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Bozer J, Peng K, Magyer M, Niedermeier M, Makary MS. Interventional radiology education: Patient experience with an educational website. Clin Imaging 2024; 105:110026. [PMID: 37992626 DOI: 10.1016/j.clinimag.2023.110026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to examine the impact of an educational website on patient understanding of Interventional Radiology (IR). MATERIAL AND METHODS An informational website with descriptions and images of 12 common IR procedures was developed with the aim of educating patients. One hundred patients referred to a large, academic institution were randomly selected to participate. Anonymous 11-question, 5-point Likert-scale assessments were administered before and after engaging with the educational website. The survey evaluated patients' understanding of IR procedures and satisfaction with the website as an educational tool. RESULTS One hundred patients completed the pre-/post-implementation evaluations. Among matched questions, there was an increase in patient understanding of IR with mean score improvement from 2.10 to 4.57 (p < 0.001), their knowledge of common procedures from 1.74 to 4.66 (p < 0.001), and their consideration for their next procedure to be with IR from 2.24 to 4.62 (p < 0.001). Additionally, patients had an overall positive impression of the website (mean 4.80). Over 75% of patients found the descriptions and images "very helpful". CONCLUSION This study demonstrated that website use for patient education has the potential to be effective in increasing overall patient understanding of IR and familiarity with common interventional procedures.
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Affiliation(s)
- Jordan Bozer
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Kevin Peng
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Melissa Magyer
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Marilyn Niedermeier
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Mina S Makary
- Department of Radiology, The Ohio State Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA.
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2
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Caplin DM, Young S, Kassin M, Dowell JD, Makary MS, Metwalli ZA, Charalel RA, Halin NJ, Kleedehn M, Lewis PB, Ward TJ, Shah RP. A History and Modern Framework for Quality Improvement in Interventional Radiology. J Vasc Interv Radiol 2023; 34:2012-2019. [PMID: 37517464 DOI: 10.1016/j.jvir.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023] Open
Abstract
Quality improvement (QI) initiatives have benefited patients as well as the broader practice of medicine. Large-scale QI has been facilitated by multi-institutional data registries, many of which were formed out of national or international medical society initiatives. With broad participation, QI registries have provided benefits that include but are not limited to establishing treatment guidelines, facilitating research related to uncommon procedures and conditions, and demonstrating the fiscal and clinical value of procedures for both medical providers and health systems. Because of the benefits offered by these databases, Society of Interventional Radiology (SIR) and SIR Foundation have committed to the development of an interventional radiology (IR) clinical data registry known as VIRTEX. A large IR database with participation from a multitude of practice environments has the potential to have a significant positive impact on the specialty through data-driven advances in patient safety and outcomes, clinical research, and reimbursement. This article reviews the current landscape of societal QI programs, presents a vision for a large-scale IR clinical data registry supported by SIR, and discusses the anticipated results that such a framework can produce.
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Affiliation(s)
- Drew M Caplin
- Division of Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York.
| | - Shamar Young
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
| | - Michael Kassin
- National Institutes of Health Clinical Center, Center for Interventional Oncology, Bethesda, Maryland
| | | | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, Ohio State University Columbus, Ohio
| | - Zeyad A Metwalli
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Resmi A Charalel
- Division of Interventional Radiology, Department of Radiology, and Department of Population Health Sciences (R.A.C.), New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Neil J Halin
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mark Kleedehn
- National Institutes of Health Clinical Center, Center for Interventional Oncology, Bethesda, Maryland
| | - Paul B Lewis
- Department of Radiology, University of Pittsburgh Physicians, Pittsburgh, Pennsylvania
| | - Thomas J Ward
- Department of Radiology, Advent Health Medical Group/Central Florida Division, Orlando, Florida
| | - Rajesh P Shah
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Radiology, Stanford University, Stanford, California
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3
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Fassia MK, Charalel R, Talenfeld AD. Demonstrating the Value of Interventional Radiology. Semin Intervent Radiol 2023; 40:403-406. [PMID: 37927519 PMCID: PMC10622236 DOI: 10.1055/s-0043-1774407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and to develop mechanisms to reimburse health care providers based on the value of the care delivered. This article investigates the meaning of value in healthcare and identifies specific services delivered by interventional radiologists that have accrued evidence that they meet criteria for high-value services. Recognizing the shift in reimbursement to high-value care, it is imperative that interventional radiology (IR) develop the evidence needed to articulate to all relevant stakeholders how IR contributes value to the system.
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Affiliation(s)
- Mohammad-Kasim Fassia
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Resmi Charalel
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Adam D. Talenfeld
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
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4
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Rodgers B, Rodgers KA, Chick JFB, Makary MS. Public Awareness of Interventional Radiology: Population-Based Analysis of the Current State of and Pathways for Improvement. J Vasc Interv Radiol 2023; 34:960-967.e6. [PMID: 36764444 DOI: 10.1016/j.jvir.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/28/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023] Open
Abstract
PURPOSE To evaluate the awareness of interventional radiology (IR) among the public and identify methods for improvement. MATERIALS AND METHODS Participants (N = 1,000) were anonymously surveyed using Amazon's Mechanical Turk crowdsourcing platform about medical and IR-specific knowledge, preferred methods of acquisition of medical information, and suggestions for improving awareness of IR. The survey consisted of 69 questions, including both Likert Scale and free text questions. RESULTS Of the participants, 92% preferred undergoing a minimally invasive procedure over surgery. However, 39.8% recognized IR as a medical specialty, and less than 50% of these participants correctly identified IR as procedurally oriented. Of those who discussed or underwent an IR procedure (n = 113), most were also offered to undergo the procedure performed by a surgeon (n = 66). Furthermore, 71% (n = 20) of those who underwent the procedure performed by a surgeon reported that lack of awareness of IR played a role in their decision. Almost half of the respondents (n = 458) were interested in learning more about IR, particularly the diseases treated and procedures performed (42% and 37%, respectively). Short (<10-minute) educational videos and increased patient education by primary care providers (PCPs) were among the most suggested ways to improve awareness. Regarding the ambiguity of the name "interventional radiology," most respondents (n = 555) reported this to be true, and "minimally invasive radiologist" was the most preferred alternative (21.18%). CONCLUSIONS Lack of awareness of IR may underlie underutilization. When presented with the knowledge that IR improves patient outcomes, minimally invasive procedures by an interventional radiologist are more often desired by the public than surgical options. Educational videos and patient education by PCPs may increase awareness of IR.
