with complaints of low back pain from 24th May, 2021 to 31st December, 2021 in a tertiary care hospital. Ethical clearance was taken from the Institutional Review Committee (Reference number: 134/2077-78). A sample size of 899 was taken and convenience sampling was done. Collected data were entered and analyzed on Statistical Package for the Social Sciences version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data and mean with standard deviation for continuous data. Among 899 patients undergoing magnetic resonance imaging, the prevalence of lumbar disc degenerative disorder was found to be 155 (17.24%) (14.77-19.70 at 95% Confidence Interval). The prevalence of lumbar disc degenerative disorder among patients undergoing magnetic resonance in our study was lower when compared to other similar studies conducted in similar settings. disc degeneration; low back pain; magnetic resonance imaging.

Role of ultrasound and colored Doppler examination in the diagnosis and the classification of the superficial soft tissue vascular anomalies

BackgroundVascular anomalies are congenital lesions of abnormal vascular development, and a primary distinction have to be made between a vascular tumor and a vascular malformation, hemangiomas are considered the commonest vascular tumor, correct diagnosis is imperative for appropriate treatment. In this report, we tried to verify the role of ultrasonography and Doppler examination in the initial diagnosis, the classification of vascular anomalies and in the post-treatment follow-up.Results (main findings)This report included cases of vascular anomalies who attended the interventional radiology department as well as the vascular anomaly clinic in Abo El-Rish hospitals during the period 2019 through 2021. Data of all patients attending the clinic were prospectively examined. Files of 60 cases with vascular anomalies were available for review. The diagnosis of vascular anomalies was done according to their history and characteristic findings at clinical examination as well as U/S and color Doppler examinations, MRI and angiographic studies were done as needed. A significant female predominance was noticed. A significant predominance in the head and neck region was noticed (60%). Treatment was individualized according to each case; propranolol was chosen as the first line of treatment in IH. Intra-lesional steroids injections were done in hemangiomas, and intra-lesional bleomycin was done in venous and lymphatic malformations, endovascular embolization was done in high flow vascular malformations.ConclusionUltrasound and color Doppler examination were effective and accurate methods in the diagnosis, the classification of superficial soft tissue vascular anomalies, the detection of early complications and in the follow-up after different treatment methods applied, it was also beneficial in the exclusion of non-vascular lesions.

Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review.

ABSTRACTObjective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room.Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm.Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients.Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.

Medical physics services in radiology and nuclear medicine in Africa: challenges and opportunities identified through workforce and infrastructure surveys

The International Atomic Energy Agency (IAEA) developed a staffing model to estimate the number of clinically qualified medical physicists (CQMP) that are required in an imaging facility, including diagnostic radiology and nuclear medicine. For the first time this staffing model was applied on a large scale across Africa. Within the framework of the IAEA African Regional Agreement (AFRA) Technical Cooperation (TC) project RAF6/053 entitled “Enhancing Capacity Building of Medical Physics to Improve Safety and Effectiveness of Medical Imaging (AFRA)”, a survey based on the IAEA staffing model was used to investigate the current CQMP workforce needs in imaging and radionuclide therapy in Africa in order to establish a baseline, identify gaps and suggest steps for improvement. The survey was open for five months, after which data verification was performed. 82 responses were received from 21 countries, including data from 97 diagnostic radiology and 40 nuclear medicine departments, as well as 75 interventional radiology departments and/or catheterization laboratories. Only 26·8% of centres employed an adequate number of CQMPs. The staffing model indicated that 134·3 CQMPs were required for these centres, but only 63 are currently employed in medical imaging and/or nuclear medicine at these centres. At least 11 countries do not have a single institution with an adequate number of CQMPs. Data analysis indicated that the number of radiology and nuclear medicine CQMPs is largely inadequate, at least by a factor of 20 in almost all countries in the region.

X-ray Dark-field Chest Radiography of Lymphangioleiomyomatosis.

