Interventional Radiology Service Research Articles

Infection of Small-Bore Tunneled Central Venous Catheters

OBJECTIVE. The purpose of this study is to evaluate the association of common clinical variables with small-bore tunneled central venous catheter (CVC) infection. MATERIALS AND METHODS. Retrospective data were collected from all small-bore (6-French) tunneled CVCs placed by the interventional radiology service between 2012 and 2015. Only patients who had a documented reason for tunneled CVC removal were included in the analysis to capture all events. Transfemoral, transhepatic, and translumbar placements were excluded to reduce cohort heterogeneity. Multiple clinical variables were collected from a review of the medical record. The t test and Fisher exact test were used for two-group comparisons for continuous variables and categoric variables, respectively. Logistic regression analyses were further used to identify variables that were associated with catheter infection. RESULTS. One hundred eighty-two patients (105 women [57.7%] and 77 men [42.3%]) with a mean (± SD) age of 49.7 ± 16 years were included. Thirty-two catheters (17.6%) were removed because of infection. Noninfected lines were removed at a mean of 39 (SD, 57.3) days, whereas infected lines were removed at a mean of 95.9 (SD, 113.4) days after placement (p < 0.001). There was a statistically significant difference in the number of tunneled CVCs removed for infection when the indication for tunneled CVC placement was the administration of IV antibiotics (p = 0.04). By multivariate analysis, only time to removal (p = 0.002; odds ratio, 0.992; 95% CI, 0.986-0.998) and a history of tunneled CVC (p = 0.01; odds ratio, 0.306; 95% CI, 0.121-0.772) were associated with catheter removal for infection. CONCLUSION. Time to catheter removal and history of tunneled CVC were associated with an increased risk of tunneled CVC removal because of infection.

Poster Presentations

Introduction and Objectives: Renal cell carcinoma (RCC) accounts for 2–3% of all cancers. With increasing use of Computer Tomography, a large proportion are detected earlier and amenable to focal therapies such as Radiofrequency Ablation (RFA). Our institution is unable to offer image‐guided percutaneous ablation (PA) through the public service due to lack of Interventional Radiology (IR) resources. Currently, patients with a small renal mass (SRM) are either actively observed, undergo radical nephrectomy (RN), partial nephrectomy (PN) or referred to another tertiary institution for focal therapy. Recent studies have demonstrated no difference in long‐term efficacy between RN, PN and PA treatment of SRMs in selected patients; but with significantly higher rates of morbidity in the surgical treatment groups. Our Urology Multidisciplinary Team (MDT) is supported by an interventional radiologist with Uroradiology specialisation who provides PA for our patients through a private facility and we assessed the cost‐effectiveness of our institution outsourcing PA . The aim of the study was to compare the costs associated with performing nephrectomies (RN, PN) in a public hospital with the costs of performing minimally invasive PA in a private hospital; and to assess the financial impact on the public system of the different treatment options for SRMs. Methods: The cost of performing PA at a large tertiary private hospital for patients with a SRM (<4 cm) between October 2017‐October 2018 was calculated and compared to the cost of RN or PN for patients with a SRM between January 2015 to June 2018 at a tertiary public hospital. Results: Twelve patients underwent PA (radiofrequency ablation or microwave ablation); 10 were performed under conscious sedation. A total of 56 RN and PN were performed during the studied period, including 19 patients with a SRM (RN = 15; PN = 4 with the majority (n = 17) performed laparoscopically. Mean size of lesions was similar (surgery = 29.8 mm; RFA = 27.2 mm). The average procedural time was significantly longer with surgery (219.66 min vs 54.75 min). Length of stay was longer with surgery. Cost per admission for surgery was $19 302.66 which was higher than PA costs of $4513 at a private institution. The cost of performing equivalent PA in a public hospital was calculated to be $2784.35, however this would not include staffing costs (doctors, nurses, radiographers etc).Outsourcing of PA was associated with additional Urology and Radiology appointments, MDT meetings, travel for patients and logistical challenges for the treating teams. Conclusion: The cost of outsourcing focal treatment of SRMs with PA to a private hospital appears to be similar to the same service provided in a public hospital. PA is more cost‐effective than surgery in carefully selected patients. The additional benefits of providing PA in a public hospital would include more streamlined management and continuity of care for patients. Greater funding for interventional radiology services to provide PA procedures in public hospitals should be considered by health authorities to improve access to less‐invasive treatments for SRMs and result in considerable cost‐savings for health budgets.

