Vascular Interventional Radiology Procedures Research Articles

Personal Protective Equipment for Common Urologic Procedures Before and During the United States COVID-19 Pandemic: A Single Institution Study

OBJECTIVETo evaluate the personal protective equipment (PPE) utilized in common urologic procedures before and during the COVID-19 outbreak in the United States. As elective urologic procedures are being reduced to conserve resources, we sought to quantify the PPE used per case to determine the impact on potentially limited resources needed for protecting healthcare providers treating COVID-19 patients.METHODSAn IRB approved retrospective analysis of all urologic procedures in March 2019 and March 2020 was performed. Additionally, all urologic procedures performed by vascular interventional radiology (VIR) in May 2019 and March 2020 were included in the analysis. Case length, surgical and operating room staff present and number of articles of PPE were quantified. Articles of PPE were defined as surgical bonnet/hat and mask, and disposable or reusable gown with 1 pair of surgical gloves.RESULTSFour hundred and thirty-seven urologic and VIR procedures were included in the analysis. The mean PPE per case varied significantly between endoscopic and robotic categories. Robotic assisted laparoscopic cystectomy required the most hats and masks (14.5 per case in March 2019) whereas percutaneous nephrostomy tube placement by VIR required the fewest (3.1 in May 2019 and March 2020).CONCLUSIONPPE consumption varied significantly across urologic procedures. Robotic-assisted cases require the most PPE and percutaneous nephrostomy placement by VIR requires the fewest. While PPE shortages are currently being addressed national and internationally, our results provide a baseline benchmark for articles of PPE required should another pandemic or global disaster requiring careful attention to resource allocation occur in the future.

Opening the Black Box: How Interventional Radiology Can Help Our Patients in Hospice and Palliative Care (SA504)

•Describe indications for four commonly used interventional procedures for patients with serious illness.•Explain the clinical experience of patients undergoing a tunneled catheter placement, kyphoplasty, celiac plexus block, and other common procedures.•Identify the most and least cost-effective procedures that VIR clinicians can perform for four common palliative care conditions. Thanks to rapidly advancing technology, the number of clinical interventions to treat serious illnesses grows each year. Vascular Interventional Radiology (VIR) is at the center of medicine’s procedural growth and has become a vital part of clinicians’ symptom management toolbox. Unfortunately, most clinicians practicing Palliative Care (PC) have had little interaction with VIR providers and, while often understanding the purpose of available procedures, have not seen and cannot explain to patients the experience of undergoing common VIR procedures. How can PC and hospice clinicians understand the complex and ever changing landscape of VIR? In this explanation and demonstration-heavy concurrent session, an academic palliative care and hospice physician with training in business and the Interventional Radiology residency/fellowship program director at a large academic hospital will join together to expose attendees to the ‘how and why’ of VIR. Evidence-based indications for common procedures like gastrostomy and jejunostomy feeding tube placement, thoracic and abdominal drainage catheter placement, kyphoplasty, celiac plexus block, and others will be provided and these procedures will be explained using a combination of hands-on demonstration, video, and illustration. In addition to the clinical aspects of each procedure, the patient experience of undergoing these interventions will be described and samples of the tools and devices being discussed will be circulated through the audience to encourage high-level understanding. Under the Medicare Hospice benefit, hospices must bear the cost of these interventions. We will discuss the relative costs of typical interventions for ascites, pleural effusion, and compression fractures and share strategies to ensure interventions are cost-effective both initially and over time. Remaining current with technological advances is difficult, especially for clinicians who practice outside the acute hospital setting. This concurrent session will shine light in the black box of VIR to improve care for many of our patients.