HomeRadiologyVol. 303, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyX-ray Dark-field Chest Radiography of LymphangioleiomyomatosisFlorian T. Gassert , Franz PfeifferFlorian T. Gassert , Franz PfeifferAuthor AffiliationsFrom the Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675 Munich, Germany (F.T.G., F.P.); and Department of Physics, School of Natural Sciences (F.P.), and Institute for Advanced Study (F.P.), Technical University of Munich, Garching, Germany.Address correspondence to F.T.G. (e-mail: [email protected]).Florian T. Gassert Franz PfeifferPublished Online:Mar 29 2022https://doi.org/10.1148/radiol.212490MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 31-year-old woman presented to our emergency department with persistent pain following epigastric herniotomy. Abdominal CT showed no evidence of recurrent hernia or incarceration. However, the partially imaged lung bases showed cystic changes in the parenchyma and multiple small nodules. A dedicated chest CT scan confirmed these findings throughout both lungs, consistent with lymphangioleiomyomatosis (LAM) (Fig 1). Transbronchial biopsy revealed cystically dilated alveolar spaces, confirming the diagnosis of LAM. LAM is a rare, idiopathic disease resulting from the proliferation of abnormal smooth muscle LAM cells in the lungs and other organs. It almost exclusively affects women of childbearing age. It is a slowly progressive disease that can lead to chronic respiratory insufficiency, and lung transplant is currently the only effective treatment available.Figure 1: (A) Coronal and (B) axial reformatted chest CT images in a 31-year-old woman show thin-walled cysts of variable sizes (arrowheads) surrounded by normal lung parenchyma as well as interlobular septal thickening in all lobes and multiple vessel-associated round foci, most likely corresponding to pulmonary arteriovenous malformations (arrows in A). The yellow line in A indicates the position of the axial reformation.Figure 1:Download as PowerPointOpen in Image Viewer X-ray dark-field chest radiography is a novel imaging technique that exploits the wave character of x-rays by measuring the amount of refraction occurring at air-tissue interfaces such as in the alveoli. Therefore, it enables assessment of the alveolar integrity and provides additional information complementing conventional, attenuation-based radiography (1,2). In animal models (3–5), dark-field imaging has previously been shown to be beneficial for the assessment of various pulmonary pathologic conditions, including lung cancer, pulmonary fibrosis, pneumonia, pneumothorax, and emphysema. In the presented case, additional x-ray dark-field chest radiography was performed, yielding both a conventional, attenuation-based radiograph and an x-ray dark-field chest radiograph (6) (Fig 2). The x-ray dark-field chest radiograph in the patient with LAM exhibited an overall low and inhomogeneous signal with focal areas of signal loss, predominantly in the right inferior lung field, corresponding well to the most affected lower lobe on the respective CT scan.Figure 2: (A, D) Conventional attenuation-based chest radiographs, (B, E) x-ray dark-field chest radiographs, and (C, F) color-coded dark-field images laid over inverted conventional radiographs in a 31-year-old woman diagnosed with lymphangioleiomyomatosis (LAM) (top row) and a healthy 33-year-old man (bottom row). The same window and level settings were applied within the respective modality. For the color-coded overlays in C and F, the dark-field signal (blue) was laid over the inverted chest radiograph. While the dark-field chest radiograph of the healthy man (E) exhibits a high, homogeneous signal, the dark-field chest radiograph of the patient with LAM (B) exhibits an overall low and inhomogeneous signal with focal areas of signal loss, predominantly in the right inferior lung field (arrowheads), corresponding well to the multiple cysts, in particular those present in the right lower lobe in the respective CT scan (Fig 1, arrowheads). The color-coded overlays combine information on both attenuating tissues and alveolar structure.Figure 2:Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: F.T.G. No relevant relationships. F.P. No relevant relationships.Supported by the European Research Council (AdG 695045) and the Deutsche Forschungsmeinschaft (GRK 2274). This work was carried out with the support of the Karlsruhe Nano Micro Facility, a Helmholtz Research Infrastructure at Karlsruhe Institute of Technology.