Fluoroscopic and Endoscopic Gastrostomy Tube Placement: Regional Variation and Their Prevalence

Abstract Objective This study aims to assess the regional variation and overall longitudinal prevalence of approaches to gastrostomy tube placement in patients covered by Medicare or Medicaid. Background Gastrostomy tubes are most commonly inserted endoscopically given the approaches’ demonstrated safety, success, and patient outcomes as compared with laparoscopic approaches. Recently, the growth of interventional radiology services has provided patients with an alternative percutaneous approach. The safety and efficacy of this approach as opposed to endoscopic approaches has yet to be determined. Methods From 2005 to 2014, Medicare Standard Analytic Files derived from Medicare parts A and B, which contain 100% of inpatient and outpatient facility records billed to Medicare, were retrospectively analyzed. Age, sex, year of placement, region, comparative quarterly ratio, regional cost variation, and overall financial cost were compared between both cohorts. Results Our population included a total of 336,021 patients; of those, 30,327 patients underwent fluoroscopic guided procedures, and 305,694 patients underwent endoscopic procedures. Age (p &lt; 0.001), region (p = 0.043), and year of placement (p &lt; 0.001) varied significantly between these populations. Fluoroscopic-guided procedures were found to have a statistically significantly lower average cost of treatment compared with endoscopic gastrostomies ($2,018.62 vs. $2,471.33, respectively, p = 0.03). Conclusion This study demonstrates an increasing prevalence of fluoroscopically placed gastrostomy tubes as compared with those placed endoscopically.

04:21 PM Abstract No. 362 Time to reevaluate the wings? A case series of thrombotic complications of Angel® catheters

Pre and post market experience with the Angel® catheter to evaluate efficacy, complication rates, and management strategy. Retrospective search of our database yielded 11 patients who underwent Angel® catheter placement from January 2016 to July 2018 with subsequent involvement of the interventional radiology service. Patient demographics, primary diagnosis, length of hospital stay, days from admission to catheter placement, days from catheter placement to removal, approach, catheter insertion length, time from placement to anticoagulation, specialty of operator, level of training, clot burden prior to retrieval, final catheter position, presence of imaging-proven deep venous thrombosis (DVT) whilst catheter in place, need for additional procedures, and complications of Angel® catheter were recorded (Table 1). All 11 patients (9 men, 2 women) underwent Angel® catheter placement at bedside under ultrasound guidance by 11 non-radiologist physicians (100%) of which 9 (81.8%) were in-training. Principal reason for admission was intracranial hemorrhage (ICH) for all patients with 9 due to trauma. Mean catheter insertion length was 25.3±4.2 cm. Catheters were left in place on average 13±3.4 days prior to first removal attempt with 8 of 11 (72.7%) catheters thrombosed at that time. 6 out of 11 (54.6%) required suprarenal IVC filter before removal while 7 of 11 (63.6%) overall required additional procedures prior to or for removal. Catheter placement to start of anticoagulation was 12.3±4.4 days. Admission to catheter placement was 4.1±1.9 days while overall length of stay was 46.5±26.6 days. One patient required contralateral replacement following unintentional removal while another patient had pulmonary embolism despite catheter placement. Based on our limited experience, Angel® catheter is associated with a high rate of caval thrombosis, need for additional invasive procedures, and increased morbidity.Table 1Angel® Catheter PerformanceCharacteristicsNoIndications Contraindication to pharmacologic prophylaxis11 (100%) Trauma9 Non-traumatic ICH2Facility location of catheter placement ICU bedside11 (100%)Approach: Right femoral11 Left femoral1*Operator Specialty: Non-radiologist11 (100%)Operator level of training: In training9 (81.82%)Time between admission and device insertion (days)4.09 ± 1.92Time between insertion and removal (days)13 ± 3.44Time between placement and starting anticoagulation (days)12.3 ± 4.4Average insertion length (cm)25.33 ± 4.21Final catheter position on abdominal radiograph T122 L1-L26 L2-L32 L3-L41DVT on Doppler ultrasound while catheter in place4 Right3 Left1Clot detection before retrieval Total8 (72.73%)Clot burden Extensive4 Large0 Moderate1 Small3Accidental catheter removal1Pulmonary embolism1No. requiring additional procedures: Overall7 (63.63%) Suprarenal filter placement6 (54.55%)*Accidental catheter removalDVT, deep vein thrombosis; ICH, intracranial hemorrhage; ICU, intensive care unit. Open table in a new tab