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Affiliation(s)
- Brandon Rodgers
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kyleigh A Rodgers
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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5
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San Valentin EMD, Barcena AJR, Klusman C, Martin B, Melancon MP. Nano-embedded medical devices and delivery systems in interventional radiology. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1841. [PMID: 35946543 PMCID: PMC9840652 DOI: 10.1002/wnan.1841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 01/31/2023]
Abstract
Nanomaterials research has significantly accelerated the development of the field of vascular and interventional radiology. The incorporation of nanoparticles with unique and functional properties into medical devices and delivery systems has paved the way for the creation of novel diagnostic and therapeutic procedures for various clinical disorders. In this review, we discuss the advancements in the field of interventional radiology and the role of nanotechnology in maximizing the benefits and mitigating the disadvantages of interventional radiology theranostic procedures. Several nanomaterials have been studied to improve the efficacy of interventional radiology interventions, reduce the complications associated with medical devices, improve the accuracy and efficiency of drug delivery systems, and develop innovative imaging modalities. Here, we summarize the recent progress in the development of medical devices and delivery systems that link nanotechnology in vascular and interventional radiology. This article is categorized under: Diagnostic Tools > Diagnostic Nanodevices Diagnostic Tools > In Vivo Nanodiagnostics and Imaging Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease.
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Affiliation(s)
- Erin Marie D San Valentin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- St. Luke's Medical Center College of Medicine-William H. Quasha Memorial, Quezon City, Philippines
| | | | - Carleigh Klusman
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Benjamin Martin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Marites P Melancon
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
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6
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Martin B, Witrick B, Sivaraj B, Tyler L, Devane AM, Gimbel RW, Rennert LM. Interventional radiologists have equitable outcomes and lower costs from totally implantable venous access device (TIVAD) placement compared to operating room placement. J Vasc Interv Radiol 2022; 33:1184-1190. [PMID: 35842028 DOI: 10.1016/j.jvir.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Compare the cost and outcomes of surgical and interventional radiology (IR) placement of totally implantable venous access devices (TIVAD) within a large regional health system to determine the service line with better outcomes and lower costs to the health system. MATERIALS AND METHODS A retrospective review of all chest port placements performed in the operating room (OR) and the IR suite over 12 months was conducted at a large, integrated health system with six major hospitals. Secondary electronic health record (EHR) and cost data were used to identify TIVAD placements, follow-up procedures indicating port malfunction, early adverse events (within 1-month post-surgery), late adverse events (2-12 months post-procedure), and health system cost of TIVAD placement and management. RESULTS For 799 total port placements included in this analysis, the rate of major adverse events was 1.3% for IR and 1.9% for OR during early follow-up (p=0.5655) and 4.9% for IR and 2.8% for OR during late follow-up (p=0.5437). Malfunction-related follow-up procedure rates were 1.8% for IR and 2.6% for OR during early follow-up (p=0.4787), and 12.4% for IR and 10.5% for OR during late follow-up (p=0.4354). The mean cost of port placement per patient was $4,509 for IR and $5,247 for OR. The difference in per-patient cost of port placement was $1,170 greater for OR (p=0.0074). CONCLUSIONS The similar rates of adverse events and follow-up procedures and significant differences in insertion cost suggest that IR TIVAD placement may be more cost-efficient than surgical placement without impacting quality.
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Affiliation(s)
| | - Brian Witrick
- Department of Public Health Sciences, Clemson University
| | - Banu Sivaraj
- Department of Public Health Sciences, Clemson University
| | - Lauren Tyler
- School of Medicine - Greenville, University of South Carolina
| | | | | | - Lior M Rennert
- Department of Public Health Sciences, Clemson University
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7
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Parikh UM, Mentz J, Collier I, Davis MJ, Abu-Ghname A, Colchado D, Short WD, King A, Buchanan EP, Balaji S. Strategies to Minimize Surgical Scarring: Translation of Lessons Learned from Bedside to Bench and Back. Adv Wound Care (New Rochelle) 2022; 11:311-329. [PMID: 34416825 DOI: 10.1089/wound.2021.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Significance: An understanding of the physiology of wound healing and scarring is necessary to minimize surgical scar formation. By reducing tension across the healing wound, eliminating excess inflammation and infection, and encouraging perfusion to healing areas, surgeons can support healing and minimize scarring. Recent Advances: Preoperatively, newer techniques focused on incision placement to minimize tension, skin sterilization to minimize infection and inflammation, and control of comorbid factors to promote a healing process with minimal scarring are constantly evolving. Intraoperatively, measures like layered closure, undermining, and tissue expansion can be taken to relieve tension across the healing wound. Appropriate suture technique and selection should be considered, and finally, there are new surgical technologies available to reduce tension across the closure. Postoperatively, the healing process can be supported as proliferation and remodeling take place within the wound. A balance of moisture control, tension reduction, and infection prevention can be achieved with dressings, ointments, and silicone. Vitamins and corticosteroids can also affect the scarring process by modulating the cellular factors involved in healing. Critical Issues: Healing with no or minimal scarring is the ultimate goal of wound healing research. Understanding how mechanical tension, inflammation and infection, and perfusion and hypoxia impact profibrotic pathways allows for the development of therapies that can modulate cytokine response and the wound extracellular microenvironment to reduce fibrosis and scarring. Future Directions: New tension-off loading topical treatments, laser, and dermabrasion devices are under development, and small molecule therapeutics have demonstrated scarless wound healing in animal models, providing a promising new direction for future research aimed to minimize surgical scarring.