Management of Etonogestrel implant migration into the pulmonary artery

ObjectivesTo evaluate the relationship between time since contraceptive implant placement and retrieval outcomes in patients with implant migration into the pulmonary artery. Study designWe reviewed all cases of pulmonary artery implant migration referred to the Marie Lannelongue hospital from 2015 through 2020. Using our hospital database, we collected patients’ clinical data and removal information to assess the success of therapeutic management according to the delay between implant insertion and removal. ResultsWe identified 8 cases. Physicians located 2 in the upper and 6 in the lower lobe. Five patients had associated pulmonary symptoms, most commonly, chest pain and dyspnea. Physicians attempted an endovascular procedure in all cases with successful removal in 3 patients. In the 5 failures, angiography displayed arterial thrombosis distal to the implant. These patients had successful removal with an open mini-thoracotomy (< 5 cm). None of the 8 patients had serious post-operative complications. For the 3 patients with successful endovascular retrieval, 2 had early diagnosis (≤ 3 months). ConclusionEndovascular approach with angiography should be performed as a first line treatment modality. Endothelialization and fibrosis within the vessel represent the principal limitations of endovascular strategy, but a retrieval could be attempted anyway with caution. In case of failure, an open approach is required. Implications statementWhen a migration into the pulmonary artery is diagnosed, health care professionals should refer patients as soon as possible to a tertiary center with a vascular surgery and/or interventional radiology and thoracic surgery departments.

Inadvertent accident during balloon-occluded glue injection for facial AVM: rescue procedure using intentional glue injection

BackgroundGlue embolization during balloon inflation is a novel technique with many advantages. However, the procedure’s major complication is the adhesion of the balloon catheter by glue. Several studies have reported strategies to prevent this. However, no reports have described a rescue method after accidental adhesion occurs.Case presentationA 26-year-old male was referred to the department of interventional radiology for sclerotherapy of an aggravating large facial arteriovenous malformation (AVM). We planned a transvenous approach to decrease the velocity of AVM and increase the efficacy of the sclerotherapy treatment. We performed glue embolization of a major draining vein during microballoon inflation. Upon injection of the glue, inadvertent glue reflux occurred, and the microballoon was stuck to the vessel wall. While removing the microballoon catheter, its shaft broke in the guiding catheter. We filled the inner lumen of the guiding catheter with glue and waited for polymerization to fixate the broken microballoon catheter inside the guiding catheter. Fortunately, the stuck microballoon was separated, and two broken pieces of microballoon catheter were removed through femoral vein short sheath.ConclusionIntentional glue casting in the outer catheter is very useful when removing anything that is inside the catheter or stuck due to the glue reflux. It can be applied to various similar emergency situations.

The Impact of a Multifaceted Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Use: Evidence From a Quasi-Experimental Study in the Department of Vascular and Interventional Radiology in a Chinese Tertiary Hospital.

Objective: The objective of the study was to assess the impact of multifaceted clinical pharmacist-led antimicrobial stewardship (AMS) program on the rational use of antibiotics for patients who receive vascular and interventional radiology therapies. Methods: A quasi-experimental retrospective intervention design with a comparison group was applied to the practice of antibiotic use in the department of vascular and interventional radiology in a Chinese tertiary hospital. We used difference-in-differences (DID) analysis to compare outcomes before and after the AMS intervention between the intervention group and control group, to determine whether intervention would lead to changes in irrationality of antibiotic prescribing, antibiotic utilization, cost of antibiotics, and length of hospital stay. Results: The DID results showed that the intervention group was associated with a reduction in the average consumption of antibiotics (p = 0.017) and cost of antibiotics (p = 0.006) and cost per defined daily dose (DDD) (p = 0.000). There were no significant differences in the mean change of total costs and length of stay between the two groups (p > 0.05). The average inappropriate score of perioperative antimicrobial prophylaxis in the intervention group declined by 0.23, while it decreased by 0.02 in the control group [0.21 (95% CI, −0.271 to −0.143); p = 0.000]. The average inappropriate score of non-surgical antimicrobial prophylaxis in the intervention group declined by 0.14, while it increased by 0.02 in the control group [0.16 (95% CI, −0.288 to −0.035); p = 0.010]. The average inappropriate score of the therapeutic use of antibiotics in the intervention group declined by 0.07, while it decreased by 0.01 in the control group [0.06 (95% CI, −0.115 to −0.022); p = 0.003]. Conclusions: This study provides evidence that implementation of AMS interventions was associated with a marked reduction of antibiotic use, cost of antibiotics, and irrationality of antibiotic prescribing in China.