Retrievable inferior vena cava filters in neurosurgical patients: Retrieval rates and clinical outcomes

ObjectiveTo assess inferior vena cava (IVC) filter retrieval rates and clinical outcomes in neurosurgical patients and to determine patient characteristics associated with filter retrieval. Patients and methodsThis single-center retrospective study included 204 consecutive neurosurgical patients (120 men, 84 women; mean age 60 ± 13 years) who underwent retrievable IVC filter insertion between 1/2011-9/2013. Institutional IVC filter database review was used to identify demographic and clinical data, indication for IVC filtration, and IVC filter type. Patients were followed clinically by the neurosurgical, hematology, and interventional radiology services until removal or conversion to a permanent device. Measured outcomes included filter retrieval rates and parameters associated with device removal. ResultsThe majority of filters were placed for venous thromboembolism (200/204, 98%). Of 204 filters, 38(19%) were retrieved at median 186 days post-placement (range 3–665 days), 112(55%) converted to permanent devices, 44(22%) patients were deceased, and 10(5%) patients were lost to follow-up after transfer to an outside healthcare facility. Patients with subarachnoid hemorrhage (18% vs. 35%, p = 0.025) and malignancy (5% vs. 25%, p = 0.009) were less likely to have filters removed. Filter type (p = 0.475), gender (p = 0.221), neurosurgical procedure (p = 0.639), and insurance status (p = 0.207) did not demonstrate a significant association with filter retrieval. ConclusionIVC filter retrieval rates in neurosurgical patients are low despite tracking patients clinically in a multidisciplinary setting. Those neurosurgical patients with intracranial hemorrhage or malignancy requiring IVC filters have a lower likelihood of filter retrieval and may benefit from use of permanent devices.

Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure.

Abnormal invasion of placenta or placenta accreta spectrum disorders refer to the penetration of the trophoblastic tissue through the decidua basalis into the underlying uterine myometrium, the uterine serosa or even beyond, extending to pelvic organs. It is classified depending on the degree of invasion into placenta accreta (invasion <50% of the myometrium), increta (invasion >50% of the myometrium) and percreta (invading the serosa and adjacent pelvic organs). Clinical diagnosis is made intra-operatively; however, the confirmative diagnosis can only be made after a histopathological examination. The incidence of abnormal invasion of placenta has increased worldwide, mostly as a consequence of the rise in caesarean section rates, from 1 in 2500 pregnancies to 1 in 500 pregnancies. The importance of the disease is due to the increased maternal and foetal morbidity and mortality. Foetal implications are mainly due to iatrogenic prematurity, while maternal implications are mostly the increased risk of obstetric haemorrhage and surgical complications. The average blood loss is 3000–5000 mL, and up to 90% of the patients require a blood transfusion. An accurate and timely antenatal diagnosis is essential to improve outcomes. The traditional management of abnormal invasion of placenta has been a peripartum hysterectomy; however, the increased incidence and the short- and long-term consequences of a radical approach have led to the development of more conservative techniques, such as the intentional retention of the placenta, partial myometrial excision and the ‘Triple P procedure’. Irrespective of the surgical technique of choice, women with a high suspicion or confirmed abnormally invasive placenta should be managed in a specialist centre with surgical expertise with a multi-disciplinary team who is experienced in managing these complex cases with an immediate availability of blood products, interventional radiology service, an intensive care unit and a neonatal intensive care unit to optimize the outcomes.