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Affiliation(s)
- Umang M. Parikh
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - James Mentz
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Ian Collier
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Matthew J. Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Daniel Colchado
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Walker D. Short
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Alice King
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Edward P. Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Swathi Balaji
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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8
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Nadjiri J, Schachtner B, Bücker A, Heuser L, Morhard D, Mahnken AH, Hoffmann RT, Berlis A, Katoh M, Reimer P, Ingrisch M, Paprottka PM, Landwehr P. Nationwide Provision of Radiologically-guided Interventional Measures for the Supportive Treatment of Tumor Diseases in Germany - An Analysis of the DeGIR Registry Data. ROFO-FORTSCHR RONTG 2022; 194:993-1002. [PMID: 35272356 DOI: 10.1055/a-1735-3615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE In addition to direct oncologic therapy, interventional radiology plays an important supportive role in oncologic therapy primarily guided by other disciplines. These supporting measures include diagnostic punctures, drainages, biliary interventions, central venous access including port implantations, osteoplasties, pain therapies etc.). This study investigated the extent to which these radiologically guided supportive measures are available in Germany. MATERIAL AND METHODS All interventional procedures documented in the DeGIR-registry (excluding transhepatic portosystemic shunts) of the years 2018 and 2019 were recorded (DeGIR-module C). A breakdown of the documented interventions was performed based on federal states as well as 40 individual regions (administrative districts and former administrative districts). RESULTS A total of 136,328 procedures were recorded at 216 centers in DeGIR Module C in 2018 and 2019. On average, 389 cases were documented per hospital in 2018 and 394 cases in 2019; the increase per hospital from 2019 is not statistically significant but is relevant in the aggregate when new participating centers are included, with an overall increase of 10 % (6,554 more cases than the previous year). Normalized to one million inhabitants, an average of 781 procedures took place across Germany in 2018 and 860 in 2019. Districts with no registered procedures are not found for Module C.Indications for Module C interventions were mostly interdisciplinary in 2018 and 2019. In this context, the quality of outcome was very high; for the procedures drain placement, marking and biopsy the technical success was 99 %, while the complication rate was lower than 1 %. CONCLUSION The structural analysis of this work concludes that in Germany there is good nationwide availability of radiologically guided supportive measures in oncological therapy. Accordingly, the training situation for prospective interventional radiologists is good, as the distribution to centers with high experience is excellent. In addition, the overall outcome quality of radiology-guided interventions is very high. KEY POINTS · In Germany, there is good nationwide coverage of radiologically guided supportive interventions in oncological therapy.. · The training situation for prospective interventional radiologists is good, as the distribution to centers with high experience is excellent.. · The overall outcome quality of radiology-guided interventions is very high.. CITATION FORMAT · Nadjiri J, Schachtner B, Bücker A et al. Nationwide Provision of Radiologically-guided Interventional Measures for the Supportive Treatment of Tumor Diseases in Germany - An Analysis of the DeGIR Registry Data. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1735-3615.
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Affiliation(s)
- Jonathan Nadjiri
- Klinikum rechts der Isar of the Technical University of Munich, Department of Interventional Radiology, Munich
| | - Balthasar Schachtner
- Ludwig Maximilians University Munich, Department of Radiology, Munich.,Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich
| | - Arno Bücker
- Saarland University Medical Center, Clinic for Diagnostic and Interventional Radiology, Homburg
| | - Lothar Heuser
- Ruhr-Universität Bochum, Diagnostic and Interventional Radiology, Bochum
| | - Dominik Morhard
- Leopoldina Krankenhaus Schweinfurt, Radiology and Neuroradiology, Schweinfurt
| | - Andreas H Mahnken
- University Hospital Marburg, Department of Diagnostic and Interventional Radiology, Marburg.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Ralf-Thorsten Hoffmann
- University Hospital Carl Gustav Carus, TU Dresden, Department of Radiology, Dresden.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Ansgar Berlis
- University Hospital Augsburg, Department of Diagnostic and Interventional Radiology and Neuroradiology, Augsburg.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Marcus Katoh
- Helios Clinic Krefeld, Department of Diagnostic and Interventional Radiology, Krefeld.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Peter Reimer
- Städtisches Klinikum Karlsruhe, Institute for Diagnostic and Interventional Radiology, Karlsruhe.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Michael Ingrisch
- Ludwig Maximilians University Munich, Department of Radiology, Munich
| | - Philipp M Paprottka
- Klinikum rechts der Isar of the Technical University of Munich, Department of Interventional Radiology, Munich.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
| | - Peter Landwehr
- DIAKOVERE Henriettenstift Hannover, Clinic for Diagnostic and Interventional Radiology, Hannover.,Board member of the German Society for Interventional Radiology and Microinvasive Therapy (DeGIR), c/o Deutsche Röntgengesellschaft e.V., Berlin
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9
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Mahnken AH, Boullosa Seoane E, Cannavale A, de Haan MW, Dezman R, Kloeckner R, O’Sullivan G, Ryan A, Tsoumakidou G. CIRSE Clinical Practice Manual. Cardiovasc Intervent Radiol 2021; 44:1323-1353. [PMID: 34231007 PMCID: PMC8382634 DOI: 10.1007/s00270-021-02904-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 12/19/2022]
Abstract
Background Interventional radiology (IR) has come a long way to a nowadays UEMS-CESMA endorsed clinical specialty. Over the last decades IR became an essential part of modern medicine, delivering minimally invasive patient-focused care. Purpose To provide principles for delivering high quality of care in IR. Methods Systematic description of clinical skills, principles of practice, organizational standards and infrastructure needed for the provision of professional IR services. Results There are IR procedures for almost all body parts and organs, covering a broad range of medical conditions. In many cases IR procedures are the mainstay of therapy, e.g. in the treatment of hepatocellular carcinoma. In parallel the specialty moved from the delivery of a procedure towards taking care for a patient’s condition with the interventional radiologists taking ultimate responsibility for the patient’s outcomes. Conclusions The evolution from a technical specialty to a clinical specialty goes along with changing demands on how clinical care in IR is provided. The CIRSE Clinical Practice Manual provides interventional radiologist with a starting point for developing his or her IR practice as a clinician.