Efficiency of personal dosimetry methods in vascular interventional radiology

PurposeThe aim of the present study was to determine the efficiency of six methods for calculate the effective dose (E) that is received by health professionals during vascular interventional procedures. MethodsWe evaluated the efficiency of six methods that are currently used to estimate professionals’ E, based on national and international recommendations for interventional radiology. Equivalent doses on the head, neck, chest, abdomen, feet, and hands of seven professionals were monitored during 50 vascular interventional radiology procedures. Professionals’ E was calculated for each procedure according to six methods that are commonly employed internationally. To determine the best method, a more efficient E calculation method was used to determine the reference value (reference E) for comparison. ResultsThe highest equivalent dose were found for the hands (0.34±0.93mSv). The two methods that are described by Brazilian regulations overestimated E by approximately 100% and 200%. The more efficient method was the one that is recommended by the United States National Council on Radiological Protection and Measurements (NCRP). The mean and median differences of this method relative to reference E were close to 0%, and its standard deviation was the lowest among the six methods. ConclusionsThe present study showed that the most precise method was the one that is recommended by the NCRP, which uses two dosimeters (one over and one under protective aprons). The use of methods that employ at least two dosimeters are more efficient and provide better information regarding estimates of E and doses for shielded and unshielded regions.

Inferior Vena Cava System Anomalies: Surgical Implications.

The inferior vena cava (IVC) system is the major venous collecting blood network of the human body. This structure is formed in a complicated series of developmental stages between the fourth and eighth weeks of intrauterine life. Alterations in the developing process of the IVC system give rise to an array of different congenital variants or developmental anomalies. IVC anomalies are uncommon, usually of little physiological consequence, and mostly discovered incidentally during cross-sectional imaging in otherwise healthy individuals. However, they do have implications of relevance to surgeons because they may lead to significant complications during vascular interventional radiology procedures and retroperitoneal surgery when undiagnosed. This review synthesizes the current literature pertaining the development and identification of IVC anomalies, highlighting their possible implications for surgical procedures involving this retroperitoneal vessel.

Occupational radiation exposure in vascular interventional radiology: A complete evaluation of different body regions

PurposeTo perform a complete evaluation on radiation doses, received by primary and assistant medical staff, while performing different vascular interventional radiology procedures. Materials and methodsWe evaluated dose received in different body regions during three categories of vascular procedures: lower limb angiography (Angiography), lower limb percutaneous transluminal angioplasty (Angioplasty) and stent graft placement for abdominal aortic aneurysm treatment (A. A. A. Treatment). We positioned the dosimeters near the eye lens, thyroid, chest, abdomen, hands, and feet of the interventional physicians. Equivalent dose was compared with annual dose limits for workers in order to determine the maximum number of procedures per year that each physician could perform. We assessed 90 procedures. ResultsWe found the highest equivalent doses in the A. A. A. Treatment, in which 90% of the evaluations indicated at least one region receiving more than 1mSv per procedure. Angioplasty was the only procedural modality that provided statistically different doses for different professionals, which is an important aspect on regards to radiological protection strategies. In comparison with the dose limits, the most critical region in all procedures was the eye lens. ConclusionsSince each body region of the interventionist is exposed to different radiation levels, dose distribution measurements are essential for radiological protection strategies. These results indicate that dosimeters placed in abdomen instead of chest may represent more accurately the whole body doses received by the medical staff. Additional dosimeters and a stationary shield for the eye lens are strongly recommended.

SU‐D‐209‐03: Radiation Dose Reduction Using Real‐Time Image Processing in Interventional Radiology

Purpose:To characterize changes in radiation dose after introducing a new real‐time image processing technology in interventional radiology systems.Methods:Interventional radiology (IR) procedures are increasingly complex, at times requiring substantial time and radiation dose. The risk of inducing tissue reactions as well as long‐term stochastic effects such as radiation‐induced cancer is not trivial. To reduce this risk, IR systems are increasingly equipped with dose reduction technologies.Recently, ClarityIQ (Philips Healthcare) technology was installed in our existing neuroradiology IR (NIR) and vascular IR (VIR) suites respectively. ClarityIQ includes real‐time image processing that reduces noise/artifacts, enhances images, and sharpens edges while also reducing radiation dose rates. We reviewed 412 NIR (175 pre‐ and 237 post‐ClarityIQ) procedures and 329 VIR (156 preand 173 post‐ClarityIQ) procedures performed at our institution pre‐ and post‐ClarityIQ implementation. NIR procedures were primarily classified as interventional or diagnostic. VIR procedures included drain port, drain placement, tube change, mesenteric, and implanted venous procedures. Air Kerma (AK in units of mGy) was documented for all the cases using a commercial radiation exposure management system.Results:When considering all NIR procedures, median AK decreased from 1194 mGy to 561 mGy. When considering all VIR procedures, median AK decreased from 49 to 14 mGy. Both NIR and VIR exhibited a decrease in AK exceeding 50% after ClarityIQ implementation, a statistically significant (p<0.05) difference. Of the 5 most common VIR procedures, all median AK values decreased, but significance (p<0.05) was only reached in venous access (N=53), angio mesenteric (N=41), and drain placement procedures (N=31).Conclusion:ClarityIQ can reduce dose significantly for both NIR and VIR procedures. Image quality was not assessed in conjunction with the dose reduction.