Access to Interventional Radiology Services in Small Hospitals and Rural Communities: An ACR Membership Intercommission Survey

PurposeTo evaluate the status of interventional radiology (IR) staffing, recruitment, and retention in the United States, specifically as they apply to small hospitals and rural communities. Materials and MethodsA 22-question survey was created by an ACR intercommission workgroup and circulated via e-mail to ACR members who self-identified as a “group practice leader,” “general radiologist,” “interventional radiologist,” or “abdominal radiologist.” Contingency tables were constructed, and bivariate analyses were performed to assess overall responses and the distribution of responses among specific groups of respondents. ResultsA total of 1,005 e-mail recipients completed the survey. A statistically significant greater proportion of responders from rural hospitals (versus nonrural hospitals) answered that (1) their group falls short or far short of meeting demand for IR services (29.1% versus 14.3%), (2) they had difficulty recruiting IR physicians to their practice (67% versus 40.6%), and (3) they had difficulty retaining IR physicians (40% versus 29%). The most frequently reported reasons for difficulty recruiting were that IR-trained physicians “do not want to do diagnostic work” (56.2%) and “do not want to practice in a small or rural setting” (48.8%). A greater proportion of respondents from rural hospitals perceived that they had difficulty retaining IR physicians because of perceived inadequate “complexity of case mix” (67.5%) or “number of cases” (66.1%). ConclusionSmall hospitals and rural communities experience greater difficulty recruiting and retaining IR physicians and meeting IR service demands compared with their nonrural counterparts.

Role of Percutaneous Transcatheter Embolization of Gonadal Vein Using N-Butyl Cyanoacrylate in Treatment of Varicocele

Background: Percutaneous embolization of the internal spermatic vein to treat varicoceles is a minimally invasive outpatient procedure that, when performed by experienced interventional radiologists, has high technical success rates, low recurrence rates, very low morbidity and minimal radiation. It has been demonstrated to be equal to surgical ligation in clinical results and as or more cost effective. Its minimally invasive nature allows it be well tolerated with shorter recovery times and less discomfort relative to surgery. When skilled and experienced vascular and interventional radiology services are available, embolization is an effective alternative to surgery and should be offered as such or as primary therapy for varicocele treatment. Objective: The aim of this study is to discuss the role of N-buty cyanoacrylate for gonadal vein embolization in treatment varicocele causing testicular pain or infertility. Methodology: this study was carried out in Radiology Department of Ain Shams University Hospitals. This сross seсtionaƖ desсriptive study inсƖuded 20 patients with variсoсeƖe presented ƅy pain, infertility or recurrence after surgery and diaɡnosis was confirmed ƅy uƖtrasound. Result: varicocele embolization has significant role in improving scrotal pain and infertility.

Metastatic Neuroendocrine Tumor of the Pancreas Presenting With Gastric Variceal Hemorrhage