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Affiliation(s)
- Andreas H. Mahnken
- Clinic of Diagnostic and Interventional Radiology, Marburg University Hospital, Baldingerstrasse, 35043 Marburg, Germany
| | - Esther Boullosa Seoane
- Department of Vascular and Interventional Radiology, University Hospital of Vigo, Vigo, Spain
| | - Allesandro Cannavale
- Department of Radiological Sciences, ‘Policlinico Umberto I’University Hospital, Rome, Italy
| | - Michiel W. de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rok Dezman
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany
| | | | - Anthony Ryan
- University Hospital Waterford and Royal College of Surgeons in Ireland, Waterford, Ireland
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10
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To New Heights: Interventional Radiology Outreach to Underserved Regions via Aircraft-Delivered Mobile Health Units. Cardiovasc Intervent Radiol 2021; 44:1478-1480. [PMID: 34019110 DOI: 10.1007/s00270-021-02869-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
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11
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Hashmi A, Parikh K, Al-Natour M, Azar N, Sutter C, Ramaiya N, Davidson J, Tavri S. Interventional radiology procedural volume changes during COVID-19 initial phase: A tertiary level Midwest health system experience. Clin Imaging 2021; 72:31-36. [PMID: 33202292 PMCID: PMC7654291 DOI: 10.1016/j.clinimag.2020.10.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/29/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND To evaluate Interventional Radiology (IR) procedural volume changes at a large Midwest health system between March 17, 2020 and April 30, 2020 following a state-mandated shutdown of nonessential procedures during the initial phase of COVID-19. METHODS IR procedural volumes were compiled, stratified by location and compared with Diagnostic Radiology (DR) volumes during the same timeframe. Procedure volume was categorized by type, including oncology, dialysis interventions, and drainage procedures with comparisons made using Z-score test for proportions. IR and system-wide surgical procedural volume was compared with baseline values. RESULTS System-wide IR procedural volume decreased by 35%, with a 41% decrease in outpatient and a 25% decrease in inpatient volume during the state-mandated order. DR volume decreased by 45%, with a 57% decrease in outpatient and a 22% decrease in inpatient volume. Total IR procedural volume during the mandate was 1077 versus 1518 during the preceding six weeks. The proportion of Interventional Oncology and dialysis interventions showed no significant change (p > 0.05) while that of drainage procedures increased (p < 0.05). Compared to baseline values, system-wide procedural volumes for IR, Vascular Surgery, Urology, General Surgery, Gastroenterology and Gynecology decreased by 3%, 11%, 25%, 20%, 38% and 31% in March 2020 and 25%, 47%, 68%, 63%, 79% and 73% in April 2020 respectively. CONCLUSION Outpatient IR volumes were less impacted compared to DR during the initial phase of COVID-19. Oncology, dialysis and drainage interventions may be considered essential procedures due to their stability. IR volumes were less affected compared to other procedural specialties.
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Affiliation(s)
- Ahmad Hashmi
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Keval Parikh
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Mohammed Al-Natour
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Christopher Sutter
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Jon Davidson
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Sidhartha Tavri
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America.
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12
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D'Souza PC, Kumar S, Kakaria A, Al-Sukaiti R, Al-Baimani K, Hamid RS, Mittal AK, Al-Balushi M, Burney IA, Al-Moundhri MS. Complications and Management of Totally Implantable Central Venous Access Ports in Cancer Patients at a University Hospital in Oman. Sultan Qaboos Univ Med J 2021; 21:e103-e109. [PMID: 33777430 PMCID: PMC7968907 DOI: 10.18295/squmj.2021.21.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/27/2020] [Accepted: 06/25/2020] [Indexed: 01/17/2023] Open
Abstract
Objectives Totally implantable central venous access ports (port-a-caths) are increasingly used for the safe administration of chemotherapy; however, their use is associated with complications. This study reviews patterns of complications, reasons for premature removal and the duration of the use of port-a-caths in patients receiving cancer treatment at Sultan Qaboos University Hospital (SQUH) and compares the infection rate with the literature and the researchers’ experiences. Methods This retrospective follow-up study included patients who had received cancer treatment through a port-a-cath and were admitted to SQUH between January 2007 and April 2019. Demographic features, underlying diagnosis, clinical stage, treatment, duration of use and the cause of premature removal of the port-a-cath were recorded. Results A total of 516 port-a-caths were inserted in 482 cancer patients. The majority of devices were implanted by interventional radiologists (n = 459; 89.0%) and the right internal jugular vein was most frequently accessed (n = 396; 76.7%). The mean indwelling time of a port-a-cath was 288 days (range: 3–1,872 days) for patients with complications and 550 days (range: 7–3,123 days) for patients without complications. Port-a-cath-related infection was the main complication (n = 63; 12.2%). Patient age, gender, treatment intent, underlying diagnosis, clinical stage, chemotherapy regimen, number of treatment courses, operator implanting the port, the type of micro-organism isolated from the port-a-cath and body mass index were significant factors affecting catheter indwelling time (P <0.05). On multivariate analysis, however, none of the factors was found to be significant. Conclusion Infection was the most common complication necessitating port-a-cath removal. The infection rate was much lower than the researchers’ previous experience and compares favorably with several published reports.