Pediatric Interventional Radiology: Vascular Interventions.

Pediatric interventional radiology (PIR) comprises a range of minimally invasive diagnostic and therapeutic procedures that are performed using image guidance. PIR has emerged as an essential adjunct to various surgical and medical conditions. Over the years, technology has undergone dramatic and continuous evolution, making this speciality grow. In this review, the authors will discuss various vascular interventional procedures undertaken in pediatric patients. It is challenging for the interventional radiologist to accomplish a successful interventional procedure. There are many vascular interventional radiology procedures which are being performed and have changed the way the diseases are managed. Some of the procedures are life saving and have become the treatment of choice in those patients. The future is indeed bright for the practice and practitioners of pediatric vascular and non-vascular interventions. As more and more of the procedures that are currently being performed in adults get gradually adapted for use in the pediatric population, it may be possible to perform safe and successful interventions in many of the pediatric vascular lesions that are otherwise being referred for surgery.

Iatrogenic percutaneous vascular injuries: clinical presentation, imaging, and management.

Vascular interventional radiology procedures are relatively safe compared with analogous surgical procedures, with overall major complication rates of less than 1%. However, major vascular injuries resulting from these procedures may lead to significant morbidity and mortality. This review will discuss the etiology, clinical presentation, diagnosis, and management of vascular complications related to percutaneous vascular interventions. Early recognition of these complications and familiarity with treatment options are essential skills for the interventional radiologist.

A preliminary real-time and realistic simulation environment for percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) is a minimally invasive surgery procedure that is widely used in the treatment of coronary artery disease. This procedure requires interventional cardiologists to have high proficiency and therefore demands an extensive training period in order to ensure successful surgical outcome. In this paper, a realistic and real-time interactive simulator for training PCI procedure is presented. A set of new approaches for core simulation components is devised and integrated into the simulator. Trainees can interact with the virtual simulation environment with real instruments and essential maneuvers encountered in real PCI procedure. Although presently targeted at PCI, our simulator could be easily extended to mimic the necessities of any vascular interventional radiology procedures by updating vascular anatomy. Preliminary validation of the proposed physical model of instruments is conducted on vascular phantom to demonstrate its performance and effectiveness.

Reducing Error and Improving Efficiency during Vascular Interventional Radiology: Implementation of a Preprocedural Team Rehearsal

To determine the type and frequency of errors during vascular interventional radiology (VIR) and design and implement an intervention to reduce error and improve efficiency in this setting. Ethical guidance was sought from the Research Services Department at Imperial College London. Informed consent was not obtained. Field notes were recorded during 55 VIR procedures by a single observer. Two blinded assessors identified failures from field notes and categorized them into one or more errors by using a 22-part classification system. The potential to cause harm, disruption to procedural flow, and preventability of each failure was determined. A preprocedural team rehearsal (PPTR) was then designed and implemented to target frequent preventable potential failures. Thirty-three procedures were observed subsequently to determine the efficacy of the PPTR. Nonparametric statistical analysis was used to determine the effect of intervention on potential failure rates, potential to cause harm and procedural flow disruption scores (Mann-Whitney U test), and number of preventable failures (Fisher exact test). Before intervention, 1197 potential failures were recorded, of which 54.6% were preventable. A total of 2040 errors were deemed to have occurred to produce these failures. Planning error (19.7%), staff absence (16.2%), equipment unavailability (12.2%), communication error (11.2%), and lack of safety consciousness (6.1%) were the most frequent errors, accounting for 65.4% of the total. After intervention, 352 potential failures were recorded. Classification resulted in 477 errors. Preventable failures decreased from 54.6% to 27.3% (P < .001) with implementation of PPTR. Potential failure rates per hour decreased from 18.8 to 9.2 (P < .001), with no increase in potential to cause harm or procedural flow disruption per failure. Failures during VIR procedures are largely because of ineffective planning, communication error, and equipment difficulties, rather than a result of technical or patient-related issues. Many of these potential failures are preventable. A PPTR is an effective means of targeting frequent preventable failures, reducing procedural delays and improving patient safety.