Pancreatic neuroendocrine tumors (PNETs) are rare, typically indolent neoplasms with a reported incidence of 0.43 per 100,000 persons per year. PNETs can occasionally invade adjacent vasculature structures with resultant vessel occlusion. This differs from other pancreatic malignancies which typically induce venous thrombosis. Gastric variceal hemorrhage is a rare complication of PNETs which can occur from tumor invasion of the splenic vein. A 56 year-old woman with a past medical history of pancreatic neuroendocrine tumor metastatic to the liver presented with a 2 week history of nausea and a 1 day history of hematemesis. She was tachycardic but normotensive on admission. Serum hemoglobin had decreased from 14.4 g/dL a week prior to 10.6 g/dL on admission. Emergent esophagogastroduodenoscopy in the critical care unit demonstrated a hematocystic spot on a gastric varix with additional fundal and gastric varices. No esophageal varices were seen. Computerized tomography scan of the abdomen demonstrated vascular occlusion of the splenic vein at the hilum from local invasion of the splenic vein by a known pancreatic tail neuroendocrine tumor. There were unchanged liver metastatic lesions without radiologic evidence of cirrhosis. Notably, liver enzymes and serum lipase were normal. The patient was transfused with 1 unit of packed red blood cells and had no further bleeding after selective embolization of the gastric varices by the interventional radiology service. Splenic vein thrombosis (SVT) and gastric variceal hemorrhage are known complications of pancreatitis and pancreatic adenocarcinoma. Venous thrombosis occurs from local inflammation, fibrotic tendencies, and possibly a hypercoagulable state. Splenic vein occlusion is a rare complication of PNETs occurring from local tumor invasion of the splenic vein. SVT and occlusion can cause regional portal hypertension and upper gastrointestinal bleeding (UGIB). Splenectomy and possibly local resection are the standard therapies for PNETs with associated gastric variceal hemorrhage. Radiologic gastric variceal embolization is a treatment option which can be particularly useful in patients with known metastatic disease. Endoscopic injection with cyanoacrylate glue is an additional therapeutic modality but is not Food and Drug Administration approved in the United States. SVT and gastric variceal hemorrhage are rare complications that should be included in the differential diagnosis of UGIB in patients with PNETs.2006_A Figure 1. Gastric varices with a hematocystic spot on a varix2006_B Figure 2. Yellow arrow: Hepatic Metastasis Red arrow: Pancreatic neuroendocrine mass with apparent splenic vein thrombosis

Quality of life after out of hospital interventional orthopaedic &amp; regenerative medicine procedures in an integrated service delivery model

Background &amp; Aim: Out of hospital interventional orthopaedic and regenerative medicine (IORM) procedures are a new addition to the subspecialty of interventional radiology. This study aimed to assess health outcomes following IORM procedures in an outpatient integrated service delivery model in clinical practice.Methods: Retrospective study of all patients who completed the pre- and post-procedure EuroQol 5D5L questionnaire over a 6 month period.Results: Forty-eight patients (age range=32-89, mean=60.5, median=63.5 years) were eligible. Mean and median pre-treatment EQ5D5L index values of 0.53 and 0.61(range: -0.248 to 0.879, SD: 0.28, 95% CI: [0.45, 0.61]) improved to 0.73 and 0.73 (range: 0.414-1.0; SD: 0.13, 95% CI [0.69, 0.76]) (p &lt; 0.01, Cohen ‘d’ = 0.93) post-treatment. Improvements in ‘no problems’ in each health dimension were: pain (mathematical infinity), mobility (109%), usual activities (137.5%), self- care (56%), anxiety/depression (23.3%). Reductions in ‘any problems’ in each dimension of health were: pain (-14.5%), mobility (-32%), usual activities (-27.5%), self-care (-60.87%), anxiety/depression (-38.8%). Pre-treatment, a strong negative correlation between EQ5D5L index values versus mobility levels (r = -0.67, p &lt; 0.01) and versus usual activities (r = -0.62, p &lt; 0.01) was present. Post-treatment, a strong negative correlation between EQ5D5L index scores versus pain level (r = -0.68, p &lt;0.01) and versus mobility (r = -0.75, p &lt;0.01) was present.Conclusion: Significant improvements in all health dimensions with a large treatment effect was shown following outpatient IORM procedures in an integrated interventional radiology service delivery model. Improvements in mobility and pain were the most important determinants of health.

The Challenges of Providing Interventional Radiology Services to Rural and Smaller Community Hospitals.