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Affiliation(s)
- Philomena C D'Souza
- Oncology Ward, Churchill Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Shiyam Kumar
- Department of Medical Oncology, Yeovil District Hospital, NHS Foundation Trust, Yeovil, United Kingdom
| | - Annupam Kakaria
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rashid Al-Sukaiti
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalid Al-Baimani
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rana S Hamid
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Alok K Mittal
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Muna Al-Balushi
- Nursing Directorate, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ikram A Burney
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Gu L, Xu L, Meng A, Shi R, Jiang D, Liu C, Mao J. Guidewire‐guided electrocardiogram for positioning the catheter tip of upper arm port in breast cancer patients. PRECISION MEDICAL SCIENCES 2021. [DOI: 10.1002/prm2.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lili Gu
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Liyong Xu
- Department of General Surgery Nanjing Agriculture University Hospital Nanjing China
| | - Aifeng Meng
- Department of Nursing Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Ruchun Shi
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Dingbiao Jiang
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Chunli Liu
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Jing Mao
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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14
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Yaras YS, Yildirim DK, Herzka DA, Rogers T, Campbell-Washburn AE, Lederman RJ, Degertekin FL, Kocaturk O. Real-time device tracking under MRI using an acousto-optic active marker. Magn Reson Med 2020; 85:2904-2914. [PMID: 33347642 DOI: 10.1002/mrm.28625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/30/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This work aims to demonstrate the use of an "active" acousto-optic marker with enhanced visibility and reduced radiofrequency (RF) -induced heating for interventional MRI. METHODS The acousto-optic marker was fabricated using bulk piezoelectric crystal and π-phase shifted fiber Bragg grating (FBGs) and coupled to a distal receiver coil on an 8F catheter. The received MR signal is transmitted over an optical fiber to mitigate RF-induced heating. A photodetector converts the optical signal into electrical signal, which is used as the input signal to the MRI receiver plug. Acousto-optic markers were characterized in phantom studies. RF-induced heating risk was evaluated according to ASTM 2182 standard. In vivo real-time tracking capability was tested in an animal model under a 0.55T scanner. RESULTS Signal-to-noise ratio (SNR) levels suitable for real-time tracking were obtained by using high sensitivity FBG and piezoelectric transducer with resonance matched to Larmor frequency. Single and multiple marker coils integrated to 8F catheters were readout for position and orientation tracking by a single acousto-optic sensor. RF-induced heating was significantly reduced compared to a coax cable connected reference marker. Real-time distal tip tracking of an active device was demonstrated in an animal model with a standard real-time cardiac MR sequence. CONCLUSION Acousto-optic markers provide sufficient SNR with a simple structure for real-time device tracking. RF-induced heating is significantly reduced compared to conventional active markers. Also, multiple RF receiver coils connected on an acousto-optic modulator can be used on a single catheter for determining catheter orientation and shape.
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Affiliation(s)
- Yusuf S Yaras
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Micromachined Sensors and Transducers Group, Atlanta, Georgia, USA
| | - Dursun Korel Yildirim
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Daniel A Herzka
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Toby Rogers
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | | | - Robert J Lederman
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - F Levent Degertekin
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Micromachined Sensors and Transducers Group, Atlanta, Georgia, USA
| | - Ozgur Kocaturk
- Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Turkey
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15
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White SB. Value in Interventional Radiology: Achieving High Quality Outcomes at a Lower Cost. Radiology 2020; 297:482-483. [PMID: 32903151 DOI: 10.1148/radiol.2020203407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah B White
- From the Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226
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Taxbro K, Hammarskjöld F, Juhlin D, Hagman H, Bernfort L, Berg S. Cost analysis comparison between peripherally inserted central catheters and implanted chest ports in patients with cancer-A health economic evaluation of the PICCPORT trial. Acta Anaesthesiol Scand 2020; 64:385-393. [PMID: 31721153 DOI: 10.1111/aas.13505] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/22/2019] [Accepted: 10/29/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND A reliable central venous access device is a cornerstone in the treatment of cancer. Both peripherally inserted central catheters (PICC) and totally implanted chest ports (PORT) are commonly used for the delivery of chemotherapy. Both types of catheter can cause adverse events such as catheter-related deep venous thrombosis (CR-DVT), infection and mechanical complications. METHOD We conducted a randomized controlled trial including 399 patients with cancer and performed a health economic evaluation investigating the cost related to PICCs and PORTs using several clinically relevant dimensions from a healthcare perspective. The cost was determined using process and cost estimate models. RESULT PICCs are associated with a higher total cost when compared with PORTs. Combining the costs of all categories, the prize per inserted device was 824.58 EUR for PICC and 662.34 EUR for PORT. When adjusting for total catheter dwell time the price was 6.58 EUR/day for PICC and 3.01 EUR/day for PORT. The difference in CR-DVT was the main contributor to the difference in cost. The daily cost of PICC is approximately twice to that of PORT. CONCLUSION We have demonstrated that the cost from a healthcare perspective is higher in cancer patients receiving a PICC than to those with a PORT. The difference is driven mainly by the cost related to the management of adverse events. Our findings are relevant to anaesthetists, oncologists and vascular access clinicians and should be considered when choosing vascular access device prior to chemotherapy.
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Affiliation(s)
- Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
- Department of Medical and Health Sciences Cardiovascular Medicine Linköping University Linköping Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - David Juhlin
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - Helga Hagman
- Department of Oncology Skåne University Hospital Lund Sweden
| | - Lars Bernfort
- Division of Health Care Analysis Linköping University Linköping Sweden
| | - Sören Berg
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care Department of Medical and Health Sciences Linköping University Linköping Sweden
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Habert P, Hak JF, Di Bisceglie M, Bartoli A, Gaubert JY, Vidal V, Tradi F. [Central venous access in interventional radiology]. Presse Med 2019; 48:1141-1145. [PMID: 31669005 DOI: 10.1016/j.lpm.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022] Open
Abstract
Some patients require iteratives intravenous administrations on a central catheter, for example in oncology or infectiology, which represents a challenge for ambulatory treatment. Interventional radiology could provide solutions with the implant and monitoring of PICC-lines and ports. These are implanted in sterile environment and under imaging guidance in an interventional radiology room by an operator and with a paramedical team that need to be experienced. This development focus on the interest of one method with respect to the other, as well as the differents ways to do, the complications that could arise and the monitoring of these devices.
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Affiliation(s)
- Paul Habert
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France.