Thrombectomy of Inferior Vena Cava Fat Embolism after Trauma

A 19-year-old man involved in a head-on motor vehicle collision presented with multiple injuries, including a displaced right femur fracture. Two days after presentation, a computed tomography scan was obtained to evaluate new-onset hematuria, and it showed an extensive hypoattenuating filling defect in the inferior vena cava (IVC) (Fig 1), concerning for free-floating fat embolus. The interventional radiology department was consulted for embolectomy due to the risk of pulmonary embolism, contraindication for anticoagulation in the setting of trauma, and decreased likelihood of fat thrombus responding to anticoagulation. Cavogram showed an extensive right iliocaval filling defect (Fig 2a). A suprarenal IVC filter was placed prior to embolectomy to prevent central migration. Following mechanical embolectomy using an Amplatz Goose Neck Snare (Medtronic, Minneapolis, Minnesota) and suction via guiding catheters, a repeat cavogram demonstrated partially embolized fat thrombus trapped at the IVC filter apex (Fig 2b), which was removed with the snare. Histopathology of the fat emboli (Fig 2c) showed “thrombus with entrapped fat.”

Influence of storage conditions and usage time on the quality of lead rubber

Lead aprons, as a type of individual radiological shields, are designed to protect the body against the negative effects of ionizing radiation. In order for the individual shields to fulfill their task, the weakening of the X-ray beam should be as high as possible. Previous reports have indicated the possibility of significant defects even among newly purchased aprons. The aim of the study was to analyze the influence of storage conditions and usage time on the permeability of lead aprons. The analysis covered 11 lead aprons used by the staff and patients of the Department of Radiodiagnostics and Interventional Radiology of the Central Clinical Hospital in Katowice, Poland. The dependent variable was the average pixel value, and the grouping variables included the storage method, age and thickness of the apron, and the type of its user. Statistically significant differences were found between the weakening value of the X-ray beam of individual aprons, and their storage conditions and age. Aprons stored in a hanging position show a greater degree of weakening of the X-ray beam, and thus a higher degree of worker protection, compared to aprons stored otherwise. The age of the apron affects its protective properties. Med Pr. 2022;73(1):13-7.

The accuracy and reliability of 3D printed aortic templates: a comprehensive three-dimensional analysis.

Advances in 3D printing technology allow us to continually find new medical applications. One of them is 3D printing of aortic templates to guide vascular surgeons or interventional radiologists to create fenestrations in the stent-graft surface for the implantation procedure called fenestrated endovascular aortic aneurysm repair. It is believed that the use of 3D printing significantly improves the quality of modified fenestrated stent-grafts. However, the accuracy and reliability of personalized 3D printed models of aortic templates are not well established. Thirteen 3D printed templates of the visceral aorta and sixteen of the aortic arch and their corresponding computer tomography of angiography images were included in this accuracy study. The 3D models were scanned in the same conditions on computed tomography (CT) and evaluated by three physicians experienced in vascular CT assessment. Model and patient CT measurements were performed at key landmarks to maintain quality for stent-graft modification, including side branches and aortic diameters. CT-scanned aortic templates were segmented, aligned with sourced patient data, and evaluated for the Hausdorff matrix. Next, Bland-Altman plots determined the degree of agreement. The Intraclass Correlation Coefficients values were more than 0.9 for all measurements of aortic diameters and aortic branches diameter in all landmark locations. Therefore, the reliability of the aortic templates was considered excellent. The Bland-Altman plots analysis indicated measurement biases of 0.05 to 0.47 for aortic arch templates and 0.06 to 0.38 for reno-visceral aortic templates. The arithmetic mean of Hausdorff's mean distances of the aortic arch templates was 0.47 mm (SD =0.06) and ranged from 0.34 to 0.58. The mean metrics for abdominal models was 0.24 mm (SD =0.03) and ranged from 0.21 to 0.31. The printed models of 3D aortic templates are accurate and reliable, thus can be widely used in endovascular surgery and interventional radiology departments as aortic templates to guide the physician-modified fenestrated stent-graft fabrication.