Cone Beam Computed Tomography for Vascular Interventional Radiology Procedures: Early Experience

Cone beam computed tomography (CBCT) is a relatively new technological innovation that utilises fl at-panel detector technology to obtain CT-like images. The key strength of a CBCT system is that cross-sectional imaging can be obtained using the angiographic fl at panel unit without having to move the patient, allowing the radiologist to obtain soft tissue imaging during the procedure. This allows treatment planning, guidance, and assessment of outcome to be performed in one interventional suite. From December 2008 to June 2009, 24 CBCT scans were performed during vascular interventional procedures on our department's newly installed multi-axis fl at panel angiographic unit. Ten cases were performed for hepatic trans-arterial chemoembolisation, 9 cases for hepatic arterial Yttrium-90 infusion, while 5 cases were for other indications. CBCT was found to be useful in 20 of the 24 cases. Our early experience showed that CBCT was useful in impacting decisions during selected vascular interventional procedures. As CBCT technology improves, we can foresee wider applications of this technology.

Enhancing the case log by coding the level of trainee participation in vascular interventional radiology procedures.

The purpose of this article is to describe a new method for coding trainee participation in vascular interventional radiology procedures. From July 2008 through June 2009, all interventional radiology fellows maintained an enhanced case log at our institution; 748 unique cases were logged by procedure type, supervising physician, and level of participation in the case. Level of participation was classified on a 5-point scale that included designations for observation, first assistant, performance of basic techniques, performance of advanced techniques, and primary operation. Descriptive statistics of participation scores were calculated for each quarter and were analyzed by procedure type and by teaching faculty member. As expected, analysis by procedure type showed that average participation scores increased from one quarter to the next in most cases. By the fourth quarter, the modal participation score was 5, indicating primary operation or performance of multiple critical steps. Analysis by teaching faculty member revealed three patterns: those attending physicians facilitating increasing levels of participation in every quarter, those facilitating maximal growth within the first 6 months, and those with irregular trainee participation profiles. Data from a 5-point participation scale add information to the procedure case log that could be used to quantitatively track the technical progress of trainees while providing education quality feedback to both teaching physicians and program directors.

CIRSE Vascular Closure Device Registry

PurposeVascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology.MethodsThe CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry.ResultsDeployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only <0.5% of patients. Postdeployment bleeding occurred in 6.4%, and most these (51.5%) could be managed with light manual compression. During follow-up, other device-related complications were reported in 1.3%: seven false aneurysms, three hematoma >5.9 cm, and two vessel occlusions.ConclusionThe conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters.

Cuidados de enfermería al paciente sometido a técnicas de neurointervencionismo endovascular

Vascular interventional radiology (VIR) procedures have increased markedly, partly due to the current healthcare context, which encourages the use of less invasive procedures that reduce pressure on surgery departments and decrease hospital stays. In most patients, these techniques can be carried out in a single intervention. VIR procedures are based on the possibility of gaining access to vascular structures through a catheter inserted percutaneously without the need for open surgery. Due to the complexity of these procedures, hospitalization is required before and after the technique is performed but length of stay is short compared with that associated with surgery. As the health workers closest to patients, nurses must respond to their information needs. The provision of comprehensive nursing care should include all the care required before, during and after the procedure and all aspects related to the quality of the healthcare process. Knowledge of how diagnostic and therapeutic VIR techniques are performed in the neurovascular section is essential. Based on the authors' experience, the present article aims to provide nurses with knowledge of some neurointerventional procedures (cerebral angiography and embolization of intracranial aneurysms) and of the care provided in RVI rooms.