| | - Jean-François Hak
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Mathieu Di Bisceglie
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Axel Bartoli
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Jean-Yves Gaubert
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Vincent Vidal
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Farouk Tradi
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
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18
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Makary MS, Gage D, Elliott ED, Dowell JD. Primary Care Provider Awareness of IR: A Single-Center Analysis. J Vasc Interv Radiol 2019; 30:1420-1427. [DOI: 10.1016/j.jvir.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/12/2019] [Accepted: 04/02/2019] [Indexed: 11/30/2022] Open
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Kunz-Virk J, Krüger K. Power-injectable totally implantable venous access devices - analysis of success and complication rates of ultrasound-guided implantation and a patient satisfaction survey. VASA 2019; 48:524-530. [PMID: 31124752 DOI: 10.1024/0301-1526/a000802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: To retrospectively evaluate the success rates, peri-interventional, early and late complications and patient satisfaction associated with power-injectable totally implantable venous access devices (TIVAPs). Patients and methods: Between April 2011 and March 2016, a total of 1,203 TIVAPs were implanted in 1,169 patients. Ultrasound-guided, fluoroscopically controlled implantation was performed through the subclavian or internal jugular vein. The systematic analysis focused on the rate of successful port implantations, the frequency of peri-interventional, early and late complications and on how the experience of the implanting radiologist impacts these parameters. Additionally, a standardized questionnaire was administered to the 102 study patients in a telephone interview to survey their subjective rating of the port implantation. Results: 99.5 % of TIVAPs were implanted successfully. In 4 out of 6 patients, the implantation was repeated successfully at a later time. Complication rates were 1.4 % (0.0512/1.000 catheter days) for peri-interventional, 2.9 % (0.081 per 1,000 catheter days) for early and 8.3 % (0.2288 per 1,000 catheter days) for late complications. The radiologist's experience level and vein selection did not have a significant impact. Most peri-interventional complications (82.4 %) were of minor severity. The early (61.5 %) and late (65.6 %) complications were more frequently of major severity. Interventions to manage complications comprised port explanation in 46.9 %, conservative therapy in 17.4 % and interventional therapy in 12.2 %. At 1 and 3 months after port placement, the majority were satisfied or very satisfied with the interventional port implantation. Conclusions: Ultrasound-guided, fluoroscopically controlled implantation of TIVAPs is a safe procedure with low complication rates, high success rates and high patient satisfaction.
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Affiliation(s)
- Julia Kunz-Virk
- Department of Radiology and Interventional Therapy, Vivantes Humboldt Hospital and Spandau Hospital, Berlin, Germany
| | - Karsten Krüger
- Department of Radiology and Interventional Therapy, Vivantes Humboldt Hospital and Spandau Hospital, Berlin, Germany
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20
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Johnson EJ. Is It Appropriate to Place Subcutaneous Chest Ports in Patients with Neutropenia? Radiology 2019; 291:519-520. [DOI: 10.1148/radiol.2019190095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Evan J. Johnson
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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21
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Blanco-Guzman MO. Implanted vascular access device options: a focused review on safety and outcomes. Transfusion 2018; 58 Suppl 1:558-568. [PMID: 29443407 DOI: 10.1111/trf.14503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Implantable vascular access devices are frequently used in patients who have poor peripheral venous access. These devices can be partially implanted as tunneled and nontunneled central catheters, or they can be fully implanted as ports. Compared with long-term catheters, implanted ports have lower infection rates and improved perceptions of quality of life, but complications still occur in 2% to 18% of patients, frequently requiring removal of the device. Since the conception of implantable vascular access device ports, numerous advances in port design, materials, and techniques for implantation and care have been developed with the goal of overcoming frequent complications. We review the evidence related to these advances and their effect on the safety profile and complications of implantable vascular access device ports.
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Affiliation(s)
- Merilda O Blanco-Guzman
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
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22
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Perioperative antibiotics should be used for placement of implanted central venous ports: A propensity analysis evaluating risk. Am J Surg 2018; 216:1135-1143. [PMID: 30268417 DOI: 10.1016/j.amjsurg.2018.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/21/2018] [Accepted: 09/16/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To quantify risk for CRI based on PABX use in CVAP placement for cancer patients. SUMMARY BACKGROUND DATA Central venous access ports (CVAP) are totally implanted devices used for chemotherapy. There is a temporal risk for catheter related infection (CRI) to insertion and perioperative prophylactic antibiotics (PABX) use is a contested issue among practitioners. METHODS Data was collected from a single center, academic oncology center. Treatment with a perioperative PABX was compared to non-treatment, to examine the incidence of 14-day CRI. Propensity scores with matched weights controlled for confounding, using 15 demographic, procedural and clinical variables. RESULTS From 2007 to 2012, 1,091 CVAP were placed, where 59.7 % received PABX. The 14-day CRI rate was 0.82%, with 78% of those not receiving PABX. While results did not achieve statistical significance, use of PABX was associated with a 58% reduction in the odds of a 14-day CRI (OR = 0.42, 95% CI: 0.08-2.24, p = 0.31). CONCLUSION The findings suggest a reduction in early CRI with the use of PABX. Since CRI treatment can range from a course of oral antibiotics, port removal, to hospital admission, we suggest clinicians consider these data when considering PABX in this high-risk population.
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Sarwar A, Hawkins CM, Bresnahan BW, Carlos RC, Guimaraes M, Krol KL, Kwan SW, Latif W, Liu R, Marder WD, Ray CE, Banovac F. Evaluating the Costs of IR in Health Care Delivery: Proceedings from a Society of Interventional Radiology Research Consensus Panel. J Vasc Interv Radiol 2018; 28:1475-1486. [PMID: 29056189 DOI: 10.1016/j.jvir.2017.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ammar Sarwar
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Brian W Bresnahan
- Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Ruth C Carlos
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan Health System, Ann Arbor, Michigan
| | - Marcelo Guimaraes
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Katharine L Krol
- Payment, Research, and Policy Taskforce, Society of Interventional Radiology, Herndon, Virginia
| | - Sharon W Kwan
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Raymond Liu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - William D Marder
- Truven Health Analytics, IBM Watson Health, Cambridge, Massachusetts
| | - Charles E Ray
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Filip Banovac
- Department of Radiology, Vanderbilt University, Nashville, Tennessee
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Li HL, Chan YC, Cheng SW. Current Evidence on Management of Aortic Stent-graft Infection: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2018; 51:306-313. [PMID: 29772328 DOI: 10.1016/j.avsg.2018.02.038] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 08/26/2017] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aortic stent-graft infection (SGI) is rare but remains one of the most challenging and threatening complications. This systematic review aimed to identify the clinical features, treatment, and outcomes of endograft infection after abdominal endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). METHODS A systematic literature review of all published literature from January 1991 to September 2016 on SGI was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Aorta, aneurysm, endovascular, stent-graft, endograft and infection were the keywords used in our comprehensive search in PubMed and MEDLINE databases. Data analysis was performed using SPSS, V 22.0. RESULTS A total of 185 potential relevant articles were identified, but only 11 studies with 402 patients met the inclusion criteria. Majority of the patients were male (308/402, 77%), with a mean age ranging from 65 to 73 years. Most of the endografts were implanted for EVAR (351/402, 87%), while the other 51 (13%) endografts were infected following TEVAR. Among the 402 patients, 39 (9.7%) patients presented with aortic rupture. Ninety-two of 380 (24.2%) patients with available data had aortoenteric fistula (AEF). Sixty-nine patients (17%) died in hospital or within 30 days after operation. One hundred fourteen patients (28%) died during follow-up. The most commonly used stent grafts were Zenith (Cook Inc, Bloomington, IN) (22%) and Excluder (W.L. Gore, Flagstaff, AZ) (20%). Of the 402 patients in this series, 108 patients (27%) had negative culture, and multiple microorganisms were identified in 103 patients (26%). The most frequently isolated microorganisms were Staphylcoccus species (30.1%), Streptococcus (14.8%), and fungus (9.2%). Forty-two patients (42/401, 10%) received conservative treatment, whereas 359 (90%) patients underwent surgical treatment, including stent graft removal with in situ reconstruction or extra-anatomical bypass, and secondary endovascular procedure. Patients in the surgical group had a higher survival rate compared with conservative group (58% vs. 33%, P = 0.002). The survival rate was higher in the patients with infected EVAR than TEVAR (58% vs. 27%, P = 0.000). Patient with AEF had a worse prognosis (survival rate 72% vs. 33%, P = 0.002). CONCLUSIONS Current evidence suggests that surgical treatment is a better option compared with conservative management in selected patients with aortic endograft infection. The outcome was worse in patients with infected TEVAR and AEF.