Recruitment and retention of interventional radiologists for rural and smaller community hospital practices is a serious physician staffing issue. This article explores rural interventional radiology and perspectives of various stakeholders, such as rural radiology group practices, rural hospitals, interventional radiologists, public and private academic institutions, and urban health care providers, and considers the unique health care needs of rural patients. Some early solutions are evident. Collaboration among all stakeholders will be necessary to properly address the challenges.

Impact of Performing Nonurgent Interventional Radiology Procedures on Weekends

Most clinical services limit weekend care to urgent or emergent situations. However, providing access to nonemergent procedures on weekends may reduce length of hospital stay and unnecessary admissions. No data are available on the impact of providing nonemergent interventional radiology (IR) procedural services on weekends. A retrospective review of nonurgent IR inpatient services on weekends over a 12-month period was performed. Using intent-to-treat analysis, 453 procedures were performed on 447 patients on 100 weekend days. Procedures included venous access (116 of 453, 25.6%), dialysis interventions (83 of 453, 18.3%), enteral access (73 of 453, 16.1%), genitourinary interventions (37 of 453, 8.2%), venous interventions (35 of 453, 7.7%), biliary interventions (33 of 453, 7.3%), percutaneous drainage (32 of 453, 7.1%), biopsy (24 of 453, 5.3%), arterial interventions (14 of 453, 3.1%), and other (3 of 453, 0.7%). Routine weekend procedural services allowed 108 of 447 (24.2%) patients to be discharged earlier than anticipated if such services were not available, resulting in 174 hospital days gained. Procedures were performed earlier than anticipated in 268 of 447 (60.0%) patients resulting in 415 days of progression of care gained over the 12-month period. For dialysis interventions, 35% (29 of 83) of patients received hemodialysis within 24 hours of intervention, and 25 patients were discharged early with 33 hospital days saved. IR procedures were performed on patients from 97% of the hospital inpatient units (22 of 23 inpatient or observation units, and 10 of 10 intensive care units) over the 12-month period. In conclusion, increased availability of nonurgent IR services on weekends can directly reduce hospital length of stay as well as improve progression of inpatients toward an early discharge.

Massive Pulmonary Embolism Thrombolysis: Early Clinical Markers of Treatment Efficacy

AbstractThe authors seek to evaluate hemodynamic parameters as potential clinical markers of real-time clinical improvement among patients with massive pulmonary embolism (PE) in correlation with post-thrombolytic pulmonary arterial pressure improvement and overall clinical outcome. Thirteen patients with submassive or massive PE were admitted to the interventional radiology service and treated with catheter-directed thrombolysis. Among the four patients who qualified as massive PE, systolic blood pressure (BP) and vasopressor dependence suggested meaningful trends toward clinical improvement, after only 26.4% of treatment course/dose. Hemodynamic parameters such as systolic BP and inotropic vasopressor dependence may be considered in future treatment protocols as early indicators of treatment response.

Liver Trauma in South Wales: the Cardiff Protocol

The liver is the most commonly injured organ following trauma. Management of liver trauma has shifted away from surgical intervention towards non-operative management (NOM), and with careful observation, regular re-examination and utilisation of interventional radiological services, there has been an improvement in outcomes. Mortality following liver trauma is quoted at 10–15%. Patients admitted between 1st January 2009 and 31st December 2014 were identified via our Trauma Audit and Research Network (TARN) officer and from CT scan reports containing the words biloma, contusion, laceration and trauma. Liver injuries were graded by a consultant radiologist using the AAST scale. Information on interventions and outcomes was gathered from a combination of TARN data and case note review. Eighty-eight patients were identified with a median age of 26 (2–71). Fifty-one patients (58%) were male. Incidence peaked in the third decade with both men and women. Median ISS was 22 (4–59). Blunt trauma was the cause in 76 (86%) of the patients. Seven patients died prior to scanning or laparotomy. Eighteen patients required laparotomy; the remaining 63 patients were managed non-operatively. Overall mortality was 13.6%—all fatalities occurring within the blunt trauma group. Mortality following laparotomy was 22% and higher in males (15.7 vs 10.8%). Non-operative management (NOM) for liver trauma is well established at our hospital. Our mortality rate is comparable to larger series. A blunt mechanism of injury and the need for surgical intervention both represent poor prognostic factors in patients with liver trauma.