Carotid artery stenting: a single-center experience

Aim: This study aimed to present the results of carotid artery stenting (CAS) in the treatment of patients with symptomatic and asymptomatic carotid artery stenosis (Cs).&#x0D; Material and Method: Between September 2016 and June 2021, patients who underwent CAS in the interventional radiology department were reviewed, retrospectively. The demographic data of patients, comorbidities, carotid stenosis rates, and early and late complication rates after treatment were recorded from medical records. Acute stent thrombosis, stroke, and death in the first 30 days after CAS were considered early periprocedural complications. Doppler ultrasonography (USG) examinations were scanned at 6 months after the procedure and restenosis rates were investigated.&#x0D; Results: There were a total of 113 patients; 31.2% female and 68.8% male. Symptomatic Cs was present in 62.8% (n=71) and asymptomatic Cs in 37.2% (n=42) of the patients. The technical success rate was determined as 98.2%. Micro-thromboembolism (n=4), pseudoaneurysm at the femoral insertion site (n=2), and acute stent thrombosis (n=1) were observed as early complications. Restenosis was detected 6 months after stenting in 1 patient (1.4%) with symptomatic Cs on Doppler USG. The mortality rate was 0.8% (n=1). &#x0D; Conclusion: CAS is an effective and safe treatment method in symptomatic and asymptomatic patients with Cs.

Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

BackgroundPatients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications.ResultsAmong the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications.ConclusionTransarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

Awareness of Radiologists and Radiographers toward Patient Care in the Interventional Radiology Department

Background: The hospitals and health care centres are organized around the patient, a model in which healthcare providers partner with patients and families to identify and satisfy patients’ needs and preferences. Providers respect patients’ values and preferences, address their emotional and social needs, and involve them and their families in decision making. According to the best of our knowledge, there is no evidence to prove, radiologists and radiographers are aware enough about the patient safety, care, and code of conduct with their patients in the interventional radiology department. Objective: This article aims to measure the awareness of radiologists and radiographers toward care and safety in an interventional radiology department. Material and Method: This study was carried in period from 15 February to 20 April 2022. One hundred sixty-four radiographers and radiologists participating in this study completed the questionnaire, which equals a response rate of approximately 82%. The questionnaire was fully completed by almost all responders; only a few of them gave partial answers. Results: The first question for radiographers and radiologists was “the sufficient awareness about the patient safety and care during the interventional radiology procedure. Also, the majority of the radiographers and radiologists are providing the patients with sufficient information when he/she ask for help or queries. A large number of radiographers and radiologists were participating in this study explaining the procedures to patients before starting the examinations in a structured way. Finally, the result shows both radiographers and radiologists respect the patient’s rights, privacy, and dignity and also kept the radiation protection during the interventional radiology procedures. Conclusion: This article summarizes the key categories of awareness of patient care issues in the provision of interventional radiology services, from the joint perspectives of radiographers and radiologists, and provides references for further reading in all major relevant areas.

A Longitudinal Study Evaluating Indications, Section Efficacy and Complications of Bronchial Artery Embolisation

Introduction: Embolisation is defined as the therapeutic introduction of Gelfoam or Poly-Vinyl Alcohol (PVA) particles into the circulation to occlude vessels. Selective embolisation of the bronchial arteries feeding the affected areas could be more effective than surgical intervention which is more hazardous leading to prolong Intensive Care Unit (ICU) stay, air leaks, stump infection. Aim: To study various indications, success rate, complications, and recurrence after Bronchial Artery Embolisation (BAE). Materials and Methods: The present longitudinal study was conducted in the Department of Pulmonary Medicine in collaboration with the Department of Interventional Radiology in Grant Medical College and JJ hospital, Mumbai, Maharashtra, India from December 2016 to December 2017. The study was done on 50 patients admitted in view of moderate to massive haemoptysis. Common indications requiring BAE, success rate with gelfoam or PVA particles, and common complications of the procedure were studied. Mean age of presentation with haemoptysis, co-morbidities associated with the disease were also studied. The patients were followed-up for six months. Repeat BAE was done in patients with PVA particles before referring for surgical intervention in cases with recurrent haemoptysis. Results: The mean age of patients requiring BAE was 37.98 years, with male predominance. Most common indication was pulmonary tuberculosis followed by post-tuberculosis sequelae. The overall success rate of the procedure was 88% at six months follow-up.BAE done with PVA (10/10) particle showed a better outcome as compared to gelfoam (34/40). The most common complication related to the procedure was puncture site pain. Three patients out of six with recurrent haemoptysis required repeat BAE within three months, out of which only one required surgery. Conclusion: The most common indication for BAE in this study was pulmonary tuberculosis. There were no major complications, even with repeat BAE. Hence, BAE should be the procedure of choice for moderate to massive haemoptysis despite of previous history of BAE, before considering for surgical intervention. BAE with PVA is associated with better success rate.