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Affiliation(s)
- Hai Lei Li
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong Shenzhen hospital, Guangdong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong, China.
| | - Stephen W Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong, China
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Makary MS, Kapke J, Yildiz V, Pan X, Dowell JD. Outcomes and Direct Costs of Inferior Vena Cava Filter Placement and Retrieval within the IR and Surgical Settings. J Vasc Interv Radiol 2018; 29:170-175. [DOI: 10.1016/j.jvir.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 09/05/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022] Open
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Jonczyk M, Gebauer B, Rotzinger R, Schnapauff D, Hamm B, Collettini F. Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience. In Vivo 2018; 32:179-184. [PMID: 29275317 PMCID: PMC5892650 DOI: 10.21873/invivo.11222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Totally implantable central venous port systems provide a safe and effective, long-term means of access for administration of hyperosmolar, local irritant medication, such as chemotherapy, antibiotics and parenteral nutrition. AIM To evaluate the combination of access site and level of experience on fluoroscopy times (FT) and dose area products (DAP) during implantation of port catheters in a large patient population. MATERIALS AND METHODS A total of 1,870 patients (992 women, 878 men; age: 61±13.14 years) were reviewed investigating two groups of junior (≤50 implantations) and senior (>50) radiologists. RESULTS Senior radiologists required less FT/DAP (0.24 s/57.3 μGy m2 versus 0.43 s/68.2 μGy m2, respectively; p<0.001). Right jugular vein access required the least FT/DAP (0.25 s/56.15 μGy m2) and right-sided implantation lower FT/DAP (right: 0.26 s/56.4 μGy m2, left: 0.40 s/85.10 μGy m2, p<0.001). CONCLUSION Due to DAP/FT reductions, the right jugular vein seems to be the most favorable implantation side for port systems. For further dose reduction, residents should be well-trained.
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Affiliation(s)
- Martin Jonczyk
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Roman Rotzinger
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Dirk Schnapauff
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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Neill M, Charles HW, Pflager D, Deipolyi AR. Factors associated with reduced radiation exposure, cost, and technical difficulty of inferior vena cava filter placement and retrieval. Proc (Bayl Univ Med Cent) 2017; 30:21-25. [PMID: 28127123 DOI: 10.1080/08998280.2017.11929515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We sought to delineate factors of inferior vena cava filter placement associated with increased radiation and cost and difficult subsequent retrieval. In total, 299 procedures from August 2013 to December 2014, 252 in a fluoroscopy suite (FS) and 47 in the operating room (OR), were reviewed for radiation exposure, fluoroscopy time, filter type, and angulation. The number of retrieval devices and fluoroscopy time needed for retrieval were assessed. Multiple linear regression assessed the impact of filter type, procedure location, and patient and procedural variables on radiation dose, fluoroscopy time, and filter angulation. Logistic regression assessed the impact of filter angulation, type, and filtration duration on retrieval difficulty. Access site and filter type had no impact on radiation exposure. However, placement in the OR, compared to the FS, entailed more radiation (156.3 vs 71.4 mGy; P = 0.001), fluoroscopy time (6.1 vs 2.8 min; P < 0.001), and filter angulation (4.8° vs 2.6°; P < 0.001). Angulation was primarily dependent on filter type (P = 0.02), with VenaTech and Denali filters associated with decreased angulation (2.2°, 2.4°) and Option filters associated with greater angulation (4.2°). Filter angulation, but not filter type or filtration duration, predicted cases requiring >1 retrieval device (P < 0.001) and >30 min fluoroscopy time (P = 0.02). Cost savings for placement in the FS vs OR were estimated at $444.50 per case. In conclusion, increased radiation and cost were associated with placement in the OR. Filter angulation independently predicted difficult filter retrieval; angulation was determined by filter type. Performing filter placement in the FS using specific filters may reduce radiation and cost while enabling future retrieval.