Management of paediatric high-grade blunt renal trauma: a 10-year single-centre UK experience.

To report the management and outcome of paediatric patients sustaining high-grade blunt renal trauma. Medical records were examined for all American Association for the Surgery of Trauma (AAST) grade III-V blunt renal trauma cases admitted to a paediatric trauma centre from 2005 to 2015. Data collected and analysed included: demographics, imaging modalities, management, length of hospital stay (LOS), complications, and follow-up outcomes. In all, 18 children (12 boys, six girls) with mean (range) age 11 (4-15) years were included. According to the AAST grading criteria, 39% (seven of 18) of the patients had grade III, 50% (nine of 18) grade IV, and 11% (two of 18) grade V injuries; 44% (eight of 18) had concomitant injuries. Most of the patients were managed conservatively (89%, 16 of 18), although two of the 16 subsequently needed JJ-stent insertion during inpatient stay for symptomatic urinoma(s). In all, 11% (two of 18) of the patients required interventional radiology service(s), involving selective embolisation for life-threatening renal tract haemorrhage. Blood transfusion for renal injury exclusively was required in 11% (two of 18) of the patients. In all, 89% (16 of 18) of the patients had at least one follow-up imaging study before hospital discharge; most (13 of 16) had ultrasonography and three required computed tomography. The median (range) LOS was 11 (4-31) days. In all, 17% (three of 18) of the patients required hospital re-admission within 30 days for complications and all required interventional procedures: JJ stent for urinoma (one), embolisation of renal arterio-venous fistula (one), and embolisation for a post-traumatic pseudoaneurysm (one). Overall, the median (range) follow-up was 6 (2-60) months. In all, 78% (14 of 18) of the patients had dimercaptosuccinic acid studies, with 11 showing reductions in renal function (range 3-44%). This study supports a care pathway strategy advocating conservative management of high-grade renal injuries in children. However, patients may experience a relative decline in renal function with higher grade injuries indicating the need for monitoring and follow-up.

The management of rectal bleeding following transrectal prostate biopsy: A review of the current literature.

Since the advent of prostate-specific antigen (PSA)-based testing, transrectal ultrasound (TRUS)-guided prostate biopsy has become a standard part of the diagnostic pathway for prostate cancer (PCa). Rectal bleeding is one of the common side effects of this transrectal route. While rectal bleeding is usually mild and self-limiting, it can be life-threatening. In this article, we examine rectal bleeding post-TRUS-guided prostate biopsy and explore the literature to evaluate techniques and strategies aimed at preventing and managing this common and important complication. A PubMed literature search was carried out using the keywords "transrectal-prostate-biopsy-bleed." A search of the bibliography of reviewed studies was also conducted. Additionally, papers in non-PubMed-listed journals of which the authors were aware were appraised. Numerous modifiable risk factors for this bleeding complication exist, particularly anticoagulants/antiplatelets and the number of core biopsies taken. Successfully described corrective measures for such rectal bleeding include tamponade (digital/packs/catheter/tampon/condom), endoscopic sclerotherapy/banding/clipping, radiological embolization, and surgical intervention. We advocate early consultation with the colorectal/gastroenterology and interventional radiology services and a progressive, stepwise approach to the management of post-biopsy rectal bleeding, starting with resuscitation and conservative tamponade measures, moving to endoscopic hemostasis ± radiological embolization ± transanal surgical methods. Given the infrequent but serious nature of major rectal bleeding after TRUS biopsy, we recommend the establishment of centralized databases or registries forthwith to prospectively capture such data. To the best of our knowledge, this is the first comprehensive look specifically at the management of post-TRUS biopsy rectal bleeding.