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Affiliation(s)
- Matthew Neill
- Vascular and Interventional Radiology, New York University School of Medicine, New York, NY (Neill, Charles); Finance-Decision Support, New York University Langone Medical Center, New York, NY (Pflager); and Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY (Deipolyi)
| | - Hearns W Charles
- Vascular and Interventional Radiology, New York University School of Medicine, New York, NY (Neill, Charles); Finance-Decision Support, New York University Langone Medical Center, New York, NY (Pflager); and Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY (Deipolyi)
| | - Daniel Pflager
- Vascular and Interventional Radiology, New York University School of Medicine, New York, NY (Neill, Charles); Finance-Decision Support, New York University Langone Medical Center, New York, NY (Pflager); and Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY (Deipolyi)
| | - Amy R Deipolyi
- Vascular and Interventional Radiology, New York University School of Medicine, New York, NY (Neill, Charles); Finance-Decision Support, New York University Langone Medical Center, New York, NY (Pflager); and Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY (Deipolyi)
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Rotzinger R, Gebauer B, Schnapauff D, Streitparth F, Wieners G, Grieser C, Freyhardt P, Hamm B, Maurer MH. Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radiology department: analysis of costs and intervention duration learning curve. Acta Radiol 2017; 58:1468-1475. [PMID: 28406048 DOI: 10.1177/0284185117695664] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Placement of central venous port catheters (CVPS) and peripherally inserted central catheters (PICC) is an integral component of state-of-the-art patient care. In the era of increasing cost awareness, it is desirable to have more information to comprehensively assess both procedures. Purpose To perform a retrospective analysis of interventional radiologic implantation of CVPS and PICC lines in a large patient population including a cost analysis of both methods as well as an investigation the learning curve in terms of the interventions' durations. Material and Methods All CVPS and PICC line related interventions performed in an interventional radiology department during a three-year period from January 2011 to December 2013 were examined. Documented patient data included sex, venous access site, and indication for CVPS or PICC placement. A cost analysis including intervention times was performed based on the prorated costs of equipment use, staff costs, and expenditures for disposables. The decrease in intervention duration in the course of time conformed to the learning curve. Results In total, 2987 interventions were performed by 16 radiologists: 1777 CVPS and 791 PICC lines. An average implantation took 22.5 ± 0.6 min (CVPS) and 10.1 ± 0.9 min (PICC lines). For CVPS, this average time was achieved by seven radiologists newly learning the procedures after performing 20 CVPS implantations. Total costs per implantation were €242 (CVPS) and €201 (PICC lines). Conclusion Interventional radiologic implantations of CVPS and PICC lines are well-established procedures, easy to learn by residents, and can be implanted at low costs.
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Affiliation(s)
- Roman Rotzinger
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dirk Schnapauff
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Streitparth
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Gero Wieners
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Grieser
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Freyhardt
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Feo CF, Ginesu GC, Bellini A, Cherchi G, Scanu AM, Cossu ML, Fancellu A, Porcu A. Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement. Ann Med Surg (Lond) 2017; 21:81-84. [PMID: 28794870 PMCID: PMC5537425 DOI: 10.1016/j.amsu.2017.07.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 02/05/2023] Open
Abstract
Background Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Materials and methods Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Results Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30–120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Conclusion Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure. Chest ports can be safely placed under local anesthesia in the office setting. Fluoroscopy and ultrasound guidance are not necessary in the majority of cases. Port placement in the outpatient clinic is cost-effective.
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Affiliation(s)
- Claudio F. Feo
- Corresponding author. UO di Clinica Chirurgica, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.UO di Clinica ChirurgicaUniversity of SassariViale San Pietro 43Sassari07100Italy
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Vaughan JG, Cauthen AB, Allen A, Dale P. Evaluation of Cardiopulmonary Complication Rates after Port Insertion: Is a Postoperative X-Ray Needed? Am Surg 2017. [DOI: 10.1177/000313481708300737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is customary for a postoperative chest radiograph to be obtained after fluoroscopic guided port insertion to exclude acute complications. In this review, we provide a cost-benefit analysis by examination of acute postoperative complications detected by postoperative port insertion chest films at our institution. We conducted a retrospective chart review of complications associated with port insertion procedures performed over a 5-year period. Our study included only ultrasound-assisted internal jugular venous or landmark guided subclavian ports placed with the assistance of fluoroscopy. A total of 519 port insertions were reviewed and there was noted to be a postoperative complication rate of 0.58 per cent. The operative note for each complication described a procedural abnormality that suggested a chest film would be of medical benefit. The total price of postoperative chest radiographs was $179,400. Performing chest X-ray films on asymptomatic patients after fluoroscopic guided placement of ports proved to be of no medical advantage to 516 out of 519 patients. Given the extremely low complication rate and financial burden placed on the patient population, we propose discontinuing routine use of postoperative port placement chest radiographs as a way to alleviate unwarranted medical cost.
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Affiliation(s)
- Justin G. Vaughan
- Mercer University School of Medicine, Medical Center Navicent Health Macon, Macon, Georgia
| | - Allison B. Cauthen
- Mercer University School of Medicine, Medical Center Navicent Health Macon, Macon, Georgia
| | - Ahkeel Allen
- Mercer University School of Medicine, Medical Center Navicent Health Macon, Macon, Georgia
| | - Paul Dale
- Mercer University School of Medicine, Medical Center Navicent Health Macon, Macon, Georgia
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Clark K, Chick JFB, Reddy SN, Shin BJ, Nadolski GJ, Clark TW, Trerotola SO. Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction. J Vasc Interv Radiol 2017; 28:602-607. [PMID: 28238580 DOI: 10.1016/j.jvir.2016.12.1222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction. MATERIALS AND METHODS CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance. RESULTS All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days). CONCLUSIONS Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.
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Affiliation(s)
- Katherine Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Shilpa N Reddy
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Radiology Associates of the Main Line, Main Line Health System, Bryn Mawr Hospital, Bryn Mawr, Pennsylvania
| | - Benjamin J Shin
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Timothy W Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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Randomized Controlled Trial of Octyl Cyanoacrylate Skin Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous Port Placement. J Vasc Interv Radiol 2017; 28:111-116. [DOI: 10.1016/j.jvir.2016.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/31/2016] [Accepted: 08/13/2016] [Indexed: 11/21/2022] Open
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Midia M, Dao D. Choose Wisely: Choose IR. J Vasc Interv Radiol 2016; 27:1623-4. [DOI: 10.1016/j.jvir.2016.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/09/2016] [Accepted: 04/10/2016] [Indexed: 11/16/2022] Open
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Introduction to Cost Analysis in IR: Challenges and Opportunities. J Vasc Interv Radiol 2016; 27:539-545.e1. [PMID: 26922978 DOI: 10.1016/j.jvir.2015.12.754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Demonstration of value has become increasingly important in the current health care system. This review summarizes four of the most commonly used cost analysis methods relevant to IR that could be adopted to demonstrate the value of IR interventions: the cost minimization study, cost-effectiveness assessment, cost-utility analysis, and cost-benefit analysis. In addition, the issues of true cost versus hospital charges, modeling in cost studies, and sensitivity analysis are discussed.
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