A nationwide population-based cohort study of peripartum hysterectomy and arterial embolisation in Belgium: results from the Belgian Obstetric Surveillance System

ObjectivesTo assess the prevalence of major obstetric haemorrhage managed with peripartum hysterectomy and/or interventional radiology (IR) in Belgium. To describe women characteristics, the circumstances in which the interventions took place,...

Teaching IR to Medical Students: A Call to Action.

Interventional radiology (IR) has grown rapidly over the last 20years and is now an essential component of modern medicine. Despite IR's increasing penetration and reputation in healthcare systems, IR is poorly taught, if taught at all, in most medical schools. Medical students are the referrers of tomorrow and potential IR recruits and deserve to be taught IR by expert IRs. The lack of formal IR teaching curricula in many medical schools needs to be addressed urgently for the continued development and dissemination of, particularly acute, IR services throughout Europe. We call on IRs to take up the baton to teach IR to the next generation of doctors.

Pediatric interventional radiology workforce survey: 10-year follow-up.

Pediatric interventional radiology is a distinct subspecialty differing from both pediatric diagnostic radiology and adult interventional radiology. We conducted a workforce survey in 2005 to evaluate the state of pediatric interventional radiology at that time. Since then there have been many advancements to the subspecialty, including the founding of the Society for Pediatric Interventional Radiology (SPIR). To evaluate the current state of the pediatric interventional radiology workforce and compare findings with those of the initial 2005 workforce survey. We sent a two-part survey electronically to members of SPIR, the Society for Pediatric Radiology (SPR), the Society of Chairmen of Radiology in Children's Hospitals (SCORCH) and the Society of Interventional Radiology (SIR). Part 1 focused on individual practitioners (n=177), while part 2 focused on group practices and was answered by a leader from each group (n=88). We examined descriptive statistics and, when possible, compared the results to the study from 2005. A total of 177 individuals replied (a 331% increase over the first study) and 88 pediatric interventional radiology (IR) service sites responded (a 131.6% increase). Pediatric IR has become a more clinically oriented specialty, with a statistically significant increase in services with admitting privileges, clinics and performance of daily rounds. Pediatric IR remains diverse in training and practice. Many challenges still exist, including anesthesia/hospital support, and the unknown impact of the new IR residency on pediatric IR training, although the workforce shortage has been somewhat alleviated, as demonstrated by the decreased mean call from 165days/year to 67.2days/year. Pediatric interventional radiology practitioners and services have grown significantly since 2005, although the profile of this small subspecialty has changed and some challenges remain.

Interventional Radiology service provision and practice for the management of traumatic splenic injury across the Regional Trauma Networks of England

IntroductionThe management of blunt splenic injuries (BSI) has evolved toward strategies that avoid splenectomy. There is growing adoption of interventional radiology (IR) techniques in non-operative management of BSI, with evidence suggesting a corresponding reduction in emergency laparotomy requirements and increased splenic preservation rates. Currently there are no UK national guidelines for the management of blunt splenic injury. This may lead to variations in management, despite the reorganisation of trauma services in England in 2012. Materials and methodsA survey was distributed through the British Society of Interventional Radiologists to all UK members aiming to identify availability of IR services in England, radiologists’ practice, and attitudes toward management of BSI. Results116 responses from respondents working in 23 of the 26 Regional Trauma Networks in England were received. 79% provide a single dedicated IR service but over 50% cover more than one hospital within the network. All offer arterial embolisation for BSI. Only 25% follow guidelines.In haemodynamically stable patients, an increasing trend for embolisation was seen as grade of splenic injury increased from 1 to 4 (12.5%–82.14%, p<0.01). In unstable patients or those with radiological evidence of bleeding, significantly more respondents offer embolisation for grade 1–3 injuries (p<0.01), compared to stable patients. Significantly fewer respondents offer embolisation for grade 5 versus 4 injuries in unstable patients or with evidence of bleeding. ConclusionSplenic embolisation is offered for a variety of injury grades, providing the patient remains stable. Variation in interventional radiology services remain despite the introduction of regional trauma networks.